Emerging resilience in a family affected by autism

The purpose of this phenomenological study was to examine the attributes conducive to the healthy adaptation of a family despite having a child with autism to gain a better understanding of autism and the effects of autism on family life. The study comprised a non-random sample of the whole four family members, which includes the child with autism. It is often the family as a whole that is greatly affected by the diagnosis and so all members of the family were deemed essential for the results. Using a phenomenological framework, the study comprised data collected during semi-structured interviews with the four members of one family. The participants were interviewed in a three-step process to determine if qualities of resilience would emerge. Six themes evolved from the participants’ interviews and were used to answer the research questions.Interviews were transcribed and analyzed according to phenomenological procedures seeking the essence of a family’s experience of raising a child with autism. The information gathered during the interviews clarified which factors contribute to the family’s resilience. The researcher gained background knowledge of the guiding principles the family has used to overcome many of the challenges of autism. As well, direction and insight intended for other families with a child with autism were gained. The contributing characteristics and attributes that emerged from the data were: acceptance and understanding; adaptability and flexibility; self-efficacy; strength and determination; and support from family or community.The findings support the existing understanding of factors that contribute to resilience in families affected by autism. The data collected during the interviews revealed that the participants share many of the same feelings of frustration, guilt and stress as other families affected by autism but also attain strength and a sense of hope or optimism for the future. Once the parents were able to move through the cycle of grief their healthy adaptation became apparent. The themes derived from the lived experiences of the participants demonstrate how they have emerged from adversity with resilience

Centralising acute stroke care within clinical practice in the Netherlands: lower bounds of the causal impact

BACKGROUND Authors in previous studies demonstrated that centralising acute stroke care is associated with an increased chance of timely Intra-Venous Thrombolysis (IVT) and lower costs compared to care at community hospitals. In this study we estimated the lower bound of the causal impact of centralising IVT on health and cost outcomes within clinical practice in the Northern Netherlands. METHODS We used observational data from 267 and 780 patients in a centralised and decentralised system, respectively. The original dataset was linked to the hospital information systems. Literature on healthcare costs and Quality of Life (QoL) values up to 3 months post-stroke was searched to complete the input. We used Synthetic Control Methods (SCM) to counter selection bias. Differences in SCM outcomes included 95% Confidence Intervals (CI). To deal with unobserved heterogeneity we focused on recently developed methods to obtain the lower bounds of the causal impact. RESULTS Using SCM to assess centralising acute stroke 3 months post-stroke revealed healthcare savings of $US 1735 (CI, 505 to 2966) while gaining 0.03 (CI, − 0.01 to 0.73) QoL per patient. The corresponding lower bounds of the causal impact are$US 1581 and 0.01. The dominant effect remained stable in the deterministic sensitivity analyses with $US 1360 (CI, 476 to 2244) as the most conservative estimate. CONCLUSIONS In this study we showed that a centralised system for acute stroke care appeared both cost-saving and yielded better health outcomes. The results are highly relevant for policy makers, as this is the first study to address the issues of selection and unobserved heterogeneity in the evaluation of centralising acute stroke care, hence presenting causal estimates for budget decisions

Childhood Socioeconomic Status and Late-Adulthood Mental Health: Results from the Survey on Health, Ageing and Retirement in Europe.

A growing literature acknowledges the association between childhood socioeconomic status (SES) and health in late adulthood (i.e., 50+). Less, however, is known about the association with mental health outcomes, such as depression. We use the Survey on Health, Ageing and Retirement in Europe (SHARE) to analyse overall and gender-specific associations between childhood SES and late-adulthood depression.Using life-history and contemporaneous data from 21,989 SHARE respondents in combination with principal component analysis we construct indices of childhood SES. We measure late-adulthood depression using the EURO-D scale. Contemporaneous SES is operationalized as the logarithm of household equivalised income. We estimate associations using linear regression models.We document a positive association between childhood SES and the late-adulthood EURO-D score. The association persists even when allowing for contemporaneous SES. Zooming in on gender-specific associations reveals that the association for mental health is particularly pronounced for women.Our findings reveal the long-term association between childhood socioeconomic conditions and depression later in life, which persists even after taking into account current socioeconomic conditions and are stronger for women than for men. These results imply that boosting childhood socioeconomic conditions can potentially have effects lasting well beyond the childhood phase

Lactic acid bacteria: reviewing the potential of a promising delivery live vector for biomedical purposes

Lactic acid bacteria (LAB) have a long history of safe exploitation by humans, being used for centuries in food production and preservation and as probiotic agents to promote human health. Interestingly, some species of these Gram-positive bacteria, which are generally recognized as safe organisms by the US Food and Drug Administration (FDA), are able to survive through the gastrointestinal tract (GIT), being capable to reach and colonize the intestine, where they play an important role. Besides, during the last decades, an important effort has been done for the development of tools to use LAB as microbial cell factories for the production of proteins of interest. Given the need to develop effective strategies for the delivery of prophylactic and therapeutic molecules, LAB have appeared as an appealing option for the oral, intranasal and vaginal delivery of such molecules. So far, these genetically modified organisms have been successfully used as vehicles for delivering functional proteins to mucosal tissues in the treatment of many different pathologies including GIT related pathologies, diabetes, cancer and viral infections, among others. Interestingly, the administration of such microorganisms would suppose a significant decrease in the production cost of the treatments agents since being live organisms, such vectors would be able to autonomously amplify and produce and deliver the protein of interest. In this context, this review aims to provide an overview of the use of LAB engineered as a promising alternative as well as a safety delivery platform of recombinant proteins for the treatment of a wide range of diseases

Governing budgetary commons: what can we learn from Elinor Ostrom?

Fiscal commons, Budgetary institutions, Constitutional law and economics, Institutional economics, Constitutional economics, B52, H11, H30, H61, H62,