Treatment of oppositional defiant and conduct problems in young Norwegian children

The efficacy of the Incredible Years parent training and child therapy programs was examined in a randomized controlled study including 127 Norwegian children aged 4–8 years. Children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) were randomized to parent training (PT), parent training combined with child therapy (PT + CT), or a waiting-list control condition (WLC). Assessments were carried out at baseline, posttreatment and at a one-year follow-up using standardized measures and a semi-structured interview. Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC, while differences between the two treatment conditions were small and nonsignificant. About two thirds of the treated children functioned within normal variation after treatment, and the same proportion no longer received an ODD diagnosis at the one-year follow-up. Parental use of positive strategies increased after treatment, and the use of harsh and inconsistent discipline decreased as did mother experience of stress. The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home. The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries.     

患者反馈意见分析与思考

目的：描述患儿家长感谢和赞赏的医务人员的行为特征。方法：对2005—2007年寄至某儿科专科医院的104封感谢信运用现象学研究法进行定性研究。结果：患儿家长感谢和赞赏的医务人员的行为特征有6个方面：是高尚医德、高超医术、有效沟通、维护权利、提供便利和救命之恩。结论：医院管理者应培养医务人员用＂心＂构建患者的放心,严格执行操作规范、确保医疗质量的不断提高,从加强优质有效的医患沟通入手,加强对医务人员服务水平和技巧的培训。     

Two-stage analysis for gene-environment interaction utilizing both case-only and family-based analysis

The case-only study and family-based study are two popular study designs for detecting gene-environment interactions. It is well known that the case-only analysis is efficient, but its validity relies crucially on the assumption of gene-environment independence in the study population. In contrast, the family-based analysis is robust to the violation of such an assumption, but is less efficient. We propose a two-stage study design for detecting gene-environment interactions, where a case-only study is performed at the first stage, and a case-parent/case-sibling study is performed at the second stage on a random subsample of the first-stage case sample as well as their parents/unaffected siblings. Statistical inference procedures are developed for the proposed two-stage study designs, which not only preserve the robustness property of the family-based analysis, but also utilize information from the case-only analysis to enhance estimation efficiency and testing power. Simulation results reveal both the robustness and efficiency of the proposed strategies.     

广州市某区儿童家长强化免疫知信行调查研究

目的了解广州市某区儿童家长对强化免疫知识、行为和态度倾向。方法采用分层随机抽样的方法调查学生家长：采用随机偶遏方式调查散居儿童家长;统计分析主要使用频数和χ^2分析的方法。结果散居儿童和学生家长的健康知识知晓率分别为78．5％、77．1％,P〉0．05;健康行为形成率分别为91．5％,87．9％,P〈O．0001;两类儿童家长中．均有97．0％以上认为有必要开展计划免疫工作。结论针对不同人群开展健康教育,以提高强化免疫接种率。     

父母的文化程度与孤独症的早期发现的相关性分析

目的:探讨父母文化程度对于孤独症患儿的早期发现之间有无相关。方法:收集门诊就诊的383例孤独症患者的一般性资料,使用SPSS软件进行统计分析。结果:孤独症儿童父母的文化程度与症状的早期发现之间存在相关性。父母文化程度相对较高的能够早期发现,早期就诊;而文化程度低的父母带来就诊儿童年龄偏大。两者有统计学差异。P<0.05。结论:加强健康教育,针对不同文化程度的父母制定不同的训练计划,提高孤独症的知晓率,以争取早期发现,早期治疗。     

Development of the congenital adrenal hyperplasia knowledge assessment questionnaire (CAHKAQ)

