Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...
Using two waves of data, this study examined relations among neighborhood and housing disorder, parents' psychological distress, parenting behaviors, and subsequent youth adjustment in a low-income, multiethnic sample of families with children aged 6-16. Results supported the hypothesized indirect relation between disorder and youth outcomes via parenting processes. Higher levels of neighborhood and housing disorder were associated with higher levels of parents' psychological distress, which was in turn related to more frequent use of harsh and inconsistent discipline strategies and lower parental warmth. More frequent use of harsh and inconsistent discipline was associated with higher levels of youth internalizing and externalizing behaviors 3 years later. Housing disorder contributed more strongly to parents' psychological distress than neighborhood disorder, whereas neighborhood disorder contributed more strongly to youth externalizing behaviors compared to housing disorder. Multiple-group analyses showed that the patterns of relations were similar for younger and older children, and for girls and boys.
SYNOPSIS Objective. This paper investigates the mean level and within-family similarities and differences in Filipino mothers’ and fathers’ attributions about success and failure in caregiving situations, and their progressive and authoritarian parenting attitudes. Design. Both mothers and fathers in 95 families in metropolitan Manila completed interviews. Results. Controlling for parents’ age, education, and possible social desirability bias, there was a significant gender difference in modernity of attitudes, with mothers exhibiting higher levels of modernity than fathers. There was a strong correlation in mothers’ and fathers’ authoritarian attitudes and moderate correlations in modernity of attitudes. There were neither parent gender effects nor concordance in the attributions of mothers and fathers. Conclusions. Cultural explanations are presented to account for the findings, specifically the sociocultural values that foster traditional attitudes favoring parental authority and child obedience, and the differences in gender and family roles of Filipino mothers and fathers.
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