Primary Caretakers Research Articles

Study of Pathway to Care among Patients with Epilepsy

Objective: To assess the pathway to care among patients with epilepsy up to the tertiary care centre Methods: It is a hospital based, cross-sectional descriptive study of 47 patients visiting BPKIHS psychiatry OPD. Written informed consent was taken from the patients and the primary caretaker. A semi structured Performa was used to record the basic sociodemographic details. Pathway Interview Schedule developed by WHO was used to collect the data. Results Majority (66.0%) of subjects were male. Generalized Seizures were most common (76.6%) type of seizure followed by complex-partial seizure (10.6%). More than half (51.1%) first contacted dhami-jhakri for treatment of their illness. About sixty two percent of patients had the first contact with the treatment provider less than 4 yrs ago. Thirty eight percent subjects sought treatment as per advice from the family members while only 2.1% sought treatment as per advice from the healthcare worker. The most common presenting complaints were sudden loss of consciousness in 89.4%of patients. In majority of patients (57.4%), problem arised ≤ 4yrs back. Significant high numbers of patients (51.1%) were prescribed alternative forms of treatment like herbal medications, talisman, offerings and sacrifices and jhadphook for their presenting problem. About eighty seven percent patients had to travel ≤12 hours for the treatment while 10.7% had to travel a distance of >24 hrs for treatment. The mean duration that one had to travel for seeking treatment was 7.95±14.58 hours. It was found that the mean duration that one patient spend before coming to a hospital for modern treatment was 5.64 months. Conclusions People suffering from epilepsy are still using the traditional healing practices leading to delay in the patient care. These findings call for a comprehensive educational program that can remove the misconcepts regarding the illness. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8418 Journal of Universal College of Medical Sciences Vol.1(1) 2013: 20-25

A Pilot Study of the Relation between Humor Styles and the Past-Positive and Past-Negative Time Perspectives

Those who use self-enhancing and affiliative humor styles tend to recall positive experiences with their parents and primary caretakers, whereas those who use the self-defeating humor style tend to recall negative experiences with them. Considering the importance of experiences with parents and primary caretakers for life satisfaction and happiness, it was hypothesized that the affiliative and self-enhancing humor styles would be positively correlated with past-positive experiences and negatively correlated with past-negative experiences, and that the self-defeating humor style would be positively correlated with past-negative experiences and negatively correlated with past-positive experiences. The Humor Styles Questionnaire and the Past-Positive and Past-Negative subscales of the Zimbardo Time Perspective Inventory were administered to 114 undergraduates. The hypotheses were partially supported despite the retrospective nature of the Past-Positive and Past-Negative Subscales and the correlational nature of the study, indicating further research is needed.

The socioeconomic burden of Buruli Ulcer disease in the Ga West District of Ghana

Buruli ulcer (BU) is the third most common mycobacterial infection in humans after tuberculosis and leprosy. We highlight the social and economic burden of 86 BU patients studied in a Ghanaian district in 2008 which has the fifth highest BU prevalence rate in the country and is the most endemic in the Greater Accra Region. We traced patients who had received treatment for BU within the year preceding the study and interviewed them or the primary caretakers of minors mostly using a semi-structured interview guide. We found that against a background of living in abject poverty, the affected households spent on average over 80 per cent of their annual incomes on seeking health care for the disease despite the policy of free treatment for BU in government health care institutions. Beyond the direct financial costs, households incurred huge social and psychological burdens such as social stigma, isolation, and even divorce. Labor time lost due to care-seeking came close to one year for some affected patients. The extent of the burden from the disease had a relationship with care seeking patterns for the disease. We recommend that BU affected households be enrolled in the social protection programs of Ghana.KEY WORDS: Buruli ulcer, socioeconomic burden, stigma, poverty, Ghana

Determinants of Health Care Seeking for Diarrheal Illness in Young Children in Urban Slums of Kolkata, India

Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.

