Improving the safety of street-vended food.

An integrated plan of action for improving street food involving health and other regulatory authorities, vendors and consumers should address not only food safety, but also environmental health management, including consideration of inadequate sanitation and waste management, possible environmental pollution, congestion and disturbances to traffic. However, WHO cautions that, in view of their importance in the diets of urban populations, particularly the socially disadvantaged, every effort should be made to preserve the benefits provided by varied, inexpensive and often nutritious street food. Therefore, authorities concerned with street food management must balance efforts aimed at reducing the negative aspects on the environment with the benefits of street food and its important role in the community. Health authorities charged with responsibility for food safety control should match risk management action to the level of assessed risk. The rigorous application of codes and enforcement of regulations more suited to larger and permanent food service establishments is unlikely to be justifiable. Such rigorous application of codes and regulations may result in disappearance of the trade with consequent aggravation of hunger and malnutrition. Moreover, most codes and regulations have not been based on any systematic identification and assessment of health hazards associated with different types of foods and operations as embodied in the HACCP approach which has been recognized by Codex as the most cost-effective means for promoting food safety. WHO encourages the development of regulations that empower vendors to take greater responsibility for the preparation of safe food, and of codes of practice based on the HACCP system.

Treatment of traumagenic beliefs among sexually abused girls and their mothers: an evaluation study.

The objective of this study was to evaluate and compare the efficacy of two short-term individual therapy interventions for sexually abused girls and their nonoffending female caretakers. Thirty-two girls, ages 8 to 13, and their caretakers from primarily low-income, African-American families were randomly assigned to a theoretically based, structured experimental treatment program or to a relatively unstructured comparison intervention. Measures of child outcome were completed before and after the treatment program by each parent and child, and by a clinician blind to treatment condition. Pre- and postmeasures of maternal outcome were completed by the caretaker and a clinician not involved in the treatment. Both treatment programs yielded decreases in children's posttraumatic stress disorder symptoms and traumagenic beliefs reflecting self-blame and powerlessness, and increases in children's overall psychosocial functioning. The experimental intervention was more effective than the comparison program in increasing abuse-related caretaker support of the child and in decreasing caretaker self-blame and expectations of undue negative impact of the abuse on the child. Clinical implications of these findings include the development of interventions targeting sexually abused children's traumagenic beliefs and nonoffending parents' support of their victimized children.

Predicting symptomatology and self-blame among child sex abuse victims.

Fifty-six sexually-abused girls and their nonoffending female caretakers from primarily low-income. African American families were comprehensively assessed in order to determine factors related to child symptomatology and self-blame. Girls whose overall relationships with their caretakers were somewhat negative exhibited more behavioral difficulties. Girls with disruptions in their relationship with a primary caretaker and who felt powerless as a result of the abuse were rated as functioning less well overall by clinicians. Child age, general attributional style, and caretaker blame of the child were related to child self-blame. Clinical implications of these findings include identification of clients at high risk for negative sequelae and development of interventions targeted at specific clinical issues.

Factors affecting group therapy outcome for adult sexual abuse survivors.

Adult female sexual abuse survivors (N = 148) participated in year-long therapy groups. Demographic, abuse history, initial symptomatology, and group process variables were examined in relationship to group completion and improvement over time. Survivors who had previously been psychiatrically hospitalized were less likely to complete group treatment. Among group completers, significant pretreatment-posttreatment changes were found on measures of locus of control, sexual problems, self-esteem, trauma-related symptomatology (TSC-33), and general psychological distress (SCL-90-R). Greater changes on the SCL-90-R were found among Caucasian women, women with more initial trauma-related symptomatology, women whose abuse included intercourse, members of groups with similar abuse histories, and women with previous psychotherapy experience.

Psychiatric and family functioning in children with leukemia and their parents.

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.

After a child's death: factors related to parental bereavement.

Bereavement responses were assessed in 45 parents whose children died 6 months to 4 years earlier. Correlational analyses were used to determine which demographic and experiential variables were related to parental responses on 10 scales of the Grief Experiences Inventory (GEI). Parents of boys or children who died suddenly experienced more despair, anger, guilt, and depersonalization. Social support and stress since the child's death and fate-blame versus self-blame were also related to parental responses on specific GEI scales. Clinical implications for work with bereaved parents are discussed.

Child sexual abuse prevention: evaluation and one-year follow-up.

