Physical fitness levels and trends of kindergarteners in Hong Kong during the COVID-19 pandemic

Background/objectives

The study aimed to examine the physical fitness and activity levels of kindergarteners in Hong Kong during the coronavirus disease 2019 pandemic.

Methods

A total of 2052 kindergarteners (48% girls; 32.9% Grade 1, 34% Grade 2, and 33.1% Grade 3) were recruited from July 2020 to November 2021. Participants completed the physical fitness tests, including body composition, flexibility, lower-limb muscle strength, upper-limb muscle strength, lower-limb muscle endurance, and agility. Children's physical activity and overall well-being were examined using parental proxy reports. Parents also reported their physical activity and parental support to children's physical activity engagement, as well as their perception of children's kindergarten physical activity environment. Fitness differences by age and gender were analyzed using one-way ANOVA and ANCOVA measuring effect size with partial eta-squared. Additionally, correlations assessed the relationship between children's fitness and parents' proxy reports.

Results

The results of the physical fitness tests were higher than those in previous studies conducted by the Physical Fitness Association of Hong Kong in 2015-2018. Gender-based differences were observed in most tests for children aged 4 years and older, with boys showing higher scores in the standing long jump, shot put, and balance tests, while girls had higher scores in the sit-and-reach test. Parents' proxy questionnaire answers indicated that children's continuous jump test performances were significantly related to their frequency of physical activity per week (r = 0.19, p < 0.001), and that children's health was significantly and positively correlated with their fitness level (r = 0.179, p < 0.009). Inadequate school physical activity was associated with poor upper-limb strength (r = 0.078, p < 0.005). Moreover, a high level of parental support for their children's participation in physical activity was correlated with a high level of parental participation in vigorous-intensity physical activities (r = 0.167, p < 0.005).

Conclusion

The physical fitness of children in Hong Kong was less affected by the epidemic. Parents' healthy behaviors and support were related to children's participation in PA. Efforts to improve children's physical fitness and motor development should include parent education and physical activity involvement.

Family pressure and support on young adults' eating behaviors and body image: The role of gender

Families play a key role in establishing eating habits of children, yet whether families continue to influence eating behaviors of young adults remains an open question. It is also not clear whether associations between family variables (i.e., support and pressure) are similar for adult sons and daughters regarding eating pathology. The present cross-sectional study examined family correlates on disordered eating, body satisfaction, and drive for muscularity. The aim was to examine the associations of family support and family pressure with eating pathology, and to determine whether gender moderated the associations. Among 365 undergraduates (Mage = 18.9 years, 62 % Caucasian, 48 % female), neither family pressure nor family support were significantly associated with the drive for muscularity, whereas both were associated with disordered eating, and family pressure was associated with body satisfaction. Gender moderated the relationship of family pressure and body satisfaction (p = 0.03) and, unexpectedly, the relationship of family support and disordered eating (p = 0.02). Contrary to prediction, family pressure had stronger associations with body satisfaction for men (i.e., men had a more robust association (beta = -0.31, p < .001) than women (beta = -0.19, p = 0.004)). For women, the relationship of family support and disordered eating was not significant (beta = 0.07, p = 0.452); but, was significant for men (beta = -0.25, p < .001). These findings suggest that family pressure and support are associated with eating pathology among young adults, and that in some instances the associations were larger for men, thus highlighting the importance of including men in eating pathology research. Pending replication, these results suggest that family attitudes, behaviors, and support may be necessary topics to address when designing prevention programs for young adults.

An exploratory study of the prevalence and adverse associations of in-school traditional bullying and cyberbullying among adolescents in Connecticut

Bullying, traditional or cyber, among adolescents, is a public health concern. In this study, we explored frequencies and correlates of different forms of bullying among Connecticut high-school students. Youth Risk Behavior Survey data from 2019 from Connecticut adolescents (N = 1814) were used. χ2 tests and survey-weighted logistic regressions examined relationships between bullying subgroups (in-school traditional bullying (ISTB) only, cyberbullying only, and both) and mental concerns, risk behaviors, academic performance, physical health, and receipt of social support, with the logistic regressions adjusted for demographics. The past-12-month frequency of having experienced only cyberbullying was 5.6%, only ISTB was 9.1%, and both forms was 8.7%. Between-group differences were observed by bullying status in terms of sex and race/ethnicity. In adjusted models, bullying status was associated with suicide attempts, suicidal ideation, self-harm, depression/dysphoria, mental health, use of alcohol, marijuana, injection drugs, tobacco, and e-vapor, gambling, driving under influence of alcohol, high-risk sexual behavior, physical fights, weapon-carrying, injuries/threats at school, feeling unsafe at school, dating violence, obesity, poor general health, insecure housing, less perceived family support, and poor academic performance. People experiencing both types of bullying were typically more likely to report adverse measures. High-school students commonly report bullying. The findings that both forms (traditional and cyber) were more robustly linked to negative experiences highlight the need for examining further relationships between types and patterns of bullying and mental health and functioning. Better understanding may help improve preventive anti-bullying interventions.

Identifying distinct subtypes of mother-to-infant bonding using latent profile analysis in a nationwide Japanese study

BACKGROUND

Mother-to-infant bonding (MIB) is foundational for nurturing behaviors and an infant's development. Identifying risk factors for difficulties or problems in MIB is vital. However, traditional research often dichotomizes MIB using cutoff thresholds, overlooking its underlying complexities. This research utilizes latent profile analysis (LPA) to discern MIB subtypes in a nationwide Japanese dataset.

METHODS

We conducted LPA on data from the Mother-to-Infant Bonding Scale (MIBS), collected from 3,877 postpartum women within one year of childbirth. To empirically validate the derived profiles, we examined their associated risk factors, focusing on sociodemographic, health, and perinatal variables.

RESULTS

Four distinct MIB profiles emerged. Profile 1 indicated minimal difficulties, while Profile 4 exhibited severe multifaceted difficulties. Profiles 2 and 3 showed moderate difficulties distinguished by lack of positive affection and presence of negative affection (especially indifference), respectively. Compared to Profile 1, women in Profiles 2-4 had a higher likelihood of postpartum depression and low family support. Each profile also presented unique risk factors: medium family support in Profile 2, maternal working status in Profile 3, and pre-pregnancy underweight status in Profile 4. Notably, both Profiles 3 and 4 were also linked to increased feelings of loneliness since the onset of the COVID-19 pandemic.

CONCLUSION

This study represents the first application of LPA to MIB, revealing distinct subtypes and their respective risk profiles. These insights promise to enhance and personalize early interventions for difficulties in MIB, affirming the necessity of acknowledging MIB's heterogeneity.

Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses

PURPOSE

In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology.

METHODS

81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression.

RESULTS

Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers.

CONCLUSIONS

While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.

Association between social support and ambulance use among older people in Japan: an empirical cross-sectional study

BACKGROUND

Ambulance service demand and utilization are increasing worldwide. To address this issue, the factors that affect ambulance use must be identified. Few studies have examined factors that can intervene and thus reduce the frequency of ambulance use. This study aimed to examine the association between social support and ambulance use among older adults in Japan. We hypothesize that social support is associated with reduced ambulance use.

METHODS

This cross-sectional study was conducted as part of the Japan Gerontological Evaluation Study. In December 2019 and January 2020, we collaborated with individuals aged 65 years or above with no long-term care needs. A total of 24,581 participants were included in the analysis. The objective and explanatory variables were ambulance use and social support, respectively. Binomial regression analysis was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Social support was associated with ambulance use. People who had no one to listen to their complaints or worries were significantly more likely to use ambulance services than those who did (OR [95% CI] = 1.26 [1.03-1.53]). People with no one to take care of them when they were ill were also significantly more likely to use ambulance services than those who had someone to provide care (1.15 [1.01-1.31]). Moreover, the results of binomial logistic regression analysis indicated that individuals who called an ambulance but were not hospitalized had significantly lower social support compared to those who did not call an ambulance.

