The impact of a family-centered case management approach.

Two urban programs of family-centered case management services were established for families of children with both a developmental disability and a chronic health condition. These are children who present significant caregiving demands due to the long-term and severe nature of their disabilities. Thirty-two mothers were interviewed within the family's first month in the project and reinterviewed approximately one year later. The results indicate that more families received respite care, nursing services, training in the care of the child, educational services and transportation to school at follow-up than had been receiving those services at baseline. However, families still indicated high service needs for recreational activities, life planning, regular day care, legal services, and speech therapy at follow-up. Mothers indicated that program services were helpful in obtaining services, financing, information, support, and advocacy. Although maternal life satisfaction improved with program participation, non-handicapped siblings continued to have difficulties coping. The model employed is described and the practice and policy implications of the findings discussed.     

Family structure, socioeconomic status, and access to health care for children

OBJECTIVE: To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families. DATA SOURCES: The National Health Interview Surveys of 1993-95, including 63,054 children. STUDY DESIGN: Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES. PRINCIPAL FINDINGS: Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage. CONCLUSIONS: At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.     

Factors associated with clients not keeping their initial home health visit.

Public health nursing home visits are one strategy used by health care providers and communities to improve the health of pregnant women and families with young children. This study investigates the influence of client characteristics, nurse characteristics, and nurse-client interaction on clients keeping or not keeping their initial maternal and child health promotion home visit appointments with a public health nurse. Results of the study suggest the hiring decisions for nurse home visitors should give priority to the nurse's experience and education, as well as his/her practice style of handling maternal/child health visits.     

Health and poverty: health management by the woman.

The goal this follow-up study was to relate the mother's marital satisfaction to family health status in a low SES. The random sample was made up of 30 families with children under 7 years old: 15 considered as sick (Group A) and 15 as healthy (Group B). Both group had similar demographic characteristics (age of father and mother, persons per family group and age of children) and SES. Results showed that mothers were those mainly in charge of their family groups. Mothers of Group A were significantly less understanding and more dissatisfied than those of Group B (p < .05 and p < .01). Mothers of Group A had significantly more arguments with their partners than those of Group B (p < .006). Health care was learned less from the child's own mother in group A than in B (p < .05). Health was considered by mothers of Group A as something that "must be taken care of" more than by those of Group B p < .01). The behaviours of mothers in choosing one of the health systems was similar in both groups. Dissatisfied mothers were associated more with sick family members during the 6 month follow-up. It is suggested that the satisfaction of the mother is a factor that needs further investigation because health is managed by mothers is the large majority of families.     

应用母婴床旁护理模式的效果

目的:探讨母婴床旁护理模式对产妇及家属的影响,以指导产科护理工作。方法:将120对产妇分为实验组及对照组各60对,对照组按传统护理模式护理,而实验组实施母婴床旁护理模式(各项护理操作及健康教育由专科护士在床旁完成)。出院前统计两组产妇健康教育知识、护理技能掌握情况,调查产妇及家属对护理工作的满意度。结果:实验组产妇健康教育知识达标率及新生儿护理技能掌握情况均明显优于对照组,差异有统计学意义(p<0.05);实验组产妇及家属对护理工作满意度也明显高于对照组(P<0.05)。结论:采用母婴床旁护理模式可以提高护理工作满意度及护理工作质量,同时让产妇、家属掌握母婴保健知识与保健技能,提高了母婴生活质量。     

孤独症谱系障碍儿童家庭疾病负担的现状与思考

近年来孤独症谱系障碍(autism spectrum disorder,ASD)患病率在全球范围内呈明显上升趋势,已成为广泛关注的公共卫生问题.ASD儿童长期、高强度的康复训练大大增加了其家庭的经济和精神压力,严重影响家长的健康状况及生存质量.本文主要介绍了现阶段中国ASD儿童家庭的经济负担、养护负担、亲职压力等现状以及目前国家针对ASD的救助和帮扶政策,提出了减轻ASD患儿家庭疾病负担的几点思考与建议,供相关人员了解和参考.     

