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1.
J Exp Psychol Gen ; 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38695796

RESUMO

Practicing retrieval is a potent learning enhancer. Theoretical accounts of the testing effect generally suggest that the magnitude of the testing effect is dependent on retrieval practice performance, such that conditions that promote better retrieval practice performance should result in a greater testing effect. Empirical evidence, however, has been mixed. Although some studies showed a positive association between retrieval practice performance and the testing effect, others have shown either no relation or the reverse. In the present study, we experimentally manipulated retrieval practice performance using a retrieval-based response deadline manipulation and an encoding-based study trial manipulation. Across six experiments, the magnitude of the testing effect was independent of retrieval practice performance. However, when we aggregated the data across the experiments, participants with superior retrieval practice performance showed a greater testing effect-an individual difference. This dissociation between experimental and correlational outcomes suggests that the positive relation between retrieval practice performance and the testing effect is not causal, and indeed, simulation data showed that the correlation between retrieval practice performance and testing effect was an artifact. We discuss the challenges these findings present to existing accounts of the testing effect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

2.
Plast Reconstr Surg ; 2024 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-38546544

RESUMO

INTRODUCTION: In children with PRS, MDO is routinely performed to alleviate airway obstruction; however, it involves risk of injury to the MMN. We hypothesize that MMN palsy incidence following MDO, reported at 1-15%, is underestimated. This study investigates the true incidence of MMN palsy after MDO to better guide follow-up care and improve treatment of this complication. METHODS: A retrospective review of PRS patients who underwent MDO at a single, tertiary pediatric hospital between September 2007 and March 2021 was conducted. Patients who underwent MDO under one year of age and had postoperative clinical evaluations detailing MMN function were included. Logistic regression analysis was performed to investigate predictors of MMN injury. RESULTS: Of 93 patients who underwent MDO, 59.1% met inclusion criteria. 56.4% were female, 43.6% were syndromic, and average age at MDO was 1.52 ± 2.04 months. The average length of mandibular distraction was 17.3 ± 4.36mm, average duration of intubation was 6.57 ± 2.37 days, and average time until hardware removal was 111.1 ± 23.6 days. Sixteen patients (29.1%) presented with permanent MMN dysfunction, comprised of 8 patients with bilateral weakness and 8 with unilateral weakness. An additional five patients (9.1%) presented with transient MMN weakness that resolved within a year. Average length of follow-up postoperatively was 6.02 years, and no significant predictors of nerve injury were found. CONCLUSION: In this 14-year review of patients with PRS who underwent MDO, 38.2% demonstrated evidence of MMN palsy (29.1% permanent, 9.1% transient), which is much greater than previously described.

3.
Vet Parasitol Reg Stud Reports ; 48: 100976, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38316502

RESUMO

Multiple species of brown dog ticks have been described in the United States and the Caribbean: Rhipicephalus sanguineus sensu stricto (s.s.), also referred to as temperate lineage; R. linnaei (=tropical lineage); and R. rutilus (=southeastern Europe lineage) However, Rhipicephalus spp. are rarely recovered from dogs in Canada. To identify canine Rhipicephalus spp. in Canada and determine the influence of travel history on infestation, ticks morphologically identified as brown dog ticks (n = 93) collected from dogs (n = 13) in British Columbia, Ontario, and Québec, Canada were submitted with information regarding each dog's geographic location and travel history. Nucleic acid was extracted from available individual ticks (n = 86) and PCR was used to amplify sequences of a 12S rRNA mitochondrial gene fragment. Sequences were compared to published reference sequences of known species and a phylogenetic tree constructed. Twenty-three ticks (26.7%) consistent with R. linnaei were identified on seven dogs, including dogs from British Columbia and Ontario, with a median infestation intensity of 2 ticks/dog (mean = 3.3 ticks/dog). Sixty-one ticks (70.9%) consistent with R. sanguineus s.s. were found on two dogs from Québec and Ontario (median = 30.5 ticks/dog; mean = 30.5 ticks/dog). One dog from Ontario was infested with R. rutilus (n = 2) (2.3%). Species could not be determined for ticks from three dogs from Ontario and Québec. Most infested dogs (10/13; 76.9%) had a recent (< 1 month) international travel history. These data confirm that multiple species of canine Rhipicephalus are occasionally found in Canada and suggest introduction following travel is likely responsible for these infestations. Further analysis will allow for greater understanding of the range and diversity of canine Rhipicephalus spp. in North America and may reveal risk factors for infestation.


