Anxiety and uncertainty in Korean mothers of children with febrile convulsion: cross-sectional survey

The effect of an educational program on illness uncertainty in mothers of children with type 1 diabetes: a quasi-experimental study

The mother is traditionally the primary caregiver for the child, and uncertainty is a major source of psychological distress for parents of sick children. As a result, the current study sought to investigate the impact of an educational program on illness uncertainty in mothers of children with insulin-dependent diabetes mellitus (IDDM). This is a quasi-experimental study with a pretest-posttest design, involving 40 mothers of children with IDDM. After visiting the research site and recruiting eligible mothers, the researcher used the purposive sampling method to randomly assign them to one of two intervention and control groups. Taking into account their needs and conditions, mothers were scheduled for at least three sessions, with a 30-minute interval every other day. The data analysis revealed no significant differences between the two groups in terms of child age and gender, mother age and education level, number of children, and duration of diabetes. There was a significant difference in the total score of uncertainty, total score of ambiguity, lack of clarity, lack of information, unpredictability, and their dimensions between mothers of diabetic children before and after the intervention (P=0.02). Based on the findings, it is recommended that the educational needs of children and their mothers be assessed upon admission and that educational content be prepared and taught accordingly, thereby helping to reduce illness uncertainty in mothers.

The non-clinical burden of febrile seizures: a systematic review

Febrile seizures (FS) can be frightening for parents, even though they are usually harmless. Various questionnaires have been used to assess parental reactions and awareness about FS, revealing insufficient knowledge. Studies have shown that educational interventions significantly reduce parental concerns, improve knowledge, and promote better first-aid measures. Providing clear information and emotional support to parents is important to reduce their concerns and improve FS management. Healthcare providers should give comprehensive information about FS, including the risk of recurrence, and provide clear instructions on their management. The economic impact of FS includes direct and indirect costs. Studies have shown a decrease of hospitalizations and associated costs due to improved clinical adherence to guidelines, which also reduces the inappropriate use of healthcare resources. This systematic review provides a comprehensive overview of the existing literature on parental anxiety and education about FS, as well as their economic impact, aiming at identifying areas for improvement in the management of FS and providing valuable insights for healthcare providers and policymakers to better address the non-clinical burden of this condition.

Korean Childcare Providers' Knowledge, Attitudes, Concerns, and Practices of Febrile Convulsions

With the increase in the number of childcare facilities, childcare providers’ coping skills to take quick action in emergencies have become crucial. This study was to examine Korean childcare providers’ knowledge, attitudes, concerns, and practices regarding febrile convulsions (FCs), and to identify factors influencing their management of FCs. A cross-sectional study was conducted using a questionnaire of 216 Korean childcare providers. Descriptive statistics were used to describe the sample characteristics and FC questionnaires. The differences in the FC practice by demographic variables were assessed using t-test and one-way analysis of variance. The relationships between FC practice and other variables were investigated using Pearson correlations and regression analysis. The childcare providers showed unfavorable levels of outcomes regarding FCs with a low percentage of correct answers on FC knowledge and recommended practices as well as negative attitudes and concerns toward FCs. Additionally, results indicated that the knowledge, education, attitudes toward, and actual experiences of FCs were related to FC practices. The current findings provide important evidence to develop interventions targeting childcare providers.

Predictors of uncertainty in parents of children living with chronic conditions

BACKGROUND

Uncertainty in illness implies no meaning has been attributed to an illness event. Although many studies focus on this issue in adults, there is limited research into children with chronic illnesses. Parental uncertainty has been associated with increased risk of post-traumatic stress, which can in turn adversely affect child and parent coping strategies.

AIM

To identify the characteristics of parents who are at greater risk of uncertainty and the associated characteristics of their children's chronic illnesses.

METHOD

An exploratory, cross-sectional study design was adopted across three different sites in the United Arab Emirates. Data were collected from parents who accompanied their children, who were receiving treatment, using a validated, culturally adapted Parent Perception of Uncertainty Scale.

RESULTS

Scores for illness uncertainty ranged from 86.5 to 92.6, on a scale of 31-155, with higher scores indicating greater uncertainty. The highest scores were found in parents of children being cared for in ward settings who had previously been hospitalised, parents of children up to two years of age or those approaching adolescence, fathers, and parents whose first language was Arabic.

