Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Abstract

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.

Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master^® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.

Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.

Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.     

Clinical Implications for Supporting Caregivers at the End-of-Life: Findings and from a Qualitative Study

Despite families providing considerable care at end of life, there are substantial gaps in the provision of supportive care. A qualitative interview study was conducted with 17 caregivers of people supported by an adult hospice to explore the support needs of families. Family members readily identified the ways in which the diagnosis of a life-limiting illness impacted on them and the family as a whole, not just the patient. Implications for practice demonstrate the need to intervene at a family and relational level prior to bereavement, in order to mitigate complicated grief for the surviving family members. Such an approach offers a fruitful prospective alternative to supporting caregivers post-bereavement.     

Intelligence of Children from Economically Disadvantaged Families: Role of Parental Education

The impact of parental education status on the intelligence of children from economically disadvantaged families was examined. One-hundred school going children aged 4 to 8 years from low income families were divided into 3 groups based on the level of their parental education. The main outcome measure was the intelligence of the child. Significant differences (p < .000) in the IQs of the 3 groups of children were found. Children with high parental education had significantly higher IQs as compared to children with moderate and low parental education level. Stepwise regression analysis revealed that 33.7% of the variance in the IQ of the child was explained by the education of the mother and income of the household. It is concluded that economic disadvantage may not necessarily constrain the cognitive development of children living in poverty, provided parents have some threshold level of education.     

Serial Neuropsychological Assessment and Evidence of Shunt Malfunction in Spina Bifida: A Longitudinal Case Study

Myelomeningocele is often accompanied by hydrocephalus (MMH), making it a potentially unstable neurological condition requiring shunt placement and possible revisions. Serial neuropsychological assessment is an important tool in monitoring children with MMH, as cognitive changes can indicate shunt malfunction and hydrocephalus. We present the case of a girl with MMH who had five neuropsychological assessments (ages 5, 7, 11, 12, and 14). Despite a lack of overt neurological symptoms or report of behavioral decline, testing at age 11 revealed decline in multiple neurobehavioral domains, and imaging at that time showed increased hydrocephalus, requiring shunt revision. Subsequent neuropsychological assessment conducted after a 2-year period of medical stability showed improvement and/or a return to baseline levels in some skill areas (i.e., working memory, verbal memory, visuomotor integration, and sustained attention), yet more lasting impairments in others (i.e., Verbal IQ, processing speed, organization, and response inhibition). These lasting cognitive deficits potentially impact independent completion of complex medical self-care tasks. This pattern of recovery highlights vulnerability of brain systems supporting executive functions in children with hydrocephalus and shunt failure.     

Exploring the Impact of Parental Military Deployment/Field Posting on Adolescents in Indian Military Families

The purpose of this study was to explore the consequences of parental deployment for adolescents and to identify the risk and protective factors which may affect their well- being. The study being exploratory in nature, focus group was chosen for data collection. Three focus groups were held with boys and girls in the age group 12–18 years who were experiencing the deployment of their father for more than six months. Each group consisted of 6–8 participants. A semi structured interview schedule was prepared for the focus group interviews. Each focus group was audio taped and then transcribed for further analysis. Response themes indicate relocation in the absence of the father, changes in roles and responsibilities, routine changes, not having the parent to help with the homework, participate in activities and provide guidance as major sources of stress. While the relaxation in family rules and discipline is cherished by all, there are reintegration problems when the parent returns. Some adolescents expressed concern about the health and worries of the at-home parent, for most of them the mother or the at home parent is the central figure who helps steer through the multiple deployments.     

中文读写能力及其相关因素研究

使用5点量表,本研究在北京地区调查了2187名小学一、三、五年级儿童的中文读写能力及其相关因素。因素分析抽取了8个因素：书面语意义理解、基本知觉能力、书写技能、家庭阅读背景、动作技能、口语能力、朗读和听写、书面表达。对上述因素进行多元逐步回归分析发现,各种读写能力内部相关显著。基本知觉能力、口语能力、家庭阅读背景和动作技能分别对中文读写能力的不同成分有显著解释作用。这个结果对于理解阅读能力发展及其与家庭阅读背景、口语、基本知觉一动作能力之间的关系,以及阅读障碍的内在机制具有重要的理论意义。     