Assuntos
Doenças do Cão , Rhipicephalus sanguineus , Rhipicephalus , Animais , Cães , Filogenia , Doenças do Cão/epidemiologia , Ontário
4.
Trends Parasitol ; 40(3): 273-274, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38262836
5.
Child Care Health Dev ; 50(1): e13158, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37582547

RESUMO

BACKGROUND: Almost half of all children and young people with a disability or developmental difficulty (DDD) have complex disability and are likely to require multidisciplinary care. Care coordination (CC) aims to provide a single point of contact and a coordinated service, thereby improving care experiences, meeting unmet needs and empowering families. The impact of CC for children with DDD was evaluated. METHOD: Between May and August 2020, an in-depth evaluation of CC in Gwent, South Wales was conducted. Of 284 families who accessed CC, 38 were approached, as well as 177 health and social care professionals based at Serennu, Nevill Hall and Caerphilly Children's Centres. Nine families and 14 professionals completed semi-structured interviews. Interview transcripts were analysed using thematic analysis. RESULTS: This evaluation found perceived improvements in families' abilities to navigate, organize and understand care and increased parental engagement. Professionals observed fewer missed appointments, and both professionals and families described CC as a source of holistic support, including practical advice regarding housing, finances and emotional support. Professionals commented on CC easing pressure on their service. Potential limitations included restricted staff capacity and the role not being defined clearly for families and professionals. CONCLUSIONS: At a time of increased stress for families of children with DDD, and scarce resources to support them, care coordinators play a vital role in assisting families to engage with health services, while feeling supported and empowered. CC reduces the burden on professionals, while enhancing relationships with families.


Assuntos
Pessoas com Deficiência , Criança , Humanos , Adolescente , Pais/psicologia , Apoio Social , Serviços de Saúde
6.
Soc Sci Med ; 335: 116170, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37757578

RESUMO

Female genital mutilation or cutting (FGMC) has profound consequences for an estimated 200 million women world-wide, yet affected communities often resist efforts to end the practice. Marriage market dynamics have been proposed as key to this resistance, because where FGMC is normative, parents are motivated to cut their daughters to improve their marriage prospects. Some economists have also argued that financial gain, through bride wealth payments, incentivises parents to cut daughter's at time of marriage. Bride wealth, however, does not necessarily equal net economic return, confounding efforts to test this assumption. Here we use detailed data on the financial value of all exchanges at marriage from Ethiopian Arsi Oromo agropastoralists to assess their association with FGMC. We also explore the idea that parents must replace FGMC with other forms of investment (e.g., education) when cutting practices are rejected. Multivariate multilevel Bayesian models were run using data from the first marriages of 358 women to assess the association between FGMC status and education and marriage-related outcomes: bride wealth payments, dowry costs, and age at marriage. Being cut is associated with lower dowry costs and earlier age at marriage but does not predict bride wealth paid by the groom's family. School attendance is associated with higher bride wealth, particularly for women with four or more years of education, and with later age at marriage. These findings indicate that bride wealth payments do not maintain FGMC among the Arsi Oromo. While we find a relative economic loss for parents from FGMC abandonment through higher value dowry gifts, this may be traded-off against the health benefits to uncut daughters. These findings point to the emergence of new norms, whereby Arsi Oromo parents reject cutting for their daughters and prefer their daughters-in-law to be educated.


Assuntos
Circuncisão Feminina , Feminino , Humanos , Etiópia , Teorema de Bayes , Pais , Família , Casamento
7.
J Exp Psychol Appl ; 2023 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-37589715

RESUMO

Given the finding that retrieval practice improves memory, it is frequently suggested that students test themselves while studying. This study examined whether participants benefit from testing if they create and use their own test questions. In Experiment 1, participants read passages, generated questions about the passages, and then either answered their questions as they created them (the procedure used in previous studies) or after a delay. In Experiments 2 and 3, participants either generated questions and answered them after a delay (i.e., self-testing), answered experimenter-provided questions, or reread the passages before taking a final test administered shortly after learning or following a 2-day delay. The experiments found no benefits of answering one's own questions after a delay. In fact, those who self-tested tended to have worse performance on a final assessment of learning than the other learning conditions. Exploratory analyses suggested that participants' questions often did not target material that was on the later criterion test, which may explain why self-testing was not beneficial. The present study suggests that testing may not benefit learning if students create their own test questions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

8.
Evol Med Public Health ; 11(1): 149-162, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37274122

RESUMO

Background and objectives: There is significant evidence from large-scale, industrial and post-industrial societies that greater income and wealth inequality is negatively associated with both population health and increasing health inequalities. However, whether such relationships are inevitable and should be expected to impact the health of small-scale societies as they become more market-integrated is less clear. Methodology: Here, using mixed-effect models, we explore the relationship between health, wealth, wealth inequality and health inequalities in a small-scale foraging population from the Philippines, the Agta. Results: Across 11 camps, we find small to moderate degrees of wealth inequality (maximal Gini Coefficient 0.44) which is highest in the most permanent camps, where individuals engage more heavily in the formal market. However, in both adults (n = 161) and children (n = 215), we find little evidence that either wealth or wealth inequality associates with ill health, except for one measure of nutritional condition-red blood cell count. Conclusions and implications: We interpret these results in the light of high levels of cooperation among the Agta which may buffer against the detrimental effects of wealth inequality documented in industrial and post-industrial societies. We observe little intergenerational wealth transmission, highlighting the fluid nature of wealth, and thus wealth inequality, particularly in mobile communities. The deterioration of nutritional status, as indicated by red blood cell counts, requires further investigation before concluding the Agta's extensive cooperation networks may be beginning to breakdown in the face of increasing inequality.

9.
Z Gesundh Wiss ; : 1-13, 2023 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-37361305

RESUMO

Aims: This study examines the impact of COVID-19 lockdown on postpartum mothers in England, with the aim of identifying opportunities to improve maternal experience and wellbeing. The postpartum/postnatal period is widely acknowledged as a time when mothers require greater levels of support from multiple sources. However, stay-at-home orders, commonly known as "lockdown," deployed in some countries to limit COVID-19 transmission reduced access to support. In England, many postpartum mothers navigated household isolation within an intensive mothering and expert parenting culture. Examining the impact of lockdown may reveal strengths and weaknesses in current policy and practice. Subject and methods: We conducted online focus groups involving 20 mothers living in London, England, with "lockdown babies," following up on our earlier online survey on social support and maternal wellbeing. We thematically analysed focus group transcripts, and identified key themes around Lockdown Experience and Determinants of Lockdown Experience. Results: Participants raised some positives of lockdown, including fostering connections and protection from external expectations, but also raised many negatives, including social isolation, institutional abandonment, and intense relationships within the household. Potential reasons behind variations in lockdown experience include physical environments, timing of birth, and number of children. Our findings reflect how current systems may be "trapping" some families into the male-breadwinner/female-caregiver family model, while intensive mothering and expert parenting culture may be increasing maternal stress and undermining responsive mothering. Conclusions: Facilitating partners to stay at home during the postpartum period (e.g., increasing paternity leave and flexible working) and establishing peer/community support to decentre reliance on professional parenting experts may promote positive postpartum maternal experience and wellbeing. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01922-4.

