Grandmothers raising grandchildren: are they at increased risk of health problems?

Many grandparents faced with the need to raise their grandchildren have health risks that could destabilize any family structure established for the child. This is especially problematic for grandparents of color who have higher health risk factors that their white counterparts. This article describes the physical and mental health status and behaviors of 100 African American grandmothers who are the primary caretakers for their grandchildren. The findings suggest the physical functioning of the grandmothers is at a level that could jeopardize the quality of life with their grandchildren. In spite of their diminished physical capacity, the grandmothers reported that their emotional state is equal to or better than the general population. Suggestions for community practice are provided.

A multimodal intervention for grandparents raising grandchildren: results of an exploratory study.

This article describes the results of an exploratory study of a multimodal, home-based intervention designed to reduce psychological stress, improve physical and mental health, and strengthen the social support and resources of grandparents raising grandchildren. The six-month intervention included home visits by registered nurses, social workers, and legal assistants; the services of an attorney; and monthly support group meetings. The intervention resulted in improved mental health scores, decreased psychological distress scores, and increased social support scores. Participants also experienced improvement in the level of public benefits received and in their legal relationships with their grandchildren. Implications of these findings for practice are highlighted.

Candidate inhibitor of the volume-sensitive kinase regulating K-Cl cotransport: the myosin light chain kinase inhibitor ML-7.

K-Cl cotransport, KCC, is activated by swelling in many cells types, and promotes volume regulation by a KCl efflux osmotically coupled to water efflux. KCC is probably activated by swelling-inhibition of a kinase, permitting dephosphorylation, and activation of the cotransporter by a phosphatase. The myosin light chain kinase (MLCK) inhibitor ML-7 inhibits transporters activated by shrinkage. In red blood cells from three mammalian species, ML-7 stimulated KCC in a volume-dependent manner. Relative stimulation was greatest in more shrunken cells. Stimulation was reduced by moderate cell swelling and abolished by further swelling. The half-maximal stimulation is at approximately 20 microm ML-7, 50-fold greater than the IC(50) for inhibition of MLCK in vitro. Stimulation of KCC by ML-7 did not require cell Ca, while MLCK does. Therefore the target of ML-7 in stimulating KCC in red cells is probably not MLCK. The evidence favors stimulation of KCC by ML-7 by inhibiting the volume-sensitive kinase. Qualitatively similar effects of ML-7 on KCC in red cells from three mammalian species suggest a general mechanism.

Psychological distress in grandmother kinship care providers: the role of resources, social support, and physical health.

OBJECTIVE: The purpose of the present study was to investigate predictors of psychological distress in grandmother kinship care providers. More specifically, it was hypothesized that social support, family resources, and physical health would predict psychological distress in grandmothers raising grandchildren. METHOD: One hundred and two grandmothers raising grandchildren in parent-absent homes completed the Brief Symptom Inventory, Short Health Form-36, Family Resource Scale, Family Support Scale, and a questionnaire requesting background and demographic data. RESULTS: Results indicated that psychological distress was predicted by family resources, participants' physical health, and to a lesser extent, social support. CONCLUSION: The findings indicate that family resources, social support, and physical health affected psychological distress in grandmothers raising grandchildren. Grandmothers who reported fewer resources, less social support, and poorer physical health tended to experience higher levels of psychological distress. This study suggests that greater attention be given to interventions aimed to decrease psychological distress and improve the financial resources and physical health of grandmothers raising grandchildren.

21st century house call: the Internet and the World Wide Web.

Changes in health care delivery and the explosion of health information available on the Internet are affecting primary care practice in America. The provider is no longer the distributor, interpreter, and filter of information in the health care setting. Clients are becoming informed about their treatment options via the World Wide Web and are eager to discuss their therapeutic alternatives, gleaned from a variety of sources, with their practitioners. The shifting paradigm of practitioners as information provider to information broker is explored. Useful sites for primary care providers and guidelines for obtaining and evaluating electronically available information is provided. Additionally, caveats in this era of electronic communication are presented.

Stress and coping behaviors of substance-abusing mothers.

