Addressing the wicked problem of childhood trauma through a nursing and cooperative extension system collaboration

The purpose of this clinical concept report is to describe a public health project in rural Indiana that addressed the complex social issue or “wicked problem” of childhood trauma. The project was implemented through a unique partnership between nursing faculty and Cooperative Extension Educators, community‐based workers who are associated with fulfilling the mission of Land Grant Universities. The core focus of the project entailed a nurse and a Cooperative Extension Educator co‐teaching trauma‐informed parenting classes to rural dwelling, kinship caregivers. Kinship caregivers are often grandparents who assume the parenting role after the child has been removed from the birth parents’ care. The trauma‐informed curriculum was developed by experts in child trauma and is available through the National Child Traumatic Stress Network. The unique partnership provided insight into the different missions of the two organizations, different values and workflow metrics, and different schedules, which at times proved to be barriers to implementation. This discussion focuses on deconstructing the goals and objectives of the project and retrospectively, describing recommendations so that public health nurses may partner with Extension Educators in their communities for optimal project success.     

The effect of kin, social network and neighbourhood support on individual well-being

This paper explores the effects of kin, social network and the neighbourhood on an individual's well-being. The material is drawn from a community-based qualitative study that explored the attitudes and experiences of African-Caribbean adolescents and their families in the north of England towards healthy lifestyles. A convenience sample of 10 African-Caribbean households units comprising 24 adolescents (12-18 years of age) and 18 adults (22-60 years of age) participated in the study with interviews conducted in their homes. The paper focuses on the adult participants' perception of the role of social support networks and neighbourhood effects on well-being. An in-depth interview schedule was used to explore participants' perceptions on barriers to health and healthy lifestyles; and factors facilitating and inhibiting good health and healthy lifestyles. Data were subjected to thematic analysis with the aid of a Qualitative Data Analysis software package. Emerging categories were discussed with participants by conducting post interview visits and at community events. Findings indicated that participants believed that being a member of a kin network enhanced one's well-being, with such networks described as capable of providing protective support for one's health and well-being. In addition, they preferred to live in neighbourhoods with a high concentration of people of the same ethnicity, despite the effects of neighbourhood deprivation such as poor housing and lack of services. However, participants believed that ethnic segregation leads to marginalisation and further deprivation. These findings suggest that there is a need to explore further the influence of social networks and neighbourhoods on the full spectrum of an individual's well-being. The study concludes by suggesting that in considering new paradigms for the promotion of well-being, health and social care practitioners need to incorporate ways to promote social support and consider relevant psychosocial and neighbourhood factors in designing models of community well-being.     

A statistical test for detection of ancestral genetic contributions to disease occurrence in finite populations

We have been investigating cancer patterns in the Hutterites, a religious isolate residing on communal farms [Martin et al, 1980a,b,c]. Advantages of this population include extensive and accurate genealogies, essentially complete case ascertainment, and relatively uniform environmental background with regard to geographic location, lifestyle, and diet. However, application of the common epidemiological approach to familial risk assessment based on incidence in relatives of index cases [Haenszel, 1959] posed difficulties because all cases are probands. We also planned to employ matching to control for important confounders and thus had to deal with the problems of the matching of cases and controls as well as the existence of complex inbreeding [Hauck and Martin, 1982]. Our basic approach was to compare coefficients of kinship (F_m, a measure of coancestry) of cases with each other to coefficients between cases and matched controls drawn from the same population. We have developed a paired t-type statistic to assess the significance of observed differences. We present, as examples, application of our methods to the analysis of Hutterite data on neurofibromatosis, known to be inherited in autosomal dominant fashion, and on cancer. Neurofibromatosis showed significant familial aggregation, as expected. Breast, colon-rectal, and stomach cancer did not. We then show how to evaluate power and to determine appropriate sample sizes for detecting specified increases in kinship.     

