Secondary Analysis Of Longitudinal Data Research Articles

Somatic symptoms in cancer patients trajectory over 12 months and impact on functional status and disability

Cross-sectional studies have established the prevalence and functional impairment of somatic symptoms in cancer patients. The purpose of this study was to determine the trajectory and adverse consequences of such symptoms over time. Secondary analysis of longitudinal data from 405 cancer patients enrolled in a telecare management trial for pain and/or depression. Somatic symptom burden was measured with a 22-item scale at baseline, 1, 3, 6, and 12 months. Outcomes included the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, the Sheehan Disability Scale (SDS) score, and self-reported total disability days. Mixed methods repeated measures analyses were conducted to determine whether antecedent change in somatic symptom burden predicted functional status and disability. Symptoms were highly prevalent at baseline, with 15 of the 22 symptoms endorsed by more than half of the patients. A rather constant cross-sectional prevalence over 12 months at the group level belied a quite different trajectory at the patient level where the median persistence, resolution, and incidence rates for 14 of the most common symptoms were 39%, 37%, and 24%, respectively. A clinically significant (i.e., five points) reduction in somatic symptom burden predicted improvement in PCS, MCS, and SDS (all P < 0.001), as well as a lower likelihood of ≥14 disability days in the past 4 weeks (odds ratio, 0.84; 95% CI, 0.74 to 0.95). Somatic symptoms remain burdensome in cancer patients over 12 months and symptom improvement predicts significantly better functional status and less disability.

Cross-Cultural Variations in Adolescents’ Perceived Maternal Expectancy and Sexual Initiation

This study built on previous findings and compared the effects of maternal influences on adolescents' sexual initiation among four racial and ethnic groups: Asian American Pacific Islanders, African Americans, Hispanic Americans, and Caucasians. An exploratory, comparative secondary analysis of longitudinal data from 433 Asian American Pacific Islanders, 1,367 African Americans, 1,241 Hispanic Americans, and 4,567 Caucasian adolescents between the ages of 15 and 17 years at Wave 1 was conducted using structural equation modeling. Bronfenbrenner's Social Ecological Model guided the modeling and analyses. Adolescents' sexual initiation was significantly associated with mother-adolescent interactions and adolescents' perceived maternal sexual expectations. Cross-cultural variations are noted and discussed. Nursing interventions designed to delay adolescents' sexual initiation need to focus on familial and cultural variations associated with mother-adolescent interactions.

Outcome Moderators of a Fatigue Management Program for People With Multiple Sclerosis

We determined whether age, gender, work status, or impairment moderated fatigue management program outcomes for people with multiple sclerosis (MS). We conducted a secondary analysis of longitudinal data from a randomized controlled trial using mixed-effects models (N = 181) and examined outcomes of fatigue impact, mental health, physical health, and self-efficacy. Measures were collected before and immediately after intervention and at 6 wk, 3 mo, and 6 mo postintervention. Younger participants experienced greater reductions in fatigue impact and greater improvements in self-efficacy over time than did older participants, but we found no age differences in physical or mental health. Participants with less impairment experienced greater mental health gains and were more likely to retain these gains over time than were participants with greater impairment. Although women experienced greater fatigue impact benefits, men experienced greater mental health benefits. Work status did not moderate outcomes. Fatigue management program outcomes for people with MS are moderated by age, gender, and impairment.

Depressive Symptoms Before and After Elective Hysterectomy

To examine the factors associated with depressive symptoms before and after surgery in women who undergo elective hysterectomy. A secondary analysis of longitudinal data from a prospective cohort study designed to understand chronic postsurgical pain in women. One acute care hospital in southeastern, Ontario, over a 4-year period (2006-2010). Three hundred eighty-four (384) English-speaking women, age 18 years or older, who presented for elective hysterectomies. Data were gathered preoperatively in the same-day admission center and six months postoperatively using validated web-based or mailed questionnaires. Thirty six percent (36%) of participants reported depressive symptoms before surgery, 22% reported symptoms afterwards, 15% reported symptoms at both time points, and 6% developed new onset depressive symptoms postoperatively. Younger (odds ratio [OR]=2.5, 95% confidence interval [CI],[1.7, 5.0]) women, those with higher levels of anxiety (state: OR=8.6, 95% CI[5.2, 14.0]), or who experienced pain that interfered with their daily functioning (OR=2.8, 95% CI[1.7, 4.7]) were more likely to report depressive symptoms prior to hysterectomy. Preoperative pain (OR=2.0, 95% CI[1.1, 3.6]), trait anxiety (OR=2.4, 95% CI[1.2, 4.6]), and depressive symptoms (OR=3.9, 95% CI[2.1, 7.5]) increased the risk of depressive symptoms 6 months postoperatively. Young women who exhibit high levels of anxiety and pain and who require a hysterectomy are at risk of experiencing psychological distress prior to and following their surgery.

