Breast-feeding and respiratory syncytial virus infection.

The pattern of breast-feeding in 127 infants admitted to hospital with respiratory syncytial virus infection was compared with that in 503 age-matched controls. Thirty per cent of children with infection had been breast-fed compared with 49% of controls. The approximate relative risk of being admitted to hospital with respiratory syncytial virus infection if not breast-fed was 2.2. Several other factors were also considered, including an assessment of maternal care and home environment; the mother''s age, marital state, and smoking habits; the number of siblings; and gestation. Adverse factors were all associated with an increased risk of admission with infection, but breast-feeding still appeared to provide protection after controlling for these other factors in turn. These findings provide further support for encouraging mothers to breast-feed their infants and should prompt further studies into the immune status of mothers and into the nature of the protective factors in their breast milk.     

Sociodemographic and motivational characteristics of parents who volunteer their children for clinical research: a controlled study.

OBJECTIVE--To determine the sociodemographic and motivational characteristics of parents who volunteer their children for clinical research. DESIGN--A questionnaire was administered to parents who volunteered their children for a randomised, double blind, placebo controlled trial of a drug to treat asthma and to a control group of parents whose children were eligible for the trial but had refused the invitation. SETTING--A children''s hospital in Australia. SUBJECTS--68 Parents who had volunteered their children and 42 who had not; a response rate of 94% and 70%, respectively. MAIN OUTCOME MEASURES--Responses of parents to questionnaire designed to assess their perceptions, attitudes, and health seeking behaviour as well as sociodemographic data. RESULTS--Volunteering parents were less well educated with only 15% (10/68) of mothers and 16% (11/68) and of fathers having had a tertiary or university education compared with 26% (11/42) of mothers and 45% (19/42) in the non-volunteering group. Fewer volunteering parents had professional or administrative jobs than did non-volunteering parents (mothers 6% (4/68); fathers 9% (6/68) v mothers 14% (6/42); fathers 31% (13/42)). Volunteering parents had less social support, and they displayed greater health seeking behaviour and consumed more habit forming substances. They were motivated by a desire to help others and to contribute to medical research, but they were also searching for more information and better ways to help their own children. CONCLUSION--Parents who volunteer their children for medical research are significantly more socially disadvantaged and emotionally vulnerable.     

Qualitative interview study of communication between parents and children about maternal breast cancer

ObjectiveTo examine parents'' communication with their children about the diagnosis and initial treatment of breast cancer in the mother.DesignQualitative interview study within cross sectional cohort.SettingTwo breast cancer treatment centres.Participants32 women with stage I or stage II breast cancer with a total of 56 school aged children.ResultsWomen were most likely to begin talking to their children after their diagnosis had been confirmed by biopsy, but a minority waited until after surgery or said nothing at all. Family discussion did not necessarily include mention of cancer. There was considerable consistency in the reasons given for either discussing or not discussing the diagnosis. The most common reason for not communicating was avoidance of children''s questions and particularly those about death. While most mothers experienced helpful discussion with a doctor concerning their illness, few were offered help with talking to children; many would have liked help, particularly the opportunity for both parents to talk to a health professional with experience in understanding and talking to children.ConclusionsParents diagnosed with cancer or other serious illnesses should be offered help to think about whether, what, and how to tell their children and about what children can understand, especially as they may well be struggling themselves to come to terms with their illness.     

Impact of whooping cough on patients and their families.

The effects of whooping cough were studied in 21 children admitted to hospital with the disease and in their families. The illness caused considerable distress to both child and family. Parents suffered especially from fears for the life and health of their child and from serious loss of sleep. Two months after admission the child''s behaviour was still disturbed, but in most cases the rest of the family had returned to normal. There was much misunderstanding and misinformation about whooping cough among both parents and doctors.     

Case-control study of leukaemia and non-Hodgkin's lymphoma among children aged 0-4 years living in west Berkshire and north Hampshire health districts.

