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1.
Fam Process ; 63(2): 768-787, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38548477

RESUMO

The transition to parenthood can be a challenging time for the relationships of new parents and result in declines in relationship satisfaction. Although a robust literature has identified characteristics that predict changes in relationship satisfaction during this period, the relationships of Black mothers postpartum remain understudied. To address this gap, we examined a set of relational, individual, and external characteristics as predictors of relationship satisfaction trajectories over the first four months postpartum. First-time Black mothers (N = 93, 22.6% married, 52.7% cohabiting, 24.7% not cohabiting) reported on relational, individual, and external characteristics at 1 week postpartum and their relationship satisfaction at 1, 8, and 16 weeks postpartum. Mothers who reported more commitment and partner support were higher in initial satisfaction, as were mothers who were married or cohabiting with a partner (relative to mothers who were not cohabiting with their partner). Mothers with clinically significant depressive symptoms at 1 week postpartum had lower initial relationship satisfaction than mothers without clinically significant depressive symptoms. Mothers' sleep difficulties and experiences of racial discrimination were associated with changes in relationship satisfaction over time; mothers experiencing more sleep difficulties and racial discrimination experienced larger declines in satisfaction. These findings offer new insights into risk and protective factors associated with relationship satisfaction among Black mothers during the early postpartum period and can inform multicomponent interventions to enhance their relationship functioning.


Assuntos
Negro ou Afro-Americano , Mães , Satisfação Pessoal , Período Pós-Parto , Humanos , Feminino , Adulto , Período Pós-Parto/psicologia , Período Pós-Parto/etnologia , Mães/psicologia , Negro ou Afro-Americano/psicologia , Relações Interpessoais , Adulto Jovem , Racismo/psicologia , Depressão Pós-Parto/psicologia , Depressão Pós-Parto/etnologia , Apoio Social , Casamento/psicologia , Casamento/etnologia
2.
Fam Process ; 62(3): 915-931, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36802046

RESUMO

Compared to higher income couples, those with low incomes experience a host of challenges and disparities in their intimate relationships, including lower levels of relationship satisfaction, higher rates of breakup of cohabiting relationships, and higher rates of divorce. In recognition of these disparities, a number of interventions targeting couples with low incomes have been developed. These interventions historically focused primarily on improving relationship skills through relationship education, but in recent years a new approach that integrates economic-focused interventions alongside relationship education has emerged. This integrated approach is intended to better address the challenges facing couples with low incomes, but the theory-driven, top-down approach to intervention development leaves open the question of whether couples with low incomes are interested in participating in a program that combines these two disparate components. The current study draws from a large randomized controlled trial of one such program (N = 879 couples) to provide descriptive information about the recruitment and retention of couples with low incomes in a study of relationship education with integrated economic services. Results indicate that it is possible to recruit a large, linguistically, and racially diverse sample of couples living with low income to participate in an integrated intervention, but the uptake of relationship-focused services was higher than the uptake of economic-focused services. Additionally, attrition over a 1-year follow-up data collection period was low but required labor-intensive efforts to reach participants for the survey. We highlight successful strategies for the recruitment and retention of diverse couples and discuss implications for future intervention efforts.


Assuntos
Comportamento Sexual , Parceiros Sexuais , Humanos , Escolaridade , Inquéritos e Questionários
3.
J Soc Pers Relat ; 39(4): 1087-1109, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35655791

RESUMO

The social and behavioral sciences have long suffered from a lack of diversity in the samples used to study a broad array of phenomena. In an attempt to move toward a more contextually-informed approach, multiple subfields have undertaken meta-science studies of the diversity and inclusion of underrepresented groups in their body of literature. The current study is a systematic review of the field of relationship science aimed at examining the state of diversity and inclusion in this field. Relationship-focused papers published in five top relationship science journals from 2014-2018 (N = 559 articles, containing 771 unique studies) were reviewed. Studies were coded for research methods (e.g., sample source, dyadic data, observational data, experimental design) and sample characteristics (e.g., age, education, income, race/ethnicity, sexual orientation). Results indicate that the modal participant in a study of romantic relationships is 30 years old, White, American, middle-class, college educated, and involved in a different-sex, same-race relationship. Additionally, only 74 studies (10%) focused on traditionally underrepresented groups (i.e., non-White, low-income, and/or sexual and gender minorities). Findings underscore the need for greater inclusion of underrepresented groups to ensure the validity and credibility of relationship science. We conclude with general recommendations for the field.

