The influence of parenting on early childhood health and health care utilization

Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization

INTRODUCTION

Scant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART - a technology-assisted intervention for parents of adolescents in residential treatment - was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization.

METHOD

The study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization.

RESULTS

Both the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization.

CONCLUSION

Residential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.

Emergency Department Visits During Pregnancy

STUDY OBJECTIVE

Pregnant women often seek care in an emergency department (ED). We sought to describe the frequency, characteristics, and factors associated with increased ED visits during pregnancy.

METHODS

We conducted a retrospective cohort study using administrative health data of all pregnancies resulting in a live birth at 20 or more weeks of gestation in Alberta, Canada, from 2011 to 2017. The primary outcome was the occurrence of any ED visit during pregnancy. The secondary outcomes were ED visit characteristics and discharge disposition. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for associations between sociodemographic and clinical factors and increased ED visits during pregnancy using random-effect negative binomial regression adjusting for multiple pregnancies per person during the study period.

RESULTS

We included 255,929 pregnancies from 193,965 women. Of all the pregnancy episodes followed, 37.3% (95% CI 37.1 to 37.5) had at least 1 ED visit, resulting in a total of 226,811 ED visits and an overall ED visit rate of 94.0 visits per 100 pregnancies (95% CI 93.6 to 94.3). Most visits were nonobstetric (46.4%) and resulted in ED discharge (85.3%). Increased ED visits were associated with living in remote (RR 6.9; 95 %CI 6.7 to 7.1) or rural (RR 3.4; 95% CI 3.4 to 3.5) areas, younger age (RR 1.9; 95% CI 1.8 to 2.0), intensive prenatal care (RR 1.5; 95% CI 1.5 to 1.5), major/moderate health conditions (RR 1.6; 95% CI 1.6 to 1.6), mental health conditions (RR 1.6; 95% CI 1.5 to 1.6), and high antepartum risk score (RR 1.1; 95% CI 1.1 to 1.1).

CONCLUSION

Approximately 1 in 3 women in our sample visited the ED during pregnancy. A higher number of visits occurred in those with rural/remote residence, younger maternal age, and concomitant health conditions.

Influence of parental behavior on myopigenic behaviors and risk of myopia: analysis of nationwide survey data in children aged 3 to 18 years

Background

Preventive parental behavior may play an important role in the outcomes of children’s myopia. We investigated associations between parental behavior and children’s myopia status and daily activities using data from the most recent myopia survey in Taiwan.

Methods

In total, 3845 children aged 3 to 18 years who completely responded to the questionnaire were included (total score ranging from 0 to 75). A score of ≥ 50 was considered to indicate beneficial parental behavior. Time allocation data for near-work activities, using electronic devices, and outdoor activities were collected using a separate self-reported questionnaire. Associations between beneficial parental behavior and children’s myopia status and activity patterns were analyzed and stratified by school level.

Results

Beneficial parental behavior was positively associated with children’s myopia in the overall samples [adj. odds ratio (OR): 1.31, 95% confidence interval (CI): 1.08–1.59, p = 0.006)] and at the elementary school level (adj. OR: 1.43, 95% CI: 1.11–1.83, p = 0.005). However, a negative association with high myopia was observed in the overall samples (adj. OR: 0.71, 95% CI: 0.50–0.99, p = 0.049) and high school level (adj. OR: 0.62, 95% CI: 0.41–0.92, p = 0.02). Beneficial parental behavior was associated with less time spent on near work (≥ 180 min/day) and electronic device use (≥ 60 min/day), but not with outdoor activities.

Conclusion

In Taiwan, children’s myopia is associated with higher rate of parents’ beneficial behaviors, which suggests that regular vision surveillance is necessary to promote better parental behavior toward children’s eye care. Certain parental practices may influence children’s behavior pattern and reduce the risk of children’s high myopia development in the long run.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14036-5.

Case Report: ASI intervention on a child with autism in Saudi Arabia

Background: Ayres Sensory Integration (ASI) is widely employed by occupational therapists working with clients who experience challenges in sensory integration, including those with autism spectrum disorder (ASD). However, there is a dearth of research examining the feasibility of ASI outside of Western nations. This study documented the barriers associated with ASI in Saudi Arabia and assessed whether the intervention could improve process and participation skills. Methods: Single-Subject experimental design was used. The participant was a 4-year-old girl with ASD from Saudi Arabia. Data were gathered on sensory processing, motor skills, and participation in activities of daily living. The study used semi-structured interviews and assessments (Sensory Integration and Praxis Tests, the Sensory Processing Measure-Preschool, and the Peabody Developmental Motor Scale-2) to develop goals, identify outcome measures, and plan an ASI intervention. Results: Despite the limited availability of resources (e.g., toys, treatment spaces) and Arabic measures, improvements were observed on motor and sensory tasks and in occupational performance. Conclusion: ASI that adheres to the ASI fidelity tool can be of value for Saudi Arabian children with ASD. Additionally, the study provides a stepping-stone to further research for occupational therapists in Saudi Arabia working with children with ASD.

