Primary Caretakers Research Articles

The Second Birth

The Second Birth Monica Boothe (bio) From the day I was born, my parents wanted me to ask Jesus into my heart. It was their number one dream for me. The only thing they ever really wanted for my life. Dreams are funny things. So I slept in a crib under a framed cross stitch, "As for me and my house, we will serve the Lord," and I was given a pink Baby's First Bible and then later The Bible for Little Ones which had colorful pictures, and my mom read to me every night little fantastic stories, brief and simplified, stripped of all real theology. And at church every Sunday and Wednesday, I sat in classrooms with little plastic chairs just my size and watched the Bible unfold in felt cartoons and sang songs with King James words that sounded like a foreign language. But when I was five I did it: I asked Jesus into my heart. At least that's what I was taught to call it. But that doesn't really describe what happened at all. It sounds too domestic. Like I was a suburban two-story home with a tire swing in the backyard, and He moved in some Ikea furniture and settled in for a comfortable middle class life. But really Jesus was more of a forest fire, the kind that spreads through a cracked skeleton of a forest after years of relentless summer drought, where the trees are mostly dead, and the fire flashes through them in seconds, leaving the whole place flat, with nothing but ash. But then there's room for real life again, not just old dying trees, and little blades of grass pierce the ashes one by one, and they're all tiny and frail, but they're alive and new. So the next Sunday at church, when they were passing around the body and blood of Jesus, I tried to take my share, assuring my mom that I had asked Jesus into my heart. But she wouldn't let me, and she didn't believe me. I kept asking for weeks, and finally she relented. So I began to eat and drink Jesus every week with a ravenous appetite that unnerved my parents in spite of all they had hoped for. The very thing they craved for me was the one thing that could take me from them, the one thing that usurped their role in my life as primary authority and caretaker. [End Page 71] Pretty soon I was asking to be baptized, and that was where they drew the line. "Not until you're old enough," they said. But there was already a new wilderness growing inside me that could not be trimmed and mowed and weeded into something clean and manageable. And then the conflicts really began. When I tried to purge the house of secular music because it was only holding us back. When I tried to stay home from school some days saying I just wanted a day with God. When I planned a trip to Arizona to spend forty days fasting in the desert because Jesus had done it and it must be invigorating. When I insisted that we should sell our house and give the money to the poor because that was what Jesus had said to do. When I kept talking about Jesus on the playground at school until the teacher told me to stop and I wouldn't and she called my parents and my parents demanded that I keep my mouth shut and respect everyone's religious privacy. I wanted to scream at them "You're not my real dad!" but I didn't because I knew it would only hurt them even though it was true and it was what they had always wanted. Dreams are funny things. So when I was eleven and the church announced a baptismal Sunday coming up, I asked again if I could be baptized. They agonized over the question as they did every time I asked saying that it was a "sweet thought" and that they were "touched" that I was thinking about these things but talked about it being...

Insights into psychosocial problems of primary caretakers of patients with schizophrenia in India

Context: Schizophrenia affects 1%–1.5% of the population of the world. The illness commonly affects young population disturbing and disrupting the patient as well as his family. Research has demonstrated increased physical and mental health morbidities among these caretakers. Aims: The aim of this study was to explore various stresses and social problems faced by caretakers due to patient's schizophrenia. Settings and Design: A qualitative study of the distress experienced by primary caretaker of schizophrenia patients was undertaken at a tertiary hospital in an urban Indian setting. Methods: Relatives of 30 patients were assessed for their physical, psychological, and social problems. Their narratives of distress caused by patients' illness were recorded as verbatim and analyzed qualitatively manually. Statistical Analysis: Manual qualitative and quantitative analysis. Results: Caretaker was a parent in 72.3% of the cases. Distress due to blaming by relatives for not bringing up the child carefully was reportedly experienced by most parents, especially the mothers. Local cultural setting plays a huge influence in these highly personal and sensitive concerns. Social stigma, anxiety about illness, anger, and resentment were commonly reported. Conclusions: These insights into suffering of the caretakers of people suffering from schizophrenia in current local setting need to be considered and addressed as essential part of the management of Schizophrenia.

Rural Grandparent Headed Households: A Qualitative Description.

