Male Caregivers of Persons with End Stage Renal Disease: A Literature Review

This literature review examined burden, depressive symptoms, and perceived health reported by male caregivers of persons with end stage renal disease. These studies suggest that male caregivers often experience negative outcomes. Compared to non-caregivers, male caregivers had higher levels of anxiety and depressive symptoms. Qualitative studies suggest depression is common and associated with conflict between caregiving responsibilities and work, poor caregiver health, and fears about the future outcomes of relatives for whom they provide care. Future research will assist healthcare providers to identify at-risk male caregivers and develop effective interventions to support this understudied caregiver population.

Measuring Health-Related Quality of Life of Adults With Down Syndrome

This study examined self- and caregiver-reported health-related quality of life (HRQOL) of 60 adults with Down syndrome (DS) using the QualityMetric Short Form-12 version 2 (SF-12v2). All HRQOL scores exceeded means and fell within one standard deviation of the SF-12v2 normative sample. Similarities between eight self- and caregiver-reported HRQOL scales were found with the exception of role physical scores (impact of health problems on typical accomplishments), which were lower when obtained by caregiver-report. A positive association was found between self- and caregiver-reported physical functioning scores (impact of health problems on physical activity). The SF-12v2 had high construct validity in this study. These findings support the feasibility of measuring HRQOL of adults with DS using self-report rather than reliance on caregiver-report.

Gestational Vitamin 25(OH)D Status as a Risk Factor for Receptive Language Development: A 24-Month, Longitudinal, Observational Study

Emerging data suggest that vitamin D status during childhood and adolescence can affect neurocognitive development. The purpose of this study was to investigate whether gestational 25(OH)D status is associated with early childhood cognitive and receptive language development. The Conditions Affecting Neurocognitive Development and Learning in Early Childhood Study (CANDLE) study enrolled 1503 mother-child dyads during the second trimester of healthy singleton pregnancies from Shelby County TN. Among 1020 participants of the total CANDLE cohort for whom 25(OH)D levels were available, mean gestational 25(OH)D level during the second trimester was 22.3 ng/mL (range 5.9–68.4), with 41.7% of values <20 ng/dL. Cognitive and language scaled scores increased in a stair-step manner as gestational 25(OH)D levels in the second trimester rose from <20 ng/dL, through 20–29.99 ng/dL, to ≥30 ng/dL. When controlling for socioeconomic status, race, use of tobacco products, gestational age of the child at birth, and age at the 2-year assessment, the gestational 25(OH)D was positively related to receptive language development (p < 0.017), but not cognitive or expressive language.

Transition from pediatric to adult care in sickle cell disease: perspectives on the family role

Transition from pediatric to adult care poses challenges for adolescents with sickle cell disease (SCD). This study explored the transition perspectives of adolescents with SCD, their siblings, and caregivers. Focus groups were conducted with 12 African American families. Adolescents, siblings, and caregivers demonstrated awareness of transition and need for disease management responsibility. Siblings' and caregivers' concerns included adolescent medication adherence. Family concerns included leaving the pediatric environment and adult providers' lack of knowledge. Families recommended more transition preparation opportunities. Family members' perspectives are valuable in informing transition planning. Family-focused interventions designed to prepare and support families during transition are necessary.

Parental stress in families of children with a genetic disorder/disability and the resiliency model of family stress, adjustment, and adaptation

BACKGROUND

Research suggests that parents of children with disabilities endure increased amounts of stress but also experience positive outcomes.

PURPOSE

To further investigate findings from focus group interviews that explored parental stress in families of children with disabilities using a sequential mixed methods design.

METHOD

This study sought to model parental stress using the McCubbin and McCubbin (1993) Resiliency Model of Stress, Adjustment, and Adaptation using qualitative and quantitative data collected sequentially. Twenty-five parents of children with autism spectrum disorder, cerebral palsy, Down syndrome, and sickle cell disease participated in a 2-step study that encompassed qualitative followed by quantitative data ascertainment.

RESULTS

Parents who quantitatively experienced high stress or low stress used different behavioral themes to describe their experience qualitatively. Positive appraisals, resources, and ability to engage in problem solving and coping were associated with family resiliency.

