scholarly journals Adult Outcomes

2021 ◽  
pp. 223-265
Author(s):  
Harriet Ward ◽  
Lynne Moggach ◽  
Susan Tregeagle ◽  
Helen Trivedi
Keyword(s):  
Protective Factor ◽  
Poor Mental Health ◽  
Adoptive Parent ◽  
Composite Measure ◽  
Adult Outcomes ◽  
Adult Adoptees ◽  
Care Leavers ◽  
Education And Employment ◽  
Survey Responses

AbstractThe chapter focuses exclusively on the 60 adoptees aged over 18 who completed the follow-up survey. It draws on data collected through survey responses and interviews focusing on 24 adult adoptees. It explores their outcomes across a range of dimensions that together contribute to a composite measure of adult functionality. It presents the outcomes the adoptees achieved on each of these key domains and explores how they compared both with those of the normative Australian population and a contemporaneous cohort of care leavers. The adoptees showed more evidence of poor mental health than care leavers, but often did better in terms of education and employment. The presence of a committed adoptive parent appears to have acted as a powerful protective factor, and only extreme indicators of vulnerability at entry to the adoptive home correlated with poor adult outcomes.

scholarly journals Progress After Placement

2021 ◽  
pp. 199-222
Author(s):  
Harriet Ward ◽  
Lynne Moggach ◽  
Susan Tregeagle ◽  
Helen Trivedi
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Online Survey ◽  
Poor Mental Health ◽  
Adoptive Parents ◽  
Developmentally Delayed ◽  
Physical And Mental Health ◽  
Adult Adoptees

AbstractThe chapter explores the progress made by the 93 adoptees in the core follow-up sample in terms of physical and mental health and education from the time they entered their adoptive homes until they were followed up, on average 18 years later. It draws on data collected through responses to an online survey concerning 93 adoptees (44% of the cohort) completed at follow-up, and interviews focusing on 24 adult adoptees. On entering their placements, 40% of adoptees were developmentally delayed; 13% had poor physical health; 38% were in poor mental health. Emotional and behavioural problems affected their academic progress; 76% required specialist help. After placement, 74% improved in physical health, 66% in mental health and 68% in academic performance. The challenges faced by adoptive parents provide a powerful case for careful preparation and long-term post-adoption support.

scholarly journals Permanence

2021 ◽  
pp. 125-150
Author(s):  
Harriet Ward ◽  
Lynne Moggach ◽  
Susan Tregeagle ◽  
Helen Trivedi
Keyword(s):  
Online Survey ◽  
Foster Parents ◽  
Adoptive Parents ◽  
Adult Adoptees ◽  
Original Cohort ◽  
Extensive Data ◽  
Care Leavers

AbstractThis chapter considers how far the Barnardos adoptees achieved legal, residential and emotional permanence after adoption. It draws on minimal follow-up data, available for 124 adoptees (59% of the original cohort); extensive data collected through responses to an online survey concerning 93 adoptees (44% of the cohort) 5–37 years after placement; and interviews focusing on 24 adult adoptees. Ages at follow-up ranged from 5 to 44. All adoptees had achieved legal permanence. Many had achieved residential permanence after numerous placements in care: 34% of those aged 18 or over were still living with their adoptive parents. Twelve (13%) placements had disrupted, but all except eight (9%) adoptees had achieved psychological permanence. Relationships between adoptees and adoptive parents were twice as likely to persist as those between care leavers and foster parents.

scholarly journals Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yahya Dadjo ◽  
Maryam Moshkani Farahani ◽  
Reza Nowshad ◽  
Mohsen Sadeghi Ghahrodi ◽  
Alireza Moaref ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Stenosis ◽  
Protective Factor ◽  
Cardiac Events ◽  
Mitral Valve Area ◽  
Adverse Cardiac Events ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Mitral Commissurotomy ◽  
Valve Area

Abstract Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

scholarly journals Levels of physical activity in four domains and affective wellbeing before and during the Covid-19 pandemic

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Eliane S. Engels ◽  
Michael Mutz ◽  
Yolanda Demetriou ◽  
Anne K. Reimers
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Protective Factor ◽  
Total Sample ◽  
Poor Mental Health ◽  
German Population ◽  
Time Points ◽  
Sport And Exercise ◽  
Over Time ◽  
Time Point

