The Division of Family Work among Fathers and Mothers of Children with an Autism Spectrum Disorder: Implications for Parents and Family Functioning

n often ignored aspect of parenting and family work is the responsibility-related caregiving (i.e. the monitoring, arranging, and planning) that is done to ensure that a child is cared for. Among fathers and mothers who have a child with an autism spectrum disorder (ASD), the intensity of meeting these needs is greater than for a typically developing child (e.g. additional coordination of schooling, interventions, healthcare, recreation, respite, and after-school services). As is the case for all parents, they must also attend to the demands of household labor (e.g. car maintenance, groceries, laundry, yard care), nurture their relationships (e.g. partner, friends, other family members) and find time to pursue interests outside of the home. The aim of this study was to examine parents’ management of and satisfaction with the division of responsibility-related caregiving and household labor, parenting stress, the couple’s relationship quality, and family functioning among parents of children with an ASD. Fathers (n = 66) and mothers (n = 104) of school-age children with an ASD responded to an online questionnaire. Most parents (mean 41.4 y.) were white (95%) and well-educated (98% had at least some college). All lived in the United States with the child and the child’s other parent. Parents provided information about their child (82% boys, mean 8.8 y.), including level of functioning. Fathers managed less responsibility-related caregiving than mothers, but they did not differ in their management of household labor. Parents were most satisfied with how the family work was shared when they managed less of it; however, when one parent always managed the work, satisfaction with the couple’s relationship was lowest and parenting stress was highest. Satisfaction with how the family work was shared was positively associated with overall family functioning. In general, parents, couples, and families fare better when the management of family work is shared between parents. Findings will further our understanding of the experience of fathers and mothers who have a child with an ASD, and may aid in our efforts to best support families affected by the autism spectrum disorders

2024 MERC Annual Report

This is the annual report of the Metropolitan Educational Research Consortium (MERC) in the School of Education at Virginia Commonwealth University for the 2023-2024 academic year. It includes vignettes depicting MERC activities in the past year that align with each of its five principles: research, relevance, rigor, multiple perspectives, and impact. It concludes with a discussion of MERC\u27s commitment moving forward

Disparities in the Clinical Encounter: Virginia's African American Children with Special Health Care Needs

This study analyzed Virginia data from the most recent National Survey of Children with Special Health Care Needs. Logistic regression models were run for six Maternal and Child Health Bureau core outcomes and included demographics, child characteristics, health care providers, and health care access variables as predictors. Race/ethnicity disparities were judged to be present if the race/ethnicity variable was a significant predictor in the final model. Examining the components of disparate outcomes, African American children were found to be less likely than their white counterparts to have a usual source for sick and preventive care and to have a personal doctor or nurse. Their parents were less likely to say that doctors spent enough time, listened carefully, were sensitive to values and customs, and made them feel like a partner. These findings emphasize the need to examine health care disparities at a state level in order to guide efforts at remediation

Epidemiology of viruses causing chronic hepatitis among populations from the Amazon Basin and related ecosystems Epidemiología de las hepatitis crónicas con carácter vírico en las comunidades indígenas de la cuenca amazónica y de otros ecosistemas similares

On the last twenty years, viral hepatitis has emerged as a serious problem in almost all the Amerindian communities studied in the Amazon Basin and in other Amazon-related ecological systems from the North and Center of South America. Studies performed on communities from Bolivia, Brazil, Colombia, Peru and Venezuela have shown a high endemicity of the hepatitis B virus (HBV) infection all over the region, which is frequently associated to a high prevalence of infection by hepatitis D virus among the chronic HBV carriers. Circulation of both agents responds mainly to horizontal virus transmission during childhood through mechanisms that are not fully understood. By contrast, infection by hepatitis C virus (HCV), which is present in all the urban areas of South America, is still very uncommon among them. At the moment, there is not data enough to evaluate properly the true incidence that such endemicity may have on the health of the populations affected. Since viral transmission might be operated by mechanisms that could not be acting in other areas of the World, it seems essential to investigate such mechanisms and to prevent the introduction of HCV into these populations, which consequences for health could be very serious.<br>A lo largo de los últimos veinte años, las hepatitis víricas se han revelado como un importante problema para las comunidades indígenas de la cuenca amazónica y de otros ecosistemas similares del norte y centro de Sudamérica. Los estudios realizados en comunidades de Bolivia, Brasil, Colombia, Perú y Venezuela han demostrado una alta propensión endémica para la infección por el virus de la hepatitis B, que se asocia con frecuencia a una elevada prevalencia de coinfección con el virus de la hepatitis D entre los portadores crónicos. La circulación de ambos agentes responde a su transmisión horizontal durante la infancia, a través de mecanismos aún poco conocidos. Por el contrario, la infección por el virus de la hepatitis C es aún muy infrecuente entre los indígenas. No existen, por el momento, datos suficientes para evaluar el impacto real que esta endemia pueda tener sobre la salud de esas poblaciones. Considerando que la transmisión de estos agentes podría involucrar mecanismos que quizá no actúen en otras regiones, parece indispensable investigar dichos mecanismos y prevenir cuidadosamente la introducción del virus de la hepatitis C en esas comunidades, ya que las consecuencias para su salud podrían ser muy graves

Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis

Background: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2&nbsp;days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48&nbsp;h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results: Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2&nbsp;years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90&nbsp;days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28&nbsp;days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions: In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

Purpose: We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. Methods: International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. Results: 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p &lt; 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p &lt; 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p &lt; 0.001)]. Conclusions: Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. Trial registration: ACTRN12620000421932 registered on 30/03/2020

Correction: Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies (Critical Care, (2023), 27, 1, (3), 10.1186/s13054-022-04294-5)

Following publication of the original article [1], the authors identified that the collaborating authors part of the collaborating author group CCCC Consortium was missing. The collaborating author group is available and included as Additional file 1 in this article

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc