A qualitative study of the emotional coping and support needs of children living with a parent with a brain injury

Primary objective: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children. Design: The study was qualitative, using a thematic analysis approach. Methods and procedure: Six children between 9 and 18 years of age, six parents (three with ABI), and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide. Results: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs. Conclusions: The results reveal an interaction between the child’s experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child, and the children’s need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

Parents’ experiences during the transition from childhood to adolescence with Type 1 Diabetes: Parent-child relationships and support received during this time and clinical research portfolio

Background: Type 1 Diabetes (T1D) management often worsens as children become adolescents. This can be a difficult time for parents as they hand over responsibility of diabetes management to their adolescent. Objectives: To look at the experiences of parents with a child with T1D as they move to adolescence and take more responsibility for their diabetes management. To find out about parents’ experience of support during this transition. Subjects: Three parents of adolescents with T1D. Participants were recruited from the NHS Highland Paediatric Diabetes Service. Methods: Participants took part in a one-to-one semi-structured interview with a researcher. Interpretative Phenomenological Analysis was used to analyse the interviews and find common themes across the interviews. Results: Participants experienced worry throughout their child’s transition to adolescence. They found it difficult to let their child take responsibility for their diabetes but acknowledged that their involvement caused tensions with their adolescent. Participants’ experience was that there were a number of practical adjustments to be made with a diagnosis of T1D and educating the network around their child was important. The participants reported that the diagnosis of T1D had an impact on the whole family and not just the child with the diagnosis. The parents felt well supported medically but said that the amount of time before their first clinic appointment felt too long. All participants had concerns about their adolescent moving to the adult diabetic service. Conclusions: Participants experienced worry relating to aspects of their adolescents T1D that they could not control, but were aware of the tensions caused by trying to keep elements of control. Areas of future research were identified.

Parent sensitive support by paediatric nurses

Introduction The hospitalization of a child causes big changes in child and his family life. Parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectives: To define what family-centered care is, the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs and to identify the differences between parental support given by nurses in Belgium and Portugal. Methods and procedures The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion criteria. Second part is a focus group. The participants were pediatric nurses from Portugal and Belgium. Results family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. Conclusion Nurses should collect information which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children and take care of themselves. Nurses must create an environment where parents feel safe and have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Parent sensitive support by paediatric nurses

Introduction The hospitalization of a child causes big changes in child and his family life. Parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectives: To define what family-centered care is, the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs and to identify the differences between parental support given by nurses in Belgium and Portugal. Methods and procedures The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion criteria. Second part is a focus group. The participants were pediatric nurses from Portugal and Belgium. Results family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. Conclusion Nurses should collect information which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children and take care of themselves. Nurses must create an environment where parents feel safe and have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Parent training skills and methadone maintenance: clinical opportunities and challenges

Children raised in substance abusing families show high rates of behavioural and emotional problems, in particular oppositional, defiant and non-compliant behaviours. While a range of social and individual factors correlate with poor parenting, it is often the quality of the parent-child relationship that mediates the effects of most other risk factors on child development. By addressing this relationship using behavioural family interventions, child behaviour problems have been reduced in multiple problem families. However, there has been little attempt to systematically evaluate such programs in substance abusing families. It is argued that methadone replacement programs provide a window of opportunity to deliver well-validated parent training programs that enhance the quality of parent-child relations. However, it is likely that such programs would need to be medium to long term and address issues beyond parent child relationships. How such interventions may be delivered and evaluated is discussed. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

Bioactivity of phenolic acids: Metabolites versus parent compounds: A review

Phenolic acids are present in our diet in different foods. In particular, mushrooms are a good source of these molecules. Due to their bioactive properties, phenolic acids are extensively studied and there is evidence of their role in disease prevention. Nevertheless, in vivo, these compounds are metabolized and circulate in the organism as glucuronated, sulfated and methylated metabolites, displaying higher or lower bioactivity. To clarify the importance of the metabolism of phenolic acids, the knowledge about the bioactivity of the metabolites is extremely important. In this review, chemical features, biosynthesis and bioavailability of phenolic acids are discussed as well as the chemical and enzymatic synthesis of their metabolites. Finally, the metabolites bioactive properties are compared with that of the corresponding parental compounds.

The contribution of phenolic acids to the anti-inflammatory activity of mushrooms: Screening in phenolic extracts, individual parent molecules and synthesized glucuronated and methylated derivatives

In the present study, the ethanolic extracts of fourteen edible mushrooms were investigated for their anti-inflammatory potential in LPS (lipopolysaccharide) activated RAW 264.7 macrophages. Furthermore the extracts were chemically characterized in terms of phenolic acids and related compounds. The identified molecules (p-hydroxybenzoic, p-coumaric and cinnamic acids) and their glucuronated and methylated derivatives obtained by chemical synthesis were also evaluated for the same bioactivity, in order to establish structure-activity relationships and to comprehend the effects of in vivo metabolism reactions in the activity of the compounds. The extracts of Pleurotus ostreatus, Macrolepiota procera, Boletus impolitus and Agaricus bisporus revealed the strongest anti-inflammatory potential (EC50 values 96 ± 1 to 190 ± 6 µg/mL, and also the highest concentration of cinnamic acid (656 to 156 µg/g), which was also the individual compound with the highest anti-inflammatory activity. The derivatives of p-coumaric acid revealed the strongest properties, specially the derivative methylated in the carboxylic group (CoA-M1) that exhibited similar activity to the one showed by dexamethaxone used as anti-inflammatory standard; by contrast, the derivatives of p-hydroxybenzoic revealed the lowest inhibition of NO production. All in all, whereas the conjugation reactions change the chemical structure of phenolic acids and may increase or decrease their activity, the glucuronated and methylated derivatives of the studied compounds are still displaying anti-inflammatory activity.

Socio-demographic predictors of high support needs in newly diagnosed breast cancer patients.

GRIESSER A.-C., VLASTOS G., MOREL L., BEAUME C., SAPPINO A.-P. & HALLER G. (2010) European Journal of Cancer Care Socio-demographic predictors of high support needs in newly diagnosed breast cancer patients This study aimed to identify high support needs and their socio-demographic predictors to improve supportive care for newly diagnosed breast cancer patients. A cross-sectional study measured patients' needs and unsatisfied support needs by the supportive care needs survey (SCNS-34), administered after surgery, chemotherapy or radiotherapy. Socio-demographic, disease and treatment characteristics completed data collection. A total of 308 questionnaires were completed with a response rate of 88%. The most frequent support needs (73.3% of patients) related to information and the highest unsatisfied support needs to the management of emotions and daily life (36.3-39.6% of patients). Younger age predicted high and dissatisfied support needs (P < 0.05). Patients born outside Switzerland or with a lower level of education had more needs in daily living and psychological domains (P < 0.05). Being born outside Switzerland also predicted dissatisfaction with information provided. Being parent was a predictor of significant needs in the daily living domain after adjusting for disease and treatment characteristics (P= 0.01). Therefore, information, psychological and daily living support for newly diagnosed breast cancer patients should be strongly reinforced, particularly in patients being born outside Switzerland, those with children or being younger. For the latter, support in sexuality domain should also be emphasised.

Parent-child agreement and prevalence estimates of diagnoses in childhood: direct interview versus family history method.

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention-deficit and disruptive behavioural disorders]; (2) assess mother-child, father-child and inter-parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother-offspring, 189 father-offspring and 128 mother-father pairs. Diagnostic assessment included the Kiddie-schedule for Affective Disorders and Schizophrenia (K-SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow-up) interviews. Parental reports were collected using the Family History - Research Diagnostic Criteria (FH-RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K-SADS; (2) mother-child and father-child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub-sample followed-up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow-up data also supports the validity of information provided by adolescent offspring.

