Single mothers in Ontario: sociodemographic,physical and mental health characteristics

OBJECTIVE: To examine the sociodemographic, physical and mental health characteristics of single mothers in Ontario. DESIGN: Cross-sectional. SETTING: Ontario. PARTICIPANTS: Ontario residents aged 15 years or older who participated in the Ontario Health Supplement survey conducted between December 1990 and April 1991; of 9953 eligible participants, 1540 were mothers with at least 1 dependent child (less than 16 years of age). OUTCOME MEASURES: Prevalence rates of sociodemographic, physical and mental health characteristics. RESULTS: Single mothers were significantly more likely than the mothers in 2-parent families to be poor, to be 25 years of age or less, to have mental health problems (dissatisfaction with multiple aspects of life, affective disorder ever and 1 or more psychiatric disorders in the past year or ever) and to use mental health services. When compared by income level, poor single mothers had a higher prevalence of all mental health outcomes measured; the difference was significant for anxiety disorder in the past year or ever and for 1 or more psychiatric disorders in the past year or ever. In a logistic regression analysis, single-mother status was found to have the strongest independent effect on predicting mental health morbidity and utilization of mental health services; the next strongest was low income. CONCLUSIONS: Single mothers are more likely to be poor, to have an affective disorder and to use mental health services than mothers in 2-parent families. The risk of mental health problems is especially pronounced among poor single mothers. Further studies are needed to determine which aspects of single motherhood, apart from economic status, affect mental health outcomes.     

Unmet need for additional medical care for sick children in mother's view in rural Bangladesh: implications for improving child health services

While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users' perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child's socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children's chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers' views to manage the illness. The survey also recorded household socioeconomic data. Logistic regression was used to examine the data. The results reveal that unmet needs for additional medical care were 5.4% for children with acute illnesses, and 30.2% for children with chronic illnesses. For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0.42 (95% CI: 0.28-0.64) times that for sick children of the very poor households. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.     

Mental health problems of homeless children and families: longitudinal study

Objective: To establish the mental health needs of homeless children and families before and after rehousing. Design: Cross sectional, longitudinal study. Setting: City of Birmingham. Subjects: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. Main outcome measures: Children’s mental health problems and level of communication; mothers’ mental health problems and social support one year after rehousing. Results: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P=0.04; children 39% v 11%, P=0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. Conclusions: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.

Key messages

• Homeless children and their mothers have a high level of mental health problems
• Homeless families experience many risk factors, such as domestic violence, abuse, and family and social disruption
• In two fifths of children and a quarter of mothers, mental health problems persisted after rehousing
• In contrast with a comparison group of families of low socioeconomic status, a substantial proportion of homeless families remained residentially and socially unstable

     

Demand-side medical education: educating future physicians for Ontario.

Initiated by Associated Medical Services (AMS), Educating Future Physicians for Ontario is a 5-year collaborative project whose overall goal is to make medical education in Ontario more responsive to that province''s evolving health needs. It is supported by AMS, the five universities with medical schools or academic health sciences centres and the Ontario Ministry of Health. The project''s five objectives are to (a) define the health needs and expectations of the public as they relate to the training of physicians, (b) prepare the educators of future physicians, (c) assess medical students'' competencies, (d) support related curricular innovations and (e) develop ongoing leadership in medical education. There are several distinctive features: a focus on "demand-side" considerations in the design of curricula, collaboration within a geopolitical jurisdiction (Ontario), implementation rather than recommendation, a systematic project-evaluation plan and agreement as to defined project outcomes, in particular the development of institutional mechanisms of curriculum renewal as health needs and expectations evolve.     

MEETING COMMUNITY HEALTH NEEDS—The Combined Role of the Physician,Health Department and Hospital

Social and economic changes—the lengthening life span, the shift of population from rural to urban areas, the growth of industry and other factors—have brought about radical changes in the nation''s health needs. Our greatest health problem today is chronic illness. To cope with these problems public health, medical care and hospital services, which are at present geared primarily for acute illness, must be revised.Immediate and specific steps which physicians, health departments and hospitals can take to accomplish this are to define the problem and to initiate studies in several areas: To determine the incidence and prevalence of disease, injuries and impairments; the nature, degree and duration of resulting disability; and the type of care received.The basic approach to chronic illness is prevention. To accomplish this, more emphasis needs to be placed upon health education. Good health cannot be forced upon the public, but educated and enlightened citizens can and do solve their own health problems and those of their families and communities.Due to the complex nature of today''s health problems, they must be approached jointly by physicians, local health services, hospitals and the public. The efforts of those groups must be coordinated and aimed, directly and indirectly, at preventing disease and disability.     