Abstract Background Latest studies indicated that the general mental health level is low during the pandemic. Probably, this deterioration of the mental health situation is partly due to declines in physical activity. The aim of this study was to investigate differences in and the association between affective wellbeing and levels of different domains of physical activity at three time points before and during the pandemic. Method We used a nationwide online panel with a trend data design encompassing a total sample of N = 3517, representing the German population (> 14 years). Four different activity domains (sport and exercise, light outdoor activity, housework/gardening, active travel) and affective wellbeing (positive and negative affect) were assessed at three time points before and during the Covid-19 pandemic (October 2019, March 2020, October 2020). Results Multivariate analyses of variance (MANOVA) indicate differences regarding affective wellbeing over the three time points with the lowest values at the second time point. Levels of activity in the four domains differed significantly over time with the strongest decrease for sport and exercise from the first to the second time point. Partial correlations indicated that the relationships between sport and exercise and positive affect were most consistent over time. Conclusions Overall, our findings suggest that physical activity plays a particularly important role in the pandemic period as a protective factor against poor mental health. Especially sports and exercise seem to be supportive and should be encouraged, e.g. by providing additional support in finding adequate outdoor, home-based or digital substitutes.

scholarly journals Prediction of parental alienation on depression in left-behind children: A 12-month follow-up investigation

2021 ◽  
Vol 30 ◽  
Author(s):  
Xiaoxiao Sun ◽  
Xuemei Qin ◽  
Mengjia Zhang ◽  
Aigang Yang ◽  
Xiaomei Ren ◽  
...  
Keyword(s):  
Life Events ◽  
Protective Factor ◽  
Stressful Life Events ◽  
Parental Alienation ◽  
Left Behind ◽  
Resilience Scale ◽  
Children’S Depression ◽  
Risk Predictor ◽  
High Level

Abstract Aims Alienation towards parents often occurs when parents divorce; however, it can also occur when one or both parents leave for work for more than 6 months. Our previous investigation has confirmed a high level of feelings of alienation towards parents among Chinese left-behind children. However, the longitudinal prediction of alienation on children's mental health outcomes remains largely unknown. This study aims to observe the prediction of alienation towards parents on children's depression 12 months later and potential mediators and moderators. Methods A total of 1090 Chinese left-behind children took part in this 12-month follow-up investigation, using the Chinese version of the Inventory of Alienation towards Parents (IAP), the Children's Depression Inventory (CDI), the Adolescent Self-Rating Life-events Checklist (ASLEC), and the Adolescent Resilience Scale. Results Alienation towards parents was high (16.42 ± 7.27 for mother, 15.63 ± 7.17 for father) in left-behind children, and 21.01% of children reported depression. Alienation towards parents predicted current depression of children directly and later depression indirectly; children's alienation toward their mothers was a stronger predictor of depression than alienation towards fathers. In models, stressful life-events acted as a risk mediator. Previous depression was the strongest risk predictor, resilience was the strongest protective factor, and duration of fathers’ absence and parents’ marital status moderated the predictive effects. Conclusions This study is among the first to longitudinally confirm that alienation towards parents is a predictor of children's later depression. The results provide important suggestions for families and schools; i.e. to prevent depression in left-behind children, parent−child bonds especially alienation towards mothers, should be carefully considered, and individuals with more negative life-events and weaker resilience need further attention.

Suicidal ideation in an ethnically mixed, highland Guatemalan community

2021 ◽  
pp. 136346152097693
Author(s):  
Carla Pezzia ◽  
Luisa M. Hernandez
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Ethnic Identity ◽  
Suicidal Ideation ◽  
Mental Health Care ◽  
Protective Factor ◽  
Indigenous Populations ◽  
Structured Interviews ◽  
And Gender ◽  
Survey Responses

Reported suicide rates in Latin America remain low, but there is evidence to suggest they may be increasing, particularly among indigenous populations. To better understand who may be at risk for suicide, we examined the prevalence of suicidal ideation and explored factors contributing to suicidal thoughts in an ethnically mixed, highland Guatemalan community. The data presented in this article are from a mixed methods ethnographic field project conducted over 15 months from 2010 to 2011 in Panajachel, Guatemala. We surveyed a random sample of 350 community members. Survey questions included standardized modules from the Mini-International Neuropsychiatric Interview, as well as questions on experiences of violence and mental health care. We also conducted semi-structured interviews with 13 self-selected survey participants with current suicidal ideation. These interviews included questions regarding survey responses, experiences of mental illness, and access to mental health care. A total of 55 survey participants (N = 350; 15.7%) scored positive for suicidality. Ethnic identity, gender, psychiatric illness, and experiences of violence were all correlated to suicidal ideation. Qualitative interview data highlight distinctions between genders within prominent themes of religion, family, experiences of violence, and seeking resources. Three key findings emerged from our research that are relevant to the literature: 1) ethnic identity may be both a critical risk and a protective factor for suicide in some indigenous people; 2) intersections between violence and gender highlight different patterns in suicidal ideation; and 3) high rates of suicidal ideation and other psychiatric comorbidities underscore the need for greater access to mental health services.

