Family Illness Research Articles

The Relationship of Relatives’ Illness Perception, Expressed Emotion and Their Burden in Caring for Patients with Schizophrenia

Background: The chronic burden of care to a patient with schizophrenia which produce negative emotions. As a result of de-institutionalization, caregivers have greater burden for the care of their mentally ill relatives. Objective of this study was to explore the relationship of relatives’ illness perception, expressed emotion and their burden in caring for patients with schizophrenia. Design: This study followed a correlation descriptive research design. Setting: This study conducted at inpatient and outpatient psychiatric department of Tanta University Hospital. Subject: The study subjects consist of 100 relatives of patient with schizophrenia. Tools: Tool 1 consisted of 2 parts: Part 1 Socio-demographic and general characteristics of studied participants, Part 2 Illness Perception Questionnaire-Schizophrenia Carers Version (IPQ-SCV), Tool 2 Family Questionnaire (FQ), Tool 3 Caregiver Burden Interview. Results: it was found that the studied participants had poor illness perception total score, it was found that the studied subjects (47%) had high emotional over- involvement level while it was observed that the two thirds of the studied relatives (61%) had high level of family criticism. majority of studied participants had moderate level of family burden. Conclusion: The results concluded that there was a significant positive correlation between family illness perception and family expressed emotion, also there was a significant positive correlation between family emotional expression and family burden level. Recommendations: this study recommended future studies to investigate distress and burden among caregivers with high emotion expression for intervention, reducing family stress and burden.

Studying the evolution of miasm in autism spectrum disorders: A case series

Objectives: Autism spectrum disorder (ASD), a neurodevelopmental disorder, is one of the several developmental disorders observed in children. The current prevalence of ASD among those under 18 years of age is 0.09 and 0.11 in an urban and rural area, respectively. Being a developmental disorder, it starts showing signs in the first 3 years of life and is present for the rest of the individual’s life. Studies have identified genetic predominance and a disturbed mental state in the mother during pregnancy in the genesis of disease. Modern medicinal interventions target only some specific and uncontrolled behaviours in ASD children; hence, the management is focused mainly on self-sustenance with integrated care with the help of ancillary therapies. Homoeopathically, these factors carry considerable importance as they contribute to the fundamental or miasmatic load, based on which the totality is formulated to select homeopathic simillimum. This paper studies the miasm in ASD cases treated in the Child Psychiatry OPD at Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar (2015–2018) by studying miasmatic load in detail. Materials and Methods: ASD cases diagnosed according to ICD-10 criteria were studied in detail with evolutionary data collected from parents in terms of current complaints and illnesses (past, personal and family) in both families and were analysed for miasmatic load. The fundamental and dominant miasm derived from the disease expressions and history of family illnesses. Homoeopathic simillimum selected based on the predominant miasm/s along with the totality erected as per the available characteristic expressions in the cases. Results: Administration of simillimum healed the patient at the constitutional and miasmatic level and resulted insignificant improvement in the characteristic expressions in the patients. Timely identification and intervention yield a quicker response. Conclusion: Selecting homoeopathic remedies that cover the miasmatic background yields good results in children with ASD.

Evaluation of the Predictors of Breath Holding Spell (BHS) in Children under 5 Years of Iran: A Hospital-based Case-Control Study

Objective: Breath holding spell(BHS) is a sudden, reflexive, non-epileptic phenomenon that is common in infancy and early childhood. The aim of this study was to determine the predictors of breath holding spell(BHS) in children under 5 in Iran. Methods: The study was case-control study(case, n=55; control, n=55). The cases were selected from children with BHS who had been referred to Mohammad Kermanshahi Hospital of Kermanshah, during 2019. Then, for each case, one control was selected among the children who referred to other wards of this hospital for reasons other than BHS.The data collection tool was a data collection form consisted of demographic, family, obstetric and biochemical characteristics. The biochemical parameters(such as serum calcium, magnesium, albumin, phosphorus and vitamin D levels) were measured by fully automatic autoanalyzer(Prestige 24i Tokyo-Boeki, Japan). Univariate and multivariate logistic regression model were used to data analysis by STATA 14. Results: The mean age of children for case and control groups were 22.85 ± 15.34 and 23.29 ± 16.91months, respectively. The numbers of boys were 32(58.20) and 29(52.70) for case and control groups; respectively. The multivariate logistic regression model showed that the calcium(OR=9.03; 95% CI: 2.51 – 32.48), household size(OR=0.19; 95% CI:0.04–0.90), paternal education(OR=0.48; 95% CI:0.24–0.97), and history of mental illness in family(OR=8.97; 95% CI: 1.15–69.72) were the most important predictors statistically of BHS in children under 5 years. Conclusion: Calcium, household size, paternal education and history of mental illness in family were the most important predictors of BHS in children under 5 years; however, studies with larger sample size are required.