Correlates of care relationship mutuality among carers of people with Alzheimer's and Parkinson's disease.

This paper presents findings from secondary analysis of longitudinal data on correlates of care relationship mutuality collected from 91 carers of people with Alzheimer's disease and Parkinson's disease in the control group of a randomized trial of home-care skill training. Many family members and other informal carers are reported to suffer multiple adverse social, financial, psychological and physical caregiving outcomes. High levels of mutuality, the perception that the quality of the care relationship is positive, reportedly ameliorate these negative outcomes. Multilevel models for change were used to explore whether care recipient functional ability, carer gender, depressive symptoms, kin relation to care recipient (spouse, non-spouse) and years of caregiving experience were related to carers' perceptions of care relationship mutuality over a 12-month period. Data collection took place between 2003 and 2008. Carers who reported lower mutuality: (1) were caring for care recipients with lower functional ability, (2) had less caregiving experience and (3) had more depressive symptoms. Informal carers who perceive little mutuality in their relationship with the care recipient may be more likely to terminate care early. Clinicians and researchers should explore the quality of the caregiving relationship as a critical factor in carer and care recipient outcomes. Home-care skill training may need to include relationship-building skills to offset adverse carer outcomes.

The Impact of Sacral Sensory Sparing in Motor Complete Spinal Cord Injury

Kirshblum S, Botticello A, Lammertse DP, Marino RJ, Chiodo AE, Jha A. The impact of sacral sensory sparing in motor complete spinal cord injury. Objective To determine the effect of sensory sparing in motor complete persons with spinal cord injury (SCI) on completion of rehabilitation on neurologic, functional, and social outcomes reported at 1 year. Design Secondary analysis of longitudinal data collected by using prospective survey-based methods. Setting Data submitted to the National SCI Statistical Center Database. Participants Of persons (N=4106) enrolled in the model system with a motor complete injury (American Spinal Injury Association Impairment Scale [AIS] grade A or B) at the time of discharge between 1997 and 2007, a total of 2331 (56.8%) completed a 1-year follow-up interview (Form II) and 1284 (31.3%) had complete data for neurologic (eg, AIS grade, injury level) variables at 1 year. Interventions Not applicable. Main Outcome Measures AIS grade (A vs B) at 1 year, bladder management, hospitalizations, perceived health status, motor FIM items, Satisfaction With Life Scale, depressive symptoms, and social participation. Results Compared with persons with AIS grade A at discharge, persons with AIS grade B were less likely to require indwelling catheterization and be hospitalized and more likely to perceive better health, report greater functional independence (ie, self-care, sphincter control, mobility, locomotion), and report social participation in the first year postinjury. A greater portion of individuals with AIS grade B at discharge had improved neurologic recovery at 1 year postinjury than those with AIS grade A. Significant AIS group differences in 1-year outcomes related to physical health were maintained after excluding persons who improved to motor incomplete status for only bladder management and change in perceived health status. This recognition of differences between persons with motor complete injuries (AIS grade A vs B) has important ramifications for the field of SCI rehabilitation and research.

Adverse Adolescent Reproductive Health Outcomes After Pelvic Inflammatory Disease