Family structure differences in health care utilization among U.S. children

This study explores the relationship between family structure and children's access to health care using data from the 2001-2003 waves of the child sample files from the U.S. National Health Interview Survey. Specifically, we investigate the extent to which family structure types predict children's utilization of preventive health care, and barriers to care. We then explore whether observed differences across family structures can be attributed to differences in demographic characteristics, socioeconomic status (SES), and child health status. Using logistic regression models, we document substantial variation in health care usage and barriers to health care across a variety of family structures. Of note is the finding that the children of single mothers demonstrate extremely different patterns of health care access than do the children of single fathers, and the importance of SES as a risk factor for diminished levels of access to health care varies by family type. SES plays a major role in mediating the relationship between access to care for children in single mother and cohabiting families (when contrasted against children in two married parent families), but less of a role for children living with stepparents, a single father, or with parents and other relatives.     

A household study of the pattern of utilization of mother and child health services in rural Greece and variation by socioeconomic status

Summary A household study of all families with children under 6 years in three villages in rural north-west Greece was conducted in August-September 1981. Ninety-four mothers were interviewed about each of their children to find out who they had consulted seeking advice and care during pregnancy, for delivery, in the post-natal period, for child immunization, and in cases of mild or severe child illness. All 142 children were examined physically and developmentally. Information was also collected on the socioeconomic status of the family. Particular causes for concern were the findings that 30% of the mothers said they had experienced at least one induced abortion; 5% had delivered without the help of any trained birth attendant; most of those who delivered in the district town (usually the better off) had received no postnatal care; 37% of children had not seen a doctor in their first year of life either for sickness or for a developmental assessment. Only 41% of children were fully immunized for their age, and 23% of those who should have started their immunizations had not begun. Most of the 30 children who had been severely or chronically ill had bypassed the local doctor and sought services in the district town. There was clear variation in the pattern of use of health services and socioeconomic status as shown by the availability of household facilities including water and electricity. The poorer mothers (30% of the sample) were more likely than the better-off mothers to have delivered at home. Many had had the help of the local midwife, but all those who had no help from a trained attendant came from the poorer families. Post-natal care was provided to most (79%) of these families, by the midwife. The poorer the family the more likely that a sick child would be treated with a home remedy. Children from poor families were likely never to have seen a doctor and if a child did go, it was likely to be older at the time of its first visit. Very few poor families had ever consulted a specialist. Mothers in a better-off situation were more likely to have delivered in the district town at a private clinic with a specialist obstetrician. They were unlikely to have received any post-natal care. Their children were likely to be younger when first taken to the doctor for a routine developmental check-up, usually in the first year of life. Home remedies were less likely to be used for child illnesses. It is suggested that the experienced rural community midwife is providing an excellent service to mothers from all social strata ante-natally; in delivery and post-natal care for poorer mothers, and in informal child care for everyone. She is well respected in the community and knows and is well known to all the children. It is suggested that the trend found for better-off mothers to go to the town for some private health services may undermine the crucial role the midwife has at the village level in rural Greece in pro-tecting the health of the poor and less educated mother.     

Insights in Public Health: The Special Supplemental Nutrition Program for Women,Infants and Children: Strengthening Families for 40 Years

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a proven, cost-effective investment in strengthening families. As part of the United States Department of Agriculture''s (USDA) 15 federal nutrition assistance programs for the past 40 years, WIC has grown to be the nation''s leading public health nutrition program. WIC serves as an important first access point to health care and social service systems for many limited resource families, serving approximately half the births in the nation as well as locally. By providing nutrition education, breastfeeding promotion and foods in addition to referrals, WIC plays a crucial role in promoting lifetime health for women, infants and children. WIC helps achieve national public health goals such as reducing premature births and infant mortality, increasing breastfeeding, and reducing maternal and childhood overweight. Though individuals and families can self-refer into WIC, physicians and allied health professionals have the opportunity and are encouraged to promote awareness of WIC and refer families in their care.     

Desired outcomes for children and young people with complex health care needs, and children who do not use speech for communication

Within recent policies and initiatives, there is a growing emphasis on outcomes-focused practice and user-defined outcomes to ensure that the children and families most at risk of social exclusion have every opportunity to build successful and independent lives. However, we still know little about what children and young people with disabilities consider constitutes a good quality of life. The present paper reports the findings of a qualitative research project that aimed to identify the desires and aspirations of children and young people with complex health care needs (CHNs), as well as those who do not use speech for communication (NS) and their parents. Fifty families participated in this study; 26 families had a child with CHNs and 24 had a child with NS. Semistructured interviews were carried out with 50 parents, 18 children and 17 other informants (teachers and other non-parent carers who knew the child well). A range of visual or non-verbal techniques were used to facilitate interviews with children. The research found that, while children and their parents aspired to the same sort of outcomes as those of non-disabled children, such as to have friends, interests and future independence, the specific meaning they attached to certain outcomes and the way they prioritised aspirations differed. These findings have implications for the ways in which outcomes are defined and measured, and the role of services in achieving these outcomes.     