The relationships among adaptive behaviors of children with autism, family support, parenting stress, and coping

BACKGROUND

As the number of children diagnosed with autism continues to rise, resources must be available to support parents of children with autism and their families. Parents need help as they assess their unique situations, reach out for help in their communities, and work to decrease their stress levels by using appropriate coping strategies that will benefit their entire family.

METHODS

A descriptive, correlational, cross-sectional study was conducted with 75 parents/primary caregivers of children with autism. Using the McCubbin and Patterson model of family behavior, adaptive behaviors of children with autism, family support networks, parenting stress, and parent coping were measured.

FINDINGS AND CONCLUSIONS

An association between low adaptive functioning in children with autism and increased parenting stress creates a need for additional family support as parents search for different coping strategies to assist the family with ongoing and new challenges. Professionals should have up-to-date knowledge of the supports available to families and refer families to appropriate resources to avoid overwhelming them with unnecessary and inappropriate referrals.

"It's our job": qualitative study of family responses to ableism

Forty-five parents of children with autism, cerebral palsy, Down syndrome, and sickle cell disease participated in 8 focus groups. Parents discussed how they, the child with the disability, and the siblings addressed community perceptions about the child's disability. Themes evolving from the interviews included (a) support and lack of support, (b) inclusion and exclusion, and (c) the family members' roles during their interactions with the community. Parents viewed their roles in the community as (a) advocating, (b) educating, (c) informing, (d) ignoring, and (e) hiding. The relationship between themes is presented, and the relationship between themes and parent empowerment is discussed as well as the ways in which the themes reflect underlying ableism.

Exploring parent-sibling communication in families of children with sickle cell disease

BACKGROUND

Communication within families of children with sickle cell disease is important yet has not been adequately investigated.

METHODS

Focus group interviews were conducted with parents of children with sickle cell disease to explore parent-sibling communication about sickle cell disease.

RESULTS

Communication was influenced by attributes and behaviors of the parent, the child with sickle cell disease, and the sibling; extended family, neighbors, friends, and church members or social networks; and available, accessible resources related to the child's health, child's school, and parent employment. Outcomes that influenced and were influenced by factors within and outside the parent-sibling dyad and nuclear family included parent satisfaction, parent roles, family intactness, and status attainment.

CONCLUSIONS

These findings support previous research with African-American families and expand our views of the importance of educating parents, family members, and others about sickle cell disease. The findings suggest a need to explore sibling perception of this communication, parent and sibling perception of the impact of frequent hospitalizations and clinic visits on the sibling and family, and variations within families of children with sickle cell disease.

The health-related quality of life of custodial grandparents

Health-related quality of life (HRQOL) was explored in a sample of 119 custodial grandparents. A latent profile analysis identified three groups of grandparents along a continuum of good to poor HRQOL, with most custodial grandparents reporting Short Form-12 Health Survey (version 2) scores significantly below U.S. population means. Grandparent and grandchild characteristics that predicted grandparent HRQOL were identified. Grandchild health problems, number of grandchildren in custody, and grandparent education contributed to a moderate reduction in HRQOL. A large reduction in HRQOL was predicted by depression. Differences in depression were reported between groups, with grandparents with poor HRQOL also reporting clinically significant depression, grandparents with fair HRQOL reporting marginally clinically significant depression, and grandparents with good HRQOL reporting no depression. In a qualitative analysis, grandparent conceptualization of what they need to do to maintain and improve their health was explored for each group. Findings from the quantitative analysis indicate variation in grandparent health and mental health status and suggest that services should be tailored to address grandparent needs. The qualitative analysis highlights the importance of religion and spirituality to grandparents, the economic concerns of grandparents, and the need for transdisciplinary services.

Developmental disabilities: effects on well siblings

BACKGROUND

Forty studies performed between 1970 and 1995 indicated that 60% of parents with children with developmental disabilities reported manifestations of increased risk or negative effects on the well siblings.

