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COVID-19 has had serious consequences in all areas of social life, including education. In this period, distance education appeared as an inevitable solution. Even today, when the pandemic process is over and re-normalization has begun, online teaching environments have become such an indispensable part of education systems that it has been decided that a certain proportion of the courses will be conducted online in universities. For this reason, determining student experiences in online courses is important in planning the future of distance education. Since academic performance is the output of the teaching process, students' academic performance is one of the topics of interest in higher education research. There may be different factors affecting the academic performance of students in the distance education process, which imposes more responsibility on students and requires self-control. This study aimed to examine the relationship of academic performance in the distance education with home infrastructure, student interaction, computer skills, academic satisfaction. This research is based on a large-scale study, "The impact of the COVID-19 pandemic on the lives of higher education students", examining the pandemic's impact on higher education student perceptions in 2020. It has been observed that home infrastructure has a significant impact on the student's academic performance. The infrastructure increases the interaction of the student. When home infrastructure is taken as a control variable, students' computer skills are the highest predictor of their perception of academic performance, followed by their online interactions and, finally, perceived satisfaction. Today, pandemic conditions are still ongoing. In addition, even as the pandemic ends, online education has become an indispensable part of our education system. Therefore, the findings of the research would be beneficial for the ongoing planning process.
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Education plays a critical role in promoting preventive behaviours against the spread of pandemics. In Japan, handwashing education in primary schools was positively correlated with preventive behaviours against COVID-19 transmission for adults in 2020, during the early stages of COVID-19. The following year, the Tokyo Olympics were held in Japan, and a state of emergency was declared several times. Public perceptions of and risks associated with the pandemic changed drastically with the emergence of COVID-19 vaccines. We re-examined whether the effect of handwashing education on preventive behaviours persisted by covering a longer period of the COVID-19 pandemic than previous studies. A total of 26 surveys were conducted nearly once a month for 30 months from March 2020 (the early stage of COVID-19) to September 2022 in Japan. By corresponding with the same individuals across surveys, we comprehensively gathered data on preventive behaviours during this period. In addition, we asked about the handwashing education they had received in their primary school. We used the data to investigate how and to what degree school education is associated with pandemic-mitigating preventive behaviours. We found that handwashing education in primary school is positively associated with behaviours such as handwashing and mask wearing as a COVID-19 preventive measure but not related to staying at home. We observed a statistically significant difference in handwashing between adults who received childhood handwashing education and those who did not. This difference persisted throughout the study period. In comparison, the difference in mask wearing between the two groups was smaller but still statistically significant. Furthermore, there was no difference in staying at home between them. Childhood hygiene education has resulted in individuals engaging in handwashing and mask wearing to cope with COVID-19. Individuals can form sustainable development-related habits through childhood education.
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Social determinants of mental and physical health that influence young peoples' trajectories into adulthood are often remediable through law. To address inequalities, including those exacerbated since the COVID-19 pandemic, there is a need to better understand young people's need for and uptake of advice for social welfare legal problems. This scoping review aimed to review available evidence and identify gaps to inform further research. To identify studies relevant to social welfare legal advice among young adults we conducted searches of eight bibliographic databases (compiled between January 1998 and June 2020), hand searches of included article reference lists and targeted grey literature searches. 35 peer reviewed and grey literature studies were selected based on inclusion and exclusion criteria including evaluations of interventions to promote access to advice, general population surveys, observational studies, and audits of charity data or targeted surveys. Evidence suggests considerable and inequitable need for social welfare legal advice among young adults with adverse consequences for health and wellbeing. Needs among higher risk groups are likely underestimated. Evidence for interventions to enhance access/uptake of advice is limited and methodologically weak. We identify several gaps in the literature to inform research and to enable systematic reviews around more specific questions to inform practice.
