Referral patterns for children with chronic diseases.

A sample of 1377 physicians were surveyed by mailed questionnaire to study to what extent primary care physicians are involved in the long-term care of children with chronic disorders. The sample included all pediatricians practicing in the province of Quebec and a stratified random sample of general practitioners (10% sample in urban areas and 25% sample in rural areas). A response rate of 81% was achieved. Referral patterns were studied for asthma, congenital heart disease, and diabetes. Although pediatricians referred their patients less frequently than general practitioners, referral patterns depended mainly on the clinical condition. "No routine referral" was the most popular management strategy for asthma, whereas for congenital heart disease and diabetes more than 20% of physicians referred their patients for all aspects of care. Rural physicians tended to assume patient care to a greater extent than did urban physicians. Most pediatricians referred patients directly to subspecialists practicing in tertiary care centers, whereas general practitioners often sent patients to pediatricians practicing elsewhere, or to other specialists. These data suggest that the availability of medical resources in the community and accessibility to tertiary care centers also influence physicians' involvement in the long-term care of these children.

[Influence of follow-up education of mothers about too early introduction of solid food to infants]. / Influence d'une éducation suivie auprès des mères sur l'introduction trop rapide des solides dans l'alimentation du nourrisson.

We developed a program intended to modify maternal attitudes towards feeding in order to delay the introduction of solids to infants until they are 2 months of age. The program was provided by nurses using an individualized, educational approach. To evaluate its efficacy, a randomized trial design was used. The results in the 2 groups were comparable. The educational trial's lack of success when compared to others and the reasons for this are discussed.

Bicycle accidents among children in the urban environment.

We studied all bicycling accidents requiring hospital visits among children 15 years of age and less, occurring on the Island of Montreal over an 18-month period. Data collected from 11 major Montreal hospitals and police accident reports were examined using various statistical methods: visual representation (a comparative accident index), spatial (quadrat analysis), and a comparative environmental analysis (differentiation of means). The results suggest that these accidents are not distributed randomly but correspond to a particular spatial pattern. High-risk areas are characterized by high population density, fast and dense vehicular traffic, and the absence of parks. Accidents usually take place on two-way streets, on straight stretches far from traffic lights, on dry pavement, and during clear weather when the visibility is good. More boys than girls are involved in these accidents and, more often than not, failure to obey traffic regulations is involved. The socio-economic status of the injured child tends to be low.

Expected diabetic control in childhood and psychosocial functioning in early adult life.

This study examined relationships between the extent to which doctors seek to achieve good (i.e., tight) diabetic control during childhood and the frequency of psychosocial problems in later life. A sample of 225 young adults with insulin-dependent diabetes mellitus was studied by use of a systematic interview. A measure of the level of control the doctor was attempting to achieve was developed from questionnaires administered to the doctors who provided most of the patient's care during childhood. The results were compared with scores on three indices of psychosocial functioning based on responses given in structured interviews with the patients. Although potentially important psychosocial problems were found for 10-20%, there was no statistically significant relationship between any of these problems and the doctors' desired levels of control. Thus, efforts to achieve good control during childhood, whether successful or not, may not be followed by psychosocial problems in later life. This finding should help support clinicians' attempts to obtain the levels of control during childhood judged to be essential in preventing serious organic complications.

Controlled trial of social work in childhood chronic illness.

Children with chronic illnesses have a doubled risk of becoming psychosocially maladjusted, and social-work support and counselling are commonly used to reduce this secondary morbidity. A randomised controlled trial of this type of intervention was conducted in 345 children with chronic physical disorders cared for in eleven specialty clinics at a children's hospital. Four months after a six-month period of social-work services, no significant difference was found between social-work and control groups in overall prevalence of maladjustment. There was no evidence to support a preventive or therapeutic effect of social work on child behaviour disorder or social dysfunction on the principal outcome measure, the Child Behaviour Checklist. Nor was there any detectable effect on child self-esteem, on maternal psychological function, or on the impact of the child's illness on the family. Furthermore, no patient subgroup could be shown to benefit from the intervention, and restriction of the analysis to individuals who received the intervention did not alter the results.

Sleep patterns and problems in adolescents.

A sleep questionnaire was administered to 390 students in an urban high school. Total sleep hours per week appeared to decrease between the ages of 12 and 18 years. In general, girls slept more than boys. The quality of sleep and the perception of sleep adequacy also decreased with age. Reporting of the occasional use of sleep medications and alcohol at bedtime was 4.6% and 10.5%, respectively. These findings suggest that sleep problems among adolescents represent normal physiologic processes as well as some serious disturbances that may reflect the social pressures prevalent during adolescence.

Birth defects and psychosocial adjustment.

A one-year prospective study was conducted to examine the extent to which type of disability, severity, and family functioning serve to predict maladjustment. One hundred forty children, aged 4 to 13 years, born with cardiovascular disorders, cleft lip or palate, or hearing defects were assessed using the Child Behavior Checklist at two points in time. The results suggest that the type of disorder and severity are associated with remaining or becoming maladjusted. Deaf girls and boys with cardiac problems were most likely to be affected, followed by boys with clefts and boys with hearing problems. A direct relationship is found with severity assessed by the Functional Status Measure. Family functioning, however, is not significantly related to maladjustment. These findings provide a framework for better understanding factors contributing to the increased risk of maladjustment for some children with birth defects.

The organization and evaluation of a computer-assisted, centralized immunization registry.

The rationale for, and establishment of, a computer-assisted, centralized immunization registry are described. This registry was created to improve the quality and quantity of information regarding immunization status for a defined population receiving primary care from a variety of providers, principally public clinics and private practitioners. An evaluation of the feasibility of the registry after one year's function shows that 93 per cent of eligible providers initially agreed to participate and 73 per cent continue to do so. Their reports have resulted in the creation of 17,500 individual patient files. Of a prospective cohort of newborns, 23 per cent were identified as "high-risk" for overdue immunizations. After one year, the immunization rates in audited groups improved significantly. The direct cost of this registry is less than 65 cents per currently registered child per year.