Walking the Dog: The Effect of Pet Ownership on Human Health and Health Behaviors

This analysis explores whether pet owners have better physical health outcomes, and if so, whether the positive physical health benefits are explained by better health behaviors that result from having to take care of the pet’s physical needs. Data come from the National Health and Nutrition Examination Survey, a representative sample of the non-institutionalized United States population. Analyses were limited to persons living alone (n = 2,474) in order to isolate primary pet caretakers from those merely living in a pet household. Results showed that pet owners, particularly dog and cat owners, had more positive physical health outcomes when compared to non pet owners or those owning other types of pets. Surprisingly, the effect of pet ownership was not mediated by health behaviors such as recreational walking. However, the health benefits of pet ownership were largely reduced once sociodemographic variables such as age, socioeconomic status, and residential location were controlled. The positive health effects of pet ownership appear to be primarily the result of selection, not increased physical activity associated with the active caretaking of pets.

Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia

ObjectivesTo assess risk for unintended pregnancy, this study describes the correlates of unprotected sexual intercourse (UPSI) among women who inject illicit drugs or who have sexual partners who inject drugs...

Laboring Above Ground: Indigenous Women in New Spain’s Silver Mining District, Zacatecas, Mexico, 1620–1770

Abstract This article considers the roles and experiences of indigenous women in the silver mining town of Zacatecas, Mexico, from the early seventeenth century through the late colonial period (1620–1770). Indigenous women of all ages and civil statuses migrated and settled in Zacatecas through the colonial period. Using Spanish sources, this article highlights the importance of their contributions to the production of silver and to the settlement of the city and its four Indian towns. It argues for a broader understanding of the labor involved in silver production to include activities performed outside the mines by women. Some of this work involved the preparation and distribution of goods and foodstuffs and basic housekeeping at mining haciendas, and women’s engagement with small-scale trade, market activities, and the management of properties in the city. Indian women also contributed to the vitality of the city and its Indian communities, migrating and settling in Zacatecas in large numbers even during periods of mining declines. Within these communities, episodes of high male absenteeism often left Indian women in charge of their households. As primary caretakers, they cared for their children and often used legal measures to protect them from abusive labor practices common to mining towns. Ultimately, this article argues that indigenous women’s roles above ground were as important as those performed by their male, silver-extracting counterparts below ground.

The use of home-based caregiver assessment to improve children’s health: a pilot project

Background: Grandparents Raising and Nurturing Dependents with Disabilities (Project GRANDD) is a support program for grandparents who are the primary caregivers of grandchildren with developmental disabilities, chronic illness, and behavior or learning difficulties. A critical problem contributing to diminished quality of life for the family is the grandparents’ own poor health, as well as the lack of access to available resources. This project pairs nursing students from the local university with grandparents participating in the GRANDD support program to improve the caregiving grandparents’ health. Methods: A total of 12 nurse practitioner (NP) students were paired with six grandparents. Students performed home visits and assessments, health histories, environmental assessments, and windshield surveys over the course of several weeks. Follow-up visits for medication reconciliation, referral to resources, or for patient health education were conducted in person or via phone. Results: The grandparents’ demographic characteristics were as follows: African American females, on fixed incomes on or near poverty level, had multiple co-morbidities, and showed reluctance in seeking help because of their role as primary caretaker. Nursing students demonstrated increased awareness of the cycle of disability and disadvantage, and improved skills that enable them to aid vulnerable individuals in accessing community resources. Conclusions: This pilot program had a positive impact on students and grandparents. Much is needed regarding outcome measurement and standardization of methods, but the initial results demonstrated a beneficial relationship between NP students and Project GRANDD participants, thus contributing to the ongoing effort to break the cycle of disadvantage and disability in this vulnerable population.