4.
Psychol Sci ; 32(11): 1709-1719, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34694943

RESUMO

How do natural disasters affect intimate relationships? Some research suggests that couples are brought closer together after a disaster, whereas other research suggests that relationships become more strained in the aftermath. Yet all of this work is limited by a lack of predisaster data that would allow for examination of how relationships actually change. The current study is the first to use longitudinal data collected before and after a natural disaster to examine its effect on relationship outcomes. Using a sample of 231 married couples in Harris County, Texas, who experienced Hurricane Harvey, we found that spouses experienced significant increases in satisfaction from before to after the hurricane, but the increase was temporary; couples decreased in satisfaction after the initial boost. Thus, couples appear to grow closer in the immediate aftermath of a natural disaster but then revert to their prehurricane levels of functioning as the recovery period continues.


Assuntos
Tempestades Ciclônicas , Desastres , Desastres Naturais , Humanos , Casamento , Satisfação Pessoal
5.
Pediatr Hematol Oncol ; 38(8): 731-744, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33970762

RESUMO

Pediatric neuroblastoma (NB) patients receive multi-modal therapy and may experience care fragmented among multiple institutions with a significant travel burden, which has been associated with poor outcomes for some adult cancers. We hypothesized that fragmented care for pediatric NB patients is associated with inferior outcomes compared to treatment consolidated at one location. We reviewed paper and electronic records for pediatric NB patients who received ≥1 hematopoietic stem cell transplant (HSCT) at Duke from 1990-2017. Fragmented care was defined by treatment at >1 institution and grouped by 2 institutions vs. 3+ institutions. Distances were calculated using Google Maps. To compare all care groups, we used Fisher's Exact and Kruskal-Wallis tests for demographic and treatment characteristics, Kaplan-Meier for unadjusted overall survival (OS), and Cox proportional hazards for factors associated with OS. Of 127 eligible patients, 102 (80.3%) patients experienced fragmented care, with 17 treated at 3+ facilities. Kaplan-Meier analysis did not associate fragmented care with increased mortality (log-rank p = 0.13). With multivariate analysis, only earlier diagnostic decade and greater distance to HSCT remained significantly associated with worsened OS. In this single institutional study, we found fragmented care did not impact overall survival. Worsened overall survival was associated with increased travel distance for HSCT and further research should aim to improve supportive processes for patients undergoing HSCT for high-risk neuroblastoma.


Assuntos
Continuidade da Assistência ao Paciente , Transplante de Células-Tronco Hematopoéticas , Neuroblastoma , Criança , Humanos , Estimativa de Kaplan-Meier , Neuroblastoma/terapia , Estudos Retrospectivos
6.
Cancer ; 126(12): 2859-2865, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32212334

RESUMO

BACKGROUND: Investigating scientific publication trends in the field of oncology may highlight opportunities for improved representation, mentorship, collaboration, and advancement for women. METHODS: We conducted a bibliometric analysis of Annals of Surgical Oncology; Cancer; International Journal of Radiation Oncology, Biology, Physics (IJROBP); JAMA Oncology; and Journal of Clinical Oncology in 1990, 2000, 2010, and 2017. Full name and degree credentials per author role (ie, first or senior author), article type, publication year, and citation metrics were collected. First names were used to identify author gender. RESULTS: Across 9189 articles, female representation rose between 1990 and 2017 (first authors: 17.7% in 1990, 36.6% in 2017; senior authors: 11.7% in 1990, 28.5% in 2017). For the 50 most cited articles per year, women comprised a smaller percent of first (26.5%) and senior (19.9%) authors. The average citation count was higher for male first (44.8 per article) and senior (47.1) authors compared to female first (39.7) and senior (44.1) authors. With male senior authors, the first author was more likely male (71.4% male; 25.0% female); with female senior authors, first authors were 50.2% male and 47.6% female. IJROBP had the lowest total female representation among first (25.1%) and senior (16.7%) authors. Women had more MDs with Masters degrees, whereas men held more MDs only and more MDs with PhDs. CONCLUSION: Despite positive trends, substantial gendered differences in oncology publications persist. Fostering more women in oncology research will benefit female representation at many levels of academia and improve productivity, collaboration, and recruitment, especially in technical fields such as radiation and surgical oncology.


