COVID-19 Time of Intubation Mortality Evaluation (C-TIME): A System for Predicting Mortality of Patients with COVID-19 Pneumonia at the Time They Require Mechanical Ventilation.

Background: An accurate system to predict mortality in patients requiring intubation for COVID-19 could help to inform consent, frame family expectations and assist end-of-life decisions. Research objective: To develop and validate a mortality prediction system called C-TIME (COVID-19 Time of Intubation Mortality Evaluation) using variables available before intubation, determine its discriminant accuracy, and compare it to APACHE IVa and SOFA. Methods: A retrospective cohort was set in 18 medical-surgical ICUs, enrolling consecutive adults, positive by SARS-CoV 2 RNA by reverse transcriptase polymerase chain reaction or positive rapid antigen test, and undergoing endotracheal intubation. All were followed until hospital discharge or death. The combined outcome was hospital mortality or terminal extubation with hospice discharge. Twenty-five clinical and laboratory variables available 48 hours prior to intubation were entered into multiple logistic regression (MLR) and the resulting model was used to predict mortality of validation cohort patients. AUROC was calculated for C-TIME, APACHE IVa and SOFA. Results: The median age of the 2,440 study patients was 66 years; 61.6 percent were men, and 50.5 percent were Hispanic, Native American or African American. Age, gender, COPD, minimum mean arterial pressure, Glasgow Coma scale score, and PaO2/FiO2 ratio, maximum creatinine and bilirubin, receiving factor Xa inhibitors, days receiving non-invasive respiratory support and days receiving corticosteroids prior to intubation were significantly associated with the outcome variable. The validation cohort comprised 1,179 patients. C-TIME had the highest AUROC of 0.75 (95%CI 0.72-0.79), vs 0.67 (0.64-0.71) and 0.59 (0.55-0.62) for APACHE and SOFA, respectively (Chi2 P<0.0001). Conclusions: C-TIME is the only mortality prediction score specifically developed and validated for COVID-19 patients who require mechanical ventilation. It has acceptable discriminant accuracy and goodness-of-fit to assist decision-making just prior to intubation. The C-TIME mortality prediction calculator can be freely accessed on-line at https://phoenixmed.arizona.edu/ctime.

Self-Employment or Selfless Employment? Exploration of Factors that Motivate, Facilitate, and Constrain Latina Entrepreneurship from a Family Embeddedness Perspective

As the economic and social importance of Latina-owned businesses continues to grow, research is needed on the factors that motivate entrepreneurship among Latinas and that facilitate and constrain their success. This study draws on in-depth interviews and survey data to explore the experiences of Latina entrepreneurs in Idaho, USA, from an embeddedness perspective combining family embeddedness and intersectionality frameworks to illustrate how family and social positioning affects motivations, opportunities, and access to resources. We found Latinas were motivated to start businesses by a range of interacting factors, including centrally a strong sense of responsibility to their nuclear and families of origin. Prominent family motivations included the desire to provide opportunities for younger and older generations and the need for flexibility to manage family and work obligations. Compared to their middle-class peers, working-class Latina entrepreneurs were more likely to need flexibility because they could not afford third-party care for a family member, to experience greater barriers to accessing traditional financing and professional advice, and to be more dependent on family support for their success, although not all had family-based resources upon which they could rely. Latinas struggled to fulfill traditional family role expectations and obligations while assuming the expanded responsibilities of running a business. While a central tension in their lives, this struggle provides the impetus to renegotiate and update traditional gender and family expectations as they navigate role conflict and strain.

A qualitative analysis of family caregiver perspectives from the Caregiving Transitions Study

As people live longer, informal caregiving for family and friends is becoming increasingly common. Caregiver satisfaction with their role is now of greater importance to an increasing proportion of the U.S. population. Most research on caregivers has studied convenience samples, often restricted to caregivers of people with dementia. Various studies have examined the impact of caregiving on caregivers’ health but to our knowledge there are no qualitative studies of caregiving experiences from caregivers in population-based samples. This study investigated the impact of caregiving on participants who transitioned into a caregiving role while participating in a national population-based study. Participants were from the Caregiving Transitions Study, which is ancillary to the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. We thematically analyzed responses from 150 caregivers providing care for multiple different conditions to an open-ended question asked at the time of enrollment and designed to encourage caregivers to share additional details about their caregiving experience. Four major themes were identified: cultural/family expectations; growth opportunities and reciprocity; stressors and challenges; and recommendations. Participants shared both positive and challenging experiences in their role as a family caregiver as well as the impact that these experiences had on their lives. Caregivers shared that one of the most important motivations for taking on this role was their sense of duty toward family. Caregivers also highlighted the positive impact of caregiving on their lives such as opportunities for personal growth, acquisition of new skills, and finding a sense of fulfillment and gratitude.

Family Expectations

The chapter “Family Expectations” examines how members of Generation Disaster envision their pursuit of traditional goals like finding a partner, having children, and buying a home in an era when they have more choices than ever—but each choice comes at some cost. For many, the rocky economy, their perceptions about the general safety of the world, and fears about climate change make them question whether it’s appropriate to reproduce at all. As a result of external forces and the major societal shifts around these customary but no longer automatic markers of adulthood, some are taking alternative paths around traditional approaches to family formation—whether by choice or because they feel circumstances beyond their control, like their finances, have forced them to.

