Grandparent Health & Functioning after a Grandchild’s Death

Approximately 160,000 grandparents experience the death of a grandchild each year; this represents a permanent, irrevocable loss for the grandparent resulting in physical and emotional responses. Grandparents who lose a grandchild experience increased alcohol and drug use, thoughts of suicide, and pain for their adult child who is also grieving. Supportive resources available to grieving grandparents, the effects of the grandchild’s death on the grandparent-parent relationship and the influence of race/ethnicity on grandparent grieving are discussed. Despite about 40,000 child and infant deaths each year, knowledge about grandparent health and functioning following the death of a grandchild is limited

Blood Lead Levels in Children and Environmental Lead Contamination in Miami Inner City, Florida

Studies have shown that the environmental conditions of the home are important predictors of health, especially in low-income communities. Understanding the relationship between the environment and health is crucial in the management of certain diseases. One health outcome related to the home environment among urban, minority, and low-income children is childhood lead poisoning. The most common sources of lead exposure for children are lead paint in older, dilapidated housing and contaminated dust and soil produced by accumulated residue of leaded gasoline. Blood lead levels (BLL) as low as 10 ?g/dL in children are associated with impaired cognitive function, behavior difficulties, and reduced intelligence. Recently, it is suggested that the standard for intervention be lowered to BLL of 5 ?g/dl. The objectives of our report were to assess the prevalence of lead poisoning among children under six years of age and to quantify and test the correlations between BLL in children and lead exposure levels in their environment. This cross-sectional analysis was restricted to 75 children under six years of age who lived in 6 zip code areas of inner city Miami. These locations exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Using the 5 ?g/dL as the cutoff point, the prevalence of lead poisoning among the study sample was 13.33%. The study revealed that lead levels in floor dust and window sill samples were positively and significantly correlated with BLL among children (p \u3c 0.05). However, the correlations between BLL and the soil, air, and water samples were not significant. Based on this pilot study, a more comprehensive environmental study in surrounding inner city areas is warranted. Parental education on proper housecleaning techniques may also benefit those living in the high lead-exposed communities of inner city Miami

Intergenerational associations between a consensual childhood sexual experience and adult substance abuse among Latina mothers and daughters

Purpose: Early onset of sexual activity has been linked to later substance abuse. Our study aimed to further describe the associations between Latina mothers’ and daughters’ early sexual activity and adult substance abuse. Methods: A survey was conducted with 92 Latina mother–daughter dyads whose members never experienced sexual abuse. Childhood sexual experience was defined as the occurrence of a consensual sexual encounter at the age of 15 years or younger. Substance abusers were identified by the extent of substance use during the 12 months prior to the interview. Path analysis was used to fit our conceptual models to the data. Main findings: Daughters’ current, adult substance abuse was associated independently with: their own childhood sexual experience (odds ratio [OR] = 6.0) and mothers’ current, adult substance abuse (OR = 2.0). Compared with daughters who first experienced sex after the age of 19, the odds of using substances were 17.7 times higher among daughters who had childhood sexual experience and 3.8 times higher among daughters who first experienced sex between the age of 16–19 years. Explicitly, sexual experiences between the ages of 16–19 years were also risk factors for later adult substance abuse. Mothers’ childhood sexual experience (OR = 7.3) was a strong predictor for daughters’ childhood sexual experience. Conclusions: Our study supported a link between mother and daughter childhood sexual experience among Latinas, and indicated it is a correlate of adult substance abuse. Family based substance abuse prevention efforts and future longitudinal studies should consider maternal childhood sexual experience as a potential indication of risk for Latina daughters

Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service

Background: Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. Objectives: To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. Design/Methods: In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the ‘Access’, ‘Acceptability’ and ‘Shared Decision Making’ dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. Results: Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. Conclusions: The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health car

Omega-3 and Omega-6 Polyunsaturated Fatty Acid Levels and Correlations with Symptoms in Children with Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorder and Typically Developing Controls.

BACKGROUND:There is evidence that children with Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorder (ASD) have lower omega-3 polyunsaturated fatty acid (n-3 PUFA) levels compared with controls and conflicting evidence regarding omega-6 (n-6) PUFA levels. OBJECTIVES:This study investigated whether erythrocyte n-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were lower and n-6 PUFA arachidonic acid (AA) higher in children with ADHD, ASD and controls, and whether lower n-3 and higher n-6 PUFAs correlated with poorer scores on the Australian Twin Behaviour Rating Scale (ATBRS; ADHD symptoms) and Test of Variable Attention (TOVA) in children with ADHD, and Childhood Autism Rating Scale (CARS) in children with ASD. METHODS:Assessments and blood samples of 565 children aged 3-17 years with ADHD (n = 401), ASD (n = 85) or controls (n = 79) were analysed. One-way ANOVAs with Tukey's post-hoc analysis investigated differences in PUFA levels between groups and Pearson's correlations investigated correlations between PUFA levels and ATBRS, TOVA and CARS scores. RESULTS:Children with ADHD and ASD had lower DHA, EPA and AA, higher AA/EPA ratio and lower n-3/n-6 than controls (P<0.001 except AA between ADHD and controls: P = 0.047). Children with ASD had lower DHA, EPA and AA than children with ADHD (P<0.001 for all comparisons). ATBRS scores correlated negatively with EPA (r = -.294, P<0.001), DHA (r = -.424, P<0.001), n-3/n-6 (r = -.477, P<0.001) and positively with AA/EPA (r = .222, P <.01). TOVA scores correlated positively with DHA (r = .610, P<0.001), EPA (r = .418, P<0.001) AA (r = .199, P<0.001), and n-3/n-6 (r = .509, P<0.001) and negatively with AA/EPA (r = -.243, P<0.001). CARS scores correlated significantly with DHA (r = .328, P = 0.002), EPA (r = -.225, P = 0.038) and AA (r = .251, P = 0.021). CONCLUSIONS:Children with ADHD and ASD had low levels of EPA, DHA and AA and high ratio of n-6/n-3 PUFAs and these correlated significantly with symptoms. Future research should further investigate abnormal fatty acid metabolism in these disorders