10.
Proc Biol Sci ; 290(1995): 20230159, 2023 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-36946117

RESUMO

Humans exhibit a broad range of post-marital residence patterns and there is growing recognition that post-marital residence predicts women's reproductive success; however, the nature of the relationship is probably dependent on whether co-resident kin are cooperators or competitors. Here, we explore this relationship in a Tibetan population, where couples practice a mixture of post-marital residence patterns, co-residing in the same village with the wife's parents, the husband's parents or endogamously with both sets of parents. Using detailed demographic data from 17 villages we find that women who live with only their own parents have an earlier age at first birth (AFB) and age at last birth (ALB) than women who live with only their parents-in-law. Women who co-reside with both sets of parents have the earliest AFB and ALB. However, those with co-resident older siblings postponed reproduction, suggestive of competition-related delay. Shifts to earlier reproductive timing were also observed in relation to the imposition of family planning policies, in line with Fisherian expectations. Our study provides evidence of the costs and benefits to women's direct fitness of co-residing with different kin, against a backdrop of adaptive responses to cultural constraints on completed fertility.


Assuntos
Características da Família , Casamento , Feminino , Humanos , Fatores Socioeconômicos , Reprodução , Fertilidade
11.
Behav Brain Res ; 437: 114130, 2023 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-36179806

RESUMO

This study examined the impact of Type 1 Diabetes Mellitus (T1DM) on executive function using a series of operant conditioning-based tasks in rats. Sprague Dawley rats were randomized to either non-diabetic (n = 12; 6 male) or diabetic (n = 14; 6 male) groups. Diabetes was induced using multiple low-dose streptozotocin injections. All diabetic rodents were insulin-treated using subcutaneous insulin pellet implants (9-15 mM). At week 14 of the study, rats were placed on a food restricted diet to induce 5-10 % weight loss. Rodents were familiarized and their set-shifting ability was tested on a series of tasks that required continuous adjustments to novel stimulus-reward paradigms in order to receive food rewards. Results showed no differences in the number of trials, nor number and type of errors made to successfully complete each task between groups. Therefore, we report no differences in executive function, or more specifically set-shifting abilities between non-diabetic and diabetic rodents that receive insulin.


Assuntos
Diabetes Mellitus Tipo 1 , Função Executiva , Animais , Masculino , Ratos , Diabetes Mellitus Tipo 1/induzido quimicamente , Insulina/farmacologia , Ratos Sprague-Dawley
12.
Cureus ; 15(12): e51314, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38288222

RESUMO

Benign Prostatic Hyperplasia (BPH) is a prevalent condition that affects aging men, leading to the development of lower urinary tract symptoms (LUTS) and potentially severe complications such as complete obstruction. The management of BPH typically involves the use of medications from different classes, including alpha-1 antagonists, 5-alpha reductase inhibitors, and anticholinergics. Combination therapy utilizing drugs from different classes can also effectively manage the BPH-LUTS complex. Recent research has revealed that phosphodiesterase 5 (PDE5) inhibitors, including Tadalafil and Sildenafil, are highly effective in treating LUTS associated with BPH. Tadalafil as a monotherapy has recently been shown to significantly improve LUTS in BPH patients. Additionally, the use of herbal remedies as a treatment option for BPH has also been widely debated. Previous research suggests that saw palmetto can reduce BPH symptoms through several proposed mechanisms, but recent trials have found inconsistencies in its efficacy. In this literature review, we conducted an extensive PubMed database search to provide current and comprehensive insights into BPH treatment options. This review comprehensively evaluates available treatments for managing BPH, highlighting the effectiveness of different classes of medications and combination therapies in managing associated symptoms. The present investigation also discusses recent research on the efficacy of PDE5 inhibitors in treating LUTS associated with BPH and the uncertain efficacy of herbal remedies. The insights provided by this study can guide healthcare professionals in making informed decisions about managing BPH, ultimately improving patient outcomes.

13.
Front Aging Neurosci ; 14: 914360, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35942230

RESUMO

Cognitive impairment involves complex interactions between multiple pathways and mechanisms, one of which being cardiac disorders. Atrial cardiopathy (AC) is a structural and functional disorder of the left atrium that may be a substrate for other cardiac disorders such as atrial fibrillation (AF) and heart failure (HF). The association between AF and HF and cognitive decline is clear; however, the relationship between AC and cognition requires further investigation. Studies have shown that several markers of AC, such as increased brain natriuretic peptide and left atrial enlargement, are associated with an increased risk for cognitive impairment. The pathophysiology of cognitive decline in patients with AC is not yet well understood. Advancing our understanding of the relationship between AC and cognition may point to important treatable targets and inform future therapeutic advancements. This review presents our current understanding of the diagnosis of AC, as well as clinical characteristics and potential pathways involved in the association between AC and cognitive impairment.

