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PubMed2005

MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis.

AIM: Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated. We compared the predictive values of MELD, Child-Pugh and creatinine-modified Child-Pugh scores in decompensated cirrhosis. METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was studied. Two types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were evaluated. RESULTS: The areas under the receiver operating characteristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas: 0.71-0.79). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predicting medium-term survival. In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65). Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics: 0.77-0.81). Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups with worse prognosis. CONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice.

Adult↗
PubMed2006

The other children: a survey of child abuse physicians on the medical evaluation of children living with a physically abused child.

OBJECTIVE: To explore the practice and attitudes of child abuse physicians regarding the evaluation of "contact children" identified in the home of a physically abused index child. DESIGN: A self-administered survey. SETTING: E-mail and postal mailings from May 10 through September 30, 2005. PARTICIPANTS: Physicians in the United States recognized as experts in child abuse medicine based on membership in the Helfer Society. MAIN OUTCOME MEASURES: Descriptive measures of recommended medical evaluations of contact children in 3 clinical settings, estimates of association between these recommendations, and respondent experiences. RESULTS: There was a 61% (93/153) response rate. Respondents uniformly endorsed medical evaluation for contact children, although there was substantial variability in the extent of evaluation recommended. Recommended diagnostic testing varied by age of contact child and by type of abuse in the index child. Recommendations were influenced by anecdotal recall of abused contact children "missed" during the initial evaluation of another child in the household. Of our 93 respondents, 37 (40%) reported routine disagreement with child protection workers about the need for medical evaluation of contact children. CONCLUSIONS: Child abuse physicians perceive that findings of abuse in contact children are sufficiently frequent to warrant medical examination of most contact children, but there is no consensus on the extent of evaluation needed for contact children. A better understanding of risk of abuse in contact children and improved collaboration between physicians and child protection workers are needed to improve evidence-based care of this high-risk population.

Attitude of Health Personnel↗
PubMed2004

Child motor vehicle occupant and pedestrian casualties before and after enactment of child restraint seats legislation in Japan.

PROBLEM: Prevention of injuries to child passengers is a significant public health priority, as motor vehicle-related injuries remain a leading cause of death for children in Japan. The purpose of compulsory child restraint seats legislation in April 2000 was to reduce the number of child passengers killed or injured in motor vehicle crashes. METHODS: The objectives of this preliminary evaluation are to measure the effectiveness, benefits and usage of safety seats for child passengers aged 1-5 years by analysing the child casualty data for the period of 1997--2002. Population and vehicle miles travelled based injury and fatality rates were used to compare before and after legislation trends in child casualties. RESULTS: Despite overall increases in the use of child restraint seats (as observed by different national surveys), overall casualty rates in motor vehicle occupants in the 1-5 year age group did not change (fatalities and serious injuries) or even increased (minor injuries). CONCLUSIONS: Casualties among restrained children have not decreased since the law came to effect in the year 2000, perhaps because of incorrect usage of the seats. Given that exposure to crash environments is increasing, traffic safety advocates and public health community need to be aware of the importance of child restraints as a means of reducing the likelihood of injury. It is necessary to implement effective community-based child safety seat campaigns to disseminate the information on appropriate restraint use and to increase efforts to enforce the existing legislation.

Accidents, Traffic↗
PubMed2004

Alcohol outlets and child physical abuse and neglect: applying routine activities theory to the study of child maltreatment.

OBJECTIVE: The purpose of this study is to examine whether or not alcohol access in neighborhood areas is differentially related to substantiated reports of child physical abuse and neglect. METHOD: This cross-sectional ecological study uses spatial regression procedures to examine the relationship between the number of bars, restaurants and off-premise outlets per population and rates of child physical abuse and neglect in 940 census tracts in California, while controlling for levels of social disorganization, population density and county of residence. RESULTS: The number of off-premise outlets per population was positively associated with rates of child physical abuse (b = 3.34, SE = 1.14), and the number of bars per population was positively related to rates of child neglect (b = 1.89, SE = 0.59). CONCLUSIONS: These results suggest that alcohol access is differentially related to type of child maltreatment, with higher densities of bars being related to higher rates of child neglect, and higher rates of off-premise outlets related to higher rates of child physical abuse. The findings suggest there is a spatial dynamic of neighborhoods that can result in child maltreatment and underscore the importance of examining the alcohol environment when developing programs to prevent child maltreatment.