Experimental support for the make-up hypothesis in nestling tawny owls (Strix aluco)

Body condition can affect coloration of traits used in sexual selection and parent-offspring communication by inducing rapid internal changes in pigment concentration or aggregation, thickness of collagen arrays, or blood flux. The recent "makeup hypothesis" proposes an alternative honesty-reinforcing mechanism, with behaviorally mediated deposition of substances on body surfaces ("cosmetics") generating covariation between body condition and coloration. In birds, the uropygial gland wax is actively spread on feathers using the bill and changes in its deposition rate may cause rapid changes in bill and plumage coloration. Using tawny owl nestlings, we tested 3 predictions of the makeup hypothesis, namely that 1) quantity of preen wax deposited accounts for variation in bill coloration, 2) an immune stimulation (induced by injection of a lipopolysaccharide [LPS]) impairs uropygial gland wax production, and 3) different intensities of immune stimulations (strong vs. weak stimulations induced by injections of either LPS or phytohemagglutinin [PHA], respectively) and high versus low food availabilities result in different bill colorations. We found that 1) preen wax reduced bill brightness, 2) a challenge with LPS impaired uropygial gland development, and 3) nestlings challenged with LPS had a brighter bill than PHA-injected nestlings, whereas diet manipulation had no significant effect. Altogether, these results suggest that a strong immune challenge may decrease preen wax deposition rate on the bill of nestling birds, at least by impairing gland wax production, which causes a change in bill coloration. Our study therefore highlights that cosmetic colors might signal short-term variation in immunological status.

Assessing technology-based spin-offs from university support units

This paper takes a regional studies approach to assess spin-offs from a university-based technology transfer network. We first detect the regional objectives, inputs and outputs needed to assess spin-offs from support programmes. We then provide evidence on regional mechanisms for firm creation. We analyse spin-offs created at Catalan universities and find that many efficient spin-offs have formal technology transfer agreements, and emerge from technology-oriented universities. We also find that higher innovation levels and experience from the parent university are associated with higher efficiency, which is positively related to future fundamental profitability. Finally, we propose regional policy making and research directions.

Effects of a preschool parent enrichment programme on children and their parents /

This study evaluated a preschool parent enrichment programme to assess if child and parent involvement in the programme facilitated the children's subsequent school adjustment. Also examined were the programme's effects on parent-child relationships. Participants were 56 Junior-Senior Kindergarten and Grade One students from one elementary school. Parent participants were 12 parents from the preschool parent enrichment programme, 6 parents whose children had attended other preschool programmes, and 6 parents whose children had remained at home prior to school. Five elementary teachers and both nursery school teachers from the parent enrichment programme also participated. Measures used included the Florida Key to assess children's inferred self-concept as learner and four subscales (relating, asserting, coping and investing), and interviews to assess parent and teacher perceptions. Findings indicated that there was little difference between parent and teacher perceptions about children who had attended a preschool programme. Both groups showed improved social, emotional, and behavioural skill development, together with increased self-esteem, and the ability to cope with separation from their parents. This enabled children to make the transition from preschool to primary school more successful. Children from the parent enrichment programme were not readily identifiable in terms of the profile promulgated for disadvantaged children. The Florida Key showed a main effect for the coping subscale, indicating that children from the parent enrichment programme may show more confidence in their abilities, and seek assistance from teachers than children who had no preschool experience. The parent enrichment programme appeared to have the biggest impact on the parents. Parents reported improved relationships with their children, increased confidence and self-esteem, as well as improved parenting and general life skills. The implications for short-term gains for children from this type of programme are better readiness for school, more positive self-esteem, improved social behaviour, and a higher achievement motivation. The long-term gains for children are predicted to be fewer special education placements, less grade retention, and a lower dropout rate from school. The short-term gains for parents are better social support networks," greater self-confidence, better interactions with children, and improved parenting skills. The long-term benefits may be an increased motivation to continue education, gain employment, and less family breakdown and abuse.

