Worried Parents Research Articles

An Improvement Project in Reducing After-Visit Phone Calls in a Community Pediatric Neurology Clinic: Too Much Communication?

Physicians strive to provide high-quality clinical care, yet after-visit patient telephone calls create extra demands on a clinician's time. Pediatric neurologists are particularly affected by this challenge given the number of patients with chronic illnesses they serve and the volume of worried parents they support. Added workload coupled with a busy office practice increases the likelihood of early physician burnout, which can have downstream effects on the quality of patient care and patient satisfaction. Using the IHI model for quality improvement (abbreviated QI moving forward), QI methodology was used to determine volume and key drivers of patient/family communications after a visit to a pediatric neurology clinic. Interventions aimed at reducing telephone messages by 15% over a 6-month period were put into place. A baseline audit of clinic phone calls was completed in 2019 to develop an overview of after-visit communications. After-visit telephone calls and web-based portal messages were then tracked for 3-week periods in 2019, 2020, and 2021 to understand key trends. A key driver diagram of patient/family communications after a clinic visit was created, and interventions aimed at reducing telephone messages were discussed. These interventions included optimizing MD-RN workflows, synchronous and asynchronous educational initiatives, and changes to our clinic's voicemail phone tree. Our primary outcome measure was the average monthly telephone call volume, and this measure was tracked monthly from November 2020 through December 2022. Similarly, electronic portal message volume was tracked and served as our balancing measure. Physicians, nurses, and patients were primary drivers of phone call volume. After interventions were in place, the average monthly call volume decreased by 30% from a baseline of 293 calls to 203 calls. This change was sustained for at least 1 year. The average monthly portal message volume remained consistent throughout the study period at 359 messages. Both physicians and nurses agree that after-visit patient communication affects their workload. This study illustrates that QI methodology can be used to plan and implement interventions aimed at decreasing after-visit telephone calls.

Challenging parents, teacher occupational stress and health in Dutch primary schools

Continual exposure to challenging behaviour, i.c. from parents, can seriously deplete the teacher’s emotional and physical resources, leading to self-doubt, loss of satisfaction from teaching, impulsivity, rigidity or feelings of anger and guilt. Research on teacher stress has largely focused on environmental and contextual factors while ignoring personality characteristics of teachers. In this study, we examined teacher’s perceptions of their own ability to handle challenging parent behaviour and to establish positive relationships as a possible influence on the quality of teacher-parent relationships. Using a canonical correlation method, we found that unsatisfied parents, overprotective parents, neglectful parents and excessively worried parents have the largest impact on teacher stress. Teachers who experience stress from challenging parent behaviour, suffer mostly from negative feelings toward parents, frustration on working with parents, loss of satisfaction with teaching and to a lesser extent health problems. The data for this research was collected in February and March 2007, amongst 212 elementary school teachers in the middle and middle-east region and urban agglomeration of Western-Holland, the Netherlands. The main aim of this research project is to identify at risk teachers (i.e. those most vulnerable to the presence of behaviourally challenging parents) so that interventions, both in initial teacher training as well as in in-service training, can be applied to help them develop adequate attitudes and coping skills.

Study Confirms Safety and Effectiveness of Intra-Articular Glucocorticoids for Painful Hip Dislocation in Children and Young Adults with Neurologic Impairment.

Hip dislocation is a common source of pain in children with neurologic impairment. When medical interventions fail, orthopedic surgery does not guarantee a definitive result as the displacement may continue postoperatively and a second operation is often required. Retrospective analysis of data regarding the safety and effectiveness of an intra-articular corticosteroid injection (IACI) in 11 patients, aged 15 ± 5 years old, collected through a telephonic questionnaire administered to parents. 21 IACIs were performed, a mean number of 1.9 ± 1.5 times for each patient, at a mean age (of the first IACI) of 13.5 ± 5 years. According to the parents, the IACI significantly lowered the number of participants experiencing pain (82% reduction) and using analgesics (60% reduction). There was also a significant improvement in the children's hip mobility (63% reduction in patients experiencing stiffness), decubitus (90% reduction in obligated positioning), behavior (80% reduction in lamenting or crying patients), sleep quality (87.5% reduction in patients awakening every night), and caregivers' quality of life (91% reduction in worried parents). The mean reported duration of the IACIs' benefit was 5.4 ± 2.4 months (range 1-9), with a positive correlation with the number of IACIs (r = 0.48; p-value = 0.04) and a negative correlation with the age at the first injection (r = -0.71; p-value = 0.02). The only reported adverse event was mild local swelling in one child. the IACI could represent a safe and effective intervention for painful hip dislocation, both before and after surgery, with a long-lasting benefit which seems to increase as multiple IACIs are performed.

