Family mealtime interactions and overweight children with asthma: potential for compounded risks?

OBJECTIVE: Exploratory study aimed to examine differences in family interaction patterns during a routine mealtime between overweight, at-risk for overweight, and average weight children with asthma. METHODS: Eighty families of children with asthma, aged 5-12 years, were videotaped during a mealtime in their homes. The videotapes were rated using the McMaster Mealtime Family Interaction Coding System (MICS). Structural aspects of the meal such as presence of sugary drinks and whether the television was on were also coded. RESULTS: Significant differences were found on the MICS with families of children with asthma who were overweight scoring lower on task accomplishment, affect management, interpersonal involvement, and roles. Families of overweight children with asthma also displayed an increased presence of sugary beverages, shorter meal length, and fewer adults at the table. CONCLUSIONS: Preliminary findings suggest that families with children with asthma who are overweight may have a more difficult time managing mealtimes and feel overwhelmed by this family routine.     

The Impact of Household Chaos and Dietary Intake on Executive Function in Young Children

Children’s executive functions (EFs) emerge over time and can be shaped by household environments and dietary intake. However, there is a lack of knowledge about how these factors influence EFs in children aged 18–24 months. This study tested a model exploring the relations between parent-reported dietary intake, household chaos, and child EF. The sample consisted of 294 families participating in the STRONG Kids2 birth cohort study of nutrition and child health. Caregivers completed the Food Frequency Questionnaire (FFQ), the Confusion, Hubbub, and Order Scale (CHAOS), and the Behavior Rating Inventory of Executive Function^®-Preschool Version (BRIEF-P) to assess model variables. Regression analyses revealed a significant and independent association between assorted snacks and processed foods and two EF subscales. There were also significant associations between household chaos and each EF subscale. There was no significant moderation effect. These findings suggest that family households characterized by dysregulation are associated with children’s EF difficulties during early childhood and that the role of unhealthy dietary intake in child EF should be explored further. Future longitudinal studies that include multi-method approaches are needed to document the mechanisms through which household chaos impacts child EF over time.     

Childhood Overweight/Obesity and Pediatric Asthma: The Role of Parental Perception of Child Weight Status

Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child’s weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child’s overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.     

Persistent foramen of Huschke: possible risk factor for otologic complications after arthroscopy of the temporomandibular joint

Several cases of otologic injury after arthroscopy of the TMJ have been reported. This study describes the persistent foramen of Huschke, an area of incomplete ossification of the tympanic plate of the temporal bone present in some persons. The presence of this foramen may render middle and inner ear structures vulnerable to injury during arthroscopy of the TMJ.     

Children’s family experiences: development of the PROMIS<Superscript>®</Superscript> pediatric family relationships measures

Purpose

To describe the development of pediatric family relationships measures, with versions for child self-report (8–17 years) and parent-report for children 5–17 years old. Measures were created for integration into the Patient Reported Outcomes Measurement Information System (PROMIS^®).

Methods

Semi-structured interviews with 10 experts, 24 children, and 8 parents were conducted to elicit and clarify essential elements of family relationships. A systematic literature review was conducted to identify item concepts representative of each element. The concepts were transformed into items that were iteratively revised based on cognitive interviews (n = 43 children) and item translatability review. Psychometric studies involving 2846 children and 2262 parents were conducted to further refine and validate the instruments.

Results

Qualitative procedures supported the development of content valid Family Relationships item banks. Final child- and parent-report item banks each contain 47 items. Unidimensional item banks were calibrated using IRT-modeling to estimate item parameters representative of the US population and to enable computerized adaptive test administration. Four- and eight-item short forms were constructed for standard fixed format administration. All instruments have strong internal consistency, retest-reliability, and provide precise estimates of various levels of family relationship quality. Preliminary evidence of the instruments’ validity was provided by known-group comparisons and convergence with legacy measures.

Conclusion

The PROMIS pediatric Family Relationships measures can be applied in research focused on determinants, outcomes, and the protective effects of children’s subjective family relationship experiences.

     

Tales of pediatric asthma management: family-based strategies related to medical adherence and health care utilization

OBJECTIVES: To examine how family management styles, garnered from parent interviews about the effect of asthma on family life, are related to medical adherence and health care utilization. STUDY DESIGN: Eighty parents with a child with asthma were interviewed. Computerized monitoring of medication use was collected every 2 months for 1 year. Parents and children completed measures of medical adherence and health care utilization at the time of the interview and at 1-year follow-up. Three categories of disease management were identified: reactive, coordinated care, and family partnerships. Group comparisons were made by using analysis of variance with medical adherence and health care utilization as dependent variables. RESULTS: Management strategies revealed in the interview were distinguishable by adherence rates at the time of interview and 1 year after. Interview categories were also predictive of emergency department use at 1-year follow-up. The reactive group received a diagnosis of asthma 1 year after noting symptoms, in contrast with the other groups, who received a diagnosis within 6 months. CONCLUSIONS: The use of semistructured interviews may reveal important information about how families manage asthma. Further work may help identify areas amenable to intervention and provide a better understanding of why some families delay treatment.     

Issues in dental and surgical management of the pregnant patient

The "echo boom" of the 1980s has increased the incidence of pregnancy in our patient population. When a gravid patient has an urgent or emergent problem, knowledge of the unique aspects of pregnancy is necessary for optimal patient care. Maternal health is protected by an appreciation of the physiologic changes and demands of pregnancy. Fetal well-being is protected by avoidance of teratogens, fetal anoxia, and premature labor. Attention to these factors allows the clinician to provide treatment with minimal maternal or fetal risk.     

Parent–child mealtime interactions in racially/ethnically diverse families with preschool-age children

Family meals may improve diet and weight outcomes in children; however, results from nationally representative samples suggest that these relationships vary by race/ethnicity. Observing parent–child mealtime interactions may lend insight to why racial/ethnic differences exist. In this pilot study, a multi-ethnic sample of low-income families (n = 30) with a preschool-age child was videotaped during a dinner in their home. A global coding scheme was used to assess the following: ‘Action’ (behaviors that divert attention from eating), ‘Behavior Control’ (behaviors intended to modify another person’s behavior), and ‘Communication’ (i.e., meal-oriented, interpersonal, and critical). All families spent a significant amount of time in ‘action’ oriented behaviors that diverted their attention from eating. We also observed racial/ethnic differences in communication (i.e. critical) and behavior patterns (i.e. behavior control). This study demonstrated that this approach for observing parent–child mealtime interactions in a naturalistic setting among a diverse study sample was feasible; however, future studies should address how these patterns relate to dietary intake and weight status.     

General pharmaceutics--the new physical pharmacy

General Pharmaceutics is proposed as the broad study of the biopharmaceutical and physical chemical properties of each potential drug substance. When the first quality bulk lot is delivered, usually the first GMP bulk lot, an extensive profiling of the potential drug substance should commence. This profile should include solid-state characterization as well as thorough analyses of solubility, stability, and absorption properties of the drug substance that could affect the development of a viable medicine. As a result of these studies, a number of initial specifications could be developed: the preferred polymorphic or crystalline form identified, the preferred particle size to optimize absorption/development, and an initial biopharmaceutics classification with a dose limit to identify those cases in which the formulation can be expected to improve absorption and exposure. The broad topic of General Pharmaceutics is discussed in this Minireview including many advances in technology in this field as well as the rationale behind the proposed initial specifications.