Young AIDS migrants in Southern Africa: policy implications for empowering children

Many AIDS-affected children in southern Africa engage in migration when household members fall sick or die from AIDS, or because they are sent to assist relatives. Despite this, little attention has been paid to the consequences of these movements for children's lives. Multi-method research, conducted in Lesotho and Malawi, revealed that children sent to live with kin commonly move over long distances and between urban and rural areas. They are generally not consulted or informed about these migrations and face a range of associated difficulties, particularly with integrating into new families and communities. Severed family ties exacerbate the difficulties faced by children who end up in institutions or on the streets. This paper advocates that policy approaches for those affected by AIDS should be children-centred and take into account the implications of migration at three levels. First, many of the difficulties children face could be overcome if they were familiar with the place and people they were moving to Second, children would be better able to cope with new situations if they were included in family discussions with decision-makers regarding their migration preferences. Third, maintaining ties with kin would ensure that children do not become distanced from their family and cultural heritage, which is essential for post-institutional support.     

Predictors of satisfaction with children's help for younger and older elderly parents

In structured interviews, parents aged 60 to 90 described their children's work and family responsibilities, the practical and affective support they exchanged with each of their children, their satisfaction with assistance received from their children, and their values regarding family relationships. Self-reported general health, proximity values, and kin-orientation values predicted satisfaction with children's help for the total sample. For parents aged 74 and younger, proximity values, reciprocity in help exchanges, number of children helping relatives other than the participant, and number of children working outside of the home predicted satisfaction; for parents aged 75 and older, self-reported general health and kin-orientation values predicted satisfaction. It is concluded that values regarding families, interdependence, and autonomy provide a critical context for reactions to help by adult children.     

Screening of family members of patients with premature coronary heart disease; results from the EUROASPIRE II family survey.

AIMS: To determine whether the Joint European Societies' recommendations that first degree blood relatives of patients with premature coronary heart disease (CHD) should be screened for coronary risk factors is being followed and, if so, how effectively these relatives are being managed. METHODS AND RESULTS: Using a postal questionnaire, 3322 relatives (siblings and children >/=18 years of age) of 1289 index patients in the EUROASPIRE II survey who had suffered from premature CHD (men under 55 years and women under 65 years) were asked whether screening for coronary risk factors had occurred and, if so, how they were being managed in terms of lifestyle advice and drug therapies. Overall, screening for coronary risk factors because of CHD in the family was only performed in 11.1% of siblings and 5.6% of children. However, prevalences of different cardiac risk factors were high both in relatives and offspring and a clear familial clustering could be documented. Less than 50% of siblings and 25% of children were given some general lifestyle advice regarding cardiac risk factors. Moreover, active interventions such as starting antihypertensive or lipid lowering drugs were rarely carried out, particularly in children of patients with premature CHD. CONCLUSIONS: European physicians rarely screen family members of patients with premature CHD for cardiac risk factors. General lifestyle style advice or active treatment for these risk factors are also rarely given. However, since these family members have a high prevalence and familial clustering of cardiac risk factors, they form an ideal target population for primary prevention of CHD in high-risk patients.     

Association between social relationships and survival of Swiss octogenarians. A five-year prospective, population-based study

BACKGROUND AND AIMS: Data from the literature reveal the contrasting influences of family members and friends on the survival of old adults. On one hand, numerous studies have reported a positive association between social relationships and survival. On the other, ties with children may be associated with an increased risk of disability, whereas ties with friends or other relatives tend to improve survival. A five-year prospective, population-based study of 295 Swiss octogenarians tested the hypothesis that having a spouse, siblings or close friends, and regular contacts with relatives or friends are associated with longer survival, even at a very old age. METHODS: Data were collected through individual interviews, and a Cox regression model was applied to assess the effects of kinship and friendship networks on survival, after adjusting for socio-demographic and health-related variables. RESULTS: Our analyses indicate that the presence of a spouse in the household is not significantly related to survival, whereas the presence of siblings at baseline improves the oldest old's chances of surviving five years later. Moreover, the existence of close friends is a central component in the patterns of social relationships of oldest adults, and one which is significantly associated with survival. Overall, the protective effect of social relationships on survival is more related to the quality of those relationships (close friends) than to the frequency of relationships (regular contacts). CONCLUSIONS: We hypothesize that the existence of siblings or close friends may beneficially affect survival, due to the potential influence on the attitudes of octogenarians regarding health practices and adaptive strategies.     

