Beyond the Nuclear Family: A Qualitative Examination of Extended Family Involvement Among American Indian Families

A common practice among American Indian (AI) families, as well as many ethnic minority families, is involving both nuclear and extended family members in raising children. This practice is believed to serve as a protective factor for families against negative outcomes and provide a potential avenue for social support. Several authors have described extended family members being involved in helping to care taking, sharing cultural knowledge and customs, and disciplining youth. As a result, it has been proposed that extended family members help to nurture the parent-child relationship and provide various forms of support to parents. Despite this, the available research with AI families has been limited to specific examinations of their involvement as custodial guardians or in providing kinship care. Given the various roles extended family members play in children’s development, an examination of types of support and impact of support is warranted. The purpose of the current study is to examine how extended family members help support families. Specifically, the study will gain information from the perspectives of caregivers and extended family members on their specific roles in supporting parents and helping to raise children. Qualitative data revealed a broad definition of family which included biological and non-biological family members who help to raise children. Several themes concerning extended family involvement emerged from interviews with caregivers and family members including teaching and reinforcing cultural knowledge and shaping children’s behaviors, for example. Their definitions and perspective are much broader than originally discussed in extant literature. Extended family members described their involvement as providing them a new sense of purpose and helping to keep them active. Findings support and extend previous literature on the involvement of extended family by describing their role in the family and the impact of their involvement. Clinical implications include encouraging clinicians to consider engaging family members actively involved in raising children in helping to deter problematic behavior. Future directions for research are discussed

Does Core Area Theory Apply to STIs in Rural Environments?

Our objective was to determine the extent to which geographical core areas for gonorrhea and syphilis are located in rural areas, as compared to urban areas

HIV mortality and infection in India: estimates from nationally representative mortality survey of 1.1 million homes

Objective To determine the rates of death and infection from HIV in India

Are Neighborhood Sociocultural Factors Influencing the Spatial Pattern of Gonorrhea in North Carolina?

PURPOSE: To determine if the spatial pattern of gonorrhea observed for North Carolina was influenced by neighborhood-level sociocultural determinants of health, including race/ethnicity. METHODS: A generalized linear mixed model with spatially correlated random effects was fit to measure the influence of socio-cultural factors on the spatial pattern of gonorrhea reported to the North Carolina State Health Department (January 1, 2005 to March 31, 2008). RESULTS: Neighborhood gonorrhea rates increased as the percent single mothers increased (25th to 75th neighborhood percentile Relative Rate 1.18, 95% CI 1.12, 1.25), and decreased as socioeconomic status increased (Relative Rate 0.89, 95% CI 0.84, 0.95). Increasing numbers of men in neighborhoods with more women than men did not change the gonorrhea rate, but was associated with decreased rates in neighborhoods with more men than women. Living in the mountains was protective for all race/ethnicities. Rurality was associated with decreased rates for Blacks and increased rates for Native Americans outside the mountains. PURPOSE: Neighborhood-level sociocultural factors, primarily those indicative of neighborhood deprivation, explained a significant proportion of the spatial pattern of gonorrhea in both urban and rural communities. Race/ethnicity was an important proxy for social and cultural factors not captured by measures of socioeconomic status

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Daphne du Maurier: Gendering the Gothic

This thesis examines the ways in which Daphne du Maurier (1907-1989) uses the Gothic as a device to explore her own conflicted gender identity through fiction. Although this is not a new concept, my focus differs from the extant criticism on du Maurier’s work by extending analysis to the critically neglected sections of the author’s extensive and generically varied oeuvre. While the academy has seen a wider resurgence of interest in du Maurier’s life and work since the millennium, many critics continue to ignore her vast collection of short stories, focusing primarily on her more popular “romantic” novels. This thesis attempts to readdress this imbalance by considering much more of the author’s oeuvre and making greater use of the biographical and archival material available to cryptomically decode the autobiographical traces “closeted” within du Maurier’s Gothic writing – her non-normative or possibly non-binary gender and sexual identity – to contend that her fiction can be read as an oblique form of life-writing. My research therefore combines various intersecting theoretical frameworks, including the Gothic, gender theory, queer studies, life-writing and auto/biographical practice, but mainly draws upon the psychoanalytical readings and concepts that inform these fields of research, particularly as they relate to the conventions of the double, spatial settings and spectrality, which form the thematic basis of the chapters

Gothic Hauntings and Representations of Gender in Daphne du Maurier’s “The Apple Tree”

This contribution examines the instability of Daphne du Maurier’s gendered characterisation of the protagonists in the short story “The Apple Tree” (1952), and the resulting tensions that arise from their inability to fulfil the binary gender roles imposed by the Gothicised marital/familial home. Through her disabling depiction of matrimonial power struggles and the divide between the sexes, du Maurier draws upon the psychological and gendered anxieties of the post-war period. Entering into conversation with the wider theoretical debates surrounding the Gothic and gender studies, this article considers du Maurier’s use of spectrality and a fear of domestic entrapment and violence to suggest that the true horror at the centre of this text is an oppressive masculine and submissive feminine identity which ultimately leads the reader to question the ideological construction of gender within society. In this way, “The Apple Tree” is best read as an allegory for the inherent (self-) destructiveness of traditional gender roles/identities.Cet article examine l’instabilité de la caractérisation genrée des protagonistes de la nouvelle “The Apple Tree” (1952) de Daphne du Maurier, ainsi que les tensions qui résultent de leur incapacité à remplir les rôles binaires imposés par un domicile conjugal/familial gothisé. Pour décrire les luttes de pouvoir entre époux et le fossé entre les sexes, du Maurier puise dans les angoisses psychologiques et genrées de l’après-guerre. Dialoguant avec les débats théoriques entourant plus généralement le gothique et les études de genre, cet article considère l’utilisation par du Maurier de la spectralité ou de la peur de l’emprisonnement et de la violence domestiques pour suggérer que la véritable horreur au centre de ce texte provient d’une identité masculine oppressive et d’une identité féminine soumise qui conduit le lecteur à remettre en question la construction idéologique du genre dans la société. Ainsi, il convient de lire “The Apple Tree” comme une allégorie de la destructivité (y compris tournée contre soi-même) inhérente aux identités ou rôles genrés traditionnels