PURPOSE: To examine parenting stress and coping behaviors in substance-abusing and non-substance-abusing mothers. DESIGN: A comparative descriptive design. SETTING: Pediatric primary care clinic. PARTICIPANTS: Low-income, predominantly African-American mothers (N = 60) of young children recruited from a pediatric primary care clinic. Thirty mothers were known substance abusers and 30 had no known history of substance abuse. MAIN OUTCOME MEASURES: Parenting Stress Index/Short Form (PSI/SF) and Child Protective Service (CPS) validation of abuse or neglect. RESULTS: Substance-abusing mothers scored significantly higher than comparison mothers on total stress and the three subscales of the PSI/SF: parent-child dysfunctional interaction, difficult child, and parental distress. Forty-seven percent of substance-abusing mothers scored in the clinical range on total stress compared with only 3.3% of non-substance-abusing mothers. Proportionately more substance-abusing mothers than comparisons demonstrated maladaptive parenting behaviours as evidenced by CPS-confirmed abuse or neglect of their youngest child. CONCLUSIONS: Substance-abusing mothers of young children are at increased risk for increased levels of stress and maladaptive coping behaviors. Substance-abusing mothers need support and monitoring in the parenting role and referrals to substance-abuse and parenting programs.

To grandmother's house we go ... and stay. Children raised in intergenerational families.

An increased incidence in child abuse and neglect has resulted in a dramatic rise in the number of grandparents raising grandchildren and great-grandchildren. Grandchildren raised by grandparents often suffer from emotional and behavioral problems due to prior abuse, neglect, and abandonment. Grandparent caregivers experience increased health problems, psychological distress, and social isolation related to their roles as primary caregivers of children. Grandparents who become caregivers of grandchildren face increased financial responsibilities at a time in their lives, close to or at retirement, when income is dramatically decreased.

Mechanism of swelling activation of K-Cl cotransport in inside-out vesicles of LK sheep erythrocyte membranes.

Stimulation by swelling of K-Cl cotransport was studied in inside-out vesicles (IOVs) made from membranes of LK sheep erythrocytes. The purpose was to understand this stimulation in terms of the three-state process proposed for regulation of the cotransporter (P.B. Dunham, J. Klimczak, and P.J. Logue. J. Gen. Physiol. 101: 733-765, 1993). The first step in this process, A --> B, is rate limiting and controlled by transphosphorylation reactions. The second step, B --> C, is fast; its control is unknown. Predictions were that maximum velocity (Jmax) of cotransport increases with A --> B and concentration at one-half Jmax (K1/2) of K+ as a substrate decreases with B --> C. We tested the hypothesis that most transporters in IOVs are in the B state and that swelling activates cotransport in vesicles by the B --> C conversion. In accordance with this hypothesis, swelling should activate K+ influx with no discernable delay. It did. K1/2 for K+ should decrease with swelling and Jmax should not change. K1/2 decreased 10-fold, and Jmax did not change. Inhibitors of transphosphorylation, reactions of A --> B, should not affect K+ flux into IOVs, and they did not. The results support the hypothesis: swelling activation of K+ flux into IOVs corresponds to B --> C. A mechanical change in the membrane causes a specific change in the cotransporter: an increase in apparent affinity for K+.

The influence of large deletions on the mutation frequency induced by tritiated water and X-radiation in male Drosophila melanogaster post-meiotic germ cells.

Tritium beta radiation (3H beta-radiation) in the form of tritiated water was used to induce mutations at the alcohol dehydrogenase (Adh) locus in male Drosophila melanogaster post-meiotic germ cells. All 23 Adh null mutations were large deletions (> 20 kb), determined by genetic complementation and Southern blot analyses. 27 Adh null mutations have been induced by 100-kVp X-rays (Aaron, 1979) and have been genetically and molecularly characterized (Ashburner et al., 1982; Chia et al., 1985; LoMonaco et al., 1987; Mahmoud et al., 1991). In contrast to 3H beta-radiation, 100-kVp X-rays induced a bimodal distribution of Adh null mutations, intragenic mutations, < or = 250 bp, and large deletions, > 100 kb. A statistically significant difference was observed between the frequency of large deletions (23/23 or 1.0) induced by 3H beta-radiation and the frequency of large deletions (19/27 or 0.7) induced by 100-kVp X-rays. However, a statistical difference was not observed between the size distribution of the large deletions induced by 3H beta-radiation and X-rays. The relative deletion frequency (RDF) induced by 3H beta-radiation and 100-kVp X-rays was (1.0/0.7 = 1.4). The relative biological effectiveness (RBE) of these two radiation sources was 1.4, determined from the ratio of the regression coefficients of the respective 3H beta-radiation and X-ray sex-linked recessive lethal (SLRL) dose-response data. The large difference in size between the two classes of X-ray-induced Adh null mutations and the increase in mutation frequency and deletion frequency for 3H beta-radiation with respect to X-rays may indicate that the relative deletion frequency (RDF) is the molecular biological basis for the increase in the RBE for radiation sources with a mean LET value < or = 10 keV/microns.