Attitudes of Turkish students toward elderly relatives

A sample of 152 Turkish university students responded to a questionnaire regarding their attitudes toward their elderly relatives. Attitudes toward elderly relatives and their presence in the home were generally positive, as would be expected in a traditional society. However, students' plans for their own old age indicated an orientation toward personal freedom and independence, rather than tradition. Males were more likely than females to foresee living with their children in old age, and females were more likely than males to mention a desire for independence. It was concluded that the extended family is losing its status as the ideal family type in Turkey, although close, cooperative family relations are still regarded as the norm.     

Fictive kin among oldest old African Americans in the San Francisco Bay area

OBJECTIVES: The purpose here is to identify those processes that account for the more active and supportive kinship networks among Black oldest old than found among their White age peers. METHODS: Focused interviews were conducted with 122 Blacks 85 years and older. Both open-ended and semistructured questions were asked in order to determine how Blacks defined family and kinship membership, their expectations for kin, and the desired levels of reciprocity. FINDINGS: A content analysis of the responses indicated that Blacks defined the boundaries of their families flexibly so as to include fictive kin, and they upgraded more distant kin into the status of primary kin. They also emphasized the importance of collateral relatives so as to expand the size of the network. DISCUSSION: These processes use personal choices as well as immediate needs to expand the basis of relatedness beyond blood and marriage. Thus the supportive capacities of networks increase in order to serve a potentially vulnerable population.     

Familial Risk of Asthma Among Adolescents and Their Relatives in Taiwan

Although family studies have established that asthma has a hereditary basis, little evidence has been presented about the family risk of simple asthma (AS or nonatopic asthma) and asthma with other atopic diseases (AWAD or atopic asthma) after adjusting for potential risk factors. In this study, data were collected on demographic variables and a wide range of known risk factors for asthma. Study participants were asthmatic adolescents and controls, and their relatives. The role of a familial history of asthma and atopic diseases in predicting asthma risk among asthmatic adolescents and their relatives was evaluated in a population-based family study conducted in southern Taiwan. Asthma risk factor data were collected through telephone interviews with students' parents for 207 asthmatic adolescents 11-16 years of age, their 1600 relatives, and 207 nonasthmatic adolescents in the control group and their 1638 relatives. The results show (after adjusting potential confounders) that a family history of asthma is highly associated with asthma in adolescents. Having two or more family members with asthma was associated with a 3.4-fold (95% confidence interval [CI]=1.0-12.0) increased risk of asthma among adolescents. Logistic regression was used to assess the effects of having an asthmatic relative and the effect of atopic diseases among relatives of cases. Having a family history of asthma and other atopic conditions, such as rhinitis and atopic dermatitis (adjusted odds ratio [AOR]=3.64, 95% CI=2.29-5.74 and AOR=1.94, 95% CI=1.53-2.46, respectively), was found to be a significant predictor of asthma in children. Along with a history of allergic rhinitis or atopic dermatitis, familial risks of asthma occurring in adolescents with and without other atopic diseases will be analyzed separately. A critical finding was the significant difference in a risk of asthma and atopic diseases among the relatives of asthma cases with atopic diseases and controls. However, for relatives of asthma cases without atopic diseases compared to control probands, AORs were highly significant for family history of asthma, but not for the family history of atopic diseases. These findings suggest that both forms of asthma may be hereditary, but there are differences in their modes of inheritance. Atopic status itself did not predispose a child to AS. A concomitant inheritance of a predisposition to asthma and atopic condition for AWAD cases was suggested.     