METHOD

A secondary data analysis was performed using qualitative data gathered during the baseline of a randomized controlled clinical trial of an intervention for siblings/families of children with long-term conditions, including developmental disabilities. Content analysis was used to identify themes from responses of 151 parents to an open-ended question on their perceptions of the effects on well siblings of living at home with a brother/sister with developmental disabilities.

RESULTS

Of 363 themes identified, 61.1% reflected negative manifestations of increased risk in well siblings; 1.7% indicated no risk; and 37.2% reflected positive outcomes, suggesting the continued need for potential interventions.

CONCLUSION

Contemporary family life in these families, as portrayed by parents' descriptions, reflects need in child health care for more intervention research on this vulnerable population.

Family decision making: benefits to persons with developmental disabilities and their family members

Family involvement in planning and choosing services has become a key intervention concept in developmental disability services. This study (N = 547) modeled patterns of family decision making and assessed benefits to persons with developmental disabilities (DDs) and their family members. A latent profile analysis identified 4 classes that were highly involved in decision making (n = 118), involved only in planning (n = 166), involved only in financial decisions (n = 75), and uninvolved (n = 188). Multiple regression analysis indicated that consumers with DD whose family members were highly involved received more services than consumers in other families. A multivariate analysis of covariance indicated that the family members in the highly involved and planning classes experienced more family member satisfaction than others. Findings have implications for practice.

Formative and Summative Evaluation of a Practice Doctorate Program

Practice doctorate programs are developing rapidly to meet the American Association of Colleges of Nursing recommendation that advanced practice nurses will be prepared with a Doctor of Nursing Practice by 2015. Evaluation of nursing doctoral programs has focused almost exclusively on research doctorate programs. The authors examine formative evaluations from students enrolled in a practice doctorate program and summative evaluations provided by students at the time of and 1 year following graduation. Suggestions for nurse educators and administrators are presented.

In-home toxic chemical exposures and children with intellectual and developmental disabilities

Despite the focus on preventing toxic chemical exposures during pregnancy, the perinatal period, and childhood, health professionals have given little attention to the risks and effects of toxic chemical exposures on children with intellectual and developmental disabilities (DD). Children with DD may be at higher risk due to behaviors that persist past a developmentally appropriate age, communication skills, motor skills, nutrition issues, and health problems related to DD. This article examines exposure of children to lead, mercury, and environmental tobacco smoke, three toxicants known to affect children's health and development. The authors identify sources of these toxicants, examine research documenting their effects on children, consider strategies to prevent and manage exposure, identify characteristics and behaviors placing children with DD at increased risk of exposure, and discuss implications for health providers.

A community-based intervention for siblings and parents of children with chronic illness or disability: the ISEE study

OBJECTIVE

Siblings of children with chronic illness or disability have been reported to have a 1.6 to 2.0 risk for behavioral and mental health problems. Our objective was to examine the effects of an intervention for siblings (age 7-15 years) of children with chronic illness or disability.

METHOD

A randomized, three-group repeated-measures design was used: full intervention (n=79), partial intervention (n=71), and a waiting list control group (n=102). Outcomes were sibling knowledge about illness, behavior problems, social support, self-esteem, attitude, and mood measured over four postintervention periods. Covariates were family cohesion, maternal mood, socioeconomic status, and well sibling age. The full intervention included structured teaching and psychosocial sessions at a 5-day residential summer camp. The partial intervention included camp only. Treatment effects were estimated by using generalized estimating equation panel analyses.

RESULTS

The full treatment group showed significant improvements on all six outcomes over most periods, the partial treatment group on three outcomes, and the control group on two outcomes. Improvements in outcomes ranged from 5% to 25% increases over baseline measures.

CONCLUSIONS

A dose-response relationship to intervention was found. Treatment gains were sustained over a period of 12 months.

Interrelationships among variables affecting well siblings and mothers in families of children with a chronic illness or disability

A structural equation model (SEM) examined interrelationships among psychosocial variables known to affect the health and development of well siblings and parents when a child with a chronic illness or disability is a member of the family. Using dyads of 252 well children and parents, socioeconomic status (SES) and family cohesion were associated with the parent-reported behavior of the well sibling. SES also influenced the mood of the mother that in turn influenced family cohesion. The well sibling's knowledge about the illness of the brother or sister, attitude toward the illness, mood, self-esteem, and feelings of social support were interrelated and related to the behavior of the well sibling. The SEM suggests that interventions may be directed at several points in these interactions including boosting knowledge levels of the well sibling, improving family cohesion, and assuring adequate "income" support to the family through income transfers or in-kind services.

