Family Survey Research Articles

POS-260 Polycystic kidney disease in Chad: about 26 cases

Polycystic kidney disease is the most common inherited kidney disease with easy diagnosis by ultrasound. The aim of our work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of renal polyskystosis in Chad and to assess the value of screening in patients at risk. We carried out a descriptive cross-sectional study over a period of 26 months (January 1, 2018 to May 1, 2020) in the two nephrology departments of the Renaissance and the National Reference centers of N’Djamena. were included all patients who had polycystosis (PEI ultrasound criteria). Then a family survey was carried out among family members of patients included between June 1, 2020 and October 1, 2020 During our study, 2229 patients had consulted in the 2 university hospitals. Fifteen (15) cases met the ultrasound criteria for PEI, as a hospital prevalence of 0.67% of cases. From these 15 cases, a family investigation was carried out on the members of 3 families. Eleven (11) patients were diagnosed as carriers of polycystic kidney disease (Figure 2). We identified a total of 26 cases in our study, as a prevalence of 1.16%. The average age was 42.4 years [15 and 70 years] with a sex ratio of 1.3. The mean age of onset of the first clinical signs was 37.7 years. Arterial hypertension (hypertension) was the main circumstance of discovery in 53.8% (n = 14) followed by abdominal pain, urinary tract infection and chronic renal failure in respectively 7.6% (n = 2); 7.6% (n = 2) and 3.8% (n = 1). Grade I, II and III hypertensions were found in 42.1%, respectively (n = 8); 36.9% (n = 7) and 21% (n = 4). There was a statistically significant relationship between circumstance of discovery and age (p = 0.034). A hemoglobin level of between 8 and 10g / dl was found in 57.7% of cases. The mean serum creatinine level was 45 mg / l with [4.5 to 274.42 mg / l]. It was noted that 12 patients or 46.1% of patients were in the chronic renal failure stage, including 26.9% in the end stage. All had received conservative treatment. In multivariate analysis, there was a statistically significant relationship between the different stages of chronic kidney disease and the occurrence of complications (p = 0.0000). Therapeutically, 14 patients (53.8%) were on antihypertensive drugs such as ACE inhibitors. No patient had received Tolvaptan. Urinary tract infections were the main complications (19.2%) of hypertension in the blood (15.3%) and macroscopic hematuria (15.3%). Polycystosis in Chad is an unrecognized and underdiagnosed pathology. Clinical screening should focus on the etiological research of arterial hypertension in the young subject and ultrasound screening of family members of the polycystic patient.

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non-randomised, concurrent mixed methods study protocol.

The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). The concurrent mixed-method design will collect data from: A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. Documentation about the child's referral needs and uptake by disadvantage families. Interviews with housing insecure families, and staff/managers of the specialist homeless service. A review of Nurse Practitioner case notes. Surveys of families with children accessing the Nurse Practitioner service. Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes.

Identifying the Factors Influencing Patients' Telehealth Visit Satisfaction: Survey Validation Through a Structural Equation Modeling Approach.

Introduction: The COVID-19 pandemic accelerated the adoption of telehealth as an alternative to in-person hospital visits. To understand the factors impacting the quality of telehealth services, there is a need for validated survey instruments and conceptual frameworks. The objective of this study is to validate a telehealth patient satisfaction survey by structural equation modeling (SEM) and determine the relationship between the factors in the proposed telehealth patient satisfaction model (TPSM). Methods: We conducted a cross-sectional survey of pediatric patients and families receiving care from a comprehensive pediatric hospital in the Midwest between September 2020 and January 2021. In total, 2,039 usable responses were collected. We used an SEM approach by performing confirmatory factor analysis with Diagonally Weighted Least Squares modeling and Partial Least Squares-Path Modeling to establish the structural validity and examined the relationships among the constructs of "Admission Process" (AP), "Perceived Quality of Service" (PQS), and "Telehealth Satisfaction" (TS). Results: Participants were predominantly White (75%) and English-speaking (95%) parents (85%) of patients (mean age of patients was 10.2 years old). The survey responses were collected from patients visiting 43 department specialties, whereas 50% were behavioral and occupational therapy patients. The structural model showed that the admission process (AP) had a strong positive impact on perceived quality of service (PQS) (p = 0.67, t = 36.1, p < 0.001). The PQS had a strong positive impact on telehealth satisfaction (TS) (p = 0.66, t = 31.8, p < 0.001). The AP had a low positive direct impact on TS (p = 0.16, t = 7.46, p < 0.05). Overall, AP and PQS explained 61% variances (R2) of TS. Conclusions: We validated a newly proposed TS assessment model by using SEM. The TPSM will inform researchers to better understand the influencing factors in TS and help health care systems to improve telehealth patient satisfaction through a validated model.

