The current state of personal assistance services: implications for policy and future research.

PubMed

Hagglund, Kristofer J; Clark, Mary J; Mokelke, Emily K; Stout, Brian J

2004-01-01

Personal assistant services (PAS) are designed to support persons with disabilities in their routine performance of activities of daily living (ADLs) and to provide individuals with disability the opportunity to go to school, volunteer, obtain active employment, and participate in social and recreational activities. PAS are primary and essential to the realization of societal inclusion and personal freedom among persons with severe, disabling conditions. This paper reviews the personal assistance literature for persons with spinal cord injury and other disabilities. Evidence-based recommendations are made for PAS policy initiatives and future directions in PAS research.

Fostering Personalized Learning in Science Inquiry Supported by Mobile Technologies

ERIC Educational Resources Information Center

Song, Yanjie; Wong, Lung-Hsiang; Looi, Chee-Kit

2012-01-01

In this paper, we present a mobile technology-assisted seamless learning process design where students were facilitated to develop their personalized and diversified understanding in a primary school's science topic of the life cycles of various living things. A goal-based approach to experiential learning model was adopted as the pedagogical…

A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults.

PubMed

Dolovich, Lisa; Oliver, Doug; Lamarche, Larkin; Agarwal, Gina; Carr, Tracey; Chan, David; Cleghorn, Laura; Griffith, Lauren; Javadi, Dena; Kastner, Monika; Longaphy, Jennifer; Mangin, Dee; Papaioannou, Alexandra; Ploeg, Jenny; Raina, Parminder; Richardson, Julie; Risdon, Cathy; Santaguida, P Lina; Straus, Sharon; Thabane, Lehana; Valaitis, Ruta; Price, David

2016-04-05

Healthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person's life that centers on meeting a person's health goals and needs will result in optimal aging. This is a 12-month delayed intervention pragmatic randomized controlled trial. The study will be performed in Hamilton, Ontario, Canada in the two-site McMaster Family Health Team. Participants will include 316 patients who are 70 years of age or older. Participants will be randomized to the Health TAPESTRY approach or control group. The Health TAPESTRY approach includes intentional, proactive conversations about a person's life and health goals and health risks and then initiation of congruent tailored interventions that support achievement of those goals and addressing of risks through (1) trained volunteers visiting clients in their homes to serve as a link between the primary care team and the client; (2) the use of novel technology including a personal health record from the home to link directly with the primary healthcare team; and (3) improved processes for connections, system navigation, and care delivery among interprofessional primary care teams, community service providers, and informal caregivers. The primary outcome will be the goal attainment scaling score. Secondary outcomes include self-efficacy for managing chronic disease, quality of life, the participant perspective on their own aging, social support, access to health services, comprehensiveness of care, patient empowerment, patient-centeredness, caregiver strain, satisfaction with care, healthcare resource utilization, and cost-effectiveness. Implementation processes will also be evaluated. The main comparative analysis will take place at 6 months. Evidence of the individual elements of the Health TAPESTRY platform has been shown in isolation in the previous research. However, this study will better understand how to best integrate them to maximize the system's transformation of person-focused, primary care for older adults. ClinicalTrials.gov NCT02283723.

Mental Health Collaborative Care and Its Role in Primary Care Settings

PubMed Central

Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M.; Bauer, Mark S.

2013-01-01

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714

Mental health collaborative care and its role in primary care settings.

PubMed

Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

2013-08-01

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

Experience of Primary Care among Homeless Individuals with Mental Health Conditions

PubMed Central

Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers. PMID:25659142

Primary Support Persons for Individuals Who Are Visually Impaired: Who They Are and the Support They Provide

ERIC Educational Resources Information Center

Silva-Smith, Amy L.; Theune, Thomas W.; Spaid, Penny E.

2007-01-01

As the proportion of older adults in the U.S. population grows, the prevalence of visual impairment related to cataracts, glaucoma, macular degeneration, and diabetic retinopathy will increase as well. Individuals who are visually impaired require various degrees of support and assistance in their daily activities. This assistance is frequently…

Who Mentors Hispanic English Language Learners?

ERIC Educational Resources Information Center

De La Cruz, Yolanda

2008-01-01

Ten Hispanic university students enrolled in higher education courses were interviewed and considered successful despite the lack of support they received in learning English during their primary and secondary education. Analysis of the questionnaires and personal interviews reveal four major types of mentors who supported and motivated them to…

75 FR 54898 - Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-09

... Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... Part C funds under The Ryan White HIV/AIDS Program to support comprehensive primary care services for persons living with HIV/AIDS, including primary medical care, laboratory testing, oral health care...

Personalizing prenatal care using family health history: identifying a panel of conditions for a novel electronic genetic screening tool.

PubMed

Lin, Bruce K; Edelman, Emily; McInerney, Joseph D; O'Leary, James; Edelson, Vaughn; Hughes, Kevin S; Drohan, Brian; Kyler, Penny; Lloyd-Puryear, Michele; Scott, Joan; Dolan, Siobhan M

2013-05-01

In the age of genomic medicine, family health history (FHH) remains an important tool for personalized risk assessment as it can inform approaches to disease prevention and management. In primary care, including in prenatal settings, providers recognize that FHH enables them to assess the risk for birth defects and complex conditions that not only affect the fetus health, but also the mother's. However, many providers lack the time to gather FHH or the knowledge to confidently interpret the data. Electronic tools providing clinical decision support using FHH data can aid the busy provider with data collection and interpretation. We describe the scope of conditions included in a patient-entered FHH tool that provides clinical decision support and point-of-care education to assist with patient management. This report details how we selected the conditions for which it is appropriate to use FHH as a means to promote personalized medicine in primary prenatal care.

Authenticity-Sensitive Preferentism and Educating for Well-Being and Autonomy

ERIC Educational Resources Information Center

Haji, Ishtiyaque; Cuypers, Stefaan E.

2008-01-01

An overarching aim of education is the promotion of children's personal well-being. Liberal educationalists also support the promotion of children's personal autonomy as a central educational aim. On some views, such as John White's, these two goals--furthering well-being and cultivating autonomy--can come apart. Our primary aim in this paper is…

A dyadic model of living with epilepsy based on the perspectives of adults with epilepsy and their support persons

PubMed Central

Walker, Elizabeth Reisinger; Barmon, Christina; McGee, Robin E.; Engelhard, George; Sterk, Claire E.; DiIorio, Colleen; Thompson, Nancy J.

2015-01-01

Epilepsy is a chronic condition that significantly affects the lives of individuals with epilepsy and their support persons, though few studies have examined the experiences of both individuals. To examine these experiences and explore the interpersonal relationships between dyad members, we conducted in-depth interviews with 22 people with epilepsy and 16 support persons. Data analysis was guided by a grounded theory perspective. We developed a model that shows how epilepsy impacts the lives of both people with epilepsy and support persons and how the experiences of people with epilepsy and supporters influence one another. The core model elements were seizure and treatment factors, relationship characteristics, self-management, seizure control, support provided, illness intrusiveness, and quality of life. People with epilepsy moved through the model in five trajectories depending on seizure control, relationship type, and gender. Support providers followed four trajectories based on seizure control, perception of burden, and support for themselves. People with epilepsy and their primary support providers have varied experiences in how epilepsy affects their lives. This model could serve as a basis for future research and intervention efforts focused on ways to reduce illness intrusiveness and improve quality of life for people with epilepsy and their supporters. PMID:26515151

Validating Female Psychopathy Subtypes: Differences in Personality, Antisocial and Violent Behavior, Substance Abuse, Trauma, and Mental Health

PubMed Central

Hicks, Brian M.; Vaidyanathan, Uma; Patrick, Christopher J.

2010-01-01

Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems including symptoms of post-traumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to non-violent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. PMID:20582155

Recruiting and Retaining Primary Care Physicians in Urban Underserved Communities: The Importance of Having a Mission to Serve

PubMed Central

Ryan, Gery; Ramey, Robin; Nunez, Felix L.; Beltran, Robert; Splawn, Robert G.; Brown, Arleen F.

2010-01-01

Objectives. We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. Methods. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Results. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Conclusions. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work–life balance. PMID:20935263

Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

PubMed

Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

2010-11-01

We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

Mathematical Investigations for Supporting Pre-Service Primary Teachers Repeating a Mathematics Education Course

ERIC Educational Resources Information Center

Bailey, Judy

2014-01-01

Preparing to become an effective primary school mathematics teacher is a challenging and complex task; and is influenced by one's past experiences, personal knowledge of, and beliefs and attitudes towards mathematics. This paper examines the experiences of a small group of pre-service teachers who did not pass their first year mathematics…

[Personality disorders in the elderly].

PubMed

Saarela, Tuula; Stenberg, Jan-Henry

2011-01-01

The diagnostic assessment of old age personality disorders is challenging. Medical illnesses and cognitive impairment may influence the clinical symptoms. Common elements of effective approaches such as building a collaborative relationship and maintaining consistency as well as structured framework of treatment can be tailored to the problems of a patient. Pharmacological treatment guidelines of personality disorders need to be individually applied to elderly persons. Comorbid depression is often the primary symptom seen and needs to be treated. Psychiatry should take steps to promote effective treatments and provide support and clinical supervision to health staff treating these individuals.

Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system.

PubMed

Bengtsson, Ulrika; Kjellgren, Karin; Hallberg, Inger; Lundin, Mona; Mäkitalo, Åsa

2018-03-01

This paper reports on how the clinical consultation in primary care is performed under the new premises of patients' daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients' contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. A qualitative, explorative study design was used, examining 20 audio- (n = 10) and video-recorded (n = 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. Four primary health care centers in Sweden. Patients with hypertension (n = 20) and their health care professional (n = 7). The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients' contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Patients' contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients' and health care professionals' equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management Key points   The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations. Self-reporting combined with increased patient-health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life. These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

Why can't we fund supported employment?

PubMed

Mueser, Kim T; Cook, Judith A

2016-06-01

Work is one of the most valued social rules in modern society, contributing to a person's sense of economic well-being, self-esteem, personal identity, and social status. Conversely, the inability to work or sustain employment due to a psychiatric condition is the primary factor in determining eligibility for disability benefits, such as Social Security Disability Income or Social Security Supplemental Income. Just as work is valued strongly by society, it is also important to people with serious mental illness. In this editorial, we contemplate why we cannot "do the right thing" and fully fund supported employment for persons with serious mental illness. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

In Support of Others: An Examination of Psychological Capital and Job Satisfaction in Academic Staff

ERIC Educational Resources Information Center

Mello, James A.

2013-01-01

The purpose of this research was to examine the relationship between psychological capital and job satisfaction among academic support staff. An online questionnaire served as the primary data source with follow-up personal interviews used to provide descriptive information that complemented the quantitative data. This study explores the…

Women with spontaneous 46,XX primary ovarian insufficiency (hypergonadotropic hypogonadism) have lower perceived social support than control women

PubMed Central

Orshan, Susan A.; Ventura, June L.; Covington, Sharon N.; Vanderhoof, Vien H.; Troendle, James F.; Nelson, Lawrence M.

2009-01-01

Objective To test the hypothesis that women with spontaneous primary ovarian insufficiency differ from control women with regard to perceived social support and to investigate the relationship between perceived social support and self-esteem. Design Cross-sectional Setting Mark O. Hatfield Clinical Research Center, National Institutes of Health. Patient(s) Women diagnosed with spontaneous primary ovarian insufficiency (N=154) at a mean age of 27 years and healthy control women (N=63). Intervention(s) Administration of validated self-reporting instruments. Main Outcome Measure(s) Personal Resource Questionnaire-85 (PRQ85), Rosenberg Self-Esteem Scale Result(s) Women with primary ovarian insufficiency had significantly lower scores than controls on the perceived social support scale and the self-esteem scale. The findings remained significant after modeling with multivariate regression for differences in age, marital status, and having children. In patients there was a significant positive correlation between self-esteem scores and perceived social support. We found no significant differences in perceived social support or self-esteem related to marital status, whether or not they had children, or time since diagnosis. Conclusion(s) This evidence supports the need for prospective controlled studies. Strategies to improve social support and self-esteem might provide a therapeutic approach to reduce the emotional suffering that accompanies the life-altering diagnosis of spontaneous primary ovarian insufficiency. PMID:18829005

How Positive Is Their Future? Assessing the Role of Optimism and Social Support in Understanding Mental Health Symptomatology among Homeless Adults.

PubMed

Fitzpatrick, Kevin M

2017-04-01

Optimism has been noted as a primary protective factor in understanding mental health symptomatology in clinical and non-clinical settings. Any exploration of optimism has been absent in understanding mental health outcomes among homeless people. This study, using intensive interviews with 168 homeless adults in Northwest Arkansas, examines the role that social support and optimism play in lessening the negative impact of homeless circumstances/experiences on mental health symptomatology. Using OLS, findings support a mediating/protective role that social support and optimism play in lowering the negative effects of childhood life experiences on depressive symptoms among homeless persons. Despite the overwhelming conditions of homelessness, persons with higher levels of optimism and social support report lower depression and anxiety symptoms. The findings are discussed paying particular attention to the importance of developing and maintaining the perception of support and resiliency in preserving a positive outlook for the future among homeless persons facing often-debilitating circumstances. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The brain's emotional foundations of human personality and the Affective Neuroscience Personality Scales.

PubMed

Davis, Kenneth L; Panksepp, Jaak

2011-10-01

Six of the primary-process subcortical brain emotion systems - SEEKING, RAGE, FEAR, CARE, GRIEF and PLAY - are presented as foundational for human personality development, and hence as a potentially novel template for personality assessment as in the Affective Neurosciences Personality Scales (ANPS), described here. The ANPS was conceptualized as a potential clinical research tool, which would help experimentalists and clinicians situate subjects and clients in primary-process affective space. These emotion systems are reviewed in the context of a multi-tiered framing of consciousness spanning from primary affect, which encodes biological valences, to higher level tertiary (thought mediated) processing. Supporting neuroscience research is presented along with comparisons to Cloninger's Temperament and Character Inventory and the Five Factor Model (FFM). Suggestions are made for grounding the internal structure of the FFM on the primal emotional systems recognized in affective neuroscience, which may promote substantive dialog between human and animal research traditions. Personality is viewed in the context of Darwinian "continuity" with the inherited subcortical brain emotion systems being foundational, providing major forces for personality development in both humans and animals, and providing an affective infrastructure for an expanded five factor descriptive model applying to normal and clinical human populations as well as mammals generally. Links with ontogenetic and epigenetic models of personality development are also presented. Potential novel clinical applications of the CARE maternal-nurturance system and the PLAY system are also discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Social support versus chosen health status indicators in primary care patients].

PubMed

Kurpas, Donata; Piotrowski, Patryk; Marciniak, Doininik; Kasprzak, Maja; MroczekS, Bożena; Nitsch-Osuchi, Aneta; Kasssolik, Krzysztof; Karakiewicz, Beata; Bielska, Dorota; Kiejna, Andrzej

2014-01-01

The purposes of our study were to determine the level of total social support, informational support, instrumental support, appraisal support and emotional support received by patients of primary care as well as factors related to this level with reference to health status and sociodemographic variables. The sample for current analysis included 516 patients of primary care clinics in Poland cooperating with medical universities. Questionnaires: STAI (State-Trait Anxiety Inventory), SCL-90 (Symptom Checklist-90), EPQ-R (Eysenck Personality Questionnaire-Revised), GHQ (General Health Questionnaire)and SSS (Social Support Scale)were used in the study. Results from last two questionnaires are presented in the paper. The highest mean levels were obtained for instrumental support, while the lowest levels were observed for emotional support. The highest means were indicated in the GHQ-28-social dysfunction, the lowest-GHQ-severe depression. Statistically significant relation was found between the level of social support and gender. Less subjectively evaluated total social support as well as instrumental and appraisal support were obtained by women. The highest Spearman score was found in the case of total GHQ-28 score, somatic symptoms, anxiety and insomnia, severe depression and total support. Taking into account the ANOVA findings, it was observed that an increasing GHQ score was associated with intensively increasing emotional support, informative support, appraisal support and the most- instrumental support. The results display the underestimated role of emotional, informational and appraisal support and the overestimated role of instrumental support in primary care. The consequence may be a more frequent using health care accompanied by low level of patients' satisfaction, severity of social dysfunction disorders, particularly in patients with chronic diseases, who constitute an increasingly large group of primary health care.

Supporting Primary Care Practices in Building Capacity to Use Health Information Data

PubMed Central

Fernald, Douglas; Wearner, Robyn; Dickinson, W. Perry

2014-01-01

Introduction: Our objective was to describe essential support resources and strategies in order to advance the pace and scope of the use of health information technology (HIT) data. Background and Context: Primary data were collected between January 2011 and October 2012. The primary study population comprised 51 primary care practices enrolled in the Colorado Beacon Consortium in western Colorado. Methods: We used qualitative methods embedded in a mixed-method evaluation: monthly narrative reports from practices; interviews with providers and staff; and focused, group discussions with quality improvement (QI) advisors and staff from the Health Information Technology Regional Extension Center. Findings: Practices valued effective support strategies to assist with using HIT, including the following: translating rules and regulations into individual practice settings; facilitating peer-to-peer connections; providing processes and tools for practice improvement; maintaining accountability and momentum; and providing local electronic health record (EHR) technical expertise. Benefits of support included improved quality measures, operational improvements, increased provider and staff engagement, and deeper understanding of EHR data. Discussion: The findings affirm the utility of practice facilitation for HIT-focused aims with personalized attention and cross-fertilization among practices for improvements. Facilitation to sustain ongoing improvements and prepare for future HIT-intensive improvement activities was highly valued. In addition to the general practice facilitator, an EHR technical expert was critical to improving practice capacity to use electronic clinical data. Collaborative learning expands the pool of mentors and teachers, who can further translate their own lessons into practical advice for their peers, yielding the emergence of a stronger sense of community among the practices. Conclusions: Using HIT more effectively in primary care will require sustained, focused efforts by practices as regulations, incentives and HIT evolve. Ongoing support for community-based practice facilitators; collaborative learning; and local, personalized EHR advisors will help practices care for patients while more effectively deploying HIT to improve care. PMID:25848621

Further Characterization of CELSS Wastes: A Review of Solid Wastes Present to Support Potential Secondary Biomass Production

NASA Technical Reports Server (NTRS)

Muller, Matthew S.

1996-01-01

Controlled ecological life support systems (CELSS) may one day play an essential role in extraterrestrial colonies. Key to the success of any CELSS will be the system's ability to approach a self-supporting status through recovery and reuse of basic resources. Primary CELSS solid wastes with potential to support secondary biomass production will be inedible plant biomass and metabolic human wastes. Solid waste production is summarized and reported as 765 g N per day per person, including 300 g C and 37 g N per day per person. One Resource Recovery configuration using the bioprocessing of solid wastes into a Tilapia feed stream is examined. Based on estimated conversion efficiencies, 12 g of protein per day per person is produced as a nutrition supplement. The unique tissue composition of crops produced at the Kennedy Space Center CELSS Program highlights the need to evaluate Resource Recovery components with data generated in the CELSS environment.

Association of Psychologic and Nonpsychologic Factors With Primary Dysmenorrhea

PubMed Central

Faramarzi, Mahbobeh; Salmalian, Hajar

2014-01-01

Background: Primary dysmenorrhea seems to be one the most common gynecologic condition in women of childbearing age. Objectives: The aim of this research was to evaluate psychologic and nonpsychologic risk factors of primary dysmenorrhea. Materials and Methods: A cross-sectional study was conducted on medical sciences students of Babol University of Medical Sciences. In this study, 180 females with dysmenorrhea and 180 females without dysmenorrhea were enrolled. Psychological risk factors were evaluated in four domains including affect, social support, personality, and alexithymia. Four questionnaires were used to assessed aforementioned domains, namely, Social Support Questionnaire (SSQ), depression, anxiety, stress (DAS-21), 20-item Toronto Alexithymia Scale (TAS-20), and NEO-Five Factor Inventory of Personality (NEO-FFI). In addition, nonpsychologic factors were evaluated in three domains including demographic characteristics, habits, and gynecologic factors. Data were analyzed using the χ2 test and multiple logistic regression analysis. Results: The strongest predictor of primary dysmenorrhea was low social support (OR = 4.25; 95% CI, 2.43-7.41). Risk of dysmenorrhea was approximately 3.3 times higher in women with alexithymia (OR = 3.26; 95% CI, 1.88-5.62), 3.1 times higher in women with menstrual bleeding duration ≥ 7 days (OR = 3.06; 95% CI, 1.73-5.41), 2.5 times higher in women with a neurotic character (OR = 2.53; 95% CI, 1.42-4.50), 2.4 times higher in women with a family history of dysmenorrhea (OR = 2.43; 95% CI, 1.42-4.50), and twice higher in women with high caffeine intake (OR = 1.97; 95% CI, 1.09-3.59). Conclusions: Low social support, alexithymia, neuroticism trait, long menstrual bleeding, family history of dysmenorrhea, and high-caffeine diet are important risk factors for women with primary dysmenorrhea. This study recommended considering psychologic factors as an adjuvant to medical risks in evaluation and treatment of primary dysmenorrhea. PMID:25389482

International Student Affairs.

ERIC Educational Resources Information Center

Wood, Melinda; Kia, Parandeh

2000-01-01

Describes international student service units in higher education, including their primary functions, staff roles and responsibilities, major functional challenges, professional challenges and support systems, professional literature, and tips for those interested in the field. Also describes the author's personal career path in international…

The physical environment of purpose-built and non-purpose-built supported housing for persons with psychiatric disabilities in Sweden.

PubMed

Johansson, Maria; Brunt, David

2012-04-01

The primary aim of the present study was to investigate if methods derived from environmental psychology can be used to study the qualities of the physical environment of supported housing facilities for persons with psychiatric disabilities. Three units of analysis were selected: the private area, the common indoor area, and the outdoor area. Expert assessments of 110 features of the physical environment in these units and semantic environmental description of the visual experience of them consistently showed that purpose-built supported housing facilities had more physical features important for high quality residential environments than the non-purpose-built supported housing facilities. The employed methods were thus seen to be able to describe and discriminate between qualities in the physical environment of supported housing facilities. Suggestions for the development of tools for the assessment of the physical environment in supported housing are made.

Primary care and care for older persons: position paper of the European Forum for Primary Care.

PubMed

Boeckxstaens, Pauline; De Graaf, Pim

2011-01-01

This article explores how to address the needs of the growing number of older patients in primary care practice. Primary care is not a fixed organisational structure but a combination of functional characteristics which has developed variably in European countries with differing responses to the emerging needs of older persons. Multimorbidity, frailty, disability and dependence play out differently in older persons; a key challenge for primary care is to provide a response that is adapted to the needs of individuals - as they see them and not as the professional defines them. Indeed, growing experience shows how to involve older persons in taking decisions. Contrary to popular opinion, older persons often rate their quality of life as high. Indeed, comprehensive primary care offers health promotion and prevention: also older people may benefit from measures that support their health and independence and some case descriptions show this potential. Although most people prefer to be in their own environment (home, community) during the last stage of life, providing end-of-life care in the community is a challenge for primary care because it requires continuity and coordination with specialist care. Successful models of care however do exist. Delivering seamless integrated care to older persons is a central theme in primary care. Rather than disease management, in primary care, case management is the preferred approach. Proactive geriatric assessment of individual medical, functional and social needs, including loneliness and isolation, has been shown to be useful and its place in primary care is the subject of further research. Clinical practice guidelines for multimorbidity are badly needed. Non-adherence to medication, linked to multiple and uncoordinated prescriptions, is a widespread and costly problem. Successful approaches in primary care are being developed, including the use of electronic patient files. With the general practitioner (GP) as the central care provider, primary care is increasingly teamwork, and the role of nurses and other (new) professions in primary care is developing constantly. The composition and coordination of teams are two components of one of the major complexities to address: how to provide individualised care with standardisation at organisation the level. (Lack of) Coordination with specialist care remains a widespread problem and needs attention from policy makers and practitioners alike. Alignment with home care and social services remains a challenge in all countries, not least because of the different funding arrangements between the services. Further priorities for research and development are summarised.

Primary care support for tackling obesity: a qualitative study of the perceptions of obese patients.

PubMed

Brown, Ian; Thompson, Joanne; Tod, Angela; Jones, Georgina

2006-09-01

Obesity has become a major public health issue and there is concern about the response of health services to patients who are obese. The perceptions of obese patients using primary care services have not been studied in depth. To explore obese patients' experiences and perceptions of support in primary care. Qualitative study with semi-structured interviews conducted in participants' homes. Five general practices contrasting in socioeconomic populations in Sheffield. Purposive sampling and semi-structured interviewing of 28 patients with a diverse range of ages, backgrounds, levels of obesity and experiences of primary care services. Participants typically felt reluctance when presenting with concerns about weight and ambivalence about the services received. They also perceived there to be ambivalence and a lack of resources on the part of the health services. Participants showed a strong sense of personal responsibility about their condition and stigma-related cognitions were common. These contributed to their ambivalence about using services and their sensitivity to its features. Good relationships with primary care professionals and more intensive support partly ameliorated these effects. The challenges of improving access to and quality of primary care support in tackling obesity are made more complex by patients' ambivalence and other effects of the stigma associated with obesity.

Problem solving as a core strategy in the prevention of schizophrenia and other mental disorders.

PubMed

Falloon, I R

2000-11-01

To outline the rationale for implementing training in structured problem solving as a primary prevention strategy for major mental disorders. The evidence that training people in a structured method of solving their personal problems is an effective strategy in the treatment of established cases of schizophrenic and major mood disorders, is selectively reviewed. Most of the relevant research focused on the prevention of major recurrent episodes of psychosis. There is some evidence to support the hypothesis that this strategy may assist many people to achieve a full and sustained recovery from the clinical and social impairments of these disorders, especially when patients are taught to use structured problem solving with members of their personal resource groups, and they continue to take optimal doses of psychoactive medication. There is support for the hypothesis that the key therapeutic factor associated with these benefits is the improved efficiency of the management of life stress. The simplicity of problem solving, the educational methods used, and the widespread application to a person's lifestyle would appear to make this a possible candidate for a primary prevention program for major mental disorders. Guidebooks and teaching aids have been developed and show excellent consumer acceptance.

Brief encounters: what do primary care professionals contribute to peoples' self-care support network for long-term conditions? A mixed methods study.

PubMed

Rogers, Anne; Vassilev, Ivaylo; Brooks, Helen; Kennedy, Anne; Blickem, Christian

2016-02-17

Primary care professionals are presumed to play a central role in delivering long-term condition management. However the value of their contribution relative to other sources of support in the life worlds of patients has been less acknowledged. Here we explore the value of primary care professionals in people's personal communities of support for long-term condition management. A mixed methods survey with nested qualitative study designed to identify relationships and social network member's (SNM) contributions to the support work of managing a long-term condition conducted in 2010 in the North West of England. Through engagement with a concentric circles diagram three hundred participants identified 2544 network members who contributed to illness management. The results demonstrated how primary care professionals are involved relative to others in ongoing self-care management. Primary care professionals constituted 15.5 % of overall network members involved in chronic illness work. Their contribution was identified as being related to illness specific work providing less in terms of emotional work than close family members or pets and little to everyday work. The qualitative accounts suggested that primary care professionals are valued mainly for access to medication and nurses for informational and monitoring activities. Overall primary care is perceived as providing less input in terms of extended self-management support than the current literature on policy and practice suggests. Thus primary care professionals can be described as providing 'minimally provided support'. This sense of a 'minimally' provided input reinforces limited expectations and value about what primary care professionals can provide in terms of support for long-term condition management. Primary care was perceived as having an essential but limited role in making a contribution to support work for long-term conditions. This coalesces with evidence of a restricted capacity of primary care to take on the work load of self-management support work. There is a need to prioritise exploring the means by which extended self-care support could be enhanced out-with primary care. Central to this is building a system capable of engaging network capacity to mobilise resources for self-management support from open settings and the broader community.

Evaluating the Implementation and Feasibility of a Web-Based Tool to Support Timely Identification and Care for the Frail Population in Primary Healthcare Settings.

PubMed

Lawson, Beverley; Sampalli, Tara; Wood, Stephanie; Warner, Grace; Moorhouse, Paige; Gibson, Rick; Mallery, Laurie; Burge, Fred; Bedford, Lisa G

2017-03-07

Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions to respond to frailtyl in community PHC practice. This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative's feasibility and scalability. Methods will be informed by the 'Implementing the Frailty Portal in Community Primary Care Practice' logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR). The 'Frailty Portal' aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers' ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening tools, offer evidence based severity-specific care goals and connect providers with local available community supports. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Women's experiences of social support during the first year following primary breast cancer surgery.

PubMed

Drageset, Sigrunn; Lindstrøm, Torill Christine; Giske, Tove; Underlid, Kjell

2016-06-01

The aim of this qualitative follow-up study was to describe women's individual experiences of social support during their first year after primary breast cancer surgery. Individual semi-structured interviews with 10 women 1 year after surgery analysed by Kvales' meaning condensation method. Sharing experiences, being understood as an individual, continuity, and information and explanations were themes identified. Sharing mutual experiences increased the women's knowledge regarding cancer, increased experience of support and minimised rumination. After 1 year, the women felt that the network around them had 'normalised' and was less supportive. Being seen as a person, not as 'a diagnosis being treated', and continuity of professional support were important, giving feelings of security and trust. The women felt uncertainty after loss of professional support post-treatment. Information and explanations regarding treatment and treatment-related problems were essential. Mutual sharing of experiences is an important part of social support. Continuity, availability, information and respect were essential aspects of experienced professional support. © 2015 Nordic College of Caring Science.

Public health and primary care: struggling to "win friends and influence people".

PubMed

Mayes, Rick; McKenna, Sean

2011-01-01

Why are the goals of public health and primary care less politically popular and financially supported than those of curative medicine? A major part of the answer to this question lies in the fact that humans often worry wrongly by assessing risk poorly. This reality is a significant obstacle to the adequate promotion of and investment in public health, primary care, and prevention. Also, public health's tendency to infringe on personal privacy-as well as to call for difficult behavioral change-often sparks intense controversy and interest group opposition that discourage broader political support. Finally, in contrast to curative medicine, both the cost-benefit structure of public health (costs now, benefits later) and the way in which the profession operates make it largely invisible to and, thus, underappreciated by the general public. When curative medicine works well, most everybody notices. When public health and primary care work well, virtually nobody notices.

Family support and other social factors precipitating suicidal ideation.

PubMed

Hirsch, J; Ellis, J B

1995-01-01

To examine the effects of family support and demographics on suicidal behavior, 385 subjects completed a demographic questionnaire and a Suicidal Ideation Questionnaire (SIQ). Sixteen percent described themselves as "serious" ideators, while 59% were seen as ideators, numbers consistent with past suicide research. Multiple regression analyses revealed that the type of caregiver a person reported having while growing up accounted for a significant amount of the variance on ideator status. Serious ideators were more common among single parent households. Although many demographic variables were assessed, only the primary caregiver a person had as a child impacted their status as a suicidal ideator. This suggests that suicidal behaviors may occur due to a complex interaction between social factors and childhood care. The influence of living in a single-parent home may contribute to whether or not a person considers suicide.

Support Seeking or Familial Obligation: An Investigation of Motives for Disclosing Genetic Test Results.

PubMed

Greenberg, Marisa; Smith, Rachel A

2016-01-01

Genetic test results reveal not only personal information about a person's likelihood of certain medical conditions but also information about the person's genetic relatives. Given the familial nature of genetic information, one's obligation to protect family members may be a motive for disclosing genetic test results, but this claim has not been methodically tested. Existing models of disclosure decision making presume self-interested motives, such as seeking social support, instead of other-interested motives, like familial obligation. This study investigated young adults' (N = 173) motives to share a genetic-based health condition, alpha-1 antitrypsin deficiency, after reading a hypothetical vignette. Results show that social support and familial obligation were both reported as motives for disclosure. In fact, some participants reported familial obligation as their primary motivator for disclosure. Finally, stronger familial obligation predicted increased likelihood of disclosing hypothetical genetic test results. Implications of these results were discussed in reference to theories of disclosure decision-making models and the practice of genetic disclosures.

A national evaluation of homeless and nonhomeless veterans' experiences with primary care.

PubMed

Jones, Audrey L; Hausmann, Leslie R M; Haas, Gretchen L; Mor, Maria K; Cashy, John P; Schaefer, James H; Gordon, Adam J

2017-05-01

Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not access or receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons' avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and nonhomeless veterans with MHSUDs receiving care in the Veterans Health Administration's medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Health Care Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth "homeless") were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 veterans with MHSUDs (9.2% homeless). Compared with their nonhomeless counterparts, homeless veterans were younger, more likely to be non-Hispanic Black and nonmarried, had less education, and were more likely to live in urban areas. Homeless veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than nonhomeless veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Bar and restaurant workers' attitudes towards Norway's comprehensive smoking ban: a growth curve analysis.

PubMed

Braverman, Marc T; Aarø, Leif Edvard; Bontempo, Daniel E; Hetland, Jørn

2010-06-01

Norway passed legislation banning smoking in restaurants, bars and other public spaces in 2004. This study tracks changes in hospitality workers' attitudes towards Norway's ban over three time points, using growth modelling analysis to examine predictors of attitude change. Participants were a national sample of 1525 bar and restaurant workers. Surveys were conducted, by phone or internet, one month before the ban's implementation and at 4 and 12 months thereafter. Exploratory principal components analysis of nine survey items revealed one primary attitude component. A latent growth model was fitted to the data to examine trajectories of attitude change and individual differences in rate of change. Respondents supported the ban before implementation and increased support at 4 months (p=0.021) and again at 12 months (p=0.001). Concern for one's job followed a quadratic trend, increasing at 4 months and decreasing at 12 months (p<0.001). All demographic categories were associated with attitude increase; rate of increase was greater for females than males. Two within-person variables--change in smoking status and change in job concern--strongly predicted (p<0.001) respondents' deviations from their predicted group trajectories, explaining over 70% of residual between-person slope variance. Norway's hospitality workers increased their support of the ban over its first year. The strong influence of the within-person variables leads to two primary policy recommendations. First, support should be provided to assist cessation efforts and prevent relapse. Second, informational campaigns should inform hospitality workers about evidence that smoking bans are not economic threats to the industry.

A Requirements Analysis for Primary Care at Womack Army Medical Center

DTIC Science & Technology

2006-06-16

posed by threats such as weapons of mass destruction and terrorism (Army Transformation Plan, 2001). The Army Transformation Plan revising European...Health Systems Specialist for Clark Health Clinic, Expansion Plan 14 personal comunication , May 2006) . Robinson Health Clinic supports the 8 2 nd

Posttraumatic growth and its correlates in primary caregivers of schizophrenic patients

PubMed Central

Balaban, Ozlem Devrim; Yazar, Menekse Sila; Aydin, Erkan; Agachanli, Ruken; Yumrukcal, Huseyin

2017-01-01

Context: The concept of posttraumatic growth (PTG) is important to focus on positive outcomes of a challenging process like caregiving. Aims: The aim of the present study is to investigate the factors inclusively considered to be related to PTG in primary caregivers of schizophrenic patients. Settings and Design: This cross-sectional study was conducted with caregivers of patients with schizophrenia between January 2013 and February 2014 at a mental health hospital. Materials and Methods: The study was carried out on 109 schizophrenic patients followed up at Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, and 109 family members who are the primary caregivers of the patients. All caregivers were evaluated with Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support, Ways of Coping Inventory, and the Basic Personality Traits Inventory and Religious Orientation Scale. Statistical Analysis: Kruskal–Wallis and Mann–Whitney U-test were used in quantitative analysis of data. Spearman's correlation analysis was used in the determination of correlation between variables. Linear regression analysis was used in the determination of predictors of PTG. Results: Optimistic and problem-focused coping, perceived social support (total and all three - family, friends, significant others - domains), personality traits such as extraversion, conscientiousness, and openness to experience, and religiousness were found to be related with PTG. Religiousness, perceived social support, and openness to experience were independent predictors of PTG. Conclusions: Interventions to caregivers of schizophrenic patients on the domains of social support and coping strategies may contribute to caring process in a positive change. PMID:29497186

Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care.

PubMed

O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M

2013-12-01

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

Meta-Analysis of Personality Traits in Alzheimer’s Disease: A Comparison with Healthy Subjects

PubMed Central

D’Iorio, Alfonsina; Garramone, Federica; Piscopo, Fausta; Baiano, Chiara; Raimo, Simona; Santangelo, Gabriella

2018-01-01

Background: The role of specific personality traits as factor risks of Alzheimer’s disease (AD) has been consistently found, whereas personality traits specifically related to AD (after the diagnosis) have not been outlined yet. Objective: A meta-analysis of published studies was performed to determine whether AD patients have a distinctive personality trait profile compared to healthy subjects (HC), similar to or different from a premorbid personality profile consistently reported in previous studies. Methods: A systematic literature search was performed using PsycInfo (PROQUEST), PubMed, and Scopus. The meta-analysis pooled results from primary studies using Hedges’ g unbiased approach. Results: The meta-analysis included 10 primary studies and revealed that, when the personality was evaluated by informant-rated measures, AD patients had significantly higher levels of Neuroticism, lower levels of Openness, Agreeableness, Conscientiousness, and Extraversion than HCs. When the personality was evaluated by self-rated measures, the results obtained from informants were confirmed for Neuroticism, Openness, and Extraversion but not for Agreeableness and Conscientiousness where AD patients and HCs achieved similar scores. Conclusions: The meta-analysis revealed that high Neuroticism and low Openness and Extraversion are distinctive personality traits significantly associated with a diagnosis of AD when evaluated both self-rated and informant-rated measures. This personality trait profile is similar to premorbid one, which contributes to development of AD over time. Therefore, our findings indirectly support the idea of specific premorbid personality traits as harbingers of AD. PMID:29480186

Habitat use by Mexican criollo and British beef cattle breeds in arid-and semi-arid environments of New Mexico and Chihuahua

USDA-ARS?s Scientific Manuscript database

Background/Question/Methods Livestock grazing is the primary activity on rangelands that encompass nearly half of the Earth’s terrestrial surface and directly supports a quarter of the world’s population. With one person in t...

Understanding the barriers to identifying carers of people with advanced illness in primary care: triangulating three data sources

PubMed Central

2014-01-01

Background Approximately 10% of the UK population have an unpaid caring role for a family member or friend. Many of these carers make a significant contribution to supporting patients at the end of life. Carers can experience poor physical and psychosocial wellbeing, yet they remain largely unsupported by health and social care services. Despite initiatives for general practices to identify carers and their needs, many remain unidentified. Neither are carers self-identifying and requesting support. This study set out to explore the barriers to, and consider strategies for, identifying carers in primary care. Methods We integrated findings from three data sources – a review of the caregiving literature; a workshop with researchers who have undertaken research with those caring at the end of life, and focus groups with carers and health professionals. Results Three categories of barrier emerged. 1) Taking on the care of another person is often a gradual process, carers did not immediately identify with being a ‘carer’ – preferring to think of themselves in relational terms to the patient e.g. spouse, sibling, son or daughter. Often it was health and social care professionals who encouraged carers to consider themselves as an unpaid carer. 2) As the cared-for person’s condition deteriorated, the caring role often became all-encompassing so that carers were managing competing demands, and felt unable to look after their own needs as well as those of the cared-for person. 3) There was ambiguity about the legitimacy of carer needs and about the role of the primary health care team in supporting carers, from both the perspective of the carers and the health professionals. GPs were thought to be reactive rather than proactive which discouraged carers from asking for help. Conclusions The needs of carers have to be legitimised to ensure primary care staff are proactive in their approach and carers are empowered to utilise the support available. Strategies to identify carers have to be sensitive to the complex dynamics of a caring relationship as well as the primary care context. Identification is a key factor in improving support for carers themselves and to enable them to support the patient. PMID:24690099

Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): study protocol for a randomised controlled trial

PubMed Central

2012-01-01

Background The provision of appropriate medical and nursing care for people with dementia is a major challenge for the healthcare system in Germany. New models of healthcare provision need to be developed, tested and implemented on the population level. Trials in which collaborative care for dementia in the primary care setting were studied have demonstrated its effectiveness. These studies have been conducted in different healthcare systems, however, so it is unclear whether these results extend to the specific context of the German healthcare system. The objective of this population-based intervention trial in the primary care setting is to test the efficacy and efficiency of implementing a subsidiary support system on a population level for persons with dementia who live at home. Methods and study design The study was designed to assemble a general physician-based epidemiological cohort of people above the age of 70 who live at home (DelpHi cohort). These people are screened for eligibility to participate in a trial of dementia care management (DelpHi trial). The trial is a cluster-randomised, controlled intervention trial with two arms (intervention and control) designed to test the efficacy and efficiency of implementing a subsidiary support system for persons with dementia who live at home. This subsidiary support system is initiated and coordinated by a dementia care manager: a nurse with dementia-specific qualifications who delivers the intervention according to a systematic, detailed protocol. The primary outcome is quality of life and healthcare for patients with dementia and their caregivers. This is a multidimensional outcome with a focus on four dimensions: (1) quality of life, (2) caregiver burden, (3) behavioural and psychological symptoms of dementia and (4) pharmacotherapy with an antidementia drug and prevention or suspension of potentially inappropriate medication. Secondary outcomes include the assessment of dementia syndromes, activities of daily living, social support health status, utilisation of health care resources and medication. Discussion The results will provide evidence for specific needs in ambulatory care for persons with dementia and will show effective ways to meet those needs. Qualification requirements will be evaluated, and the results will help to modify existing guidelines and treatment paths. Trial registration NCT01401582 PMID:22575023

Evaluating a Modular Decision Support Application for Colorectal Cancer Screening

PubMed Central

Diiulio, Julie B.; Borders, Morgan R.; Sushereba, Christen E.; Saleem, Jason J.; Haverkamp, Donald; Imperiale, Thomas F.

2017-01-01

Summary Background There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework. Objective To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing. Methods We leveraged two evaluation formats, online and in-person, to obtain feedback from a range primary care clinicians and obtain comparative data. Both the online and in-person evaluations used mock patient data to simulate challenging patient scenarios. Primary care clinicians responded to a series of colorectal cancer-related questions about each patient and made recommendations for screening. We collected data on performance, perceived workload, and usability. Key elements of Decision-Centered Design include evaluation in the context of realistic, challenging scenarios and measures designed to explore impact on cognitive performance. Results Comparison of means revealed increases in accuracy, efficiency, and usability and decreases in perceived mental effort and workload when using the Screening and Surveillance App. Conclusion The results speak to the benefits of using the Decision-Centered Design approach in the analysis, design, and evaluation of Health Information Technology. Furthermore, the Screening and Surveillance App shows promise for filling decision support gaps in current electronic health records. PMID:28197619

Debating the use of work-based learning and interprofessional education in promoting collaborative practice in primary care: a discussion paper.

PubMed

Cameron, Shona; Rutherford, Ishbel; Mountain, Kristina

2012-01-01

The context of primary care in the UK is changing rapidly, underpinned by continuing policy drivers to ensure person-centred safe and effective practice. Undergraduate and postgraduate programmes for healthcare practitioners are increasingly using interprofessional education (IPE) as one route to engender greater understanding of others' roles and contributions to health care, with the suggestion that IPE leads to better integration and teamwork, and thus stronger collaborative practice. Access to education and professional development for those working in primary care is difficult, and individuals need the focus of learning to be clearly relevant to their practice. To review and debate the evidence on the role of work-based learning and IPE in enhancing collaborative practice in primary care. Literature search and critique of key papers relevant to primary care practice. The three themes emerged of IPE, workbased learning (WBL) and collaborative practice. There is a growing body of literature to support the positive outcomes of IPE and the utilisation of WBL in developing practice. A range of practitioners in a variety of work settings have used WBL approaches in the implementation of innovations and the development of communities of practice. However, little evidence exists to support these approaches in primary care. The application of WBL across primary care teams can support a positive and collaborative learning culture, resulting in changes to professional practice.

HealtheSteps™ Study Protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinics.

PubMed

Gill, Dawn P; Blunt, Wendy; Bartol, Cassandra; Pulford, Roseanne W; De Cruz, Ashleigh; Simmavong, P Karen; Gavarkovs, Adam; Newhouse, Ian; Pearson, Erin; Ostenfeldt, Bayley; Law, Barbi; Karvinen, Kristina; Moffit, Pertice; Jones, Gareth; Watson, Cori; Zou, Guangyong; Petrella, Robert J

2017-02-07

Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015.

Quality of life and social support in patients with multiple sclerosis.

PubMed

Rosiak, Katarzyna; Zagożdżon, Paweł

2017-10-29

Quality of life and needforsocial support in persons diagnosed with multiple sclerosis (MS) are to a large extent determined by the degree of their disability. The aim of the study was to analyze an association between specific forms of MS, subjectively perceived quality of life and social support. The study included subjects with established diagnosis of MS, treated at rehabilitation centers, hospitals and in a home setting, as well as the members of patient organizations. After being informed about objectives of the study, type of included tasks and way to complete them, each participant was handed out a set of questionnaires: Berlin Social Support Scales (Łuszczyńska, Kowalska, Schwarzer, Schulz), Quality of Life Questionnaire (WHOQOLBREF), as well as a survey developed specifically for the purposes of this project. The results were subjected to statistical analysis with STATA 12 package. The study included a total of 110 persons (67 women and 43 men). Quality of life overall, as well in physical, psychological, social relationships and environmental health domains, turned out to be particularly important in patients with primary-progressive MS. Irrespective of MS type, social support overall did not play a significant role on univariate analysis. However, subgroup analysis according to sex demonstrated that men with MS received social support four times less often than women. Quality of life in individuals with primary-progressive MS is significantly lower than in patients presenting with other types of this disease. Men with MS are more likely to present with worse scores for social support overall. They are less likely both to acknowledge the need for support and to realize the availability of support they actually need.

Gender and socio-economic inequalities in health and living conditions among co-resident informal caregivers: a nationwide survey in Spain.

PubMed

Abajo, María; Rodríguez-Sanz, Maica; Malmusi, Davide; Salvador, María; Borrell, Carme

2017-03-01

To explore the associations between social determinants, caregiver's network support, burden of care and their consequences in health and living conditions of informal caregivers. The socio-demographic trends regarding population ageing and changes in family models trigger an increased demand for care. Cross-sectional study based on the 2008 edition of the National Disability, Independence and Dependency Situations Survey (DIDSS-2008) conducted by the National Statistics Institute in Spain. Analyses focused on persons identified as primary caregivers who co-reside with the dependent person. The associations between social determinants of caregivers, burden of care, support network and problems attributed to informal care (impaired health, depression, professional, economic and personal issues) were estimated by fitting robust Poisson regression models. Analyses were conducted separately for women and men. The study sample included 6923 caregivers, 73% of women and 27% of men. Gender and socio-economic inequalities were found in assumption of responsibilities and burden of caring for dependents, which tend to fall more on women and persons of lower socio-economic level, who in turn have less access to formal support. These aspects translate into a higher prevalence of health, professional, economic and personal problems. The study highlights gender and socio-economic inequalities in informal caregiving and its negative consequences. These findings may be useful in the design of policies and support programmes targeting the most affected groups of informal caregivers. © 2016 John Wiley & Sons Ltd.

Patient reactance as a moderator of the effect of therapist structure on posttreatment alcohol use.

PubMed

Karno, Mitchell P; Longabaugh, Richard; Herbeck, Diane

2009-11-01

We sought to replicate findings about the effect of therapist-imposed structure on alcoholism-treatment effectiveness for aftercare patients at different levels of interpersonal reactance and to examine if the effect generalizes to patients in a primary phase of treatment. Analyses were based on ex post facto observer ratings combined with outcome data from a randomized clinical trial. Participants had alcohol abuse or dependence (N = 247) and received treatment at either a primary outpatient treatment site (n = 125) or an aftercare site (n = 122) of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Patients' trait reactance and therapist structure were assessed via observer ratings based on videotaped therapy sessions. Dependent variables included percentage days abstinent, percentage heavy-drinking days, time to first drinking day, and time to first heavy-drinking day throughout a 1-year posttreatment period. The results indicated that increased therapist structure during aftercare treatment predicted fewer abstinent days and more heavy-drinking days for persons at a high level of reactance than for persons at a low level of reactance. The effect was a consistent predictor of alcohol use throughout each 3-month interval within the follow-up period. The interaction effect was not supported in the primary outpatient treatment sites, and it was not supported as a predictor of time to first drink or time to first heavy drink in either the aftercare or the outpatient sites. This study successfully replicated the finding that level of patient reactance appears to moderate the effect of therapist structure on alcohol-use outcomes in aftercare treatment settings. The lack of support for this effect in primary outpatient treatment settings suggests that the negative effect of structured treatment may be limited to patients who are further along in the recovery process.

Mental disorder and violence: personality dimensions and clinical features.

PubMed

Nestor, Paul G

2002-12-01

This review examines the role of personality dimensions in the greater rates of violence that have now been established to accompany certain classes of mental disorders. Empirical studies are reviewed that have often used objective measures of personality and epidemiological samples with low levels of subject selection biases. The risk of violence may be understood in terms of four fundamental personality dimensions: 1) impulse control, 2) affect regulation, 3) narcissism, and 4) paranoid cognitive personality style. Low impulse control and affect regulation increase the risk for violence across disorders, especially for primary and comorbid substance abuse disorders. By contrast, paranoid cognitive personality style and narcissistic injury increase the risk for violence, respectively, in persons with schizophrenia spectrum disorders and in samples of both college students and individuals with personality disorders. This review supports the hypothesis that these four fundamental personality dimensions operate jointly, and in varying degrees, as clinical risk factors for violence among groups with these classes of mental disorders.

Scalable Clinical Decision Support for Individualized Cancer Risk Management | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

We will build a scalable clinical decision support (CDS) platform that helps clinicians and patients select cancer screening strategies that are best suited to each individual. This kind of CDS is important because increased evidence supports personalizing cancer screening decisions according to each individual's unique cancer risks. While a highly desired goal, individualizing screening at a population scale requires the implementation of patient-specific risk assessments for several types of cancer. This is quite challenging in today's overwhelmed primary care environment.

Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform

PubMed Central

Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

2018-01-01

Background Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. Objective The aim of this study was to develop and evaluate a computerized decision support platform called “Diabetes Web-Centric Information and Support Environment” (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. Methods A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners’ readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association’s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients’ progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient’s self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. Results For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool’s screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. Conclusions This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients’ feedback is now being used to make necessary modification to DWISE. PMID:29669705

Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform.

PubMed

Abidi, Samina; Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

2018-04-18

Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. The aim of this study was to develop and evaluate a computerized decision support platform called "Diabetes Web-Centric Information and Support Environment" (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines-based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners' readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association's (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients' progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient's self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool's screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients' feedback is now being used to make necessary modification to DWISE. ©Samina Abidi, Michael Vallis, Helena Piccinini-Vallis, Syed Ali Imran, Syed Sibte Raza Abidi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

The Effect of Personalization on Smartphone-Based Fall Detectors

PubMed Central

Medrano, Carlos; Plaza, Inmaculada; Igual, Raúl; Sánchez, Ángel; Castro, Manuel

2016-01-01

The risk of falling is high among different groups of people, such as older people, individuals with Parkinson's disease or patients in neuro-rehabilitation units. Developing robust fall detectors is important for acting promptly in case of a fall. Therefore, in this study we propose to personalize smartphone-based detectors to boost their performance as compared to a non-personalized system. Four algorithms were investigated using a public dataset: three novelty detection algorithms—Nearest Neighbor (NN), Local Outlier Factor (LOF) and One-Class Support Vector Machine (OneClass-SVM)—and a traditional supervised algorithm, Support Vector Machine (SVM). The effect of personalization was studied for each subject by considering two different training conditions: data coming only from that subject or data coming from the remaining subjects. The area under the receiver operating characteristic curve (AUC) was selected as the primary figure of merit. The results show that there is a general trend towards the increase in performance by personalizing the detector, but the effect depends on the individual being considered. A personalized NN can reach the performance of a non-personalized SVM (average AUC of 0.9861 and 0.9795, respectively), which is remarkable since NN only uses activities of daily living for training. PMID:26797614

Impact of health literacy, accessibility and coordination of care on patient's satisfaction with primary care in Germany.

PubMed

Altin, Sibel Vildan; Stock, Stephanie

2015-10-22

Although health policy makers call for the transformation of health care organizations to health literacy responsive ones, there is limited evidence on the care experiences of patients with limited health literacy skills (HL) in respect to health care quality. We explored if HL and patient-reported experiences regarding access to care and support in care-coordination in primary care organizations (PCO) have an impact on patients satisfaction with the care received by their personal general practitioner (GP). A nationwide representative survey was administered in a random sample of 1125 German adults. Binary logistic regression analyses were performed to determine whether HL and perceived access to and coordination of care were associated with satisfaction with care received in primary care adjusting for demographics and health status. In the unadjusted as well as adjusted model, better accessibility of the primary care practice (β= 1.858; 2.032 p < 0.001) frequent support in care coordination by the general practitioner (β = 2.680; 2.820 p < 0.001) as well as sufficient HL (β = 0.888; 1.228 p < 0.05) were independent predictors of a higher satisfaction with care received in the general practice. German adults with sufficient HL and positive experiences regarding care coordination and access to care are more satisfied with care received by their personal general practitioner. This result is from major importance for primary care organizations intending to transform their processes and structures to respond to the health literacy needs of their patients more effectively.

Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable.

PubMed

David, Sean P; Johnson, Samuel G; Berger, Adam C; Feero, W Gregory; Terry, Sharon F; Green, Larry A; Phillips, Robert L; Ginsburg, Geoffrey S

2015-01-01

Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system. © 2015 Annals of Family Medicine, Inc.

Factors shaping intersectoral action in primary health care services.

PubMed

Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

2014-12-01

To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

Resilience of primary healthcare professionals: a systematic review

PubMed Central

Robertson, Helen D; Elliott, Alison M; Burton, Christopher; Iversen, Lisa; Murchie, Peter; Porteous, Terry; Matheson, Catriona

2016-01-01

Background Modern demands and challenges among healthcare professionals can be particularly stressful and resilience is increasingly necessary to maintain an effective, adaptable, and sustainable workforce. However, definitions of, and associations with, resilience have not been examined within the primary care context. Aim To examine definitions and measures of resilience, identify characteristics and components, and synthesise current evidence about resilience in primary healthcare professionals. Design and setting A systematic review was undertaken to identify studies relating to the primary care setting. Method Ovid®, Embase®, CINAHL, PsycINFO, and Scopus databases were searched in December 2014. Text selections and data extraction were conducted by paired reviewers working independently. Data were extracted on health professional resilience definitions and associated factors. Results Thirteen studies met the inclusion criteria: eight were quantitative, four qualitative, and one was an intervention study. Resilience, although multifaceted, was commonly defined as involving positive adaptation to adversity. Interactions were identified between personal growth and accomplishment in resilient physicians. Resilience, high persistence, high self-directedness, and low avoidance of challenges were strongly correlated; resilience had significant associations with traits supporting high function levels associated with demanding health professional roles. Current resilience measures do not allow for these different aspects in the primary care context. Conclusion Health professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it. PMID:27162208

Resilience of primary healthcare professionals: a systematic review.

