Attire and appearance of pediatrician: Parents’/guardians’ opinion

Professional appearance of a pediatrician is an important element affecting the perception of competence of the doctor among patients and their parents/ guardians, thus influencing their compliance. As there is no study on this issue addressing the Indian scene, we requested responses to a questionnaire containing 15 questions from the parents/ guardians of the children. The purpose of the study was to assess their opinion regarding attire and appearance of pediatricians. Five each of the questions were related to common aspects of appearance and attire of the pediatrician in general and that of the male and the female pediatrician in particular. A total of 210 parents/ guardians responded to see the question listed in the questionnaire. Assertive responses to each question were analysed for any association with the following categories — Urban, Rural, Males, Females, Urban Males, Rural Males, Urban Females, Rural Females, age below 40 years and age 40 years or more. Majority of the total assertive respondents preferred a formal/ traditional attire and appearance for the pediatrician. Although most of the above categories concurred with this general opinion, some categories showed statistically significant, but practically unimportant, differences in the extent of agreement. The respondents generally favoured a white coat and nameplate on the pediatrician, shoes and a necktie for the male pediatrician andsaree for the female pediatrician. They did not approve clothes with bizarre designs, use of perfumes by the pediatrician, long hair, Tshirts and jeans pant for the male pediatrician,chudidar, lipstick and other make-ups, costly jewellery and short hair for the female pediatrician.     

Children's and parents' visual perception of physicians.

The purpose of this study is to evaluate the child's and parents' visual perception of physicians. To do this, 50 children and their parents were asked which physician they preferred, when shown eight pairs of photographs. Four characteristics were tested twice, white coat versus no white coat, smile versus stern face, cartoon posters versus no posters, and standing versus stooping. We found that both children and parents preferred the smiling physician and the physician with cartoon posters on the wall. Surprisingly 54% of children preferred the physician in the white coat, whereas only 35% of parents preferred the white coat. Sixty-eight percent of children also preferred the standing physician compared with only 41% of parents. There was little correlation between the parent's and child's answers. The results did not differ significantly with age, gender, or number of hospitalizations. In conclusion our study did not confirm the popular belief that children are afraid of physicians in white coats, although children did strongly prefer physicians who smiled and those with cartoon posters on the wall.     

Psychological functioning in boys of short stature: effects of different levels of growth hormone secretion

Aim: To examine the relationship between growth hormone (GH) and psychological functioning, especially self-perception and well-being, in 60 prepubertal boys of short stature with a wide range of GH levels. Methods: A comparison was made of the well-being and self-perception of children with GH insufficiency, children with idiopathic short stature (ISS), a normative sample and healthy boys with normal stature. Results: Children with GH insufficiency had a more negative perception of their own physical appearance than the normative sample. They perceived themselves as more alert but also more inhibited than both the children with ISS and the healthy boys with normal stature. In comparison with the healthy boys with normal stature they perceived themselves as having more stability. The parents of the boys with GH insufficiency also perceived their children as being more stable compared with how the parents of boys with ISS perceived their children. To elucidate the effects of GH on psychological functioning a multiple regression analysis was performed.

Conclusion: The lower the levels of GH the more inhibited were the boys of short stature, as perceived both by themselves and by their parents. The boys with GH insufficiency had a more negative perception of their physical appearance than the normative sample.     

Short-term effects of coping skills training in school-age children with type 1 diabetes

Objective:  Little is known about the use of psychosocial interventions in children younger than adolescence with type 1 diabetes (T1D) and their parents. We report preliminary short-term outcomes of a randomized controlled trial of coping skills training (CST) compared with group education (GE) in school-aged children with T1D and their parents.
Methods:  One hundred and eleven children (range = 8–12 yr) with T1D for at least 6 months (3.71 ± 2.91 yr) were randomized to CST (55.6% female (F); 81.5% white (W)) or GE (69.7% F; 90.9% W). Children and parents (n = 87) who completed the intervention, baseline, 1- and 3-month data are included. Children completed measures of self-efficacy, coping, and quality of life; parents completed measures of family functioning (adaptability and cohesion), diabetes-related conflict, parent depression, and parent coping. Metabolic control was assessed with glycosylated hemoglobin A1c. Mixed-model repeated measures anova was used to analyze the data.
Results:  CST and GE group composition was generally comparable. Children had good psychosocial adaptation and metabolic status. CST parents reported significantly more improvement in family adaptability compared with GE parents, and a trend was seen indicating that CST children showed greater improvement in life satisfaction than GE children. Effect sizes for this short-term follow-up period were small, but group participants were receptive to the intervention and reported positive gains.
Conclusions:  In these preliminary results, CST and GE were more similar than different across multiple measure of psychosocial adaptation, although CST showed promising statistical trends for more adaptive family functioning and greater life satisfaction. Longer term follow-up is underway.     