Involvement and performance of women in community-directed treatment with ivermectin for onchocerciasis control in Rukungiri District,Uganda

The present study aimed: (1) to assess and improve the level of women's involvement in a strategy to control onchocerciasis by community-directed treatment with ivermectin (CDTI) in three parishes of Rukungiri District, Uganda; (2) to measure the performance of female community-directed health workers (CDHWs) in comparison with males; and (3) to identify culturally acceptable means of enhancing women's involvement in community-directed healthcare. Health education sessions were used to instruct community members to select female CDHWs in Masya Parish and to stress their potential importance in Karangara Parish; this subject was not raised in Mukono Parish. In all, 403 mature women who were randomly selected from the three parishes were interviewed as to their: (1) knowledge of the classes of people not eligible to take ivermectin; (2) knowledge and beliefs about the benefits of ivermectin; (3) participation in decision-making; and (4) attitudes on the performance of female CDHWs. For analysis, the respondees were divided into: (1) those who had or had not taken ivermectin treatment during the previous year; and (2) those who had or had not attended health education sessions. During the period when face-to-face interviews with women in randomly selected households were being carried out, participatory evaluation meetings (PEMs) were conducted in selected communities from the same parishes in order to reach a consensus on issues which could not easily be included in individual face-to-face interviews. Participant observations were also made regarding: how communities selected their CDHWs; how the CDHWs organised the distribution exercise and treated community members; and how the CDHWs kept records in order to understand issues which were deliberately hidden from the researchers during face-to-face interviews and PEMs. Significantly, the women who had been treated or health educated in Masya Parish were: (1) more knowledgeable on the groups which were not supposed to be treated; (2) aware of women's involvement in mobilisation of other community members; (3) involved in CDTI decision-making; and (4) had a better attitude towards female CDHWs' performance compared with males when compared with those from Karangara and Mukono parishes. There were no differences between the attitude of women in Karangara and Mukono parishes towards performance of female CDHWs. Face-to-face interviews and records from all parishes indicated that female CDHWs achieved as good a coverage as their male counterparts, and sometimes better, in about the same time. Health education increased the number of female CDHWs from nine to 52 in Masya Parish, from 7 to 22 in Karangara Parish and from 6 to 20 in Mukono Parish. Health education improved the attitude of women towards female CDHWs, but the actual experience of having and observing female CDHWs in action in Masya Parish had a more significant positive impact on the womenfolk, as well as on the rest of the community members, and created an impetus for more of them to become actively involved in actual ivermectin distribution. The present authors conclude that recruiting more female CDHWs and supervisors would reduce the current male domination of the health delivery services, greatly strengthening the activities of CDTI programmes.     

A population-based familial aggregation analysis indicates genetic contribution in a majority of renal cell carcinomas

The etiology of RCC is incompletely understood and the inherited genetic contribution uncertain. Although there are rare mendelian forms of RCC stemming from inherited mutations, most cases are thought to be sporadic. We sought to determine the extent of familial aggregation among Icelandic RCC patients in general. Medical and pathologic records for all patients diagnosed with RCC in Iceland between 1955 and 1999 were reviewed. This included a total of 1,078 RCC cases, 660 males and 418 females. With the use of an extensive computerized database containing genealogic information on 630,000 people in Iceland during the past 11 centuries, several analyses were conducted to determine whether the patients were more related to each other than members drawn at random from the population. Patients with RCC were significantly more related to each other than were subjects in matched groups of controls. This relatedness extended beyond the nuclear family. RRs were significantly greater than 1.0 for siblings, parents and cousins of probands. RRs were 2-3 for first-degree relatives and 1.6 for third-degree relatives. The risk of RCC is significantly higher for members of the extended family of an affected individual, as well as the nuclear family. Our results indicate that germline mutations are significantly involved in what has been defined as sporadic RCC.     

Gender,kinship and caregiver burden: the case of community-dwelling memory impaired seniors

BACKGROUND: This study examined whether there were gender and kinship (spouse, child, more distant relative) differences in caregiver burden. It further examined the constellation of gender and kinship by examining whether adult daughter caregivers experienced greater burden compared to wives, husbands, sons, and other more distant relatives. METHODS: The sample consisted of 305 family caregivers of memory-impaired individuals who were age 70 years or older and resided in non-institutional settings in Arkansas. A cross-sectional design was employed using validated measures to assess both the memory-impaired elders' and family caregivers' self-reported physical and memory status. RESULTS: After controlling for the age and health status characteristics of the memory-impaired elder, sociodemographic and health status characteristics of the family caregiver, and the caregiver coping response (measured by the sense of coherence), multiple regression analyses found kinship, but not gender differences in caregiver burden. Adult children experienced more caregiver burden than more distant relatives. There were no significant differences in caregiver burden between adult children and spouses. Adult daughters had greater caregiver burden scores compared to more distant relatives, but had comparable scores to wives, sons, and husbands. Other significant correlates of burden included caregiver personal characteristics (age and ethnicity) and the sense of coherence. CONCLUSIONS: The study discusses the practice implications of adult children and adult daughters' propensity to suffer burden when caring for their memory-impaired parents living in the community. It also discusses the relevance of caregiver personal characteristics and the sense of coherence as correlates of burden.     

