Family Disruption Research Articles

AN ASSESSMENT OF CONFLICT-INDUCED INTERNAL DISPLACEMENT TRENDS AND SITUATIONS OF IDPS IN ETHIOPIA

Internal displacement has emerged as one of the world's greatest human disasters today. IDMC 2023 statistics showedthat, there are approximately 77.1 million internally displaced persons. It causes death and property damage, foodinsecurity and starvation, family disruption, psychological and physical problems on IDPs. Hence, the objective of thisstudy was to examine the prevalence of conflict-induced internal displacement in Ethiopia from 2017 to 2023, andidentify the situations of IDPs housed in IDPs camps of North-western Ethiopia (Amhara region). The data wascollected from 415 surveyed IDPs, 14 interviewee and 8 key informants. The secondary sources i.e. published articlesand IDMC data were taken. Descriptive statistics and textual analysis were used to analyse the data.The result demonstrated that, a total of 670,999; 187,592, and 1,431,682 persons were displaced within the regions andwithin the country due to the escalation of conflict before 2018, during 2018, and in 2019 respectively. This shows thatan enormous tragedy also referred to as a human catastrophe occurred in the Ethiopian historic event in 2019, withabout 1.432 million people fleeing their homes because of inter-communal violence in the country. As a result of conflictand violence, more than 2.9 million people have been internally displaced in the country since 2020. Hence, from 2008to December 2021, the overall number of internal displaced people in Ethiopia was more than 5,142,000, whereas thetotal number of IDPs due to conflict is more than 3,589,000 as of the end of 2021. As of March 2022, an estimated5,582,000 people were internally displaced within Ethiopia as a result of armed conflict and disasters, with 2,848, 0001IDPs in the Amhara, Afar, and Tigray regions. Nearly 3.9 million people living in displacement because of conflict andviolence across Ethiopia at the end of 2022. Based on the findings, a significant number of displaced people housed inIDP camps did not have shelter, shortage of food and nonfood items, rare safe drinking water sources, high sicknessand death, limited sanitation, health and hygiene services. Additionally, IDPs did not have security protection, whichprevent them from physical and psychological harms, and did not receive any protective and resilient support fromgovernment to their survival in the dwelled camp sites. In conclusion, Ethiopia represented the highest proportion ofIDPs in the global displacement numbers. Conflict-induced displaced persons housed in the camps of Amhara regionare living in desperate conditions. Therefore, federal government of Ethiopia should work towards addressing thecauses of conflict and ethnic based violence, human rights protection, and political commitment with regionalgovernments on the issues of IDPs for durable solutions.

Promotive and preventive interventions for adolescent mental health in Sub-Saharan Africa: a combined scoping and systematic review

IntroductionPoor mental health in adolescence is associated with mental, physical and social problems in later life. Adolescence is, therefore, a critical time for promoting mental well-being and preventing mental illness,...

Children of Separation: An International Profile

AbstractThis study offers a comprehensive international overview of children from separated families across 13 countries, with an emphasis on the European context. We investigate changes in the number of children experiencing parental separation over birth cohorts (1960–1989) and changes in their social composition using data from the Generations and Gender Survey and official statistics. Results on absolute numbers highlight the impact of demographic shifts and complement previous research that focused on the relative risk of experiencing parental separation. We show that declining fertility rates have, in most countries, mitigated the rise in the number of children affected by increasing separation rates. Moreover, a large majority of contemporary children of separation are born to higher‐educated mothers, demonstrating that the spread of education across parent cohorts outweighed educational risk gradients in shaping the socioeconomic background of children of separation. These findings improve our demographic understanding of children of separation and inform policy targeting family disruption as a social problem and allocating resources to address it.

Risk Factors And Youths Suicidal Tendencies In Tertiary Institutions In South South, Nigeria

The study sought to ascertain the influence of certain risk factors on suicidal tendencies among youths in tertiary institutions in South South, Nigeria. Descriptive survey design was utilized. The population consisted of undergraduate students of four tertiary institutions located in Niger Delta Region of South South Nigeria. Through stratified random sampling, coupled with purposive sampling technique, a sample size of 620 was derived. Four research questions were raised and a questionnaire titled, Risk Factors and Suicidal Tendencies Questionnaire (RFSTQ) was used for the data collection. Accruing data were analyzed using frequencies and percentages. The result revealed that risk factors such as family disruptions, substance abuse, academic stress and internet exposure influence suicidal tendencies. It was therefore concluded that certain risk factors such as substance abuses, academic stress and depression are closely associated with suicidal tendencies among youths. Hence, the recommendation was that all tertiary institutions should have fully functioning counselling centres that would mount intervention programmes aimed at boosting the mental health of their student clientele; where students can be taught adaptive, coping and problem solving skills to handle the myriads of pressures and problems they face at home, school and among friends.
 