'Pals'. A medical student public service program.

We designed a public service and educational program to aid children and families coping with chronic illness and to augment medical student education. Medical students developed relationships with chronically ill children and families based on the Big Brother-Big Sister program model. In addition, students attended bimonthly seminars on childhood chronic illness and family dynamics. Medical students learned about the psychosocial aspects of illness through these relationships and reported that the program contributed to their sense of worth as caregivers. By fostering students'' innate altruism, medical schools may succeed in cultivating caring and humanism in their student physicians. We propose a model that encourages medical students to relate personally with patients and their families. A program such as this has the potential to nurture compassion in medical students, contribute to medical education, and provide support to patients and families.     

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.     

Mental Health of Parents as Caregivers of Children with Disabilities: Based on Japanese Nationwide Survey

The number of children with disability is increasing gradually in Japan. Previous researches in other countries have reported that parents as caregivers (CGs) of children with disability have mental health problems, but the actual situation has not been examined nationwide in Japan so far. The aim of this study was to evaluate the association between mental health of CGs who had children with disability and characteristics of children, CGs, and household based on the nation-wide survey. This study utilized data from 2010 Comprehensive Survey of the Living Conditions, and defined children with disability aged 6 to 17. Individual data of children and CGs were linked, and 549 pairs of them were extracted. The Japanese version of Kessler 6 (K6) was used to assess mental health status of caregiver, scored 5 and over represented to general psychological distress. Logistic regression was used to evaluate the associations of interest. The almost half (44.4%) of CGs had psychological distress (k6 score; 5 +) in nationwide, and 8.9% of CGs might have serious mental illness (K6 score; 13+). After adjusting covariates of child, CG, and household factors, CG having a current symptom (OR, 95% CI: 3.26, 1.97–5.39), CG''s activity restriction (OR, 95% CI: 2.95, 1.38–6.32), low social support (OR, 95%CI: 9.31, 1.85–46.8), three generation family (OR, 95% CI: 0.49, 0.26–0.92), and lower 25% tile group of monthly household expenditure (OR, 95% CI:1.92, 1.05–3.54), were significantly associated with psychological distress of CGs. This study encourages health care providers to pay more attentions toward parent''s mental health, especially for in case of having low social support, and lower income family. Further research should examine the detailed information of child''s disease and disability, medical service use, and quality and quantity of social support in nationwide to straighten the system for supporting services of both children with disabilities and their CGs.     

Correlates of certification in family medicine in the billing patterns of Ontario general practitioners.

There is conflicting evidence as to whether physicians who are certified in family medicine practise differently from their noncertified colleagues and what those differences are. We examined the extent to which certification in family medicine is associated with differences in the practice patterns of primary care physicians as reflected in their billing patterns. Billing data for 1986 were obtained from the Ontario Health Insurance Plan for 269 certified physicians and 375 noncertified physicians who had graduated from Ontario medical schools between 1972 and 1983 and who practised as general practitioners or family physicians in Ontario. As a group, certificants provided fewer services per patient and billed less per patient seen per month. They were more likely than noncertificants to include counselling, psychotherapy, prenatal and obstetric care, nonemergency hospital visits, surgical services and visits to chronic care facilities in their service mix and to bill in more service categories. Certificants billed more for prenatal and obstetric care, intermediate assessments, chronic care and nonemergency hospital visits and less for psychotherapy and after-hours services than noncertificants. Many of the differences detected suggest a practice style consistent with the objectives for training and certification in family medicine. However, whether the differences observed in our study and in previous studies are related more to self-selection of physicians for certification or to the types of educational experiences cannot be directly assessed.     

Hospitals' response to the buckle-up baby legislation in Ontario.

Drivers in Ontario are legally responsible to ensure that infants and toddlers are restrained in a child safety seat or by a lap belt. In 1982 the minister of health sent a memorandum to all medical officers of health and the administrators and medical directors of all public hospitals in Ontario, urging them to encourage and assist parents in protecting their newborn children with safety seats. In 1983 the Toronto General Hospital established the Cooperative Hospital Infant Restraint Program (CHIRP) to study the feasibility of a "loaner" program for hospitals in metropolitan Toronto. The authors describe CHIRP and its objectives. They also report the results of a questionnaire they sent in 1984 to all Ontario hospitals that had a newborn or pediatric service to assess their response to the minister''s memorandum.     