CONCLUSIONS

The results suggest that the presence and quality of social support play a significant role in ambulance use among older adults in Japan. Our findings can help policymakers to plan and implement strategies for reducing the burden on emergency medical care.

Magnitude and determinants of psychological morbidities among pregnant women: Results from a pregnancy cohort in rural Central India

Background

Psychological morbidities are one of the emerging global health problems. It affects a considerable number of ante-natal women leading to consequences during the postnatal period as well. We conducted this research to study the magnitude and determinants of psychological morbidities during pregnancy.

Methods

In this study, we included 650 pregnant women from an established cohort of 2500 pregnant women and assessed the psychological morbidities among them using the GMHAT/PC tool.

Results

The overall prevalence of psychological morbidities during pregnancy was 14.6%, with anxiety and depression being the leading ones. Low education levels, lower socio-economic status, unintended pregnancy, complicated previous pregnancy, lack of family and social support, and domestic violence increased the odds of psychological morbidity. On Multivariate logistic regression, Low education levels increased the odds to more than twice [illiterate/primary schooling OR: 4.00, p = 0.026; secondary schooling OR: 2.64, p = 0.034; high school OR: 2.60, p = 0.033] unintended pregnancy [OR: 1.91, p = 0.043] and lack of family support [OR: 7.19, p < 0.001] increased the odds of psychological morbidity among pregnant women.

Conclusion

Bringing these issues to the mainstream and addressing them by developing interventions to address them during the lifecycle of a female will help to prevent episodes of psychological stress and morbidity among pregnant females.

Predictors of depressive and anxiety symptoms among lesbian, gay and bisexual young adult individuals experiencing the COVID-19 pandemic: A four-year follow-up study

BACKGROUND/PURPOSE

Depressive and anxiety symptoms were common among lesbian, gay, and bisexual (LGB) individuals during the COVID-19 pandemic. This 4-year follow-up study was conducted to investigate the predictors of depressive and anxiety symptoms in Taiwan's young adult LGB population.

METHODS

Baseline data, including depressive and anxiety symptoms, demographic characteristics, sexual stigma, self-identity confusion, and family support were collected from 1000 LGB individuals. The participants' depressive and anxiety symptoms were reassessed 4 years after the baseline measurements. The predictive effects of the baseline factors on depressive and anxiety symptoms at follow-up were examined through linear regression analysis.

RESULTS

Greater lack of identity, unconsolidated identity, sexual orientation microaggression, and lower perceived family function at baseline were significantly associated with more severe depressive and anxiety symptoms at follow-up. After adjustment for baseline depressive symptoms, being men, greater lack of identity, lower perceived family function, and more severe anxiety symptoms at baseline were significantly associated with more severe depressive symptoms at follow-up. After adjustment for baseline anxiety symptoms, greater unconsolidated identity and more severe depressive symptoms at baseline were significantly associated with more severe anxiety symptoms at follow-up.

CONCLUSIONS

Intervention aimed at reducing depressive and anxiety symptoms in LGB individuals should be developed considering the predictors identified in this study.

Varying (preferred) levels of involvement in treatment decision-making in the intensive care unit before and during the COVID-19 pandemic: a mixed-methods study among relatives

BACKGROUND

In the intensive care unit (ICU) relatives play a crucial role as surrogate decision-makers, since most patients cannot communicate due to their illness and treatment. Their level of involvement in decision-making can affect their psychological well-being. During the COVID-19 pandemic, relatives' involvement probably changed. We aim to investigate relatives' involvement in decision-making in the ICU before and during the pandemic and their experiences and preferences in this regard.

METHODS

A mixed-methods study among relatives of ICU patients admitted to an ICU before or during the COVID-19 pandemic. Relatives in six ICUs completed a questionnaire (n = 329), including two items on decision-making. These were analysed using descriptive statistics and logistic regression analyses. Subsequently, relatives (n = 24) were interviewed about their experiences and preferences regarding decision-making. Thematic analysis was used for analysing the qualitative data.

RESULTS

Nearly 55% of the relatives indicated they were at least occasionally asked to be involved in important treatment decisions and of these relatives 97.1% reported to have had enough time to discuss questions and concerns when important decisions were to be made. During the first COVID-19 wave relatives were significantly less likely to be involved in decision-making compared to relatives from pre-COVID-19. The interviews showed that involvement varied from being informed about an already made decision to deliberation about the best treatment option. Preferences for involvement also varied, with some relatives preferring no involvement due to a perceived lack of expertise and others preferring an active role as the patient's advocate. Discussing a patient's quality of life was appreciated by relatives, and according to relatives healthcare professionals also found this valuable. In some cases the preferred and actual involvement was in discordance, preferring either a larger or a smaller role.

CONCLUSIONS

As treatment alignment with a patient's values and preferences and accordance between preferred and actual involvement in decision-making is very important, we suggest that the treatment decision-making process should start with discussions about a patient's quality of life, followed by tailoring the process to relatives' preferences as much as possible. Healthcare professionals should be aware of relatives' heterogeneous and possibly changing preferences regarding the decision-making process.

Multidimensional analysis of schoolteachers' occupational stress by the New Brief Job Stress Questionnaire: focusing on gender differences

This study investigated teachers' occupational stress using a comprehensive job stress questionnaire, or the New Brief Job Stress Questionnaire, while considering gender differences. A total of 1,825 elementary and junior high school teachers participated in the study. The results revealed that female teachers significantly exhibited more psychological and physical stress reactions and perceived less job resource availability than did male teachers. Moreover, multiple regression analyses demonstrated that support from family and friends was a larger factor associated with mental health outcomes among female teachers than among male teachers. The impacts of marital status also differed between male and female teachers. Job demands were strongly associated with psychological and physical stress reactions among teachers. Meanwhile, job resources were more strongly associated with positive workplace outcomes, such as workplace engagement and social capital, than were job demands. Administrators should consider the distinctive nature of teachers' occupational stress in addition to its gender specific influence. Organizational support, such as securing teachers' autonomy, encouraging their career development, and acknowledging diversity, should be considered to foster teachers' work engagement and create a cohesive environment in the school workplace.

Loss of Autonomy: Likely Dementia and Living Arrangement Transitions Among Mexicans and Mexican Americans

BACKGROUND AND OBJECTIVES

To examine the role of probable dementia on changes in living arrangements and mortality among very old Mexicans and Mexican Americans in 2 different nations.

RESEARCH DESIGN AND METHODS

We employ the Hispanic Established Population for the Epidemiologic Study of the Elderly and the Mexican Health and Aging Study, 2 comparable longitudinal data sets, to identify predictors of changes in living arrangements using multinomial logistic regression, controlling for cognitive status, demographic characteristics, and resources.

RESULTS

In Mexico, women with dementia who lived alone at baseline were more likely to become part of an extended family household than men with similar levels of cognitive impairment. A similar pattern emerges for the oldest Mexican-American women. Spousal loss increases the likelihood of living alone for women in the United States regardless of dementia. Although dementia elevates the risk of mortality for men living alone in the United States, in both countries, women in their 90s who lived alone with dementia had a lower risk of mortality relative to men.

DISCUSSION AND IMPLICATIONS

Longer life spans increase the risk of living alone with dementia in both countries, especially for women. Older individuals in both countries face financial hardships. Mexicans have limited formal options in dementia care. Mexican Americans with dementia continue to live alone despite low income although, unlike the Mexicans, they have access to Medicaid long-term care. For Mexico and the United States, the growing number of older individuals with dementia represents a growing public health concern.

"It's a big trauma for the family": A qualitative insight into the psychological trauma of paediatric burns from the perspective of mothers

BACKGROUND

Despite the medical and surgical improvements of paediatric burn injuries, burn injuries can be a painful and traumatic experience for the child and their family. It is therefore important to explore the experiences of caregivers who support their child throughout the burn journey. Thus, the purpose of this study was to explore the traumatic nature of paediatric burns on the family from a caregiver's perspective.