구조적 면담으로 ADHD로 진단받은 아동의 주산기 요인 및 발달력상 위험인자

Objectives:The objective of this study was to examine the perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD) diagnosed with a structured interview among Korean children. Methods:The current study included 924 children (6-15 years) recruited from schools in five Korean cities or a child psychiatry outpatient clinic of Seoul National University Children's Hospital. The parents of the children completed the structured diagnostic interview for attention-deficit hyperactivity disorder, as well as questionnaires on perinatal and developmental risk factors. Results:Preterm delivery, severe maternal stress during pregnancy, change in primary care taker during the first three years, postpartum depression, and delayed first sentence showed a significant association with ADHD diagnosis. Conclusion:These findings suggest that perinatal and developmental factors contribute to development of ADHD in Korean children. Conduct of future research using a prospective design is needed in order to identify the causal relationship between observed risk factors and development of ADHD.

Schizencephaly

Schizencephaly is a rare malformation of cortical development characterized by congenital clefts extending from the pial surface to the lateral ventricle that are lined by heterotopic gray matter. The clinical presentation is variable and can include motor or cognitive impairment and epilepsy. The causes of schizencephaly are heterogeneous and can include teratogens, prenatal infection, or maternal trauma. Reported genetic causes include chromosomal aneuploidy, EMX2 mutations, and possible autosomal recessive familial cases based on recurrence in siblings. In an effort to identify risk factors for schizencephaly, we conducted a survey of 48 parents or primary caretakers of patients with schizencephaly born between 1983 and 2004. We discovered that young maternal age, lack of prenatal care, and alcohol use were all significantly associated with risk of schizencephaly. Our results suggest that there are important nongenetic, intrauterine events that predispose to schizencephaly.

Investigation on the anxiety and depression of children' s primary caretakers in class "AAA" hospital and influcing factors

Objective To look into the anxiety and dcpression of children' s primary caretakers and analyze the influencing factors,so as to provide scientific references for the implementation of nursing intervention.Methods Convenience sampling was used to enlist 90 primary caretakers of children in a A level hospital in Wuhan from December 2011 to Apria 2012 to the research.And SAS and SDS were used to investigate these caretakers.Results 95 questionnaires were handed out and 90 were recovered with the rate of 94.73％.The average SAS and SDS scores of primary caretakers were respectively (49.57 ± 8.67) and (54.49 ± 8.16),both were higher than those of national norm group (37.23 ± 12.58) and (41.88 ± 10.57),respectively,and the differences were statistically significant (t =13.504,14.650,respectively ; P =0.000).SAS and SDS scores of caretakers with different patients' ages,caretakers' genders,caretakers' educational degrees and family monthly income per person were significantly different (F =15.917,9.257,3.558,3.069,respectively; P ＜ 0.05).The anxiety and depression of caretakers were negatively related to patients' age,caretakers' educational degrees and family monthly income per person (P ＜ 0.05),and positively related to caretakers' genders (P ＜ 0.05).Conclusions The average SAS and SDS scores of caretakers are obviously higher than those of the norm group,and the anxiety and depression were influenced by patients' age,caretakers' gender,caretakers' educational degree and family monthly income per person,which should draw nursing attention. Key words: Surgery; Anxiety; Depression; Primary caretakers; Children

Variations in Energy and Nutrient Specific Consumption Over the Course of Therapy in Children with Acute Lymphoblastic Leukemia.

AbstractAbstract 2575 Introduction:Few research studies have investigated the nutritional status of children with acute lymphoblastic leukemia (ALL). Preliminary studies have found that malnutrition is associated with lower 5-year survival, increased relapse rates and more frequent reductions in chemotherapy dose. The extent of malnutrition has not been well characterized. Results of a prospective multi-institution study investigating dietary micronutrient intake over the course of treatmentfor ALL are reported. Methods:Assessment of dietary intake was collected for participants enrolled on the DFCI ALL Consortium Protocol 05-001 from 2005–2011. Institutional review board approval was obtained by each of the 9 participating centers. Dietary intake was assessed at three timepoints in therapy: diagnosis (T1), Day 32 (end) of induction therapy (T2), and 15 months post-diagnosis (T3) (during maintenance therapy) with the Harvard Service Food Frequency Questionnaire for children ages 1–5 years and the Youth and Adolescent Harvard Food Frequency Questionnaire for children ages 5–18 years. Questionnaires were self-administered and were completed by parents or primary care takers when children were below age 6 years. Dietary intake was examined by comparing energy and nutrient specific consumption above and below recommended intake using age specific values for Dietary Reference Intake (DRI). Results:Among 794 patients with ALL registered on the 05-001 Protocol, dietary intake questionnaires were availablefor 622, 564, and 423 patients at T1, T2, and T3, respectively. Median age of participants at T1 was 5 yrs (range 1–17.9 yrs) and 272 (44%) were female, 350 (56%) were male. Initial leukemia risk classification included 363 standard risk (58%) and 259 (42%) high risk. At diagnosis, the majority of children reported consuming more than the age and gender specific DRI. For 388 children (62%), reported caloric intake was >25% the DRI, while another 81 (13%) reported caloric consumption >10% the DRI. In contrast, only 116 (19%) did not meet the DRI. At T2, similar findings were observed, despite administration of a 32 day prednisone course which would have been expected to result in a higher proportion of children exceeding recommended caloric intake. Of those responding at T2, 128 (23%) were not meeting the DRI, while 65 (12%) and 335 (59%) exceeded the recommended caloric intake by >10% and >25% respectively. During maintenance therapy (T3), total caloric intake declined with a greater proportion of participating children reporting intake below the DRI (30%) and a smaller proportion reporting intake >25%DRI (49%), while the proportion consuming recommended intake or >10% DRI remained stable. Distribution of children reporting nutrient consumption below, at, or above age and gender specific DRI values for key micronutrients is summarized in Figure 1. The majority of patients did not meet the DRI for vitamin E and vitamin D at all 3 time points, while nearly half the participants exceeded the DRI for zinc and folate. Conclusions:The majority of children with newly diagnosed ALL have evidence of overnutrition or malnutrition, as demonstrated by overconsumption of calories, or deficiency or overconsumption of key micronutrients, which may be associated with increased risk for treatment related toxicities. Increased consumption of folate during the maintenance phase in which methotrexate is a major component of treatment also needs further study. Additional analyses are underway to explore these relationships. [Display omitted] Below DRIAt DRIAbove DRI Disclosures:No relevant conflicts of interest to declare.

Sleep problems and functional disability in children with functional gastrointestinal disorders: An examination of the potential mediating effects of physical and emotional symptoms

BackgroundSleep disturbances are increasingly recognized as a common problem for children and adolescents with chronic pain conditions, but little is known about the prevalence, type, and impact of sleep problems in pediatric functional gastrointestinal disorders (FGIDs). The objectives of the current study were two-fold: 1) to describe the pattern of sleep disturbances reported in a large sample of children and adolescents with FGIDs; and, 2) to explore the impact of sleep by examining the inter-relationships between sleep disturbance, physical symptoms, emotional problems, and functional disability in this population.MethodsOver a 3-year period, 283 children aged 8–17 years who were diagnosed with an FGID and a primary caretaker independently completed questionnaires regarding sleep, emotional functioning, physical symptoms, and functional disability during an initial evaluation for chronic abdominal pain at a pediatric tertiary care center. A verbal review of systems also was collected at that time. Descriptive statistics were used to characterize the pattern of sleep disturbances reported, while structural equation modeling (SEM) was employed to test theorized meditational relationships between sleep and functional disability through physical and emotional symptoms.ResultsClinically significant elevations in sleep problems were found in 45% of the sample, with difficulties related to sleep onset and maintenance being most common. No difference was seen by specific FGID or by sex, although adolescents were more likely to have sleep onset issues than younger children. Sleep problems were positively associated with functional disability and physical symptoms fully mediated this relationship. Emotional symptoms, while associated with sleep problems, evidenced no direct link to functional disability.ConclusionsSleep problems are common in pediatric FGIDs and are associated with functional disability through their impact on physical symptoms. Treatments targeting sleep are likely to be beneficial in improving physical symptoms and, ultimately, daily function in pediatric FGIDs.

Pathways into a Gendered Occupation

Although São Paulo is the hub of a growing technology industry in Brazil, female participation in São Paulo’s male-dominated IT sector has decreased over recent decades. Reasons for this trend are complex and research on this topic in Brazil is limited. In an effort to learn about barriers to entry and retention for women in IT careers in Brazil 10 interviews were conducted in São Paulo with women working in information technology (IT) careers. Findings from this study include: 1) IT jobs are considered appropriate for some Brazilian women, but those women are sometimes regarded as abnormal, and technical programs and workplaces are mainly occupied by men, 2) Brazilian women feel constrained by the expectation that they be primary caretakers of domestic responsibilities, and 3) most upper-level leadership positions in IT are held by men. This study is an initial effort on which further research can expand.

소아기 우울장애의 유병률 및 역학적 특성 : 자가평가 연구

Objectives : Childhood depressive disorder one of the most prevalent chronic health conditions affecting school aged children. The objective of this study was to examine the prevalence and epidemiological characteristics of childhood depressive disorder in Korea. Methods : In this study, a survey was conducted of elementary school children in the Cheonan area from September 2009 to August 2010. A total of 12,084 children were included in the analyses. The primary measure of depression was the 27-item Kovacs' Children's Depression Inventory (CDI), the Korean Dupaul attention-deficit hyperactivity disorder Rating Scales (K-ARS), Autism Spectrum Screening Questionnaire (ASSQ) and Restless Legs Syndrome Questionnaire (RLSQ) were also administered. Results : The prevalence rate of childhood depressive disorder was 3.07%. The mean age was <TEX>$9.21{\pm}1.81$</TEX> years for the control group (5,969 male, 6,054 female) and <TEX>$9.91{\pm}1.83$</TEX> years for the depression group (CDI score<TEX>${\geq}$</TEX>22 ; 159 male, 210 female). Age, height, weight, and economic status were similar for the two groups. However, there were statistically significant differences in the distribution of sex. The distribution of school grade also differed between the two groups. Scores for CDI, K-ARS, and ASSQ in the depressive group were higher than those of the control group. Conclusions : This is the first large-scale population-based study to report on the prevalence of childhood depressive disorder in South Korea. Increased rates of childhood depressive disorder, as reported by primary caretakers, might reflect the increasing negative impact of environmental risk factors on neurobehavioral health. Longitudinal study of the prevalence of childhood depressive disorder should be considered for further evaluation.

Change in Parent- and Child-Reported Internalizing and Externalizing Behaviors Among Substance Abusing Runaways: The Effects of Family and Individual Treatments

Shelter-recruited adolescents are known to have high rates of substance abuse and co-occurring internalizing and externalizing problem behaviors. Many studies have documented these mental health concerns, but only a small number of studies have tested interventions that may be useful for ameliorating these vulnerabilities. The current study compared three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically-Based Family Therapy (EBFT) with 179 substance abusing runaway adolescents (47% female, 74% minority) and their primary caretaker recruited through a Midwestern runaway crisis shelter. Examining both child and primary caretaker reports, each treatment was associated with significant reductions in internalizing and externalizing behaviors to 24months post-baseline. However, the trajectory of change differed among the treatments. Adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to evidence improvements to 24months. The findings provide support for continued evaluation of these treatments for use with this vulnerable population of adolescents.