La transformation du rôle de représentante d’aidantes familiales pendant l’hébergement de leur parent atteint de démence : une théorisation ancrée

RÉSUMÉ L‘hébergement en centre de soins de longue durée d'un parent âgé atteint de démence marque une transition pour les personnes qui occupent un rôle d’aidant familial principal. Ces personnes, principalement des femmes, poursuivent leur engagement après l’hébergement et souhaitent être impliquées dans les décisions concernant les soins offerts à leur parent. Souvent l'hébergement survient au moment où la personne âgée n'est plus en mesure, compte tenu de ses déficiences cognitives, d'exprimer clairement ses besoins; les aidantes accordent alors une place centrale au rôle de représentante de leur proche hébergé. Cette étude avait pour but d’expliquer la transformation du rôle de représentante chez des aidantes familiales dont le parent atteint de démence vit dans un centre d’hébergement et de soins de longue durée (CHSLD). La méthode qualitative de la théorisation ancrée a été retenue pour expliquer ce processus social. Les résultats obtenus reposent sur 14 entrevues en profondeur réalisées auprès de filles dont le parent atteint de démence était hébergé depuis plus de six mois dans un CHSLD. Ces aidantes ont été sélectionnées selon une procédure d’échantillonnage théorique et l’analyse des données a été réalisée à partir de la transcription intégrale des entrevues en suivant trois niveaux d'analyse, soit la codification ouverte, axiale et sélective. Une proposition théorique, générée par voie inductive, met en lumière trois processus intermédiaires interreliés expliquant la transformation du rôle de représentante pendant l’hébergement du proche : 1) l’intégration dans le milieu ; 2) l’évaluation de la qualité des soins et 3) le développement de la confiance envers le milieu d’hébergement. Plus précisément, les aidantes déploient différentes stratégies d’intégration dans le milieu d’hébergement, soit l’établissement de relations de réciprocité et d’une collaboration avec le personnel soignant, ainsi que l’utilisation d’un style de communication diplomatique. Parallèlement, elles évaluent la qualité des soins en trois étapes : jugement, pondération et action. Finalement, une relation de confiance avec les membres du personnel de l’établissement se développe en lien avec cinq facteurs spécifiques, soit les premières impressions, la comparaison avec d’autres CHSLD, l’intérêt démontré par le personnel envers le proche, le fait d’être entendue et prise au sérieux et la transparence du milieu d’hébergement. Ces trois processus contribuent au bien-être du parent hébergé et à celui de l’aidante. Le développement de la confiance étant associé aux deux autres processus intermédiaires ainsi qu’au bien-être de l’aidante, il est le processus central de la théorie contextuelle qui émerge de cette recherche. Cette étude contribue au développement des connaissances, notamment en fournissant plusieurs éléments inédits de compréhension du processus de transformation du rôle de représentante des aidantes familiales, de même que des pistes pour soutenir ces aidantes dont le parent, souffrant de démence, n’est plus en mesure de prendre des décisions. La théorie contextuelle proposée dans le cadre de cette étude constitue les prémices d’une théorie de niveau intermédiaire portant sur le rôle de représentant des aidants familiaux dans le contexte plus général du système de santé. Des études réalisées dans d’autres contextes de soins et auprès d’aidants de proches vulnérables ayant d’autres types d’affections sont ainsi recommandées.

Analyse du lien séquentiel entre les comportements d'anxiété et d'évitement lors d'interactions parent-enfant