Adult↗
PubMed1996

Quality of care at school-aged child-care programs: regulatable features, observed experiences, child perspectives, and parent perspectives.

This study investigates children's experiences at 30 school-aged child-care (SACC) programs. Regulatable features such as total enrollment, child-staff ratio, and staff education were assessed via director report. Observers recorded positive/neutral and negative staff-child interactions, and rated programs in terms of flexibility and age appropriateness. Negative staff-child interactions were more frequent when child-staff ratios were larger and when staff had less formal education. The presence of a greater number of different types of program activities was associated with staff having more frequent positive interactions with children and with observers rating programs as flexible and age appropriate. These regulatable and observed features were examined in relation to children's (N = 180) and parents' (N = 152) perceptions of program psychosocial climate. Children's reports of overall climate, emotional support from staff, and autonomy/privacy provisions were predicted by program features. Children reported poorer program climate when programs had larger enrollments and when observers recorded more frequent negative staff-child interactions. Children had more positive program perceptions when programs offered a greater variety of activities. Children's reports of program climate in addition to observed child-staff ratios were associated with parental perceptions of the programs. Parents had more positive perceptions when child-adult ratios were smaller and when their children reported more positive climates. This study suggests a convergence between observer, child, and parent about factors contributing to quality of after-school programs.

Attitude↗
PubMed2000

Impact of child noncompliance on stress appraisals, attributions, and disciplinary choices in mothers at high and low risk for child physical abuse.

OBJECTIVE: The study investigated the impact of repeated child noncompliance on stress appraisals, attributions, and disciplinary choices in high- and low-risk mothers. METHOD: Fifty (25 high-risk and 25 demographically, matched low-risk) mothers responded to questions related to stress appraisals, attributions, and disciplinary choices following presentations of a child engaging in repeated noncompliance. RESULTS: After repeated child noncompliance, high-risk, compared to low-risk, mothers perceived more threat and uncontrollability, rated child behaviors as more stressful, and reported higher levels of negative affect. High-risk mothers also reported more stable, global, and intentional attributions, with a trend toward more internal attributions, but did not differ in their evaluations of wrongness and seriousness of the child's behavior. After repeated noncompliance, a risk group difference was found in estimates of future child compliance but not in the use of power assertive discipline. CONCLUSIONS: Results support the view that high-risk, relative to low-risk, mothers are differentially responsive to stressful situations and differ in their attributions for negative child behaviors and in their expectations of future child compliance. However, since risk group differences in disciplinary choices were not also found, additional research is needed to demonstrate the process through which risk group cognitive and affective differences are related to differences in disciplinary behavior.

Adult↗
PubMed2000

Developmental outcome, child behaviour and mother-child interaction at 3 years of age following Newborn Individualized Developmental Care and Intervention Program (NIDCAP) intervention.

The aim of the present pilot study was to investigate the impact of early intervention in the form of family-centred developmentally supportive care according to NIDCAP((R)) (Newborn Individualized Developmental Care and Assessment Program) on the development and behaviour of the child and on the mother-child interaction at 3 years of age. Two groups of very-low-birth-weight (VLBW) infants (< or = 1500 g) were studied. The control group (n=21) was born in 1990, i.e. prior to implementation of the NIDCAP. The intervention group, born in 1992-1993 (n=21), was subjected to formal NIDCAP observation once every 10 days. Development was assessed using the Griffiths' Developmental Scale II in conjunction with a neurological examination. Behaviour was assessed on the basis of a parental interview. Mother-child interaction was assessed according to the Parent-Child Early Relational Assessment Scale (ERA). There was no significant difference in motor development. The total developmental quotient (DQ) on the Griffiths' developmental scale was 109 (94-122) [median (range)] for the NIDCAP group and 108 (93-120) for the control group (n.s.). On the subscale hearing-speech, the intervention group scored 119 (72-157) and the control group 108 (84-130) (P=0.02). The total score with respect to the Behaviour Symptom Interview was 6 (0-20) for the NIDCAP group and 16 (0-54) for the control group (P=0.03). With respect to the mother-child interaction, there was a significant difference in the child cluster 'communication', the total score being 12 (11-13) for the NIDCAP group and 10 (9-13) for the control group (P=0.03). In conclusion, care of VLBW infants according to NIDCAP appears to have certain positive long-term effects on the child's behaviour and mother-child interaction.

Adult↗
PubMed2003

Are discrepancies among child, mother, and father reports on children's behavior related to parents' psychological symptoms and aspects of parent-child relationships?

