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.

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.

Cohesion and organization patterns among family members coping with rheumatoid arthritis.

The effects of rheumatoid arthritis (RA) on family functioning are described from two perspectives, cohesiveness and organization. These concepts are believed to be essential for assessing levels of family stability following the onset of a life crisis. In this study we characterized the ways in which families organize their daily activities and achieve family cohesiveness. Fifteen families participated in the study. The data showed family members have positive perceptions about their family cohesiveness and organizational behaviors, which were characterized in personal interviews. Families also discussed active and passive coping styles in response to RA. Implications for social work practice and issues for future research are presented.

Variability in the attainment of functional milestones during the acute care admission after total joint replacement.

OBJECTIVE: To quantify patients' functional improvement in the immediate postoperative period after total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: A prospective observational study design was used to examine the number of physical therapy treatment sessions and postoperative days required to attain independence in 4 critical functional milestones, with independence defined as the ability to perform the activity without the assistance of another person. The 4 functional milestones selected were the ability to perform supine to sit transfers; sit to stand transfers; ambulation to 100'; and the ability to climb stairs. Consecutive patients undergoing elective THA or TKA for the first time at a community teaching hospital were entered into the study. RESULTS: The study group consisted of 81 patients undergoing elective THA or TKA (33 THA and 48 TKA). There was wide variability in the number of physical therapy sessions and postoperative days required to attain each of the 4 milestones and all 4 milestones. Climbing stairs was the most difficult task, followed by walking 100', performing sit to stand transfers, and performing supine to sit transfers. The achievement of the latter 2 milestones was similar. CONCLUSION: Our examination of patients' progress in attaining specific functional milestones is a unique approach to outcome assessment that emphasizes the physical therapy aspect of postsurgical rehabilitation. A wide variability in patients' functional progress during the acute care admission after elective THA or TKA was demonstrated. The reasons for this variability need to be explored since they may have important implications for planning rehabilitation related to THA, TKA or other orthopedic reconstructive procedures.

Age, sex, and the familial risk of rheumatoid arthritis.

The familial aggregation of rheumatoid arthritis was examined to determine factors modifying the risk of rheumatoid arthritis in first degree relatives of 165 cases ascertained from January 1, 1987, through March 31, 1987, using the Saint Margaret Memorial Hospital Rheumatoid Arthritis Registry, Pittsburgh, Pennsylvania, without regard to previous information concerning the occurrence of rheumatoid arthritis among their family members. The reported affection status of first degree relatives, verified through a structured clinical evaluation, revealed a false-positive reporting rate for family members of 61%. In contrast, there were no false-negative cases detected. There were no differences in average family size or total number of years at risk between 135 simplex and 30 multiplex families; however, aggregation analysis revealed that only 18 of 30 confirmed multiplex families had significant excess risk of rheumatoid arthritis. Significant differences were found when probands from multiplex families were compared with those from simplex families with regard to female to male ratio for probands (1:1 in multiplex families vs. 3:1 in simplex families) and average age of onset for probands (41 years in multiplex families vs. 48 years in simplex families). The familial risk for rheumatoid arthritis was similar in parents (4.2%) and siblings (4.6%) and lowest for children (0.7%) of probands. The authors assert that the affection status of first degree relatives of patients with rheumatoid arthritis is often falsely reported as positive. The familiality of rheumatoid arthritis may be more accurately related to the sex and age at onset of the affected family member.