Lessons from health trends for systems of child health care.
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Canada↗
Biomedical subjects
I B Pless
Publications and source records attributed to I B Pless.
Can effective parent education occur during emergency room visits?
BACKGROUND: Parents might not feel the need to make as many visits to an emergency room (ER) for a sick child if they had more information about common illnesses and their management. This study measured the effect on future ER use of parent education on common childhood illnesses. METHODS: Children who were over 6 months old and had visited the ER at least twice in the preceding year were enrolled in an experimental group (n = 118) or in a control group (n = 128) over consecutive two-month periods. The intervention consisted of a pamphlet and a videotaped presentation that discussed the features and management of common childhood illnesses. RESULTS: Over the following year, an average of 0.43 (SD = 0.9) ER visits were made by experimental subjects compared to 0.52 (SD = 1.31) by control subjects (P = .30). Twenty percent (SD = .4) and 22% (SD = .4) of subsequent illnesses of experimental and control children respectively resulted in an ER visit. CONCLUSION: Our study demonstrated no effect of an educational intervention designed to decrease ER visits. Limitations of our study, however, suggest that further attempts to educate parents in this setting may still be warranted.
Child↗
Issues involved in the definition and classification of chronic health conditions.
The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.
Child↗
Long-term psychosocial sequelae of chronic physical disorders in childhood.
OBJECTIVE: This study was designed to examine the long-term psychosocial sequelae of chronic physical disorders that begin during childhood. DESIGN: We analyzed data from a national birth cohort. 12,537 children were followed until age 23 years--76% of all born in Britain during one week in 1958. Of these, 1667 had a chronic disorder before age 16 and 1279 were included in the 23-year follow-up. MEASURES: Outcome measures included self-reported psychological disturbances between ages 16 and 23, scores on the Malaise Inventory, social class, educational qualifications, unemployment, and social activities. RESULTS: The total cumulative incidence rate before 16 years was 109.5 per 1000. Demographic comparisons showed that the group with chronic physical disorders was similar to those free of chronic disorders in all respects except the sex ratio. Men with chronic physical disorders had significantly higher relative risks for abnormal scores on the Malaise Inventory (1.52, confidence interval [CI] 1.13, 2.05); specialist psychological care (1.43, CI 1.00, 2.03); poor educational qualifications (1.26, CI 1.08, 1.47); periods of unemployment (1.20, CI 1.03, 1.41); and less social drinking (1.36, CI 1.15, 1.60). In contrast, women only had a significantly elevated risk for having seen a mental health specialist (1.32, CI 1.02, 1.71). Among the men some of the risks were further elevated for those in specific diagnostic groups. These findings are examined in the light of postulates about the impact of chronic physical disorders as a whole and in an attempt to explain the striking sex differences. For clinicians they provide further reason to justify concern about the psychosocial aspects of care for children with chronic disorders.
Affective Symptoms↗
Psychosocial adjustment in juvenile arthritis.
Psychosocial adjustment in 102 children with arthritis, ages 4-16, and their families was assessed by parents, who completed the Child Behavior Checklist (CBCL) and Profile of Mood States (POMS). On average, parental distress (POMS) was lower than reference norms. POMS distress was correlated with children's behavioral problems (r = .41) but not with children's social competence (r = .15). General linear models explained 25% of the variance in CBCL behavioral problem scores. Older age was associated with more behavior problems in males, but not females. Disease severity and disease activity were also associated with behavioral problems. Although 27% of the variance in CBCL social competence could be explained, no single predictor variable was especially strong. Poorer social competence was associated with older age and shorter disease duration. Teenagers, especially those with recent onset and those with mild disease activity, may be at increased risk for psychosocial maladjustment.
Adaptation, Psychological↗
Self-report of family histories of learning difficulties.
Self-reports of learning difficulties by parents of reading disabled children may be inflated because of recall bias. A retrospective study of the association between specific reading disabilities and familial reports of learning difficulties indicated the relative odds of being reading disabled for those whose relatives reported learning difficulties compared with children whose relatives did not report learning difficulties was statistically significant if fathers or siblings reported learning difficulties. No significant association was found between mothers' self-reports of learning difficulties and a diagnosis of specific learning disabilities in their children. The results support the association between specific reading disabilities and self-reported histories of academic problems in the father or siblings, but not in mothers of learning disabled children. The results suggest that reports of learning difficulties among mothers of reading disabled children may be inflated because of recall bias.
