Hospital care of children in four countries

Background. While perceptions of parents and staff about care of hospitalized children have been explored in developed countries, little research has examined these in developing countries. Assumptions about family-centred care are often based on Western values, with little evidence of how cultural constructs affect care delivery in developing nations. Aim. This paper reports a study to provide evidence from which culturally-appropriate hospital care for children can be delivered. Methods. Using a rigorously devised and trialed questionnaire, attitudes of staff and parents about the way children are cared for in children's hospitals in four countries were examined and subjected to a four way analysis: parents and staff within and between developed and developing countries. Results. There were no questions where all parents and staff in both developed and developing country groups were in complete agreement. However, there was some indication that, while culture plays a major role in paediatric care delivery, basic concepts of family-centred care are similar. Conclusions. The findings are limited by the sampling strategy. Nevertheless, while differences were found between parents' and staff's expectations of the delivery of care to children in hospitals, similarities existed and the influence of culture cannot be ignored. Education programmes for staff and parents should reflect these influences to ensure the optimum delivery of family-centred care, regardless of where the hospital is situated.

A cognitive model of binge drinking: The influence of alcohol expectancies and drinking refusal self-efficacy

While binge drinking-episodic or irregular consumption of excessive amounts of alcohol-is recognised as a serious problem affecting our youth, to date there has been a lack of psychological theory and thus theoretically driven research into this problem. The current paper develops a cognitive model using the key constructs of alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE) to explain the acquisition and maintenance of binge drinking. It is suggested that the four combinations of the AE and DRSE can explain the four drinking styles. These are normal/social drinkers, binge drinkers, regular heavy drinkers, and problem drinkers or alcoholics. Since AE and DRSE are cognitive constructs and therefore modifiable, the cognitive model can thus facilitate the design of intervention and-prevention strategies for binge drinking. (C) 2003 Elsevier Ltd. All rights reserved.

Change in physiotherapy management of children with cystic fibrosis in a large urban hospital

A retrospective audit was conducted in 1998 and 2000 to review the physiotherapy management of hospitalized children with cystic fibrosis (CF) at the Brisbane Royal Children's Hospital (RCH). The objective was to detect and explore possible changes in patient management in this time period and investigate whether these changes reflected changes in the current theory of CF management. All children over two years of age with CF admitted during 1998 and 2000 with pulmonary manifestation and who satisfied set criteria were included (n = 249). Relative frequency of each of six treatment modalities used were examined on two occasions, revealing some degree of change in practice reflecting the changes in current theory. There was a significant decrease in the frequency of usage of postural drainage with head-down tilt (p < 0.001), and autogenic drainage (p < 0.001) between 1998 and 2000. Modified postural drainage without head-down tilt (p < 0.001), and positive expiratory pressure devices (p < 0.001) were used more frequently in 2000 (p < 0.001). No significant changes were identified in the use of Flutter VRP1 (p = 0.145) and exercise (p = 0.763). No significant differences were found in population demographics or occurrence of concomitant factors that may influence patient management.

Teacher responses to the communicative attempts of children with autism

We assessed teacher responses to the communicative attempts of children with autism. Teachers were first interviewed using the Inventory of Potential Communicative Acts (IPCA) to identify behaviors in each child's repertoire that the teachers considered to be communicative. Interview results suggested that the teachers interpreted many of the children's prelinguistic gestures, body movements, and facial expressions, as forms of communication. Naturalistic observations were then conducted in the child's classroom to determine how teachers responded to the children's identified forms of prelinguistic behaviors. The results of these naturalistic observations suggested that the teachers often did not respond to the child's prelinguistic behaviors in ways that acknowledged their communicative intent. Implications of the results on the child's communication development and for intervention efforts are discussed.

