Detached, distraught or discerning? Fathers of adolescents with chronic illness: a review of the literature.

Abstract Parenting a child with chronic disease provides a unique set of challenges for both mothers and fathers throughout all phases of the illness. However, fathers of these children are under-represented in existing research. This review focuses on the fathers of children with chronic disease included in 44 original articles. We address the challenges to the father's role as breadwinner, leader and strength-giver in the family. Three time-periods describe the obstacles fathers tackle when parenting children with chronic disease: a) diagnosis and short-term, characterized by distress, isolation and uncertainty; b) the mastery period, characterized by the struggle to establish routine and by support and spirituality; and c) the long-term, characterized by relationship and personality change, worries and bereavement. Overall, whilst current research has revealed some key themes pertaining to fathers of children with chronic disease, further studies are required to foster the development of support mechanisms for the specific needs of these fathers.

Mainmise sur l'état social : mobilisation patronale et caisse de compensation en Suisse (1908-1960)

Qui sait qu'en Suisse, les associations patronales mettent en oeuvre l'Etat social ? Qui sait que associations organisent la majorité des caisses de compensation, dont la fonction principale est de collecter les cotisations et de payer les rentes de l'Assurance-vieillesse et survivants ? Qui connaît ces caisses par lesquelles transitent les milliards de l'Etat social ? L'objectif de cette thèse consiste à comprendre les raisons qui ont poussé le patronat helvétique à mettre en oeuvre les politiques de protection sociale, dont il a pourtant toujours essayé de limiter le développement. Résoudre ce paradoxe implique de se pencher sur près d'un siècle d'histoire mêlée du patronat et des politiques sociales. Ce travail retrace, sur la base d'archives privées et publiques souvent inédites, les raisons qui ont poussé les patrons à créer les premières caisses de compensation dans l'entre-deux-guerres, puis à imposer cette forme d'organisation pour l'aide aux soldats mobilisés (autour de 1940) et l'Assurance- vieillesse et survivants (autour de 1948). Il étudie également comment les associations patronales sont parvenues à défendre leurs caisses jusqu'à aujourd'hui, contre ceux qui dénonçaient l'irrationalité de l'existence d'une centaine de caisses de compensation publiques et privées concurrentes pour mettre en oeuvre un seul système d'assurances sociales. Cette recherche amène deux grands résultats. D'une part, elle propose une histoire originale des politiques sociales en Suisse. Le prisme des caisses de compensation patronales contribue en effet à interroger notre compréhension de l'histoire des politiques de protection sociale, dans laquelle on sous-estime parfois l'importance des conflits pour fixer les frontières entre formes de protection publique et privée. D'autre part, ce travail présente une histoire inédite de l'action collective des patrons dans les régulations du travail au sens large. A travers les caisses de compensation, c'est en effet à réaliser une histoire de l'Union centrale des associations patronales suisses que je me suis aussi attelé. Faute de parvenir à empêcher tout développement des politiques sociales, les patrons ont fait en sorte d'acquérir sur ces politiques une forme de mainmise. Entre histoire des politiques sociales et histoire du patronat, ce travail tente d'expliquer comment les caisses de compensation y ont contribué. Who knows that, in Switzerland, employers' associations implement the best known policies constituting the welfare state? Who knows that the equalization funds, (Caisses de compensation / Ausgleichskassen), organized by employers' associations or by the Swiss Cantons, are responsible for pooling payroll deductions and for paying benefits of the Swiss public pay-as-you-go, old-age insurance and many other branches of the welfare policies? Who knows these caisses de compensation that channel the monies dedicated to the financing of the Welfare state ? The main objective of this research is to understand the reasons why Swiss employers do implement such welfare policies that they usually reject for political reasons. In order to solve this puzzle, this research investigates half of a century of the connected histories of welfare policies and employers' collective action. It also investigates, based on public and private archive records, how employers founded the first caisses in the Interwar period, and imposed them to organize the main developments of the Welfare state during the Second World War. The research also underlines how employers defended their caisses de compensation against those questioning the rationality of this fragmented system aiming to implement one single set of public welfare through one hundred competing private and public caisses de compensation. This research highlights two main results. On the one hand, it helps to improve our understanding of the history of the welfare policies in Switzerland. Underlining the role of the caisses de compensation helps to highlight the importance of the interplay of public and private actors regarding social polices. On the other hand, this research charts a pioneering history of Swiss' employers' collective action regarding labor issues. Because they could not prevent all public welfare policy, employers achieved a form of stranglehold (mainmise) on the welfare State. Halfway between social policy and employers' associations' history, this research try to reveal how their caisses de compensation helped them in this objective.

Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms.