Child rearing in the new independent states: a review of the literature

Child rearing in the New Independent States (NIS) is explored through a literature review examining child rearing practices in the former Union of Soviet Socialist Republics and the NIS. As exchanges between the NIS and other countries are underway, this information will help nurses understand issues faced by citizens of the NIS, families immigrating from the NIS, and health care professionals visiting the NIS. This review raises questions about NIS child rearing practices and may serve as a stimulus for further exploration of issues related to the health of children and families living in or emigrating from the NIS.

Guidelines for working with students having special health care needs

Students with special health care needs present challenges to persons involved with their education, but school staff are accepting the challenge to create safe, nurturing, and stimulating environments for these students. This article proposes guidelines for school staff working with students having special health care needs. The guidelines evolved from the authors' experiences and are child-related, family-related, and school-related. Discussion of each guideline includes illustrations of issues arising from them. Considerations for implementing the guidelines are presented and include discussion of school policies and procedures and state laws and regulations related to school staff working with students having special health care needs.

Facilitated transport of 6-mercaptopurine and 6-thioguanine and non-mediated permeation of 8-azaguanine in Novikoff rat hepatoma cells and relationship to intracellular phosphoribosylation

6-Mercaptopurine and 6-thioguanine strongly inhibited the zero-trans entry of hypoxanthine into Novikoff rat hepatoma cells which lacked hypoxanthine/guanine phosphoribosyltransferase, whereas 8-azaguanine had no significant effect. 6-Mercaptopurine was transported by the hypoxanthine carrier with about the same efficiency as its natural substrates (Michaelis-Menten constant = 372 +/- 23 microM; maximum velocity = 30 +/- 0.7 pmol/microl cell H2O per s). 8-Azaguanine entry into the cells, on the other hand, showed no sign of saturability and was not significantly affected by substrates of the hypoxanthine/guanine carrier. The rate of entry of 8-azaguanine at 10-100 microM amounted to only about 5% of that of hypoxanthine transport and was related to its lipid solubility in the same manner as observed for various substances whose permeation through the plasma membrane is believed to be non-mediated. Only the non-ionized form of 8-azaguanine (pKa = 6.6) permeated the cell membrane. Studies with wild type Novikoff cells showed that permeation into the cell was the main rate-determining step in the conversion of extracellular 8-azaguanine to intracellular aza-GTP and its incorporation into nucleic acids. In contrast, 6-mercaptopurine was rapidly transported into cells and phosphoribosylated; the main rate-determining step in its incorporation into nucleic acids was the further conversion of 6-mercaptopurine riboside 5'-monophosphate.

Hexose transport in Novikoff rat hepatoma cells. A simple carrier with directional symmetry, but variable relative mobilities of loaded and empty carrier

The kinetics of transport of the non-metabolizable hexose, 3-O-methyl-D-glucose, have been measured in Novikoff rat hepatoma cells by both zero-trans entry and equilibrium exchange procedures. Transport conformed to a simple carrier model which operates symmetrically with respect to direction, but with greater mobility of the loaded than of the empty carrier. Although a complete kinetic description of the transporter can, in theory, be obtained by application of integrated equations describing the time course of substrate equilibrium across the membrane beginning from the zero-trans situation, statistical analysis of hypothetical data indicated that directional asymmetry or differential mobilities of loaded and empty carrier cannot be discerned reliably from such data alone. The difference in mobility of loaded and empty carrier, apparent in a comparison of zero-trans entry and exchange data, ranged from 1.5--7-fold in different batches of cells. It is concluded that the magnitude of the difference is not an inherent property of the transporter, but is determined physiologically, and may be involved in regulation of hexose transport.