Health-Related Quality of Life in a National Sample of Caregivers: Findings from the Behavioral Risk Factor Surveillance System

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers <55 years old had a 35% increased risk of having fair or poor health (odds ratio [OR] = 1.35, 95% confidence interval [CI] 1.28, 1.43) as compared to non-caregivers in that age group, while caregivers 55 years and older had a 3% decreased risk in having fair or poor health (OR = 0.97, 95% confidence interval [CI] 0.92, 1.03) compared to non-caregivers of the same age. In the adjusted models that examined the association of caregiving and healthy days, younger caregivers similarly showed larger deficits in both mental and physical HRQoL compared to older caregivers. For example combining mental and physical days, caregivers <55 had 1.44 fewer healthy days (β = −1.44, standard error (SE) = 0.07), while caregivers 55+ had 0.55 fewer days *β = −0.55, standard error (SE) = 0.13 (compared to non-caregivers in their respective age groups). Implications With increasing population age and the projected increase in caregivers, it is important that we understand the social and public health burden of caregiving and begin to identify interventions to sustain the HRQoL of caregivers. We found that caregivers have a slight to modest decline in HRQoL compared to non-caregivers, and that caregiving affects the HRQoL of younger adults more than older adults. Further research at the population level as to the type and level of burden of caregiving is needed.     

Impact of Psychoeducational Interventions on Distressed Family Caregivers

This study compared the effectiveness of two active interventions to a waiting-list control condition to reduce depression and burden and increase use of adaptive coping strategies in family caregivers (N = 161) of physically and/or cognitively impaired older adults. Chi-square analysis of change in depression status from pre- to postintervention showed a higher percentage of improvement among participants in the increasing life satisfaction psychoeducational condition compared to the improvement rate in either the problem-solving psychoeducational class or the wait-list condition. Change in coping strategies and subjective level of burden also differed by group, with participants in the class conditions reporting more frequent use of cognitive or behavioral coping strategies, and less subjective burden, from pre- to postintervention. There was no change in either avoidant coping or perceived stress over time. Results show that intervention programs targeted to improve specific coping skills and psychological symptoms can have a significant impact on caregivers' distress.     

The Influence of Parental Expectations and Parental Control on Adolescent Well-Being in Poor Chinese Families

Based on a sample of 275 Chinese poor families in Hong Kong, the influence of parental expectations of children’s future and adolescents’ perceived parental control on adolescent well-being (cognitive competence and self-identity) was examined. Consistent with our hypotheses, the results indicated that parental expectations of children’s future and adolescents’ perceived parental control directly influenced adolescent cognitive competence and self-identity. Furthermore, adolescent perceived maternal control moderated the influence of paternal expectations on cognitive competence and self-identity among Chinese adolescents. Simple slope analyses showed that paternal expectations influenced adolescent cognitive competence and self-identity under low levels of perceived maternal control than did high levels of perceived maternal control. The present study underscores the dynamic nature of the influence of parental expectations and perceived parental control on adolescent well-being (cognitive competence and self-identity) in poor Chinese families.

     

Parental Divorce and Adult Religiosity: Evidence from the General Social Survey

This study explores the relationship between parental divorce and religiosity, including religious affiliation change and church attendance. Data from the 1991, 1998, and 2008 waves of the General Social Survey provide information both on current religiosity and religiosity in respondents’ families of origin. The results suggest that living with a single divorced parent—but not a remarried or widowed parent—increases church attendance and the odds of a change in religious affiliation. Catholics and Protestants from divorced families are disproportionately likely to become apostates as adults, while people growing up in unaffiliated divorced families more often become affiliated as adults. However, parental divorce has fewer effects on the likelihood of moving from one denomination to another.     

Integrating Immigrants into the Life of Canadian Urban Christian Congregations: Findings from a National Survey

In just one generation the cultural face of Canadian society has been transformed. The relative level of immigration has increased rapidly as has diversity among those immigrants. This article reports on the findings of a national survey that offers a baseline of how and to what extent local Canadian Christian congregations are responding to this cultural diversity. In particular, it explores how churches are integrating immigrants within the life of their local congregations. This article uses a systems change perspective to frame immigrant integration. This perspective emphasizes three requirements for change: vision, structure and processes that promote immigrant integration. Data was collected using an online survey of urban congregations in the nine urban Canadian communities having an immigrant population above the national average (20% foreign-born). Using these data this article explores the full range of immigrant integration efforts from the initial welcome to inclusion into congregational life. It describes the present status of immigrant integration, details reported successes and challenges and notes respondent suggestions for better integration. Results of this survey provide first-time baseline insights into how a range of urban Christian congregations from across Canada are presently responding to the Canadian immigrant reality.     

