Transitions in Social Network Types over Time among Older Adults

<b><i>Objective:</i></b> Network typology studies have identified heterogeneous types of older adults’ social networks. However, little is known about stability and change in social network types over time. We investigate transitions in social network types among older adults, aged 60 years and older, and factors associated with such transitions. <b><i>Methods:</i></b> We used data on 1,305 older adults, participating in 2 waves of a national, longitudinal survey, conducted in 2016–2017 and 2019, in Singapore. Latent transition analysis identified the distinct types of social networks and their transition patterns between the waves. Multinomial logistic regression examined the association of baseline and change in physical, functional, and mental health and baseline sociodemographic characteristics with network transitions into more diverse or less diverse types. <b><i>Results:</i></b> We found 5 social network types at both waves, representing the most to the least diverse types – diverse, unmarried and diverse, extended family, immediate family, and restricted. Between waves, about 57% of respondents retained their social network type, whereas 24% transitioned into more diverse types and 19% into less diverse types. Those who were older and less educated and those with worsening functional and mental health were more likely to transition into less diverse types versus remaining in the same type. <b><i>Discussion:</i></b> The findings capture the dynamics in social network composition among older adults in the contemporary aging society. We highlight sociodemographic and health disparities contributing to later life social network diversity.

Brief family history questionnaire to screen for Lynch syndrome in women with newly diagnosed non-serous, non-mucinous ovarian cancers

ObjectivesWhile ovarian cancer is the third most common Lynch syndrome-associated cancer in women, there is no established screening strategy to identify Lynch syndrome in this population. The objective of this study was to assess whether the 4-item brief Family History Questionnaire can be used as a screening tool to identify women with ovarian cancer at risk of Lynch syndrome.MethodsIn this prospective cohort study, participants with newly diagnosed non-serous, non-mucinous ovarian cancer completed the brief Family History Questionnaire, extended Family History Questionnaire, and had tumors assessed with immunohistochemistry for mismatch repair proteins, MLH1 methylation, and microsatellite instability testing. All underwent universal germline testing for Lynch syndrome. Performance characteristics were compared between the brief Family History Questionnaire, extended Family History Questionnaire, immunohistochemistry±MLH1 methylation, and microsatellite instability testing.ResultsOf 215 participants, 169 (79%) were evaluable with both the brief Family History Questionnaire and germline mutation status; 12 of these 169 were confirmed to have Lynch syndrome (7%). 10 of 12 patients (83%) with Lynch syndrome were correctly identified by the brief Family History Questionnaire, compared with 6 of 11 (55%) by the extended Family History Questionnaire, 11 of 13 (85%) by immunohistochemistry±MLH1 methylation, and 9 of 11 (82%) by microsatellite instability testing. The sensitivity, specificity, positive predictive values, and negative predictive values of the brief Family History Questionnaire were 83%, 65%, 15%, and 98%, respectively. A combined approach with immunohistochemistry and the brief Family History Questionnaire correctly identified all 12 patients with Lynch syndrome. The brief Family History Questionnaire was more sensitive than the extended Family History Questionnaire and took <10 min for each patient to complete.ConclusionsThe brief Family History Questionnaire alone or combined with immunohistochemistry may serve as an adequate screening strategy, especially in centers without access to universal tumor testing.

Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study

Background: Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes. Aim: To explore the communication strategies used in shared decision-making for children with life-limiting conditions. Design: A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11. Setting/participants: Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of nine children reviewed. Findings: Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child’s best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child’s psychosocial wellbeing. Conclusions: Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals’ moral reasoning may assist the process of shared decision-making.

A qualitative study of military officers’ perceptions of the adaptions couples make to meet the military organisation’s implicit expectations

Purpose The purpose of this study was to investigate military officers’ perception of the implicit expectations the organisation has for the officer’s private life and what implications it may have for gender norms at the organisation, family and individual levels. Design/methodology/approach A qualitative approach, using an inductive thematic analysis, was performed. The data was based on 20 interviews with military officers, including 18 men and 2 women. Findings Two main themes, with three subsequent subthemes, were identified. These themes were interpreted as being necessary for the military officer to be able to manage organisational demands. The first included the implicit expectations the organisation had for the family. The three subthemes included the officer’s acceptance of frequent travel demands, adapting private life in accordance to organisational demands and picking a partner that matches the goals of the organisation. The second identified main theme included the military officer’s descriptions of implicit expectations the organisation held for the officer’s partner. Three subthemes were identified, including the partner’s need to be independent and psychologically strong, to take the main responsibility for managing family life and to engage in emotion work with the extended family. Originality/value The findings identify important perceptions that military officers have regarding the military’s expectations for their private life and the adaptive behaviors regularly performed. These adaptive behaviors allow the military officer to be able to engage in work that sustains the organisation.

