ABSTRACT
Sixty-five families were enlisted in a study exploring factors associated with distress behavior in 5-year-old children receiving diphtheria-tetanus-pertussis immunizations. At a home visit 1 month before the immunization, the following measures were obtained: (1) the Behavioral Style Questionnaire, a measure of temperament: (2) parental self-reports of medically related attributes (eg. "good patient"); (3) parental attitudes toward pain in children and responsiveness to their child's pain; and (4) parental prediction of distress at upcoming immunization. The child's distress behavior during the immunization was evaluated using a modification of the Procedure Rating Scale-Revised and, after the procedure, the child's assessment of his or her pain was elicited using the Oucher. Children's mean Procedure Rating Scale-Revised score was 2.57 of a possible 11. Thirty-one (48%) had low (less than or equal to 1) and 7 (11%) had high distress scores (greater than or equal to 2 SD above the mean). Factors positively correlated with distressed behavior included more "difficult child" cluster characteristics, the individual temperamental dimension of adaptability, but few parental attitudes and attributes. Parent's predictions of distress were the strongest correlates. These findings document the variation that children demonstrate in response to pain and offer some insight into associated innate and environmental factors. These results imply that treatment strategies derived from parental knowledge and tailored to individual characteristics of the child may be most effective in alleviating pain-related distress in medical settings.
Subject(s)
Child Behavior , Diphtheria-Tetanus-Pertussis Vaccine/adverse effects , Individuality , Pain/psychology , Parents/psychology , Temperament , Attitude , Child, Preschool , Female , Humans , Male , Pain/etiology , Sex FactorsABSTRACT
A descriptive analysis was done on 73 consecutive cases of childhood sexual abuse seen in 1978. There were conspicuous similarities among the cases. Sexually abused children tended to come from households with evidence of family stress. The events occurred in safe havens such as the childrens' own homes, by individuals known and trusted by the children. An intrafamilial stress-dysfunction model, rather than a victim-assailant model, is more applicable to childhood sexual abuse.
Subject(s)
Child Abuse , Sex Offenses , Adolescent , Child , Child, Preschool , Female , Humans , Incest , Infant , Male , Maryland , Pediatrics , Physician's Role , Physician-Patient Relations , Rape , Socioeconomic FactorsABSTRACT
Families bringing children to the pediatric walk-in clinic at Boston City Hospital were interviewed randomly over a 15-week period. Families were classified as having a stable or unstable relationship with either a hospital or a neighborhood health center (NHC) from their answers to a structured questionnaire. Little change was found in the proportion of unstable users of health facilities from a similar study conducted in 1964, suggesting that the introduction of the NHCs and Medicaid, which increased the availability and accessibility of health services for the urban poor, has no effect on patterns of multiple utilization of health providers. The major variables affecting a family's utilization pattern are hypothesized to be the level of satisfaction toward the primary care facility, as expressed by the family, and the perceived ability of different health care facilities to deal with a particular health situation.
