Maternal feeding practices and childhood obesity: a focus group study of low-income mothers

OBJECTIVE: To identify maternal beliefs and practices about child feeding that are associated with the development of childhood obesity. DESIGN: Four focus groups. One group of dietitians from the Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the Northern Kentucky Health District and 3 groups of mothers with children enrolled in WIC. SETTING: The WIC program in the Northern Kentucky Health District. PARTICIPANTS: Fifteen WIC dietitians and 14 mothers (14 to 34 years of age) with young children (12 to 36 months of age) enrolled in WIC. RESULTS: The mothers in this study (1) believed that it was better to have a heavy infant because infant weight was the best marker of child health and successful parenting, (2) feared that their infants were not getting enough to eat, which led them to introduce rice cereal and other solid food to the diets before the recommended ages, and (3) used food to shape their children's behaviors (eg, to reward good behavior or to calm fussiness). The mothers acknowledged that some of their child-feeding practices went against the advice of their WIC nutritionists and physicians. Instead, the participants relied on their mothers as their main source of information about child feeding. CONCLUSIONS: Physicians and allied health professionals discussing childhood growth with mothers should avoid implying that infant weight is necessarily a measure of child health or parental competence. Parents who use food to satisfy their children's emotional needs or to promote good behavior in their children may promote obesity by interfering with their children's ability to regulate their own food intake. Interventions to alter child-feeding practices should include education of grandmothers.     

Children's health and their mothers' risk of divorce or separation

The purpose of this study is to determine how children's health conditions are related to their mothers' risk of divorce or separation. The study is based on data from over 7,000 children born to once-married mothers identified in the 1988 Child Health Supplement to the National Health Interview Survey. The effects of 15 childhood health conditions on the mothers' risk of divorce are estimated with Cox's proportional hazard models. Controlling for demographic, marital, and reproductive measures, we find that mothers' prospects for divorce are affected both positively or negatively by their children's health status, depending on the type of childhood condition and, in the case of low birth weight children, timing within the marriage. Women whose children have congenital heart disease, cerebral palsy, are blind, or had low birth weight appear to have higher risks of marital disruption than mothers of healthy children. In contrast, mothers whose children have migraines, learning disabilities, respiratory allergies, missing/deformed digits or limbs, or asthma have somewhat lower rates of divorce.     

Introduction: Methodological issues in school-based mental health services research.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between resting behavior and health locus of control among elementary schoolgirls

PURPOSE: To clarify the effects of Internal Health Locus of Control (IHLC) on the practice of resting behavior. Resting has recently gained attention because of overwork and stressful social situations. We investigated daily preventive health behaviors and Health Locus of Control (HLC) in children and their mothers over three years from 1991. This paper reports on the relationships between resting and IHLC among elementary schoolgirls. METHODS: The subjects of this study in 1991 were public elementary schoolgirls in their 3rd year (8-9 years old) and their mothers. Three years, later in 1994, we investigated the same children and their mothers, with 104 girls answering questionnaires in both studies. The resting behavior data was obtained from the question "Do you rest or take a nap when you are very tired?". We used Parcel & Meyer's Children's HLC Scales for children and Horige's Japanese version of Health Locus of Control (JHLC) Scales for mothers. Only the data concerning IHLC was extrapolated for this study. RESULTS: 1. The data for resting behavior for 1991 in the 3rd grade did not coincide with that for 1994 in the 6th grade. On the whole rest was taken more frequently in the 3rd grade than in the 6th grade. 2. Perceived health state had a significant association with resting behavior. 3. Girls who perceived rest was relating directly to their personal health, took a rest more often than those who did not perceive a personal application for rest. 4. IHLC data distribution shows a marked difference between grades. Scores were significantly higher in the 6th grade than in the 3rd grade. This rising tendency of internality seems to be a developmental change. 5. IHLC scores of 1991 3rd graders classified their 3rd grade behavior patterns. The 3rd grade (1991) "usually taking a rest" group scored significantly higher than the other groups. 1991 IHLC scores classified their 1994 6th grade behavior patterns. The 6th grade (1994) "usually taking a rest" group also scored significantly higher than the other groups. 6. The data for resting behavior of the girls did not coincide with that of their mothers. There were no correlations between the girls's IHLC scores and their mothers's IHLC scores. CONCLUSION: This study revealed some significant relationships between resting behaviors and IHLC scores among the schoolgirls. It seems that girls who had high IHLC tendency in the 3rd grade were growing up with this tendency. Perhaps in the interest of self-care, they elected to rest to keep healthy when they were tired.     

