Search results for: family doctors

Authors: Angelis P. Barlampas

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The purpose of this study is to inform the reader, about the various applications of artificial intelligence (AI), in cardiac imaging. AI grows fast and its role is crucial in medical specialties, which use large amounts of digital data, that are very difficult or even impossible to be managed by human beings and especially doctors.Artificial intelligence (AI) refers to the ability of computers to mimic human cognitive function, performing tasks such as learning, problem-solving, and autonomous decision making based on digital data. Whereas AI describes the concept of using computers to mimic human cognitive tasks, machine learning (ML) describes the category of algorithms that enable most current applications described as AI. Some of the current applications of AI in cardiac imaging are the follows: Ultrasound: Automated segmentation of cardiac chambers across five common views and consequently quantify chamber volumes/mass, ascertain ejection fraction and determine longitudinal strain through speckle tracking. Determine the severity of mitral regurgitation (accuracy > 99% for every degree of severity). Identify myocardial infarction. Distinguish between Athlete’s heart and hypertrophic cardiomyopathy, as well as restrictive cardiomyopathy and constrictive pericarditis. Predict all-cause mortality. CT Reduce radiation doses. Calculate the calcium score. Diagnose coronary artery disease (CAD). Predict all-cause 5-year mortality. Predict major cardiovascular events in patients with suspected CAD. MRI Segment of cardiac structures and infarct tissue. Calculate cardiac mass and function parameters. Distinguish between patients with myocardial infarction and control subjects. It could potentially reduce costs since it would preclude the need for gadolinium-enhanced CMR. Predict 4-year survival in patients with pulmonary hypertension. Nuclear Imaging Classify normal and abnormal myocardium in CAD. Detect locations with abnormal myocardium. Predict cardiac death. ML was comparable to or better than two experienced readers in predicting the need for revascularization. AI emerge as a helpful tool in cardiac imaging and for the doctors who can not manage the overall increasing demand, in examinations such as ultrasound, computed tomography, MRI, or nuclear imaging studies.

Keywords: artificial intelligence, cardiac imaging, ultrasound, MRI, CT, nuclear medicine

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Authors: A. Benedetto, P. Wong, N. Papouchis, L. W. Samstag

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Bowen’s concept of self-differentiation describes a healthy balance of autonomy and intimacy in close relationships, and it has been widely researched in the context of family dynamics. The current study aimed to clarify the impact of family dysfunction on self-differentiation by specifically examining conflict between parents, and by including young adults, an underexamined age group in this domain (N = 300; ages 18 to 30). It also identified a protective factor for offspring from conflictual homes. The 300 young adults (recruited online through Mechanical Turk) completed the Differentiation of Self Inventory (DSI), the Children’s Perception of Interparental Conflict Scale (CPIC), the Parental Bonding Instrument (PBI), and the Symptom Checklist-90-Revised (SCL-90-R). Analyses revealed that interparental conflict significantly impairs self-differentiation among young adult offspring. Specifically, exposure to parental conflict showed a negative impact on young adults’ sense of self, emotional reactivity, and interpersonal cutoff in the context of close relationships. Parental conflict was also related to increased psychological distress among offspring. Surprisingly, the study found that parental divorce does not impair self-differentiation in offspring, demonstrating the distinctly harmful impact of conflict. These results clarify a unique type of family dysfunction that impairs self-differentiation, specifically in distinguishing it from parental divorce; it examines young adults, a critical age group not previously examined in this domain; and it identifies a moderating protective factor (a strong parent-child bond) for offspring exposed to conflict. Overall, results suggest the need for modifications in parental behavior in order to protect offspring at risk of lasting emotional and interpersonal damage.

Keywords: divorce, family dysfunction, parental conflict, parent-child bond, relationships, self-differentiation, young adults

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Authors: Brian Carey Sims

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The current study examines psychological factors relevant to child custody litigation among African American fathers. Thirty-seven fathers engaged in various stages of custody litigation involving their children were surveyed about their perceptions of racial stereotypes, parental motivations, and racialized dynamics of the court/ legal process. Data were analyzed using a Critical Race Theory model designed to statistically isolate fathers’ perceptions of the existence and maintenance of structural racism through the legal process. Results indicate significant correlations between fathers’ psychological measures and structural outcomes of their cases. Findings are discussed in terms of ethical implications for family court judicial systems and attorney practice.

Keywords: ethics, family, legal psychology, policy, race

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Authors: Marine Hascoet, Valentina Giaconi, Ludivine Jamain

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The aim of our study is to examine if the family socio-economic status (SES) has an influence on students’ academic achievement. We first make the hypothesis that the more their families have financial and social resources, the more students succeed at school. We second make the hypothesis that this family SES has also an impact on parents’ expectations about their children educational outcomes. Moreover, we want to study if that parents’ expectations play the role of mediator between parents’ socio-economic status and the student’ self-concept and academic outcome. We test this model with a longitudinal design thanks to the census-based assessment from the System of Measurement of the Quality of Education (SIMCE). The SIMCE tests aim to assess all the students attending to regular education in a defined level. The sample used in this study came from the SIMCE assessments done three times: in 4th, 8th and 11th grade during the years 2007, 2011 and 2014 respectively. It includes 156.619 students (75.084 boys and 81.535 girls) that had valid responses for the three years. The family socio-economic status was measured at the first assessment (in 4th grade). The parents’ educational expectations and the students’ self-concept were measured at the second assessment (in 8th grade). The achievement score was measured twice; once when children were in 4th grade and a second time when they were in 11th grade. To test our hypothesis, we have defined a structural equation model. We found that our model fit well the data (CFI = 0.96, TLI = 0.95, RMSEA = 0.05, SRMR = 0.05). Both family SES and prior achievements predict parents’ educational expectations and effect of SES is important in comparison to the other coefficients. These expectations predict students’ achievement three years later (with prior achievement controlled) but not their self-concept. Our model explains 51.9% of the achievement in the 11th grade. Our results confirm the importance of the parents’ expectations and the significant role of socio-economic status in students’ academic achievement in Chile.

Keywords: Chilean context, parent’s expectations, school achievement, self-concept, socio-economic status

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Authors: Li Pan

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The recently prevalent government procurement of public services in China boasts a new form of government’s provision of public service through the purchasing of social work from social organizations, a new measure of the transformation in governmental functions as well as an unprecedented opportunity for the development of social organizations. For the past few years, the phenomenon of a surge in the number of social work organizations and social work staff emerged right with the initiatives of energetically carrying out the purchase of public services by the government. Such efforts have presented the strong determination of the Chinese government in building a small government by streamlining administration and delegating part of the governmental power to social organizations. This paper is based on the 2012-2014 performance appraisal project of the Guangzhou municipal government’s purchasing of public services and the project was carried out in the summer of 2015. During the process of the appraisal, several general problems hindering the sustainable development of government purchasing of public service have been observed. As Guangzhou is among the rank of pioneer cities in the conduct of the reform, it is representative and imperative to study the sustainability of government purchasing of public service. In 2012, Guangzhou local government started contracting out public service to the community social organizations to provide general family services and special services to community residents, since when integrated family service centers and special service centers were established as platforms to provide public social service in a city-wide range. Consequently, taking an example of the current rapid development of government purchase of the integrated family services and special services in Guangzhou, this paper puts up several proposals for the sustainable development of Guangzhou municipal government’s procurement of public services on the perspective of social work’s resource dependence.

Keywords: government procurement of public services, Guangzhou, integrated family service center, social work, sustainability.

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Authors: Yu-Ching Liu

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Background: Family numbers usually take responsibility for taking care of their elderly relatives, especially parents. Caring for a patient with chronic diseases is a stressful experience, which makes carers suffer physical and mental health stress, difficulties maintaining family relationships and issues in participating in the labor market, which may lower their quality of life (QoL). The issue of providing care to relatives with chronic illness has been widely explored in Taiwan, but most studies focus on the need for full-time caregivers. Objective: The main goal of this study was to examine the topic of working carers involved in the decision-making process of LTC services and to explore what affects working carers considering when they choose the care services for their disabled, elderly relatives. Method: A total of 7 working caregivers were enrolled in this study. A face-to-face and semi-structured in-depth qualitative interview study were conducted to explore the caregivers' perspectives. Results: Working carers have a positive experience of using LTC service because it allows them to kill two birds with one stone, continue employment, and care for an elderly disabled relative. However, working carers have still been struggling to find friendly community-based LTC services. There were no longer available community services that could be used with the illness condition of patients getting worse. As such, patients have to be cared for at home, which might increase the caregiver burden of carers. Conclusion: Working family caregivers suffer from heavy physical and psychological burdens as they not only have to maintain their employment but care for elderly disabled relatives; however, the current support provided is insufficient. The design of services should consider working carers' employment situation and need rather than the only caring situation of patients at home.

Keywords: family caregiver, Long-term care, work-life balance, decision-making

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Authors: Vikash Yadav, Ashish Arora

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Microorganisms have self-defense mechanisms to protect themselves from toxic environments. Phenolic acid decarboxylase(pad) is responsible for the defense against toxicity caused by phenolic acids, converting them into less toxic vinyl derivatives. The transcription of the pad gene is regulated by a negative transcription factor, phenolic acid decarboxylase regulators (PadR), in a substrate-inducible manner. The PadR family members share the conserved DNA-binding features and interact with the operator DNA using a winged helix-turn-helix (wHTH) motif, which contains a three-helix motif and a β-stranded wing. The members of this family function as transcriptional regulators that are involved in various cellular survival processes, such as toxin production, detoxification, multidrug resistance, antibiotic biosynthesis, and carbon catabolism. Rv1176 of Mycobacterium tuberculosis H37Rv has been assigned to the PadR family protein that remains to be structurally and functionally uncharacterized. To reveal the structural mechanism by which Rv1176 could regulates effector-responsive transcription, several experiments were performed, including Electrophoretic Mobility Shift Assay (EMSA) for DNA protein interaction, differential scanning calorimetry (DSC) and Differential Scanning Fluorimetry (DSF) for temperature and ligand-dependent protein stability, Circular Dichroism (CD) spectroscopy for secondary structure analysis. Further, to evaluate the functional role of Rv1176, the intracellular survival of recombinant M. smegmatis was examined in murine macrophage cell line J774A.1 and different stressed conditions like oxidative, pH, and nutritive stress. All these studies demonstrated that Rv1176 could behave as a transcription regulator and its expression in recombinant M. smegmatis increases intracellular survival.

Keywords: EMSA, Mycobacterium tuberculosis, PadR family protein, transcriptional regulator

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Authors: Magdalena Hasplova, Katerina Ivanova

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Perinatal palliative care is a relatively young and developing field that includes the care of a fetus or newborn with a life-threatening or limiting defect and his family. However, the training of midwives in perinatal palliative care is insufficient and midwives do not feel prepared for this aspect of their work. This fact can affect the barriers to communication with the mother or family of the endangered child. The main aim was to analyze the awareness of midwifery students on the issue of perinatal palliative care in the Czech Republic. Based on the analysis, draw attention to possible communication barriers that may be caused by insufficient information. The research was carried out using a qualitative method, the method of data collection was a semi-structured interview. Eleven female students took part in the research, and the respondents were selected using the Snowballing method. Some methods of grounded theory (open coding and category creation) were used to analyze the data. Based on the results of the research, questions were set in a questionnaire focused on communication barriers between mothers (family) and health care professionals in the care of newborns with life-threatening or limiting disabilities. Based on the analysis of data, categories 1 were determined. Knowledge of perinatal palliative care 2. Education 3. Practical experience 4. Readiness and concerns in the provision of perinatal palliative care 6. Supervision. The questions in the questionnaire were then derived taking into account the data obtained, and the operationalization of health literacy in the field of perinatal palliative care was performed. The analysis of the interviews revealed that the education of midwives in the Czech Republic in the issue of perinatal palliative care is not uniform. The research confirmed the insufficient knowledge and skills of midwifery students preparing to provide perinatal palliative care. Respondents reported feelings of unpreparedness in the areas of communication with a woman after perinatal loss, psychological support for a woman and her family, the care of a stillborn or dying child, or self-coping with death. The questions in the questionnaire then develop these areas. We assumed that by analyzing and interpreting the data obtained from our research, we will help to better understand the concerns and motivations of students in providing holistic perinatal palliative care. We came to the conclusion that it would be appropriate to set up a unified and comprehensive education on this issue in the Czech Republic. Healthcare professionals are in a unique position that can positively or negatively affect the intensity of perinatal loss. Already properly set up education of health professionals leads to overcoming barriers in communication between health professionals and the family, experiencing perinatal loss.

Keywords: midwife, perinatal loss, perinatal palliative care, communication, barriers, mothers, family

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Authors: Okunola Solomon Olufemi

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The study focused on the contribution of urban agriculture to the livelihood of 107 respondents in Kwara State of Nigeria. The study employed structured questionnaire to collect relevant data for the study while descriptive statistics such as frequency distribution and percentage were employed to analyses the objectives. Most respondents (82.9%), were one time or the other in a married state and they had formal education (80.4%) while many of the lot (58.9%) had superior education ranging from OND to Ph.D level. These farmers were either retired government workers or those trying to argument their family income or trying to be food sufficient. Most of the respondents (77.4%) had a farm size of less than or equal to 3 hectares showing that most the urban farmers were smallholders which might be as a result of stiff completion for land resource. Most of the respondents had a relatively large family size of 6 and above members. Most respondents used family labor (59.8%). Respondents in the study area also made use of the cooperatives and daily contributions for loanable funds, while few respondents utilized the formal sector. .Urban agriculture accounted for 84.4% of the Livelihood outcomes of the respondents. While non-farming activities contributed 17.6%.Most of the respondents (31.8%) participated in non-farming activities to generate extra income while their major constraints were shortage of land both in term of access and tenure (34.1%), limited access to resource and agricultural inputs (29.3%), and prohibitive urban policies and regulation (23.2%).

Keywords: poverty throes, urban agriculture, rigors of farming, non-farming, married state

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Authors: Shyamani Hettiarachchi

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Aim: Siblings of children with cerebral palsy are often in the periphery of discussions; their views not always taken into account. The aim of this study was to uncover the narratives of young siblings of children with cerebral palsy in Sri Lanka. Methods: Semi-structured interviews and artwork were gathered from 10 children who have siblings diagnosed with cerebral palsy. The data was analyzed using the key principles of Framework Analysis to determine the key themes within the narratives. Results: The key themes to emerge were complex and nuanced. These included themes of love and feeling of protectiveness; jealousy and uncertainly; guilt and hope. Conclusions: The results highlight the need to take document the views of siblings who are often on the margins of the family and of family decisions and discussions. It also supports the need to offer safe spaces and opportunities for siblings of children with disabilities to express their feelings and to receive support where required.

Keywords: disability, grandmothers, mothers, narratives, women

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

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Diabetes in India is growing at an alarming rate and the complications caused by it need to be controlled. Coronary heart disease (CHD) is one of the complications that will be discussed for prediction in this study. India has the second most number of diabetes patients in the world. To the best of our knowledge, there is no CHD risk score for Indian type 2 diabetes patients. Any form of CHD has been taken as the event of interest. A sample of 750 was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of CHD. Predictive risk scores of CHD events are designed by cox proportional hazard regression. Model calibration and discrimination is assessed from Hosmer Lemeshow and area under receiver operating characteristic (ROC) curve. Overfitting and underfitting of the model is checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Youden’s index is used to choose the optimal cut off point from the scores. Five year probability of CHD is predicted by both survival function and Markov chain two state model and the better technique is concluded. The risk scores for CHD developed can be calculated by doctors and patients for self-control of diabetes. Furthermore, the five-year probabilities can be implemented as well to forecast and maintain the condition of patients.

Keywords: coronary heart disease, cox proportional hazard regression, ROC curve, type 2 diabetes Mellitus

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Authors: Suresh Sharma, Neeti Goutam

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In India abortions are legal and with the exceedingly liberal and broadened law that was passed in 1971, “Medical Termination of Pregnancy Act” had opened a new window to Women’s’ freedom and choice over their fertility. This paper would like to focus on the factors responsible for or leading to unsafe abortion as well as such high incidence of abortion in India which can help in understanding the ways in which we can prevent this apathy. To study the intricacies involved in delivering safety to womanhood in terms of safe abortion practice which includes more trained personnel, detailed explanation and consequences of conducting an abortion, fine reporting, awareness regarding family planning measures and not only pressurizing them to sterilize immediately after an abortion but also prior to that informing them and lastly easy accessibility of Contraceptives with a educated and brief information on that. Data has been drawn from various sources such as National Family Household Survey (1, 2, 3), Health Management Information System and Annual Health Survey. To safeguard the interest of women when it comes to complications resulting from unsafe abortions, Reproductive Health laid its strict adherence to it in its guidelines. The Government could induce more measures in terms of family planning measures and increase in the number of skilled medical health force, chiefly in rural areas to prevent the illegality of abortions. But before that fine reporting on the number of abortions performed will give an insight to this very issue only then policies and programs will work much better in favor of women.

Keywords: abortion, MTP act, India, women

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Authors: Mbuotidem Brendan, Nathanael Afolabi

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Teenage pregnancy is a major health concern because of its association with high morbidity and mortality for both mother and child. In 2013, 23% of women in Nigeria, aged 15 - 19 yr have begun childbearing: 17% have had a child and 5% are pregnant with their first child. Reported differences across locations have been attributed to factors such as educational attainment and exposure to mass media. This study therefore seeks to determine the difference in the level of exposure among teenage mothers and older women of reproductive age in Nigeria. Over 12,000 women of reproductive age (18 – 49 yr) were interviewed across 8 states from the Northern and Southern region of Nigeria. The women were further segregated into two groups of 0 (women aged 18 – 20 yr who had children of their own) and 1 (women of reproductive age excluding teenage mothers). Data was collected via structured questionnaires on mobile devices using the open data kit platform. Initial data formatting and recoding was done using STATA 13 package. Initial analysis was also conducted using SPSS version 21 and the data points were mapped on QuantumGIS package. From the results of analyzed data obtained from the studied states, there were various mean ages of first births across the supported states. Though Akwa Ibom had one of the oldest mean ages (21.2 yr) at first birth and the lowest fertility rate of 3.9 births/woman according to the National Demographic Health Survey 2013, Akwa Ibom had the highest rate of teenage pregnancy (18.2%) across the respondents. Based on education, the respondents that had completed secondary school education (56.9%) made up the greatest cohorts of the teenage parents. This is counter indicative of the initial thinking that there is an inverse relationship between level of education and teenage pregnancy. Akwa Ibom, Bauchi and Delta states are states where respondents felt that contraceptive use is dangerous to health and they were the top 4 states that had a large proportion of teenage mothers. Similarly, across the states examined, all the women of reproductive age felt they could convince their spouses to use contraceptives, as using family planning does not cause women to be promiscuous. This study thus reveals that across the states studied, there was no marked variation in the perception of family planning between teenage parents and women of reproductive age. The study also highlights the need for future planning and exposure to family planning messages at secondary school level.

Keywords: adolescent, family planning, mass media, teenage mothers

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Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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Authors: C. Scurr, J. Jeans, S. Srivastava

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Introduction: Acute type two respiratory failure (T2RF) has become a common presentation over the last two decades primarily due to an increase in the prevalence of chronic lung disease. Acute exacerbations can be managed either medically or in combination with non-invasive ventilation (NIV) which should be monitored with regular arterial blood gas samples (ABG). Arterial lines allow more frequent arterial blood sampling with less patient discomfort. We present the experience from a teaching hospital emergency department (ED) and level 2 medical high-dependency unit (HDU) that together form the pathway for management of acute type 2 respiratory failure. Methods: Patients acutely presenting to Charing Cross Hospital, London, with T2RF requiring non-invasive ventilation (NIV) over 14 months (2011 to 2012) were identified from clinical coding. Retrospective data collection included: demographics, co-morbidities, blood gas numbers and timing, if arterial lines were used and who performed this. Analysis was undertaken using Microsoft Excel. Results: Coding identified 107 possible patients. 69 notes were available, of which 41 required NIV for type 2 respiratory failure. 53.6% of patients had an arterial line inserted. Patients with arterial lines had 22.4 ABG in total on average compared to 8.2 for those without. These patients had a similar average time to normalizing pH of (23.7 with arterial line vs 25.6 hours without), and no statistically significant difference in mortality. Arterial lines were inserted by Foundation year doctors, Core trainees, Medical registrars as well as the ICU registrar. 63% of these were performed by the medical registrar rather than ICU, ED or a junior doctor. This is reflected in that the average time until an arterial line was inserted was 462 minutes. The average number of ABGs taken before an arterial line was 2 with a range of 0 – 6. The average number of gases taken if no arterial line was ever used was 7.79 (range of 2-34) – on average 4 times as many arterial punctures for each patient. Discussion: Arterial line use was associated with more frequent arterial blood sampling during each inpatient admission. Additionally, patients with an arterial line have less individual arterial punctures in total and this is likely more comfortable for the patient. Arterial lines are normally sited by medical registrars, however this is normally after some delay. ED clinicians could improve patient comfort and monitoring thus allowing faster titration of NIV if arteral lines were regularly inserted in the ED. We recommend that ED doctors insert arterial lines when indicated in order improve the patient experience and facilitate medical management.

Keywords: non invasive ventilation, arterial blood gas, acute type, arterial line

