52 research outputs found
Iraq and Afghanistan veteransâ experiences living with their parents after separation from the military
When military service members separate from the military, many return to their families of origin, living with their parents for a period of several weeks to years. While research with veterans and their spouses has documented the particular strain of this reintegration period on veterans and their partners, little research to date has examined veteransâ experiences living with their parents. The present study sought to fill this research gap by investigating veteransâ experiences living with their parents using qualitative, in-depth interviews with Iraq and Afghanistan veterans in California. Overall, veterans appreciated the instrumental and emotional support their parents provided when they separated. However, in some cases, living with parents also produced conflict and strain. In situations where adult veteran children had difficulty with the transition to civilian life or returned with mental health problems, parents were often the first to identify these problems and to support their children in accessing appropriate care. We analyze these findings in light of family systems theory, identifying ways in which adult veteran children continue a process of differentiation while living with their parents and maintaining emotional connectedness. We suggest ways that clinicians can better support veterans and their parents through the reintegration period and recommend that programming for military families explicitly include parents of service members in addition to conjugal families
Intra-operative phacoemulsification conversion to extracapsular cataract extraction: risk factors and visual outcome
Phacoemulsification (PEA) is currently the procedure of choice for most cataract extraction. However, intra-operative complications may require the procedure to be converted to extracapsular cataract extraction (ECCE). We have evaluated the indications for conversion and visual outcomes in cases converted from phacoemulsification to ECCE. A retrospective review was performed on 33 eyes in which phacoemulsification was initiated and then converted to ECCE. The main parameters evaluated were indications for conversion and visual outcomes at 3 months. Thirty-three cases out of 1448 operations were identified from January 2013 to February 2014.The incidence of PEA converted to ECCE was 2.2%. The indications for ECCE conversion were posterior capsular rupture (PCR) in twenty-two cases, combined capsulorhexis extension with PCR in three cases, capsulorhexis extension and zonular dialysis in two cases respectively. Combined zonular dialysis with PCR, corneal toxicity, Descemetâs tear and obscured edge of capsulorhexis had one case each. Twenty-six (78%) cases had gain in vision, one (3%) case had unchanged vision and six (18%) cases had worsening of vision. The incidence of complicated phacoemulsification surgery requiring intra-operative conversion to ECCE was low in our study (2.2%). Seventy-eight percent of cases achieved final VA of 6/12 or better. Therefore, early recognition of complications and timely intra-operative conversion of PEA to ECCE may result in good visual outcome
Defining appropriateness in coach-athlete sexual relationships: The voice of coaches
The sporting culture, with omnipotent coaches, fierce competition for recognition and funding, and âwin at all costâ ethos, creates an environment conducive to sexual exploitation of athletes. Recent increased public awareness and the development of child protection policies in sport have led to the questioning of previously accepted coach-athlete relationships. This study is an exploratory investigation into male swimming coachesâ perceptions of appropriateness of coach-athlete sexual relationships. Sexual relationships with athletes under the age of 16 were unanimously considered totally inappropriate. With regard to sexual relationships with athletes above the age of consent for heterosexual sex, opinions ranged from âtotally inappropriateâ to âitâs a question of civil liberties.â These results are discussed in relation to how coaches have adapted their own behaviours in the face of public scrutiny but are still reluctant to restrict the rights of their fellow coaches
Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists.
Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman's risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1)
Combining value of information analysis and ethical argumentation in decisions on participation of vulnerable patients in clinical research
Clinical characteristics of patients with suspected cardiac chest pain and angiographically normal coronary arteries in a secondary care hospital
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Hepcidin-mediated hypoferremia disrupts immune responses to vaccination and infection
Background: How specific nutrients influence adaptive immunity is of
broad interest. Iron deficiency is the most common micronutrient deficiency worldwide and imparts a significant burden of global disease;
however, its effects on immunity remain unclear.
Methods: We used a hepcidin mimetic and several genetic models to
examine the effect of low iron availability on T cells in vitro and on immune responses to vaccines and viral infection in mice. We examined
humoral immunity in human patients with raised hepcidin and low
serum iron caused by mutant TMPRSS6. We tested the effect of iron
supplementation on vaccination-induced humoral immunity in piglets,
a natural model of iron deficiency.
Findings: We show that low serum iron (hypoferremia), caused by
increased hepcidin, severely impairs effector and memory responses
to immunizations. The intensified metabolism of activated lymphocytes
requires the support of enhanced iron acquisition, which is facilitated by
IRP1/2 and TFRC. Accordingly, providing extra iron improved the
response to vaccination in hypoferremic mice and piglets, while
conversely, hypoferremic humans with chronically increased hepcidin
have reduced concentrations of antibodies specific for certain pathogens. Imposing hypoferremia blunted the T cell, B cell, and neutralizing
antibody responses to influenza virus infection in mice, allowing the virus to persist and exacerbating lung inflammation and morbidity.
Conclusions: Hypoferremia, a well-conserved physiological innate
response to infection, can counteract the development of adaptive immunity. This nutrient trade-off is relevant for understanding and
improving immune responses to infections and vaccines in the globally
common contexts of iron deficiency and inflammatory disorders
Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?
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