Because of the high incidence and negative psychological consequences of child sexual abuse, prevention programs have been developed and implemented nationwide. Few programs, however, have been comprehensively evaluated. In this multimodal study, a 3-session adaptation of the Feeling Yes, Feeling No curriculum was provided to 286 third and fourth graders from four schools whose responses were compared to 113 delayed-treatment control children from two schools. Program impact was assessed using a knowledge scale, the State-Trait Anxiety Inventory for Children, a videotape vignettes measure, a parent questionnaire, and disclosure data. Treatment children exhibited significantly greater knowledge and better ability to discriminate safe from unsafe situations on the video measure than control children at posttesting. These gains were maintained at 6-week follow-up testing. There were no differences in treatment and control children's self-reported anxiety or parents' reports of negative emotional/behavioral consequences, which were minimal. Over 5% of participating children reported ongoing or past sexual abuse. In the One-Year Follow-Up Study, children's knowledge gains and prevention skills scores on the video measure were maintained at one-year follow-up. A 1-session "booster shot" program further enhanced children's safety discrimination skills on the video measure.

Factors related to adherence to medication regimens in pediatric seizure patients.

Factors related to medication adherence were studied in 35 pediatric seizure patients at a public hospital serving primarily low-income minority patients. Adherence ratings by pediatric neurologists were based primarily on three blood assays drawn at monthly intervals and patients were rated as adherent on 1, 2, or 3 visits. Parent and child satisfaction with medical care was associated with greater adherence. Parental worry about the child's health was positively correlated with the number of behavioral restrictions placed on the child, and both variables were negatively related to adherence. The authors hypothesize that anxiety-based denial and perceived threats to patient autonomy may interfere with medication adherence. Implications for the development of intervention strategies for improving adherence among pediatric seizure patients are discussed.

Child sexual abuse prevention: evaluation of a teacher training model.

Teachers are potentially helpful resource persons for large numbers of sexually abused children who may have difficulty disclosing abuse, particularly to family members. In the present study, the effectiveness of a 6-hour teacher training workshop on child sexual abuse prevention was evaluated. Responses of 26 female elementary teachers who participated in the workshop were compared to responses of 19 control teachers on several pre-, post-, and follow-up measures. Relative to controls, trained teachers demonstrated significant increases from pre- to post-testing in knowledge about child sexual abuse and pro-prevention opinions. On a post-only vignettes measure, trained teachers were better able than control teachers to identify behavioral indicators of abuse and suggest appropriate interventions for hypothetical sexually abused children. Over a 6-week follow-up period, trained teachers read more about child abuse than control teachers but did not differ on other behavioral dimensions such as reporting suspected abuse cases. Further research will examine the effects of additional teacher training over an extended follow-up period.

Group therapy with sexually abused adolescent girls.

Clinical guidelines are presented for conducting group therapy with sexually abused adolescent girls, based on a literature review and the authors' clinical experience. Common treatment themes, pragmatic issues related to setting up a group treatment program, and group process issues are discussed.

Knowledge, attitudes, and behavior in children with asthma.

Psychosocial aspects of asthma were studied by administering questionnaires to 80 children with asthma and their parents. Overall, children demonstrated high levels of knowledge about asthma, an internal health locus of control, and positive self-concepts. Increased knowledge was associated with more internal health locus of control scores, whereas more positive self-concept scores were associated with more adaptive asthma-related behavior. Children who attended a week-long camp did not differ significantly from comparison children on these measures.

Effects of swimming on health.

An epidemiological study involving 893 people was undertaken during the 1980/81 summer period in the Richmond and Windsor region of New South Wales to determine the incidence of swimmers and non-swimmers reporting ear, eye, skin, throat and gastrointestinal complaints. Swimmers were found to report a greater incidence of ear and eye complaints than non-swimmers. Swimmers who swam in community pools were found to have a significantly higher incidence of earache compared to other swimmers. The findings of the study supported overseas work which suggests that the incidence of earache among swimmers may be a useful health indicator in the evaluation of waters for recreational use.

Videotaped parent education in pediatric waiting rooms.

Parents in pediatric appointment clinic and pediatric emergency clinic waiting rooms were exposed to a five-minute videotaped program offering parenting tips. For half of the parents, the program was presented incidentally on a television monitor in the waiting room. The remaining half were asked to view the program individually in an adjacent room. Half of the first group actually watched the program, and those who watched learned less than half as much as did parents who viewed the program in a structured setting. In both conditions, parents rated the programs as highly appealing. Type of clinic did not affect parents' awareness, learning, or appeal ratings.

Children's perceptions of parental behaviors.

Children's perceptions of positive and negative parental behaviors were assessed using a newly-developed scale, the Parent Perception Inventory (PPI). Reliability and validity were examined across a sample of 75 children aged 5 to 13 using additional measures administered to the children and measures completed by their parents. The scale showed acceptable levels of internal consistency. No effects of children's age were apparent, but effects of the child's and parent's gender were found. Boys reported more positive parental behaviors, particularly for fathers, and children reported more negative (disciplinary) behaviors by mothers. PPI scores were predictably related to child's self-concept and behavior problems (convergent validity) and generally unrelated to measures of child's achievement (discriminant validity). As predicted by family systems theory, children from nondistressed families viewed their parents as behaving more similarly on the PPI than did children from distressed families.