Concerns and expectations of parents with atopic infants

Family management of childhood atopic dermatitis

AIMS

To identify the variables that affect family management of childhood atopic dermatitis and establish a prediction model based on Bandura's self-efficacy theory.

BACKGROUND

Atopic dermatitis is a chronic recurrent skin disease and common health problem in childhood. It is necessary to use an approach that includes parental factors when considering the effective management of childhood atopic dermatitis.

DESIGN

A cross-sectional study design.

METHODS

A convenience sample, comprising 168 Korean mothers caring for a child with atopic dermatitis under the age of 13, was recruited from the paediatric outpatient departments of two general hospitals in Seoul, South Korea. Data were collected using structured self-reported questionnaires including severity, antecedents, effort, self-efficacy and family management of childhood atopic dermatitis from 1 November 2015-28 February 2016. Descriptive statistics about the participants and variables were examined and data were analysed using structural equation modelling.

RESULTS

The hypothetical model had an adequate fit to the data, indicating that severity, antecedents, effort and self-efficacy influenced family management of childhood atopic dermatitis.

CONCLUSION

These results suggest that strategies to support children with atopic dermatitis and their family should consider the influence of such variables.

Development of the scale of psychosocial factors in food allergy (SPS-FA)

BACKGROUND

Food allergy (FA) is a growing condition among children and it's psychological impact over the patients and their caregivers is well known, establishing a vicious circle that perpetuates stress levels. However, psychosocial factors are not commonly included in allergy treatments. Based on the lack of evidence of records about a scale that indicates the level of interaction between biopsychosocial factors in the patient-caregivers dyad for FA, the present research aims to develop a scale with these characteristics as a helpful tool to achieve a more comprehensive system of health care.

METHODS

A preliminary 28-item scale was generated (sample N = 99). The scale was adjusted in contents and language after expert opinion and application on patients. A factor analysis was carried out selecting the items from the final scale.

RESULTS

The final 9-item scale included three areas: impact on quality of life, social impact and conflicts. The scale had a good internal consistency (Cronbach's α = 0.870) and correlated significantly with anxiety and depression measurements. Moreover, it was able to discriminate between study groups (members and non-members of peer support groups) and proved construct validity.

CONCLUSIONS

The SPS-FA is the first scale for the assessment of the interaction of biopsychosocial factors on FA that includes the patient-caregiver dyad. Its application might be relevant for future research, and it can provide the clinician and the researcher with a solid tool to define which type of psychosocial support is required to provide a more comprehensive care in FA.

The challenges of facilitating primary healthcare discussions on traditional, complementary and alternative medicine for childhood eczema: piloting a computerized template

OBJECTIVE

Healthcare practitioners (HCPs) experience barriers to changing routine consultation practice. Communication and recording of traditional, complementary and alternative medicines (TCAM) is inadequate. This pilot study explored the challenges of implementing a computerized template in primary care to facilitate communication on TCAM for paediatric eczema.

METHODS

A computerized template to record TCAM use, with links to evidence-based TCAM databases, was designed, based on qualitative research with patients and HCPs. Four London general practices implemented the template integrated with usual practice. Twelve focus groups during the 6 month study period explored HCPs' knowledge, communication and information sources regarding TCAM and perceived barriers to template implementation.

RESULTS

HCPs were initially enthusiastic about discussing TCAM, for improving communication and understanding patient's choices, but the template was used in under a third of consultations. HCPs were surprised at low TCAM use (10%) and lack of correlation with eczema or ethnicity. Reported barriers were time and remembering, due to busy, target-driven practice.

CONCLUSION

HCPs recognize the importance of discussing TCAM use for childhood eczema, and potential benefits for HCP-patient communication.

PRACTICE IMPLICATIONS

Future tools to facilitate TCAM discussion should prioritise use of existing IT systems and address barriers to use, especially lack of time.

Eczema and sleep and its relationship to daytime functioning in children

Chronic childhood eczema has significant morbidity characterised by physical discomfort, emotional distress, reduced child and family quality-of-life and, of particular note, disturbed sleep characterised by frequent and prolonged arousals. Sleep disturbance affects up to 60% of children with eczema, increasing to 83% during exacerbation. Even when in clinical remission, children with eczema demonstrate more sleep disturbance than healthy children. Notably, disturbed sleep in otherwise healthy children is associated with behavioural and neurocognitive deficits. Preliminary evidence suggests that disturbed sleep in children with eczema is also associated with behavioural deficits while the impact on neuropsychological functioning remains unexplored. In conclusion, a disease which affects up to 20% of children in some countries and may produce long-term behavioural and neurocognitive deficits merits further evaluation using standardised tests of sleep, behaviour and neurocognition.