Examined whether parents' symptoms and qualitative and quantitative aspects of parent-child relationships make unique contributions to mothers' and fathers' reports of, and mother-child, father-child, and father-mother discrepancies on, children's behavior. Participants were 100 children, aged 10-12, and their mothers and fathers. Parents' symptoms and parent-child relationships made unique contributions to both parents' ratings of externalizing behavior. Although parent-child relationship variables were related to both parents' ratings of internalizing behavior, only parents' symptoms made unique contributions. On mother-child and father-child discrepancies, differences emerged between mother and father, and internalizing and externalizing behaviors. Both fathers' and mothers' symptoms contributed to father-mother discrepancies on both behavior types, with parent-child relationships contributing unique variance to discrepancies on internalizing behavior. Results highlight the importance of each informant's symptoms and relationship variables in understanding informant discrepancies.

Adult↗
PubMed1995

Parent-child relationship disorders. Part II. The vulnerable child syndrome and its relation to parental overprotection.

Parents who are excessively concerned about their child's health are often characterized as being overprotective. We hypothesized that parental overprotection is independent of parental perception of child vulnerability to illness or injury despite their presumed interchangeability. A community-based sample of 892 parents (92% white, 84% married, 88% middle-upper socioeconomic status, 90% mothers) completed a three-part protocol (clinical background data, the Child Vulnerability Scale, and the Parent Protection Scale). Correlates of high parental perception of child vulnerability included a medical condition in the child, a history of life-threatening illness or injury, and the child being seen for a sick visit. Correlates of high parental overprotection included younger age of child and parent. Only 20% of those parents who considered their child vulnerable were also considered overprotective.

Child↗
PubMed2001

Utilizing the child abuse potential inventory in a community health nursing prevention program for child abuse.

The objectives of this study were to: (a) Determine the potential for child abuse among the Joint New Parent Support Program Hawaii (Joint NPSP) client population, (b) Determine whether client participation in this program can reduce the potential for child abuse, and (c) Determine what client demographics correlate with the potential for child abuse. Joint NPSP is a prevention program for child abuse, screening all pregnant military families in Hawaii. The instrument used in this study was the Child Abuse Potential Inventory (CAP), a reliable and valid instrument used in the screening of physical child abuse. The CAP was completed by 142 pregnant Joint NPSP patients, ages 13-40 years, at the beginning of service provision and approximately 16 months later. Statistical measures used in analyzing the data were the t test and analysis of variance (ANOVA). Paired t tests were used to compare pre- and postprogram scores. Relations between the demographic profile information and CAP scores were analyzed with multiple regression analysis to identify risk factors for high child abuse. Out of 142 surveyed, 77 scored > 166 (signal detection) on the pretest abuse scale, and 65 scored < 166. In the > 166 group the pretest mean was a score of 257, and the posttest mean was 137. T-test results in the > 166 group were highly significant at .0001 on the scales of abuse, distress, rigidity, unhappiness, problems with family, and problems with others. ANOVA results in the > 166 group revealed a significant difference between an elevated abuse scale and patients with psychiatric problems (.0485), relationship problems (.0452), and past or present spouse abuse (.0421). This study validated that Joint NPSP is servicing a population at risk for child abuse potential. After intense home visitation by the community health nurses, the scores for child abuse potential decreased. A major limitation was the lack of a control group, the problem of maturation and history, and the possibility of regression toward the mean in scores. These limitations should be addressed in future studies with the use of 2 treatment modalities. Results highlight the need for focusing on relationship and spouse abuse issues in a military population.

Analysis of Variance↗
PubMed2004

Socio-economic determinants of child labour and attitudes to child labour among school children in Ibadan.

This cross sectional study was designed to compare the characteristics of working and non-working school children. Two hundred and thirty one working and 236 non-working children were interviewed. The socio economic factors associated with child labour were trading as mother's occupation, father's educational status, religion, family type (monogamous vs polygamous) and type of residence. Family type (OR = 0.562, 95% C.I. 0.353-0.897, p = 0.016), religion (OR = 0.559, 95% C.I. 0.361-0.867, p = 0.009) and trading as mother's occupation (O.R = 2.49, 95% CI 1.68-3.68, p = 0.000) were sustained on logistic regression analysis. With regard to attitude to child work, 186 (40%) of all respondents thought that children should be allowed to work. The majority of those who held this opinion 150, were child workers. Ten percent of working children had themselves chosen to work without any parental influence to do so. Seventy five respondents had ever repeated a class. Forty nine of these were working children a prevalence of 21% of repeaters compared to 26 non working children, (11%.) p = 0.004. Sixty eight percent of children aspiring to careers in artisan trades were child workers. Road traffic accidents and poor school performance were the commonest adverse effects of child labour indicated by school children. Parents should be educated about the adverse effects of child labour on child development. As poverty is one of the major root causes of child labour, free and compulsory primary education may help to reduce the notion of child work as an option for survival in poor families.