Risk for ingestion of toxic substances in children with Prader–Willi syndrome

Individuals with Prader-Willi syndrome (PWS) have several common findings that may predispose to ingestion of potentially dangerous items. This study examined whether individuals with PWS have an increased prevalence of toxic ingestions. A survey regarding history of ingestions in PWS individuals and sibling controls was designed, piloted, and distributed on-line. The subjects were individuals with PWS (N = 129). The subjects' non-PWS siblings served as controls (N = 134). Participants who completed the anonymous online survey were either the parents or the primary caretaker of individuals with PWS. Responses were submitted by 141 participants, providing information about 130 PWS subjects (M/F: 66:64) and 134 sibling controls. Subjects and controls ranged in age from 2 to 18 years at the time of the survey. Eleven participants did not answer the questions regarding ingestions. History of toxic ingestion was more prevalent in PWS subjects (20% vs. 2% of controls). Several features of PWS, including history of searching for food and eating unusual objects, along with decreased cognitive ability, appeared to associate with increased prevalence of toxic ingestion in PWS individuals. PWS children appear to have an ∼12-fold increased risk of ingesting toxins compared to the general population. Geneticists should include this information in counseling and in recommendations to primary care providers. Also, poison control centers need to be aware of this association and of the physiological and behavioral aspects of PWS that may complicate the diagnosis and management of a toxic ingestion.

Consistency analysis of parenting styles in Thailand during children's first year

This descriptive study identifies and examines the consistency of parenting styles during the first year of their children's lives. The data were collected from interviewing 4088 parents or primary care takers of the 6 month old infants during the third wave of data collection of The Prospective Cohort of Thai Children project. The instrument used was the Infant Parenting Styles Questionnaire, developed by the researchers, which reflected parental responses to infant care in five different situations. After the answers were categorized into controlling, reasoning, overprotection, and neglectful parenting styles, the weighted kappa was used for the consistency analysis. The findings revealed that during the first 6 months of life, the overprotection style was the most common, followed by the reasoning style. The controlling and neglectful styles were very seldom used. The consistency of the parental styles in the same care givers using the kappa values showed that agreement between each of the styles was very low (-0.0419 to 0.0688). This suggests that parenting styles during the first year of life seem to occur in random patterns.

The relation between order of acquisition, segmental frequency and function: the case of word-initial consonants in Dutch

The impact of input frequency (IF) and functional load (FL) of segments in the ambient language on the acquisition order of word-initial consonants is investigated. Several definitions of IF/FL are compared and implemented. The impact of IF/FL and their components are computed using a longitudinal corpus of interactions between thirty Dutch-speaking children (age range: 0 ; 6-2 ; 0) and their primary caretaker(s). The corpus study reveals significant correlations between IF/FL and acquisition order. The highest predictive values are found for the token frequency of segments, and for FL computed on minimally different word types in child-directed speech. Although IF and FL significantly correlate, they do have a different impact on the order of acquisition of word-initial consonants. When the impact of IF is partialed out, FL still has a significant correlation with acquisition order. The reverse is not true, suggesting that the acquisition of word-initial consonants is mainly influenced by their discriminating function.

Prevalence of psychiatric illness in primary caretakers of childhood-onset schizophrenia subjects.

Childhood-onset schizophrenia (COS) refers to schizophrenia with onset of psychotic symptoms prior to a child's 13th birthday. Optimal treatment likely includes family-based services supplementing antipsychotic pharmacotherapy. However, family-based services can require adjustment based on parental psychopathology; there has been little literature exploring the frequency or type of psychopathology seen in parents of COS cases. This report includes the results of a structured psychiatric evaluation on 80 parents of a COS case with comparison to a sample of 304 parents. Having a child with psychosis and being of minority racial/ethnicity status increased risk for psychiatric illness. Psychotic disorders (15% vs. 5%), mood disorders (54% vs. 27%), anxiety disorders (30% vs. 18%), and substance use disorders (49% vs. 31%) were all increased in the parents with a psychotic child. Psychiatric illness is common in parents of a child with COS and will need to be considered as family-based services for COS are developed.