CONCLUSION

The groups of parents with the highest illness uncertainty may benefit most from interventions to improve communication and psychological support.

Prognostic factors for epilepsy following first febrile seizure in Saudi children

BACKGROUND

Febrile seizure is the most common convulsive event during childhood, but it is generally considered benign.

OBJECTIVES

To estimate the rate of epilepsy after first presentation of febrile seizure and to describe factors that can predispose children to have subsequent epilepsy after their first febrile seizure.

DESIGN

Retrospective chart review.

SETTING

A tertiary care center in Riyadh.

PATIENTS AND METHODS

All children whose first febrile seizure developed between 2009-2012, and who were admitted to the pediatric wards.

MAIN OUTCOME MEASURES

The rate of epilepsy and prognostic factors for epilepsy following first febrile seizure.

RESULTS

Of 109 febrile seizure patients, 6 (5.5%, 95% CI: 2.1% - 11.6%) were diagnosed with subsequent epilepsy 5 to 46 months after their first febrile seizure. The risk of having subsequent epilepsy was higher in children who were convulsing at a low-grade fever during their first febrile convulsion (P=.02). Moreover, delayed vaccination status (P=.03), prolonged duration of the first convulsion (P=.04), frequent febrile seizures (P=.01), and fever without documented infection (P=.03) during the first febrile convulsion were associated with epilepsy.

CONCLUSION

The rate of epilepsy following first febrile seizure in Saudi children is within the range of values reported in different populations. Although most childhood febrile seizures are self-limiting, careful observation is needed, particularly for children who exhibit factors associated with epilepsy.

LIMITATIONS

Conducted at a single center in Saudi Arabia, which may limit generalizability.

Evaluating the Reliability and Validity of the Arabic Version of the Parents Perceptions of Uncertainty Scale (A-PPUS)

BACKGROUND

Uncertainty often accompanies illness and may be a major aversive component of the patients' treatment process. There is evidence that parental uncertainty has a negative impact on their own and on their child's coping strategies and may affect family functioning. Key to the provision of competent care, to address uncertainty, is the use of an appropriate validated assessment tool to understand key parental concerns. The 'Parent Perception of Uncertainty Scale' (PPUS) has been widely used for this purpose.

AIM

This study reports on the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A-PPUS).

METHODS

The scale was translated to Arabic using the translation-back-translation method. Appropriate statistical tests were performed including measurements of internal consistency, item to total scale correlation, and univariate and multivariate analyses.

RESULTS

The study included 240 parents of children with chronic illnesses. Cronbach's alpha coefficient of the whole scale was 0.93. All the items were positively correlated to the total score. The univariate and multivariate analysis supported the previous tests and the assertion that the Arabic version of the PPUS provided a relevant measure of the uncertainty level.

CONCLUSION

This study has identified that the A-PPUS is a reliable tool for parent report of their uncertainty, in the UAE and Arabic population.

The quality of information received by parents of children with chronic ill health attending hospitals as indicated by measures of illness uncertainty

BACKGROUND

The effectiveness of communication can be defined in terms of one of its outcomes: the uncertainty that it eliminates. Clear unambiguous communication is important for the parents of children to help them understand problems, explore alternative solutions and help make decisions. Persistent uncertainty is known to produce anxiety, unpredictable responses, emotional distress and poor quality of life. The uncertainty experienced by parents is one indicator of quality in the healthcare system which could have diagnostic and predictive value.

AIM

To assess the uncertainty experienced by parents of children with chronic conditions in the United Arab Emirates (UAE).

DESIGN

An exploratory descriptive, cross-sectional design was chosen across different sites in the UAE.

METHODS

Data were collected from parents accompanying children receiving treatment either as an inpatient or outpatient, using the previously validated, culturally adapted 'Parent Perception of Uncertainty Scale' (PPUS).

RESULTS

Most study participants experienced moderate or high levels of uncertainty. Parents who did not speak the local language, whose child was less than 1 year old or who was acutely ill had significantly more uncertainty than others, as did those parents whose child was approaching adolescence and puberty.

CONCLUSIONS

As only 5% of all participants reported low levels of uncertainty this should be of major concern as both an indicator of the quality of communication between health professionals and parents, and of the adverse health effects and poor quality of life experienced by parents of patients with chronic illness.