METHODS

This study used a descriptive qualitative approach to conduct online semi-structured interviews with caregivers (18 years and older) of children (aged four to 17 years) that had previously been admitted with an unintentional acute burn injury to a paediatric burns unit in Western Australia. Interviews explored the child's and caregiver's experiences throughout the burn journey from the perspective of the caregiver and were digitally recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke's six stages of reflexive thematic analysis.

RESULTS

Eleven mothers participated in the interviews and identified a range of poor psychological and psychosocial outcomes that themselves and their child experienced. Three overarching themes were elaborated from the interviews: Child and caregiver mental health difficulties during and after the burn (including medical trauma, mental health outcomes and caregiver guilt); Lifestyle and physical changes following the burn (including disruptions to routine, appearance concerns and puberty); and factors supporting or inhibiting the recovery journey (including personality factors, coping strategies, family dynamics and support).

FINAL CONSIDERATIONS

This study has presented the difficulties that children, young people, and their family face throughout a paediatric burn injury, which makes the implementation of timely and effective family centred interventions imperative. Meeting the needs and supporting these families with their mental health throughout this traumatic recovery journey, can ensure positive psychosocial outcomes and adaptive coping strategies are adopted early on.

The Association Between Family Support and Changes in Self-Rated Health Among Chinese Older Adults: How Living Arrangements Moderate the Association?

OBJECTIVES

The study intends to investigate the association between family support and older adult health as well as the interaction between family support and living arrangements on their health.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Samples included in the final analysis (N = 11,430) come from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

Multiple logistic regression analysis was used to analyze the associations between family supports, multiplicative interaction of family supports and living arrangements, and self-rated health change. Subgroup analysis on disabled older adults was supplemented.

RESULTS

Older adult individuals who received functional support, provided financial support, and had frequent emotional communication with their children in the past year reported better self-rated health. Moreover, having frequent emotional communication with children could bring better self-rated health for the older adults living with spouses and children (ORbetter vs same = 2.765, P < .01) and empty nesters who lived without children (ORbetter vs same = 1.551, P < .05).

CONCLUSIONS AND IMPLICATIONS

Our findings imply that functional support and emotional support may play an increasingly important role in the health of Chinese older individuals. The interaction between emotional support and 2 living arrangements mentioned above is relevant to better health of older individuals. We advocate for culturally tailored Age-Friendly Communities augmenting the geriatric health care framework. While bolstering social support for seniors, prioritizing fundamental needs is paramount for those with disabilities.

The Social Environment Matters for Telomere Length and Internalizing Problems During Adolescence

Depression and anxiety symptoms are on the rise among adolescents. With increasing evidence that cellular aging may be associated with depressive and anxiety symptoms, there is an urgent need to identify the social environment context that may moderate this link. This study addresses this research gap by investigating the moderating role of the social environment on the relation between telomere length and emotional health among adolescents. Participants were 411 non-Hispanic (88.56%) Black (100%) adolescents (M = 14.23 years, SD = 1.85, female = 54%) in a major metropolitan city. Youth and parents reported on an array of social risk and protective factors, and youth provided DNA samples for telomere length measurement. Results demonstrated that the association of telomere length and anxiety symptoms was stronger among youth with higher perceived stress or lower school belongingness, and the association of telomere length with depressive symptoms was stronger under conditions of higher parent inter-partner psychological aggression. The results enhance our understanding of the complex associations between biological aging, the social environment, and mental health in adolescence.

Family Support During Hospitalization Buffers Depressive Symptoms Among Independent Older Adults

OBJECTIVES

Hospitalization is a stressful event that may lead to deterioration in older adults' mental health. Drawing on the stress-buffering hypothesis, we examined whether family support during hospitalization would moderate the relations between level of independence and in-hospital depressive symptoms.

METHOD

This research was a secondary analysis of a cohort study conducted with a sample of 370 hospitalized older adults. Acutely ill older adults reported their level of independence at time of hospitalization and their level of depressive symptoms three days into the hospital stay. Family support was estimated by a daily report of hours family members stayed with the hospitalized older adult.

RESULTS

Independent older adults whose family members stayed longer hours in the hospital had fewer depressive symptoms than independent older adults with shorter family visits. Relations between depressive symptoms and family support were not apparent for dependent older adults, even though their family members stayed more hours.

CONCLUSIONS

This study partially supports the stress-buffering hypothesis, in that social support ameliorated depressive symptoms among hospitalized independent older adults.

CLINICAL IMPLICATIONS

Assessing depressive symptoms and functional ability and creating an environment conducive to family support for older adults may be beneficial to hospitalized older adults' mental health.

What Counteracts Problematic Social Media Use in Adolescence? A Cross-National Observational Study

PURPOSE

Social media use has increased rapidly during the past decade, raising concerns about adolescents who display problematic social media use (PSMU), as indicated by addiction-like symptoms (e.g., preoccupation, tolerance). We aimed to assess the extent to which an individual resource (health literacy), and social resources (friend support and family support), moderated the association between a range of individual characteristics (gender, age, family affluence, and depressive feelings) and PSMU; also the association between PSMU and health outcomes (self-rated health, life satisfaction, and sleep difficulties), both cross-nationally and nationally.

METHODS

Our sample included 22,226 adolescents from six European countries. We used data from the Health Behaviour in School-aged Children cross-sectional survey (2017/2018). Random-effects models and moderator analyses were applied.

RESULTS

Six moderations were found, with the resources moderating the association between individual characteristics and PSMU. One moderation emerged cross-nationally, namely that a higher level of family support was associated with a lower likelihood of PSMU, especially among adolescents who did not have frequent depressive feelings. In addition, five national moderations were identified. For example, a higher level of health literacy was associated with a lower likelihood of PSMU among Finnish girls. The resources were also found to moderate the association between PSMU and health outcomes, with two moderations emerging cross-nationally. For instance, a higher level of family support was related to higher self-rated health, especially among problematic users. In addition, nine national moderations were identified; these included a higher level of health literacy being associated with having less sleep difficulties, especially among problematic users in Germany.

DISCUSSION

In adolescence, health literacy, family support, and friend support have the potential to moderate the association between individual characteristics and PSMU, and between PSMU and health outcomes, cross-nationally and nationally. We recommend the use of universal and targeted interventions to promote individual and social resources to counteract PSMU.

Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review

Objective

Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU.

Method

An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation.

Result

A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life.

Conclusion

The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.

Impact of respiratory care training and family support using telemedicine on tracheostomized children admitted with respiratory infection after discharge

OBJECTIVE

Children with tracheostomies usually require a long hospital stay, high healthcare costs and caregiver burden. With the help of telemedicine, this study attempted to determine how home respiratory care training and family support affected admission days, admission costs, ICU admission rates, and caregivers' confidence.

METHODS

We enrolled children with tracheostomies who were admitted between 2020 and 2022 with respiratory infections. Before discharge, we evaluated the knowledge and skills of the caregivers and gave them practice in home respiratory care while providing them with structured feedback using a checklist, a peer-to-peer mentor assignment, a virtual home visit, teleeducation, and teleconsultation via a mobile application. We compared the admission days, admission costs, and ICU admission rates one year following the program with the historical control one year earlier.

RESULTS

Forty-eight children with tracheostomies were enrolled. Thirteen percent of those had a 1-year readmission. The median [IQR] number of admission days decreased from 55 [15-140] to 6 [4-17] days (p value < 0.001). The median [IQR] admission costs decreased from 300,759 [97,032 - 1,132,323] to 33,367 [17,898-164,951] baht (p value < 0.001). The ICU admission rates decreased from 43.8% to 2.1% (p value < 0.001). Immediately after the program, caregivers' confidence increased from 47.9% to 85.5% (p value < 0.001).