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Authors: Rana Alkhamra

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Background: Child's earliest experiences with books and stories during the first years of his life are strongly linked with the development of his early language and literacy skills. Interacting in routine learning activities, such as shared book reading, storytelling, and teaching about the letters of the alphabet make a critical foundation for early learning, language growth and emergent literacy. Aim: The current study explores family and preschool early interactive literacy practices in families and preschools (nursery and kindergarten) in Jordan. It highlights the importance of early interactive literacy activities on child language and literacy growth and development. Methods: This is a cross sectional study that surveyed 243 Jordanian families. The survey investigated literacy routine practices, largely shared books reading, at home and at preschool; child speech and language development; and family demographics. Results: Around 92.5% of the families read books and stories to their children, as frequently as 1-2 times weekly or monthly (75%). Only 19.6% read books on daily basis. Many families reported preferring story-telling (97%). Despite that families acknowledged the importance of early literacy activities, on language, reading and writing, cognitive, and academic development, 45% asked for education and training pertaining to specific ways and ideas to help their young children develop language and literacy skills. About 69% of the families reported reading books and stories to their children for 15 minutes a day, while 71.2% indicated having their children watch television for 3 to > 6 hours a day. At preschool, only 52.8% of the teachers were reported to read books and stories. Factors like parent education, monthly income, living inside (33.6%) or outside (66.4%) the capital city of Amman significantly (p < 0.05) affected child early literacy interactive activities whether at home or at preschool. Conclusion: Early language and literacy skills depend largely on the opportunities and experiences provided to children in the home and in preschool environment. Family literacy programs can play an important role in bridging the gap in early literacy experiences for families that need help. Also, speech therapists can work in collaboration with families and educators to ensure that young children have high quality and sufficient opportunities to participate in early literacy activities both at home and in preschool environments.

Keywords: literacy, interactive activities, language, practices, family, preschool, Jordan

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Authors: Szu-Mei Hsiao

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Many nurses have concerns about the difficulties of providing spiritual care for ethnic-Chinese patients and family members within their cultural context. This is due to a lack of knowledge and training. Most family caregivers are female. There has been little research exploring the potential impact of Chinese cultural values on the spiritual distress of couple dyadic participants in Taiwan. This study explores the spiritual issues of Taiwanese women coping with their husband’s advanced cancer during palliative care to death. Qualitative multiple case studies were used. Data was collected through participant observation and in-depth face-to-face interviews. Transcribed interview data was analyzed by using qualitative content analysis. Three couples were recruited from a community-based rural hospital in Taiwan where the husbands were hospitalized in a medical ward. Four spiritual distress themes emerged from the analysis: (1) A personal conflict in trying to come to terms with love and forgiveness; the inability to forgive their husband’s mistakes; and, lack of their family’s love and support. (2) A feeling of hopelessness due to advanced cancer, such as a feeling of disappointment in their destiny and karma, including expressing doubt on survival. (3) A feeling of uncertainty in facing death peacefully, such as fear of facing the unknown world; and, (4) A feeling of doubt causing them to question the meaning and values in their lives. This research has shown that caregivers needed family support, friends, social welfare, and the help of their religion to meet their spiritual needs in coping within the final stages of life and death. The findings of this study could assist health professionals to detect the spiritual distress of ethnic-Chinese patients and caregivers in the context of their cultural or religious background as early as possible.

Keywords: advanced cancer, Buddhism, Confucianism, Taoism, qualitative research, spiritual distress

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Authors: Anteneh Getachew Gebrie, Rabian Wangkeeree

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The purpose of this paper is to introduce iterative algorithm solving split system of minimization problem given as a task of finding a common minimizer point of finite family of proper, lower semicontinuous convex functions and whose image under a bounded linear operator is also common minimizer point of another finite family of proper, lower semicontinuous convex functions. We obtain strong convergence of the sequence generated by our algorithm under some suitable conditions on the parameters. The iterative schemes are developed with a way of selecting the step sizes such that the information of operator norm is not necessary. Some applications and numerical experiment is given to analyse the efficiency of our algorithm.

Keywords: Hilbert Space, minimization problems, Moreau-Yosida approximate, split feasibility problem

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Authors: Leslie M. Gutman

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Conduct problems (CP) represent a major dilemma, with wide-ranging and long-lasting individual and societal impacts. Children experience heterogeneous patterns of conduct problems; based on the age of onset, developmental course and related risk factors from around age 3. Early childhood represents a potential window for intervention efforts aimed at changing the trajectory of early starting conduct problems. Using the UK Millennium Cohort Study (n = 17,206 children), this study (a) identifies trajectories of conduct problems from ages 3 to 14 years and (b) assesses the cumulative and interactive effects of individual, family and socioeconomic risk factors from ages 9 months to 14 years. The same factors according to three domains were assessed, including child (i.e., low verbal ability, hyperactivity/inattention, peer problems, emotional problems), family (i.e., single families, parental poor physical and mental health, large family size) and socioeconomic (i.e., low family income, low parental education, unemployment, social housing). A cumulative risk score for the child, family, and socioeconomic domains at each age was calculated. It was then examined how the cumulative risk scores explain variation in the trajectories of conduct problems. Lastly, interactive effects among the different domains of cumulative risk were tested. Using group-based trajectory modeling, four distinct trajectories were found including a ‘low’ problem group and three groups showing childhood-onset conduct problems: ‘school-age onset’; ‘early-onset, desisting’; and ‘early-onset, persisting’. The ‘low’ group (57% of the sample) showed a low probability of conducts problems, close to zero, from 3 to 14 years. The ‘early-onset, desisting’ group (23% of the sample) demonstrated a moderate probability of CP in early childhood, with a decline from 3 to 5 years and a low probability thereafter. The ‘early-onset, persistent’ group (8%) followed a high probability of conduct problems, which declined from 11 years but was close to 70% at 14 years. In the ‘school-age onset’ group, 12% of the sample showed a moderate probability of conduct problems from 3 and 5 years, with a sharp increase by 7 years, increasing to 50% at 14 years. In terms of individual risk, all factors increased the likelihood of being in the childhood-onset groups compared to the ‘low’ group. For cumulative risk, the socioeconomic domain at 9 months and 3 years, the family domain at all ages except 14 years and child domain at all ages were found to differentiate childhood-onset groups from the ‘low’ group. Cumulative risk at 9 months and 3 years did not differentiate between the ‘school-onset’ group and ‘low’ group. Significant interactions were found between the domains for the ‘early-onset, desisting group’ suggesting that low levels of risk in one domain may buffer the effects of high risk in another domain. The implications of these findings for preventive interventions will be highlighted.