Psychopathology and Coping strategies in adolescent children of patients with alcohol dependence in an urban population

Background: Alcohol dependence is a mental disorder and a “Family illness.” Indian survey on substance use (2019) found 14.6% of the population (age 10 to 75 years) using alcohol. Adolescence is crucial with social and biological changes. Parental alcohol dependence causes a chaotic family environment. Adolescent children comprise 21% of the Indian population, and those having drinking parents face a lot of stress. Effective coping is a crucial component of resilience. Aim: To Study psychopathology, coping, and their association in adolescent children of patients with alcohol dependence and comparing with adolescent children of parents without alcohol dependence. Methods: Subjects were adolescent children of patients with alcohol dependence in a tertiary care hospital, and controls were children of parents without alcohol dependence selected from a school. CBCL was applied to study psychopathology and A-COPE for coping strategies. Results: Subjects included 67 boys and 33 girls whose fathers were alcohol dependent. Thirty-nine children did unskilled work to earn money, including students. The majority had academic problems, less involvement in games, selective friends and substance use. Subjects had high internalizing (mainly girls) and externalizing scores (mainly boys) compared to controls indicating higher psychopathology. Subjects would cope by ventilating feelings while controls developed social support and sought professional help. Comparing coping in subjects, boys avoided problems, used humour and relaxation while girls sought spiritual support. Conclusion: Psychopathology in adolescent children of drinking parents is higher, and they lack problem-focused coping strategies. Early screening and interventions improving coping with individualized care considering social context are important.

Children, poverty and mental health in rural and urban England (1850–1907)

AbstractOver the course of the nineteenth century children increasingly became social, economic and scientific concerns. Their physical and mental well-being was deemed intrinsic to the future development of Britain and its Empire, and thus maintaining healthy youngsters was, by the turn of the twentieth century, considered a national priority. This article explores the interconnectivity between poverty and the child residents of pauper lunatic asylums in England. It draws on a corpus of extant patient case files from four pauper lunatic asylums between 1851 and 1907 and engages with detailed information about the children and their mental conditions. Additionally, there will be a focus on understanding family backgrounds, parental occupations, the correlation between diagnoses and class, and methods of ‘treatment’ designed to equip children for independent working lifestyles. The overarching objective is to consider the socio-economic ramifications of child mental illness for parents and families and better understand how Victorian institutions accommodated this specific class of patient.

Disruption, worries and autonomy in the everyday lives of adolescents with type 1 diabetes and their family members: A qualitative study of intrafamilial challenges.

To explore daily life with type 1 diabetes in families with an adolescent with type 1 diabetes. Management of adolescent type 1 diabetes is carried out in the context of everyday life, thus involving and affecting the entire family. Type 1 diabetes causes disruption of family life, but the specific experiences and challenges of adolescents with type 1 diabetes, siblings and parents are not well-explored. Specifically, research is lacking on the siblings' experience of adolescents with type 1 diabetes. A qualitative design using participatory workshops. A sample of 21 families comprising adolescents with type 1 diabetes (aged 8-18) (N=20), their parents (N=29) and siblings (N=10) participated in four workshops exploring everyday life in families with adolescent diabetes from the perspective of all family members. Data were analysed using systematic text condensation. The COREQ checklist was used preparing the manuscript. Family life with type 1 diabetes was characterised by three overarching themes: (a) the perpetual challenges and disruptive nature of life with diabetes, (b) different ways of worrying about diabetes and (c) diabetes autonomy and emancipation from parents. All family members' lives were marked by these aspects, however in different ways and to varying degrees. Our findings emphasise that type 1 diabetes is indeed a family illness affecting all family members. The study provides insight into the unique experiences of adolescents with diabetes, their parents and siblings, all of whom encounter diabetes-related challenges in their daily lives. The findings call for the inclusion of all family members of adolescents with type 1 diabetes in both research and healthcare practice. Family-oriented approaches targeting adolescents with diabetes as well as their parents and siblings will enable provision of nursing care that can meet the needs of the entire family.