BMI, Blood Pressure, and Plasma Lipids among Centenarians and Their Offspring.

Background The burden of cardiovascular diseases (CVDs) is increasing substantially due to population growth and aging. Determining effective prevention and understanding the underlying mechanisms remain desirable pursuits for increasing the quality of life. As centenarians and their offspring may have genetic advantages, they may present with healthier cardiovascular-related profiles. Methods We launched a cross-sectional household-based survey of centenarian families, including 253 centenarians, 217 centenarian offspring, and 116 offspring spouses without centenarian parents from county-level Chinese longevity city Rugao. Among offspring and offspring spouses were the following arrangements: 101 paired offspring and offspring spouses who lived together, 116 unpaired offspring, and 16 unpaired spouses. We investigated their cardiovascular-related health status including waist circumference, body mass index (BMI), blood pressure, and plasma lipids and compared results among centenarians, centenarian offspring, and offspring spouses. Results Centenarians ranged from 99 to 109 years with a median age of 100 years. Centenarian offspring, with a median age of 70 years, and offspring spouses, with a median age of 69 years, shared similar age. Results of blood pressure, plasma lipid levels, and BMI displayed no significant difference between centenarian offspring and offspring spouses. However, centenarians appeared to have lower waist circumference, BMI, TC, LDL-C, TG, and diastolic blood pressure but higher levels of systolic blood pressure (p < 0.05). Multivariate analysis showed the prevalence of obesity, hypertension, and dyslipidemia was similar between centenarian offspring and offspring spouses, while centenarians appeared to have a lower prevalence of obesity and a higher prevalence of hypertension (p < 0.05). Conclusions Centenarians and centenarian offspring did not present healthier BMI, blood pressure, or plasma lipids than offspring spouses. Further research on longevity and cardiovascular diseases are desirable.

The impact of COVID‐19 on patient engagement in the health system: Results from a Pan‐Canadian survey of patient, family and caregiver partners

IntroductionThe COVID‐19 pandemic has had an impact on all aspects of the health system. Little is known about how the activities and experiences of patient, family and caregiver partners, as a large group across a variety of settings within the health system, changed due to the substantial health system shifts catalysed by the pandemic. This paper reports on the results of a survey that included questions about this topic.MethodsCanadian patient, family and caregiver partners were invited to participate in an online anonymous survey in the Fall of 2020. A virtual snowballing approach to recruitment was used. Survey invitations were shared on social media and emailed to health system and governmental organizations with the request that they share the survey with patient partners. This paper focuses on responses to two questions related to patient partner experiences during the COVID‐19 pandemic.ResultsThe COVID‐19 questions were completed by 533 respondents. Over three quarters of respondents (77.9%, n = 415) indicated their patient engagement activities had been impacted by COVID‐19. The majority (62.5%, n = 230) experienced at least a temporary or partial reduction in their patient engagement activities. Some respondents did see increases in their patient engagement activities (11.4%, n = 42). Many respondents provided insights into their experience with virtual platforms for engagement (n = 194), most expressed negative or mixed experiences with this shift.ConclusionsThis study provides a snapshot of Canadian patient, family and caregiver partners' perspectives on the impact of COVID‐19 on their engagement activities. Understanding how engagement unfolded during a crisis is critical for our future planning if patient engagement is to be fully integrated into the health system. Identifying how patient partners were engaged and not engaged during this time period, as well as the benefits and challenges of virtual engagement opportunities, offers instructive lessons for sustaining patient engagement, including the supports needed to engage with a more diverse set of patient, family and caregiver partners.Patient ContributionPatient partners were important members of the Canadian Patient Partner Study research team. They were engaged from the outset, participating in all stages of the research project. Additional patient partners were engaged to develop and pilot test the survey, and all survey respondents were patient, family or caregiver partners. The manuscript is coauthored by two patient partners.

