Parental Loss Research Articles

Regulating Emotion: Burial and Mourning of Children in Early Modern Ashkenaz

Abstract: This article addresses a lacuna in scholarship: the burial and mourning rites for premodern Jewish children's deaths. I explore three genres of sources from western and central Europe: bylaws, custom books, and epitaphs. I argue that communal leaders regulated the process of grieving one's children, marking those deaths in ways that are different from how an adult is memorialized. Nevertheless, by creating additional rites or by permitting parents to circumvent certain norms, communal leaders acknowledged and even facilitated more intense expressions of parental loss.

Increased Cardiometabolic Risk in Healthy Young Adults With Early Life Stress.

This study aimed to evaluate the relationship between early life stress (ELS) and metabolic risk in healthy young adults and assess the role of health behaviors. Young adults aged 18 to 40 years ( N = 190) with no medical conditions or medication usage were recruited from the community. Participants with ELS ( N = 113) had a history of childhood maltreatment, and most also experienced parental loss ( n = 88). Controls ( N = 77) had no history of maltreatment or parental loss. Standardized interviews and self-reports assessed demographics, adversity, medical/psychiatric history, and health behaviors. Blood pressure and anthropometrics were measured, and fasting plasma assayed for lipid profiles, glucose, insulin level, and hemoglobin A 1c . We calculated both a clinical cut-point and continuous composite metabolic risk score based on clinical risk factors and the mean of z scores of each measure, respectively. ELS was significantly associated with increased clinical cut-point ( β = 0.68, 95% confidence interval [CI] = 0.20-1.17, p = .006) and continuous ( β = 0.23, 95% CI = 0.08-0.038, p = .003) composite metabolic risk scores. On sensitivity analysis, the association of ELS with the continuous composite metabolic risk score was reduced to a trend after adjusting for a range of psychosocial and health predictors ( β = 0.18, 95% CI = 0.00-0.36, p = .053), with both diet and college graduate status significant in the model. Healthy young adults with a history of ELS have increased metabolic risk scores as compared with controls. This relationship may be partially due to health behaviors and socioeconomic factors. These findings underline that ELS is an early contributor to metabolic risk.

Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring

Prenatal stress is associated with increased risks of several cardiovascular risk factors later in life. However, knowledge regarding the role of prenatal stress in the development of ischemic heart disease (IHD) and stroke is very limited. To examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring. A cohort study was conducted using data from Danish and Swedish registries. Live singleton births during calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021) were included in the analysis. Maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy. Diagnoses of IHD and stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for IHD and stroke in the offspring according to maternal bereavement. The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 (IQR, 13.9-35.1) years, 8664 offspring (0.1%) were diagnosed with IHD and 13 094 with stroke (0.2%). Overall, maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98; 95% CI, 0.85-1.13) or stroke (AHR, 1.04; 95% CI, 0.94-1.16) in offspring. Similarly, no associations were observed when exposure was classified by the mother's relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85; 95% CI, 0.64-1.14 for IHD and 0.98; 95% CI, 0.77-1.25 for stroke) or loss of parent or sibling (HR, 1.03; 95% CI, 0.87-1.21 for IHD and 1.06; 95% CI, 0.94-1.19 for stroke). However, associations between loss in the third trimester and IHD (AHR, 1.50; 95% CI, 1.06-2.13), and loss due to cardiovascular disease and stroke (AHR, 1.22; 95% CI, 1.03-1.44) were identified when exposure was classified by time of loss or the relative's cause of death. The findings of this study provide little support for the hypothesis that prenatal stress is associated with risks of IHD and stroke in the first 5 decades of life. However, the association observed between stress in the third trimester and IHD warrants further investigation.

ASSOCIATIONS BETWEEN REVERSED CHILDHOOD EXPERIENCE AND LATE-LIFE COGNITIVE IMPAIRMENT: THE CASE IN CHINA

Abstract Exposure to violence, parental incarceration, household substance abuse and some other reversed childhood experience is associated with some negative impacts in one’s late life in some countries, such as difficulties in maintaining interpersonal relationships, being more likely to experience depressive symptoms, and performing certain physical functions. However, the impacts of reversed childhood experiences, such as starvation, unmet needs of healthcare services, and loss of parents, are still unknown. Using nationally representative data, China. Longitudinal Aging Social Survey, and the hierarchical cluster-based partial least squares regression, this study found a notably high prevalence of reversed childhood experience regarding childhood hunger and unmet healthcare needs. In China, 65% of the older adults aged 60 and above had experienced falling asleep with hunger, 83.1% think that their healthcare needs were not met in childhood, and 10.26% lost one or both parents before 10 years old. The regression analysis results show that compared to those who did not have experience falling asleep with hunger, those who had such experience were more likely to have a declined cognitive function by 33.8% (p< 0.001). Additionally, the loss of parents also significantly caused poorer cognitive function by 44.2% (p< 0.001). However, such a causality relationship was not detected among those who experienced unmet healthcare needs. These findings suggest that early prevention and interventions are needed among older adults with adverse childhood experience.

BIOSOCIAL PATHWAYS AFFECTING HEALTH AND AGING IN THE HEALTH AND RETIREMENT STUDY

Abstract Representative population studies, like the Health and Retirement Study (HRS), are gathering large amounts of biomarker and multi-omic data. This presents a unique opportunity to investigate how population-level aging effects is driven by social inequality. This research has the capacity to uncover targets for intervention that could result in extending longevity and healthy life span and reducing inequalities in aging. There has been substantial research and progress in identifying biological processes underlying age-related decline, morbidity, and mortality (the so-called biological hallmarks of aging); however, despite this progress, demographic, social, and psychological factors (the so-called social hallmarks of aging) are substantially associated with cognitive aging and ADRD above-and-beyond genetic and biological factors There is, therefore, a need for research that carefully integrates the social and biological hallmarks of the human aging processes. This symposium highlights research that investigates interactions between biological and social processes that lead to inequalities in health and aging among older adults utilizing recently released data from the HRS Venous Blood Study (a nationally representative sample of US adults over age 55). Included are papers investigating the role of timing of childhood adversity in affecting adult DNA methylation patterns, how childhood parental loss is associated with accelerated epigenetic aging, how socioeconomic status patterns expression of genes related to inflammation and cellular senescence, and how sets of age-related biomarkers can explain sociodemographic inequalities in mortality. These studies contribute to an emerging literature integrating social and biological sciences to better understand inequalities in the aging process.

The value of using a storybook to protect the psychological health of children during COVID-19 in resource-limited communities

Globally, the COVID-19 pandemic has caused poor mental health, parental loss and food insecurity in children. At the peak of the pandemic, context-relevant and child-friendly COVID-19 tools for child counselling and education were limited in low-income communities. Researchers and social work practitioners created Uhambo Lwami storybook in IsiZulu language to initiate conversations with children about COVID-19. The findings reported are drawn from in-depth interviews with 13 purposively selected community-based social workers and child and youth workers who integrated the storybook into child counselling during the pandemic. The central premise of the paper is their experiences about the use and value of the storybook to support children’s psychological well-being during the pandemic. Two themes are discussed: The use of the storybook with children and its value to support children during the pandemic. The results indicated that the storybook created a child-friendly environment for children to share their psychosocial experiences of living during the pandemic. Furthermore, it facilitated sharing of experiences about death and illness in a caring and responsive manner. Well-designed storybooks are a cost-effective tool useful to initiate sensitive discussions with children. Context-relevant storybooks can be used to educate and alleviate distress in children during pandemics.

The effect of parental diabetes prevention program participation on weight loss in dependent children: a prospective cohort study

IntroductionObesity has reached epidemic proportions in children and adolescents in the United States. Children’s behaviors are strongly influenced by parental behaviors, and weight loss in parents is positively associated with weight changes in their overweight/obese children. Research is limited on how parents’ National Diabetes Prevention Program (DPP) participation affects the health outcomes of their dependent children. Analyzing the impact of parental DPP participation on weight loss in their dependent children may provide valuable insight into an important secondary benefit of DPP participation.MethodsIn this study, we identified 128 adults with prediabetes who were offered the opportunity to participate in a DPP (n = 54 DPP participants and n = 74 DPP non-participants) and who had at least one child 3 to 17 years of age living with them. Age and BMI percentile for dependent children were collected from insurance claims data for 203 children (n = 90 children of DPP participants and n = 113 children of DPP non-participants). Parental practices related to diet and physical activity were assessed by surveys.ResultsThere were no significant changes in BMI percentiles of overweight or obese children (i.e. BMI percentile ≥ 50%) of DPP participants vs DPP non-participants with prediabetes over one-year. Parents who enrolled and did not enroll in the DPP did not report differences in their parenting practices related to diet and physical activity.DiscussionThese results are not consistent with the literature that suggests parent-based interventions may influence their children’s weight trajectories. Limitations include small sample size, short time span of intervention, and limited availability of additional health/biographic data on dependent children. Future studies should collect primary outcome data on children, investigate whether there is a minimum duration of parental involvement and level of parental adherence, and assess the effect of parent–child dynamics on child weight trajectories.

Economic Distress and Children’s Mental Health: Evidence from the Brazilian High-Risk Cohort Study for Mental Conditions

Abstract This paper assesses the effects of adverse economic shocks on children’s mental health. We rely on the Brazilian High-Risk Cohort Study for mental conditions, which provides an unprecedented array of data on psychopathology, life events, family medical history as well as parental behaviour and polygenic scores for mental disorders over a ten-year period. Our empirical strategy exploits parental job loss events over time in a difference-in-differences framework. We document that parental job loss significantly worsens children’s mental health, resulting in increased clinical diagnoses of mental disorders. These results are robust to several specifications and pre-trends. Heterogeneous results and mechanism analysis indicate that psychological distress in the household brought about by job loss events may be a key mechanism affecting children’s mental health.

I don't understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences.

Childhood adversity is associated with the severity of multiple dimensions of psychosis, but the mechanisms underpinning the close link between the two constructs is unclear. Mentalization may underlie this relationship, as impaired mentalizing is found in various stages of the psychosis continuum. Nonetheless, the differential roles of self- and other-mentalizing in psychosis are not well understood. Parallel multiple mediation was conducted for the relationship between a diverse range of childhood adversity types, including intentional and nonintentional harm, and schizotypy (positive, negative, disorganized), psychotic-like experiences (PLE) and paranoia via self-mentalizing (attention to emotions and emotional clarity) and other-mentalizing in n = 1,156 nonclinically ascertained young adults. Significant parallel multiple mediation models were found for all psychotic outcomes except negative schizotypy. The associations between intentionally harmful childhood adversity and psychotic outcomes were significantly mediated by increased attention to emotions for most models and decreased emotional clarity for some models. No significant mediation was found for parental loss. Paternal abuse was only mediated by attention to emotions whereas the effects of maternal abuse were mediated by attention to emotions and emotional clarity. Other-mentalizing only showed mediating effects on one of thirty models tested. Results highlight the mediating role of impaired self-mentalizing in the association between childhood adversity and psychosis. This is consistent with disturbances of self-concept and self-boundary characterizing, in particular, the positive dimension of psychosis. Maternal versus paternal figures may contribute differentially to the development of mentalizing. These results could inform future preventative interventions, focusing on the development and maintenance of self-mentalizing.

