Displaying publications 81 - 100 of 101 in total

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  1. Chan CYW, Chong JSL, Lee SY, Ch'ng PY, Chung WH, Chiu CK, et al.
    Spine (Phila Pa 1976), 2020 Dec 01;45(23):1661-1667.
    PMID: 32756286 DOI: 10.1097/BRS.0000000000003641
    STUDY DESIGN: Prospective study.

    OBJECTIVE: To determine the parents'/patients' perception on the informed consent process prior to posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) patients.

    SUMMARY OF BACKGROUND DATA: Understanding parents/patients perspective on the process is important in order to achieve the goal of consent and prevent medico-legal implications.

    METHODS: Fifty AIS patients operated between August 2019 and November 2019 were prospectively recruited. Parents'/patients' perceptions on three sections were evaluated: the process of the informed consent, specific operative risk which they were most concerned with and the accountability of surgeons for the surgical risks. These data were ranked and scored using a 5-point Likert Scale. Preferences were reported in mean and standard deviation. Differences in terms of preferences were studied using One-way analysis of variance (ANOVA) analysis and deemed significant when P 

    Matched MeSH terms: Parents/psychology*
  2. Noor AM, Muthupalaniappen L, Shamsul AS, Hizlinda T, Khairani O, Fatimah A
    Malays J Nutr, 2012 Apr;18(1):47-55.
    PMID: 23713229 MyJurnal
    Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding.
    Matched MeSH terms: Parents/psychology*
  3. Chu SY, Park H, Lee J, Shaharuddin KKB, Gan CH
    Child Care Health Dev, 2020 07;46(4):485-494.
    PMID: 32396218 DOI: 10.1111/cch.12771
    BACKGROUND: This study explored the relationship between self-perceived stigmatization (affiliate stigma), stress and quality of life among parents of children with autism spectrum disorder (ASD).

    METHOD: Participants (N = 110) filled-in the Affiliate Stigma Scale, the Caregiver Burden Inventory and the CarerQOL scale.

    RESULTS: Parents reported low scores on stigma and fair levels of stress and quality of life, indicating that parents do not feel stigmatized by affiliation with a child with ASD nor are they stressed from affiliate stigma. After controlling for demographic factors, both the relationships of affiliate stigma with stress and with quality of life were weak, indicating that stigma may have little to no effect on stress and quality of life.

    CONCLUSION: Cultural and religious beliefs may play a part in the acceptance of a child's condition, resulting in less impact of stigma on the parents.

    Matched MeSH terms: Parents/psychology*
  4. Chong LT, Chong MC, Tang LY, Ramoo V, Chui PL, Hmwe NTT
    J Pediatr Nurs, 2019 06 15;48:e15-e20.
    PMID: 31213340 DOI: 10.1016/j.pedn.2019.05.016
    STUDY PURPOSE: This study was conducted to examine the relationship between religious practice, religious coping methods and psychological distress among parents caring for children with transfusion-dependent thalassemia.

    DESIGN AND METHODS: This is a cross-sectional survey. Data were collected on 162 parents of children diagnosed with thalassemia aged 12 years and younger in thalassemia day care centers of three public hospitals in Sabah, Malaysia. Data were collected using questionnaires, including General Health Questionaire-12 (GHQ-12), Duke University Religion Index (DUREL) and Brief RCOPE.

    RESULTS: Forty-two percent of parents had psychological distress with GHQ score ≥ 3 (mean score of 2.85 ± 3.17). Ninety-five percent of parents used positive religious coping methods (mean P-COPE score 22.35 ± 2.33) more than negative religious coping methods (mean N-COPE score was 12.19 ± 5.23). They used Organized Religious Activities (mean ORA score of 4.20 ± 1.27), and Non-Organized Religious Activities (NORA, the mean was 4.17 ± 1.37). Positive and negative religious coping methods were significantly related to parents' psychological distress (P-COPE and GHQ-12 scores (rs (df) = 0.19, p 

