Relationship between Patient, Caregiver, and Asthma Characteristics, Responsibility for Management, and Indicators of Asthma Control within an Urban Clinic

To assess child adherence to preventive asthma medications; to investigate relations between knowledge, reasoning about asthma, and responsibility for management and adherence; and to determine the association between adherence and morbidity. Participants were 106 children with asthma and their parents. Medication adherence was electronically monitored for 1 month. Participants completed self-report measures. Children were interviewed to assess reasoning about asthma. Children's adherence was approximately 48% of prescribed doses. Adherence was negatively related to age (r = -.21, p <.05); minority status, F(1, 98) = 7.55, p <.01; and morbidity (r = -.26, p <.01). Age was associated with increased child knowledge (r =.47, p <.001), reasoning about asthma (tau =.23, p <.01), and responsibility for asthma management (r =.44, p <.01). These variables were not associated with adherence. Although older children know more about asthma and assume more responsibility for disease management, their adherence is lower than that of younger children. No association was found between adherence and child knowledge, reasoning about asthma, or responsibility for asthma management.

Child, caregiver, and family characteristics associated with emergency department use by children who remain at home after a child protective services investigation

Family involvement in the planning and execution of mental health treatment has been shown to positively influence child outcomes; however, there is wide variability in the levels of involvement by families. The current study investigated the influence of child, family caregiver, service system, and community factors on the level of family involvement in the mental health treatment of children with severe emotional disturbances (SED). While prior work in this area has primarily focused on family and child characteristics, the current study adds to the knowledge base by also exploring factors associated with the quality of service delivery that may influence levels of family involvement. The current study is a secondary analysis of existing data from the Impact Study of Medicaid in Mississippi and Tennessee (Brannan & Heflinger, 2006) that used in-depth interviews with parents and case review ratings. One hundred thirty-six children and adolescents who received Medicaid coverage for mental health treatment in Mississippi and Tennessee were the focus of this study that assessed child and caregiver characteristics at the beginning of the study and rated service system factors six-month after the study began. Results of the multiple regression analysis revealed the quality of the service delivery system had the most influence on level of family involvement. Results suggest that levels of family involvement may have less to do with caregiver health, or other family characteristics, and more to do with the quality of the service delivery system.

12127 Background: Adult children caring for a parent with cancer comprise a significant segment of caregivers. Demographic trends indicate this caregiving population will grow as the baby boomer generation ages. Yet little is known about adult child caregivers’ needs and experiences and how they differ from the well-studied spousal caregiver. This knowledge gap may hinder efforts to ameliorate adult children’s caregiver burden and its impact on patients. Methods: We analyzed adult child and spousal/partner caregivers’ surveys from the Cancer Care Outcomes Research and Surveillance consortium, a multi-regional population-based study of approximately 10,000 persons with newly diagnosed colorectal and lung cancer. We used t-tests and a series of multivariate regression models to assess whether adult child and spousal caregivers’ caregiving responsibilities, social/emotional burden, and financial burden (scaled 0-10) differed and examined patient and caregiver characteristics’ mediation of variation in burden. Results: Compared to spouses/partners (N=1029), adult children (N=230) completed similar levels of caregiving tasks but spent less time (14 vs. 24 hours/week; p&lt;0.001). However, adult children experienced higher social/emotional burden (2.9 vs. 2.4; p&lt;0.01). In baseline models controlling for patient clinical factors, caregiving characteristics, and caregiver demographics, adult children’s average social/emotional and financial burdens were statistically higher than spouses/partners. Additional adjustment for caregivers’ childcare responsibilities and employment eliminated social/emotional and financial burden disparities. Additional adjustment to the baseline model for caregiver-patient gender concordance eliminated the social/emotional burden gap. Communication quality was a large and statistically significant predictor of both burdens (p&lt;0.001). Conclusions: Adult children spend less time caregiving than spouses/partners but experience higher caregiving burden. Adult children’s childcare and career responsibilities help explain this increased burden. Gender concordance between caregiver and patient may also contribute to social/emotional burden, adding important context to prior research indicating female caregivers experience the greatest burden. Interventions to improve communication between caregivers and patients have the potential to reduce both adult child and spouses/partners caregiver burden. Adjusted average caregiver burden for adult child and spousal caregivers. [Table: see text]