1150. Invasive meningococcal disease vaccination – a targeted literature review of adolescents and parents/caregivers’ preferences

Abstract Background Invasive meningococcal disease (IMD) serogroups A, B, C, W, Y are commonly prevented by MenACWY and MenB vaccines. MenABCWY candidate vaccines could potentially provide benefits as less injections, simplified schedules, and increased uptake. However, there is limited insight on factors influencing preferences for IMD vaccines/vaccination (Vax). This targeted literature review synthesized evidence of factors influencing IMD Vax preferences in 16–23-year-old adolescents/young adults (Ado/YA) and parents/caregivers (P/CG) of 16-18 year-old adolescents. Methods PubMed and Google Scholar were searched globally to identify publications on IMD Vax attitudes and preferences (Table 1). Studies were restricted to English and published between 2005-2022. Data were extracted and synthesized from full text reviews to list IMD Vax preference attributes. Results From the 77 abstracts screened, 19 publications were extracted (Table 2) and 17 relevant for Ado/YA and P/CG. Knowledge of disease severity (20% of Ado/YA articles) and vaccine (29% of P/CG articles) were the most reported factors influencing Vax preference. Severity of disease increased Vax preference for both groups (14%), while low disease awareness limited P/CGs’ willingness to vaccinate children (14% of P/CG articles). Some Ado/YA preferred fewer injections in the immunization series due to reduced injection site discomforts (13%). P/CG preferred less injections due to less time and less physician visits, as it may reduce vaccine preparation/injection/administration and indirect costs associated with parental work loss (7%). However, their concerns over injection-related pain were a Vax barrier (14%). IMD vaccine effectiveness was recognized by Ado/YA (13%). Longer duration of protection was important for P/CG (14%), whilst herd immunity and direct protection was preferred in Ado/YA (13%). Conclusion Findings highlight IMD Vax characteristics as key considerations among Ado/YA and P/CG when making Vax decisions. To improve vaccination coverage and protection, the evidence supports preferences for vaccinations offering benefits such as fewer injections. Trade-offs between factors relevant for a IMD combination vaccine need further research. Disclosures Shahina Begum, GSK: Employee Eliazar Sabater Cabrera, PhD, GSK: Employee|GSK: Stocks/Bonds Oscar Herrera-Restrepo, PhD, GSK: Stocks/Bonds Twinkle Khera, Mtech, IQVIA: Advisor/Consultant Willings Botha, PhD, IQVIA: Advisor/Consultant Laurie Batchelder, PhD, IQVIA: Advisor/Consultant Zeki Kocaata, PhD, GSK: Stocks/Bonds

I occasionally wear his huge sweaters… but I often prefer not to think about it: Bereaved children talking and not talking about parental loss

The unique perspective of children communicating about the loss of a parent has rarely been studied. In this qualitative research, we interviewed 12 children aged 7–12 and asked them about their experience communicating their loss. The children’s verbal and non-verbal communication was characterized by constant movements away from and closer to various aspects of their loss, illustrated by three main themes: (a) children either talking about the loss or not talking about it; (b) first talking about the loss and then stopping to talk about it; and (c) simultaneously talking and not talking about the loss. Based on Stern’s interpersonal relational thinking, our findings indicate that children wish to talk about the loss but also to avoid talking about it. The possibility of choosing to talk and not to talk with themselves and close individuals about the loss allows children to think about and articulate their feelings and thoughts.

PEDAGOGICAL STRATEGIES TO MITIGATE SUICIDAL BEHAVIOR AMONG CHILDREN WITHIN THE CONTEXT OF FAMILY EDUCATION

At the moment, many approaches try to explain the true causes of suicide in children and adolescents. Particular attention is paid to the consideration of the family as a factor in the consolidation of auto-aggressive patterns in children and adolescents. The deformation of parent-child relationships and the disorganization of the family as a whole can be considered one of the main socio-psychological causes of suicide. Often the reason for the suicidal risk of a teenager can be an early loss of parents or a violation of constructive relationships with them, an incomplete family, or economic problems in the family. The article aims to describe the factors of suicidal risk, in particular, significant experiences associated with close relationships in the family throughout the life of the individual. To gauge the propensity for suicidal ideation, a suicidal risk questionnaire was employed Additionally, the Eysenck test, encompassing 70 inquiries, was harnessed to ascertain the proclivity towards extraversion or introversion. The results show that conflicting parenting style is closely associated with self-destructive personality behavior. Keywords: adolescence; suicidal risk; family disorganization; conflict situations; emotional and behavioral disorders; family psychological support.