General event representations of young children in a child psychiatric clinic.

Thirty-nine Children (5-8 years old) in a child psychiatric clinic and 50 5-year-old and 50 7-year-old schoolchildren were interviewed about two events: "getting dressed" and "a day in school". Both the children in the clinical and in the normal group formed general representations of these events. Children in the clinical group mentioned fewer acts, props and locations. Nearly all the children in both groups described how one gets dressed in the correct temporal order, but fewer children in the clinical than in the normal group described a day in school in the correct temporal order. Fewer children in the clinical than in the normal group gave causal explanations. Within the clinical group children with cognitive/attentional deficits tended to have less complete and less organized representations than children whose primary problems are relational.     

Body proportions in fanconi anemia heterozygotes

To study the anthropometric ratios in parents (heterozygotes) of children withFanconi anemia. The study was carried out in the Department of Hematology, Institute of Child Health & Hospital for Children, Chennai. Parents of children with Fanconi anemia were the subjects of the study. Applying standard instruments and methods, various body measurements were recorded. 31 fathers and 37 mothers were included in the study. A hundred male and female controls of the same ethnic group were also studied for the same parameters. The ratios were calculated and statistically analyzed. It was observed that fathers (male heterozygotes) had shorter forearms, the ratio of upper arm: forearm was significantly increased compared to male controls. In mothers (female heterozygotes) the inter-pupillary distance was increased, the ratio of head circumference to inter-pupillary distance was decreased compared to female controls.     

Identification of resident and attending physicians: do parents know who is caring for their hospitalized child?

OBJECTIVE: Correct identification of a physician or resident is an essential first step in developing a good relationship between physicians, patients, and their families. However, many parents are unfamiliar with the individuals responsible for their children's care. This study was conducted to determine how often parents/guardians of hospitalized children could identify the residents and attending physicians caring for their children and what factors they considered important in physician identification. METHODS: This was a cross-sectional study with a convenience sample of the parents/guardians of hospitalized pediatric patients admitted to a university teaching hospital over a 2-month period; we used a self-administered, confidential questionnaire. RESULTS: Subjects were 144 parents/guardians of hospitalized children (100% of subjects asked to participate, 19.3% of all hospitalized children); parents had the following characteristics: mean age, 30 years; 51% Caucasian, 43% African American; 82% female. Physician identification was 76% for attending physicians and 73% for residents. The factors rated as most important to parents were physician introduction (50%-76%), prior relationship (27%-13%), wearing of a white coat (2%-8%), wearing of a name tag (4%-10%), and wearing of a stethoscope (0%-2%). Physician introduction was ranked higher for first hospitalizations. Subsequent hospitalizations increased identification of attending physicians but not residents. CONCLUSIONS: This study indicates that up to a quarter of parents could not identify the physician responsible for their children's care during a hospitalization. Improving physician identification may enhance other aspects of physician-family communication.     

Assessment of Psychosocial Status among Short-stature Children with and without Growth Hormone Therapy and Their Parents