Asthma is one of the most prevalent chronic illnesses among children in the United States and it disproportionately affects members of minority groups living in low-income and urban environments. In these environments, illness-related stressors are often experienced alongside a variety of family and social stressors, and parents may carry significant additional caregiving responsibilities over and above their child's asthma management. Participants in the current study included 23 girls and 22 boys, all diagnosed with asthma and living in low-income, urban neighborhoods; 85% of participants were members of ethnic minority groups. This study utilized a family systems framework to examine links among parents' caregiving responsibilities, parent-child conflict, and asthma morbidity. Caregiving load refers to the number of children and adults for whom the parent endorsed caregiving responsibilities. Two indicators of asthma morbidity were assessed, including asthma-related restrictions in the family's activities and the child's asthma quality of life. The findings of this study suggested a pivotal role of parent-child conflict in predicting children's and families' asthma-related morbidity. Higher levels of parent-child conflict were directly associated with higher levels of family activity restriction. Interestingly, under conditions of high parent-child conflict, higher caregiving load was associated with lower pediatric quality of life, but under conditions of low parent-child conflict, higher caregiving load was associated with higher quality of life. Implications of these findings for asthma treatment programs are discussed.

Responsibility for Asthma Management Among Adolescents With and Without Attention-Deficit/Hyperactivity Disorder

To examine how asthma control is related to the association between the division of responsibility for asthma management and asthma-related quality of life among early adolescents. Forty-nine youth aged 10-15 years (Mage = 12.25, 57.1% female) with a physician-verified asthma diagnosis completed the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Asthma Control Test (ACT). Youth and their caregivers also completed the Asthma Responsibility Questionnaire (ARQ). Higher ACT scores indicate better asthma control. There was a significant difference in ARQ scores between youth and caregivers (p < .001, d = .94). Youth reported sharing equal responsibility for asthma management with caregivers, while caregivers reported having more responsibility relative to youth. Greater youth-reported ARQ (p = .004) and greater ACT scores (p < .001) were associated with higher PAQLQ scores. ACT scores moderated the effect of youth-reported ARQ on PAQLQ scores (p = .043). For youth with lower ACT scores, higher youth-reported responsibility was associated with higher PAQLQ scores; while for youth with higher ACT scores, PAQLQ scores were high regardless of perceived responsibility. The interaction between caregiver ARQ scores and ACT scores was not significant. This study suggests youth and caregivers report discrepant ARQ for asthma management tasks. Responsibility and level of asthma control are important factors for PAQLQ, with results indicating that fostering responsibility is an important factor, even among youth with poorly controlled asthma. Findings suggest that healthcare providers should assess family responsibility and help caregivers support adolescents in developing asthma management skills.

Parent-youth teamwork in pediatric asthma management

The replicability of the physical and mental component summary scores of the Short Form (SF)-36 has been established using the SF-12 in selected patient populations but has yet to be assessed in stroke patients. If the summary scores of the SF-12 are highly correlated with those of the SF-36, the benefits of using a shorter health-status measure may be realized without substantial loss of information or precision. Both self-reported and proxy assessments were evaluated for replicability. Intraclass correlation coefficients (ICCs) and linear regression were used to assess the ability of the SF-12 physical component summary (PCS-12) scores to predict PCS-36 scores and the SF-12 mental component summary (MCS-12) scores to predict MCS-36 scores. Multivariate regression was used to explore the relationship between SF-12 and SF-36 scores. The MCS-12 and PCS-12 scores were strongly correlated with the corresponding SF-36 summary scores for surveys completed by proxy or self-report (ICCs ranged from 0.954 to 0.973). Regression analysis of the proxy assessments indicated that patient age was an important effect modifier in the relationship between MCS-12 and MCS-36 scores. The SF-12 reproduced SF-36 summary scores without substantial loss of information in stroke patients. Accordingly, the SF-12 can be used at the summary score level as a substitute for the SF-36 in stroke survivors capable of self-report. However, the mental health summary scores of proxy assessments are influenced by patient age, thereby limiting the replicability of the SF-36 by the SF-12 under these conditions.

The striking variation in patterns of child care usage across states reflects differences in family characteristics, but may also reflect exogenous differences in local child care markets. Type of care selected will be influenced by the availability, cost, and accessibility of supply in the child care market as well as by family and child characteristics and cultural preferences. This study contributes to the growing literature on parental demand for child care by using a recent detailed data set from the state of Minnesota. We link household-level data on child care usage and family characteristics with county-level data on average provider rates and availability by type of care in order to estimate multinomial logit models analyzing the family, child, and market characteristics that predict type of care. Our analysis shows that using a relative or friend to care for a child is largely determined by availability, and choice of family care providers is most responsive to price for employed mothers. The types of care chosen by mothers who are not in the paid labor force differ substantially from the choices of employed mothers, and their use of center care is influenced by the prices of both center and family providers. Attitudes towards relative care are also shown to influence type of care chosen.