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Suicide remains to be one of the leading causes of death amongst young people worldwide. Help-seeking, however, remains disproportionately suboptimal in the youth population. Identifying more effective and less stigmatizing markers of suicidal ideation and behaviours can be important for improving early engagement and intervention work. We therefore examined the prevalence of suicidal ideation, plan, and attempt in a large epidemiological youth sample in Hong Kong (n = 2540) during the period of 2019-2021, as well as the factors associated with each of these outcomes using separate multivariable logistic regression models. In this sample, the 12-month prevalence of suicidal ideation, plan, and attempt was 20.0%, 4.6%, and 1.3%, respectively. In particular, we found 'suicide-related rumination' to be amongst the only factor that was significant for all three outcomes (p < .010). Using a two-stage approach (i.e., selecting only those with suicidal ideation), we found that suicide-related rumination, poorer cognitive ability, and 12-month major depressive episode were specifically associated with 12-month suicide plan, while environmental factors, including COVID-19 stressors, personal life stressors, poorer family relationships, as well as non-suicidal selfharm, were specifically associated with 12-month suicide attempt. A two-stage approach should be considered in future interventions targeting youth suicide. Suicide-related rumination may be an important marker of overall suicidal risk. The role of environmental stressors in addition to intrinsic vulnerability also need to be emphasized to best support young people at risk.
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Submission content Introduction: An unusual case of a very young patient without previously known cardiac disease presenting with severe left ventricular failure, detected by a point of care echocardiogram. Main Body: A 34 year old previously well man was brought to hospital after seeing his general practitioner with one month of progressive shortness of breath on exertion. This began around the time the patient received his second covid-19 vaccination. He was sleeping in a chair as he was unable to lie flat. Abnormal observations led the GP to call an ambulance. In the emergency department, the patient required oxygen 5L/min to maintain SpO2 >94%, but he was not in respiratory distress at rest. Blood pressure was 92/53mmHg, mean 67mmHg. Point of care testing for COVID-19 was negative. He was alert, with warm peripheries. Lactate was 1.0mmol/L and he was producing more than 0.5ml/kg/hr of urine. There was no ankle swelling. ECG showed sinus tachycardia. He underwent CT pulmonary angiography which demonstrated no pulmonary embolus, but there was bilateral pulmonary edema. Troponin was 17ng/l, BNP was 2700pg/ml. Furosemide 40mg was given intravenously by the general medical team. Critical care outreach asked for an urgent intensivist review given the highly unusual diagnosis of pulmonary edema in a man of this age. An immediate FUSIC Heart scan identified a dilated left ventricle with end diastolic diameter 7cm and severe global systolic impairment. The right ventricle was not severely impaired, with TAPSE 18mm. There was no significant pericardial effusion. Multiple B lines and trace pulmonary effusions were identified at the lung bases. The patient was urgently discussed with the regional cardiac unit in case of further deterioration, basic images were shared via a cloud system. A potential diagnosis of vaccination-associated myocarditis was considered,1 but in view of the low troponin, the presentation was felt most likely to represent decompensated chronic dilated cardiomyopathy. The patient disclosed a family history of early cardiac death in males. Aggressive diuresis was commenced. The patient was admitted to a monitored bed given the potential risk of arrhythmia or further haemodynamic deterioration. Advice was given that in the event of worsening hypotension, fluids should not be administered but the cardiac centre should be contacted immediately. Formal echocardiography confirmed the POCUS findings, with ejection fraction <35%. He was initiated on ACE inhibitors and beta adrenergic blockade. His symptoms improved and he was able to return home and to work, and is currently undergoing further investigations to establish the etiology of his condition. Conclusion(s): Early echocardiography provided early evidence of a cardiac cause for the patient's presentation and highlighted the severity of the underlying pathology. This directed early aggressive diuresis and safety-netting by virtue of discussion with a tertiary cardiac centre whilst it was established whether this was an acute or decompensated chronic pathology. Ultrasound findings: PLAX, PSAX and A4Ch views demonstrating a severely dilated (7cm end diastolic diameter) left ventricle with global severe systolic impairment.