To evaluate the psychosocial status of short children with and without growth hormone therapy (GHT) and that of their parents, self-administered questionnaires were collected from patients and parents who regularly visit the outpatient clinics participating in the Child Health and Development Network. Completed questionnaires were received for one hundred and thirteen patients with GHT and 67 patients without GHT. According to the parents, both children with GHT and without GHT have no difficulty in their daily lives (89% vs. 95%) and are positive (56% vs. 65%), respectively. Ninety-eight percent of parents of children with GHT and 83% of parents of children without GHT had expected the current treatment strategy to be effective. Parents of children with GHT are more satisfied with the current therapy than those without GHT (79% vs. 50%), and feel less anxiety about the on-going therapy than (31% vs. 58%, respectively). Children treated with or without equally reported having no difficulty in their daily lives (90% vs. 93%), and being positive in their lives (81% vs. 75%, respectively) despite their short stature. Although less than one third of the patients have been bullied in their classroom (26% with GHT vs. 29% without GHT), younger and shorter children tend to be bullied more often. Short children undergoing GHT and their parents have anxiety regarding their height and expectations of the effect of GHT. It is important for doctors to inform their patients regarding realistic height expectations before starting GHT. Additionally, medical consultation is recommended for patients who remain below –2 SD in height despite GHT.     

Therapy preference and decision-making among patients with severe sickle cell anemia and their families

BACKGROUND: Patients with severe sickle cell anemia (SCA) may benefit from therapeutic intervention with hydroxyurea (HU), chronic red cell transfusion (CT), or stem cell transplantation (SCT). Determination of best treatment is complicated by the tradeoff between each treatment's risks and benefits and the lack of data comparing them to determine efficacy. We explored factors that influenced making decisions regarding interventions and examined the relations between treatment preference and health-related quality of life (HRQOL). METHODS: Children with severe SCA and their parents received brochures describing each treatment, discussed risk/benefits with a nurse-educator, and answered questions regarding HRQOL and the factors influencing treatment preference. Severe SCA was defined as >or=3 pain events requiring ER visits or hospitalizations within 12 months, >or=2 acute chest syndrome (ACS) events within 24 months, or a combination of the two. RESULTS: Thirty parents and 7 patients participated. HU was preferred by 21 parents and 4 children, CT by 5 parents and 1 child, and SCT by 3 parents and 1 child. One parent was undecided and one child preferred no treatment. Interviewees were most influenced by perceived efficacy and safety, but no factors differed significantly among treatment preference groups. HRQOL median scores (0-100 scale) for parents (56; range, 28-91) and children (61; range, 31-96) did not differ significantly among treatment preference groups. CONCLUSIONS: Patients with severe SCA and their parents can identify their treatment preferences. Improved understanding of their preferences and decision-making process will aid in the design of future clinical trials and in medical decision-making.     

Children's Perceptions of Influenza Illness and Preferences for Influenza Vaccine

Introduction

In this qualitative study we explored children's perceptions of influenza, preferences for influenza vaccines, and ability to understand “risk” of vaccine adverse effects and different attributes between injectable and intranasal vaccines.

Method

In-person, semi-structured interviews were conducted among 28 U.S. children aged 6 through 12 years.

Results

Many children understood the concept of influenza illness and believed vaccination was important. Efficacy, adverse effects, and mode of administration affected their preferences for influenza vaccines. Children 8 years of age and older were able to consider multiple attributes when selecting between hypothetical vaccines, and their responses were consistent with their previously stated preferences for individual attributes. Most children would prefer a nasal spray over a shot vaccine when all other vaccine attributes were equal.

Discussion

Efficacy, adverse effects, and mode of administration were important factors in children's preferences for influenza vaccine. Children as young as 8 years of age appeared to understand vaccine “risk” and were able to consider multiple attributes simultaneously when choosing between vaccine alternatives.     

Stuttering as a complication of strabismus surgery

Children may experience extremely high levels of psychological stress in the operating suite because of anxiety associated with the separation from their parents, the unfamiliar and intimidating environment, the presence of strangers in unusual attire (masks, caps, gowns), the act of being forcibly restrained, and the forceful pressing over the mouth and nose of an anesthetic mask which emits a foul-smelling gas and which seems to restrict breathing in a manner reminiscent of suffocation. High levels of anxiety can lead to regression in a child's mental development, including stuttering, which is a regression to an earlier speech pattern and failure to develop fluent speech. Two cases are reported in which children developed stuttering following inappropriate or abusive treatment by the anesthesia departments of the hospitals in which they had surgery for strabismus. Both patients were four-year-old boys.     