    Matched MeSH terms: Parents/psychology*
  5. Ahmed A, Lee KS, Bukhsh A, Al-Worafi YM, Sarker MMR, Ming LC, et al.
    J Infect Public Health, 2017 10 04;11(2):153-155.
    PMID: 28988775 DOI: 10.1016/j.jiph.2017.09.007
    The increase in Muslim parents' refusal and hesitancy to accept childhood vaccination was identified as one of the contributing factors in the increase of vaccine-preventable diseases cases in countries such as Afghanistan, Malaysia and Pakistan. The spread of inaccurate and irresponsible information by the anti-vaccination movement may inflict more harm than good on Muslim communities. To curb this issue, health authorities in Pakistan and Malaysia have resorted to imposing strict punishments on parents who refuse to allow their children to be vaccinated. Information addressing religious concerns such as the halal issue must be made priority and communicated well to the general public, encouraging not only the acceptance of vaccinations but motivating communities to play an active role in promoting vaccination. Local government of the affected region need to work towards creating awareness among Muslim parents that vaccinations are a preventative public health strategy that has been practised and acknowledged by many doctors of all faiths.
    Matched MeSH terms: Parents/psychology
  6. Sng QW, Kirk AH, Buang SN, Lee JH
    Pediatr Crit Care Med, 2017 Apr;18(4):e167-e175.
    PMID: 28230713 DOI: 10.1097/PCC.0000000000001095
    OBJECTIVES: This study examined satisfaction of parents whose children were admitted to the PICU to identify priority areas for improvement. We hypothesized that differences exist in satisfaction of parents of different ethnicities.

    DESIGN: Prospective observational study.

    SETTING: PICU in a tertiary care pediatric hospital.

    PATIENTS: All English-literate parents whose child was admitted to our PICU between February 2014 and February 2015 were eligible after informed consent was obtained. Parents included in this study in previous admission(s) were excluded.

    INTERVENTION: Nil.

    MEASUREMENTS AND MAIN RESULTS: We adapted Empowerment of Parent in the Intensive Care Questionnaire, a validated questionnaire survey specific for measuring parental satisfaction in PICUs. This adapted survey consisted of 31 questions (based on a scale of 1-6) examining five domains as follows: information giving, care and cure, parental participation, organization, and professional attitude. Reliability of Empowerment of Parent in the Intensive Care Questionnaire in our population was analyzed using Cronbach's alpha. We used ordinal logistic regression, controlling for socioeconomic status and educational level, to examine differences in parental perceptions of various ethnicities. We obtained a total of 206 responses (36.5%) from 543 admissions. There were 116 (56%) emergency and 90 (44%) elective admissions. The proportion of respondents were Chinese (126 [61%]), Malay (32 [16%]), Indian (23 [11%]), and "Others" (25 [12%]). Cronbach's alpha for domains of information giving (α = 0.80), care and cure (α = 0.93), parental participation (α = 0.84), organization (α = 0.79), and professional attitude (α = 0.88) were good. In all five domains, our median PICU scores were 6 (interquartile range, 5-6). Compared to other ethnic groups, Malay parents did perceive that domains of "care and cure," "parental participation," and "professional attitude" were less satisfactory.

    CONCLUSIONS: Significant differences were found in satisfaction ratings between parents of different ethnicities. Further studies are needed to explore and determine reasons for these differences.

    Matched MeSH terms: Parents/psychology*
  7. Bukhsh A, Rehman H, Mallhi TH, Ata H, Rehman IU, Lee LH, et al.
    Hum Vaccin Immunother, 2018 04 03;14(4):952-957.
    PMID: 29333939 DOI: 10.1080/21645515.2017.1415686
    National immunization program of Pakistan does not include Influenza vaccines. The low rate of immunization might be attributed to the poor knowledge of influenza vaccination in Pakistan. Current study was aimed to assess the knowledge and attitude of influenza vaccination among parents. A questionnaire-based cross sectional study was conducted among randomly selected parents with at least one child aged >6 months. The responses were recorded against 27 items questionnaire assessing knowledge, perception, attitude and behaviours of parents. Data were analysed by using appropriate statistical methods. A total 532 responses were recorded with male gender preponderance (65%). Most of the parents (61.1%) reported that their children had received or planned to receive all recommended vaccines in Expanded Program on Immunization (EPI) of Pakistan. Only one third of the parents (24.4%) were aware of the availability of influenza vaccines in Pakistan, and very few (6.6%) reported vaccinating their child against influenza. Exploring the parents' attitudes regarding children vaccination, the top motivator was 'immunization is important to keep my children healthy' (relative index = 0.93, p < 0.000). However, substantial number of parents believed that influenza is not a serious disease (18.5%) and vaccines are accompanied by several side effects (24.6%). A positive attitude was reflected among parents who were aware of influenza vaccines in Pakistan. About 35% participants believed that influenza vaccines are not required for healthy children. Current study demonstrated very low vaccination rate against influenza. Awareness and health literacy regarding influenza vaccine is poor among parents. These findings necessitate the need to appropriately structured awareness programs regarding influenza vaccination among parents.
    Matched MeSH terms: Parents/psychology*
  8. Kaartina S, Chin YS, Fara Wahida R, Woon FC, Hiew CC, Zalilah MS, et al.
    Health Qual Life Outcomes, 2015 Apr 08;13:44.
    PMID: 25889663 DOI: 10.1186/s12955-015-0234-4
    BACKGROUND: The Pediatric Quality of Life Inventory Generic Core Scales (PedsQL) 4.0 is a generalized assessment of health-related quality of life (HRQoL) based on adolescent self-report and parent proxy-report. This study aims to determine the construct validity and reliability of PedsQL 4.0 among a sample of Malaysian adolescents and parents.

    METHODS: A cross-sectional study was carried out at three selected public schools in the state of Selangor. A total of 379 Malaysian adolescents completed the PedsQL 4.0 adolescent self-report and 218 (55.9%) parents completed the PedsQL 4.0 parent proxy-report. Weight and height of adolescents were measured and BMI-for-age by sex was used to determine their body weight status.

    RESULTS: There were 50.8% male and 49.2% female adolescents who participated in this study (14.25 ± 1.23 years). The prevalence of overweight and obesity (25.8%) was four times higher than the prevalence of severe thinness and thinness (6.1%). Construct validity was analyzed using Confirmatory Factor Analysis (CFA). Based on CFA, adolescent self-report and parent proxy-report met the criteria of convergent validity (factor loading > 0.5, Average Variance Extracted (AVE) > 0.5, Construct Reliability > 0.7) and showed good fit to the data. The adolescent self-report and parent proxy-report exhibited discriminant validity as the AVE values were larger than the R(2) values. Cronbach's alpha coefficients of the adolescent self-report (α = 0.862) and parent proxy-report (α = 0.922) showed these instruments are reliable. Parents perceived the HRQoL of adolescents was poorer compared to the perception of the adolescent themselves (t = 5.92, p < 0.01). There was no significant difference in total HRQoL score between male and female adolescents (t = 0.858, p > 0.05). Parent proxy-report was negatively associated with the adolescents' BMI-for-age (r = -0.152, p < 0.05) whereas no significant association was found between adolescent self-report and BMI-for-age (r = 0.001, p > 0.05).

    CONCLUSION: Adolescent self-report and parent proxy-report of the PedsQL 4.0 are valid and reliable to assess HRQoL of Malaysian adolescents. Future studies are recommended to use both adolescent self-report and parent-proxy report of HRQoL as adolescents and parents can provide different perspectives on HRQoL of adolescents.

    Matched MeSH terms: Parents/psychology*
  9. Tung SE, Ng XH, Chin YS, Mohd Taib MN
    Child Care Health Dev, 2016 Jul;42(4):478-85.
    PMID: 27272607 DOI: 10.1111/cch.12355
    BACKGROUND: This study aimed to evaluate parental perception of neighbourhood environments and safety in association with children's physical activity among primary school children in Klang, Selangor, Malaysia.

    METHODS: A total of 250 children (9-12 years of age) and their parents participated in this cross-sectional study. Physical Activity Questionnaire for Older Children and Neighbourhood Environmental Walkability Scale as well as questions on constrained behaviours (avoidance and defensive behaviours) were used to assess the children's physical activity and parental perception of neighbourhood environment and safety, respectively.