CONCLUSIONS

This respiratory care training and telehealth program decreased admission days, admission costs, and ICU admission rates for children with tracheostomies admitted with respiratory infections. The confidence of caregivers was also increased immediately after the program.

Association between having a meal together with family and smoking: a cross-sectional nationwide survey

BACKGROUND

Smoking is a major risk factor that significantly affects public health. Although the South Korean government spends significant money on smoking cessation services, the smoking rate remains stagnant. Families influence health-conscious decisions, and family meals can positively affect smoking suppression and health behaviors. Therefore, this study investigated whether family meals are correlated with adults' smoking behaviors.

METHODS

This study used data from the 2019-2021 Korean National Health and Nutrition Examination Survey. Having a meal together with family was defined as "yes" for those who have at least one meal with their family each day and "no" for those who do not. Current smoking status was classified as having smoked at least 5 packs of cigarettes (100 cigarettes) in one's lifetime and having used either conventional cigarettes or e-cigarettes in the last 30 days. Multiple logistic regression analyses were used to examine the association between eating together, smoking, and weight application.

RESULTS

When comparing the group that ate with their family compared to the group that did not, the odds ratio for current smoking status was 1.27 (95% confidence interval [CI]: 1.05-1.54) for male participants and 1.90 (95% CI: 1.33-2.71) for female participants. This showed a dose-dependent effect according to the frequency of family meals. Those who smoked conventional cigarettes had a strong association (men: OR 1.28, 95% CI 1.00-1.67; women: OR 2.22, 95% CI 1.42-3.46). However, those who only vaped e-cigarettes or used both conventional cigarettes and e-cigarettes had no statistically significant correlations.

CONCLUSION

This study provides evidence suggesting that eating meals as a family is related to smoking behavior and can positively affect smoking cessation intentions in adults. Consequently, a smoking cessation program can be developed that uses social support, such as encouraging family meals.

A Survey of Emergency Nurses' Perceptions and Practices to Support Patients' Families as Surrogate Decision Makers

INTRODUCTION

Family members acting as surrogate decision makers for severely ill patients in emergency and critical care centers face psychological burdens. This study aimed to investigate the actual situation of emergency nurses' perceptions and practices to support patients' families and its structural elements.

METHODS

We created an original 25-item questionnaire and surveyed 164 emergency nurses from 64 emergency and critical care centers regarding their perceptions of caring for people making surrogate decisions. Participants averaged 35.6 years old and 5.1 years as emergency nurses.

RESULTS

Cronbach's α coefficients for importance and practice on the original questionnaire were 0.936 and 0.933, respectively. We identified 4 elements of necessary support for patient families making surrogate decisions according to emergency nurses: "collaboration in understanding the condition of the patient as well as empathetic support," "care that addresses the needs of patient's family members," "confirming the role of nurses and surrogate decision making," and "participation in meeting with a doctor and patient families." In addition, we identified 5 elements that indicate the current state of practice: "support from specialists such as nurses and other professionals," "compassionate care for family members and those who are providing support to family members," "empathetic support for family members," "support for making arrangements that address the needs of family members," and "considerations for family members."

DISCUSSION

According to the findings of this study, emergency nurses should coordinate with other professionals and talk with family members and physicians to increase their understanding of the need to assist in surrogate decision making. In addition, emergency nurses also need to explain to patients' relatives how to support them in surrogate decision making.

Cochlear implant decision-making for children with residual hearing: Perspectives of parents

PURPOSE

Cochlear implant (CI) decision-making is particularly challenging for families of children who have residual hearing. Parents of these children may be uncertain about whether the potential benefits of CIs outweigh the risks. This study aimed to understand parents' decisional needs during the decision-making process for children with residual hearing.

METHOD

Semi-structured interviews were conducted with parents of 11 children who had received CIs. Open-ended questions were asked to encourage parents to share their experiences about the decision-making process, their values/preferences, and their needs. The interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Data were organized according to three key themes: (1) Parents' decisional conflict, (2) values and preferences, (3) decision support and parents' needs. We found that overall parents were satisfied with their decision-making process and the decision support from practitioners. However, parents stressed the importance of receiving more personalized information that considers their specific concerns, values and preferences related to family's circumstances.

CONCLUSIONS

Our research provides additional evidence to guide the CI decision-making process for children with residual hearing. Additional collaborative research with audiology and decision-making experts specifically on facilitating shared decision-making is needed to provide better decision coaching for these families.

Analysis of the duration of exclusive breastfeeding in premature infants and its influencing factors

PURPOSE

The purpose of this study was to investigate the duration of breastfeeding among preterm infants within the first 12 months after birth and analyzed factors influencing the duration of exclusive breastfeeding.

DESIGN AND METHODS

In this retrospective study, premature infants who were hospitalized in the Neonatal Intensive Care Unit (NICU) premature delivery area of a third-class maternal and child health hospital in Changsha City, Hunan Province, China from October 2020 to January 2021 were selected as the participants for this study. Relevant data of these infants during their hospitalization was obtained from the hospital information system, while the rate of exclusive breastfeeding among preterm infants at a corrected age of 12 months was tracked through telephone follow-up. Univariate analysis of the effects of breastfeeding duration in preterm infants was conducted based on Mann-Whitney U test and Kruskal-Wallis H test. Multiple linear regression was then applied to determine the factors influencing the duration of exclusive breastfeeding in preterm infants.

RESULTS

The median and interquartile range of breastfeeding duration for preterm infants in this study was 4.00 (1.00, 6.00) months. Multiple linear regression analysis showed that the duration of exclusive breastfeeding was affected by several factors including how much other family members support breastfeeding, whether the mother returns to work after maternal leave, and whether the infant is a twin (P < 0.05).

CONCLUSION

The duration of exclusive breastfeeding among preterm infants needs to be improved by strengthening health education regarding the benefits of breastfeeding for preterm infants. Medical staff should provide guidance, encourage continuous nursing after discharge, and work with the community to implement targeted intervention measures with the goal of increasing the duration of exclusive breastfeeding among premature infants.

IMPLICATIONS TO PRACTICE

Because breastfeeding is vitally important for premature infants, we should encourage longer breastfeeding duration for premature infants by increasing family support, removing barriers to workplace breastfeeding, enhancing people's confidence in breastfeeding and providing support to mothers with twins. Hopefully, these measure can promote breastfeeding for premature infants.

Korean Immigrant Mothers and the Journey to Autism Diagnosis and Services for Their Child in the United States

Since autism diagnosis is directly linked to the availability of supportive services, identifying best practices for early diagnosis of autism has long been a concern of professionals and families. Meanwhile, studies show persistent racial disparities in autism diagnosis. Although numerous clinical diagnostic guidelines have been published, there is not enough discussion of diagnostic procedures through the lens of culturally diverse families.

PURPOSE

This study focuses on the autism diagnostic experiences that Korean immigrant mothers had with their children.

METHODS

Eleven first-generation Korean-American mothers of children with autism were included in the study. The data was collected using semi-structured interviews in Korean.

RESULTS

The main five factors (i.e., cultural beliefs and values, language barriers, complex emotions, immigration and navigating systems, and facilitators and assets) that mainly influence the diagnosis process were identified through thematic analysis.

CONCLUSION

Dynamics are interactive within and between the factors, influencing the entire diagnostic process by either delaying or facilitating the identification of a child's autism and the provision of treatment.

African American Women Breast Cancer Survivors: Coping with the COVID-19 Pandemic

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers

Objectives

To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers.

Methods

We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs).

Results

The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales.

Conclusions

The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.

Measuring COVID-19 related stress and its associated factors among the parents of school-aged children during the first lockdown in France

BACKGROUND

The COVID-19 pandemic placed important challenges on parents, as they had to meet various demands during lockdown, including childcare, work and homeschooling. Therefore, the current study aimed to investigate perceived stress levels among the parents of school-aged children and explore their association with sociodemographic, environmental and psychological factors during lockdown.

METHODS

A cross-sectional study was conducted among the parents of school-aged children ages 8 to 18, who lived in the Grand Est region of France during the first wave of the pandemic. An online survey collected sociodemographic data, living and working conditions, and exposure to COVID-19 as well as parent's levels of perceived stress (PSS-10), self-perceived health status (SF-12), social support (MSPSS) and resilience (BRS). Multivariable logistic regression models were conducted to evaluate the association between moderate to severe perceived stress and various factors.

RESULTS

In total, 734 parents were included. The results indicated that 47% were experiencing moderate stress and 7.2% were experiencing severe stress. Factors most strongly associated with risk of moderate to severe levels of stress were lower levels of parental resilience (OR = 3.8, 95% CI: 2.2-6.6) and poor self-perceived mental health status (OR = 7.3, 95% CI: 5.0-10.8). The following risk factors were also identified: female sex; being in the age range of 35-44; difficulties isolating and contracting COVID-19, which involved hospitalization and separation or isolation from family. The support of friends (OR = 0.8, 95% CI: 0.7-1.0) and family (OR = 0.5, 95% CI: 0.3-0.8) were protective factors.

CONCLUSIONS

These findings suggest that supportive and preventive programs should focus on the improvement of resilience and mental health management to promote parents' wellbeing. Research has to focus both on individuals' inner potential for increasing resilience and the environmental resources to be activated. Building and boosting resilience among parents could serve as a protective factor against negative outcomes for them and their families.

Predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery: a cross-sectional study in China

BACKGROUND

Psychological birth trauma exhibits a high incidence worldwide, resulting in a wide range of negative impacts on mothers, infants, couples, families and society at large through the maternal-centered ripple effect. However, there is currently limited research on psychological birth trauma in China. Social support and pregnancy stress are important influencing factors of psychological birth trauma. Consequently, this study aimed to explore predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery in China.

METHODS

This cross-sectional study was performed at a single medical center between December 2021 and May 2022 in Hangzhou, China. Participants were selected using a convenience sampling technique. A total of 351 postpartum women within one week after vaginal delivery were included. Questionnaires were used to collect sociodemographic and obstetric characteristics and scores on the Pregnancy Stress Rating Scale (PSRS), City Birth Trauma Scale (City BiTS), Social Support Rating Scale (SSRS) and Family Adaptation Partnership Growth Affection and Resolve index (Family APGAR). Both univariate analysis and multiple linear regression analysis were conducted to assess predictors of pregnancy stress and psychological birth trauma.

RESULTS

The median (IQR) of PSRS and City BiTS scores were 10.00 (14.00) and 3.00 (9.00), respectively. The incidence of postpartum posttraumatic stress disorder was 4.0% (14/351). Parity, social support, family support and level of education were predictors of pregnancy stress. Delivery complications, psychological traumatic event, pregnancy stress and family support were predictors of psychological birth trauma (P < 0.05).

CONCLUSION

Pregnancy stress is related to social support, family support and some sociodemographic and obstetric characteristics. Psychological birth trauma is correlated with delivery complications, psychological traumatic event, pregnancy stress and family support. Consequently, enhancing social support, especially family support, for pregnant women as a means of reducing pregnancy stress can effectively prevent psychological birth trauma.

Association of Social Support and Postpartum Depression According to the Time After Childbirth in South Korea

OBJECTIVE

This study examined the association between social support and postpartum depression (PPD) according to the time after childbirth within 12 months in South Korea.

METHODS

Data were collected from 1,481 women in Chungnam Province, South Korea from September 21 to 30, 2022. Multivariate logistic regression models were used to examine the association between social support and PPD. Subgroup analysis of the associations of support from family, friends, and significant others with PPD according to the time after childbirth was undertaken using crude and adjusted models.

RESULTS

Of the participants, 39.91% had PPD. The prevalence of PPD was 36.05% at <3 months, 37.50% at 3≤ to <6 months, and 44.41% at 6≤ to <12 months. A 1-point increase in the social support score was associated with an increase in the adjusted odds ratio of PPD of 0.91 (95% confidence interval=0.90-0.93). Social support from family was significantly associated with PPD regardless of the time after childbirth. Support from significant others was significantly associated with PPD after 6≤ to <12 months.

CONCLUSION

Family support should be provided consistently to women after birth; social connections with significant others can prevent PPD.

Emotional support among partnered sexual minority and heterosexual individuals during the COVID-19 pandemic

Emotional support, particularly support from family and friends, is essential to health outcomes especially for marginalized communities. Although emotional support is recognized as a critical resource, especially during the COVID-19 pandemic, to date no research has examined access to support during the pandemic for sexual diverse populations. This study aims to apply minority stress theory by drawing on a new population-based data source of 3,642 respondents, the National Couples' Health and Time Study (NCHAT), which oversampled sexual and gender diverse populations during the pandemic. We focus on two sources of emotional support: family members and friends. Exclusively heterosexual respondents relied more on emotional support from family than respondents who identified as exclusively gay/lesbian, bisexual including pan, omni, and queer, and those reporting another sexual identity or multiple sexual identities. However, respondents who did not identify as heterosexual relied more on emotional support from friends compared to exclusively heterosexual respondents. There were no significant differences among respondents with sexual minority identities in regard to family or friend support. Other factors, such as outness to friends and family, identity centrality, aggressions, and relationship satisfaction are found to be associated support from friends and family. The findings presented here add to a growing body of work on social support while adding sexual minority-specific factors that may affect receipt of, need for, and outcomes relating to support. This work contributes to understanding of the social climate and resources available to sexual diverse populations during a major public health crisis.

Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic

BACKGROUND

Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave  support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences.

METHODS

We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support.

RESULTS

A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support.

CONCLUSIONS

Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.

What Are the Various Comprehensive Treatment Models to Improve Self-Efficacy and Self-Management in Adolescents with Diabetes Mellitus? A Scoping Review

Background

This review aimed to synthesize intervention models involving the role of adolescent and family support as part of comprehensive care to improve self-efficacy and self-management among adolescents with Diabetes Mellitus (DM).

Methods

A review was conducted to conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We searched PubMed, Research Gate, Science Direct, Cochrane Library databases, and grey literature. We included articles exploring family intervention models on improving self-efficacy and self-management among adolescents with DM, published from January 1, 2009, to June 30, 2022, and in English. Articles were declared eligible, reviewed critically, and then synthesized narratively.

Results

We identified 487 abstracts and title records from the initial search and excluded 409 irrelevant studies. Sixty-six full-text articles were screened, and nine were included in the synthesis. Five articles presented findings from using models focusing on child and adolescent intervention, while in the remaining four articles, the intervention models involved adolescents and their caregivers or parents. Only two models provide comprehensive care that requires collaboration among healthcare providers, patients, and families. Adolescent self-efficacy and self-management schemes as intermediary variables are closely related to everything that can influence health behavior, metabolic control, and quality of life for adolescents, which requires support from a multidisciplinary collaborative team.

Conclusion

Excellent comprehensive care team collaboration involving family support is essential to increase the self-efficacy and self-management of adolescents with DM.

Associations between social support and poverty among older adults

BACKGROUND

With population aging becoming a pressing global concern, social support is more meaningful for older adults. In particular, financial supports, such as health insurance and financial assistance derived from family, all play great role in assistance affairs. Research shows social support possibly has an impact on poverty, but the association between formal and informal supports is unclear. We are aimed at verifying the association between distinct social supports and exploring whether this association would affect poverty alleviation for older adults.