Assuntos
Oncologia , Publicações Seriadas/estatística & dados numéricos , Oncologia Cirúrgica , Bibliometria , Escolaridade , Feminino , Humanos , Masculino , Publicações Seriadas/tendências , Fatores Sexuais
7.
Psychol Sci ; 31(12): 1479-1487, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33151125

RESUMO

How has the COVID-19 pandemic affected intimate relationships? The existing literature is mixed on the effect of major external stressors on couple relationships, and little is known about the early experience of crises. The current study used 654 individuals involved in a relationship who provided data immediately before the onset of the pandemic (December, 2019) and twice during the early stages of the pandemic (March and April, 2020). Results indicate that relationship satisfaction and causal attributions did not change over time, but responsibility attributions decreased on average. Changes in relationship outcomes were not moderated by demographic characteristics or negative repercussions of the pandemic. There were small moderation effects of relationship coping and conflict during the pandemic, revealing that satisfaction increased and maladaptive attributions decreased in couples with more positive functioning, and satisfaction decreased and maladaptive attributions increased in couples with lower functioning.


Assuntos
Adaptação Psicológica , COVID-19 , Conflito Psicológico , Relações Interpessoais , Satisfação Pessoal , Parceiros Sexuais/psicologia , Cônjuges/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
J Surg Res ; 255: 536-548, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32640405

RESUMO

BACKGROUND: Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, but no formal evaluation has identified stressors specific to this environment. METHODS: A survey was distributed to all members of the College of Surgeons of East, Central, and Southern Africa (COSECSA). Burnout, depression, and stressors were assessed with validated measures: Maslach Burnout Inventory for Medical Personnel, Patient Health Questionnaire (PHQ) 9, and Holmes-Rahe Life Stress Inventory. RESULTS: There were 131 participants (98 African and 33 non-African surgeons). The incidence of moderate to severe depression was 48% (n = 63), and the incidence of burnout was as high as 38% (n = 48). There were no significant differences between African and non-African surgeons in marital status, number of children, partners in practice, or distribution of time. More African surgeons experienced birth of a child (18% versus 3%, P = 0.04) but had less workplace conflict (7.1% versus 10.7%, P = 0.045) than non-African surgeons. African surgeons more consistently felt they were positively influencing others (P = 0.008), enjoyed working with patients (P = 0.009), and were more satisfied (P = 0.04). For all surgeons, predictors of increased PHQ-9 depression were serious professional conflict (P = 0.02), difficulty accessing childcare (P = 0.04), and racial discrimination (P = 0.003). In the Maslach model, predictors of burnout were difficulty accessing childcare (P = 0.05) and denial of promotion based on gender (P = 0.006). CONCLUSIONS: Burnout and depression in surgeons practicing in East, Central, and Southern Africa are substantial. Despite significant challenges, African surgeons tended to have a more positive outlook on their work. Improvements can be made to reduce burnout and depression by focusing on work conditions, equality of promotion opportunities, workplace conflict management, childcare support, and increasing the numbers of surgeons in practice.


Assuntos
Esgotamento Profissional/epidemiologia , Depressão/epidemiologia , Cirurgiões/estatística & dados numéricos , Adulto , África Central/epidemiologia , África Oriental/epidemiologia , África Austral/epidemiologia , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/psicologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente/estatística & dados numéricos , Prevalência , Cirurgiões/psicologia , Carga de Trabalho/psicologia
9.
World J Surg ; 44(12): 3975-3985, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32951061

RESUMO

INTRODUCTION: The surgical workforce in sub-Saharan Africa is insufficient to meet population needs. Therefore, medical students should be encouraged to pursue surgical careers and "brain drain" must be minimized. It is unknown to what extent foreign aid priorities influence medical student career choices in Uganda. METHODS: Medical students in Uganda completed an online survey examining their career choices and attitudes regarding career opportunities and funding priorities. Data were analyzed using descriptive statistics, and responses among men and women were compared using Fisher's exact tests. RESULTS: Ninety-eight students participated. Students were most influenced by inspiring role models, employment opportunities and specialty fit with personal skills. Filling an underserved specialty was near the bottom of the influence scale. Women placed higher importance on advice from mentors (p = 0.049) and specialties with lower stress burden (p = 0.027). Men placed importance on opportunities in non-governmental organizations (p = 0.033) and academia (p = 0.050). Students expressed that the most supported specialties were infectious disease (n = 65, 66%), obstetrics (n = 15, 15%) and pediatrics (n = 7, 7%). Most students (n = 91, 93%) were planning a career in infectious disease. Fifty-three students (70%) indicated plans to leave Africa for residency. Female students were more likely to have a plan to leave (p = 0.027). CONCLUSION: Medical students in Uganda acknowledge the career opportunities for physicians in specialties prioritized by the Sustainable Development Goals. In order to avoid "brain drain" and encourage students to pursue careers in surgery, career opportunities including surgical residencies must be prioritized and supported in sub-Saharan Africa.


Assuntos
Escolha da Profissão , Mentores , Estudantes de Medicina/psicologia , Adulto , Criança , Feminino , Humanos , Masculino , Inquéritos e Questionários , Uganda
10.
Fam Process ; 59(4): 1434-1446, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31660612

RESUMO

Compared to higher-income couples, low-income couples experience higher rates of relationship disruption, including divorce and breakup of cohabiting relationships. In recognition of this disparity in relationship outcomes, relationship interventions have increasingly been targeted at this population. However, these interventions have had limited impacts on the relationships of low-income couples. Developing interventions that are effective and responsive to the needs of low-income couples requires descriptive data on the challenges those couples perceive in their own relationships and an assessment of how their needs compare to the more affluent couples typically served by relationship interventions. The current study sampled over 5,000 individuals at the time they were seeking an online relationship intervention and compared the relationship functioning and life circumstances reported by low-income individuals to that of higher-income individuals. Results indicate that low-income individuals seeking a relationship intervention had higher levels of relationship distress (lower relationship satisfaction, more intense primary relationship problems, and less relationship stability), and had greater levels of contextual stress (more children living at home, less likely to be employed full-time, and lower levels of perceived health). Results suggest that future interventions designed to target low-income couples, as well as practitioners working with low-income couples, should be prepared to handle higher levels of relationship distress and contextual stressors than they may typically see in more affluent couples.


En comparación con las parejas de recursos más altos, las parejas de bajos recursos tienen índices altos de dificultades en las relaciones, incluidos el divorcio y la ruptura de las relaciones de convivencia. En reconocimiento de esta disparidad en las consecuencias de las relaciones, se han destinado cada vez más a esta población intervenciones en las relaciones. Sin embargo, estas intervenciones han tenido efectos limitados en las relaciones de las parejas de bajos recursos. El desarrollo de intervenciones que sean eficaces y sensibles a las necesidades de las parejas de bajos recursos exige datos descriptivos sobre las dificultades que esas parejas perciben en sus propias relaciones y una evaluación de cómo sus necesidades se comparan con las de las parejas más pudientes que normalmente reciben intervenciones en las relaciones. El presente estudio tomó muestras de más de 5000 personas en el momento en que estaban buscando una intervención en las relaciones por internet y comparó el funcionamiento de las relaciones y las circunstancias de vida informadas por personas de bajos recursos con las de personas de recursos más altos. Los resultados indican que las personas de bajos recursos que buscaban una intervención en las relaciones tenían niveles más altos de distrés relacional (una menor satisfacción con las relaciones, problemas más intensos en las relaciones principales y menos estabilidad relacional) y tenían niveles más altos de estrés contextual (más niños viviendo en la casa, menos probabilidades de estar empleados tiempo completo y niveles más bajos de salud percibida). Los resultados sugieren que las futuras intervenciones diseñadas para las parejas de bajos recursos, así como los profesionales que trabajan con estas parejas deberían estar preparados para manejar niveles más altos de distrés relacional y factores de estrés contextual que los que pueden ver normalmente en las parejas más pudientes.