Coal Fire Sublimates: Are We Missing Something?

Uncontrolled coal fires present a nearly unparalleled environmental and human health disaster. These fires can cause the destruction of the ecosystem, ignite forest fires, become a source of windblown dust and siltation of streams, and pollute surface water, ground water, and crops. They can cause significant disruption of families and communities resulting from physical hazards of collapse or explosion, excessive heat, visual blight and loss of potentially valuable acreage, deterioration of cultural infrastructure, personal and public property, and loss of a valuable energy resource. The emission of CO2 and other greenhouse gases presents a significant health hazard due to respiration of dust and aerosols, and exposure to acidic gases, potentially toxic trace elements, and organic compounds. Numerous studies have described many dozens of phases that have condensed from the effluents of these fires. However, many of these studies may have overlooked the nano- and ultra-fine particles that exist beside, in, and under the brightly colored, often spectacular crystalline macro phases. Using a scanning electron microscope with an energy dispersive X-ray detector we examined a small (30 mm × 10 mm) piece of condensate from an uncontrolled coal fire in the Jharia region of India and found more than 30 different phases in this one small piece. The phases included ammonium, copper, iron, lead, bismuth chlorides; bismuth, lead, and ammonium silici-fluorides; ammonium and lead iodates; iron, barium, lead, copper, and zinc sulfides; iron and silicon oxides; and others. Broken fragments revealed multiple generations of phases. Though not strictly nanoparticles (smaller than 0.1 μm), many of these particles are in the micrometer to sub-micron range and it is likely that there are phases present in the nanoparticle size range. Certainly, particulates in the nanoparticle and ultra-fine particle range are being released from the uncontrolled coal fires and may be impacting the environment and the health of the mine workers and nearby residents, an issue that should be investigated.

Siblings’ experiences of sleep disruption in families with a child with Down syndrome

ObjectiveAdverse effects of sleep disruption are identified in parents who live with a child with Down Syndrome (DS), yet there is no research on siblings’ experiences. This study addresses this knowledge gap. DesignA qualitative research study using semi-structured interviews to understand the experiences of siblings of a child with DS and sleep difficulties from the perspectives of parents and siblings. ParticipantsEleven siblings aged 5-15 years old, and 11 parents, from 8 families with a child with DS in Australia. MethodsSemi-structured sibling interviews explored what it was like to have a sibling with DS and sleep difficulties; the participant’s own sleep; how their sleep affected how they felt during the day; how sleep impacted their family; and advice that they would give to other siblings. Parent interviews included similar topics; here we report on excerpts in which parents reference siblings. Interviews were audio recorded, transcribed verbatim, and analyzed using a reflexive thematic analysis. ResultsSiblings and parents acknowledge sleep disruption for siblings; yet sleep disruption is normalized, viewed with acceptance and inevitability. Siblings report adverse effects from sleep disruption, view sleep in a relational way, and cope with sleep disruption. Parents can underestimate siblings’ sleep disruption and are uncertain whether siblings’ symptoms result from sleep disruption or other causes. ConclusionsSiblings of a child with DS experience sleep disruption and may be at risk of developing long-term health problems without focused support.

Developing a secure base in family intervention: using the adult attachment projective system to assess attachment in family relationships.

Families are core to human well-being. Therapeutic intervention may be needed in the context of family disruptions. Attachment theory conceptualizes parents as the secure base and safe haven that support children's optimal development. Parents who have experienced their own attachment difficulties or traumas may not provide quality caregiving necessary for balanced secure parent-child attachment relationships. Following Bowlby's original thinking (1988), an attachment approach to family intervention views the therapist as a secure base that enables families to explore individual and system problems to restore equilibrium. Attachment informed therapy uses attachment theory to understand family functioning. However, the unavailability of valid economical assessment for examining attachment representations has constricted the practical utility of attachment theory in family therapy beyond applications of general concepts. This chapter describes the Adult Attachment Projective Pictures System (AAP) and explores its use as an efficient manner for assessing attachment representations within families that allows therapists to understand problematic interactions, disabling defensive processes, make predictions concerning negative patterns, and create targets for change and restorative intervention. Consolidating three decades of attachment and caregiving system research, we describe how distinct patterns of AAP responses for each adult attachment group map onto expected parenting and family system expectations and behaviors to provide a concise and informative framework. In addition to the traditional adult attachment patterns (Secure, Dismissing, Preoccupied, Unresolved), we describe for the first time expectations for two additional forms of incomplete pathological mourning (Failed Mourning and Preoccupied with Personal Suffering) that have been overlooked in the field.