Aims. The purpose of this study was to develop a validated Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire (CAHKAQ) that can be used to identify deficits in the knowledge of families living with CAH regarding the disease and its management. Background. Management of CAH requires good parental and/or patient knowledge and understanding of the disorder, and the action required when clinical problems arise. Effective education initiatives are important in helping families to manage the disorder. However, there are currently no established questionnaires available to assess the knowledge of CAH. Method. An extensive survey of the literature was conducted to develop a list of questions about CAH. The Delphi technique was used to develop and determine content validity of the CAHKAQ using a panel of 15 nursing and medical experts in endocrinology. The instrument was piloted to test for item variation, meaning and redundancy, and to determine instrument unidimensionality and internal consistency. The questionnaire was distributed to a convenience sample of family members (n = 98) of 36 children/adults with CAH recorded on the database of a large children's hospital endocrine clinic. Results. Three Delphi rounds were required to achieve final consensus for content validity. The resulting questionnaire contained 22 multiple‐choice items and had a Flesch Reading Ease score of 67. Statistical analysis found the instrument to be internally consistent and unidimensional with a reported Cronbach's coefficient alpha of 0·67. Conclusion. The CAHKAQ is a valid and reliable questionnaire suitable for use in conjunction with education about CAH. Relevance to clinical practice. The CAHKAQ will be invaluable in assessing parental and patient knowledge and understanding of the disorder and identifying deficits that can be addressed through education. Further research is required to determine whether the underlying factors of the instrument are consistent with components of CAH knowledge.     

Being there: parenting the child with acute lymphoblastic leukaemia

Aims and objectives. To gain insight into the lived experience of parenting a child with leukaemia during treatment. Background. Diagnosis of leukaemia in children leads to an existential shock for parents and a reversal of normal family life. Today, in the Netherlands, after diagnosis, children stay at home most of the time. Therefore, their parents face considerable responsibilities for administering home‐based treatment and for the support of their child during illness and treatment. Methods. A grounded theory study was undertaken at a Dutch University Hospital and involved one‐time individual in‐depth interviews with 12 mothers and 11 fathers (n = 23) of 12 children. Findings. ‘Being there’, was identified as the core concept. It means: ‘I’ll be there for you; I will never let you down’. ‘Being there’ is described as a parental response to the perceived vulnerability of the child and the parental need to give meaning to parenthood. It serves two purposes: protection and preservation. Protection means guarding the child against the negative aspects of illness and treatment. Preservation refers to the way parents influence the child’s perception of his/her life, thus contributing to his/her coping and willingness to undergo treatment, to maximise the chances for survival. Six aspects were identified: a trusting relationship, presence, emotional support, advocacy, routines and rituals and effacing oneself. Conclusions. The concept provides a theoretical frame for parenting the child with cancer. It clarifies the actions and reactions of parents and increases insight into the underlying force that enables parents to provide continuing care despite their personal burden. Relevance to clinical practice. The concept offers an essential insight into parenting the child with acute lymphoblastic leukaemia and has relevance for nursing practice and education. Understanding of the concept would improve the ability to understand, communicate and work pro‐actively in partnership with parents.     

Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis

Title.  Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis.
Aim.  This paper is a report of a meta-analysis to investigate the association between self-report pain ratings for the dyads of child and parent, child and nurse and parent and nurse.
Background.  Existing research has shown conflicting results with regard to agreements of self-report pain ratings between the three dyads.
Data sources.  The CINAHL, Medline, Ovid and PsycINFO databases were searched using keyword, such as 'children/adolescents', 'parents/nurses', 'pain assessment', 'pain ratings', 'association' and 'agreement'. Studies published in English in or after 1990 were included.
Methods.  Meta-analysis methodology was applied to 12 pain assessment studies published between 1990 and 2007 which met the inclusion criteria. In the 12 studies a common effect size was estimated using the Pearson's correlation coefficient. Therefore, a fixed-effects model was chosen for this meta-analysis.
Results.  We found moderate summary effect sizes between self-reported pain ratings for the dyad of child and parent ( r  = 0·64) and the child and nurse dyad ( r  = 0·58) and a weak summary effect size of r  = 0·49 for the dyad of parent and nurse. The summarized effect sizes for each of the three dyads varied across the studies. A test of homogeneity ( Q -statistic) indicated that all effect size estimates were not homogeneous.
Conclusion.  Parents' and nurses' perceptions of children's pain should only be considered as estimates rather than expressions of the pain experienced, and not the same as children's self-reports. There is a need for education on selection of appropriate pain assessment scales in relation to the age and development of the child.     

Involving fathers in research

Column Editor: Lauren Clark Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.