PubMed

Robertson, Helen D; Elliott, Alison M; Burton, Christopher; Iversen, Lisa; Murchie, Peter; Porteous, Terry; Matheson, Catriona

2016-06-01

Modern demands and challenges among healthcare professionals can be particularly stressful and resilience is increasingly necessary to maintain an effective, adaptable, and sustainable workforce. However, definitions of, and associations with, resilience have not been examined within the primary care context. To examine definitions and measures of resilience, identify characteristics and components, and synthesise current evidence about resilience in primary healthcare professionals. A systematic review was undertaken to identify studies relating to the primary care setting. Ovid(®), Embase(®), CINAHL, PsycINFO, and Scopus databases were searched in December 2014. Text selections and data extraction were conducted by paired reviewers working independently. Data were extracted on health professional resilience definitions and associated factors. Thirteen studies met the inclusion criteria: eight were quantitative, four qualitative, and one was an intervention study. Resilience, although multifaceted, was commonly defined as involving positive adaptation to adversity. Interactions were identified between personal growth and accomplishment in resilient physicians. Resilience, high persistence, high self-directedness, and low avoidance of challenges were strongly correlated; resilience had significant associations with traits supporting high function levels associated with demanding health professional roles. Current resilience measures do not allow for these different aspects in the primary care context. Health professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it. © British Journal of General Practice 2016.

Getting Personal about Values: Scaffolding Student Participation towards an Inclusive Classroom Community

ERIC Educational Resources Information Center

Morcom, Veronica Elizabeth; MacCallum, Judith Anne

2012-01-01

The development of an inclusive community is underpinned by values that support an appreciation of diversity. This paper is based on a larger research project, "student leadership in a primary classroom", which developed different ways for students to interact with each other. The focus not only promoted full student participation in…

Predictors of Urgency of Out-of-Home Placement Needs.

ERIC Educational Resources Information Center

Kobe, Frank H.; And Others

1991-01-01

Interviews with 137 primary caregivers with developmentally disabled family members (ages 2-62) on waiting lists for out-of-home placement found that caregiver stress was a significant predictor of the urgency of placement need. Behavior problems of the disabled person were almost as important. Lack of support services was correlated with…

Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care

PubMed Central

2014-01-01

Background There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial. Methods This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures. Results All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients. Conclusions This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context. Trial registration Current Controlled Trials ISRCTN31685626. PMID:24886516

Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors.

PubMed

Valaitis, Ruta K; O'Mara, Linda; Wong, Sabrina T; MacDonald, Marjorie; Murray, Nancy; Martin-Misener, Ruth; Meagher-Stewart, Donna

2018-04-12

AimThe aim of this paper is to examine Canadian key informants' perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration. Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context. This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor - effective communication - interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.

Effectiveness of web-based versus folder support interventions for young informal carers of persons with mental illness: a randomized controlled trial.

PubMed

Ali, Lilas; Krevers, Barbro; Sjöström, Nils; Skärsäter, Ingela

2014-03-01

Compare the impact of two interventions, a web-based support and a folder support, for young persons who care for people who suffer from mental illness. This study was a randomized control trial, following the CONSORT statements, which compared the impact of two interventions. Primary outcome variable was stress, and secondary outcome variables were caring situation, general self-efficacy, well-being, health, and quality of life of young informal carers (N=241). Data were collected in June 2010 to April 2011, with self-assessment questionnaires, comparing the two interventions and also to detect changes. The stress levels were high in both groups at baseline, but decreased in the folder group. The folder group had improvement in their caring situation (also different from the web group), general self-efficacy, well-being, and quality of life. The web group showed increase in well-being. Young informal carers who take on the responsibility for people close to them; suffer consequences on their own health. They live in a life-situation characterized by high stress and low well-being. This signals a need for support. The non-significant differences show that each intervention can be effective, and that it depends upon the individual's preferences. This highlights the importance of adopting person-centered approach, in which young persons can themselves choose support strategy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Personality characteristics and psychological distress associated with primary exercise dependence: an exploratory study.

PubMed

Grandi, Silvana; Clementi, Cecilia; Guidi, Jenny; Benassi, Mariagrazia; Tossani, Eliana

2011-09-30

The aim of this study was to assess personality characteristics and psychological distress associated with primary exercise dependence (ExeDepI) in a mixed gender sample. A cross-sectional study was carried out with adult habitual physical exercisers. A total of 79 participants voluntarily completed a package of self-report questionnaires including the Exercise Dependence Questionnaire (EDQ), the Eating Disorder Inventory II (EDI-2), the Temperament and Character Inventory (TCI), the Attitude Toward Self scale (ATS), and the Symptom Questionnaire (SQ). Significant differences were found on the EDQ exercise for weight control subscale with regard to gender, as well as on the EDI-2 total score and five of its subscales, with higher scores for females compared to males. Participants reporting primary exercise dependence (N=32) were more likely to present with disordered eating patterns than controls (N=47). They also showed higher levels of harm avoidance and persistence on the TCI, but lower self-directness and less mature character. Furthermore, ExeDepI group scored higher on the ATS dysmorphophobia subscale, as well as on the anxiety and hostility subscales of the SQ compared to the control group. These findings provide support to the idea that primary exercise dependence can be considered as a clinical syndrome associated with certain personality characteristics and psychological symptoms that might be accurately assessed in clinical settings. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Improving Obesity Prevention and Management in Primary Care in Canada.

PubMed

Campbell-Scherer, Denise; Sharma, Arya Mitra

2016-09-01

Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve.

Facilitating pediatric patient-provider communications using wireless technology in children and adolescents with sickle cell disease.

PubMed

Jacob, Eufemia; Pavlish, Carol; Duran, Joana; Stinson, Jennifer; Lewis, Mary Ann; Zeltzer, Lonnie

2013-01-01

Use of wireless devices has the potential to transform delivery of primary care services for persons with sickle cell disease (SCD). The study examined text message communications between patients and an advanced practice registered nurse (APRN) and the different primary care activities that emerged with use of wireless technology. Patients (N = 37; mean age 13.9 ± 1.8 years; 45.9% male and 54.1% female) engaged in intermittent text conversations with the APRN as part of the Wireless Pain Intervention Program. Content analyses were used to analyze the content of text message exchanges between patients and the APRN. The primary care needs that emerged were related to pain and symptom management and sickle cell crisis prevention. Two primary care categories (collaborating and coaching), four primary care subcategories (screening, referring, informing, and supporting), and 16 primary care activities were evident in text conversations. The use of wireless technology may facilitate screening, prompt management of pain and symptoms, prevention or reduction of SCD-related complications, more efficient referral for treatments, timely patient education, and psychosocial support in children and adolescents with SCD. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Personality Influences the Relationship Between Primary Emotions and Religious/Spiritual Well-Being.

PubMed

Hiebler-Ragger, Michaela; Fuchshuber, Jürgen; Dröscher, Heidrun; Vajda, Christian; Fink, Andreas; Unterrainer, Human F

2018-01-01

The study of human emotions and personality provides valuable insights into the parameters of mental health and well-being. Affective neuroscience proposes that several levels of emotions - ranging from primary ones such as LUST or FEAR up to higher emotions such as spirituality - interact on a neural level. The present study aimed to further explore this theory. Furthermore, we hypothesized that personality - formed by bottom-up primary emotions and cortical top-down regulation - might act as a link between primary emotions and religious/spiritual well-being. A total sample of 167 (78% female) student participants completed the Affective Neuroscience Personality Scale (primary emotions), the Big Five Personality Inventory and the Multidimensional Inventory of Religious/Spiritual Well-Being (higher emotions). Correlation analyses confirmed the link between primary and higher emotions as well as their relation to personality. Further regression analyses indicated that personality dimensions mediate the relationship between primary and higher emotions. A substantial interaction between primary emotions, personality dimensions, and religious/spiritual well-being could be confirmed. From a developmental perspective, cortical top-down regulation might influence religious/spiritual well-being by forming relevant personality dimensions. Hence, CARE as well as Agreeableness seem of special importance. Future studies might focus on implications for clinical groups.

Personality Influences the Relationship Between Primary Emotions and Religious/Spiritual Well-Being

PubMed Central

Hiebler-Ragger, Michaela; Fuchshuber, Jürgen; Dröscher, Heidrun; Vajda, Christian; Fink, Andreas; Unterrainer, Human F.

2018-01-01

The study of human emotions and personality provides valuable insights into the parameters of mental health and well-being. Affective neuroscience proposes that several levels of emotions – ranging from primary ones such as LUST or FEAR up to higher emotions such as spirituality – interact on a neural level. The present study aimed to further explore this theory. Furthermore, we hypothesized that personality – formed by bottom-up primary emotions and cortical top-down regulation – might act as a link between primary emotions and religious/spiritual well-being. A total sample of 167 (78% female) student participants completed the Affective Neuroscience Personality Scale (primary emotions), the Big Five Personality Inventory and the Multidimensional Inventory of Religious/Spiritual Well-Being (higher emotions). Correlation analyses confirmed the link between primary and higher emotions as well as their relation to personality. Further regression analyses indicated that personality dimensions mediate the relationship between primary and higher emotions. A substantial interaction between primary emotions, personality dimensions, and religious/spiritual well-being could be confirmed. From a developmental perspective, cortical top-down regulation might influence religious/spiritual well-being by forming relevant personality dimensions. Hence, CARE as well as Agreeableness seem of special importance. Future studies might focus on implications for clinical groups. PMID:29615950

Improving the Effectiveness of Mathematics Teaching through Active Reflection

ERIC Educational Resources Information Center

Driscoll, Kerryn

2015-01-01

A small study of active reflection was undertaken with 21 primary students in a Prep and Year 1 classroom. To provide feedback from the students on their views about their personal learning and ways they could be better supported to learn mathematics a simple survey was supplemented by one-to-one interviews. Students' perceptions of their learning…

The Work-Life Balance Pursuit: Challenges, Supports, and Strategies of Successful Women Senior Student Affairs Officers

ERIC Educational Resources Information Center

Stirling, Carolyn C.

2012-01-01

Women educational leaders struggle to achieve and sustain success in senior positions due to their attempts to manage societal expectations for balancing work and family. Societal expectations of being the primary caregivers result in working women attempting to navigate multiple professional and personal roles. Those who have attained the highest…

Mathematics Education ITE Students Examining the Value of Digital Learning Objects

ERIC Educational Resources Information Center

Hawera Ngarewa; Wright, Noeline; Sharma, Sashi

2017-01-01

One issue in mathematics initial teacher education (ITE) is how to best support students to use digital technologies (DTs) to enhance their teaching of mathematics. While most ITE students are probably using DTs on a daily basis for personal use, they are often unfamiliar with using them for educative purposes in New Zealand primary school…

Dyslexia in general practice education: considerations for recognition and support.

PubMed

Shrewsbury, Duncan

2016-07-01

Dyslexia is a common developmental learning difficulty, which persists throughout life. It is highly likely that those working in primary care will know, or even work with someone who has dyslexia. Dyslexia can impact on performance in postgraduate training and exams. The stereotypical characteristics of dyslexia, such as literacy difficulties, are often not obvious in adult learners. Instead, recognition requires a holistic approach to evaluating personal strengths and difficulties, in the context of a supportive relationship. Strategies to support dyslexic learners should consider recommendations made in formal diagnostic reports, and aim to address self-awareness and coping skills.

Health behavior in persons with spinal cord injury: development and initial validation of an outcome measure.

PubMed

Pruitt, S D; Wahlgren, D R; Epping-Jordan, J E; Rossi, A L

1998-10-01

To describe the development and initial psychometric properties of a new outcome measure for health behaviors that delay or prevent secondary impairments associated with spinal cord injury (SCI). Persons with SCI were surveyed during routine annual physical evaluations. Veterans Affairs Medical Center Spinal Cord Injury Unit, which specializes in primary care for persons with SCI. Forty-nine persons with SCI, aged 19-73 years, 1-50 years post-SCI. The newly developed Spinal Cord Injury Lifestyle Scale (SCILS). Internal consistency is high (alpha = 0.81). Correlations between clinicians' ratings of participants' health behavior and the new SCILS provide preliminary support for construct validity. The SCILS is a brief, self-report measure of health-related behavior in persons with SCI. It is a promising new outcome measure to evaluate the effectiveness of clinical and educational efforts for health maintenance and prevention of secondary impairments associated with SCI.

The Impact of Personal Background and School Contextual Factors on Academic Competence and Mental Health Functioning across the Primary-Secondary School Transition

PubMed Central

Vaz, Sharmila; Parsons, Richard; Falkmer, Torbjörn; Passmore, Anne Elizabeth; Falkmer, Marita

2014-01-01

Students negotiate the transition to secondary school in different ways. While some thrive on the opportunity, others are challenged. A prospective longitudinal design was used to determine the contribution of personal background and school contextual factors on academic competence (AC) and mental health functioning (MHF) of 266 students, 6-months before and after the transition to secondary school. Data from 197 typically developing students and 69 students with a disability were analysed using hierarchical linear regression modelling. Both in primary and secondary school, students with a disability and from socially disadvantaged backgrounds gained poorer scores for AC and MHF than their typically developing and more affluent counterparts. Students who attended independent and mid-range sized primary schools had the highest concurrent AC. Those from independent primary schools had the lowest MHF. The primary school organisational model significantly influenced post-transition AC scores; with students from Kindergarten - Year 7 schools reporting the lowest scores, while those from the Kindergarten - Year 12 structure without middle school having the highest scores. Attending a school which used the Kindergarten - Year 12 with middle school structure was associated with a reduction in AC scores across the transition. Personal background factors accounted for the majority of the variability in post-transition AC and MHF. The contribution of school contextual factors was relatively minor. There is a potential opportunity for schools to provide support to disadvantaged students before the transition to secondary school, as they continue to be at a disadvantage after the transition. PMID:24608366

The impact of personal background and school contextual factors on academic competence and mental health functioning across the primary-secondary school transition.

PubMed

Vaz, Sharmila; Parsons, Richard; Falkmer, Torbjörn; Passmore, Anne Elizabeth; Falkmer, Marita

2014-01-01

Students negotiate the transition to secondary school in different ways. While some thrive on the opportunity, others are challenged. A prospective longitudinal design was used to determine the contribution of personal background and school contextual factors on academic competence (AC) and mental health functioning (MHF) of 266 students, 6-months before and after the transition to secondary school. Data from 197 typically developing students and 69 students with a disability were analysed using hierarchical linear regression modelling. Both in primary and secondary school, students with a disability and from socially disadvantaged backgrounds gained poorer scores for AC and MHF than their typically developing and more affluent counterparts. Students who attended independent and mid-range sized primary schools had the highest concurrent AC. Those from independent primary schools had the lowest MHF. The primary school organisational model significantly influenced post-transition AC scores; with students from Kindergarten--Year 7 schools reporting the lowest scores, while those from the Kindergarten--Year 12 structure without middle school having the highest scores. Attending a school which used the Kindergarten--Year 12 with middle school structure was associated with a reduction in AC scores across the transition. Personal background factors accounted for the majority of the variability in post-transition AC and MHF. The contribution of school contextual factors was relatively minor. There is a potential opportunity for schools to provide support to disadvantaged students before the transition to secondary school, as they continue to be at a disadvantage after the transition.

A salutogenic approach to prevention of metabolic syndrome: a mixed methods population study.

PubMed

Miettola, Juhani; Viljanen, Anna Maria

2014-12-01

To find a salutogenic approach for prevention of metabolic syndrome in primary care practice. An explanatory sequential mixed-methods procedure was used to find salutogenic approaches for lifestyle change by assessing individual need, potential, and personal motivation. Data from a population health survey and interviews that focused on a sense of coherence were analysed. Altogether 480 Finnish subjects participated in a population health survey, and 43 of them were interviewed. The 43 interviewees' data were included in the final analysis. With the health survey participants' liability for MetS was assessed, and the objective need for lifestyle intervention was determined. Through the focused interviews potential and personal motivation for lifestyle modification were explored. Finally the data of the 43 interviewed subjects were merged. Four possible lifestyle intervention approaches were identified for specific intervention. First, subjects with a strong sense of coherence only need encouragement to maintain a healthy lifestyle; second, professional support was found important for subjects with gaps in health awareness to improve health understanding; third, strengthening of social support for lifestyle change is necessary for subjects with various practical constraints in their everyday life; and fourth, strengthening of stress adaptation is important for subjects with redundant concerns about their health. Salutogenic client-centred lifestyle modification approaches should be part of primary care practice. Further, a cross-disciplinary approach is needed in primary care research and practice to combat the exploding lifestyle illnesses.

Dialectical principlism: an approach to finding the most ethical action.

PubMed

Weinstock, Robert

2015-03-01

Most forensic psychiatrists occasionally face complex situations in forensic work in which ethics dilemmas cause discomfort. They want to determine the most ethical action, but the best choice is unclear. Fostering justice is primary in forensic roles, but secondary duties such as traditional biomedical ethics and personal values like helping society, combating racism, and being sensitive to cultural issues can impinge on or even outweigh the presumptive primary duty in extreme cases. Similarly, in treatment the psychiatrists' primary duty is to patients, but that can be outweighed by secondary duties such as protecting children and the elderly or maintaining security. The implications of one's actions matter. In forensic work, if the psychiatrist determines that he should not assist the party who wants to hire him, despite evidence clearly supporting its side, the only ethical option becomes not to accept the case at all, because the evidence does not support the better side. Sometimes it can be ethical to accept cases only for one side. In ethics-related dilemmas, I call the method of prioritizing and balancing all types of conflicting principles, duties, and personal and societal values in a dialectic to resolve conflicts among them dialectical principlism. This approach is designed to help determine the most ethical action. It is aspirational and is not intended to get the psychiatrist into trouble. © 2015 American Academy of Psychiatry and the Law.

Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine

PubMed Central

Chapman, Benjamin P.; Roberts, Brent; Duberstein, Paul

2011-01-01

We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or “distressed” personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine. PMID:21766032

Rural health workers and their work environment: the role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea

PubMed Central

2012-01-01

Background Job satisfaction is an important focal attitude towards work. Understanding factors that relate to job satisfaction allows interventions to be developed to enhance work performance. Most research on job satisfaction among nurses has been conducted in acute care settings in industrialized countries. Factors that relate to rural nurses are different. This study examined inter-personal, intra-personal and extra-personal factors that influence job satisfaction among rural primary care nurses in a Low and Middle Income country (LMIC), Papua New Guinea. Methods Data was collected using self administered questionnaire from rural nurses attending a training program from 15 of the 20 provinces. Results of a total of 344 nurses were available for analysis. A measure of overall job satisfaction and measures for facets of job satisfaction was developed in the study based on literature and a qualitative study. Multi-variate analysis was used to test prediction models. Results There was significant difference in the level of job satisfaction by age and years in the profession. Higher levels of overall job satisfaction and intrinsic satisfaction were seen in nurses employed by Church facilities compared to government facilities (P <0.01). Ownership of facility, work climate, supervisory support and community support predicted 35% (R2 =0.35) of the variation in job satisfaction. The factors contributing most were work climate (17%) and supervisory support (10%). None of these factors were predictive of an intention to leave. Conclusions This study provides empirical evidence that inter-personal relationships: work climate and supportive supervision are the most important influences of job satisfaction for rural nurses in a LMIC. These findings highlight that the provision of a conducive environment requires attention to human relations aspects. For PNG this is very important as this critical cadre provide the frontline of primary health care for more than 70% of the population of the country. Many LMIC are focusing on rural health, with most of the attention given to aspects of workforce numbers and distribution. Much less attention is given to improving the aspects of the working environment that enhances intrinsic satisfaction and work climate for rural health workers who are currently in place if they are to be satisfied in their job and productive. PMID:22691270

Rural health workers and their work environment: the role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea.

PubMed

Jayasuriya, Rohan; Whittaker, Maxine; Halim, Grace; Matineau, Tim

2012-06-12

Job satisfaction is an important focal attitude towards work. Understanding factors that relate to job satisfaction allows interventions to be developed to enhance work performance. Most research on job satisfaction among nurses has been conducted in acute care settings in industrialized countries. Factors that relate to rural nurses are different. This study examined inter-personal, intra-personal and extra-personal factors that influence job satisfaction among rural primary care nurses in a Low and Middle Income country (LMIC), Papua New Guinea. Data was collected using self administered questionnaire from rural nurses attending a training program from 15 of the 20 provinces. Results of a total of 344 nurses were available for analysis. A measure of overall job satisfaction and measures for facets of job satisfaction was developed in the study based on literature and a qualitative study. Multi-variate analysis was used to test prediction models. There was significant difference in the level of job satisfaction by age and years in the profession. Higher levels of overall job satisfaction and intrinsic satisfaction were seen in nurses employed by Church facilities compared to government facilities (P <0.01). Ownership of facility, work climate, supervisory support and community support predicted 35% (R2 =0.35) of the variation in job satisfaction. The factors contributing most were work climate (17%) and supervisory support (10%). None of these factors were predictive of an intention to leave. This study provides empirical evidence that inter-personal relationships: work climate and supportive supervision are the most important influences of job satisfaction for rural nurses in a LMIC. These findings highlight that the provision of a conducive environment requires attention to human relations aspects. For PNG this is very important as this critical cadre provide the frontline of primary health care for more than 70% of the population of the country. Many LMIC are focusing on rural health, with most of the attention given to aspects of workforce numbers and distribution. Much less attention is given to improving the aspects of the working environment that enhances intrinsic satisfaction and work climate for rural health workers who are currently in place if they are to be satisfied in their job and productive.

Patient Perceptions of Telehealth Primary Care Video Visits.

PubMed

Powell, Rhea E; Henstenburg, Jeffrey M; Cooper, Grace; Hollander, Judd E; Rising, Kristin L

2017-05-01

Telehealth is a care delivery model that promises to increase the flexibility and reach of health services. Our objective is to describe patient experiences with video visits performed with their established primary care clinicians. We constructed semistructured, in-depth qualitative interviews with adult patients following video visits with their primary care clinicians at a single academic medical center. Data were analyzed with a content analysis approach. Of 32 eligible patients, 19 were successfully interviewed. All patients reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical examination. Primary care video visits are acceptable in a variety of situations. Patients identified convenience, efficiency, communication, privacy, and comfort as domains that are potentially important to consider when assessing video visits vs in-person encounters. Future studies should explore which patients and conditions are best suited for video visits. © 2017 Annals of Family Medicine, Inc.

A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series.

PubMed

Bigford, Gregory E; Mendez, Armando J; Betancourt, Luisa; Burns-Drecq, Patricia; Backus, Deborah; Nash, Mark S

2017-01-01

This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS). Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides. We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision.

Foster Care: Creating Interpersonal Change through Story-Telling and Family Play. Strategies to Support Client Assessment and Intervention.

ERIC Educational Resources Information Center

Schatz, Mona Struhsaker; Gaddis, Stephen R.; Zimmerman, Toni Schindler

Story-telling and family play can exert powerful effects on children. Some beliefs, values, and personal life-style choices that relate to how play is created are examined. Using the primary concepts in "narrative therapy,""adventure-based programming," and "family play therapy," play is employed to create an empowerment framework to consider the…

A Baseline Description of DTIC Scientific and Technical Information Support System

DTIC Science & Technology

1986-09-01

discussed below. Operations Research And Economic Analysis Office (DTIC-LO) This organizational element is currently being staffed. Its primary planned... Analysis Centers DASIAC - Ed Martin, Dave Reitz GACIAC - Richard Bartl* MCIAC - Helen Pestel * MMIAC - Sarah Ellingsworth...Overall Organization 2-5 Office Of The Administrator And Personal Staff 2-7 Equal Employment Opportunity Manager 2-7 Information Analysis

Clinical decision support for genetically guided personalized medicine: a systematic review

PubMed Central

Welch, Brandon M

2013-01-01

Objective To review the literature on clinical decision support (CDS) for genetically guided personalized medicine (GPM). Materials and Methods MEDLINE and Embase were searched from 1990 to 2011. The manuscripts included were summarized, and notable themes and trends were identified. Results Following a screening of 3416 articles, 38 primary research articles were identified. Focal areas of research included family history-driven CDS, cancer management, and pharmacogenomics. Nine randomized controlled trials of CDS interventions for GPM were identified, seven of which reported positive results. The majority of manuscripts were published on or after 2007, with increased recent focus on genotype-driven CDS and the integration of CDS within primary clinical information systems. Discussion Substantial research has been conducted to date on the use of CDS to enable GPM. In a previous analysis of CDS intervention trials, the automatic provision of CDS as a part of routine clinical workflow had been identified as being critical for CDS effectiveness. There was some indication that CDS for GPM could potentially be effective without the CDS being provided automatically, but we did not find conclusive evidence to support this hypothesis. Conclusion To maximize the clinical benefits arising from ongoing discoveries in genetics and genomics, additional research and development is recommended for identifying how best to leverage CDS to bridge the gap between the promise and realization of GPM. PMID:22922173

Using Mobile & Personal Sensing Technologies to Support Health Behavior Change in Everyday Life: Lessons Learned

PubMed Central

Klasnja, Predrag; Consolvo, Sunny; McDonald, David W.; Landay, James A.; Pratt, Wanda

2009-01-01

Lifestyle modification is a key facet of the prevention and management of chronic diseases. Mobile devices that people already carry provide a promising platform for facilitating these lifestyle changes. This paper describes key lessons learned from the development and evaluation of two mobile systems for encouraging physical activity. We argue that by supporting persistent cognitive activation of health goals, encouraging an extensive range of relevant healthy behaviors, focusing on long-term patterns of activity, and facilitating social support as an optional but not primary motivator, systems can be developed that effectively motivate behavior change and provide support when and where people make decisions that affect their health. PMID:20351876

Imaging Surveillance After Primary Breast Cancer Treatment

PubMed Central

Lam, Diana L.; Houssami, Nehmat; Lee, Janie M.

2017-01-01

OBJECTIVE Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen. CONCLUSION Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens. PMID:28075622

A narrative review of mental health support for people during transition from incarceration to community: the grass can be greener on the other side of the fence.

PubMed

Smith-Merry, Jennifer; Mellifont, Damian; McKenzie, Kirsty; Clenaghan, Paul

2018-04-28

Despite significant need for mental health services targeting the requirements of inmates transitioning into the community there is little research about successful recovery-oriented or person-centred transition programs. This systematic narrative review brings together existing evidence to inform policymakers and practitioners about current practice in transition support, and barriers and facilitators of effective practice. We carried out a systematic narrative review of recovery-oriented or person-centred mental health support programs supporting transition from incarceration to the community. Results were obtained from a systematic search of Medline, PubMed and Scopus databases. We found 23 papers which met the paper inclusion criteria along with four other papers which were identified incidentally. Identified barriers to the implementation of effective transition support programs are: administrative problems leading to ineffective in-reach into correctional facilities or untimely support, lack of support for immediate needs meaning that inmates deprioritise their mental health needs, a lack of ongoing program resources and poor communication between correctional facilities and mental health services. Enablers for transition reflect the inverse of these barriers, alongside other successful strategies including medical home models, regionalised programs, programs which target connections with primary care, nurse-led patient-centred health programs and peer support initiatives.

Evaluation of the Effectiveness and Cost-Effectiveness of Personalized Surveillance After Colorectal Adenomatous Polypectomy.

PubMed

McFerran, Ethna; O'Mahony, James F; Fallis, Richard; McVicar, Duncan; Zauber, Ann G; Kee, Frank

2017-01-01

Lifetime risk of developing colorectal cancer is 5%, and 5-year survival at early stage is 92%. Individuals with precancerous lesions removed at primary screening are typically recommended surveillance colonoscopy. Because greater benefits are anticipated for those with higher risk of colorectal cancer, scope for risk-specific surveillance recommendations exists. This review assesses published cost-effectiveness estimates of postpolypectomy surveillance to consider the potential for personalized recommendations by risk group. Meta-analyses of incidence of advanced neoplasia postpolypectomy for low-risk cases were comparable to those without adenoma, with both rates under the lifetime risk of 5%. This group may not benefit from intensive surveillance, which risks unnecessary harm and inefficient use of often scarce colonoscopy capacity. Therefore, greater personalization through deintensified strategies for low-risk individuals could be beneficial. The potential for noninvasive testing, such as fecal immunochemical tests, combined with primary prevention or chemoprevention may reserve colonoscopy for targeted use in personalized risk-stratified surveillance. This review appraised evidence supporting a program of personalized surveillance in patients with colorectal adenoma according to risk group and compared the effectiveness of surveillance colonoscopy with alternative prevention strategies. It assessed trade-offs among costs, benefits, and adverse effects that must be considered in a decision to adopt or reject personalized surveillance. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care system.

PubMed

Knerr, Sarah; Wernli, Karen J; Leppig, Kathleen; Ehrlich, Kelly; Graham, Amanda L; Farrell, David; Evans, Chalanda; Luta, George; Schwartz, Marc D; O'Neill, Suzanne C

2017-05-01

Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress. This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months. Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient Reactance as a Moderator of the Effect of Therapist Structure on Posttreatment Alcohol Use*

PubMed Central

Karno, Mitchell P.; Longabaugh, Richard; Herbeck, Diane

2009-01-01

Objective: We sought to replicate findings about the effect of therapist-imposed structure on alcoholism-treatment effectiveness for aftercare patients at different levels of interpersonal reactance and to examine if the effect generalizes to patients in a primary phase of treatment. Method: Analyses were based on ex post facto observer ratings combined with outcome data from a randomized clinical trial. Participants had alcohol abuse or dependence (N = 247) and received treatment at either a primary outpatient treatment site (n = 125) or an aftercare site (n = 122) of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Patients' trait reactance and therapist structure were assessed via observer ratings based on videotaped therapy sessions. Dependent variables included percentage days abstinent, percentage heavy-drinking days, time to first drinking day, and time to first heavy-drinking day throughout a 1-year posttreatment period. Results: The results indicated that increased therapist structure during aftercare treatment predicted fewer abstinent days and more heavy-drinking days for persons at a high level of reactance than for persons at a low level of reactance. The effect was a consistent predictor of alcohol use throughout each 3-month interval within the follow-up period. The interaction effect was not supported in the primary outpatient treatment sites, and it was not supported as a predictor of time to first drink or time to first heavy drink in either the aftercare or the outpatient sites. Conclusions: This study successfully replicated the finding that level of patient reactance appears to moderate the effect of therapist structure on alcohol-use outcomes in aftercare treatment settings. The lack of support for this effect in primary outpatient treatment settings suggests that the negative effect of structured treatment may be limited to patients who are further along in the recovery process. PMID:19895770

[Appraisal of occupational stress and its influential factors in nurses].

PubMed

Yang, Xin-wei; Wang, Zhi-ming; Wang, Mian-zhen; Lan, Ya-jia

2004-04-01

To assess the occupational stress and its influential factors in nurses. A test of occupational stress, its influential factors, work ability were carried out for 248 nurses and 319 controls with revised occupational stress inventory (OSI-R) and work ability index (WAI). The scores of personal cope resource (131.266 +/- 17.176) and work ability index (32.581 +/- 3.158) in nurse group were significantly higher than those in control group (126.931 +/- 19.108, 31.840 +/- 4.069) (P < 0.05). The main occupational stressors scores (role insufficiency, role clash, and responsibility) in nurses were higher than those in controls (P < 0.05). The stress response of interpersonal relationship in nurses was also higher. The items of personal cope resource, such as recreation, self-care and social support of nurses were superior to those of controls (P < 0.05). Stress response was positively correlated with occupational role (r = 0.512, P < 0.01), and negatively correlated with the personal cope resource (r = -0.475, P < 0.01). The primary influential factors of personal stress were recreation, social support, rational conduct, role insufficiency, role clash, responsibility, and poor work environment. To strengthen social support, to improve work condition for nurses, so as to reduce the occupational stress and to enhance the work ability of nurses are important task in occupational health field.

Using program evaluation to support knowledge translation in an interprofessional primary care team: a case study.

PubMed

Donnelly, Catherine; Shulha, Lyn; Klinger, Don; Letts, Lori

2016-10-06

Evaluation is a fundamental component in building quality primary care and is ideally situated to support individual, team and organizational learning by offering an accessible form of participatory inquiry. The evaluation literature has begun to recognize the unique features of KT evaluations and has described attributes to consider when evaluating KT activities. While both disciplines have focused on the evaluation of KT activities neither has explored the role of evaluation in KT. The purpose of the paper is to examine how participation in program evaluation can support KT in a primary care setting. A mixed methods case study design was used, where evaluation was conceptualized as a change process and intervention. A Memory Clinic at an interprofessional primary care clinic was the setting in which the study was conducted. An evaluation framework, Pathways of Influence provided the theoretical foundation to understand how program evaluation can facilitate the translation of knowledge at the level of the individual, inter-personal (Memory Clinic team) and the organization. Data collection included questionnaires, interviews, evaluation log and document analysis. Questionnaires and interviews were administered both before and after the evaluation: Pattern matching was used to analyze the data based on predetermined propositions. Individuals gained program knowledge that resulted in changes to both individual and program practices. One of the key themes was the importance clinicians placed on local, program based knowledge. The evaluation had less influence on the broader health organization. Program evaluation facilitated individual, team and organizational learning. The use of evaluation to support KT is ideally suited to a primary care setting by offering relevant and applicable knowledge to primary care team members while being sensitive to local context.

Dimensions of autonomy: Primary teachers' decisions about involvement in science professional development

NASA Astrophysics Data System (ADS)

Schibeci, Renato A.; Hickey, Ruth L.

2004-01-01

Professional development (PD) for primary science teachers is recognized as an important activity which can support improved science education for students. Analysis of interviews with practicing primary science teachers is used to identify the range of PD experiences of a sample of teachers from Western Australia. Teachers' reasons for attending or avoiding science-related PD are categorized as decision issues which include opportunity, compulsion, convenience, enticement, interest, recommendation, and relevance. Case studies describe the interplay of these issues, which result in teachers' attendance or avoidance of PD. A subset of the sample is used to explore teachers' views of other activities which they recognize as contributing to their science teaching, content knowledge, and pedagogy. These other activities include hobbies, partner's job, and pursuing students' interests. Legitimating teachers' own interests as a source of personally derived PD is supported as an avenue to increase the diversity of topics studied by students and to increase the level of content knowledge held by teachers.

Long-Term Experiences in Cash and Counseling for Young Adults with Intellectual Disabilities: Familial Programme Representative Descriptions.

PubMed

Harry, Melissa L; MacDonald, Lynn; McLuckie, Althea; Battista, Christina; Mahoney, Ellen K; Mahoney, Kevin J

2017-07-01

Our aim was to explore previously unknown long-term outcomes of self-directed personal care services for young adults with intellectual disabilities and limitations in activities of daily living. The present authors utilized participatory action research and qualitative content analysis in interviewing 11 unpaid familial programme representatives of young adults with intellectual disabilities, ages 23-34, who were eligible for income-based Medicaid and enrolled five or more years in a Cash and Counseling-based programme of self-direction in the United States. Young adults are represented as receiving services and supports in a supportive and stable environment, with previously identified short-term programme benefits evident over the long-term. Young adults are also transitioning to adulthood at home with their families as primary social support and caregivers, bridging a service gap. Our results show that self-direction helps meet these young adults' personal care and community engagement needs over time. © 2016 John Wiley & Sons Ltd.

[Problems in the process of adapting to change among the family caregivers of elderly people with dementia].

PubMed

Moreno-Cámara, Sara; Palomino-Moral, Pedro Ángel; Moral-Fernández, Lourdes; Frías-Osuna, Antonio; Del-Pino-Casado, Rafael

2016-01-01

To identify and analyse problems in adapting to change among the family caregivers of relatives with dementia. Qualitative study based on the methodology of Charmaz's Constructivist Grounded Theory. Seven focus groups were conducted in different primary health care centres in the province of Jaen (Spain). Eighty-two primary family caregivers of relatives with dementia participated by purposeful maximum variation sampling and theoretical sampling. Triangulation analysis was carried out to increase internal validity. We obtained three main categories: 'Changing Care', 'Problems in the process of adapting to change' and 'Facilitators of the process of adapting to change'. Family caregivers perform their role in a context characterized by personal change, both in the person receiving the care and in the social and cultural context. The challenge of adaptation lies in the balance between the problems that hamper adaptation of the caregiver to new situations of care and the factors that facilitate the caregiver role. The adaptation of family caregivers to caring for a person with dementia is hindered by the lack of formal support and under-diagnosis of dementia. The adaptation process could be improved by strengthening formal support in the early stages of care to reduce the stress of family caregivers who must teach themselves about their task and by interventions adapted to each phase in the development of the caregiver role. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.

PubMed

Von Korff, M; Moore, J E; Lorig, K; Cherkin, D C; Saunders, K; González, V M; Laurent, D; Rutter, C; Comite, F

1998-12-01

Randomized, controlled trial. To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations. Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated. Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.

Social Conditions for People With Down Syndrome: A Register-Based Cohort Study in Denmark

PubMed Central

Zhu, Jin Liang; Obel, Carsten; Hasle, Henrik; Rasmussen, Sonja A.; Li, Jiong; Olsen, Jørn

2015-01-01

Today, most persons with Down syndrome (DS) survive into middle age, but information on their social conditions as adults is limited. We addressed this knowledge gap using data from national registers in Denmark. We identified a national cohort of 1,998 persons with DS who were born between 1968 and 2007 (1,852 with standard trisomy 21, 80 with Robertsonian translocations and 66 with mosaicism) using the Danish Cytogenetic Register. We followed this cohort from 1980 to 2007. Information on social conditions (education, employment, source of income, marital status, etc.) was obtained by linkages to national registers, including the Integrated Database for Longitudinal Labor Market Research. For those aged 18 and older, more than 80%of persons with DS attended 10 years of primary school, with about 2% completing secondary or post-secondary education. About 4% obtained a full-time job, whereas the remaining mainly received public support from the government. Only a few (1–2%) of persons with DS were married or had a child. No significant differences in these social conditions were seen between males and females. More persons with mosaic DS attended secondary or post-secondary education, had a full-time job, were married, or had a child (18%, 28%, 15%, and 7%, respectively), compared with persons with standard DS (1%, 2%, 1%, and 1%, respectively). These data may provide families with better insight into social conditions and society with a better understanding of the social support needed for persons with DS. PMID:24273114

How Today's Mentoring Relationships Can Influence Tomorrow's Physical Education

ERIC Educational Resources Information Center

McCluney, E. Nicole; Fallaize, Ashley; Schempp, Paul

2018-01-01

The purpose of this article is to describe effective functions that mentors can use to assist in both the personal and professional development of protégés. Mentors help their protégés in two primary areas: career development and psychosocial support. Career development functions are intended to advance the protégé's adjustments within the…

Setting the Stage for Personalized Treatment of Glioma | Center for Cancer Research

Cancer.gov

Gliomas, the most common type of primary brain tumors in adults, arise from different types of glial cells, which support and protect the neurons of the central nervous system. How a patient’s glioma is treated depends in part on the type of glial cell from which the tumor developed. Classification of gliomas has traditionally been done by microscopic analysis of tumor

Demonstrating Understanding, a Whole Body Experience? Can Year One Children Show Their Science Understanding through the Use of Gestures?

ERIC Educational Resources Information Center

Davis, Anthony

2016-01-01

This research project uses the methods of Crowder and Callinan and Sharp to assess year one children's (age 5-6) personal understanding of scientific concepts. This research project uses video recording as a primary resource of data collection within a case study approach using a participant observer method. Analysis supports the work of Crowder…

Exploring the Association Between Emotional Abuse and Childhood Borderline Personality Features: The Moderating Role of Personality Traits

PubMed Central

Gratz, Kim L.; Latzman, Robert D.; Tull, Matthew T.; Reynolds, Elizabeth K.; Lejuez, C. W.

2012-01-01

Most of the extant literature on borderline personality disorder has focused on the course, consequences, and correlates of this disorder among adults. However, little is known about childhood borderline personality (BP) features, or the factors associated with the emergence of BP pathology in childhood. A greater understanding of childhood BP features and associated risk factors has important implications for the development of primary and secondary prevention programs. The goal of the present study was to examine the interrelationships among two BP-relevant traits (affective dysfunction and impulsivity), a BP-relevant environmental stressor (emotional abuse), and BP features in a sample of 225 children aged 11 to 14 years. Results provide support for the role of both trait vulnerabilities and environmental stressors in childhood BP features. Further, findings highlight the moderating role of affective dysfunction in the relationship between emotional abuse and childhood BP features. PMID:21658531

Psychological Resources, Personality Traits and Buddhism: A Study of Italian Young Adults.

PubMed

Giannini, Marco; Loscalzo, Yura; Beraldi, Daniela; Gori, Alessio

2018-04-28

We aimed to examine whether young adults practicing Buddhism have elevated levels of psychological resources and specific personality traits compared to Catholics and Atheists. We recruited 184 participants: Soka Gakkai Buddhists (n = 60); non-practicing Roman Catholic Church believers (n = 62); Atheists (n = 62). We found that the Buddhists have higher optimism than both Catholics and Atheists. They also have higher self-efficacy and self-esteem than Catholics and higher perceived social support than Atheists. Concerning global personality factors, they are more extraverted than the other groups, and they are less tough-minded than Catholics. Differences also emerged relating some primary personality factors. Since we did not find differences between Catholics and Atheists about psychological resources, we speculate that religion alone does not provide an efficacious source of psychological resources; it could be that religious practice is determinant.

The CELSS breadboard project: Plant production

NASA Technical Reports Server (NTRS)

Knott, William M.

1990-01-01

NASA's Breadboard Project for the Controlled Ecological Life Support System (CELSS) program is described. The simplified schematic of a CELSS is given. A modular approach is taken to building the CELSS Breadboard. Each module is researched in order to develop a data set for each one prior to its integration into the complete system. The data being obtained from the Biomass Production Module or the Biomass Production Chamber is examined. The other primary modules, food processing and resource recovery or waste management, are discussed briefly. The crew habitat module is not discussed. The primary goal of the Breadboard Project is to scale-up research data to an integrated system capable of supporting one person in order to establish feasibility for the development and operation of a CELSS. Breadboard is NASA's first attempt at developing a large scale CELSS.

Registered nurses' perceptions of conditions for patient education - focusing on organisational, environmental and professional cooperation aspects.

PubMed

Bergh, Anne-Louise; Karlsson, Jan; Persson, Eva; Friberg, Febe

2012-09-01

To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work. © 2012 Blackwell Publishing Ltd.

Eliciting perceptions of satisfaction with services and supports from persons with intellectual disability and developmental disabilities: a review of the literature.

PubMed

Copeland, S R; Luckasson, R; Shauger, R

2014-12-01

Assessing the perceptions of individuals with intellectual disability (ID) and developmental disabilities (DD) is an essential part of evaluating and planning services and an important component of respect for self-direction and autonomy. It can be difficult, however, to assess satisfaction in such a way that individuals with disabilities' actual perceptions of satisfaction are accurately represented because of intellectual and communication difficulties they may have, the restricted range and nature of service systems, and the limitations of strategies used by some researchers. The purpose of this literature review was to systematically examine research studies designed to solicit personal satisfaction information from individuals with ID and DD. We reviewed 29 studies that met inclusion criteria to determine (1) who were participants in the studies, (2) what processes researchers used to obtain opinions and perspectives of persons with ID and DD, and (3) how researchers ensured the credibility, accuracy and voluntariness of participants' responses. Findings revealed that most of the research participants had ID with higher IQs and limited needs for supports. Researchers utilised a variety of processes to elicit perceptions of satisfaction. Most studies employed individual interviews; researchers addressed comprehensibility of questions in a number of ways (e.g. use of visuals, adjusting wording of questions, providing clear examples). Few studies reported training interviewers or taking into account participants' primary language or cultural background. No studies reported educating participants about how to understand the satisfaction information data or how to use it in advocating for more appropriate supports. Assessing the satisfaction with supports and services of individuals with ID and DD is complex particularly for persons with extensive support needs. Continued research using varied conceptual frameworks and new technologies is needed. Also helpful will be teaching persons with disabilities about the assessment process and how to use its results. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Midwives' perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review.

PubMed

Noonan, Maria; Doody, Owen; Jomeen, Julie; Galvin, Rose

2017-02-01

perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. to synthesise primary research on midwives' perceived role in Perinatal Mental Health (PMH). integrative review. Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. a total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

Within-person variation in security of attachment: a self-determination theory perspective on attachment, need fulfillment, and well-being.

PubMed

La Guardia, J G; Ryan, R M; Couchman, C E; Deci, E L

2000-09-01

Attachment research has traditionally focused on individual differences in global patterns of attachment to important others. The current research instead focuses primarily on within-person variability in attachments across relational partners. It was predicted that within-person variability would be substantial, even among primary attachment figures of mother, father, romantic partner, and best friend. The prediction was supported in three studies. Furthermore, in line with self-determination theory, multilevel modeling and regression analyses showed that, at the relationship level, individuals' experience of fulfillment of the basic needs for autonomy, competence, and relatedness positively predicted overall attachment security, model of self, and model of other. Relations of both attachment and need satisfaction to well-being were also explored.

Who are the support persons of haematological cancer survivors and how is their performance perceived?

PubMed

Hall, Alix; Lynagh, Marita; Carey, Mariko; Sanson-Fisher, Rob; Mansfield, Elise

2017-12-01

To explore: (1) how haematological cancer survivors and their support persons perceive the overall performance of the support person; (2) disagreement between survivor and support person ratings; and (3) characteristics associated with support persons rating their performance poorly. This is a substudy of a larger project of Australian haematological cancer survivors and their support persons. For this substudy, haematological cancer survivors were recruited from 4 Australian population-based cancer registries and asked to pass on a questionnaire package to their support persons. Survivors who passed on a questionnaire package to their support person were asked to answer questions about the support person and how they perceived the support person's performance. Similarly, support persons answered questions on their own performance as a support person. A total of 924 haematological cancer survivors and 821 support persons were eligible for this study. Most survivors rated their support person as performing very well (84%) while less than half (48%) of support persons rated their own performance as very well. There was significant disagreement between survivor and their support person (dyad) ratings of the support person's performance. Support persons with above normal levels of depression (vs those with normal levels) had significantly higher odds of rating their own performance as "not well/somewhat well." Health care providers should consider providing additional education and skills-based interventions to support persons who experience increased symptoms of depression. Copyright © 2017 John Wiley & Sons, Ltd.

[Risk factors and burnout levels in Primary Care nurses: A systematic review].

PubMed

Gómez-Urquiza, Jose L; Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Fernández-Castillo, Rafael; Aguayo-Estremera, Raimundo; Cañadas-de la Fuente, Guillermo A

2017-02-01

To determine the risk factors and levels of burnout in Primary Care nurses. A systematic review was performed. CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

A disease management program for families of persons in Hong Kong with dementia.

PubMed

Chien, Wai Tong; Lee, Yuet Ming

2008-04-01

This study tested the effectiveness of a dementia care management program for Chinese families of relatives with dementia on caregivers' and patients' health outcomes over a 12-month follow-up period. The dementia care management program is an educational and supportive group for caregivers that lasts six months. A controlled trial was conducted with 88 primary caregivers of persons with dementia in two dementia care centers in Hong Kong. Family members were assigned randomly to either the dementia care program or standard care. The two groups were compared for patients' symptoms and institutionalization rates and caregivers' quality of life, burden, and social support upon recruitment and six and 12 months after group assignment. Over the 12-month follow-up period, patients with family members in the dementia care program showed significantly greater improvements in symptoms and institutionalization rates and their caregivers reported significantly greater improvements in quality of life and burden compared with the control group. The findings provide evidence that the dementia care management program can improve the psychosocial functioning of Chinese persons with dementia and their caregivers.

Family physicians' attitude and practice of infertility management at primary care--Suez Canal University, Egypt.

PubMed

Eldein, Hebatallah Nour

2013-01-01

The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians' attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians' practice. Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management.

Family physicians’ attitude and practice of infertility management at primary care - Suez Canal University, Egypt

PubMed Central

Eldein, Hebatallah Nour

2013-01-01

Introduction The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. The aim of the work: to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. Methods This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Results Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians′ attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians′ practice. Conclusion Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management. PMID:24244792

The effects of Web site structure: the role of personal difference.

PubMed

Chung, Hwiman; Ahn, Euijin

2007-12-01

This study examined the effects of Web site structures in terms of advertising effectiveness- memory, attitude, and behavioral intentions. The primary research question for this study is, What type of Web site (Web ad) structure is most effective? In the pilot study, we tested the difference between two Web site structures, linear and interactive, in terms of traditional advertising effectiveness. Results from the pilot study did not support our research expectations. However, differences in terms of memory were noted between the two structures. After re-creating the Web site based on subjects' comments, in the final experiment, we examined the differences between the two structures and the moderating role of personality difference on the effects of Web site structure. The results confirm that participants' attitude, memory, and behavioral intentions were affected differently by the different Web site structures. However, some research hypotheses were not supported by the current data.

The roles of social bonds, personality, and perceived costs: an empirical investigation into Hirschi's "new" control theory.

PubMed

Intravia, Jonathan; Jones, Shayne; Piquero, Alex R

2012-12-01

Hirschi's reconceptualized control theory suggests that social bonds serve as the primary inhibitors to delinquency and that personality-based self-control (PBSC) is not relevant. He also indicates that the number of inhibitors, multiplied by their salience, influences the perceived costs of delinquency. These claims have not been widely tested. Using a large, school-based sample of adolescents, the authors test Hirschi's reconceptualization and find that certain inhibitors (e.g., parental monitoring) are more important than others (e.g., maternal attachment). There are also unique types of costs (e.g., parental costs, peer costs) with differential impacts. Salience exerts a main effect, but there was little evidence to suggest it interacts with costs. Finally, PBSC has the strongest effect. These findings not only offer support for some of Hirschi's claims but also provide directions to better formulate a more comprehensive and empirically supported control theory.

Examining Concurrent and Longitudinal Relations Between Personality Traits and Social Well-being in Adulthood

PubMed Central

Hill, Patrick L.; Turiano, Nicholas A.; Mroczek, Daniel K.; Roberts, Brent W.

2013-01-01

Past work has demonstrated that Big Five personality traits both predict relationship success and respond to changes in relationship status. The current study extends this work by examining how developments on the Big Five traits correspond to another important social outcome in adulthood, social well-being. Using the Mid-Life Development in the U.S. longitudinal data sample of adults, the authors examined traits and social well-being at two time points, roughly 9 years apart. Results find support for two primary claims. First, initial levels of social well-being correlated positively with initial standing on extraversion, agreeableness, conscientiousness, emotional stability, and openness. Second, changes in social well-being over time coincided with changes on these traits, in the same directions. Taken together, these findings provide broad support that trait development and social well-being development coincide during adulthood. PMID:23526708

Impact of a personalised active labour market programme for persons with disabilities.

PubMed

Adamecz-Völgyi, Anna; Lévay, Petra Zsuzsa; Bördős, Katalin; Scharle, Ágota

2018-02-01

The paper estimates the impact of a supported employment programme implemented in Hungary. This is a non-experimental evaluation using a matching identification strategy supported by rich data on individual characteristics, personal employment and unemployment history and the local labour market situation. We use a time-window approach to ensure that programme participants and matched controls entered unemployment at the same point in time, and thus faced very similar labour market conditions. We find that the programme had a positive effect of 16 percentage points on the probability of finding a job among men and 25 percentage points among women. The alternative outcome indicator of not re-entering the unemployment registry shows somewhat smaller effects in the case of women. In comparison to similarly costly programmes that do not facilitate employment in the primary labour market, rehabilitation services represent a viable alternative.

A Meta-Analysis of Adult-Rated Child Personality and Academic Performance in Primary Education

ERIC Educational Resources Information Center

Poropat, Arthur E.

2014-01-01

Background: Personality is reliably associated with academic performance, but personality measurement in primary education can be problematic. Young children find it difficult to accurately self-rate personality, and dominant models of adult personality may be inappropriate for children. Aims: This meta-analysis was conducted to determine the…

Is the Australian 75+ Health Assessment person-centred? A qualitative descriptive study of older people's perceptions.

PubMed

Price, Kay; Grimmer, Karen; Foot, Jan

2017-12-01

Objective The aim of the present study was to explore the perspectives of older people following their recent participation in a 75+ Health Assessment (75+HA) and interrogate these perspectives using a person-centred lens. Methods A qualitative descriptive study design was used within a larger study funded by the Australian Primary Health Care Research Institute. Nineteen participants from four different general practices in one Australian state described their perceptions of the 75+HA in a face-to-face interview. Data were then analysed using a qualitative content analysis approach. Results The purpose of the 75+HA was not well understood by participants. Participant responses reveal that where, when, who and how a primary health professional conducted the 75+HA affected what older people talked about, the guidance they sought to deal with issues and, in turn, the actioning of issues that were discussed during the 75+HA. Conclusion To enable older people to make informed decisions about and successfully manage their own health and well being, and to choose when to invite others to act on their behalf, primary health professionals need to ask questions in the 75+HA within a person-centred mindset. The 75+HA is an opportunity to ensure older people know why they need support, which ones, and agree to, supports and services they require. What is known about the topic? The Australian Medicare Benefits Schedule includes the 75+HA, developed as a proactive primary care opportunity for general practitioners and practice nurses to identify issues affecting community-dwelling older people's health and well being. The aim of the 75+HA is to consider a broad range of factors that could affect physical, psychological and social functioning, which, in turn, affects overall health, and the capacity of older people to live independently in the community. Underlying the 75+HA is the importance of detecting early functional decline to enable healthy aging. What does this paper add? There is scant, if any, attention in the literature to the views of consumers who have completed a 75+HA, especially with regard to whether this opportunity is conducted with a person-centred mindset. This paper addresses this gap. Even after participating in the 75+HA, most participants were unclear as to the purpose of the assessment, what information had been recorded and what would happen from any concerns identified in the assessment. Comments about the 75+HA included that it did not ask people about their goals and what comprised their functionality to ensure their independent living. What are the implications for practitioners? A person-centred approach requires active collaboration between primary health professionals and older people who are living the process of, and planning for, aging-in-place. Assessments like the 75+HA can assist in identifying whether older people may be experiencing early signs of functional decline, even if older people self-report living without problems in their home. Practitioners need to ask questions of older people and respond to what they say with a person-centred mindset.

The role of patient personality in the identification of depression in older primary care patients.

PubMed

McCray, Laura W; Bogner, Hillary R; Sammel, Mary D; Gallo, Joseph J

2007-11-01

Our aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. We examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care. Copyright 2007 John Wiley & Sons, Ltd.

A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series

PubMed Central

Bigford, Gregory E; Mendez, Armando J; Betancourt, Luisa; Burns-Drecq, Patricia; Backus, Deborah; Nash, Mark S

2017-01-01

Introduction This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS). Case presentation: Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides. Discussion: We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision. PMID:28382218

State of personal hygiene among primary school children: A community based cohort study.

PubMed

Ahmadu, Baba Usman; Rimamchika, Musa; Ibrahim, Ahmad; Nnanubumom, Andy Angela; Godiya, Andrew; Emmanuel, Pembi

2013-01-01

Good personal hygiene in primary school children could be effective towards preventing infectious diseases. This work examined personal cleanliness of primary school children in Banki based on the following variables: bathing, state of uniforms, hair, nails and oral hygiene. One hundred and fifty primary school children in Banki community were selected using the cluster random sampling method. Analysis of variance was used to compare means and to test for significance of data, and coefficient of correlation to investigate the relationship between cleanliness and age of subjects. There were 87 (58 %) boys and 63 (42 %) girls in a ratio of 1.4:1. Ninety six (64 %) pupils belong to low socioeconomic class. Whereas, 53 (35.3 %) were found within 11-13 years age group, the overall mean age was 9 years (Standard deviation [SD] was 2.2), 95 CI (7.0 - 11.0) years. Comparing means for the different categories of personal hygiene, there was significant difference (F= 61.47, p < 0.0001). General personal cleanliness in our participants improved with age, and a positive significant correlation was observed between age and personal cleanliness in (r = 0.971, p = 0.026). In conclusion, significant number of primary school pupils in Banki community had good personal hygiene, which was observed to be directly proportional with age. Therefore, all efforts towards quality health education on personal hygiene as a means of primary prevention of illnesses in primary school pupils should be sustained.

