Parent–Child Agreement of Child Health-Related Quality-of-Life in Maltreated Children

This article examines the differences between self-reports and parent-proxy reports of pediatric health-related quality of life among families receiving child welfare services for child physical abuse and neglect. This study assesses child well-being using a pediatric health-related quality of life measure (Pediatric Quality of Life Inventory; PedsQL 4.0) with parent-child dyads (N?=?129). Child and parent reports are compared for total and domain score on the PedsQL. Child-reported scores are lower than parent-proxy reports on total and all domain scores. For the total score, 57 % of child reports are below the clinical cutoff for poor well-being compared with 19 % of parent proxy reports. Analyses indicate poor agreement between parent and child reports, with this disagreement associated with high parent anger and parental self-report of poor mental health. Fully assessing child health and well-being requires multiple perspectives of child well-being. Gaining information from both the child and the parent provides different but equally useful information.     

Child Health in Child Care: A Multi-state Survey of Head Start and Non–Head Start Child Care Directors

IntroductionDirectors of Head Start (HS) and non–Head Start (non-HS) child care centers were surveyed to compare health consultation and screening for and prevalence of health risks among enrolled children.MethodsDirectors of licensed centers from five states were surveyed from 2004 to 2005. Data were analyzed using cross-tabulation and logistic regression techniques.ResultsA total of 2753 surveys were completed. HS centers were more likely than non-HS centers to consult health professionals (P < .0001). More than 90% of HS centers screened for health problems compared with 64.9% of non-HS centers (P < .0001). Almost all HS centers provided parents with child health information. Children at HS centers were at high risk for dental problems. Less than 3% of HS center directors, versus 11.3% of non-HS directors (P < .0002), reported TV viewing for more than an hour a day.DiscussionChildren in HS centers were more likely to receive health consultations and screenings, were at higher risk for dental problems, and watched less TV compared with children in non-HS centers. HS centers promoted health significantly more frequently than did non-HS centers.     

Asthma prevention: Breast is best?

Whilst breastfeeding has been considered to exert a preventative effect on the development of allergic disease, several recent publications have challenged this view, particularly with respect to the long-term outcomes for asthma. There are many other beneficial effects of breastfeeding apart from the possibility of allergy prevention. The suggestion that breastfeeding may increase the development of allergic disease raises concerns about the appropriate steps to take for primary prevention of allergy. It is concluded that breastfeeding can still be recommended for the beneficial effects in reducing atopic disease in childhood in addition to the other demonstrated benefits, and that there are unresolved questions concerning the few studies that suggest the possibility of increased allergic disease in later life.     

Asthma — The changing face of drug therapy

Until the recent introduction of long acting p2-agonists and the leukotriene antagonists, the drug treatment of asthma had remained largely unchanged for a quarter century. Recent studies have demonstrated the efficacy of the long acting pjagonists in the management of asthma in children and highlighted their value as an adjunct to inhaled corticosteroids. The leukotriene antagonists are an important new class of drug therapy which target a specific area of asthma pathogenesis. Whilst they have been shown to be effective for asthma, their exact role in the clinical situation remains to be established. Recent guidelines have emphasised the important role of inflammation in persistent asthma and recommended the early institution of anti-inflammatory treatment. Many patients remain uncontrolled despite high doses of anti-inflammatory agents including oral corticosteroids. Recent experience with other immunomodulatory agents such as cyclosporin, methotrexate and intravenous immunoglobulin has highlighed their potential as steroid sparing agents. With improved understanding of asthma pathogenesis the potential for specific targeted therapies has become evident. Monoclonal antibodies to IgE and certain cytokines are being investigated as possible treatments for asthma. Similarly, preliminary studies of selective phosphodiesterase inhibitors in asthmatic individuals have been encouraging. Other potential therapies include platelet-activating factor receptor antagonists, tryptase inhibitors and prostaglandin E analogs. The continued development of such targetea1 treatments should ensure a greater diversity of therapeutic options for the management of asthma in the new millennium.     

Asthma und Allergie Genetische Prädisposition und Umweltfaktoren

Genetic disposition and environmental factors determine the development of asthma and other allergic diseases. Genetic disposition can be viewed as a complex combination of changes in a number of genes involved in various diseases causing mechanisms. Using a number of different approaches candidate genes for the development of asthma and allergy have been identified and polymorphisms in those genes have been detected. While numerous studies reported associations between polymorphisms and asthma and allergy related phenotypes the functional background of those associations are not jet clear. Variations in the signaling pathway of IL-4 and IL-13 highlight the complexity of gene-gene interactions. Furthermore, it can be speculated that gene-environment interactions might determine the development of asthma and allergy as effects of exposure to bacterial lipopolysaccharide (LPS) are influenced by genetic variants of the LPS-receptor CD14. In addition, successful therapy of asthma symptoms is also dependant on the genetic background of the patient. Discussion. While the role of genetic factors in the development, expression and therapy of asthma and other allergic diseases starts to unfold in the context of recent studies numerous questions still remain.     