Achievement↗
Referral patterns for children with chronic diseases.
A sample of 1377 physicians were surveyed by mailed questionnaire to study to what extent primary care physicians are involved in the long-term care of children with chronic disorders. The sample included all pediatricians practicing in the province of Quebec and a stratified random sample of general practitioners (10% sample in urban areas and 25% sample in rural areas). A response rate of 81% was achieved. Referral patterns were studied for asthma, congenital heart disease, and diabetes. Although pediatricians referred their patients less frequently than general practitioners, referral patterns depended mainly on the clinical condition. "No routine referral" was the most popular management strategy for asthma, whereas for congenital heart disease and diabetes more than 20% of physicians referred their patients for all aspects of care. Rural physicians tended to assume patient care to a greater extent than did urban physicians. Most pediatricians referred patients directly to subspecialists practicing in tertiary care centers, whereas general practitioners often sent patients to pediatricians practicing elsewhere, or to other specialists. These data suggest that the availability of medical resources in the community and accessibility to tertiary care centers also influence physicians' involvement in the long-term care of these children.
Asthma↗
Chronic illness and mental health problems in pediatric practice: results from a survey of primary care providers.
The prevalence of chronic physical illnesses and their association with mental disorders was assessed using data collected by primary care pediatricians. A chronic illness was diagnosed in 1573 (15.6%) of 10,058 children aged 4 to 16 years, 945 (9.4%) of whom had a "serious" disorder, 535 (5.3%) had a minor disorder (hay fever or dermatitis), and 121 (1.2%) had a speech or language disorder. Behavioral problems were identified more often among patients with "serious" disorders than among those without chronic illnesses (2.4% vs 1.7%), as were emotional problems (5.0% vs 3.1%). Among those with "serious" conditions involving the central nervous system, the prevalence of behavioral (5.2%) and emotional (10.4%) disorders was still higher. Although children with "serious" disorders not involving the central nervous system also showed elevated prevalence rates of behavioral (2.1%) and emotional (4.5%) disturbances, this increase did not reach statistical significance. No association with "minor" chronic disorders was found. The negative impact of these mental health problems on the child was more severe when a chronic illness was also present, but referrals for mental health services did not reflect his association.
Adolescent↗
Accident prevention.
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Accident Prevention↗
The new environmental health.
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Accident Prevention↗
Geographical and socio-ecological variations of traffic accidents among children.
This paper deals with geographical and socio-ecological variations of pedestrian and cyclist accidents (n = 1233) among children (less than 15 years) on the Island of Montreal. The model includes variables on each child and his behavior when the accident happened and other temporal and spatial characteristics; environmental and socio-ecological data on the areas in which accidents occurred were also recorded. Descriptive, spatial and comparative analyses show specific patterns of location and occurrence of accidents. Factor analysis identifies the structure of characteristics linked to high accident areas for children's traffic accidents. A strong similarity between zone characteristics emerged from the factor analysis for both types of accident. Only a few census tracts (between 9% to 13%) are high accident areas, but they are very concentrated spatially, and for some of them (2% for pedestrians and 4% for cyclists) the rate is five to eight times higher than for the rest of the urban area. Population structure and density factors contribute 40% of the variation in accident rates. In terms of numbers, fewer children were injured as cyclists than as pedestrians, and more boys than girls are involved in these accidents. Accidents occur under good conditions of visibility and on straight streets. Parked cars in school areas are also a sign of danger. Difficulties in interpreting information on directions and speed of moving vehicles are associated with high accident frequencies, particularly for young pedestrians (6-7 years).
Accidents, Traffic↗
Revision, replication and neglect--research on maladjustment in chronic illness.
