Predictors of psychological adjustment,experienced parenting burden and chronic sorrow symptoms in parents of children with cerebral palsy

Aim To investigate the role of child behaviour, parental coping and experiential avoidance in predicting the psychological outcomes of: (i) psychological symptoms; (ii) chronic sorrow symptoms; and (iii) experienced parenting burden in parents of children with cerebral palsy (CP). Method This study is a cross‐sectional, correlational study. Ninety‐four parents of children (aged 2–12 years) with CP (various levels of motor functioning GMFCS I–V) participated. Results Together, the three predictors of child behaviour, parental coping and experiential avoidance explained 36.8% of the variance in psychological symptoms with child behavioural problems and experiential avoidance as significant unique predictors. In addition, 15.8% of the variance in chronic sorrow symptoms was explained by the three predictors with experiential avoidance alone as a significant unique predictor. Lastly, the predictors together explained 24.3% of the variance in experienced parenting burden with child behavioural problems and experiential avoidance as significant unique predictors. Conclusions This study demonstrates a relationship between child behavioural problems and parental psychological symptoms and experienced parenting burden as well as a relationship between experiential avoidance and parental psychological symptoms, experienced parenting burden and chronic sorrow symptoms.     

A multifaceted strategy to reduce inappropriate use of frozen plasma transfusions in the intensive care unit

Purpose

The purpose of this study is to determine the effect of a multifaceted behavior-change strategy on inappropriate use of frozen plasma (FP) transfusions in the intensive care unit (ICU).

Materials and Methods

A prospective, time-series study was conducted in a 15-bed medical-surgical ICU in 3 phases: (1) baseline observation; (2) educational campaign, audit and feedback to prescribers, and implementation of an FP request form; and (3) FP request form only. Independently, in triplicate and blinded to study phase, appropriateness of each FP request was adjudicated based on published guidelines and clinical context.

Results

Over the 15-month study period, 626 FP transfusions (210 FP requests) were administered to 88 patients. Inappropriate FP requests decreased slightly from phases I to III (60% vs 46%; P = .09), FP requests that were consistent with the guidelines did not change (23% vs 22%; P = .86), and FP requests that were appropriate for the ICU yet inconsistent with the guidelines increased (17% vs 32%; P = .04). Although uptake of the FP request form decreased in phase III, it was associated with fewer inappropriate transfusions.

Conclusions

The behavior-change strategy modestly improved appropriate use of FP transfusions in the ICU. Improving FP request form accuracy, completeness, and compliance may be required to achieve maximum effect and ensure sustainability.     

Elevated numbers of cells producing interleukin-5 and interleukin-10 in a boy with Kimura disease

Kimura disease is a rare disorder of unknown etiology, characterized by the presence of benign subcutaneous granuloma, marked peripheral blood eosinophilia and elevation of the immunglobulin E (IgE) serum level. Here, we present a case of a 12-year-old boy with Kimura disease who had a history of repeated severe influenza virus A infection. Along with the characteristic histological findings of granuloma, including eosinophil infiltration, enzyme-linked immunospot assay showed elevated numbers of IL-5- and IL-10-producing cells in the peripheral blood. Immunohistochemical evaluation, however, did not detect IL-5 in the tissue. Possible cytokine dysregulation in Kimura disease was suggested, but the pathogenesis remains unclear.     

Characteristics of children with unilateral hearing loss

Objective: The purpose of this study was to describe the clinical characteristics of children with unilateral hearing loss (UHL), examine deterioration in hearing, and explore amplification decisions. Design: Population-based data were collected prospectively from time of diagnosis. Serial audiograms and amplification details were retrospectively extracted from clinical charts to document the trajectory and management of hearing loss. Sample: The study included all children identified with UHL in one region of Canada over a 13-year period (2003–2015) after implementation of universal newborn hearing screening. Results: Of 537 children with permanent hearing loss, 20.1% (108) presented with UHL at diagnosis. They were identified at a median age of 13.9 months (IQR: 2.8, 49.0). Children with congenital loss were identified at 2.8 months (IQR: 2.0, 3.6) and made up 47.2% (n?=?51), reflecting that a substantial portion had late-onset, acquired or late-identified loss. A total of 42.4% (n?=?39) showed deterioration in hearing, including 16 (17.4%) who developed bilateral loss. By study end, 73.1% (79/108) of children had received amplification recommendations. Conclusions: Up to 20% of children with permanent HL are first diagnosed with UHL. About 40% are at risk for deterioration in hearing either in the impaired ear and/or in the normal hearing ear.     

Experimental pretesting of public health campaigns: a case study

The aim of the present study is to demonstrate the merits of evaluating new public health campaign materials in the developmental phase using an experimental design. This is referred to as experimental pretesting. In practice, most new materials are tested only after they have been distributed using nonexperimental or quasiexperimental designs. In cases where materials are pretested prior to distribution, pretesting is usually done using qualitative research methods such as focus groups. Although these methods are useful, they cannot reliably predict the effectiveness of new campaign materials in a developmental phase. Therefore, we suggest when pretesting new materials, not only qualitative research methods but also experimental research methods must be used. The present study discusses an experimental pretest study of new campaign materials intended for distribution in a national sexually transmitted infection (STI) AIDS prevention campaign in the Netherlands. The campaign material tested was the storyline of a planned television commercial on safe sex. A storyboard that consisted of drawings and text was presented to members of the target population, namely, students between the ages of 14 and 16 enrolled in vocational schools. Results showed positive effects on targeted determinants of safe sexual behavior. The advantages, practical implications, and limitations of experimental pretesting are discussed.     

Designing effective health education materials: experimental pre-testing of a theory-based brochure to increase knowledge

The aim of this study is to demonstrate the usefulness of developing health education materials with a theoretical and empirical research basis. With a specific focus on increasing knowledge, the authors utilized well-researched principles in cognitive psychology to increase the message comprehension of an existing health education brochure. The brochure used was produced by a Dutch national campaign office for preventing alcohol abuse among undergraduate students. In two experimental studies, the original version of the brochure was compared with the theory-based modified version on measures of knowledge and psychosocial determinants of alcohol use among undergraduate university students. The results show significant differences in knowledge uptake between the two versions. In both experiments, the modified version elicited higher scores on knowledge uptake than the original version. These findings underscore the importance of theory in the design of health education brochures. Despite these positive findings, no differences in more proximal psychosocial determinants of behavior could be found. As a result, the authors conclude that principles in cognitive psychology should be complemented by determinant-specific theory-driven change methods if behavior change is to occur.     

A tribute to an outstanding immunologist - Ian Reay Mackay

The 11th Australasian Autoimmunity Workshop was held in Melbourne, Australia from July 6-8, 2007 organized by the Monash University Autoimmunity Network. The workshops, founded by the late Kevin Lafferty, are a chance for Australasians interested in research into autoimmune disease to present and discuss their work. This workshop also was a chance to acknowledge Ian Mackay, a pioneer clinician-scientist who has made major contributions to our understanding of autoimmune diseases. Friends, colleagues and former students attended the Workshop and acknowledged Ian's expertise and mentorship. This edition of the Journal of Autoimmunity pays tribute to Ian Mackay. It features articles from attendees at the workshop, and contributions from some of Ian's past students and past and current collaborators.