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The COVID-19 pandemic has impacted society: causing the collapse of health systems around the world, and also had a significant impact on the economy, personal care, mental health and the quality of life of the population. Few studies have been done about pandemic and the climacteric population, and the impact on quality of life and health. Our objective was to Investigate changes in the health and health care of climacteric women residing in Brazil during the pandemic period. Cross-sectional study with climacteric women aged between 40 and 70 years, residing in Brazil. The evaluation was carried out using a Google Docs electronic form with questions related to sociodemographic, clinical, gynecological data, treatments, access to health services and consultations, as well as changes in behavior. The Menopause Rating Scale - MRS was applied to assess climacteric symptoms, validated for Portuguese. Result(s): 419 women answered the questionnaire. More than 45% were between 51 and 60 years of age, 56.6% being married and residing in Brazilian capitals. 60% of participants reported weight gain during the pandemic. 50.8% of participants reported a decrease in the weekly practice of physical activity More than 80% reported worsening mental health during this period, and 66.1% had a change in their sleep pattern. More than half reported having difficulty accessing gynecological consultations. Women living in capital cities reported a greater increase in alcohol consumption (p=0.002). Food intake increased for 54.9%;the category of civil servant was associated with a significant increase in consumption in relation to other professions (p=0.038). Women whose family incomes changed during the pandemic had a higher prevalence of weight gain (p=0.033) and also had a higher occurrence of changes in sleep quality (72.6% vs. 61.5%;p=0.018). Women with a high school education had a higher occurrence of alterations in personal and health care outcomes (p<0.001). Conclusion(s): We observed an important reduction in the health care of climacteric women during the pandemic period. Changes in life habits, such as increased food consumption and reduced physical activity, were quite prevalent. There was a deterioration in mental health, with a high prevalence of anxiety symptoms and changes in sleep quality. Despite the attenuation of the pandemic, attention should be given to the health care of this population, as the changes may have repercussions for many years.Copyright © 2023
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BackgroundConsideration is needed when using Janus kinase (JAK) inhibitors to treat RA in pts aged ≥65 years or those with cardiovascular (CV) risk factors. The JAK1 preferential inhibitor FIL was generally well tolerated in clinical trials[1];safety has not been determined in a real-world setting.ObjectivesTo report baseline characteristics and up to 6-month safety data from the first 480 pts treated with FIL in the FILOSOPHY study (NCT04871919), and in two mutually exclusive subgroups based on age and CV risk.MethodsFILOSOPHY is an ongoing, phase 4, non-interventional, European study of pts with RA who have been prescribed FIL for the first time and in accordance with the product label in daily practice. Baseline characteristics and the incidence of select adverse events (AEs) are assessed in pts aged ≥65 years and/or with ≥1 CV risk factor (Table 1), and in those aged <65 years with no CV risk factors.ResultsAs of the end of June 2022, 480 pts had been treated: 441 received FIL 200 mg and 39 received FIL 100 mg. Of the 480 pts, 148 (30.8%) were aged ≥65 years;332 (69.2%) were aged <65 years. In total, 86 (17.9%) were former smokers, 81 (16.9%) were current smokers and 203 (42.3%) were non-smokers (data were missing for 110 pts [22.9%]). In addition to smoking, the most frequent CV risk factors included a history of hypertension (32.3%), a history of dyslipidemia (10.2%) and a family history of myocardial infarction (8.5%;Table 1).23 pts (4.8%) discontinued treatment due to AEs. Of the 354 pts aged ≥65 years or with ≥1 CV risk factor, infections affected 64 