Changes in students' moral development during medical school: a cohort study

INTRODUCTION: The requirements of professionalism and the expected qualities of medical staff, including high moral character, motivate institutions to care about the ethical development of students during their medical education. We assessed progress in moral reasoning in a cohort of medical students over the first 3 years of their education. METHODS: We invited all 92 medical students enrolled at the University of Sherbrooke, Que., to complete a questionnaire on moral reasoning at the start of their first year of medical school and at the end of their third year. We used the French version of Kohlberg's Moral Judgment Interview. Responses to the questionnaire were coded by stage of moral development, and weighted average scores were assigned according to frequency of use of each stage. RESULTS: Of the 92 medical students, 54 completed the questionnaire in the fall of the first year and again at the end of their third year. The average age of the students at the end of the third year was 21 years, and 79% of the students included in the study were women. Over the 3-year period, the stage of moral development did not change substantially (i.e., by more than half a stage) for 39 (72%) of the students, shifted to a lower stage for 7 (13%) and shifted to a higher stage for 8 (15%). The overall mean change in stage was not significant (from mean 3.46 in year 1 to 3.48 in year 3, p = 0.86); however, the overall mean change in weighted average scores showed a significant decline in moral development (p = 0.028). INTERPRETATION: Temporal variations in students' scores show a levelling process of their moral reasoning. This finding prompts us to ask whether a hidden curriculum exists in the structure of medical education that inhibits rather than facilitates the development of moral reasoning

Improving birth preparedness and complication readiness in rural India through an integrated microfinance and health literacy programme:evidence from a quasi-experimental study

OBJECTIVE: Recently, a novel community health programme—the integrated microfinance and health literacy (IMFHL) programme was implemented through microfinance-based women’s only self-help groups (SHGs) in India to promote birth preparedness and complication readiness (BPCR) to improve maternal health. The study evaluated the impact of the IMFHL programme on BPCR practice by women in one of India’s poorest states—Uttar Pradesh—adjusting for the community, household and individual variables. The paper also examined for any diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in programme villages. DESIGN: Quasi-experimental study using cross-sectional survey data. SETTINGS: Secondary survey data from the IMFHL programme were used. PARTICIPANTS: Survey data were collected from 17 244 women in households with SHG member and non-member households in rural India. PRIMARY OUTCOMES: Multivariable logistic regression was used to estimate main and adjusted IMFHL programme effects on maternal BPCR practice in their last pregnancy. RESULTS: Membership in SHGs alone is positively associated with BPCR practice, with 17% higher odds (OR=1.17, 95% CI 1.07 to 1.29, p<0.01) of these women practising BPCR compared with women in villages without the programmes. Furthermore, the odds of practising complete BPCR increase to almost 50% (OR=1.48, 95% CI 1.35 to 1.63, p<0.01) when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members when the health literacy component was integrated into the SHG model. CONCLUSIONS: The results suggest that SHG membership exerts a positive impact on planned health behaviour and a diffusion effect of BPCR practice from members to non-members when SHGs are enriched with a health literacy component. The study provides evidence to guide the implementation of community health programmes seeking to promote BPCR practise in low resource settings

Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review

Background Human immunodeficiency virus/acquired immunodeficiency disease syndrome-associated mortality contributes considerably to overall mortality rates among adults in the United States. The purpose of this review is to systematically examine conceptual approaches that have been used to evaluate the association between socioeconomic status of people infected with human immunodeficiency virus and their survival and summarize existing evidence regarding the association between socioeconomic status and mortality due to human immunodeficiency virus/acquired immunodeficiency disease syndrome. Methods We systematically retrieved neighborhood and individual-level studies of acquired immunodeficiency disease syndrome-related or all-cause mortality among patients diagnosed with human immunodeficiency virus that reported original data and analyzed socioeconomic status as a predictor of mortality. Results We included 21 studies (19 cohort and 2 case-control studies). Heterogeneity in both the conceptual approaches to socioeconomic status measurements and selection of variables for the adjustment of the measure of association precluded meta-analysis of the results. Six studies observing populations before the introduction of highly active antiretroviral therapy found that socioeconomic status was not associated with human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality. In the post- highly active antiretroviral therapy period socioeconomic status was inconsistently associated with Human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality risk in studies adjusting for highly active antiretroviral therapy use. Conclusion Further studies considering multilevel socioeconomic status measurements and controlling for treatment and clinical variables are needed to enhance understanding of the role of socioeconomic gradients on human immunodeficiency virus outcomes