Objectives: Numerous studies have examined determinants contributing to methylphenidate adherence and persistence, but these were mainly conducted in adults. These determinants are likely to be different in children as they usually rely on their parents to provide them with the care they need. The objective was to study child and family characteristics as determinants of methylphenidate adherence and persistence in children. Methods: The study population consists of 307 children from the Generation R Study in the Netherlands, who had at least one dispensing record of methylphenidate until the age of 16 years. Adherence was defined as a medication possession ratio ≥0.80 up to 2 years after treatment initiation. Persistence was defined as the duration of treatment until a discontinuation period of ≥6 months. Family and child characteristics were tested as determinants of adherence with multivariable logistic regression analysis. Persistence was evaluated using a Kaplan-Meier analysis. Results: Children of mothers with one child (adjusted odds ratio [OR]: 2.31, 95% confidence interval [CI]: 1.17-4.54) or of mothers with an average household income (compared to high) were more likely to be adherent (adjusted OR: 3.45, 95% CI: 1.43-8.31). Children who started treatment at the age of 12-16 years (compared to <12 years) (adjusted hazard ratio [HR]: 3.55, 95% CI: 2.54-4.98) and girls (adjusted HR: 1.44, 95% CI: 1.07-1.95) were more often nonpersistent. Conclusion: Both child and family characteristics may play a role in methylphenidate treatment adherence. Furthermore, gender and the start age of treatment were found to be associated with nonpersistence. These findings may be important for health care professionals when initiating methylphenidate treatment in children.

The purpose of this study was to examine perceptions of children and parents regarding shared responsibilities for asthma management. The study included 72 children with asthma who were between the ages of 7 and 12 years and their parents. Asthma management responsibilities were assessed by the "Asthma Responsibility Questionnaire." Disagreements occurred between parents and children on assuming responsibility. Children reported higher asthma management responsibility scores than reported by parents for them. It is important that nurses provide education and counseling to both children and their families to ensure that children take responsibility for disease management.

Kinship care is the increasingly preferred child placement with a relative when the biological parents are unable to provide care. Program and resource supports must understand how to best meet these caregivers’ needs. Through thematic analysis of existing literature, this study aims to understand how kin caregiver characteristics affect kinship care outcomes. A total of 28 peer-reviewed articles were included in this analysis. Findings indicate that caregiver characteristics, including racial differences, family roles, economic burden, structural supports, and caregiver health, have potentially differential impacts on kinship care and outcomes. Identifying influential caregiver characteristics highlights the importance of adapting policy, programming, and research to support diverse kinship families, rather than viewing them as homogeneous. Incorporation of these characteristic considerations may lead to more effective and impactful supports and improved well-being for all kinship families.

Can transcranial brain-targeted bright light treatment via ear canals be effective in relieving symptoms in seasonal affective disorder? – A pilot study

Little is known about the health-related quality of life (HRQOL) of nonclinical samples of people with irritable bowel syndrome (IBS) in Canada. In a pilot survey, the impact of IBS on HRQOL using a population-based, urban sample was examined. A random sample of Calgary residents (18 years of age or older), selected by random digit dialing (n=1521), completed a structured questionnaire including ROME II Criteria and Medical Outcomes Study Short-Form 12-Item Health Survey, version 2 (SF-12v2). The mean scale and summary scores of SF-12v2 for those who did and did not meet ROME II criteria and for those who met ROME II criteria with and without visiting a physician in past three months were determined and compared using multiple regression analyses. Of the 951 households successfully contacted, 590 (62%) were willing to participate, of which 437 (74%) individuals were recruited. One hundred ten IBS cases (81 of which were women) and 327 non-IBS controls (180 of which were women) were identified. All of the eight mean scale scores and the two mean summary scores were significantly lower in people with IBS than in those without, whether or not adjusting for demographics. Forty-four of the 110 IBS cases (40%) sought medical help. Significantly lower mean physical component score and three scale scores (general health, social functioning and role physical) were found in those who sought medical help than in those who did not. People with IBS experience significant impairment in HRQOL, including both physical and mental well-being. People with IBS who seek medical help report worse physical health than those who do not, but their mental health is no different.