pts (18.1%), 34 (9.6%) had COVID-19, 2 (0.6%) had herpes zoster, and cardiac disorders (angina pectoris, atrial fibrillation, palpitations and tachycardia) affected 5 pts (1.4%);no cases of malignancies were observed. In the subgroup aged <65 years and with no CV risk factors (n=126), infections occurred in 18 pts (14.3%) (9 [7.1%] had COVID-19;3 [2.4%] had herpes zoster) and malignancies (myeloproliferative neoplasm) affected 1 pt (0.8%);no pts had cardiac disorders. There were no cases of deep vein thrombosis or pulmonary embolism in either subgroup.ConclusionIn this interim analysis of FILOSOPHY, no unexpected safety signals emerged at up to 6 months. Although infections and cardiac disorders affected a numerically greater proportion of pts aged ≥65 years or with ≥1 CV risk vs those aged <65 years with no CV risk, longer follow-up on a broader cohort is necessary to further characterize the safety of FIL in different groups of pts with RA.Reference[1]Winthrop K, et al. Ann Rheum Dis 2022;81:184–92Table 1.Baseline characteristics and CV risk factorsBaseline demographics/CV risk factorsAll FIL-treated pts (N=480)≥65 years or with ≥1 CV risk factor (n=354)<65 years and no CV risk factor (n=126)*Female sex, n (%)351 (73.1)252 (71.2)99 (78.6)Age, years, mean (SD)57.6 (11.5)60.4 (10.8)49.6 (9.6)Rheumatoid factor positive, n (%)†228 (47.5)167 (47.2)61 (48.4)Anti-citrullinated protein antibody positive, n (%)‡243 (50.6)176 (49.7)67 (53. 2)Body mass index, kg/m2, mean (SD)27.6 (5.7) n=43728.0 (5.4) n=33126.3 (6.4) n=106RA disease duration, years, mean (SD)10.4 (9.4) n=47810.5 (9.5) n=35310.0 (8.8) n=125Tender joint count 28, mean (SD)8.6 (6.9) n=4578.7 (7.1) n=3408.3 (6.3) n=117Swollen joint count 28, mean (SD)5.6 (5.2) n=4525.7 (5.4) n=3365.4 (4.4) n=116Former smoker, n (%)§86 (17.9)86 (24.3)0Current smoker, n (%)§81 (16.9)81 (22.9)0Non-smoker, n (%)§203 (42.3)130 (36.7)73 (57.9)Family history of myocardial infarction, n (%)41 (8.5)41 (11.6)0Medical history of: n (%) CV disease33 (6.9)33 (9.3)0 Diabetes35 (7.3)35 (9.9)0 Dyslipidemia49 (10.2)49 (13.8)0 Hypertension155 (32.3)155 (43.8)0 Ischemic CNS vascular disorders11 (2.3)11 (3.1)0 Peripheral vascular disease17 (3.5)17 (4.8)0*Includes 53 pts with missing smoking status data who were aged <65 years with no other CV risk factors.†Missing/unknown in 154 pts;‡Missing in 153 pts;§Smoking status data missing in 110 pts (22.9%).AcknowledgementsWe thank the physicia s and patients who participated in this study. The study was funded by Galapagos NV, Mechelen, Belgium. Publication coordination was provided by Fabien Debailleul, PhD, of Galapagos NV. Medical writing support was provided by Debbie Sherwood, BSc, CMPP (Aspire Scientific, Bollington, UK), and funded by Galapagos NV.Disclosure of InterestsPatrick Verschueren Speakers bureau: AbbVie, Eli Lilly, Galapagos, Roularta, Consultant of: Celltrion, Eli Lilly, Galapagos, Gilead, Nordic Pharma, Sidekick Health, Grant/research support from: Galapagos, Pfizer, Jérôme Avouac Speakers bureau: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, MSD, Novartis, Pfizer, Sandoz, Sanofi, Consultant of: AbbVie, Fresenius Kabi, Galapagos, Sanofi, Grant/research support from: BMS, Fresenius Kabi, Novartis, Pfizer, Karen Bevers Grant/research support from: Galapagos, Susana Romero-Yuste Speakers bureau: AbbVie, Biogen, BMS, Lilly, Pfizer, Consultant of: Sanofi, Lilly, Grant/research support from: Lilly, MSD, Roberto Caporali Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Sandoz, UCB, Consultant of: AbbVie, Amgen, BMS, Celltrion, Eli Lilly, Fresenius Kabi, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Thomas Debray Consultant of: Biogen, Galapagos, Gilead, Francesco De Leonardis Employee of: Galapagos, James Galloway Speakers bureau: AbbVie, Biogen, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Grant/research support from: AstraZeneca, Celgene, Gilead, Janssen, Medicago, Novavax, Pfizer, Monia Zignani Shareholder of: Galapagos, Employee of: Galapagos, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Amgen, BMS, Chugai, Galapagos, Lilly, Pfizer, Sanofi, Consultant of: AbbVie, Amgen, BMS, Galapagos, Lilly, Pfizer, Sanofi.