Personalized, bilateral whole-body somatosensory cortex stimulation to relieve fatigue in multiple sclerosis.

PubMed

Cancelli, Andrea; Cottone, Carlo; Giordani, Alessandro; Migliore, Simone; Lupoi, Domenico; Porcaro, Camillo; Mirabella, Massimiliano; Rossini, Paolo Maria; Filippi, Maria Maddalena; Tecchio, Franca

2017-07-01

The patients suffering from multiple sclerosis (MS) often consider fatigue the most debilitating symptom they experience, but conventional medicine currently offers poorly efficacious therapies. We executed a replication study of an innovative approach for relieving MS fatigue. According to the sample size estimate, we recruited 10 fatigued MS patients who received 5-day transcranial direct current stimulation (tDCS) in a randomized, double-blind, Sham-controlled, crossover study, with modified Fatigue Impact Scale (mFIS) score reduction at the end of the treatment as primary outcome. A personalized anodal electrode, shaped on the magnetic resonance imaging (MRI)-derived individual cortical folding, targeted the bilateral whole-body primary somatosensory cortex (S1) with an occipital cathode. The amelioration of fatigue symptoms after Real stimulation (40% of baseline) was significantly larger than after Sham stimulation (14%, p = 0.012). Anodal whole body S1 induced a significant fatigue reduction in mildly disabled MS patients when the fatigue-related symptoms severely hampered their quality of life. This second result in an independent group of patients supports the idea that neuromodulation interventions that properly select a personalized target might be a suitable non-pharmacological treatment for MS fatigue.

Dual tuning in creative processes: Joint contributions of intrinsic and extrinsic motivational orientations.

PubMed

Gong, Yaping; Wu, Junfeng; Song, Lynda Jiwen; Zhang, Zhen

2017-05-01

Intrinsic and extrinsic motivational orientations often coexist and can serve important functions. We develop and test a model in which intrinsic and extrinsic motivational orientations interact positively to influence personal creativity goal. Personal creativity goal, in turn, has a positive relationship with incremental creativity and an inverted U-shaped relationship with radical creativity. In a pilot study, we validated the personal creativity goal measure using 180 (Sample 1) and 69 (Sample 2) employees from a consulting firm. In the primary study, we tested the overall model using a sample of 657 research and development employees and their direct supervisors from an automobile firm. The results support the hypothesized model and yield several new insights. Intrinsic and extrinsic motivational orientations synergize with each other to strengthen personal creativity goal. Personal creativity goal in turn benefits incremental and radical creativity, but only up to a certain point for the latter. In addition to its linear indirect relationship with incremental creativity, intrinsic motivational orientation has an inverted U-shaped indirect relationship with radical creativity via personal creativity goal. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Association between personality traits and future choice of specialisation among Swedish doctors: a cross-sectional study.

PubMed

Bexelius, Tomas S; Olsson, Caroline; Järnbert-Pettersson, Hans; Parmskog, Malin; Ponzer, Sari; Dahlin, Marie

2016-08-01

Medical students' choice of their future specialty is influenced by several factors, including working conditions and type of patient relations. The aim of this study was to investigate the association between the choice of specialty and personality traits. This is a cross-sectional questionnaire-based study of 399 alumni from Karolinska Institutet Medical School who were assumed to undergo specialty training at the time of the survey in 2013. The Big Five Inventory was used to assess the personality traits extraversion, agreeableness, conscientiousness, neuroticism and openness to experience. Medical specialties were categorised as primary care, psychiatry, internal medicine and surgical and hospital service specialties. Adjustments were made for demographic factors and the method of selection for medical school admission. The response rate was 72% (n=289, of which 262 were in training to become specialists). Among these, surgeons scored lower in agreeableness than physicians in primary care, internal medicine and hospital services. Psychiatrists and hospital service physicians showed lower conscientiousness compared with surgeons. We found distinctive differences in personality traits between medical specialties even after adjusting for other potential explanatory variables. Since there are differences between specialties, for example, surgeons and psychiatrists, this supports previous findings that personality may affect medical students' specialty choice also in a Swedish setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Functional connectivity in the resting brain as biological correlate of the Affective Neuroscience Personality Scales.

PubMed

Deris, Nadja; Montag, Christian; Reuter, Martin; Weber, Bernd; Markett, Sebastian

2017-02-15

According to Jaak Panksepp's Affective Neuroscience Theory and the derived self-report measure, the Affective Neuroscience Personality Scales (ANPS), differences in the responsiveness of primary emotional systems form the basis of human personality. In order to investigate neuronal correlates of personality, the underlying neuronal circuits of the primary emotional systems were analyzed in the present fMRI-study by associating the ANPS to functional connectivity in the resting brain. N=120 healthy participants were invited for the present study. The results were reinvestigated in an independent, smaller sample of N=52 participants. A seed-based whole brain approach was conducted with seed-regions bilaterally in the basolateral and superficial amygdalae. The selection of seed-regions was based on meta-analytic data on affective processing and the Juelich histological atlas. Multiple regression analyses on the functional connectivity maps revealed associations with the SADNESS-scale in both samples. Functional resting-state connectivity between the left basolateral amygdala and a cluster in the postcentral gyrus, and between the right basolateral amygdala and clusters in the superior parietal lobe and subgyral in the parietal lobe was associated with SADNESS. No other ANPS-scale revealed replicable results. The present findings give first insights into the neuronal basis of the SADNESS-scale of the ANPS and support the idea of underlying neuronal circuits. In combination with previous research on genetic associations of the ANPS functional resting-state connectivity is discussed as a possible endophenotype of personality. Copyright © 2016 Elsevier Inc. All rights reserved.

The mediating role of mentalizing capacity between parents and peer attachment and adolescent borderline personality disorder.

PubMed

Beck, Emma; Sharp, Carla; Poulsen, Stig; Bo, Sune; Pedersen, Jesper; Simonsen, Erik

2017-01-01

Insecure attachment is a precursor and correlate of borderline personality disorder. According to the mentalization-based theory of borderline personality disorder, the presence of insecure attachment derails the development of the capacity to mentalize, potentially resulting in borderline pathology. While one prior study found support for this notion in adolescents, it neglected a focus on peer attachment. Separation from primary caregivers and formation of stronger bonds to peers are key developmental achievements during adolescence and peer attachment warrants attention as a separate concept. In a cross-sectional study, female outpatients (M age 15.78=, SD = 1.04) who fulfilled DSM-5 criteria for BPD ( N  = 106) or met at least 4 BPD criteria ( N  = 4) completed self-reports on attachment to parents and peers, mentalizing capacity (reflective function) and borderline personality features. Our findings suggest that in a simple mediational model, mentalizing capacity mediated the relation between attachment to peers and borderline features. In the case of attachment to parents, the mediational model was not significant. The current study is the first to evaluate this mediational model with parent and peer attachment as separate concepts and the first to do so in a sample of adolescents who meet full or sub-threshold criteria for borderline personality disorder. Findings incrementally support that mentalizing capacity and attachment insecurity, also in relation to peers, are important concepts in theoretical approaches to the development of borderline personality disorder in adolescence. Clinical implications are discussed.

The Scientific Study of Parents and Caregivers of Children with ASD: A Flourishing Field but Still Work to Be Done

ERIC Educational Resources Information Center

Nordahl-Hansen, Anders; Hart, Logan; Øien, Roald A.

2018-01-01

There is a long history of research on parents and caregivers of individuals within autism. Parents and other primary caregivers typically play the most important part in the lives of persons with ASD although the need for support as the child becomes of age varies widely. This special issue includes 30 articles on central areas related to…

Patient attitudes toward using computers to improve health services delivery.

PubMed

Sciamanna, Christopher N; Diaz, Joseph; Myne, Puja

2002-09-11

The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients. Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001. Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). In multivariate testing, the only variable that was associated with acceptability of the point of care computerized prompts was patient's confidence in their ability to answer questions about their health using a computer (beta = 0.39, p =.001). Concerns about data security were expressed by 36.3% of subjects, but were not related to acceptability of the prompts. Support for using computers to generate point of care prompts to improve quality-oriented processes of care was high in our sample, but may be contingent on patients feeling familiar with their personal medical history.

Supporting family carers through telephone-mediated group programs: opportunities for gerontological social workers.

PubMed

Shanley, Chris

2008-01-01

Telephone-mediated group programs are an important but under-utilized medium for reaching frail or disabled older persons' family carers who are in need of support. The primary purpose and style of group programs can range across a broad spectrum-encompassing educational, supportive and therapeutic types. Gerontological social workers are the members of the multidisciplinary care team whose training, experience and supervision makes them most suitable for facilitating this broad range of group types. Drawing on the experience of training a number of group facilitators, this article provides suggestions for social workers contemplating the use of telephone-mediated groups and highlights groupwork skills peculiar to conducting group programs via the telephone.

Supporting Family Carers Through Telephone-Mediated Group Programs: Opportunities For Gerontological Social Workers.

PubMed

Shanley, Chris

2008-01-01

Telephone-mediated group programs are an important but under-utilized medium for reaching frail or disabled older persons' family carers who are in need of support. The primary purpose and style of group programs can range across a broad spectrum–encompassing educational, supportive and therapeutic types. Gerontological social workers are the members of the multidisciplinary care team whose training, experience and supervision makes them most suitable for facilitating this broad range of group types. Drawing on the experience of training a number of group facilitators, this article provides suggestions for social workers contemplating the use of telephone-mediated groups and highlights groupwork skills peculiar to conducting group programs via the telephone.

Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse‐led clinics

PubMed Central

Neely, Dermot; Humphries, Steve E.; Saunders, Tanya; Gray, Val; Gordon, Louise; Payne, Jules; Carter, Slade; Neuwirth, Clare; Rees, Alan; Gallagher, Hazel

2015-01-01

Abstract Rationale, aims and objectives In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider the possibility of FH in adults who have raised total cholesterol concentrations, thereby improving the detection of people with FH. Methods Utilizing clinical decision support software (Audit+) we developed an FH Audit Tool and implemented a systematic audit of electronic medical records within GP practices, first identifying all patients diagnosed with FH or possible FH and next electronically flagging patients with a recorded total cholesterol of >7.5 mmol L−1 or LDL‐C > 4.9 mmol L−1 (in adults), for further assessment. After a 2‐year period, a nurse‐led clinic was introduced to screen more intensely for new FH index cases. We evaluated if these interventions increased the prevalence of FH closer to the expected prevalence from epidemiological studies. Results The baseline prevalence of FH within Medway CCG was 0.13% (1 in 750 persons). After 2 years, the recorded prevalence of diagnosed FH increased by 0.09% to 0.22% (1 in 450 persons). The nurse advisor programme ran for 9 months (October 2013–July 2014) and during this time, the recorded prevalence of patients diagnosed with FH increased to 0.28% (1 in 357 persons) and the prevalence of patients ‘at risk and unscreened’ reduced from 0.58% to 0.14%. Conclusions Our study shows that two simple interventions increased the detection of FH. This systematic yet simple electronic case‐finding programme with nurse‐led review allowed the identification of new index cases, more than doubling the recorded prevalence of detected disease to 1 in 357 (0.28%). This study shows that primary care has an important role in identifying patients with this condition. PMID:26608940

Personal hygiene among primary school children living in a slum of Kolkata, India.

PubMed

Sarkar, M

2013-09-01

For children, maintenance of personal hygiene helps to improve the quality of life and longevity. This is of particular importance in a slum community with compromised living situation. This study was undertaken to find out the knowledge and practice of personal hygiene among the primary school children living in a slum area, to identify any misconception among them regarding the maintenance of personal hygiene, to find out their morbidity pattern, and also to elicit the relationship between practice of personal hygiene among the children and the literacy status of their mother. A cross-sectional observational study was conducted among 104 primary school children of a primary school situated in the slum area of Chetla, Kolkata, India with the help of a predesigned, pre-tested and structured questionnaire. Data were analyzed statistically by simple proportions and tests of significance. It was found that the female students were more knowledgeable than the male students regarding the maintenance of personal hygiene. There was a wide gap between practice and knowledge of personal hygiene among the primary school children living in the slum area. Even, misconceptions do exist on certain indicators of personal hygiene among the students. Statistically significant association was observed between practices of personal hygiene among the primary school children and the literacy status of their mother. Future of a society depends considerably on the health of its children. The parents and the school teachers, as constructive shapers of children's health behaviors, should play a responsible role in early education of children on personal hygiene.

'Personal Care' and General Practice Medicine in the UK: A qualitative interview study with patients and General Practitioners.

PubMed

Adam, Rachel

2007-08-31

Recent policy and organisational changes within UK primary care have emphasised graduated access to care, speed of access to the first available general practitioner (GP) and care being provided by a range of healthcare professionals. These trends have been strengthened by the current GP contract and Quality and Outcomes Framework (QOF). Concern has been expressed that the potential for personal care is being diminished as a result and that this will reduce quality standards. This paper presents data from a study that explored with patients and GPs what personal care means and whether it has continuing importance to them. A semi-structured questionnaire was used to interview participants and Framework Analysis supported analysis of emerging themes. Twenty-nine patients, mainly women with young children, and twenty-three GPs were interviewed from seven practices in Lothian, Scotland, ranged by practice size and relative deprivation score. Personal care was defined mainly, though not exclusively, as care given within the context of a continuing relationship in which there is an interpersonal connection and the doctor adopts a particular consultation style. Defined in this way, it was reported to have benefits for both health outcomes and patients' experience of care. In particular, such care was thought to be beneficial in attending to the emotions that can be elicited when seeking and receiving health care and in enabling patients to be known by doctors as legitimate seekers of care from the health service. Its importance was described as being dependent upon the nature of the health problem and patients' wider familial and social circumstances. In particular, it was found to provide support to patients in their parenting and other familial caring roles. Personal care has continuing salience to patients and GPs in modern primary care in the UK. Patients equate the experience of care, not just outcomes, with high quality care. As it is mainly conceptualised and experienced as care within the context of a continuing relationship, policies and organisational arrangements that support and give incentives to this must be in place. These preferences are not strongly reflected in the QOF. Specific questions need to be addressed by future audit and research on the impact of the contract on these aspects of service.

Combined Diet and Physical Activity Promotion Programs for Prevention of Diabetes: Community Preventive Services Task Force Recommendation Statement.

PubMed

Pronk, Nicolaas P; Remington, Patrick L

2015-09-15

Community Preventive Services Task Force recommendation on the use of combined diet and physical activity promotion programs to reduce progression to type 2 diabetes in persons at increased risk. The Task Force commissioned an evidence review that assessed the benefits and harms of programs to promote and support individual improvements in diet, exercise, and weight and supervised a review on the economic efficiency of these programs in clinical trial, primary care, and primary care-referable settings. Adolescents and adults at increased risk for progression to type 2 diabetes. The Task Force recommends the use of combined diet and physical activity promotion programs by health care systems, communities, and other implementers to provide counseling and support to clients identified as being at increased risk for type 2 diabetes. Economic evidence indicates that these programs are cost-effective.

A qualitative approach to social support and breast-feeding decisions.

PubMed

Barona-Vilar, Carmen; Escribá-Agüir, Vincenta; Ferrero-Gandía, Raquel

2009-04-01

to explore pregnant women's perceptions and personal experiences of the influence of formal and informal social support on breast-feeding decision-making, in relation to breast-feeding initiation and duration. qualitative focus groups and interviews. four primary-care centres in Valencia, Spain. 19 primiparous women in their first trimester of pregnancy participated in focus groups and 12 primiparous and multiparous women in their third trimester of pregnancy participated in interviews. Women had different socio-demographic backgrounds and socio-economic status. women's perceptions and personal experiences of formal and informal social support of breast feeding may be linked to age and socio-cultural status. Women from higher socio-cultural backgrounds took their partner's opinion and support more into account when choosing breast feeding. They also conceded great importance to formal health support, and employed mothers wished to have more institutional support. Among women from lower socio-cultural backgrounds, friends were the closest social network and had the greatest influence on feeding decisions. They perceived some contradictions in health-promotion messages on breast feeding, and most of them preferred to leave work after birth to exclusively care for their baby. Younger women, without previous experience of breast feeding or possibility of receiving tangible support from their mothers, wanted more practical health-care support (e.g. providing skills in breast-feeding technique). breast-feeding promotion strategies should take into account women's different characteristics. Health professionals should consider offering postnatal support as a follow-up to practical support (e.g. breast-feeding workshops).

Deficiencies in social relationships of individuals with neurosis

PubMed Central

Srivastava, Sunil

2006-01-01

Background: Social interaction and network of individuals with neurosis have been reported to be inadequate. Aim: To measure deficiencies in the social network of individuals with neurosis. Methods: Fifty consecutive patients with neurosis attending the OPD of the Department of Psychiatry, King George's Medical College, Lucknow, who were diagnosed as per the criteria of ICD-9, were included in the study. A control group of 40 healthy persons matched for age, sex, education and marital status was also taken. Interaction with the primary group (defined as consisting of all kin, nominated friends, work associates and neighbours) was measured by the Social Interaction Schedule of Henderson et al. as modified for the Indian population. Results: Patients reported significantly higher mean duration of unpleasant but affectively intense interaction with one person within or outside the primary group and affectively unpleasant and intense interaction with more than one person within or outside the primary group or affectively superficial but unpleasant interaction with one or more person of the primary group. Healthy subjects reported more of pleasant interaction with one person within or outside the primary group and affectively intense and pleasant interaction with more than one person within or outside the primary group or affectively superficial but pleasant interaction with one or more persons of the primary group; the difference was statistically significant as compared to patients with neurosis. Conclusion: The primary group of patients with neurosis was significantly smaller in numerical size as compared with that of controls and in terms of the total time spent with members of the primary group, patients with neurosis reported more interactions of unpleasant type and less of pleasant type as compared with healthy controls. PMID:20844645

Chronic Pain Predicting Reciprocity of Support Among Vulnerable, Predominantly African-American Persons Living with HIV/AIDS.

PubMed

Mitchell, Mary M; Isenberg, Sarina R; Maragh-Bass, Allysha C; Knowlton, Amy R

2018-06-01

Among persons living with HIV/AIDS (PLHIV), approximately two-thirds report moderate to severe pain. Chronic pain can negatively affect PLHIVs' health behaviors and outcomes by interfering with their reciprocity (mutual exchange) of support in their caregiving relationships, which has been found to be associated with PLHIVs' antiretroviral adherence and viral suppression. Data were longitudinal (baseline, 6- and 12-month follow-up) from 383 PLHIV who were formerly or currently using drugs. Utilizing a longitudinal lagged fixed effects structural equation model, we found that never having pain in the past 6 months was predictive of increased reciprocity of support. Sub-analyses by care relationship type revealed never having pain was a significant predictor of greater reciprocity for sexual partner caregiving dyads, but not for kin or friend caregiving dyads. Our study emphasizes the importance of pain management in quality caregiving relationships characterized by reciprocity, which has consistently been found to be associated with stronger, more supportive caregiving relationships and better quality of life. Our findings suggest the importance of pain management intervention for improving reciprocity between vulnerable PLHIVs and their primary caregivers, especially between PLHIVs and caregivers who are current or former sexual partners.

The Role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction Among Individuals in Recovery from Alcohol and Drug Problems

PubMed Central

Laudet, Alexandre B.; Morgen, Keith; White, William L.

2006-01-01

SUMMARY Many recovering substance users report quitting drugs because they wanted a better life. The road of recovery is the path to a better life but a challenging and stressful path for most. There has been little research among recovering persons in spite of the numbers involved, and most research has focused on substance use outcomes. This study examines stress and quality of life as a function of time in recovery, and uses structural equation modeling to test the hypothesis that social supports, spirituality, religiousness, life meaning, and 12-step affiliation buffer stress toward enhanced life satisfaction. Recovering persons (N = 353) recruited in New York City were mostly inner-city ethnic minority members whose primary substance had been crack or heroin. Longer recovery time was significantly associated with lower stress and with higher quality of life. Findings supported the study hypothesis; the ‘buffer’ constructs accounted for 22% of the variance in life satisfaction. Implications for research and clinical practice are discussed. PMID:16892161

Predictors of depression screening rates of nurses receiving a personal digital assistant-based reminder to screen.

PubMed

Schnall, Rebecca; Currie, Leanne M; Jia, Haomiao; John, Rita Marie; Lee, Nam-Ju; Velez, Olivia; Bakken, Suzanne

2010-07-01

The purpose of this study was to determine if race/ethnicity, payer type, or nursing specialty affected depression screening rates in primary care settings in which nurses received a reminder to screen. The sample comprised 4,160 encounters in which nurses enrolled in advanced practice training were prompted to screen for depression using the Patient Health Questionnaire (PHQ)-2/PHQ-9 integrated into a personal digital assistant-based clinical decision support system for depression screening and management. Nurses chose to screen in response to 52.5% of reminders. Adjusted odds ratios showed that payer type and nurse specialty, but not race/ethnicity, significantly predicted proportion of patients screened.

"Supporting Early Career Women in the Geosciences through Online Peer-Mentoring: Lessons from the Earth Science Women's Network (ESWN)"

NASA Astrophysics Data System (ADS)

Holloway, T.; Hastings, M. G.; Barnes, R. T.; Fischer, E. V.; Wiedinmyer, C.; Rodriguez, C.; Adams, M. S.; Marin-Spiotta, E.

2014-12-01

The Earth Science Women's Network (ESWN) is an international peer-mentoring organization with over 2000 members, dedicated to career development and community for women across the geosciences. Since its formation in 2002, ESWN has supported the growth of a more diverse scientific community through a combination of online and in-person networking activities. Lessons learned related to online networking and community-building will be presented. ESWN serves upper-level undergraduates, graduate students, professionals in a range of environmental fields, scientists working in federal and state governments, post-doctoral researchers, and academic faculty and scientists. Membership includes women working in over 50 countries, although the majority of ESWN members work in the U.S. ESWN increases retention of women in the geosciences by enabling and supporting professional person-to-person connections. This approach has been shown to reduce feelings of isolation among our members and help build professional support systems critical to career success. In early 2013 ESWN transitioned online activities to an advanced social networking platform that supports discussion threads, group formation, and individual messaging. Prior to that, on-line activities operated through a traditional list-serve, hosted by the National Center for Atmospheric Research (NCAR). The new web center, http://eswnonline.org, serves as the primary forum for members to build connections, seek advice, and share resources. For example, members share job announcements, discuss issues of work-life balance, and organize events at professional conferences. ESWN provides a platform for problem-based mentoring, drawing from the wisdom of colleagues across a range of career stages.

Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre

PubMed Central

Patterson, Christine; Arthur, Heather; Peachey, Gladys; Vohra, Julie; Price, David; Pearson, Dave; Mariani, Rob

2013-01-01

Importance Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs) which involve multiple health disciplines working together to provide team-based care. Objective The purpose of this project was: (1) to explore the use of an online resource, the Interprofessional Resource Centre (IRC), when planning for interprofessional change and; (2) to explore the experience of planning interprofessional change. Design and setting Six FHTs organized under the structure of one Local Health Integrated Network (LHIN) in Ontario, Canada. Intervention Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity. Results Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support. Conclusion and relevance Based on the results of the study, it appears that online resource centers do have some value in knowledge translation when combined with in-person meetings. In exploring the planning of interprofessional change in primary health care teams, it was found that buy-in with physicians is a key challenge. PMID:23901309

Efficacy of a multicomponent support programme for the caregivers of disabled persons: a randomised controlled study.

PubMed

Ryynänen, O-P; Nousiainen, P; Soini, E J O; Tuominen, S

2013-07-01

The goal of the present work was to measure the efficacy of a multicomponent programme designed to provide tailored support for the caregivers of disabled persons. A total of 135 caregivers-care receiver dyads were randomly divided into an intervention group (n = 66) and a control group (n = 69). One-third of the care receivers were demented, and two-thirds had other diseases. Health centres (publicly funded primary health care systems) in 8 rural and urban communities in southeast Finland. The multicomponent support programme for the caregivers consisted of a 2-week rehabilitation period. The control group received standard care. Continuation of the caregiver and care receiver relationship, care receiver mortality at the 2-year follow-up as well as the health-related quality of life (15D scale) and Zung's depression scale of the caregiver at the 1-year follow-up were evaluated. At the 2-year follow-up, the caregiver-care receiver relationship was terminated for any reason in 11 cases (17%) in the intervention group, and in 25 cases (36%) in the control group. After adjusting, the primary outcome (i.e., termination of care giving for any reason) indicated statistical significance (p = 0.04) with a hazard rate of 1.83 (95% confidence interval 1.03-3.29). With a similar adjustment, the difference in mortality and placement to institutional care between the two groups demonstrated a trend towards statistical significance. The caregivers' health, as related to quality of life and depressive symptoms, remained unchanged in both groups at the 1-year follow-up. These results indicate that a tailored support programme for caregivers may help the caregiver to continue the caregiver-care receiver relationship and delay institutionalization.

Diabetes Patient Tracker, a personal digital assistant-based diabetes management system for primary care practices in Oklahoma.

PubMed

Nagykaldi, Zsolt; Mold, James W

2003-01-01

It has been demonstrated that electronic patient registries combined with a clinical decision support system have a significant positive impact on the documentation and delivery of services provided by health care professionals. While implementation of available commercial systems has not always been proven effective in a number of primary care practices, development and implementation of such a system in a practice-based research network might enhance successful implementation. Physicians in our practice-based research network (Oklahoma Physicians Resource/Research Network) initiated a project that aimed at designing, testing, and implementing a personal digital assistant-based diabetes management system. We utilized the "best practice" approach to determine the principles on which the application must operate. System development and beta testing were also accomplished based on the direct feedback of user clinicians. Practice Enhancement Assistants (PEAs) were available in the practices for assistance with implementation. Implementation of the Diabetes Patient Tracker (DPT) resulted in a significant improvement (p<0.05) in nine of 10 diabetic quality of care measures compared with pre-intervention levels in 20 primary care practices. Regular PEA visits similarly increased the number of foot exams and retinal exams performed in the last year (p=0.03 and 0.02, respectively). DPT is a low-cost, feasible, easily implementable, and very effective paper-less tool that significantly improves patient care and documentation in primary care practices.

[Improving Mental Health Care in People at Risk for Getting Homeless].

PubMed

Salize, Hans Joachim; Arnold, Maja; Uber, Elisa; Hoell, Andreas

2017-01-01

Objective: Overall aim was to reduce the untreated prevalence in persons with untreated mental disorders and at risk for loosing accommodation and descending into homelessness. Primary aim was treatment initiation and treatment adherence by motivational interviewing. Secondary aims were to reduce social or financial problems. Methods: Persons at risk were identified in social welfare services or labour agencies, diagnosed and motivated to initiate treatment in a community mental health service. Results: 58 persons were included, 24 were referred to regular mental health care, 8 were stabilized enough after the initial motivational to refrain from acute treatment, 26 dropped out. During a 6-month follow-up quality of life and social support was improved (partly statistically significant) and psycho-social needs for care decreased. Conclusion: Motivational interviewing is likely to increase insight into illness and acceptance of mental health care in untreated persons with mental disorders at risk for social decline. © Georg Thieme Verlag KG Stuttgart · New York.

Essential elements of the relationship between the nurse and the person with advanced and terminal cancer: A meta-ethnography.

PubMed

Errasti-Ibarrondo, Begoña; Pérez, Mercedes; Carrasco, José Miguel; Lama, Marcos; Zaragoza, Amparo; Arantzamendi, María

2015-01-01

The purpose of this study was to understand how the nurse-patient relationship is interpreted by nurses and patients with advanced and terminal cancer (ATC) and which aspects of this relationship are perceived to be the most valuable for patients. A literature search was conducted using the Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, and PsycINFO databases and was supported by reviewing reference lists. Nine articles were selected, and the quality of them was assessed using the Critical Appraisal Skills Program. A synthesis was performed following the seven-stage meta-ethnography described by Noblit and Hare. Four primary themes were derived from the synthesis: (a) being with and being for the person with ATC, (b) time is required for establishing the relationship, (c) the influence of the primary actors in the relationship: the nurse and the person with ATC, and (d) the effects of the relationship on both the nurse and the person with ATC. Finally, an explanatory model of the relationship between the nurse and the patient with ATC was developed, which shows that the relationship is an interpersonal process with several key elements including familiarity with one another, reciprocity, respect, and confidence. The nurses and patients with ATC perceive that their relationship is important and beneficial. The patients demand a helping and caring relationship focused on them as persons, not only as patients. Patients with ATC and nurses consider their relationship to be important and beneficial. An approach to caring focused on patients as persons should be fostered among health care professionals and students. Copyright © 2015 Elsevier Inc. All rights reserved.

Social participation of children age 8-12 with SLI.

PubMed

Sylvestre, Audette; Brisson, Jacinthe; Lepage, Céline; Nadeau, Line; Deaudelin, Isabelle

2016-01-01

Two objectives are being pursued: (1) to describe the level of social participation of children aged 8-12 presenting a specific language impairment (SLI) and (2) to identify personal and family factors associated with their level of social participation. This cross-sectional study was conducted among 29 children with SLI and one of their parents. Parental stress and family adversity were measured as risk factors. The measure of life habits (LIFE-H) adapted to children aged 5-3 was used to measure social participation. The assumption that social participation of these children is impaired in relation to the communication dimension was generally confirmed. The statements referring to the "communication in the community" and "written communication" are those for which the results are weaker. "Communication at home" is made easier albeit with some difficulties, while "telecommunication" is totally preserved. A high level of parental stress is also confirmed, affecting the willingness of parents to support their child's autonomy. The achievement of a normal lifestyle of children with SLI is upset in many spheres of life. Methods of intervention must better reflect the needs and realities experienced by these children in their various living environments, in order to optimize social participation, and consequently, to improve their well-being and that of their families. The need to develop strategies to develop children's independence and to reduce parental stress must be recognized and all stakeholders need to be engaged in the resolution of this challenge. The realization of life habits of SLI children is compromised at various levels, especially in the domain related to "communication in the community" and "written communication". Speech-language pathologists must consider providing ongoing support throughout the primary years of these children and during adolescence, to promote and facilitate the continued realization of life habits of SLI persons. Providing ongoing support throughout the primary years and thereafter is needed to facilitate the continuing realization of life habits of SLI persons. Parents of children with SLI experience considerable stress in relation to the exercise of their parental roles. It is important to intervene and to support parents to promote autonomy for their SLI children.

Assessment of primary care services and perceived barriers to care in persons with disabilities.

PubMed

Harrington, Amanda L; Hirsch, Mark A; Hammond, Flora M; Norton, H James; Bockenek, William L

2009-10-01

To determine what percentage of persons with disabilities have a primary care provider, participate in routine screening and health maintenance examinations, and identify perceived physical or physician barriers to receiving care. A total of 344 surveys, consisting of 66 questions, were collected from adults with disabilities receiving care at an outpatient rehabilitation clinic. A total of 89.5% (95% CI 86.3%-92.8%) of participants reported having a primary care physician. Younger persons (P < 0.0001), men (P < 0.02), persons with brain injury (P < 0.05), or persons with amputations (P < 0.05) were less likely to have a primary care physician. Participant report of screening for alcohol, nonprescription drug use, and safety with relationships at home ranged from 26.6% to 37.5% compared with screening for depression, diet, exercise, and smoking (64.5%-70%). Completion rates of age- and gender-appropriate health maintenance examinations ranged from 42.4% to 90%. A total of 2.67% of participants reported problems with physical access at their physician's office, and 36.4% (95% CI 30.8%-42.1%) of participants reported having to teach their primary care physician about their disability. Most persons with disabilities have a primary care physician. In general, completion rates for routine screening and health maintenance examinations were high. Perceived deficits in primary care physicians' knowledge of disability issues seem more prevalent than physical barriers to care.

Women's characteristics and gender role attitudes: support for father involvement with children.

PubMed

Hoffman, C D; Moon, M

1999-12-01

Women's (N = 364) personal characteristics and gender role attitudes were examined in relation to their support for father involvement with children. The respondents completed measures of trust, attitudes toward women, hostility, self-esteem, and father involvement. Nontraditional gender role attitudes, positive ratings of their own interpersonal trust, and low hostility toward men were predictive of the respondents' support for father involvement. Participant demographics (including age, marital status, and number of children) were unrelated to their views of father involvement. Results indicate the importance of considering the characteristics and attitudes women bring to the co-parental relationship in the examination of factors influencing father involvement with children. Findings are discussed within the context of mothers' primary child-care and gatekeeping roles.

Phase 1 pilot study of e-mail support for people with long term conditions using the Internet

PubMed Central

2011-01-01

Background Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group. Methods Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes. Results Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable. Conclusion E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs. PMID:21466699

Phase 1 pilot study of e-mail support for people with long term conditions using the Internet.

PubMed

Sheaves, Bryony; Jones, Ray B; Williamson, Graham R; Chauhan, Rohan

2011-04-05

Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group. Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes. Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable. E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs.

Energy balance related behaviour: personal, home- and friend-related factors among schoolchildren in Europe studied in the ENERGY-project.

PubMed

te Velde, Saskia J; Singh, Amika; Chinapaw, Mai; De Bourdeaudhuij, Ilse; Jan, Natasa; Kovacs, Eva; Bere, Elling; Vik, Froydis N; Bringolf-Isler, Bettina; Manios, Yannis; Moreno, Luis; Brug, Johannes

2014-01-01

To design interventions that target energy balance-related behaviours, knowledge of primary schoolchildren's perceptions regarding soft drink intake, fruit juice intake, breakfast consumption, TV viewing and physical activity (PA) is essential. The current study describes personal beliefs and attitudes, home- and friend-related variables regarding these behaviours across Europe. Cross-sectional study in which personal, family and friend -related variables were assessed by validated questionnaires, and dichotomized as favourable versus unfavourable answers. Logistic regression analyses were conducted to estimate proportions of children giving unfavourable answers and test between-country differences. A survey in eight European countries. A total of 7903 10-12 year old primary schoolchildren. A majority of the children reported unfavourable attitudes, preferences and subjective norms regarding soft drink, fruit juice intake and TV viewing accompanied with high availability and accessibility at home. Few children reported unfavourable attitudes and preferences regarding breakfast consumption and PA. Many children reported unfavourable health beliefs regarding breakfast consumption and TV viewing. Substantial differences between countries were observed, especially for variables regarding soft drink intake, breakfast consumption and TV viewing. The surveyed children demonstrated favourable attitudes to some healthy behaviours (PA, breakfast intake) as well as to some unhealthy behaviours (soft drink consumption, TV viewing). Additionally, many children across Europe have personal beliefs and are exposed to social environments that are not supportive to engagement in healthy behaviours. Moreover, the large differences in personal, family and friend-related variables across Europe argue for implementing different strategies in the different European countries.

Awareness and Awakening: A Narrative-Oriented Inquiry of Undergraduate Students' Development of Mindful Agency in China

PubMed Central

Wang, Qing; Law, Ho Chung; Li, Yan; Xu, Zhanfei; Pang, Weiguo

2017-01-01

The article explores undergraduate students' experiences of developing mindful agency as a positive learning disposition, their perceived change as a learner, and the possible impact of mindful agency coaching on students' learning and personal growth, using a narrative research method. Seventy Chinese undergraduate students generated personal reflective journals and eight participants' journals were selected to enter into the narrative-oriented inquiry. Our analysis revealed a number of primary themes based on which we produced a meta-story. The supplements of the story were exacted for further critical cross-case discussion. The finding indicated that the multifaceted development of mindful agency involved learning methods, emotional regulation, strategic thinking, and awareness of planning, openness to experience, self-acceptance and self-esteem, and learning engagement, with enhanced sense of personal awareness and awakening. The coaching was supportive for students to foster positive self-identities and become more reflective, mindful, and self-determined. PMID:29209260

Modelling psychiatric and cultural possession phenomena with suggestion and fMRI.

PubMed

Deeley, Quinton; Oakley, David A; Walsh, Eamonn; Bell, Vaughan; Mehta, Mitul A; Halligan, Peter W

2014-04-01

Involuntary movements occur in a variety of neuropsychiatric disorders and culturally influenced dissociative states (e.g., delusions of alien control and attributions of spirit possession). However, the underlying brain processes are poorly understood. We combined suggestion and fMRI in 15 highly hypnotically susceptible volunteers to investigate changes in brain activity accompanying different experiences of loss of self-control of movement. Suggestions of external personal control and internal personal control over involuntary movements modelled delusions of control and spirit possession respectively. A suggestion of impersonal control by a malfunctioning machine modelled technical delusions of control, where involuntary movements are attributed to the influence of machines. We found that (i) brain activity and/or connectivity significantly varied with different experiences and attributions of loss of agency; (ii) compared to the impersonal control condition, both external and internal personal alien control were associated with increased connectivity between primary motor cortex (M1) and brain regions involved in attribution of mental states and representing the self in relation to others; (iii) compared to both personal alien control conditions, impersonal control of movement was associated with increased activity in brain regions involved in error detection and object imagery; (iv) there were no significant differences in brain activity, and minor differences in M1 connectivity, between the external and internal personal alien control conditions. Brain networks supporting error detection and object imagery, together with representation of self and others, are differentially recruited to support experiences of impersonal and personal control of involuntary movements. However, similar brain systems underpin attributions and experiences of external and internal alien control of movement. Loss of self-agency for movement can therefore accompany different kinds of experience of alien control supported by distinct brain mechanisms. These findings caution against generalization about single cognitive processes or brain systems underpinning different experiences of loss of self-control of movement. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social networks of older adults living with HIV in Finland.

PubMed

Nobre, Nuno Ribeiro; Kylmä, Jari; Kirsi, Tapio; Pereira, Marco

2016-01-01

The aim of this study was to explore the social networks of older adults living with HIV. Interviews were conducted with nine individuals aged 50 or older living with HIV in Helsinki, Finland. Analysis of transcripts was analysed by inductive qualitative content analysis. Results indicated that these participants' networks tended to be large, including those both aware and unaware of the participants' health status. Analysis identified three main themes: large multifaceted social networks, importance of a support group, and downsizing of social networks. Support received appeared to be of great importance in coping with their health condition, especially since the time of diagnosis. Friends and family were the primary source of informal support. The majority of participants relied mostly on friends, some of whom were HIV-positive. Formal support came primarily from the HIV organisation's support group. In this study group, non-disclosure did not impact participants' well-being. In years to come, social networks of older adults living with HIV may shrink due to personal reasons other than HIV-disclosure. What is of primary importance is that healthcare professionals become knowledgeable about psychosocial issues of older adults living with HIV, identifying latent problems and developing adequate interventions in the early stages of the disease; this would help prevent social isolation and foster successful ageing with HIV.

Primary emotional traits in patients with personality disorders.

PubMed

Karterud, Sigmund; Pedersen, Geir; Johansen, Merete; Wilberg, Theresa; Davis, Ken; Panksepp, Jaak

2016-11-01

There is a longstanding tradition that connects temperament pathology and personality disorders. Emotions are the major constituents of temperament. In mammals, seven primary emotions have been identified: SEEKING, FEAR, CARE, RAGE, SADNESS/PANIC, LUST and PLAY. The study aimed at exploring the relationship between primary emotions and personality disorders (PDs). Five hundred forty-six patients with different degrees and qualities of personality pathology, admitted to treatment in specialized PD services, were diagnosed according to Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and their primary emotional profiles were assessed by the Affective Neuroscience Personality Scales. The Affective Neuroscience Personality Scales explained 19% of the variance in borderline and avoidant criteria. The DSM-IV PD categories displayed different patterns of association to the primary emotions, e.g. the borderline PD profile suggested low thresholds for RAGE and SADNESS, but on the positive side a propensity for SEEKING. In contrast, the dependent PD profile suggested a low threshold for SADNESS but a high threshold for RAGE and SEEKING. The results are promising for a more coherent and evolution-based overall theory of PDs, and the correlations found in this study indicate testable causal pathways to PDs. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Predictors of pre- and post-competition affective states in male martial artists: a multilevel interactional approach

PubMed Central

Cerin, E; Barnett, A

2011-01-01

The aims of this study were to examine (a) the effects of competition-related and competition-extraneous concerns on affective states; (b) the relationships of primary and secondary appraisal with affective states and (c) the main and moderating effects of personality traits on pre- and post-competition affects. Thirty-nine male elite martial artists were assessed on 12 affective states, concerns and dimensions of primary and secondary appraisal at five random times a day across 1 week before and 3 days after a competition. On the competition day, they were assessed 1 h before and immediately after the contest. Competitive trait anxiety, neuroticism and extraversion were measured at the start of the study. The competition was the most significant and stressful event experienced in the examined period and had a pervasive influence on athletes' affective states. All examined appraisal and personality factors were somewhat associated with pre- and post-competition affective states. Competitive trait anxiety was a key moderator of the relationship between cognitive appraisal and affective states. This study supports the idea that cognitive appraisal and situational and personality factors exert main and interactive effects on athletes' pre- and post-competition affects. These factors need to be accounted for in planning of emotion regulation interventions. PMID:19883381

The risk of Clostridium difficile infection in patients with pernicious anaemia: a retrospective cohort study using primary care database.

PubMed

Othman, Fatmah; Crooks, Colin J; Card, Timothy R

2017-11-01

Studies have found an association between proton pump inhibitor (PPI) use and Clostridium difficile infection. The purpose of this study was to determine whether the mechanism by which PPIs induce an increased risk of C. difficile infection is supported by the same mechanism acting in another cause of achlorhydria, pernicious anaemia. Using a database of anonymised primary care records between 1990 and 2013, we selected exposed patients with a diagnosis of pernicious anaemia treated with vitamin B12 therapy. Each exposed patient was matched by age, gender and general practice to up to 10 controls. Cox regression analysis was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for C. difficile infection with pernicious anaemia, adjusted for potential confounders. We identified 45,467 exposed patients matched to 449,635 controls. The crude incidence rate of C. difficile infection was 1.85/1000 person-years for the exposed cohort and 1.09/1000 person-years for controls. Patients with pernicious anaemia had a greater risk of C. difficile infection than the controls (adjusted HR 1.57, 95% CI 1.40-1.76). Pernicious anaemia patients have an increased risk of C. difficile infection. This supports the theory that severe achlorhydria is the mechanism that increases the risk of C. difficile infection in long-term PPI users.

The risk of Clostridium difficile infection in patients with pernicious anaemia: a retrospective cohort study using primary care database

PubMed Central

Crooks, Colin J; Card, Timothy R

2017-01-01

Background Studies have found an association between proton pump inhibitor (PPI) use and Clostridium difficile infection. The purpose of this study was to determine whether the mechanism by which PPIs induce an increased risk of C. difficile infection is supported by the same mechanism acting in another cause of achlorhydria, pernicious anaemia. Methods Using a database of anonymised primary care records between 1990 and 2013, we selected exposed patients with a diagnosis of pernicious anaemia treated with vitamin B12 therapy. Each exposed patient was matched by age, gender and general practice to up to 10 controls. Cox regression analysis was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for C. difficile infection with pernicious anaemia, adjusted for potential confounders. Results We identified 45,467 exposed patients matched to 449,635 controls. The crude incidence rate of C. difficile infection was 1.85/1000 person-years for the exposed cohort and 1.09/1000 person-years for controls. Patients with pernicious anaemia had a greater risk of C. difficile infection than the controls (adjusted HR 1.57, 95% CI 1.40–1.76). Conclusions Pernicious anaemia patients have an increased risk of C. difficile infection. This supports the theory that severe achlorhydria is the mechanism that increases the risk of C. difficile infection in long-term PPI users. PMID:29163961

The value of personal health records for chronic disease management: what do we know?

PubMed

Tenforde, Mark; Jain, Anil; Hickner, John

2011-05-01

Electronic personal health records (PHRs) allow patients access to their medical records, self-management tools, and new avenues of communication with their health care providers. They will likely become a valuable component of the primary care Patient-centered Medical Home model. Primary care physicians, who manage the majority of chronic disease, will use PHRs to help patients manage their diabetes and other chronic diseases requiring continuity of care and enhanced information flow between patient and physician. In this brief report, we explore the evidence for the value of PHRs in chronic disease management. We used a comprehensive review of MEDLINE articles published in English between January 2000 and September 2010 on personal health records and related search terms. Few published articles have described PHR programs designed for use in chronic disease management or PHR adoption and attitudes in the context of chronic disease management. Only three prospective randomized trials have evaluated the benefit of PHR use in chronic disease management, all in diabetes care. These trials showed small improvements in some but not all diabetes care measures. All three trials involved additional interventions, making it difficult to determine the influence of patient PHR use in improved outcomes. The evidence remains sparse to support the value of PHR use for chronic disease management. With the current policy focus on meaningful use of electronic and personal health records, it is crucial to investigate and learn from new PHR products so as to maximize the clinical value of this tool.

Implementing an evidence-based computerized decision support system linked to electronic health records to improve care for cancer patients: the ONCO-CODES study protocol for a randomized controlled trial.

PubMed

Moja, Lorenzo; Passardi, Alessandro; Capobussi, Matteo; Banzi, Rita; Ruggiero, Francesca; Kwag, Koren; Liberati, Elisa Giulia; Mangia, Massimo; Kunnamo, Ilkka; Cinquini, Michela; Vespignani, Roberto; Colamartini, Americo; Di Iorio, Valentina; Massa, Ilaria; González-Lorenzo, Marien; Bertizzolo, Lorenzo; Nyberg, Peter; Grimshaw, Jeremy; Bonovas, Stefanos; Nanni, Oriana

2016-11-25

Computerized decision support systems (CDSSs) are computer programs that provide doctors with person-specific, actionable recommendations, or management options that are intelligently filtered or presented at appropriate times to enhance health care. CDSSs might be integrated with patient electronic health records (EHRs) and evidence-based knowledge. The Computerized DEcision Support in ONCOlogy (ONCO-CODES) trial is a pragmatic, parallel group, randomized controlled study with 1:1 allocation ratio. The trial is designed to evaluate the effectiveness on clinical practice and quality of care of a multi-specialty collection of patient-specific reminders generated by a CDSS in the IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) hospital. We hypothesize that the intervention can increase clinician adherence to guidelines and, eventually, improve the quality of care offered to cancer patients. The primary outcome is the rate at which the issues reported by the reminders are resolved, aggregating specialty and primary care reminders. We will include all the patients admitted to hospital services. All analyses will follow the intention-to-treat principle. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in cancer hospitals, thereby informing healthcare policy about the potential role of CDSS use. Furthermore, the study will inform whether CDSS may facilitate the integration of primary care in cancer settings, known to be usually limited. The increasing use of and familiarity with advanced technology among new generations of physicians may support integrated approaches to be tested in pragmatic studies determining the optimal interface between primary and oncology care. ClinicalTrials.gov, NCT02645357.

Uncovering the mask of borderline personality disorder: knowledge to empower primary care providers.

PubMed

Wehbe-Alamah, Hiba; Wolgamott, Susan

2014-06-01

This manuscript will provide a review of the literature and a report on the findings of a qualitative study that explored the lived experiences of people with borderline personality disorder (BPD). It also offers resources designed to empower healthcare professionals to provide timely and accurate referrals, diagnosis, or collaborative management of BPD in primary care. Review of the literature examining background, epidemiology, pharmacotherapy, psychotherapy, and available resources regarding BPD. Content analysis conducted on data obtained from 1109 postings on three different public online forums/blogs specifically for BPD. BPD is characterized by unstable moods, behaviors, and relationships. While navigating a healthcare system fraught with health disparities, BPD sufferers may have their feelings of abandonment and hopelessness reinforced. Four core themes emerged (a) a reliance on online blogging to cope; (b) a quality of life that is impacted by debilitating effects of condition; (c) coping mechanisms that encompass healthy and destructive measures; and (d) social injustices that include stigmatization, prejudice, delayed diagnosis, misdiagnosis, limited healthcare access, and lack of cure. Knowledgeable, nonjudgmental primary healthcare providers can play a key role in providing BPD sufferers and their loved ones with accurate and timely diagnosis, referral, treatment, resources, and support. Internet blogging may have important implications in care. ©2014 The Author(s) ©2014 American Association of Nurse Practitioners.

Principal-agent relationships in general practice: the first wave of English Personal Medical Services pilot contracts.

PubMed

Sheaff, R; Lloyd-Kendall, A

2000-07-01

To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal-agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. Content analysis of 71 first-wave PMS contracts. Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. First-wave PMS contracts do not appear to embody a strong principal-agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the 'institutional embedding' of independent general practice in the wider management systems of the NHS.

Perceptions of Personalized Medicine in an Academic Health System: Educational Findings.

PubMed

Vorderstrasse, Allison; Katsanis, Sara Huston; Minear, Mollie A; Yang, Nancy; Rakhra-Burris, Tejinder; Reeves, Jason W; Cook-Deegan, Robert; Ginsburg, Geoffrey S; Ann Simmons, Leigh

Prior reports demonstrate that personalized medicine implementation in clinical care is lacking. Given the program focus at Duke University on personalized medicine, we assessed health care providers' perspectives on their preparation and educational needs to effectively integrate personalized medicine tools and applications into their clinical practices. Data from 78 health care providers who participated in a larger study of personalized and precision medicine at Duke University were analyzed using Qualtrics (descriptive statistics). Individuals age 18 years and older were recruited for the larger study through broad email contacts across the university and health system. All participants completed an online 35-question survey that was developed, pilot-tested, and administered by a team of interdisciplinary researchers and clinicians at the Center for Applied Genomics and Precision Medicine. Overall, providers reported being ill-equipped to implement personalized medicine in clinical practice. Many respondents identified educational resources as critical for strengthening personalized medicine implementation in both research and clinical practice. Responses did not differ significantly between specialists and primary providers or by years since completion of the medical degree. Survey findings support prior calls for provider and patient education in personalized medicine. Respondents identified focus areas in training, education, and research for improving personalized medicine uptake. Given respondents' emphasis on educational needs, now may be an ideal time to address these needs in clinical training and public education programs.

The social context of food insecurity among persons living with HIV/AIDS in rural Uganda

PubMed Central

Tsai, Alexander C.; Bangsberg, David R.; Emenyonu, Nneka; Senkungu, Jude K.; Martin, Jeffrey N.; Weiser, Sheri D.

2011-01-01

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA. PMID:22019367

The social context of food insecurity among persons living with HIV/AIDS in rural Uganda.

PubMed

Tsai, Alexander C; Bangsberg, David R; Emenyonu, Nneka; Senkungu, Jude K; Martin, Jeffrey N; Weiser, Sheri D

2011-12-01

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA. Copyright © 2011 Elsevier Ltd. All rights reserved.

Use of and interest in mobile health for diabetes self-care in vulnerable populations.

PubMed

Humble, James R; Tolley, Elizabeth A; Krukowski, Rebecca A; Womack, Catherine R; Motley, Todd S; Bailey, James E

2016-01-01

We aimed to assess use of and interest in mobile health (mHealth) technology and in-person services for diabetes self-care in vulnerable populations. We delivered a self-administered cross-sectional survey. Participants were recruited at two primary care practices (P1 and P2) with P1 located in a medically underserved area and P2 in an affluent suburb. Two-sample t-tests and chi-square tests were used with p < 0.05 significant. In addition, a secondary analysis was performed to analyse differences in use and interest in mHealth by age. Of 75 eligible patients, 60 completed the survey (80% response rate). P1 patients had significantly higher interest in three of five categories of in-person diabetes support services, one of four categories of health-related text messages (TM), and three of eight categories of mHealth applications (p < 0.05). Smartphone users reported higher interest in TM (p = 0.004) and mHealth applications for diabetes self-care (p = 0.004). Younger patients were more likely to have a smartphone (p < 0.006), use the Internet (p < 0.0012), use smartphone applications (p < 0.0004), and to be interested in using applications to manage their diabetes (p < 0.004). This study shows substantial patient interest in TM and mHealth applications for diabetes self-care and suggests that patients in underserved areas may have particularly high interest in using mHealth solutions in primary care. Younger patients and smartphone users were more likely to be interested in using applications to manage their diabetes. As more patients use smartphones, interest in using mHealth to support patient self-care and strengthen primary care infrastructure will continue to grow. © The Author(s) 2015.

"They're homeless in a home": Retaining homeless-experienced consumers in supported housing.

PubMed

Gabrielian, Sonya; Hamilton, Alison B; Alexandrino, Adrian; Hellemann, Gerhard; Young, Alexander S

2017-05-01

Permanent, community-based housing with supportive services ("supported housing") has numerous favorable outcomes for homeless-experienced consumers. Little is known, however, about consumers who attain but subsequently lose their supported housing. Using mixed methods, we compared persons who retained their supported housing for at least 1 year ("stayers") with those who lost their supported housing within 1 year of move-in ("exiters"). Among persons housed through the VA Supported Housing (VASH) program at the VA Greater Los Angeles between 2011 and 2012, we queried VA homeless registry data to identify stayers (n = 1,558) and exiters (n = 85). We reviewed the medical records of 85 randomly selected stayers and all 85 exiters to compare demographics, homelessness chronicity, era of service, income, presence or absence of a serious mental illness, and health service utilization. From this subsample, we purposively selected 20 stayers and 20 exiters for semistructured, qualitative interviews, and more detailed medical record review. We also performed qualitative interviews and focus groups with VASH staff/leadership (n = 15). Recursive partitioning identified quantitative variables that best-differentiated stayers from exiters. Thematic analyses were performed on qualitative data. Interrelated factors were associated with exiting supported housing: chronic homelessness; low intrinsic motivation; unmet needs for mental health care, substance abuse treatment, and independent living skills; poor primary care engagement; frequent emergency department use; and recent mental health hospitalizations. These findings suggest the value of clinical interventions that address these factors-for example, motivational interviewing or social skills training-adapted to the setting and context of supported housing. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

PubMed Central

2013-01-01

Summary Introduction and objectives. For children, maintenance of personal hygiene helps to improve the quality of life and longevity. This is of particular importance in a slum community with compromised living situation. This study was undertaken to find out the knowledge and practice of personal hygiene among the primary school children living in a slum area, to identify any misconception among them regarding the maintenance of personal hygiene, to find out their morbidity pattern, and also to elicit the relationship between practice of personal hygiene among the children and the literacy status of their mother. Methods. A cross-sectional observational study was conducted among 104 primary school children of a primary school situated in the slum area of Chetla, Kolkata, India with the help of a predesigned, pre-tested and structured questionnaire. Data were analyzed statistically by simple proportions and tests of significance. Results. It was found that the female students were more knowledgeable than the male students regarding the maintenance of personal hygiene. There was a wide gap between practice and knowledge of personal hygiene among the primary school children living in the slum area. Even, misconceptions do exist on certain indicators of personal hygiene among the students. Statistically significant association was observed between practices of personal hygiene among the primary school children and the literacy status of their mother. Discussion and conclusions. Future of a society depends considerably on the health of its children. The parents and the school teachers, as constructive shapers of children's health behaviors, should play a responsible role in early education of children on personal hygiene. PMID:24783893

Frozen shoulder and the Big Five personality traits.

