Adolescents’ Experiences 7 and 13 Months Following the Death of a Brother or Sister

This qualitative study used semi-structured interviews to describe adolescents’ responses at 7 and 13 months to siblings’ NICU/PICU/ED death. At 7 months, adolescents were asked about events around the sibling’s death; at 7 and 13 months, about concerns/fears, feelings, and life changes. Seventeen adolescents participated (13-18 years; M=15); 65% Black, 24% Hispanic, 11% White. Themes included death circumstances, burial events, thinking about the deceased sibling, fears, and life changes. Adolescents reported shock and disbelief that the sibling died; 80% knew the reason for the death; many had difficulty getting through burials; all thought about the sibling. From 7 - 13 months fears increased including losing someone and thoughts of dying. Adolescents reported more changes in family life and greater life changes in them (more considerate, mature) by 13 months; some felt friends abandoned them after the sibling’s death. Girls had more fears and changes in family life and themselves. Adolescent’s responses to sibling death may not be visually apparent. One recommendation from this study is to ask adolescents how they are doing separately from parents since adolescents may hide feelings to protect their parents, especially their mothers. Older adolescents (14-18 years) and girls may have more difficulty after sibling death

Parent & Child Perceptions of Child Health after Sibling Death

Background Understanding children?s health after a sibling?s death and what factors may affect it is important for treatment and clinical care. This study compared children?s and their parents? perceptions of children?s health and identified relationships of children?s age, gender, race/ethnicity, anxiety, and depression and sibling?s cause of death to these perceptions at 2 and 4 months after sibling death. Methods 64 children and 48 parents rated the child?s health ?now? and ?now vs before? the sibling?s death in an ICU or ER or at home shortly after withdrawal of life-prolonging technology. Children completed the Child Depression Inventory and Spence Children?s Anxiety Scale. Sibling cause of death was collected from hospital records. Results At 2 and 4 months, 45% to 54% of mothers? and 53% to 84% of fathers? ratings of their child?s health ?now? were higher than their children?s ratings. Child health ratings were lower for: children with greater depression; fathers whose children reported greater anxiety; mothers whose child died of a chronic condition. Children?s ratings of their health ?now vs before? their sibling?s death did not differ significantly from mothers? or fathers? ratings at 2 or 4 months. Black fathers were more likely to rate the child?s health better ?now vs before? the death; there were no significant differences by child gender and cause of death in child?s health ?now vs before? the death. Conclusions Children?s responses to a sibling?s death may not be visually apparent or become known by asking parents. Parents often perceive their children as healthier than children perceive themselves at 2 and 4 months after sibling death, so talking with children separately is important. Children?s perceptions of their health may be influenced by depression, fathers? perceptions by children?s anxiety, and mother?s perceptions by the cause of sibling death

Death of a Brother or Sister: Siblings\u27 Perception of their Health, Treatments and the Associated Health Care Costs

Death of a child is a very painful experience for parents and remaining siblings who experience physiological and emotional symptoms as described by the parents. There are few reports from the remaining siblings on their physical and emotional health and even less data on their treatments and associated health care costs after sibling loss. The purpose of this study in children who have lost a sibling in the NICU/PICU, ER or those who have been sent home on technology dependent equipment to die, is to compare parents’ and children’s perceptions of the surviving sibling’s health, identify factors related to these perceptions, and describe treatments for the sibling’s physical and mental health at 2 and 4 months after a sibling’s death. Sixty four surviving siblings and their parents reported on the siblings’ mental and overall health. Available treatment charges (visits to the emergency room, physician office, hospitalization, and any health services (mental & physical) since the sibling death were collected from bills and insurance receipts. Cause of child death (acute or chronic) was collected from the deceased child’s hospital record. The relationship between parent and sibling’s perception of the surviving sibling’s health, and anxiety and depression at 2 and 4 months post the death were measured using the Children’s Depression Inventory and the Spence Anxiety Scales. Data were analyzed using: T-Tests, ANOVA, Pearson correlations, frequencies and descriptive statistics. Findings indicated that at 2 and 4 months parent’s perceived their surviving siblings’ health to be better than the child perceived his/her health to be. At 4 months fathers rated the siblings’ health compared to their peers lower than the siblings. Greater child anxiety was related to lower father’s ratings of the child’s health now and compared to peers. Treatments and charges increased from 2 months to 4 months with males having more treatments than females. The majority of the treatments consisted of routine physician visits, non-routine physician visits, emergency room/urgent care visits and counseling. Study findings can help guide healthcare providers and educators in identifying those children that are at high risk for negative health effects after the death of a sibling

Surviving Siblings’ Illnesses, Treatments/Health Services over 13 Months after a Sibling’s Death

Two million children experience sibling death annually and have problems that require clinical intervention although few receive such help. Effects on surviving siblings’ mental health has been well documented, however their physical health has not. This study described surviving siblings’ illnesses, treatments/health services at 2, 4, 6, and 13 months post-sibling death. The 132 children (76 girls, 56 boys, M 10.6 years, SD 3.43); 30% Hispanic, 51% Black, 26% White were recruited via hospital ICUs and published obituaries. Using a longitudinal design, parents reported types and numbers of surviving siblings’ illnesses, treatments/health services, and dates post-sibling death. Most of the 207 illnesses and 674 treatments/health services occurred in the first 6 months post-sibling death. While girls had more illnesses (131) than boys (76) and Hispanic children had more illnesses than White or Black children, these differences were not statistically significant. Girls accounted for 66% of the treatments/health services and boys 34%. There was no significant difference in treatments/health service use by gender of the children (F = 1.00, p = .32). Hispanic children had significantly more treatments/health service use than Black children (F = 6.81, p = .002). Sibling death affects surviving siblings’ physical health. Study data document the importance of monitoring the health, treatments and health service use of surviving siblings especially in the first 6 months after a sibling death, regardless of the child’ s gender. On average, Hispanic children had greater health service use, which may warrant greater attention

Death Rituals Reported by White, Black, and Hispanic Parents Following the ICU Death of an Infant or Child

Purpose To examine rituals (disposing remains, wakes, funerals/burials, celebrations) of White, Black, Hispanic parents post ICU infant/child death. Design and methods Qualitative design, 63 parents completed English or Spanish semi-structured interviews at 7 & 13 months after infant’s/child’s death. Interviews were audio-recorded, transcribed verbatim, and entered into Atlas.ti for analysis. An inductive approach to thematization was used to develop codes. Results Parents: mean age 35.1 years (SD = 9.03); 33% Black, 27% White, 40% Hispanic; from 17 countries. Three themes emerged: immediately after death - shock and stress, needing help with arrangements, decisions on burial or cremation (conflicts due to finances, religion, culture), when and where to hold wakes, funerals/burials. Wakes and funerals - who prepares child’s body, appropriate dress (deceased child, mourners), who can come (cultural restrictions),-variations by child age, parent choice, culture, religion, country. After burial/cremation - being with family, milestone celebrations. Conclusion Child death is devastating for parents, other children, grandparents, and family members. Practice Implications. Rituals after child death require decisions about the child’s remains, wakes, funerals/burials at time of great pain for parents. This is especially true for newly immigrated parents and those with language barriers where making arrangements is especially hard and often very isolating. Health professionals who provide support need to be cognizant of practice differences based on religion, culture, economics, family traditions, and individual preference and provide as much support and resource as possible. A list of religious leaders representing the community’s cultures and funeral service providers who may provide lower cost burials/cremations is helpful

Infant and Child Deaths: Parent Concerns about Subsequent Pregnancies

Purpose—examine parents\u27 concerns about subsequent pregnancies after experiencing an infant or child death (newborn to 18 years). Data Sources—39 semi-structured parent (White, Black, Hispanic) interviews 7 and 13 months post infant/child death conducted in English and/or Spanish, audio-recorded, transcribed and content analyzed. Mothers\u27 mean age was 31.8 years, fathers\u27 was 39 years; 11 parents were White, 16 Black, 12 Hispanic. Conclusions—Themes common at 7 and 13 months: wanting more children; fear, anxiety, scared; praying to God/God\u27s will; thinking about/keeping the infant\u27s/child\u27s memory and at 7 months importance of becoming pregnant for family members; and at 13 months happy about a new baby. Parents who lost a child in NICU commented more than those who lost a child in PICU. Black and Hispanic parents commented more on praying to God and subsequent pregnancies being God\u27s will than White parents. Implications for Practice—Loss of an infant/child is a significant stressor on parents with documented negative physical and mental health outcomes. Assessing parents\u27 subsequent pregnancy plans, recognizing the legitimacy of their fears about another pregnancy, discussing a plan should they encounter problems and carefully monitoring the health of all parents who lost an infant/child is an essential practitioner role

Parent’s Perceptions of Health Care Providers Actions Around Child ICU Death: What Helped, What Did Not

Purpose To describe parents’ perspectives of health care provider actions that helped or did not around the time of infant/child’s intensive care unit (ICU) death. Semistructured interviews with 63 parents (Black, White, and Hispanic) 7 months post infant/child death were audio-recorded, transcribed, analyzed, and themes identified. Findings What helped most: compassionate, sensitive staff; understandable explanations of infant’s/child’s condition; experienced, competent nurses; providers did everything to help infant/child; and parents’ involvement in care decisions. What did not help: insensitive, nonsupportive staff; conflict between providers and parents; communication problems around the death; inexperienced nurses and doctors; parents not understanding child’s disease, care, complications. Conclusions Compassionate, sensitive staff and understandable explanations of children’s conditions were most helpful; insensitive, nonsupportive staff least helpful by gender, racial group, or care setting. Conflict between providers and parents was most problematic for minority parents and mothers