Infant Botulism.

Infant Botulism.

The preoccupied parent: How financial concerns affect child investment choices

We examine the hypothesis that low parental investments in children may be a consequence of the adverse cognitive effects of poverty: financial worries preoccupy low-income parents with immediate concerns, shifting their attention away from stimulating parenting tasks. We test this hypothesis in an online experiment studying the purchase decisions of UK parents, including their responsiveness to financial subsidies for child development products. Both low and higher-income parents respond to a subsidy on such products, increasing their demands. However, when primed with financial worries under the same budget, low-income parents respond less to the subsidy, prioritizing instead the purchase of products addressing immediate household needs. This lower responsiveness to subsidies appears to be driven by worried parents further away from their last payday. Stronger safety nets and better alignment of financial subsidies to payday cycles may help achieve more investment and better child outcomes in poorer families.

Antenatal consultation and deliberation: adapting to parental preferences.

To analyze and compare perspectives on antenatal consultation and decision-making from participants with varying degrees of prematurity experience and clinician-experts. Open-ended interviews structured around topics previously identified by recognized clinician-experts were conducted with participants having different levels of prematurity experience. Analysis used mixed methods (thematic and mental models analysis). Secondary sub-group comparisons were performed, based on degree of experience. Non-clinician participants' (n = 80) perspectives differed regarding: amount and content of information desired, decision-making strategies, and who - parent or clinician - should direct consultations. Most wanted to retain decisional authority, all recognized their emotional limitations and many advocated for deliberation support. Participants worried parents' would regret choosing palliative care contrary to clinicians. Bereaved parents often saw issues differently. Parents approach risk and decision-making for extremely premature infants in a personal fashion. They need personalized support tailored to their unique circumstances, decision-making preferences, and emotions.

“Flexibility, Compassion, and Support” – A Study on Multilayer Mitigation Effects on Pedagogy and Resilience in Thai Classroom, June-September 2022

This qualitative study analyzed pedagogical effects of multilayer mitigation in a Thai classroom. The triangulated data set were confidential, comprising teachers’ voluntary anonymous information, pedagogical views and opinions, respectively. First, pupils’ low absence rates enabled pedagogical focus on learning losses, which were mainly skills. The second effect was related to assessment. None of the teachers mentioned test results as learning loss indicators but regarded learning and qualified assessment as dynamic processes. An interesting dilemma was the learning loss measurements by non-pedagogical experts. Mostly those were presented as test scores, working hour counts, or annual formalities. However, optimized learning strategies’ research had existed for decades, being responded better by these pupils. The third effect was the improved resilience of pupils and caretakers. Initially worried parents turned relieved. Resilience fostered the intrinsic motivation of all. When compared to some countries, firmer resilience made the difference in learning loss endurance for this group. “All-inclusive” mitigation had given families meaningful support. They shared visions of community roles, mediated by teachers and school management. The latter were backed by epidemiologists and medical experts. Further studies should discuss schools in a longer timeframe. External, quantified test scores without in-depth pedagogical analyses seem outdated by the early fourth pandemic year.

The rise in youth vaping and potential risks

Kimberly Lloyd Rees discusses the rising figures of children vaping and the message to give to worried parents.

Acute Flaccid Myelitis.

Acute Flaccid Myelitis.

Parental Satisfaction and Associated Factors Toward Their Child's Anesthesia Service at a Comprehensive Specialized Referral Hospital in Ethiopia, 2021: A Cross-Sectional Study.