Evaluation of children with possible appendicitis using technetium 99m leukocyte scan

We evaluated the use of technetium 99m albumin colloid white blood cell (TAC-WBC) scan in 33 children with possible appendicitis. Ten children had appendicitis, four of whom had perforated their appendix at the time of surgery. Children with appendicitis differed from children without appendicitis in the incidence of right lower quadrant rebound tenderness (60% vs 17.4%), and white blood cell count (X10(3)/mm3) (14.0 + 1.9 vs 10.7 +/- 1.0). TAC-WBC scans were interpreted as either positive, negative, or indeterminate for appendiceal pathology. Twenty-five children had positive or negative scans for appendiceal pathology. There were 7 true positives, 2 false positives, 16 true negatives, and 0 false negatives. This resulted in a sensitivity of 100%, a specificity of 89%, an accuracy of 92%, a positive predictive value of 78%, and a negative predictive value of 100%. The TAC-WBC scan was indeterminate (abnormal but nondiagnostic for appendicitis) in eight children (24%), three of whom had appendicitis. The main values of TAC-WBC scan in our study of children with possible appendicitis were that it could be used emergently, it was abnormal in 100% of children with appendicitis, and it had a high negative predictive value (100%). The main limitation of TAC-WBC scan in our study was that it was indeterminate for appendiceal pathology in 24% of children. We recommend that TAC-WBC scan be used in children with possible appendicitis because it may allow outpatient management of up to 48%.     

Longitudinal parental preferences for late effects communication during cancer treatment

Few studies have investigated parent preferences for late effects communication during pediatric cancer treatment. We used questionnaire data to assess whether parental preferences for late effects information change over the year after diagnosis. Most parents found this information to be very/extremely important at baseline, assessed soon after diagnosis, (94%, 153/162), 4 months (91%, 147/162), and 12 months (96%, 156/163). Similarly, most parents wanted as much detail as possible about late effects at baseline (85%, 141/165), 4 months (87%, 144/165), and 12 months (83%, 137/165). Parents of children with favorable prognoses preferred more details at baseline (OR 2.94, 1.18–7.31, P = 0.02) than parents whose children had less favorable prognoses.     

Investigating inflammatory bowel disease--white cell scanning, radiology, and colonoscopy

OBJECTIVE: To evaluate different methods of examination of the bowel in suspected inflammatory bowel disease. DESIGN: Prospective investigation of all children over a three year period with suspected inflammatory bowel disease. A technetium-99m-HMPAO labelled white cell scan (Tc-WCS), barium follow through examination (Ba-FT), and colonoscopy plus biopsy were undertaken. SETTING: Great Ormond Street Hospital for Children, London. SUBJECTS: 39 children (20 male and 19 female), median age 12.1 years (range 3.9-15.1 years). MAIN OUTCOME MEASURES: There was total agreement in 21/39 cases, positive in 16, and negative in five. Of 31 histologically proved cases, positive results were obtained in 28 Tc-WCSs (sensitivity 90%), 10 of 24 Ba-FTs (sensitivity 42%), and 27 colonoscopies (sensitivity 87%). CONCLUSION: The Tc-WCS is sensitive, specific, and non-invasive and should be a first line investigation. Ba-FT with a high radiation burden and relatively low sensitivity requires its role to be redefined. Colonoscopy, with endoscopic biopsy, has a high pick-up rate where facilities and expertise exist.     

Sedation for intra-articular corticosteroid injections in juvenile idiopathic arthritis: the views of patients and their parents

Intra-articular corticosteroid injections (IACI) are one of the mainstays of treatment for children with juvenile idiopathic arthritis. The most important disadvantage of IACI is the pain associated with the procedure. Little is known about the children or parents' perception of this pain. This study was undertaken to determine whether patients and their parents prefer sedation to receive IACI or not and why. A survey form was presented to patients and/or their parents from January to March 2010 to evaluate their choice of anesthesiologist-controlled deep sedation (with sevoflurane) vs. no sedation–no local anesthesia and the reasons for it. All participants had experienced the two options. In addition, there were two visual analog scales (VAS) to evaluate pain associated with blood draws and IACI, respectively. A total of 45 patients and their parents filled out the survey form. There were 34 females; the median age was 10.6 years, and the median duration of the disease was 6.4 years. Median VAS score was 1.3 for pain associated with blood draws, and 6, for IACI. Most children preferred sedation for IACI (26 vs. 15), although four did not show preference for either method. Children who preferred sedation for IACI were younger (p?=?0.03) and had a shorter course of disease (p?=?0.04). Conclusions: While most children prefer to receive IACI under sedation, a majority of parents prefer to avoid its risks. Children who prefer IACI without sedation are significantly older and have a longer course of disease.     

Cardiovascular risk factors in parents of short children born small for gestational age

Small for gestational age (SGA) children have a higher prevalence of cardiovascular risk factors at a young age. It is not known whether this increased risk is caused by their size at birth, a familial predisposition for cardiovascular disease or smallness at birth or a combination of these factors. The cardiovascular risk profile of parents of SGA children is unknown. We compared anthropometry, blood pressure, fasting serum lipid, glucose, and insulin levels of 482 parents (mean age 41 y) and 286 short SGA children with age- and sex-matched references. We also investigated whether these parameters correlated between parents and their offspring. Mothers had higher systolic blood pressure, fathers had a higher body mass index and parents had more frequently high fasting glucose levels than age- and sex-matched references. Children had significantly higher systolic and diastolic blood pressure than sex- and height-matched references. Twenty-four percent (mothers) and 10% (fathers) were born SGA but they did not have more cardiovascular risk factors than those born appropriate for gestational age. Cardiovascular risk factors did not correlate between parents and children. In conclusion, parents of short SGA children have a modest increase in some cardiovascular risk factors but risk factors did not correlate between parents and children.     

Exploring the cognitive phenotype of autism: weak "central coherence" in parents and siblings of children with autism: II. Real-life skills and preferences

Information on everyday life activities and preferences in both social and nonsocial domains was obtained from parents and children who had taken part in an experimental study of central coherence. Comparisons were made between parents who had a son with autism, parents with a dyslexic son, and families without a history of developmental disorder, as well as the male siblings in these families. Data on everyday preferences and abilities were elicited by means of an experimental questionnaire. Significant group differences in social and nonsocial preferences were found, suggesting that some parents showed similarities with their son with autism, in preference for nonsocial activities and ability in detail-focused processing. A similar experimental questionnaire, completed by parents on behalf of their sons, discriminated between autism group probands and controls, but did not differentiate sibling groups. The relevance of the nonsocial items to central coherence is discussed in the light of the findings in Part I: autism parents who reported more autism-related nonsocial (but not social) preferences, tended to show a piecemeal processing style on the experimental tasks.     

Children's visits to providers of complementary and alternative medicine in San Diego.

OBJECTIVE: Increased attention has been focused on the growing use of complementary and alternative medicine (CAM); however, few studies have included children in the general US population. The present study investigated children's visits to CAM providers and factors associated with these visits. METHODS: Analysis of cross-sectional data from the 2001 United Way Outcomes and Community Impact Program telephone survey, a representative sample of households in San Diego County, California. We selected households with children younger than 19 years of age (N = 1104). Parents reported on children's CAM visits in the past year. RESULTS: Approximately 23% of parents reported that their child saw a CAM provider in the past 12 months. CAM care was sought for sick and routine care. Children of white parents had greater odds of having a CAM visit in the past year compared with children whose parents were Hispanic (adjusted odds ratio 1.71, 95% confidence interval [95% CI] 1.11-2.63). Children whose parents were college graduates had a greater likelihood of seeing a CAM provider than children of parents with high school education (adjusted odds ratio = 1.82, 95% CI 1.19-2.79). Children who were insured were also more likely to have CAM visits than uninsured children (adjusted odds ratio = 2.32, 95% CI 1.04-5.21). CONCLUSIONS: Visits to CAM providers were much more common among children in the general San Diego population compared with 1996 national estimates. Pediatric health care providers should remain aware that their patients may be using CAM so they can provide coordinated care.     