Sexual Violence as a Key Predictor of Depressive Symptoms in Women: Korean Longitudinal Survey of Women and Families.

The purpose of this study was to identify the influence of violence on depressive symptoms in women. We analyzed panel data from the Korean Longitudinal Survey of Women and Families (n = 6,632). Exposure to sexual violence was a significant predictor of the onset of depressive symptoms. After adjusting for all covariates, other predictors included the perception of a poor or very poor health status than normal and participants in their 40s and 50s versus participants younger than 40 years. Assessing exposure to sexual violence might be beneficial for evaluating depressive symptoms in women who are newly diagnosed with depression.

Care processes and racial/ethnic differences in family reports of end-of-life care among Veterans: A mediation analysis.

Bereaved family members of racial/ethnic minority Veterans are less likely than families of White Veterans to provide favorable overall ratings of end-of-life (EOL) care quality; however, the underlying mechanisms for these differences have not been explored. The objective of this study was to examine whether a set of EOL care process measures mediated the association between Veteran race/ethnicity and bereaved families' overall rating of the quality of EOL care in VA medical centers (VAMCs). A retrospective, cross-sectional analysis of linked Bereaved Family Survey (BFS), administrative and clinical data was conducted. The sample included 17,911 Veterans (mean age: 73.7; SD: 11.6) who died on an acute or intensive care unit across 121 VAMCs between October 2010 and September 2015. Mediation analyses were used to assess whether five care processes (potentially burdensome transitions, high-intensity EOL treatment, and the BFS factors of Care and Communication, Emotional and Spiritual Support, and Death Benefits) significantly affected the association between Veteran race/ethnicity and a poor/fair BFS overall rating. Potentially burdensome transitions, high-intensity EOL treatment, and the three BFS factors of Care and Communication, Emotional and Spiritual Support, and Death Benefits did not substantially mediate the relationship between Veteran race/ethnicity and poor/fair overall ratings of quality of EOL care by bereaved family members. The reasons underlying poorer ratings of quality of EOL care among bereaved family members of racial/ethnic minority Veterans remain largely unexplained. More research on identifying potential mechanisms, including experiences of racism, and the unique EOL care needs of racial and ethnic minority Veterans and their families is warranted.

Satysfakcja z pracy współczesnych Koreanek

The article analyses job satisfaction among contemporary Korean women in correlation with the respondents’ age group. The examined aspects relate to wage levels, working conditions, working hours, and responsibilities. The results indicate that the respondents’ age group has a significant impact on job satisfaction in the aspects under review. The independence test X2 (chisquare) has been applied and the Cramér’s coefficient V and the materiality level (p) have been interpreted. The analysed data are derived from the Korean Longitudinal Survey of Women and Family (KLoWF) of 2007 (Wave 1) and 2016 (Wave 6). Changes in satisfaction are evident in all analysed aspects, in the context of a comparative analysis of both waves. The analysis demonstrated that contemporary Korean women had little job satisfaction in the surveyed aspects in 2016. However, in 2007, the majority did not have any opinion on the subject. The greatest differences in satisfaction relate to working conditions, working hours, and responsibilities. The slightest difference (although still significant) was observed in the wage satisfaction analysis.

Psychometric properties of parent- and staff-reported measures and observational measures of infant and toddler development in Early Head Start

Using longitudinal data from the Early Head Start Family and Child Experiences Survey 2009 (Baby FACES 2009), this study examines the psychometric properties of infant and toddler measures of language and cognitive development and social-emotional competence collected from multiple sources, including parent and Early Head Start staff reports and direct assessments from trained assessors. We examined the validity and reliability of parent/staff ratings and observational measures derived from adult/child play-based interactions using independently administered standardized measures from direct assessments as the criteria or comparison measures. Participants included 846 children and families with low incomes enrolled in Early Head Start in spring 2009 who were followed from ages 1 to 3, drawn from a nationally representative sample of programs. The results suggest adequate internal consistency reliability for most of the measures. We found stronger rater effects for staff-reported measures compared with assessor effects for direct child assessment and observational measures. Moreover, the rater effects in the staff-reported measures varied by staff characteristics. There was some evidence of validity for the staff- and parent-reported measures at ages 2 and 3, but little evidence of validity for the age 1 measures. We discuss the implications of these findings for research on infants and toddlers from families with low incomes. It is important to consider the purpose of the assessments and their psychometric properties for the particular group of children with whom the assessments will be used when selecting assessment tools.