BackgroundParental satisfaction is a key measure of the quality of a child's anesthetic care. Understanding of parents' opinions and satisfaction about their child's anesthesia service in the hospital is vital for hospital funding and parent experience.ObjectiveThe purpose of this study was to determine the level of parental satisfaction with their child's anesthetic care and the factors that contributed to that satisfaction.MethodsAn institution-based cross-sectional study was undertaken between March and June 2021. A structured questionnaire with the background characteristics of parents and children was used to collect data. A total of 238 parents were included in the study. To find parameters linked to parental satisfaction with their child's anesthetic service, bi-variable, and multi-variable logistic regression analyses were used. Crude odds ratio and adjusted odds ratio with a 95% confidence interval (CI) were estimated. Variables with a p-value < 0.05 were considered statistically significant in multivariable analysis.ResultThe proportion of parental satisfaction toward their child's anesthesia service was 77.7% (95% CI: 72.3, 82.4%). Non-anxious, male, employed, and urban resident parents and parents of pre-medicated children were associated with high satisfaction scores.Conclusion and RecommendationOverall, parents' satisfaction with their child's anesthesia service was promising. Parents who were non-anxious, male, employed, and lived in an urban area and whose child had received sedative premedication had high rates of parental satisfaction with their child's anesthetic care.Parents from rural areas, as well as worried and female parents, should receive extra care. Preoperative anxiety is reduced when parents are given enough and understandable information. Thus, the provision of comprehensive information on their child's anesthesia care process and psychological or emotional support to parents are necessary to boost their satisfaction.

Difficultés diagnostiques du trouble de conversion à l’adolescence : étude mixte qualitative et clinique autour du parcours de soin d’une jeune fille de 15 ans

IntroductionThe diagnosis of conversion disorder causes many difficulties in children and adolescents. As a diagnosis of exclusion, it implies diagnostic procedures that are often long and costly. The objective is to describe the difficulties encountered by health professionals in the diagnostic process when faced with an atypical neurological symptom. MethodA mixed study combining a case study and a thematic qualitative study based on semi-directed interviews with the physicians who managed the patient of the case study. ResultsThe case study highlighted the difficulties of articulation with psychiatry. The thematic analysis revealed four main difficulties: 1) specific patients with a complex picture that lead to diagnostic difficulties in emergency; 2) specific parents with a strong demand for a precise diagnosis despite an ambivalence towards psychiatric illness; 3) a specific physio-psycho-pathology that can be difficult to explain to patients and families due to a lack of knowledge among somatic physicians; 4) a feeling of failure and doubt with regard to these complex pictures leading to difficulties in positioning the patients. ConclusionPatients with conversion disorders require time, listening and reflection. This temporality is not compatible with the emergency context, often reinforced by the pressure of worried parents. The lack of specialized training in mental health and interdisciplinarity and the stigmatization of psychiatric diagnostic hypotheses hinder care and can lead to serious consequences in the short and long term.

Readiness to change among parents of overweight/obese children in Saudi Arabia and influencing factors.

Pediatric overweight/obesity is a major health problem worldwide. Accurate parental perception of children's weight status is crucial in preventing and tackling this issue. Despite the consistent increase in prevalence of the childhood obesity in Saudi Arabia, the role of the parents is not well described. This study aims to explore Saudi parents' readiness to change the lifestyle of their overweight/obese children and the barriers facing it. Through a cross-sectional design, 362 parents of overweight/obese children attending King Abdulla Specialized Children's Hospital were selected and requested to fill a predesigned questionnaire reflecting their perception about their children's weight status and their preparedness to change their lifestyle. A Chi-square test was used to verify significance. A P value of <0.05 was considered an indication of significance. Among all overweight/obese children (n = 362), obese children formed 39.5 and 22.7% had morbid obesity. Only one half of the parents (49.7%) had correct perception about their children's weight. Correct perception increases significantly with an increase age of the child and in the presence of family history of diabetes, P < 0.05. Only 68.9% were worried about body weight of their children, the percentage was significantly higher in younger parents; parents with obese children and with a positive family history of hypertension P < 0.05. In total, 83.1% of the worried parents proceeded to preparation and action stages; the percentage was significantly higher among parents whom their children were free from identified comorbidities, P < 0.05. Misconception about real weight status of overweight/obese children is common in Saudi parents. Parents who have correct perception and worried about health status of their children are more likely to take actions. The first step in controlling children's obesity is to educate parents about how to recognize the real weight status of their children and to be aware about the health-related problems of obesity.

Fifteen-minute consultation: Paediatric night sweats—when to reassure and when to investigate

3-year-old Susie has been referred to the medical paediatric clinic by her general practitioner with sweating at night; her parents change Susie’s pillowcase whilst she is asleep at around 11pm...

Visual Resources for Postoperative Care to Overcome Language and Cultural Barriers.

Visual Resources for Postoperative Care to Overcome Language and Cultural Barriers.

Crossed Testicular Ectopia: Case Report

Crossed testicular ectopia or transverse testicular ectopia (TTE) is one of the rare congenital anomaly upon the genitourinary system. It happens when one of the hemiscrotum is empty and the other side contains two testes. Hernia association, worried parents about the undescended testis and incidental imaging are the classic scenarios of presentation. However, multiple reported cases are diagnosed during the surgery as incidental finding. Accordingly, bilateral orchidopexy is warranted.