Accidents, Traffic↗
PubMed1995

Child fostering and children's nutritional outcomes in rural Mali: the role of female status in directing child transfers.

Research in West Africa has begun to document the phenomenon of child fostering although little attention has focussed on other types of non-maternal child care arrangements and their impact on child health. Evidence from a sample of 77 weaned children under five in rural Mali found that over one third (35%) of children were not the prime responsibility of both their biological parents. Nineteen per cent (N = 15) of the sample were formally fostered children, known as sukaabe bambaabe, who lived neither with their biological mothers nor with their biological fathers. Others lived under flexible or semi-permanent non-maternal care arrangements both within and outside the agnatic family. Factors precipitating fostering are outlined and are divided into: (i) those under which the child is fostered away from its biological family through force of circumstance; and (ii) those under which the child is actively requested by its foster mother. Rather than fostering providing a universal option for over-burdened mothers with too many or too closely-spaced children, the field evidence shows that the movement of children within and between households is rigorously controlled by the female social hierarchy. Children are transferred in a uni-directional fashion from the care of their low status biological mothers to high status foster mothers. Their transfer serves to visibly reinforce socio-political power differentials between these women who are at different stages of the female life-cycle and in different sets of household circumstances. Economic factors are not associated with the decision to keep the child or to foster it away, but do appear to determine whether the children living under non-maternal care are fostered out under a structured or unstructured fostering arrangement. Contrary to findings in other West African settings, fostering per se has little impact on children's nutritional outcomes as measured by their weight-for-age Z-Scores, probably because the use of surrogate or sibling caretakers is common in this environment even for children who are the full responsibility of their biological mothers. The context of the fostering, however, does influence fostered children's nutritional status. Those children who were requested by their foster mothers had better nutritional outcomes than those who were fostered in by force of circumstances. It is concluded that the concept of 'maternal and child health' and the 'maternal-child' dyad around which both health interventions and demographic evaluations are centred, may not always be appropriate in areas of high fostering prevalence.

Adolescent↗
PubMed1998

A longitudinal analysis of risk factors for child maltreatment: findings of a 17-year prospective study of officially recorded and self-reported child abuse and neglect.

OBJECTIVE: To identify demographic, family, parent, and child factors prospectively associated with risk for child abuse and neglect among families in the community, using data on child maltreatment obtained from both official records and youth self-reports. METHOD: Surveys assessing demographic variables, family relationships, parental behavior, and characteristics of parents and children were administered to a representative sample of 644 families in upstate New York on four occasions between 1975 and 1992. Data on child abuse and neglect were obtained from New York State records and retrospective self-report instruments administered when youths were > or = 18 years old. RESULTS: Logistic regression analyses indicated that different patterns of risk factors predicted the occurrence of physical abuse, sexual abuse, and neglect, although maternal youth and maternal sociopathy predicted the occurrence of all three forms of child maltreatment. In addition, the prevalence of child abuse or neglect increased from 3% when no risk factors were present to 24% when > or = 4 risk factors were present. State records and self-reports of child maltreatment did not correspond in most cases when maltreatment was reported through at least one data source, underlining the importance of obtaining data from both official records and self-reports. CONCLUSIONS: Assessment of a number of risk factors may permit health professionals to identify parents and children who are at high risk for child maltreatment, facilitating appropriate implementation of prevention and treatment interventions.

Child↗
PubMed1999

Parent-child relationships, child temperament profiles and children's alcohol use norms.

OBJECTIVE: The purpose of this study was to examine the contributions of child temperament, parents' alcohol use norms for their children and parent-child relationship quality to children's alcohol use norms. METHOD: Observational and self-report data on these variables were gathered from mothers, fathers and target children during home visits to a purposive random sample of 171 intact white families with a 10- to 12-year-old child, 85 with girls and 86 with boys. RESULTS: Liberality in children's norms was associated with active, sensation-seeking temperament, liberality in parents' norms and poor parent-child relationship quality. Positive parent-child, particularly father-child, relationships were associated with less liberal child norms even when parents' norms were liberal and children's temperaments were active and sensation oriented. CONCLUSIONS: Positive parent-child relationships have a conventionalizing effect on children's alcohol use norms that moderates the effects of temperament and parental norms. The development of alcohol use norms is best described by transactional models.