Current Data Gaps in Modeling Essential Worker Absenteeism Due to COVID-19.

With the uncertain physical and mental health implications of COVID-19 infection, companies have taken a myriad of actions that aim to reduce the risk of employees contracting the virus, with most grounded in reducing or eliminating in-person interactions. Our preliminary analysis indicates that while there is some data to support modelling absenteeism, there are gaps in the available evidence, requiring the use of assumptions that limit precision and efficacy for decision support. Improved data on time-to-recovery after hospitalization, absenteeism due to family or other household member illness, and mental health's impact on returning to work will support the development of more robust absenteeism models and analytical approaches.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

An Opportunity to Promote Health Equity: National Paid Family and Medical Leave

* Abbreviations: COVID-19 — : coronavirus disease 2019 FMLA — : Family and Medical Leave Act PFL — : paid family leave PFML — : paid family and medical leave > When my daughter was born prematurely at 27 weeks, I was faced with the agonizing choice of staying with her in the neonatal intensive care unit or going back to work at my federally qualified community health center. Even as a pediatrician who is familiar with the enormous benefits of kangaroo care and singing, talking, and reading to newborns, I returned to work within two weeks of her birth because of my own economic situation. At the time, the state I lived in, Massachusetts, did not offer paid family and medical leave (PFML), and the clinic I worked at offered unpaid leave options. As a physician, I am enormously privileged with respect to job protection and income. However, the families I care for are particularly vulnerable to the adverse impacts of unpaid leave. I have come to recognize PFML as a health equity crisis that requires an urgent national policy solution. > > Dr Kimberly Montez The United States is the only developed nation that fails to guarantee any kind of paid leave to workers. We lack a national paid family and medical leave (PFML) policy that encompasses: (1) paid parental leave, which would apply to both mothers and fathers after the birth of a child, adoption of a child, or fostering a child; (2) paid family leave (PFL), which would apply to caregivers of a hospitalized child, a medically complex child, or a family member such as a declining parent; and (3) paid medical or sick leave, which would allow one to manage personal or family illness. Although the 1993 Family and Medical … Address correspondence to Kimberly Montez, MD, MPH, Department of Pediatrics, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157. E-mail: kmontez{at}wakehealth.edu

Asthma Care and Out‐of‐Pocket Costs for Families of Children with Asthma in High‐Deductible Health Plans

Asthma is the most common pediatric chronic condition, with substantial morbidity, health care utilization, and costs. Enrollment has increased in high‐deductible health plans (HDHPs) that require families to assume greater responsibility for out‐of‐pocket (OOP) costs for asthma and other family health care needs, creating potential barriers to use of recommended asthma controller medications. Data are limited on children in HDHPs. We sought to examine changes in asthma controller medication use, exacerbations, and OOP costs for children with asthma enrolling in HDHPs and whether this varies for children in families with multiple competing health care needs.We measured OOP costs for children’s asthma care and for care for all family members in the same insurance plan, and children’s rates of 30‐day fills for asthma controller medications and exacerbations (measured by oral steroid bursts). We controlled for the number of chronic conditions among all family members, defining high illness burden as presence of ≥ 4 chronic conditions. We used a difference‐in‐differences design with models controlling for individual and employer‐level characteristics, and tested for effect modification by family illness burden using a three‐way interaction.We identified children aged 4‐17 years with persistent asthma with employer coverage in a large commercial and Medicare Advantage claims database between 2002 and 2014. We selected children with 12 months of enrollment in a plan with low or no deductible (“traditional plan”) before either switching to a HDHP or staying in the traditional plan (controls) for another 12 months. The sample included only employers offering a single deductible level.The sample included 4708 children who switched to HDHPs and 47,414 who remained in traditional plans. Children switching to HDHPs had higher OOP costs for asthma care than controls (difference‐in‐differences (DiD) $21; 95% confidence interval (CI) $14‐$28), a relative increase of 21.5% (13.5%‐29.4%). Their families had greater OOP spending (DiD $605; 95% CI $505‐$704), a relative increase of 26.8% (21.8%‐31.8%). Children in HDHPs had a relative decrease in 30‐day controller medication fills (−7.4%, 95% CI −12.0% to −2.8%) but no relative difference in exacerbations (1.3%, 95% CI −10.5% to 13.2%). There was no evidence of effect modification by family illness burden.This study found increases in OOP asthma costs for children in HDHPs and lower rates of controller medication use, but no differences in asthma exacerbations. Families experienced an increase in total OOP costs in HDHPs, although this may have been offset by lower premiums. The lack of difference in the impact of HDHP enrollment on children’s controller use in families with high illness burden suggests these families are not trading off OOP spending on children’s asthma care for OOP spending on other care.Although families face increased OOP costs in HDHPs for children’s asthma and other health care, the impact on asthma medication use and exacerbations may be moderated by the fact that medications were subject to copayments rather than the deductible in most plans in our study. Value‐based insurance designs that exempt important pediatric health services from the deductible may help reduce adverse outcomes in HDHPs.Patient‐Centered Outcomes Research Institute.

