Parenting challenges of grandparents raising grandchildren: Discipline, child education, technology use, and outdated health beliefs

BACKGROUND: As of 2015, approximately three million children in the United States were being raised primarily by their grandparents. This study aims to examine, in a large national sample, to what extent grandparents raising grandchildren (GRGs) have difficulty with discipline and meeting their grandchild’s educational and social needs, find computers/other technology challenging, and subscribe to outdated health beliefs. METHODS: An anonymous online parenting questionnaire was administered to GRGs recruited through state and local grandparent support groups and elderly service agencies. RESULTS: 733 grandparents that self-identified as the primary caregiver of one or more grandchildren met inclusion criteria. 56.5% of GRGs reported difficulties with discipline, and 19.1% believed corporal punishment to be an appropriate method of discipline. Approximately a third of GRGs reported difficulties with their grandchild’s education, social and recreational activities. Nearly a third of GRGs did not find using their grandchild’s school website or portal to be easy; those who had difficulty were more likely to experience difficulties registering their grandchild for school (τ = -.127, p = .007) and were less likely to feel that teachers maintained adequate contact (τ = .242, p \u3c .001). A large percentage of GRGs subscribed to outdated health beliefs, such as scrapes healing better if they are not covered with a bandage (64.0%) and ice baths beingan appropriate treatment for a fever (39.8%). CONCLUSION: GRGs encounter significant parenting challenges, owing to generational differences. Healthcare providers and other professionals should provide GRGs with anticipatory guidance to ensure grandchildren’s needs are properly met

Effect of threshold growth as a major feature on LI-RADS categorization.

PurposeLiver Imaging Reporting and Data System (LI-RADS) uses major features (arterial phase hyperenhancement [APHE], "washout" [WO], "capsule," diameter, threshold growth [TG]) to codify probability of hepatocellular carcinoma for each observation. This study assessed the effect of removing TG as a major feature on LI-RADS categorization.Materials and methodsIn this HIPAA-compliant, IRB-approved study, all MR and CT clinical reports containing a standardized LI-RADS v2014 template between 4/15-1/17 were retrospectively reviewed for each LR-3, LR-4, and LR-5 reported observation. Two LI-RADS categories were then assigned: one using all LI-RADS major features and one after removing TG as a major feature. The two categories were compared descriptively.ResultsThe study included 265 patients (172 [65%] male, mean age 63 [±10] years) with 489 observations (median diameter 14 mm, IQR 10-20 mm), of which 345 (71%) had APHE, 307 (63%) had WO, 86 (18%) had "capsule," and 72 (15%) had TG. Of 86 observations with TG, 47 (65%) were new observations ≥10 mm, 14 (19%) had diameter increase ≥50% in ≤6 months, and 11 (15%) had diameter increase ≥100% in >6 months. Using all major features, 214/489 (44%) observations were LR-3, 129/489 (26%) were LR-4, and 146/489 (30%) were LR-5. After removing TG, 237/489 (48%) were LR-3, 119/489 (24%) were LR-4, and 133 (27%) were LR-5. Removing TG caused a category downgrade for 35/489 (7%, 95% CI 5-10) observations, including 13/146 (9%, 95% CI 3-14) LR-5 observations.Conclusion9% of LR-5 observations would be downgraded without TG

Effect of threshold growth as a major feature on LI-RADS categorization.

PurposeLiver Imaging Reporting and Data System (LI-RADS) uses major features (arterial phase hyperenhancement [APHE], "washout" [WO], "capsule," diameter, threshold growth [TG]) to codify probability of hepatocellular carcinoma for each observation. This study assessed the effect of removing TG as a major feature on LI-RADS categorization.Materials and methodsIn this HIPAA-compliant, IRB-approved study, all MR and CT clinical reports containing a standardized LI-RADS v2014 template between 4/15-1/17 were retrospectively reviewed for each LR-3, LR-4, and LR-5 reported observation. Two LI-RADS categories were then assigned: one using all LI-RADS major features and one after removing TG as a major feature. The two categories were compared descriptively.ResultsThe study included 265 patients (172 [65%] male, mean age 63 [±10] years) with 489 observations (median diameter 14 mm, IQR 10-20 mm), of which 345 (71%) had APHE, 307 (63%) had WO, 86 (18%) had "capsule," and 72 (15%) had TG. Of 86 observations with TG, 47 (65%) were new observations ≥10 mm, 14 (19%) had diameter increase ≥50% in ≤6 months, and 11 (15%) had diameter increase ≥100% in >6 months. Using all major features, 214/489 (44%) observations were LR-3, 129/489 (26%) were LR-4, and 146/489 (30%) were LR-5. After removing TG, 237/489 (48%) were LR-3, 119/489 (24%) were LR-4, and 133 (27%) were LR-5. Removing TG caused a category downgrade for 35/489 (7%, 95% CI 5-10) observations, including 13/146 (9%, 95% CI 3-14) LR-5 observations.Conclusion9% of LR-5 observations would be downgraded without TG

Liver Imaging Reporting and Data System Version 2018: Impact on Categorization and Hepatocellular Carcinoma Staging.