To compare longitudinal adolescent and adult reproductive outcomes after pelvic inflammatory disease (PID). Secondary analysis of longitudinal data from the Pelvic Inflammatory Disease Evaluation and Clinical Health study. A large multicenter randomized clinical trial assessing PID treatment strategies in the United States. Eight hundred thirty-one female patients aged 14 to 38 years with a diagnosis of PID. Adverse longitudinal outcomes were compared in adolescents (≤19 years) and adults (>19 years). Primary outcome measures included recurrent sexually transmitted infection at 30 days, recurrent PID, chronic abdominal pain, infertility, pregnancy, and times to recurrent PID and pregnancy. Cox proportional hazards modeling was used to examine the effect of young age on times to pregnancy and recurrent PID. Adolescents were more likely than adults to have positive results of sexually transmitted infection testing at baseline and at 30 days. There were no significant group differences in chronic abdominal pain, infertility, and recurrent PID at 35 or 84 months, but adolescents were more likely to have a pregnancy at both time points. Adjusted hazard ratios (95% confidence intervals) also demonstrated that adolescents had shorter times to pregnancy (1.48 [1.18-1.87]) and recurrent pelvic inflammatory disease (1.54 [1.03-2.30]). Adolescents may require a different approach to clinical care and follow-up after PID to prevent recurrent sexually transmitted infections, recurrent PID, and unwanted pregnancies.

End-of-High-School Mathematics Attainment: How Did Students Get There?

Background Many studies have looked at students’ mathematics achievement in the middle and high school years and the kinds of factors that are associated with their achievement. Within this domain, however, most research utilized cross-sectional data. Cross-sectional designs have both statistical and conceptual limitations. A few studies that used longitudinal data typically included two time points, occasionally three. A pure longitudinal design is problematic as well because it does not take into account the multilevel nature of data derived from educational settings. In an attempt to account for differences in mathematics achievement, researchers have advanced different explanations, varying from affective/psychological factors (e.g., math attitude) to social factors (e.g., influences of parents, teachers, and peers). However, because of the division of psychology and sociology, subdivisions within these fields, and specialized individual research interests, a limitation of the research in this literature is that the variables are often studied in isolation rather than in concert. A promising way to resolve this problem, as Herbert Walberg argued in his psychological theory of educational productivity, is to include the chief known correlates of educational achievement derived from experimental and nonexperimental research and simultaneously analyze panel data collected on many individuals over multiple time periods on variables such as age or developmental level; ability, including prior achievement; social environment for learning; and home environment. Taken together, these studies provide a foundation for studying individual differences in secondary mathematics growth and end-of-high-school mathematics attainment and exploring various psychological and social factors that might predict such differences from a longitudinal and multilevel perspective. Building on this earlier research, the present study attempted to address these issues through longitudinal and multilevel analysis of a national probability sample of Grade 7 students who were followed until the end of high school. Focus of Study The present study attempted to investigate how high school seniors get to where they are in terms of end-of-high-school mathematics attainment. In addition, the study explored what factors might predict students’ attainment and their growth trajectories in mathematics during secondary school years. Research Design The present study is a secondary analysis of longitudinal data that tracked a national probability sample of seventh graders until they graduated from high school. Three-level hierarchical linear models were fitted to the data using a Level 1 piece-wise linear growth model nested within students (Level 2) across schools (Level 3). Conclusions One of the important findings of this study was that on average, there was a drop in mathematics achievement during the senior year of high school for students in the sample regardless of student mathematics achievement in Grade 7. Additionally, the study found an inequitable distribution of mathematics attainment at the end of high school associated with initial differences in mathematics achievement. Several individual, school composition, and opportunities to learn variables, such as early tracking and course progress, were found to be strong predictors of students’ mathematics attainment and growth. These empirical findings point to the further directions we may take to promote student achievement in mathematics.

Physicians’ reactions to uncertainty in the context of shared decision making

Objective Physicians’ reactions towards uncertainty may influence their willingness to engage in shared decision making (SDM). This study aimed to identify variables associated with physician's anxiety from uncertainty and reluctance to disclose uncertainty to patients. Methods We conducted a cross-sectional secondary analysis of longitudinal data of an implementation study of SDM among primary care professionals ( n = 122). Outcomes were anxiety from uncertainty and reluctance to disclose uncertainty to patients. Hypothesized factors that would be associated with outcomes included attitude, social norm, perceived behavioral control, intention to implement SDM in practice, and socio-demographics. Stepwise linear regression was used to identify predictors of anxiety from uncertainty and reluctance to disclose uncertainty to patients. Results In multivariate analyses, anxiety from uncertainty was influenced by female gender ( β = 0.483; p = 0.0039), residency status (1st year: β = 0.600; p = 0.001; 2nd year: β = 0.972; p < 0.001), and number of hours worked per week ( β = −0.012; p = 0.048). Reluctance to disclose uncertainty to patients was influenced by having more years in formal education ( β = −1.996; p = 0.012). Conclusion Variables associated with anxiety from uncertainty differ from those associated with reluctance to disclose uncertainty to patients. Practice implications Given the importance of communicating uncertainty during SDM, measuring physicians’ reactions to uncertainty is essential in SDM implementation studies.