Venetoclax Has Potent Efficacy in NPM1 mutated AML with Acquired Resistance Associated with Either Perturbed Pro-Survival Signalling or NPM1 wild-Type Populations

Background We have previously reported outcomes for patients (pts) receiving venetoclax (VEN) combined with intensive chemotherapy in fit older pts ≥65 years with newly diagnosed AML (Chua et al, JCO 2020). In contrast to younger populations, NPM1(mut) does confer favorable prognosis in older AML populations. Our prior studies indicate that VEN-based therapies in older pts have promising efficacy in NPM1(mut) AML (DiNardo et al, Blood 2020). To characterise this further, we performed a posthoc analysis of the efficacy of single agent VEN and in combination with chemotherapy in NPM1(mut) AML in the CAVEAT study and explored mechanisms of treatment failure using a multi-omic approach. Methods NPM1 MRD was performed using RT-qPCR (sensitivity 10 -6). Integrated analysis from bulk sequencing (targeted 42-gene NGS, whole exome/genome sequencing (WES/WGS), RNAseq), single cell (sc) proteogenomic and transcriptomic assessments (scDNA plus surface protein, Tapestri MissioBio; scRNAseq, 10x Genomics) were performed. Flow cytometry included analysis of BCL-2, BCL-XL, MCL1 and BFL1 expression. Results Of 85 pts enrolled on the CAVEAT study, 20 had NPM1(mut). Median age of NPM1(mut) vs (wt) was 71 vs 70 years. At a median follow-up of 38.6 months, CR/CRi rates and median OS for NPM1(mut) vs (wt) was 85% vs 72% (p=0.37), and 43.9 vs 15.1 months (p=0.04), respectively. Pts received a 7-day VEN monotherapy pre-phase prior to CAVEAT induction with paired bone marrow (BM) assessments pre- and at day 8 to evaluate VEN sensitivity. NPM1(mut) pts had a greater median relative blast reduction after 7-day VEN at -66% (range -7 to -98%), compared to -37% (range +51 to -94%) for NPM1(wt) (p=0.03). 18/20 NPM1(mut) sub-group pts completed induction and 17 had serial NPM1 MRD assessments. The NPM1(mut) level fell a median of 4.55-log 10 following induction, with 6 (35%) pts achieving MRD negative (MRDneg) status. After all consolidation, 12/16 (75%) were MRDneg. 12/12 (100%) pts in long-term follow up remain MRDneg. We investigated the mechanisms of resistance in the 5/20 pts with NPM1(mut) whose disease was primary refractory (RD; n=1) or had acquired secondary resistance (Fig). Two patients (CAL-045, CAL-021) had shown BM blast reductions of ≥45% during VEN pre-phase. Subsequently, at the time of clinical treatment failure, both were NPM1(mut) MRD negative indicating eradication of the starting NPM1(mut) clone and early evolution of a new NPM1(wt) population as the mechanism of resistance. Detailed genomic analysis of CAL-045 showed that a TET2/CBL/NPM1(mut) clone was eradicated, with persistence of TET2 and TET2/CBL(mut) clones lacking NPM1(mut) at the time of refractory disease. scRNAseq analysis of these NPM1(wt) clones revealed a pro-inflammatory signature with elevation in BFL1, a pro-survival gene not targeted by VEN (Fig). In patient CAL-021, NPM1(mut) was also absent with the emergence of nonsense/frameshift BAX variants at relapse as previously described (Moujalled et al, Blood 2022). BAX deficiency is associated with resistance to BH3-mimetics. Two other cases (CAL-014, CAL-020) showed BM blast reductions of <45% during VEN pre-phase. In CAL-014, the expansion of an NPM1 subclone was associated with FLT3-ITD. WES revealed evolution of FLT3-ITD loss of heterozygosity at relapse. Flow cytometric analysis demonstrated disproportionate upregulation of intracellular MCL-1 (Fig). In case CAL-020, no obvious genetic determinants of resistance were identified at relapse, with persistence of a DNMT3A/ KIT/ NPM1(mut) clone (VAF~50%). Whole transcriptome analysis revealed skewed expression of a KIT(mut)allele (from 45% to 88%) at relapse, and protein assessment by flow cytometry revealed marked upregulation of BCL-XL (Fig). Conclusion VEN in combination with intensive chemotherapy for NPM1(mut) AML pts ≥65 years resulted in rapid and deep responses ( NPM1(mut) MRD-negativity) that are associated with prolonged remissions and OS. Mechanisms of treatment failure among pts with NPM1(mut) are diverse and may include kinase-linked upregulation of alternative BCL-2 family pro-survival members or disruption of downstream pro-apoptotic BAX.