Outdoor CPD: part 4: Parental consent

How can practitioners convince sceptical or worried parents that learning outside is safe and involves much more than just playing? Gabriella Jozwiak reports

Neonatal Birthmarks at the 4 Central Hospitals in Vientiane Capital, Lao PDR.

Newborn skin disorders are quite common and happen to occur during the neonatal period. Most of the birthmarks are transient; however, worried parents often seek medical advice from their child’s physician regarding skin lesions. Thus, it is important to differentiate the skin lesions from pathologic ones to avoid unnecessary diagnostic or therapeutic procedures. This is the first published study in Lao neonates that carried out the data from 4 central hospitals in Vientiane Capital, Lao PDR from September 2019 to February 2020. Among 500 neonates, Sebaceous gland hyperplasia (53%), Mongolian patches (46.6%), and Erythema toxicum neonatorum (30%) were the 3 most common cutaneous conditions found in the Lao newborns. From a clinical point of view, these findings are often a source of parental anxiety and medical concern for inexperienced clinicians.

Confronting a rare ovarian cancer during lockdown

Confronting a rare ovarian cancer during lockdown

Limited access to family-based addiction prevention services for socio-economically deprived families in Switzerland: a grounded theory study

BackgroundFamilies living in poor socio-economic circumstances, already confronted with social and health inequalities, are often not reached by family-based addiction prevention services. Besides quantitative models and health literacy approaches, qualitative research is lacking that could shed light on the exact circumstances and processes that lead to hindered addiction prevention service uptake by these families. Drawing on the concept of candidacy, we therefore reconstructed how socio-economically deprived parents and their (pre) adolescent children in the German-speaking part of Switzerland (non-)identified their candidacy for family-based addiction prevention services.MethodsFollowing grounded theory, we collected and analysed data in an iterative-cyclical manner using theoretical sampling and theoretical coding techniques. Sixteen families with children aged 10–14 years were interviewed in depth (parent/s and child separately). All but one family lived below the at-risk-of-poverty threshold.ResultsSocio-economically deprived families’ modes of recognizing and handling problems in everyday life were found to be core phenomena that structure the process towards (non) identification of candidacy for family-based addiction prevention services. Four modes anchored within socio-demographic resources were found: Families with mode A perceived their current life situation as existentially threatening and focused daily coping on the main pressing problem. Others (mode B) perceived prevalent multiple problems as normal (now); problems were normalized, often not recognized as such. In mode C families, problems were pragmatically recognized at a low threshold and pragmatically dealt with, mostly within the family. In mode D families, problems were constantly produced and dealt with early by the worried and anxious parents monitoring their child. From modes D to A, vulnerability increased concerning non-identification of candidacy for family-based addiction prevention services. Further, thematic relevance of addiction prevention, past experience with offers, integration in systems of assistance, strategies to protect the family, and families’ search for information influenced whether identification of candidacy took place.ConclusionsSocio-economically deprived families differ in modes of problem construction and handling in everyday life; this differently opens up or closes routes to family-based addiction prevention. Addiction prevention practice should build on a bundle of diverse strategies for outreach to these families, stressing especially interventions on the structural and environmental level.

When duty house calls

A neurologist conducts her first "house call" during the Covid-19 pandemic: the quaint nostalgia of a bygone era and seeming anachronism meet the conveniences of modernity and uncover the timeless qualities of medicine.The phrase "house call" conjures up nostalgia for an era most of us have never experienced, painted with cheerful and tender Norman Rockwell-style strokes. The avuncular physician, likely a man, clad in a crisp suit, with a capacious leather satchel filled with tinctures of now-illegal substances clinking in glass bottles. The cherubic child clad in a white nightgown, tucked under a patchwork quilt, curls against the pillow, clutching a beloved doll. The worried parent, likely a woman, hovering over the bedside with a cool compress against the fevered forehead.While I have only sepia photos and phonograph recordings to inform me of such a time, my patient Mary actually lived through it. She was born in the thick of such a period, in the 1930's, an era when 40% of physician encounters were house calls. When I had established care for dementia in her 80's, she still had a razor wit, mischievous grin, and twinkling blue eyes. I could tell she had been a kind, but firm, schoolteacher, likely not one to have put up with tomfoolery.