scholarly journals Hypertensive response in exercise - a tool to predict stroke risk?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
TE Graca Rodrigues ◽  
N Cunha ◽  
P Silverio-Antonio ◽  
P Couto Pereira ◽  
B Valente Silva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Exercise Test ◽  
Cardiovascular Events ◽  
Protective Factor ◽  
Independent Predictor ◽  
Stress Test ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction There is some evidence suggesting that exaggerated hypertensive response to exercise (HRE) may be associated with higher risk of future cardiovascular events, however the relationship between systolic blood pressure (SPB) during exercise test and stroke is not fully understood. Purpose To evaluate the ability to predict the risk of stroke in patients with HRE in exercise test. Methods Single-center retrospective study of consecutive patients submitted to exercise test from 2012 to 2015 with HRE to stress test. HRE was defined as a peak systolic blood pressure (PSBP) &gt; 210 mmHg in men and &gt; 190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure &gt; 90 mmHg or a rise of 10 mmHg. Patient’s demographics, baseline clinical characteristics, vital signs during the stress test and the occurrence of stroke during follow-up were analysed Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%), dyslipidaemia (61%), previously known coronary disease (32%), diabetes (28%) and smoking (38%). Atrial fibrillation was present in 5.9% of patients. During a mean follow-up of 60 ± 2 months, the incidence of stroke was 2.1% (n = 8), all with ischemic origin. Considering the parameters analysed on exercise test, only PSBP demonstrated to be an independent predictor of stroke (HR 1.042, CI95% 1.002-1.084, p = 0.039,) with moderate ability to predict stroke (AUC 0.735, p = 0.0016) with a most discriminatory value of 203 mmHg (sensibility 56%, specify 67%). Regarding baseline characteristics, after age, sex and comorbidities adjustment, previously controlled hypertension was found to be an independent protective factor of stroke (OR 4.247, CI 95% 0.05-0.9, p = 0.036) and atrial fibrillation was an independent predictor of stroke occurrence (HR 8.1, CI95% 1.4-46.9, p = 0.018). Atrial fibrillation was also associated with hospitalization of cardiovascular cause and major cardiovascular events occurrence (mortality, coronary syndrome and stroke). Baseline SBP was associated with atrial fibrillation development (p = 0.008). Conclusion According to our results, PSBP during exercise test is an independent predictor of stroke occurrence and should be considered as a potencial additional tool to predict stroke occurrence, particularly in high risk patients. The identification of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs.

Counselor Confirmation of Middle School Student Self-Reports of Bullying Victimization

2011 ◽  
Vol 14 (4) ◽  
pp. 2156759X1101400 ◽  
Author(s):  
Dewey Cornell ◽  
Sharmila B. Mehta
Keyword(s):  
Middle School ◽  
School Counselors ◽  
Middle School Student ◽  
Self Report ◽  
School Students ◽  
Self Reports ◽  
Peer Nomination ◽  
Survey Responses ◽  
Victims Of Bullying

School counselors frequently use self-report surveys to assess bullying despite little research on their accuracy. In this study, counselor follow-up interviews found that only 24 (56%) of 43 middle school students who self-identified as victims of bullying could be confirmed as actual victims. Other students described peer conflicts that did not constitute bullying, mis-marked the survey, or reported previous bullying. Counselor judgments were supported by peer-nomination data and other survey responses indicative of victimization.

scholarly journals Bioabsorbable vascular scaffolds in routine practice: long-term results

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R M Mori ◽  
I N G Nunez
Keyword(s):  
Protective Factor ◽  
Randomized Clinical Trials ◽  
Real Life ◽  
Long Term Results ◽  
Routine Practice ◽  
Target Vessel ◽  
Intracoronary Imaging ◽  
Vascular Scaffolds

