Rie Sakai

Parental Knowledge and Perceptions of Fever in Children and Fever Management Practices : Differences Between Parents of Children With and Without a History of Febrile Seizures

Objectives: The aim of this study was to compare maternal knowledge and perceptions of fever, fever management practices, and information sources of mothers of children with and without a history of febrile seizures. Methods: A questionnaire was used to survey mothers of children who visited health departments for a routine 18-month-old well baby check-up. Results: A total of 386 responses were analyzed. More mothers of children with a history of febrile seizures than mothers of children without it stated that high fever caused febrile seizures and antipyretics prevented it. Fewer mothers of children with a history of febrile seizures than mothers in the other group thought that high fever caused brain damage and antipyretics prevented the disease from worsening and warmed the childs body during fever episode. Many mothers in both groups stated that they considered physicians to be their primary information source. Spouse and own parents were named as information sources among mothers of children with a history of febrile seizures, whereas books and the Internet were named in the other group. Conclusions: Mothers of children with a history of febrile seizures demonstrated a higher rate of accuracy in their knowledge of fever than those in the other group. Mothers of children with a history of febrile seizures used personal communication, whereas those in the other group relied on mass communication for health information. Providing accurate information to family members is essential to provide mothers with both accurate information and emotional support.

Does fever phobia cross borders? The case of Japan

Background:  Undue parental fear of fever in children was termed “fever phobia” by Schmitt following a survey in the USA in 1980. In 2000, Crocetti et al. conducted the same survey and concluded that fever phobia existed even 20 years later. In this study, we explore differences in fever phobia between these two US populations and a Japanese sample, and determine whether parents of a single child or those whose child was previously hospitalized or had a febrile seizure report greater anxiety about fever.

Disease patterns of outpatient visits by Japanese expatriate children in Thailand

Aim: To clarify the health‐related conditions of Japanese expatriate children in Thailand.

Fever phobia; can we blame the trend to nuclear family or having a single child?

Fever is one of the most common reasons that parents seek medical attention for their children. Fever phobia is the undue parental fear of fever in children, which was first reported by Schmitt in 1980 (1). Some argue that fever phobia in Japan is attributable to the Japanese’s lack of child-rearing experience as a result of declining national birthrates, and also to a reduction of generational child-rearing tips as a result of a trend toward nuclear families (2). In this study, we introduce fever phobia in Japan to the international community and explored the influence of the nuclear family and the single-child family structure on fever phobia. An anonymous, self-administered questionnaire was administered to parents of children who visited one of the five health departments in Tokyo for a routine 18-month well-baby check-up between February and March 2006. Although many people responded to our questionnaire, including fathers and grandparents, we selected responses only from mothers. The purpose was to minimize confounding factors. The questionnaire included basic parental characteristics (number of children, residing with grandparents, etc.), body temperature considered indicating fever, possible complications of fever, use of antipyretics, sources of information relied upon during episodes of fever and management of fever at home. A written explanation of our study objectives was distributed at the well-baby clinics. Those who consented to the study were ushered to another room and handed the questionnaire. Questionnaires were later collected on site. SPSS 11.0J for Windows (SPSS Inc., Chicago, USA) was used for the analysis of data. The Mantel–Haenszel test was used to evaluate the differences between the parental groups; p < 0.05 was considered to indicate statistical significance. Differences between the two parental groups for questions that required numeric responses such as ‘temperatures that are considered to indicate fever’ were evaluated at 95% confidence intervals (CI). A total of 480 parents agreed to participate in the study and all of them returned the questionnaire. Of these, 418 responses—excluding 9 responses from fathers, 4 responses from grandparents and 49 responses which did not answer the number of children or residing with grandparents—were analysed. The number of mothers in nuclear families was 374 (89.5%). The number of mothers who had a single child was 216 (51.7%), that of mothers who had 2 children was 156 (37.3%), that of mothers who had 3 children was 38 (9.1%), and that of mothers who had more than 4 children was 8 (1.9%). As for temperatures considered by mothers to indicate fever (open-ended question), the mean was 37.8◦C, in the range of 37.7 to 37.8◦C at 95% CI. A total of 407 mothers (97.4%) believed that fever results in some type of complication and only 11 mothers (2.6%) answered that fever did not cause any complications. As for possible complications of fever (multiple answers allowed), ‘dehydration’ received the highest response rate (69.4%), followed by ‘febrile seizure’ (58.9%) and ‘brain damage’ (43.3%). As for temperatures that cause complications (openended question), responses from 376 parents—excluding 11 parents who answered, ‘Fever alone does not cause any complications,’ and 31 parents who did not answer this question—were analysed. The mean temperature was 39.2◦C, in the range of 39.1 to 39.3◦C at 95% CI. As for management of fever at home (multiple answers allowed), ‘give fluids’ received the highest response rate at 88.0%, followed by ‘cool the head’ (54.1%), ‘cool the body’ (23.2%), ‘use antipyretics’(13.6%), and ‘keep the body warm’ (11.7%). As for temperatures that determine whether or not to consult a healthcare provider, 404 mothers, excluding 14 mothers who answered ‘did not seek medical attention for fever alone’, were analysed. A total of 137 mothers (33.9%) answered that they did not seek treatment based on the height of their child’s fever. Among those who an-

Validation of predictive equations for resting energy expenditure in Japanese pediatric Crohn's disease patients: preliminary study.