PubMed

Debeer, Philippe; Franssens, Fien; Roosen, Isabelle; Dankaerts, Wim; Claes, Laurence

2014-02-01

In the past, several studies have suggested the existence of a "periarthritic personality" in patients with frozen shoulder. We conducted a study to determine differences in personality traits in patients with primary and secondary frozen shoulders. We prospectively evaluated 118 patients (84 women and 34 men; mean age, 53.8 years; SD 7.56) with a frozen shoulder. Of these patients, 48 had an idiopathic frozen shoulder and 70 had a secondary frozen shoulder. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale. This questionnaire measures the 5 major personality traits and is based on the norms determined in a neutral test situation for 2415 controls. Compared with healthy controls, no differences in personality traits were found in patients with primary and secondary frozen shoulder, except for Conscientiousness and Extraversion, for which patients with secondary frozen shoulder scored significantly higher than healthy controls. Patients with primary frozen shoulder scored significantly higher on Openness to Experience than did patients with secondary frozen shoulder; on the other 4 Big Five personality traits, no significant differences were found between patients with primary and secondary frozen shoulder. More specifically, patients with idiopathic frozen shoulder did not score higher on the trait Neuroticism as would be expected from previous publications. Our study results do not indicate that patients with an idiopathic frozen shoulder have a specific personality compared with healthy controls. Only a few differences were found in personality traits when the entire frozen shoulder group was compared with healthy controls and between patients with primary and secondary frozen shoulders. The results of this study suggest that these differences are not sufficient to speak about a specific "frozen shoulder personality." Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Political Attitudes Develop Independently of Personality Traits

PubMed Central

Hatemi, Peter K.; Verhulst, Brad

2015-01-01

The primary assumption within the recent personality and political orientations literature is that personality traits cause people to develop political attitudes. In contrast, research relying on traditional psychological and developmental theories suggests the relationship between most personality dimensions and political orientations are either not significant or weak. Research from behavioral genetics suggests the covariance between personality and political preferences is not causal, but due to a common, latent genetic factor that mutually influences both. The contradictory assumptions and findings from these research streams have yet to be resolved. This is in part due to the reliance on cross-sectional data and the lack of longitudinal genetically informative data. Here, using two independent longitudinal genetically informative samples, we examine the joint development of personality traits and attitude dimensions to explore the underlying causal mechanisms that drive the relationship between these features and provide a first step in resolving the causal question. We find change in personality over a ten-year period does not predict change in political attitudes, which does not support a causal relationship between personality traits and political attitudes as is frequently assumed. Rather, political attitudes are often more stable than the key personality traits assumed to be predicting them. Finally, the results from our genetic models find that no additional variance is accounted for by the causal pathway from personality traits to political attitudes. Our findings remain consistent with the original construction of the five-factor model of personality and developmental theories on attitude formation, but challenge recent work in this area. PMID:25734580

Political attitudes develop independently of personality traits.

PubMed

Hatemi, Peter K; Verhulst, Brad

2015-01-01

The primary assumption within the recent personality and political orientations literature is that personality traits cause people to develop political attitudes. In contrast, research relying on traditional psychological and developmental theories suggests the relationship between most personality dimensions and political orientations are either not significant or weak. Research from behavioral genetics suggests the covariance between personality and political preferences is not causal, but due to a common, latent genetic factor that mutually influences both. The contradictory assumptions and findings from these research streams have yet to be resolved. This is in part due to the reliance on cross-sectional data and the lack of longitudinal genetically informative data. Here, using two independent longitudinal genetically informative samples, we examine the joint development of personality traits and attitude dimensions to explore the underlying causal mechanisms that drive the relationship between these features and provide a first step in resolving the causal question. We find change in personality over a ten-year period does not predict change in political attitudes, which does not support a causal relationship between personality traits and political attitudes as is frequently assumed. Rather, political attitudes are often more stable than the key personality traits assumed to be predicting them. Finally, the results from our genetic models find that no additional variance is accounted for by the causal pathway from personality traits to political attitudes. Our findings remain consistent with the original construction of the five-factor model of personality and developmental theories on attitude formation, but challenge recent work in this area.

Comparison of two psycho-educational family group interventions for improving psycho-social outcomes in persons with spinal cord injury and their caregivers: a randomized-controlled trial of multi-family group intervention versus an active education control condition.

PubMed

Dyck, Dennis G; Weeks, Douglas L; Gross, Sarah; Lederhos Smith, Crystal; Lott, Hilary A; Wallace, Aimee J; Wood, Sonya M

2016-07-26

Over 12,000 individuals suffer a spinal cord injury (SCI) annually in the United States, necessitating long-term, complex adjustments and responsibilities for patients and their caregivers. Despite growing evidence that family education and support improves the management of chronic conditions for care recipients as well as caregiver outcomes, few systematic efforts have been made to involve caregivers in psycho-educational interventions for SCI. As a result, a serious gap exists in accumulated knowledge regarding effective, family-based treatment strategies for improving outcomes for individuals with SCI and their caregivers. The proposed research aims to fill this gap by evaluating the efficacy of a structured adaptation of an evidence-based psychosocial group treatment called Multi-Family Group (MFG) intervention. The objective of this study is to test, in a randomized-controlled design, an MFG intervention for the treatment of individuals with SCI and their primary caregivers. Our central hypothesis is that by providing support in an MFG format, we will improve coping skills of persons with SCI and their caregivers as well as supportive strategies employed by caregivers. We will recruit 32 individuals with SCI who have been discharged from inpatient rehabilitation within the previous 3 years and their primary caregivers. Patient/caregiver pairs will be randomized to the MFG intervention or an active SCI education control (SCIEC) condition in a two-armed randomized trial design. Participants will be assessed pre- and post-program and 6 months post-program. Intent to treat analyses will test two a priori hypotheses: (1) MFG-SCI will be superior to SCIEC for SCI patient activation, health status, and emotion regulation, caregiver burden and health status, and relationship functioning, and (2) MFG will be more effective for individuals with SCI and their caregivers when the person with SCI is within 18 months of discharge from inpatient rehabilitation compared to when the person is between 19 and 36 months post discharge. Support for our hypotheses will indicate that MFG-SCI is superior to specific education for assisting patients and their caregivers in the management of difficult, long-term, life adjustments in the months and years after SCI, with increased efficacy closer in time to the injury. ClinicalTrials.gov NCT02161913 . Registered 10 June 2014.

Personal and professional support for mothers of NICU and healthy newborns.

PubMed

Coffman, S; Levitt, M J; Deets, C

1991-01-01

Personal support provided by close social network members and professional support provided by nurses were studied in 83 postpartum mothers and newborns in neonatal intensive care units and newborn nurseries. Mothers perceived each type of support differently in terms of outcomes. Only personal support was significantly related to emotional affect and life satisfaction outcomes. Both personal and professional support were related to relationship satisfaction outcomes. Findings suggest that personal support and professional support be treated as separate concepts.

The Friedrich-Lively Instrument to Assess the Impact of Schizophrenia on Siblings (FLIISS): Part I--instrument construction.

PubMed

Friedrich, Rose Marie; Lively, Sonja; Rubenstein, Linda; Buckwalter, Kathleen

2002-01-01

Siblings of persons with schizophrenia may provide primary or secondary care for their sibling and support to parents who are primary care givers. These siblings experience stress and the accompanying sequelae of decreased quality of life, grief, chronic illness, and symptoms of depression and anxiety. Comprehensive measures of sibling stress have not been published. Before interventions to help siblings can be created, health professionals need such an assessment. The Friedrich-Lively Instrument to Assess the Impact of Schizophrenia on Siblings (FLIISS) has been developed to meet the needs of both health workers and siblings. The instrument has a strong conceptual basis adapted from Pearlin's model of stress in caregiving and was preceded by pilot work that evaluated both quantitative and qualitative data. In this article, (Part I), the development of the instrument and its relationships to the conceptual model are described. Health professionals can use the instrument for collecting information that will increase their ability to identify sources of stress faced by siblings of persons with schizophrenia, and from this assessment they may develop interventions for this underserved population.

Primary healthcare NZ nurses' experiences of advance directives: understanding their potential role.

PubMed

Davidson, Raewyn; Banister, Elizabeth; de Vries, Kay

2013-07-01

Advance directives are one aspect of advance care planning designed to improve end of life care. The New Zealand Nurses Organisation released their first mission statement in 2010 concerning advance directives suggesting an increase in the use of these. A burgeoning older population, expected to rise over the next few years, places the primary healthcare nurse in a pivotal role to address the challenges in constructing advance directives. While literature supports the role for primary healthcare nurses in promoting advance directives, no research was found on this role in the New Zealand context. This paper presents results of a qualitative study conducted in New Zealand with 13 senior primary healthcare nurses with respect to their knowledge, attitudes, and experiences of advance directives. Results of the analysis revealed a dynamic process involving participants coming to understand their potential role in this area. This process included reflection on personal experience with advance directives; values and ethics related to end of life issues; and professional actions.

SUPPORTING CHILDREN IN U.S. LEGAL PROCEEDINGS

PubMed Central

McAuliff, Bradley D.; Nicholson, Elizabeth; Amarilio, Diana; Ravanshenas, Daniel

2012-01-01

We conducted a national survey of 786 victim/witness assistants (VWAs) to provide descriptive and attitudinal information about support person use in U.S. legal proceedings involving children. VWAs (N = 414) from 46 states returned completed surveys (response rate = 53%). Prosecutor-based VWAs or parents/guardians most frequently served as support persons. One support person was almost always or often used with child victims and/or witnesses of all ages. Support persons were extremely common in cases involving child sexual abuse, physical abuse, neglect, and adult domestic violence. Overall, support persons provided more informational than emotional support. The most common informational support was to provide referrals to community resources, conduct courtroom visit/orientation, and disseminate relevant procedural information. The most common emotional support was to accompany the child to trial. Support persons rarely or never questioned children directly during investigative interviews or in court. Respondents believed support persons decrease children’s stress and increase accuracy and credibility; however, this effect varied as a function of who provided support, child age, case type, and type of emotional or informational support. Respondents believed that support person presence at trial probably does not prejudice jurors against defendants. These survey data provide a benchmark for legal professionals and a foundation for future social scientific research examining the effects of support person use on children. PMID:24741286

A Drupal-Based Collaborative Framework for Science Workflows

NASA Astrophysics Data System (ADS)

Pinheiro da Silva, P.; Gandara, A.

2010-12-01

Cyber-infrastructure is built from utilizing technical infrastructure to support organizational practices and social norms to provide support for scientific teams working together or dependent on each other to conduct scientific research. Such cyber-infrastructure enables the sharing of information and data so that scientists can leverage knowledge and expertise through automation. Scientific workflow systems have been used to build automated scientific systems used by scientists to conduct scientific research and, as a result, create artifacts in support of scientific discoveries. These complex systems are often developed by teams of scientists who are located in different places, e.g., scientists working in distinct buildings, and sometimes in different time zones, e.g., scientist working in distinct national laboratories. The sharing of these specifications is currently supported by the use of version control systems such as CVS or Subversion. Discussions about the design, improvement, and testing of these specifications, however, often happen elsewhere, e.g., through the exchange of email messages and IM chatting. Carrying on a discussion about these specifications is challenging because comments and specifications are not necessarily connected. For instance, the person reading a comment about a given workflow specification may not be able to see the workflow and even if the person can see the workflow, the person may not specifically know to which part of the workflow a given comments applies to. In this paper, we discuss the design, implementation and use of CI-Server, a Drupal-based infrastructure, to support the collaboration of both local and distributed teams of scientists using scientific workflows. CI-Server has three primary goals: to enable information sharing by providing tools that scientists can use within their scientific research to process data, publish and share artifacts; to build community by providing tools that support discussions between scientists about artifacts used or created through scientific processes; and to leverage the knowledge collected within the artifacts and scientific collaborations to support scientific discoveries.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

Development of family medicine in Ukraine.

PubMed

Kolesnyk, Pavlo; Švab, Igor

2013-12-01

This article includes a personal history of a family physician working in Ukraine. In June 2012, Pavlo Kolesnyk, Ukrainian Assistant Professor and a Family Doctor was awarded the second Montegute Scholar grant and had the chance to attend the Wonca Europe Conference 2012 in Vienna. In many developed countries, family medicine is already well established. In Ukraine, which has the legacy of a socialist health care system the implementation of the discipline started only at the end of the last century. The changes in the health care system were of greater importance in primary care and family medicine. It gave greater decentralization of the health care system and supported investment in primary care. This article describes the development of family medicine in undergraduate and postgraduate education. Whilst family medicine is officially a priority of health care policy, there is still a long process ahead. Family medicine needs financial support from the government and doctor's wages have to be increased, to prevent this branch of medicine being unpopular among graduating medical students.

From One to Many Boxes: Mobile Devices as Primary and Secondary Screens

NASA Astrophysics Data System (ADS)

Cesar, Pablo; Knoche, Hendrik; Bulterman, Dick C. A.

This chapter looks at the current changing habits on audiovisual content consumption at home, with special focus on potential uses of mobile devices. Standard television plus a remote control impose a use that is too coarse to support the various personal needs of people, while mobile devices open new possibilities from engagement and immersion into content and deliberately controlled disengagement with others to providing a screen that can be offered to include others in sharing experiences in a huddled setting.

The Design and Implementation of a Public Relations Program in Support of the Composite Health Care System at Ireland Army Community Hospital, Fort Knox, Kentucky

DTIC Science & Technology

1987-10-01

effectiveness of a particular health care provider or treatment procedure (Doering, 1983; Ben-Sira, 1983; Kotler & Clarke, 1986). Instead, much of a...criteria for quality of care ( Kotler & Clarke, 1986). There is great potential for positively influencing a patient’s percep- tion of care through a...important quality of care indicator for patients (Doering, 1983; Kotler & Clarke, 1986). Personal attention of the patient must remain a primary

Fundamental Components For The Realization of a Federated Integrated Electronic Health Record Environment

DTIC Science & Technology

2001-10-25

for the deployment of the I- EHR at a regional level, and a large number of CISs systems have been supported, ranging from primary health care and...1 of 4 Abstract - The Integrated Electronic Health Record (I- EHR ) is a term used to describe the whole set of information that exists in...electronic form and is related to the personal health of an indi- vidual. Any approach towards I- EHR focuses on the needs of professionals or citizens who

Australian primary health care nurses most and least satisfying aspects of work.

PubMed

Halcomb, Elizabeth; Ashley, Christine

2017-02-01

To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. A cross-sectional online survey. Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care. © 2016 John Wiley & Sons Ltd.

Reducing overweight and obesity: closing the gap between primary care and public health.

PubMed

Anderson, Peter

2008-12-01

Although overweight and obesity are major risk factors for ill health and premature death, leading to significant increases in workload and prescribing costs, primary health care providers continue to find managing overweight and obesity a difficult business. Six questions are addressed in an attempt to close the gap between primary care activities and public health goals to reduce overweight and obesity: what is overweight and obesity; what is the health impact of overweight and obesity; is individually directed advice effective in reducing overweight and obesity; can we increase the involvement of primary care in reducing overweight and obesity; how can public health actions complement the role of primary care; and how do we chose cost-effective interventions? Systematic reviews and key texts were identified from literature searches to provide a narrative summary to answer the six questions. Overweight is defined as a body mass index (BMI) of > or = 25 and obesity as a BMI of > or = 30 where BMI = weight (kg)/height (m(2)). There is a positive relationship between the level of BMI and a wide range of conditions, including cancers and cardiovascular diseases. There is evidence that individually directed advice can reduce overweight and obesity or its risk. There is mixed evidence for the effectiveness of strategies in increasing the involvement of primary care in reducing overweight and obesity. There are many examples of public health actions that complement the role of primary care in reducing overweight and obesity. Overall cost-effective policy analyses have not been done per se for overweight and obesity but have shown that a combination of personal and non-personal interventions can be effective and cost-effective in reducing cardiovascular events. The gap between primary care and public health in reducing overweight and obesity can be closed, but it requires sustained political support and investment.

Medical Students' Personal Qualities and Values as Correlates of Primary Care Interest

ERIC Educational Resources Information Center

Borges, Nicole J.; Jones, Bonnie J.

2004-01-01

Medical schools must use selection methods that validly measure applicants' noncognitive qualities, but primary-care (PC) schools have a particular need. This study correlated entering students' personality and values scores with their professed interest in PC. 93 medical students completed instruments assessing personality (16PF & PSP), values,…

Teacher perspectives on implementing and sustaining a handwashing promotion intervention in Western Kenyan primary schools.

PubMed

Graves, Janessa M; Finsness, Erica D; Quick, Robert; Nyando Integrated Child Health And Education Project Niche Study Team; Harris, Julie R; Daniell, William E

School-based handwashing programs are challenging to establish and sustain, especially in low-resource settings. This qualitative study described teacher perspectives associated with implementing and sustaining a handwashing program in primary schools participating in the Nyando Integrated Child Health and Education (NICHE) project. Structured key informant interviews were conducted with teachers. Prevalent concepts and themes were grouped into themes and topic areas using an iterative, open coding approach. Forty-one teacher respondents reported favorable expectations and benefits of handwashing programs. The importance of available resources (e.g., reliable water) was cited as a primary concern. Other challenges included time and personal or institutional financial commitment necessary to ensure program sustainability. Handwashing programs in low-income, rural schools, where infrastructure is lacking and "student ambassadors" extend the intervention to the surrounding community, hold great promise to improve community health. Teachers must have adequate support and resources to implement and sustain the programs.

Longitudinal associations between case management and supportive services use among black and Latina HIV-positive women in New York City.

PubMed

Halkitis, Perry N; Kupprat, Sandra A; Mukherjee, Preetika Pandey

2010-01-01

The literature analyzing the relationship between case management and supportive service use longitudinally among African American and Latina HIV-positive women is limited. This retrospective analysis of participant case management, supportive service, and medical charts sought to examine both descriptive and relational data on use of case management and supportive services over a 2-year period from 2002 to 2005 and to analyze moderating person- level or institution-level factors. The analyzed case management, supportive service, and medical charts revealed that participants interacted with their case manager four times and received 3.6 supportive services per month. Transportation, primary healthcare/medical specialists, and support groups were the services most used, with rates ranging from 70% to 80%. Using hierarchical linear modeling (HLM), the unconditional growth models showed that case management and supportive service use patterns remained constant over the 24-month period. Additionally, the multivariate unconditional model suggests a significant positive relationship between case management and supportive services. No moderation was indicated in the association between case management and supportive service use by person-level (e.g., mental illness, substance use) and institution-level (i.e., service delivery model) factors. Participants use supportive and case management services in a similar manner based on individual need. This synergistic relationship suggests that increases in either may result in retaining women in care. Implications for service delivery point to the need for skills building training for case managers, outreach workers, or system navigators to assist with short-term goals of establishing rapport and maintaining the client relationship, as this may lead to HIV-positive women accessing services. Additionally, outreach and engagement strategies need to be developed for those who typically underuse these services.

Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse-led clinics.

PubMed

Green, Peter; Neely, Dermot; Humphries, Steve E

2016-06-01

In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider the possibility of FH in adults who have raised total cholesterol concentrations, thereby improving the detection of people with FH. Utilizing clinical decision support software (Audit+) we developed an FH Audit Tool and implemented a systematic audit of electronic medical records within GP practices, first identifying all patients diagnosed with FH or possible FH and next electronically flagging patients with a recorded total cholesterol of >7.5 mmol L(-1) or LDL-C > 4.9 mmol L(-1) (in adults), for further assessment. After a 2-year period, a nurse-led clinic was introduced to screen more intensely for new FH index cases. We evaluated if these interventions increased the prevalence of FH closer to the expected prevalence from epidemiological studies. The baseline prevalence of FH within Medway CCG was 0.13% (1 in 750 persons). After 2 years, the recorded prevalence of diagnosed FH increased by 0.09% to 0.22% (1 in 450 persons). The nurse advisor programme ran for 9 months (October 2013-July 2014) and during this time, the recorded prevalence of patients diagnosed with FH increased to 0.28% (1 in 357 persons) and the prevalence of patients 'at risk and unscreened' reduced from 0.58% to 0.14%. Our study shows that two simple interventions increased the detection of FH. This systematic yet simple electronic case-finding programme with nurse-led review allowed the identification of new index cases, more than doubling the recorded prevalence of detected disease to 1 in 357 (0.28%). This study shows that primary care has an important role in identifying patients with this condition. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

The development of a simulation model of primary prevention strategies for coronary heart disease.

PubMed

Babad, Hannah; Sanderson, Colin; Naidoo, Bhash; White, Ian; Wang, Duolao

2002-11-01

This paper describes the present state of development of a discrete-event micro-simulation model for coronary heart disease prevention. The model is intended to support health policy makers in assessing the impacts on health care resources of different primary prevention strategies. For each person, a set of times to disease events, conditional on the individual's risk factor profile, is sampled from a set of probability distributions that are derived from a new analysis of the Framingham cohort study on coronary heart disease. Methods used to model changes in behavioural and physiological risk factors are discussed and a description of the simulation logic is given. The model incorporates POST (Patient Oriented Simulation Technique) simulation routines.

[Hyperfrequent consultations: is there a relationship with the mother's personality?].

PubMed

Igual Rosado, R; Castro Nicolau, E; Alonso Martínez, I; Terradas Corominas, M; de Frutos Gallego, E; Cebrià Andreu, J

2003-01-01

To study the psychological profile of mothers who overuse pediatric services and associated social and demographic characteristics, as well as to evaluate the association between maternal personality profile and greater use of pediatric services. Cross-sectional descriptive study, at the Basic Health Areas of Granollers Sud and Granollers Oest-Canovelles in Barcelona (Spain). Forty-four mothers, representing 21.5 % of the population meeting the inclusion criteria were studied. The population consisted of mothers of children who visited the center on an equal or higher number of occasions as two standard deviations. One-hour interviews were conducted. A data sheet to assess social and demographic variables, Milton's Multiaxial Inventory II, and Goldberg's Anxiety and Depression Scale to detect symptoms of depression and anxiety were administered. Forty-four mothers (21.5 %) attended the interviews. The mean age was 36.6 years. Most of the mothers (90.9 %) were married, 73 % had completed primary studies, 5 % were housewives, and 75 % had no family support. Fifty percent of the children were the youngest in their family, and 30 % were only children. Concerning personality disorders, 55.8 % of overusing mothers showed compulsive personality, 30.23 % schizoid personality, and 14 % dependent personality while 47.7 % of mothers presented significant symptoms of anxiety. Sociodemographic profile, anxiety, and maternal personality profile are related to overuse of pediatric services. Compulsive, schizoid and dependent personality disorders seem to be associated with overuse.

Borderline personality disorder in the primary care setting.

PubMed

Dubovsky, Amelia N; Kiefer, Meghan M

2014-09-01

Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Implementing long-term EAP follow-up with clients and family members to help prevent relapse-With implications for primary prevention.

PubMed

Foote, A; Googins, B; Moriarty, M; Sandonato, C; Nadolski, J; Jefferson, C

1994-12-01

This paper reports on a study in progress which involves (a) regular post-treatment contact by employee assistance program (EAP) staff with employees who seek help through the EAP, and (b) contact with a family member or other support person designated by the employee. The contacts are designed to provide support for maintenance of therapeutic gains, assistance in adjusting to current life situations, and early identification and prevention of relapse. The study will evaluate the process of initiating these contacts and will examine their effectiveness at reducing relapse. Factors associated with implementing these services in an EAP context are discussed.

Deliberative Assessment of Surrogate Consent in Dementia Research

PubMed Central

Kim, Scott Y. H.; Uhlmann, Rebecca A.; Appelbaum, Paul S.; Knopman, David S.; Kim, H. Myra; Damschroder, Laura; Beattie, Elizabeth; Struble, Laura; De Vries, Raymond

2009-01-01

Background Research involving incapacitated persons with dementia involves complex scientific, legal, and ethical issues, making traditional surveys of layperson views regarding the ethics of such research challenging. We therefore assessed the impact of democratic deliberation (DD)—involving balanced, detailed education and peer deliberation—on the views of those responsible for persons with dementia. Methods 178 community-recruited caregivers or primary decision-makers for persons with dementia were randomly assigned to either an all-day DD session group or a control group. Educational materials used for the DD session were vetted for balance and accuracy by an interdisciplinary advisory panel. We assessed the acceptability of family surrogate consent for dementia research (‘surrogate-based research’ or SBR) from a societal policy perspective as well as from the more personal perspectives of deciding for a loved one or for oneself (surrogate and self perspectives), assessed at baseline, immediately post-DD session, and a month after DD date, for 4 research scenarios of varying risk-benefit profiles. Results At baseline, a majority in both DD and control groups supported a policy of family consent for dementia research for all research scenarios. The support for a policy of family consent for SBR increased for the DD group, but not for the control group; the change in the DD group was maintained one month later. In the DD group, there were transient changes in attitudes from surrogate or self perspectives; in the control group, there were no changes from baseline in attitude toward surrogate consent from any perspective. Conclusions Intensive, balanced, and accurate education along with peer deliberation provided by democratic deliberation leads to a sustained increase in support for a societal policy of family consent for dementia research among those responsible for dementia patients. PMID:20188635

Deliberative assessment of surrogate consent in dementia research.

PubMed

Kim, Scott Y H; Uhlmann, Rebecca A; Appelbaum, Paul S; Knopman, David S; Kim, H Myra; Damschroder, Laura; Beattie, Elizabeth; Struble, Laura; De Vries, Raymond

2010-07-01

Research involving incapacitated persons with dementia entails complex scientific, legal, and ethical issues, making traditional surveys of layperson views on the ethics of such research challenging. We therefore assessed the impact of democratic deliberation (DD), involving balanced, detailed education and peer deliberation, on the views of those responsible for persons with dementia. One hundred and seventy-eight community-recruited caregivers or primary decision-makers for persons with dementia were randomly assigned to either an all-day DD session group or a control group. Educational materials used for the DD session were vetted for balance and accuracy by an interdisciplinary advisory panel. We assessed the acceptability of family-surrogate consent for dementia research ("surrogate-based research") from a societal policy perspective as well as from the more personal perspectives of deciding for a loved one or for oneself (surrogate and self-perspectives), assessed at baseline, immediately post-DD session, and 1 month after DD date, for four research scenarios of varying risk-benefit profiles. At baseline, a majority in both the DD and control groups supported a policy of family consent for dementia research in all research scenarios. The support for a policy of family consent for surrogate-based research increased in the DD group, but not in the control group. The change in the DD group was maintained 1 month later. In the DD group, there were transient changes in attitudes from surrogate or self-perspectives. In the control group, there were no changes from baseline in attitude toward surrogate consent from any perspective. Intensive, balanced, and accurate education, along with peer deliberation provided by democratic deliberation, led to a sustained increase in support for a societal policy of family consent in dementia research among those responsible for dementia patients. Copyright 2010 The Alzheimer

Research on Dengue during World War II Revisited

PubMed Central

Snow, Grace E.; Haaland, Benjamin; Ooi, Eng Eong; Gubler, Duane J.

2014-01-01

Much of the basic clinical information about dengue infection comes from experimental human studies conducted in the 1920s and 1940s. Albert Sabin's original laboratory records from one such study were bequeathed to Duane J. Gubler. These records were reviewed and 150 experiments were included in our analyses. Persons were inoculated with dengue virus 1 (DENV-1) and DENV-2. Median fever duration was shorter in primary DENV-2 infections compared with DENV-1, although maximum temperature and severity of illness were comparable. At 1.5–9 months after primary infection, 20 persons were inoculated with the heterologous serotype. Only one person inoculated with a heterologous serotype at < 8 weeks showed development of a clinical infection with a maximum temperature of 38°C, and 7 (88%) of 8 persons inoculated with a heterologous serotype at 4–9 months post-primary infection showed development of fever. On average, persons had a shorter incubation period in secondary infection compared with primary infection. PMID:25311700

Validating the Changes to Self-identity After Total Laryngectomy.

PubMed

Bickford, Jane; Coveney, John; Baker, Janet; Hersh, Deborah

2018-05-25

A total laryngectomy often prolongs life but results in long-term disablement, disfigurement, and complex care needs. Current clinical practice addresses the surgical options, procedures, and immediate recovery. Less support is available longer-term despite significant changes to aspects of personhood and ongoing medical needs. The aim of this study was to explore the experience of living with and/or supporting individuals with a laryngectomy at least 1 year after surgery. Constructivist grounded theory methods and symbolic interactionism were used to guide collection and analysis of interview data from 28 participants (12 individuals with a laryngectomy, 9 primary supporters, and 7 health professionals). The phenomena of "validating the altered self after total laryngectomy" highlighted how individuals, postlaryngectomy, navigate and negotiate interactions due to the disruption of their self-expression, related competencies, and roles. Several reframing patterns representing validation of the self emerged from the narratives. They were as follows: destabilized, resigned, resolute, and transformed. The data describe the influence of the processes of developing competence and building resilience, combined with contextual factors, for example, timing and turning points; being supported; and personal factors on these reframing patterns. The findings further our understanding of the long-term subjective experience of identity change after laryngectomy and call attention to the persisting need for psychosocial support. This research provides important evidence for evaluating and strengthening the continuum of services (specialist to community) and supporting social participation, regardless of communication method, and for competency training for all involved to optimize person-centered practices.

SUPPORTING CHILDREN IN U.S. LEGAL PROCEEDINGS: Descriptive and Attitudinal Data From a National Survey of Victim/Witness Assistants.

PubMed

McAuliff, Bradley D; Nicholson, Elizabeth; Amarilio, Diana; Ravanshenas, Daniel

2013-01-01

We conducted a national survey of 786 victim/witness assistants (VWAs) to provide descriptive and attitudinal information about support person use in U.S. legal proceedings involving children. VWAs ( N = 414) from 46 states returned completed surveys (response rate = 53%). Prosecutor-based VWAs or parents/guardians most frequently served as support persons. One support person was almost always or often used with child victims and/or witnesses of all ages. Support persons were extremely common in cases involving child sexual abuse, physical abuse, neglect, and adult domestic violence. Overall, support persons provided more informational than emotional support. The most common informational support was to provide referrals to community resources, conduct courtroom visit/orientation, and disseminate relevant procedural information. The most common emotional support was to accompany the child to trial. Support persons rarely or never questioned children directly during investigative interviews or in court. Respondents believed support persons decrease children's stress and increase accuracy and credibility; however, this effect varied as a function of who provided support, child age, case type, and type of emotional or informational support. Respondents believed that support person presence at trial probably does not prejudice jurors against defendants. These survey data provide a benchmark for legal professionals and a foundation for future social scientific research examining the effects of support person use on children.

On the Prototyping of an ICT-Enhanced Toilet System for Assisting Older Persons Living Independently and Safely at Home.

PubMed

Panek, Paul; Fazekas, Gabor; Lüftenegger, Theresa; Mayer, Peter; Pilissy, Tamas; Raffaelli, Matteo; Rist, Atilla; Rosenthal, Ramona; Savanovic, Arso; Sobjak, Anna; Sonntag, Franziska; Toth, Andras; Unger, Birgit

2017-01-01

Standard toilets often do not meet the needs of a significant number of older persons and persons with disabilities. The EU funded iToilet project aims at design and development of a new type of ICT enhanced modular toilet system which shall be able to support autonomy, dignity and safety of older persons living at home. Methodologically the project started with gathering user requirements by means of questionnaires, interviews and focus group discussion involving a total of 74 persons, thereof 41 subjects with movement disorders (primary users), 21 caregivers (secondary users) and 12 healthcare managers (tertiary users). Most important wishes were bilateral removable handrails, height and tilt adjustment, emergency detection, simplicity. In parallel to the ongoing technical development participatory design activities have been carried out at user test sites in order to continuously involve users into the design process and to allow quick feedback with regards to early prototype parts. The project currently is working on the finalization of the first prototype ready to enter the lab trial stage in spring 2017. The experiences will be used for redesigning a prototype 2 which is planned to be tested in real life settings early 2018.

Exploring interprofessional collaboration during the integration of diabetes teams into primary care.

PubMed

Gucciardi, Enza; Espin, Sherry; Morganti, Antonia; Dorado, Linda

2016-02-01

Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work. Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators' reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software. Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange. Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.

Examining Live-In Foreign Domestic Helpers as a Coping Resource for Family Caregivers of People With Dementia in Singapore.

PubMed

Basnyat, Iccha; Chang, Leanne

2017-09-01

In Singapore, the responsibility of caring for persons with dementia falls on family members who cope with a long-term caregiver burden, depending on available support resources. Hiring foreign domestic workers to alleviate caregiver burden becomes a prevalent coping strategy that caregivers adopt. This strategy allows caregivers to provide home care as part of fulfilling family obligations while managing the caregiver burden. This study aimed to investigate primary caregivers' relationship with hired support and its impact on coping with caregiver burden. Twenty in-depth interviews were conducted with primary caregivers who hired live-in domestic helpers to take care of their family members with dementia. The findings revealed that caregivers perceived the normative obligations to provide home care to family members with dementia. They sought support from domestic helpers to cope with physical and mental burnout, disruption of normal routines, and avoidance of financial strain. A mutual-support relationship was built between caregivers and domestic helpers through trust and interdependence. The presence of domestic helpers as a coping resource reveals the positive outcomes of problem-, emotional-, and diversion-focused coping. This study illustrates that coping strategies are employed in different ways depending on the needs of caregivers, access to infrastructure, cultural expectations, and available resources.

MAXCOG-Maximizing Cognition: A Randomized Controlled Trial of the Efficacy of Goal-Oriented Cognitive Rehabilitation for People with Mild Cognitive Impairment and Early Alzheimer Disease.

PubMed

Regan, Bridget; Wells, Yvonne; Farrow, Maree; O'Halloran, Paul; Workman, Barbara

2017-03-01

To review the efficacy of a home-based four-session individualized face-to-face cognitive rehabilitation (MAXCOG) intervention for clients with mild cognitive impairment (MCI) or early dementia and their close supporters. Randomized controlled trial comparing the intervention group (MAXCOG) with treatment as usual (control). A total of 55 client-supporter dyads were enrolled in the study and 40 completed; 25 client-supporter dyads completed MAXCOG and 15 completed treatment as usual. Both MAXCOG and control groups included more MCI cases than dementia (22 versus 3 and 12 versus 3, respectively). Four weekly individual sessions of MAXCOG consisting of personalized interventions to address individually relevant goals, supported by the provision of the MAXCOG information resource. The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure (COPM). Questionnaires assessing mood, illness adjustment, quality of life, and carer burden were also administered. The intervention group displayed significantly higher performance and satisfaction with primary goals on the COPM post-intervention than the control group, using a per-protocol analysis. The MAXCOG intervention is effective in improving goal performance and satisfaction in clients with MCI and early dementia. Copyright © 2017 American Association for Geriatric Psychiatry. All rights reserved.

The Intersection of Intellectual Disability and Dementia: Report of The International Summit on Intellectual Disability and Dementia.

PubMed

Watchman, Karen; Janicki, Matthew P

2017-11-02

An International Summit on Intellectual Disability and Dementia, held in Glasgow, Scotland (October 13-14, 2016), drew individuals and representatives of numerous international and national organizations and universities with a stake in issues affecting adults with intellectual disability (ID) affected by dementia. A discussion-based consensus process was used to examine and produce a series of topical reports examining three main conceptual areas: (a) human rights and personal resources (applications of the Convention for Rights of People with Disabilities and human rights to societal inclusion, and perspectives of persons with ID), (b) individualized services and clinical supports (advancing and advanced dementia, post-diagnostic supports, community supports and services, dementia-capable care practice, and end-of-life care practices), and (c) advocacy, public impact, family caregiver issues (nomenclature/terminology, inclusion of persons with ID in national plans, and family caregiver issues). Outcomes included recommendations incorporated into a series of publications and topical summary bulletins designed to be international resources, practice guidelines, and the impetus for planning and advocacy with, and on behalf of, people with ID affected by dementia, as well as their families. The general themes of the conceptual areas are discussed and the main recommendations are associated with three primary concerns. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Psychometric Properties of the French Version of the Personality Inventory for DSM-5

PubMed Central

Roskam, Isabelle; Galdiolo, Sarah; Hansenne, Michel; Massoudi, Koorosh; Rossier, Jérôme; Gicquel, Ludovic; Rolland, Jean-Pierre

2015-01-01

In the context of the publication of DSM-5, the Personality Inventory for DSM-5 (PID-5) has been proposed as a new dimensional assessment tool for personality disorders. This instrument includes a pool of 220 items organized around 25 facets included in a five-factor second-order domain structure. The examination of the replicability of the trait structure across methods and populations is of primary importance. In view of this need, the main objective of the current study was to validate the French version of the PID-5 among French-speaking adults from a European community sample (N=2,532). In particular, the assumption of unidimensionality of the 25 facet and the five domain scales was tested, as well as the extent to which the five-factor structure of the PID-5 and the DSM-5 personality trait hierarchical structure are replicated in the current sample. The results support the assumption of unidimensionality of both the facets and the domains. Exploratory factor and hierarchical analyses replicated the five-factor structure as initially proposed in the PID-5. PMID:26193699

The Psychometric Properties of the French Version of the Personality Inventory for DSM-5.

PubMed

Roskam, Isabelle; Galdiolo, Sarah; Hansenne, Michel; Massoudi, Koorosh; Rossier, Jérôme; Gicquel, Ludovic; Rolland, Jean-Pierre

2015-01-01

In the context of the publication of DSM-5, the Personality Inventory for DSM-5 (PID-5) has been proposed as a new dimensional assessment tool for personality disorders. This instrument includes a pool of 220 items organized around 25 facets included in a five-factor second-order domain structure. The examination of the replicability of the trait structure across methods and populations is of primary importance. In view of this need, the main objective of the current study was to validate the French version of the PID-5 among French-speaking adults from a European community sample (N=2,532). In particular, the assumption of unidimensionality of the 25 facet and the five domain scales was tested, as well as the extent to which the five-factor structure of the PID-5 and the DSM-5 personality trait hierarchical structure are replicated in the current sample. The results support the assumption of unidimensionality of both the facets and the domains. Exploratory factor and hierarchical analyses replicated the five-factor structure as initially proposed in the PID-5.

Doulas for surgical management of miscarriage and abortion: a randomized controlled trial.

PubMed

Wilson, Susan F; Gurney, Elizabeth P; Sammel, Mary D; Schreiber, Courtney A

2017-01-01

Women undergoing office-based surgical management of a failed or undesired pregnancy often report fear of pain and anxiety pertaining to the procedure. Doulas are trained to specifically address women's physical and emotional needs in obstetric care, and recently have extended their practice to support women through all pregnancy outcomes. We sought to evaluate the impact of doulas on patients' physical and emotional responses to surgical management of a first-trimester failed or undesired pregnancy under local anesthesia. In this nonblinded, randomized trial, women received doula support or routine care during office uterine aspiration for failed or unwanted pregnancies in the first trimester. The primary outcome was pain measured on a 100-mm visual analog scale. Secondary outcomes included satisfaction, emotional state, sense of personal empowerment, and ability to cope immediately and 1 month after the procedure, as well as medical assistants' assessment of the doula's utility. A sample size of 35 per group (N = 70) was planned to detect a 20% difference in pain score. From April 2014 through January 2015, 129 women were screened and 70 were randomized. The 2 study groups were similar on all baseline characteristics. The primary outcome was not different between the doula and control groups (pain score 70.7 ± 24.5 mm vs 59.7 ± 32.5 mm, P = .11, respectively), even after controlling for procedure indication (P = .20). While 97% of women who received doula support reported this helped with their experience, there was no statistically significant difference in satisfaction, emotional response, sense of empowerment, or perceived ability to cope between the 2 groups of women immediately following or 1 month after the procedure. Of all study participants, 72% reported that it was important to have someone with them during the procedure, but that the support person did not have to be a doula. Doula support during office uterine aspiration for failed or undesired pregnancies is well received and desired by women undergoing this procedure despite no significant effect on physical comfort or emotional responses related to the procedure. This may suggest an unmet psychosocial need for procedure-related support among such women. Copyright © 2016 Elsevier Inc. All rights reserved.

The Coming Primary Care Revolution.

PubMed

Ellner, Andrew L; Phillips, Russell S

2017-04-01

The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

Information interventions for recovery following vehicle-related trauma to persons of working age: a systematic review of the literature.

PubMed

Clay, Fiona J; Collie, Alex; McClure, Roderick J

2012-06-01

Given the burden associated with vehicle-related trauma, there is interest in time and cost effective methods of providing information to assist recovery. This systematic review aims to address the question: "Do targeted early information interventions improve outcomes following vehicle--related injuries for persons of working age?" Ovid Medline, EMBASE, PsychINFO and Cochrane databases were searched for studies published between 1990-April 2011. Included studies were randomized or pseudo--randomized controlled trials of information interventions delivered to working age persons following vehicle-related injuries. Two reviewers independently selected and appraised the studies. Sixteen publications (13 primary studies) met the inclusion criteria and were assessed for bias. Hetero-geneity in terms of the information interventions and measured outcomes was encountered. In 4 of the included studies, the intervention was positively associated with at least one outcome reported. Methodological issues limited the conclusions that could be drawn. Following vehicle-related trauma, people often experience difficulties in ongoing functioning. The current evidence neither supports nor fails to support the effectiveness of information interventions in promoting injury recovery. There is a need for larger more methodologically and conceptually rigorous randomized controlled trials that better consider the type and timing of the intervention.

Understanding contextual influences of community reintegration among injured servicemembers.

PubMed

Hawkins, Brent L; McGuire, Francis A; Linder, Sandra M; Britt, Thomas W

2015-01-01

As part of a larger mixed-methods research project investigating the influence of contextual factors on community reintegration (CR), this qualitative study sought to understand the subjective experiences of injured servicemembers and their perception of how contextual factors influenced their CR. More specifically, this article addresses how the influences of contextual factors differ between injured servicemembers with different levels of CR. Using a phenomenological framework, semistructured interviews were conducted with nine injured, community-dwelling servicemembers with low, moderate, and high levels of CR (three per category). Participants provided in-depth descriptions of the contextual barriers and facilitators of CR. Thematic analysis indicated the importance of social support and personal factors (e.g., self-efficacy, personal motivation) as the primary means for being reintegrated into their homes and communities. Other themes indicated factors that had an indirect but important influence on CR, including adapted sports, recreation, and other social programs; rehabilitation programs and therapists; school, work, and volunteering; and organizations and policies in developing social supports and personal factors. Comparisons between servicemembers indicated participants with low CR described many more contextual barriers and far fewer contextual facilitators to reintegration than those with high CR. Those with moderate CR were unique in that they described many facilitators and barriers to reintegration.

[Specialized outpatient care in the Unified Health System: how to fill a void].

PubMed

Tesser, Charles Dalcanale; Poli, Paulo

2017-03-01

The structuring of specialized outpatient care is a bottleneck in the operation of the Unified Health System. Based on a brief discussion about this void in an organizational model, we propose the federal induction of a format of specialized services from the experiences of Centers of Support for Family Health (NASF). They adapted matrix operations and constitute an excellent prototype for the organization of specialized outpatient care. It allows for equal access and maximum proximity to the specialized care of the reality of primary care users, the personal relationship and the close relationship between the family health teams and medical and non-medical specialists, enabling mutual lifelong learning, negotiated regulation and increased efficacy of primary care. Municipal experiences of Florianopolis and Curitiba are synthesized as partial examples of the proposal. the structure of care in mental health of Florianópolis, all organized as a matrix support is briefly described; and we focus on the change in the action of the support teams of Curitiba, which gradually began to engage, involve and mediate the relationship between basic and specialized care. This format can be expanded to most medical specialties.

The Bidimensional Impression Management Index (BIMI): measuring agentic and communal forms of impression management.

PubMed

Blasberg, Sabrina A; Rogers, Katherine H; Paulhus, Delroy L

2014-01-01

Measures of impression management have yet to incorporate two-factor models of person perception. The 2 primary factors are often labeled agency and communion. In Study 1, we assembled a new measure of impression management—the Bidimensional Impression Management Index (BIMI): It comprises 2 subscales designed specifically to tap agentic and communal content. Both subscales showed adequate alpha reliabilities under both honest and faking conditions. In Study 2, the BIMI was cross-validated in a new sample: The subscales remained relatively independent, and their reliabilities remained solid. A coherent pattern of personality correlates also supported the validities of both subscales. In Study 3, the differential sensitivity of the 2 subscales was demonstrated by manipulating the job type in simulated job applications. Implications and applications of the BIMI are discussed.

Type D personality as a predictor of self-efficacy and social support in patients with type 2 diabetes mellitus.

PubMed

Shao, Yechang; Yin, Honglei; Wan, Chengsong

2017-01-01

The aim of this study was to estimate the prevalence of Type D personality and assess the relationship between this personality type and self-efficacy/social support in Chinese patients with type 2 diabetes mellitus (T2DM). From January 1, 2014, to July 31, 2014, 532 consecutive patients with T2DM were recruited from two hospitals in Guangzhou, China. The participants completed questionnaires containing questions about sociodemographic characteristics, Type D personality, self-efficacy, and social support scales, and their medical records were reviewed for additional data. Of the 532 patients, 18.2% had Type D personality. Patients with this personality type reported significantly lower levels of self-efficacy ( P <0.001), total social support ( P <0.001), subjective support ( P <0.001), and support utilization ( P =0.003), but similar level of objective support ( P =0.314), compared to those of patients without Type D personality. Negative affectivity and social inhibition, two intrinsic traits of Type D personality, negatively correlated with self-efficacy and social support scores. Type D personality was significantly associated with less self-efficacy and social support ( P <0.001), controlling for other sociodemographic factors. Glycosylated hemoglobin (HbA1c) levels were significantly higher in T2DM patients with Type D personality than in patients with non-Type D personality. This study provides new evidence linking Type D personality with self-efficacy, social support, and poor glycemic control, highlighting the special need for care among T2DM patients with Type D personality.

Health care utilisation among older persons with intellectual disability and dementia: a registry study.

PubMed

Axmon, A; Karlsson, B; Ahlström, G

2016-12-01

Both persons with intellectual disability (ID) and persons with dementia have high disease burdens, and consequently also high health care needs. As life expectancy increases for persons with ID, the group of persons with the dual diagnosis of ID and dementia will become larger. Through national registries, we identified 7936 persons who had received support directed to persons with ID during 2012, and an age- and gender-matched sample from the general population. A national registry was also used to collect information on health care utilisation (excluding primary care) for the period 2002-2012. Health care utilisation was measured as presence and number of planned and unplanned in-patient and out-patient visits, as well as length of stay. In comparison with persons with ID but without dementia, persons with ID and dementia were more likely to have at least one planned out-patient visit (odds ratio [OR] 8.07), unplanned out-patient visit (OR 2.41), planned in-patient visit (OR 2.76) or unplanned in-patient visit (OR 4.19). However, among those with at least one of each respective outcome, the average number of visits did not differ between those with and without dementia. Persons with ID and dementia were less likely to have at least one planned out-patient visit than persons with dementia in the general population sample (OR 0.40), but more likely to have at least one unplanned in-patient visit (OR 1.90). No statistically significant differences were found for having at least one unplanned out-patient or planned in-patient visit. Nevertheless, among those with at least one unplanned out-patient visit, the number of visits was higher in the general population sample. Persons with ID and dementia are less likely to receive planned health care than persons with dementia in the general population. They have, however, higher levels of unplanned health care utilisation. This may be an indication that the current support system is not sufficient to meet the challenges of increased longevity among persons with ID. © 2016 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disibilities and John Wiley & Sons Ltd.

Ready for Life: Education for Personal and Social Development in Primary Schools

ERIC Educational Resources Information Center

Her Majesty's Inspectorate of Education, 2007

2007-01-01

In this report HM Inspectorate of Education sets out to present an evaluation of how well primary schools promote education for pupils' personal and social development (PSD). As indicated in "Improving Scottish Education" (ISE) (HMIE 2006), primary schools deliver well overall and there is much to be said that is very positive about PSD.…

Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry.

PubMed

Lowenstein, Margaret; Bamgbose, Olusinmi; Gleason, Nathaniel; Feldman, Mitchell D

2017-08-04

Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. ©Margaret Lowenstein, Olusinmi Bamgbose, Nathaniel Gleason, Mitchell D Feldman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.08.2017.

Dyadic interdependence of psychosocial outcomes among haematological cancer survivors and their support persons.

PubMed

Paul, Christine; Hall, Alix; Oldmeadow, Christopher; Lynagh, Marita; Campbell, Sharon; Bradstock, Ken; Williamson, Anna; Carey, Mariko; Sanson-Fisher, Rob

2017-11-01

This study aimed to explore the dyadic relationships between unmet need, depression, and anxiety in people diagnosed with haematological cancer and their support persons. Adult survivors (18 years+) who had been diagnosed with a haematological cancer were recruited to a cross-sectional mailed survey via five state cancer registries in Australia. Participating survivors invited a support person to also complete a survey. Structural equation modelling was used to explore the relationships among survivor and support person self-reported depression, anxiety, and unmet needs. Of the 4299 eligible haematological cancer survivors contacted by the registries, 1511 (35%) returned a completed survey as did 1004 support persons. There were 787 dyads with complete data. After adjusting for age, gender, rurality, cancer type, and whether the support person was a relative, positive correlations were found between survivor and support person scores for depression (p = 0.0029) and unmet needs (p < 0.001), but not anxiety scores (p = 0.075). Survivor unmet needs were significantly related to support person depression (p = 0.0036). Support person unmet needs were significantly related to a higher depression score for survivors (p = 0.0067). Greater support person unmet needs were significantly related to a higher anxiety score for survivors (p = 0.0083). Survivor unmet needs did not have a significant relationship to support person anxiety (p = 0.78). Unmet needs may mediate the interdependence of psychosocial experiences for survivors and support persons, although a longitudinal study is required to confirm causality. Addressing unmet needs may be a potential target for improving outcomes for both groups.

[Polio and post-polio syndrome, viewed by patients and health professionals in primary care].

PubMed

Muñoz Cobos, Francisca; Morales Sutil, María Luisa; Faz García, María Carmen; Ariza González, Marta; Salazar Agulló, José Andrés; Burgos Varo, María Luz

2018-06-25

Polio affects the quality of life of those who have suffered from it and causes health problems including the post-polio syndrome. The main goals of this work were to know the patients perspective of how they have been affected by the disease and establish the knowledge of post-polio syndrome among patients and primary health care professionals. Interpretive qualitative research based on the Grounded Theory carried out in two health-care centers in the city of Malaga, one of them with care-rural clinics. Four focal groups were established with the participation of thirteen patients and two focus groups with twenty-six professional participants. Intentional sampling is performed until saturation. The analysis follows an inductive strategy using the Atlas Ti5.2 software. The people affected by polio reports their personal histories of suffering counteracted by strong family support and an active coping attitude, marked by great effort exertion, willpower and endurance. These people made a positive assessment of their lives minimising the limitations. They presented compatible symptoms with post-polio syndrome, which remain unidentified due to the lack of knowledge of it among patients and health-care professionals. The health care provided was considered deficient due to several causes as for instance lack of involvement, communication problems. The day-to-day polio experience is focused on personal overcoming with major roles played by family support, difficult relationships with the healthcare system and lack of knowledge of the post-polio syndrome.

Effects of benefits and harms on older persons' willingness to take medication for primary cardiovascular prevention.

PubMed

Fried, Terri R; Tinetti, Mary E; Towle, Virginia; O'Leary, John R; Iannone, Lynne

2011-05-23

Quality-assurance initiatives encourage adherence to evidenced-based guidelines based on a consideration of treatment benefit. We examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms. In-person interviews were performed with 356 community-living older persons. Participants were asked about their willingness to take medication for primary prevention of myocardial infarction (MI) with varying benefits in terms of absolute 5-year risk reduction and varying harms in terms of type and severity of adverse effects. Most (88%) would take medication, providing an absolute benefit of 6 fewer persons with MI out of 100, approximating the average risk reduction of currently available medications. Of participants who would not take it, 17% changed their preference if the absolute benefit was increased to 10 fewer persons with MI, and, of participants who would take it, 82% remained willing if the absolute benefit was decreased to 3 fewer persons with MI. In contrast, large proportions (48%-69%) were unwilling or uncertain about taking medication with average benefit causing mild fatigue, nausea, or fuzzy thinking, and only 3% would take medication with adverse effects severe enough to affect functioning. Older persons' willingness to take medication for primary cardiovascular disease prevention is relatively insensitive to its benefit but highly sensitive to its adverse effects. These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms.

Person-centred care in chronic kidney disease: a cross-sectional study of patients' desires for self-management support.

PubMed

Havas, Kathryn; Douglas, Clint; Bonner, Ann

2017-01-13

People with chronic kidney disease (CKD) must self-manage their illness to assist with slowing disease-progression, but this is a complex task requiring support from healthcare professionals. Despite the established importance of person-centred care, people with CKD are rarely consulted regarding their desires for self-management support (SMS). A cross-sectional survey was conducted face-to-face in a Queensland primary care clinic and distributed Australia-wide via an online interface promoted by Kidney Health Australia during 2015. Participants were ≥18 years old and had a self-reported doctor's diagnosis of CKD (any stage; N = 97). The survey was based upon existent literature which identified 10 areas that those with CKD believe require additional support. Descriptive data were generated and Mann-Whitney U tests were performed to compare the desires of different groups of participants. Of the 97 participants, 36 completed a hardcopy survey in clinic, and 61 completed the online version. Just over half (60.8%) were female, age ranged from 16-89 (M = 56.44), and time since diagnosis ranged from just diagnosed to 60 years (Mdn = 8.08 years). Strong interest in receiving additional support across all 10 areas was reported (Mdns = 8.00-10.00), with "keeping a positive attitude and taking care of mental and physical health" receiving the highest rating. Those who were: younger (p < .001); more highly educated (p < .001); working (p < .001); diagnosed longer ago (p = .015); and women (p = .050) expressed stronger overall desire for additional support. In addition to information about CKD and medications, everyday strategies ought to be prioritised in patient education. Varying levels of engagement and eagerness to learn more about self-management highlight the need for a person-centred approach to SMS.

Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial

PubMed Central

Gitlin, Laura N.; Piersol, Catherine Verrier; Hodgson, Nancy; Marx, Katherine; Roth, David L.; Johnson, Deidre; Samus, Quincy; Pizzi, Laura; Jutkowitz, Eric; Lyketsos, Constantine G.

2016-01-01

Among over 5 million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, , identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6 months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3 months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategies to address care challenges. The comparison group controls for time and attention and involves 8 in-home sessions delivered by health educators who provide dementia education, home safety recommendations, and advanced care planning. We are randomizing 250 racially diverse families (person with dementia and primary caregiver dyads) recruited from community-based social services, conferences and media announcements. The primary outcome is change in agitation/aggression at 3 and 6 months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS. PMID:27339865

24 CFR 891.863 - Maintenance as supportive housing units for elderly persons and persons with disabilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... units for elderly persons and persons with disabilities. 891.863 Section 891.863 Housing and Urban... ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SUPPORTIVE HOUSING FOR THE ELDERLY AND PERSONS WITH DISABILITIES For-Profit Limited Partnerships and Mixed-Finance...

24 CFR 891.863 - Maintenance as supportive housing units for elderly persons and persons with disabilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... units for elderly persons and persons with disabilities. 891.863 Section 891.863 Housing and Urban... ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SUPPORTIVE HOUSING FOR THE ELDERLY AND PERSONS WITH DISABILITIES For-Profit Limited Partnerships and Mixed-Finance...

Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach.

PubMed

Findyartini, Ardi; Sudarsono, Nani Cahyani

2018-05-02

Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students' perceptions of their personal identity formation and professional development following completion of the course. This qualitative study, adopting a phenomenological design, uses the participants' reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation. Three main themes were revealed. First, students highlighted the strength of small group activities in helping them 'internalise the essential concepts'. Second, the role-model shadowing supported their understanding of 'what kind of medical doctors they would become'. Third, the field work allowed them to identify 'what the "noble values" are and how to implement them in daily practice'. By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.