Anxiety of Not Being Appointed: A Qualitative Study

This study aims to reveal the opinions of the senior students of education faculty about the anxiety of not being appointed. Phenomenological research design is used in this research. The convenience sampling method was used in the selection of the participants. The data of the study is collected through face-to-face individual interviews with the students. The research form consists of 2 parts. The questions in the first part are about the demographic information of the participants. The second part includes questions aiming to reveal the experiences of the participants regarding the anxiety of not being appointed. Each interview lasted 20 minutes on average. All interviews conducted within the scope of the research were recorded using a voice recorder with the permission of the participants. Descriptive analysis was used in the analysis of data. According to the findings, it was observed that family expectations affected all of the participants who had anxiety about not being appointed. All of the prospective teachers who experienced anxiety about not being appointed were found to catastrophize the situation. Five of the participants who had anxiety about not being appointed had physiological symptoms and that anxiety affected daily life. Three of the participants who experienced anxiety about preparation for appointment stated that they had no additional effort to be appointed. All of the participants stated that they used social support mechanisms for anxiety.

Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol

Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS).Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: “regret and decision,” “regret and physicians,” and “regret and nurses.” An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports—recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty.Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals.Spanish National Register (SL42129-20/598-E).

A Conceptual Model of Work-Family Balance Among Qatari Adults

Work-family balance is shrouded in conceptual ambiguity and WEIRD (western, educated, industrialized, rich, and democratic) understanding, which impedes scientific advancement and subsequent practical solutions. This qualitative study constructs a conceptual model of work-family balance among Qatari adults. Based on grounded theory methods, in-depth interview data from 20 Qatari adults (10 women and 10 men) indicated that work-family balance means meeting both work and family expectations. “Work” is driven primarily by family financial needs and therefore it must be undertaken for the sake of the family. However, work-family balance is an idealized goal; the demands of work, rising needs of the family, and insufficient supports make work-family balance impossible. Nevertheless, working adults actively pursue work-family balance through negotiation of expectations with role-related partners and adaptation to varying circumstances in work and family domains. Overall, the findings suggest that work-family balance is viewed by Qataris as a socially and relationally constructed concept.

Pengalaman Keluarga Dalam Memberikan Dukungan Terhadap Penderita Hipertensi

Hipertensi termasuk salah satu penyakit degenaratif yang sering dijumpai di masyarakat dan sering muncul tanpa gejala. Penyakit hipertensi akan menjadi masalah yang serius jika tidak dikelola dengan baik, karena akan berkembang dan menimbulkan komplikasi yang berbahaya. Keberhasilan pengendalian hipertensi, salah satunya dipengaruhi oleh dukungan keluarga. Dukungan keluarga merupakan bentuk interaksi antar anggota keluarga yang dapat memberikan kenyamanan fisik dan psikologis. Tujuan penelitian ini adalah untuk mendapatkan pemahaman mendalam mengenai arti dan makna dukungan keluarga terhadap penderita hipertensi. Penelitian ini menggunakan desain fenomenologi deskriptif. Pengumpulan data dilakukan dengan wawancara mendalam. Partisipan dalam penelitian ini adalah keluarga yang mempunyai anggota keluarga menderita hipertensi yang tinggal di wilayah Kebonsari Surabaya. Data yang dikumpulkan adalah rekaman wawancara yang dibuat transkrip verbatim serta dianalisa menggunakan aplikasi Open Code 4.0. Hasil penelitian ini adalah teridentifikasi 4 tema yaitu Respon psikologis emosional, Dukungan finansial, Dukungan instrumen dan Harapan keluarga. Peningkatan pengetahuan dan peran serta keluarga sangat diperlukan untuk penderita hipertensi dalam mengendalikan tekanan darah ABSTRACT Hypertension is a degenerative disease that is often found in society and often appears without symptoms. Hypertension will become a serious problem if it is not managed properly, because it will develop and cause dangerous complications. The successfull of controlling hypertension is influenced by family support. Family support is a form of interaction between family members that can provide physical and psychological comfort. The purpose of this study was to gain an in-depth understanding of the meaning and meaning of family support for hypertensive sufferers. This study used a descriptive phenomenology design. Data collection was carried out by in-depth interviews. Participants in this study are families who have family members suffering from hypertension who live in the Kebonsari area of ​​Surabaya. The data collected were recorded interviews made with verbatim transcripts and analyzed using the Open Code 4.0 application. The results of this study identified 4 themes, namely emotional psychological response, financial support, instrument support and family expectations. Increased knowledge and family participation is needed for people with hypertension in controlling blood pressure.

Prevalence of Depression, Anxiety and Stress among School Going Adolescents and their Relationship to Socioeconomic Status

Introduction: Adolescence is a phase involving risk taking, autonomy, adventure and efforts to fit into adulthood. Physical and emotional changes, peers, social media, education, family expectations etc. make individuals vulnerable. Aims: To study the prevalence of depression, anxiety and stress in school going adolescents from 9th -12th standard from Bagdogra, to examine the association with family factors and Socio Economic Status and to identify the co-morbidities between Depression, Anxiety and Stress. Methods: A cross sectional study was carried out using DASS-21 scale on a total of 231 students. In addition, a self-structured questionnaire on family structure and socio economic status was administered and SPSS software was used for analysis. Result: Overall, 76.2% had at least one of the mental morbidities under study. Depression was significantly more common in class 12th, (28.4%), 9th (28.4%) &10th (27.6%) and stress was significantly common in 12th(55.4%) & 10th (55.2%). There was no significant difference in relation to age, sex, family structure and socioeconomic status. All mental morbidities more frequently occurred in combination with each other, rather than exclusively. Depression most frequently occurred with stress (8 times) followed by anxiety (4 times), whereas anxiety was 6 times more likely to occur with stress. Conclusions: Almost 3 out of 4 children had symptoms related to at least one of the mental morbidities discussed. Depression and stress was significantly more prevalent in students answering board exams (class 10th and 12th) than those not answering board exams. Depression, Anxiety and Stress were highly correlated with each other.