Adaptation of medical care to the changing disease spectrum of adolescents

The spectrum of diseases affecting today's children and adolescents has changed. Today's urgent health problems are no longer acute and infectious disorders but much rather psychosomatic and chronic disorders. However, the present health delivery system has not adapted its structure to this changed spectrum of disease. This paper reports on a study carried out by the project "Health Risks and Structures of Medical and Mental Health Care." The project belongs to the North Rhine-Westphalian Consortium for Public Health, and the study was carried out in cooperation with the Special Research Unit 227: "Prevention and Intervention in Childhood and Adolescence." Results show that a small proportion of adolescents actually consult general practitioners. Inadequate cooperation between medical and mental health care services as well as insufficient links between these services and the life world of adolescents have led to a situation in which the use of professional assistance meets with barriers. As a result, adolescents continue to avoid visiting a physician even when they have already become ill. For this reason, there is an increasingly strong need to consider how to change the structures of medical and mental health care. Proposals are developed that meet the needs of adolescents and are oriented toward the requirements arising from the changing spectrum of disease.     

Health assessment in the rheumatic diseases of childhood

Assessment of children and adults with rheumatic diseases, both in clinical practice and controlled clinical trials in rheumatology, has traditionally focused on the measurement of disease activity. More recently emphasis has been placed on the need to incorporate estimates of physical, social, and mental functioning into health assessment. Thus there has been a tremendous growth in the development of measurement instruments that evaluate health status, functional status, disability, and quality of life. This type of measurement has become essential, particularly for clinical trials in adults with rheumatic diseases, for which the AIMS (Arthritis Impact Measurement Scales), the HAQ (Health Assessment Questionnaire), and the MACTAR (McMaster-Toronto arthritis) patient preference questionnaire have been the most widely used. In the past few years, similar measures have been developed for application in children with rheumatic diseases. These include the CHAIMS (Childhood Arthritis Impact Measurement Scales), the CHAQ (Childhood Health Assessment Questionnaire), the JAFAR (Juvenile Arthritis Functional Assessment Report), the JASI (Juvenile Arthritis Self-report Index), the JAQQ (Juvenile Arthritis Quality of Life Questionnaire), and the CAHP (Childhood Arthritis Health Profile). In this review, the development and measurement properties of these childhood instruments are discussed, with particular emphasis on their potential roles as supported by recent literature.     

Influence of paid work on the perceived health state in women

BACKGROUND: Several studies show that paid work has a positive effect on women's health, although few studies have shown this relationship in Southern-European countries. The aim of this paper was to analyze the self-perceived health status of women of Barcelona, Spain according to their type of work (homemaker or worker). PATIENTS AND METHODS: Cross sectional study using the 1992 Barcelona Health Interview Survey data. Subjects: 1194 women aged 25 to 64 years old. Bivariate analysis of women's perceived health status by all other variables. A logistic regression model was performed with the dependent variable being women's self-perceived health status and the independent variables: type of work (homemaker or worker), age, number of chronic diseases, medical care visits, children under 12 years and elderly over 65 years living at home and social class based on occupation. RESULTS: 15.8% of workers and 31.4% of homemakers reported poor self-perceived health status (p < 0.05). This same distribution was maintained when adjusting for all independent variables. Social class had an important relationship with health, with women from lower social classes reporting poorer self-perceived health status than homemakers from upper social classes. CONCLUSIONS: The 1992 Barcelona Health Interview Survey analysis confirms that in Barcelona as well, paid work has a positive relationship on women's self-perceived health status.     

Woman-centered information on menopause for health care providers: findings from the Midlife Women's Health Survey

Despite their growing numbers, midlife women continue to feel marginalized by a health care system that is unresponsive to their needs for current information about the perimenopausal experience and for egalitarian, woman-centered care. In this article, the authors call upon physicians, health educators, nurses, counselors, and other health providers to meet the consumer needs of this ever-growing clientele. To this end, they provide data-based information derived from the responses of more than 400 middle-aged women from across the United States to annual Midlife Women's Health Surveys from 1990 to 1993. The authors focus on enhancing the sensitivity of health care providers toward their midlife clients by offering data describing the normal menopausal transition and the feelings and concerns of this group.     

Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey

OBJECTIVE: To assess whether equity is achieved in use of general practitioner, outpatient, and inpatient services by children and young people according to their ethnic group and socioeconomic background. DESIGN: Secondary analysis of the British general household survey, 1991-94. SUBJECTS: 20 473 children and young people aged between 0 and 19 years. MAIN OUTCOME MEASURES: Consultations with a general practitioner within a two week period, outpatient attendances within a three month period, and inpatient stays during the past year. RESULTS: There were no significant class differences in the use of health services by children and young people, and there was little evidence of variation in use of health services according to housing tenure and parental work status. South Asian children and young people used general practitioner services more than any other ethnic group after controlling for socioeconomic background and perceived health status, but the use of hospital outpatient and inpatient services was significantly lower for children and young people from all minority ethnic groups compared with the white population. CONCLUSIONS: Our results differ from previous studies, which have reported significant class differences in use of health services for other age groups. We found no evidence that children and young people's use of health services varied according to their socioeconomic status, suggesting that equity has been achieved. A child or young person's ethnic origin, however, was clearly associated with use of general practitioner and hospital services, which could imply that children and young people from minority ethnic groups receive a poorer quality of health care than other children and young people.     

Caries prevalence in primary teeth of German and foreign children within the scope of the 1995/96 school entrance examination in Dusseldorf

900 children of 6 years of age were examined and interviewed by dentists of the Board of Health before they started school. 29.77% of these prospective pupils were children of foreign workers, i.e., the amount of foreign pupils within the examined group was approximately twice as high as it actually is in the population of Düsseldorf (15.21%). The caries prevalence dmf-t (ratio of decayed, missing and filled teeth to the total number of teeth) of these foreign pupils shows an evident need for dental treatment, which is higher than among German pupils. This fact correlates with the low percentage of foreign children with no tooth decay at all. Dental health programmes do not seem to reach this group of the population. Improvement might be possible with the help of foreign organisations or groups in Germany who know the respective foreign cultures and habits of personal hygiene and so could enable their transfer into programmes to promote the oral health of foreigners living here.     

Television and behavior: Research conclusions of the 1982 NIMH report and their policy implications.

Research on TV and behavior in the 1970's has recently been reviewed and evaluated in a 2-volume report from the National Institute of Mental Health (NIMH). The most widely publicized conclusion of the report was that violence on TV does lead to aggressive behavior by children. The TV networks' response to this conclusion has been one of denial. Research also documented that young children are often unable to relate a series of complex actions to their final consequence. Another area in the cognitive and affective aspects of TV concerns the effects of TV viewing on child development and on academic achievement. Findings suggest a need for increased emphasis on teaching children critical TV viewing skills. TV also has the potential to affect social beliefs and behaviors, such as beliefs about sex roles, minorities, prosocial behavior, and products advertised on TV. The impact of TV on social relations, especially familial relations, and on health is also addressed. The NIMH report demonstrates a need to see TV viewing as a continuing form of informal education. What is needed is more creativity on the part of the industry and more discrimination on the part of the viewer. The teaching of critical viewing skills and parental interest in what children watch are especially important. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosing neurofibromatosis type I in children

Neurofibromatosis is the single most common genetic disease of the neurologic system. Because neurofibromatosis type 1 (NF-1) is often diagnosed early in life, it is essential that health care providers deepen their understanding of this common genetic disorder. Children who meet particular criteria, as formulated by the National Institutes of Health, must be worked-up for NF-1 in order to initiate appropriate treatment implementation and evaluation. This article provides a review of the literature regarding the pathophysiology, clinical manifestations, and plan of treatment related to NF-1, specifically as it affects children. Clear guidelines for health care providers in primary care are outlined.     

Health, health promotion and the elderly

Health promotion is a mode of practice which is being increasingly examined by policymakers (DHSS, 1987; DoH, 1992). Although practitioners are being required to screen people over 75 years of age and are exhorted to reduce accidents in the elderly by 33% between 1990 and 2005 (DoH, 1992), there is evidence that they do not value this sort of work (Pursey & Luker, 1993). This paper looks at the findings from 178 interviews with people aged over 75 years, examining the importance of health and health promotion to the elderly. Further to the work of Cox et al. (1987), it is clear that people aged over 75 years continue to engage in a wide variety of activities which are designed to keep or improve their health. Elderly people's accounts of their health suggest that the real influence of social circumstances and environment must be assessed and planned for if health promotion activity is to have relevance and meaning to this group of people. Evidence is presented which indicates that the elderly are a group of people who would welcome health-promotion activity provided it is given in easily accessible forms. The notion of client participation is highlighted as a difficult area, which is likely to require particular skill in working with elderly clients. In the light of these findings, practitioners may need to examine their own attitudes to their work with the elderly.     