The public's priorities in health services.

PubMed

Kaplan, Giora; Baron-Epel, Orna

2015-10-01

Rationing in health services cannot be solved only by cost-effective analysis because social values play a central role in the difficult trade-off dilemma of prioritizing some service over others. To examine the relative importance ascribed by the public to selected components of health services, in the national allocation of resources as well as in their personal insurance. A telephone survey of a representative sample of the Israeli adult population (N = 1225). Two versions of the questionnaire were used. At the national level, interviewees were asked to assume they were the Minister of Health. At the personal level, interviewees were asked to choose items to be included in their personal complementary health insurance. Check-ups for early disease detection and nursing care for the frail elderly got the highest support for extra budget as well as to be included in personal insurance. Other items presented were fertility treatments, cardiac rehabilitation, mental health, dental health, programmes for preventive medicine and health promotion, subsidizing supplemental insurance for the poor, additional staff for primary clinics and building a new hospital. The lowest support was for alternative medicine and for cosmetic surgery. No subgroup in the Israeli society presented a different first priority. The Israeli public does not give high priority to 'nice to have' services but their selections are 'mature' and responsible. Rationing in health care requires listening to the public even if there are still many methodological limitations on how to reflect the public's opinion. © 2013 Blackwell Publishing Ltd.

Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients.

PubMed

Derksen, Frans; Olde Hartman, Tim C; van Dijk, Annelies; Plouvier, Annette; Bensing, Jozien; Lagro-Janssen, Antoine

2017-05-01

There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care. Participants were recruited by a press report in local newspapers. adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis. In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP. Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP. More explicit attention should be given to empathy during medical education in general and during vocational GP-training. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa

PubMed Central

Daire, Judith; Gilson, Lucy

2014-01-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. PMID:25274644

Effectiveness of Personalized Feedback Alone or Combined with Peer Support to Improve Physical Activity in Sedentary Older Malays with Type 2 Diabetes: A Randomized Controlled Trial.

PubMed

Sazlina, Shariff-Ghazali; Browning, Colette Joy; Yasin, Shajahan

2015-01-01

Regular physical activity is an important aspect of self-management among older people with type 2 diabetes but many remain inactive. Interventions to improve physical activity levels have been studied but few studies have evaluated the effects of personalized feedback (PF) or peer support (PS); and there was no study on older people of Asian heritage. Hence, this trial evaluated whether PF only or combined with PS improves physical activity among older Malays with type 2 diabetes (T2DM) compared to usual care only. A three-arm randomized controlled trial was conducted in a primary healthcare clinic in Malaysia. Sixty-nine sedentary Malays aged 60 years and older with T2DM who received usual diabetes care were randomized to PF or PS interventions or as controls for 12 weeks with follow-ups at weeks 24 and 36. Intervention groups performed unsupervised walking activity and received written feedback on physical activity. The PS group also received group and telephone contacts from trained peer mentors. The primary outcome was pedometer steps. Secondary outcomes were self-reported physical activity, cardiovascular risk factors, cardiorespiratory fitness, balance, quality of life, and psychosocial wellbeing. Fifty-two (75.4%) completed the 36-week study. The PS group showed greater daily pedometer readings than the PF and controls (p = 0.001). The PS group also had greater improvement in weekly duration (p < 0.001) and frequency (p < 0.001) of moderate intensity physical activity, scores on the Physical Activity Scale for Elderly (p = 0.003), 6-min walk test (p < 0.001), and social support from friends (p = 0.032) than PF and control groups. The findings suggest that PF combined with PS in older Malays with T2DM improved their physical activity levels, cardiorespiratory fitness, and support from friends. Current Controlled Trials ISRCTN71447000.

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention.

PubMed

Markle-Reid, Maureen F; McAiney, Carrie; Forbes, Dorothy; Thabane, Lehana; Gibson, Maggie; Hoch, Jeffrey S; Browne, Gina; Peirce, Thomas; Busing, Barbara

2011-08-25

Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. ClinicalTrials.gov: NCT01407926.

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

PubMed Central

2011-01-01

Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. Trial Registration ClinicalTrials.gov: NCT01407926 PMID:21867539

Differences in the Perception of Social Support Among Rural Area Seniors-A Cross-Sectional Survey of Polish Population.

PubMed

Chruściel, Paweł; Kulik, Teresa; Jakubowska, Klaudia; Nalepa, Dorota

2018-06-19

Introduction and objective : Social support constitutes an important determinant of an elderly person’s health and of functioning in his or her living environment. It depends on available support networks and the type of help received. Measurement of social support should encompass both its structure and the functions it fulfills, which enables detailed assessment of the phenomenon. The aim of the study was to compare the perception of social support among rural area seniors provided with institutional care with those living in a home setting. Material and method : Using the diagnostic survey method and the technique of the distribution of a direct questionnaire, 364 respondents from rural areas were examined: those living in an institutional environment ( n = 190) and those living in their home (natural) environment ( n = 174). The respondents were selected on the basis of a combined sampling method: proportionate, stratified, and systematic. Variables were measured with the following questionnaires: Courage Social Network Index (CSNI) and Social Support Scale (SSS). Results : The living environment has been proved to differentiate average values of support both in the structural and functional dimensions in a statistically significant way ( p < 0.001). An untypical phenomenon was higher average values pertaining to emotional bonds, frequency of direct contacts, and help received in the group of respondents living in an institutional environment. Conclusions : The living environment and demographic variables affect the perception of social support among elderly people. Full-time institutional care of a senior citizen leads to the deterioration of social support; therefore, keeping an elderly person in a home environment should be one of the primary goals of the senior policy.

Generic quality of life in persons with hearing loss: a systematic literature review.

PubMed

Nordvik, Øyvind; Laugen Heggdal, Peder O; Brännström, Jonas; Vassbotn, Flemming; Aarstad, Anne Kari; Aarstad, Hans Jørgen

2018-01-01

To the best of our knowledge, no empirically based consensus has been reached as to if, and to what extent, persons with hearing loss (HL) have reduced generic Quality of life (QoL). There seems to be limited knowledge regarding to what extent a hearing aid (HA) would improve QoL. The main aim of the present study was to review studies about the relationship between HL and QoL. A supporting aim was to study the association between distress and HL. Literature databases (Cinahl, Pub Med and Web of Science) were searched to identify relevant journal articles published in the period from January 2000 to March 17, 2016. We performed a primary search pertaining to the relationship between HL, HA and QoL (search number one) followed by a supporting search pertaining to the relationship between distress/mood/anxiety and HL (search number two). After checking for duplications and screening the titles of the papers, we read the abstracts of the remaining papers. The most relevant papers were read thoroughly, leaving us with the journal articles that met the inclusion criteria. Twenty journal articles were included in the present review: 13 were found in the primary search (HL and QoL), and seven in the supporting search (HL and distress). The literature yields equivocal findings regarding the association between generic QoL and HL. A strong association between distress and HL was shown, where distressed persons tend to have a lowered generic QoL. It is suggested that QoL is lowered among HL patients. Some studies suggest an increased generic QoL following the use of HA, especially during the first few months after initiation of treatment. Other studies suggest that HA use is one of several possible factors that contribute to improve generic QoL. The majority of the studies suggest that HL is associated with reduced generic QoL. Using hearing aids seem to improve general QoL at follow-up within the first year. HL is a risk factor for distress. Further research is needed to explore the relationship between HL and generic QoL, in addition to the importance of influencing variables on this relationship.

The role of personal values, urban form, and auto availability in the analysis of walking for transportation.

PubMed

Coogan, Matthew A; Karash, Karla H; Adler, Thomas; Sallis, James

2007-01-01

To examine the association of personal values, the built environment, and auto availability with walking for transportation. Participants were drawn from 11 U.S. metropolitan areas with good transit services. 865 adults who had recently made or were contemplating making a residential move. Respondents reported if walking was their primary mode for nine trip purposes. "Personal values" reflected ratings of 15 variables assessing attitudes about urban and environmental attributes, with high reliability (ot = 0.85). Neighborhood form was indicated by a three-item scale. Three binary variables were created to reflect (1) personal values, (2) neighborhood form, and (3) auto availability. The association with walking was reported for each of the three variables, each combination of two variables, and the combination of three variables. An analysis of covariance was applied, and a hierarchic linear regression model was developed. All three variables were associated with walking, and all three variables interacted. The standardized coefficients were 0.23for neighborhood form, 0.21 for autos per person, and 0.18 for personal values. Positive attitudes about urban attributes, living in a supportive neighborhood, and low automobile availability significantly predicted more walking for transportation. A framework for further research is proposed in which a factor representing the role of the automobile is examined explicitly in addition to personal values and urban form.

The effects of pulsed auditory stimulation on various gait measurements in persons with Parkinson's Disease.

PubMed

Freedland, Robert L; Festa, Carmel; Sealy, Marita; McBean, Andrew; Elghazaly, Paul; Capan, Ariel; Brozycki, Lori; Nelson, Arthur J; Rothman, Jeffrey

2002-01-01

The purpose of this study was to examine the Functional Ambulation Performance Score (FAP; a quantitative gait measure) in persons with Parkinson's Disease (PD) using the auditory stimulation of a metronome (ASM). Participants (n = 16; 5F/11M; range 60--84 yrs.) had a primary diagnosis of PD and were all independent ambulators. Footfall data were collected while participants walked multiple times on an electronic walkway under the following conditions: 1) PRETEST: establishing baseline cadence, 2) ASM: metronome set to baseline cadence, 3) 10ASM: metronome set to 10% FAP scores increased between PRETEST and POSTTEST. PRE/POSTTEST comparisons also indicated decreases in cycle time and double support and increases in step length and step-extremity ratio (step length/leg length). The results confirm prior findings that auditory stimulation can be used to positively influence the gait of persons with PD and suggest beneficial effects of ASM as an adjunct to dopaminergic therapy to treat gait dysfunctions in PD.

Patient participation during and after a self-management programme in primary healthcare - The experience of patients with chronic obstructive pulmonary disease or chronic heart failure.

PubMed

Luhr, Kristina; Holmefur, Marie; Theander, Kersti; Eldh, Ann Catrine

2018-06-01

Patient participation is facilitated by patients' ability to take responsibility for and engage in health issues. Yet, there is limited research as to the promotion of these aspects of patient participation in long-term healthcare interactions. This paper describes patient participation as experienced by patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF); the aim was to describe if and how a self-management programme in primary healthcare influenced patient participation. Patients who had participated in a self-management programme were interviewed in nine focus groups (36 patients). Data was analysed using qualitative content analysis. Patients described equality in personal interactions, opportunities to share and discuss, and a willingness to share and learn to facilitate patient participation in a self-management programme. Consequently, patient participation was promoted by a match between the individuals' personal traits and the context. Features facilitating patient participation by means of sharing and assimilating knowledge and insights should be included in self-management programmes and in the care for patients with COPD and CHF. A self-management programme can complement regular primary care regarding enhanced understanding of one's disease and support patient participation and the patient's own resources in self-management. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain

PubMed Central

Fernandez, Ana; Garcia-Alonso, Judith; Royo-Pastor, Concepción; Garrell-Corbera, Immaculada; Rengel-Chica, Jordi; Agudo-Ugena, Josep; Ramos, Alberto; Mendive, Juan Manuel

2015-01-01

Background Economic recession affects quality of life by increasing rates of mental disorders in particular. Social support can be an important protective factor. Aim To estimate the impact of being personally affected by an economic crisis on health-related quality of life (HRQoL), taking into account the possible buffering effect of perceived social support. Design and setting Data from the first wave (March 2012 to November 2012) of the ‘Social Support and Quality of Life Study’, a longitudinal study carried out in a primary health care centre in a deprived neighbourhood of Barcelona, Spain. Method A total of 143 participants were assessed using the 12-item Short-Form Health Survey, the List of Threatening Experiences and the Duke Social Support scales. The effect of economic crisis on mental and physical HRQoL was assessed using ordinary least squares regression models to test the interaction between social support and having experienced an economic crisis. Results There was no statistical association between having suffered an economic crisis and physical HRQoL. The interaction between social support and economic crisis was also tested without finding any statistical association. An interaction was detected between social support and economic crisis in relation to mental HRQoL; those who had low levels of social support and had also experienced an economic crisis had the lowest levels of mental HRQoL. Conclusion Social support constitutes a safety net that offers protection against the adverse effect of economic recessions on mental health. Primary care professionals are in a key position to promote social activities and to strengthen social networks in the community. PMID:25733442

Personal Smartphones in Primary School: Devices for a PLE?

ERIC Educational Resources Information Center

Honegger, Beat Döbeli; Neff, Christian

2011-01-01

This paper describes the goals and first results of an ongoing two year case study in a European primary school (5th primary class) where the teacher and all students were equipped with a personal smartphone. Students are allowed to use phone and internet services at no charge and to take home their smartphones after school. In this project the…

Illness representations of depression and perceptions of the helpfulness of social support: comparing depressed and never-depressed persons.

PubMed

Vollmann, Manja; Scharloo, Margreet; Salewski, Christel; Dienst, Alexander; Schonauer, Klaus; Renner, Britta

2010-09-01

Interactions between depressed persons and persons within their social network are often characterized by misunderstanding and unsuccessful social support attempts. These interpersonal problems could be fostered by discrepancies between depressed and never-depressed persons' illness representations of depression and/or discrepancies in the perceived helpfulness of supportive behaviors. Illness representations of depression (IPQ-R) and perceptions of the helpfulness of different social support behaviors (ISU-DYA and ISAD) were assessed in 41 currently depressed persons and 58 persons without a history of depression. Never-depressed persons perceived depression as more controllable by treatment and as less emotionally impairing than depressed persons, but also as having more severe consequences. Never-depressed persons considered activation-oriented support (motivation to approach problems) as more helpful and protection-oriented support (allowance to draw back) as less helpful in comparison to depressed persons. Data were collected in unrelated samples of depressed and never-depressed persons. Discrepancies in illness representations and perceptions of the helpfulness of social support do exist and may be the origin of problematic social interactions between depressed patients and persons within their social network. Therapeutic interventions should address the issue of conflicting perceptions and encourage depressed patients to acknowledge and discuss this topic within their social network. 2010 Elsevier B.V. All rights reserved.

Becoming and Being DLP: Designated Liaison Persons' Experience of the Role in the Irish Primary School

ERIC Educational Resources Information Center

Nohilly, Margaret

2018-01-01

This paper reviews the role of the Designated Liaison Person (DLP) for Child Protection in the Irish primary school context. This is a role assigned by the Board of Management to a person in the school who oversees all matters pertaining to child protection including reporting abuse, liaising with staff and outside agencies in relation to child…

Principles of strengths-based nursing leadership for strengths-based nursing care: a new paradigm for nursing and healthcare for the 21st century.

PubMed

Gottlieb, Laurie N; Gottlieb, Bruce; Shamian, Judith

2012-06-01

The current healthcare system is slowly evolving into a new system built on a vision of health promotion, primary care and community-based home care, with hospitals still being a core pillar of the healthcare system but not its primary service. This transformation requires a new approach to practice, namely, Strengths-Based Nursing Care (SBC). SBC is about mobilizing, capitalizing and developing a person's strengths to promote health and facilitate healing. For nurses to practise SBNC requires strong nursing leadership that creates conditions to enable them to do so. Strengths-Based Nursing Leadership complements and acts in synergy with, SBNC. This paper describes eight principles of Strengths-Based Nursing Leadership to support SBNC.

Avian influenza and South Jakarta primary healthcare workers: a controlled mixed-method study.

PubMed

Koh, Gerald Choon-Huat; Abikusno, Nugroho; Kwing, Cheong Seng; Yee, Wong Teck; Kusumaratna, Rina; Sundram, Meena; Koh, Kelvin; Eng, Chia Sin; Koh, David

2009-07-01

To study the attitudes, concerns, perceived impact, coping strategies, knowledge on avian influenza (AI) and personal protection measures, and institutional and personal preparedness for AI among all Indonesian primary healthcare workers (PHW). Questionnaire survey of PHW from four public primary healthcare clinics in South Jakarta (n = 333), with Singaporean PHW from 18 such clinics as controls (n = 1321). Twelve focus group discussions with 51 South Jakarta PHW were also conducted. Quantitative and qualitative data were analysed separately with statistical and thematic analysis, respectively, then combined. South Jakarta PHW had positive attitudes but major concerns about contracting AI, difficulties in diagnosing human AI and inadequacy of personal protection provided. South Jakarta PHW are less knowledgeable about AI and use of personal protection equipment, and reported poorer awareness, availability and participation in AI preparation activities. Only 3% of South Jakarta PHW received influenza vaccination in the preceding 6 months and few felt prepared for AI. South Jakarta primary healthcare workers are not well prepared for avian influenza. There is an urgent need to build their primary healthcare capacity to protect them and contain this global health threat.

Social support modifies the relationship between personality and depressive symptoms in older adults.

PubMed

Oddone, Cameron G; Hybels, Celia F; McQuoid, Douglas R; Steffens, David C

2011-02-01

To explore the relationship between personality, social support, and depression in older adults, identify the personality trait and social support dimension most closely associated with depression, and determine whether the relationship between personality and depression varies by level of social support. Cross-sectional analysis within longitudinal study. Older patients originally diagnosed with major depression (n = 108) and never-depressed comparison group of older adults (n = 103). Patients sufficiently recovered from major depression and comparison participants were administered the NEO Personality Inventory. Social support was measured annually for both groups. Patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS) every 3 months. Patients and comparison participants differed on four of the five NEO domains and all four social support dimensions, but personality did not significantly predict depression status (patient/comparison) in controlled analyses. Within the patient group, subjective social support was the only dimension correlated with MADRS score. In separate linear regression analyses among the patients, controlling for age, sex, and subjective social support, the domains of Neuroticism, Openness to Experience, Conscientiousness, and Extraversion were associated with MADRS score. For Neuroticism and Openness, the association varied by level of subjective social support. Our research confirmed that older patients differed from never-depressed older adults in dimensions of personality and social support, and the relationship between these variables differed by depression status. The relationship between personality, social support, and depressive symptoms in older adults recovering from depression is also complex, with subjective social support modifying the association between personality and depression.

Offering Person-Centered Supports on a Daily Basis: An Initial Appreciative Inquiry into the Relationship between Personal Assistants and Those Seeking Support

ERIC Educational Resources Information Center

Romer, Lyle T.; Walker, Pamela

2013-01-01

This paper focuses on aspects of the relationship that develops between people offering daily support and those seeking those supports. We interviewed 16 personal assistants employed in two agencies in the Pacific Northwest. Both agencies are members of a community of practice among organizers of person-centered supports that is coordinated…

Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions.

PubMed

Fried, Terri R; Tinetti, Mary E; Iannone, Lynne

2011-01-10

Clinicians are caring for an increasing number of older patients with multiple diseases in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process. Focus groups were conducted with 40 primary care clinicians (physicians, nurse practitioners, and physician assistants) in academic, community, and Veterans Affairs-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. The participants were concerned about their patients' ability to adhere to complex regimens derived from guideline-directed care. There was variability in beliefs regarding, and approaches to balancing, the benefits and harms of guideline-directed care. There was also variability regarding how the participants involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients' goals. The participants listed a number of barriers to making good treatment decisions, including the lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, the support of their subspecialist colleagues, and an altered reimbursement system.

Psychological well-being and workability in child abuse investigators.

PubMed

Tehrani, N

2018-05-17

Working with victims and offenders of child abuse can impact on the health and well-being of police officers and staff. To identify the effects of tenure, work ability, gender and a personal experience of child abuse on symptoms of anxiety, depression and primary and secondary trauma in child abuse investigators (CAIs). Screening questionnaires were sent to police officers and staff. The officers and staff worked in child protection in seven police forces. The surveillance was undertaken online and the data were encrypted and personal identifiers removed. The four clinical measures were Goldberg Anxiety/Depression Scale, Professional Quality of Life and Impact of Events (extended). Eighty-two per cent of 2798 CAIs returned questionnaires. There was a statistically significant relationship between all four clinical symptoms and workability (P < 0.001), between tenure and primary trauma (P < 0.01) and between anxiety, depression, primary trauma and workability and adverse childhood experience (ACE) scores (P < 0.001). Regression analysis showed that workability, tenure and ACE scores explained between 12 and 23% of the variance. There were gender differences with women having higher levels of symptoms; however, the effect size and clinical significance were negligible for all but the primary trauma scores. Psychological surveillance can provide an important source of evidence for occupational health practitioners working with CAIs in informing them of the factors which could be considered in selecting, training, supporting and retaining officers and staff. Psychological surveillance can also help police management to identify ways to monitor the long-term effectiveness and well-being of CAIs.

Infectious disease management in primary care: perceptions of GPs

PubMed Central

2011-01-01

Background It is important to keep the level of antibiotic prescribing low to contain the development of resistant bacteria. This study was conducted to reveal new knowledge about how GPs think in relation to the prescribing of antibiotics - knowledge that could be used in efforts toward rational treatment of infectious diseases in primary care. The aim was to explore and describe the variations in GPs' perceptions of infectious disease management, with special reference to antibiotic prescribing. Methods Twenty GPs working at primary care centres in a county in south-west Sweden were purposively selected based on the strategy of including GPs with different kinds of experience. The GPs were interviewed and perceptions among GPs were analysed by a phenomenographic approach. Results Five qualitatively different perceptions of infectious disease management were identified. They were: (A) the GP must help the patient to achieve health and well-being; (B) the management must meet the GP's perceived personal, professional and organisational demands; (C) restrictive antibiotic prescribing is time-consuming; (D) restrictive antibiotic prescribing can protect the effectiveness of antibiotics; and (E) patients benefit personally from restrictive antibiotic prescribing. Conclusions Restrictive antibiotic prescribing was considered important in two perceptions, was not an issue as such in two others, and was considered in one perception although the actual prescribing was greatly influenced by the interaction between patient and GP. Accordingly, to encourage restrictive antibiotic prescribing several aspects must be addressed. Furthermore, different GPs need various kinds of support. Infectious disease management in primary care is complex and time-consuming, which must be acknowledged in healthcare organisation and planning. PMID:21223592

Psychometric testing of an instrument to measure the experience of home.

PubMed

Molony, Sheila L; McDonald, Deborah Dillon; Palmisano-Mills, Christine

2007-10-01

Research related to quality of life in long-term care has been hampered by a paucity of measurement tools sensitive to environmental interventions. The primary aim of this study was to test the psychometric properties of a new instrument, the Experience of Home (EOH) Scale, designed to measure the strength of the experience of meaningful person-environment transaction. The instrument was administered to 200 older adults in diverse dwelling types. Principal components analysis provided support for construct validity, eliciting a three-factor solution accounting for 63.18% of variance in scores. Internal consistency reliability was supported with Cronbach's alpha of .96 for the entire scale. The EOH Scale is a unique research tool to evaluate interventions to improve quality of living in residential environments.

The Influence of Contextual Factors on the Sustainability of Professional Development Outcomes

NASA Astrophysics Data System (ADS)

Sandholtz, Judith Haymore; Ringstaff, Cathy

2016-03-01

This study investigated how contextual factors influenced the sustainability of outcomes from a 3-year, state-funded professional development program that provided science assistance for K-2 teachers in small, rural school districts. The research used a case-study approach with a purposive sample of five elementary schools that varied in instructional time in science several years after the funding period. The primary data sources were teacher surveys and interviews conducted 2 and 3 years after the end of the professional development program. The findings highlight variations across schools and the influence of principal support, resources, collegial support, personal commitment, and external factors. The research holds practical implications for enhancing long-term sustainability of professional development outcomes in science education.

Setting the Stage for Personalized Treatment of Glioma | Center for Cancer Research

Cancer.gov

Gliomas, the most common type of primary brain tumors in adults, arise from different types of glial cells, which support and protect the neurons of the central nervous system. How a patient’s glioma is treated depends in part on the type of glial cell from which the tumor developed. Classification of gliomas has traditionally been done by microscopic analysis of tumor sections. This process is subjective and prone to inconsistencies, which may explain in part the wide-ranging and often suboptimal responses of gliomas to treatment.  

Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing health-care organization

PubMed Central

Wojda, Thomas R.; Stawicki, Stanislaw P.; Yandle, Kathy P.; Bleil, Maria; Axelband, Jennifer; Wilde-Onia, Rebecca; Thomas, Peter G.; Cipolla, James; Hoff, William S.; Shultz, Jill

2017-01-01

Organ procurement (OP) from donors after brain death and circulatory death represents the primary source of transplanted organs. Despite favorable laws and regulations, OP continues to face challenges for a number of reasons, including institutional, personal, and societal barriers. This focused review presents some of the key components of a successful OP program at a large, high-performing regional health network. This review focuses on effective team approaches, aggressive resuscitative strategies, optimal communication, family support, and community outreach efforts. PMID:28660162

A national study of the unmet needs of support persons of haematological cancer survivors in rural and urban areas of Australia.

PubMed

Lynagh, Marita C; Williamson, A; Bradstock, K; Campbell, S; Carey, M; Paul, C; Tzelepis, F; Sanson-Fisher, R

2018-06-01

This study aimed to compare support persons of haematological cancer survivors living in rural and urban areas in regard to the type, prevalence and factors associated with reporting unmet needs. One thousand and four (792 urban and 193 rural) support persons of adults diagnosed with haematological cancer were recruited from five Australian state population-based cancer registries. Participants completed the Support Person Unmet Needs Survey (SPUNS) that assessed the level of unmet needs experienced over the past month across six domains. Overall, 66% of support persons had at least one 'moderate, high or very high' unmet need and 24% (n = 182) reported having multiple (i.e. 6 or more) 'high/very high' unmet needs in the past month. There were no significant differences between rural and urban support persons in the prevalence of multiple unmet needs or mean total unmet needs scores. There were however significant differences in the types of 'high/very high' unmet needs with support persons living in rural areas more likely to report finance-related unmet needs. Support persons who indicated they had difficulty paying bills had significantly higher odds of reporting multiple 'high/very high' unmet needs. This is the first large, population-based study to compare the unmet needs of support persons of haematological cancer survivors living in rural and urban areas. Findings confirm previous evidence that supporting a person diagnosed with haematological cancer correlates with a high level of unmet needs and highlight the importance of developing systemic strategies for assisting support persons, especially in regard to making financial assistance and travel subsidies known and readily accessible to those living in rural areas.

Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes.

PubMed

Kim, Hongsoo; Park, Yeon-Hwan; Jung, Young-Il; Choi, Hyoungshim; Lee, Seyune; Kim, Gi-Soo; Yang, Dong-Wook; Paik, Myunghee Cho; Lee, Tae-Jin

2017-04-18

Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate. The multifaceted SPEC intervention, a geriatric care model guided by the chronic care model, consists of five components: comprehensive geriatric assessment for need/risk profiling, individual need-based care planning, interdisciplinary case conferences, person-centered care coordination, and a cloud-based information and communications technology (ICT) tool supporting the intervention process. The primary outcome is quality of care for older residents using a composite measure of quality indicators from the interRAI LTCF assessment system. Outcome assessors and data analysts will be blinded to group assignment. Secondary outcomes include quality of life, healthcare utilization, and cost. Process evaluation will be also conducted. This study is expected to provide important new evidence on the effectiveness, cost-effectiveness, and implementation process of an ICT-supported chronic care model for older persons with multiple chronic illnesses. The SPEC intervention is also unique as the first registered trial implementing an integrated care model using technology to promote person-centered care for frail older nursing home residents in South Korea, where formal LTC was recently introduced. ISRCTN11972147.

Telehealth Problem-Solving Therapy for Depressed Low-Income Homebound Older Adults: Acceptance and Preliminary Efficacy

PubMed Central

Choi, Namkee G.; Hegel, Mark T.; Nathan Marti, C.; Mary Lynn Marinucci, M.S.S.W.; Leslie Sirrianni, M.S.S.W.; Bruce, Martha L.

2012-01-01

Objective To evaluate the acceptance and preliminary efficacy of in-home telehealth delivery of problem-solving therapy (tele-PST) among depressed low-income homebound older adults in a pilot randomized control trial (RCT) designed to test its feasibility and preliminary efficacy. Methods 121 homebound individuals who were age 50+ and scored 15+ on the 24-item Hamilton Rating Scale for Depression (HAMD) participated in the 3-arm RCT, comparing tele-PST to in-person PST and telephone support calls. Six sessions of the PST-PC (primary care) were conducted for the PST participants. For tele-PST, second through sixth sessions were conducted via Skype video call. Acceptance of tele-PST or in-person PST was measured with the 11-item, 7-point scale modified Treatment Evaluation Inventory (TEI). Mixed-effect regression analysis was used to examine the effects of treatment group, time, and the interaction term between treatment group and time on the HAMD scores. Results The TEI score was slightly higher among tele-PST participants than among in-person PST participants. The HAMD scores of tele-PST participants and in-person PST participants at 12-week follow-up were significantly lower than the HAMD scores of telephone support call participants, and the treatment effects were maintained at 24-week follow-up. The HAMD scores of tele-PST participants did not differ from those of in-person PST participants. Conclusions Despite their initial skepticism, almost all participants had extremely positive attitudes toward tele-PST at 12-week follow-up. Tele-PST also appears to be an efficacious treatment modality for depressed homebound older adults and to have significant potential to facilitate their access to treatment. PMID:23567376

Fit for purpose? Validation of a conceptual framework for personal recovery with current mental health consumers.

PubMed

Bird, Victoria; Leamy, Mary; Tew, Jerry; Le Boutillier, Clair; Williams, Julie; Slade, Mike

2014-07-01

Mental health services in the UK, Australia and other Anglophone countries have moved towards supporting personal recovery as a primary orientation. To provide an empirically grounded foundation to identify and evaluate recovery-oriented interventions, we previously published a conceptual framework of personal recovery based on a systematic review and narrative synthesis of existing models. Our objective was to test the validity and relevance of this framework for people currently using mental health services. Seven focus groups were conducted with 48 current mental health consumers in three NHS trusts across England, as part of the REFOCUS Trial. Consumers were asked about the meaning and their experience of personal recovery. Deductive and inductive thematic analysis applying a constant comparison approach was used to analyse the data. The analysis aimed to explore the validity of the categories within the conceptual framework, and to highlight any areas of difference between the conceptual framework and the themes generated from new data collected from the focus groups. Both the inductive and deductive analysis broadly validated the conceptual framework, with the super-ordinate categories Connectedness, Hope and optimism, Identity, Meaning and purpose, and Empowerment (CHIME) evident in the analysis. Three areas of difference were, however, apparent in the inductive analysis. These included practical support; a greater emphasis on issues around diagnosis and medication; and scepticism surrounding recovery. This study suggests that the conceptual framework of personal recovery provides a defensible theoretical base for clinical and research purposes which is valid for use with current consumers. However, the three areas of difference further stress the individual nature of recovery and the need for an understanding of the population and context under investigation. © The Royal Australian and New Zealand College of Psychiatrists 2014.

MYPLAN -mobile phone application to manage crisis of persons at risk of suicide: study protocol for a randomized controlled trial.

PubMed

Andreasson, Kate; Krogh, Jesper; Bech, Per; Frandsen, Hanne; Buus, Niels; Stanley, Barbara; Kerkhof, Ad; Nordentoft, Merete; Erlangsen, Annette

2017-04-11

Persons with a past episode of self-harm or severe suicidal ideation are at elevated risk of self-harm as well as dying by suicide. It is well established that suicidal ideation fluctuates over time. Previous studies have shown that a personal safety plan can assist in providing support, when a person experiences suicide ideation, and help seeking professional assistance if needed. The aim of the trial is to determine whether a newly developed safety mobile app is more effective in reducing suicide ideation and other symptoms, compared to a safety plan on paper. The trial is designed as a two-arm, observer-blinded, parallel-group randomized clinical superiority trial, where participants will either receive: (1) Experimental intervention: the safety plan provided as the app MyPlan, or (2) Treatment as Usual: the safety plan in the original paper format. Based on a power calculation, a total of 546 participants, 273 in each arm will be included. They will be recruited from Danish Suicide Prevention Clinics. Both groups will receive standard psychosocial therapeutic care, up to 8-10 sessions of supportive psychotherapy. Primary outcome will be reduction in suicide ideation after 12 months. Follow-up interviews will be conducted at 3, 6, 9, and 12 months after date of inclusion. A safety plan is a mandatory part of the treatment in the Suicide Prevention Clinics in Demark. There are no studies investigating the effectiveness of a safety plan app compared to a safety plan on paper on reducing suicide ideation in patients with suicide ideation and suicidal behavior. The trial will gain new knowledge of whether modern technology can augment the effects of traditional personalized safety planning. ClinicalTrials.gov, NCT02877316 . Registered on 19 August 2016.

Living arrangements and mental health in Finland

PubMed Central

Joutsenniemi, Kaisla; Martelin, Tuija; Martikainen, Pekka; Pirkola, Sami; Koskinen, Seppo

2006-01-01

Background Non‐married persons are known to have poor mental health compared with married persons. Health differences between marital status groups may largely arise from corresponding differences in interpersonal social bonds. However, official marital status mirrors the social reality of persons to a decreasing extent, and living arrangements may be a better measure of social bonds. Little is known about mental health in different living arrangement groups. This study aims to establish the extent and determinants of mental health differences by living arrangement in terms of psychological distress (GHQ) and DSM‐IV psychiatric disorders (CIDI). Methods Data were used from the nationally representative cross sectional health 2000 survey, conducted in 2000–1 in Finland. Altogether 4685 participants (80%) aged 30–64 years were included in these analyses; comprehensive information was available on measures of mental health and living arrangements. Living arrangements were measured as follows: married, cohabiting, living with other(s) than a partner, and living alone. Results Compared with the married, persons living alone and those living with other(s) than a partner were approximately twice as likely to have anxiety or depressive disorders. Cohabiters did not differ from the married. In men, psychological distress was similarly associated with living arrangements. Unemployment, lack of social support, and alcohol consumption attenuated the excess psychological distress and psychiatric morbidity of persons living alone and of those living with other(s) than a partner by about 10%–50% each. Conclusions Living arrangements are strongly associated with mental health, particularly among men. Information on living arrangements, social support, unemployment, and alcohol use may facilitate early stage recognition of poor mental health in primary health care. PMID:16698975

Nutrition in primary health care: using a Delphi process to design new interdisciplinary services.

PubMed

Brauer, Paula; Dietrich, Linda; Davidson, Bridget

2006-01-01

A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers' nutrition services. The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Integrating pharmacists into primary care teams: barriers and facilitators.

PubMed

Jorgenson, Derek; Laubscher, Tessa; Lyons, Barry; Palmer, Rebecca

2014-08-01

This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada. Qualitative design using data from one-on-one telephone interviews with pharmacists, physicians and nurse practitioners from the 23 teams that integrated a new pharmacist role. Four researchers from varied backgrounds used thematic analysis of the interview transcripts to determine key themes. The research team met on multiple occasions to agree on the key themes and received written feedback from an external auditor and two of the original interviewees. Seven key themes emerged describing the barriers and facilitators that the teams experienced during the pharmacist integration: (1) relationships, trust and respect; (2) pharmacist role definition; (3) orientation and support; (4) pharmacist personality and professional experience; (5) pharmacist presence and visibility; (6) resources and funding; and (7) value of the pharmacist role. Teams from urban and rural communities experienced some of these challenges in unique ways. Primary care teams that integrated a pharmacist experienced several common barriers and facilitators. The negative impact of these barriers can be mitigated with effective planning and support that is individualized for the type of community where the team is located. © 2013 Royal Pharmaceutical Society.

Issues concerning international comparison of free-field calibrations of acoustical standards

NASA Astrophysics Data System (ADS)

Nedzelnitsky, Victor

2002-11-01

Primary free-field calibrations of laboratory standard microphones by the reciprocity method establish these microphones as reference standard devices for calibrating working standard microphones, other measuring microphones, and practical instruments such as sound level meters and personal sound exposure meters (noise dosimeters). These primary, secondary, and other calibrations are indispensable to the support of regulatory requirements, standards, and product characterization and quality control procedures important for industry, commerce, health, and safety. International Electrotechnical Commission (IEC) Technical Committee 29 Electroacoustics produces international documentary standards, including standards for primary and secondary free-field calibration and measurement procedures and their critically important application to practical instruments. This paper addresses some issues concerning calibrations, standards activities, and the international key comparison of primary free-field calibrations of IEC-type LS2 laboratory standard microphones that is being planned by the Consultative Committee for Acoustics, Ultrasound, and Vibration (CCAUV) of the International Committee for Weights and Measures (CIPM). This comparison will include free-field calibrations by the reciprocity method at participating major national metrology laboratories throughout the world.

Translating person-centered care into practice: A comparative analysis of motivational interviewing, illness-integration support, and guided self-determination.

PubMed

Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig; Graue, Marit; Rasmussen, Bodil; Wahl, Astrid; Kirkevold, Marit

2016-03-01

Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. Professionals must critically consider the context in their choice of approach. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Personality as a Predictor of First-Semester Adjustment to College: The Mediational Role of Perceived Social Support

ERIC Educational Resources Information Center

Lidy, Kara M.; Kahn, Jeffrey H.

2006-01-01

Personality was hypothesized to predict college adjustment because of the role of perceived social support. A sample of III freshmen completed measures of personality, perceived social support, and college adjustment twice in their 1st semester. Perceived social support mediated the relationships between 3 personality factors (Emotional Stability,…

Weighing the Anti-Ischemic Benefits and Bleeding Risks from Aspirin Therapy: a Rational Approach.

PubMed

Dugani, Sagar; Ames, Jeffrey M; Manson, JoAnn E; Mora, Samia

2018-02-21

The role of aspirin in secondary cardiovascular prevention is well understood; however, the role in primary prevention is less clear, and requires careful balancing of potential benefits with risks. Here, we summarize the evidence base on the benefits and risks of aspirin therapy, discuss clinical practice guidelines and decision support tools to assist in initiating aspirin therapy, and highlight ongoing trials that may clarify the role of aspirin in cardiovascular disease prevention. In 2016, the USPSTF released guidelines on the use of aspirin for primary prevention. Based on 11 trials (n = 118,445), aspirin significantly reduced all-cause mortality and nonfatal myocardial infarction, and in 7 trials that evaluated aspirin ≤ 100 mg/day, there was significant reduction in nonfatal stroke. The USPSTF recommends individualized use of aspirin based on factors including age, 10-year atherosclerotic cardiovascular disease risk score, and bleeding risk. Several ongoing trials are evaluating the role of aspirin in primary prevention, secondary prevention, and in combination therapy for atrial fibrillation. Evidence-based approaches to aspirin use should consider the anti-ischemic benefits and bleeding risks from aspirin. In this era of precision medicine, tools that provide the personalized benefit to risk assessment, such as the freely available clinical decision support tool (Aspirin-Guide), can be easily incorporated into the electronic health record and facilitate more informed decisions about initiating aspirin therapy for primary prevention. Aspirin has a complex matrix of benefits and risks, and its use in primary prevention requires individualized decision-making. Results from ongoing trials may guide healthcare providers in identifying appropriate candidates for aspirin therapy.

Motivational interviewing: experiences of primary care nurses trained in the method.

PubMed

Östlund, Ann-Sofi; Wadensten, Barbro; Kristofferzon, Marja-Leena; Häggström, Elisabeth

2015-03-01

Motivational interviewing is a person-centered counseling style used to promote behavioral change regarding a wide variety of lifestyle problems. Use of motivational interview is growing worldwide and among many different healthcare professions, including primary care nursing. The study aim was to describe motivational interview trained nurses' experiences of motivational interviewing in primary care settings. The study had a qualitative descriptive design. It was carried out in Swedish primary care settings in two county council districts, with 20 primary care nurses trained in motivational interviewing. Half of them used the method in their work, half did not. Qualitative semi-structured interviews were used. Data were analyzed using qualitative content analysis. The nurses experienced that openness to the approach and an encouraging working climate are required to overcome internal resistance and to increase use of motivational interviewing. They also experienced mutual benefit: motivational interviewing elicits and develops abilities in both nurses and patients. For the nurses using it, motivational interviewing is perceived to facilitate work with patients in need of lifestyle change. Lack of training/education, support, interest and appropriate work tasks/patients are reasons for not using motivational interviewing.

"Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics.

PubMed

Schapiro, Naomi A

2002-01-01

While coprolalia is the most well-known symptom of Tourette's syndrome (TS), it affects only a minority of persons with the condition. TS is a chronic neurobiological condition consisting of vocal and motor tics. Many children with TS have associated obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD), both of which can interfere with school, peer, and family functioning more than the tics themselves. The article distinguishes TS from other tic disorders and reviews literature on epidemiology, etiology, clinical course, and diagnostic and treatment issues. The article discusses the role of primary care pediatric and advanced practice nurses in the diagnosis and management of TS and details helpful interventions in the arenas of personal, family, and educational support, as well as symptom management and indications for medications. The author also suggests areas for future nursing research.

Antisocial personality disorder: diagnostic, ethical and treatment issues.

PubMed

Kaylor, L

1999-01-01

Antisocial personality disorder (ASPD) is a complex disorder that creates a diagnostic, ethical, and treatment dilemma for mental health professionals. Psychosocial, biological, and cultural influences play a role in the development of ASPD. People with ASPD often had harsh early childhoods that impaired their ability to trust in adulthood. Research supports intriguing biological links, but it remains unclear if biological differences are the cause or the effect of ASPD. Individualism, patriarchy, and widespread media violence create the cultural context for the development of ASPD. ASPD is difficult to clinically diagnose and treat, and there is controversy concerning whether ASPD is a psychiatric or a legal-ethical problem. However, the management of ASPD often falls to mental health services. This article addresses treatment and primary prevention of ASPD in a way that is relevant to mental health practice.

Assessing conscientious personality in primary care: an opportunity for prevention and health promotion.

PubMed

Israel, Salomon; Moffitt, Terrie E

2014-05-01

The articles in this special section bolster the already strong evidence base that personality differences in the trait of conscientiousness predict health. What is now needed is a research agenda for translating documented risk associations between low conscientiousness and poor health into policies and interventions that improve health outcomes for individuals and populations. In this commentary, we highlight 1 such avenue: introducing brief personality assessment into primary care practice. We provide examples of how conscientiousness assessment may help health care professionals get to know their patients better and potentially serve as a guide for more personalized care. We also raise key considerations for implementation research aimed at examining the feasibility and utility of integrating conscientiousness assessment into primary care settings. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

The INSPIRED study: a randomised controlled trial of the Whole Person Model of disease self-management for people with type 2 diabetes.

PubMed

Clarke, David M; Baird, Donita E; Perera, Dinali N; Hagger, Virginia L; Teede, Helena J

2014-02-08

The prevalence of type 2 diabetes has increased dramatically in the last decade, and is continuing to rise. It is a chronic condition, often related to obesity, diet and sedentary lifestyles, and can lead to significant health complications, disability and early death. Diabetes is commonly associated with depression, which can impact significantly on a person's ability to manage their illness and, consequently, on disease outcomes. Disease self-management is fundamental in diabetes and requires support from multiple health professionals and the active participation of the person, including in maintaining a healthy lifestyle. The Whole Person Model was developed in order to integrate emotional and behavioural aspects into a self-management program for people with type 2 diabetes. Here we describe a study designed to test the efficacy of the Whole Person Model of disease self-management in type 2 diabetes. In a parallel-group randomised trial, 180 people with type 2 diabetes of between 2-10 years duration will be recruited via invitation through the Australian National Diabetes Services Scheme. Participants will undergo baseline assessment, followed by randomisation to either intervention or control condition. Control participants will receive fact sheets containing key information about diabetes self-management. The intervention group will receive the INSPIRED (Individual Support & Resources for Diabetes) Manual and be assigned a Health Coach. The INSPIRED Manual consists of six modules that provide key information about diabetes and disease management using the Whole Person Model. Engagement is facilitated by interactive tasks and contact with a Health Coach over seven weeks--an introductory face-to-face session, and six subsequent contacts by phone following each module. Follow-up assessments occur at 13 weeks (post-intervention) and 26 weeks. Primary outcomes include blood glucose management (HbA1c), weight and mood. Secondary outcomes include level of exercise, confidence to manage diabetes, and psychosocial well-being. The Whole Person Model is designed to enable health professionals to address mood disturbance without pathologizing any disorders and, in the context of the chronic illness, empowering behavior change and self-management. If proven effective, this model will strengthen capacity of the healthcare workforce to foster and support effective diabetes self-management. Australia and New Zealand Clinical Trials Register, ACTRN12613000391774.

Social Support Modifies the Relationship between Personality and Depressive Symptoms in Older Adults

PubMed Central

Oddone, Cameron G.; Hybels, Celia F.; McQuoid, Douglas R.; Steffens, David C.

2010-01-01

Objective To explore the relationship between personality, social support, and depression in older adults, identify the personality trait and social support dimension most closely associated with depression, and determine if the relationship between personality and depression varies by level of social support. Design Cross-sectional analysis within longitudinal study. Participants Older patients originally diagnosed with major depression (n=108) and never depressed comparison group of older adults (n=103). Measurements Patients sufficiently recovered from major depression and comparison participants were administered the NEO Personality Inventory. Social support was measured annually for both groups. Patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS) every three months. Results Patients and comparison participants differed on four of the five NEO domains and all four social support dimensions, but personality did not significantly predict depression status (patient/comparison) in controlled analyses. Within the patient group, subjective social support was the only dimension correlated with MADRS score. In separate linear regression analyses among the patients, controlling for age, sex, and subjective social support, the domains of Neuroticism, Openness to Experience, Conscientiousness, and Extraversion were associated with MADRS score. For Neuroticism and Openness, the association varied by level of subjective social support. Conclusions Our research confirmed older patients differed from never depressed older adults in dimensions of personality and social support, and the relationship between these variables differed by depression status. The relationship between personality, social support, and depressive symptoms in older adults recovering from depression is also complex, with subjective social support modifying the association between personality and depression. PMID:21328795

A qualitative comparison of primary care clinicians’ and their patients’ perspectives on achieving depression care: implications for improving outcomes

PubMed Central

2014-01-01

Background Improving the patient experience of primary care is a stated focus of efforts to transform primary care practices into “Patient-centered Medical Homes” (PCMH) in the United States, yet understanding and promoting what defines a positive experience from the patient’s perspective has been de-emphasized relative to the development of technological and communication infrastructure at the PCMH. The objective of this qualitative study was to compare primary care clinicians’ and their patients’ perceptions of the patients’ experiences, expectations and preferences as they try to achieve care for depression. Methods We interviewed 6 primary care clinicians along with 30 of their patients with a history of depressive disorder attending 4 small to medium-sized primary care practices from rural and urban settings. Results Three processes on the way to satisfactory depression care emerged: 1. a journey, often from fractured to connected care; 2. a search for a personal understanding of their depression; 3. creation of unique therapeutic spaces for treating current depression and preventing future episodes. Relative to patients’ observations regarding stigma’s effects on accepting a depression diagnosis and seeking treatment, clinicians tended to underestimate the presence and effects of stigma. Patients preferred clinicians who were empathetic listeners, while clinicians worried that discussing depression could open “Pandora’s box” of lengthy discussions and set them irrecoverably behind in their clinic schedules. Clinicians and patients agreed that somatic manifestations of mental distress impeded the patients’ ability to understand their suffering as depression. Clinicians reported supporting several treatment modalities beyond guideline-based approaches for depression, yet also displayed surface-level understanding of the often multifaceted support webs their patient described. Conclusions Improving processes and outcomes in primary care may demand heightened ability to understand and measure the patients’ experiences, expectations and preferences as they receive primary care. Future research would investigate a potential mismatch between clinicians’ and patients’ perceptions of the effects of stigma on achieving care for depression, and on whether time spent discussing depression during the clinical visit improves outcomes. Improving care and outcomes for chronic disorders such as depression may require primary care clinicians to understand and support their patients’ unique ‘therapeutic spaces.’ PMID:24428952

Innovation in survivor care: group visits.

PubMed

Trotter, Kathryn; Frazier, Alana; Hendricks, Colleen K; Scarsella, Heidi

2011-04-01

The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.

Conflicts and dilemmas in prevention of cardiovascular disease. The new, Norwegian guidelines--a new approach to risk management.

PubMed

Gjelsvik, Bjørn

2012-03-01

Prevention of cardiovascular disease (CVD) has been debated for many years, between an organ-specialist perspective versus a public health view. As an illustration, the Wonca Europe Council decided in 2004 to withdraw its support to the 2003 European Guidelines. This paper discusses the main sources of disagreement, most important the levels of risk when treatment should be offered. The Norwegian Guideline for primary prevention of CVD (2009) introduced a new principle of age-differentiated risk levels. Pharmacological treatment should be offered to all persons aged 40-49 years with 10-year mortality risk ≥ 1%, all persons aged 50-59 years at ≥ 5% risk, and all persons aged 60-69 years at ≥ 10% risk. Lower thresholds for younger persons are based on the fact that life years lost, will be considerable if drugs are prescribed only for risk levels above 5%. For persons aged 60-69 years, age is the dominant risk factor and the benefits of treatment are smaller. The implications of the recommendation are discussed, both at an individual and a societal level. Compared to the European 2007 guidelines, the total sum of life years gained is about the same, but the number of patients treated is considerably lower.

"Seeing a doctor is just like having a date": a qualitative study on doctor shopping among overactive bladder patients in Hong Kong

PubMed Central

2014-01-01

Background Although having a regular primary care provider is noted to be beneficial to health, doctor shopping has been documented as a common treatment seeking behavior among chronically ill patients in different countries. However, little research has been conducted into the reasons behind doctor shopping behavior among patients with overactive bladder, and even less into how this behavior relates to these patients’ illness and social experiences, perceptions, and cultural practices. Therefore, this study examines overactive bladder patients to investigate the reasons behind doctor shopping behavior. Methods My study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong. Results My study found six primary themes that influenced doctor shopping behavior: lack of perceived need, convenience, work-provided medical insurance, unpleasant experiences with doctors, searching for a match doctor, and switching between biomedicine and traditional Chinese medicine. Besides the perceptual factors, participants’ social environment, illness experiences, personal cultural preference, and cultural beliefs also intertwined to generate their doctor shopping behavior. Due to the low perceived need for a regular personal primary care physician, environmental factors such as time, locational convenience, and work-provided medical insurance became decisive in doctor shopping behavior. Patients’ unpleasant illness experiences, stemming from a lack of understanding among many primary care doctors about overactive bladder, contributed to participants’ sense of mismatch with these doctors, which induced them to shop for another doctor. Conclusions Overactive bladder is a chronic bladder condition with very limited treatment outcome. Although patients with overactive bladder often require specialty urology treatment, it is usually beneficial for the patients to receive continuous, coordinated, comprehensive, and patient-centered support from their primary care providers. Primary care doctors’ understanding on patients with overactive bladder with empathetic attitudes is important to reduce the motivations of doctor shopping behavior among these patients. PMID:24502367

"Seeing a doctor is just like having a date": a qualitative study on doctor shopping among overactive bladder patients in Hong Kong.

PubMed

Siu, Judy Yuen-Man

2014-02-06

Although having a regular primary care provider is noted to be beneficial to health, doctor shopping has been documented as a common treatment seeking behavior among chronically ill patients in different countries. However, little research has been conducted into the reasons behind doctor shopping behavior among patients with overactive bladder, and even less into how this behavior relates to these patients' illness and social experiences, perceptions, and cultural practices. Therefore, this study examines overactive bladder patients to investigate the reasons behind doctor shopping behavior. My study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong. My study found six primary themes that influenced doctor shopping behavior: lack of perceived need, convenience, work-provided medical insurance, unpleasant experiences with doctors, searching for a match doctor, and switching between biomedicine and traditional Chinese medicine. Besides the perceptual factors, participants' social environment, illness experiences, personal cultural preference, and cultural beliefs also intertwined to generate their doctor shopping behavior. Due to the low perceived need for a regular personal primary care physician, environmental factors such as time, locational convenience, and work-provided medical insurance became decisive in doctor shopping behavior. Patients' unpleasant illness experiences, stemming from a lack of understanding among many primary care doctors about overactive bladder, contributed to participants' sense of mismatch with these doctors, which induced them to shop for another doctor. Overactive bladder is a chronic bladder condition with very limited treatment outcome. Although patients with overactive bladder often require specialty urology treatment, it is usually beneficial for the patients to receive continuous, coordinated, comprehensive, and patient-centered support from their primary care providers. Primary care doctors' understanding on patients with overactive bladder with empathetic attitudes is important to reduce the motivations of doctor shopping behavior among these patients.

Personal therapy for undergraduate music therapy students: a survey of AMTA program coordinators.

PubMed

Gardstrom, Susan C; Jackson, Nancy A

2011-01-01

The primary purpose of this study was to gather information in order to understand if and how various modalities of personal therapy are employed with undergraduate music therapy students in the United States. AMTA degree program coordinators were asked about 3 therapy modalities, in particular: verbal therapy, music therapy, and expressive arts therapy (excluding music therapy). It was predicted that less than a quarter of the respondents would indicate that personal therapy of any modality was required in their undergraduate curricula, but that a larger percentage would indicate that it was encouraged. Both hypotheses were supported, with just over 14% of the respondents indicating that they require some form of personal therapy and 32% indicating that they encourage it, with 73% of this latter subgroup encouraging verbal therapy and 46% encouraging music therapy. It was further predicted that, when therapy was required or encouraged, it was most often provided by an individual who was associated with the college/university and that therapy was usually provided in a group format. Respondent comments related to these 2 questions revealed considerable confusion between experiential exercises and personal therapy, leading to dubious validity of some of the numerical data. Qualitative treatment of narrative responses illuminated 4 salient issues regarding personal therapy for undergraduate music therapy students, as follows: (a) the legal and ethical feasibility of making personal therapy a requirement; (b) the cost and availability of qualified professionals; (c) the benefits of personal therapy as an integral facet of undergraduate music therapy training and education; and (d) the appropriateness of personal therapy at the undergraduate level of training.

The Life Mission Theory II. The Structure of the Life Purpose and the Ego

PubMed Central

Ventegodt, Soren; Andersen, Niels Jorgen; Merrick, Joav

2003-01-01

Pursuing your life mission is often very difficult, and many frustrations are experienced along the way. Major failures to bring out our potential can cause us considerable emotional pain. When this pain is unbearable, we are induced to shift from one intention and talent to another that better allows us to adapt and survive. Thus, we become set on a course that brings out a secondary or tertiary talent instead of the primary talent. This talent displacement may be expressed as a loss of our true nature or true self. The new purpose in life now functions as the core of a new personality: the ego. The ego has a structure similar to that of the true self. It is anchored in a talent and it draws on subtalents. But the person who is centered in his or her ego is not as powerful or talented as the person he or she originally was, living the primary purpose of life. This is because the original personality (the true self or “higher self”) is still there, active and alive, behind the ego. Symptoms, disorders, and diseases may be explained by the loss of energy, joy in life, and intuitive competence because of inner conflicts, which may be alleviated or cured in the salutogenetic process of Antonovsky that helps patients find their sense of coherence or their primary purpose in life. Many cases of reduced ability to function, physically as well as psychologically, socially or sexually, can also be explained and alleviated in this way. When a person discovers his true talent and begins to use it with dedication, privately as well as professionally, his life will flourish and he may overcome even serious disease and great adversity in life. The salutogenetic process can also be called personal development or “quality of life as medicine”. It is important to note that the plan for personal development laid out by this theory is a plan not for the elimination of the ego, but for its cultivation. An existentially sound person still has a mental ego of course, but it is centered on the optimal verbal expression of the life mission. Such an ego is not in conflict with one's true self, but supports the life and wholeness of the person, although in an invisible and seamless way. The more developed the person, the more talents are taken into use. So although the core of existence remains the same throughout life, the healthy person continues to grow. As the number of talents we can call on is unlimited, the journey ends only at death. Understanding the concept of the ego, it is very easy for the physician to motivate the patient to go through a lot of difficulties in order to grow and develop, and when the patient fully understands the concept of the ego and the true self (higher self), the patient gets a strong feeling of direction in personal development, and a motivation to fight the internal obstacles for quality of life, health, and the ability to function. PMID:14755108

The life mission theory II. The structure of the life purpose and the ego.