How are adverse childhood experiences and women's mental health associated? A latent class analysis

BackgroundAdverse childhood experiences (ACEs) have a cumulative effect on adult mental health; however, the effect of such combinations is less well known. The purpose of this study is to assess the association between specific combinations of early adversities and women's mental health. MethodsA total of 378 women (Myears = 41.4; SDyears = 13) receiving support from mental health and social services participated in this cross-sectional study. Latent class analysis was performed to classify participants based on the number of ACEs types. ResultsOur results provided support for four latent classes which differed in ACEs types reported: class 1 range of maltreatment but no family disruption (16.40 %; n = 62), class 2 range of maltreatment with family disruption (24.87 %; n = 94), class 3 few ACEs (44.71 %; n = 169), class 4 high maltreatment/high family disruption (14.02 %; n = 53). Differences in psychological functioning (presence of psychopathology, attachment, emotion dysregulation, and coping strategies) were found between the classes, especially between few ACEs and high maltreatment/high family disruption classes. In addition, women who lived in a low-adversity home and those who lived in a home with maltreatment, but no family disruption, differed in their desire for closeness, problem-solving and emotional expression strategies. ConclusionThis study highlights that the probability of exposure to different combinations of ACEs is associated with differences in adult psychological functioning. Deeper insight into this association may contribute to a better understanding of mental health problems and to improved prevention and intervention strategies in public support systems.

Effectiveness of an e-Health Quasi-Randomized Controlled Universal Prevention Program for Eating Disorders in Spanish Adolescents

Eating disorders (EDs) and sub-threshold conditions are prevalent in the adolescent population. Unfortunately, most preventive interventions have been targeted at emerging adults and the effectiveness of online prevention programs has yet to be determined in adolescents. This study sought to examine the short-term effectiveness of a universal e-Health psychoeducational prevention program for EDs compared to a control (non-intervention) group in Spanish adolescents. Using a quasi-randomized trial design, a total of 161 [% girls: 45.96; Mage(SD) = 12.43 (0.43)] adolescents from 5 participating schools were allocated to two intervention arms: (1) psychoeducational intervention (n = 79) and (2) wait-list control (n = 82). The intervention was delivered over 3 months through 3 modules that were accessible 24/7 and 3 school sessions guided by the students´ tutors focusing on nutrition, promoting a healthy lifestyle, mitigating body concerns, and social pressures. Participants completed an online assessment battery including the Eating Attitudes Test (EAT-26) and measures of self-esteem, family disruption, compliance with the Mediterranean diet, and lifestyle. Correlational analysis showed small to moderate relationships between self-esteem and family function (rho = 0.413, p = 0.001), BMI (body mass index) and the EAT-26 dieting subscale (rho = 0.417, p = 0.001), physical activity and the bulimia subscale (rho = − 0.237, p = 0.003), and self-esteem and the dieting subscale (rho = − 0.223, p = 0.004). At the post-intervention assessment, the intervention group showed a statistically significant reduction in ED risk (EAT-26) (d = − 0.323, p = 0.040) and the oral control subscale (d = 0.327, p = 0.038). The e-health intervention including tutor-led digital components was effective for reducing ED risk in children. Results must be interpreted with caution due to the low statistical power and the limited sample size. Large scale randomized controlled trials with longer follow-ups will be needed to bolster the evidence.