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BACKGROUND: Vaccines are one of the most important weapons in protection against diseases, especially pandemics lacking available treatment. The objective of this study was to investigate the knowledge, attitudes, and behaviors of individuals presenting to family medicine polyclinics for COVID-19 and influenza vaccines. METHOD(S): The cross-sectional descriptive study comprised healthy individuals who presented to family medicine polyclinics in Ankara Training and Research Hospital, Ankara, Turkiye between 10 December 2020 and 31 January 2021. Data on participants' knowledge and attitudes for COVID-19 and influenza vaccines were collected through questionnaire surveys. In total, 521 individuals aged older than 18 years were included in the study. RESULT(S): If a COVID-19 vaccine were available, 34.4% (N.=179) of respondents would be vaccinated, and 35.3% (N.=184) of respondents would not consider vaccination. Of those considering COVID-19 vaccination, 55.3% (N.=99) of respondents deemed the vaccine an effective way of providing protection against the virus. Increased willingness to have the COVID-19 vaccine was associated with the following factors: considering the influenza vaccine an effective protection method (P<0.001), a history of influenza vaccination (P=0.003), and concern about COVID-19 related death rates (P=0.008). CONCLUSION(S): The most common reasons for COVID-19 vaccine hesitancy and refusal were fear of vaccine-related side effects and a lack of perceived research evidence on the vaccine. Having a positive view of the influenza vaccine had a positive impact on attitudes toward the COVID-19 vaccine.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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The resilience of B2B sales forces is crucial in face of severe wide-ranging challenges during a crisis. This study aims to investigate the role of leader communication of the crisis in promoting salesperson resilience during the COVID-19. The data were gathered from 418 salespersons from 36 manufacturing firms in times of the COVID-19. The data were analyzed using multilevel structural equation modeling. The results demonstrated the positive relationship between leader crisis communication and salesperson resilience, mediated by salespersons' positive stress mindset. Family strain and core beliefs challenge were found to attenuate the positive linkage between leader crisis communication and salespersons' positive stress mindset. Theoretical and practical implications are presented. This study offers insights to help managers in B2B organizations better understand and implement mechanisms that can foster resilience among their B2B sales forces in the COVID-19 outbreak and other crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The anti-colonial struggle against literary assimilation and the claim to our linguistic space in validating our own stories as W°C, first generation college students, first generation college graduates, and caregivers to dependents, elders, and extended family members requires an activist spirit. [...]someone posted that they would be hosting a virtual writing group on Saturday mornings. A few text messages, utilization of social capital to invite non-M°CA members and a few electronic RSVPs later, we had commitments from the four of us. Being genuine and vulnerable through convivencia allowed us to place extreme care and attention on building social relationships while tearing down the conventional power structure often found in groups.