PubMed

Ventegodt, Søren; Andersen, Niels Jørgen; Merrick, Joav

2003-12-11

Pursuing your life mission is often very difficult, and many frustrations are experienced along the way. Major failures to bring out our potential can cause us considerable emotional pain. When this pain is unbearable, we are induced to shift from one intention and talent to another that better allows us to adapt and survive. Thus, we become set on a course that brings out a secondary or tertiary talent instead of the primary talent. This talent displacement may be expressed as a loss of our true nature or true self. The new purpose in life now functions as the core of a new personality: the ego. The ego has a structure similar to that of the true self. It is anchored in a talent and it draws on subtalents. But the person who is centered in his or her ego is not as powerful or talented as the person he or she originally was, living the primary purpose of life. This is because the original personality (the true self or "higher self") is still there, active and alive, behind the ego. Symptoms, disorders, and diseases may be explained by the loss of energy, joy in life, and intuitive competence because of inner conflicts, which may be alleviated or cured in the salutogenetic process of Antonovsky that helps patients find their sense of coherence or their primary purpose in life. Many cases of reduced ability to function, physically as well as psychologically, socially or sexually, can also be explained and alleviated in this way. When a person discovers his true talent and begins to use it with dedication, privately as well as professionally, his life will flourish and he may overcome even serious disease and great adversity in life. The salutogenetic process can also be called personal development or "quality of life as medicine". It is important to note that the plan for personal development laid out by this theory is a plan not for the elimination of the ego, but for its cultivation. An existentially sound person still has a mental ego of course, but it is centered on the optimal verbal expression of the life mission. Such an ego is not in conflict with one's true self, but supports the life and wholeness of the person, although in an invisible and seamless way. The more developed the person, the more talents are taken into use. So although the core of existence remains the same throughout life, the healthy person continues to grow. As the number of talents we can call on is unlimited, the journey ends only at death. Understanding the concept of the ego, it is very easy for the physician to motivate the patient to go through a lot of difficulties in order to grow and develop, and when the patient fully understands the concept of the ego and the true self (higher self), the patient gets a strong feeling of direction in personal development, and a motivation to fight the internal obstacles for quality of life, health, and the ability to function.

Policy, environment, and worksite fitness program participation among financial enterprise employees in Taiwan.

PubMed

Huang, Sheu-Jen; Hung, Wen-Chi

2016-06-01

This study explored the intertwined effects between the policies and regulations of the companies and personal background on participation in the physical fitness programs and leisure-time activities in financial enterprises. A total of 823 employees were selected as the sample with the multilevel stratification random-sampling technique. The response rate was 52.0%. Data were analyzed with descriptive statistics and hierarchical linear logistic regression. Thirty-two percent and 39% of the employees participated in the physical fitness programs and leisure-time activities, respectively. The factors affecting participation were categorized into intrapersonal factors, interpersonal processes, and primary groups, as well as institutional factors. In the interpersonal processes and primary groups level, higher family social support, more equipment in health promotion was associated with more participation in the programs. With the influence from the institutional level, it was found that health promotion policy amplified the relationship between employees' age and participation, but attenuated the relationship between education level and participation. Health promotion equipment in the institutes attenuated the relationship between colleague social support, family social support, and education level with program participation. Physical activity equipment in the community attenuated the relationship between family social support and program participation. The influential factors of social support and worksite environment could predict the employees' participation in the physical fitness programs and leisure-time physical activities. Health promotion policy and equipment attenuated the negative effects of nonparticipation as well as amplified the positive effects of participation.

Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study.

PubMed

Sokol, Randi; Albanese, Chiara; Chaponis, Deviney; Early, Jessica; Maxted, George; Morrill, Diana; Poirier, Grace; Puopolo, Fran; Schuman-Olivier, Zev

2018-01-02

Primary care providers are well positioned to respond to the opioid crisis by providing buprenorphine/naloxone (B/N) through shared medical appointments (SMAs). Although quantitative research has been previously conducted on SMAs with B/N, the authors conducted a qualitative assessment from the patients' point of view, considering whether and how group visits provide value for patients. Twenty-five participants with opioid use disorder (OUD) who were enrolled in a weekly B/N group visit at a family medicine clinic participated in either of two 1-hour-long focus groups, which were conducted as actual group visits. Participants were prompted with the question "How has this group changed you as a person?" Data were audio-recorded and professionally transcribed and analyzed using a qualitative thematic approach, identifying common communication behaviors and resulting attitudes about the value of the group visit model. Participants demonstrated several communication behaviors that support group members in their recovery, including offering direct emotional support to others struggling with difficult experiences, making an intentional effort to probe about others' lives, venting about heavy situations, joking to lighten the mood, and expressing feelings of gratitude to the entire group. These communication behaviors appear to act as mechanisms to foster a sense of accountability, a shared identity, and a supportive community. Other demonstrated group behaviors may detract from the value of the group experience, including side conversations, tangential comments, and individual participants disproportionately dominating group time. The group visit format for delivering B/N promotes group-specific communication behaviors that may add unique value in supporting patients in their recovery. Future research should elucidate whether these benefits can be isolated from those achieved solely through medication treatment with B/N and if similar benefits could be achieved in non-primary care sites.

What’s Past is Prologue: A Scoping Review of Recent Public Health and Global Health Informatics Literature

PubMed Central

Dixon, Brian E.; Pina, Jamie; Kharrazi, Hadi; Gharghabi, Fardad; Richards, Janise

2015-01-01

Objective: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. Methods: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. Results: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we identified a small but growing set of articles that measure the impact of ICT on clinical outcomes. Discussion: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. Conclusion: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in ICT by governmental health agencies. PMID:26392846

Monitoring Exposure to Ebola and Health of U.S. Military Personnel Deployed in Support of Ebola Control Efforts - Liberia, October 25, 2014-February 27, 2015.

PubMed

Cardile, Anthony P; Murray, Clinton K; Littell, Christopher T; Shah, Neel J; Fandre, Matthew N; Drinkwater, Dennis C; Markelz, Brian P; Vento, Todd J

2015-07-03

In response to the unprecedented Ebola virus disease (Ebola) outbreak in West Africa, the U.S. government deployed approximately 2,500 military personnel to support the government of Liberia. Their primary missions were to construct Ebola treatment units (ETUs), train health care workers to staff ETUs, and provide laboratory testing capacity for Ebola. Service members were explicitly prohibited from engaging in activities that could result in close contact with an Ebola-infected patient or coming in contact with the remains of persons who had died from unknown causes. Military units performed twice-daily monitoring of temperature and review of exposures and symptoms ("unit monitoring") on all persons throughout deployment, exit screening at the time of departure from Liberia, and post-deployment monitoring for 21 days at segregated, controlled monitoring areas on U.S. military installations. A total of 32 persons developed a fever during deployment from October 25, 2014, through February 27, 2015; none had a known Ebola exposure or developed Ebola infection. Monitoring of all deployed service members revealed no Ebola exposures or infections. Given their activity restrictions and comprehensive monitoring while deployed to Liberia, U.S. military personnel constitute a unique population with a lower risk for Ebola exposure compared with those working in the country without such measures.

Towards an international taxonomy of integrated primary care: a Delphi consensus approach.

PubMed

Valentijn, Pim P; Vrijhoef, Hubertus J M; Ruwaard, Dirk; Boesveld, Inge; Arends, Rosa Y; Bruijnzeels, Marc A

2015-05-22

Developing integrated service models in a primary care setting is considered an essential strategy for establishing a sustainable and affordable health care system. The Rainbow Model of Integrated Care (RMIC) describes the theoretical foundations of integrated primary care. The aim of this study is to refine the RMIC by developing a consensus-based taxonomy of key features. First, the appropriateness of previously identified key features was retested by conducting an international Delphi study that was built on the results of a previous national Delphi study. Second, categorisation of the features among the RMIC integrated care domains was assessed in a second international Delphi study. Finally, a taxonomy was constructed by the researchers based on the results of the three Delphi studies. The final taxonomy consists of 21 key features distributed over eight integration domains which are organised into three main categories: scope (person-focused vs. population-based), type (clinical, professional, organisational and system) and enablers (functional vs. normative) of an integrated primary care service model. The taxonomy provides a crucial differentiation that clarifies and supports implementation, policy formulation and research regarding the organisation of integrated primary care. Further research is needed to develop instruments based on the taxonomy that can reveal the realm of integrated primary care in practice.

A taboo within a stigma? a qualitative study of managing incontinence with people with dementia living at home.

PubMed

Drennan, Vari M; Cole, Laura; Iliffe, Steve

2011-11-14

Incontinence in people with dementia is one of the factors associated with the decision to move to a care home. Managing incontinence adds to carer burden and has been reported by family carers as more difficult to manage than behavioural symptoms. Active management strategies have been reported to be associated with less carer depression. The purpose of this study was to investigate carers' perceptions of the range of incontinence problems they helped their relative with and the strategies they employed to manage these. Family carers of people with dementia living in their own homes were recruited through primary care, specialist community mental health services and voluntary organisations. Qualitative semi structured interviews were conducted either face to face or by telephone and thematically analysed. Thirty two carers were interviewed. They described a range of problems from supporting the person to remain independent in toileting, through to dealing with inappropriate behaviours, to containing and managing incontinence. All carers actively used problem solving strategies but sometimes these were not acceptable or understood by the person with dementia, particularly as the dementia progressed. Most carers reported protecting the person's dignity by not seeking health professionals help often until the point of a crisis. Once the carer has decided to seek help the responses from health professionals can be less than helpful, and carers report local health service policies on access to continence products to be inconsistent and often inappropriate to their circumstances. A few carers reported strategies for managing toileting and incontinence that have the potential for distress and harm to the person with dementia. Primary care professionals could be more proactive in enquiry, repeated over time, about toileting and incontinence problems and in giving advice and information to reduce crisis and problems.

What can individuals do to reduce personal health risks from air pollution?

PubMed Central

Laumbach, Robert; Meng, Qingyu

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources. PMID:25694820

Reactive and proactive aggression as meaningful distinctions at the variable and person level in primary school-aged children.

PubMed

Carroll, Annemaree; McCarthy, Molly; Houghton, Stephen; Sanders O'Connor, Emma; Zadow, Corinne

2018-04-24

Reactive and proactive aggression is a dichotomous classification of aggression in adults and children. This distinction has been supported by a number of variable-based and factor analytic studies. Due to high inter-correlations, however, the reactive-proactive aggression distinction may not be entirely useful for understanding how group or individual aggressive behavior varies in children and adolescents. Drawing on a sample of primary school-aged children (N = 242) aged 7-12 years, this study sought to determine whether reactive and proactive aggression could be distinguished at the variable-level and the person-level in children. Exploratory Factor Analysis of data from an aggression instrument measuring both functions and forms of aggression, found a two-factor construct of aggression constituted by a reactive and proactive aggression factor. A person-based analysis was then conducted after classifying children according to the presence of reactive and/or proactive aggression. Discriminant function analysis was used to discern whether classifications on the basis of aggression function produced meaningful distinctions in terms of antisocial traits and emotional valence and intensity measures. Two functions were identified which distinguished children with different combinations of reactive and proactive aggression. Reactive-only aggressive children were defined primarily by high levels of impulsivity, while proactive-only children were defined primarily by higher levels of antisocial traits. Children high in both types of aggression exhibited both the presence of antisocial traits and impulsivity. Contrary to recent findings, this suggests that differences in aggression functions remain meaningful at the person level in children. Implications for interventions are discussed. © 2018 Wiley Periodicals, Inc.

Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial.

PubMed

Gitlin, Laura N; Piersol, Catherine Verrier; Hodgson, Nancy; Marx, Katherine; Roth, David L; Johnston, Deidre; Samus, Quincy; Pizzi, Laura; Jutkowitz, Eric; Lyketsos, Constantine G

2016-07-01

Among over 5million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategies to address care challenges. The comparison group controls for time and attention and involves 8 in-home sessions delivered by health educators who provide dementia education, home safety recommendations, and advanced care planning. We are randomizing 250 racially diverse families (person with dementia and primary caregiver dyads) recruited from community-based social services, conferences and media announcements. The primary outcome is change in agitation/aggression at 3 and 6months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS. Copyright © 2016 Elsevier Inc. All rights reserved.

What can individuals do to reduce personal health risks from air pollution?

PubMed

Laumbach, Robert; Meng, Qingyu; Kipen, Howard

2015-01-01

In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or risk highlight the primary importance of reducing emissions of air pollutants at their sources.

A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

PubMed Central

2014-01-01

Background The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, has been highlighted as a key potential protective factor. This study aimed to review systematically the global literature on the impact of resilience on the mental health of adult conflict-driven forced migrants. Methodology Both quantitative and qualitative studies that reported resilience and mental health outcomes among forcibly displaced persons (aged 18+) by way of exploring associations, links, pathways and causative mechanisms were included. Fourteen bibliographic databases and seven humanitarian study databases/websites were searched and a four stage screening process was followed. Results Twenty three studies were included in the final review. Ten qualitative studies identified highlighted family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. Thirteen quantitative studies were identified, but only two attempted to link resilience with mental disorders, and three used a specific resilience measure. Over-reliance on cross-sectional designs was noted. Resilience was generally shown to be associated with better mental health in displaced populations, but the evidence on this and underlying mechanisms was limited. Discussion The review highlights the need for more epidemiological and qualitative evidence on resilience in forcibly displaced persons as a potential avenue for intervention development, particularly in resource-poor settings. PMID:25177360

Borderline Personality in the Medical Setting

PubMed Central

Sansone, Lori A.

2015-01-01

Objective: Individuals with borderline personality disorder in mental health settings tend to present with relationship difficulties, mood instability/dysphoria, and overt self-harm behavior. In contrast, it appears that individuals with borderline personality disorder in medical settings manifest physical symptoms that are medically difficult to substantiate. Through a review of the literature, we examine 2 symptom manifestations among patients with borderline personality in primary care and general medical settings—namely pain sensitivity and multiple somatic complaints. In addition to reviewing the research of others, we also highlight our own investigations into these 2 areas. Data Sources: We conducted a literature search of the PubMed database and a previous version of the PsycINFO search engine (no restrictions). Search terms included borderline personality, borderline personality disorder, personality disorders; chronic pain, pain, pain syndromes; and somatization disorder, Briquet’s syndrome, somatic preoccupation, somatic. Study Selection: Published articles related to borderline personality, pain and somatic symptoms (ie, somatization disorder, somatic preoccupation) were examined. Results: According to our review, the literature indicates higher-than-expected rates of borderline personality disorder among patients in primary care and general medical settings who present with chronic pain conditions and/or somatic preoccupation. Conclusions: Unlike patients with borderline personality disorder in mental health settings, who tend to present with relationship difficulties, mood instability/dysphoria, and overt self-harm behavior, patients with borderline personality disorder in primary care settings tend to present with unsubstantiated chronic pain of various types as well as somatic preoccupation. PMID:26644960

Online Social Support for Young People: Does It Recapitulate In-person Social Support; Can It Help?

PubMed

Cole, David A; Nick, Elizabeth A; Zelkowitz, Rachel L; Roeder, Kathryn M; Spinelli, Tawny

2017-03-01

As social media websites have grown in popularity, public concern about online victimization has grown as well; however, much less attention has focused on the possible beneficial effects of online social networks. If theory and research about in-person social networks pertain, then online social relationships may represent an important modern source of or vehicle for support. In a study of 231 undergraduates, three major findings emerged: (1) for people with weaker in-person social support, social media sites provide a source of social support that is less redundant of the social support they receive in person; (2) in ways that were not redundant of each other, both online and in-person social support were associated with lower levels of depression-related thoughts and feelings, and (3) the beneficial effects of online social support (like in-person social support) offset some of the adverse effects of peer victimization. The study suggests that augmenting social relations via strategic use of social media can enhance young people's social support systems in beneficial ways.

Online Social Support for Young People: Does It Recapitulate In-person Social Support; Can It Help?

PubMed Central

Cole, David A.; Nick, Elizabeth A.; Zelkowitz, Rachel L.; Roeder, Kathryn M.; Spinelli, Tawny

2017-01-01

As social media websites have grown in popularity, public concern about online victimization has grown as well; however, much less attention has focused on the possible beneficial effects of online social networks. If theory and research about in-person social networks pertain, then online social relationships may represent an important modern source of or vehicle for support. In a study of 231 undergraduates, three major findings emerged: (1) for people with weaker in-person social support, social media sites provide a source of social support that is less redundant of the social support they receive in person; (2) in ways that were not redundant of each other, both online and in-person social support were associated with lower levels of depression-related thoughts and feelings, and (3) the beneficial effects of online social support (like in-person social support) offset some of the adverse effects of peer victimization. The study suggests that augmenting social relations via strategic use of social media can enhance young people’s social support systems in beneficial ways. PMID:28993715

Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden.

PubMed

Andersen, Pia; Holmberg, Sara; Lendahls, Lena; Nilsen, Per; Kristenson, Margareta

2018-04-16

Background : Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included ( n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support.

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

PubMed

Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

2016-11-10

eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. A self-administered questionnaire was used to assess participants' socio-demographics, computer use, literacy, and access, and participants' readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane's T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants' level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy. The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

Survey shows that Swedish healthcare professionals have a positive attitude towards surrogacy but the health of the child is a concern.

PubMed

Armuand, G; Lampic, C; Skoog-Svanberg, A; Wånggren, K; Sydsjö, G

2018-01-01

In February 2016, Sweden upheld its ban on surrogacy following a Government enquiry. This survey investigated attitudes towards surrogacy among primary health professionals working with children and their experiences of working with families following surrogacy abroad. From April to November 2016, nurses, physicians and psychologist working in primary child health care in four counties in Sweden were invited to participate in a cross-sectional online survey about surrogacy. The mean age of the 208 participants was 49.2 years (range 27-68) and nearly 91% were women. Approximately 60% supported legalised surrogacy. Wanting a conscience clause to be introduced in Sweden was associated with not supporting surrogacy for any groups, while personal experiences of infertility and clinical experiences with families following surrogacy were associated with positive attitudes towards surrogacy for heterosexual couples. The majority (64%) disagreed that surrogate children were as healthy as other children, and many believed that they risked worse mental health (21%) and social stigmatisation (21%). We found that 60% supported legalised surrogacy, but many expressed concerns about the children's health and greater knowledge about the medical and psychosocial consequences of surrogacy is needed. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.

PubMed

Grove, Lexie R; Olesiuk, William J; Ellis, Alan R; Lichstein, Jesse C; DuBard, C Annette; Farley, Joel F; Jackson, Carlos T; Beadles, Christopher A; Morrissey, Joseph P; Domino, Marisa Elena

2017-07-01

Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home. We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010. Using a fixed-effects regression approach, we also assessed the effect of medical home enrollment on utilization of primary care and specialty mental health care and medication adherence. A substantial majority (78.5%) of person-years had at least one primary care visit, and 17.9% had at least one primary care visit but no specialty mental health services use. Medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence. Medical home enrollees with schizophrenia and comorbid chronic conditions exhibited significant engagement in primary care, suggesting that primary-care-based medical homes could serve a care coordination function for persons with schizophrenia. Copyright © 2017 Elsevier Inc. All rights reserved.

The uses and gratifications of online care pages: a study of CaringBridge.

PubMed

Anderson, Isolde K

2011-09-01

This study investigated how online care pages help people connect with others and gain social support during a health care event. It reports the results of a survey of 1035 CaringBridge authors who set up personalized web pages because of hospitalization, serious illness, or other reasons, regarding the uses and gratifications obtained from their sites. Four primary benefits were found to be important to all authors of CaringBridge sites: providing information, receiving encouragement from messages, convenience, and psychological support. Hierarchical multiple regression revealed significant effects for six demographic and health-related variables: gender, age, religiosity, Internet usage, the purpose for which the site was set up, and sufficiency of information received from health care providers. Support was obtained for the perspective that online care pages provide new media gratifications for authors, and that health-related antecedents of media use may affect media selection and gratifications. The implications of this study for communication researchers and support services like CaringBridge are also discussed.

Marginalization and social change processes among lesbian, gay, bisexual and transgender persons in Swaziland: implications for HIV prevention.

PubMed

H Logie, Carmen; Perez-Brumer, Amaya; Jenkinson, Jesse; Madau, Veli; Nhlengethwa, Winnie; Baral, Stefan

2018-05-30

Swaziland has among the highest national adult HIV prevalence globally. There is limited knowledge of HIV vulnerabilities and prevention engagement among lesbian, gay, bisexual and transgender (LGBT) persons in the context of Swaziland's criminalization of consensual same-sex practices. This study explored social processes of marginalization to assess how they could potentiate HIV vulnerabilities and limit engagement in HIV prevention services. Additionally, we assessed positive change to better understand existing strategies employed by LGBT persons to challenge these HIV prevention barriers. Guided by community-based research methodology and conducted in Mbabane and Manzini, Swaziland, data were collected by LGBT peer-research assistants (PRA) in collaboration with an LGBT community organization in Manzini. Semi-structured interviews were conducted by trained PRAs and explored HIV prevention, including experiences of stigma and coping. Audio files were transcribed verbatim, translated to English, and analyzed using thematic techniques. Among participants (n = 51; mean age: 26.47, SD: 4.68), 40 self-identifed as gay or lesbian (78.4%), 11 bisexual (22.6%), and 12 (23.5%) identified as transgender. Findings highlighted three primary processes of marginalization and positive change in structural, community, and internal domains. First, structural marginalization, which included criminalization, healthcare discrimination, and a scarcity of LGBT tailored HIV prevention resources was challenged by grassroots networks created to access and share specific HIV resources with LGBT persons and the Ministry of Health. Second, community marginalization included stigma and multi-dimensional forms of violence, however, this was met with LGBT persons providing mutual peer support, including for accessing HIV testing services. Thirdly, internal marginalization comprised of self-stigma and associated sexual risk practices was contrasted with coping strategies focused on self-acceptance, stemming from social support and leading to healthcare utilization. Jointly, these findings can inform the implementation of community-based and rights affirming HIV prevention and care cascade strategies that improve coverage of services with LGBT persons in Swaziland.

The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial.

PubMed

Andreasson, Kate; Krogh, Jesper; Rosenbaum, Bent; Gluud, Christian; Jobes, David A; Nordentoft, Merete

2014-05-29

In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual. The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective treatments. Clinical Trial.gov: NCT01512602.

Investigating Nigerian Primary School Teachers' Preparedness to Adopt Personal Response System in ESL Classroom

ERIC Educational Resources Information Center

Agbatogun, Alaba Olaoluwakotansibe

2012-01-01

This study investigated the extent to which computer literacy dimensions (computer general knowledge, documents and documentations, communication and surfing as well as data inquiry), computer use and academic qualification as independent variables predicted primary school teachers' attitude towards the integration of Personal Response System in…

Effects of induced social roles on the High School Personality Questionnaire.

PubMed

Merydith, S P; Wallbrown, F H

1995-08-01

A one-way multivariate analysis of variance design with a control group (regular directions) and three treatment groups using induced social roles (Faking Good, Teacher, and Ideal Teacher) as independent variables and the High School Personality Questionnaire primary scores as dependent variables was used. Subjects were 384 male high school students from Grades 9 through 12. Within each classroom, students were randomly assigned to the four groups noted above. A broad pattern of differences in scores on primary and secondary personality dimensions were obtained. Significant differences between the control (standard directions) and the Faking Good, Teacher, and Ideal Teacher roles were obtained on three secondary and most of the primary personality dimensions. In several cases the ideal social role and neutral social role showed distinct differences from the more pervasive favorable impression role.

Primary prevention of lead poisoning in rural Native American children: behavioral outcomes from a community-based intervention in a former mining region.

PubMed

Kegler, Michelle C; Malcoe, Lorraine Halinka; Fedirko, Veronika

2010-01-01

The current study examined the effectiveness of a community-based lay health advisor intervention, combined with youth engagement, in improving lead poisoning prevention behaviors and associated beliefs in a rural Native American population located in and near a Superfund site containing mining waste. Three sequential (1997, 2000, and 2004) cross-sectional assessments involving in-person interviews with Native American and White caregivers of young children were conducted. Results showed significant improvements over time for Native American, but not for White, for children washing their hands before meals and snacks, and for annual blood lead testing of both Native American and White children. Findings lend support to the value of community-based education for primary prevention of lead poisoning in Native American and rural communities.

[Psychological Treatments for Borderline Personality Disorder: A Review of Cognitive-Behavioral Oriented Therapies].

PubMed

Marques, Sofia; Barrocas, Daniel; Rijo, Daniel

2017-04-28

Borderline personality disorder is the most common personality disorder, with a global prevalence rate between 1.6% and 6%. It is characterized by affective disturbance and impulsivity, which lead to a high number of self-harm behaviors and great amount of health services use. International guidelines recommend psychotherapy as the primary treatment for borderline personality disorder. This paper reviews evidence about the effects and efficacy of cognitive-behavioral oriented psychological treatments for borderline personality disorder. A literature review was conducted in Medline and PubMed databases, using the following keywords: borderline personality disorder, cognitive-behavioral psychotherapy and efficacy. Sixteen randomized clinical trials were evaluate in this review, which analyzed the effects of several cognitive-behavioral oriented psychotherapeutic interventions, namely dialectical behavioral therapy, cognitive behavioral therapy, schema-focused therapy and manual-assisted cognitive therapy. All above stated treatments showed clinical beneficial effects, by reducing borderline personality disorder core pathology and associated general psychopathology, as well as by reducing the severity and frequency of self-harm behaviors, and by improving the overall social, interpersonal and global adjustment. Dialectical behavioral therapy and schema-focused therapy also caused a soaring remission rate of diagnostic borderline personality disorder criteria of 57% and 94%, respectively. Although there were differences between the psychotherapeutic interventions analysed in this review, all showed clinical benefits in the treatment of borderline personality disorder. Dialectical behavioral therapy and schema-focused therapy presented the strongest scientific data documenting their efficacy, but both interventions are integrative cognitive-behavioral therapies which deviate from the traditional cognitive-behavioral model. In summary, the available studies support cognitive-behavioral psychological treatments as an efficacious intervention in borderline personality disorder. However, the existing scientific literature on this topic is still scarce and there is need for more studies, with higher methodological rigor, that should validate these results.

Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care.

PubMed

Björk Brämberg, Elisabeth; Torgerson, Jarl; Norman Kjellström, Anna; Welin, Peder; Rusner, Marie

2018-01-09

Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.

Influence of clinical outcome and outcome period definitions on estimates of absolute clinical and economic benefits of influenza vaccination in community dwelling elderly persons.

PubMed

Nichol, K L; Nordin, J; Mullooly, J

2006-03-06

Studies assessing the clinical and economic benefits of vaccination in the elderly have used different clinical outcomes (e.g. hospitalizations for pneumonia or influenza versus hospitalizations for respiratory and cardiovascular causes) and different outcome periods (e.g. peak versus total influenza season) on which to base estimates of clinical effectiveness and cost effectiveness. We explored the implications of these varying approaches by comparing two health economic analysis models of influenza vaccination of community-dwelling elderly persons. We developed computerized models using clinical data from 3 large US HMOs for the 1998-1999 and 1999-2000 influenza seasons. The primary health economic model used a broad definition of clinical events and outcome period and included hospitalizations for all respiratory and cardiovascular events that occurred during the entire influenza season. The alternative model used more restrictive definitions and included pneumonia or influenza hospitalizations occurring during the peak influenza season. The results of Monte Carlo simulation showed that, with the more inclusive primary model, influenza vaccination resulted in net medical care cost savings due to fewer respiratory or cardiovascular hospitalizations of Dollars 71/person vaccinated (5th-95th percentile Dollars 32-118) and net savings of Dollars 809/year of life saved (5th-95th percentile Dollars 331-1450). In contrast, the alternate model found costs of Dollars 3.50/person vaccinated (5th-95th percentile Dollars -11 to 5) and net costs of Dollars 91/year of life saved (5th-95th percentile Dollars -309 to 126). Our findings confirm that influenza vaccination of the elderly is most likely cost saving and supports policies and programs that advocate routine immunization of all persons 65 and older. They also highlight how different outcome definitions can influence the results of health economic analyses.

Burden and depression in primary caregivers of persons with visual impairment.

PubMed

Khare, Shubhank; Rohatgi, Jolly; Bhatia, Manjeet Singh; Dhaliwal, Upreet

2016-08-01

Caregivers who assist persons with visual impairment often neglect their needs, resulting in burden and depression. Rehabilitation efforts, directed to the disabled, seldom target the caregiver. To assess burden and depression in persons caring for blind individuals. This was a cross-sectional study carried out in the outpatient department of a tertiary-level teaching hospital in New Delhi. Institutional Ethical Board approval was obtained and written informed consent too was obtained from the participants involved in this study. Persons with best-corrected vision <20/200 in the better eye, and their primary caregivers, were recruited. We recorded demography, other illness/disability, household income, relationship with disabled person, and caregiver burden (Caregiver Burden Scale) and depression (Centre for Epidemiologic Studies Depression Scale). Statistical analysis was carried out using SPSS version 20 (Released 2011. Armonk, NY: IBM Corp.); range, average, and standard deviation were determined for age, burden, and depression. The association between burden and depression was determined using Pearson's correlation; the relationship between degree of disability and caregiver burden and depression was determined using unpaired t-test; using multiple linear regression, factors were found to be statistically significant; significance was taken at P < 0.05. Twenty-seven (53.0%) men and 24 (47.0%) women had visual impairment. Most caregivers (n = 40; 81.6%) were first-degree relatives or a spouse; 32 (65%) had schooling <5 years; and 29 (59%) were unemployed. Depression ranged from 21 to 52 (average 43.2 ± 5.71); it correlated with degree of disability (P = 0.012), household income (r = -0.320; P = 0.025), and burden (r = 0.616; P < 0.001). Burden ranged from 30 to 73 (average 54.5 ± 6.73) and correlated with degree of disability (P = 0.006). On multiple linear regression, burden predicted depression (r = 0.557; P < 0.001). Caregivers merit community support, financial benefit, interventions to diagnose and treat depression, and training in coping. Centers that provide disability certification could offer counseling.

Engaging primary care patients to use a patient-centered personal health record.

PubMed

Krist, Alex H; Woolf, Steven H; Bello, Ghalib A; Sabo, Roy T; Longo, Daniel R; Kashiri, Paulette; Etz, Rebecca S; Loomis, John; Rothemich, Stephen F; Peele, J Eric; Cohn, Jeffrey

2014-01-01

Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. © 2014 Annals of Family Medicine, Inc.

Resilience of primary healthcare professionals working in challenging environments: a focus group study

PubMed Central

Matheson, Catriona; Robertson, Helen D; Elliott, Alison M; Iversen, Lisa; Murchie, Peter

2016-01-01

Background The modern primary healthcare workforce needs to be resilient. Early research framed professional resilience as avoiding ‘burnout’; however, more recent literature has introduced the concept of positive adaptation to professional challenges, which results in individuals thriving in their role. Aim To explore what primary health professionals working in challenging environments consider to be characteristics of resilience and what promotes or challenges professional resilience. Design and setting A qualitative focus group in north east Scotland. Method Five focus groups were held with 20 health professionals (six GPs, nine nurses, four pharmacists, and a practice manager) based in rural or deprived city areas in the north east of Scotland. Inductive thematic analysis identified emerging themes. Results Personal resilience characteristics identified were optimism, flexibility and adaptability, initiative, tolerance, organisational skills, being a team worker, keeping within professional boundaries, assertiveness, humour, and a sense of self-worth. Workplace challenges were workload, information overload, time pressures, poor communication, challenging patients, and environmental factors (rural location). Promoters of professional resilience were strong management support, teamwork, workplace buffers, and social factors such as friends, family, and leisure activities. Conclusion A model of health professional resilience is proposed that concurs with existing literature but adds the concept of personal traits being synergistic with workplace features and social networks. These facilitate adaptability and enable individual health professionals to cope with adversity that is inevitably part of the everyday experience of those working in challenging healthcare environments. PMID:27162205

Resilience of primary healthcare professionals working in challenging environments: a focus group study.

PubMed

Matheson, Catriona; Robertson, Helen D; Elliott, Alison M; Iversen, Lisa; Murchie, Peter

2016-07-01

The modern primary healthcare workforce needs to be resilient. Early research framed professional resilience as avoiding 'burnout'; however, more recent literature has introduced the concept of positive adaptation to professional challenges, which results in individuals thriving in their role. To explore what primary health professionals working in challenging environments consider to be characteristics of resilience and what promotes or challenges professional resilience. A qualitative focus group in north east Scotland. Five focus groups were held with 20 health professionals (six GPs, nine nurses, four pharmacists, and a practice manager) based in rural or deprived city areas in the north east of Scotland. Inductive thematic analysis identified emerging themes. Personal resilience characteristics identified were optimism, flexibility and adaptability, initiative, tolerance, organisational skills, being a team worker, keeping within professional boundaries, assertiveness, humour, and a sense of self-worth. Workplace challenges were workload, information overload, time pressures, poor communication, challenging patients, and environmental factors (rural location). Promoters of professional resilience were strong management support, teamwork, workplace buffers, and social factors such as friends, family, and leisure activities. A model of health professional resilience is proposed that concurs with existing literature but adds the concept of personal traits being synergistic with workplace features and social networks. These facilitate adaptability and enable individual health professionals to cope with adversity that is inevitably part of the everyday experience of those working in challenging healthcare environments. © British Journal of General Practice 2016.

Self-report versus Medical Records for Assessing Cancer-Preventive Services Delivery

PubMed Central

Ferrante, Jeanne M.; Ohman-Strickland, Pamela; Hahn, Karissa A.; Hudson, Shawna V.; Shaw, Eric K.; Crosson, Jesse C.; Crabtree, Benjamin F.

2010-01-01

Accurate measurement of cancer-preventive behaviors is important for quality improvement, research studies, and public health surveillance. Findings differ, however, depending on whether patient self-report or medical records are used as the data source. We evaluated concordance between patient self-report and medical records on risk factors, cancer screening, and behavioral counseling among primary care patients. Data from patient surveys and medical records were compared from 742 patients in 25 New Jersey primary care practices participating at baseline in SCOPE (supporting colorectal cancer outcomes through participatory enhancements), an intervention trial to improve colorectal cancer screening in primary care offices. Sensitivity, specificity, and rates of agreement describe concordance between self-report and medical records for risk factors (personal or family history of cancer, smoking), cancer screening (breast, cervical, colorectal, prostate), and counseling (cancer screening recommendations, diet or weight loss, exercise, smoking cessation). Rates of agreement ranged from 41% (smoking cessation counseling) to 96% (personal history of cancer). Cancer screening agreement ranged from 61% (Pap and prostate-specific antigen) to 83% (colorectal endoscopy) with self-report rates greater than medical record rates. Counseling was also reported more frequently by self-report (83% by patient self-report versus 34% by medical record for smoking cessation counseling). Deciding which data source to use will depend on the outcome of interest, whether the data is used for clinical decision making, performance tracking, or population surveillance; the availability of resources; and whether a false positive or a false negative is of more concern. PMID:18990740

Identifying primary care patient safety research priorities in the UK: a James Lind Alliance Priority Setting Partnership

PubMed Central

Stocks, Susan Jill; Alam, Rahul; Taylor, Sian; Rolfe, Carly; Glover, Steven William; Whitcombe, Joanne; Campbell, Stephen M

2018-01-01

Objectives To identify the top 10 unanswered research questions for primary care patient safety research. Design A modified nominal group technique. Setting UK. Participants Anyone with experience of primary care including: patients, carers and healthcare professionals. 341 patients and 86 healthcare professionals submitted questions. Main outcomes A top 10, and top 30, future research questions for primary care patient safety. Results 443 research questions were submitted by 341 patients and 86 healthcare professionals, through a national survey. After checking for relevance and rephrasing, a total of 173 questions were collated into themes. The themes were largely focused on communication, team and system working, interfaces across primary and secondary care, medication, self-management support and technology. The questions were then prioritised through a national survey, the top 30 questions were taken forward to the final prioritisation workshop. The top 10 research questions focused on the most vulnerable in society, holistic whole-person care, safer communication and coordination between care providers, work intensity, continuity of care, suicide risk, complex care at home and confidentiality. Conclusions This study was the first national prioritisation exercise to identify patient and healthcare professional priorities for primary care patient safety research. The research priorities identified a range of important gaps in the existing evidence to inform everyday practice to address primary care patient safety. PMID:29490970

A mobile phone-based Communication Support System for elderly persons.

PubMed

Ogawa, Hidekuni; Yonezawa, Yoshiharu; Maki, Hiromichi; Caldwell, W Morton

2007-01-01

A mobile phone-based communication support system has been developed for assisting elderly people to communicate by mobile phone. The system consists of a low power mobile phone (PHS phone) having a large liquid crystal screen. When an elderly person telephones, they then choose a communication person from registered support personnel pictures displayed on the liquid crystal screen. The PHS phone dials that person automatically. The elderly person can therefore easily recognize and verify the person. The newly-developed communication support system assists a significant percentage of elderly people with poor eyesight and memory, which frequently cause communication problems, such as dialing a wrong number.

Women who abuse their children: implications for pediatric practice.

PubMed

Rosen, B; Stein, M T

1980-10-01

Parents who abuse their children may not accept traditional therapy but may be influenced by the child's primary care physician. A comparative study of abusive and nonabusive mothers showed abusers to have lower self-concept and higher self-concept incongruence and inconsistency than nonabusers. They were also found to value authority over others more, and conformity and benevolence less, than nonabusers. Practically applied, the data lead the pediatrician to an educative and supportive role in which he or she may enhance self-esteem and lower unrealistic expectations in the course of treating the child. In addition, there seems to be a need to develop access to support groups, day care, and other avenues for the mother's personal growth. This may be done either within a pediatric practice or through liaison with community resources.

How do the Polytechnic Students Cope with the Difficulties in Composing Abstracts for Their Final Projects?

NASA Astrophysics Data System (ADS)

Niswatin, C.; Latief, M. A.; Suharyadi, S.

2018-02-01

This research aims to uncover the fact about engineering students in dealing with composing abstracts for their final projects. The research applies a descriptive qualitative quantitative design. The data were collected through questioners involving 104 engineering students, including the alumni at Politeknik Kota Malang, Indonesia. Furthermore, interviews were carried out to explain the details where necessary to support the primary data. It is found that the common problems faced by engineering students include 1) combining words into sentences, 2) identifying the most appropriate technical terms in engineering, and 3) applying grammar in context. To cope with those difficulties they demanded translation application machines, supported by peer-proofreaders. In addition, they considerably engaged personal tutoring with the lectures more than three times.

Supportive monitoring and disease management through the internet: an internet-delivered intervention strategy for recurrent depression.

PubMed

Kordy, Hans; Backenstrass, Matthias; Hüsing, Johannes; Wolf, Markus; Aulich, Kai; Bürgy, Martin; Puschner, Bernd; Rummel-Kluge, Christine; Vedder, Helmut

2013-11-01

Major depression is a highly prevalent, disabling disorder associated with loss of quality of life and large economic burden for the society. Depressive disorders often follow a chronic or recurrent course. The risk of relapses increases with each additional episode. The internet-deliverable intervention strategy SUMMIT (SUpportive Monitoring and Disease Management over the InTernet) for patients with recurrent depression has been developed with the main objectives to prolong symptom-free phases and to shorten symptom-loaden phases. This paper describes the study design of a six-sites, three-arm, randomized clinical trial intended to evaluate the efficacy of this novel strategy compared to treatment as usual (TAU). Two hundred thirty six patients who had been treated for their (at least) third depressive episode in one of the six participating psychiatric centers were randomized into one of three groups: 1) TAU plus a twelve-month SUMMIT program participation with personal support or 2) TAU plus a twelve-month SUMMIT program participation without personal support, or 3) TAU alone. Primary outcome of this study is defined as the number of "well weeks" over 24months after index treatment assessed by blind evaluators based on the Longitudinal Interval Follow-Up Evaluation. If efficacious, the low monetary and nonmonetary expenditures of this automated, yet individualized intervention may open new avenues for providing an acceptable, convenient, and affordable long-term disease management strategy to people with a chronic mental condition such as recurrent depression. © 2013.

Effectiveness of therapeutic conversation intervention among caregivers of people with eating disorders: quasi-experimental design.

PubMed

Gisladottir, Margret; Treasure, Janet; Svavarsdottir, Erla Kolbrun

2017-03-01

The aim of this study was to evaluate the effectiveness of therapeutic conversation intervention in group and caregiver sessions on the supporting role of caregivers. Caregivers of people with eating disorders are known to suffer major difficulties and are in great need of support. Unhelpful parental support strategies can delay the recovery of an individual with an eating disorder. Skill training interventions can equip parents with skills, guidance and techniques by helping them to be a support person and making them one of the most important links in the treatment process. The therapeutic conversation intervention consisted of five group and caregiver sessions and three booster sessions. The Calgary Family Assessment and Calgary Family Intervention Models, the Illness Beliefs Model and the New Maudsley Method were used as theoretical frameworks. The content of the intervention consisted of work on difficult behaviours, feelings and helpful strategies. The participants (n = 58) included primary and secondary caregivers of 12- to 24-year-old patients with eating disorders. Eight caregivers dropped out of treatment. This study had a quasi-experimental design with one pre- and two post-test measures. Between 90-96% of caregivers rated the therapeutic conversation intervention as supportive. Furthermore, the study revealed significant differences in caregiver emotional and cognitive support, illness beliefs, disruptive behaviour and quality of life, negative aspects of care giving demands and caregiver and patient behavioural difficulties after the intervention and/or at follow-up. Therapeutic conversation intervention with caregivers in group and private sessions proved to be beneficial. This outcome provides information for healthcare professionals on how they can help primary caregivers in their supporting role, which can, in turn, improve services in healthcare centres and psychiatric hospitals. © 2016 John Wiley & Sons Ltd.

Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study

PubMed Central

Strand, Monica; Eng, Lillian Sofie; Børøsund, Elin; Varsi, Cecilie; Ruland, Cornelia

2017-01-01

Background Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective The aim was to illustrate uses and experiences with the secure e-recovery portal “ReConnect” as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users’ control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions Regardless of providers’ portal use, service users’ control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users’ autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). PMID:28465277

Perceived social support in pregnant adolescents in Mersin area in Turkey.

PubMed

Yurdakul, Mine

2018-01-01

The study examines the level and source of perceived social support in pregnant adolescents and the factors related to their perception of social support. This descriptive study was conducted with the voluntary participation of 127 adolescent pregnant females who visited the Gynecology and Pediatric Hospital in Mersin, Turkey. The data were collected based on the participants' self-expression, using the Socio-demographic Information Form and Multidimensional Scale of the Perceived Social Support. The average age of the pregnant adolescents was 18 years. Approximately one-fifth of all participant females were either illiterate or had dropped out of the primary school. All pregnant adolescents were housewives with a low economic status. Findings pertaining to the participants'fertility showed that 69.3% were primiparous, 24.4% had at least one living child. The mean score for pregnant adolescents' perception of social support was 50.79±8.72. The mean score on the subscales was 23.32±3.23 for family support; 16.17±4.35 for friend support; and 12.29 ± 5.54 for special person support. Pregnant adolescents had a low perception of social support. Families were found to be the most common source of social support available to pregnant adolescents, and they lacked the support from their friends and other special people.

Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis.

PubMed

Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Gómez-Urquiza, Jose L; Albendín-García, Luis; Aguayo, Raimundo; Cañadas-De la Fuente, Guillermo A

2018-05-10

burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses. We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017. After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment. Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.

Online social support as a buffer against online and offline peer and sexual victimization among U.S. LGBT and non-LGBT youth.

PubMed

Ybarra, Michele L; Mitchell, Kimberly J; Palmer, Neal A; Reisner, Sari L

2015-01-01

In today's technology-infused world, we need to better understand relationships youth form with friends online, how they compare to relationships formed in-person, and whether these online relationships confer protective benefits. This is particularly important from the perspective of peer victimization, given that social support in-person appears to reduce the odds of victimization in-person. To address this literature gap, data from a sample of 5,542 U.S. adolescents, collected online between August 2010 and January 2011, were analyzed. The main variables of interest were: online and in-person peer victimization (including generalized and bullying forms) and online and in-person sexual victimization (including generalized and sexual harassment forms). Lesbian, gay, bisexual, and transgender (LGBT) youth were more likely than non-LGBT youth to have online friends and to appraise these friends as better than their in-person friends at providing emotional support. Peer victimization and unwanted sexual experiences were more commonly reported by LGBT than non-LGBT youth. Perceived quality of social support, either online or in-person, did little to attenuate the relative odds of victimization for LGBT youth. For all youth, in-person social support was associated with reduced odds of bully victimization (online and in-person) and sexual harassment (in-person), but was unrelated to the other outcomes of interest. Online social support did not reduce the odds of any type of victimization assessed. Together, these findings suggest that online friends can be an important source of social support, particularly for LGBT youth. Nonetheless, in-person social support appears to be more protective against victimization, suggesting that one is not a replacement for the other. Copyright © 2014 Elsevier Ltd. All rights reserved.

Predicting suicide ideation through intrapersonal and interpersonal factors: The interplay of Big-Five personality traits and social support.

PubMed

Ayub, Nailah

2015-11-01

While a specific personality trait may escalate suicide ideation, contextual factors such as social support, when provided effectively, may alleviate the effects of such personality traits. This study examined the moderating role of social support in the relationship between the Big-Five personality traits and suicide ideation. Significant interactions were found between social support and extraversion and emotional stability. Specifically, the relationship between emotional stability and extraversion to suicide ideation was exacerbated when social support was low. Slope analysis showed openness also interacted with low social support. Results were computed for frequency, duration and attitude dimensions of suicide ideation. Extraversion interacted with social support to predict all three dimensions. Social support moderated emotional stability to predict frequency and duration, moderated conscientiousness towards frequency and attitude, and moderated openness towards attitude. The results imply that whereas personality traits may be difficult to alter, social support may play a significant role in saving a life. Psychologists should include family and friends when treating a suicidal youth, guiding them to awareness of one's personality and being more supportive. Copyright © 2015 John Wiley & Sons, Ltd.

Personality traits and perceived social support among depressed older adults.

PubMed

Cukrowicz, Kelly C; Franzese, Alexis T; Thorp, Steven R; Cheavens, Jennifer S; Lynch, Thomas R

2008-09-01

The contribution of personality traits and social support to mental health is well established, but to our knowledge there have been no longitudinal investigations of the relation between personality and social support in depressed older adults. In the current study, we examined a repeated measures multi-level mixed model of change in perceived social support to determine whether personality traits and depressive symptoms were associated with changes in perceived social support over the 3 year study interval in a sample of depressed older adults. Results suggest that Conscientiousness and Extraversion were personality traits that were significantly predictive of changes in perceived social support over this time interval. Based on these results it appears that, among depressed older adults, those with conscientious or extraverted personality traits are more likely to resist impulses to withdraw from relationships. In addition, these traits may lead to more satisfying interactions and greater perceived social support over time. The implications of these results are discussed.

Home e-health system integration in the Smart Home through a common media server.

PubMed

Pau, I; Seoane, F; Lindecrantz, K; Valero, M A; Carracedo, J

2009-01-01

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

Strengthening the dementia care triad: identifying knowledge gaps and linking to resources.

PubMed

Jensen, Christine J; Inker, Jennifer

2015-05-01

This article describes a project to identify the needs of family caregivers and health care providers caring for persons with dementia. Participants included 128 caregivers, who completed a survey, and 27 health care providers, who participated in a focus group and completed a survey. Caregivers reported their primary source of information about the disease was the doctor; however, the majority also reported they were primarily informed of medications and not about needed resources. Health care providers identified limited time with patients and families, and lack of awareness of community services, as their main challenges. Recommendations include strengthening the partnership between physicians, patients, and caregivers (the dementia care triad) through additional support and training for physicians and caregivers, increasing awareness of the Alzheimer's Association, and utilization of technology for families and professionals to track the needs of persons with dementia. © The Author(s) 2014.

The Value of Measurement for Development of Nursing Knowledge:Underlying Philosophy, Contributions and Critiques.

PubMed

Durepos, Pamela; Orr, Elizabeth; Ploeg, Jenny; Kaasalainen, Sharon

2018-06-26

A philosophical discussion of constructive realism and measurement in the development of nursing knowledge is presented. Through Carper's four patterns of knowing, nurses come to know a person holistically. However, measurement as a source for nursing knowledge has been criticized for underlying positivism and reductionist approach to exploring reality. Which seems mal-alignment with person-centered care. Discussion paper. Constructive realism bridges positivism and constructivism, facilitating the measurement of physical and psychological phenomena. Reduction of complex phenomena and theoretical constructs into measurable properties is essential to building nursing's empiric knowledge and facilitates (rather than inhibits) person-knowing. Nurses should consider constructive realism as a philosophy to underpin their practice. This philosophy supports measurement as a primary method of inquiry in nursing research and clinical practice. Nurses can carefully select, and purposefully integrate, measurement tools with other methods of inquiry (such as qualitative research methods) to demonstrate the usefulness of nursing interventions and highlight nursing as a science. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Commercial products that convey personal health information in emergencies.

PubMed

Potini, Vishnu C; Weerasuriya, Dilani N; Lowery-North, Douglas W; Kellermann, Arthur L

2011-12-01

Describe commercially available products and services designed to convey personal health information in emergencies. The search engine Google®, supplemented by print ads, was used to identify companies and organizations that offer relevant products and services to the general market. Disease-specific, health system, and health plan-specific offerings were excluded. Vendor web sites were the primary sources of information, supplemented by telephone and e-mail queries to sales representatives. Perfect inter-rater agreement was achieved. Thirty-nine unique vendors were identified. Eight sell engraved jewelry. Three offer an embossed card or pamphlet. Twelve supply USB drives with various features. Eleven support password-protected web sites. Five maintain national call centers. Available media differed markedly with respect to capacity and accessibility. Quoted prices ranged from a one-time expenditure of $3.50 to an annual fee of $200. Associated features and annual fees varied widely. A wide range of products and services exist to help patients convey personal health information. Health care providers should be familiar with their features, so they can access the information in a disaster or emergency.

Job Satisfaction of Primary-Care Workers Who Assist the Elderly.

ERIC Educational Resources Information Center

Carter, Travis A.

1988-01-01

Used Job Descriptive Index to appraise level of job satisfaction of 111 primary-care employees. The results revealed that varied personality types chose occupations in the caregiving field; satisfaction tended to be independent of personality type. Issues such as pay, promotion, and relationships with supervisors and co-workers were important…

School Teachers' Job Satisfaction and Personal Characteristics: A Quantitative Research Study in Greece

ERIC Educational Resources Information Center

Saiti, Anna; Papadopoulos, Yiannis

2015-01-01

Purpose: The purpose of this paper (based on the relevant literature) is to: investigate, through empirical analysis, primary school teachers' perceptions regarding their job satisfaction, and examine whether or not the personal characteristics of primary school educators (such as gender, age, family status, educational level, and the total years…

Building New Teams for Late Life Care: Lessons From LifeCourse.

PubMed

Schellinger, Sandra; Cain, Cindy L; Shibrowski, Kathleen; Elumba, Deborah; Rosenberg, Erin

2016-07-01

This article details team development within a longitudinal cohort study designed to bring team-based, whole person care early in the course of serious illness. The primary innovation of this approach is the use of nonclinically trained care guides who support patients and family members by focusing care around what matters most to patients, linking to resources, collaborating with other providers, and offering continuity through care transitions. By describing the development of this team, we document the kinds of questions others may ask during the process of team creation. © The Author(s) 2015.

Support for liberal development policies among community elites and non-elites in a rural region of Wisconsin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buttel, F.H.; Johnson, D.E.

Liberal development policies for rural areas, aimed at improving economic conditions and helping corporations find more profitable production sites, are found to fit the traditional role of intervention by government to encourage private investment in underdeveloped areas. Two strategies used in Wisconsin are analyzed to determine the level of community support and compare the social and intellectual support for growth centers of community elites with non-elites. Results indicate the general public does not support the concept of planned growth centers, with primary opposition coming from professional and farm groups rather than the ''traditionalism'' that is often used to characterize themore » area. Those favoring growth-center policies are primarily elites, who tend to limit their support to development of their own community. Elites also favor consolidating community and county delivery of services. Data for the study consisted of 231 personal interviews with leaders of 32 small- and mid-size communities. Their responses were then compared with a random sampling of non-elites. 27 references. (DCK)« less

Advancing Space Sciences through Undergraduate Research Experiences at UC Berkeley's Space Sciences Laboratory - a novel approach to undergraduate internships for first generation community college students

NASA Astrophysics Data System (ADS)

Raftery, C. L.; Davis, H. B.; Peticolas, L. M.; Paglierani, R.

2015-12-01

The Space Sciences Laboratory at UC Berkeley launched an NSF-funded Research Experience for Undergraduates (REU) program in the summer of 2015. The "Advancing Space Sciences through Undergraduate Research Experiences" (ASSURE) program recruited heavily from local community colleges and universities, and provided a multi-tiered mentorship program for students in the fields of space science and engineering. The program was focussed on providing a supportive environment for 2nd and 3rd year undergraduates, many of whom were first generation and underrepresented students. This model provides three levels of mentorship support for the participating interns: 1) the primary research advisor provides academic and professional support. 2) The program coordinator, who meets with the interns multiple times per week, provides personal support and helps the interns to assimilate into the highly competitive environment of the research laboratory. 3) Returning undergraduate interns provided peer support and guidance to the new cohort of students. The impacts of this program on the first generation students and the research mentors, as well as the lessons learned will be discussed.

Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.

PubMed

Brouwers, Melissa C; Vukmirovic, Marija; Tomasone, Jennifer R; Grunfeld, Eva; Urquhart, Robin; O'Brien, Mary Ann; Walker, Melanie; Webster, Fiona; Fitch, Margaret

2016-10-01

To report on the findings of the CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) Casebook project, which systematically documented Canadian initiatives (ie, programs and projects) designed to improve or support coordination and continuity of cancer care between primary care providers (PCPs) and oncology specialists. Pan-Canadian environmental scan. Canada. Individuals representing the various initiatives provided data for the analysis. Initiatives included in the Casebook met the following criteria: they supported coordination and collaboration between PCPs and oncology specialists; they were related to diagnosis, treatment, survivorship, or personalized medicine; and they included breast or colorectal cancer or both. Data were collected on forms that were compiled into summaries (ie, profiles) for each initiative. Casebook initiatives were organized based on the targeted stage of the cancer care continuum, jurisdiction, and strategy (ie, model of care or type of intervention) employed. Thematic analysis identified similarities and differences among employed strategies, the level of primary care engagement, implementation barriers and facilitators, and initiative evaluation. The CanIMPACT Casebook profiles 24 initiatives. Eleven initiatives targeted the survivorship stage of the cancer care continuum and 15 focused specifically on breast or colorectal cancer or both. Initiative teams implemented the following strategies: nurse patient navigation, multidisciplinary care teams, electronic communication or information systems, PCP education, and multicomponent initiatives. Initiatives engaged PCPs at various levels. Implementation barriers included lack of care standardization across jurisdictions and incompatibility among electronic communication systems. Implementation facilitators included having clinical and program leaders publicly support the initiative, repurposing existing resources, receiving financial support, and establishing a motivated and skilled project or program team. The lack of evaluative data made it difficult to identify the most effective interventions or models of care. The CanIMPACT Casebook documents Canadian efforts to improve or support the coordination of cancer care by PCPs and oncology specialists as a means to improve patient outcomes and cancer system performance. Copyright© the College of Family Physicians of Canada.

