Secrets about biological parentage: experiences of concealment and revelation; a qualitative study

This qualitative study investigated the experiences of twelve adults who discovered new information about the identity of one or both parents in adolescence or later. Some had grown up in adoptive or step-families; others had been conceived using donated sperm. Participants were interviewed once about their experiences when the information was revealed, and the effect they perceived it had over time. The transcribed interviews were analysed using Interpretative Phenomenological Analysis (Smith, Jarman & Osborn, 1999). The findings indicated that for many participants the impact of unplanned revelations was considerable, and the emotional repercussions often persisted for many years. The information affected participant's perceptions of their sense of self, and who they were in relation to others. The effects of this appeared to reverberate through many parts of the family system. It was suggested that concealment may have affected early parent-child relationships and contributed to feelings of difference or not belonging. The secret was perceived to have affected family communication before the revelation, and this was often difficult afterwards. Findings were considered in relation to identity development, attachment theory and social constructionist perspectives. A tentative model of the processes by which people integrate this information was proposed. Suggestions were made regarding therapeutic work with individuals and families after revelations of this nature, and those considering the opening of such secrets. Further research in this area is indicated and is particularly relevant to families created through gamete donation

Multicenter Evaluation of Current Knowledge of Intestinal Transplantation and Rehabilitation Among Trainee Physicians

BACKGROUND: The management of intestinal failure has evolved dramatically over the last 2 decades. In addition, improved management of patients requiring parenteral nutrition-associated liver disease is creating a paradigm shift in both intestinal failure management and in the evolving indications for intestinal transplantation. OBJECTIVES: We conducted an evaluation measuring current awareness among house officers (HO) regarding nutritional and transplant principles in the management of intestinal disease. Our goal was to use board-style questions with a single correct response to measure current knowledge level between HO. METHODS: A survey was distributed to HO via email to measure knowledge regarding 3 areas: principles of intestinal failure (PI), medical management of intestinal disease (MI), and transplantation for intestinal disease (TI). This was evaluated at 3 busy nontransplant centers (NTC) and a tertiary care intestine transplant center (TC). Statistical analysis was conducted using the independent samples t test and multiple linear regression analysis. RESULTS: Surveys were distributed to a total of 1068 HO; 208 (19.47%) responded. We received 139 responses (67%) from NTC and 69 (33%) from TC. 82% were postgraduate year (PGY) 1-3 and 18% were PGY 4-7. Of the respondents, 27% correctly answered questions regarding PI, 40% about MI, and 21% on TI. HO in NTC demonstrated more knowledge regarding PI than those in TC (P = .000). There was, otherwise, no difference between PGY 1-3 and PGY 4-7 (P \u3e .05). CONCLUSIONS: This evaluation demonstrates potential deficiencies in the basic understanding of issues surrounding intestinal disease that can be used for implementation of an educational program regarding intestinal disease and transplantation