Outcomes of 75 consecutive cases of laparoscopic one-anastomosis gastric bypass: A prospective study

Background: Obesity is increasing at an alarming rate in India along with rest of the world. In the National Family and Health survey - IV conducted in 2015-16; 31.3% women and 26.6% men in urban area were obese or over weight. Bariatric surgery has long been introduced for weight control and is well established measure and superior to other weight control measures. Procedures like laparoscopic Roux en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are more commonly performed than Laparoscopic One Anastomosis Gastric Bypass (LOAGB). Although sufficient data has accumulated in literature regarding the safety and efficacy of LOAGB, some of standard textbooks still mention it as an experimental procedure and not the mainstream procedure. Aims and Objective: The present study was conducted with objective to find out changes in pre-operative and post-operative status of diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnoea, osteoarthritis, GERD and quality of life after laparoscopic one anastomosis gastric bypass along with its safety and efficacy in Indian population. Material and Methods: The study was conducted at a tertiary care bariatric surgical centre and included 75 consecutive individual operated between January 2016 to December 2017 who underwent Laparoscopic One Anastomosis Gastric Bypass and followed prospectively for minimum 1 year (mean 18 months) and statistical analysis was done using SPSS 21 software. Result: One Anastomosis Gastric Bypass was completed laparoscopically in all the patients without need for conversion to an open procedure. The overall complication with Laparoscopic One Anastomosis Gastric Bypass was 1.3% without any mortality. Mean percentage of excess weight loss (% EWL) achieved was 72.73. 93.9 % patients with diabetes, 67.43% patients with hypertension, 87.1% patient with hyperlipidemia, all the patient with obstructive sleep apnoea and osteoarthritis of knee showed improvement in their disease status. None of the patient showed worsening of gastroesophageal reflux or development of new symptoms of gastro esophageal reflux. All patients had improvement in their quality of life as seen in the improvement of their SF 36 scores. Conclusion: Laparoscopic One Anastomosis Gastric Bypass is a safe and effective bariatric procedure. The post procedure improvement in diabetes, hypertension, hyperlipidemia, obstructive sleep apnoea, osteoarthritis of knee and quality of life is significant in Indian context.

Sociodemographic Differences in Multimorbidity: A Closer Look from Indonesian Family and Life Survey

The prevalence of multimorbidity, the coexistence of two or more chronic diseases, is expected to increase, including in Indonesia. This phenomenon is associated with increased life expectancy and incidence of non-communicable diseases. Therefore, this study assesses the burden of multimorbidity in Indonesia by sociodemographic factors. The researchers analyzed cross-sectional data from the latest wave of IFLS conducted in 2014, the IFLS wave 5. The researchers included individuals aged 15 and above with blood pressure measurements (n= 32.256) from 13,536 households. Meanwhile, the researchers excluded individuals with missing data on BMI (183 individuals) or who had biologically implausible or extreme values (n=6). The analyses were then conducted on 32,067 individuals. The analyses comprised the ten most common self-reported chronic diseases diagnosis in IFLS-5. The findings revealed that the prevalence of self-reported multimorbidity in Indonesia was relatively high, at 9.32% (n= 2.989), with the highest proportion of multimorbidity reported among the elderly. Approximately 2.76% of the respondents (n- 885) reported having three or more chronic diseases. The most common combinations were hypertension and digestive problem (2.15%, n= 689), followed by hypertension and arthritis (1.79%, n= 574), and hypertension and high cholesterol (1.68%, n= 539). When stratified by sociodemographic factors, the researchers found a higher proportion of multimorbidity among females (11.01%, n= 3,530) compared to males (7.41%, n= 2.376), elderly (21.54%, n= 3.530) compared to younger adults, and previous smokers (20.90%, n= 6.072). People who were obese and overweight also reported a higher prevalence of multimorbidity (13.73%, n= 4.403 and 9.3%, n= 2.998, respectively). In addition, those living in urban areas had a higher proportion of multimorbidity (10.33%, n= 3.313) compared to rural areas (7.2%, n= 2.527). In conclusion, this study uncovered a relatively high prevalence of multimorbidity. People living in urban areas were overweight/obese and those who had low SES had a higher proportion of multimorbidity. With the nature of self-reported data and previously reported underdiagnosis of chronic diseases, screening to examine multimorbidity is needed.