Adjustment in mothers of children with Asperger syndrome: An application of the double ABCX model of family adjustment

The present study examined the applicability of the double ABCX model of family adjustment in explaining maternal adjustment to caring for a child diagnosed with Asperger syndrome. Forty-seven mothers completed questionnaires at a university clinic while their children were participating in an anxiety intervention. The children were aged between 10 and 12 years. Results of correlations showed that each of the model components was related to one or more domains of maternal adjustment in the direction predicted, with the exception of problem-focused coping. Hierarchical regression analyses demonstrated that, after controlling for the effects of relevant demographics, stressor severity, pile-up of demands and coping were related to adjustment. Findings indicate the utility of the double ABCX model in guiding research into parental adjustment when caring for a child with Asperger syndrome. Limitations of the study and clinical implications are discussed.

Study of the integrated cognitive model of depression among Latin-Americans

Objective: The objective of the present study is to test the validity of the integrated cognitive model (ICM) of depression proposed by Kwon and Oei with a Latin-American sample. The ICM of depression postulates that the interaction between negative life events with dysfunctional attitudes increases the frequency of negative automatic thoughts, which in turns affects the depressive symptomatology of a person. This model was developed for Western Europeans such as Americans and Australians and the validity of this model has not been tested on Latin-Americans. Method: Participants were 101 Latin-American migrants living permanently in Brisbane, including people from Chile, El Salvador, Nicaragua, Argentina and Guatemala. Participants completed the Beck Depression Inventory, the Dysfunctional Attitudes Scale, the Automatic Thoughts Questionnaire and the Life Events Inventory. Alternative or competing models of depression were examined, including the alternative aetiologies model, the linear mediational model and the symptom model. Results: Six models were tested and the results of the structural equation modelling analysis indicated that the symptom model only fits the Latin-American data. Conclusions: Results show that in the Latin-American sample depression symptoms can have an impact on negative cognitions. This finding adds to growing evidence in the literature that the relationship between cognitions and depression is bidirectional, rather than unidirectional from cognitions to symptoms.

Cost-benefit analyses for your group and yourself: The rationality of decision-making in conflict

Two studies in the context of English-French relations in Québec suggest that individuals who strongly identify with a group derive the individual-level costs and benefits that drive expectancy-value processes (rational decision-making) from group-level costs and benefits. In Study 1, high identifiers linked group- and individual-level outcomes of conflict choices whereas low identifiers did not. Group-level expectancy-value processes, in Study 2, mediated the relationship between social identity and perceptions that collective action benefits the individual actor and between social identity and intentions to act. These findings suggest the rational underpinnings of identity-driven political behavior, a relationship sometimes obscured in intergroup theory that focuses on cognitive processes of self-stereotyping. But the results also challenge the view that individuals' cost-benefit analyses are independent of identity processes. The findings suggest the importance of modeling the relationship of group and individual levels of expectancy-value processes as both hierarchical and contingent on social identity processes

Seclusion of children and adolescents: Psychopathological and family factors

This paper describes the use of seclusion in a child and adolescent inpatient unit, including precipitating events, management strategies, details of seclusion episodes and individual and family risk factors. Inpatient ward documentation of seclusion episodes, demographic data and measures of individual psychopathology and impairment, parent mental health, life events and family functioning were used to compare secluded, non-secluded and outpatient groups. Secluded individuals had elevated psychopathology compared with non-secluded inpatients and outpatients. Their families reported poorer parental mental health and family functioning and more recent stressful life events. The results indicate that seclusion is most common among high-risk inpatients.

Cognitive mediation of panic severity: The role of catastrophic misinterpretation of bodily sensations and panic self-efficacy

This study examined the differential role of negative and positive cognitions in mediating treatment outcome in CBT for Panic Disorder through comparison of a Standard CBT (n = 36) versus a Waitlist Condition (n = 24). Regression analyses indicated that, relative to the Waitlist Condition, patients in the Standard CBT condition reported significantly greater shifts both towards higher panic self-efficacy and lower catastrophic misinterpretation of bodily sensations during treatment, as well as a significantly lower level of panic severity at posttreatment. Changes in catastrophic misinterpretation of bodily sensations and panic self-efficacy contributed significantly more to prediction of panic severity than did assignment to either Standard CB T or a Waitlist Condition. Results are discussed in terms of the importance of including both negative and positive cognitions in demonstrating cognitive mediation.