Allergy from infancy to adolescence. A population-based 18-year follow-up cohort

BACKGROUND

Anxious parents have many concerns about the future health of their atopic infants. Paediatricians and primary care practitioners need to seek knowledge on long-term outcomes in order to cope with the increasing caseload of suspected allergy and the concerns of parents. The aim of the study was to assess suspected and diagnosed allergy in infancy as predictors of allergy and asthma in adolescence.

METHODS

Families expecting their first baby and making their first visit to a maternity health care clinic in 1986 were selected as the study population in a random sample. There were 1278 eligible study families. The data were provided of the children at the ages of 9 and 18 months and 3, 5, 12, 15 and 18 years by health care professionals, parents, and adolescents (themselves).

RESULTS

At the age of 9 months, the prevalence of allergy suspicions was distinctly higher than that of allergy diagnoses. At the age of five years suspected allergy approaches were nil, and the prevalence of diagnosed allergy was about 9%. During the adolescence, the prevalence of self-reported allergy increases steadily up to the age of 18 years, and that of asthma remains at approximately 5%. Suspected allergy at the age of 9 or 18 months and at the 5 years of age does not predict allergy at adolescence. Compared with non-allergic children, children with definite allergy at the age of 5 were over 8 times more likely to have allergy and nearly 7 times more likely to have asthma in adolescence.

CONCLUSION

An early ascertained diagnosis of allergy, but not suspicions of allergy, predicts prevailing allergy in adolescence. Efforts need to be focused on accurate diagnosis of early childhood allergies.

Organizing allergy and being a `good' parent: parents' narratives about their children's emerging problems

The article focuses on the early and problem-solving phases of the child's illness trajectory and on how child allergies are constructed and organized by the parents in a moral everyday context. The parents' narratives were reconstructed as narratives, describing the pathways parents take before they decide to seek professional medical aid as well as showing how they construct themselves as responsible parents. Before consulting health professionals the parents have often tried a range of different ways to define, control and manage their children's various problems. Allergy problems were interpreted and responded to differently, depending on the way they emerged in everyday life. Acute reactions quickly led to an illness definition and a diagnosis. Gradual and diffuse problems were not so easily defined. They were at first interpreted and responded to as normal infant problems, but, through the parents' readiness and various situational and temporal clues, they were organized as symptoms of illness . Parents seek medical aid when their own strategies fail or do not fully work, but their decisions are also formed within a pre-problem context of their moral accountability as parents.

Food hypersensitivity and quality of life

PURPOSE OF REVIEW

The present article presents an accessible review of research results on food hypersensitivity and quality of life (QoL), including 15 original articles on the subject.

RECENT FINDINGS

Research on food hypersensitivity and QoL covers children and their parents, adolescents and adults. Several domains of QoL are affected, such as family and social activities, emotional issues and family economy. Food-hypersensitive children are to a large extent limited in their autonomous social activities. Food-allergic adolescents have a higher number of weeks absent from school compared with a control group, and a relatively high percentage of food-allergic young adults do not participate in the labour market. Comorbidity has to be taken into consideration when assessing QoL in food-hypersensitive individuals. Research on gender differences in food hypersensitivity and QoL are scarce.

SUMMARY

Although development in this research field has only just begun, it is obvious that food hypersensitivity has a significant impact on individuals' and families' QoL. An important advance is the disease-specific QoL measure instruments that have been created. There is still, however, a need for a more in-depth knowledge as a basis for further development of QoL instruments, and as a basis for societal interventions and family/individual support.

Avaliação dos sintomas emocionais e comportamentais em crianças portadoras de dermatite atópica

INTRODUÇÃO: A dermatite atópica (DA) é uma doença inflamatória crônica da pele que apresenta um impacto significativo na qualidade de vida dos pacientes, em conseqüência de episódios recorrentes durante a vida. Considerando estudos recentes que descrevem a associação entre aspectos psicológicos e DA, acredita-se que a investigação da existência de um possível perfil comportamental destas crianças possa auxiliar o desenvolvimento de intervenções psicoterápicas específicas, assim como aumentar o conhecimento sobre a doença. MÉTODOS: Este trabalho tem como objetivo realizar uma avaliação do perfil sociocomportamental de crianças portadoras de DA, comparando-as com crianças sem a doença. Neste estudo, do tipo caso-controle, foram incluídos dois grupos com idades entre 4 e 18 anos: o grupo-estudo, com pacientes portadores de DA que consultam no ambulatório do Hospital de Clínicas de Porto Alegre (HCPA), e o grupo-controle, composto por crianças e adolescentes sem doença dermatológica, matriculados em escola da rede pública de Porto Alegre. O tamanho estimado da amostra foi de 25 indivíduos em cada grupo. A coleta dos dados realizou-se através do Child Behavior Checklist (CBCL), validado no Brasil com o nome de Inventário de Comportamento da Infância e Adolescência. RESULTADOS: Foram encontradas diferenças estatisticamente significativas nas duas dimensões globais (internalização e externalização), sendo que as crianças portadoras de DA mostraram mais sintomas relacionados com ansiedade, depressão, alterações de pensamento e comportamento agressivo quando comparadas com crianças sem a doença. CONCLUSÃO: Os resultados demonstram a necessidade de abordagens interdisciplinares no tratamento da criança com DA, valorizando não só as lesões dermatológicas, como também os aspectos emocionais dos indivíduos.