PERSONAL CHARACTERISTICS OF OLDER PRIMARY CARE PATIENTS WHO PROVIDE A BUCCAL SWAB FOR APOE TESTING AND BANKING OF GENETIC MATERIAL: THE SPECTRUM STUDY

PubMed Central

Bogner, Hillary R.; Wittink, Marsha N.; Merz, Jon F.; Straton, Joseph B.; Cronholm, Peter F.; Rabins, Peter V.; Gallo, Joseph J.

2009-01-01

OBJECTIVE To determine the personal characteristics and reasons associated with providing a buccal swab for APOE genetic testing in a primary care study. METHODS The study sample consisted of 342 adults aged 65 years and older recruited from primary care settings. RESULTS In all, 88% of patients agreed to provide a DNA sample for APOE genotyping and 78% of persons providing a sample agreed to banking of the DNA. Persons aged 80 years and older and African-Americans were less likely to participate in APOE genotyping. Concern about confidentiality was the most common reason for not wanting to provide a DNA sample or to have DNA banked. CONCLUSION We found stronger relationships between sociodemographic variables of age and ethnicity with participation in genetic testing than we did between level of educational attainment, gender, function, cognition, and affect. PMID:15692195

Breathlessness in the primary care setting.

PubMed

Baxter, Noel

2017-09-01

Breathlessness is a high-volume problem with 10% of adults experiencing the symptom daily placing a heavy burden on the health and wider economy. As it worsens, they enter the specialist and hospital-based symptom services where costs quickly escalate and people may find themselves in a place not of their choosing. For many, their care will be delivered by a disease or organ specialist and can find themselves passing between physicians without coordination for symptom support. General practitioners (GPs) will be familiar with this scenario and can often feel out of their depth. Recent advances in our thinking about breathlessness symptom management can offer opportunities and a sense of hope when the GP is faced with this situation. Original research, reviews and other findings over the last 12-18 months that pertain to the value that general practice and the wider primary care system can add, include opportunities to help people recognize they have a problem that can be treated. We present systems that support decisions made by primary healthcare professionals and an increasingly strong case that a solution is required in primary care for an ageing and frail population where breathlessness will be common. Primary care practitioners and leaders must start to realize the importance of recognizing and acting early in the life course of the person with breathlessness because its impact is enormous. They will need to work closely with public health colleagues and learn from specialists who have been doing this work usually with people near to the end of life translating the skills and knowledge further upstream to allow people to live well and remain near home and in their communities.

Factors influencing the development of primary care data collection projects from electronic health records: a systematic review of the literature.

PubMed

Gentil, Marie-Line; Cuggia, Marc; Fiquet, Laure; Hagenbourger, Camille; Le Berre, Thomas; Banâtre, Agnès; Renault, Eric; Bouzille, Guillaume; Chapron, Anthony

2017-09-25

Primary care data gathered from Electronic Health Records are of the utmost interest considering the essential role of general practitioners (GPs) as coordinators of patient care. These data represent the synthesis of the patient history and also give a comprehensive picture of the population health status. Nevertheless, discrepancies between countries exist concerning routine data collection projects. Therefore, we wanted to identify elements that influence the development and durability of such projects. A systematic review was conducted using the PubMed database to identify worldwide current primary care data collection projects. The gray literature was also searched via official project websites and their contact person was emailed to obtain information on the project managers. Data were retrieved from the included studies using a standardized form, screening four aspects: projects features, technological infrastructure, GPs' roles, data collection network organization. The literature search allowed identifying 36 routine data collection networks, mostly in English-speaking countries: CPRD and THIN in the United Kingdom, the Veterans Health Administration project in the United States, EMRALD and CPCSSN in Canada. These projects had in common the use of technical facilities that range from extraction tools to comprehensive computing platforms. Moreover, GPs initiated the extraction process and benefited from incentives for their participation. Finally, analysis of the literature data highlighted that governmental services, academic institutions, including departments of general practice, and software companies, are pivotal for the promotion and durability of primary care data collection projects. Solid technical facilities and strong academic and governmental support are required for promoting and supporting long-term and wide-range primary care data collection projects.

An intensive social cognitive program (can do treatment) in people with relapsing remitting multiple sclerosis and low disability: a randomized controlled trial protocol.

PubMed

Jongen, Peter Joseph; Heerings, Marco; Ruimschotel, Rob; Hussaarts, Astrid; Evers, Silvia; Duyverman, Lotte; Valkenburg-Vissers, Joyce; Cornelissen, Job; Bos, Michel; van Droffelaar, Maarten; Lemmens, Wim A; Donders, Rogier; van der Zande, Anneke; Visser, Leo H

2016-05-28

In people with multiple sclerosis (MS) disabilities and limitations may negatively affect self-efficacy. Lowered self-efficacy has been associated with decreases in health-related quality of life, physical activity and cognitive performance. In an explorative observational study we found that a 3-day intensive social cognitive program (Can Do Treatment [CDT]) with the participation of support partners was followed by substantial increases in self-efficacy control and health-related quality of life 6 months after treatment in those people with MS who had relapsing remitting disease and low disability. CDT is a sociologically oriented approach, its goal is to uncover and promote existing capabilities, and the notion "stressor" is the central concept. CDT's components are plenary group sessions, small group sessions, consultations, a theatre evening, and start of the day with a joint activity. The small group sessions form the actual training. Depending on their individual goals the participants join the training groups 'Body', 'Feeling' or 'Life', to work out their aims and to reduce their stressors. The multidisciplinary team includes a psychiatrist, psychiatric nurse, neurologist, specialized MS nurse, physiotherapist, dance therapist, and a person with MS. To evaluate the (cost)effectiveness of CDT in persons with relapsing remitting MS and low disability we perform a single-centre, randomized controlled trial in 140 patients, with or without support partners. The primary outcome is self-efficacy control. The secondary outcomes are self-efficacy function, health-related quality of life, autonomy and participation, anxiety, depression, cost effectiveness and cost utility. The tertiary outcome is care-related strain to support partners. Outcomes are assessed at baseline and at 1, 3 and 6 months after CDT. This randomized controlled trial will adequately evaluate the clinical and cost effectiveness of a 3-day intensive social cognitive program in people with relapsing remitting MS and low disability, with self-efficacy control as primary outcome. Application number: 22444.

Managing 'difficult emotions' and family life: exploring insights and social support within online self-management training.

PubMed

Sanders, C; Rogers, A; Gardner, C; Kennedy, A

2011-06-01

Previous research has demonstrated how the Internet can foster emotional support and provide a 'private' space for discussing sensitive issues. Whilst the family has been located as a primary source of support, empirical research on the dynamics of close personal relationships in chronic illness experience remains a challenge. To explore the role of family relationships in supporting self-care and the nature of social support exchanged within an online self-management training course. Qualitative thematic and narrative analysis of online discussion boards. Postings for 218 participants, divided between 11 groups were included for a course section that focused on 'difficult emotions'. Participants exchanged a high degree of emotional support and revealed much about their 'real life' relationships. The latter highlighted the complexities of managing illness within family contexts alongside additional pressures of daily life such as caring commitments and work roles. The private interactive space created within the course allowed insights into the dynamics of family life associated with illness management that are challenging to research. Simultaneously, collective support was developed amongst this group of predominantly working women. The article points to the implications for such interventions and associated evaluative research beyond this selective group.

Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom.

PubMed

Pietrzak, Robert H; Johnson, Douglas C; Goldstein, Marc B; Malley, James C; Southwick, Steven M

2009-01-01

A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population. A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support. Resilience scores in the full sample were comparable to those observed in civilian outpatient primary-care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure. These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans. (c) 2009 Wiley-Liss, Inc.

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Association of personal hygiene with common morbidities among upper primary school children in rural Odisha.

PubMed

Paul, Kalyan Kumar; Panigrahi, Sandeep Kumar; Soodi Reddy, Arun Kiran; Sahu, Trilochan

2017-01-01

In India, children of upper primary school receive less attention from health-care providers. The majority of their health problems are preventable through hygienic practices. The aim of this study was to find out the association of personal hygiene with common morbidities among upper primary school children. A cross-sectional study conducted in a rural upper primary school of Odisha. A semi-structured schedule based on the Global School Health Survey Questionnaire and necessary instruments for clinical examination were used. Data were entered in Microsoft Excel 2007 and analyzed by SPSS version 20 software. Of 90 participants, 58 (64.4%) were girls. The mean age was 11.8 (±1.01) years. The mean body mass index of females was significantly higher than males (16.95 vs. 14.72; P = 0.001). More than 90% of children maintained good personal hygiene such as clean tongue, clean hair, handwashing, and using footwear. The most common morbidities found were dental caries (38.9%), history of worms in stool and lethargy (20%). A mean score of 6.14 ± 0.11 (out of 8) was seen for personal hygiene and not associated with any particular morbidity or gender. Brushing daily was significantly associated with reduced dental caries (χ 2 = 8.7; P < 0.005) and foul-smelling breath (χ 2 = 4.93; P < 0.05). Fungal infections were significantly less in children who bathed daily (χ 2 = 28.7; <0.005) and wore clean clothes (χ 2 = 5.06; P < 0.05). Dental caries, foul-smelling breath, and fungal infections were significantly associated with poor personal hygiene. School health services should also focus on upper primary school children for improvement of personal hygiene.

Personal contact with HIV-positive persons is associated with reduced HIV-related stigma: cross-sectional analysis of general population surveys from 26 countries in sub-Saharan Africa.

PubMed

Chan, Brian T; Tsai, Alexander C

2017-01-11

HIV-related stigma hampers treatment and prevention efforts worldwide. Effective interventions to counter HIV-related stigma are greatly needed. Although the "contact hypothesis" suggests that personal contact with persons living with HIV (PLHIV) may reduce stigmatizing attitudes in the general population, empirical evidence in support of this hypothesis is lacking. Our aim was to estimate the association between personal contact with PLHIV and HIV-related stigma among the general population of sub-Saharan Africa. Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 26 African countries between 2003 and 2008. We fitted multivariable logistic regression models with country-level fixed effects, specifying social distance as the dependent variable and personal contact with PLHIV as the primary explanatory variable of interest. We analyzed data from 206,717 women and 91,549 men living in 26 sub-Saharan African countries. We estimated a statistically significant negative association between personal contact with PLHIV and desires for social distance (adjusted odds ratio [AOR] = 0.80; p  < 0.001; 95% Confidence Interval [CI], 0.73-0.88). In a sensitivity analysis, a similar finding was obtained with a model that used a community-level variable for personal contact with PLHIV (AOR = 0.92; p  < 0.001; 95% CI, 0.89-0.95). Personal contact with PLHIV was associated with reduced desires for social distance among the general population of sub-Saharan Africa. More contact interventions should be developed and tested to reduce the stigma of HIV.

Personal contact with HIV-positive persons is associated with reduced HIV-related stigma: cross-sectional analysis of general population surveys from 26 countries in sub-Saharan Africa

PubMed Central

Chan, Brian T; Tsai, Alexander C

2017-01-01

Abstract Introduction: HIV-related stigma hampers treatment and prevention efforts worldwide. Effective interventions to counter HIV-related stigma are greatly needed. Although the “contact hypothesis” suggests that personal contact with persons living with HIV (PLHIV) may reduce stigmatizing attitudes in the general population, empirical evidence in support of this hypothesis is lacking. Our aim was to estimate the association between personal contact with PLHIV and HIV-related stigma among the general population of sub-Saharan Africa. Methods: Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 26 African countries between 2003 and 2008. We fitted multivariable logistic regression models with country-level fixed effects, specifying social distance as the dependent variable and personal contact with PLHIV as the primary explanatory variable of interest. Results: We analyzed data from 206,717 women and 91,549 men living in 26 sub-Saharan African countries. We estimated a statistically significant negative association between personal contact with PLHIV and desires for social distance (adjusted odds ratio [AOR] = 0.80; p < 0.001; 95% Confidence Interval [CI], 0.73–0.88). In a sensitivity analysis, a similar finding was obtained with a model that used a community-level variable for personal contact with PLHIV (AOR = 0.92; p < 0.001; 95% CI, 0.89–0.95). Conclusions: Personal contact with PLHIV was associated with reduced desires for social distance among the general population of sub-Saharan Africa. More contact interventions should be developed and tested to reduce the stigma of HIV. PMID:28362067

A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All

PubMed Central

Cloninger, C. Robert; Salvador-Carulla, Luis; Kirmayer, Laurence J.; Schwartz, Michael A.; Appleyard, James; Goodwin, Nick; Groves, JoAnna; Hermans, Marc H. M.; Mezzich, Juan E.; van Staden, C. W.; Rawaf, Salman

2015-01-01

Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine’s 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one’s life in ways that are personally meaningful and that are respectful of others and the environment in which we live together. Evidence suggests that health care organizations function well when they operate in a person-and people-centered way because that stimulates better coordination, cooperation, and social trust. Health care coverage must be integrated at several interconnected levels in order to be effective, efficient, and fair. To reduce the burden of disease, integration is needed between the people seeking and delivering care, within the social network of each person, across the trajectory of each person’s life, among primary caregivers and specialists, and across multiple sectors of society. For integration to succeed across all these levels, it must foster common values and a shared vision of the future. PMID:26140190

Surviving Sudden Cardiac Arrest: A Pilot Qualitative Survey Study of Survivors.

PubMed

Sawyer, Kelly N; Brown, Frances; Christensen, Roxanne; Damino, Colleen; Newman, Mary M; Kurz, Michael C

2016-06-01

Research describing survivors of sudden cardiac arrest (SCA) has centered on quantifying functional ability, perceived quality of life, and neurocognitive assessment. Many gaps remain, however, regarding survivors' psychosocial perceptions of life in the aftermath of cardiac arrest. An important influence upon those perceptions is the presence of support and its role in a survivor's life. An Internet-based pilot survey study was conducted to gather data from SCA survivors and friends and/or family members (FFMs) representing their support system. The survey was distributed to members of the Sudden Cardiac Arrest Foundation (SCAF) via the Internet by SCAF leadership. Questions included both discrete multiple-choice and open-ended formats. Inductive thematic analyses were completed by three independent researchers trained in qualitative research methodology to identify primary themes consistent among study participants until thematic saturation was achieved. No statistical inferences were made. A total of 205 surveys were returned over the 5-month study period (July to November 2013); nine were received blank, leaving 196 surveys available for review. Major themes identified for survivors (N = 157) include the significance of and desire to share experiences with others; subculture identification (unique experience from those suffering a heart attack); and the need to seek a new normal, both personally and inter-personally. Major themes identified for FFMs (N = 39) include recognition of loved one's memory loss; a lack of information at discharge, including expectations after discharge; and concern for the patient experiencing another cardiac arrest. This pilot, qualitative survey study suggests several common themes important to survivors, and FFMs, of cardiac arrest. These themes may serve as a basis for future patient-centered focus groups and the development of patient-centered guidelines for patients and support persons of those surviving cardiac arrest.

Randomized feasibility trial to improve hydroxyurea adherence in youth ages 10-18 years through community health workers: The HABIT study.

PubMed

Green, Nancy S; Manwani, Deepa; Matos, Sergio; Hicks, April; Soto, Luisa; Castillo, Yina; Ireland, Karen; Stennett, Yvonne; Findley, Sally; Jia, Haomiao; Smaldone, Arlene

2017-12-01

The main therapeutic intervention for sickle cell disease (SCD) is hydroxyurea (HU). The effect of HU is largely through dose-dependent induction of fetal hemoglobin (HbF). Poor HU adherence is common among adolescents. Our 6-month, two-site pilot intervention trial, "HABIT," was led by culturally aligned community health workers (CHWs). CHWs performed support primarily through home visits, augmented by tailored text message reminders. Dyads of youth with SCD ages 10-18 years and a parent were enrolled. A customized HbF biomarker, the percentage decrease from each patients' highest historical HU-induced HbF, "Personal best," was used to qualify for enrollment and assess HU adherence. Two primary outcomes were as follows: (1) intervention feasibility and acceptability and (2) HU adherence measured in three ways: monthly percentage improvement toward HbF Personal best, proportion of days covered (PDC) by HU, and self-report. Twenty-eight dyads were enrolled, of which 89% were retained. Feasibility and acceptability were excellent. Controlling for group assignment and month of intervention, the intervention group improved percentage decrease from Personal best by 2.3% per month during months 0-4 (P = 0.30), with similar improvement in adherence demonstrated using pharmacy records. Self-reported adherence did not correlate. Dyads viewed CHWs as supportive for learning about SCD and HU, living with SCD and making progress in coordinated self-management responsibility to support a daily HU habit. Most parents and youth appreciated text message HU reminders. The HABIT pilot intervention demonstrated feasibility and acceptability with promising effect toward improved medication adherence. Testing in a larger multisite intervention trial is warranted. © 2017 Wiley Periodicals, Inc.

Internal resources among informal caregivers: trajectories and associations with well-being.

PubMed

Litzelman, Kristin; Tesauro, Gina; Ferrer, Rebecca

2017-12-01

The experiences, skills, and internal resources that informal caregivers bring into their role may play a critical part in their mental health and well-being. This study examined how caregiver internal resources changed over a 10 year period, and how this was related to caregivers' well-being. Data are from the Midlife in the United States (MIDUS) study, a national sample of adults, at two time points: 1995-1996 (T1) and 2004-2006 (T2). We identified subjects who reported being a caregiver at T2 and starting care after T1 (mean age = 56; 65% female). We examined internal resources: sense of control (personal mastery); primary and secondary control strategies (persistence in goal striving, positive reappraisal, and lowering expectations); and social support seeking, and psychological and subjective well-being. We evaluated how internal resources changed over time, and how these trajectories were associated with well-being at T2 using multivariable linear regressions. Most caregivers had stable levels of internal resources (between 4 and 13% showed an increase or decrease). Caregivers with increasing or high-stable levels of personal mastery had significantly better well-being scores on 6 out of 8 subscales compared with low-stable levels [effect sizes (ES) between 0.39 and 0.79]. Increasing persistence was associated with better personal growth and environmental mastery (ES = 0.96 and 0.91), and increasing and high-stable positive reappraisals were associated with better affect (ES = 0.63 and 0.48) compared with low-stable levels. Lowering aspirations and support seeking were not associated with well-being outcomes. Practices or interventions that support or improve internal resources could potentially improve caregiver well-being.

Views of general practitioners on the use of STOPP&START in primary care: a qualitative study.

PubMed

Dalleur, O; Feron, J-M; Spinewine, A

2014-08-01

STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice. We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes. Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes. Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.

Alginate foam-based three-dimensional culture to investigate drug sensitivity in primary leukaemia cells.

PubMed

Karimpoor, Mahroo; Yebra-Fernandez, Eva; Parhizkar, Maryam; Orlu, Mine; Craig, Duncan; Khorashad, Jamshid S; Edirisinghe, Mohan

2018-04-01

The development of assays for evaluating the sensitivity of leukaemia cells to anti-cancer agents is becoming an important aspect of personalized medicine. Conventional cell cultures lack the three-dimensional (3D) structure of the bone marrow (BM), the extracellular matrix and stromal components which are crucial for the growth and survival of leukaemia stem cells. To accurately predict the sensitivity of the leukaemia cells in an in vitro assay a culturing system containing the essential components of BM is required. In this study, we developed a porous calcium alginate foam-based scaffold to be used for 3D culture. The new 3D culture was shown to be cell compatible as it supported the proliferation of both normal haematopoietic and leukaemia cells. Our cell differential assay for myeloid markers showed that the porous foam-based 3D culture enhanced myeloid differentiation in both leukaemia and normal haematopoietic cells compared to two-dimensional culture. The foam-based scaffold reduced the sensitivity of the leukaemia cells to the tested antileukaemia agents in K562 and HL60 leukaemia cell line model and also primary myeloid leukaemia cells. This observation supports the application of calcium alginate foams as scaffold components of the 3D cultures for investigation of sensitivity to antileukaemia agents in primary myeloid cells. © 2018 The Author(s).

Protocol of a multi-centre randomised controlled trial of a web-based information intervention with nurse-delivered telephone support for haematological cancer patients and their support persons.

PubMed

Bryant, Jamie; Sanson-Fisher, Rob; Stevenson, William; Smits, Rochelle; Henskens, Frans; Wei, Andrew; Tzelepis, Flora; D'Este, Catherine; Paul, Christine; Carey, Mariko

2015-04-17

High rates of anxiety, depression and unmet needs are evident amongst haematological cancer patients undergoing treatment and their Support Persons. Psychosocial distress may be minimised by ensuring that patients are sufficiently involved in decision making, provided with tailored information and adequate preparation for potentially threatening procedures. To date, there are no published studies evaluating interventions designed to reduce psychosocial distress and unmet needs specifically in patients with haematological cancers and their Support Persons. This study will examine whether access to a web-based information tool and nurse-delivered telephone support reduces depression, anxiety and unmet information needs for haematological cancer patients and their Support Persons. A non-blinded, parallel-group, multi-centre randomised controlled trial will be conducted to compare the effectiveness of a web-based information tool and nurse-delivered telephone support with usual care. Participants will be recruited from the haematology inpatient wards of five hospitals in New South Wales, Australia. Patients diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, Burkitt's lymphoma, Lymphoblastic lymphoma (B or T cell), or Diffuse Large B-Cell lymphoma and their Support Persons will be eligible to participate. Patients and their Support Persons will be randomised as dyads. Participants allocated to the intervention will receive access to a tailored web-based tool that provides accurate, up-to-date and personalised information about: cancer and its causes; treatment options including treatment procedures information; complementary and alternative medicine; and available support. Patients and Support Persons will complete self-report measures of anxiety, depression and unmet needs at 2, 4, 8 and 12 weeks post-recruitment. Patient and Support Person outcomes will be assessed independently. This study will assess whether providing information and support using web-based and telephone support address the major psychosocial challenges faced by haematological patients and their Support Persons. The approach, if found to be effective, has potential to improve psychosocial outcomes for haematological and other cancer patients, reduce the complexity and burden of meeting patients' psychosocial needs for health care providers with high potential for translation into clinical practice. ACTRN12612000720819.

Bolstering the pipeline for primary care: a proposal from stakeholders in medical education

PubMed Central

Shi, Hanyuan; Lee, Kevin C.

2016-01-01

The Association of American Medical Colleges reports an impending shortage of over 90,000 primary care physicians by the year 2025. An aging and increasingly insured population demands a larger provider workforce. Unfortunately, the supply of US-trained medical students entering primary care residencies is also dwindling, and without a redesign in this country's undergraduate and graduate medical education structure, there will be significant problems in the coming decades. As an institution producing fewer and fewer trainees in primary care for one of the poorest states in the United States, we propose this curriculum to tackle the issue of the national primary care physician shortage. The aim is to promote more recruitment of medical students into family medicine through an integrated 3-year medical school education and a direct entry into a local or state primary care residency without compromising clinical experience. Using the national primary care deficit figures, we calculated that each state medical school should reserve 20–30 primary care (family medicine) residency spots, allowing students to bypass the traditional match after successfully completing a series of rigorous externships, pre-internships, core clerkships, and board exams. Robust support, advising, and personal mentoring are also incorporated to ensure adequate preparation of students. The nation's health is at risk. With full implementation in allopathic medical schools in 50 states, we propose a long-term solution that will serve to provide more than 1,000–2,700 new primary care providers annually. Ultimately, we will produce happy, experienced, and empathetic doctors to advance our nation's primary care system. PMID:27389607

The relationship between family resiliency factors and caregiver-perceived duration of untreated psychosis in persons with first-episode psychosis.

PubMed

Mo'tamedi, Hadi; Rezaiemaram, Peyman; Aguilar-Vafaie, Maria E; Tavallaie, Abaas; Azimian, Mojtaba; Shemshadi, Hashem

2014-11-30

Although the family has an important role in the early detection and intervention of first-episode psychosis (FEP), there are few findings reporting associations between family strengths and early treatment-seeking experiences. This study aimed to investigate, within the framework of the resiliency model of family stress, adjustment, and adaptation, the association between family coping strategies, resource management factors and duration of untreated psychosis (DUP) in Iranian families with one adult child with FEP. Hundred and seven individuals referred to three medical centers in Tehran and diagnosed with FEP participated in this study. Caregiver-perceived DUP was measured via semi-structured interviews administered to primary caregivers. They also completed two questionnaires regarding family resources of stress management and family coping strategies. Data analysis indicated that the Family Inventory of Resources of Management (FIRM) total scale score did not significantly explain the variance of caregiver-perceived DUP, but one of the FIRM subscales, the Extended Family Social Support, and the Family Crisis-Oriented Personal Evaluation scale (F-COPES) total score and one its subscales, the Acquiring Social Support, explained a significant amount of the variance of caregiver-perceived DUP. The results suggest that higher family resiliency, especially social support, facilitates the family's appropriate adaptive reaction (i.e., treatment-seeking), with the consequent decrease of DUP. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Medical support to Sri Lanka in the wake of tsunamis: planning considerations and lessons learned.

PubMed

Lane, David A

2006-10-01

When massive tsunamis affected the coast of Sri Lanka and other Indian Ocean littorals, elements of the Third Force Service Support Group and assigned Navy, Air Force, Army, and Coast Guard units from the U.S. Pacific Command were "task organized" to form Combined Support Group-Sri Lanka (CSG-SL), charged to conduct humanitarian assistance/disaster relief (HA/DR) operations. The specific mission was to provide immediate relief to the affected population of Sri Lanka and the Maldives, to minimize loss of life, and to mitigate human suffering. A 30-person health care team deployed to the northern province of Jaffna and provided medical assistance to that chronically underserved and acutely overstressed region. For a 12-day period, the team served as the principal medical staff of an under-resourced government hospital and conducted mobile primary care clinics at nearby welfare camps housing > 7,000 internally displaced persons made homeless by the tsunamis. By every measurable standard, CSG-SL accomplished its assigned HA/DR task in Sri Lanka, including the medical mission. In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. This article discusses the context in which CSG-SL planned and executed the medical aspects of its HA/DR operations in Sri Lanka, and it describes the most significant medical lessons learned.

Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa.

PubMed

Daire, Judith; Gilson, Lucy

2014-09-01

In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better support for leadership development could include talent-spotting and nurturing, induction and peer-mentoring for newly appointed facility managers, ongoing peer-support once in post and continuous reflective practice. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Hope, social support, and depression among Hong Kong youth: personal and relational self-esteem as mediators.

PubMed

Du, Hongfei; King, Ronnel B; Chu, Samuel K W

2016-12-01

Previous studies have shown that depression is negatively associated with hope and social support. However, little research has been undertaken to investigate the theoretical mechanisms underlying the connections among hope, social support, and depression. This study examined how two types of self-esteem (personal and relational) would mediate the relationship of hope and social support to depression among 384 Hong Kong adolescents (age: 12-18 years; M = 14, SD = 1.19). Participants reported their levels of hope, social support, personal self-esteem, relational self-esteem, and depressive mood. Results of the path analysis showed that both personal and relational self-esteem mediated the associations of hope and social support with depression. Hope and social support were associated with higher levels of personal and relational self-esteem, which were in turn related to decreased levels of depression. Theoretical and practical implications are discussed.

[Facts visualized through job support activities for mentally disordered persons--what is the objective of medical treatment for mental disorder?].

PubMed

Tagawa, Seiji

2014-01-01

According to a recent investigation by the Public Employment Security Office, the rate of employing mentally disordered persons is increasing. In the report, it was predicted that the number of employed mentally disordered persons will exceed the number of physically disordered persons within a few years, and will become the highest of the main three disabled types. Despite the strong desire of mentally disordered persons to work, supporting systems have been inadequate. In 2007, mental clinic doctors in Osaka took the lead and established the NPO Osaka Job Support Network for Mentally Disordered Persons (JSN) to support their employment persons. We aimed to establish a support system for mentally disordered persons who have a strong will to work, stating "I would like to work" to their family doctors, who introduce JSN to the patients, and then the family doctors and JSN cooperate to support the patients to realize the desire to "work". Since April 2013, 49 persons have found a job and "graduated" from JSN. Over 6 years until the end of March, 2013, a total of 154 persons found jobs and "graduated" from JSN. From now on, it is expected that around 50 persons will find jobs and "graduate" from JSN every year. It is definitely insufficient just to repeat "temporary" medical treatment for mental disorders with a long course like schizophrenia. A care management view that values the hopes and dreams of patients is required in psychiatric treatment.

Nonfatal Assaults Among Persons Aged 10-24 Years - United States, 2001-2015.

PubMed

David-Ferdon, Corinne F; Haileyesus, Tadesse; Liu, Yang; Simon, Thomas R; Kresnow, Marcie-Jo

2018-02-09

In 2015, persons aged 10-24 years who were treated for nonfatal assault injuries in emergency departments (EDs) in the United States accounted for 32% of the approximately 1.5 million patients of all ages that EDs treated for nonfatal assault injuries (1). CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) to examine 2001-2015 trends in nonfatal assault injuries among youths treated in EDs, by sex and age group, and to assess current rates by sex, age group, mechanism of injury, and disposition (1). Rates for 2001-2015 were significantly higher among males than among females and among young adults aged 20-24 years than among youths aged 10-14 and 15-19 years. During 2011-2015, rates declined for all groups. The 2015 rate among persons aged 10-24 years was 753.2 per 100,000 population, the lowest in the 15-year study period. Despite encouraging trends, the assault rate among young persons remains high. Rates in 2015 were higher among males, persons aged 20-24 years, and those who incurred intentional strike or hit injuries. Nearly one in 10 patients were admitted to the hospital, transferred to another hospital, or held for observation. Youth violence prevention strategies, including primary prevention approaches that build individual skills, strengthen family relationships, or connect young persons treated in EDs to immediate and ongoing support, can be implemented to decrease injuries and fatalities (2).

24 CFR 891.740 - Responsibilities of Borrower.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROGRAM, SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SUPPORTIVE HOUSING FOR THE ELDERLY AND PERSONS WITH DISABILITIES Loans for Housing for the Elderly and Persons with Disabilities Section 202 Projects for the Nonelderly...

Evaluating the professional libraries of practicing physical therapists.

PubMed

Brown, Suzanne R; Roush, James R; Lamkin, Alyson R; Perrakis, Rena; Kronenfeld, Michael R

2007-01-01

The primary objective of this study was to explore the use of information resources by a sample of physical therapists. A qualitatively designed study using structured individual interviews, examination of professional libraries, and identification of information resources was initiated in three sites (Southern California, Arizona, and Georgia). Participants included forty physical therapists with between five and twenty years of experience. The Internet and continuing education activities appeared to be the primary information sources for the physical therapists surveyed. The personal professional libraries of participants were limited in scope and contained titles copyrighted more than ten years ago. Access to peer-reviewed journals in the sample was limited primarily to those received as a benefit of professional association membership. Participants did not maintain current print professional information resources. The majority of books in the personal and workplace professional libraries held copyrights dating from the time of the participants' enrollment in an entry-level physical therapy program. Medical librarians may play an important role in shifting physical therapy towards evidence-based practice by collaborating in professional development for this group. Physical therapy educators and professional leaders should support current public collections of physical therapy-related information resources to encourage the movement towards an evidence-based practice model in physical therapy.

Evaluating the professional libraries of practicing physical therapists

PubMed Central

Brown, Suzanne R.; Roush, James R.; Lamkin, Alyson R.; Perrakis, Rena; Kronenfeld, Michael R.

2007-01-01

Background and Purpose: The primary objective of this study was to explore the use of information resources by a sample of physical therapists. Methods: A qualitatively designed study using structured individual interviews, examination of professional libraries, and identification of information resources was initiated in three sites (Southern California, Arizona, and Georgia). Participants included forty physical therapists with between five and twenty years of experience. Results: The Internet and continuing education activities appeared to be the primary information sources for the physical therapists surveyed. The personal professional libraries of participants were limited in scope and contained titles copyrighted more than ten years ago. Access to peer-reviewed journals in the sample was limited primarily to those received as a benefit of professional association membership. Discussion and Conclusions: Participants did not maintain current print professional information resources. The majority of books in the personal and workplace professional libraries held copyrights dating from the time of the participants' enrollment in an entry-level physical therapy program. Medical librarians may play an important role in shifting physical therapy towards evidence-based practice by collaborating in professional development for this group. Physical therapy educators and professional leaders should support current public collections of physical therapy-related information resources to encourage the movement towards an evidence-based practice model in physical therapy. PMID:17252068

[Pilot plan for a mobile health communication and monitoring system for people with diabetes].

PubMed

Alcayaga, Claudia; Pérez, Janet Carola; Bustamante, Claudia; Campos, Solange; Lange, Ilta; Zuñiga, Francisca

2014-01-01

mHealth is a practical, useful, and available tool for one-way or two-way communication between health professionals and patients. It is especially promising in countries such as Chile, with widespread and growing mobile telephone coverage that is very well accepted by the public. Our objective is to demonstrate the process for designing a mobile communication and monitoring model, aimed at providing communication between professionals in primary healthcare centers and their patients, to facilitate timely diagnosis and initiation of treatment for type 2 diabetes. This model's characteristics include use of mobile telephones as a communication tool, a one-way method (from health centers to patients), integration into in-person care delivered at health centers, use of different communication strategies (voice and written), and integrated functioning using open-source software. The system includes personalized communication, automated voice communication, and automated written communication using short message service (SMS). We describe the strategies and components of the system. The lessons learned include the contribution from successful implementation of COSMOS (consolidated online modulated operating systems), a technological innovation, to support the health care of people with suspected type 2 diabetes in primary healthcare centers. Working together with teams in the field is essential to this achievement.

A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong.

PubMed

Lam, Linda C W; Lee, Jenny S W; Chung, Jenny C C; Lau, Anna; Woo, Jean; Kwok, Timothy C Y

2010-04-01

To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used. Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months. CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05). Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.

Personal and Familial Predictors of Peer Victimization Trajectories from Primary to Secondary School

ERIC Educational Resources Information Center

Brendgen, Mara; Girard, Alain; Vitaro, Frank; Dionne, Ginette; Boivin, Michel

2016-01-01

Using a sample of 767 children (403 girls, 364 boys), this study aimed to (a) identify groups with distinct trajectories of peer victimization over a 6-year period from primary school through the transition to secondary school, and (b) examine the associated personal (i.e., aggression or internalizing problems) and familial (family status,…

Ambulatory Care Sensitive Conditions in Persons with an Intellectual Disability--Development of a Consensus

ERIC Educational Resources Information Center

Balogh, Robert S.; Ouellette-Kuntz, Helene; Brownell, Marni; Colantonio, Angela

2011-01-01

Background: There is evidence that the primary care provided for persons with an intellectual disability living in the community has been inadequate. Hospitalization rates for ambulatory care sensitive (ACS) conditions are considered an indicator for access to, and quality of, primary care. The objective of this research was to identify ACS…

HIV prevention in primary care: impact of a clinical intervention.

PubMed

Bluespruce, J; Dodge, W T; Grothaus, L; Wheeler, K; Rebolledo, V; Carey, J W; McAfee, T A; Thompson, R S

2001-05-01

Discomfort, lack of confidence in skills, and environmental constraints may cause primary care providers to miss opportunities to discuss human immunodeficiency virus (HIV) risk with patients. We used a systems approach to address both intrapersonal and environmental barriers to HIV risk assessment and prevention counseling in a managed care clinical setting. The design was one-group pretest/posttest. The study took place in two primary care clinics of a large Pacific Northwest managed care organization. Participants (n = 49) included physicians, physician assistants, nurse practitioners, registered nurses, and social workers. The intervention included training, clarification of provider/staff roles, assess to tools and materials, and reminders/reinforcers. Outcome measures were provider attitudes, beliefs, outcome expectations, knowledge, confidence in skills, and perceived supports and barriers, measured by written pretest/posttest surveys administered 12 months apart. Seven months after the most intensive part of the intervention, providers' attitudes and beliefs were more favorable to HIV risk assessment and prevention counseling. They were less likely to express frustration with high-risk patients (decrease from 100% to 79% agreement, p = 0.001) and more confident that their advice would be effective with gay men and single adult heterosexuals (p = 0.002 and 0.005, respectively). They reported more confidence in their training in sexual history taking (p = 0.0003) and their skills assessing readiness for change (p = 0.007), and more support in practice environments. This study demonstrated that it is possible to affect important personal and environmental factors that influence primary care providers' HIV prevention behavior using an interactive, real-world systems approach. Further research is needed on providers' impact on patient behavior.

Employment of persons with spinal cord lesions injured more than 20 years ago.

PubMed

Lidal, Ingeborg Beate; Hjeltnes, Nils; Røislien, Jo; Stanghelle, Johan Kvalvik; Biering-Sørensen, Fin

2009-01-01

The primary objective was to study factors influencing post-injury employment and withdrawal from work in persons who sustained traumatic spinal cord injury (SCI) more than 20 years ago. A secondary objective was to study life satisfaction in the same patients. A cross-sectional study with retrospective data of 165 SCI-patients admitted to Sunnaas Rehabilitation Hospital 1961-1982. Multiple logistic regression was used to identify predictors for obtaining work post-injury. A Cox proportional hazards regression model was used to study factors influencing early withdrawal from work, i.e. time from injury until discontinuing employment. Sixty-five percent of the participants were employed at some point after the injury. Thirty-five percent still had work at the time of the survey. The odds of obtaining work after injury were higher in persons of younger age at injury, higher in males versus females, higher for persons with paraplegia versus tetraplegia, and for persons classified as Frankel D-E compared to a more severe SCI. Factors associated with shorter time from injury until discontinuing employment were higher age at injury, incidence of injury after 1975 versus before, and a history of pre-injury medical condition(s). Life satisfaction was better for currently employed participants. The study indicates a low employment-rate in persons with SCI, even several years after injury. From the results, we suggest more support, especially to persons of older age at injury and/or with a history of pre-injury medical condition(s), to help them to obtain work and sustain employed for more years after injury.

Understanding causal associations between self-rated health and personal relationships in older adults: A review of evidence from longitudinal studies.

PubMed

Craigs, Cheryl L; Twiddy, Maureen; Parker, Stuart G; West, Robert M

2014-01-01

As we age we experience many life changes in our health, personal relationships, work, or home life which can impact on other aspects of our life. There is compelling evidence that how we feel about our health influences, or is influenced by, the personal relationships we experience with friends and relatives. Currently the direction this association takes is unclear. To assess the level of published evidence available on causal links between self-rated health and personal relationships in older adults. MEDLINE, CINAHL, and PsycINFO searches from inception to June 2012 and hand searches of publication lists, reference lists and citations were used to identify primary studies utilizing longitudinal data to investigate self-rated health and personal relationships in older adults. Thirty-one articles were identified. Only three articles employed methods suitable to explore causal associations between changes in self-rated health and changes in personal relationships. Two of these articles suggested that widowhood leads to a reduction in self-rated health in the short term, while the remaining article suggested a causal relationship between self-rated health and negative emotional support from family or friends, but this was complex and mediated by self-esteem and sense of control. While there is an abundance of longitudinal aging cohorts available which can be used to investigate self-rated health and personal relationships over time the potential for these databases to be used to investigate causal associations is currently not being recognized. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Construct validity of adolescents' self-reported big five personality traits: importance of conceptual breadth and initial validation of a short measure.

PubMed

Morizot, Julien

2014-10-01

While there are a number of short personality trait measures that have been validated for use with adults, few are specifically validated for use with adolescents. To trust such measures, it must be demonstrated that they have adequate construct validity. According to the view of construct validity as a unifying form of validity requiring the integration of different complementary sources of information, this article reports the evaluation of content, factor, convergent, and criterion validities as well as reliability of adolescents' self-reported personality traits. Moreover, this study sought to address an inherent potential limitation of short personality trait measures, namely their limited conceptual breadth. In this study, starting with items from a known measure, after the language-level was adjusted for use with adolescents, items tapping fundamental primary traits were added to determine the impact of added conceptual breadth on the psychometric properties of the scales. The resulting new measure was named the Big Five Personality Trait Short Questionnaire (BFPTSQ). A group of expert judges considered the items to have adequate content validity. Using data from a community sample of early adolescents, the results confirmed the factor validity of the Big Five structure in adolescence as well as its measurement invariance across genders. More important, the added items did improve the convergent and criterion validities of the scales, but did not negatively affect their reliability. This study supports the construct validity of adolescents' self-reported personality traits and points to the importance of conceptual breadth in short personality measures. © The Author(s) 2014.

Nursing implications of personalized and precision medicine.

PubMed

Vorderstrasse, Allison A; Hammer, Marilyn J; Dungan, Jennifer R

2014-05-01

Identify and discuss the nursing implications of personalized and precision oncology care. PubMed, CINAHL. The implications in personalized and precision cancer nursing care include interpretation and clinical use of novel and personalized information including genetic testing; patient advocacy and support throughout testing, anticipation of results and treatment; ongoing chronic monitoring; and support for patient decision-making. Attention must also be given to the family and ethical implications of a personalized approach to care. Nurses face increasing challenges and opportunities in communication, support, and advocacy for patients given the availability of advanced testing, care and treatment in personalized and precision medicine. Nursing education and continuing education, clinical decision support, and health systems changes will be necessary to provide personalized multidisciplinary care to patients, in which nurses play a key role. Copyright © 2014 Elsevier Inc. All rights reserved.

Helping Depressed Adolescents: A Menu of Cognitive-Behavioral Procedures for Primary Care

PubMed Central

Clabby, John F.

2006-01-01

Depression among adolescents has received recognition as a significant psychiatric problem that requires prompt intervention. This article will help primary care providers to understand the significance of adolescent depression, recognize its prevalence in primary care, cite the evidence supporting cognitive-behavioral therapy (CBT) as a treatment for depressed adolescents, recognize the challenges of using CBT in primary care, and use 7 different CBT approaches with their patients. Psychiatric diagnoses may be present in 38% of adolescents who see a primary care physician, and among that number, depression is the most common diagnosis. Cognitive-behavioral therapy provides a scientifically proven tool for those physicians who want to provide their young depressed patients an effective counseling approach. Cognitive-behavioral therapy enhances self-control, perceptions of personal efficacy, rational problem-solving skills, social skills, and participation in activities and physical exercise that bring the adolescent a sense of pleasure or mastery. CBT has been proven to be effective when delivered by physicians who have received significant instructions. Unfortunately, CBT techniques can at first seem overly abstract, overwhelming in number, and difficult to teach in the 15-minute visit. However, CBT techniques can be made clear and accessible for a busy physician. The case of a depressed 14-year-old male high school student who comes to his physician for a pre-participation sports physical is presented to illustrate the application of CBT in primary care. PMID:16912815

[Multimorbidity in general practice and the Ariadne principles. A person-centred approach].

PubMed

Prados-Torres, Alexandra; Del Cura-González, Isabel; Prados-Torres, Juan Daniel; Leiva-Fernández, Francisca; López-Rodríguez, Juan Antonio; Calderón-Larrañaga, Amaia; Muth, Christiane

2017-05-01

Multimorbidity, defined as the coexistence of two or more chronic conditions in one same individual, has negative consequences for people suffering from it and it poses a real challenge for health systems. In primary care, where most of these patients are attended, the clinical management of multimorbidity can be a complex task due, among others, to the high volume of clinical information that needs to be handled, the scarce scientific evidence available to approach multimorbidity, and the need for coordination among multiple health providers to guarantee continuity of care. Moreover, the adequate implementation of the care plan in these patients requires a process of shared decision making between patient and physician. One of the available tools to support this process, which is specifically directed to patients with multimorbidity in primary care, is described in the present article: the Ariadne principles. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy

PubMed Central

Obrisca, Bogdan; Ismail, Gener; Jurubita, Roxana; Baston, Catalin; Andronesi, Andreea; Mircescu, Gabriel

2015-01-01

Since the identification of PLA2R (M-type phospholipase A2 receptor) as the first human antigenic target in primary membranous nephropathy (MN), perpetual progress has been made in understanding the pathogenesis of this disease. Accumulating clinical data support a pathogenic role for the anti-PLA2R antibodies (PLA2R ABs), but confirmation in an animal model is still lacking. However, PLA2R ABs were related to disease activity and outcome, as well as to response therapy. Accordingly, PLA2R ABs assay seems to be promising tool not only to diagnose MN but also to predict the course of the disease and could open the way to personalize therapy. Nevertheless, validation of a universal assay with high precision and definition of cut-off levels, followed by larger studies with a prolonged follow-up period, are needed to confirm these prospects. PMID:26576418

Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy.

PubMed

Obrisca, Bogdan; Ismail, Gener; Jurubita, Roxana; Baston, Catalin; Andronesi, Andreea; Mircescu, Gabriel

2015-01-01

Since the identification of PLA2R (M-type phospholipase A2 receptor) as the first human antigenic target in primary membranous nephropathy (MN), perpetual progress has been made in understanding the pathogenesis of this disease. Accumulating clinical data support a pathogenic role for the anti-PLA2R antibodies (PLA2R ABs), but confirmation in an animal model is still lacking. However, PLA2R ABs were related to disease activity and outcome, as well as to response therapy. Accordingly, PLA2R ABs assay seems to be promising tool not only to diagnose MN but also to predict the course of the disease and could open the way to personalize therapy. Nevertheless, validation of a universal assay with high precision and definition of cut-off levels, followed by larger studies with a prolonged follow-up period, are needed to confirm these prospects.

Qualitative Analysis of Resources and Barriers for Borderline Personality Disorder in the U.S.

PubMed Central

Lohman, Matthew C.; Whiteman, Karen L.; Yeomans, Frank E.; Cherico, Sheila A.; Christ, Winifred R.

2016-01-01

Objective Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. Experiences and preferences of individuals seeking care are seldom examined but important elements in determining challenges to obtaining appropriate care. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD, from the perspective of individuals seeking care. Methods Data came from transcripts of resource requests made to the Borderline Personality Disorder Resource Center from January 2008 to December 2015 (N=6,253). Basic statistics regarding requested BPD service types, demographic information, and national distribution of requests were generated for all eligible transcripts. Qualitative analysis was used to identify themes, challenges, and common experiences reported among a random subset of those seeking services (N=500). Results Primary services or resources requested were outpatient services (51%), informational materials (13%), and daycare programs (9%). Care-seekers identified family services, crisis intervention, and mental health literacy as areas where available resources did not meet current demand and which could be improved and/or expanded. Factors identified as potential barriers to finding and obtaining appropriate treatment for BPD included stigmatization and marginalization within mental healthcare systems, financial concerns, and comorbidity with psychiatric or medical disorders. Conclusions Individuals seeking supportive services and treatment for BPD face numerous barriers to obtaining appropriate care. Expanded services and resources to connect individuals with treatment are needed to meet the current demands and preferences of those seeking care. PMID:27691382

Needs of caregivers of cancer patients: validation of the Mexican version of the Support Person Unmet Needs Survey (SPUNS-SFM).

PubMed

Doubova, Svetlana V; Aguirre-Hernandez, Rebeca; Infante-Castañeda, Claudia; Martinez-Vega, Ingrid; Pérez-Cuevas, Ricardo

2015-10-01

The purpose of this study was to validate the Mexican version of the Support Person Unmet Needs Survey (SPUNS-SFM). A cross-sectional survey that included 826 primary caregivers of cancer patients was conducted from June to December 2013 at the Oncology Hospital of the Mexican Institute of Social Security in Mexico City. The validation procedure comprised (1) content validity through a group of experts; (2) construct validity through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach's alpha; (4) convergent validity between SPUNS-SFM and quality of life, anxiety-and-depression scales by calculating Spearman's rank correlation coefficient;( 5) discriminative validity through the Wilcoxon rank-sum test; and (6) test-retest reliability using intraclass correlation coefficient. SPUNS-SFM has 23 items with six factors accounting for 65 % of the total variance. The domains were concerns about the future, access and continuity of healthcare, information, work and finance, and personal and emotional needs. Cronbach's alpha values ranged from 0.70 to 0.88 among factors. SPUNS-SFM had moderate convergent validity compared with quality of life and depression-and-anxiety scales and good discriminative validity, revealing high needs for younger caregivers and more emotional needs for caregivers of patients with advanced cancer stages. Intraclass correlation coefficient between SPUNS-SFM measurements was 0.78. SPUNS-SFM is a valid and reliable tool to identify needs of caregivers of cancer patients.

Time-space clustering of Vibrio cholerae 01 in Matlab, Bangladesh, 1970-1982.

PubMed

Craig, M

1988-01-01

Growing evidence for the existence of an aquatic reservoir of Vibrio cholerae has led some observers to postulate the existence of two distinct modes of disease transmission: primary and secondary. In primary transmission vibrios pass from the aquatic reservoir to humans via edible aquatic flora or fauna, or drinking water. Secondary transmission consists of faecal-oral transmission from person-to-person and may spawn epidemics. Cholera outbreaks are particularly well documented for the Matlab area of Bangladesh, where a field station has been run since 1963, at which patients from a study population of nearly 200,000 are treated for diarrhoeal diseases and monitored in a longitudinal demographic surveillance system. This paper seeks to illuminate the process of secondary transmission by presenting preliminary results of an analysis of the time-space distribution of cholera cases in Matlab for the period 1970-1982. It is argued that the detection of time-space clusters of cases resulting from secondary transmission requires locational data below the level of the village, that is at the level of the bari, or patrilineally-related household group because this is where inter-personal contact is greatest. The mapping of the study area at the bari level is described briefly and it is argued that the proportion of all asymptomatic infections and cases which can be mapped is great enough to enable inferences about transmission processes to be drawn. Results of the analysis of time-space interaction using the Knox method are presented and provide some support for within-bari clustering of cases resulting from secondary transmission.(ABSTRACT TRUNCATED AT 250 WORDS)

[Governance in a project addressing care of disabled elderly persons within the regional healthcare system of Tuscany, Italy].

PubMed

Pedace, Claudio; Rosa, Antonella; Francesconi, Paolo; Acampora, Anna; Ricciardi, Walter; Damiani, Gianfranco

2017-01-01

Population aging and the concurrent increase of age-related chronic degenerative diseases and disability are associated with an increased proportion of elderly persons who are dependent in activities of daily living (ADL). ADL-dependent persons need continuous and long-term health and social care according to the "taking charge" rationale, in order to warrant access and continuity of care. A healthcare system needs to respond to the long-term and complex needs, such as those of disabled elderly people, by providing appropriate health and social care services in Primary Care. A Primary Health Care system is organized according to two governance levels have distinct aims but are closely inter-dependent in their operational mechanisms. The system governance is accountable for the community and individual health protection while the delivery governance is accountable for the provision of services in accordance with appropriateness, safety and economic criteria. Delivery governance can be considered "integrated governance" as a synergy exists between two decision-making systems guiding provider choices, which are corporate governance and clinical governance. The aim of this study was to analyse the abovementioned governance levels within the healthcare system in Tuscany (Italy) referring to long-term residential care for disabled elderly people. The case of excessive accesses to emergency departments from different types of Nursing Homes (NH) is used as an example to analyse different levels of responsibility involved in the management of a critical phenomenon. Suggestions for improvement in the different levels of governance for disabled elderly people are provided, in order to support institutional programming activities.

Cost-effectiveness of structured group psychoeducation versus unstructured group support for bipolar disorder: Results from a multi-centre pragmatic randomised controlled trial.

PubMed

Camacho, E M; Ntais, D; Jones, S; Riste, L; Morriss, R; Lobban, F; Davies, L M

2017-03-15

Bipolar disorder (BD) costs the English economy an estimated £5.2billion/year, largely through incomplete recovery. This analysis estimated the cost-effectiveness of group psychoeducation (PEd), versus group peer support (PS), for treating BD. A 96-week pragmatic randomised controlled trial (RCT), conducted in NHS primary care. The primary analysis compared PEd with PS, using multiple imputed datasets for missing values. An economic model was used to compare PEd with treatment as usual (TAU). The perspective was Health and Personal Social Services. Participants receiving PEd (n=153) used more (costly) health-related resources than PS (n=151) (net cost per person £1098 (95% CI, £252-£1943)), with a quality-adjusted life year (QALY) gain of 0.023 (95% CI, 0.001-0.056). The cost per QALY gained was £47,739. PEd may be cost-effective (versus PS) if decision makers are willing to pay at least £37,500 per QALY gained. PEd costs £10,765 more than PS to avoid one relapse. The economic model indicates that PEd may be cost-effective versus TAU if it reduces the probability of relapse (by 15%) or reduces the probability of and increases time to relapse (by 10%). Participants were generally inconsistent in attending treatment sessions and low numbers had complete cost/QALY data. Factors contributing to pervasive uncertainty of the results are discussed. This is the first economic evaluation of PEd versus PS in a pragmatic trial. PEd is associated with a modest improvement in health status and higher costs than PS. There is a high level of uncertainty in the data and results. Copyright © 2017 Elsevier B.V. All rights reserved.

Supporting the self-concept with memory: insight from amnesia

PubMed Central

Verfaellie, Mieke

2015-01-01

We investigated the extent to which personal semantic memory supports the self-concept in individuals with medial temporal lobe amnesia and healthy adults. Participants completed eight ‘I Am’ self-statements. For each of the four highest ranked self-statements, participants completed an open-ended narrative task, during which they provided supporting information indicating why the I Am statement was considered self-descriptive. Participants then completed an episodic probe task, during which they attempted to retrieve six episodic memories for each of these self-statements. Supporting information was scored as episodic, personal semantic or general semantic. In the narrative task, personal semantic memory predominated as self-supporting information in both groups. The amnesic participants generated fewer personal semantic memories than controls to support their self-statements, a deficit that was more pronounced for trait relative to role self-statements. In the episodic probe task, the controls primarily generated unique event memories, but the amnesic participants did not. These findings demonstrate that personal semantic memory, in particular autobiographical fact knowledge, plays a critical role in supporting the self-concept, regardless of the accessibility of episodic memories, and they highlight potential differences in the way traits and roles are supported by personal memory. PMID:25964501

Five on one side: personal and social information in spatial choice.

PubMed

Brown, Michael F; Saxon, Marie E; Bisbing, Teagan; Evans, Jessica; Ruff, Jennifer; Stokesbury, Andrew

2015-03-01

To examine whether the outcome of a rat's own choices ("personal information") and the choice behavior of another rat ("social information") can jointly control spatial choices, rats were tested in an open field task in which they searched for food. For the rats of primary interest (Subject Rats), the baited locations were all on one side of the arena, but the specific locations baited and the side on which they occurred varied over trials. The Subject Rats were sometimes tested together with an informed "Model" rat that had learned to find food in the same five locations (all on the same side of the arena) on every trial. Unintended perceptual cues apparently controlled spatial choices at first, but when perceptual cues to food location were not available, choices were controlled by both personal information (allowing the baited side of the arena to be determined) and social information (allowing baited locations to be determined more precisely). This shows that control by personal and social information are not mutually exclusive and supports the view that these two kinds of information can be used flexibly and adaptively to guide spatial choices. This article is part of a Special Issue entitled: tribute to Tom Zentall. Copyright © 2015 Elsevier B.V. All rights reserved.