Fathers' beliefs about parenting and fathers' clubs to promote child health in rural Haiti

Health care providers are challenged to use culturally appropriate, low-technology approaches to improve child health in resource-poor countries. Village fathers' clubs is one approach used in rural Haiti since 1994. Fathers meet regularly for health education and community-building activities. Our aim was to investigate parenting practices and beliefs among Haitian fathers of young children and to explore their views on fathers' clubs. We conducted semistructured interviews with 18 fathers. Themes identified were fathers' involvement in routine care of their children, the close partnerships of fathers and mothers in child care, fathers' responsibilities to their communities, and fathers' clubs as an important supportive institution for the Haitian fathers and their families. Rural Haitian fathers reported taking a very active role in the lives of their families and children. Increased involvement of fathers should be explored as a strategy to improve child health and survival in other parts of Haiti and throughout the world.     

Mothers' view on late postoperative pain management by the nursing team in children after cardiac surgery

Postoperative pain management in children is a complex, multidimensional and subjective phenomenon. It represents a challenge for children, parents and health professionals. This study aimed to understand how mothers assess their children's pain management by the nursing team in the late postoperative phase of cardiac surgery. Empirical data collection was carried out through semistructured interviews with 17 mothers who accompanied their children. Data were subject to qualitative analysis, revealing that, for the mothers, taking good care results from the confidence they vest in the nursing team and from the observation of the medication interventions this team performs. Not taking good care of their children is a consequence of lack of information or inadequate communication between the team and the mothers. The results of this study permit identifying aspects that strengthen and weaken nursing care for these clients, contributing to the improvement of the delivered care.     

Millions of mothers lack health insurance coverage in the United States. Most uninsured mothers lack access both to employer-based coverage and to publicly subsidized health insurance.

Some 5.9 million American mothers caring for young or school-aged children lack health insurance. Although nearly nine in ten uninsured mothers are members of working families, most lack access to affordable coverage through their job or a spouse's job. Most are ineligible for publicly subsidized coverage unless their incomes are far below the poverty line. The millions of uninsured mothers are at high risk of going without needed preventive and primary care. If they become seriously ill, their families can face the prospect of a financial crisis. The nation has made significant progress in extending health care coverage to children in low-income families through Medicaid and the State Children's Health Insurance Program (SCHIP), but no comparable effort has been made to insure the mothers of these children. A few states have started to address the problem by transforming their SCHIPs into family-based programs that also cover low-income parents. Bipartisan legislation under consideration, known as FamilyCare, would encourage this trend by providing more federal funding to states that could be used to extend health insurance to the parents of children already covered by publicly funded programs.     

Hospitalized child: care sharing between mother and nursing

This research aimed to verify at what moment, in what kinds of care and in what way mothers are included in care to the hospitalized child and to verify how care is negotiated between nursing team and mothers. The field research was carried out through participant observation of everyday care at a pediatric hospital unit, as well as interviews with mothers and the nursing team. The inclusion of the mother in care has taken place in a subtle way. The mother has taken on procedures that had been part of nursing competence before, concentrating information on the therapeutic process. The lack of a collective therapeutic project from the perspective of family-centered care is one of the obstacles to the involvement of mothers in care. Results demonstrate that the relation between mothers and the nursing team reveal to be complex and influenced by the exercise of power, which results in the need to construct shared care.     

Enhancing maternal depression recognition in health care settings: a review of strategies to improve detection, reduce barriers, and reach mothers in need

Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.     

Needs in health: important questions for nursing work

The construction of new paradigms and practices in health and nursing, directed to an effective exercise of social rights is an actual challenge. The present study is a contribution to solve this challenge. Looking at nursing knowledge, authors reflect on a way of interpreting the needs in health. Based on a discussion about human needs and their relationship with the health work, they analyse them following the direction of Wanda de Aguiar Horta's theory. They emphasize the importance of human autonomy/selfvaluing and the interpretation of needs based on the consideration of people who receive and give health care and of the social context.