METHODS

A total of 2,683 individuals aged 60 years or older who have medical expenses were included in a survey conducted by the China Health and Retirement Longitudinal Study in 2018. A chi-square analysis and an independent samples T test all were used to explore the differences of social supports among old people with different economic condition. A binary logistic regression was aimed at analyzing the association between social supports and poverty for older adults. The structural equation model was established to evaluate the association between formal support and informal support and the mechanism(s) of social supports affecting poverty.

RESULTS

The overall average rate of reimbursement for outpatient care was 0.20 with standard deviation 0.22, and the average reimbursement rate of inpatient care for the poor older adults is nearly 5% lower than the average of the non-poor older adults. We found that having private health insurance and higher reimbursement rate of inpatient care were associated with lower likelihood of living in poverty for older adults. Formal support would directly affect poverty, but its impact on poverty through informal support is insignificant even if formal support is negatively associated with informal support.

CONCLUSION

A dilemma in reducing the economic burden of disease and receiving family assistance for older adults was revealed, and a more complete health security and higher level of medical expenses compensation would be beneficial to prevent poverty. Optimizing the primary healthcare and increasing the percentage of insurance compensation, policies that focus on the specific cultural values and strengthening the role of supplementary insurance are advantaged for alleviating poverty among older adults.

Qualitative study on the use of emergency services by people with serious mental disorder in Spain

BACKGROUND

The population with severe mental disorders (SMD) is a frequent user of emergency services. Situations of psychiatric decompensation can have devastating consequence and can cause problems in getting urgent medical care. The objective was to study the experiences and needs of these patients and their caregivers regarding the demand for emergency care in Spain.

METHODS

Qualitative methodology involving patients with SMD and their informal caregivers. Purposive sampling by key informants in urban and rural areas. Paired interviews were carried out until data saturation. A discourse analysis was conducted, obtaining a codification in categories by means of triangulation.

RESULTS

Forty-two participants in twenty-one paired interviews (19 ± 7.2 min as mean duration). Three categories were identified. 1º Reasons for urgent care: poor self-care and lack of social support, as well as difficulties in accessibility and continuity of care in other healthcare settings. 2º Urgent care provision: trust in the healthcare professional and the information patients receive from the healthcare system is crucial, telephone assistance can be a very useful resource. 3º Satisfaction with the urgent care received: they request priority care without delays and in areas separated from the other patients, as well as the genuine interest of the professional who attends them.

CONCLUSIONS

The request for urgent care in patients with SMD depends on different psychosocial determinants and not only on the severity of the symptoms. There is a demand for care that is differentiated from the other patients in the emergency department. The increase in social networks and alternative systems of care would avoid overuse of the emergency departments.

Factors related to parenting styles of Chinese mothers of children with and without intellectual disability

BACKGROUND

Parenting styles play a crucial role in children's development. However, approaches to parenting children with intellectual disability (ID) beyond Western cultures have been underexamined. This study compared the self-reported parenting styles of Chinese mothers of children with and without ID and examined some factors that might be related.

METHODS

Chinese mothers of children with ID (n = 173) and mothers of typically developing children (n = 119) completed measures of their parenting style, parenting stress, parenting sense of competence and family support.

RESULTS

Both groups endorsed similar levels of authoritative parenting, but mothers of children with ID were more likely to report adopting strategies aligned with authoritarian parenting. For mothers in the ID group, family support moderated the effects of parenting stress and parenting sense of competence on authoritative parenting. Parenting stress and parenting sense of competence, respectively, predicted authoritarian parenting for mothers of children with and without ID.

CONCLUSIONS

This study highlights the importance of reducing parenting stress, strengthening parenting sense of competence and providing family support in order to promote optimal parenting styles for Chinese mothers of children with ID.

Exploring the importance of predisposing, enabling, and need factors for promoting Veteran engagement in mental health therapy for post-traumatic stress: a multiple methods study

PURPOSE

This study explored Veteran and family member perspectives on factors that drive post-traumatic stress disorder (PTSD) therapy engagement within constructs of the Andersen model of behavioral health service utilization. Despite efforts by the Department of Veterans Affairs (VA) to increase mental health care access, the proportion of Veterans with PTSD who engage in PTSD therapy remains low. Support for therapy from family members and friends could improve Veteran therapy use.

METHODS

We applied a multiple methods approach using data from VA administrative data and semi-structured individual interviews with Veterans and their support partners who applied to the VA Caregiver Support Program. We integrated findings from a machine learning analysis of quantitative data with findings from a qualitative analysis of the semi-structured interviews.

RESULTS

In quantitative models, Veteran medical need for health care use most influenced treatment initiation and retention. However, qualitative data suggested mental health symptoms combined with positive Veteran and support partner treatment attitudes motivated treatment engagement. Veterans indicated their motivation to seek treatment increased when family members perceived treatment to be of high value. Veterans who experienced poor continuity of VA care, group, and virtual treatment modalities expressed less care satisfaction. Prior marital therapy use emerged as a potentially new facilitator of PTSD treatment engagement that warrants more exploration.

CONCLUSIONS

Our multiple methods findings represent Veteran and support partner perspectives and show that amid Veteran and organizational barriers to care, attitudes and support of family members and friends still matter. Family-oriented services and intervention could be a gateway to increase Veteran PTSD therapy engagement.

The effect of childhood social isolation on behavioral cognition in Chinese middle-aged and older adults: The moderating effect of family support

INTRODUCTION

This study aimed to analyze the association of childhood social isolation and behavioral cognition, and moderating effect of family support in middle-aged and older adults.

METHODS

The study samples were from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2018. The dependent variable was behavioral cognitive ability, measured by episodic memory and mental state; The independent variable was childhood social isolation, and the moderating variable was family support. The baseline OLS regression model was used to explore the correlation among independent variables, dependent variables and moderating variables, the least square regression model was used to analyze the moderating effect of family support, and the replacement model and the method of replacing characteristic variables were used for the robustness test. Hierarchical regression heterogeneity analysis was performed to further verify the results of the moderating effect.

RESULTS

In this study, 3459 samples were selected for analysis. OLS baseline regression results showed that the deepening of childhood social isolation was significantly correlated with the decline of behavioral cognitive ability in middle-aged and elderly people (β=-0.9664, t = 0.0893). After adding all covariates, we found that childhood social isolation was significantly negatively correlated with behavioral cognitive ability in middle-aged and elderly people (β=-0.4118, t = 0.0785). Among the moderating variables of family support, we found that there is a moderating effect on female guardians' efforts of caring in early parental support (β=0.0948, t = 0.0320) and the frequency of children's visits in late children support (β=0.0073, t = 0.0036). Finally, through the heterogeneity test, we found that there were differences in the relationship between childhood social isolation and behavioral cognitive ability among middle-aged and elderly people of different ages, genders and places of residence. Moreover, there are significant differences in the moderating effect of female guardian's effort of caring and the frequency of children's visits in heterogeneous groups.

CONCLUSIONS

The greater the degree of childhood social isolation experienced by middle-aged and elderly people, the worse their behavioral cognitive ability. Female guardian's effort of caring and the frequency of children's visits have a moderating effect to suppress this negative effect.

Cancer patients as parents: implementation of a cross sector service for families with adolescent and young adult children

BACKGROUND

Cancer patients who are parents show concerns about their ability to parent following diagnosis, and their adolescent and young adult (AYA) children have a need for improved cancer communication within the family. However, psychosocial support for families affected by parental cancer is not routinely available. This study explores the implementation of the Parent Support Worker (PSW) role, as part of a new cross sector model of care to support parent patients, their partners, and AYA children.

METHODS

Two PSWs, social workers and healthcare staff (n = 26) from three hospitals participated in audio-recorded, semi-structured interviews about implementation of the PSW role. Template Analysis and Normalization Process Theory were used to analyze the interviews. Data on PSW service activity and referrals of AYA to support from a community organization were analyzed using descriptive statistics.