Les troubles anxieux figurent parmi les psychopathologies les plus fréquentes chez les enfants. Ils peuvent avoir de graves répercussions sur leur développement et, à long terme, ils tendent à persister ainsi qu’à s’aggraver. L’évitement est un moyen souvent utilisé par les personnes anxieuses, adultes ou enfants, afin de tenter d’échapper à l'objet de leur peur et ainsi faire diminuer leur niveau d’anxiété. Les schémas cognitifs dysfonctionnels reliés à l’anxiété, et à l’origine de l’évitement, se développent tôt chez l’enfant et sont en partie reliés aux interactions parent-enfant. La présente recherche vise à examiner, à l’aide d’une analyse séquentielle des interactions, la dépendance entre les comportements d’anxiété et d’évitement chez les membres de 20 dyades parent-enfant, dont les enfants sont âgés entre 4 et 7 ans. La tâche d’interaction, une histoire à compléter par les membres de la dyade, a la capacité de susciter des émotions anxieuses chez les participants. Les résultats de cette étude ne permettent pas de démontrer une dépendance entre les comportements d’anxiété et d’évitement des parents et ceux des enfants. La discussion présente des éléments de réflexion sur des pistes de recherche à explorer.

Facteurs associés à la résilience des aidantes familiales d’un parent âgé en perte d’autonomie à domicile au Liban

Avec l’avancement en âge, les personnes âgées qui vivent à domicile ont besoin du soutien des membres de leur entourage, notamment d’un aidant familial dont le rôle n’est toutefois pas sans conséquence sur sa santé. Les écrits empiriques ont montré que certains aidants sont résilients, c’est-à-dire qu’ils s’adaptent à leur situation et continuent leur développement. Toutefois, aucune étude n’a été effectuée au Liban auprès des aidantes familiales pour expliquer la résilience dans ce contexte et, plus spécifiquement, pour déterminer les facteurs qui pourraient l’influencer. Cette étude à devis corrélationnel de prédiction avait pour but de vérifier certaines des relations postulées par un modèle empirique découlant des écrits, soit la contribution de facteurs personnels (stratégies de coping et auto-efficacité) et de facteurs contextuels (relations familiales, perception du soutien de l’entourage, et sens accordé au « prendre soin »),à la résilience des aidantes familiales libanaises qui prennent soin d’un proche âgé à domicile. L’étude a été effectuée au Liban auprès d’un échantillon de convenance composé de 140 aidantes familiales principales cohabitant à domicile avec un parent âgé de 65 ans et plus ayant une perte d’autonomie fonctionnelle ou cognitive. La collecte des données a été réalisée en arabe en utilisant un guide d’entrevue standardisé regroupant des instruments nord-américains traduits selon la méthode de traduction inversée parallèle, de même qu’une question ouverte portant sur la perception des aidantes de la résilience, soit des facteurs qui les aident à continuer à prendre soin de leur proche âgé tout en continuant à se développer. Une analyse de régression hiérarchique a permis de vérifier la contribution unique des facteurs personnels et contextuels à expliquer la résilience des aidantes familiales, en contrôlant pour l’âge et le niveau de scolarité des aidantes et pour le niveau de perte d’autonomie et la fréquence des comportements dysfonctionnels de leurs parents âgés. Une analyse de contenu a permis de décrire la perception des aidantes eu égard à la résilience. Les résultats ont montré que le modèle empirique, incluant les variables de contrôle explique 54% de la variance de la résilience et que quatre des facteurs considérés, soit les stratégies de coping centrées sur le problème, les stratégies de coping centrées sur les émotions, le sentiment d’auto-efficacité et le sens du « prendre soin » ont une contribution statistiquement significative à la résilience des aidantes. Parmi ces quatre facteurs, le sens du « prendre soin » et le sentiment d’auto-efficacité expliquent davantage de variance, soit 11% et 5% respectivement. L’analyse qualitative du discours des aidantes a montré qu’elles prennent soin de leur proche âgé surtout par souci de réciprocité, mais également parce qu’il s’agit d’un membre de la famille et par respect pour Dieu. Ce sont par ailleurs leurs croyances et la satisfaction liée au prendre soin qui les aident à continuer et à se développer. Cette étude offre une meilleure compréhension du concept de la résilience des aidantes familiales au Liban et de certains facteurs qui en sont des prédicteurs significatifs. Elle offre des pistes pour l’intervention infirmière dans le but de promouvoir la santé de la personne/famille en tant que partenaire de soins. Des recommandations pour la pratique, la formation et la recherche sont proposées.