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Objectives: Acne is a leading skin problem in adolescents. After the end of COVID-19 pandemic, with the gradual transition to the routine life, we started to encounter more severe forms of acne in the last 6-month than we had seen before in the 10 year period of our Paediatric Dermatology outpatient clinic. Method(s): We evaluated the demographic and clinical characteristics, COVID infection and vaccination status, and treatment of patients who were treated at our Paediatric Dermatology outpatient clinic in the last 6 months due to severe acne. Result(s): One of our patients had acne fulminans, and four patients had acne conglobata. The common features of these patients presenting with severe acne were that they were young boys aged 15- 16 years, medium height, normal weight, and skin type 3-4. All patients had a family history of acne in their parents. They had no known comorbidities, additional treatment, history of nutritional supplement use, or accompanying arthralgia or arthritis. Four patients were initially treated with isotretinoin for severe acne, developed acne conglobata, and one developed acne fulminans during the follow-up period. Dapsone therapy was initiated in all patients according to the severity of the lesions, and adalimumab was administered to acne fulminans. Discussion(s): The frequent occurrence of severe forms of acne after the pandemic raises the question of whether COVID-19 infection or vaccination may play a role in its aetiology. Cases of mask-related acne exacerbation during COVID-19 have been well-described in the literature. However, there are no data on the effects of COVID-19 vaccination or infection on the development of severe acne. In this report, we present cases of adolescent patients with severe acne to investigate the possible reasons for the increasing number of severe acne cases presenting to our outpatient clinic during the postpandemic period.
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Objectives: The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. Method(s): The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics' urbanicity classification;and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. Result(s): SDoH data were available for ~95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87);median family income ($98k/$76k/$70k vs. $82k);% of members living in low-income low-food-access tracts (9/14/18 vs. 13);urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. Conclusion(s): We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.Copyright © 2023
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PurposeThis study is aimed at developing an understanding of the consequences of the pandemic on families' socioeconomic resilience, and the strategies adopted by the families in overcoming social vulnerabilities amid uncertainty.Design/methodology/approachThe materials for this study consist of semi-structured interviews with 21 families spread across the South Sumatra Province, Indonesia. Families in the study represent four different income levels, namely very high, high, middle and low, and who also work in the informal sector. Each family has at least 1 or more members who fall into the vulnerable category (children, the elderly, people with disabilities unemployed or having potential economic vulnerability).FindingsTwo main findings are outlined. Regardless of their socioeconomic status, many of the families analyzed adopted similar strategies to remain resilient. Among the strategies are classifying the urgency of purchasing consumer goods based on financial capacity rather than needs, leveraging digital economic opportunities as alternative sources of income, utilizing more extensive informal networks and going into debt. Another interesting finding shows that the pandemic, to some extent, has saved poor families from social insecurity. This is supported by evidence showing that social distancing measures during the pandemic have reduced the intensity of sociocultural activities, which require invited community members to contribute financially. The reduction of sociocultural activities in the community has provided more potential savings for the poor.Research limitations/implicationsIn this study, informants who provided information about their family conditions represent a major segment of the workforce and tend to be technologically savvy and younger, due to the use of Zoom as a platform for conducting interviews. Therefore, there may be a bias in the results. Another limitation is that since the interviewees were recommended by our social network in the fields, there is a risk of a distorted selection of participants.Originality/valueThis study offers insights that are critical in helping to analyze family patterns in developing countries in mitigating the risks and uncertainties caused by COVID-19. In addition, the literature on social policy and development could benefit from further research on COVID-19 as an alternative driver to identify mechanisms that could bring about change that would result in "security.” Critical questions and limitations of this study are presented at the end of the paper to be responded to as future research agenda.