Job Insecurity and Change Over Time in Health Among Older Men and Women

We estimated associations between job insecurity and change over time in the physical and psychological health of older adult men and women. We conducted secondary analyses of longitudinal data from men and women (N = 190) born between 1935 and 1952 in the Chicago Health, Aging, and Social Relations Study. We used multivariate regression techniques to test the association of job insecurity with changes in physical health (self-reported global health, resting blood pressure, and urinary catecholamines [epinephrine]) and psychological health (depressive symptoms, hostility, loneliness, and personal stress). We controlled for individual characteristics and baseline measures of the outcomes. Men who experience job insecurity rate themselves in significantly poorer physical health and have higher blood pressure and higher levels of urinary catecholamines compared with men who do not experience job insecurity and women who do. Women who experience job insecurity show higher depressive symptoms and report more hostility, loneliness, and personal stress compared with women who do not experience job insecurity and men who do. The correlation between job insecurity and health is different in men and women but may be clinically significant in both populations and is a potentially important threat to older adults' health and well-being.

TANF status, ethnicity, and early school success

This article presents a secondary analysis of longitudinal data from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K), conducted by the U.S. Department of Education's National Center for Education Statistics (NCES). The ECLS-K data are from a national sample of children who began kindergarten during 1998/9. The article reviews literature about the relationships among poverty, ethnicity, and early success in school, analyses three-year longitudinal data by student ethnicity and TANF status, and provides a discussion of policy implications. The findings suggest that, although many children from non-English-speaking backgrounds catch up with peers during the first three years of school, TANF status remains a good predictor of overall achievement in the third grade.

Posttraumatic Stress Disorder does not Increase Recurrent Intimate Partner Violence

ABSTRACT To determine whether posttraumatic stress disorder (PTSD) increases the risk of recurrent intimate partner violence, I conducted a secondary analysis of longitudinal data from 321 women in the Chicago Women's Health Risk Study. PTSD at baseline showed a moderate unadjusted association with recurrent IPV in the 2-year follow-up period. However, when important confounding factors, such as severity of previous abuse and use of control tactics by the partner, were controlled in a logistic regression model, there was no association between PTSD and recurrent victimization.

Disruptive behavior disorders in offspring of parents with major depression: Associations with parental behavior disorders

Objective Although the offspring of parents with major depressive disorder (MDD) are at increased risk to develop disruptive behavior disorders (DBD) in addition to MDD, it remains unclear whether this heightened risk is due to MDD or to comorbid DBD in the parents. Method In a secondary analysis of longitudinal data from offspring at risk for MDD and panic disorder and comparison children, we stratified 169 children of parents who had been treated for MDD based upon presence ( n = 50) or absence ( n = 119) of parental history of DBD (ADHD, oppositional disorder, and conduct disorder) and contrasted them with children of parents with DBD but without MDD ( n = 19) and children whose parents had neither MDD nor DBD ( n = 106). The children had been assessed in middle childhood using structured diagnostic interviews. Results Offspring of parents with MDD + DBD had significantly higher rates of MDD, DBD in general, and ADHD in particular, compared with offspring of parents with MDD alone. Offspring of parents with MDD + DBD also had higher rates of mania than controls. Both parental MDD and DBD conferred independent risk for MDD and DBD in the offspring. However, only parental DBD conferred independent risk for conduct disorder and ADHD and only parental MDD conferred independent risk for oppositional defiant disorder. Conclusion Elevated rates of DBD in the offspring of parents with MDD appear to be due in part to the presence of DBD in the parents. Further studies of samples not selected on the basis of parental panic disorder are needed to confirm these results.