14.
Semin Oncol Nurs ; 38(2): 151280, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35477650

RESUMO

OBJECTIVE: Breast cancer survivors are at increased risk of bone complications, indicating the need to better understand the effects of necessary treatments on bone health. The role of chemotherapy in bone loss is unclear, and its influence over time is not understood. This integrative review examined the existing literature on chemotherapy-induced bone loss in patients with early-stage, curative breast cancer focusing on long-term outcomes. Evaluating the mechanisms of chemotherapy-induced bone loss in humans along with preclinical (animal) models may elucidate pathways and improve care by providing targets for bone health-related interventions. DATA SOURCES: A review of retrieved articles dated January 2010 to December 2020 from MEDLINE and EMBASE databases were searched. A total of six clinical (human) and three preclinical (animal) studies were included. CONCLUSION: The findings identified two main themes (1) indirect and direct cellular mechanisms of chemotherapy-induced bone loss and (2) long-term bone complications and symptoms in breast cancer survivors. Implications for pre- and postmenopausal women are presented. IMPLICATIONS FOR NURSING PRACTICE: Enhanced bone surveillance performed by the specialized oncology nurse can improve long-term bone health outcomes. Prospective analyses evaluating short- and long-term chemotherapy-induced bone loss are recommended for future clinical trials to inform practice and evidence-informed interventions and treatments.


Assuntos
Antineoplásicos , Neoplasias da Mama , Sobreviventes de Câncer , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversos , Feminino , Humanos , Estudos Prospectivos , Sobreviventes
15.
Am J Hum Biol ; 34(2): e23621, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34056792

RESUMO

OBJECTIVES: Physical breastfeeding problems can lead women to terminate breastfeeding earlier than planned. In high-income countries such as the UK, breastfeeding problems have been attributed to the cultural and individual "inexperience" of breastfeeding, ultimately leading to lower breastfeeding rates. Yet, cross-cultural evidence suggests breastfeeding problems still occur in contexts where breastfeeding is common, prolonged, and seen publicly. This suggests breastfeeding problems are not unusual and do not necessarily lead to breastfeeding cessation. As humans evolved to raise children cooperatively, what matters for breastfeeding continuation may be the availability of social support during the postnatal period. Here, we test the hypothesis that social support buffers mothers from the negative impact breastfeeding problems have on duration. METHODS: We run Cox models on a sample of 565 UK mothers who completed a retrospective online survey about infant feeding and social support in 2017-2018. RESULTS: Breastfeeding problems were important predictors of cessation; however, the direction of the effect was dependent on the problem type and type of support from a range of supporters. Helpful support for discomfort issues (blocked ducts, too much milk) was significantly associated with reduced hazards of cessation, as predicted. However, helpful support for reported milk insufficiency was assoicated with an increased hazard of cessation. CONCLUSIONS: Experiencing breastfeeding problems is the norm, but its impact may be mitigated via social support. Working from an interdisciplinary approach, our results highlight that a wide range of supporters who provide different types of support have potential to influence maternal breastfeeding experience.


Assuntos
Aleitamento Materno , Apoio Social , Criança , Feminino , Humanos , Lactente , Mães , Estudos Retrospectivos , Inquéritos e Questionários , Reino Unido
16.
JAMA Dermatol ; 157(10): 1219-1226, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468690

RESUMO

IMPORTANCE: There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE: To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW: Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS: The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE: Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.