Domestic Violence Current Legal Status: Psychiatric Evaluation of Victims and Offenders.

Domestic Violence Current Legal Status: Psychiatric Evaluation of Victims and Offenders.

Early positive approaches to support for families of young children with intellectual disability: the E-PAtS feasibility RCT

Background Parents of children with intellectual disability are 1.5–2 times more likely than other parents to report mental health difficulties. There is a lack of clinically effective and cost-effective group well-being interventions designed for family carers of young children with intellectual disability. Aim To examine the feasibility of a randomised controlled trial of the clinical effectiveness and cost-effectiveness of the Early Positive Approaches to Support (E-PAtS) intervention. Design A feasibility study (including randomisation of families into a two-arm trial), questionnaires to assess the feasibility of proposed outcome measures (including resource use and health-related quality of life) and practitioner/family carer interviews. An additional question was included in an online UK survey of families, conducted by the research team to assess usual practice, and a survey of provider organisations. Setting Families recruited from community contexts (i.e. third sector, local authority services, special schools) and self-referral. The E-PAtS intervention was delivered by trained community-based providers. Participants Families with at least one child aged 1.5–5 years with an intellectual disability. At least one parent had to have English-language ability (spoken) for E-PAtS programme participation and participants had to provide informed consent. Interventions E-PAtS intervention – two caregivers from each family invited to eight 2.5-hour group sessions with usual practice. Usual practice – other support provided to the family, including other parenting support. Objectives To assess randomisation willingness/feasibility, recruitment of providers/parents, retention, usual practice, adherence, fidelity and feasibility of proposed outcome measures (including the Warwick–Edinburgh Mental Well-Being Scale as the proposed primary outcome measure, and parent anxiety/depression, parenting, family functioning/relationships, child behavioural/emotional problems and adaptive skills, child and parent quality of life, and family services receipt as the proposed secondary outcome measures). Results Seventy-four families (95 carers) were recruited from three sites (with 37 families allocated to the intervention). From referrals, the recruitment rate was 65% (95% confidence interval 56% to 74%). Seventy-two per cent of families were retained at the 12-month follow-up (95% confidence interval 60% to 81%). Exploratory regression analysis showed that the mean Warwick–Edinburgh Mental Well-Being Scale well-being score was 3.96 points higher in the intervention group (95% confidence interval –1.39 to 9.32 points) at 12 months post randomisation. High levels of data completeness were achieved on returned questionnaires. Interviews (n = 25) confirmed that (1) recruitment, randomisation processes and the intervention were acceptable to family carers, E-PAtS facilitators and community staff; (2) E-PAtS delivery were consistent with the logic model; and (3) researchers requesting consent in future for routine data would be acceptable. Recorded E-PAtS sessions demonstrated good fidelity (96% of components present). Adherence (i.e. at least one carer from the family attending five out of eight E-PAtS sessions) was 76%. Health-related quality-of-life and services receipt data were gathered successfully. An online UK survey to assess usual practice (n = 673) showed that 10% of families of young children with intellectual disability received any intervention over 12 months. A provider survey (n = 15) indicated willingness to take part in future research. Limitations Obtaining session recordings for fidelity was difficult. Recruitment processes need to be reviewed to improve diversity and strategies are needed to improve primary outcome completion. Conclusions Study processes were feasible. The E-PAtS intervention was well received and outcomes for families were positive. A barrier to future organisation participation is funding for intervention costs. A definitive trial to test the clinical effectiveness and cost-effectiveness of E-PAtS would be feasible. Trial registration Current Controlled Trials ISRCTN70419473. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 2. See the NIHR Journals Library website for further project information.

중년 맞벌이 부부의 성역할 태도가 부부관계 만족도에 미치는 영향에 대한 가사노동 참여의 매개효과: 자기효과와 상대방효과를 중심으로

This study focused on actor and partner effects of participation in household work on the association between gender role attitudes and marital satisfaction among middle-aged dual-earner couples. The sample included 762 middle-aged dual-earner couples aged 40 to 60 who participated in the 2015 Family Survey (N=1,524). Both husbands and wives self-reported on gender role attitudes, marital satisfaction, and household work participation. The respondent’s age, education level, length of marriage, and number of children were controlled for in the analysis. The Actor-Partner Interdependence Mediation Model analysis indicated that the husband’s gender role attitudes showed significant effects on their own and partners’ household work participation and the husband’s household work participation showed significant effects on their own and partners’ marital satisfaction. Also, both husbands’ and wives’ gender role attitudes showed significant effects on their own and partners’ marital satisfaction and the effects of husband’s gender role attitude on both husband’s and wife’s marital satisfaction were mediated by the husband’s participation in household work. These findings suggest that husbands’ household work participation could improve the quality of marital relationships, especially for middle-aged dual-earner couples.