Cytokine overproduction in healthy first degree relatives of patients with IDDM

Summary Healthy family members of patients with insulin-dependent diabetes mellitus (IDDM) are known to share a number of immunological abnormalities with their affected relatives. Since monocyte and type 1 T-cell-derived cytokines contribute to the pathogenesis of IDDM, we studied the production of these cytokines in the healthy first degree relatives of 29 children with IDDM. We report that circulating tumour necrosis factor-α (TNF-α) and soluble interleukin-2 (sIL-2) receptor were present in increased amounts in non-diabetic family members at levels similar to those found in the diabetic children (duration of disease 3 months–5 years). Furthermore, marked hypersecretion of IL-1α and TNF-α by mitogen-stimulated peripheral blood mononuclear cells was found in both diabetic and healthy family members. Abnormalities of cytokine production in healthy relatives did not correlate with the presence of islet cell antibodies or with HLA DR type. These data indicate that healthy family members of patients with IDDM exhibit overproduction of a number of cytokines that have been implicated in diabetogenesis. [Diabetologia (1998) 41: 343–349] Received: 26 August 1997 and in revised form: 24 October 1997     

Personality, relationship closeness, and loneliness of oldest old adults and their children

This study examined the effects of personality, attachment, and dimensions of family solidarity on the loneliness of oldest old adults (i.e., 85 years and older) and their adult children. Parent-child dyads were formed with data collected from 100 parents and their children. Results from path analyses indicated that oldest old adults' loneliness was reduced by affection both for and from their children. Although an anxious personality decreased affection, perceptions of attachment to children increased feelings of affection. In addition, parents and children who had anxious personalities were more likely to be lonely, whereas loneliness was decreased for those with an extraverted personality. Children's loneliness also was decreased by association with their parents and by the quality of their friendships. Perceptions of childhood attachment to parents increased current affection and association with and fulfillment of parents' expectations.     

Comparison between ambulatory or stationary treatment systems for patients with rhematoid arthritis with reference to the development of the family situation

The evaluation of a detailed questionaire which was issued to 44 German female rheumatoid arthritis patients (family mothers) who underwent "Kur" treatment courses and a comparable group of Dutch patients who had ambulatory treatment only shows little advantage to the "Kur" system). The "Kur" patients had adjusted somewhat better to their illness and had retained more easily the extra-familial social contacts. In contrast, statistically significant advantages were clearly evident in the Dutch ambulatory treatment programm: 1. Over-all reduction in "feeling ill" 2. Reduced stress in association with the objectively reduced joint mobility 3. Reduced stress in association with pain 4. The support of the patient by immediate family members and other relatives is generally better 5. Better patient support possibilities by family friends 6. Reduced negative effects on family life 7. Reduced disruptive effects in relationships between the patients and their husbands and children 8. Higher degree of satisfaction with physicians and the treatment. In conclusion: Even if national behavioral differences are taken into consideration, the ambulatory system as practiced in Holland seems to hold significant advantages to the "Kur" system.     

Caring for the caregiver: evaluation of support groups for guardians of orphans and vulnerable children in Kenya

HIV and AIDS have altered the context in which millions of children in sub-Saharan Africa are raised. Many are under the care of a widowed or ill parent, and others are residing with their extended family. Caregivers of orphans and other vulnerable children (OVC) face a variety of stressors that may adversely affect children. This study explores potential benefits of caregivers' membership in support groups on their own psychosocial wellbeing, and on the treatment and psychosocial well-being of OVC aged 8-14 under their care. A post-test study design comparing members and non-members was applied, drawing upon random samples of current and prospective beneficiaries from a rural community in Kenya. With up to two children per caregiver eligible for study inclusion, the sample comprised 766 caregivers and 1028 children. Three-quarters of children had lost at least one parent. Nearly 90% were cared for by a female, often their natural mother or grandmother. Half of the caregivers were widowed and one-fifth had a chronic illness. Over one-third of caregivers were members of support groups, more commonly female caregivers. Regression analyses assessed the effect of support group membership after controlling for household, caregiver and child characteristics. Members reported less social marginalization, better family functioning and more positive feelings towards the children in their care than nonmembers. Children with caregivers in support groups exhibited fewer behavioral problems, higher rates of prosocial behavior and reported lower incidence of abuse from adults in their household. The psychological state of caregivers, however, was not associated with support group membership. Results underscore that quality care of vulnerable children hinges on interventions that address the psychosocial challenges facing their caregivers.     