OBJECTIVE--To investigate the relation between parental employment in the nuclear industry and childhood leukaemia and non-Hodgkin''s lymphoma. DESIGN--Case-control study. SETTING-West Berkshire and Basingstoke and North Hampshire District Health Authorities. SUBJECTS--54 children aged 0-4 years who had leukaemia or non-Hodgkin''s lymphoma diagnosed during 1972-89, who were born in the study area and were resident there when cancer was diagnosed. Six controls were selected for each case: four from hospital delivery registers and two from livebirth registers maintained by the NHS central register. Controls were matched for sex, date of birth (within six months), and area of residence at birth and time of diagnosis. MAIN OUTCOME MEASURES--Parents'' employment by the nuclear industry and exposure to ionising radiation at work. RESULTS--Five (9%) of the 54 cases and 14 (4%) of the 324 controls had fathers or mothers, or both, who had been employed by the nuclear industry (relative risk 2.2, 95% confidence interval 0.6 to 6.9). Nuclear industry employees who work in areas where exposure to radiation is possible are given film badges to monitor their exposure to external penetrating ionising radiation. Three fathers of cases and two fathers of controls (and no mothers of either) had been monitored in this way before their child was conceived (relative risk 9.0, 95% confidence interval 1.0 to 107.8). No father (of a case or control) had accumulated a recorded dose of more than 5 mSv before his child was conceived, and no father had been monitored at any time in the four years before his child was conceived. A dose-response relation was not evident among fathers who had been monitored. CONCLUSIONS--These results suggest that the children of fathers who had been monitored for exposure to external penetrating ionising radiation in the nuclear industry may be at increased risk of developing leukaemia before their fifth birthday. The finding is based on small numbers and could be due to chance. If the relationship is real the mechanisms are far from clear, except that the effect is unlikely to be due to external radiation; the possibility that it could be due to internal contamination by radioactive substances or some other exposure at work should be pursued. The above average rates of leukaemia in the study area cannot be accounted for by these findings.     

Infant-feeding practices among immigrants in Glasgow.

Two hundred and six Asian, 99 African, 99 Chinese, and 102 Scottish children from 172 families were studied to ascertain infant-feeding practices. After arriving in the United Kingdom most of the immigrant mothers had not wished to breast-feed their babies because of wrong information or misconceptions about British infant-feeding practices. The Asians had largely adopted British habits of introducing solid foods to their babies'' diets, but the habits of the African and Chinese mothers in this respect had changed little. Furthermore, many of the African and Chinese children had received no vitamin preparation. The survey showed that all mothers resident in Britain urgently need advice on some aspects of infant feeding.     

Paediatric home nursing scheme in Gateshead.

A scheme to provide specialised nursing care for sick children in their own homes was begun in Gateshead in 1974. Selected district nurses were retrained in the paediatric unit on which the scheme was based and nursed at home 22 children referred to them by general practitioners as the alternative to hospital admission and 39 discharged to their care by the hospital. Most of the children were aged 3 years or less and came from working-class homes. Most of the mothers who were asked were in favour of the scheme.     

Analyses of toxic metals and essential minerals in the hair of arizona children with autism and associated conditions, and their mothers

The objective of this study ws to assess the levels of 39 toxic metals and essential minerals in hair samples of children with autism spectrum disorders and their mothers compared to controls. Inductively coupled plasma-mass spectrometry was used to analyze the elemental content of the hair of children with autism spectrum disorders (n=51), a subset of their mothers (n=29), neurotypical children (n=40), and a subset of their mothers (n=25). All participants were recruited from Arizona. Iodine levels were 45% lower in the children with autism (p=0.005). Autistic children with pica had a 38% lower level of chromium (p=0.002). Autistic children with low muscle tone had very low levels of potassium (−66%, p=0.01) and high zinc (31%, p=0.01). The mothers of young children with autism had especially low levels of lithium (56% lower, p=0.005), and the young children (ages 3–6 yr) with autism also had low lithium (−30% p=0.04). Low iodine levels are consistent with previous reports of abnormal thyroid function, which likely affected development of speech and cognitive skills. Low lithium in the mothers likely caused low levels of lithium in the young children, which could have affected their neurological and immunological development. Further investigations of iodine, lithium, and other elements are warranted.     

Reproductive patterns and thalassaemia major

This study investigated the effect of the diagnosis of transfusion-dependent homozygous beta-thalassemia on subsequent parental reproductive patterns in 44 families in New South Wales. The results indicate a shift over time from parental risk-taking (either consciously or in ignorance of the implications of the diagnosis) to premature curtailment of reproduction to the likelihood of attaining birth expectations through antenatal diagnosis. 67% of families with both of their 1st 2 children affected by thalassemia major had additional children, compared with 38% of those where the 1st child was affected and the 2nd child was unaffected and 37% of families where the 1st child was unaffected and the 2nd child was affected. Overall, 48% of mothers of children with thalassemia major had as many children as they had expected at the time of marriage, 13% had more, and 39% had fewer children. The mothers of older children were less likely to have had the planned number of births than those of children born more recently. The value of antenatal diagnosis to couples at risk of thalassemia appears to have been to enable them to meet or almost meet their birth expectations.     

