Testing candidate genes for non-syndromic oral clefts using a case-parent trio design.

Markers in five candidate genes were examined on 269 case-parent trios ascertained through a child with an isolated, non-syndromic oral cleft (cleft lip, CL; cleft palate, CP; or cleft lip and palate, CLP). Cases and their parents were ascertained through treatment centers in Maryland. Markers at two of the five candidate genes, transforming growth factor beta3 (TGFbeta3) and MSX1, showed consistent evidence of linkage and disequilibrium due to linkage using several statistical tests (e.g., the global chi-square for TGFbeta3 was 21.1 with 12 df, P = 0.03; that for MSX1 was 8.7 with 3 df, P = 0.03). There was little evidence of heterogeneity in the role of TGFbeta3 between different types of oral clefts, but MSX1 did yield marginal evidence for such heterogeneity. MSX1 also showed evidence for interaction between infant's genotype and maternal smoking, giving a likelihood ratio test for heterogeneity between smoker and non-smoker mothers of 7.16 (2 df, P = 0.03). Using a conditional logistic model to test for gene-gene interaction showed no evidence of interaction between TGFbeta3 and MSX1, with both seeming to contribute independently to risk of isolated, non-syndromic oral clefts.     

The RETHINK Parenting and Anger Management Program: A Follow‐Up Validation Study*

Abstract: This study is the first follow‐up assessment of the RETHINK Parenting and Anger Management Program. Parent participants (N = 168) reduced their anger, violence, and family conflict levels from posttest to follow‐up, on average, at 2.5 months on 13 of 15 dependent variables. Current findings are consistent with a small, albeit growing body of literature supporting the efficacy of RETHINK in improving anger management and parenting skills. When mothers and fathers participate in 6 or 7 weekly RETHINK sessions, they appear to learn the verbal reasoning skills they need to lower their anger, conflict, and violence levels and the changes persist for at least 2.5 months.     

From tears to words: the development of language to express pain in young children with everyday minor illnesses and injuries

Background Little is known about the development of language to express pain in the young or how children and parents verbally communicate when young children have everyday minor illnesses and injuries. Methods UK parents of children between the ages of 1 and 6 were invited to complete an Internet survey on children's pain language during everyday situations of minor illness or injury. Results Of the 1716 parents completing the survey, 45% reported their child had at least one word to express pain by 17 months of age, increasing to 81% by 23 months of age. Children used different words based on their age and in the contexts of minor illnesses and injuries, with words for expressing pain related to illness emerging slightly later. Children's language was purposeful in describing causes of pain and requesting specific forms of assistance from parents even in the very youngest age groups. Parents' communicated with their children primarily to gain further information about the source and nature of pain and to direct children's behaviour. Conclusions Children rapidly develop an extensive vocabulary to describe pain between 12 and 30 months of age, with words for pain from injury emerging first and reflecting the development of normal speech acquisition. The differences in verbal expressions in the context of minor illnesses and injuries suggest that children make a cognitive distinction between the origins and sensory aspects of pain. These findings can help parents, childcare and healthcare professionals to appreciate the early communication capabilities of young children and to engage in more effective pain assessment and management for young children.     

Developing pathways to assist parents to exit the child protection system in Australia

The prevalence of child abuse and neglect is an international concern that justifies the existence of child protection systems. An important first principle for all such statutory child protection systems is to ensure that the system itself does no further harm. It can be argued that there are specific circumstances within which well‐meaning services have the potential to do harm: specifically, processes and actions that disempower parents by reducing their autonomy and capacity for positive action. Exploring the circumstances in which reduced parental autonomy impacts negatively on families is an important first step in developing procedures for working with families that not only avoid harm but are orientated to produce meaningful change. Two evidence‐based programs are described that together have the potential to assist child protection practitioners to develop a collaborative helping partnership with families, clarify goals for change and support parents to achieve meaningful improvement in their family functioning. The programs described are both manualised and have empirical support for their effectiveness. The potential benefits for both families and practitioners working within child protection agencies in the two programs are described.     

John Bowlby and James Robertson: theorists, scientists and crusaders for improvements in the care of children in hospital

AIMS: John Bowlby and James Robertson, two men who were extremely influential in the latter part of the 20th Century, combined scientific theory with evangelism to bring about changes in the way in which children were cared for in hospitals and other institutions. This paper discusses their work together, their theories and their influence on the care of children and paediatric nursing. BACKGROUND: Bowlby and Robertson collaborated early in their working relationship on research about separation of mother and child. Bowlby was the scientist who developed classic theories about maternal separation. Robertson focused his research on separation of mother and child due to hospital admission. Between the two of them, they derived a classic theory about the phases of 'protest', 'despair' and 'denial' (Bowlby called this last stage 'detachment') through which small children pass when isolated from their mothers for a length of time. DISCUSSION: Bowlby became an internationally recognized theorist, widely acclaimed and considered an expert in the field of maternal care and child development. Robertson, with his wife, Joyce, not only continued Bowlby's work investigating children separated from their mothers, but also took on the role of campaigner for the welfare of children in hospital. James Robertson, with his impressive speaking powers, established an international reputation proselytizing the need to admit parents to hospital with their children. The work of Bowlby and Robertson coincided with new knowledge about cross-infection, which had been one of the reasons for excluding parents from hospital wards. At the same time, and influenced by their work, community groups, which championed the idea of admitting parents with their children, developed. The combination of these factors provided a catalyst for changes within the health systems of many developed countries. Because of the theoretical work of Bowlby and Robertson's missionary zeal, government policies, staff attitudes and parents' expectations changed. Children's wards and hospitals in developed countries today admit parents as part of normal routine and actively involve them in the planning and implementation of their child's care.     