Some observations and comments on the psychosocial profile of first-ever referrals to the psychiatric hospital,Enugu, Nigeria

The psychosocial characteristics of 126 consecutive first-ever referrals over a 30-day period to a psychiatric hospital in Nigeria are analysed. There was a male to female ratio of 1.7:1. The largest age group was of those aged 20–29 who constituted about 37.3 % of the total sample. The great majority were aged below 50 years. There were more married females (14.3 %) than single ones (11.9 %); while more men (34.1 %) were single than married (19.1 %). The majority (76.2 %) had received varying degrees of formal education in a country where there is a literacy rate of only about 20 %. About 50 % were unemployed at the time of referral while the majority of those employed were either farm workers or small tradesmen and artisans. The largest diagnostic category was schizophrenia, followed by the affective psychoses. Paranoid and catatonic schizophrenias were diagnosed more commonly than the other types of schizophrenia. Neurotic disorders were the third commonest group. An unclassified group consisting of those presenting with states of acute excitement was also delineated. There was a predominance of persons from the rural areas. Generally, violence, disruptive and abnormal behaviour were the main reasons for referral to hospital. The results obtained are compared with the results of studies from various other workers, while some of the problems hindering systematic field studies in psychiatric epidemiology in Africa are mentioned, as well as certain socio-cultural characteristics of the target population (of this study) which might be affecting the course of mental disorder occurring in its members.     

Just Like Raising Your Own? Grandmothers’ Perceptions of Parenting a Second Time Around*

Abstract: A defining characteristic of grandparents raising grandchildren is parenting a second generation of children. To learn how grandmothers compare parenting their grandchildren to parenting their children, 40 custodial grandmothers were interviewed. Results of a qualitative analysis indicated that grandmothers perceived themselves as wiser, more relaxed, and more involved with their grandchildren. Grandmothers also perceived added challenges such as having limited energy, negotiating changing family roles, and parenting in a toxic social environment. In terms of parenting behaviors and emotional bonds, some grandmothers saw similarities in parenting their children and grandchildren. Findings suggest that custodial grandmothers would benefit from parent education and training that takes into account their previous parenting experience yet still addresses the unique challenges associated with parenting grandchildren.     

Tattered Textures of Kinship: The Effects of Torture Among Iraqi Families in Denmark

ABSTRACT

Drawing on ethnographic fieldwork in Denmark, primarily among Iraqi women and secondarily among Iraqi men who are either direct or indirect victims of torture, I explore how the memories of torture are distributed in the everyday lives of Danish families originating from Iraq. I argue that torture is folded into kin histories and the everyday work of bearing and resisting painful memories. Consequently, torture affects not only the mental and physical health of the singular survivor, but also the entire texture of kin relatedness around him or her, to the extent that kinship normativity may be disrupted. Leaning on the metaphor of a rugged cloth, I conclude by arguing that the way in which torture makes and unmakes kin relatedness congeals in what I term tattered textures of kinship.     

山西省贲门癌患者血缘亲属患病风险比较研究

目的 对比分析贲门癌病例组与对照组血缘亲属患病风险,了解家族中危险亲属人群患贲门癌的新线索.方法 采用病例对照方法,对贲门癌病例组和对照组各772例进行逐层分析,比较两组各血缘亲属父系、母系贲门癌患病相对危险度(RR)及差异.结果 (1)合计和男性病例组一级亲属贲门癌患病危险显著高于对照组(RR=2.61,95％CI:1.44～ 4.73,P＜0.01).(2)以父系和母系亲属逐层分析,合计和男性病例组父系亲属贲门癌患病危险显著高于对照组(P＜0.05),母系亲属中男性贲门癌患病危险显著高于对照组(P＜0.05);进一步分析显示,合计和男性病例组中父系亲属中男性、母系亲属中女性贲门癌患病危险显著高于对照组(P＜0.05).(3)贲门癌患者一级亲属患贲门癌危险度显著高于对照组(P＜0.05).(4)贲门癌患者父系亲属与对照组患病危险的差异无统计学意义(P＞0.05),贲门癌患者母系亲属患病危险显著高于对照组(P＜0.05).结论 山西省贲门癌患者血缘亲属中贲门癌发病危险人群主要是一级亲属,应对此高风险人群开展防癌知识普及和筛查.