RESULTS

Eleven themes categorized into enablers and barriers of implementation were identified. Regarding acceptability of the role, three enablers (social workers' understanding of the PSW role increasing, easy and prompt access of staff and parent patients to PSWs, satisfaction with the PSW role) and one barrier (communication related confusion and frustration about the PSW role) were identified. Additionally, three enablers (the PSW role fills gaps in parenting-focused support and continuity of care, the PSW role alleviates social workers' workload, negotiation helped to define responsibilities) and one barrier (fear of social work roles to be overtaken by PSWs) for appropriateness of the role were found. Finally, two enablers of feasibility of the role (PSWs and social workers co-managing the work, higher confidence from hospital staff to talk about children in the family) and one barrier (lack of systematic identification and referral processes) were identified. Across hospitals, the number of referrals of AYA children to the community organization increased between 2.7 and 12 times nine months post-introduction of the service.

CONCLUSIONS

Established in response to identified gaps in oncology care for parents with cancer, their partners and AYA children, a novel cross-sector model of care was acceptable, appropriate, and feasible. Barriers and enablers to implementation identified in this study need to be considered when designing and implementing similar services.

The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study

Introduction

This study aimed to measure dyadic adjustment, social support, and psychological well-being.

Methods

A research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals.

Results

Higher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress.

Conclusions

The results indicate that the support and acceptance of one's partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes.

Policy Implications

The findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.

The relationship between family support and the level of self care in type 2 diabetes patients

AIMS

The purpose of the study was to determine the relationship between family support and self-care in patients with type 2 diabetes in Middle Anatolia Region of Turkey.

METHODS

This descriptive relation-seeker-type study conducted with 284 patients who met inclusion criteria between February and May 2020 in the internal medicine and endocrinology clinics and polyclinics of a university hospital. Data were collected using, a demographic questionnaire, Hensarling's Diabetes Family Support Scale (HDFSS), and Diabetes Self-Care Scale (DSCS).

RESULTS

Participants had a mean DSCS and HDFSS score of 83.20 ± 18.63 and 82.44 ± 28.04, respectively. There was a strong correlation between DSCS and HDFSS scores (r:.621) (p < 0.001). Participants' DSCS totals score was strongly correlated with their HDFSS "empathetic support" (p = 0.001, r = 0.625), "encouragement" (p = 0.001, r = 0.558), "facilitative support" (p = 0.001, r = 0.558), and "participative support" scores (p = 0.001, r = 0.555).

CONCLUSIONS

Patients with more family support have higher levels of self-care. The results underline the significance of focusing on the relationship between self-care and family support in patients with type 2 diabetes.

Effect of different types of social support on physical frailty development among community-dwelling older adults in Japan: Evidence from a 10-year population-based cohort study

PURPOSE

Social support is associated with multiple positive health outcomes and is negatively associated with frailty in older adults. However, most evidence came from cross-sectional research. This study aimed to longitudinally explore the relationship between different types of social support and incident physical frailty.

MATERIALS AND METHODS

A 10-year prospective cohort study data from the National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA) database, from 2000 to 2012 on older adults aged ≥65 years were analyzed excluding those with physical frailty at baseline, missing data, or not attending follow-up. We measured three kinds of social support, whether from within or outside family members, including emotional, instrumental, and negative support. The generalized estimating equation (GEE) model was used to examine the longitudinal relationships between social support and subsequent frailty.

RESULTS

The final analysis included 466 participants, with an average age of 71.3 (standard deviation [SD], 4.3) years and 7.33 years of follow-up (SD, 3.11). GEE analysis showed that emotional and instrumental supports from within and outside family members were associated with a significantly lower risk of physical frailty (odd ratio (OR) and 95% confidence interval (CI): 0.80 [0.64-1.00] and 0.74 [0.58-0.95]; 0.77 [0.60-0.99] and 0.79 [0.63-0.99], respectively). Both negative support from within or outside family members had no significant relationship with the risk of physical frailty.

CONCLUSIONS

This longitudinal study suggested that emotional, and instrumental support both from within or outside family members can reduce future physical frailty among older adults.

[Children visiting intensive care units and emergency departments : Kids are welcome!]

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration.

WITHDRAWN: Associations between family support, loneliness, and underlying depression among children and adolescents in the China family panel studies: A mediation analysis

OBJECTIVE

This study aimed to assess the association between depression and family support among Chinese children and adolescents and to investigate whether loneliness could mediate this relationship.

METHODS

There were 2755 children and adolescents aged 18 and below from the China Family Panel Studies (CFPS) that participated in our study. Depression in children and adolescents was assessed by the Center for Epidemiologic Studies Depression Scale (CESD). Binary logistic regression combined with mediation analysis was used to examine the association between family support and depression and the mediating effect of loneliness on this relationship.

RESULTS

Of the 2755 children and adolescents, 848 (30.8 %) reported feeling lonely and 310 (11.3 %) reported feeling depressed. Multivariate logistic regression analysis showed that compared with children and adolescents with family support, children and adolescents without family support had a higher risk of loneliness (odds ratio (OR) = 1.668, 95 % confidence interval (CI): 1.318-2.111) and depression (odds ratio (OR) = 2.252, 95 % confidence interval (CI) 1.669-3.039). Mediation analysis revealed that loneliness played a partial mediating role in the association between family support and depression (β = -0.109, P < 0.001), and the mediation proportion was 38.11 %.

CONCLUSION

Family support affects depression directly and indirectly through loneliness. The results suggest that parents should provide more support to children and adolescents to reduce the risk of loneliness and underlying depression during the COVID-19 pandemic.

Peer victimization and adolescent problematic social media use: The mediating role of psychological insecurity and the moderating role of family support

Peer victimization is a serious risk factor for the development of problematic social media use (PSMU) among adolescents. However, little is known about the mediating and moderating mechanisms underlying this association. The current study tested whether psychological insecurity mediated the relation between peer victimization and PSMU, and whether this mediating process was moderated by family support among adolescents. A large sample of 1506 Chinese adolescents (M_age = 13.74 years, SD = 0.98) completed self-report measures regarding peer victimization, psychological insecurity, family support, and PSMU. After controlling for age, gender, and family economic status, results indicated that increased peer victimization was associated with higher psychological insecurity, which in turn predicted a greater incidence of PSMU. Moreover, family support moderated the first part of the mediation process, such that the relation between peer victimization and psychological insecurity was exacerbated for adolescents with high family support. This study advanced the current understanding of the mediating and moderating mechanisms associating peer victimization with PSMU among adolescents.

Psychosocial determinants of sleep difficulties in adolescence: the role of perceived support from family, peers, and school in an Italian HBSC sample

The present study explores the concurrent contribution to sleep problems of individual-related, family-related, and school-related factors in adolescence. Gathering from the Italian 2018 Health Behavior in School-Aged Children (HBSC) data collection, we used hierarchical logistic regression on a sample of 3397 adolescents (51% females, Mage = 13.99, SD = 1.62) to explore the contribution to sleep problems of the individual (Model 1: alcohol use, smoking, screen time, physical activity), familial (Model 2: parental communication, parental support), and school-related (Model 3: peer support, schoolmates/students support, teacher support and school pressure) variables. 28.3 percent of adolescents reported having sleep difficulties. Overall, Model 3 significantly improved over Model 2 and Model 1. Data showed that increasing smoking (OR = 1.11; 95% CI: 1.03-1.20) and screen time (OR = 1.05; 95% CI: 1.02-1.08) were associated with sleep difficulties but not alcohol use and physical activity. Also, impaired communication with both parents and increasing parental support (OR = 0.84; 95% CI: 0.78-0.90) were associated with decreased odds of sleep problems. Finally, both increases in school pressure (OR = 1.40; 95% CI: 1.26-1.56) and lack of student support (OR = 1.25; 95% CI: 1.10-1.42) were associated with a higher likelihood of sleep problems, while peer support and teacher support were not.   Conclusion: Our findings highlight the importance of an integrated approach to the study of sleep difficulties in adolescence that includes specific psychosocial contributors such as the quality of parental communication and perceived parental support and considers the quality of the day-to-day relationship with schoolmates and the school level of demands. What is Known: • Adolescents' are at-risk of more significant sleep difficulties, and recent literature highlights the importance of an integrated approach to understanding this phenomenon, including biological, psychosocial, and contextual factors. • The literature lacks findings that consider the concurrent contribution of individual and psychosocial factors to sleep difficulties in adolescence. What is New: • The quality of parental communication and perceived parental support, as expressions of adult figures' emotional and behavioural availability in the adolescent's life, are significant determinants of sleep difficulties. • The quality of day-to-day relationships with schoolmates and the school level of demands contribute to adolescent sleep problems.