To explore, from an emic perspective, the unique socio ecological context in which rural grandparent headed households (GHH) exist, and therefore provide a foundation for the development of culturally-appropriate interventions that might impact their health. This qualitative descriptive study was based on the conduct of in-depth, semi-structured interviews with fifteen grandparents, residing in rural Appalachian Kentucky, who were the primary caretakers for their grandchildren. The interviews were conducted using an interview guide that was based on the premises of the Social Ecological Model (SEM). A basic assumption of this model is that intrapersonal, social-cultural, organizational, and policy factors influence individual health and health behaviors, and that these influences are interrelated and reciprocal. Data was analyzed by the research team using line by line coding of the audio recorded transcriptions of the interviews. GHH experience both barriers and facilitators to maintaining the health of GHH. Many grandparents viewed the experience of belonging to a GHH as a positive one, believing that having their grandchildren in their home improved their health. They relied on formal and informal networks such as extended family and churches to help with caretaking responsibilities. Grandparents experienced notable barriers to health related to having the primary responsibility of their grandchildren, including lack of resources and family tension related to incarceration and/or opioid drug use by biological parents. GHH, one of the fastest growing family constellations in rural Appalachia and the US, may be particularly vulnerable to health threats elevating their risk for many chronic diseases. Effective health related interventions to address this risk should be based on the socio-ecological context in which these families exist.

Association Between Parents Variable on Problems Experienced and Coping Strategies of Primary Caretakers Attending to Children with Cardiac Problems

Association Between Parents Variable on Problems Experienced and Coping Strategies of Primary Caretakers Attending to Children with Cardiac Problems

Vicarious Experiences of Unemployment Scale Development: Relationships to Mental Health and Help-Seeking Among Undergraduate Students

Vicarious experiences of unemployment (VUE), or having a primary caretaker such as a parent or legal guardian who is unemployed, have been demonstrated to impact adolescent and young adult physical and mental health, career decision-making, and educational development. This study describes the development of a new measure, the VUE Scale designed to tap the nature of stigma and struggle associated with an experience of vicarious unemployment (VU). Following results from pilot testing, 395 undergraduate students participated in the study. Results demonstrated preliminary support for the psychometric properties of the VUE. Consistent with hypotheses, results also indicated that more substantive experiences of VU related significantly and positively to heightened levels of depressive, anxiety, and stress, as well as to lower levels of self-esteem and social support. We also explored the relationship between VUE and help-seeking intentions and attitudes. These exploratory findings suggested that more impactful VU experiences relate to less positive formal help-seeking attitudes and intentions. Limitations and future directions for practice and research are described.

Skin care services and disease prevalence in Taiwan: A nationwide study

Abstract Background/Objective Numerous studies have suggested that dermatologists are superior to nondermatologists in managing skin diseases. However, it is still not known whether the public are convinced that dermatologists should be the primary caretakers for the skin. This study sought to characterize the delivery of skin care services, with a particular focus on the epidemiology of skin diseases and the distributions of patients and their visits to dermatologists and nondermatologists. Methods The cohort datasets were drawn from Taiwan's National Health Insurance Research Database (NHIRD) and contained all the original claims data for one million beneficiaries enrolled in 2010. We analyzed the epidemiologic profiles of this population-based cohort for 2013. Descriptive statistics were applied to examine the epidemiology of skin diseases and the distributions of visits and patients according to physician specialty. Results We identified 989,039 persons who remained in the cohort in 2013. Of those, 351,330 (or 35.5%) had skin diseases, and made 989,514 ambulatory care visits in 2013. Visits to dermatologists accounted for 62.2% of these visits. Among the patients with skin diseases, 52.6% of patients made visits to dermatologists, compared with 32.6% who visited nondermatologists and 14.8% who visited both in 2013. In this cohort, dermatitis and eczema had the highest prevalence (16.2%), followed by fungal infections (6.3%) and pruritus (5.5%). Conclusion Dermatologists play major roles in providing skin care services in Taiwan. This finding might be partially explained by the weak role of primary care physicians and the perceptions of patients toward dermatologists and nondermatologists in Taiwan.

Salivary intercellular adenosine triphosphate testing in primary caretakers: An examination of statistical significance versus diagnostic predictability.