U.S. Navy Bolsters Mental Health Services During Pandemic

Back to table of contents Previous article Next article Clinical & ResearchFull AccessU.S. Navy Bolsters Mental Health Services During PandemicNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:16 Jul 2020https://doi.org/10.1176/appi.pn.2020.6b28AbstractWith services ranging from peer counseling groups to psychiatrists embedded within deployed personnel, the Navy’s No Wrong Door program is striving to provide mental health services to all personnel.iStock/Avigator PhotographerAs highlighted by the large-scale outbreak of COVID-19 on the USS Theodore Roosevelt aircraft carrier that started in late March, the U.S. Navy is not immune to the virus. Given the existing stresses of military service and the close quarters many naval personnel operate in, the COVID-19 pandemic might be a recipe for significant psychological burden.“[S]o far, we have not seen a spike in demand for our mental health services,” said physician Capt. James Reeves, director for primary care and mental health at the Navy Bureau of Medicine and Surgery, during a virtual roundtable event in late May discussing how the COVID-19 crisis has impacted the Navy. “Inpatient hospital admissions have even diminished during this time.”While it may still be some time before the mental health effects of COVID-19 emerge, Reeves said he is encouraged by these early trends.The lack of a significant mental health spike is due in part to some broad protective factors, according to Reeves. “As a group, our personnel are all still employed and have access to health care,” he said. As many personnel are accustomed to long periods on vessels, they may also be more resilient to the effects of self-isolation. “Some individuals might even appreciate the necessity of spending more time at home with family,” he said.Reeves also said he believes that the comprehensive mental health program developed by Navy Medicine known as No Wrong Door may be contributing to the positive early data. If Navy personnel experience mental health problems, they have a range of service options—from peer support to psychiatry specialists, Reeves said.In addition to having psychiatrists available at the large Navy hospitals and medical centers, the Navy provides behavioral services (generally psychologists and/or social workers) at many of their smaller on-base primary care clinics. In the last decade, the Navy and other military branches have also started embedding mental health professionals with specific units such as submarine crews, aviators, or special forces. “Each of our units is unique in what it does and has its own culture,” Reeves said, noting that currently about one-third of mental health professionals in the Navy are embedded. “These embedded staff know how the units operate, they deploy with them, and can provide concierge-level care.”Due in part to a multifaceted strategy of peer and professional behavioral services, Navy personnel have not experienced significant mental distress during the COVID-19 outbreak, says Capt. James Reeves.Additionally, a referral program known as Military OneSource can help U.S. servicemembers to connect with non-military counselors if they feel more comfortable going to someone outside their base.Supporting the long-term mental health of Navy personnel requires tending to stressors that were likely around before and will extend beyond the pandemic.“This is especially concerning now since the extra time needed to manage a crisis situation prevents personnel from caring for their personal health,” said Joshua Morganstein, M.D., an associate professor of psychiatry at the Uniformed Services University of the Health Sciences (USUHS) and chair of APA’s Committee on the Psychiatric Dimensions of Disasters.Fleet and Family Support Centers on bases and deployment resiliency counselors on ships offer counseling for issues including family illness, marriage problems, or sexual harassment. Additionally, Navy chaplains play a key role in supporting personnel, Reeves said. “People may think of chaplains purely as spiritual help, but they are trained in counseling on issues like grief and loss,” he said.In response to COVID-19, the Navy has been quick to increase virtual mental health services. Reeves noted that most services being offered are telephone-based, though they are ramping up their video-conferencing abilities. Several Navy hospitals have also developed virtual programs to help both patients and caregivers during this crisis.“We know that this pandemic is straining the health care system and creating excess operational stress on caregivers,” Reeves said. “We want our staff to be able to recognize stress symptoms early and ensure they can get the support needed.”Morganstein added that the Center for the Study of Traumatic Stress at USUHS has created numerous resource sheets on how caregivers, patients, and families can mitigate the impact of the COVID-19 crisis. ■The Center for the Study of Traumatic Stress pandemic resources are posted here. ISSUES NewArchived