PURPOSE: Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood and adolescence. Both neurocognitive and environmental factors have been related to ADHD. The current study contributes to the documentation of the predictive relation between early attachment deprivation and ADHD. METHOD: Data were collected from 641 adopted adolescents (53.2 % girls) aged 11-16 years in five countries, using the DSM oriented scale for ADHD of the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families, Burlington, 2001). The influence of attachment deprivation on ADHD symptoms was initially tested taking into consideration several key variables that have been reported as influencing ADHD at the adoptee level (age, gender, length of time in the adoptive family, parents' educational level and marital status), and at the level of the country of origin and country of adoption (poverty, quality of health services and values). The analyses were computed using the multilevel modeling technique. RESULTS: The results showed that an increase in the level of ADHD symptoms was predicted by the duration of exposure to early attachment deprivation, estimated from the age of adoption, after controlling for the influence of adoptee and country variables. The effect of the age of adoption was also demonstrated to be specific to the level of ADHD symptoms in comparison to both the externalizing and internalizing behavior scales of the CBCL. CONCLUSION: Deprivation of stable and sensitive care in infancy may have long-lasting consequences for children's development.

Mothers' and Fathers' Early Relationship With Their Infant: Similar Yet Temporally Discordant Themes [La relation initiale des parents avec leur nourrisson: Thèmes similaires quoique temporellement discordants]

Objective: To examine first-time mothers' and fathers' themes in their relationship with their infant, how these themes change during the first four months postpartum, and similarities and differences in mothers' and fathers' themes. Participants: Eighteen first-time mother-father couples were separately interviewed at one; six and 16 weeks postpartum. Data Analysis: Audio-taped, transcribed interviews were analysed using a Grounded Theory approach. Results: Our findings reveal a common set of themes for mothers and fathers in relation to the infant : 1: Discovery, 2: Physical Proximity, 3: Emotional Closeness, 4: Initiation of Complementary Interactions and 5: Commitment to Love and Care. However, there was a striking lack of concordance between mothers and fathers for these themes at each point in time. Conclusions: Mothers' and fathers' experience of the early relationship with their infant is unique. Focussing on maternal as well as paternal ways of experiencing the early relationship with their infant sets the way to understanding early developing relationships in the family context.

"A renewed sense of purpose": Mothers' and fathers' experience of having a child following a recent stillbirth.

Background Most research has focused on mothers¿ experiences of perinatal loss itself or on the subsequent pregnancy, whereas little attention has been paid to both parents¿ experiences of having a child following late perinatal loss and the experience of parenting this child. The current study therefore explored mothers¿ and fathers' experiences of becoming a parent to a child born after a recent stillbirth, covering the period of the second pregnancy and up to two years after the birth of the next baby.MethodIn depth interviews were conducted with 7 couples (14 participants). Couples were eligible if they previously had a stillbirth (after 24 weeks of gestation) and subsequently had another child (their first live baby) who was now under the age of 2 years. Couples who had more than one child after experiencing a stillbirth and those who were not fluent in English were excluded. Qualitative analysis of the interview data was conducted using Interpretive Phenomenological Analysis.ResultsFive superordinate themes emerged from the data: Living with uncertainty; Coping with uncertainty; Relationship with the next child; The continuing grief process; Identity as a parent. Overall, fathers' experiences were similar to those of mothers', including high levels of anxiety and guilt during the subsequent pregnancy and after the child was born. Coping strategies to address these were identified. Differences between mothers and fathers regarding the grief process during the subsequent pregnancy and after their second child was born were identified. Despite difficulties with bonding during pregnancy and at the time when the baby was born, parents' perceptions of their relationship with their subsequent child were positive.ConclusionsFindings highlight the importance of tailoring support systems not only according to mothers' but also to fathers' needs. Parents¿, and particularly fathers', reported lack of opportunities for grieving as well as the high level of anxiety of both parents about their baby's wellbeing during pregnancy and after birth implies a need for structured support. Difficulties experienced in bonding with the subsequent child during pregnancy and once the child is born need to be normalised.

From controlling to letting go : what are the psychosocial needs of parents of adolescents with a chronic illness?

While one of the main objectives of adolescence is to achieve autonomy, for the specific population of adolescents with a chronic illness (CI), the struggle for autonomy is accentuated by the limits implied by their illness. However, little is known concerning the way their parents manage and cope with their children's autonomy acquisition. Our aim was to identify the needs and preoccupations of parents of adolescents with CI in coping with their children's autonomy acquisition and to determine whether mothers and fathers coped differently. Using a qualitative approach, 30 parents of adolescents with CI participated in five focus groups. Recruitment took place in five specialized pediatric clinics from our university hospital. Thematic analysis was conducted. Transcript analyses suggested four major categories of preoccupations, those regarding autonomy acquisition, giving or taking on autonomy, shared management of treatment and child's future. Some aspects implied differences between mothers' and fathers' viewpoints and ways of experiencing this period of life. Letting go can be hard for the father, mother, adolescent or all three. Helping one or the other can in turn improve family functioning as a whole. Reported findings may help health professionals better assist parents in managing their child's acquisition of autonomy.

Fathers of girls, fathers of boys: influence of child's gender on fathers' experience of, engagement in, and representations of paternity.

The aim of this study was to examine the influence of child's gender on several dimensions-of paternity: the fathers' personal experience of paternity, their involvement in child rearing, and their representations. A total of 147 Swiss fathers of 18-month-old children (65 girls and 82 boys) relationship to the child or relationship with the child's completed questionnaires. The child's gender had little influence on paternal experience, mother. Globally, the fathers took on few responsibilities which were largely devolved to mothers. Fathers of boys were more involved in child care than fathers of girls. Finally, a discrepancy was found between the fathers representations of paternal roles in rearing girls and boys and the actual level of responsibility that fathers adopted in their relationship with their child.

Research priorities for nursing care of infants, children and adolescents: a West Australian Delphi study.

This paper describes a study that aimed to identify research priorities for the care of infants, children and adolescents at the sole tertiary referral hospital for children in Western Australia. The secondary aim was to stimulate nurses to explore clinical problems that would require further inquiry. Background. Planning for research is an essential stage of research development; involving clinicians in this exercise is likely to foster research partnerships that are pertinent to clinical practice. Nursing research priorities for the paediatric population have not previously been reported in Australia. Design. Delphi study. Method. Over 12 months in 2005-2006, a three-round questionnaire, using the Delphi technique, was sent to a randomly selected sample of registered nurses. This method was used to identify and prioritise nursing research topics relevant to the patient and the family. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data. Results. In Round I, 280 statements were identified and reduced to 37 research priorities. Analysis of data in subsequent rounds identified the top two priority research areas as (1) identification of strategies to reduce medication incidents (Mean = 6 center dot 47; SD 0 center dot 88) and (2) improvement in pain assessment and management (Mean = 6; SD 1 center dot 38). Additional comments indicated few nurses access the scientific literature or use research findings because of a lack of time or electronic access. Conclusions. Thirty-seven research priorities were identified. The identification of research priorities by nurses provided research direction for the health service and potentially other similar health institutions for children and adolescents in Australia and internationally. Relevance to clinical practice. The nurse participants showed concern about the safety of care and the well-being of children and their families. This study also enabled the identification of potential collaborative research and development of pain management improvement initiatives.

Mothers' and fathers' views of the interdependence of their relationships with their infant: a systems perspective on early family relationships.

This study examined the interrelatedness of mother-infant and father-infant relationships as they develop over the first 4 months postpartum as well as the dynamics used by the couple to balance these relationships. First-time mother-father couples (n = 18) were interviewed separately at 1, 6, and 16 weeks postpartum using the Parent-Infant Relationship Interview. The data were analyzed using in-depth qualitative strategies. The parents' core themes of their early family relationships ranged from an undifferentiated unit at 1 week, to being a highly disorganized unit at 6 weeks, to a more integrated unit at 16 weeks. These results suggest that one should be thinking of early family relationships and parenting in terms of "messy processes" out of which new ways of being together are created. This disorganization plays a fundamental role in the establishment of early family relationships and warrants further empirical and clinical attention.

Parents' alcohol use: gender differences in the impact of household and family chores.

BACKGROUND: Social roles influence alcohol use. Nevertheless, little is known about how specific aspects of a given role, here parenthood, may influence alcohol use. The research questions for this study were the following: (i) are family-related indicators (FRI) linked to the alcohol use of mothers and fathers? and (ii) does the level of employment, i.e. full-time, part-time employment or unemployment, moderate the relationship between FRI and parental alcohol use? METHODS: Survey data of 3217 parents aged 25-50 living in Switzerland. Mean comparisons and multiple regression models of annual frequency of drinking and risky single occasion drinking, quantity per day on FRI (age of the youngest child, number of children in the household, majority of child-care/household duties). RESULTS: Protective relationships between FRI and alcohol use were observed among mothers. In contrast, among fathers, detrimental associations between FRI and alcohol use were observed. Whereas maternal responsibilities in general had a protective effect on alcohol use, the number of children had a detrimental impact on the quantity of alcohol consumed per day when mothers were in paid employment. Among fathers, the correlations between age of the youngest child, number of children and frequency of drinking was moderated by the level of paid employment. CONCLUSION: The study showed that in Switzerland, a systematic negative relationship was more often found between FRI and women's drinking than men's. Evidence was found that maternal responsibilities per se may protect from alcohol use but can turn into a detrimental triangle if mothers are additionally in paid employment.

Shorter time since inflammatory bowel disease diagnosis in children is associated with lower mental health in parents.

AIM: This study assessed the mental health of parents of children with inflammatory bowel disease (IBD), compared their mental health with age-matched and gender-matched references and examined parental and child predictors for mental health problems. METHODS: A total of 125 mothers and 106 fathers of 125 children with active and inactive IBD from the Swiss IBD multicentre cohort study were included. Parental mental health was assessed by the Symptom Checklist 27 and child behaviour problems by the Strengths and Difficulties Questionnaire. Child medical data were extracted from hospital records. RESULTS: While the mothers reported lower mental health, the fathers' mental health was similar, or even better, than in age-matched and gender-matched community controls. In both parents, shorter time since the child's diagnosis was associated with poorer mental health. In addition, the presence of their own IBD diagnosis and child behaviour problems predicted maternal mental health problems. CONCLUSIONS: Parents of children with IBD may need professional support when their child is diagnosed, to mitigate distress. This, in turn, may help the child to adjust better to IBD. Particular attention should be paid to mothers who have their own IBD diagnosis and whose children display behaviour problems.