A primary caretaker is a potential reservoir of bacteria for an infant child and can be evaluated during a child's caries risk assessment. The aim of this study was to investigate an indirect method for assessing Streptococcus mutans and Streptococcus sobrinus (MS) and lactobacillus (LB) levels in a caretaker's saliva. Thirty‐eight primary caretakers participated in the study to determine whether a 2‐step method to assess the intracellular adenosine triphosphate (ATP) levels in saliva (saliva i‐ATP method) predicted higher MS and LB levels. This method was tested against a 1‐step swab‐based total ATP testing of dental plaque (plaque t‐ATP method). Receiver operating characteristic (ROC) curves were used to examine the relationship between specificity and sensitivity of the two diagnostic tests. Although the area under the ROC curves of both the saliva i‐APT (0.823) and the plaque t‐ATP (0.774) methods were shown to be statistically different (p < .05) than the null hypothesis test of a random coin flip, the diagnostic predictability of the ATP tests to assess high levels of MS and LB remained low. The optimal cutoff, which was defined by the Youden index, for the saliva i‐ATP method produced a sensitivity/specificity of 60.7/100.0 for MS and 78.6/88.9 for LB. Applying these results to populations of low or high bacterial level prevalence produced undesirable positive and negative predictive values for future potential patients. A pair‐wise comparison of both area under the ROC curve values of the saliva i‐ATP and plaque t‐ATP did not find a statistically significant difference in using one test over the other (MS, p = .629; LB, p = .737). The findings of this study can educate dental clinicians that diagnostic tests, such as the 2‐step saliva i‐ATP method, can be found to be statistically significant but not ideal for patient use in terms of diagnostic predictability.

The Neurobiology of Attachment: From Infancy to Clinical Outcomes.

Attachment theory was developed by John Bowlby in the 1950s. He defined attachment as a specific neurobiological system that resulted in the infant connecting to the primary caretaker in such a way to create an inner working model of relationships that continues throughout life and affects the future mental health and physical health of the infant. Given the significance of this inner working model, there has been a tremendous amount of research done in animals as well as humans to better understand the neurobiology. In this article the neurobiology of early development will be outlined with respect to the formation of attachment. This article will review what we have begun to understand as the neurobiology of attachment and will describe how the relationship with the primary caretaker affects the infant in a way leading to neurobiological changes that later in life affect emotional responses, reward, and perception difficulties that we recognize as psychiatric illness and medical morbidity.

A Statewide Hospital-Based Safe Infant Sleep Initiative: Measurement of Parental Knowledge and Behavior

Sleep-related infant deaths are a leading cause of infant mortality in Georgia, and these deaths are largely associated with unsafe sleep practices among caregivers. In early 2016, the Georgia Department of Public Health launched the Georgia Safe to Sleep Hospital Initiative, providing hospitals with safe infant sleep information and educational materials to be distributed to families and newborns. This study examined the knowledge and behaviors of a sample of Georgia parents after the implementation of the Hospital Initiative and identified the family characteristics and intervention components most closely associated with the knowledge and practice of safe infant sleep. The primary caretakers of all infants born in Georgia from August to October 2016 were invited to complete a web-based survey 1 month after hospital discharge. The final sample size included 420 parents of newborns, and the primary outcomes assessed included two measures of knowledge and four measures of infant sleep behaviors regarding infant sleep position and location. Most respondents demonstrated knowledge of the correct recommended sleep position (90%) and location (85%). Logistic regression revealed that receipt of information in the hospital was significantly correlated with safe sleep behaviors, and infant sleep habits tended to influence safe sleep practices. Additionally, Medicaid parents receiving bassinets from the hospital were 74% less likely to bed share (OR 0.26; 95% CI 0.007). Implementation of a statewide hospital initiative was associated with high levels of parental knowledge and behavior and may have been successful in reducing the practice of bed sharing among Medicaid parents.

Coping and spirituality among caregivers of patients with schizophrenia: a descriptive study from South India

In many parts of the world family members are the primary caretakers of persons with mental illness. The chronic stress associated with being a caregiver for an individual with schizophrenia can re...

Lost in transition: menstrual experiences of intellectually disabled school-going adolescents in Delhi, India

Issues around reproductive health of intellectually disabled adolescents have received limited attention in India. This study aimed to bring to light these issues to inform policy and practice surrounding reproductive health among intellectually disabled adolescents. The objectives of this study were to understand the problems encountered by intellectually disabled adolescents and their primary caretakers during management of the adolescent’s menstrual cycle, and to explore the strategies adopted to overcome them. Using qualitative methodology, in-depth interviews were carried out with 23 primary caretakers (all mothers) of adolescent girls in the age group of 11–19 years with IQ of 20–50 were interviewed using in-depth interviews. The mothers of adolescents were selected using purposive sampling and grounded theory methodology was followed for data analysis. The adolescents faced a whole range of issues; from not being able to change sanitary napkins due to physical constraints, to not being able to comm...