Galactic Extinction from Colors and Counts of Field Galaxies in WFPC2 Frames: An Application to GRB 970228

We develop the ``simulated extinction method'' to measure average foreground Galactic extinction from field galaxy number-counts and colors. The method comprises simulating extinction in suitable reference fields by changing the isophotal detection limit. This procedure takes into account selection effects, in particular, the change in isophotal detection limit (and hence in isophotal magnitude completeness limit) with extinction, and the galaxy color--magnitude relation. We present a first application of the method to the HST WFPC2 images of the gamma-ray burster GRB 970228. Four different WFPC2 high-latitude fields, including the HDF, are used as reference to measure the average extinction towards the GRB in the F606W passband. From the counts, we derive an average extinction of A_V = 0.5 mag, but the dispersion of 0.4 mag between the estimates from the different reference fields is significantly larger than can be accounted by Poisson plus clustering uncertainties. Although the counts differ, the average colors of the field galaxies agree well. The extinction implied by the average color difference between the GRB field and the reference galaxies is A_V = 0.6 mag, with a dispersion in the estimated extinction from the four reference fields of only 0.1 mag. All our estimates are in good agreement with the value of 0.81\pm0.27 mag obtained by Burstein & Heiles, and with the extinction of 0.78\pm0.12 measured by Schlegel et al. from maps of dust IR emission. However, the discrepancy between the widely varying counts and the very stable colors in these high-latitude fields is worth investigating.Comment: 14 pages, 2 figures; submitted to the Astrophysical Journa

Practices following the death of a loved one reported by adults from 14 countries or cultural/ethnic group

Aims: The purpose of this study was to examine the reported ritual practices (dealing with the deceased\u27s remains, wake, funeral, burial and celebration) of White non-Hispanic, Black non-Hispanic and Hispanic/Latino adults in their country of origin or ethnic or cultural group in the United States following the death of a loved one. Design: This descriptive study is a secondary analysis from a longitudinal mixed-methods study that examined parents\u27 health and functioning following the death of a child. Methods: Adult parents whose child died in neonatal intensive care units or paediatric intensive care units were recruited from four hospitals and from death records. Data were collected from 61 adult parents at 7 and 13 months postinfant/child death using semi-structured interviews about the child\u27s death. Only those parents who responded to questions about usual death practices in their country of origin or cultural group were included in the data analysis. Results: Thirty-two adults from 14 countries reported practices in their country or cultural group after a loved one\u27s death including keeping the front door closed, walking funeral processions with a band playing, the deceased in a car accompanied by family and friends, fireworks, making home altars for deceased spirits with food and water for adults, toys and candy for children and no TV or radio for sometime. Relevance to clinical practice: For community health nurses, understanding these practices is important in being sensitive and appropriate around the death. Asking the family about specific practices they hope to carry out and noting this in the family\u27s record will help alert providers to the family\u27s wishes at this challenging time

The Opacity of Nearby Galaxies from Counts of Background Galaxies: II. Limits of the Synthetic Field Method

Recently, we have developed and calibrated the Synthetic Field Method (SFM) to derive the total extinction through disk galaxies. The method is based on the number counts and colors of distant background field galaxies that can be seen through the foreground object, and has been successfully applied to NGC 4536 and NGC 3664, two late-type galaxies located, respectively, at 16 and 11 Mpc. Here, we study the applicability of the SFM to HST images of galaxies in the Local Group, and show that background galaxies cannot be easily identified through these nearby objects, even with the best resolution available today. In the case of M 31, each pixel in the HST images contains 50 to 100 stars, and the background galaxies cannot be seen because of the intrinsic granularity due to strong surface brightness fluctuations. In the LMC, on the other hand, there is only about one star every six linear pixels, and the lack of detectable background galaxies results from a ``secondary'' granularity, introduced by structure in the wings of the point spread function. The success of the SFM in NGC 4536 and NGC 3664 is a natural consequence of the reduction of the intensity of surface brightness fluctuations with distance. When the dominant confusion factor is structure in the PSF wings, as is the case of HST images of the LMC, and would happen in M 31 images obtained with a 10-m diffraction- limited optical telescope, it becomes in principle possible to improve the detectability of background galaxies by subtracting the stars in the foreground object. However, a much better characterization of optical PSFs than is currently available would be required for an adequate subtraction of the wings. Given the importance of determining the dust content of Local Group galaxies, efforts should be made in that direction.Comment: 45 pages, 10 Postscript figure