Keywords: conduct problems, cumulative risk, developmental trajectories, early childhood, adolescence

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Authors: Gladys Oppong, Saumya Singh, Pramod Pathak

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Women entrepreneurship has started establishing itself globally. Despite various social hurdles, Indian women have proved their strength in the area of entrepreneurship. Rising pattern of women entrepreneurship in Indian context make it significant to know the reason behind it. It’s a normal perception that women with financially strong backgrounds are highly motivated to progress in the area of entrepreneurship while lack of money becomes a major restraint for others. The proposed study attempts to identify the motivational factors for becoming women entrepreneur. The research work is to be conducted on women entrepreneurs. For this purpose, factor analysis will be used. The study has identified a set of motivational factors namely family business, social status, education and qualification, self-fulfillment and achievement among others that give momentum to the women to become an entrepreneur. The outcome of the study will be helpful in developing women entrepreneurship in India.

Keywords: women entrepreneurship, motivation, family business, social status

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Authors: Anjali Bansal

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Reproductive preferences mainly deal with two questions: when a couple wants children and how many they want. Questions related to these desires are often included in the fertility surveys as they can provide relevant information on the subsequent behavior. The aim of the study is to observe whether respondent’s response to these questions changed over time or not. We also tried to identify socio- economic and demographic factors associated with the stability (or instability) of fertility preferences. For this purpose, we used IHDS1 (2004-05) and follow up survey IHDS2 (2011-12) data and applied bivariate, multivariate and multilevel repeated measure analysis to it to find the consistency between responses. From the analysis, we found that preferences of women changes over the course of time as from the bivariate analysis we have found that 52% of women are not consistent in their desired family size and huge inconsistency are found in desire to continue childbearing. To get a better overlook of these inconsistencies, we have computed Intra Class Correlation (ICC) which tries to explain the consistency between individuals on their fertility responses at two time periods. We also explored that husband’s desire for additional child specifically male offspring contribute to these variations. Our findings lead us to a cessation that in India, individuals fertility preferences changed over a seven-year time period as the Intra Class correlation comes out to be very small which explains the variations among individuals. Concerted efforts should be made, therefore, to educate people, and conduct motivational programs to promote family planning for family welfare.

Keywords: change, consistency, preferences, over time

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Authors: Glaucia Maricato

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Our research deals with specific use of DNA tests in Brazil – aimed at financial reparation for the institutionalized and otherwise scattered offspring of leprosy patients who, from the 1920s up through the 1980s, were subjected to compulsory internment in the 'hospital-colonies', specialized in the containment of Hansen’s disease. Through a social movement, the ex-patients themselves gained the right, in 2007, to financial compensations. At the moment, the movement is seeking reparation for the (now adult) children of these people as well. Many of these children grew up in orphanages, in adopted families, or do not have official documents to prove their family belonging. In 2011, a team of Brazilian geneticists had volunteered their services, applying DNA tests in order to ascertain the connection of certain individuals to an ex-internee of the leprosarium. We have accompanied the activities in four different ex-colonies in order to understand how the DNA test was being signified by those being tested, and how the test fit into already existent notions of family. Inspired in the writings of scholars such as Sheila Jasanoff and Helena Machado, we examine the possibility of a 'geneticization of family ties' when people are obliged to back their claim for human rights by producing legal proof based on blood tests. However, in like fashion to other ethnographic studies on this theme, we encountered among tested adults a number of creative strategies that allow for the co-existence of the idea of 'scientifically-based' blood ties alongside other more traditional ways of signifying kinship.

Keywords: human rights, social movements, DNA tests, Hansen's disease

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Authors: Anmol Patel

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Cardiopulmonary resuscitation is medical intervention which should be considered for all inpatients; with a patient centred approach, open communication and accurate documentation of clinical decisions. National enquiries have shown that in a significant number of cases CPR was attempted when it was considered inappropriate. In these circumstances attempting to prevent a natural death and subjecting a patient to trauma at the end of life would deprive them of a dignified death. Anticipatory “do not attempt CPR (DNACPR)” decisions aim to prevent this for those considered appropriate. As a legal document, these forms are required to be completed accurately and thoroughly. The aim of this study was to evaluate the difference in quality of DNACPR forms completed using electronic versus paper formats. A retrospective review of DNACPR forms and related documentation was completed in two District General Hospitals in South-East England, one of which uses electronic forms, while the other uses paper red forms. 50 completed forms from each hospital were analysed to assess for legibility, and quality of completion of all subsections of the form, including communications with family, relatives and the Multidisciplinary team. The hospital using paper forms showed a 40-44% rate of completion of sections relating to communication with patients and family, compared to 70% with the hospital using electronic forms. Similar trends were observed with other sections of the form. Conclusion: This study suggests that the implementation of electronic DNACPR forms significantly improves clinical practice and promotes better open communication with patients, family and the MDT.