Violence against women and the risk of under‐five mortality: analysis of community‐based data from rural Bangladesh

To assess whether violence against women was associated with increased mortality risks for their daughters and sons before the age of 5. Secondary analysis of longitudinal data from rural Bangladesh of 2691 live-born children in relation to their mother's experience of physical, sexual and emotional partner violence and level of controlling behaviour in marriage. Analyses were adjusted for potential confounders and stratified by gender. Under five-mortality was 88 per 1000 in this cohort. Overall, there was no association between different forms of violence against women and under-five mortality. However, more educated women had an increased risk of under-five deaths of their female offspring if ever exposed to severe physical violence (adjusted hazard ratio 2.2, 95% CI 1.06-4.50) or to a high level of controlling behaviour in marriage (adjusted hazard ratio 2.5, 95% CI 1.30-4.90). Controlling behaviour in marriage increased the hazard ratios in a dose-response manner. Increased mortality risks were neither shown for offspring of women with low or no education nor for boys in any educational group. Severe physical violence and controlling behaviour in marriage were associated with higher under-five mortality among daughters of educated mothers in rural Bangladesh, indicating gender-biased consequences of partner violence for child mortality.

Red in the desert

<h3>Background</h3> Adolescents who experience pelvic inflammatory disease (PID) are highly likely to experience adverse reproductive health outcomes. Some adolescents might benefit from intensive clinical services to prevent recurrent disease and/or associated sequelae such as chronic pelvic pain (CPP). The objective of this study is to explore the relationship between health-related quality of life (HRQL) and baseline biological outcomes with subsequent reproductive health outcomes. <h3>Methods</h3> We conducted secondary analysis of longitudinal data from the 386 young women ≤ 21 years of age enrolled in the Pelvic Inflammatory Disease Clinical Evaluation and Health (PEACH) Trial. Demographic and reproductive health histories, SF-12 HRQL assessments, and biological samples for sexually transmitted infection (STI) testing (Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC)) were provided at baseline and follow-up research visits. Stepwise linear regression analyses were conducted to assess differences in HRQL over time, baseline HRQL and reproductive health outcomes, and baseline STI status and 32-month HRQL outcomes. <h3>Results</h3> There were significant improvements in mean physical health (PH) and mental health (MH) HRQL scores from 5-days to 32 months (PH: 61.7 vs. 79.4, MH: 58.3 vs. 68.6, p &lt; 0. 001). While the 5-day HRQL was not predictive of CPP at 32 months, women who had recurrent STI/PID over 32 months had lower 5-day mental health composite and physical functioning subscale scores. Women with non-GC/CT PID at baseline had lower 32-month HRQL composite scores for physical and mental functioning than those with GC/CT positivity at baseline. <h3>Conclusions</h3> Lower baseline HRQL scores are associated with recurrent STI/PID and non-GC/CT PID is associated with lower HRQL at 32 months. Additional work exploring the potential use of baseline biological STI outcomes and HRQL to enhance risk delineation during service delivery for vulnerable young women with mild-moderate PID is warranted.

Perceived Ambiguity about Screening Mammography Recommendations: Association with Future Mammography Uptake and Perceptions

Conflicting expert recommendations regarding cancer screening and prevention are growing in number, visibility, and importance, but their impact are not well understood. In this study, we examined the impact of conflicting recommendations about mammography screening on women's mammography behavior and perceptions. We conducted a secondary analysis of longitudinal data from the 1995 Maximizing Mammography Participation Trial, a large randomized interventional trial examining the effectiveness of patient reminders in increasing mammography utilization among women ages 50 to 79. Using the decision theory concept of "ambiguity" as an analytic framework, we tested several predictions about the effects of conflicting recommendations regarding mammography recommendations on behavior, cognitions, and emotions related to mammography screening. We found high perceived ambiguity about mammography recommendations to be associated with both diminished uptake of mammography over time [odds ratio (OR), 0.42; 95% confidence interval (95% CI), 0.23-0.76; P < 0.0001] and lower intentions for future mammography (OR, 0.34; 95% CI, 0.20-0.55; P < 0.0001). High perceived ambiguity also predicted greater mammography-related worry over time (OR, 2.60; 95% CI, 1.79-3.78; P < 0.0001). These findings suggest that conflicting recommendations regarding cancer screening and prevention have important effects, and we discuss the implications of these findings for future research.