Dialectic of Public Sphere vs. Private Sphere in Millennial Families in Lampung Customary Law Community

Lampung’s patriarchal customary law faces severe challenges from the millennial generation, who constitute more than 29% of the total population of Lampung. This challenge is based on the fundamental character of the millennial generation, who are open-minded and obtain the opportunity of having an interethnic marriage. This article maps the dialectic of the public sphere vs. private sphere in millennial families in the Lampung customary law community and how women’s strategies survive the confines of patriarchy. This article explored data from a millennial married couple who live in four districts/cities in Lampung using a qualitative, socio-legal study approach standing with ten principles of marriage on happy family (SMART)’s Khoiruddin Nasution. The findings: The boundaries between the public and the private were no longer tight because husband and wife could work collaboratively, even though there were some challenges due to the dominance of patriarchal mindset in extended families, which was sometimes affirmed, even enjoyed by the husband. However, the subconscious of the millennial family was still patriarchal even though it no longer applied strictly at the practical level. Meanwhile, women survived passively by taking advantage of the economic conditions of their families or changing environments. In addition, the active strategy is to improve formal education; live separately from the extended family; have a stable job (before marriage), and manage working time

Balancing Reproductive and Productive Responsibilities: Childcare Strategies Implemented by Migrant Mothers in the Thailand–Myanmar Border Region

Background: In Myanmar, formerly known as Burma, conflicts between ethnic minorities, the government, and the military have been ongoing for decades. Enduring unrest has caused thousands to flee to the region around Mae Sot, a city on Thailand’s western border. Women around the world assume a combination of reproductive and productive responsibilities, and during situations of armed conflict and displacement, conditions for women often worsen. This study investigated the parenting experiences of female migrants from Myanmar living in protracted refugee situations in Mae Sot. Methods: This research was part of a mixed-methods international comparative study on the experiences of parenting in adversity. In this analysis, 62 first-person qualitative narratives shared by migrant mothers in the Thailand–Myanmar border region were inductively analyzed using the Qualitative Analysis Guide of Leuven method. Results: The results highlight how migrant mothers undertake significant reproductive responsibilities, such as breastfeeding and child-rearing, as well as productive responsibilities, including paid labour in the agricultural, formal, and informal sectors. In order to care and provide for their families, female migrants in the Thailand–Myanmar border region utilized four childcare strategies: caring for children while working, caring for children instead of working, dispersing responsibilities amongst extended family members and children, and delegating reproductive responsibilities to formal and non-familial caretakers. Conclusions: Most mothers shared stories in which they or their immediate family members cared for their children, rather than depending on neighbours or formal childminders. Female migrants may face challenges locating desirable work that is compatible with childcare, rendering certain childcare arrangement strategies more prevalent than others. Further research could elucidate these challenges and how opportunities for gainful employment that are conducive to childcare can be generated for women living in protracted refugee situations.

Family Outcomes After the Pediatric Intensive Care Unit: A Scoping Review

Background Intensivists are increasingly attuned to the postdischarge outcomes experienced by families because patient recovery and family outcomes are interdependent after childhood critical illness. In this scoping review of international contemporary literature, we describe the evidence of family effects and functioning postpediatric intensive care unit (PICU) as well as outcome measures used to identify strengths and weaknesses in the literature. Methods We reviewed all articles published between 1970 and 2017 in PubMed, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), or the Cochrane Controlled Trials Registry. Our search used a combination of terms for the concept of “critical care/illness” combined with additional terms for the prespecified domains of social, cognitive, emotional, physical, health-related quality of life (HRQL), and family functioning. Results We identified 71 articles reporting on the postPICU experience of more than 2400 parents and 3600 families of PICU survivors in 8 countries. These articles used 101 different metrics to assess the various aspects of family outcomes; 34 articles also included open-ended interviews. Overall, most families experienced significant disruption in at least five out of six of our family outcomes subdomains, with themes of decline in mental health, physical health, family cohesion, and family finances identified. Almost all articles represented relatively small, single-center, or disease-specific observational studies. There was a disproportionate representation of families of higher socioeconomic status (SES) and Caucasian race, and there was much more data about mothers compared to fathers. There was also very limited information regarding outcomes for siblings and extended family members after a child's PICU stay. Conclusions Significant opportunities remain for research exploring family functioning after PICU discharge. We recommend that future work include more diverse populations with respect to the critically ill child as well as family characteristics, include more intervention studies, and enrich existing knowledge about outcomes for siblings and extended family.