Assuntos
Terapia de Casal/economia , Renda/estatística & dados numéricos , Intervenção Baseada em Internet/economia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pobreza/psicologia , Adulto , Status Econômico , Feminino , Disparidades nos Níveis de Saúde , Humanos , Relações Interpessoais , Masculino , Avaliação das Necessidades , Estresse Psicológico/economia , Estresse Psicológico/psicologia
11.
J Surg Oncol ; 120(2): 132-141, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062375

RESUMO

BACKGROUND AND OBJECTIVES: We sought to evaluate the impact of chemotherapy sequence on survival by comparing node-positive invasive lobular carcinoma (ILC) patients who received neoadjuvant (NACT) and adjuvant (ACT) chemotherapy. METHODS: cT1-4c, cN1-3 ILC patients in the National Cancer Data Base (2004-2013) who underwent surgery and chemotherapy were divided into NACT and ACT cohorts. Kaplan-Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. RESULTS: Five thousand five hundred fifty-one (35.6%) of 15 573 ILC patients treated with chemotherapy received NACT. NACT patients had similar rates of pT3/4 disease (26.6% vs 26.2%), nodal involvement (median 3 vs 4), and number of lymph nodes examined (median 13 vs 14) but higher rates of mastectomy (81.8% vs 74.5%, P < 0.001) vs ACT patients. 3.4% of NACT patients experienced pathologic complete response (pCR). Unadjusted 10-year OS was worse for NACT vs ACT patients (65.1% vs 54.4%, log-rank P < 0.001). After adjustment for known covariates, NACT continued to be associated with worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.25-1.52). CONCLUSIONS: In node-positive ILC, NACT yielded low rates of pCR, was not associated with lower rates of mastectomy or less extensive axillary surgery, and was associated with worse survival vs ACT, suggesting limited benefit for these patients.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/terapia , Carcinoma Lobular/terapia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Lobular/mortalidade , Carcinoma Lobular/patologia , Quimioterapia Adjuvante , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Invasividade Neoplásica , Modelos de Riscos Proporcionais , Taxa de Sobrevida
12.
AJR Am J Roentgenol ; 213(6): 1232-1239, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31613663

RESUMO

OBJECTIVE. The purpose of this study was to investigate whether, compared with traditional criteria, the modified Response Evaluation Criteria in Solid Tumors version 1.1 for immune-based therapeutics (iRECIST) improves prediction of local tumor control and survival in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS. Fifty-one HCC lesions (mean size, 3.1 cm) treated with SBRT in 41 patients (mean age, 67 years) were retrospectively included. Each patient underwent CT or MRI before SBRT and at least once after SBRT. Best overall response was categorized using Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), iRECIST, World Health Organization (WHO) criteria, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and European Association for the Study of the Liver (EASL) criteria. Lesions were then classified as local tumor control (i.e., stable disease, partial response, or complete response) or local treatment failure (i.e., progressive disease) by each tumor response criteria. Proportions of local tumor control were compared using the McNemar exact test. The 1-year overall survival was estimated using the Kaplan-Meier method. RESULTS. The median follow-up after SBRT was 21.0 months. The local tumor control rate was 94.1% (48/51) by iRECIST, 88.2% (45/51) by RECIST 1.1, 72.5% (37/51) by WHO criteria, 80.4% (41/51) by mRECIST, and 72.5% (37/51) by EASL criteria. The local tumor control rate was significantly higher according to iRECIST compared with WHO (p = 0.0010) and EASL (p = 0.0225) criteria. The 1-year survival rate for patients with local tumor control according to iRECIST (86.4%) was higher (although not statistically significant) compared with the 1-year survival rate for patients with local tumor control according to the other response criteria. CONCLUSION. iRECIST may provide more robust interpretation of HCC response after SBRT, yielding improved prediction of local tumor control and 1-year survival rates compared with traditional criteria.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Critérios de Avaliação de Resposta em Tumores Sólidos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
Fam Process ; 56(4): 869-882, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-27859099

RESUMO

Prevailing views of marital functioning generally adopt the view that marital problems predict decreases in marital satisfaction, but alternative theoretical perspectives raise the possibility that lowered satisfaction can also predict increases in problems. The current study sought to integrate and compare these perspectives by examining the bidirectional cross-lagged associations between newlyweds' reports of their marital satisfaction and marital problems over the first 4 years of marriage. Using annual assessments from 483 heterosexual newlywed couples, we find evidence for problem-to-satisfaction linkages as well as satisfaction-to-problem linkages. Satisfaction was a stronger predictor of marital problems early in marriage but not as time passed; by Year 4 only problem-to-satisfaction linkages remained significant. These findings are consistent with the idea that couples with more problems go on to report lower levels of satisfaction and couples with lower levels of satisfaction go on to report more marital problems. This dynamic interplay between global judgments about relationship satisfaction and ongoing specific relationship difficulties highlights the value of examining bidirectional effects to better understand marital functioning over time.


Assuntos
Conflito Familiar/psicologia , Casamento/psicologia , Satisfação Pessoal , Cônjuges/psicologia , Fatores de Tempo , Adulto , Feminino , Humanos , Julgamento , Estudos Longitudinais , Masculino , Modelos Psicológicos , Adulto Jovem
15.
J Soc Pers Relat ; 33(8): 1120-1134, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34045779

RESUMO

Divorced individuals offer explanations for why their relationship ended, yet little is known about the development of these problems during the relationship. Problems that lead to divorce may exist at the beginning of the marriage (enduring dynamics model) or may develop over time (emergent distress model). We asked 40 divorced individuals about the reasons for their divorce and compared the development of problems that did and did not contribute to their divorce over the first few years of their marriage. Results support an emergent distress model for wives; they saw problems that lead to divorce increasing over time, whereas results for husbands indicated that they were less attuned to problems overall, suggesting that wives are the bellwether for relationship problems.

16.
Crit Care ; 19: 127, 2015 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-25888469

RESUMO

INTRODUCTION: With growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study. METHODS: Sixty-six individuals were assessed at awakening and ICU discharge. Measures included: PFIT-s, FSS-ICU, IMS and SPPB. Bivariate relationships (Spearman's rank correlation coefficient) and predictive validity (logistic regression) were determined. Responsiveness (effect sizes); floor and ceiling effects; and minimal important differences were calculated. RESULTS: Mean ± SD PFIT-s at awakening was 4.7 ± 2.3 out of 10. On awakening a large positive relationship existed between PFIT-s and the other functional measures: FSS-ICU (rho = 0.87, p < 0.005), IMS (rho = 0.81, p < 0.005) and SPPB (rho = 0.70, p < 0.005). The PFIT-s had excellent construct validity (rho = 0.8, p < 0.005) and FSS-ICU (rho = 0.69, p < 0.005) and IMS (rho = 0.57, p < 0.005) had moderate construct validity with muscle strength. The PFIT-s and FSS-ICU had small floor/ceiling effects <11% at awakening and ICU discharge. The SPPB had a large floor effect at awakening (78%) and ICU discharge (56%). All tests demonstrated responsiveness; however highest effect size was seen in the PFIT-s (Cohen's d = 0.71). CONCLUSIONS: There is high criterion validity for other functional measures against the PFIT-s. The PFIT-s and FSS-ICU are promising functional measures and are recommended to measure function within the ICU. TRIAL REGISTRATION: Clinicaltrials.gov NCT02214823. Registered 7 August 2014).