Livelihood strategies of marginalised Zimbabwean women living in South Africa

abstract Zimbabwean women constitute a significant number of migrants living in South Africa. Both accompanying spouses and lone Zimbabwean migrant women face challenges in securing formal employment and are often forced to establish informal businesses for their survival. Drawing on qualitative interviews, this study explored perceived challenges and triumphs encountered by Zimbabwean women in informal trading across South Africa. All the women indicated that they established survivalist businesses once in South Africa. Lack of fulfilling employment, poor wages, family financial pressures, disruptions and exclusion from social welfare benefits during the coronavirus lockdown were some of the factors that pushed migrant women into informal businesses. Establishment of informal businesses protected women from resorting to commercial sex work and other transactional relations. Challenges encountered include lack of funding to establish their businesses, low returns, crime, sexual harassment from clients, extortion, and fear of xenophobic attacks. Despite these challenges, Zimbabwean women described how they managed to build a strong clientele and improve their financial wellbeing in the process. Funding institutions can support migrant women through the provision of business loans, and training women on how to run businesses and saving. This will financially empower migrant women and protect their physical, sexual, and mental health.

Peptides from conserved tandem direct repeats of SHORT-LEAF regulate gametophore development in moss P. patens.

Tandem direct repeat (TDR)-containing proteins, present across all domains of life, play crucial roles in plant development and defense mechanisms. Previously, we identified that disruption of a bryophyte-specific protein family, SHORT-LEAF (SHLF), possessing the longest reported TDRs, is the cause of the shlf mutant phenotype in Physcomitrium patens. shlf exhibits reduced apical dominance, altered auxin distribution, and 2-fold shorter leaves. However, the molecular role of SHLF was unclear due to the absence of known conserved domains. Through a series of protein domain deletion analyses, here, we demonstrate the importance of the signal peptide and the conserved TDRs and report a minimal functional protein (miniSHLF) containing the N-terminal signal peptide and first two TDRs (N-TDR1-2). We also demonstrate that SHLF behaves as a secretory protein and that the TDRs contribute to a pool of secreted peptides essential for SHLF function. Further, we identified that the mutant secretome lacks SHLF peptides, which are abundant in WT and miniSHLF secretomes. Interestingly, shlf mutants supplemented with the secretome or peptidome from WT or miniSHLF showed complete or partial phenotypic recovery. Transcriptomic and metabolomic analyses revealed that shlf displays an elevated stress response, including high ROS activity and differential accumulation of genes and metabolites involved in the phenylpropanoid pathway, which may affect auxin distribution. The TDR-specific synthetic peptide SHLFpep3 (INIINAPLQGFKIA) also rescued the mutant phenotypes, including the altered auxin distribution, in a dosage-dependent manner and restored the mutant's stress levels. Our study shows that secretory SHLF peptides derived from conserved TDRs regulate moss gametophore development.

Risk of suicidal behavior as a function of alcohol use disorder typologies: A Swedish population-based study.

Alcohol use disorder (AUD) is one of the strongest predictors of suicidal behavior. Here, we measured risk of suicide attempt and death as a function of AUD typologies. We used AUD typologies from previous latent class analysis: (i) externalizing subtype (characterized by externalizing symptomatology and early age of onset; individuals in this group have lower education and higher familial/social difficulties); (ii) subtype described by minimal psychopathology; and (iii) internalizing subtype (characterized by internalizing symptomatology and later age of onset; individuals in this group have higher education). We used class membership to predict distal outcomes (attempt and death) and performed regressions to evaluate whether differences in suicidal behavior were explained by the group characteristics (sex, age of onset, number and type of AUD registrations, familial/genetic risk for AUD, externalizing and internalizing behaviors, socio-economic indicators, marital status and childhood family status). We also evaluated the effect of suicide attempt prior to AUD. Based on longitudinal Swedish registry data, we included 217 074 individuals with AUD born 1950-80. Suicide attempts were identified using medical registers and deaths using the mortality register. Individuals with the externalizing subtype had higher risks of suicidal behavior than other groups [attempt: externalizing versus minimal psychopathology: odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.35, 1.35; externalizing versus internalizing: OR = 1.47, 95% CI = 1.46, 1.48; death: externalizing versus minimal psychopathology: OR = 1.57, 95% CI = 1.57, 1.58; externalizing versus internalizing: OR = 1.99, 95% CI = 1.93, 2.06]. Individuals with minimal psychopathology had higher risks than those with internalizing symptomatology (attempt: OR = 1.09, 95% CI = 1.08, 1.10, death: OR = 1.26, 95% CI = 1.23, 1.30). These differences were explained by age at registration and were related to the number of registrations, sex, education, family disruption and suicide attempt prior to AUD. Among people in Sweden, considering alcohol use disorder (AUD) heterogeneity appears to be a meaningful way to evaluate suicide risk. The highest risk of suicide attempt and death occurs in the externalizing subtype of AUD, followed by the minimal psychopathology subtype, and then the internalizing subtype.

Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence

PurposeYouth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline. MethodsWe used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care. ResultsVictims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator. DiscussionMedical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.

How can migration unequalize inheritance: Theory and insights from Bolivia

Indian communities in Latin America, like in the Middle East and other regions of the world, tend to have rules of equal inheritance. Yet, migration can transform ex ante egalitarian rules into unequal ex post practices. In this paper, based on evidence collected at both sides of the migration link in Bolivia, we find that the unequalization process caused by migration tends to paradoxically harm poor migrants from egalitarian communities who are driven to voluntarily forfeit their inheritance. To resolve the puzzle, we propose a novel theory placed in the framework of strategic exchange but where the migration decision is endogenized: upon migration, children take into account the prospect of potentially losing access to family land if they are unable to fulfill their care obligations. Voluntary exclusion from inheritance is especially likely if the value of rural public goods is low, farm output per capita is small, and the wages in the urban modern sector are high compared to those in the informal sector. The main policy implication is the following: a more equal pattern of economic growth, along both the rural–urban and the intersectoral intra-urban dimensions, helps minimize the disruption of rural families and communities, which play an important social insurance function.

Exploring Bracing Adherence in Ponseti Treatment of Clubfoot: A Comparative Study of Factors and Outcomes in Uganda.

The Ponseti method of clubfoot treatment involves two phases: initial correction, usually including tenotomy; and bracing, to maintain correction and prevent relapse. Bracing should last up to four years, but in Uganda, approximately 21% of patients drop from clinical oversight within the first two years of using the brace. Our study compared 97 adherent and 66 non-adherent cases to assess the influential factors and effects on functional outcomes. We analyzed qualitative and quantitative data from clinical records, in-person caregiver interviews, and assessments of foot correction and functionality. Children who underwent tenotomy had 74% higher odds of adherence to bracing compared to those who did not undergo tenotomy. Conversely, children from rural households whose caregivers reported longer travel times to the clinic were more likely to be non-adherent to bracing (AOR 1.60 (95% CI: 1.11-2.30)) compared to those without these factors. Adhering to bracing for a minimum of two years was associated with improved outcomes, as non-adherent patients experienced 2.6 times the odds of deformity recurrence compared to adherent patients. Respondents reported transportation/cost issues, family disruptions, and lack of understanding about the treatment method or importance of bracing. These findings highlight the need to address barriers to adherence, including reducing travel/waiting time, providing ongoing education for caregivers on bracing protocol, and additional support targeting transportation barriers and household complexities.

The Experience of Families Caring for Asthma Sufferers During the COVID-19 Pandemic in Indonesia: A Qualitative Research

Familial support was essential to the care of asthma patients during the COVID-19 pandemic. It helps clients in making asthma care decisions. The purpose of this study was to explain the experience of families in providing asthma care and the effects of family care on the patient during the COVID-19 pandemic in Indonesia. This qualitative study was conducted using a content analysis approach on three families in East Java Province, Indonesia. Data were collected from the 3 families, using semi-structured interviews between 2020 and 2021. The subjects were all families in which some members had asthma. Sampling was done using the purposeful technique with maximum variation. Immediately after each interview, the content was transcribed using the Word software. The interviews were conducted with one individual at a time in the family’s home. Data were analyzed using the conventional content analysis method with simultaneous data collection based on five steps. The data analysis showed three main themes: family burdens and disruption when asthma relapsed, using a mask, keeping up stamina, keeping the mind relaxed, and staying away from crowds as an effort to prevent asthma, and pharmacological and non-pharmacological treatments carried out by families. The burden faced by the family when the disease recurs can be curbed through the family’s taking anticipatory measures that involve cooperation between family members. The family also plays a vital role in limiting the patient’s activities when the disease relapses.
 Keywords: Family, Experiences, Asthma, Qualitative research, Covid-19

‘Dear Aunty Eleanor’: Eleanor Roosevelt, Anna Freud and the politics of emotion in letters by children in war