Parental job loss and the role of unemployment duration and income changes for children’s education

Abstract This article studies the impact of parental job loss, subsequent unemployment duration, and income changes on the results of the final exam in lower secondary education and on the decision to pursue an academic track in Denmark. Drawing on administrative register data we use sibling fixed effects models as well as a before-after-test design to investigate the shorter-term effects of parental job loss. The results show that there are hardly any effects of parental job losses on children’s exam results, while we find a reduction in the transition to the academic upper secondary track, both for maternal and paternal job losses. We find no systematic evidence that the negative effects would be larger if the job loss is followed by a longer period of unemployment or by a loss of income, and no evidence for a moderating role of parental education.

Associations of adverse childhood experiences with common psychiatric disorder in later life: results from the China mental health survey

BackgroundAssociations between adverse childhood experiences (ACEs) and common psychiatric disorders among older Chinese individuals have not been well reported. The objectives of this study are to examine the prevalence of ACEs and the associations of ACEs with common psychiatric disorders among older adults in China.MethodsThe study used data from the China Mental Health Survey (CMHS), a nationally representative epidemiological survey, which used computer-assisted personal interviewing (CAPI), logistic regression models were used to examine community-based adult psychiatric disorders and associated risk factors. Finally, 2,317 individuals aged 60 years or over were included in the CMHS. The national prevalence of ACEs in older adults were estimated and logistic regression were used to analyse the association between ACEs and past-year psychiatric disorders.ResultsPrevalence of ACEs among older adults in China was 18.1%. The three most common types of ACEs were neglect (11.6%), domestic violence (9.2%), and parental loss (9.1%). This study proved the association between ACEs and common past-year psychiatric disorders in older adults. ACEs increased the risk of past-year psychiatric disorders in older adults. After adjustment for age, sex, marital status, employment status, education, rural or urban residence, region, and physical diseases, the association between ACEs and past-year psychiatric disorders were still significant.ConclusionsACEs are linked to an increased risk for past-year psychiatric disorders in older adults. ACEs may have long-term effects on older adults’ mental well-being. Preventing ACEs may help reduce possible adverse health outcomes in later life.

Comparison of psychotropic medication use before and after parental death by number of siblings

Abstract Background Ageing populations and decreasing family size suggest more persons might need to take care of their aging parents for longer periods and eventually cope with the loss of their parents with fewer siblings. However, little is known about how number of siblings or specific causes of death, such as dementia, may moderate the burden of impending parental death and coping with parental loss. Methods Using Finnish population registers, we assess annual psychotropic medication use among adult offspring around the time of parental death. We use deaths that occurred in Finland during 2004 to 2016 and assess medication use up to two years before and after parental death with generalized estimation equations while controlling for sociodemographic factors. We assess whether sibship size moderates medication use and whether the associations differ by parental causes of death (e.g. dementia, neoplasms or cardiovascular diseases) that convey information about the abruptness of death and care burden prior to death. Results Before and after parental death, psychotropic medication use increased more among individuals with fewer siblings. The differences were largest in the first year after parental death, e.g., the increase in medication prevalence was 2.8% (95% CI: 2.5; 3.1) among only children, 2.2% (2.0; 2.2) with those with one to two siblings and 1.1% (0.4; 1.8) with those with three or more siblings. There were little differences between causes of death. Our results are preliminary and based on a 10% subsample of deaths in Finland (n = 110,000). Conclusions Parental death was associated with an increase in adult offspring psychotropic medication use that was larger among those with fewer siblings. Decreases in sibship sizes may significantly increase the care burden on offspring caring for their aging parents. Yet, more studies are needed to establish how sibling characteristics moderate these associations. Key messages • There is a clear increase in adult offspring psychotropic medication use in the event of a parental death, yet there was little variation according to cause of death. • Having more siblings was associated with a smaller and belated increase in psychotropic medication use in the event of parental death, which could be interpreted as sharing the burden.