Keywords: DNACPR, resuscitation, DNAR, patient communication

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Authors: Iori Hamada

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Australia's skilled migrant selection system is constantly changing its target skills and criteria according to the labour market demands. The government's intention to employ this highly selective market-driven selection system is to better target the skills needed in the economy, enable skilled migrants to be employed in industries that have the highest need, and consequently boost the economy and population. However, migration scholars have called this intention into question, arguing that the system is not making the best use of skilled migrants. This paper investigates the impact of recent reforms in Australian skilled migration system on skilled migrants' employment and related life conditions. Drawing on semi-structured qualitative interviews with Japanese skilled migrants in Australia, it argues that Australia’s skilled migrant selection system guarantees neither skilled migrants' employment nor successful transfer of their skills to the labour market. The findings show that Japanese skilled migrants are often unemployed or under-employed, although they intend to achieve upward occupational mobility. The interview data also reveal that male unemployment or under-employment status prompts some Japanese men to leave Australia and find a job that better matches their skills and qualifications in a new destination. Further, it finds that Japanese male skilled migrants who experience downward occupational mobility tend to continue to take a primary breadwinner role, which affects the distribution of paid and unpaid work within their families. There is a growing body of research investigating skilled migrants’ downward career mobility. However, little has been written on skilled Japanese migrants. Further, the work-family intersection is a 'hot public policy topic' in Australia and elsewhere. Yet, the existing studies focus almost exclusively on non-migrant families. This calls attention to the urgency of assessing the work-family lives of skilled migrants. This study fills these gaps, presenting additional insight into Japanese skilled migrants’ work and family in and beyond Australia.

Keywords: Australia, employment, family, Japanese skilled migrants

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Authors: Xu Qian

Abstract:

This abstract explores the importance of building resilience within families and offers evidence-based strategies for promoting positive parenting and enhancing emotional well-being. It emphasizes the role of effective communication, conflict resolution, and fostering a supportive environment to strengthen family bonds and promote healthy child development. Introduction: The well-being and resilience of families play a crucial role in fostering healthy child development and promoting overall emotional well-being. This abstract highlights the significance of nurturing resilient families and provides evidence-based strategies for positive parenting. By focusing on effective communication, conflict resolution, and creating a supportive environment, families can strengthen their bonds and enhance emotional well-being for both parents and children. Methods: This abstract draws upon a comprehensive review of existing research and literature on resilient families, positive parenting, and emotional well-being. The selected studies employ various methodologies, including surveys, interviews, and longitudinal observations, to investigate the factors contributing to family resilience and the strategies that promote positive parenting practices. The findings from these studies serve as the foundation for the strategies discussed in this abstract. Results: The results of the reviewed studies demonstrate that effective communication within families is a key factor in building resilience and promoting emotional well-being. Open and honest communication allows family members to express their thoughts, feelings, and concerns, fostering trust and understanding. Conflict resolution skills, such as active listening, compromise, and problem-solving, are vital in managing conflicts constructively and preventing negative consequences on family dynamics and children's well-being. Creating a supportive environment that nurtures emotional well-being is another critical aspect of promoting resilient families. This includes providing emotional support, setting clear boundaries, and promoting positive discipline strategies. Research indicates that consistent and responsive parenting approaches contribute to improved self-regulation skills, emotional intelligence, and overall mental health in children. Discussion: The discussion centers on the implications of these findings for promoting positive parenting and emotional well-being. It emphasizes the need for parents to prioritize self-care and seek support when facing challenges. Parental well-being directly influences the quality of parenting and the overall family environment. By attending to their own emotional needs, parents can better meet the needs of their children and create a nurturing atmosphere. Furthermore, the importance of fostering resilience in children is highlighted. Resilient children are better equipped to cope with adversity, adapt to change, and thrive in challenging circumstances. By cultivating resilience through supportive relationships, encouragement of independence, and providing opportunities for growth, parents can foster their children's ability to bounce back from setbacks and develop essential life skills. Conclusion: In conclusion, nurturing resilient families is crucial for positive parenting and enhancing emotional well-being. This abstract presents evidence-based strategies that emphasize effective communication, conflict resolution, and creating a supportive environment. By implementing these strategies, parents can strengthen family bonds, promote healthy child development, and enhance overall family resilience. Investing in resilient families not only benefits individual family members but also contributes to the well-being of the broader community.

Keywords: childrearing families, family education, children's mental health, positive parenting, emotional health

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Authors: Nithra Kitreerawutiwong, Sunsanee Mekrungrongwong, Artitaya Wongwonsin, Chakkraphan Phetphoom, Buaploy Phromjang

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Background: Thailand has implemented a district health system based on the concept of primary health care. Since 2014, Family Care Team (FCT) was launched to improve the quality of care through a multidisciplinary team include not only the health sector but also social sector work together. FCT classified into 3 levels: district, sub-district, and community. This system now consists of 66,353 teams, including 3,890 teams at district level, 12,237 teams at the sub-district level, and 50,326 teams at the community level. There is a report regarding assessment the situation and perception on FCT, however, relatively few examined the operationality of this policy. This study aimed to explore the perception of district manager on the process of the implementation of FCT policy and the factors associating to implement FCT in the district health system. Methods/Results: Forty in-depth interviews were performed: 5 of primary care manager at the provincial medical health office, 5 of community hospital director, 5 of district administrative health office, 10 of sub-district health promoting hospital, and 10 of local organization. Semi-structure interview guidelines were used in the discussions. The data was analyzed by thematic analysis. This policy was formulated based on the demographic change and epidemiology transition to serve a long term care for elderly. Facilitator factors are social capital in district health systems such as family health leader and multidisciplinary team. Barrier factors are communication to the frontline provider and local organization. The output of this policy in relation to the structure of FCT is well-defined. Unanticipated effects include training of FCT in community level. Conclusion: Early feedback from healthcare manager is valuable information for the improvement of FCT to function optimally. Moreover, in the long term, health outcome need to be evaluated.

