The health of grandparents raising grandchildren: results of a national study.
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OBJECTIVES: This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. METHODS: A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. RESULTS: Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. CONCLUSIONS: Further research is needed to determine whether the differences observed reflect artifacts or actual differences in functional abilities and other health measures. The need for policies that support rather than penalize grandparents raising grandchildren is stressed. (+info)
Family ward: a new therapeutic approach.
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This article describes a new integrated child psychiatric family ward treatment model at the Tampere University Hospital. Theoretically, the treatment is based on an integration of systems and psychoanalytical theories as well as behavioral approach. A centerpiece of the model is a 3-week treatment period for the whole family at the family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are also used as tools, including a reflective working model and sharing concrete interaction with the family. So far, the family ward has offered 165 family treatment periods for 113 different families. Altogether in 63% of the total treatment periods one or both parents have had mental illness and in 15% of the total treatment periods there have been serious custody disputes with accusations of sexual abuse of the child. Helping these multi-problem families is a special challenge for our treatment model and at the moment we are developing new methods for assessment and support of parenthood. (+info)
An intervention for parents with AIDS and their adolescent children.
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OBJECTIVES: This study evaluated an intervention designed to improve behavioral and mental health outcomes among adolescents and their parents with AIDS. METHODS: Parents with AIDS (n = 307) and their adolescent children (n = 412) were randomly assigned to an intensive intervention or a standard care control condition. Ninety-five percent of subjects were reassessed at least once annually over 2 years. RESULTS: Adolescents in the intensive intervention condition reported significantly lower levels of emotional distress, of multiple problem behaviors, of conduct problems, and of family-related stressors and higher levels of self-esteem than adolescents in the standard care condition. Parents with AIDS in the intervention condition also reported significantly lower levels of emotional distress and multiple problem behaviors. Coping style, levels of disclosure regarding serostatus, and formation of legal custody plans were similar across intervention conditions. CONCLUSIONS: Interventions can reduce the long-term impact of parents' HIV status on themselves and their children. (+info)
Case-control study of the health of those looked after by local authorities.
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AIMS: To assess the health needs and provision of health care to school age children in local authority care. METHODS: A total of 142 children aged 5 to 16 in local authority care, and 119 controls matched by age and sex were studied. Main outcome measures were routine health care, physical, emotional, and behavioural health, health threatening and antisocial behaviour, and health promotion. RESULTS: Compared with children at home, those looked after by local authorities were significantly more likely to: experience changes in general practitioner; have incomplete immunisations; receive inadequate dental care; suffer from anxieties and difficulties in interpersonal relationships; wet the bed; smoke; use illegal drugs; and have been cautioned by police or charged with a criminal offence. They also tend to receive less health education. They were significantly more likely to have had a recent hearing or eye sight test, and reported significantly less physical ill health overall. CONCLUSIONS: The overall health care of children who have been established in care for more than six months is significantly worse than for those living in their own homes, particularly with regard to emotional and behavioural health, and health promotion. In contrast to uncontrolled observational studies we have not found evidence of problems with the physical health of these children. (+info)
Investigating subdural haemorrhage in infants.
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When an infant or young child presents with subdural haemorrhage, the diagnostic priority is to exclude physical child abuse. A team approach should be adopted for the clinical child protection investigation. The diagnostic process is inevitably one of detective work; appropriate radiological, ophthalmological, haematological, biochemical, and postmortem investigations are discussed. (+info)
Sudden unexpected death in infancy associated with maltreatment: evidence from long term follow up of siblings.
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AIMS: To identify any association between sudden unexpected death in infancy (SUDI) and maltreatment within local families. METHODS: Retrospective enquiry and subsequent follow up of all siblings and later births within the families. Full investigation of the circumstances of all unexpected deaths. SETTING: Scarborough and Bridlington Health Districts and Trusts, North and East Yorkshire. SUBJECTS: All local families losing a baby from SUDI, 1982-96. Follow up to end of 2000. MAIN OUTCOME MEASURES: Court judgements and the objective decisions of legally constituted Social Services Case Conferences to place siblings on the Child Protection Register (CPR), or provide equivalent safeguards. RESULTS: Sixty nine families had 72 unexpected deaths; three families had two deaths, with two families raising maltreatment issues. Three families had other children subsequently put on the CPR, all identifiable as likely problems of maltreatment at the time of the single SUDI. In 64/69 families, no child protection issues were formally raised at the time of the SUDI; 41/64 of these families already had 63 children. Four families were lost to follow up after the SUDI; 52/60 of the remaining families have had 93 more children without objective evidence of maltreatment. CONCLUSIONS: The association of SUDI and maltreatment within families was at the lower end of previous estimates, 3-10%. Child protection intervention is rarely needed, but investigation and follow up for maltreatment is mandatory where apparent life threatening episodes are reported with a second baby, and after a recurrence of apparent SUDI. (+info)
Lawsuits and secondhand smoke.
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OBJECTIVE: This paper describes secondhand smoke (SHS) litigation over the past quarter century where non-smoking litigants have prevailed and attempts to decipher trends in the law that may impact the course of future cases. METHODS: Since the early 1980s, the author has sought and examined legal cases in which SHS exposure is an important factor. Law library searches using the official reporter system (for example, Shimp v. New Jersey Bell Telephone Co., 368 A.2d 408) have more recently been combined with computerised online searches using LexisNexis and Westlaw. The author has learned of other cases through personal correspondence and from articles in newspapers. Over 420 cases involving exposure to SHS were identified. Each case was reviewed and summarised. RESULTS: Since 1976, the year of the first reported SHS lawsuit, this type of litigation has increased both in number and in scope with increasing success. While it is common for initial cases to lose in a new area where the law eventually evolves, litigants and their lawyers who later bring similar cases can learn from those previous, unsuccessful cases. It is now apparent that the judicial branch has begun to recognise the need to protect the public-especially some of the most vulnerable members of our society-from the serious threat to their health that is exposure to SHS. CONCLUSIONS: Successful cases brought on behalf of individuals exposed to SHS produce an additional benefit for the public health by both paving the way for other non-smoking litigants to succeed in their cases and persuading business owners and others voluntarily to make their facilities 100% smoke-free. (+info)
Childhood malignancies and decision making.
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Failure to obtain "adequate" medical care for a child constitutes child neglect, which may be used as the basis for prosecution of parents, removal of the child from the home, or court-ordered medical treatment. "Adequate" care is usually construed as that which is given by a licensed physician, but, in case of dispute, courts almost never engage in choosing one medical approach over another. The principle that parents may not refuse medical care, however, is made very difficult when children have malignancies--the long-term nature of the treatment means that, if the child is left at home, court order or not, the parents may flee with their child. Removing the child from the home, however, adds that trauma to the ill child's burdens. Questions should be asked before making a request to a court to order a therapy which will prolong but not save a child's life if the parents would prefer to spare their child the side effects. Parents, however, may always refuse to permit their child to participate in research studies, no matter how promising. Adolescents are increasingly believed to be capable of medical decision making; most courts, however, would not allow an adolescent to refuse life-saving treatment. (+info)