Influence of parents' eating behaviors and child feeding practices on children's weight status

Objective : To investigate the effects of mothers’ and fathers’ eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. Research Methods and Procedures : Four hundred fifty‐eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three‐Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self‐reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents’ BMI and questionnaire scores and children's weight status. Results : One hundred forty‐three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers’ BMI, but not fathers’. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters’ future health. Discussion : Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.     

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

Abstract

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.     

Impact of counselling on careseeking behaviour in families with sick children: cluster randomised trial in rural India

Objective To assess whether training doctors in counselling improves careseeking behaviour in families with sick children.Design Pair matched, community randomised trial conducted in 12 primary health centres (six pairs). Doctors in intervention centres were trained in counselling, communication, and clinical skills, using the integrated management of childhood illness approach.Setting Rural district in Rajasthan, India.Participants Children aged under 5 years presenting for curative care and their mothers were recruited and visited monthly at home for six months. A total of 2460 children were recruited (1248 intervention, 1212 control).Main outcome measures Careseeking behaviour of mothers for sick children; mothers'' knowledge and perceptions of seeking care; counselling performance of doctors.Results For episodes of illness with at least one reported danger sign, 15% of intervention group mothers and 10% of control group mothers reported having sought care from an appropriate provider promptly; this difference was not statistically significant (relative risk reduction 5%, 95% confidence interval -0.4% to 11%; P = 0.07). One month after training, intervention site doctors counselled more effectively than control group doctors, but at six months their performance had declined. A greater proportion of mothers in the intervention group than in the control group recalled having had at least one danger sign explained (45% v 8%; P = 0.02).Conclusions Mothers'' appreciation of the need to seek prompt and appropriate care for severe episodes of childhood illness increased, but their careseeking behaviour did not improve significantly.     

Your child is dead.

OBJECTIVE--To determine parent''s views on how death of their children should have been handled. DESIGN--Retrospective questionnaire survey of parents who had experienced death of their child. SETTING--Charitable organisation of bereaved parents. SUBJECTS--150 bereaved parents, all members of the organisation, of whom 120 (80%) participated voluntarily in the study. MAIN OUTCOME MEASURES--Child''s age; date and cause of death; details of person breaking the news and handling of the interview; time parents spent with dead child, their attitude to requests for organ donation, and follow up support received. RESULTS--122 children''s deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled as badly or offensively handled (68 v 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child''s body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents organ donation had not been discussed. Only 16 parents recorded any follow up support from hospital staff and very few support at the time. CONCLUSIONS--The consistency of the responses suggests a serious need to revise the in service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.     

Mothers' birth weight and survival of their offspring: population based study.

OBJECTIVE: To test the hypothesis that a baby''s survival is related to the mother''s birth weight. DESIGN: Population based dataset for two generations. SETTING: Population registry in Norway. SUBJECTS: All birth records for women born in Norway since 1967 were linked to births during 1981-94, thereby forming 105104 mother-offspring units. MAIN OUTCOME MEASURES: Perinatal mortality specific for weight for offspring in groups of maternal birth weight (with 500 g categories in both). RESULTS: A mother''s birth weight was strongly associated with the weight of her baby. Maternal birth weight was associated with perinatal survival of her baby only for mothers with birth weights under 2000 g. These mothers were more likely to lose a baby in the perinatal period (odds ratio 2.3, 95% confidence interval 1.4 to 3.7). Among mothers with a birth weight over 2000 g there was no overall association between mother''s weight and infant survival. There was, however, a strong interaction between mother''s birth weight, infant birth weight, and infant survival. Mortality among small babies was much higher for those whose mothers had been large at birth. For example, babies weighing 2500-2999 g had a threefold higher mortality if their mother''s birth weight had been high (> or = 4000 g) than if the mother had been small (2500-2999 g). CONCLUSION: Mothers who weighed less than 2000 g at birth have a higher risk of losing their own babies. For mothers who weighed > or = 2000 g their birth weight provides a benchmark for judging the growth of their offspring. Babies who are small relative to their mother''s birth weight are at increased risk of mortality.     