Vaccination against influenza at a European pediatric cancer center: immunization rates and attitudes among staff, patients, and their families

Influenza is an important cause of infectious morbidity in pediatric cancer patients. We conducted a single-center survey to explore adherence and attitudes towards the recommended annual influenza vaccination. Self-administered, standardized questionnaires were distributed to 143 staff members and 264 families. Items analyzed included demographic data, knowledge about influenza, history of prior influenza infections and vaccinations, routes of information and education, and attitudes towards the recommended influenza. Variables associated with vaccination were explored by univariate and multivariate analyses. One hundred six staff members with patient contact and 139 primary caretakers completed the questionnaire. Fifty-nine percent of staff members and 60% of the caretakers provided correct answers to all four knowledge questions; 32 and 54% reported a history of prior influenza, and 61 and 47% had received at least one influenza vaccination in the past. Vaccination rates for the previous season were 47, 34, 30, 25, and 29% in staff members, primary caretakers, their partners, diseased children, and their siblings, respectively. Main motivations (>75% in ≥ 1 cohort) for vaccination were prevention of influenza disease and concerns to transmit it to others (77-100%) and reasons for not being immunized concerns of adverse effects and use of alternative protection (33-83%). Variables significantly associated with vaccination by multivariate analysis included receipt of influenza vaccinations in the past (OR 2.2-20.5), recommendations by health care providers (OR 4.8-45.5), a lower level of education (caretakers; OR 2.2), and younger age (children; OR 0.9). The results of this survey indicate insufficient vaccination rates and provide potential approaches for improved vaccination strategies in the setting of pediatric cancer care.

Family Burden and Coping among Caregivers of Schizophrenia

Schizophrenia is a strict mental disorder affecting about human population. Being chronic and often incapacitating, it extracts tremendous cost from patients, caregivers and society. Caregivers of patients with schizophrenia face stress and emotional hardship and are frequently forced to assume lifelong care-taking roles. Subjective burden refers to the caregivers’ short term and long term reactions to the patient’s symptoms and behaviors, and the care giving task resulting from it. Perceived distress and interpersonal strain are examples. It refers to the extent to which the care giver feels he or she is burdened. This study aims to conducted for analysis the burden and coping among caregivers of schizophrenia. This study conducted with 30 Schizophrenic patients and 30 primary caretakers of the patients, totally 60 samples were studied. The result shows that there is association between burden assessment schedules of caregiver with that of caregivers coping scale. It revealed statistical significance. Low coping score seen in caregiver who had high burden score. Lower burden score seen in caregivers who had high coping level.

Combining work and child care: The experiences of mothers in Accra, Ghana

ABSTRACTWork–family research has focused predominantly on western women. Yet the forms of economic labour in which women are typically involved and the meaning of motherhood are context specific. This article aims to explore the experience of combining economic activity and child care of mothers with young children using urban Ghana as a case study. Semi-structured interviews (n = 24) were conducted in three locations in the Accra Metropolitan Area. Transcripts were analysed using the general inductive approach. The results found women’s experience of role conflict to be bi-directional. With regard to role enhancement, economic activity allowed women to provide materially for their children. The combination of work and child care had negative consequences for women’s well-being. This research questions policy-makers’ strategy of frequently targeting women in their roles either as generators of income or as the primary care-takers of children by highlighting the reality of women’s simultaneous performance of these roles.

Hand washing with soap and WASH educational intervention reduces under-five childhood diarrhoea incidence in Jigjiga District, Eastern Ethiopia: A community-based cluster randomized controlled trial.