Alu element in the RNA binding motif protein, X-linked 2 (RBMX2) gene found to be linked to bipolar disorder

Objective We have used long-read single molecule, real-time (SMRT) sequencing to fully characterize a ~12Mb genomic region on chromosome Xq24-q27, significantly linked to bipolar disorder (BD) in an extended family from a genetic sub-isolate. This family segregates BD in at least four generations with 24 affected individuals. Methods We selected 16 family members for targeted sequencing. The selected individuals either carried the disease haplotype, were non-carriers of the disease haplotype, or served as married-in controls. We designed hybrid capture probes enriching for 5-9Kb fragments spanning the entire 12Mb region that were then sequenced to screen for candidate structural variants (SVs) that could explain the increased risk for BD in this extended family. Results Altogether, 201 variants were detected in the critically linked region. Although most of these represented common variants, three variants emerged that showed near-perfect segregation among all BD type I affected individuals. Two of the SVs were identified in or near genes belonging to the RNA Binding Motif Protein, X-Linked (RBMX) gene family—a 330bp Alu (subfamily AluYa5) deletion in intron 3 of the RBMX2 gene and an intergenic 27bp tandem repeat deletion between the RBMX and G protein-coupled receptor 101 (GPR101) genes. The third SV was a 50bp tandem repeat insertion in intron 1 of the Coagulation Factor IX (F9) gene. Conclusions Among the three genetically linked SVs, additional evidence supported the Alu element deletion in RBMX2 as the leading candidate for contributing directly to the disease development of BD type I in this extended family.

Social determinants of mental well-being: senses of powerlessness and empowerment among Romani in Ukraine

Purpose The purpose of this paper is to explore senses of powerlessness and empowerment among Romani in Ukraine in relation to such social circles as the extended family, the Romani local community and the whole Ukrainian society. The main research interest is focused on situations and factors that make people feel powerless or empowered. Design/methodology/approach The study was conducted using a semi-structured interview method via telephone. Romani NGO experts approved the interview content. Trained Roma-facilitators were interviewers. Every interview was transcribed for further thematic analysis. Findings The most prominent empowerment factors for Romani people are located within their families and local communities, while the bigger society (Ukrainians themselves and Ukrainian public institutions) is a main source of powerlessness. At the same time, the rigid role of family and community expectations is seen as detrimental for both males and females. Originality/value The paper is original in terms of its topic (senses of powerlessness and empowerment among Romani in Ukraine as social determinants of mental well-being) and research strategy (engagement of Roma-facilitators as interviewers).

New Zealand Young Adult Fiction: National Myths, Identity and Coming-of-age

<p>Tara, the 17-year-old narrator of Dear Vincent by Mandy Hager, struggles in the relationship with her mother and learns about her family’s past on a trip to Ireland. She must decide whether she follows in the footsteps of her sister who died by suicide or whether she chooses life for herself and what her life will look like. Whiti Hereaka’s Bugs follows the development of Bugs, who turns 17 about half-way through the novel. She faces low expectations and institutional discrimination at school and must make decisions about her future. While Bugs chooses to stay; her personal growth is like that of Tara who leaves. In Kate De Goldi’s The 10PM Question, we engage with 12-year-old Frankie, who struggles with anxiety and a permanently house-bound mother. Like the protagonists of the other novels, Frankie must determine who he is by forming his first strong friendship with a teenager of the opposite sex and by questioning the adults around him. He, too, must make decisions which contradict the actions of his family. All three, Tara, Bugs and Frankie, are supported in this process by friends and extended family, and, as we will see, these characters come to play crucial roles in each protagonist’s identity formation. What this thesis shows is that their stories are both universal and local. All three novels include common elements of Young Adult fiction about identity formation and coming-of-age and they are firmly located in New Zealand by way of incorporating uniquely New Zealand national myths. These myths shape our collective identities and adolescence is a time when teenagers form theirs. It is during this time that they explicitly notice and, at times, question the myths that they have been raised to believe in. This thesis is concerned with Overseas Experience (OE) as a way to develop one’s sense of self and broadening one’s horizons, the egalitarian myth or the belief that ‘we are all equal here’, and the ‘she’ll be right’ myth, the assumption that things will somehow right themselves. It seeks to explore what these novels suggest about the three different national myths of New Zealand and their role in identity formation. It will also discuss whether different views are presented.</p>