Search

Traditionally, studies on parenting children with disabilities have focused mostly on experiences of stress. More recently, studies have turned to examining parental coping from the perspective of strength, focusing on the ability to achieve growth and empowerment. Most studies, however, have not examined parental activism as a coping mechanism. Based on the Double ABCX Model of Family Adjustment and Adaptation, this study, conducted in Israel, assessed the adequacy of a theoretical model linking stress, coping, activism, growth, and empowerment of parents of children with disabilities. Activist and nonactivist parents (N = 123) completed a structured questionnaire that included measures of stress, coping, empowerment, and growth. Stress was negatively associated with empowerment and growth, whereas problem-focused coping and parental activism were positively associated with empowerment and growth. Activism was found to mediate the relationships between stress and growth and empowerment, with lower levels of stress being related to higher levels of activism, which was in turn correlated to higher levels of empowerment and growth. Parental activism, consisting of deconstructing problems faced by the family and demanding change in social discourse with a view toward inclusion, choice, rights, and equality, is a useful mechanism for parents in alleviating levels of stress and enhancing sense of empowerment and growth.Tradicionalmente, los estudios sobre la crianza de los niños con discapacidades se han centrado principalmente en las experiencias de estrés. Pero recientemente, los estudios se han volcado a analizar el afrontamiento de los padres desde la perspectiva de la fortaleza, centrándose en la capacidad de crecer y empoderarse. Sin embargo, la mayoría de los estudios no han analizado el activismo parental como mecanismo de afrontamiento. Este estudio, realizado en Israel y basado en el modelo Doble ABCX de Adaptación Familiar, evaluó la adecuación de un modelo teórico que conecta el estrés, el afrontamiento, el activismo, el crecimiento y el empoderamiento de los padres de niños con discapacidades. Un grupo de padres activistas y no activistas (N = 123) contestaron un cuestionario estructurado que incluyó medidas de estrés, afrontamiento, empoderamiento y crecimiento. El estrés estuvo asociado negativamente con el empoderamiento y el crecimiento, mientras que el afrontamiento centrado en los problemas y el activismo parental estuvieron asociados positivamente con el empoderamiento y el crecimiento. Se descubrió que el activismo medió las relaciones entre el estrés, el crecimiento y el empoderamiento. Los niveles más bajos de estrés estuvieron relacionados con niveles más altos de activismo, el cual, a su vez, estuvo correlacionado con niveles más altos de empoderamiento y crecimiento. El activismo parental, que consiste en deconstruir los problemas que enfrenta la familia y exigir un cambio en el discurso social en beneficio de la inclusión, la elección, los derechos y la igualdad, es un mecanismo útil para los padres a la hora de aliviar los niveles de estrés y mejorar el sentido de empoderamiento y crecimiento.关于如何养育残疾儿童的研究比较传统的做法就是主要关注对压力相关的体验上。最近的研究已经向研究父母们的应对方式转变, 而且是从力量的角度, 重点转而关注家长们获得成长和获得授权的能力。然而, 大多数研究并没有将父母方面的积极举措作为一种应对机制来考察。本研究在以色列进行, 采用家庭调整和家庭适应的双ABCX模型为基础,评估了一个理论模型的充分性, 即该模型是否足以将残疾儿童的父母面临的压力、应对方式、激进行动主义活动、家长的成长和获得授权感联系起来。积极行动的父母和不践行积极主动行为的父母一共有123人 (N = 123) , 完成了一份结构性问卷, 其中包括对压力、应对、赋权和成长的测量。压力与授权感和成长呈负相关, 而以问题为中心的应对方式和父母的积极性与赋权和成长呈正相关。研究发现, 激进行动主义可以调节压力和成长与被授权之间关系, 压力水平较低与激进行为水平较高有关, 而激进主义水平较高又与赋权和成长水平较高有关。父母的激进行为包括解构家庭所面临的问题, 要求社会话语的改变, 以实现包容、选择、权利和平等, 这种激进主义是一种有用的机制, 可以帮到父母减轻压力、增强被授权感和意识到有成长的。.

Tracheal intubation is common in the care of critically ill adults and is frequently complicated by hypotension, cardiac arrest, or death. We aimed to evaluate administration of an intravenous fluid bolus to prevent cardiovascular collapse during intubation of critically ill adults.We did a pragmatic, multicentre, unblinded, randomised trial in nine sites (eight ICUs and one emergency department) around the USA. Critically ill adults (≥18 years) undergoing tracheal intubation were randomly assigned (1:1, block sizes of 2, 4, and 6, stratified by study site) to either an intravenous infusion of 500 mL of crystalloid solution or no fluid bolus. The primary outcome, assessed in the intention-to-treat population, was cardiovascular collapse, defined as a new systolic blood pressure65 mm Hg; new or increased vasopressor receipt between induction and 2 min after tracheal intubation; or cardiac arrest or death within 1 h of tracheal intubation. Adverse events were assessed in the as-treated population. This trial, which is now complete, is registered with ClinicalTrials.gov, number NCT03026777.Patients were enrolled from Feb 6, 2017, to Jan 9, 2018, when the data and safety monitoring board stopped the trial on the basis of futility. By trial termination, 337 (63%) of 537 screened adults had been randomly assigned. Cardiovascular collapse occurred in 33 (20%) of 168 patients in the fluid bolus group compared with 31 (18%) of 169 patients in the no fluid bolus group (absolute difference 1·3% [95% CI -7·1% to 9·7%]; p=0·76). The individual components of the cardiovascular collapse composite outcome did not differ between groups (new systolic blood pressure65 mm Hg 11 [7%] in the bolus group vs ten [6%] in the no-bolus group, new or increased vasopressor 32 [19%] vs 31 [18%], cardiac arrest within 1 h seven [4%] vs two [1%], death within 1 h of intubation two [1%] vs one [1%]). In-hospital mortality was not significantly different in the fluid bolus group (48 [29%]) compared with no fluid bolus (59 [35%]).Administration of an intravenous fluid bolus did not decrease the overall incidence of cardiovascular collapse during tracheal intubation of critically ill adults compared with no fluid bolus in this trial.US National Institutes of Health.

Salmonella meningitis is a rare infection, particularly in adults. We report the case of a 75-year-old female with a history of rheumatoid arthritis on TNF-antagonist immunosuppressive therapy who initially presented to the hospital for management of back and leg pain and was ultimately diagnosed with bacterial meningitis secondary to Salmonella species infection. She was treated with ceftriaxone with slow improvement in neurological function. Though the source of infection was never clearly identified from multiple imaging studies, we suspect the severity of her presentation was due to her history of TNF-antagonist use.