Attitudes of Turkish students toward elderly relatives

A sample of 152 Turkish university students responded to a questionnaire regarding their attitudes toward their elderly relatives. Attitudes toward elderly relatives and their presence in the home were generally positive, as would be expected in a traditional society. However, students' plans for their own old age indicated an orientation toward personal freedom and independence, rather than tradition. Males were more likely than females to foresee living with their children in old age, and females were more likely than males to mention a desire for independence. It was concluded that the extended family is losing its status as the ideal family type in Turkey, although close, cooperative family relations are still regarded as the norm.An earlier version of this paper, based on a smaller sample of respondents, was presented at the 41st Annual Convention of the International Council of Psychologists, San Francisco, August 1983.     

The social support system of the Japanese elderly

The social support system of the Japanese elderly was observed in a national representative sample of elderly community residents. Perceived availability of emotional and instrumental support from family members, children living apart, siblings and relatives, neighbors, and friends was respectively estimated. For both emotional and instrumental support, the perceived most dependable source of support was family members living together, followed by children living apart, while neighbors and friends were less dependable sources of support. The results clearly indicated family-centrality in the social support system of the Japanese elderly. However, the results also indicated differential roles of family members, children living apart, and non-kin others in the social support system of the elderly, and suggested the need to observe dyadic social relationships of Japanese elderly individuals.Department of Public Health Practice Institute of Public Health     

Social aspects of patients with pulmonary tuberculosis in Indonesia

Tuberculosis (TB) patients have not only medical but also social problems related to their illness, which may influence their motivation for the completion of treatment. This study investigated the social aspects of patients with TB in an urban area of Jakarta, Indonesia. Most TB patients had poor nutritional status and lived in crowded environments. They faced joblessness and negative attitudes from their neighbors and relatives. A few of the patients were afraid that they would not find a partner; others said that their diseases impaired their marriages. We found that patients with a subnormal body mass index restricted their social contact with their family more than patients with a normal body mass index. In general, patients were supported by their families, both financially and socially. Our findings suggest that priority should be given to developing programs aimed at strengthening the family support of TB patients.     

Colonoscopic screening examination of relatives of patients with colorectal cancer. II. Relations between tumour characteristics and the presence of polyps.

Colonoscopy was offered to 206 first-degree relatives of 181 patients operated on for colorectal cancer (CRC). Findings of polyps in relatives correlated with Dukes staging, extent of dedifferentiation and localization of tumour in the operated patient, and type of family relationship. Adenomas in relatives and Dukes staging of carcinoma in the patients were inversely related. Relatives of patients with Dukes stage A tumour had more than twice as many adenomas as and a higher prevalence of multiple adenomas than relatives of patients with advanced cancer at the time of operation. If the patient had polyp(s) in addition to tumour, the number of adenomas per relative was almost doubled. Hyperplastic polyps in relatives were associated with poorly differentiated carcinoma in their related patients. These results support the theory that not all CRC are derived from polyps and that adenoma-derived CRC may have a better prognosis than 'de novo' CRC. An adenoma prevalence risk table is also presented.     

Older Persons in Thailand: A Demographic, Social and Economic Profile

Population aging is proceeding at a rapid pace in Thailand posing important challenges for the government and society as a whole. On the positive side, the material well-being of older persons in Thailand has been improving. Older Thais live in better quality houses with far more appliances and amenities compared to a decades or two ago. The recent spread of telephones improves their ability to maintain contact with children and relatives who live elsewhere. Still, a large rural and urban gap in material well-being remains. Also of concern, given current widespread reliance on children for material support, is that future elderly will have far fewer children to depend on. Hopefully efforts by family and state will complement each other and allow Thailand to adapt constructively to the inevitable ageing of its population.     