    RESULTS: More than one-third (36.0%) of the children were physically inactive compared with only a small percentage (4.8%) who were physically active, with boys achieving higher physical activity levels than girls (t = 2.564, P = 0.011). For the environmental scale, parents' perception of land-use mix (access) (r = 0.173, P = 0.006), traffic hazards (r = -0.152, P = 0.016) and defensive behaviour (r = -0.024, P = 0.143) correlated significantly with children's physical activity. In multiple linear regression analysis, child's gender (β = -0.226; P = 0.003), parent's education (β = 0.140; P = 0.001), household income (β = 0.151; P = 0.024), land-use mix (access) (β = 0.134; P = 0.011) and defensive behaviour (β = -0.017; P = 0.038) were significantly associated with physical activity in children (R = 0.349, F = 6.760; P 

    Matched MeSH terms: Parents/psychology*
  10. Nathan AM, Muthusamy A, Thavagnanam S, Hashim A, de Bruyne J
    Pediatr Pulmonol, 2014 May;49(5):435-40.
    PMID: 24482322 DOI: 10.1002/ppul.23001
    To investigate the impact of chronic suppurative lung disease (CSLD) on growth and lung function in the child as well as quality of life of the child and parent.
    Matched MeSH terms: Parents/psychology*
  11. Clark M, Brown R, Karrapaya R
    J Intellect Disabil Res, 2012 Jan;56(1):45-60.
    PMID: 21435066 DOI: 10.1111/j.1365-2788.2011.01408.x
    While there is a growing body of literature in the quality of life of families that include children with disabilities, the majority of research has been conducted in western countries. The present study provides an initial exploration of the quality of life of Malaysian families that include children with developmental/intellectual disabilities. Dynamics characterising Malaysian society are described as developments in social policy and service delivery that support persons with disabilities and their families.
    Matched MeSH terms: Parents/psychology
  12. Khan TM, Sahibzada MU
    Vaccine, 2016 Apr 19;34(18):2074-81.
    PMID: 26993330 DOI: 10.1016/j.vaccine.2016.03.008
    A qualitative study design was adapted to explore the challenges faced by health workers (HWs) during the polio health campaign. In addition, HWs' opinions about the factors causing parents to refuse oral polio vaccination (OPV) were also explored. Four focus group discussions (FGDs) were held (from 1st January 2015-31st March 2015) with the HWs who participated in the OPV campaigns in the polio red zones of Khyber Pakhtoon Khawa (KPK) province of Pakistan, namely Kohat (FG 1), Domel and Bannu (FG 2), Hangoo (FG 3), and Peshawar (FG 4). A total of N=42 HWs (10-11 in each FG) agreed to participate in this study. Overall, HWs disclosed that public attitude and harsh behaviour towards the HWs and security threats are the two main challenges they face. Common issues hindering parents' willingness to vaccinate their children against OPV are: OPV is seen as haram and not permitted in Islam, it is said to contain the blood of pigs (Khinzir) and monkeys, and parents are afraid that it is done to induce sterility among their children. HWs also shared that parents have a strong belief in the conspiracies that are associated with OPV, i.e. the USA and CIA, are spying on us and our government is helping them to achieve their agenda. Furthermore, HWs revealed that frequent visits may further strengthen parents' perceptions and make them more resistant to OPV. The common side effects of OPV reported by parents were mainly gastro-intestinal problems and in some cases mild to moderate fever with some respiratory symptoms. There is a great need to improve the logistics and facilities for HWs assisting in vaccination programmes. Furthermore, it is necessary to improve education, so people understand the basic concept of revaccination and booster doses, thereby assisting in creating a basic understanding of vaccinations, which may trigger changes in attitudes and make people believe in the benefits of OPV rather than following the conspiracies that lead them to refuse it.
    Matched MeSH terms: Parents/psychology*
  13. Kasim MS, Shafie HM, Cheah I
    Child Abuse Negl, 1994 May;18(5):401-7.
    PMID: 8032970
    Available evidence has shown that the type of abuse perpetrated on children depends considerably on the social and other factors inherently faced by these children. A total of 119 cases of physical abuse was detected by the Suspected Child Abuse and Neglect (SCAN) Team of General Hospital, Kuala Lumpur in 1991. Eighty-two cases were categorized as mild and 37 as severe. The average age of those mildly abused was 7.9 years, for those severely abused the average age was 4.2 years. The perpetrators of those mildly abused were often their own parents. However, among those severely abused, the child-minder was the most frequent abuser. Ninety-two of all cases were in families of social classes IV and V. In 47 cases, there was definite evidence of family disharmony or disruption. Among the 37 severely abused, the parents were either divorced or separated in 14 cases. There was a personality disorder in seven of the cases. Six of the abusers were also using drugs and nine were alcoholics. This paper shows that, even in a developing country, the social milieu is important in the type of abuse inflicted.
    Matched MeSH terms: Child of Impaired Parents/psychology
  14. Huang H, Wan Mohamed Radzi CW, Salarzadeh Jenatabadi H
    PMID: 28208833 DOI: 10.3390/ijerph14020181
    The main purpose of the current article is to introduce a framework of the complexity of childhood obesity based on the family environment. A conceptual model that quantifies the relationships and interactions among parental socioeconomic status, family food security level, child's food intake and certain aspects of parental feeding behaviour is presented using the structural equation modeling (SEM) concept. Structural models are analysed in terms of the direct and indirect connections among latent and measurement variables that lead to the child weight indicator. To illustrate the accuracy, fit, reliability and validity of the introduced framework, real data collected from 630 families from Urumqi (Xinjiang, China) were considered. The framework includes two categories of data comprising the normal body mass index (BMI) range and obesity data. The comparison analysis between two models provides some evidence that in obesity modeling, obesity data must be extracted from the dataset and analysis must be done separately from the normal BMI range. This study may be helpful for researchers interested in childhood obesity modeling based on family environment.
    Matched MeSH terms: Parents/psychology*
  15. Al Maghaireh DF, Abdullah KL, Chong MC, Chua YP, Al Kawafha MM
    J Pediatr Nurs, 2017 06 19;36:132-140.
    PMID: 28888494 DOI: 10.1016/j.pedn.2017.06.007
    PURPOSE: To investigate the stressors and stress levels among Jordanian parents of infants in the NICU and their relationship to three factors: anxiety, depression and sleep disturbance.