An Analysis of Six Month Follow-Up Data from a Peer Parent Support Study

The current study examines trajectories of treatment outcomes 6 months after completion of a peer parent program, NAMI Basics. Fifty-two caregivers who were part of a larger trial completed questionnaires prior to, immediately after, and 6 months after completing NAMI Basics. Growth curve models were used to examine trajectories of caregiver ratings of parent activation and engagement, parent help-seeking intentions, child symptoms, outpatient service use, and parent stress at 6 months after completion of the program. Prior improvements to the outcomes of parent activation and engagement (β = 2.31, p < .001, d = 1.35), parent help-seeking intentions (β = 1.94, p = .017, d = 0.69), and child intrapersonal distress (β = - 3.93, p = 0.046, d = 0.58) were maintained at 6 months, while help-seeking intentions was not (β = 1.31, p = .222, d = 0.47). Though no changes were observed immediately post-class, caregivers reported significant increases in outpatient services use (β = - 1.51, p = .030, d = 0.68) and reductions in parenting stress (β = - 4.99, p = 0.009, d = 0.75) and overall child symptoms (β = - 19.67, p = 0.001, d = 0.90) at 6 month follow-up. These results suggest that many of the positive impacts of the NAMI Basics program are sustained 6 months after the intervention. Additionally, these results suggest that some positive outcomes of the program may not emerge until several months after taking the class. Implications and future directions are discussed.

Mapping Patients' Perceived Facilitators and Barriers to In-Center Hemodialysis Attendance to the Health Belief Model: Insights from a Qualitative Study

BACKGROUND

Previous research has shown that deliberate withdrawal, skipping, and/or shortening hemodialysis sessions has become a major health problem associated with poor clinical outcomes and early mortality in patients with end-stage renal disease (ESRD). However, patients' experiences with this treatment remain largely unexplored. This study aimed to explore patients' perceived facilitators and barriers to in-center hemodialysis attendance and map these findings to the Health Belief Model.

METHODS

A qualitative exploratory study was conducted with a purposive sample. Semi-structured interviews were conducted and submitted to thematic analysis.

RESULTS

Twenty-four patients (66.2 ± 12.3 years old; length of time on hemodialysis: 35.2 ± 51.5 months) were interviewed. Five major facilitators (social support, perceived benefits, self-efficacy, time on dialysis, and risk/susceptibility perception) and two barriers (lack of knowledge about ESRD and hemodialysis, and psychosocial costs) were identified.

CONCLUSION

Adherence to the prescribed regimen of hemodialysis attendance is a complex and multidimensional phenomenon that involves an interaction between modifying factors (social support, disease and treatment knowledge, time on dialysis) and patients' perceived benefits, perceived risks, self-efficacy, and treatment costs. This study findings expand knowledge by suggesting that perceiving health benefits from the beginning of treatment, self-efficacy to deal with dialysis demands, and purpose in life are important facilitators of adherence to in-center hemodialysis sessions. Furthermore, it suggests that the impact of the hemodialysis regimen on the emotional well-being of family members is an important barrier. Future interventions should focus on skills training to promote self-efficacy and family coping with the demands of in-center hemodialysis, improve disease and treatment knowledge, and help balance perceived benefits with dialysis costs.

Early Emergence of Rumination has no Association with Performance on a Non-affective Inhibitory Control Task

Rumination is a vulnerability for depression and potentially linked to inhibitory control weaknesses. We aimed to replicate the association observed in adults between inhibitory control and rumination in adolescents, and to examine putative moderating roles of childhood maltreatment and perceived family cohesion in an adolescent sample at risk for depression due to familial/personal history. Ninety adolescents aged 11-17 (M = 14.6, SD = 1.8) completed self-report scales of rumination, maltreatment, and family cohesion, and performed a task assessing inhibitory control. Hierarchical regression models showed no significant relation between inhibitory control and moderator variables on rumination. However, adolescents who reported higher levels of maltreatment and who perceived lower family cohesion tended to indicate higher levels of rumination (BChilhood Maltreatment = 27.52, 95% CIs [5.63, 49.41], BFamily Cohesion = -0.40, 95% CIs [-0.65, -0.15]). These findings demonstrate an alternative understanding of factors that increase depression onset risk and recurrence in adolescents.

A Comparative Study of Work Stress among Working Females Getting Paid and Working Women Unpaid (Housewives) During Pregnancy

Introduction

The potential impact of employment on pregnancy is an important issue as several occupational factors have been reported to be associated with adverse pregnancy outcomes through increased work stress. The current study was undertaken among pregnant women to understand the difference in pregnancy-related stress among pregnant working women getting paid (WWP) and working women unpaid (WWU) (housewives) and to assess workplace stress among working WWP.

Methods

A total of 426 study participants which included 213 participants in each group were recruited from a tertiary care hospital in Chennai. All the study participants were interviewed using an A-Z scale to understand pregnancy-related stress while WWP were also interviewed using Workplace Stress Questionnaire (WSQ).

Results

It was observed that the mean score of WWP was significantly higher than the mean scores of WWU (t = 94.63; df = 1, P = 0.000). Those WWP who were working for >8 h daily had higher scores as compared to those working for ≤8 h.

Conclusion

The study shows that the WWP had work stress in addition to background pregnancy-related stress.

Burdens on caregivers of patients with stroke during a pandemic: relationships with support satisfaction, psychological distress, and fear of COVID-19

BACKGROUND

Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic.

METHODS

A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden.

RESULTS

The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19.

CONCLUSIONS

Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.

Discrimination keeps transgender people awake at night: A nationwide cross-sectional survey of 583 transgender adults in South Korea

OBJECTIVES

We sought to investigate the association between transgender identity discrimination and sleep problems among transgender people in South Korea (hereafter, Korea), and whether family support for transgender identity plays a protective role in the association.

DESIGN & SETTING

We analyzed a nationwide cross-sectional survey of 583 Korean transgender adults which was anonymously conducted through an online platform.

MEASUREMENTS

Transgender identity discrimination was assessed using a single-item question. Sleep problems were defined as having any of the following problems: poor sleep quality, short sleep duration, and use of alcohol or sleep medications to fall asleep. Family support for transgender identity was classified into 3 groups as follows: not supportive, supportive, and unaware of participants' transgender identity.

RESULTS

Of 583 participants, 383 (65.7%) experienced transgender identity discrimination over the past 12 months. Participants who experienced transgender identity discrimination were 1.48 times (95% confidence intervals [95% CI] = 1.19-1.83) more likely to have any sleep problems, compared to those who never experienced transgender identity discrimination. When stratified by family support level, the associations between transgender identity discrimination and sleep problems remained statistically significant only among those with a family unsupportive (adjusted prevalence ratio [aPR] = 1.64; 95% CI = 1.16-2.31) or unaware (aPR = 1.60; 95% CI = 1.01-2.52) of participants' transgender identity. However, the association was not statistically significant among those with a supportive family (aPR = 1.41; 95% CI = 0.96-2.07).

CONCLUSION

Given transphobic environments in Korea, legal and institutional efforts are required to reduce transgender identity discrimination (eg, anti-discrimination laws) as well as to build trans-specific family resources.