Case Report: ASI intervention on a child with autism in Saudi Arabia

Background: Ayres Sensory Integration (ASI) is widely employed by occupational therapists working with clients who experience challenges in sensory integration, including those with autism spectrum disorder (ASD). However, there is a dearth of research examining the feasibility of ASI outside of Western nations. This study documented the barriers associated with ASI in Saudi Arabia and assessed whether the intervention could improve process and participation skills. Methods: A pre-test/post-test case study design was used. The participant was a 4-year-old girl with ASD from Saudi Arabia. Data were gathered on sensory processing, motor skills, and participation in activities of daily living. The study used semi-structured interviews and assessments (Sensory Integration and Praxis Tests, the Sensory Processing Measure-Preschool, and the Peabody Developmental Motor Scale-2) to develop goals, identify outcome measures, and plan an ASI intervention. Results: Despite the limited availability of resources (e.g., toys, treatment spaces) and Arabic measures, improvements were observed on motor and sensory tasks and in occupational performance. Conclusion: ASI that adheres to the ASI fidelity tool can be of value for Saudi Arabian children with ASD. Additionally, the study provides a stepping-stone to further research for occupational therapists in Saudi Arabia working with children with ASD.

Are Family Physical Activity Habits Passed on to Their Children?

Studies of the familial association of physical activity (PA) and sedentary behavior (SB) have increased in recent years. However, there is a lack of studies that have objectively examined the correlates between parents, grandparents, and childrens' PA. Therefore, the purpose of this study was to measure PA using accelerometers to determine the extent to which PA and SB correlate among parents, grandparents, and children. A sample of 169 children between 11 and 14 years (77 boys and 97 girls), 225 parents (98 males and 127 females), and 52 grandparents (16 males and 36 females) were recruited for the current study. Accelerometers RM42 (UKK Terveyspalvelut Oy, Tampere, Finland) were used to determine PA levels of children, parents, and grandparents. Epoch length was 6 s. Mothers' moderate-to-vigorous PA (MVPA) was associated with children's MVPA (p < 0.05). After adjusting for age, BMI (child), and educational status, the results remain the same. Results of linear regression analyses for boys' sedentary time showed that fathers' sedentary time was significantly associated with boys (p < 0.01), but not with girls. The association of grandmothers' and grandfathers' MVPA activity with that of children showed that grandparents' MVPA, when adjusted for age, BMI, and educational status, was not a significant predictor (p > 0.05) of children's MVPA (total sample). In contrast, grandfathers' sedentary behavior was a significant predictor (β = 0.269; p < 0.05) of children's sedentary behavior (total sample). The results of the current study suggest that parental involvement in PA, particularly by mothers, is important for children's PA and, accordingly, healthy outcomes.

Male reproductive health and intergenerational metabolic responses from a small RNA perspective

The world has recently experienced a decline in male reproductive (e.g. sperm counts and motility) and metabolic (e.g. obesity and diabetes) health. Accumulated evidence from animal models also shows that the metabolic health of the father may influence the metabolic health in his offspring. Vectors for such paternal intergenerational metabolic responses (IGMRs) involve small noncoding RNAs (sncRNAs) that often increase in spermatozoa during the last days of maturation in the epididymis. We and others have shown that the metabolic state - depending on factors such as diet, obesity and physical exercise - may affect sperm quality and sperm sncRNA. Together, this suggests that there are overlapping aetiologies between the male metabolic syndrome, male factor infertility and intergenerational responses. In this review, we present a theoretical framework for an overlap of these aetiologies by exploring the advances in our understanding of the roles of sncRNA in spermatogenesis and offspring development. A special focus will lie on novel findings about tRNA-derived small RNA (tsRNA), rRNA-derived small RNA (rsRNA) and small mitochondrial RNA (mitoRNA), and their emerging roles in intergenerational metabolic and reproductive health.

Insurance Coverage and Health Care Utilization Among Asian Youth Before and After the Affordable Care Act

OBJECTIVE

We examined changes in insurance coverage and health care utilization associated with the Affordable Care Act (ACA) among subgroups of Asian youth relative to non-Latino white youth.

