Filial therapy with parents of chronically ill children.

This study was designed to determine the effectiveness of a 10-wk filial therapy training model as a method of intervention for parents of chronically ill children. 23 parents, with children between the ages of 3 to 10 yrs, were included in the study. Results of the analysis of covariance revealed that parents in the experimental group significantly increased their attitude of acceptance toward their children and significantly reduced their level of stress as compared to parents in the control group. Children in the experimental group scored significantly lower than did children in the control group on total behavioral problems and anxiety and depression. This study supports filial therapy as an effective intervention for parents of chronically ill children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotionally focused marital intervention for couples with chronically ill children.

Couples with chronically ill children are at risk for experiencing marital distress. The present study was a randomized control trial that assessed the efficacy of emotionally focused therapy (EFT) in decreasing marital distress in this population of couples. Thirty-two couples with chronically ill children seen at a tertiary care pediatric hospital were randomly assigned to EFT or to a waitlist control group. EFT couples demonstrated significant decreases in marital distress at posttreatment and at a 5-month follow-up in comparison to controls. Clinical improvements in marital functioning following EFT were also demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotionally focused therapy improves marital adjustment in parents of children with chronically ill children

The hemodynamic consequences of a pneumoperitoneum are well understood, but there have been no studies investigating its impact on splanchnic mucosal perfusion. By use of nasogastric tonometry, this study demonstrates that fit patients undergoing elective laparoscopic cholecystectomy at normal pneumoperitoneum pressures (12-15 mm Hg) develop significant splanchnic mucosal ischemia. This is a particular concern in patients with preexistent peripheral vascular disease undergoing prolonged laparoscopic procedures.     

The experiences of discrimination: challenges for chronically ill children

The purpose of this study was to examine mothers' perceptions of discrimination experienced by chronically ill school-age children. Discrimination was seen to originate within the school system, peer group, and community and governing institutions. Several demographic and child factors were found to significantly predict mothers' perceptions of discrimination. Nursing implications addressing discrimination for chronically ill children and families are addressed.     

The efficacy of intensive individual play therapy for chronically ill children.

Examined the effectiveness of play therapy for children (aged 7-11 yrs) diagnosed with insulin-dependent diabetes mellitus (IDDM). Specifically, the intent of the study was to determine the effectiveness of an intensive play therapy intervention in (a) reducing symptoms of anxiety in children with IDDM, (b) reducing the overall behavior difficulties in children with IDDM, (c) increasing healthy adjustment in children with IDDM, (d) increasing diabetic's children's adherence to their diabetic regime, and (e) having an impact on these emotional and behavioral symptoms over time. The experimental group comprised 9 boys and 6 girls. Analysis of covariance revealed that the children in the experimental group significantly improved their adaptation to their diabetes following intensive play therapy. Results indicate that intensive play therapy may be an effective intervention for children diagnosed with IDDM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Families of chronically ill children: A systems and social-ecological model of adaptation and challenge.

A family systems model is presented for understanding adaptation and coping in childhood chronic illness. The importance of a systems perspective in work with children and families who may not display psychopathology is stressed. A general overview of systems and social-ecological theories relevant to children with chronic illnesses and their families is presented. Literature on stress and coping in these families is reviewed, then some of the unique issues that merit consideration in this area of research and intervention are examined. Finally, the importance of these models for responding to the growing number of families with children with AIDS is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of parental and extrafamilial social support in the psychosocial adjustment of children with a chronically ill father

The relationships among illness stress, perceived support, and child psychosocial adjustment were examined for children living with a chronically ill father. Participants included fathers, mothers, and one child from 53 families in which the father had hemophilia and, in some cases, was HIV seropositive. Objective indicators of severity of illness and subjective measures of the physical and psychological impact of illness were used as sources of children's stress. Results indicated that the impact of illness, but not the severity of illness itself, related to child psychosocial adjustment. Main effects were observed for parental support on child- and parent-reported internalizing problems and stress-buffering effects were obtained for parental support and extrafamilial support on parent-reported internalizing problems. Parental support also demonstrated a stress-buffering effect for child-reported depression. Assessment and intervention implications for behavioral clinicians and researchers are discussed.     

Factors associated with the adaptation of parents with a chronically ill child

Improvement and standardization of the conservative therapy of inflammatory bowel disease has lead to a better prognosis for the patients. During the acute flare of Crohn's disease steroids are still the standard therapy, whereas 5-aminosalicylic acid (5-ASA) preparations are used for maintenance therapy during remission. In contrast ulcerative colitis may be treated with 5-ASA also for acute exacerbations. The development of new drugs as for example the topical steroids helps to improve life quality of the patients by reducing adverse side effects. Potent immunosuppressants as azathioprine and methotrexate are useful in chronic active and refractory disease. Cyclosporin A plays a role in severe steroid refractory colitis. In the future immunomodulation by application of antiinflammatory cytokines or antibodies to inflammatory cytokines may have its place in the treatment of IBD patients. In some cases, however, the conservative therapy reaches its limits. Mistakes in the therapy are made, when these limits are not recognized and complications are not discovered in time.     