Parents Plus Programme 1: Evaluation of Its Effectiveness for Pre‐School Children with Developmental Disabilities and Behavioural Problems

Background This study aimed to evaluate the effectiveness of the Parents Plus programme with families of pre‐school children with developmental disabilities and significant behavioural problems in the Irish health service. The Parents Plus programme is a group‐based parent training package involving video modelling, which was designed to be effective for children with conduct problems, but without developmental disabilities. Materials and methods Pre‐ and post‐treatment assessments were conducted with 22 treated cases and 19 waiting‐list controls with a protocol that included the Strengths and Difficulties Questionnaire, the Child Behaviour Checklist, the General Health Questionnaire‐12, the Kansas Parental Satisfaction Scale, the Family Assessment Device, the Perceived Social Support Scale, the Family Inventory of Life Events and Changes, the Parenting Stress Index and the Questionnaire on Resources and Stress. Results Following the treatment, a comparison of treatment and control group means showed that the treated group showed better adjustment on the total difficulties scale of the Strengths and Difficulties Questionnaire. These gains were maintained at 10‐month follow‐up. Fifty per cent of treated cases showed clinically significant improvement and 14% showed reliable change on the Strengths and Difficulties Questionnaire. The treatment group reported a high level of satisfaction with the Parents Plus programme and showed significant goal attainment after treatment and at follow‐up. Conclusions For some families of pre‐school children with developmental disabilities and significant behavioural problems, the Parents Plus programme is an effective intervention and may be incorporated into routine early intervention clinics in the Irish health service.     

Developing an audio-based communication tool for NICU discharge of Latino families with limited English proficiency

ObjectiveResearch shows NICU Latino parents with limited English proficiency (LEP) feel less comfortable asking questions and participating in medical decision-making, which may negatively affect transition to community healthcare. Question prompt lists (QPL), suggested questions sometimes drawn from families and providers, can improve family-centered communication. We explored clinician and parent perceptions to inform development of and pilot a NICU discharge QPL.MethodsFocus groups with NICU and primary care providers explored perceived educational needs of Latino parents LEP and barriers to effective transition to community healthcare. Semi-structured interviews with Latino parents LEP explored perceptions of knowledge gaps and recommendations to improve the transition process. A Spanish audio QPL for parents and an English written version for providers were developed and pilot tested for acceptability.ResultsProvider focus groups (n = 27) and parent interviews (n = 19) identified themes: decreased parent activation, knowledge gaps, limited-use interpreters, unfamiliarity with healthcare system, and social isolation as barriers to smooth NICU-to-home transition. Providers (n = 11) and parents (n = 10) favored QPL introduction early in NICU admission, finding it useful to improve communication and transition processes for families.ConclusionOur QPL may address challenges faced by Latino parents LEP when transitioning home.Practice implicationsQPLs may improve Latino NICU infants’ healthcare outcomes.     

家长的依从性对肾病综合征患儿康复的影响

[目的 ]探讨肾病综合征 (NS)患儿家长依从性对患儿康复的影响 ,并寻找护理对策 ,达到促进患儿康复的目的。 [方法 ]对 10 8例肾病综合征患儿及家长在入院后随机分为研究组和对照组 ,每组各 5 4例 ,给予研究组家长综合性护理干预 ,对照组则给予常规护理 ,比较两组家长的依从性及其患儿平均住院日、治疗效果及并发症。[结果 ]研究组家长的依从性评分高于对照组 (P <0 .0 1) ,且研究组患儿平均住院日缩短 ,治疗有效率高 ,并发症较少。 [结论 ]提高NS患儿家长的依从性 ,可促进NS患儿的康复。护理工作中 ,在重视患儿护理的同时 ,还应重视对其家长的指导     

Moving into Parenthood: A Program for New Adolescent Mothers Combining Parent Education With Creative Physical Activity

ISSUES AND PURPOSE. To describe a school-based program combining traditional parent education with creative physical activity classes to assist newly delivered adolescent mothers to develop positive parenting behaviors while remaining in school.
CONCLUSIONS. The program contains sessions on parenting information, creative coping strategies, fitness, and role modeling of positive parenting behaviors to help young mothers learn healthy parenting skills as they continue in their own adolescent development.
PRACTICE IMPLICATIONS. The content and teaching strategies can be adapted for individual or group clinical work with teen mothers and their infants in a variety of community settings as well as in school-based healthcare programs.