Qualitative inquiry into the experience of suicide loss, aftereffects and coping strategies of suicide-bereaved Greek-speaking parents in Cyprus

ABSTRACT Purpose Studies on suicide-bereaved parents are scarce in South European and Eastern Mediterranean countries. We explored the experiences of Greek-speaking suicide-bereaved parents in Cyprus, with emphasis on the interpretations of their child’s suicide, its aftereffects and their coping strategies. Methods A qualitative methodology based on inductive content analysis of the interviews of ten mothers and two fathers was applied. Results The participants described their efforts to make sense of the senseless, reporting numerous interpretations of their child’s suicide. Some participants had achieved to move on by trying to keep the remaining family together. Others felt detached from their social network. The different coping strategies and support systems described, reflected participants’ efforts to escape from obsessive, enduring and deeply traumatizing thoughts about their child’s suicide. The analysis mirrored participants’ ultimate desire to find existential relief and serenity through the management of distressing reminders of their child’s suicide, and alleviate the burden of their own negative self-judgement and the criticism of others. They sought physical and emotional comfort in the inner realm of their psyche, through spiritual and psychological coping processes. Conclusion Further exploration is suggested about intervention planning aiming to strengthen effective coping strategies and external supportive resources in mourning parents.

Experiences of Indonesian Adolescents Losing Parents Due to COVID-19: a Phenomenological Study

Background: Adolescents losing their parents is the worst event they experience during the COVID-19 pandemic. Adolescents raise a traumatic response after a loss occurs.Objective: This study aims to explore the description of the condition of adolescents in dealing with the loss of parents due to COVID-19.Methods: Qualitative research design with a phenomenological approach. The number of participants is 12 people with the criteria of youth aged 10-19 years consisting of men and women who have lost their parents due to COVID-19. Interview data were processed using the Colaizzi technique.Results: Four themes through the theme analysis, namely adolescents are not ready to face sudden loss, adolescents experience suffering due to the loss of parents, adolescents find it difficult to go through the loss process, and changes occur in adolescents due to the loss of parents.Conclusion: The findings of this study show that the sudden loss of parents due to COVID-19 harms adolescent mental health. As a result, mental health nurses in the community need to detect adolescents early for signs of stress and anxiety due to the loss of parents and take steps to strengthen adolescents' self-defense after loss.

Portraits of Life After Loss: Understanding Parental Loss Within A Social Context

Parental loss at any age is a life transition that brings with it unprecedented changes. Encountering this loss in emerging adulthood can be especially challenging because of the many consequences characteristic of this stage of life. Existing research has excluded the experiences of young people grieving the death of a parent. Thus, the present study attempts to bridge this gap by focusing on the experiences of emerging adults dealing with parental loss with an emphasis on their journeys of coping with the loss, and how grief unfolded in a social context. In this exploratory research, four participants in the age range of 18–28 years were interviewed, and the data were subjected to interpretative phenomenological analysis. Three superordinate themes emerged from the data, namely, early days following the loss, changing relational realities, and coping in the context of the other. Limitations and implications of the study have been discussed.