Mother-child separation: a study in a remote health care setting.

The literature indicates that the birth of a sibling and the consequent temporary separation from the mother is usually a stressful experience for a child. It was hypothesized that this stress would result in an increased number of visits by the child to health care facilities because of new health problems. In a controlled study of 89 matched pairs of Indian families in a remote region of northwestern Ontario this hypothesis was not supported. During the intervals studied - the anticipatory period before delivery, the separation itself and the period immediately following the mother''s return home - the number of diagnoses of new medical problems was significantly less for the children who were separated from their mothers for the birth of a sibling. As well, the number of diagnoses of new medical problems in the children separated form their mothers decreased over the three intervals. The fathers'' reluctance to seek health care probably played a major role in this decrease.     

Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study

ObjectivesTo examine whether self reported health status and use of health services varies in children of different social class and ethnic group.DesignCross sectional study from the 1999 health survey for England.Subjects6648 children and young adults aged 2-20 years.SettingPrivate households in England.ResultsLarge socioeconomic differences were observed between ethnic subgroups; a higher proportion of Afro-Caribbean, Indian, Pakistani, and Bangladeshi children belonged to lower social classes than the general population. The proportion of children and young adults reporting acute illnesses in the preceding two weeks was lower in Bangladeshi and Chinese subgroups (odds ratio 0.41, 95% confidence interval 0.27 to 0.61 and 0.46, 0.28 to 0.77, respectively) than in the general population. Longstanding illnesses was less common in Bangladeshi and Pakistani children (0.52, 0.40 to 0.67 and 0.57, 0.46 to 0.70) than in the general population. Irish and Afro-Caribbean children reported the highest prevalence of asthma (19.5% and 17.7%) and Bangladeshi children the lowest (8.2%). A higher proportion of Afro-Caribbean children reported major injuiries than the general population (11.0% v 10.0%), and children from all Asian subgroups reported fewer major and minor injuries than the general population. Indian and Pakistani children were more likely to have consulted their general practitioner in the preceding fortnight than the general population (1.86, 1.35 to 2.57 and 1.51, 1.13 to 2.01, respectively). Indian, Pakistani, Bangladeshi, and Chinese children were less likely to have attended outpatient departments in the preceding three months. No significant differences were found between ethnic groups in the admission of inpatients to hospitals. Acute and chronic illness were the best predictors of children''s use of health services. Social classes did not differ in self reported prevalence of treated infections, major injuries, or minor injuries, and no socioeconomic differences were seen in the use of primary and secondary healthcare services.ConclusionsChildren''s use of health services reflected health status rather than ethnic group or socioeconomic status, implying that equity of access has been partly achieved, although reasons why children from ethnic minority groups are able to access primary care but receive less secondary care need to be investigated.

What is already known on this topic

Children from lower socioeconomic classes and from Indian ethnic subgroups may make more use of general practitioners'' services than other childrenAfro-Caribbean, Indian, Pakistani, and Bangladeshi children are less likely to be referred to outpatient and inpatient services at hospitals than white children

What this study adds

Indian, Pakistani, and Bangladeshi children reported less acute and chronic illness, asthma, and injuries than the general population, whereas Afro-Caribbean children reported moreChildren''s self reported health status and use of health services did not vary by social classIndian and Pakistani children make more use of general practitioners'' services, but Indian, Pakistani, Bangladeshi, and Chinese children are less likely to be referred to outpatient clinicsSelf reported health status rather than socioeconomic status or ethnicity is the best predictor of use of primary and secondary services     

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

Objectives

Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need.

Methods

Data are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics.

Results

Weighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05).

Conclusions

CSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.     

Meeting community health needs; the combined role of the physician,health department and hospital

Social and economic changes-the lengthening life span, the shift of population from rural to urban areas, the growth of industry and other factors-have brought about radical changes in the nation's health needs. Our greatest health problem today is chronic illness. To cope with these problems public health, medical care and hospital services, which are at present geared primarily for acute illness, must be revised. IMMEDIATE AND SPECIFIC STEPS WHICH PHYSICIANS, HEALTH DEPARTMENTS AND HOSPITALS CAN TAKE TO ACCOMPLISH THIS ARE TO DEFINE THE PROBLEM AND TO INITIATE STUDIES IN SEVERAL AREAS: To determine the incidence and prevalence of disease, injuries and impairments; the nature, degree and duration of resulting disability; and the type of care received. The basic approach to chronic illness is prevention. To accomplish this, more emphasis needs to be placed upon health education. Good health cannot be forced upon the public, but educated and enlightened citizens can and do solve their own health problems and those of their families and communities. Due to the complex nature of today's health problems, they must be approached jointly by physicians, local health services, hospitals and the public. The efforts of those groups must be coordinated and aimed, directly and indirectly, at preventing disease and disability.     

Community Mental Health

The distinctive feature of a community mental health program is the comprehensive responsibility assumed for the mental health as well as the psychiatric needs of a particular area. Not only must programs provide psychiatric services but, in addition, they are concerned with assessing the community''s psychiatric and mental health status; with preventive services; with mental health education; with contributions directed toward the solution of certain social problems; as well as with a variety of other indirect services, including, importantly, mental health consultation. This form of consultation can support and help the large number of community care-takers whose contribution is vital to the promotion of community mental health.     

Influence of passive smoking on admissions for respiratory illness in early childhood.

An association was sought between passive smoking and inpatient admissions for respiratory illness in 1058 children born between 1 June and 31 December 1981 and living in the neighborhoods of Nan-Jing Western Road and Yan-An Western Road in Jing-An District, Shanghai. The admission rate for first episodes of respiratory illness was positively correlated with the total daily cigarette consumption of family members during the children''s first 18 months of life. The relative risk of developing a first episode of respiratory illness was 1.80 for children living in families including people who smoked 10 or more cigarettes a day compared with those living in non-smoking families. Multiple logistic regression analysis showed that the effect of passive smoking on inpatient admission for respiratory illness was independent of the child''s birth weight, type of feeding, father''s education, size of the home, and chronic respiratory disease among adults in the family. The adjusted odds ratios compared with the non-smoking group were 1.17 in families smoking 1.9 cigarettes daily and 1.89 in families smoking 10 or more cigarettes daily. These data suggest that exposure to household cigarette smoke of children in early life increases the risk of severe respiratory illness.     

Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders

ObjectiveTo test the hypothesis that a community based intervention by secondary child and adolescent mental health services would be significantly more effective and less costly than a hospital based intervention.DesignOpen study with two randomised parallel groups.SettingTwo health districts in the north of England.ParticipantsParents of 3 to 10 year old children with behavioural disorder who had been referred to child and adolescent mental health services.InterventionParental education groups.Results141 subjects were randomised to community (n=72) or hospital (n=69) treatment. Primary outcome data were obtained on 115 (82%) cases a year later. Intention to treat analyses showed no significant differences between the community and hospital based groups on any of the outcome measures, or on costs. Parental depression was common and predicted the child''s outcome.ConclusionsLocation of child mental health services may be less important than the range of services that they provide, which should include effective treatment for parents'' mental health problems.     

Cost analysis of the Kozak protocol as used in an Ontario hospital in the treatment of children with epidermolysis bullosa.

Conventional treatment of epidermolysis bullosa is often unsuccessful. The Kozak protocol is an alternative that has been given considerable public support in Ontario. The incremental cost of this treatment program at the Hospital for Sick Children, Toronto, was examined. The departments of nursing, pharmacy and food services each kept records of salaries and supply costs applicable to the care of nine patients with epidermolysis bullosa who were treated in the fiscal year 1982-83. The selected direct costs to the hospital were compared with the projected costs if these patients had been treated in Dr. Kozak''s clinic in West Germany or under the financial arrangements offered to Dr. Kozak by the Ontario minister of health. At a total incremental cost of +255.92 per patient-day, care at the Hospital for Sick Children may not currently be the least expensive means of offering the Kozak protocol to Ontario children. However, the major expense of the program, the nurses'' salaries, could be reduced if the patients'' parents were to assume many of the nursing tasks; this would make the hospital''s program the most cost-effective method of treating children with epidermolysis bullosa.     

Prevention of psychosocial problems in children with chronic illness.

Children with chronic illness and disability are at considerably increased risk of psychosocial problems, such as neurosis, attention deficit and poor adjustment to school. Health care professionals, especially primary care physicians, can do a great deal to prevent such problems in these children and their families. The approach outlined here is based on an understanding of the transactional model of development, in which the child interacts with--and to some extent creates--the social environment, and on a "noncategorical" concept in which common elements in chronic illness are recognized and emphasized. The physician''s role is to inform the family of the child''s condition as soon as possible, to offer hope, encouragement and guidance, to watch the child''s development, to maintain a shared view of the child and family, and, if possible, to ensure continuity of care.