Alcohol Drinking↗
PubMedDate not supplied

Relationship of parent-child communication to child's exploratory behavior and self-differentiation.

In a study that investigated the relationship between patterns of acknowledgment in parent--child communication and the child's exploratory behavior and self-differentiation, subjects included 77 healthy perschool children between the ages of 3 years, 3 months and 4 years, 9 months and their mothers. Data on parent--child communication were collected in the home setting during a 30-minute observation in which mothers and children were engaged in a series of semi-structured play activities. Maternal responses to their children's assertions were coded as nonevaluative recognition, positive recognition, negative recognition, direction, or nonrecognition. A score on parent--child communication was the ratio of parental nonevaluative recognition and positive recognition combined to parental negative recognition, direction, and nonrecognition combined. Testing of the children on exploratory behavior and self-differentiation was done on an individual basis in their respective nursery schools. A low positive correlation (r = .237, p less than .05) between parent--child communication and children's self-differentiation was observed. Contrary to expectation, a slight negative correlation (r = -.101, p greater than .05) between parent--child communication and children's exploratory behavior was observed. Auxiliary analyses of the data, taking into consideration the child's sex, revealed that the negative relationship between parent--child-communication and children's exploratory behavior was characteristic of the mother-daughter dyads only (r = -.325, p = .08). A correlation of .078 (p greater than .05 was obtained for mother--son communication with boys' exploratory behavior.

Child Behavior↗
PubMed1997

Child-care personnel's failure to report child maltreatment: some Swedish evidence.

Professionals who are legally required to report suspicions of child abuse and neglect to child protective agencies have often been found not to do so. In this article, 341 child-care institutions in three suburbs of Stockholm were surveyed for suspected child abuse. Of the 3,737 children attending these child-care institutions, 3% (N = 112) were suspected of being maltreated. Of these suspected cases, only 37% were reported to the Child Protective Agencies (CPA). Furthermore, interviews with the directors of the nursery schools revealed that there was a considerable delay in reporting suspicions of child abuse to the CPA. A follow-up study conducted approximately 5 years after the suspicions were first identified showed that 43% of the suspected children were still unknown to the CPA. Data also indicates that one possible reason for the low degree of reporting is the way in which the reports have been processed by the CPA.

Child↗
PubMed1997

Parent-child interactions and child outcomes as related to gender of alcoholic parent.

Parents and children from alcoholic and non-alcoholic families (N = 137) were compared in regard to quality of interactions (using the Marital Interaction Coding System), child outcomes (using the Child Behavior Checklist), and the possible moderating effects of parenting behavior on child outcomes. Alcoholic families were subdivided by gender (father-alcoholic, mother-alcoholic, both parents alcoholic) to assess for the effect that gender of alcoholic parent has on parent-child interactions and child outcomes. Results indicated that dual and mother-only alcoholic families exhibited the most impaired interactions, although child problem behavior was not significantly different across the three groups containing one or two alcoholic parents. Furthermore, father's behavior (both alcoholic fathers and those married to an alcoholic), as compared to mother's behavior, most clearly moderated child outcomes. The possible protective effect of having a non-alcoholic mother was also indicated. Results are discussed in regard to the negative and positive effects that parents from alcoholic households can have on children.

Adolescent↗
PubMed1999

Parent-child relationship disorders: what do the Child Vulnerability Scale and the Parent Protection Scale measure?

While scales exist to aid clinicians in the assessment of parent-child relationship disorders, there are minimal data regarding their clinical usefulness. This study examined the ability of parent responses to questions regarding the child's health, behavior, and development to predict total scores on the Child Vulnerability Scale and the Parent Protection Scale. Of 120 potential participants, 103 parents (92% mothers, 69% white, 54% married, 44% lower socioeconomic status) with children aged 2-5 years completed the Child Health and Family Functioning Questionnaire. Logistic regression yielded a correct prediction rate of 77% for perceived child vulnerability and 76% for parental overprotection. Our data provide support for the independence of parental perceptions of increased child vulnerability and parental overprotection as well as for the content validity of the Child Vulnerability Scale and the Parent Protection Scale.

Child Behavior↗