Prevalence of Maternal Postpartum Depression, Health-Seeking Behavior and Out of Pocket Payment for Physical Illness and Cost Coping Mechanism of the Poor Families in Bangladesh: A Rural Community-Based Study.

The burden of depression is high globally. Maternal depression affects the mother, the child, and other family members. We aimed to measure the prevalence of maternal postpartum depressive (PPD) symptoms having a child aged 6–16 months, health-seeking behavior for general illness of all family members, out of pocket (OOP) payments for health care and cost coping mechanisms. We conducted a cross sectional study with 591 poor families in rural Bangladesh. The survey was conducted between August and October, 2017. Information was collected on maternal depressive symptoms using the Self Reporting Questionnaire (SRQ-20), health-seeking behavior, and related costs using a structured, pretested questionnaire. The prevalence of depressive symptoms was 51.7%. Multiple logistic regression analysis showed that PPD symptoms were independently associated with maternal age (p = 0.044), family food insecurity (p < 0.001) and violence against women (p < 0.001). Most (60%) ill persons sought health care from informal health providers. Out of pocket (OOP) expenditure was significantly higher (p = 0.03) in the families of depressed mothers, who had to take loan or sell their valuables to cope with expenditures (p < 0.001). Our results suggest that postpartum depressive symptoms are prevalent in the poor rural mothers. Community-based interventions including prevention of violence and income generation activities for these economically disadvantaged mothers should be designed to address risk factors. Health financing options should also be explored for the mothers with depressive symptoms

Somatik belirtilerin sosyodemografik ve klinik özellikler ile ilişkisi

Objevtive: Somatization is a psychiatric condition characterized by recurring somatic symptoms that cannot be fully explained by the general medical condition of the individual and are not attributable to another mental disorder. There are physical, psychological and social factors that affect somatic symptoms of individuals. The aim of this study is to screen somatic symptoms of patients admitted to our clinic and to investigate the relationship between scanning results and sociodemographic and clinical characteristics of the patients. Methods: This cross-sectional study included 414 participants aged 18-65 years who admitted to the …. between February 2018 and November 2018. Sociodemographic data form and SCL90-R (Symptom Checklist 90-Revised) psychological symptom screening test was applied to the participants through face to face interview method. Results: Of all the participants, 256 (61.8%) were female and 158 (38.2%) were male and the mean age was 33.7±13.6 years. Of all the participants, 47.3% were university graduates or had a higher educational background. The mean score of the somatization subscale of the SCL90-R screening test was 1.0±0.6. The factors increasing the somatic symptoms were female gender, increasing number of children, being an immigrant, decreasing education level, increasing amount of drug use, increasing number of applications to health institutions, and implementation of alternative medicine techniques, presence of mental illness in families and their relatives. Conclusion: In the present study, the prevalence of somatic symptoms was found to be high and clinically significant. In particular, the social position of women in Turkey, their lifestyles, and their specific characteristics such as using body language more are associated with high somatic symptoms. Emotional disability caused by migrations makes individuals be at greater risk in terms of somatization. The personality development that increases with the education level and increased communication skills reduce the risk of somatization. Symptoms of patients who frequently use health care and treatment options and apply alternative medicine are more significant in terms of somatization.