西安市2010-2015年0-5岁儿童HBV感染状况的流行病学研究

摘要 目的：总结西安市2010-2015年 0-5岁儿童乙肝病毒感染的发病趋势和流行病学特征,寻找高危人群。通过随访研究获取HBV感染儿童疾病转归及乙肝监测系统存在的问题,为乙肝监测系统完善及制定防治策略提供科学依据。方法：采用描述性流行病学方法对西安市2010-2015年的0-5岁儿童乙肝患者进行三间分布描述分析;采用前瞻性队列研究方法,检测母亲及儿童的外周血HBV病毒学情况,获得母亲感染状况和患儿转归。结果：6年间,西安市0-5岁儿童共上报乙肝病例175例,年均HBV感染率为6.05/10万,2013年最高,为9.73/10万,以散发为主;0-1岁为高发年龄段,男童发病多于女童;未央区、雁塔区为高发地区。截止2016年8月,随访HBV感染学龄前儿童139例,仅17例完成流行病学调查和体检检测,失访率高达87.7%,17例HBV感染儿童中HBsAg慢性化高达88.2%,其中14例(82.3%)母亲为HBsAg阳性者。结论：西安市0-5岁儿童HBV感染的高危人群为HBsAg阳性母亲的儿童,与宫内感染/母婴传播有关。0-5岁HBV感染儿童转归结局不良,建议加强HBV宫内阻断,并对高危新生儿进行乙肝抗体监测。     

Psychological consequences for parents of false negative results on prenatal screening for Down's syndrome: retrospective interview study

ObjectiveTo determine the psychological consequences for parents of children with Down''s syndrome of having received a false negative result on prenatal screening.DesignComparison of adjustment of parents who received a false negative result with that of parents not offered a test and those who declined a test.SettingParents were interviewed in their own homes.ParticipantsParents of 179 children with Down''s syndrome (mean age 4 (range 2-6) years).ResultsOverall, regardless of screening history, parents adjusted well to having a child with Down''s syndrome. Compared with mothers who declined a test, mothers in the false negative group had higher parenting stress (mean score 81.2 v 71.8, P=0.016, 95% confidence interval for the difference 1.8 to 17.0) and more negative attitudes towards their children (124.9 v 134.2, P=0.009, −16.2 to −2.4). Fathers in the false negative group had higher parenting stress test scores (77.8 v 70.0, P=0.046, 1.5 to 14.2) than fathers not offered a test. Mothers in the false negative group were more likely to blame others for the outcome than mothers who had not been offered the test (28% v 13%, P=0.032, 3% to 27%). Mothers and fathers in the false negative group were more likely to blame others for this outcome than parents who had declined a test (mothers 28% v 0%, P=0.001, 19% to 37%; fathers 27% v 0%, P=0.004, 17% to 38%). Blaming others was associated with poorer adjustment for mothers and fathers.ConclusionsA false negative result on prenatal screening seems to have a small adverse effect on parental adjustment evident two to six years after the birth of an affected child.     

Health problems of anaesthetists and their families in the West Midlands.

A survey of all anaesthetists in the West Midlands region--that is, 10% of all the anaesthetists in England and Wales--showed that one in 10 of their children had been referred to a consultant because of a congenital or nonacquired anomaly. Abortions among anaesthetists'' families were also common but more so when the mother was an anaesthetist. The anomalies were concentrated particularly in the central nervous system and musculoskeletal system, and girls were worst affected. The mean birth weights were below normal, more so when the mothers were anaesthetists. Girls with anomalies were particularly underweight. Other effects observed were unexpected infertility, cancer both in the adults and in the children, and, possibly, impaired intellectual development in the children. Many anaesthetising areas were inadequately ventilated, and scavenging devices despite their inefficiency are recommended as a stopgap measure. The results of the study closely resemble those of other studies with similar high response rates to requests for information.     

Qualitative interview study of communication between parents and children about maternal breast cancer

Objective To examine parents'' communication with their children about the diagnosis and initial treatment of breast cancer in the mother. Design Qualitative interview study within a cross-sectional cohort. Setting Two breast cancer treatment centers. Participants 32 women with stage I or stage II breast cancer with 56 school-aged children. Main outcome measures Semistructured interview regarding timing and extent of communication with children about the diagnosis and initial treatment of the mother''s illness, reasons for talking to children or withholding information, and help available and requested from health professionals. Results Women were most likely to begin talking to their children after their diagnosis had been confirmed by biopsy, but a few waited until after surgery or said nothing at all. Family discussion did not necessarily include mention of cancer. There was considerable consistency in the reasons given for either discussing or not discussing the diagnosis. The most common reason for not communicating was to avoid children''s questions, particularly those about death. Although most women had helpful discussion with a physician concerning their illness, few were offered help with talking to their children; many would have liked help, particularly the opportunity for both parents to talk to a health professional with experience in understanding and talking to children. Conclusion Parents diagnosed with cancer or other serious illnesses should be offered help to think about whether, what, and how to tell their children and about what children can understand, especially as they may well be struggling themselves to come to terms with their illness.