The information needs and preferred roles in treatment decision-making of parents caring for infants with atopic dermatitis: a qualitative study

BACKGROUND

Information needs and preferences in treatment decision-making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information-giving and involvement of health-care users in treatment decisions.

OBJECTIVE

To explore information needs and decisional role-preferences of parents caring for infants with AD.

METHODS

Qualitative study. Purposive sample: 31 parents caring for infants with AD. Tape-recorded focussed conversation-style interviews. Interview topic-guide literature-derived. Control Preferences Scale (5 sort-card vignettes 'very active' to 'very passive' role) adapted for use with parents; used to facilitate discussion. Thematic analysis of verbatim transcripts.

RESULTS

Nine core information needs identified: AD-causation, role of diet, medication-use, medication-side-effects, exacerbating factors, new/alternative medication, nonpharmacological treatments, AD-prevention, AD and other atopic conditions. Parents desired verbal and written information. Many felt their baby's condition was not taken seriously, leading to delayed diagnosis and treatment. They had to be more active than they wished to obtain information/treatment. Parents preferred sharing decisions with their doctor.

CONCLUSIONS

Parents caring for infants with AD have clearly defined, unmet information needs, forcing them into more active roles in the treatment decision-making process than they desire. The study-findings may inform the development of written information specifically for these parents and improve partnership during consultations.

Monitoring of IgE-mediated food allergy in childhood

BACKGROUND

The prevalence of IgE-mediated food allergy (FA) in childhood varies from 6% to 8% in the first year of life compared to 1% to 2% in adults. In contrast to adults, FA in childhood, often part of the "allergic march", resolves in more than 85% of children, especially those with hypersensitivity to cow's milk and egg.

AIM

This paper explains the rationale for continuing care for childhood FA and describes how children should be monitored for resolution/persistence of FA.

METHODS

A clinical, multidisciplinary approach and management algorithm based on relevant, peer-reviewed original research articles and reviews using the keywords anaphylaxis, atopic eczema, children, milk allergy, double-blind placebo-controlled food challenge, egg allergy, epinephrine, failure to thrive, food allergy, food challenge, food hypersensitivity, immunoglobulin E, nutrition, natural history, paediatrics, peanut allergy, prevalence, psychosocial factors, quality of life, radioallergosorbent test, and tolerance from years 1966 to 2003 in MEDLINE. Additional studies were identified from article reference lists.

RESULTS

A combination of outcome measures, a multidisciplinary approach involving a dietitian and allergy nurse specialist, and a management algorithm are useful tools in clinical management.

CONCLUSIONS

Prospective studies of non-selected children, optimally from birth cohorts, are needed to evaluate the effects of such management programmes regarding FA in childhood.

Evaluation of a parental training program for the management of childhood atopic dermatitis

Atopic dermatitis (AD) in childhood is a common disease with prevalence rates as high as 20%. Its early onset in infancy and its chronic relapsing course puts a special burden on families. Supporting parents in dealing with the management of AD presents a challenge for physicians. The objective of this study was to determine the effect of a structured parental training program on managing AD in children. Two-hundred and four families participated in a prospective, randomized controlled trial. Children (5 months to 12 years in age) had suffered from moderate-to-severe AD for at least 4 months. They were randomly assigned to either the intervention group or a waiting, control group who could participate in the training program 1 year later. The intervention was an inter-disciplinary, structured educational program which covered medical, nutritional, and psychological issues in six group sessions of 2 h each. The families were assessed at the beginning of the study and 1 year later. Main outcome measures were: severity of eczema (SCORAD); treatment habits; treatment costs; quality of life; and coping strategies. Significant effects were shown regarding treatment behavior, such as regular use of emollients, use of antiseptics and topical steroids in the event of exacerbation, and a reduction in the use of unconventional therapies. Satisfaction with medical treatment was improved, and rumination as an ineffective coping strategy was reduced. Finally, significant reduction of treatment costs was achieved. We conclude that structured training programs for parents of children with AD is a helpful adjunct to dermatological treatment.