“And then every time I fell back, I had my friends to help me” Exploring the role of peer relationships for adolescents in alternative care: a systematic review and grounded theory study

BACKGROUND. The positive impact of attachment relations with adults for young people in alternative care is well documented. However, more understanding of parental and peer relationships for young people in alternative care, particularly the potential role of peers in fulfilling attachment needs in this population, is needed. OBJECTIVES. Research objectives are addressed across two studies. In article one, a systematic review searched the existing quantitative evidence base to investigate the research question, how do positive peer relationships influence psychological variables related to coping and resilience in young people in alternative care? In article two, an empirical paper used a grounded theory methodological approach to explore the principle research question, how do young people in alternative care conceptualize parental and peer relationships? PARTICIPANTS AND SETTING. This research portfolio investigated adolescents living in alternative care, of any setting. The systematic review targeted literature relating to adolescents aged ten to eighteen, and the empirical paper included fourteen participants aged fourteen to eighteen, who were still in contact with a birth parent. METHODS. In article one, a systematic search of the literature for studies of psychological resilience-based variables and peer relationships led to the inclusion of ten papers. These were assessed using standardized quality criteria and a narrative synthesis of the methodology and findings are presented. In article two, semi-structured interviews were transcribed and analysed, to propose a grounded theory model. In line with a constant comparative approach, data collection and analysis occurred simultaneously. RESULTS. Article one highlights four key themes, (1) Perceived satisfaction with peer relationships; (2) The impact of peer group processes; (3) Positive attachments in adolescence and; (4) The role of social skills. Article two presents the five key themes of (1) Trust (2) Unresolved trauma (3) Feeling different to peers (4) A need to put others first and (5) A dismissive coping style, associated with anger and self-reliance. These are proposed to be interrelated to a non-linear process model and contextualized within a resilience framework. Conclusions. Relationships are a complex and non-linear process for this population, that is likely to impact on normative developmental processes in relation to others, including peers. Implications for clinical practice and research are highlighted across both articles. Article one emphasizes a need to investigate a positive developmental rhetoric, using standardized measures for variables of resilience and peer attachment directly. Article two presents a need to further explore the nuances of the proposed relationship process presented, in relation to both peers and services, and promotes the value of directly involving young people in this endeavour. It emphasises the importance of trauma informed practice and puts forward relationships as a starting point to interventions with this population

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

Are the Emotionally Intelligent Happier? Associations Between the Trait Emotional Intelligence Questionnaire (TEIQUE) and External Measures of Happiness and Well-Being.

This study used self-report questionnaires to investigate emotional intelligence (EI) in relation to happiness and well-being. Previous research has supported the links between well-being and life satisfaction to EI. This study aimed to look specifically at associations between the full version of the ‘Trait Emotional Intelligence Questionnaire’ (TEIQue) (Petrides, 2009) for trait EI and an external measure of happiness. A student sample (N=187) completed 4 questionnaires online; The TEIQue for trait EI, the Oxford Happiness Questionnaire (Hills & Argyle, 2002) for happiness, and two scales, the Satisfaction With Life Scale (Diener, Emmons, Larsen & Griffin, 1985) and the ‘Positive Affect Negative Affect Schedule’ (Watson, Clark, & Tellegen, 1988) were combined to form an overall well-being measure. The data showed high internal consistencies and was primarily analysed via Pearson’s product moment correlations. As hypothesised, overall trait EI was significantly positively correlated to happiness. Significant correlations were seen between happiness to all trait EI factors and all trait EI facets, excluding empathy and emotion management. Emotion management was shown to be a significant predictor of happiness via regression analysis. Regression analysis also suggested ‘well-being’ was the only overall TEIQue factor that could significantly predict happiness. ‘Social competence’, ‘stress management’, ‘emotion regulation’, ‘emotion management’ (in that order), were the only TEIQue facets suggested to significantly predict happiness. Females showed higher levels of empathy and emotionality and no age related differences were found. Unexpectedly, overall trait EI was not correlated to overall well-being. No significant negative correlations were seen. These results offer preliminary evidence that happiness shows a genuine relationship to trait EI, as measured by the full version of the TEIQue. Limitations to the study are discussed and a number of suggestions for future research are outlined