监护人员对农村3～7岁留守儿童情绪行为问题影响分析

目的 初步探讨监护人员对农村3～7岁留守儿童情绪行为问题的影响.方法 采用自拟儿童基本情况调查表、儿童长处和困难问卷(父母版)对805例农村3～7岁留守儿童进行调查评估.结果 留守儿童困难问题检出率为3.5%,男性为4.1%,女性为2.7%,男女性儿童困难问题检出率差异无统计学意义(X~2=1.154,P>0.05).留守儿童同伴交往问题评分(2.30±1.86)显著高于非留守儿童(2.09±1.74),差异有统计学意义(t=2.318,P<0.05).父母双方外出留守儿童情绪症状评分(2.76±1.84)、困难总分评分(11.41±4.77)显著高于父/母单方外出者(2.29±1.64)、(10.41±5.18),差异均有统计学意义(t=-2.489～-2.006,P<0.05);亲社会行为评分(6.39±2.26)显著低于父/母单方外出者(7.34±2.18),差异有统计学意义(t=4.036,P<0.001).监护人员文化程度为"初中及以上"者,留守儿童亲社会行为评分(7.02±2.21)显著高于"文盲/半文盲"(6.20±2.44)、"小学"(6.42±2.16),差异均有统计学意义(P<0.01).监护人员为"祖辈"者,留守儿童情绪症状评分(2.77±1.84)、困难总分评分(11.45±4.74)显著高于"父/母亲"为监护人员者(2.29±1.64)、(10.41±5.18),差异均有统计学意义(P<0.05),而亲社会行为评分(6.37±2.25)要低于"父/母亲"为监护人员者(7.34±2.18),差异有统计学意义(P<0.001).监护人员照顾留守儿童"非常愿意"者,留守儿童多动注意不能评分(5.02±1.95)、困难总分评分(12.26±4.39)显著高于监护人员照顾留守儿童意愿"愿意"者(4.10±2.02)、(11.06±4.88),差异有统计学意义(P<0.01～0.001).监护人员照顾留守儿童感受"负担很重"者,留守儿童情绪症状评分(3.33±2.19)高于"有能力带"者(2.60±1.72),差异有统计学意义(P<0.05);多动注意不能评分(5.17 ±1.76)、同伴交往评分(3.87 ±1.96)、困难总分评分(14.70±5.03)均高于"负担重"(4.26±2.03)、(2.63±1.70)、(11.85±4.95);"说不上负担"(4.32±1.88)、(1.87±1.82)、(10.91±4.42);"有能力带"者(4.16±2.16)、(2.20 ±1.86)、(10.86±4.85),差异均有统计学意义(P<0.01～0.05);而亲社会行为评分(5.53±1.98)显著低于"有能力带"者(6.81±2.20),差异有统计学意义(P<0.01).监护人员照顾留守儿童感受(β=-0.725,P=0.000)及意愿(β=-1.069,P=0.000)影响留守儿童困难问题.结论 父母双方外出留守儿童情绪行为问题更为突出,父母外出时尽量留下一方照顾儿童.提高监护人员素质,有利于留守儿童身心健康发展.     

White-black disparities in family-centered care among children with autism in the United States: evidence from the NS-CSHCN 2005-2006

ObjectivesThe aim of this study was to compare the reported receipt of family-centered care between parents of white and black children with autism spectrum disorders (ASD) in the United States, and to disentangle the associations of race and ASD on different aspects of family-centered care.MethodsParents of 35 386 children, aged 0 to 17 years, were surveyed by the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005–2006. Autism was defined by the question, “To the best of your knowledge, does [child] currently have autism or autism spectrum disorder, that is, ASD?” Family-centered care was measured with 5 key indicators on a 4-point Likert scale. Univariate and multivariate analyses were used, with adjustment for the complex sampling design.ResultsThe prevalence of autism in this sample was 5.4% (n = 1869). We found that, among children with SHCN but no ASD, more white parents than black parents reported receiving family-centered care. Further, fewer parents of both white children and black children with ASD reported receiving family-centered care compared with those with a child who had special needs other than ASD. Lastly, among parents with a child with ASD, being black was associated with lower reporting of family-centered care for 3 of 5 items. In multivariate analyses, black parents with a child with ASD had 2 to 5 times greater odds of not reporting family-centered care on each item compared with white parents without a child with ASD.ConclusionTargeted efforts are needed to improve family-centered care for parents with a child with ASD, and particularly for black families.