Preventing sleep problems in infants: a randomized controlled trial

In the pre-school years sleep problems are one of the most common subjects on which parents seek advice from health professionals. In the majority of cases a sleepless child causes significant stress within the family, and if parents do not obtain sufficient sleep this can have a detrimental effect on their physical and emotional well-being. In a small number of cases a child who wakes frequently and will not settle back to sleep may be at risk of physical abuse. In recent years it has been suggested that it may be possible to prevent sleep problems developing by providing parents with advice in the post-natal period. Parents have stated that they find this type of intervention helpful, however, there has been no attempt to establish whether a preventive approach is effective. The aim of this research was to evaluate the efficacy of health education in reducing the incidence of sleep problems. Adopting an experimental approach, participants were randomly allocated to a control group or an intervention group. Parental knowledge of sleep and settling behaviour was manipulated when the children in the intervention group were 3 months old. The sleeping behaviour of the infants in both groups was compared 6 months later, when the children were 9 months old. Data was collected from 86 families in the intervention group and 83 families in the control group. A comprehensive analysis of the sleeping behaviour demonstrated that a significantly smaller percentage of babies in the intervention group had settling and night-waking difficulties than in the control group.     

Maternal health services in South Africa. During the 10th anniversary of the WHO 'Safe Motherhood' initiative

The tenth anniversary of the World Health Organisation's 'Safe Motherhood' initiative is being celebrated this year and the organisation is using the opportunity to assess critically its gains, its strengths and its weaknesses. South Africa has taken some bold steps to address maternal health services, specifically introducing free health care for pregnant women and children under 5. In this paper we explore what further steps are necessary to ensure improved health outcome for pregnant women. South African health care administrations are, in some cases, engaged in broad health systems interventions at provincial level. This approach to improving health services is nonetheless frustrated by programme-specific initiatives, such as the introduction of female condoms or other piecemeal additions. We argue that making the systems function is the essential, primary step in the success of any intervention. The case of maternal health is explored in this paper.     

Medication development and testing in children and adolescents. Current problems, future directions

Progress in pediatric psychopharmacological research has suffered notable delay, especially compared with the achievements in adult psychopharmacology. Although safety and efficacy of the use of many psychotropic agents in children remain largely unproved, their pediatric use has been increasing and their widespread off-label prescribing by practitioners has raised some important concerns. The National Institute of Mental Health, in cooperation with the Food and Drug Administration and leading researchers, has coordinated systematic efforts to identify the major obstacles to research in pediatric psychopharmacology and to propose feasible solutions. In 1995, a conference cosponsored by the national Institute of Mental Health and the Food and Drug Administration gathered more than 100 research experts, family and patient advocates, and representatives of mental health professional associations. Participants met in working groups focused on specific aspects of child research and reached consensus on various recommendations. Each of the various aspects relevant to conducting research in this area (methodological, ethical, legal, regulatory, financial, and family or community context) presents specific challenges, which are herein outlined. Recommendations for possible solutions are presented, some of which are being implemented. Because data about drug safety and efficacy in adults can rarely be extrapolated to children, there is no substitute for pediatric psychopharmacological research. Successful strategies for overcoming the many obstacles with which this research has to contend must enlist the concerted efforts of all the relevant parties (investigators, clinicians, industry, federal agencies, ethicists, families, and community representatives).     

Quality-of-life assessment in children and adolescents with asthma

Health-related quality of life has become an essential part of health outcome measurement in chronic disorders. However, it is only recently that health professionals have focused on quality-of-life assessment in children and adolescents. Several generic, as well as the asthma-specific quality-of-life instruments specifically designed for use in children and adolescents are reviewed in this article with particular regard to the conceptual and methodological features of the measures and their applicability in clinical studies. The recently published Child Health Questionnaire is a useful generic instrument to comprehensively assess quality of life, in particular when comparing young people with different chronic disorders. The Pediatric Asthma Quality-of-life Questionnaire has shown responsiveness to change over time, but it lacks age-specificity with regard to psychosocial issues and comprehensiveness of quality-of-life assessment. In contrast, the Childhood Asthma Questionnaire provides three different versions for different target ages. However, its generic part is not reflective of the respondent's health status. The other asthma-specific instruments have major conceptual deficiencies when used as a single measure for quality-of-life assessment. In the absence of a single ideal instrument, the use of batteries of quality-of-life instruments is therefore recommended and further research is required to identify the impact that age and developmental status have on quality-of-life assessment.