Study of mortality associated with febrile neutropenia among children with cancer

8526 Background: Febrile neutropenia is a common occurrence in children with cancer. This study aims to evaluate risk factors for mortality in this population. Methods: This is a secondary analysis of longitudinal data from the University HealthSystem Consortium database which includes information from discharge data on all patients hospitalized at 115 academic centers across the U.S. from 1995 to 2002. All patients who were at most 21 years of age and had at least one diagnostic code each for neoplastic disease and febrile neutropenia were included in this study. Patients who were undergoing or had undergone bone marrow transplantation were excluded from the study. Only one observation per patient was selected randomly. Results: A total of 12446 patients were identified for the study. There were 7045 (57%) males and 5401 (43%) females. The median age was 8 years (range: 0 to 21 yrs). The length of stay was less than 5 days for 6799 (55%) patients and greater than 5 days for 5647 (45%) patients (range: 1 to 359 days, median: 5 days). 7233 patients (58%) had a hematological malignancy, 4652 (38%) had a solid tumor and 561 (4%) were coded as in-situ, benign or unspecified tumors. The mortality rate was 2.88%. On bivariate analysis, race (p=0.0046), length of stay (p<0.0001), age (p<0.0001) and histopathology (p<0.0001) were significantly associated with mortality. Using logistic regression, infancy (compared to child aged 1–12 years, OR=2.06), adolescence (age:13–21 years, OR=2.26), hematological malignancies (versus solid tumors, OR=1.48) and length of stay >5 days (OR=6.86) were significantly associated with increased risk of mortality after accounting for sex, race and year of discharge. Conclusions: Age, length of stay and histopathology were variables that were significantly associated with risk of mortality in this study. Further evaluation of the role of complications and comorbidities at the time of hospitalization may help in identifying high-risk patients who might benefit from targeted antibiotic therapy or prophylactic hematopoietic growth factor support. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen

The Matthew Effect in Dutch Primary Education: differences between schools, cohorts and pupils

Secondary analysis of longitudinal data from Dutch primary education was used to assess to what extent differences between educationally disadvantaged pupils and other pupils increase during their school careers. For language and arithmetic the differences between pupils with poorly educated and well-educated parents increases, while the disadvantage of Turkish and Moroccan pupils in non-verbal intelligence slightly decreases. Most progress was made in schools and cohorts with a low starting level. Differences in language achievement between schools were greatest where pupils of poorly educated parents were in a setting with many other disadvantaged pupils. Several cohorts per school were included in our analyses so that the development of schools could be examined. However, no significant differences were found between cohorts within schools regarding the size of the Matthew effect.

Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron.

Restless legs syndrome (RLS) is a neurosensory disorder that typically begins in the evening and often prevents a person from falling asleep. It has been associated with iron deficiency anemia and dopaminergic pathways and is often treated with iron infusion or dopamine agonists. The purpose of this secondary analysis of longitudinal data collected on women before, during, and after pregnancy is to document the prevalence of RLS during pregnancy, contrast its effect on sleep and mood state, and explore the role of folate and iron in the expression of RLS, specifically during the third trimester when the syndrome is most distressing. The prevalence increased from 0 during preconception to 23% (n = 7) during the third trimester of pregnancy. Only 1 subject continued to experience RLS after delivery. Compared with those without complaints of restless legs, those with restless legs had low serum ferritin at preconception and significantly lower folate levels during preconception and at each trimester. In addition, time to sleep onset was significantly delayed and depressed mood was significantly higher in the RLS group. Rather than indicators of iron deficiency anemia (serum ferritin, serum iron, and hemoglobin) or pernicious anemia (vitamin B(12)), it was reduced serum folate level that was associated with RLS in this sample of pregnant women. Findings indicate a need to reconsider recommendations about the normal ranges of serum ferritin and serum folate levels during pregnancy to minimize the complaints of restless legs and promote more consolidated sleep and better daytime mood state during pregnancy.

"It's Just a Fact of Life": Family Members' Perceptions of Parental Chronic Illness

Both parents and children constructfamily meanings when chronic illness or disability affects a parent. In this analysis, using a symbolic interaction framework, family members described implications for parenting that occurred when one of the parents experienced multiple sclerosis. This study is a secondary analysis of longitudinal data from 23 families each year for a period of 4 years. Findings indicated that both parents and children mostly thought of their families as functioning well, despite the many changes brought about by the chronic illness of one parent. Both spouses were considered good parents by children and parents, although specific changes in parenting, including increased irritability and yelling by parents, increased work and stress of the parent without multiple sclerosis, and changes in family activities away from more active pursuits were acknowledged. Knowledge of family perceptions will provide context and guidance for nurses planning intervention and counseling.