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This book is the first in-depth exploration of grandparents' relationships with adult children and grandchildren in divorced families. It asks what part grandparents might play in public policy and whether measures should be taken to support their grandparenting role. Do they have a special place in family life that ought to be recognised in law?
Ensuring equitable access to health care is a widely agreed-upon goal in medicine, yet access to care is a multidimensional concept that is difficult to measure. Although frameworks exist to evaluate access to care generally, the concept of “access to genomic medicine” is largely unexplored and a clear framework for studying and addressing major dimensions is lacking.
Methods:
Comprised of seven clinical genomic research projects, the Clinical Sequencing Evidence-Generating Research consortium (CSER) presented opportunities to examine access to genomic medicine across diverse contexts. CSER emphasized engaging historically underrepresented and/or underserved populations. We used descriptive analysis of CSER participant survey data and qualitative case studies to explore anticipated and encountered access barriers and interventions to address them.
Results:
CSER’s enrolled population was largely lower income and racially and ethnically diverse, with many Spanish-preferring individuals. In surveys, less than a fifth (18.7%) of participants reported experiencing barriers to care. However, CSER project case studies revealed a more nuanced picture that highlighted the blurred boundary between access to genomic research and clinical care. Drawing on insights from CSER, we build on an existing framework to characterize the concept and dimensions of access to genomic medicine along with associated measures and improvement strategies.
Conclusions:
Our findings support adopting a broad conceptualization of access to care encompassing multiple dimensions, using mixed methods to study access issues, and investing in innovative improvement strategies. This conceptualization may inform clinical translation of other cutting-edge technologies and contribute to the promotion of equitable, effective, and efficient access to genomic medicine.
Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.
Methods:
A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.
Results:
Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.
Conclusions:
In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
Brizolis asked for which primes p greater than 3 there exists a pair (g,h) such that h is a fixed point of the discrete exponential map with base g, or equivalently h is a fixed point of the discrete logarithm with base g. Various authors have contributed to the understanding of this problem. In this paper, we use p-adic methods, primarily Hensel’s lemma and p-adic interpolation, to count fixed points, two-cycles, collisions, and solutions to related equations modulo powers of a prime p.
Breakfast consumption has been associated with better mental health in adulthood, but the relationship between breakfast and mental health in adolescence is less well known. The aims of the present study were to evaluate breakfast quality in a cohort of adolescents and to investigate associations with mental health.
Design
Cross-sectional population-based study. Breakfast quality was assessed by intake of core food groups at breakfast, as determined from 3 d food diaries. Mental health was assessed using the Child Behaviour Checklist (CBCL), with higher scores representing poorer behaviour.
Setting
The Western Australian Pregnancy Cohort (Raine) Study, Perth, Western Australia.
Subjects
Eight hundred and thirty-six males and females aged between 13 and 15 years.
Results
Mean mental health score as assessed by the CBCL was 45·24 (sd 11·29). A high-quality breakfast consisting of at least three food groups was consumed by 11 % of adolescents, while 7 % of adolescents did not consume any items from core food groups on average over the 3 d period. The two most common core food groups consumed at breakfast in this population were dairy products followed by breads and cereals. For every additional food group eaten at breakfast, the associated total mental health score decreased by 1·66 (95 % CI −2·74, −0·59) after adjustment for potential confounding factors, representing an improvement in mental health score.
Conclusion
These findings support the concept that breakfast quality is an important component in the complex interaction between lifestyle factors and mental health in early adolescence.
We present a unique case of a mucin-secreting papillary adenocarcinoma of intestinal type which has invaded and completely destroyed the hyoid bone and metastasized to the cervical lymph nodes bilaterally. The tumour is believed to have originated from a malignant thyroglossal duct remnant, and was managed with surgery and radiotherapy. We describe the case and discuss the literature regarding hyoid bone tumours.
This chapter explores how, and to what extent, the three generations in our group of divorced families communicated with each other about marriage breakdown and its consequences. First, it looks at the way that parents warned their own parents about their impending separation, and then investigates what the grandchildren told their mothers, fathers and grandparents about their relationships with the ‘other side’ of their divided families. The chapter also investigates whether or not children were used as conduits for the flow of information between the two sides of the divorced family.
Telling grandparents about the planned separation
Although grandparents were not asked directly when and how they were told about the breakdown of their child’s marriage, the interview guide included questions about their relationships with grandchildren before and after the separation. Almost half the grandparents interviewed mentioned their surprise at learning of their child’s separation. It was common for parents to hide their marriage problems from their own parents and the news of the separation often came as a shock to grandparents. Parents admitted that they were reluctant to take grandparents into their confidence, but their explanations made it clear that this was neither symptomatic of a lack of affection nor a failure to anticipate the likely effects of their separation on the wider family. A rather similar conclusion, it may be recalled, was made as a result of the investigation of children’s reluctance to confide in their grandparents when they felt upset or worried about family break-up (see Chapter Three).