Abstract Background Recent publications suggest that bioabsorbable vascular scaffolds (BVS) carry an excess of thrombotic complications. Our goal was to describe the results in real life and in the long term, in a series of patients who received a BVS which is currently off the market. Methods Two hundred and thirteen consecutive patients who received at least 1 BVS between May 2012 and December 2016 were analyzed. The primary objective was the incidence of the compound event “target vessel failure” that included infarction or target vessel revascularization and cardiac death. Results Seventy-five percent of patients were men with a mean age of 61.4 years. They had a high prevalence of dyslipidemia (62.44%) and smoking (65.26%). The most common cause of admission was myocardial infarction without ST elevation (53.52%). A total of 233 coronary lesions were treated, with an average of 1.3±0.3 lesions per patient. The implant was successful in 99.5% of cases. Predilatation was performed in 89.3% and post dilation in 33.5% of cases. The use of intracoronary imaging (Optical Coherence Tomography OCT and/or Intravascular ultrasonography IVUS) to optimize the BVS implant was performed in 86 patients (40.38%). With a mean follow-up of 42.5 months, the incidence of target vessel failure was 6.57% during the first 24 months and 7.98% at the end of the follow-up. Regarding the device, this included 6 cases (2.81%) of thrombosis (definitive, probable or possible) and 10 cases (4.69%) of restenosis. Patients with a history of diabetes mellitus (HR 1.72 95% CI 1.01–2.95 P=0,05) and/or chronic oral anticoagulation (HR 5.71 95% CI 1.12–28.94 P=0.04) had a higher risk of target vessel failure. The use of intracoronary imaging (OCT and/or IVUS) during the BVS implantation had a considerable trend toward significance as a protective factor (HR 0.32 95% CI 0.11–1.03 P=0.06). Conclusions In this series of patients; in real life conditions, the incidence of target vessel failure was comparable to that previously described in randomized clinical trials. The events were more frequent during the first 2 years of follow-up, in the presence of greater cardiovascular comorbidity and in the absence of intracoronary imaging during the implantation. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): European Society of Cardiology KM curve for target vessel failure (TVF) Predictor analysis for TVF

scholarly journals Developing a composite outcome measure for frailty prevention trials – rationale, derivation and sample size comparison with other candidate measures

2020 ◽  
Author(s):  
Miles D. Witham ◽  
James Wason ◽  
Richard M Dodds ◽  
Avan A Sayer
Keyword(s):  
Sample Size ◽  
Transition Probabilities ◽  
Adverse Outcomes ◽  
Transition Rates ◽  
Composite Outcome ◽  
Composite Measure ◽  
Sample Sizes ◽  
Loss To Follow Up ◽  
Prevention Trials

Abstract Introduction Frailty is the loss of ability to withstand a physiological stressor, and is associated with multiple adverse outcomes in older people. Trials to prevent or ameliorate frailty are in their infancy. A range of different outcome measures have been proposed, but current measures require either large sample sizes, long follow-up, or do not directly measure the construct of frailty. Methods We propose a composite outcome for frailty prevention trials, comprising progression to the frail state, death, or being too unwell to continue in a trial. To determine likely event rates, we used data from the English Longitudinal Study for Ageing, collected 4 years apart. We calculated transition rates between non-frail, prefrail, frail or loss to follow up due to death or illness. We used Markov state transition models to interpolate one- and two-year transition rates, and performed sample size calculations for a range of differences in transition rates using simple and composite outcomes. Results The frailty category was calculable for 4650 individuals at baseline (2226 non-frail, 1907 prefrail, 517 frail); at follow up, 1282 were non-frail, 1108 were prefrail, 318 were frail and 1936 had dropped out or were unable to complete all tests for frailty. Transition probabilities for those prefrail at baseline, measured at wave 4 were respectively 0.176, 0.286, 0.096 and 0.442 to non-frail, prefrail, frail and dead/dropped out. Interpolated transition probabilities were 0.159, 0.494, 0.113 and 0.234 at two years, and 0.108, 0.688, 0.087 and 0.117 at one year. Required sample sizes for a two-year outcome were between 1000 and 7200 for transition from prefrailty to frailty alone, 250 to 1600 for transition to the composite measure, and 75 to 350 using the composite measure with an ordinal logistic regression approach. Conclusion Use of a composite outcome for frailty trials offers reduced sample sizes and could ameliorate the effect of high loss to follow up inherent in such trials due to death and illness.

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