Effects of Pediatric Chronic Physical Disorders on Child and Family Adjustment

Research conducted primarily over the past 5–8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement and intervention are discussed.     

Etiology and treatment of perinatal stroke; a role for prothrombotic coagulation factors?

The detection rate of perinatal stroke is rising due to improved neuroradiological imaging techniques, increased survival of neonates with severe underlying diseases and an increased awareness of the diagnosis by pediatricians. Its pathogenesis is multifactorial and includes a large variety of maternal and neonatal risk factors as well as prothrombotic coagulation factors. Although the relative risk of prothrombotic coagulation factors is still unknown, testing is recommended to design large studies in the near future. This article is an overview of studies of prothrombotic risk factors in both neonatal arterial ischemic stroke and cerebral sinovenous thrombosis. Although prothrombotic coagulation factors are present in more than half of the cases, we conclude that they most likely play a minor role in the pathogenesis of perinatal stroke. Current therapeutic guidelines focusing on thrombosis are based on expert opinion and recommend low molecular weight or unfractionated heparin for cardioembolic arterial ischemic stroke, antiplatelet or anticoagulant therapy for recurrent arterial ischemic stroke, and low molecular weight heparin or unfractionated heparin for sinovenous thrombosis without hemorrhage and/or when extension of the thrombotic process occurs.     

The Relationship between Mutual Family Relations and Child Psychopathology

The associations of the mutual mother-child, father-child, and mother-father relationship and various patterns of family relations with child psychopathology were investigated in a sample of 137 families referred to outpatient mental health services. Assessment of the relative association of the different family dyads showed that both the mother-child and the mother-father relationship were related to child problem behaviour. However, whereas the mother-child relationship was consistently more related to externalising behaviour, the mother-father relationship was particularly related to internalising behaviour. Our findings gave clear support for the cumulative risk model: having more negatively qualified relationships was associated with more problem behaviour. Furthermore, our results suggested a protective influence of the parent-child relationship: having one or two positive parent-child relationships was associated with less problem behaviour. No support was found for the cross-generational coalition hypothesis. Implications for future research are discussed.     

Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus

Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population‐based study. We used self‐report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child’s disease affects everyday life. Low self‐esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long‐term stress in parents of children with T1DM, we should recognize parents’ attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day‐to‐day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.     

Trends of survival in neuroblastoma and independent risk factors for survival at a single institution

To assess the progress of survival in neuroblastoma which varies with many risk factors and to evaluate the influence of these factors on survival as independent risk factors. The study subjects were 159 neuroblastoma patients seen from 1965–1994 at the oldest and largest children's hospital in Japan. Trends of survival in three treatment eras 1965–81, 1982–86, 1987–94 were assessed by the Kaplan-Meier method for different sex, age at diagnosis, the clinical stage, the site of onset, and the histological type. Then the influence on survival of these factors as independent prognostic variables was evaluated by the Cox proportional hazards regression analysis. Age at diagnosis, the clinical stage, the site of onset, the histological type, and the treatment era were independent risk factors in the order of their influence on survival. Unfavorable survival outcomes were obtained for patients with age at diagnosis above 1 year, the clinical stage of VI by the Evans classification, adrenal onset, and neuroblastoma rather than ganglioneuroblastoma. Survival improved from the first to the second and from the second to the third treatment era. Improvement of survival in neuroblastoma took place during the past 3 decades. Age at diagnosis, the clinical stage, and the histological type have still remained overwhelming prognostic factors over the progress in treatment. Med. Pediatr. Oncol. 29:197–205, 1997. © 1997 Wiley-Liss, Inc.     

Risk factors for and prevention of tobacco use

This study describes the risk factors for and prevention of tobacco use among young people. Risk factors show differential importance along the course of tobacco use development. The contents of an effective prevention effort vary as a function of the age of target group. However, the mediation of the effects of effective programs is not well known. Various modalities of implementation of prevention programming may be important, though a majority of program evaluation has occurred in the school context. The majority of well-evaluated tobacco use prevention programs that employ a comprehensive social influences model show effects over an average of 6 years post-programming.     

THE INFLUENCE OF RISK FACTORS IN PROMOTING THROMBOSIS DURING CHILDHOOD: The Role of Acquired Factors

Thrombo-embolism in childhood is a multifactorial disorder. The present study is a case-control study that investigated the role of genetic and acquired risk factors in 60 children with thrombosis and compared the results with the controls. Acquired and inherited risk factors precipitating thrombosis were present in 75 and 40% of the thrombotic children, respectively. The most frequent acquired risk factor was infection (58%). Of the genetic factors, factor V G20210A was the most common (38%). The comparison of the genetic and acquired risk factors in thrombotic versus nonthrombotic settings identified that acquired factors played a more significant role in causing thrombosis (OR:14.44; 95% CI: 7.05–29.94, p <. 001). This study has clearly suggested that the prevention of acquired risk factors, particularly infection, could decrease the risk of thrombosis in pediatric cases.     