The deliberate concealment of problems might be interpreted as evidence that parents did not consider grandparents to be involved. However, divorced couples were also concerned about disappointing their parents; they were worried about invoking their displeasure and anxious to protect them from the pain of their divorce – feelings that are characteristic of many parent–child relationships. The interview data revealed that most mothers had worried needlessly and were pleasantly surprised by their parents’ reactions to being told that the marriage had ended. For example, Alfie’s mother recalled:
Really, my parents could have said to me, ‘What are you doing, splitting up? This is so wrong! Don’t be ridiculous! For goodness sake, pull yourself together!’ . But they listened to what I had to say. And, rightly or wrongly, they love me and they told me so.
In Chapter Two, we discussed some of the factors that previous studies have indicated influence the nature of grandparents’ relationships with their grandchildren. In this chapter, we ask: ‘What importance do grandchildren attach to their relationship with their grandparents and how might these relationships be affected by divorce? And, ‘is there evidence of continuity in the grandparent–grandchild relationship in divorced families as well as evidence of change as the result of family break-up?’.
Grandparent’s relationships with their grandchildren
The studies reviewed in Chapter Two made it clear that grandparent age is related to the frequency of grandparents’ contact with their grandchildren and that older grandchildren have less contact with their grandparents. But does this mean that they are not as emotionally close to their grandparents? Here, we begin by considering the views of some teenage grandchildren and their feelings about their grandparents. They reported that they have close relationships with their grandparents, but this assertion was often accompanied by apparently contradictory evidence of a growing emotional distance. Being ‘close to grandparents’ could mean seeing them regularly, enjoying their company, sharing intimacies and expressing affection. However, we discovered that the phrase need not imply anything about frequency of contact and was used on occasion to mean ‘nurturing positive feelings’. Evidence from divorced parents suggested that older grandchildren saw their grandparents less frequently than their younger brothers and sisters. Mothers, we discovered, occasionally reminded their children that they had not seen their grandparents for some time and persuaded them to accompany them on a visit to their grandparents’ home. They reported a gradual reduction in their children’s contact with their grandparents. Most felt that this did not mean that relationships could no longer be described as ‘close’ or that grandchildren and grandparents felt less affection for each other. It was, in parents’ opinions, understandable that the relationship should change.
Alfie’s mother had been separated for two years before her decree nisi was granted over four years ago. She had a particularly close relationship with her parents who lived about a mile away and had been very supportive of her and her three children, aged 12, 16 and 18. She commented that the maternal grandparents’ ‘unconditional love’ had taught her a lot about bringing up her own children.
Following parental separation and divorce, grandparents in our study usually sympathised with their adult child and criticised the behaviour of their ex-son or ex-daughter-in-law. However, this was not the only strategy and, although it is recognised that divorce is a difficult process, some couples appeared to achieve reasonably harmonious arrangements and a minority of grandparents demonstrated that their non-partisan approach could also make a contribution to harmony. Most, however, did not think about the longer-term implications of their relationships with an ex-child-in-law. They were often angry and some were bitterly partisan in their feelings. Some grandparents took sides after the break-up and continued to harbour strong feelings of resentment for their sons or daughters-in-law long after their child’s marriage had ended. Parents often reported that their own parents had ceased contact with their exspouse because they held him or her responsible for the failure of the marriage. This was often presented as a natural feeling and one that might reasonably be expected of grandparents in a divorced family.
Grandparents’ partisan feelings
Twenty-five grandparenting couples and 11 lone grandparents in 30 different families were interviewed in the course of the research. There were 21 interviews with maternal grandparents and 15 with paternal grandparents. Five maternal and two paternal grandparents took an apparently neutral stance when asked about their relationship with their ex-child-in-law. They said that they were ‘civil’ and ‘polite’ to their child’s ex-spouse or explained that there was ‘no contact but no animosity’. In nine grandparent interviews (five with maternal and four with paternal grandparents) it was clear that they had retained friendly relationships with their divorced child’s ex-spouse. However, more than half of our grandparents (11 maternal and 9 paternal) expressed resentment.
Grandparents’ resentment
Ann’s parents and maternal and paternal grandparents were all interviewed. Ann is eight years old and has a three-year-old brother. Ann has learning difficulties (this aspect of her relationship with her grandparents was discussed in Chapter Four of this book).
Ann’s parents divorced two years ago and Ann’s father had a new partner. Ann’s mother had maintained friendly relationships with the paternal grandparents but the maternal grandparents were angry with their ex-son-in-law. Ann’s mother took Ann and her brother to see her ex-husband’s parents almost every week.