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Older adults with dementia experience hospitalizations and post-acute care transitions more than people without dementia and rely on family caregivers for support. Family caregivers of older adults with dementia, therefore, play a crucial role during care transitions, and caregiver engagement is acknowledged as a critical factor in promoting quality of care. Despite this, "engagement" has been exclusively defined from the perspective of clinical care providers in other settings, and little is known about the post-acute care experiences and perceptions of family caregivers. The purpose of this dissertation was to describe the meaning of engagement to family caregivers navigating post-acute care transition, to elucidate their perspectives on barriers and facilitators of engagement, and to explore their support needs.Following an interpretive descriptive approach and guided by Meleis's Middle Range transition theory, semi-structured interviews were conducted with a purposive sample of 15 family caregivers of older adults with dementia. Using an inductive coding process, similar codes were categorized by grouping codes that describe similar concepts related to the caregiver experiences and perceptions. The process helped to develop themes from the categories and a conceptual framework that described the meaning of engagement.Thematic findings revealed family caregivers' descriptions of the meaning of engagement during post-acute care transitions is linked to being there, having meaningful connection with professional care providers, and having communication with the person with dementia. Limited communication and not being able to be there were seen as barriers to engagement. Nine family caregivers' level of engagement was impacted by the COVID-19 pandemic new visitation policies. Facilitator to engagement were linked to having good communication with professional care providers and having past post-acute care transition experience. The support needs of family caregivers were also related to their relationship with healthcare providers and receiving support from family and friends. The study supports highlighting communication as an integral part of transition and makes an argument to expanding the Meleis's Middle Range transition theory. Findings of the study contribute to the dementia caregiving literature and make an appeal to healthcare providers and policymakers to include family caregivers as part of the care team. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Case history: We present the case of a 31-year-old Hispanic male with history of recurrent bronchiectasis, invasive aspergillosis, and severe persistent asthma, who is now status post lung transplant for end-stage lung disease. He initially presented at 7 years of age with diarrhea, failure to thrive, and nearly absent immunoglobulin levels (IgG < 33 mg/dL, IgA < 7 mg/dL, IgM = 11 mg/dL, IgE = 4 IU/dL) necessitating IVIG treatment. Small intestinal biopsy showed villous atrophy consistent with autoimmune enteropathy. Sweat chloride was reported as indeterminate (44 me/dL). Initial WBC, platelet, and T- and NK-cell counts were within normal range, and B-cell count and percentage were borderline low. Most recently, he was found to have increased immature B-cell count (CD21low), decreased memory B-cells, and poor pneumococcal vaccine antibody response. Patient has been hospitalized numerous times with increasingly severe bronchiectasis, pneumonitis, and COVID-19 infections twice despite vaccination, leading to respiratory failure and lung transplantation. Family history is negative for immune deficiency and lung diseases. Discussion(s): Of these 3 VUSs (see the table), the one in IRF2BP2 has the most pathogenic potential due to its autosomal dominant inheritance, its location in a conserved domain (Ring), and previous case reports of pathogenic variants at the same or adjacent alleles 1-3. Baxter et al reported a de novo truncating mutation in IRF2BP2 at codon 536 (c.1606CinsTTT), which is similar to our patient's mutation. This patient was noted to have an IPEX-like presentation, with chronic diarrhea, hypogammaglobulinemia, and recurrent infections. Variant Functional Prediction Score for our variant predicts a potentially high damage effect. There are 2 other case reports of heterozygous mutations in loci adjacent to this allele;one (c.1652G>A)2 with a similar clinical phenotype to our patient and the other (C.625-665 del)3 with primarily inflammatory features and few infections. Impact: This case highlights a variant in IRF2BP2 associated with severe hypogammaglobulinemia, recurrent pulmonary infections, and autoimmune enteropathy. [Table presented]Copyright © 2023 Elsevier Inc.
ABSTRACT
Genotypic definition of monogenic inborn errors of immunity (IEIs) continues to accelerate with broader access to next generation sequencing, underscoring this aggregated group of disorders as a major health burden impacting both civilian and military populations. At an estimated prevalence of 1 in 1200 individuals, IEIs affect ~8,000 patients within the Military Health System (MHS). Despite access to targeted gene/exome panels at military treatment facilities, most affected patients never receive a definitive genetic diagnosis that would significantly improve clinical care. To address this gap, we established the first registry of IEI patients within the MHS with the goal of identifying known and novel pathogenic genetic defects to increase diagnosis rates and enhance clinical care. Using the registry, a research protocol was opened in July 2022. Since July we have enrolled 75 IEI patients encompassing a breadth of phenotypes including severe and recurrent infections, bone marrow failure, autoimmunity/autoinflammation, atopic disease, and malignancy. Enrolled patients provide blood and bone marrow samples for whole genome, ultra-deep targeted panel and comprehensive transcriptome sequencing, plus cryopreservation of peripheral blood mononuclear cells for future functional studies. We are also implementing and developing analytical methods for identifying and interrogating non-coding and structural variants. Suspected pathogenic variants are adjudicated by a clinical molecular geneticist using state-of-the-art analysis pipelines. These analyses subsequently inform in vitro experiments to validate causative mutations using cell reporter systems and primary patient cells. Clinical variant validation and return of genetic results are planned with genetic counseling provided. As a proof of principle, this integrated genetic evaluation pipeline revealed a novel, candidate TLR7 nonsense variant in two adolescent brothers who both endured critical COVID-19 pneumonia, requiring mechanical ventilation and extracorporeal membrane oxygenation. Our protocol is therefore poised to greatly enrich clinical genetics resources available in the MHS for IEI patients, contributing to better diagnosis rates, informed family counseling, and targeted treatments that collectively improve the health and readiness of the military community. Moreover, our efforts should yield new mechanistic insights on immune pathogenesis for a broad variety of known and novel IEIs.Copyright © 2023 Elsevier Inc.