Child´s subjectivity in postmodern times

From mid ′50s onwards, we witness a change of paradigm in the Western world: the expression of a historical shift from modernity to postmodernity. This new era includes a strong influence of the media on the population, a change from a lineal sense of time to a virtual, punctual one, and a flooding of overwhelming amount of information, mostly irrelevant, broadcasted in a de-contextualized, synchronic, fragmented and senseless fashion. This new age is characterized, above all, by the destitution of the State, the meta- institution source of legitimacy of all modern institutions: citizenship, factory, and mainly, School, an essential determinant this last one in the construction process of child subjectivity. Having lost its modeling power, the School loses its modern meaning, becoming thus a mere physical space in which pupils meet, but where general, transcendent rules, norms and values cannot be built, as in fact happened in modern times. According to Corea and Lewkowicz, school becomes an empty shed in which rules have to be built all the time, and become valid only for a particular occasion. These changes necessarily influence child subjectivity, the way they feel, they behave, and they "live" in contemporary society. Pediatricians have to be aware and try to understand these changes, so that we can help children, and, in doing so, to build a better world for them.     

How to Keep a Child Healthy?

Keeping a child healthy is the most important priority of every parent. The child can be kept healthy by ensuring exclusive breastfeeding for first 6 mo of life, maintaining healthy weight throughout the childhood, providing adequate and balanced diet, promoting regular physical activity and adequate sleep, keeping a watch on all the parameters of development and referring the child to the specialist whenever deviation from normal is suspected. Proper and timely immunization as per the prevailing guidelines must be done to prevent serious infections. Stress should also be given on promoting oral as well as mental health besides other important general measures to improve the health of the child.     

What is New in the Management of Childhood Asthma?

Asthma still causes considerable morbidity and mortality globally and minimal improvement has been seen in key outcomes over the last decade despite increasing treatment costs. This review summarizes recent advances in the management of asthma in children and adolescents. It focuses on the need for personalized treatment plans based on heterogenous asthma pathophysiology, the use of the terminology ‘asthma attack’ over exacerbation to instill widespread understanding of severity, and the need for every attack to trigger a structured review and focused strategy. The authors discuss difficulties in diagnosing asthma, accuracy and use of Fractional exhaled nitric oxide both as second line test and as a method to monitor treatment adherence or guide the choice of pharmacotherapy. The authors discuss acute and long-term management of asthma. Asthma treatment goals are to minimize symptom burden, prevent attacks and (where possible) reduce risk and impact of progressive pathophysiology and adverse outcomes. The authors discuss pharmacological management; optimal use of short acting β₂ agonists, long acting muscarinic antagonist (tiotropium), use of which is relatively new in pediatrics, allergen specific immunotherapy, biological monoclonal antibody treatment, azalide antibiotic azithromycin, and the use of vitamin D. They also discuss electronic monitoring and adherence devices, direct observation of therapy via mobile device, temperature controlled laminar airflow device, and the importance of considering when symptoms may actually result from dysfunctional breathing rather than asthma.     

Child Poverty and Children’s Subjective Well-Being

This article examines the relationship between child poverty and children’s subjective well-being on the range of domains identified by Rees et al. (2010) in the Good Childhood Index. Data are taken from a school-based survey of children in England. Child poverty is measured using a child-derived index of material deprivation (proposed by Main and Bradshaw in Child Indicators Research 5(3): 503–521, 2012) and indicators of children living in households likely to qualify for minimum income benefits. After a review of relevant literature to provide background to the study, the relationship between material deprivation, qualification for minimum income benefits and various domains of children’s subjective well-being are examined. Finally, a more detailed analysis is performed on the relationship between poverty and children’s subjective well-being in the domains of family and choice, as relationships were found to be strongest in these domains. Findings show that poverty is an important predictor of subjective well-being and that the child-derived index is more successful than household qualification for minimum income benefits in explaining variation in Rees et al’s (2010) Good Childhood Index domains. This lends support to Cummins’s (Journal of Happiness Studies 1(2):133–158, 2000) argument that the relationship between income and subjective well-being exists but is confounded by mediating factors. The domains in which the association to material deprivation is especially strong – family and choice - are identified by Rees et al. (2010) as amongst the most strongly associated with overall subjective well-being.