Despite the tremendous achievement in reducing child mortality and morbidity in the last two decades, diarrhoea is still a major cause of morbidity and mortality among children in many developing countries, including Ethiopia. Hand washing with soap promotion, water quality improvements and improvements in excreta disposal significantly reduces diarrhoeal diseases.The objective of this study was to evaluate the effect of hand washing with soap and water, sanitation and hygiene (WASH) educational Intervention on the incidence of under-five children diarrhoea. A community-based cluster randomized controlled trial was conducted in 24 clusters (sub-Kebelles) in Jigjiga district, Somali region, Eastern Ethiopia from February 1 to July 30, 2015. The trial compared incidence of diarrhoea among under-five children whose primary caretakers receive hand washing with soap and water, sanitation, hygiene educational messages with control households. Generalized estimating equation with a log link function Poisson distribution family was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval.The results of this study show that the longitudinal adjusted incidence rate ratio (IRR) of diarrhoeal diseases comparing interventional and control households was 0.65 (95% CI 0.57, 0.73) suggesting an overall diarrhoeal diseases reduction of 35%. The results are similar to other trials of WASH educational interventions and hand washing with soap.In conclusion, hand washing with soap practice during critical times and WASH educational messages reduces childhood diarrhoea in the rural pastoralist area.

Prevalence and associated factors of attention deficit hyperactivity disorder (ADHD) among Ugandan children; a cross-sectional study

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among the children. The burden of ADHD or its associated factors in Uganda are not known. The objective of this study was to determine the prevalence and the associated factors of ADHD among children attending the neurology and psychiatry clinics at Mulago National Referral Hospital.MethodsUsing the disruptive behavior scale (45 items), we investigated the presence of ADHD symptoms among children attending Mulago Hospital. Questionnaires were administered to the primary care-takers of the study participants to gather information on the factors associated with ADHD. All children were subject to a clinical examination. Children presumed to have ADHD, using the aforementioned rating scale were further assessed by a child psychiatrist to confirm the diagnosis and associated co-morbid conditions.ResultsThe estimated prevalence of DSM-IV ADHD symptoms was 11%. Children aged less than 10 years were four times likely to have ADHD (OR 4.1, 95% CI 1.7–9.6, p < 0.001). The demographic factors independently associated with ADHD were age less than 10 years, male gender, history of maternal abnormal vaginal discharge during pregnancy, and no formal education or the highest level of education being primary school.ConclusionThe prevalence of ADHD among children attending the pediatric neurology and psychiatry clinics is high in our settings and is associated with delayed milestones. Early identification and addressing the co-morbid conditions associated with ADHD such as epilepsy, autism spectrum of disorder, conduct disorder, opposition defiant disorder and intellectual disability in our setting is needed.

Parental Migration, Caretaking Arrangement, and Children’s Delinquent Behavior in Rural China

The purpose of this study was to investigate the associations between parental rural-to-urban migration, caretaking arrangement, and left-behind children’s self-reported delinquency in rural China. The direct effect of parental migration on children’s delinquency as well as the indirect effect through children–caretaker conflict, school bonding, and children’s association with deviant peers are explored. The study uses data from the Parental Migration and Children’s Well-Being Survey, which collected information on parental migration and delinquency from a probability sample of 600 middle school students in southern China. Path models are used to evaluate hypotheses generated from mainstream criminology theories and the literature of immigration and internal migration in rural China. Parental migration and caretaking arrangement has a significant effect on children’s socialization and behavioral outcomes in rural China. Results indicate that pathways to delinquency among left-behind children differ across various caretaking arrangements. Grandparents and other extended family members, when serving as primary caretakers, are challenged to effectively monitor and supervise left-behind children’s interaction with deviant peers, which is the main route to further delinquency. Stay-at-home mothers, on the other hand, have difficulty in developing strong mother–child bonds and in avoiding conflictual and strained relationships with their children. The study highlights the importance of a father’s presence on children’s behavioral outcomes in the context of rural China.

Gaming Addiction

Gaming Addiction

Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

ObjectivesIn prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP‐related risk factors associated with glycemic control were identified. Patients, materials, and methodsA comparative cross‐sectional study was performed. Fifty‐five patients with DM1 under the age of 11 years were included. The patient‐related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP‐related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire), family functionality (family APGAR), support of another person in patient care, stress (Perceived Stress Scale), and socioeconomic status (Bronfman questionnaire). Multivariate logistic and linear regression analyses were performed. ResultsThe patients’ median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06‐151.9, p=0.001). While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238‐1.743, p=0.011) and stress (β 1.918, 95% CI 1.10‐2.736, p=0.001) in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336‐2.177, p=0.008) were associated with higher levels of glycated hemoglobin. ConclusionsLevel of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.

Processed Food—An Experiment That Failed

Processed Food—An Experiment That Failed