Assuntos
Avaliação da Deficiência , Indicadores Básicos de Saúde , Unidades de Terapia Intensiva , Avaliação de Resultados da Assistência ao Paciente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Alta do Paciente
17.
Chron Respir Dis ; 12(1): 36-46, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25518845

RESUMO

Airway clearance techniques (ACTs) are recommended for patients with stable non-cystic fibrosis (non-CF) bronchiectasis, but the efficacy of oscillating positive expiratory pressure (PEP) therapy compared to other techniques has not been reviewed. A systematic review of studies was conducted in stable patients comparing the effect of oscillating PEP therapy to other ACTs or a control condition. Data were extracted related to sputum expectoration, lung function, gas exchange, quality of life (QOL), symptoms, and exacerbation rate. Seven studies were included with a total of 146 patients, with a mean (SD) PEDro score of 7(1). Oscillating PEP therapy enhanced sputum expectoration compared to no treatment, but has equivalent benefits as the active cycle of breathing technique with gravity-assisted drainage (mean difference [95% CI] -2.8 g [-8.8 to 3.2 g]). Oscillating PEP has a similar effect as other ACTs on dynamic lung volumes, gas exchange and breathlessness. Use of oscillating PEP improved disease-specific QOL (p < 0.001) and cough-related QOL (p < 0.002) compared to no treatment but did not reduce exacerbation rate. In conclusion, in stable non-CF bronchiectasis, oscillating PEP therapy is associated with improvement in sputum expectoration and QOL compared to no treatment. Compared to other ACTs, the effect upon sputum expectoration, lung function, gas exchange, and symptoms are equivalent.


Assuntos
Bronquiectasia/reabilitação , Oscilação da Parede Torácica/métodos , Respiração com Pressão Positiva/métodos , Adulto , Humanos , Troca Gasosa Pulmonar , Testes de Função Respiratória , Terapia Respiratória/métodos , Resultado do Tratamento
19.
Biotechnol Adv ; : 108405, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38997052

RESUMO

Chimeric antigen receptor (CAR)-T cells are emerging as a generation-defining therapeutic however their manufacture remains a major barrier to meeting increased market demand. Monitoring critical quality attributes (CQAs) and critical process parameters (CPPs) during manufacture would vastly enrich acquired information related to the process and product, providing feedback to enable real-time decision making. Here we identify specific CAR-T cytokines as value-adding analytes and discuss their roles as plausible CPPs and CQAs. High sensitivity sensing technologies which can be easily integrated into manufacture workflows are essential to implement real-time monitoring of these cytokines. We therefore present biosensors as enabling technologies and evaluate recent advancements in cytokine detection in cell cultures, offering promising translatability to CAR-T biomanufacture. Finally, we outline emerging sensing technologies with future promise, and provide an overall outlook on existing gaps to implementation and the optimal sensing platform to enable cytokine monitoring in CAR-T biomanufacture.

20.
J Fam Psychol ; 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38884990

RESUMO

The transition to parenthood has long been viewed as a period of change in new parents' romantic relationships. However, this research has largely focused on changes in relationship quality, generally overlooking changes in relationship status (e.g., ending or entering a relationship during this period). To address this gap, we explored patterns and predictors of relationship dissolution and relationship formation during the early postpartum period among a sample of first-time Black mothers. A community sample of mothers living with low incomes (N = 212; 10% married; 85% enrolled in Medicaid) reported on their relationship status and other characteristics at 1, 8, and 16 weeks postpartum. Among mothers who were in a relationship at 1 week postpartum (N = 126), 20% of these relationships ended by Week 8 or 16. Mothers whose relationships ended reported lower relationship functioning at Week 1 than mothers whose relationships remained intact. Among mothers who were single at 1 week postpartum (N = 86), over 50% subsequently reported being in a relationship at Week 8 or 16. Mothers who started relationships reported lower overall social support at Week 1 relative to mothers who remained single. Together, these findings indicate that changes in relationship status during the early postpartum period were common and provide initial insights into factors characterizing mothers who experienced relationship transitions. Future work would benefit from considering changes in relationship status as well as other relational changes during the transition to parenthood to reflect a wider range of experiences among new parents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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