Consensus on the items for early identification of unmet psychosocial needs of siblings of children with cancer and blood disease: A modified Delphi method.

AIM: To reach a consensus on question items for early identification of unmet psychosocial needs of school-aged siblings of children with cancer and blood disease. DESIGN: Modified Delphi method. METHODS: Twenty-three studies were reviewed to extract question items, which were classified into seven categories. A total of 39 question items were selected for this study. The selected question items were carefully considered using the modified Delphi method. The participants were 28 medical staff from a childhood cancer hub hospital and 20 sibling support group staff members. The first round consisted of a questionnaire (n = 48); the second, a focus group interview (n = 8) and the third, another questionnaire (n = 8). The first and third rounds used a 5-point Likert scale. This survey was conducted from July to October 2021. RESULTS: A total of 38, 26, and 24 question items were included in the first, second, and third rounds respectively. A total of 24 question items were extracted using the modified Delphi method to identify siblings' unmet psychosocial needs: relationship with family members, 3; daily life issues, 4; stress, 6; emotions, 3; information, 3; relationships with medical staff, 1 and social and medical resources, 4. Seven categories and 24 question items were confirmed as items for identifying the unmet psychosocial needs of school-aged siblings of children with cancer and blood disease.

Changes, differences, and factors of parenthood in high-risk pregnant women and their partners in Japan.

BACKGROUND: Various stressors exists for pregnant women worldwide, especially negative social and environmental influences that can increase the number of high-risk pregnant women. These may cause a difficult transition to parenthood for women and their partners. However, limited studies have focused on and examined parenthood. Therefore, this study aimed to identify the changes in parenthood from pregnancy to post-discharge after childbirth among high-risk pregnant women and their partners, as well as the presence or absence of gender differences and the factors associated with parenthood. METHODS: This longitudinal quantitative study used a self-administered anonymous questionnaire distributed among 127 pregnant women and their partners who visited a high-risk pregnant outpatient clinic. The Scale of Early Childrearing Parenthood (SECP; three subareas, 33 items) was administered thrice: during pregnancy (T1), after childbirth (T2), and after discharge (T3). RESULTS: The analysis included 85 T1 (37 fathers and 48 mothers), 36 T2 (13 fathers and 23 mothers), and 31 T3 (11 fathers and 20 mothers) responses. There was a significant increase in the SECP scores for both parents from T1 to T3. Mothers had a greater increase in the SECP scores from T1 to T2 than fathers. In addition, fathers' mean SECP scores at T1 and T2 were higher compared with those of the mothers. Mothers' and fathers' SECP scores at each time point showed no significant differences. At all time points, the SECP scores were commonly and significantly associated with infertility treatment, physical and mental condition, postpartum depression at T2, and parenting stress at T3. CONCLUSIONS: Because parenthood in the infertility treatment group was significantly higher throughout the series, we need to support such couples so that childbirth does not become their main goal. We suggest interventions for factors that impede parenthood development, understand the various backgrounds of the parents, and support the couple individually while also considering them as a unit.

Do allergic clinical manifestations increase the risk of behavioral problems in children? A cross-sectional study.

BACKGROUND: Children with allergic clinical manifestations tend to have behavioral or emotional problems such as hyperactivity or worse mental health. However, previous studies on this association did not adequately adjust for confounders like parenting stress, demographic characteristics, or allergy presentation. This study aimed to investigate the relationship between childhood allergic clinical manifestations and behavioral problems, adjusting for confounders such as demographic characteristics, parenting stress, and allergy-related variables. METHODS: We conducted an online cross-sectional survey among caregivers of children aged 2-6 years (n = 633). The Strengths and Difficulties Questionnaire (SDQ) was used to determine children's behavioral characteristics as the primary outcome. Allergic clinical manifestations, wheeze, rash, and nose symptoms were the exposure variables. Associations were estimated using logistic regression analyses with propensity scores to adjust for confounders. RESULTS: We analyzed 633 caregivers of children aged 2-6 years (valid rate, 61.5%). Univariate analyses showed that wheezing was associated with conduct problems (odds ratio [OR] = 1.48, 95% confidence interval [CI]:1.01-2.16), a behavioral component of the SDQ. Rash was also associated with hyperactivity (OR = 1.62, 95% CI: 1.02-2.57). Furthermore, nose symptoms were associated with conduct problems (OR = 1.65, 95% CI:1.16-2.33) and emotional symptoms (OR=1.62, 95% CI:1.06-2.45). After adjusting for potential confounders, wheezing (adjusted OR = 1.69, 95% CI:1.04-2.75) and nose symptoms (adjusted OR = 1.56, 95% CI: 1.05-2.34) remained associated with conduct problems. CONCLUSIONS: This study revealed that a history of wheezing and nose symptoms in children is associated with an increased risk of behavioral problems, in particular, conduct problems.

Factors determining parenting stress in mothers of children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) influences a child's emotional and social well-being, as well as his or her physical health. The influence of AD on the daily lives of parents and caregivers has also been documented. This study examined how parenting stress is affected by demographic background, characteristics of children's AD, and their family systems. METHODS: The participants were mothers of children, aged 2-6 years old, who had been diagnosed with AD. The predictive power of a model of parenting stress was examined using multiple regression analysis (stepwise), with parenting stress (PSI-SF) as the dependent variable, and children's demographics, including characteristics of AD; parents' demographics; QoL of families of children with AD (JCMV-CADIS); and family functioning (FAI) as independent variables. We handled missing values using a multiple imputation method. RESULTS: The pooled coefficients obtained from the multiple regression analysis after multiple imputation indicated that "family cohesion," "family system flexibility," "emotions related to social factors" and "occupation of mother" determined parenting stress. Lower family cohesion and family system flexibility predicted higher parenting stress. The high impact of "emotions related to social factors" on families' QoL predicted higher parenting stress. Full-time work by mothers predicted lower parenting stress. CONCLUSIONS: The current results reveal that "family cohesion," "family system flexibility," "emotions related to social factors" and "full-time work by mothers" predicted parenting stress of mothers who had children with AD.

Thinking about the patient's wishes: practical wisdom of discharge planning nurses in assisting surrogate decision-making.

BACKGROUND: The accelerating trend towards shorter hospital stays in Japan has made modes of decision-making essential for effective patient transition from the hospital to recuperation in the regional community, and the ageing of the population has brought a rise in surrogate decision-making by the families of patients lacking decision-making ('self-decision') capacity. AIM: To verbalise and elucidate the practical wisdom of discharge planning nurses by focusing on the perceptions and judgements, they apply in practice and describing their methodology in concrete terms. RESEARCH METHOD: Participants were six discharge planning nurses and one person with previous experience as a discharge planning nurse, all working at discharge planning departments of acute care hospitals. Separate, semi-structured, interactive interviews were conducted with each participant. The study design was qualitative descriptive in form with qualitative content analysis. All participants provided written informed consent to participate in the study, which was approved by the study institution. RESULTS: Three concepts were extracted as the basis for discharge planning nurses' perception and judgement at acute care hospitals: working for mutual envisionment of the available postdischarge options; helping the family act as spokesperson(s) for the patient's wishes; and understanding the family inclusive of the patient as a relationship of strongly interaffecting interests. CONCLUSION: The practical wisdom of the nurse, working in mutual envisionment with the family, and collaborative decision-making through discussion with those who know the patient, leads to rational discharge assistance.

Development of a Japanese Culturally Modified Version of the Childhood Atopic Dermatitis Impact Scale (JCMV-CADIS).

BACKGROUND: The Childhood Atopic Dermatitis Impact Scale (CADIS) was developed to measure the impact of AD on QoL in both affected children and their families. However, no scale of this kind exists in Japan. The aims of this study were to validate the Japanese Culturally Modified Version of the CADIS (JCMV-CADIS) and to describe the family impact of children with AD in a Japanese context. METHODS: Participants included primary-caregivers for children with AD between 2 and 6 years of age. Interviews were conducted, and new items for the Japanese version were drafted. Reliability and validity were evaluated and compared with the original CADIS, and unique features of the Japanese version were analyzed. RESULTS: Exploratory factor analysis revealed the following factors: "Symptoms" and "Activity Limitations and Behavior" in the Child domain, and "Emotions Related to Social Factors," "Emotions Related to the Child's Condition," "Family and Social Function," "Complexity of Care," and "Approaches to Management of AD in Daily Life" in the Parent domain. The latter two factors were unique to the JCMV-CADIS and were not derived from the Original. "Emotion" was split into two independent factors. All factors showed good reliability (internal consistency and stability) and validity (concurrent validity and discriminant validity), except for the concurrent validity of "Approaches to Management of AD in Daily Life." This factor seemed to reflect characteristics similar to the family-related function. CONCLUSIONS: The JCMV-CADIS is a QoL scale developed for Japanese children with AD and their families. Further evaluation of clinical applicability is needed.

Developing the "Skippu-Mama" program for mothers of children with autism spectrum disorder.

The "Skippu-Mama" peer support program was developed to improve quality of life and reduce parental stress in mothers of children with autism spectrum disorders. The program was designed to improve these variables by refreshing and healing participants' minds and bodies. Twenty-four mothers of 26 children diagnosed with ASD in Japan were included in the study and completed measures of quality of life and parental stress before, during, and after participation in the Skippu-Mama program. Our results demonstrated that time was a significant main effect. Further, multiple comparisons with Bonferroni corrections indicated a significant increase in World Health Organization Quality of Life 26 scores three months into the program and at its conclusion six months after commencement. Overall, the Skippu-Mama program improved the quality of life of mothers of children with ASD, and we believe that the intervention's focus on both individual and family variables may be especially effective in this population.

Transition to early parenthood, and family functioning relationships in Japan: a longitudinal study.

Greater knowledge of the process by which postpartum parents acquire further awareness of their child and fulfill parental roles will likely lead to an understanding that creates a new approach to nursing. This study explored the transition to parenthood and the relationship between parenthood and family functioning in first-time mothers and fathers. Seventy-eight parents (41 mothers, 37 fathers) participated in the study and completed the Scale of Early Childrearing Parenthood and Family Assessment Inventory at birth and at 1, 3, 6, and 12 months postpartum. The levels of parental role attainment and awareness of the child rose dramatically between birth and 3 months postpartum, thereafter stabilizing up to 12 months postpartum. Parenthood and family functioning showed a moderately positive correlation, which gradually became more positive over time. Appropriate nursing interventions might be necessary for parents who show difficulty in accepting their parental roles and have low levels of awareness of their child after 3 months postpartum. Such intervention might be necessary for not only the parents, but also the family unit.

Reliability and validity of the self-report Quality of Life Questionnaire for Japanese School-aged Children with Asthma (JSCA-QOL v.3).

BACKGROUND: Asthma is a chronic disease prevalent in children which threatens their quality of life (QOL) through unexpected asthma attacks and/or the burden of daily self-management. As some conditions of chronic illness make it difficult for a child to accomplish normal developmental tasks, there may be fewer opportunities for the child to obtain a sense of achievement. This study investigated the reliability and validity of the Quality of Life Questionnaire for Japanese School-aged Children with Asthma Version 3 (JSCA-QOL v.3). This questionnaire includes 25 items with a 5-point Likert Scale format over five domains: "asthma attack triggers", "change in daily life", "family support", "satisfaction with daily life" and "restriction in participating in daily activities", and one summary scale. METHODS: In the present study, 2,425 children with asthma aged from 10 to 18 years were investigated in Japan. The internal consistency reliability of each domain was investigated with Cronbach's alpha reliability coefficient, and test-retest reliability with Spearman's correlations coefficient. Factorial validity by factor analysis using maximum-likelihood extraction with promax rotation was performed. Data analysis was performed using SPSS 12.0J. RESULTS: The final number of effective replies was 2,097 (the rate of effective data was 86.5%). "Asthma attack triggers", "change in daily life", "family support", "satisfaction with daily life" and "restriction in participating in daily activities" showed a high internal consistency (Cronbach's alpha = 0.66-0.86) as well as good test-retest reliability (Spearman's rho = 0.60, p < 0.01). The factorial validity was appropriate (KMO value = 0.90), because it was conceivable that the five factors extracted from factor analysis would be the same as in our hypothesis and support constructive validity. In addition, there was good correlation between the summary scale and the total QOL score (Spearman's rho = 0.58, p < 0.01). CONCLUSIONS: The present study showed that the JSCA-QOL v.3 is a reliable and valid measurement tool that can be used to appropriately assess QOL in school-aged children with asthma. As the JSCA-QOL v.3 can be easily completed in about 10 minutes, it can contribute as an efficient evaluation tool of the outcome of medical treatment through continual utilization in the outpatient clinic. The JSCA-QOL v.3 allows a health provider to help school-aged children with asthma to achieve their developmental tasks.