Public Health Service Settings Research Articles

Development of a Pediatric Dermatology Screening Tool Based on Two Parent-Reported Skin Symptoms: Comparison of Parental Recognition and Physician Diagnosis of Skin Symptoms of Infants and Toddlers.

AimThe objective of the present study was to develop a tool for mothers to assess their children’s skin condition with the ultimate goal of its wider use in general health checkups for infants and toddlers.MethodsThis was a single-institution, cross-sectional study in Japan, targeting parents of 200 infants and toddlers who visited a dermatology clinic between December 2018 and March 2019. The parents completed a self-administered survey of the mother’s perception of her child’s dermatological symptoms, itchiness, and sleep status, and a quality-oflife assessment, using a nine-question version of the Quality of life in Primary Caregivers of children with Atopic Dermatitis questionnaire (QP9). The attending physician was asked to complete a form about the child’s dermatological condition and the treatment prescribed. The severity of the dermatological condition noted by the physician was compared with the combined response to the 3 perception items (dermatological condition, itchiness, and sleep) reported by the parents, in order to identify the optimal cutoff score.ResultsOf 200 parent questionnaires distributed, 198 (99% response rate) were returned and analyzed, along with the responses from 198 physician records (100% response rate). The optimal cutoff score was 2/3 for the total score (range 0-6) for 2 items, itchiness and sleep status (sensitivity 73%, specificity 64%). There was a significant difference in QP9 scores between the 2 groups categorized by the cutoff scoreConclusionsA pediatric dermatological screening tool based on 2 symptoms reported by the parents of children with atopic dermatitis was developed, and its precision and criterion-related validity were confirmed. This simple tool could help parents become better aware of their children’s skin condition and allow healthcare workers to provide adequate skin care advice. This practical tool could be widely applicable in primary child care and public health service settings.

Predictors of not starting and dropping out from psychotherapy in Swedish public service settings

This naturalistic study examines potential predictors of treatment attendance and discontinuation among patients in the three most common psychotherapy types in Swedish public health service settings. Patients who did not start psychotherapy after pretherapy assessment are compared with patients who started psychotherapy. Patients who discontinued psychotherapy are compared with those remaining in treatment. Data were collected over a 3-year period at 13 outpatient psychiatric clinics, using online patient and therapist questionnaires. Of the 1498 registered patients, 14% never started psychotherapy, 17% dropped out from treatment, 33% continued in treatment, while 36% dropped out from data collection. Being dangerous to others, having Axis I diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), lower level of therapeutic alliance, organizational factors, having younger therapists, psychotic features, and being older were predictive of not starting treatment, while organizational factors, more acting out and criminality, less mental ill-health, and being younger predicted dropout from treatment. Significantly more nonstarters and dropouts were found at clinics with lower levels of organizational structure and stability. Organizational factors predicted both starting and continuing in treatment.

Pilot study on a group‐based parenting program in a Vietnamese public hospital: Program acceptance among mothers and staff

AbstractParenting practices are known to vary across different sociocultural settings, but there has been little scientific research conducted on parenting intervention in Asia to date. Building on our past research achievements that show a strong need for parenting support, we conducted a pilot trial of systematic screening of Vietnamese mothers with poor mental health and the provision of a group‐based parenting program, along with staff training sessions at a university‐affiliated general hospital in Ho Chi Minh City. Forty‐seven first‐time mothers attending routine child health checkups were screened using a brief mental health and parenting assessment tool that we had developed and used previously. We then evaluated a group‐based parenting program provided for two consecutive days to nine participants. The framework of the Canadian Nobody's Perfect Program, which we had previously adopted and evaluated in a Japanese public health service setting, was used to develop a Vietnamese version. The screening and program were found to be well accepted by both participants and staff and are considered to be feasible for use by public hospital services in Vietnam. The process of program adaptation described and discussed herein may be useful to other health professionals in the Asia‐Pacific region undertaking similar initiatives.

Short-Term Operational Evaluation of a Group-Parenting Program for Japanese Mothers With Poor Psychological Status: Adopting a Canadian Program Into the Asian Public Service Setting

Although parenting practices differ across various sociocultural settings, scientific research on parenting intervention in Asia is scarce. We adopted a Canadian multilanguage group-based parenting program (Nobody's Perfect) into the Japanese public health service setting and evaluated its impact. Our program was feasible as a public service; was well-accepted among the participants with low psychological status, many of whom were first-time mothers; and had a potential positive impact on the mood of mothers and the self-evaluation of their abilities in society. Our results may facilitate and provide direction for similar research in Asia.

What happens after diagnosis? Understanding the experiences of patients with newly‐diagnosed bipolar disorder

Bipolar disorder is chronic condition involving episodes of both depression and elevated mood, associated with significant disability and high relapse rates. Recent estimates suggest a lifetime prevalence of 5%. Little is known about the subjective experiences of patients after receiving a diagnosis of bipolar disorder, and the impact of these experiences on patients' willingness and ability to work with their health professionals to find the most effective combination of treatments and to set up self-management plans. This paper describes a qualitative study exploring the experiences and difficulties faced by patients after they have received a diagnosis of bipolar disorder, as expressed online to expert patients trained to provide informed support. Qualitative study. Online communication within a public health service setting. Twenty-six participants with recently-diagnosed bipolar disorder communicated online with 'Informed Supporters', people who had been managing their bipolar disorder effectively for 2 years or more, as part of an online psycho-education programme. Participants cited unwanted side-effects of medication, coping with unpleasant symptoms, positive and negative reactions to the diagnosis, identifying early warning signs and triggers of the illness, the loss of a sense of self, uncertainty about their future and stigma as issues of major importance after diagnosis. Personal concerns and difficulties following diagnosis can undermine effective treatment, thwart self-management efforts and interfere with effective functioning. Such data are important for clinicians to take into account when they work in partnership with their patients to fine-tune treatments and help them set up self-management plans.

Promoting condom use with main partners: a behavioral intervention trial for women.

The Stages of Change (SOC) model was used to implement and evaluate a condom promotion intervention for HIV-positive and at-risk women who were recruited from clinic and community settings in Baltimore and Philadelphia. Participants were assigned to receive standard reproductive health services or enhanced services (standard plus SOC peer advocate intervention). Women who had a main partner at baseline and at a 6-month follow-up were included in the analysis (70 HIV positive, 471 at risk). Compared with the standard group, HIV-positive women in the enhanced group were significantly more likely to have progressed in the SOC model or to have maintained consistent condom use, and less likely to have relapsed or stayed in the precontemplation stage. Among the at-risk women, exposure to the intervention was associated with being at a higher SOC and being less likely to relapse relative to the standard group. The SOC model has promise for use in social and public health service settings that serve women at risk or living with HIV.