ABSTRACT In this article I argue that the actual and imaginary presence of America looms large in the letters written to Eleanor Roosevelt by refugee children whom she sponsored through the organisation Foster Parents’ Plan for War Children (Plan). In doing so, I historicise the politics of emotion in war by examining how the concept of ‘America’ provided a positive haven for refugee children who constructed an imaginary ‘America’ – a place of security and peace – through which they discussed the fragmentation of their lives. When considering the visceral aspects of wartime experience, however, not all children found comfort in the ‘American’ imaginary. The letters of children such as eight-year-old Rosemary Hayward – who was also observed by psychoanalysts Anna Freud and Dorothy Burlingham – reveal an emotional fragility towards this notion of ‘America’. The comfort and plenty of ‘America’ was not easily appropriated by Hayward as the way in which she experienced family dislocation became pronounced. While the emotional security of the concept of ‘America’ became the cornerstone of correspondence between financial foster parents and the refugee child, it served to consolidate this exchange and the politics within it, leaving the scars of family disruption and violence in war painfully unresolved.

Development of an intravenous chemotherapy intervention for children and adolescents with cancer administered by their parents at home (INTACTatHome)

BackgroundFamilies of children and adolescents with cancer strive to maintain routines and normalcy during the child’s treatment trajectory that requires frequent hospital visits. Intravenous chemotherapy at home can reduce time spent on the frequent hospital visits and mitigate disruption in daily life. Studies on home chemotherapy for children and adolescents with cancer are limited, as is knowledge of family and health care professionals’ needs, and knowledge required to inform adaptation or replication of interventions in other settings. The aim of this study was to develop and describe an evidence-based home chemotherapy intervention that is feasible and safe for children and adolescents and suitable for future feasibility testing.MethodsThe Medical Research Council’s guidance for developing complex interventions in health care and the framework of action developed by O’Cathain et al. was used as theoretical frameworks to structure the development process. A literature search, an ethnographic study, and interviews with clinical nurse specialists from adult cancer departments formed the evidence base. Educational learning theory to support and understand the intervention was identified. Stakeholder perspectives were explored in workshops with health care professionals and parent-adolescent interviews. Reporting was qualified using the GUIDED checklist.ResultsA stepwise educational program to teach parents how to administer low-dose chemotherapy (Ara-C) to their child at home and a simple and safe administration procedure were developed. Key uncertainties were identified, including barriers and facilitators impacting future testing, evaluation, and implementation. Causal assumptions and reasoning for how the intervention leads to short-term outcomes and long-term impact were clarified in a logic model.ConclusionsThe iterative and flexible framework allowed for integration of existing evidence and new data and was successfully applied to the development process. The detailed report on the development process of the home chemotherapy intervention can enhance adaptation or replication of the intervention to other settings and thereby mitigate family disruption and stress of frequent hospital visits for these treatments. The study has informed the next phase of the research project that aims to test the home chemotherapy intervention in a prospective single-arm feasibility study.Trial registrationClinicalTrials.gov ID: NCT05372536.

(Over)Staying (Dis)Gracefully: Dissecting Pastoral transitions in AOG BTG church in Zimbabwe

Transfers and retirement of pastors positively and negatively affect their personal, family and congregational spiritual, social and economic lives. In the Zimbabwean context of political and economic volatility, pastoral transitions have been a formidable ‘elephant’ in most classical Pentecostal denominations for a number of decades. Whenever anybody triggers its discussion, some parishioners hesitantly disengage in fear of provoking and hurting each other. Against her procedural stipulation that pastoral deployments should be reviewed annually, to effect exchange of ministerial gifts and balanced edification of the Church, leaders predominantly transfer junior pastors, while most seniors usually object and only move in circumstances beyond their powers, such as when ill or dead. Consequently, juniors remain gracefully while seniors overstay disgracefully. A lot has been published on leadership successions, but attention on pastoral shifts remain passive in Zimbabwe. Thus, this paper unravels some problems and panaceas of pastoral transfers and retirement. Using qualitative grounded theory and participative observations, it discerned that contradictory theological conceptualizations, unclear constitutional and procedural provisions, policy gaps, economic instability, personal and family disruptions, insecurities and other factors problematize pastoral transitions. Conclusively, concerted efforts should be redoubled to rebuild the governance and economy of the church to mitigate disruptions, sustain, secure and create a conducive environment for smooth pastoral reshufflings. This paper addresses problematic pastoral transitions, interfaces African ecclesiology and leadership with pastoral theology from the Zimbabwean context.