Abstract C111: Identifying barriers to screening mammography use among low-income women in a public hospital setting in Los Angeles

Abstract Background: Mammography remains the most effective method for early detection of breast cancer. The Affordable Care Act requires that screening mammography be fully covered without any out-of-pocket expense for all patients. Still, disparities in mammography use persist, with the lowest rates reported for women of Hispanic ethnicity and those with Medicaid-based insurance coverage. The aim of this study was to administer a phone survey to better understand the barriers to mammography use among racially diverse low-income women with Medicaid coverage. Methods: All female patients age 50 to 74 at our facility that had not had a screening mammogram in the recent 24 months were identified. Data were collected from the electronic medical record (EMR) including race/ethnicity, primary language spoken, having had a PCP visit in the previous 12 months, having had a prior mammogram, history of depression, personal history of breast or other cancer, zip code (to estimate median household income), and marital status. Three attempts were made to contact these patients by phone to administer a phone survey that asked them to (1) state in their own words the primary reason for not getting a mammogram and (2) to complete a survey based on the Health Belief Model (HBM) subcategories: issues with self-efficacy (SE), perceived barriers (PBa), perceived benefits (PBe), perceived susceptibility (PS) and cues to action (CA). Barriers were assessed by race and characteristics collected from the EMR as well as survey responses. Results: There were 810 women due for mammography screening, 333(41%) of which were Hispanic, 146(18%) Black; 112(14%) Asian, 61(8%) Non-Hispanic White, and 158(20%) listed as ‘Other’. Data were collected from the EMR for all 810 women, and 339 (42%) were reached and agreed to participate in the survey. There were 320(40%) patients that did not speak English as their primary language, 441(54%) had not had a prior mammogram, 177(22%) had never visited a primary care physician in the system, and 237 (29%) had not visited one within the last 12 months. The most common self-stated reason Hispanic patients did not get a mammogram was due to lack of knowledge about insurance coverage of mammography; for Black women it was being busy with work related or personal and family illnesses; for Asian a language barrier; and for White/Non-Hispanic it was occupation with illness. The most commonly identified barrier for all races based off of the additional survey questions was limited mammography hours. Conclusion: In an underserved, predominantly Hispanic population who has Medicaid coverage, health professionals should better educate Hispanic patients on their insurance coverage, provide educational material that includes Asian languages, and consider that extended hours could help patients of all races find time to schedule a mammogram as efforts to minimize barriers will ultimately serve to decrease racial health disparities in breast cancer outcomes. Citation Format: Janell Holloway, Isabel del Canto, Kenny Morales, Gianna Ramos, Ashkan Moazzez, Griselda Gutierrez, Carmen Mendez, Junko Ozao-Choy, Christine Dauphine. Identifying barriers to screening mammography use among low-income women in a public hospital setting in Los Angeles [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C111.

Female perspectives on the Relationship between Janet Frame's autobiography and fiction