Assuntos
Carcinoma de Células Escamosas , Ceratose Actínica , Transplante de Órgãos , Neoplasias Cutâneas , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Técnica Delphi , Humanos , Ceratose Actínica/etiologia , Ceratose Actínica/patologia , Ceratose Actínica/prevenção & controle , Transplante de Órgãos/efeitos adversos , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , Transplantados
17.
Cogn Res Princ Implic ; 6(1): 44, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34114117

RESUMO

Test anxiety is a major concern in education because it causes uncomfortable feelings in test-anxious students and may reduce the validity of exam scores as a measure of learning. As such, brief and cost-effective interventions are necessary to minimize the negative impact of test anxiety on students' academic performance. In the present experiment, we examine two such interventions: expressive writing (Experiment 1) and an instructional intervention (Experiment 2), with the latter developed from a similar intervention for stereotype threat. Across four authentic exams in a psychology class, students alternated between completing the intervention and a control task immediately before completing the exams. Neither intervention was effective at reducing test anxiety or improving exam performance. The present results suggest that these interventions may not be successful in addressing the impacts of test anxiety in all classroom settings.


Assuntos
Ansiedade aos Exames , Universidades , Ansiedade/diagnóstico , Humanos , Estudantes , Redação
18.
J Am Board Fam Med ; 34(3): 474-476, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34088806

RESUMO

People with implantable cardiac defibrillators (ICDs) who are nearing the end of life are at risk for arrhythmias, which activate the ICD and may cause unnecessary shocks and suffering. Because ICDs have enabled more patients to live longer, they often succumb to noncardiac diseases and may be cared for by primary care physicians. Despite published recommendations 10 years ago regarding the management of ICDs during the end of life, over half of patients with ICDs who are dying still have not been offered the choice of deactivation. The Coronavirus disease 2019 (COVID-19) pandemic has complicated this issue and the need to discuss it because of practices that separate patients from loved ones and that modify the usual interactions of patients with doctors and nurses. We offer the following recommendations: (1) the management of ICDs at the end-of-life needs to be understood by all physicians who care for patients with ICDs; (2) discussions about deactivating the ICD should occur while patients have decision-making capacity and are clinically stable, beginning at the time of ICD implantation, then periodically at follow-up appointments, and certainly when a change in the patient's clinical status warrants a reconsideration of the goals of care; and (3) clinicians should compensate for the impediments to communication with patients and families associated with the COVID-19 pandemic, which includes patient isolation and restrictive visitor policies, by using devices that permit visual communication to reexamine goals of care, including defibrillator deactivation, in patients with ICDs who are expected to die.


Assuntos
COVID-19 , Desfibriladores Implantáveis , Assistência Terminal , Humanos , Pandemias
19.
Front Psychol ; 12: 648002, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34045995

RESUMO

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother's social network related to her experience of postnatal depressive symptoms during the first "lockdown" in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still "takes a village" to raise children in high-income populations and mothers are struggling in its absence.

20.
Philos Trans R Soc Lond B Biol Sci ; 376(1827): 20200019, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-33938274

RESUMO

It has long been acknowledged that women with children require social support to promote their health and wellbeing, as well as that of their children. However, the dominant conceptualizations of support have been heavily influenced by Western family norms. The consequence, at best, has been to stifle our understanding of the nature and consequences of support for mothers and children. At worst, it has led to systematic discrimination negatively impacting maternal-child health. To fully engage with the complexities of social support, we must take multidisciplinary or interdisciplinary approaches spanning diverse cultural and geographical perspectives. However, multidisciplinary knowledge-processing can be challenging, and it is often unclear how different studies from different disciplines relate. To address this, we outline two epistemological frameworks-the scientific approach and Tinbergen's four questions-that can be useful tools in connecting research across disciplines. In this theme issue on 'Multidisciplinary perspectives on social support and maternal-child health', we attempt to foster multidisciplinary thinking by presenting work from a diverse range of disciplines, populations and cultures. Our hope is that these tools, along with papers in this issue, help to build a holistic understanding of social support and its consequences for mothers and their children. Overall, a multidisciplinary perspective points to how the responsibility of childrearing should not fall solely onto mothers. Indeed, this multidisciplinary issue demonstrates that successful childrearing is consistently an activity shared beyond the mother and the nuclear family: an insight that is crucial to harnessing the potential of social support to improve maternal-child health. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.


Assuntos
Saúde da Criança , Saúde Materna , Mães , Apoio Social , Humanos , Mães/psicologia , Mães/estatística & dados numéricos
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