    DESIGN AND METHODS: A cross-sectional survey was conducted in two hospitals in Jordan among 310 parents of infants in the NICU by using PSS: NICU and PROMIS.

    RESULTS: Both parents experienced high levels of stress, anxiety, depression and sleep disturbance. There was a significant difference in stress level between mothers and fathers [t (308)=3.471, p=0.001], with the mothers experiencing higher stress than the fathers [mean: mothers=108.58; fathers=101.68]. The highest and lowest sources of stress were infant behavior and appearance (M=4.09) and sights and sounds in the NICU (M=3.54), respectively. The correlation between stress levels with anxiety (r=0.79) and depression (r=0.75) was strong and positive while sleep disturbance was significant and moderate (r=0.43).

    CONCLUSIONS: The mothers experienced higher levels of stress compared to fathers, with positive correlations between stress and anxiety, depression and sleep disturbance.

    PRACTICAL IMPLICATIONS: The findings of this study create nursing awareness of parent stress and its impact, which will help them to improve nursing care for parents.

    Matched MeSH terms: Parents/psychology*
  16. Chan GC, Tang SF
    Singapore Med J, 2006 Apr;47(4):266-70.
    PMID: 16572235
    INTRODUCTION: A study was carried out in a primary healthcare clinic in the Hulu Langat district of Malaysia to assess the parental knowledge, attitudes and antibiotic use for common childhood acute upper respiratory tract infection (URTI).
    METHODS: A cross-sectional study involving 421 parents, who were surveyed by using an interviewer-administered questionnaire, from April to June 2001.
    RESULTS: Approximately 59 percent of parents from this study believed that weather was the main cause of acute URTI of their children, 13 percent thought it was due to food, and only about 27 percent said it was caused by germs. Nearly 68 percent, 69 percent and 76 percent of them believed that antibiotics was helpful in treating the common cold, cough and fever, respectively. 29 percent of parents who thought that their child with acute URTI needed antibiotics were not prescribed with any. On the other hand, 17 percent believed that antibiotics were unnecessary when prescribed. 28 percent of parents had requested for antibiotics, and 93 percent received what they requested for their child with acute URTI. About 31 percent of parents who did not request any antibiotics claimed that private general practitioners habitually prescribed antibiotics. The antibiotic compliance was poor with only 74 percent completing the entire course, with 85 percent of them stopping once they improved symptomatically. 15 percent of parents gave "leftover" antibiotics, 24 percent gave "shared" antibiotics, and 5.5 percent bought antibiotics for their child with acute URTI without consulting a doctor.
    CONCLUSION: This study shows that parents often have inadequate knowledge and misconceptions on antibiotic use for acute URTI in children. Improved parental education may reduce unnecessary antibiotic prescription and antimicrobial resistance in the community.
    Study site: Klinik Kesihatan Batu 9, Hulu Langat, Selangor, Malaysia
    Matched MeSH terms: Parents/psychology*
  17. Gao XL, Hsu CY, Xu YC, Loh T, Koh D, Hwarng HB
    J Dent Res, 2010 Sep;89(9):985-90.
    PMID: 20554887 DOI: 10.1177/0022034510372896