The dynamics of elderly support The transmission of solidarity patterns between generations

This paper analyses the support given to the handicapped elderly by their children on the basis of a large survey done in France where both the elderly and their middle-aged children were interviewed. These data allow us to address such questions as: "Who helps?", "Who receives help?" and "According to what principles?". Besides the principle of need which is at work, the results show that there is also the principle of equity, which functions through reciprocity. This study highlights two main processes in the dynamics of support for the elderly, its redistributive effects (family support mainly benefits the poorest elderly), and its complementarity with the state health care systems (family support is mainly directed towards those who also receive public help). Can we make the deduction that the more generous the welfare state, the more developed family solidarity is? Nevertheless, some difficulties arise: support is mostly given by women. Furthermore there are a small number of people on whose shoulders it falls to take care of everybody else in the family. One sign of these difficulties is that the carers are more often in less good health than the non-carers of the same age. Comparisons from one generation to the other, including the youngest (the children of the middle generation who were also interviewed) shows that the younger generation will not want to be so completely involved in parental care at the expense of their own private time and life. Most probably family involvement will be maintained in the future, but to a lesser extent.     

Chinese Older Adults Taking Care of Grandchildren: Practices and Policies for Productive Aging

Older adults around the world provide care and support for their family, relatives, and friends. This not only generates immense economic and social value, but is also an important aspect of productive aging. This paper analyzes data from the 2005 Chinese Longitudinal Health Longevity Survey (CLHLS), the 2008 Chinese Residents’ Time Use Survey, and a study conducted by the author (Sun Popul J 4:14–18, 2006). In rural China, because the young labor force works in cities, a large number of “left-behind children” live with their grandparents. Such cross-generational families made up over a quarter of rural households in 2005. In the cross-generational family, the role and value of caregiving for grandchildren by elderly grandparents has been strengthened, as has the burden of care placed upon them. Based on an analysis of the policies and practices of productive aging, this paper seeks to raise awareness of the enormous caregiving contributions made by older adults. Collecting information on older adult caregiving will help inform a policy framework to provide professional and systematic support, so that family and social care systems can operate effectively.     

Economic burden on families of childhood type 1 diabetes in urban Sudan

The aims of this study were to estimate the direct costs of childhood diabetes in a low income country, Sudan, and to assess the effectiveness of care paid for by the families. For this purpose, socio-economic and demographic data on families were obtained from the parents of 147 children with type 1 diabetes, attending public or private clinics in Khartoum State, Sudan. The median annual income of the families of diabetic children was US dollars (US$) 1222 (range 0-14,338) of which 16% was received as financial help from relatives and friends. The median annual expenditure of diabetes care was US$ 283 per diabetic child of which 36% was spent on insulin. Of the family expenditure on health, 65% was used for the diabetic child. Families of diabetic children who were attending private clinics had a significantly higher total expenditure on health and home blood glucose monitoring than those who were attending the public clinics. However, there was no difference in total income between the two groups and glycaemic control was poor in 86% of the patients, regardless of whether care was being given by private or public clinics. The occurrence of the disease and its poor control appeared to exert a negative impact on the school performance of the diabetic child. In conclusion, the low direct costs reflect the minimal care given to the diabetic patients. Under the present economic conditions, families pay a considerable part of their income to sponsor the health of their diabetic children and receive little support other than that from relatives and friends. The present organization of diabetes care does not provide the patient with empowerment, knowledge and self-care ability. Well-trained diabetic teams and education programs may improve this situation.     

Increased intestinal permeability precedes the onset of Crohn's disease in a subject with familial risk

Increased intestinal permeability to several specific molecular probes has been observed in patients with Crohn's disease and their first-degree relatives. A positive family history is also a potent risk factor for inflammatory bowel disease. Although it has been argued that increased permeability in relatives may confer an increased future risk of developing Crohn's disease, long-term follow-up of such family members has been lacking. We describe a 24-year-old woman with a positive family history of Crohn's disease who had an elevated gut permeability to (51)Cr-EDTA at age 13, as part of a cross-sectional cohort study in patients and their first-degree relatives. She was asymptomatic at the time, and extensive investigation found no evidence of microscopic or macroscopic Crohn's disease. Repeat investigation because of symptom onset at age 21 revealed ileocolonic Crohn's disease, which required treatment with systemic corticosteroids to induce a clinical remission. In this case, a permeability defect was clearly identified to precede the onset of Crohn's disease in a subject at increased risk. This observation provides support for the hypothesis that increased gut permeability to macromolecules is an early step in the pathogenesis of this disorder.