Assessing Hypochondriasis: Findings on the Survey of Health Concerns

We describe a brief self-report measure for assessing hypochondriacal fears in adults. Called the Survey of Health Concerns (SHC), the measure was developed using DSM IV criteria for diagnosing hypochondriacal disorder as a guide. The measure was standardized on a sample of 188 college students. It was shown to have good internal and temporal reliability over a 2-week period. Moreover, scores on the SHC correlated significantly with worry proneness as measured by the Penn State Worry Questionnaire, and with the Hs scale of the MMPI-2, which together support the convergent validity of the measure. While men and women scored the same, participants who were being treated for a medical condition scored higher than those who were not being treated. Men who were under a doctor's care scored especially high, although this was based on a small sample of men and the effect could be spurious. A principal component factor analysis revealed two primary factors: one that described participants who felt poorly, made frequent trips to the doctor, and were fearful of illness and dying, and another that described participants who were particularly fearful of infectious diseases and took active steps to avoid becoming sick. Relatively little is known about hypochondriacal disorder. One reason for the dearth of knowledge in this area is that there has been no practical and reliable way to assess hypochondriacal fears, or more generally speaking, people's tendency to worry about their health. The SHC may help to fill this void. Results are admittedly preliminary and further study in medical settings is needed.     

Consumer Socialization and Parental Style Across Cultures: Findings from Australia,Greece, and India

This study examines the link between consumer socialization and general parental socialization tendencies among Australian, Indian, and Greek parents. Five basic patterns of socialization were found and the specific consumer socialization practices of each are discussed. Together these 5 parental styles provide a theoretically based typology of parental tendencies in collectivist as well as individualist nations.     

Counseling Caregivers of Families Affected by HIV/AIDS: The Use of Narrative Therapy

This article proposes the use of Narrative Therapy with family caregivers of family members diagnosed with HIV/AIDS. The authors identify the reasons for using Narrative Therapy with African family caregivers who have relocated to the United States of America. The tenets of Narrative Therapy are outlined, and a case illustration is provided to show how Narrative Therapy can be implemented. In this case study, the client moves from a state of helplessness and hopelessness to being able to regain control of her life and improve the care of her sister. She was able to re-write her story: from feeling incompetent to a position of strength. Although Narrative Therapy was used successfully with an African family caregiver within the USA, the authors assert that the interventions have the potential to be used as effectively with those clients living in Africa, provided counselors are sensitive to cultural differences that will affect their practice.     

Factors Moderating Children's Adjustment to Parental Separation: Findings From a Community Study in England

Research findings show that there is marked variability in children's response to parental separation, but few studies identify the sources of this variation. This prospective longitudinal study examines the factors modifying children's adjustment to parental separation in a community sample of 5,635 families in England. Children's behavioral/emotional problems were assessed when children were aged 47 and 81 months; marital quality, maternal depression, socioeconomic circumstances, and demographic variables were assessed prior to the separation from maternal report. Results indicated that 346 mothers separated from their partners in the 3-year period. Preseparation differences were found for measures of family process and parent risk factors, with effect sizes ranging from small to trivial. Parental separation was associated with a significant but modest increase in behavioral/emotional problems, independent of marital quality, maternal depression, socioeconomic circumstances, and demographic variables. Moderation analyses showed that children of cohabiting parents had a greater increase in adjustment problems following parental separation than children of married parents. Further research elucidating the factors that moderate children's adjustment to parental separation is needed to improve our understanding of who may most likely benefit from preventive interventions.     

The Impact of Parental Abduction on the Couple

SUMMARY

The abduction of a parent's child by the other parent can be an extremely heart-wrenching experience. Not only are the child's whereabouts and safety placed in doubt, the searching parent's life is thrown into turmoil. This case example describes the impact that the long-term abduction of a mother's son had on the mother's ability to maintain a relationship as a member of a new couple.