    Policymakers' understanding of and ability to reduce health disparities are pivotal for health promotion worldwide. This study aimed to verify the behavioral pathways leading to oral health disparities. Oral examinations were conducted for 1782 randomly selected preschoolers (3-6 yrs), and 1576 (88.4%) participants were followed up after 12 months. Parents were surveyed on their knowledge (K), attitude (A), and practices (P) regarding their children's oral health homecare (infant feeding, diet, and oral hygiene) and dental attendance. Structural equation modeling substantiated the links between specific KAs and corresponding practices, while generic KA did not affect practices. KAP pathways partly explained the ethnic and socio-economic disparities in oral health. Deprivation had a direct effect (not mediated by KA) on dental attendance, but not on oral health homecare. Ethnicity directly influenced oral health homecare practices, but not dental attendance. These behavioral pathways, furthering our understanding of health disparity, may have practical implications for health promotion and policy-making.
    Matched MeSH terms: Parents/psychology
  18. Ismail NAS, Ramli NS, Hamzaid NH, Hassan NI
    Nutrients, 2020 Aug 20;12(9).
    PMID: 32825466 DOI: 10.3390/nu12092530
    Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that is frequently associated with food refusal, limited food repertoire and high-frequency single food intake mainly among children with ASD. Provision of nutrition can be very challenging due to the fact of these behavioural problems, either for the parents or special educators. Healthy nutrition is associated with providing and consuming nutritious food with results being in a good state of health. Semi-structured focus group discussions (FGDs) were conducted among 20 participants at a National Autism Centre to explore their understanding towards healthy nutrition. They were parents and special educators who were actively involved with children with ASD. A series of discussions were transcribed verbatim, and four researchers examined each transcript. Inductive analysis linking codes into main thematic categories was conducted using the constant comparison approach across the full data set. The outcome suggested that participants had limited knowledge relating to the proper dietary and nutritional needs of the children. The key messages from the discussion provide a foundation on the development of a nutrition education module which involves primary caretakers of children with ASD.
    Matched MeSH terms: Parents/psychology*
  19. Lee WS
    J Paediatr Child Health, 2008 Jan;44(1-2):57-61.
    PMID: 17640283
    To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.
    Matched MeSH terms: Parents/psychology
  20. Kasim MS, Cheah I, Shafie HM
    Child Abuse Negl, 1995 Jul;19(7):847-54.
    PMID: 7583742
    This paper gives a detailed account of 30 cases of childhood deaths caused by physical abuse, detected by the Suspected Child Abuse and Neglect (SCAN) team, General Hospital, Kuala Lumpur. They consisted of 12 Malays, 6 Chinese, 9 Indian, and 1 Indonesian child. Three cases could not be ascertained as to their ethnic origin. There were 13 male and 17 female children. The average age of the abused children was 2 years 5 months. The most frequent causes of death were intracranial hemorrhage and intraabdominal trauma. Of the 17 cases of intracranial hemorrhage, only four had X-ray evidence of skull fracture. This suggests the possibility of whiplash injuries with/without the abuser suspecting that he/she had injured the child. Of the 22 abusers who could be identified, there was no sex differentiation. Fathers formed the largest group of perpetrators, followed by mothers and childminders. Fifteen of the natural parents of the abused children were married, four were divorced and four were never married. Five of the abusers had aggressive personalities and three were drug addicts. Only one abuser was found to be an alcoholic even though a few were also under suspicion. For most cases, trigger factors could not be identified.
    Matched MeSH terms: Child of Impaired Parents/psychology
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