Children with chronic physical disorders have twice the risk of psychosocial maladjustment compared with healthy children. This "second handicap" poses a significant mental health problem. This review examines factors related to the child, family, and clinical condition that affect the risk of maladjustment, as well as the manner in which this knowledge has influenced intervention strategies. Much of the research reviewed represents replication of what is already known and important areas of enquiry have been neglected. Investigators are urged to work towards the further identification of high risk characteristics and to apply these to the development and evaluation of new preventive and therapeutic approaches for these children and their families.
Adaptation, Psychological↗
The prevalence and correlates of behaviour problems in learning disabled children.
A retrospective cross sectional study of the prevalence of emotional problems among 502 learning disabled children seen in a specialized learning centre was conducted. Learning disabled children, diagnosed by an experienced clinician, were tested for emotional disturbances using the Child Behavior Checklist. The prevalence of behaviour problems among these children was 43%. This was much higher than the ten percent expected when this measure is used in a general population. There was no greater frequency of behaviour problems in children referred by teachers than in those referred by parents. Results of logistic regression analyses reveal that children who were adolescents, from non intact families, or from lower social class backgrounds had an increased odds of having behaviour problems. The implications of these findings are examined, especially in light of possible methodological problems including selection bias, which may account for the association between emotional problems and learning disabilities found in other studies.
Child↗
[Influence of follow-up education of mothers about too early introduction of solid food to infants].
We developed a program intended to modify maternal attitudes towards feeding in order to delay the introduction of solids to infants until they are 2 months of age. The program was provided by nurses using an individualized, educational approach. To evaluate its efficacy, a randomized trial design was used. The results in the 2 groups were comparable. The educational trial's lack of success when compared to others and the reasons for this are discussed.
Female↗
[Compliance in adolescents with chronic disease].
This study was undertaken with the aim of improving the understanding of the phenomenon of compliance in adolescents presenting with chronic diseases. In 192 subjects aged 12 to 20 years presenting with diabetes, asthma, cystic fibrosis, systemic lupus erythematosus or juvenile rheumatoid arthritis, appointment keeping, compliance with prescribed medical regimens or general instructions and the filling up of a calendar describing the daily levels of fatigue were studied. Correlations (Pearson) between these various types of measurements were weak: from 0.04 to 0.26. Appointment keeping was about 90%. Overall compliance either with treatments or with general instructions was 50% only (without clearcut changes according to diseases); however only 11% of subjects presented with a good compliance with all the treatment components. Various factors (familial environment, perception of the disease and of the patient-physician relationships) were significantly associated with compliance (p less than 0.005). These results emphasize the necessity of taking care of all aspects of compliance, which is difficult to predict at this age, due to the multiple factors involved.
Adolescent↗
Evaluation of an infant car seat program in a low-income community.
This study was designed to assess the influence of an infant car seat loan program on car seat utilization in a low-income community. An adjacent community, with no car seat program, was chosen for comparison. Systematic observations were made in the two neighborhoods, and this information was supplemented by telephone interviews. Greater use of infant seats was observed in the intervention community (41%) than in the control community (27%) for infants younger than 6 months old. The rate of observed utilization of infants between 7 and 18 months of age increased to 50% on average, but no significant differences were noted between the two communities. These findings suggest that a community-based loan program can produce short-term increases in car seat use rates for infants, even in a low-income community. A strategy to facilitate continued accessibility to such restraints is needed, however, to maintain these improvements.
Accidents, Traffic↗
Trends in medical visits and surgery for otitis media among children.
We conducted a population-based descriptive study of medical visits and surgical interventions for otitis media among 3- and 7-year-old children from the Montreal, Canada, area over the period 1981 to 1983. The number of children seen annually for otitis media increased over that time. An increase in the event rate of otitis was observed; there was also an increase in the rate of myringotomy with ventilatory tube insertion. The rate of surgery reached a level, among 3-year-old children in particular (25.0 per 1000 cases of otitis among boys, 23.9 per 1000 cases of otitis among girls), that some authors have termed "epidemic." Comparison of the trends in the rates of surgical interventions and the rates of medical consultations for otitis suggest that most of this so-called surgical epidemic for middle ear effusion is related to a higher frequency of the underlying condition and not to more aggressive patterns of therapy during the years studied.
Child↗