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Objective To assess the experience of families and clinicians at a long term acute care hospital (LTACH) after implementing a written communication intervention. Methods Written communication templates were developed for six clinical disciplines. LTACH clinicians used templates to describe the condition of 30 mechanically ventilated patients at up to three time points. Completed templates were the basis for written summaries that there were sent to families. Impressions of the intervention among families (n = 21) and clinicians (n = 17) were assessed using a descriptive correlational design. Interviews were analyzed using thematic content analysis. Results We identified four themes during interviews with families: Written summaries 1) facilitated communication with LTACH staff, 2) reduced stress related to COVID-19 visitor restrictions, 3) facilitated understanding of the patient condition, prognosis, and goals and 4) facilitated communication among family members. Although clinicians understood why families would appreciate written material, they did not feel that the intervention addressed their main challenge – overly optimistic expectations for patient recovery among families. Conclusion Written communication positively affected the experience of families of LTACH patients, but was less useful for clincians. Innovation Use of written patient care updates helps LTACH clinicians initiate communication with families.
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PurposeThe study aims to investigate the impact of workplace ostracism (WO) and fear of the COVID-19 pandemic on the family life of restaurant employees. This research is based on the conservation of resources (COR) theory and work-family interface model to understand the theoretical underpinnings of mistreatment in the food sector during the COVID-19 pandemic.Design/methodology/approachThe study utilized a survey with a structured questionnaire to collect time-lagged data from 238 restaurant employees in the central region of Punjab province in Pakistan. The collected data were analyzed using the SPSS tool with modern-day techniques like bootstrapping, process macro and SmartPLS.FindingsThe study reveals that perceived stress levels of the employees increase due to ostracism, leading to work-family conflict. Furthermore, the study found that employees who fear COVID-19 are less stressed by ostracism.Originality/valueThe study's significant contribution lies in demonstrating that the impact of ostracism in the workplace is quite different from what was expected. The results have shown that ostracism can reduce the perceived stress levels of employees, leading to a decrease in work-family conflict, especially in the presence of fear of COVID-19.
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After careful screening to exclude coronavirus symptoms we invite some patients into the practice to be examined. With longstanding patients I hope that this will be just a brief interruption to our normal relationship, but when I haven't previously met the patient it poses a significant challenge to building a rapport. In the past week the number of new patients reporting coronavirus symptoms has fallen, as has the death rate at our local hospital.
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This study focuses on family perspectives of school and home-based learning during the early months of the Covid-19 pandemic, revealing both what is lost and gained as a result of families being more intimately involved in the academic training of their children. Through the use of qualitative interviews, researchers found that parents (1) addressed challenges related to virtual learning on their own, (2) actively guided their children's learning journeys and (3) engaged in collective efforts to ensure the well-being of their children. These findings suggest that as the school systems responded to the pandemic and home became a site of academic learning, the home also became a site of everyday ingenuity as parents applied a kind of pedagogical improvisation and accessed funds of knowledge to design learning spaces and scheduling frameworks. [ FROM AUTHOR] Copyright of Journal of Family Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)