A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit

Introduction: Atrial fibrillation (AF) is common in patients in the intensive care unit (ICU) and has been associated with worse outcomes. However, it is unclear whether AF itself adds to the risk of death or is merely a marker of illness severity. We aimed to record the incidence and outcomes of all patients with different categories of AF and determine whether AF was an independent predictor of death.<p></p> Methods: This retrospective cohort study was undertaken in the ICU of a tertiary-referral university hospital. Category of AF, sex, C-reactive protein (CRP) level, APACHE II score, predicted hospital mortality and survival outcomes were analysed from 1084 records. Percentages, medians and interquartile ranges were used to describe the sample. Chi-square test and the non-parametric Mann–Whitney U test were used, as appropriate, for statistical analysis. Logistic regression analyses were performed to evaluate the association of AF with death in the ICU adjusting for age, sex, CRP level and APACHE II score.<p></p> Results: Overall, 13.6% of patients developed new-onset AF during their critical illness, while 4.3% had a pre-existing history. The hospital mortality rate was higher in those with AF compared with those without (47.9% vs. 30.9%, p<0.001) and higher in those with newly diagnosed AF compared with those with a prior history (53.1% vs. 31.9%, p=0.012). CRP levels were higher in those with AF (p<0.001) compared with those without and higher in those with newly diagnosed AF compared with those with a prior history (p=0.012). On multivariate logistic regression analysis, only the APACHE II score was found to be an independent predictor of death.<p></p> Conclusion: Despite the higher mortality rate in patients with AF, the APACHE II score was the only independent predictor of death within the ICU. Prospective studies are required to explore the apparently reduced risk of dying among those with a prior history of AF.<p></p&gt

Interrogating the Ruling Relations of Thailand’s Post-tsunami Reconstruction: Empirically Tracking Social Relations in the Absence of Conventional Texts

This paper discusses methodological strengths and challenges in doing institutional ethnographic (IE) research in communities devastated by the 2004 Indian Ocean tsunami in Southern Thailand. IE is a mode of inquiry used to describe institutional mechanisms of reconstruction, aid, and recovery and to show how recovery efforts affected real people and communities over time. The chaotic nature of a disaster zone, combined with the more common difficulties of conducting research in a developing region relying on a translator, posed various challenges in the conduct of this IE study. Textual data, one of the important tools used in IE research, were scarce and what texts emerged were unusual. Our study reveals a disordered and uneven aid distribution. We show how private interests and pressure for economic redevelopment coordinated government practices which could be portrayed as corrupt. Our paper highlights the strengths of the IE method in assessing reconstruction, aid, and recovery in a disaster zone by focusing on the everyday lives of people as they moved beyond the immediate turmoil. We discuss the methodological techniques used to uncover empirical data to support analytical work when actual texts were not available. Further, we describe how IE is an effective approach for examining peoples\u27 recall of past events, where experiences described can provide insights into the current social organization and ruling relations. These insights lead to our understanding of changes and developments that occurred in the landscape and in the community after recovery. We discuss how the reconstructed environment, including new buildings and signage, coordinated and changed people’s day-to-day activities and their ways of making a livelihood

Teenage Dating Violence: Perceptions of Need, Priority, and Prevention Responsibility among Schools in Predominantly Mexican Heritage Communities

Teen dating violence (TDV) affects adolescents’ overall wellness, subsequent social–emotional and academic development, and future success. The extent to which high schools recognize the importance of TDV prevention, and their accountability to prevent or reduce its occurrence, is largely unknown. Recently, there has been increased legislative debate urging or requiring school boards to include TDV prevention strategies in their curriculum. The purpose of this study was to understand how high school personnel from three large schools, of predominantly Mexican heritage urban communities, perceive their role to intervene and prevent TDV. The authors conducted five focus groups (N = 26). TDV was recognized as a significant problem, but opinions about the extent to which it should be prioritized varied. Some participants were concerned with a consequential reduced focus on academics, whereas others viewed TDV prevention as a necessary precursor to academic achievement. In light of these findings, authors recommend that social workers take more leadership in identifying factors contributing to TDV, provide intervention in conflict and relationship management, advocate for more preventive education on a communitywide basis, and serve as a resource for any economic or cultural considerations that may help to promote change

“It’s not just you two”: A grounded theory of peer-influenced jealousy as a pathway to dating violence among acculturating Mexican American adolescents.