The primary physician and the family with a handicapped or chronically ill child

BACKGROUND: Multiple evanescent white dot syndrome (MEWDS) is a benign acquired isolated chorioretinal disorder. Symptoms include photopsia, visual blur and scotomas. Ocular examination reveals multiple white dots at the level of the deep retina. A parainfectious disorder was suggested but the exact mechanism of MEWDS is still unknown. Postulating that MEWDS might be an antigen driven inflammatory reaction, we analyzed HLA subtypes in patients with MEWDS. PATIENTS AND METHODS: Sixteen patients were diagnosed with MEWDS in Lausanne from 1985 to 1994. Blood was withdrawn in 9/16 patients. HLA-A, -B and -DR were sought. RESULTS: HLA-B51 was detected in 4/9 patients (44.4%). Other HLA subtypes were detected sporadically. CONCLUSIONS: The frequency of HLA-B51 haplotype was found to be 3.7 times more elevated than in a normal control caucasian group. This suggests the possibility that MEWDS might be a genetically determined disorder as it is the case for other ocular diseases like Birdshot chorioretinopathy (HLA-A29), Harada's disease (HLA-DRMT3), acute anterior uveitis (HLA-B27) or Beh?et's disease (HLA-B51). We have no explanation for the presence of HLA-B51 in both Beh?et's disease and MEWDS. The association of HLA-B51 and MEWDS needs confirmation by further testing.     

The chronically ill child in the school.

Focuses on the school attendance and performance problems encountered by chronically ill children (CIC), from the point of their re-entry after diagnosis or treatment. CIC exhibit school related problems, reflected in psychological well being, interaction with peers, academic performance, and higher absenteeism. Inability to attend school may lead to decreased self esteem and hopelessness about the future. Specific aspects of the illness or its treatment, the child's emotional response to the illness, prolonged absence, and learning problems may influence school functioning. Attitudes of parents, teachers, other school personnel and the health care team, and inability of the school to provide necessary daily health care services seriously affect successful school re-entry. School psychologists play an important role in maximizing CIC's success in school, as they prospectively monitor their educational functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward life and death in suicidal, normal, and chronically ill children: An extended replication.

Evaluated the attitudes toward life and death held by 23 6–12 yr old suicidal children, 28 6–22 yr old chronically ill children, and 33 6–22 yr old normal children by examining 4 attitudes toward life and death: attraction to life, repulsion by life, attraction to death, and repulsion by death. The measurement of the intensities of these attitudes was obtained by means of the Ss' quantitative responses to questions that followed fairy tale stories. Each of the stories represented 1 of the 4 attitudes. Parallel forms of the test were administered in a time interval of 6 wks. ANOVA showed that the 4 attitudes were distinguishable from each other. The response profiles of suicidal Ss showed significantly lower repulsion by death than those of normal Ss. Chronically ill Ss presented the highest degree of repulsion by life and scored higher than normal Ss on attraction to death. On repulsion by death, they scored higher than suicidal Ss but lower than normal children. All Ss scored well on attraction to life. Findings document the construct validity of the theoretical model. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bone hyperresorption is prevalent in chronically critically ill patients

STUDY OBJECTIVE: Chronically critically ill (CCI) patients are primarily elderly people who have survived a life-threatening episode of sepsis but remain profoundly debilitated and ventilator dependent. The objective of this study was to determine the prevalence of bone hyperresorption and parathyroid hormone (PTH)-vitamin D axis abnormalities in these patients. DESIGN: Prevalence survey. SETTING: Respiratory care step-down unit (RCU) at a tertiary care teaching hospital. PATIENTS: Forty-nine ventilator-dependent CCI patients transferred from ICUs within the same institution. INTERVENTION: None. MEASUREMENTS AND RESULTS: N-telopeptide (NTx) levels in 24-h urine collections and serum intact PTH, 25-vitamin D, and 1,25-vitamin D levels were measured within 48 h of RCU admission. Patients were hospitalized a median of 30 days before RCU admission. Four patients (9%) had normal NTx and PTH levels. Forty-five patients (92%) had elevated urine NTx levels consistent with bone hyperresorption. Nineteen patients (42% of total patients) had elevated PTH levels consistent with predominant vitamin D deficiency, 4 patients (9%) had suppressed PTH levels consistent with predominant hyperresorption from immobilization, and 22 patients (49%) had normal PTH levels consistent with an overlap of both vitamin D deficiency and immobilization. There were no differences in vitamin D metabolites among these groups. CONCLUSIONS: CCI patients have a high prevalence of bone hyperresorption in which PTH levels may clarify the cause. Further studies will determine the efficacy and cost-effectiveness of routine NTx and PTH screening in these patients and the role of vitamin D and antiresorptive therapies.     

Personal values and goal orientations of chronically ill adolescents and young adults

For all those involved in the care of the chronically ill, to provide support in a professional manner implies to strive for a comprehensive understanding of the specific coping strategies in the light of the individual person's priorities. Coping research has yet to present a systematic analysis of personal values, goals and expectations of the chronically ill. The reader is invited to approach the topic by a review of the relevant literature and presentation of our own study on the classification of individual values and goals in 164 chronically ill adolescents and young adults (cystic fibrosis, Crohn's disease, haemophilia). Regarding personal values, the responses by the young patients were allocated to three main categories: pursuit of social contacts, striving for acceptance of the disease, the striving for joyful and intense living. Finally the relevance of personal values for appropriately coping with a serious illness is discussed.     

The relationship of the changing structure of families and the health of children

The changing family structure impacts on the physical and mental health, emotional state and academic performance of children. Children reared in other than a family with both biological parents have increased difficulties. Pediatric dentists will need to consider these realities in their treatment of an increasing diverse population of children.     

Issues of special concern to chronically mentally ill women.

Discusses sex differences with respect to the treatment of chronically mentally ill women and suggests that attention to these areas will aid understanding of their disorders and enhance the quality of their existence. The lives of chronically mentally ill women in relation to marital and family roles, other instrumental roles, social and sexual roles, rape and sexual exploitation, and physical health are described. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)