METHODS

Data were from the 2010 to 2017 American Community Survey and National Health Interview Survey. Difference-in-difference models were used to examine changes in insurance coverage and health care utilization associated with the ACA among subgroups of Asian youth relative to white youth and subgroups of Asian youth in households below 200% of the federal poverty level relative to comparable white youth.

RESULTS

Since the implementation of the ACA, insurance coverage increased among all Asian subgroups and white youth. The magnitude of the increase in insurance coverage was larger among Asian subgroups than white youth. More pronounced increases were found among almost all Asian subgroups in households below 200% federal poverty level. Changes in health care utilization were limited and varied by subgroup. Increases in well-child visits were observed only among Chinese and "other" Asian youth.

CONCLUSIONS

Insurance coverage increased among Asian youth after the implementation of the ACA. Improvements in health care utilization were limited and differed by subgroups. Programs to improve health care utilization should be tailored to Asian youth according to subgroup.

Parenting practices and oral health status in rural areas in Egypt: a household survey

Background

Parenting practices influence children’s health and development. The present study assessed the association between parenting practices and oral health status of children living in rural areas in Egypt.

Methods

A cross-sectional household survey including 190 households and 392 children was conducted from May 2019 to January 2020 in four villages in Egypt. Data were collected through clinical examination and interview-based questionnaires of children. Clinical examination assessed caries (DMFT and dft), oral hygiene and gingival condition. Parenting practices were assessed using the short version of the Alabama Parenting Questionnaire (APQ) and oral health practices were assessed using the WHO questionnaire-child form. Four linear regression models were used to assess the relationship between four outcome variables (oral health indicators: (DMF, df, plaque and gingival indices) and parenting practices and oral health behaviors (exposure) after adjusting for potential confounders. Regression coefficients (B), 95% confidence intervals (CI) and model adjusted R² were calculated.

Results

Complete questionnaires and clinical data were available for 392 children (response rate = 86.34%). The mean (SD) age = 9.93 (3.05) with 54.60% females. Most children (67.60%) had caries in their primary teeth, mean ± SD of df = 2.94 ± 3.10, while only 27.30% had caries in their permanent teeth, mean DMF ± SD = 0.57 ± 1.13. There was a statistically significant difference between parenting practices of both fathers and mothers (p < 0.001, < 0.001, < 0.001, 0.008 and < 0.001 for the five parenting constructs). The adjusted R² of the models that included parenting practices (for DMF = 0.168, for df = 0.400, for plaque index = 0.061 and for gingival index = 0.090) were similar to the models that included oral health behaviors (for DMF = 0.197, for df = 0.421, for plaque index = 0.059 and for gingival index = 0.084).

Conclusion

The association between oral health status and parenting practices which- although not statistically significant- was similar in impact to that between oral health behaviors and oral health status, highlighting the importance of parenting practices to oral health.

Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand

OBJECTIVES

Children's exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association.

DESIGN

Cross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 child-primary caregiver dyads; 2011/2012: n=4420 dyads).

MAIN OUTCOME MEASURES

Children's unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child's medical centre.

RESULTS

The prevalence of reporting 'any' experience of racism was higher among caregivers of indigenous Māori and Asian children (30.0% for both groups in 2006/2007) compared with European/Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child's healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child's medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose-response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 1 report of racism, OR=1.89, 95% CI 1.34 to 2.67; 2+ reports of racism, OR=3.06, 95% CI 1.27 to 7.37). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation.

CONCLUSIONS

Vicarious racism is a serious health problem in New Zealand disproportionately affecting Māori and Asian children and significantly impacting children's healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation.

The Parenting Journey: Daily Parental Management in Families with Young Children

Transitioning to parenthood and establishing a family are significant life events, and although an expected and normal part of adult life, it is a time of stress, change, and learning. The family has been well-studied with regard to developmental norms and the diagnosis and treatment of physical, cognitive, and emotional problems. However, little is known about how parents of young children establish, manage, and maintain their families on a daily basis. Social constructivist grounded theory was used to examine day to day parental management in families with young children. A theory, adjusting and redefining priorities, was developed to explain how parents make decisions related to the health and well-being of family members. A group of 24 New Zealand parents was interviewed about their daily management in families where the eldest child was aged no older than 3 years. Findings of this study revealed that parents used 4 overarching and constantly interacting viewpoints to consider situations: the personal, the parent, the parent unit, and the family unit. Their learning went through cycles of intensity and relaxation as parents considered their short term and long term priorities. Sometimes major changes to family structures and processes were required to maintain family stability, and sometimes the adjustments needed were relatively minor. These dimensions contributed to parents' continuous efforts to meet the needs of all family members and to create a unique family environment that encompassed the guiding principles upon which parents made their decisions. This study highlights the need for health professionals to recognize the unique, complex and dynamic decision-making process parents are already engaged in when managing their families.