Predictive equations are often used to estimate resting energy expenditure (REE). Determining the appropriate equation for different patient types, however, remains inconclusive, as in the case of Japanese children with Crohns disease (CD). The aim of this study was to identify an appropriate predictive equation for measuring REE in Japanese children with CD.

Does the pediatricians' work setting or years of experience influence febrile seizure education?

INTRODUCTION A febrile seizure is a benign condition. However, for parents, witnessing their childs FS can cause excessive anxiety. It is therefore important for pediatricians to provide appropriate information in order to reduce anxiety. In this study, we analyze whether work setting and years of experience influence the explanations given to caregivers. METHODS Questionnaires were mailed to members of the Japan Pediatric Society, Tokyo Chapter (n=1 870). The Mantel-Haenszel test was used for dichotomous variables. Differences for continuous variables were evaluated at 95% confidence intervals. RESULTS A total of 482 pediatricians participated. There were no significant differences in responses to any questions according to work setting. Responders with less than 20 years of experience reported a higher prevalence of febrile seizures than those in the more experienced group. Compared to the experienced group, more responders with less than 20 years of experience stated that they would administer antiepileptic prophylaxis and advise parents not to use antipyretics, and indicated that they did not know the FS treatment guidelines. CONCLUSION The findings suggest the importance of promoting a better understanding of FS among less-experienced pediatricians and encouraging adherence to the guidelines to maintain a consistent level of support for parents and caregivers.

Patterns of Outpatient Visits by Japanese Male Expatriates in Thailand

Patterns of Outpatient Visits by Japanese Male Expatriates in Thailand: Rie Sakai, et al. Department of Public Health, Juntendo University School of Medicine—Objective of this study is to clarify the health‐related conditions of Japanese male expatriates in Thailand. Records of Japanese male expatriates in their 30s to 50s who consulted outpatient clinics at Bangkok Hospital in 2005 were analyzed for number and type of outpatient visits then compared with data from the “Patient Survey” 2005 for age‐matched males in Japan. “Diseases of the respiratory system” and “Certain infectious and parasitic diseases” had a higher rate of diagnosis among Japanese men living in Thailand than those living in Japan. “Endocrine, nutritional and metabolic diseases,” and “Mental and behavioral disorders” had a lower rate of diagnosis among Japanese men living in Thailand than those in Japan. “Acute upper respiratory infections” accounted for 87.4% of “Diseases of the respiratory system” and “intestinal infections” accounted for 59.9% of “Certain infectious and parasitic diseases” among expatriates. Japanese male expatriates have a tendency of not visiting hospital when they have no subjective or objective symptoms. To support a healthy expatriate life, health information should be propagated widely and available support services, such as counseling via e‐mail or fax, should be actively promoted. Expatriates should be informed of the availability of these services before they go abroad and during their stay.

Disease pattern and seasonal variation among Japanese expatriate children in Thailand

Background:  Due to recent globalization, the number of Japanese expatriates including children has increased. The aim of the present study was to clarify the disease patterns and seasonal variation among Japanese children living in Thailand.

Current explanations regarding febrile seizures provided by pediatricians in Tokyo

provide appropriate information to caregivers in order to reduce their anxiety. We conducted this study to explore explanations regarding FS currently provided by paediatricians in Tokyo, Japan. Anonymous questionnaires were mailed to members of the Japan Pediatric Society Tokyo Chapter (n=1870). In the questionnaire we asked responding physicians to answer the questions on the assumption that they were seeing a 1-yearold child with first simple FS without a family history of FS. A total of 482 paediatricians agreed to participate in the study. The number of mean years of experience was 22 years. The prevalence of FS in Japan is generally reported to be 5 to 8%, 7,8 however, 29% of responders reported excessively high prevalence (above 10%; Table I). The rate of recurrence of FS during the subsequent febrile illness in Japan is generally reported to be about 30%; 7,9 however, 26% of responders reported prevalence above 40% (Table I). The prevalence of epilepsy after simple FS is generally reported to be 2 to 3%. 7,9,10 Only 26% of responders accurately reported this prevalence (Table 1). The FS treatment guidelines in Japan recommended that prophylactic use of intermittent diazepam (0.4–0.5mg ⁄ kg rectally or orally) during a febrile illness should be considered for patients at high-risk for the recurrence of FS during the subsequent febrile illness. 7 Many responders stated that they would administer prophylactic anticonvulsants earlier than recommended in the guidelines (Table II). The guidelines in Japan state that anticonvulsant prophylaxis should be given for 2 years or until the patients become 4 to 5 years of age. Of the responders who administer prophylactic anticonvulsants, the vast majority prescribe these longer than the duration recommended in the guidelines (Table II). Of the responders who administer prophylactic anticonvulsants, many state that they would administer these for emotional support rather than medical need (Table II). The guidelines in Japan state that antipyretics could be used to relieve discomfort of fever. However, explanations given by paediatricans for antipyretic use varied widely (Table II). Fourteen percent of responders stated that they were very familiar with the guidelines, 43% that they were familiar with them, 26% that they were not very familiar with them, and 16% stated that they were not familiar them. Of those who stated that they are very familiar or familiar with the guidelines, 32% stated that they followed them very closely, and 64% stated that they followed them fairly closely. The results of this study can be summarized as follows: (1) fewer than half of the respondents gave the same answers on each question of the questionnaire; (2) paediatricians currently reported higher prevalences of FS, recurrent FS, and epilepsy after simple FS than those gen