Deoxyglucose and 3-O-methylglucose transport in untreated and ATP-depleted Novikoff rat hepatoma cells. Analysis by a rapid kinetic technique, relationship to phosphorylation and effects of inhibitors

Detailed time courses of uptake of labeled 3-O-methyl-D-glucose and 2-deoxy-D-glycose by untreated and ATP-depleted Novikoff rat hepatoma cells were determined as function of concentration (0.2-10 mM) by a rapid mixing/sampling technique which allows uptake measurements in time intervals as short as 1.5 seconds. Intracellular accumulation of 3-O-methylglucose in untreated and ATP-depleted cells and of deoxyglucose in ATP-depleted cells to equilibrium followed pseudo-first order kinetics and initial velocities were computed from overall time courses of substrate accumulation. Initial velocity was a Michaelis-Menten function of exogenous substrate concentration. The estimated kinetic constants for zero-trans transport of 3-O-methylglucose were about the same for untreated and ATP-depleted cells (Kztm = 1.73 +/- 0.24 mM; Vztmax = 28.8 +/- 3.6 pmoles/microliter cell H2O. sec) and were similar to those for deoxyglucose transport in ATP-depleted cells (Kztm = 0.65 +/- 0.1 mM; Vztmax = 19.6 +/- 1.6 pmoles/microliter cell H2O. sec). Similar kinetic parameters were obtained for the transport of D-glucose and D-galactose in ATP-depleted cells. The transport of 3-O-methylglucose and deoxyglucose were inhibited by each other in a simple competitive manner with apparent Ki's similar to their transport Km's. In untreated cells, in which deoxyglucose was phosphorylated, intracellular steady-state levels of free deoxyglucose accumulated within 10 to 20 seconds of incubation regardless of its concentration in the medium. Thereafter, the rate of deoxyglucose incorporation into total cell material reflected the rate of phosphorylation rather than the transport rate. The rate of deoxyglucose transport exceeded the initial rate of its phosphorylation by 20-40 %. The intracellular steady-state-levels observed during the first 2 minutes of incubation decreased from about 40% of equilibrium level at 0.2 mM deoxyglucose to about 8% at 10 mM. Computer fits of a kinetic equation describing transport and phosphorylation as independent processes operating in tandem to these data are consistent with the observed kinetic constants for hexose transport and hexokinase activity with deoxyglucose as substrate. Upon longer incubation (2-10 minutes) the rate of deoxyglucose uptake by the phosphorylating cells decreased progressively, concomitant with a decrease in intracellular ATP and an increase in intracellular deoxyglucose to equilibrium levels. It is demonstrated that the rate of deoxyglucose uptake, measured at two or more minutes, seriously underestimates the hexose transport rate and yields misleading conclusions regarding the extent and type of inhibition by transport inhibitors, such as persantin or cytochalasin B. Persantin inhibited hexose transport in a simple non-competitive manner (Ki = 20 muM) indicating that the drug affects the function of the hexose carrier.

Mechanism of action of inosine dialdehyde (NSC 118994) in the inhibition of proliferation of tumor cells in culture

Inosine dialdehyde (INOX), the periodate oxidation product of inosine, inhibited the proliferation of various tumor cell lines in suspension culture in a concentration-dependent manner. A concentration of about 1 mM was required to completely inhibit the proliferation of Novikoff rat hepatoma and mouse L-cells, whereas about 0.1 mM completely inhibited the proliferation of L1210 and P388 mouse leukemia and Chinese hamster ovary cells. INOX inhibited in a similar time- and concentration-dependent manner the synthesis of protein, RNA, and DNA, as measured by the incorporation of labeled amino acid, uridine, and thymidine, into acid-insoluble material, without significantly affecting the incorporation of these precursors into the acid-soluble pool. Flow microfluorometric analyses showed that many of the INOX-treated cells became arrested in G2 + M. The results are consistent with the view that INOX affects multiple metabolic steps. The effects of INOX were quite different from those caused by typical inhibitors of ribonucleotide reductase, hydroxyurea, and 2,3-dihydro-1H-pyrazolo(2,3-a)imidazole, which very rapidly inhibited DNA synthesis and caused arrest of the cells in G1, with minimal effects on RNA and protein synthesis.