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

INTRODUCTION

Unscheduled reattendances at the paediatric emergency department may contribute to overcrowding, which may increase financial burdens. The objectives of this study were to determine the rate of reattendances and characterise factors influencing these reattendances and hospital admission during the return visits.

METHODS

Medical records of all patients who attended the emergency department at KK Women's and Children's Hospital, Singapore, from 1 June 2013 to 31 May 2014 were retrospectively reviewed. We collected data on patient demographics, attendance data and clinical characteristics. Planned reattendances, recalled cases, reattendances for unrelated complaints and patients who left without being seen were excluded. A multivariate analysis was conducted to determine the odds ratio of variables associated with hospital admission for reattendances.

RESULTS

Of 162,566 children, 6,968 (4.3%) returned within 72 hours, and 2,925 (42.0% of reattendance group) were admitted on their return visits. Children more likely to reattend were under three years of age, Chinese, triaged as Priority 2 at the first visit, and were initially diagnosed with respiratory or gastrointestinal conditions. However, children more likely to be admitted on their return visits were over 12 years of age, Malay, had a higher triage acuity or were uptriaged, had the presence of a comorbidity, and were diagnosed with gastrointestinal conditions.

CONCLUSION

We identified certain subgroups in the population who were more likely to be admitted if they reattended. These findings would help in implementing further research and directing strategies to reduce potentially avoidable reattendances and admissions.

A Survey of Parents' Perceptions and Use of Time-out Compared to Empirical Evidence

OBJECTIVE

To assess parents' perceptions and use of time-out (TO) in contrast to empirical indications and examine the relationship between reported implementation procedures and perceived effectiveness.

METHODS

We surveyed parents of preschool and school-age children (n = 401, aged 15 months to 10 years) at well-child visits with regard to their awareness, perception, and usage of TO. Parents were specifically surveyed regarding TO components that have been empirically evaluated or pertain directly to its underlying behavioral principles. Descriptive analyses, group comparisons, and correlational analyses were used to characterize responses and evaluate the relationship between TO administration variation and perceived effectiveness.

RESULTS

Most parents (76.8%) reported using TO in response to misbehavior, but a large majority of these parents (84.9%) reported implementing TO in a manner counter to empirical evidence. Parents who endorsed TO as effective varied significantly from those who did not on key implementation components (eg, use of a single warning). Further, several reported implementation practices were correlated with perceived effectiveness and challenging child behavior. For example, requiring a child to be calm before ending TO was positively correlated with perceived effectiveness.

CONCLUSIONS

These results cement TO as a widely disseminated practice but cast doubt on the fidelity with which it is typically implemented. Better methods of educating parents on evidence-based discipline are needed.

Diabetes IN develOpment (DINO): the bio-psychosocial, family functioning and parental well-being of youth with type 1 diabetes: a longitudinal cohort study design

Background

Strict glycemic control during adolescence decreases the risk of developing complications later in life, even if this level of control is not maintained afterwards. However, the majority of adolescents with type 1 diabetes (T1D) are in poor control and so far medical or psychological interventions have shown limited success. Adolescence is characterized by major biological, psychosocial, cognitive and parent–child relationship changes and the complex interaction between these developmental trajectories, and its impact on health outcomes is still poorly understood. A specific topic of interest in this context is the timing of diagnosis. The longitudinal study DINO (Diabetes IN develOpment) aims to examine:

If and how the onset of T1D before vs. during puberty results in different outcomes of glycemic control, self-management, psychological functioning and diabetes-related quality of life.

The timing of onset of disturbed eating behavior, its risk factors and its prospective course in relation to glycemic and psychological consequences.

If and how the onset of T1D before vs. during puberty results in different family functioning and parental well-being.

If and how the cognitive development of youth with T1D relates to glycemic control and diabetes self-management.

Methods/design

DINO, a longitudinal multi-center cohort study is conducted in youth with T1D in the age range 8–15 years at baseline. Participants will be divided into two subgroups: pre-pubertal and pubertal. Both groups will be followed for 3 years with assessments based on a bio-psychosocial model of diabetes, scheduled at baseline, 12 months, 24 months and 36 months examining the biological, psychosocial -including disturbed eating behaviors- and cognitive development, family functioning and parental well-being.

Discussion

A better understanding of how the different trajectories affect one another will help to gain insight in the protective and risk factors for glycemic outcomes and in who needs which support at what moment in time. First results are expected in 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0400-1) contains supplementary material, which is available to authorized users.