Caregiver stress in grandparents raising grandchildren.

The purpose of this descriptive study was to examine caregiver stress in grandparents who are raising grandchildren as well as the antecedents to the child's placement with grandparents. The sample was 41 grandparents, aged 40 to 78 years, with a mean of 55 years. Subjects reported increased psychological distress as measured by the Symptom Checklist-90-Revised inventory. Social isolation and restriction of role, as measured by the Parenting Stress Index, were found to be predictors of increased psychological distress. Child maltreatment, often involving parental substance abuse, was found to be the major antecedent to children being raised by grandparents.

Sexual abuse of children in day care centers.

Sexual abuse of children in day care center settings has received considerable attention in the past decade. The nature and extent of allegations of sexual abuse in day care poses unique challenges to clinicians. Cases of sexual abuse in day care typically involve multiple victims and multiple perpetrators, and use of extreme threats to prevent disclosure. This article reviews the available research findings on the types of abuse known to occur in day care, the dynamics involved including the types of threats used to silence young victims, and patterns of disclosure. The impact of sexual victimization in day care on children and parents is discussed. Implications for the clinical evaluation of preschool-aged children in cases of suspected abuse in day care settings are presented. Developmental considerations related to psychosexual development and the development of memory and language are reviewed. Psychological defenses in repetitive trauma are discussed.

Child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment.

This study examined the prevalence of child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment. The sample included 44 children, ages 5-13 years; 61% were male and 39% female. Results indicated that the entire sample had experienced one or more types of maltreatment, with physical abuse being more prevalent. Seventy-four percent of subjects scored in the clinical range on the Child Behavior Checklist (Achenbach & Edelbrock, 1983). Proportionally more physically abused children scored in the clinical range when compared to nonphysically abused children. The number of stressful life events experienced after admission to the treatment facility was found to be related to increased behavior problems.

Parenting stress and child maltreatment in drug-exposed children.

This study was conducted to examine the relationship between prenatal exposure to drugs and parenting stress and child maltreatment. The sample was comprised of 48 subjects including 24 drug-exposed children and a comparison group of 24 non-drug-exposed children matched on age, race, gender and socioeconomic status. The subjects' age ranged from 1 to 33 months with a mean of 13 months. As predicted, mothers who used drugs during pregnancy reported higher levels of stress than foster mothers and comparison mothers on total parenting stress, child related stress, and parent related stress as measured by the Parenting Stress Index (Abidin, 1990). Biological mothers and foster mothers of drug-exposed infants scored higher than comparisons on child-related stress, most notably in the areas of hyperactivity, distractability and adaptability. A strong association was found between maternal use of drugs and child maltreatment serious enough to necessitate removal of the children by CPS. Over 40% of the drug-exposed children were in foster care, most often with maternal grandmothers. Most mothers who used drugs during pregnancy were polysubstance abusers and 21% were intravenous drug users increasing the risk of HIV infection for mothers and children. Implications for intervention are discussed.

Birth outcomes, health problems, and neglect with prenatal exposure to cocaine.

Thirty children exposed prenatally to maternal use of cocaine were compared to 30 nonexposed subjects on maternal variables, birth outcomes, health problems in early childhood, and issues related to child maltreatment. Cocaine-exposed infants were more likely to have mothers who received inadequate prenatal care, have adverse birth outcomes including prematurity and retarded intrauterine growth, and have health problems beyond the newborn period including small stature and hypertonia. More cocaine-exposed children were placed in foster homes due to maternal neglect.

Methodological issues in child sexual abuse research.

Research has only recently documented the negative effects of child sexual abuse. Investigators attempting to validate empirically the stress responses of children to sexual abuse are confronted with many methodological issues, including those related to measurement, sample selection, use of comparison subjects, and legal and ethical considerations. This article discusses methodological issues that need to be considered when designing and implementing studies on the impact of child sexual abuse. Suggestions are made for strengthening research designs, and several studies that have incorporated some of these suggestions are reviewed. Recommendations are made for areas that nurse researchers may want to explore in the future, such as parental and sibling response to sexual victimization, characteristics of children that may ameliorate the effects of sexual abuse, and children's responses to examination of the genitalia.