THE TRAIT AND METHOD COMPONENTS OF RATINGS OF CONDUCT DISORDER—PART II. FACTORS RELATED TO THE TRAIT COMPONENT OF CONDUCT DISORDER SCORES

A theoretical model designed to estimate the associations of variables of interest with the trait component of maternal and teacher ratings of conduct disorder is outlined. This model was applied to data collected in a birth cohort of New Zealand children. The analysis showed marked differences between the correlations for various measures and observed conduct disorder scores and the corresponding correlations with the estimated trait components of these scores. In some cases correlations increased as a result of correction for measurement error whereas in other cases correlations declined as a result of correction for the effects of method factors.     

THE TRAIT AND METHOD COMPONENTS OF RATINGS OF CONDUCT DISORDER—PART I. MATERNAL AND TEACHER EVALUATIONS OF CONDUCT DISORDER IN YOUNG CHILDREN

A theoretical model designed to estimate the trait and method specific components of maternal and teacher ratings of childhood conduct disorder is presented. The model was applied to data collected on a birth cohort of New Zealand children. The model produced evidence to indicate that maternal and teacher ratings of childhood behaviour were contaminated by method variance. It was estimated that one-third of the variance in these scores reflected variance attributable to child behaviour traits. When the data were adjusted for the effects of method specific factors, the model suggested that conduct disorder measures were highly stable over time.     

Perinatal risk factors for early childhood onset type 1 diabetes in Austria – a population-based study (1989–2005)

Background:  To investigate the rapid increase in incidence of type 1 diabetes mellitus (T1DM) in children <5 yr in Austria.
Methods:  Data of children born between 1989 and 2005 (n = 444) from the T1DM children incidence registry were linked with birth certificates (n = 1 407 829).
Results:  Age of mother, level of education, birth weight, birth length, body mass index, and APGAR score at 10 min were not significant. Boys have about 25% higher risk than girls [hazard ratio = 0.75, 95% confidence interval (CI): 0.62–0.91]. The risk of developing diabetes increases over time significantly (1989–1991 vs. 2001–2005, hazard ratio = 2.86, 95% CI: 2.07–3.94). The linear effect of parity is borderline significant (p = 0.045), with lower risks for second and later born siblings. Marital status is significant [hazard ratio = 0.73, 95% CI: 0.57–0.90)]. Native-born children exhibit twice as high risk as non-native children (hazard ratio = 0.51, 95% CI: 0.37–0.71). Birth weight shows a positive but not significant effect on risk of T1DM.
Conclusions:  In this very young and rapidly increasing cohort of diabetic children <5 yr of age, no association with birth weight but with year of birth, gestational age, nationality and parity could be observed.     

Causes of near misses in critical care of neonates and children

AIM: The primary goal of this study was to examine the nature and causes of medical errors known as almost adverse events (AAEs) and potential adverse events (PAEs) in intensive care units. METHODS: Observations were conducted in the Neonatal Intensive Care Unit and in the Pediatric Intensive Care Unit in a large hospital in Israel. The AAEs and PAEs were classified into three main categories: environmental, system and human factors. Data encoding and analysis was based on a Bayesian model previously developed to analyse causes of traffic accidents, and the categories were based on systems and ergonomics approaches. RESULTS: 'Workload' (a system factor) was the main cause of AAEs and 'communication failures' (a human factor) was the second main cause of AAEs. Among the environmental factors, 'failures in medical devices' was the most cited cause of AAEs. Environmental factors accounted for most of PAEs and among them 'form failures' was the most 'AAE'-prone factor. CONCLUSIONS: Environmental factors (mainly 'failures in medical device') and system factors (mainly 'workload') accounted for most of AAEs in the intensive care units studied. The systems and the ergonomics approaches to error analysis can be useful in creating a comprehensive error management programme in order to minimize the gap between work demands and individual capabilities.     

Endogenous Digoxin-Like Factor in Neonates: Effect of Age and Relation to Serum Bilirubin Levels

ABSTRACT. Endogenous digoxin-like immunoreactive factor(s) (DLIF) have been found in serum and urine of newborn infants, including those born prematurely. We assessed the effect of age on serum levels of DLIF in 73 samples obtained from 66 healthy full term newborn infants at birth and during the first two months of life. DLIF concentrations were highest at birth and fell progressively with age. In cord blood, DLIF levels were 0.73 ± 0.35 ng/ml (mean ± SD). DLIF concentrations were 0.45 ± 0.11 ng/ml on day 1, 0.26 ± 0.08 ng/ml on day 3,0.19 ± 0.07 ng/ml on day 5, 0.17 ± 0.09 ng/ml on day 11, 0.11 ± 0.02 ng/ml on days 15–30, and not detectable after 45 days of life. We also studied the relation between serum levels of DLIF and bilirubin in 23 jaundiced newborns between 3–5 days of life. We found a highly significant positive correlation between serum bilirubin concentrations and DLIF. These findings support the assumption that DLIF plays a role in impeding bilirubin excretion in the neonatal period, perhaps by inhibiting the activity of (Na-K)ATPase.     