Female perspectives on the Relationship between Janet Frame's autobiography and fiction Eva Rueschmann Josephine A. McQuail , ed. Janet Frame in Focus: Women Analyze the Works of the New Zealand Writer. Jefferson, NC: McFarland, 2018. 207 pp. $49.95 ISBN: 9781476669731 In Patricia Moran's foreword to Janet Frame in Focus: Women Analyze the Work of the New Zealand Writer, she points out that Janet Frame may be more widely known as the [End Page 145] subject of Jane Campion's 1990 film An Angel at My Table , based on Frame's autobiography, than as a prolific writer of fiction, short stories, and poetry in her own right. Born in Dunedin, New Zealand, in 1924, Frame lived a life that was marked by multiple family tragedies, illness, and poverty; a profound sense of marginalization and insecurity; and an eight-year stay in a mental institution in her twenties, following a misdiagnosis of schizophrenia. From a young age, Frame showed an extraordinary literary inventiveness and startlingly original prose. This unconventionality and her painful shyness often resulted in her social isolation and misunderstanding by a conformist society. Yet Frame's literary talent ultimately saved her life and creativity: in 1952, the announcement of the Hubert Church Memorial Award for her first shortstory collection, The Lagoon and Other Stories (1951), was a pivotal turning point and spared her from the looming certainty of a devastating lobotomy at the young age of twenty-eight. Writing became a refuge for what Frame called her "homelessness of self." Today Frame is highly regarded for her complex experimental (some people argue postmodern) writing and her poetic, richly metaphoric use of language—but she is less well known in the United States. This new collection of scholarly essays edited by Josephine McQuail, a professor of English at Tennessee Technical University, reintroduces Frame as a writer of autobiography, fiction, and poetry to an American audience and seeks to redress the dominant preoccupation with Frame as New Zealand's stereotyped "mad woman artist." Janet Frame in Focus features ten essays—eight written exclusively for this book—that offer an array of critical approaches but center on the ways in which Frame wrote about her childhood and life experiences, her quest for an artistic identity and voice, and her preoccupation with language—its conventionality and potential for originality and rebellion—in both her autobiography and her fiction. Overall, the collection follows in a tradition of feminist criticism concerned with social images of the female writer and artist as "mad" and "dangerous." In the wake of the women's movement of the 1970s, two influential works by prominent feminist scholars, Elaine Showalter's The Female Malady: Women, Madness, and English Culture, 1890–1980 (1985) and Sandra Gilbert and Susan Gubar's The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination (1979), famously critiqued the gendered conception of female creativity as malady and insanity. This critique echoed Frame's own perspective on the gendered social construction of mental illness decades before. Among previous scholarly studies of Frame's writing, Gina Mercer's Janet Frame: Subversive Fictions (1995), which employs Luce Irigaray and Hélène Cixous as theoretical frameworks, is the most explicitly feminist treatment of Frame's work. Mercer is somewhat dismissive of Frame's autobiography as too linear and transparent compared to the radical feminist potential of her complex prose. In contrast, Claire Bazin, a French expert on Frame at the University of Paris Ouest Nanterre, argues in her book Janet Frame (2011) that Frame's more conventionally narrated autobiography serves as a valuable key to unlock the meaning of her fiction. Claire Bazin is one of the principal contributors to Janet Frame in Focus, with her essay on strategies of avoidance in The Lagoon and Other Stories. Bazin's scholarship on Frame also inspired her former students Aurelia Mouzet, Manon-Lili Morand, Jennifer Boum Make, and Marion Clavier to contribute original essays for this volume. These scholars bring a French perspective to Frame's writing, deploying the theories of Mikhail Bakhtin, Jean-François [End Page 146] Lyotard, Homi Bhabha, and Sigmund Freud in their both modern and postmodern readings of Frame. Janet Frame in...

An Analysis of Students' Makeup-Exam Results and Performance in Undergraduate Biology Courses

A consistent challenge for undergraduate instructors is how to properly and objectively assess students who cannot attend regularly scheduled exams. Though many alternatives exist, perhaps the most common strategy is to allow students to take a makeup exam at a different time. Many instructors avoid this option for fear of the students gaining an unfair advantage in their exam preparations. I assessed student performance on makeup exams in relation to their typical performance on other exams throughout the course, to determine if there was any signal of score improvement or decline on makeup exams. I analyzed the data in regard to when students took the makeup exam, what their excuse for missing the regularly scheduled exam was, and the type of course in which they took the makeup. Students' makeup-exam scores were not significantly different from their regular-exam scores, though students who took a makeup due to a school-sponsored activity scored worse than students taking a makeup due to family emergencies or illness. While this research cannot definitively state that makeup exams do not provide some sort of advantage to student scores, it suggests that if students are trying to “game the system,” at the very least, they aren't winning.

Willingness to Pay for Social Health Insurance and Associated Factors among Health Care Providers in Addis Ababa, Ethiopia.