Objective: To develop a deeper understanding of how jealousy escalates to physical dating violence within Mexican American adolescent romantic relationships. Method: Using grounded theory, 20 focus groups of self-identified Mexican American adolescents (N = 64; 15–17 years old) were analyzed by level of acculturation and gender. Results: Three distinct “jealous” typologies resulting in dating violence were identified: normative jealousy (typically highly acculturated or bicultural male and female adolescents), jealous and possessive (typically bicultural male adolescents), and jealous and accepting of dating violence norms (typically low acculturated male adolescents). Across types, jealousy was upheld within a peer culture that constructed loose definitions of cheating behavior and was identified as the most salient relationship issue that held the potential to escalate to extreme forms of anger and resulting violence. Conclusions: Adolescents’ behaviors within their romantic relationships are embedded within a peer environment that legitimizes and fosters relationship jealousy. Jealousy is a particularly salient and troublesome relationship issue among acculturating Mexican American adolescents, who struggle as it is normatively experienced yet initiates processes leading to partner violence. Dating violence preventative interventions need to target both culturally influenced intrapersonal factors (e.g., communication and anger management skills, acceptance of dating violence) as well as peer norms (e.g., partner monitoring) to effect change among Mexican American youth

Mexican American adolescent couples\u27 vulnerability for observed negativity and physical violence: Pregnancy and acculturation mismatch

Stress and vulnerability for dating violence may be heightened among acculturating Mexican American (MA) adolescents, and MA adolescent parents, because of differing cultural values and norms within romantic relationships. We hypothesized, in a sample of MA heterosexual couples (N = 30, 15–17 years), that: 1) within-couple level acculturation discrepancies, and pregnancy/parenting, would predict physical violence perpetration, and 2) that this association would have an indirect effect through couple-level negativity during an observed dyadic video-taped discussion of conflict. Using a path model we found that pregnant/parenting adolescents (B = .37, SE = .16, p = .002), and couples with greater acculturation mismatch resulted in greater couple negativity (B = .16, SE = .06, p = .01), which was associated with self-reported physical violence perpetration (B = .41, SE = .22, p = .02; indirect effect, B = .15, SE = .07, p = .03). Within-couple acculturation discrepancies and pregnancy/parenting may be a pathway to dating violence through poor communication skills around conflict for MA youth. Support services that strengthen communication skills, particularly for pregnant/parenting couples, are recommended

Parties, Drugs, and High School Hookups: Socioemotional Challenges for European and Mexican American Adolescents

Although uncommitted sexual relationships have become increasingly accepted by adolescents, the contexts and socioemotional consequences of these relationships are unknown, particularly among Mexican American youths. Using focus group methodology, we explored the dating experiences of Mexican and European American male and female middle adolescents and found that “hookups” are a salient dating experience that generally occurs in the context of substance use and parties. Females, particularly Mexican American, were more likely to hold mismatched expectations of their desire for a hookup to transition into a more committed type of relationship. A feminist developmental lens is invoked in the discussion of the findings

What they wish they would have known: Support for comprehensive sexual education from Mexican American and White adolescents\u27 dating and sexual desires

Focus groups were conducted to assess what Mexican American and White male and female adolescents wished they had known about romantic and sexual relationships. Relevant gender and ethnic differences emerged in adolescents\u27 desires and findings across all groups supported a need for comprehensive sexual education that contextualizes sexual activity within a framework that emphasizes socio-emotional skills and well-being. Adolescents\u27 desires were emotional, relational, physical and interpersonal in nature. Youth preferred parents and school educators as key sources of information and support. Recommendations for prevention programming and policy are discussed

Mexican American Adolescent Couples Communicating About Conflict: An Integrated Developmental and Cultural Perspective

Using observational methods on a small sample of committed Mexican American couples (N=10, ages 15-17, M length of relationship = 26.5 months), we describe and categorize developmental and cultural communication patterns concerning the negotiation of conflict issues. Videotaped dyadic interactions were transcribed and qualitatively coded using iterative confirmatory and exploratory approaches. Quantitative indicators confirmed the categorization of couples into discourse styles, as well as elucidated the contexts and extent of overlap of developmental and cultural themes. Nine of ten couples had a serious discussion of relational conflict issues, lasting a majority of the time allotted (14 minutes). Five couples’ conversations were consumed by blaming/criticizing, interrupted by small stretches of one-sided taking of responsibility, suggestions, or voiced intentions for new behaviors to resolve the conflict. The remaining four couples enhanced their understanding of the relationship through mutual and respectful exploration of their chosen conflict issues. Culturally salient themes were identified, including adaptive machismo, familismo, and caballero care. The latter denoted bids for demonstration of care or affection from a girl on behalf of her partner, which together with discussion of family-oriented topics, contextualized the content of conflict discussions. Adolescent boys demonstrated adaptive machismo traits, elucidating how conflict negotiation itself was influenced by cultural values. Taken together, findings point to the importance of viewing Mexican American adolescents’ negotiation of conflict in light of cultural values including commitment to the relationship