Vulnerable young adults’ retrospective perceptions of school-based psychosocial support

In this article we describe the retrospective perceptions of vulnerable young adults on the psychosocial support they had been exposed to when they were in school. Qualitative data were collected through individual interviews, collages and a focus group discussion with 5 young adults (2 females and 3 males aged from 20 to 23) who resided at a foster home in Johannesburg. Thematic data analysis identified distinct psychological and social experiences which impacted on their ability to function independently as adults. The psychological experiences highlighted their sense of vulnerability, a lack of identity, emotional pain, and the need for career and guidance counselling. Their social experiences were characterised by social isolation and a lack of social skills. Adopting Erikson’s theory of psychosocial development, we discuss what psychosocial support should be provided at schools so that vulnerable children could have a better life

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Vulnerable young adults’ experiences of post-school psycho-social preparation

M.Ed. (Educational Psychology)Abstract: According to legislation, orphans and vulnerable children (OVC) living in foster care homes and orphanages within South Africa are required by law to leave these places of care when they reach the age of 18. Many of them have been living in child-headed households. In addition, they have to leave the safety net of schooling and are expected to enter the adult world of independent living. This is often accompanied by a lack of psycho-social preparation. Research has shown that these OVC are at risk of being adversely affected psychologically as well as lacking the basic social skills for independent adult living. Instead of becoming independently functioning adults, they become vulnerable young adults who, because of circumstances and inadequate support mechanisms, are in need of protection and assistance. Psycho-social development theory proposes that a young adult can be said to be ready psychologically and socially when they have learnt and developed the necessary life skills to participate in society and to have faith for the future. The aim of this study was to explore the post-school psycho-social preparation experiences of vulnerable young adults. A phenomenological multiple case-study design was used to gain insight into five cases. The study followed a social constructivist paradigm where an individual’s sense of his or her own reality is constructed through personal experience and the use of language to describe it. Data was collected using individual semi-structured interviews, individual collages with five selected participants and a focus group discussion. The data was subjected to phenomenological explicitation so as to explore the emerging themes of the experiences of the participants’ psycho-social post-school preparation while they were still at school. The findings revealed that these experiences can be divided into two themes: psychological experiences and social experiences. Sub-themes that emerged indicated that the participants had been affected by the lack of psycho-social preparation, which had in turn affected their ability to function as independent young adults. Despite these challenges, the participants displayed resilience and hope for the future which can be attributed to their current psycho-social assistance at Hope House. The findings indicate that there is a need for a more specific programme of psycho-social preparation for OVC at schools before their transition to independent adult living. With this in mind, it is recommended that support structures as well as specifically designed programmes be developed for use in schools

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc