Parental Concerns Influencing Decisions to Seek Medical Care for a Child's Short Stature

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Abstract

Aims: To examine parental concerns about child growth and factors that drive parents' decisions whether to intervene medically with their child's height. Methods: Parents of 9- to 14-year-old pediatric primary care patients of various heights, oversampled for those with short stature, participated in exploratory focus groups and nominal group technique sessions. Growth concerns expressed by the groups were incorporated into a survey, completed by 1,820 parents, and rated for their degree of impact on medical decision-making. Ordinal logistic regression modeled concern scores against parent traits. Explanatory focus groups clarified the survey results. Results: Research team consensus and factor analysis organized the 22 distinct concerns expressed by the parent groups into 7 categories. Categories rated as having the greatest influence on parental decision-making involved: treatment efficacy and side effects, child health and psychosocial function. Level of concern was highly associated with parental education and parenting style. Conclusion: Psychosocial issues are influential, but parental decision-making is most impacted by concerns about treatment and child health. By discussing the real risks and benefits of hormone treatment and addressing parents' perceptions of what is needed for physical and psychosocial health, clinicians can be highly effective educators to assure that treatment is used only as medically indicated.

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Most cited references 28

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The effect of physical height on workplace success and income: preliminary test of a theoretical model.

T Judge, M Cable (2004)

In this article, the authors propose a theoretical model of the relationship between physical height and career success. We then test several linkages in the model based on a meta-analysis of the literature, with results indicating that physical height is significantly related to measures of social esteem (rho =.41), leader emergence (rho =.24), and performance (rho =.18). Height was somewhat more strongly related to success for men (rho =.29) than for women (rho =.21), although this difference was not significant. Finally, given that almost no research has examined the relationship between individuals' physical height and their incomes, we present four large-sample studies (total N = 8,590) showing that height is positively related to income (beta =.26) after controlling for sex, age, and weight. Overall, this article presents the most comprehensive analysis of the relationship of height to workplace success to date, and the results suggest that tall individuals have advantages in several important aspects of their careers and organizational lives. (c) 2004 APA

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Integrative medicine and patient-centered care.

Victoria Maizes, David P Rakel, Catherine Niemiec (2015)

Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate healthcare teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills. For integrative medicine to flourish in the United States, new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required.

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Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study.

Anita Hokken-Koelega, Lars Sävendahl, Kerstin Albertsson-Wikland … (2012)

The long-term mortality in adults treated with recombinant GH during childhood has been poorly investigated. Recently released data from the French part of the European Union Safety and Appropriateness of GH treatments in Europe (EU SAGhE) study have raised concerns on the long-term safety of GH treatment. To report preliminary data on long-term vital status and causes of death in patients with isolated GH deficiency or idiopathic short stature or born small for gestational age treated with GH during childhood, in Belgium, The Netherlands, and Sweden. Data were retrieved from national registries of GH-treated patients and vital status from National Population Registries. Causes of death were retrieved from a National Cause of Death Register (Sweden), Federal and Regional Death Registries (Belgium), or individual patient records (The Netherlands). All patients diagnosed with isolated GH deficiency or idiopathic short stature or born small for gestational age started on recombinant GH during childhood from 1985-1997 and who had attained 18 yr of age by the end of 2010 were included. Vital status was available for approximately 98% of these 2,543 patients, corresponding to 46,556 person-years of observation. Vital status, causes of death, age at death, year of death, duration of GH treatment, and mean GH dose during treatment were assessed. Among 21 deaths identified, 12 were due to accidents, four were suicides, and one patient each died from pneumonia, endocrine dysfunction, primary cardiomyopathy, deficiency of humoral immunity, and coagulation defect. In these cohorts, the majority of deaths (76%) were caused by accidents or suicides. Importantly, none of the patients died from cancer or from a cardiovascular disease.

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Author and article information

Journal

Journal ID (publisher-id): HRP

Journal ID (nlm-ta): Horm Res Paediatr

Journal ID (doi): 10.1159/issn.1663-2818

Title: Hormone Research in Paediatrics

Publisher: S. Karger AG

ISSN (Print): 1663-2818

ISSN (Electronic): 1663-2826

Publication date Subscription-year: 2015

Publication date (Print): November 2015

Publication date (Electronic): 09 October 2015

Volume: 84

Issue: 5

Pages: 338-348

Affiliations

^aDivision of Pediatric Endocrinology and Diabetes and ^bCraig Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, ^cDepartment of Pediatrics, ^dClinical and Translational Research Center and ^eCenter for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and ^fLeonard Davis Institute of Health Economics, University of Pennsylvania, and ^gUniversity of Pennsylvania School of Nursing, Philadelphia, Pa., USA

Author notes

*Adda Grimberg, MD, Division of Pediatric Endocrinology and Diabetes, The Children's, Hospital of Philadelphia, 3401 Civic Center Boulevard, Suite 11NW30, Philadelphia, PA 19104 (USA), E-Mail grimberg@email.chop.edu

Article

Publisher ID: 440804 Pmcid ID: PMC5576168 Other ID: Horm Res Paediatr 2015;84:338-348

DOI: 10.1159/000440804

PMC ID: PMC5576168

PubMed ID: 26448482

SO-VID: 2410993c-05c4-4f76-a7b2-f96a92f7c8a1

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 18 May 2015

Date accepted : 01 September 2015

Page count

Figures: 1, Tables: 4, References: 40, Pages: 11

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Parental Concerns Influencing Decisions to Seek Medical Care for a Child's Short Stature

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Karger: Endocrinology

Most cited references 28

The effect of physical height on workplace success and income: preliminary test of a theoretical model.

Integrative medicine and patient-centered care.

Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study.

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Cited by 10

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