Me & My Wishes: Concordance of End-of-Life Preferences between Residents with Dementia, Family, and Staff.

Objective: Me & My Wishes involves videos of persons living with dementia talking about their end-of-life (EOL) care preferences. This study aimed to examine the concordance of EOL treatment and psychosocial preferences expressed by assisted living community and nursing home residents in these videos with family and staff knowledge of preferences. Design: Randomized wait-list control. Setting/Subjects: Assisted living and nursing home residents in the United States, and their family members and caregivers. Measurements: Five EOL treatment preferences (cardiopulmonary resuscitation or CPR, breathing machine, tube feeding, life support, and pain treatment) and four near EOL psychosocial preferences (having family at the bedside, engaging in faith practices such as prayer, having a pet at bedside, and engaging in activities such as being read to or listening to music) extracted from residents' videos and captured through family and staff surveys. Results: Thirty-six resident videos were shared with family (N = 50) and staff (N = 38) during care plan meetings. Concordance between residents' stated EOL treatment preferences and family and staff knowledge improved, with results showing a treatment effect at time of sharing the video (family: Beta = 0.21, p < 0.001; staff: Beta = 0.35, p < 0.001). Conclusion: Our findings indicate that sharing Me & My Wishes videos improved family and staff concordance of EOL psychosocial and treatment preferences for assisted living and nursing home residents living with dementia. Personalized videos conveying resident preferences can help informal and formal caregivers understand the resident as a person and foster concordant care. Clinical Trial Registration Number NCT03861429.

Goals of Care Documentation: Insights from A Pilot Implementation Study

ContextThe Life Sustaining Treatment Decision Initiative is a national effort by the Veterans Health Administration to ensure goals of care documentation occurs among all patients at high risk of life-threatening events. ObjectivesExamine likelihood to receive goals of care documentation and explore associations between documentation and perceived patient care experience at the individual and site level. MethodsRetrospective, quality improvement analysis of initiative pilot data from four geographically diverse Veterans Affairs (VA) sites (Fall 2014-Winter 2016) before national roll-out. Goals of care documentation according to gender, marital status, urban/rural status, race/ethnicity, age, serious health condition, and Care Assessment Needs scores. Association between goals of care documentation and perceived patient care experience analyzed based on Bereaved Family Survey outcomes of overall care, communication, and support. ResultsVeterans were more likely to have goals of care documentation if widowed, urban residents, and of white race. Patients older than 65-years and those with a higher Care Assessment Needs score were twice as likely as a frail patient to have goals of care documented. One pilot site demonstrated a positive association between documentation and perceived support. Pilot site was a statistically significant predictor of the occurrence of goals of care documentation and Bereaved Family Survey scores. ConclusionOlder and seriously ill patients were most likely to have goals of care documented. Association between a documented goals of care conversation and perceived patient care experience were largely unsupported. Site-level largely contributed to understanding the likelihood of documentation and care experience.

Utility of Tuberculin Testing in Children Under 5 Years of Age

The usefulness of the tuberculin sensitivity in children as an index of tuberculosis was evaluated in terms of the conversion index. Out of 62 children, 27 had abnormal X-rays. Family surveys lead to picking up of nine children who had radiological evidence of the disease. Lymph node biopsy in one of the subjects showed tuberculous lymphadenitis. How relevant this index of tuberculin conversion is as an indicator of tuberculous disease in childhood is clear from the present study. It is an important procedure for screening and can considerably reduce the work load and increase case yield. It also gives us a good idea about the prevalence and epidemiology of tuberculous infection in children.