Keywords: family care team, district health system, primary care, qualitative study

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Authors: Tan Xin Zhong Timothy, Chang Chen Jie Victor, Yew Kwan Tong, Lim Geok Peng Sandy

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Background: Leaders in crisis response teams such as Trauma Teams in hospitals are essential to the effective coordination and direction of the team. The response to emergency trauma situations must be accurate, rapid, and well executed. To this end, the team leader’s social, technical and leadership skills are essential factors that implicate the success of an emergency trauma intervention. While each emergency trauma case varies in severity and complexity, and the experience and expertise of team leaders may vary, it would be productive to identify certain coordinative and directive functions that improve the capacity for leading a team. Methods: This qualitative study of Trauma Team physicians in Singapore General Hospital (SGH) involved 50 in-depth interviews with doctors and nurses involved in Trauma Team activations, observations of Trauma Teams managing emergency patients, and reviews of audio/video recordings of 65 trauma activations. The interviews were conducted with doctors of various ranks across the relevant departments, 12 from the Emergency Department (ED), 11 from General Surgery (GS) and 8 from Orthopaedics, while the 6 nurses were from ED. In accordance with the grounded theory approach, the content of the interviews was coded and analysed in order to derive broad leadership themes that corresponded with certain behavioural traits exhibited by trauma team leaders, supplemented with the observational and audio/video data. Results: The leadership behaviours of the team leaders could be typified into three broad categories: team orientation, engagement and activeness. Team orientation corresponds with the source and form of cognitive responsibility, decision-making and informational contributions, divisible into individualistic and consultative sub-categories. Engagement refers to the type of activity that leaders prefer to engage in, and which implicates their attentional focus, divisible into participatory and supervisory sub-categories. Activeness is a function of the leader’s attitudes towards the behavioural regulation of the team, which manifests in inactivity or activity to augment or merely align with protocol. These factors are not exhaustive and are contextually sensitive, but collectively implicate a significant portion of the leadership activity observed in trauma teams.

Keywords: trauma team activations, critical event management, leadership, teamwork

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Authors: Sushmita Chaudhuri, Parthiba Basu

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Urbanization leads to habitat degradation and is responsible for the fast disappearance of native butterfly species. Random sampling of rural, suburban and urban sites in an around Kolkata metropolis revealed the presence of 28 species of butterfly belonging to 5 different families in winter (February-March). Butterfly diversity, species richness and abundance decreased with increase in urbanization. Psyche (Leptosia nina of family Pieridae) was the most predominant butterfly species found everywhere in Kolkata during the winter period. The most dominant family was Nymphalidae (11species), followed by Pieridae (6 species), Lycaenidae (5 species), Papilionidae (4 species) and Hesperiidae (2 species). The rural and suburban sites had butterfly species that were unique to those sites. Vegetation cover and flowering shrub density were significantly related to butterfly diversity.

Keywords: butterfly, Kolkata metropolis, Shannon-Weiner diversity index, species diversity

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Authors: Md. Shafiullah

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This study delves into the evolving landscape of urban childcare in Bangladesh, focusing on the experiences and challenges faced by parents in Dhaka city. This paper argues that the traditional childcare arrangement of city families is inadequate to meet the development needs of children. The study aims to explore the childcare challenges faced by urban parents as they transition from traditional family-based childcare networks to alternative caregiving arrangements amidst urbanization, economic shifts, and social transformations. Utilizing a mixed-method research approach, combining quantitative surveys (n = 200) and four qualitative interviews, the research examines the parental viewpoints on childcare practices and the role of societal norms and values. The study finds childcare crises in both the family and daycare settings. In family care, caregiving suffers from the less availability of grandparents, a lack of skills of caregivers, and a lack of child interaction. As for the daycare, it is affected by the absence of appropriate policies, a lack of quality, health and safety concerns, affordability issues, and cultural concerns. Additionally, the study highlights inadequacies in childcare policies and regulatory frameworks, calling for comprehensive reforms to address the childcare vacuum in urban areas. By shifting the focus from developed to developing countries, this study contributes to the literature and suggests policy implications for Bangladesh and beyond.

Keywords: childcare, child development, childcare policy, daycare, Bangladesh

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Authors: Ana Ferraz, Martim Santos, M. Graça Pereira

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Distress among parents of children with acute lymphoblastic leukemia (ALL) is common during treatment and can persist several years post-diagnosis, impacting the adjustment of children and parents themselves. Current evidence is needed to examine the scope and nature of parental distress in childhood ALL. This review focused on associated variables, predictors, and outcomes of parental distress following their ALL diagnosis of their child. PubMed, Web of Science, and PsycINFO databases were searched for English and Spanish papers published from 1983 to 2021. PRISMA statement was followed, and papers were evaluated through a standardized methodological quality assessment tool (NHLBI). Of the 28 papers included, 16 were evaluated as fair, eight as good, and four as poor. Regarding results, 11 papers reported subgroup differences, and 15 found potential predictors of parental distress, including sociodemographic, psychosocial, psychological, family, health, and ALL-specific variables. Significant correlations were found between parental distress, social support, illness cognitions, and resilience, as well as contradictory results regarding the impact of sociodemographic variables on parental distress. Family cohesion and caregiver burden were associated with distress, and the use of healthy coping strategies was associated with less anxiety. Caregiver strain contributed to distress, and the overall impact of illness positively predicted anxiety in mothers and somatization in fathers. Differences in parental distress were found regarding group risk, time since diagnosis, and treatment phases. Thirteen papers explored the outcomes of parental distress on psychological, family, health, and social/education outcomes. Parental distress was the most important predictor of family strain. Significant correlations were found between parental distress at diagnosis and further psychological adjustment of parents themselves and their children. Most papers reported correlations between parental distress on children’s adjustment and quality of life, although few studies reported no association. Correlations between maternal depression and child participation in education and social life were also found. Longitudinal studies are needed to better understand parental distress and its consequences on health outcomes, in particular. Future interventions should focus mainly on parents on distress reduction and psychological adjustment, both in parents and children over time.

Keywords: childhood acute lymphoblastic leukemia, family, parental distress, psychological adjustment, quality of life

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