Working and caring for a child with chronic illness: A review of current literature.

BACKGROUND: Advances in medical knowledge have contributed to the increase in the number of children living with some form of long-term chronic illness or condition. As a consequence of these advancements, treatments that are more accessible and easier to administer, usually within a child's home, have been developed. However, this may mean that parents take on greater treatment responsibility and require extra time and energy to meet these tasks, additional to other responsibilities. This review paper aims to summarize and critique existing literature on working parents of children with a chronic condition, by focusing on patterns of parent work, the challenges experienced, and the flow-on consequences to well-being. METHODS: Employing a narrative, meta-synthesis of the current literature, this review identified 3 key themes related to working parents of children with chronic illness. RESULTS: The paper first identifies that although employment is less common, these parents are not necessarily nonworking. Second, these parents experience numerous challenges including balancing work and family, time constraints, stress, and feelings of "doing it all." And third, the above challenges lead to additional impacts on parental quality of life. CONCLUSIONS: This review summarizes what is currently known about work patterns, challenges, and consequences in parents of children with chronic conditions. Employment is clearly impacted for these parents. Although workplace challenges have been extensively researched, other challenges (eg, personal and family) and impacts on their well-being have not. This review discusses the present standing of this research. It outlines the strengths and limitations of the current literature, makes recommendations for future research, and suggests theoretical and practical implications of the further findings.

Femoral intercondylar notch width size: a comparison between siblings with and without anterior cruciate ligament injuries.

PURPOSE: Anterior cruciate ligament (ACL) injuries in siblings are commonly observed in the clinic. One, possibly genetic, factor contributing to the pathogenesis of sibling injuries may be narrow intercondylar notches, which are well recognized as predisposing to ACL injury. This study aimed primarily to: (1) assess the incidence of ACL injuries in siblings within an existing study cohort, (2) compare intercondylar notch width size in injured compared to matched uninjured control siblings and (3) compare the number of injured versus control sibling pairs sharing a narrow notch. METHODS: Twenty-four ACL-injured siblings from 10 families were matched for age, gender, family composition and sports activity, with 24 uninjured siblings from another 10 families. Intercondylar radiographs were taken to calculate anterior and posterior notch width indices (NWI). Notch size and the number of narrow notches in sibling pairs were compared between groups. RESULTS: Thirteen of 72 ACL-study participants had siblings with torn ACLs. Mean anterior NWI was 0.18 and 0.24 (p < 0.001), and mean posterior NWI was 0.26 and 0.3 (p = 0.006) for injured and uninjured siblings, respectively. Sixty percent of injured sibling pairs shared a narrow notch, while no uninjured sibling pairs did so (p = 0.003). CONCLUSION: This study showed that siblings (and often sibling pairs) with injuries do have significantly narrower notches than those without. This could partly explain the prevalence of ACL injuries in siblings. To reduce ACL-injury rates, we advise that siblings of ACL-injured athletes with narrow notches, be radiologically screened, and if necessary, cautioned and counselled regarding preventative training. LEVEL OF EVIDENCE: Case-control study, Level III.

The effect of anticoagulation on the restoration of range of motion after total knee arthroplasty: enoxaparin versus aspirin.

Anticoagulation used for thromboembolic prophylaxis following total knee arthroplasty (TKA) could interfere with movement. This study compares the effect of 2 anticoagulants, enoxaparin and aspirin, on restoration of range of motion (ROM) after TKA. Two groups of 75 consecutive patients, matched for age, arthritic severity, and preoperative ROM, underwent TKA. Flexion and extension milestone measures were recorded daily. Results show a highly statistically significant difference (P<.001) between the 2 groups when comparing the days on which these milestones were achieved. Group 1 (enoxaparin) reached 90 degrees, 100 degrees and 110 degrees of flexion in 8.4, 10.4, and 12.4 days, respectively. Group 2 (aspirin) reached the same goals in 6.8, 8.5, and 10.6 days, respectively. At 15 months after surgery, no statistically significant difference in flexion was seen between the groups (122 degrees vs 121 degrees ). Enoxaparin delayed the return of early but not long-term flexion after TKA.

Explicitly questioning the nature of suggestibility in preschoolers' memory and retention.

In research designed to investigate children's suggestible responses on memory tests, 190 preschoolers were read a short story. The same day or six days later, they were exposed to information that was either consistent with the original story details or inconsistent and misleading. One and seven weeks after hearing the story, the children were tested on two types of recognition tasks that involved a choice either between the original and misleading information or between the original and new information with questions that were either explicit or nonexplicit as to the time of the information to be reported. At the 1-week test, children who were exposed to misleading information were significantly less accurate under nonexplicit questioning in recognizing the original from the misleading information than were children presented with consistent information. With explicit questioning, this difference was not significant. When the choice for the children was between original and new items following exposure to delayed misleading postevent information, explicit questioning resulted in significantly more accurate responses at the 7-week test than did nonexplicit questioning. Children questioned explicitly rather than nonexplicitly were more likely to maintain correct responses on both tests. The results are discussed in terms of conversational processes and competing forms of representation in memory retention.

Where to look first for suggestibility in young children.

Preschoolers' suggestibility following exposure to biased information has often been interpreted as indicating that memory traces have been genuinely altered. However, young children may not recognize that the purpose and relevance of questions in experiments on suggestibility is to determine whether they can ignore misinformation in remembering the original details of stories. Instead, children may be prompted to regard the original story details as trivial by experimenters who are perceived as having portrayed these details as unimportant or irrelevant in that they themselves did not bother to get these right. Under such conditions, children may interpret the biased information to mean that a biased alternative was an acceptable, or even a preferred, test choice when compared to the original details. We report the results of an investigation with 3- to 5-year-olds in which children heard a story followed the next day by either biased, unbiased, or no information. The children were able to identify the original story details 6 days later when the questions were phrased in an explicit manner that referred to the time of the information to be recalled.