59 Important Pulmonary Outcomes in Extremely Preterm Infants: Parental Perspectives

Abstract Background Lung Injury is frequent in extremely preterm infants. The definition of bronchopulmonary dysplasia (BPD) has changed since it was first described in 1967. Oxygen need at 36 weeks, the current definition, is not closely associated with long-term pulmonary outcomes. This outcome, used in neonatal research, has been chosen by clinicians and researchers, not by parents. Other outcomes related to chronic respiratory disease (such as hospital readmissions, work of breathing, and/or exercise limitation) are rarely measured or reported in outcome research. What pulmonary outcomes are of importance to parents is unknown. Objectives The primary objective of this part of the “parent voices project” was to create a list of respiratory outcomes that are important to parents, both during the NICU hospitalization and after discharge, to be considered in future respiratory outcome studies. Design/Methods Over one year (2020-2021), parents of infants born <29 weeks’ gestational age (GA) who came for follow-up visits when their children were between 18 months and 7 years old, in a large academic centre, were invited to participate. They were asked both closed and open-ended questions about the following topics: • The child’s health and what they would want to improve. • The impacts (negative and positive) of prematurity on the life of their family. • Their decisional regrets. • What they wish they had known both before birth and in the NICU, and their recommendations for clinicians. We examined all the parental answers with a view to discovering how many invoked pulmonary outcomes and which themes parents described when speaking about respiratory health. The goal was to make a list of all the respiratory outcomes that were important to families, both during the NICU hospitalization and longer term. Results were analyzed using mixed methods. Results Among parents (n=285, 98% participation rate), 44% spoke about important pulmonary outcomes. Parents invoked 25 themes when they described respiratory health, some pertaining to NICU hospitalization and others to long-term outcomes (see Table below). Some themes impacted the child (child-centred), such as exercise limitation. Many other pulmonary outcomes having an impact on parents or the whole family were described by parents (parent or family-centred themes). For example, a child who had difficulty breathing would struggle and could have disturbed sleep, but parents often described their own fear, lack of sleep (or disturbed sleep in other children). When children were hospitalized because of a respiratory illness, many of the outcomes described would be both child- and parent-centred: e.g., parental loss of work or income, and loss of equilibrium for the whole family. None of the 285 parents spoke about oxygen at 36 weeks or BPD. The prevalence of parents who describe pulmonary outcomes as impacting the child and/or family was statistically similar in parents of children with and without BPD, born before or after 25 weeks, with a BW of less or more than 750 g. Parents of male infants and those who were readmitted for respiratory issues were more likely to report important pulmonary outcomes. Conclusion Many parents of children born extremely preterm describe important pulmonary outcomes, independent of BPD. None of the parents mentioned oxygen at 36 weeks or BPD. More parents report such outcomes when their child has been readmitted for pulmonary reasons. These adverse outcomes often impact the whole family. Future research will indicate which outcomes need to be included in neonatal trials (or neonatal follow-up).

A CROSS SECTIONAL STUDY OF CHALLENGES AND BARRIERS OF PSYCHO SOCIAL ADJUSTMENT TO HIV POSITIVE STATUS FACED BY HIV POSITIVE ADOLESCENTS IN JAMNAGAR DISTRICT

Background: Adolescents constitute 22% of Indias population.There are total 5.8 million people living with HIV in India, 2018. Over 35% of all reported AIDS cases in India occur among young people in the age group of 15-24 years. Aim & Objectives: To document the factors affecting the psycho- social adjustment to HIV Positive status among HIV Positive adolescents. Material &Method: It was a hospital based cross sectional study (quantitative component).There were 108 HIV positive adolescents registered upto February, 2020 at ART Centre, Jamnagar (Tertiary care institute), Gujarat. Out of 108 HIV positive adolescents, I approached 84 adolescents during their regular monthly follow up visit for treatment and counselling at ART center. 24 subjects from ART register were not included in this study because either lost to follow up at ART center or death. Out of 84 subjects only 77 were disclosed their HIV status and consented to be enrolled and interviewed under the study. Pretested semi-structured questionnaire provided to participants which containing socio-demographic information, issues during transition for adjustment within the family and society and status disclosure were filled up for quantitative data. Study was approved by Institutional Ethical Committee, shrim.p.shahgovt medical college, Jamnagar, gujarat and also approved by Gujarat state AIDS Control Society, Ahmedabad. Results:Mean age of participants was 14.88 years (SD± 2.52). Most of them were boys (55.80%) and Hindu by cast (92.20%). Majority of the participants belonged to Nuclear type of family (87.01%) and living with biological parent/parents (87.01%). Majority participants had their mother positive (80.51%) followed by father (66.23%). Majority of the participants were disclosed about their status by first degree relative (mostly mother or father) (75.32%). Only 1(1.31%) participants, reported problem in consuming medicine after transition to adult clinic. Conclusion: Stigma and Discrimination plays a pivotal role in the psychological health of HIV adolescents and loss of parents was found to have a significant impact on the psycho-social adjustment among these adolescents. The knowledge regarding the spread of HIV & its various routes of transmission was found to be low in some study participants.