Epilepsy in children with a history of febrile seizures

PURPOSE

Febrile seizure, the most common type of pediatric convulsive disorder, is a benign seizure syndrome distinct from epilepsy. However, as epilepsy is also common during childhood, we aimed to identify the prognostic factors that can predict epilepsy in children with febrile seizures.

METHODS

The study comprised 249 children at the Korea University Ansan Hospital who presented with febrile seizures. The relationship between the subsequent occurrence of epilepsy and clinical factors including seizure and fever-related variables were analyzed by multivariate analysis.

RESULTS

Twenty-five patients (10.0%) had additional afebrile seizures later and were diagnosed with epilepsy. The subsequent occurrence of epilepsy in patients with a history of febrile seizures was associated with a seizure frequency of more than 10 times during the first 2 years after seizure onset (P<0.001). Factors that were associated with subsequent occurrence of epilepsy were developmental delay (P<0.001), preterm birth (P=0.001), multiple seizures during a febrile seizure attack (P=0.005), and epileptiform discharges on electroencephalography (EEG) (P=0.008). Other factors such as the age at onset of first seizure, seizure duration, and family history of epilepsy were not associated with subsequent occurrence of epilepsy in this study.

CONCLUSION

Febrile seizures are common and mostly benign. However, careful observation is needed, particularly for prediction of subsequent epileptic episodes in patients with frequent febrile seizures with known risk factors, such as developmental delay, history of preterm birth, several attacks during a febrile episode, and epileptiform discharges on EEG.

Implications for Advanced Practice Nurses When Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) Is Suspected: A Qualitative Study

INTRODUCTION

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a relatively new but controversial diagnosis affecting hundreds of children and their families. It is generally thought to be an autoimmune disorder resulting from a streptococcal infection that causes significant and bizarre behavioral changes in children. Currently no definitive diagnostic or treatment modalities exist, which has led to misdiagnoses, ineffective treatments, and delayed care.

METHODS

A qualitative study was conducted that included 60 families with at least one child diagnosed with PANDAS. The purpose was to explore how families experience the disorder and what nurses can do to provide effective care.

RESULTS

Using paradigmatic analysis of transcribed interviews, three themes were identified: fear, frustration, and not being heard.

DISCUSSION

Results from this study suggest that more information is needed to better understand this challenging phenomenon from both medical and nursing perspectives. The study also reaffirms the importance of practicing the art of nursing, especially when the science is not yet established.

Predictors of maternal state anxiety on arrival at a Japanese hospital outpatient clinic: a cross-sectional study

AIMS AND OBJECTIVES

To identify the factors that predict maternal state anxiety when mothers and their sick children visit the outpatient unit of a paediatric hospital.

BACKGROUND

While previous studies have focused on predictors of anxiety in mothers with ill children, the existing literature is limited in study design, research timing, respondent characteristics, sample size and data analysis.

DESIGN

A cross-sectional design with self-administered questionnaires.

METHODS

Mothers were recruited from the outpatient unit of a Japanese paediatric hospital (N = 1077). Participants' state anxiety scores were collected using the Japanese version of Spielberger's State-Trait Anxiety Inventory. The independent variables were the mothers' and sick children's background information.

RESULTS

Participants were 1077 mothers; 990 provided valid responses. Mothers' mean state anxiety score was 49·72. Significant predictors of maternal anxiety were mothers' childrearing anxiety, child age, the sick child having a fever, sick child having siblings, having a person providing childrearing support, the mother's first visit to the hospital, out-of-hours visit and severity of the child's illness. The overall model explained 21·6% of the variance (multiple regression analysis).

CONCLUSIONS

As various factors predicted maternal anxiety, identifying methods to address these factors may reduce maternal state anxiety.

RELEVANCE TO CLINICAL PRACTICE

There is potential for improved understanding of the predictors of maternal state anxiety to aid in the development of materials that would best measure anxiety. The present findings may also suggest some means of providing appropriate information and support to anxious mothers. Our findings cannot demonstrate causation, however, and teaching methods and supportive practices were not investigated; therefore, a qualitative study on the concrete content of maternal anxiety and an intervention study to create support services for anxious mothers is required. In addition, prospective or longitudinal studies are also important for investigating causation.

Commentary on 'prophylactic drug management for febrile seizures in children'

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD003031. DOI: 10.1002/14651858.CD003031.pub2.