Comparison of Association Between Divorce and Access to Healthcare Services Among Married Immigrants

The number of married immigrants is increasing in Korea, and family dissolution is also growing in this population. Although divorce could impact immigrants' health status, it is unclear whether they have difficulties accessing healthcare and medical services. Thus, we examined whether divorce in married immigrants is independently associated with access to healthcare services. A retrospective analysis of 11,778 adults who participated in the 2018 National Multicultural Family Survey. We used three different covariate adjustment methods (multivariate logistic regression, inverse probability of treatment weighting, 1:1 greedy propensity score matching) to examine the association between divorce and access to healthcare services after accounting for various demographic and clinical characteristics. Overall, 5.8% (n = 691) of married immigrants reported a history of divorce. The divorce group included 107 (15.5%) males and 584 (84.5%) females, with an average age of 45.17 years (SD = 10.9). The non-divorced group included 1992 males (18.0%) and 9095 (82.0%) females, with an average age of 39.1 years (SD = 10.5). After propensity score matching, all variables were balanced (all p>0.05). Individuals who experienced divorce were more likely to have difficulties in healthcare service access than those who did not experience divorce (adjusted odds ratio 1.423, 95% CI [1.075, 1.882]). Our findings revealed that divorce increased the risk of limited healthcare services among immigrants in Korea. Healthcare policymakers should be aware of the healthcare access issues in this minority population. In addition, to improve the lifestyles of minority populations, it is necessary to study their overall lives.

Marriage Intentions Among Cohabiters in Lithuania

Living together in one household without being married in modern society is one of the defining features characterizing the transformations of the modern family, mentioned alongside late-age marriage, late-age childbearing, or frequent divorces. Marriage is still a major life transformation, but the pressure to marry today is lighter than ever before and many young couples in Europe start family life from living together in one household and not being married. However, cohabitation has not a universal meaning and role in family formation process and couples cohabit for different reasons and motives. Existing research proves, that union formation pattern depends on socioeconomical and sociodemographic characteristics, it varies by country and changes by time.&#x0D; In the research literature, cohabitation diffusion process is mainly based on the two arguments: cultural value changes which leads to “less marriage” and economic restrains which leads to postponed marriage until economic stability.&#x0D; The aim of this article is to investigate the intentions of cohabitors to marry and the factors modelling these intentions in Lithuania. The empirical analysis is based on the current Family and Inequality Survey (2019) data set about 1970-1984 birth cohort who lived in an extramarital partnership at the time of the research. The data consists rich information on the partnership and fertility, but also social and economic standing. Analysis of the data shows that, most of the cohabiting individuals in the analyzed cohort in Lithuania still undecided about marriage and could not name their intentions in the future. Descriptive statistics suggests that more man than women plan to marry their partner in the future. In addition, cohabitors with the lowest education level do not intend to marry their partner more than any another education level group.&#x0D; The multinomial regression results suggest that factors predicting marriage in the future are sex, partnership satisfaction and education. That leads to assume that in Lithuania cohabitation is only a prelude to marriage and individuals satisfied with the quality of their relationship intends to marry rather than continuing cohabitation as an alternative to marriage. Cohabitation can be chosen as a prelude to marriage to check the strength of a relationship and to accumulate economic and social resources. On another hand, having one child has a negative effect on the marriage intentions among cohabitors.

Targeting the nurse practitioner workforce: Influences and barriers in choosing rural practice

Background and objective: Recruitment and retention of primary care providers are projected to worsen in rural regions. Nurse practitioners (NPs) are a crucial solution to the shortage of primary care providers in rural America. Little research exists regarding factors influencing new NPs’ decisions to practice in rural settings, as well as practice readiness. The purpose of this study is to explore factors influencing new NPs’ decision to practice in rural settings.Methods: A survey of family nurse practitioner (FNP) graduates in a rural state was conducted. The survey measured rural background, current practice environment, the impact of rural clinical experiences on readiness to practice, and perceptions of rural NP practice.Results: The data collected over five years (N = 42) indicated several factors that influenced an NP’s decision to choose a position in a rural or underserved setting. A wide scope of practice, rural roots, a desirable job offer, and strong relationships were influential when choosing rural practice.Conclusions: Most respondents (69%) were not practicing in rural or underserved areas. Among those who were, the ability to practice to the full scope of education and autonomy were the most important factors. However, respondents were also apprehensive and intimidated with the broad skill set required in rural care. Implications: This study provides insight into factors and barriers for new graduate NPs in choosing a rural practice setting as well as possible solutions to the rural workforce shortage.