Background. Cost sharing between beneficiaries and government is critical to attain universal health coverage. The government of Ethiopia introduced social health insurance to improve access to quality health services. Hence, HCP are the ultimate frontline service provider; their WTP for health insurance could influence the implementation of the scheme directly or indirectly. However, there is limited evidence on willingness to pay (WTP) for social health insurance (SHI) among health professionals. Methods. A cross-sectional study was conducted in Addis Ababa, Ethiopia, from May 1st to August 15th, 2019. A total sample of 480 health care providers was selected using a multistage sampling method. The collected data were entered into Epi Info version 7.1 and analyzed with SPSS version 23. Binary and multiple logistic regression analysis was carried out to identify the associated factor outcome variable. The association was presented in odds ratio with 95% confidence interval and significance determined at a P value less than 0.05. Result. A total of 460 health care providers responded to the questionnaire, making a 95.8% response rate. Of the respondents, only 132 (28.7%) were WTP for SHI. Higher educational status [AOR = 2.9, 95% CI (1.2-7.3)], higher monthly income [AOR = 2.2, 95% CI (1.2-4.3)], recent family illness [AOR = 2.4, 95% CI (1.4-4.4)], and a good awareness about SHI [AOR = 4.4, 95% CI (2.4-7.8)] showed significant association with WTP for SHI. The main reasons for not WTP were thinking the government should cover the cost, preferring out-pocket payment and the provided SHI scheme does not cover all the health care costs health care providers lost interest in pay for SHI. Conclusion and Recommendation. The majority of health care providers were not willing to pay for the introduced SHI scheme. The provided SHI scheme should be clear and provide special consideration for health care providers as the majority of them receives free health care service from their employer health care institution. Also, the government, health professional associations, and other concerned stakeholders should provide awareness creation programs by targeting low and middle-level health professionals in order to increase WTP for SHI among health care providers.

Machine learning prediction of incidence of Alzheimer\u2019s disease using large-scale administrative health data

Nationwide population-based cohort provides a new opportunity to build an automated risk prediction model based on individuals’ history of health and healthcare beyond existing risk prediction models. We tested the possibility of machine learning models to predict future incidence of Alzheimer’s disease (AD) using large-scale administrative health data. From the Korean National Health Insurance Service database between 2002 and 2010, we obtained de-identified health data in elders above 65 years (N = 40,736) containing 4,894 unique clinical features including ICD-10 codes, medication codes, laboratory values, history of personal and family illness and socio-demographics. To define incident AD we considered two operational definitions: “definite AD” with diagnostic codes and dementia medication (n = 614) and “probable AD” with only diagnosis (n = 2026). We trained and validated random forest, support vector machine and logistic regression to predict incident AD in 1, 2, 3, and 4 subsequent years. For predicting future incidence of AD in balanced samples (bootstrapping), the machine learning models showed reasonable performance in 1-year prediction with AUC of 0.775 and 0.759, based on “definite AD” and “probable AD” outcomes, respectively; in 2-year, 0.730 and 0.693; in 3-year, 0.677 and 0.644; in 4-year, 0.725 and 0.683. The results were similar when the entire (unbalanced) samples were used. Important clinical features selected in logistic regression included hemoglobin level, age and urine protein level. This study may shed a light on the utility of the data-driven machine learning model based on large-scale administrative health data in AD risk prediction, which may enable better selection of individuals at risk for AD in clinical trials or early detection in clinical settings.

A Systematic Review of Somatic Symptoms in Children With a Chronically Ill Family Member.

Somatization and functional somatic symptoms reflect conditions in which physical symptoms are not sufficiently explained by medical conditions. Literature suggests that these somatic symptoms may be related to illness exposure in the family. Children with a parent or sibling with a chronic illness may be particularly vulnerable to developing somatic symptoms. This study provides a systematic review of the literature on somatic symptoms in children with a chronically ill family member. A systematic review (PROSPERO registry ID: CRD42018092344) was conducted using six databases (PubMed, EMBASE, PsychINFO, Scopus, CINAHL, and Cochrane) from articles published before April 5, 2018. All authors evaluated articles by title and abstract, and then by full-text review. Relevant data were extracted by the first author and reviewed by remaining authors. Twenty-seven unique studies met the criteria. Seventeen examined somatic symptoms in children with a chronically ill parent, and seven evaluated somatic symptoms in children with a chronically ill sibling. Three studies examined somatic symptoms in children with an unspecified ill relative. The strongest relationship between child somatization and familial illness was found with children with a chronically ill parent (13/17 studies). Evidence for somatic symptoms in children with an ill sibling was mixed (4/7 studies found a positive association). The literature on somatic symptoms in children suggests that parental illness is related to increased somatic symptoms in children. Research examining the effects of having a sibling with an illness on somatic symptoms is mixed. Several areas of future research are outlined to further clarify the relationship between familial chronic illness and somatic symptoms.

The Life of Mark Twain: The Middle Years, 1871–1891

The Life of Mark Twain: The Middle Years, 1871–1891