Relationship between parenting stress and concerns identified by developmental screening and their effects on parental medical care-seeking behavior.

This cross-sectional study examines the relationship between parenting stress and concerns identified by developmental screening and their effects on parents' decisions to seek medical care for their children. A total of 182 parents completed both the Parenting Stress Index (PSI) and the Parents' Evaluation of Developmental Status (PEDS) when their children were admitted to a sick child care program that provides parents the option of requesting medical evaluations for their children with mild acute illnesses. Although 31.6% of parents (N = 62) requested medical evaluations, neither PSI nor PEDS scores were associated with these requests. However, PEDS scores indicating significant parental concerns about their child's development or behavior predicted clinically significant levels of parenting stress on the PSI (odds ratio 4.9; 95% confidence interval, 1.5-15.9; P = .007). Primary pediatric health care providers who routinely perform developmental screening need to consider this relationship when interpreting developmental screening results and offer supportive and referral services to families as needed.

Why parents seek medical evaluations for their children with mild acute illnesses.

The reasons underlying parents' decisions to seek medical evaluations for their mildly ill children are not well understood. This cross-sectional study tracked parents' requests for on-site medical evaluations at a sick child care program. A logistic regression model identified factors associated with parents' decisions to seek medical evaluations for their children based on the data from parent-completed questionnaires. A convenience sample of 196 parents completed all questionnaires; 62 (31.6%) parents sought medical evaluations. Parents were more likely to seek medical evaluations if they were concerned about missing work (odds ratio = 8.6; 95% confidence interval, 3.3-22.0; P = .0001), if they smoked (odds ratio = 3.7; 95% confidence interval, 1.1-12.4; P = .037), or if their spouse's highest educational attainment was some high school (odds ratio = 0.4; 95% confidence interval, 0.1-1.0; P = .044). The data highlight the problems working parents have in accessing health care during usual working hours and the potential value of convenient health care programs.

The potential biases in studying the relationship between asthma and microbial infection.

OBJECTIVE: To assess bias in parent reports of asthma status of children and detection bias of medical records-based asthma ascertainment and to examine effects of such bias on the association between asthma status and infections. METHODS: A prospective cohort study was conducted to compare the correlations between the frequency of acute illnesses and that of medical evaluations between children with or without asthma according to parental report and medical record review by following a group of children who were enrolled in the Mayo Clinic Sick Child Care Program in Rochester, Minnesota. Parents completed a self-administered questionnaire to determine asthma status of their child. Also, comprehensive medical record reviews were conducted to determine asthma status of each subject by applying predetermined criteria for asthma. RESULTS: A convenience sample of 115 parents and their children participated in this study. The mean age of the parents who participated in the study was 32.8 years (standard deviation: 5.4 years); 93% were female (mothers); and 90% were white. Of the 115 children who participated in this study, 84% were reported to be white and 49% were female. The mean age of the children was 2 years (standard deviation: 1.0 year). Parents whose children had asthma by report appeared to be less likely to seek medical evaluations (Spearman's rho: 0.42,p = 0.11) when their children had acute illnesses, compared to those of non-asthmatic children (rho: 0.64,p < 0.001). Concerns that asthmatic patients (rho: 0.62,p < 0.001) are more likely to see health care providers and undergo medical evaluations and laboratory tests when they have acute illnesses than non-asthmatic patients (rho: 0.64,p < 0.001) are not supported by our study. CONCLUSION: Parental report bias needs to be considered carefully when studying the relationship between asthma and microbial infection.