The purpose of this study was to assess the concordance in categorization and radiologic T staging using Liver Imaging Reporting and Data System (LI-RADS, LR) version 2017 (v2017), version 2018 (v2018), and the Organ Procurement and Transplantation Network (OPTN) criteria. All magnetic resonance imaging and computed tomography reports using a standardized LI-RADS macro between April 2015 and March 2018 were identified retrospectively. The major features (size, arterial phase hyperenhancement, washout, enhancing capsule, or threshold growth) were extracted from the report for each LR-3, LR-4, and LR-5 observation. Each observation was assigned a new category based on LI-RADS v2017, v2018, and OPTN criteria. Radiologic T stage was calculated based on the size and number of LR-5 or OPTN class 5 observations. Categories and T stages assigned by each system were compared descriptively. There were 398 patients (66.6% male; mean age, 63.4 years) with 641 observations (median size, 14 mm) who were included. A total of 73/182 (40.1%) observations categorized LR-4 by LI-RADS v2017 were up-categorized to LR-5 by LI-RADS v2018 due to changes in the LR-5 criteria, and 4/196 (2.0%) observations categorized as LR-5 by LI-RADS v2017 were down-categorized to LR-4 by LI-RADS v2018 due to changes in the threshold growth definition. The T stage was higher by LI-RADS v2018 than LI-RADS v2017 in 49/398 (12.3%) patients. Compared with the OPTN stage, 12/398 (3.0%) patients were upstaged by LI-RADS v2017 and 60/398 (15.1%) by LI-RADS v2018. Of 101 patients, 5 (5.0%) patients with T2 stage based on LI-RADS v2017 and 10/102 (9.8%) patients with T2 stage based on LI-RADS v2018 did not meet the T2 criteria based on the OPTN criteria. Of the 98 patients with a T2 stage based on OPTN criteria, 2 (2.0%) had a T stage ≥3 based on LI-RADS v2017 and 6 (6.1%) had a T stage ≥3 based on LI-RADS v2018

Liver Imaging Reporting and Data System Version 2018: Impact on Categorization and Hepatocellular Carcinoma Staging.

The purpose of this study was to assess the concordance in categorization and radiologic T staging using Liver Imaging Reporting and Data System (LI-RADS, LR) version 2017 (v2017), version 2018 (v2018), and the Organ Procurement and Transplantation Network (OPTN) criteria. All magnetic resonance imaging and computed tomography reports using a standardized LI-RADS macro between April 2015 and March 2018 were identified retrospectively. The major features (size, arterial phase hyperenhancement, washout, enhancing capsule, or threshold growth) were extracted from the report for each LR-3, LR-4, and LR-5 observation. Each observation was assigned a new category based on LI-RADS v2017, v2018, and OPTN criteria. Radiologic T stage was calculated based on the size and number of LR-5 or OPTN class 5 observations. Categories and T stages assigned by each system were compared descriptively. There were 398 patients (66.6% male; mean age, 63.4 years) with 641 observations (median size, 14 mm) who were included. A total of 73/182 (40.1%) observations categorized LR-4 by LI-RADS v2017 were up-categorized to LR-5 by LI-RADS v2018 due to changes in the LR-5 criteria, and 4/196 (2.0%) observations categorized as LR-5 by LI-RADS v2017 were down-categorized to LR-4 by LI-RADS v2018 due to changes in the threshold growth definition. The T stage was higher by LI-RADS v2018 than LI-RADS v2017 in 49/398 (12.3%) patients. Compared with the OPTN stage, 12/398 (3.0%) patients were upstaged by LI-RADS v2017 and 60/398 (15.1%) by LI-RADS v2018. Of 101 patients, 5 (5.0%) patients with T2 stage based on LI-RADS v2017 and 10/102 (9.8%) patients with T2 stage based on LI-RADS v2018 did not meet the T2 criteria based on the OPTN criteria. Of the 98 patients with a T2 stage based on OPTN criteria, 2 (2.0%) had a T stage ≥3 based on LI-RADS v2017 and 6 (6.1%) had a T stage ≥3 based on LI-RADS v2018