Coeliac disease in children: a social epidemiological study in Sweden

Aim: Little is known on the possible existence of socioeconomic and geographical differences in early coeliac disease (CD) risk. Therefore, we investigated these aspects in children before age two. Methods: Linking the Swedish Medical Birth Registry to several other national registries, we identified all singletons born in Sweden from 1987 to 1993 (n = 792 401) and followed them until 2 years of age to identify cases of CD. Applying multilevel logistic regression analysis, we investigated the association between socioeconomic position (SEP) and CD in children and also whether a possible geographical variation in CD risk was explained by individual characteristics. Results: Low SEP was associated with CD in boys OR 1.37 (95% CI 1.03–1.82), but not in girls OR 0.87 (95% CI 0.68–1.12). We found a considerable geographical variation in disease risk (i.e. intra‐municipality correlation ≈ 10%) that was not explained by individual characteristics. Conclusions: Low SEP is associated with CD in boys but not in girls. Also, CD appears to be conditioned by geographical area of residence. While our study represents an innovative contribution to the epidemiology of CD in children, the reasons for the observed geographical and socioeconomic differences could be speculated but are still unknown.     

16例双侧肾母细胞瘤的危险因素分析

目的 分析双侧肾母细胞瘤的危险因素。方法 用Kaplan-Meier生存分析方法对我院从1960～2002年收治的16例双侧肾母细胞瘤进行生存时间研究。结果 是否伴发畸形、是否术前化疗、病理分型为影响双侧肾母细胞瘤生存的危险因素；本组病例五年生存率为37．05％。结论 伴发畸形的双侧肾母细胞瘤预后较差。术前常规化疗是提高双侧肾母细胞瘤长期生存率的重要因素。根据组织学类型和临床分期，严格按照NWTS-5的标准，以使治疗个体化，是提高双侧肾母细胞生存率的重要因素。     

儿童重型毛细支气管炎相关危险因素分析

目的 探讨儿童重型毛细支气管炎的相关危险因素.方法 回顾性分析209例毛细支气管炎患儿的临床资料,根据临床病情分为重型毛细支气管炎(27例)和普通型毛细支气管炎(182例)两组,采用单因素分析和多因素非条件Logistic回归分析探讨重型毛细支气管炎的相关危险因素.结果 单因素分析提示年龄(f =3.455;P=0.001)、被动吸烟(x2=6.119;P=0.013)、早产(x2=17.124;P =0.000)、肥胖(x2=5.673;P=0.017)、特应体质(x2=5.736;P =0.017)、先天性心脏病(x2=20.694;P=0.000)6个变量因素影响毛细支气管炎的临床严重程度;经多因素非条件Logistic回归分析表明年龄(OR 0.742;95％ CI0.601～0.917)、被动吸烟(OR3.300;95％ CI1.060 ～ 10.276)、早产(OR5.265;95％ CI 1.565～ 17.705)、先天性心脏病(OR 13.634;95％ CI3.015～ 61.663)是重型毛细支气管炎的危险因素.结论 年龄小、被动吸烟、早产、特应体质及先天性心脏病是重型毛细支气管炎的危险因素.     

Large-for-dates babies at the age of four years: health,handicap and developmental status

236 Average-for-dates (AFD) and 212 large-for-dates (LFD) children were personally examined at birth, and seen thereafter at regular intervals up to 4 yr, when a thorough assessment was made. No differences were found in the prevalence of handicap, health problems, speech and hearing defects, impaired vision or squint; and abnormalities of gross and fine-motor movements were equally low in both groups.At 4 yr the mean scores for five sectors of development were slightly higher in the LFD group, and the difference in total scores was significant; but when adjustment was made for sex and social class the difference became insignificant. Within group analyses of 16 variables and their effects on developmental scores showed no associations in either group according to maternal weight, height and siblings birthweight; hypertension, pre-eclampsia or bleeding during pregnancy; asphyxia or injury at birth. Within each group the net effect of eight factors was assessed; adjustment being made for the other seven variables. In the AFD group significant differences in total scores were found according to sex, social class, smoking, and method of infant feeding. In the LFD group social class and method of delivery made a significant contribution to total scores.     

Psychopathology among Offspring of Parents with Substance Abuse and/or Anxiety Disorders: A High–risk Study

This paper reports the results of a high–risk study of children under age 18 of parents who served as probands in a family study of comorbidity of substance abuse and anxiety disorders. There was a strong degree of specificity of familial aggregation of both the anxiety disorders and substance disorders. Rates of conduct disorder and depression were elevated among offspring of all affected parents. Inclusion of co-parent disorders in the evaluation of familial transmission in the present study strengthened the findings regarding the specificity of transmission of the anxiety disorders and the links between both parental substance abuse and antisocial personality with child conduct disorder.