Technology for Persons with Disabilities. An Introduction.

ERIC Educational Resources Information Center

IBM, Atlanta, GA. National Support Center for Persons with Disabilities.

This paper contains an overview of technology, national support organizations, and IBM support available to persons with disabilities related to impairments affecting hearing, learning, mobility, speech or language, and vision. The information was obtained from the IBM National Support Center for Persons with Disabilities, which was created to…

Psycho-education with problem solving (PEPS) therapy for adults with personality disorder: a pragmatic multi-site community-based randomised clinical trial.

PubMed

McMurran, Mary; Crawford, Mike J; Reilly, Joseph G; McCrone, Paul; Moran, Paul; Williams, Hywel; Adams, Clive E; Duggan, Conor; Delport, Juan; Whitham, Diane; Day, Florence

2011-08-24

Impairment in social functioning is a key component of personality disorder. Therefore psycho-education and problem solving (PEPS) therapy may benefit people with this disorder. Psycho-education aims to educate, build rapport, and motivate people for problem solving therapy. Problem solving therapy aims to help clients solve interpersonal problems positively and rationally, thereby improving social functioning and reducing distress. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. At the end of treatment, compared to a wait-list control group, those treated with PEPS therapy showed better social functioning, as measured by the Social Functioning Questionnaire (SFQ). A definitive evaluation is now being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorder This is a pragmatic, two-arm, multi-centre, parallel, randomised controlled clinical trial. The target population is community-dwelling adults with one or more personality disorder, as identified by the International Personality Disorder Examination (IPDE). Inclusion criteria are: Living in the community (including residential or supported care settings); presence of one or more personality disorder; aged 18 or over; proficiency in spoken English; capacity to provide informed consent. Exclusion criteria are: Primary diagnosis of a functional psychosis; insufficient degree of literacy, comprehension or attention to be able to engage in trial therapy and assessments; currently engaged in a specific programme of psychological treatment for personality disorder or likely to start such treatment during the trial period; currently enrolled in any other trial. Suitable participants are randomly allocated to PEPS therapy plus treatment as usual (TAU) or TAU only. We aim to recruit 340 men and women. The primary outcome is social functioning as measured by the SFQ. A reduction (i.e., an improvement) of 2 points or more on the SFQ at follow-up 72 weeks post-randomisation is our pre-specified index of clinically significant change. Secondary outcomes include a reduction of unscheduled service usage and an increase in scheduled service usage; improved quality of life; and a reduction in mental distress. PEPS therapy has potential as an economical, accessible, and acceptable intervention for people with personality disorder. The results from this randomised controlled trial will tell us if PEPS therapy is effective and cost-effective. If so, then it will be a useful treatment for inclusion in a broader menu of treatment options for this group of service users. International Standard Randomised Controlled Trial Number - ISRCTN70660936.

Psycho-education with problem solving (PEPS) therapy for adults with personality disorder: A pragmatic multi-site community-based randomised clinical trial

PubMed Central

2011-01-01

Background Impairment in social functioning is a key component of personality disorder. Therefore psycho-education and problem solving (PEPS) therapy may benefit people with this disorder. Psycho-education aims to educate, build rapport, and motivate people for problem solving therapy. Problem solving therapy aims to help clients solve interpersonal problems positively and rationally, thereby improving social functioning and reducing distress. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. At the end of treatment, compared to a wait-list control group, those treated with PEPS therapy showed better social functioning, as measured by the Social Functioning Questionnaire (SFQ). A definitive evaluation is now being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorder Methods This is a pragmatic, two-arm, multi-centre, parallel, randomised controlled clinical trial. The target population is community-dwelling adults with one or more personality disorder, as identified by the International Personality Disorder Examination (IPDE). Inclusion criteria are: Living in the community (including residential or supported care settings); presence of one or more personality disorder; aged 18 or over; proficiency in spoken English; capacity to provide informed consent. Exclusion criteria are: Primary diagnosis of a functional psychosis; insufficient degree of literacy, comprehension or attention to be able to engage in trial therapy and assessments; currently engaged in a specific programme of psychological treatment for personality disorder or likely to start such treatment during the trial period; currently enrolled in any other trial. Suitable participants are randomly allocated to PEPS therapy plus treatment as usual (TAU) or TAU only. We aim to recruit 340 men and women. The primary outcome is social functioning as measured by the SFQ. A reduction (i.e., an improvement) of 2 points or more on the SFQ at follow-up 72 weeks post-randomisation is our pre-specified index of clinically significant change. Secondary outcomes include a reduction of unscheduled service usage and an increase in scheduled service usage; improved quality of life; and a reduction in mental distress. Discussion PEPS therapy has potential as an economical, accessible, and acceptable intervention for people with personality disorder. The results from this randomised controlled trial will tell us if PEPS therapy is effective and cost-effective. If so, then it will be a useful treatment for inclusion in a broader menu of treatment options for this group of service users. Trial Registration International Standard Randomised Controlled Trial Number - ISRCTN70660936 PMID:21864370

Exploring the Role of In-Person Components for Online Health Behavior Change Interventions: Can a Digital Person-to-Person Component Suffice?

PubMed Central

Kane, Deborah; Senn, Charlene Y; Woodruff, Sarah J

2018-01-01

The growth of the digital environment provides tremendous opportunities to revolutionize health behavior change efforts. This paper explores the use of Web-based, mobile, and social media health behavior change interventions and determines whether there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioral theories such as the theory of reasoned action, and the social cognitive theory, and further justified by the human support constructs of the model of supportive accountability. Overall, face-to-face and online behavior change interventions have their respective advantages and disadvantages and functions, yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behavior change interventions, and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behavior change. As the popularity of the online world grows, and the interest in using the digital environment for health behavior change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored. PMID:29643048

Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample

PubMed Central

Few, Lauren R.; Miller, Joshua D.; Rothbaum, Alex; Meller, Suzanne; Maples, Jessica; Terry, Douglas P.; Collins, Brittany; MacKillop, James

2014-01-01

The DSM-5 includes a novel approach to the diagnosis of personality disorders (PDs) in Section III, in order to stimulate further research with the possibility that this proposal will be included more formally in future DSM iterations. The current study provides the first test of this proposal in a clinical sample by simultaneously examining its two primary components: a system for rating personality impairment and a newly developed dimensional model of pathological personality traits. Participants were community adults currently receiving outpatient mental health treatment who completed a semi-structured interview for DSM-IV PDs and were then rated in terms of personality impairment and pathological traits. Data on the pathological traits were also collected via self-reports using the Personality Inventory for DSM-5 (PID-5). Both sets of trait scores were compared to self-report measures of general personality traits, internalizing symptoms, and externalizing behaviors. Inter-rater reliabilities for the clinicians’ ratings of impairment and the pathological traits were fair. The impairment ratings manifested substantial correlations with symptoms of depression and anxiety, DSM-5 PDs, and DSM-5 pathological traits. The clinician and self-reported personality trait scores demonstrated good convergence with one another, both accounted for substantial variance in DSM-IV PD constructs, and both manifested expected relations with the external criteria. The traits but not the impairment ratings demonstrated incremental validity in the prediction of the DSM-IV PDs. Overall, the current results support the general validity of several of the components of this new PD diagnostic system and point to areas that may require further modification. PMID:24364607

Examining the construct and known-group validity of a composite endpoint for The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A large-scale data sharing initiative

PubMed Central

Hofman, Cynthia S.; Lutomski, Jennifer E.; Boter, Han; Buurman, Bianca M.; Donders, Rogier; Olde Rikkert, Marcel G. M.; Makai, Peter; Melis, René J. F.

2017-01-01

Background Preference-weighted multi-faceted endpoints have the potential to facilitate comparative effectiveness research that incorporates patient preferences. The Older Persons and Informal Caregivers Survey—Composite endpoint (TOPICS-CEP) is potentially a valuable outcome measure for evaluating interventions in geriatric care as it combines multiple outcomes relevant to older persons in a single metric. The objective of this study was to validate TOPICS-CEP across different study settings (general population, primary care and hospital). Methods Data were extracted from TOPICS Minimum Dataset (MDS), a pooled public-access national database with information on older persons throughout the Netherlands. Data of 17,603 older persons were used. Meta-correlations were performed between TOPICS-CEP indexed scores, EuroQol5-D utility scores and Cantril’s ladder life satisfaction scores. Mixed linear regression analyses were performed to compare TOPICS-CEP indexed scores between known groups, e.g. persons with versus without depression. Results In the complete sample and when stratified by study setting TOPICS-CEP and Cantril’s ladder were moderately correlated, whereas TOPICS-CEP and EQ-5D were highly correlated. Higher mean TOPICS-CEP scores were found in persons who were: married, lived independently and had an education at university level. Moreover, higher mean TOPICS-CEP scores were found in persons without dementia, depression, and dizziness with falls, respectively. Similar results were found when stratified by subgroup. Conclusion This study supports that TOPICS-CEP is a robust measure which can potentially be used in broad settings to identify the effect of intervention or of prevention in elderly care. PMID:28296910

Core dimensions of personality broadly account for the link from perceived social support to symptoms of depression and anxiety.

PubMed

Lewis, Gary J; Bates, Timothy C; Posthuma, Danielle; Polderman, Tinca J C

2014-08-01

Specific personality traits and poor social support are risk factors for anxiety and depression. Little work, however, has considered the effects of social support and personality on these aspects of psychopathology simultaneously. We examined whether perceived social support mediates the effects of core personality domains on symptoms of anxiety and depression. Measures of personality (based on the Five-Factor Model [FFM]), perceived social support, and symptoms of depression and anxiety were collected in a large Dutch adult population-based sample (n = 555), and, except for depression symptoms, in an independent U.S. adult population-based sample (n = 511). Path modeling was used to test the effects of FFM traits on symptoms of depression and anxiety, with and without the mediation of perceived social support. Social support showed no link to symptoms of anxiety and only modest links to symptoms of depression when controlling for the FFM traits. Neuroticism had the strongest effect on symptoms of both depression and anxiety, with Extraversion also showing links to symptoms of depression. Social support has limited influence on symptoms of depression, and no effects on anxiety, over and above the effects of personality. Links between social support and anxiety/depression may largely reflect influences of Neuroticism and Extraversion. © 2013 Wiley Periodicals, Inc.

Pityriasis versicolor in primary school children in Medan Labuhan

NASA Astrophysics Data System (ADS)

Febriyanti; Paramita, DA; Eyanoer, P.

2018-03-01

Personal hygiene is an activity in which done by someone, directly and indirectly, to keep healthy to prevent the risk of diseases. Personal hygiene is also a factor that plays a role in the occurrence of skin diseases and one of them is Pityriasis versicolor. Pityriasis versicolor is a superficial fungal infection caused by Malassezia furfur which is a saprophytic organism in the skin. Activation of M. furfur into a pathogenic form due to changes in the normal flora of the skin that caused by several factors and one of them is poor personal hygiene. A cross-sectional study consist of 115 eligible students is done to determine the relationship between personal hygiene with the occurrence of Pityriasis versicolor among students in primary school in Medan Labuhan district. The result showed that 59.8% of the subject with poor personal hygiene and there is a significant association between personal hygiene with Pityriasis versicolor (p<0.05).

Factor Structure of the Primary Scales of the Inventory of Personality Organization in a Nonclinical Sample Using Exploratory Structural Equation Modeling

ERIC Educational Resources Information Center

Ellison, William D.; Levy, Kenneth N.

2012-01-01

Using exploratory structural equation modeling and multiple regression, we examined the factor structure and criterion relations of the primary scales of the Inventory of Personality Organization (IPO; Kernberg & Clarkin, 1995) in a nonclinical sample. Participants (N = 1,260) completed the IPO and measures of self-concept clarity, defenses,…

22 CFR 96.46 - Using providers in Convention countries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... provide the primary provider on a timely basis any data that is necessary to comply with the primary...) The agency or person, when acting as the primary provider and using foreign supervised providers to... agreement with the primary provider for the provision of adoption services, discloses to the primary...

26 CFR 1.1275-1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... reopening and aggregation rules. (g) Debt instruments issued by a natural person. If an entity is a primary... natural person even if a natural person is a co-maker and is jointly liable for the debt instrument's... entity even if the partnership is composed entirely of natural persons. (h) Publicly offered debt...

24 CFR 891.545 - Completion of project, cost certification, and HUD approvals.

Code of Federal Regulations, 2011 CFR

2011-04-01

... DIRECT LOAN PROGRAM, SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SUPPORTIVE HOUSING FOR THE ELDERLY AND PERSONS WITH DISABILITIES Loans for Housing for the Elderly and Persons with Disabilities Section 202 Projects for the...

Health conditions and support needs of persons living in residential facilities for adults with intellectual disability in Western Cape Province.

PubMed

McKenzie, J; McConkey, R; Adnams, C

2013-04-17

Intellectual disability (ID) is a relatively high-incidence disability, with an increased risk of poor physical and mental health. Persons with ID also have lifelong support needs that must be met if they are to achieve an acceptable quality of life. Little is known about these health conditions and support needs in the African context. This study examines persons over the age of 18 years with ID in residential facilities in Western Cape Province. To analyse the health conditions and support needs of persons with ID in Western Cape Province. A survey of residents' health conditions and support needs was conducted in face-to-face interviews with the managers of 37 out of 41 identified facilities. The survey comprised 2 098 residents (54% of them female), representing less than 2% of the estimated population of persons with ID in the province. The survey suggests that such persons experience a wide range of health conditions (notably mental health and behavioural issues) but have limited access to general health care and rehabilitation services. Furthermore, the daily living supports required for an acceptable quality of life are limited. The findings highlight the need for better health and support provision to persons with ID.

"The more you know, the more you realise it is really challenging to do": Tensions and uncertainties in person-centred support for people with long-term conditions.

PubMed

Entwistle, Vikki A; Cribb, Alan; Watt, Ian S; Skea, Zoë C; Owens, John; Morgan, Heather M; Christmas, Simon

2018-03-30

To identify and examine tensions and uncertainties in person-centred approaches to self-management support - approaches that take patients seriously as moral agents and orient support to enable them to live (and die) well on their own terms. Interviews with 26 UK clinicians about working with people with diabetes or Parkinson's disease, conducted within a broader interdisciplinary project on self-management support. The analysis reported here was informed by philosophical reasoning and discussions with stakeholders. Person-centred approaches require clinicians to balance tensions between the many things that can matter in life, and their own and each patient's perspectives on these. Clinicians must ensure that their supportive efforts do not inadvertently disempower people. When attending to someone's particular circumstances and perspectives, they sometimes face intractable uncertainties, including about what is most important to the person and what, realistically, the person can or could do and achieve. The kinds of professional judgement that person-centred working necessitates are not always acknowledged and supported. Practical and ethical tensions are inherent in person-centred support and need to be better understood and addressed. Professional development and service improvement initiatives should recognise these tensions and uncertainties and support clinicians to navigate them well. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Factors related to Psychosocial Barriers to Drug Treatment among Chinese Drug Users

PubMed Central

Kelly, Brian C; Liu, Tieqiao; Zhang, Guanbai; Hao, Wei; Wang, Jichuan

2014-01-01

Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment – absence of problem, negative social support, fear of treatment, and privacy concerns – to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users’ lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population. PMID:24813554

Natural Sciences and Pre-Schoolers: Impact and Future Approaches

NASA Astrophysics Data System (ADS)

Mira, Sara; Leote, Catarina; Ferreira, Hélder; Correia, Diana; Alho, Joana; Costa, Júlio; Silva, Adriana; Faria, Cláudia; Azevedo Rodrigues, Luis

2017-04-01

Geosciences are more and more part of the primary school curriculum. However, the subjects of Earth and Astronomy remain very lightly approached. In Portugal, after the mandatory class period from 9 a.m. to 4 p.m., a complementary Experimental Sciences class of 1 or 2 hours per week has been introduced. In the past two years, through a partnership with the Lagos City Hall, the Lagos Ciência Viva Science Centre (CCVL) has been responsible for these classes in 8 primary schools engaging roughly 500 students in STEM activities that aim to support students to better understand and explore general scientific (and geosciences) subjects. But what is the impact of these classes in their knowledge and thinking procedure? What competencies and skills are gained, if any? And what is the background of our students regarding scientific literacy and habits? To answer these questions, we used questionnaires and personal meaning mapping to characterize our primary school population concerning scientific literacy and habits, assess the impact in their knowledge and identify potential caveats in our teaching and evaluation methods.

Earthquake Protection Measures for People with Disabilities

NASA Astrophysics Data System (ADS)

Gountromichou, C.; Kourou, A.; Kerpelis, P.

2009-04-01

The problem of seismic safety for people with disabilities not only exists but is also urgent and of primary importance. Working towards disability equality, Earthquake Planning and Protection Organization of Greece (E.P.P.O.) has developed an educational scheme for people with disabilities in order to guide them to develop skills to protect themselves as well as to take the appropriate safety measures before, during and after an earthquake. The framework of this initiative includes a number of actions have been already undertaken, including the following: a. Recently, the main guidelines have been published to help people who have physical, cognitive, visual, or auditory disabilities to cope with a destructive earthquake. Of great importance, in case of people with disabilities, is to be prepared for the disaster, with several measures that must be taken starting today. In the pre-earthquake period, it is important that these people, in addition to other measures, do the following: - Create a Personal Support Network The Personal Support Network should be a group of at least three trustful people that can assist the disabled person to prepare for a disastrous event and to recover after it. - Complete a Personal Assessment The environment may change after a destructive earthquake. People with disabilities are encouraged to make a list of their personal needs and their resources for meeting them in a disaster environment. b. Lectures and training seminars on earthquake protection are given for students, teachers and educators in Special Schools for disabled people, mainly for informing and familiarizing them with earthquakes and with safety measures. c. Many earthquake drills have already taken place, for each disability, in order to share good practices and lessons learned to further disaster reduction and to identify gaps and challenges. The final aim of this action is all people with disabilities to be well informed and motivated towards a culture of earthquake resilience, since Greece is one of the most seismically active countries of the world.

The roles and training of primary care doctors: China, India, Brazil and South Africa.

PubMed

Mash, Robert; Almeida, Magda; Wong, William C W; Kumar, Raman; von Pressentin, Klaus B

2015-12-04

China, India, Brazil and South Africa contain 40% of the global population and are key emerging economies. All these countries have a policy commitment to universal health coverage with an emphasis on primary health care. The primary care doctor is a key part of the health workforce, and this article, which is based on two workshops at the 2014 Towards Unity For Health Conference in Fortaleza, Brazil, compares and reflects on the roles and training of primary care doctors in these four countries. Key themes to emerge were the need for the primary care doctor to function in support of a primary care team that provides community-orientated and first-contact care. This necessitates task-shifting and an openness to adapt one's role in line with the needs of the team and community. Beyond clinical competence, the primary care doctor may need to be a change agent, critical thinker, capability builder, collaborator and community advocate. Postgraduate training is important as well as up-skilling the existing workforce. There is a tension between training doctors to be community-orientated versus filling the procedural skills gaps at the facility level. In training, there is a need to plan postgraduate education at scale and reform the system to provide suitable incentives for doctors to choose this as a career path. Exposure should start at the undergraduate level. Learning outcomes should be socially accountable to the needs of the country and local communities, and graduates should be person-centred comprehensive generalists.

Identifying primary care patient safety research priorities in the UK: a James Lind Alliance Priority Setting Partnership.

PubMed

Morris, Rebecca Lauren; Stocks, Susan Jill; Alam, Rahul; Taylor, Sian; Rolfe, Carly; Glover, Steven William; Whitcombe, Joanne; Campbell, Stephen M

2018-02-28

To identify the top 10 unanswered research questions for primary care patient safety research. A modified nominal group technique. UK. Anyone with experience of primary care including: patients, carers and healthcare professionals. 341 patients and 86 healthcare professionals submitted questions. A top 10, and top 30, future research questions for primary care patient safety. 443 research questions were submitted by 341 patients and 86 healthcare professionals, through a national survey. After checking for relevance and rephrasing, a total of 173 questions were collated into themes. The themes were largely focused on communication, team and system working, interfaces across primary and secondary care, medication, self-management support and technology. The questions were then prioritised through a national survey, the top 30 questions were taken forward to the final prioritisation workshop. The top 10 research questions focused on the most vulnerable in society, holistic whole-person care, safer communication and coordination between care providers, work intensity, continuity of care, suicide risk, complex care at home and confidentiality. This study was the first national prioritisation exercise to identify patient and healthcare professional priorities for primary care patient safety research. The research priorities identified a range of important gaps in the existing evidence to inform everyday practice to address primary care patient safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of value congruence on work-family conflicts: the mediating role of work-related support.

PubMed

Pan, Su-Ying; Yeh, Ying-Jung Yvonne

2012-01-01

Based on past research regarding the relationship between person-environment fit and work-family conflict (WFC), we examined the mediating effects of perceived organization/supervisor support on the relationship between person-organization/supervisor value congruence and WFC. A structural equation model was used to test three hypotheses using data collected from 637 workers in Taiwan. Person-organization value congruence regarding role boundaries was found to be positively correlated with employee perception of organizational support, resulting in reduced WFC. Person-supervisor value congruence regarding role boundaries also increased employee perception of organizational support, mediated by perceived supervisor support. Research and managerial implications are discussed.

The prevalence of trauma and its relationship to borderline personality symptoms and self-destructive behaviors in a primary care setting.

PubMed

Sansone, R A; Sansone, L A; Wiederman, M

1995-05-01

To determine the prevalence of five types of trauma and their relationship to borderline personality symptoms and self-destructive behaviors in female subjects recruited from a primary care setting. Consecutive sample. Subjects completed a lengthy research booklet. Primary care, outpatient, health maintenance organization setting. One hundred fifty-two consecutive women, aged 18 to 45 years, who were scheduled for routine gynecological care by a female family physician. Measures included a demographic questionnaire, a trauma questionnaire (ie, sexual, physical, and emotional abuse, physical neglect, and witnessing of violence), the Borderline Personality Scale of the Personality Diagnostic Questionnaire-Revised; and the Self-Harm Inventory. Traumatic experiences were reported by 70.7% of the subjects (25.8%, sexual abuse; 36.4%, physical abuse; 43.7%, emotional abuse; 9.3%, physical neglect; and 43.0%, witnessing of violence). There was a significant correlation between the acknowledged number of abuse categories and borderline personality symptoms (r = .36, P = .01) as well as self-destructive behaviors (r = .43, P = .01). Sexual abuse and witnessing of violence were most associated with borderline personality symptoms; sexual abuse, physical abuse, and witnessing of violence were most associated with self-destructive behaviors. This study provides further evidence that abuse is a nonspecific but contributory factor to psychopathologic processes, in particular borderline personality symptoms and self-destructive behaviors.

Outcomes that matter: A qualitative study with persons with schizophrenia and their primary caregivers in India

PubMed Central

Balaji, Madhumitha; Chatterjee, Sudipto; Brennan, Beth; Rangaswamy, Thara; Thornicroft, Graham; Patel, Vikram

2012-01-01

Background Involving persons with schizophrenia and their families in designing, implementing and evaluating mental health services is increasingly emphasised. However, there is little information on desired outcomes from the perspectives of these stakeholders from low and middle income countries (LMIC). Aims To explore and define outcomes desired by persons with schizophrenia and their primary caregivers from their perspectives. Method In-depth interviews were held with 32 persons with schizophrenia and 38 primary caregivers presenting for care at one rural and one semi-urban site in India. Participants were asked what changes they desired in the lives of persons affected by the illness and benefits they expected from treatment. Data was analysed using thematic and content analysis. Results Eleven outcomes were desired by both groups: symptom control; employment/education; social functioning; activity; fulfilment of duties and responsibilities; independent functioning; cognitive ability; management without medication; reduced side-effects; self-care; and self-determination. Social functioning, employment/education and activity were the most important outcomes for both groups; symptom control and cognitive ability were more important to persons with schizophrenia while independent functioning and fulfilment of duties were more important to caregivers. Conclusions Interventions for schizophrenia in India should target both clinical and functional outcomes, addressing the priorities of both affected persons and their caregivers. Their effectiveness needs to be evaluated independently from both perspectives. PMID:22981055

New capabilities for older aircraft: A study of pilot integration of retro-fit digital avionics to analog-instrumented flight decks

NASA Astrophysics Data System (ADS)

Breuer, Glynn E.

The purpose of this study was to determine whether applying Gilbert's Behavior Engineering Model to military tactical aviation organizations would foster effective user integration of retro-fit digital avionics in analog-instrumented flight decks. This study examined the relationship between the reported presence of environmental supports and personal repertory supports as defined by Gilbert, and the reported self-efficacy of users of retro-fit digital avionics to analog flight decks, and examined the efficacious behaviors of users as they attain mastery of the equipment and procedures, and user reported best practices and criteria for masterful performance in the use of retro-fit digital avionics and components. This study used a mixed methodology, using quantitative surveys to measure the perceived level of organizational supports that foster mastery of retro-fit digital avionic components, and qualitative interviews to ascertain the efficacious behaviors and best practices of masterful users of these devices. The results of this study indicate that there is some relationship between the reported presence of organizational supports and personal repertory supports and the reported self-mastery and perceived organizational mastery of retro-fit digital avionics applied to the operation of the research aircraft. The primary recommendation is that unit leadership decide exactly the capabilities desired from retro-fit equipment, publish these standards, ensure training in these standards is effective, and evaluate performance based on these standards. Conclusions indicate that sufficient time and resources are available to the individual within the study population, and the organization as a whole, to apply Gilbert's criteria toward the mastery of retro-fit digital avionics applied to the operation of the research aircraft.

Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

PubMed

Kwan, Bethany M; Jortberg, Bonnie; Warman, Meredith K; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas; Martinez, Vincent; Nease, Donald E

2017-06-01

Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Hidden Lives of Nurses' Cognitive Artifacts.

PubMed

Blaz, Jacquelyn W; Doig, Alexa K; Cloyes, Kristin G; Staggers, Nancy

2016-09-07

Standardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their "paper brains" - to support handoffs, indicating a deficiency in available electronic versions. The purpose of this qualitative study was to develop a deep understanding of nurses' paper-based cognitive artifacts in the context of a cancer specialty hospital. After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses' paper-based cognitive artifacts, and analytic memos. Findings suggest nurses' paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse's career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse's individually styled, paper brain is triggered by a change in the nurse's environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support. The "hidden lives" - the life cycle and evolution - of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses' paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses' paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized.

Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation

PubMed Central

Blakeman, Tom; Griffith, Kathryn; Lasserson, Dan; Lopez, Berenice; Tsang, Jung Y; Campbell, Stephen; Tomson, Charles

2016-01-01

Objectives Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. Design An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. Setting Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. Participants A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and ‘overdiagnosis’. Results There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. Conclusions The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs. PMID:27729353

Financial and Time Burdens for Medical Students Interviewing for Residency.

PubMed

Callaway, Paul; Melhado, Trisha; Walling, Anne; Groskurth, Jordan

2017-02-01

Interviewing for residency positions is increasingly stressful for students and challenging for programs. Little information is available about the costs and time invested by students in interviewing or about the key factors in decisions to accept interview offers. Our objective was to assess the time and financial costs of residency interviewing for an entire class at a regional campus and explore factors influencing student decisions to accept interviews. We used a 14-item survey administered electronically immediately following National Resident Matching Program results. The response rate was 75% (49 of 65 students). About half interviewed in primary care specialties. Thirty students (63%) applied to 20 or more programs, and 91% were offered multiple interviews out of state. Seventy percent limited interviews by time and cost. Other important factors included personal "fit," program reputation, and the quality of residents. About 50% of the students spent more than 20 days and $1,000-$5,000 interviewing; 29% reported spending over $5,000. Students used multiple funding sources, predominantly loans and savings. Primary care applicants applied to fewer out-of-state programs, reported fewer interview days and lower expenses, but received more financial support from programs. Students invested considerable time and resources in interviewing, and these factors significantly influenced their decisions about accepting interviews. The other major factors in interview decisions concerned personal comfort with the program, especially the residents. The costs and time reported in this study could be greater than other schools due to the regional campus location or lower due to the high proportion of students interviewing in primary care.

Designing a complex intervention for dementia case management in primary care

PubMed Central

2013-01-01

Background Community-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable. Case management is a popular approach to care co-ordination, but evidence to date on its effectiveness in dementia has been equivocal. Case management interventions need to be designed to overcome obstacles to care co-ordination and maximise benefit. A successful case management methodology was adapted from the United States (US) version for use in English primary care, with a view to a definitive trial. Medical Research Council guidance on the development of complex interventions was implemented in the adaptation process, to capture the skill sets, person characteristics and learning needs of primary care based case managers. Methods Co-design of the case manager role in a single NHS provider organisation, with external peer review by professionals and carers, in an iterative technology development process. Results The generic skills and personal attributes were described for practice nurses taking up the case manager role in their workplaces, and for social workers seconded to general practice teams, together with a method of assessing their learning needs. A manual of information material for people with dementia and their family carers was also created using the US intervention as its source. Conclusions Co-design produces rich products that have face validity and map onto the complexities of dementia and of health and care services. The feasibility of the case manager role, as described and defined by this process, needs evaluation in ‘real life’ settings. PMID:23865537

Leadership in rural medicine: the organization on thin ice?

PubMed

Hana, Jan; Rudebeck, Carl Edvard

2011-06-01

OBJECTIVE. To explore the personal experiences of and conceptions regarding leading rural primary care in Northern Norway. DESIGN. Qualitative content analysis of focus-group interviews. SETTING. Lead primary care physicians in the three northernmost counties. Subjects. Four groups with 22 out of 88 municipal lead physicians in the region. RESULTS. Three main categories were developed and bound together by an implicit theme. Demands and challenges included the wide leadership span of clinical services and public health, placed in a merged line/board position. Constraints of human resources and time and the ever changing organizational context added to the experience of strain. Personal qualifications indicates the lack of leadership motivation and training, which was partly compensated for by a leader role developed through clinical undergraduate training and then through the responsibilities and experiences of clinical work. In Exercising the leadership, the participants described a vision of a coaching and coordinating leadership and, in practice, a display of communication skills, decision-making ability, result focusing, and ad hoc solutions. Leadership was made easier by the features of the small, rural organization, such as overview, close contact with cooperating partners, and a supportive environment. There was incongruence between demands and described qualifications, and between desired and executed leadership, but nevertheless the organization was running. Leadership demonstrated a "working inadequacy". CONCLUSION. Under resource constraints, leadership based on clinical skills favours management by exception which, in the long run, appears to make the leadership less effective. Leadership training which takes into account the prominent features of rural and decentralized primary care is strongly needed.

Leadership in rural medicine: The organization on thin ice?

PubMed Central

Hana, Jan; Rudebeck, Carl Edvard

2011-01-01

Objective To explore the personal experiences of and conceptions regarding leading rural primary care in Northern Norway. Design Qualitative content analysis of focus-group interviews. Setting Lead primary care physicians in the three northernmost counties. Subjects Four groups with 22 out of 88 municipal lead physicians in the region. Results Three main categories were developed and bound together by an implicit theme. Demands and challenges included the wide leadership span of clinical services and public health, placed in a merged line/board position. Constraints of human resources and time and the ever changing organizational context added to the experience of strain. Personal qualifications indicates the lack of leadership motivation and training, which was partly compensated for by a leader role developed through clinical undergraduate training and then through the responsibilities and experiences of clinical work. In Exercising the leadership, the participants described a vision of a coaching and coordinating leadership and, in practice, a display of communication skills, decision-making ability, result focusing, and ad hoc solutions. Leadership was made easier by the features of the small, rural organization, such as overview, close contact with cooperating partners, and a supportive environment. There was incongruence between demands and described qualifications, and between desired and executed leadership, but nevertheless the organization was running. Leadership demonstrated a “working inadequacy”. Conclusion Under resource constraints, leadership based on clinical skills favours management by exception which, in the long run, appears to make the leadership less effective. Leadership training which takes into account the prominent features of rural and decentralized primary care is strongly needed. PMID:21526921

Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review.

PubMed

Gibson, Odette R; Segal, Leonie

2015-04-11

To describe reported studies of the impact on HbA1C levels, diabetes-related hospitalisations, and other primary care health endpoints of initiatives aimed at improving the management of diabetes in Indigenous adult populations of Australia, Canada, New Zealand and the United States. Systematic literature review using data sources of MEDLINE, Embase, the Cochrane Library, CINHAL and PsycInfo from January 1985 to March 2012. Inclusion criteria were a clearly described primary care intervention, model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on at least one quantitative diabetes-related health outcome, and where results were reported separately for Indigenous persons. Joanna Briggs Institute critical appraisal tools were used to assess the study quality. PRISMA guidelines were used for reporting. The search strategy retrieved 2714 articles. Of these, 13 studies met the review inclusion criteria. Three levels of primary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-level improvement processes to enhance the quality of diabetes care, 3) change in primary health funding to support better access to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care, specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studies reported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation. The methodological quality of the four comparable cohort and seven observational studies was good, and moderate for the two randomised control trials. The current literature provides an inadequate evidence base for making important policy and practice decisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very small number of published studies, the general reliance on intermediate health outcomes and the predominance of observational studies. Additional studies of the impacts of primary care need to consider carefully research design and the reporting of hospital outcomes or other primary end points. This is an important question for policy makers and further high quality research is needed to contribute to an evidence-base to inform decision making.

Consensus statement of the International Summit on Intellectual Disability and Dementia on valuing the perspectives of persons with intellectual disability.

PubMed

Watchman, Karen; Janicki, Matthew P; Udell, Leslie; Hogan, Mary; Quinn, Sam; Beránková, Anna

2018-01-01

The International Summit on Intellectual Disability and Dementia covered a range of issues related to dementia and intellectual disability, including the dearth of personal reflections of persons with intellectual disability affected by dementia. This article reflects on this deficiency and explores some of the personal perspectives gleaned from the literature, from the Summit attendees and from the experiences of persons with intellectual disability recorded or scribed in advance of the two-day Summit meeting. Systemic recommendations included reinforcing the value of the involvement of persons with intellectual disability in (a) research alongside removing barriers to inclusion posed by institutional/ethics review boards, (b) planning groups that establish supports for dementia and (c) peer support. Practice recommendations included (a) valuing personal perspectives in decision-making, (b) enabling peer-to-peer support models, (c) supporting choice in community-dwelling arrangements and (d) broadening availability of materials for persons with intellectual disability that would promote understanding of dementia.

Person-centred web-based support--development through a Swedish multi-case study.

PubMed

Josefsson, Ulrika; Berg, Marie; Koinberg, Ingalill; Hellström, Anna-Lena; Nolbris, Margaretha Jenholt; Ranerup, Agneta; Lundin, Carina Sparud; Skärsäter, Ingela

2013-10-19

Departing from the widespread use of the internet in modern society and the emerging use of web applications in healthcare this project captures persons' needs and expectations in order to develop highly usable web recourses. The purpose of this paper is to outline a multi-case research project focused on the development and evaluation of person-centred web-based support for people with long-term illness. To support the underlying idea to move beyond the illness, we approach the development of web support from the perspective of the emergent area of person-centred care. The project aims to contribute to the ongoing development of web-based supports in health care and to the emerging field of person-centred care. The research design uses a meta-analytical approach through its focus on synthesizing experiences from four Swedish regional and national cases of design and use of web-based support in long-term illness. The cases include children (bladder dysfunction and urogenital malformation), young adults (living close to persons with mental illness), and two different cases of adults (women with breast cancer and childbearing women with type 1 diabetes). All of the cases are ongoing, though in different stages of design, implementation, and analysis. This, we argue, will lead to a synthesis of results on a meta-level not yet described. To allow valid comparisons between the four cases we explore and problematize them in relation to four main aspects: 1) The use of people's experiences and needs; 2) The role of use of theories in the design of person-centred web-based supports; 3) The evaluation of the effects of health outcomes for the informants involved and 4) The development of a generic person-centred model for learning and social support for people with long-term illness and their significant others. Person-centred web-based support is a new area and few studies focus on how web-based interventions can contribute to the development of person-centred care. In summary, the main intention of the project outlined here is to contribute with both a synthesis of results on meta-level from four cases and a substantial contribution to the field person-centred care.

Role of the family doctor in the management of adults with obesity: a scoping review

PubMed Central

Elmitt, Nicholas; Haelser, Emily; Douglas, Kirsty A

2018-01-01

Objectives Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. Setting Primary care. Adult patients. Included papers Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. Primary and secondary outcome measures Data were extracted on the family doctors’ involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. Results 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. Conclusions There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development. PMID:29453301

Precedents of perceived social support: personality and early life experiences.

PubMed

Kitamura, T; Kijima, N; Watanabe, K; Takezaki, Y; Tanaka, E

1999-12-01

In order to examine the effects of personality and early life experiences on perceived social support, a total of 97 young Japanese women were investigated. Current interpersonal relationships were measured by an interview modified from Henderson et al.'s Interview Schedule for Social Interaction (ISSI). Personality was measured by Cloninger et al.'s Temperament and Character Inventory. Early life experiences at home and outside of home were also identified in the interview. The number of sources of perceived support was correlated with self-directness, while satisfaction with perceived support was correlated with novelty seeking and with low harm avoidance. No early life experiences--early loss of a parent, perceived parenting, childhood abuse experiences, experiences of being bullied and/or other life events--showed significant correlations with the number or satisfaction of supportive people. The quantity and quality of perception of social support differ in their link to personality, and perceived social support may, to some extent, be explainable in terms of personality.

Self-esteem and optimism in men and women infected with HIV.

PubMed

Anderson, E H

2000-01-01

Self-esteem and optimism have been associated with appraisal and outcomes in a variety of situations. The degree to which the contribution of self-esteem and optimism to outcomes over time is accounted for by the differences in threat (primary) or resource (secondary) appraisal has not been established in persons with human immunodeficiency virus (HIV). To examine the longitudinal relationship of personality (self-esteem and optimism) on primary and secondary appraisal and outcomes of well-being, mood, CD4+ T-lymphocyte count, and selected activities. Men (n = 56) and women (n = 42) infected with HIV completed eight self-report measures twice over 18 months. Hierarchical Multiple Regressions were used to examine the relationship of personality variables on appraisals and outcomes. The mediating effects of primary and secondary appraisals were explored. Self-esteem uniquely accounted for 6% of the variance in primary appraisal and 5% in secondary appraisal. Optimism accounted for 8% of the unique variance in secondary appraisal. Primary and secondary appraisal mediated differently between personality and outcome variables. A strong predictor of well-being, mood disturbance, and activity disruption at Time 2 was participants' initial level of these variables. Socioeconomic status was a strong predictor of mood. Self-esteem and optimism are important but different resources for adapting to HIV disease. Strategies for reducing threats and increasing resources associated with HIV may improve an individual's mood and sense of well-being.

The Edinburgh Primary Care Depression Study: personality disorder and outcome.

PubMed

Patience, D A; McGuire, R J; Scott, A I; Freeman, C P

1995-09-01

Little is known about the impact of personality pathology on the treatment outcome of major depressive illness in primary care in the UK. Patients meeting criteria for DSM-III major depressive disorder were randomly allocated to one of four treatments each lasting 16 weeks, then followed up for 18 months. Assessments were made of depressive symptoms, personality and social functioning. Personality was assessed at maximum improvement or 16 weeks. The prevalence of personality disorder (PD) in the sample of 113 patients was 26%. Patients with a PD were significantly younger and rated more depressed at entry than patients with no personality disorder (NoPD). On completion of treatment patients with a PD were significantly more depressed and had poorer social functioning than the NoPD group. After 18 months there were no differences in ratings of depression or social functioning between the groups. There was substantial improvement in both the PD and NoPD groups. The presence of personality pathology delays recovery from major depressive illness.

Pregnancy Options Counseling and Abortion Referrals Among US Primary Care Physicians: Results From a National Survey.

PubMed

Holt, Kelsey; Janiak, Elizabeth; McCormick, Marie C; Lieberman, Ellice; Dehlendorf, Christine; Kajeepeta, Sandhya; Caglia, Jacquelyn M; Langer, Ana

2017-07-01

Primary care physicians (PCPs) can play a critical role in addressing unintended pregnancy through high-quality options counseling and referrals. We surveyed a nationally representative sample of 3,000 PCPs in general, family, and internal medicine on practices and opinions related to options counseling for unintended pregnancy. We assessed predictors of physician practices using multivariable logistic regression weighted for sampling design and differential non-response. Response rate was 29%. Seventy-one percent believed residency training in options counseling should be required, and 69% believed PCPs have an obligation to provide abortion referrals even in the presence of a personal objection to abortion. However, only 26% reported routine options counseling when caring for women with unintended pregnancy compared to 60% who routinely discuss prenatal care. Among physicians who see women seeking abortion, 62% routinely provide referrals, while 14% routinely attempt to dissuade women. Family physicians were more likely to provide routine options counseling when seeing patients with unintended pregnancy than internal medicine physicians (32% vs 21%, P=0.002). In multivariable analyses, factors associated with higher odds of routine abortion referrals were more years in practice (OR=1.03 for each additional year, 95% CI: 1.00-1.05), identifying as a woman vs a man (OR=2.11, 95% CI: 1.31-3.40), practicing in a hospital vs private primary care/multispecialty setting (OR=3.17, 95% CI: 1.10-9.15), and no religious affiliation of practice vs religious affiliation (OR for Catholic affiliation=0.27, 95% CI: 0.11-0.66; OR for other religious affiliation=0.36, 95% CI: 0.15-0.83). Personal Christian religious affiliation among physicians who regularly attend religious services vs no religious affiliation was associated with lower odds of counseling (OR=0.48, 95% CI: 0.26-0.90) and referrals (OR=0.31, 95% CI: 0.15-0.62), and higher odds of abortion dissuasion (OR=4.03, 95% CI: 1.46-11.14). Findings reveal the need to support fuller integration of options counseling and abortion referrals in primary care, particularly through institutional and professional society guidelines and training opportunities to impart skills and highlight the professional obligation to provide non-directive information and support to women with unintended pregnancy.

Are we under-utilizing the talents of primary care personnel? A job analytic examination

PubMed Central

Hysong, Sylvia J; Best, Richard G; Moore, Frank I

2007-01-01

Background Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions. Methods Seventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance. Results Objective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title. Conclusion Primary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness. PMID:17397534

The personalized reminder information and social management system (PRISM) trial: rationale, methods and baseline characteristics.

PubMed

Czaja, Sara J; Boot, Walter R; Charness, Neil; A Rogers, Wendy; Sharit, Joseph; Fisk, Arthur D; Lee, Chin Chin; Nair, Sankaran N

2015-01-01

Technology holds promise in terms of providing support to older adults. To date, there have been limited robust systematic efforts to evaluate the psychosocial benefits of technology for older people and identify factors that influence both the usability and uptake of technology systems. In response to these issues, we developed the Personal Reminder Information and Social Management System (PRISM), a software application designed for older adults to support social connectivity, memory, knowledge about topics, leisure activities and access to resources. This trail is evaluating the impact of access to the PRISM system on outcomes such as social isolation, social support and connectivity. This paper reports on the approach used to design the PRISM system, study design, methodology and baseline data for the trial. The trial is multi-site randomized field trial. PRISM is being compared to a Binder condition where participants received a binder that contained content similar to that found on PRISM. The sample includes 300 older adults, aged 65-98 years, who lived alone and at risk for being isolated. The primary outcome measures for the trial include indices of social isolation and support and well-being. Secondary outcomes measures include indices of computer proficiency, technology uptake and attitudes towards technology. Follow-up assessments occurred at 6 and 12 months post-randomization. The results of this study will yield important information about the potential value of technology for older adults. The study also demonstrates how a user-centered iterative design approach can be incorporated into the design and evaluation of an intervention protocol. Copyright © 2014 Elsevier Inc. All rights reserved.

The Personalized Reminder Information and Social Management System (PRISM) Trial: Rationale, Methods and Baseline Characteristics

PubMed Central

Czaja, Sara J.; Boot, Walter R.; Charness, Neil; Rogers, Wendy; Sharit, Joseph; Fisk, Arthur D.; Lee, Chin Chin; Nair, Sankaran N.

2014-01-01

Technology holds promise in terms of providing support to older adults. To date there have been limited robust systematic efforts to evaluate the psychosocial benefits of technology for older people and identify factors that influence both the usability and uptake of technology systems. In response to these issues we developed the Personal Reminder Information and Social Management System (PRISM), a software application designed for older adults to support social connectivity, memory, knowledge about topics, leisure activities and access to resources. This trail is evaluating the impact of access to the PRISM system on outcomes such as social isolation, social support and connectivity. This paper reports on the approach used to design the PRISM system, study design, methodology and baseline data for the trial. The trial is multi-site randomized field trial. PRISM is being compared to a Binder condition where participants received a binder that contained content similar to that found on PRISM. The sample includes 300 older adults, aged 65 – 98 years, who lived alone and at risk for being isolated. The primary outcome measures for the trial include indices of social isolation and support and well-being. Secondary outcomes measures include indices of computer proficiency, technology uptake and attitudes towards technology. Follow-up assessments occurred at 6 and 12 months post-randomization. The results of this study will yield important information about the potential value of technology for older adults. The study also demonstrates how a user-centered iterative design approach can be incorporated into the design and evaluation of an intervention protocol. PMID:25460342

Exploring the relationships among performance-based functional ability, self-rated disability, perceived instrumental support, and depression: a structural equation model analysis.

PubMed

Weil, Joyce; Hutchinson, Susan R; Traxler, Karen

2014-11-01

Data from the Women's Health and Aging Study were used to test a model of factors explaining depressive symptomology. The primary purpose of the study was to explore the association between performance-based measures of functional ability and depression and to examine the role of self-rated physical difficulties and perceived instrumental support in mediating the relationship between performance-based functioning and depression. The inclusion of performance-based measures allows for the testing of functional ability as a clinical precursor to disability and depression: a critical, but rarely examined, association in the disablement process. Structural equation modeling supported the overall fit of the model and found an indirect relationship between performance-based functioning and depression, with perceived physical difficulties serving as a significant mediator. Our results highlight the complementary nature of performance-based and self-rated measures and the importance of including perception of self-rated physical difficulties when examining depression in older persons. © The Author(s) 2014.

Implementing a multi-modal support service model for the family caregivers of persons with age-related macular degeneration: a study protocol for a randomised controlled trial.

PubMed

Gopinath, Bamini; Craig, Ashley; Kifley, Annette; Liew, Gerald; Bloffwitch, Jaye; Vu, Kim Van; Joachim, Nichole; Cummins, Rob; Heraghty, Julie; Broady, Timothy; Hayes, Alison; Mitchell, Paul

2017-08-04

Age-related macular degeneration (AMD) is a leading cause of blindness and low vision among older adults. Previous research shows a high prevalence of distress and disruption to the lifestyle of family caregivers of persons with late AMD. This supports existing evidence that caregivers are 'hidden patients' at risk of poor health outcomes. There is ample scope for improving the support available to caregivers, and further research should be undertaken into developing services that are tailored to the requirements of family caregivers of persons with AMD. This study aims to implement and evaluate an innovative, multi-modal support service programme that aims to empower family caregivers by improving their coping strategies, enhancing hopeful feelings such as self-efficacy and helping them make the most of available sources of social and financial support. A randomised controlled trial consisting of 360 caregiver-patient pairs (180 in each of the intervention and wait-list control groups). The intervention group will receive the following: (1) mail-delivered cognitive behavioural therapy designed to improve psychological adjustment and adaptive coping skills; (2) telephone-delivered group counselling sessions allowing caregivers to explore the impacts of caring and share their experiences; and (3) education on available community services/resources, financial benefits and respite services. The cognitive behavioural therapy embedded in this programme is the best evaluated and widely used psychosocial intervention. The primary outcome is a reduction in caregiver burden. Secondary outcomes include improvements in caregiver mental well-being, quality of life, fatigue and self-efficacy. Economic analysis will inform whether this intervention is cost-effective and if it is feasible to roll out this service on a larger scale. The study was approved by the University of Sydney human research ethics committee. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journal articles. The trial registration number is ACTRN12616001461482; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Primary care physicians’ perspectives on facilitating older patients’ access to community support services

PubMed Central

Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie

2017-01-01

Abstract Objective To understand how family physicians facilitate older patients’ access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Design Qualitative, multiple-case study design using semistructured interviews. Setting Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Participants Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. Methods A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Main findings Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. Conclusion This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. PMID:28115458

Long-term correlated change between personality traits and perceived social support in middle adulthood.

PubMed

Allemand, Mathias; Schaffhuser, Kathrin; Martin, Mike

2015-03-01

This study investigated long-term correlated change between personality traits and perceived social support in middle adulthood. Two measurement occasions with an 8-year time interval from the Interdisciplinary Longitudinal Study on Adult Development (ILSE) were used. The sample consisted of 346 middle-aged adults (46-50 years at T1). Four different types of perceived social support were assessed. Personality traits were assessed with the NEO-Five-Factor Inventory (NEO-FFI). Longitudinal measurement invariance (MI) was established for both measures. The mean rank-order stabilities were .79 and .62 for personality traits and for perceived social support, respectively. The results demonstrated a mean-level increase for neuroticism and a decrease for extraversion and significant change variances for all constructs. The results of latent change models showed significant initial level correlations and correlated changes between personality traits and social support, implying that changes in these constructs show commonality. The results can expand our current thinking about correlated change in personality. © 2015 by the Society for Personality and Social Psychology, Inc.

Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial.

PubMed

Luger, Eva; Dorner, Thomas Ernst; Haider, Sandra; Kapan, Ali; Lackinger, Christian; Schindler, Karin

2016-07-01

The aim of this study was to examine the effects of a home-based and volunteer-administered physical training and nutritional intervention program compared with social support intervention on nutritional and frailty status in prefrail and frail community-dwelling older persons. This was a randomized controlled trial in which community-dwelling persons (mean age = 83 years) were recruited and randomly assigned to the physical training and nutritional intervention group (PTN, n = 39) and the social support group (SoSu, n = 41). The study was conducted by trained lay nonprofessionals. The community-dwelling older persons in both groups were visited twice a week by trained nonprofessional volunteers (buddies) in Vienna, Austria. Eighty prefrail and frail adults aged 65 years or older. In the PTN group, both the buddies and older persons performed 6 strength exercises within a circuit training session and discussed nutrition-related aspects. The active control group (SoSu) had the opportunity to perform cognitive training in addition to the social contact. Outcome measures as nutritional (Mini Nutritional Assessment long form [MNA-LF]) and frailty status (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe [SHARE-FI]) were obtained at baseline and after 12 weeks. Significant improvements in the MNA-LF score (1.54 points, 95% confidence interval [CI] 0.51-2.56; P = .004) and the SHARE-FI score (-0.71 discrete factor score values, 95% CI -1.07, -0.35; P < .001) were observed in the PTN group after 12 weeks. In both groups, the prevalence of impaired nutritional status and frailty decreased significantly over time. The prevalence of impaired nutritional status decreased by 25% in the PTN group and by 23% in the SoSu group. Moreover, the prevalence of frailty decreased by 17% in the PTN group and by 16% in the SoSu group. The presence of impaired nutritional status at baseline was independently associated with greater changes in the nutritional (adjusted odds ratio [OR] 3.18, 95% CI 1.26-7.98; P = .014) and frailty status (adjusted OR 3.16, 95% CI 1.01-9.93; P = .049) after 12 weeks. The results indicate that a home-based physical training, nutritional, and social support intervention conducted by nonprofessionals is feasible and can help to tackle malnutrition and frailty in older persons living at home. Furthermore, social support alone also can result in improvement. In particular, older adults with impaired nutritional status at baseline can benefit more from the intervention. Such a home visit program might also have the potential to prevent future health risks and could allay isolation and loneliness. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

77 FR 56519 - Continuation of the National Emergency With Persons Who Commit, Threaten To Commit, or Support...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-12

... of the National Emergency With Persons Who Commit, Threaten To Commit, or Support Terrorism On... persons who commit, threaten to commit, or support terrorism, pursuant to the International Emergency... the grave acts of terrorism and threats of terrorism committed by foreign terrorists, including the...

3 CFR - Continuation of the National Emergency With Respect to Persons Who Commit, Threaten To Commit, or...

Code of Federal Regulations, 2013 CFR

2013-01-01

... to Persons Who Commit, Threaten To Commit, or Support Terrorism Presidential Documents Other... Persons Who Commit, Threaten To Commit, or Support Terrorism On September 23, 2001, by Executive Order... commit, or support terrorism, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701...

3 CFR - Continuation of the National Emergency With Respect to Persons Who Commit, Threaten To Commit, or...

Code of Federal Regulations, 2012 CFR

2012-01-01

... to Persons Who Commit, Threaten To Commit, or Support Terrorism Presidential Documents Other... Persons Who Commit, Threaten To Commit, or Support Terrorism On September 23, 2001, by Executive Order... commit, or support terrorism, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701...

3 CFR - Continuation of the National Emergency With Respect to Persons Who Commit, Threaten to Commit, or...

Code of Federal Regulations, 2010 CFR

2010-01-01

... to Persons Who Commit, Threaten to Commit, or Support Terrorism Presidential Documents Other... Persons Who Commit, Threaten to Commit, or Support Terrorism On September 23, 2001, by Executive Order... commit, or support terrorism, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701...

3 CFR - Continuation of the National Emergency With Respect to Persons Who Commit, Threaten to Commit, or...

Code of Federal Regulations, 2011 CFR

2011-01-01

... to Persons Who Commit, Threaten to Commit, or Support Terrorism Presidential Documents Other... Persons Who Commit, Threaten to Commit, or Support Terrorism On September 23, 2001, by Executive Order..., or support terrorism, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701...

3 CFR - Continuation of the National Emergency With Respect to Persons Who Commit, Threaten To Commit, or...

Code of Federal Regulations, 2014 CFR

2014-01-01

... to Persons Who Commit, Threaten To Commit, or Support Terrorism Presidential Documents Other... Persons Who Commit, Threaten To Commit, or Support Terrorism On September 23, 2001, by Executive Order... commit, or support terrorism, pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701...

Relations between Media, Perceived Social Support and Personal Well-Being in Adolescence

ERIC Educational Resources Information Center

Sarriera, Jorge Castella; Abs, Daniel; Casas, Ferran; Bedin, Livia Maria

2012-01-01

This paper's main objective is to show relations between interest in media, perceived social support and adolescents' personal well-being. For this purpose, 1,589 Brazilian adolescents answered a questionnaire containing Cummins' Personal Well-Being, Vaux's Social Support Appraisals and Casas' interest in media scales. The media in study are: The…

Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study.

PubMed

Gammon, Deede; Strand, Monica; Eng, Lillian Sofie; Børøsund, Elin; Varsi, Cecilie; Ruland, Cornelia

2017-05-02

Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. The aim was to illustrate uses and experiences with the secure e-recovery portal "ReConnect" as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users' control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Regardless of providers' portal use, service users' control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users' autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). ©Deede Gammon, Monica Strand, Lillian Sofie Eng, Elin Børøsund, Cecilie Varsi, Cornelia Ruland. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.05.2017.

Association of personality, neighbourhood, and civic participation with the level of perceived social support: the HUNT study, a cross-sectional survey.

PubMed

Grav, Siv; Romild, Ulla; Hellzèn, Ove; Stordal, Eystein

2013-08-01

The aim of the current study was to examine the association of personality, neighbourhood, and civic participation with the level of perceived social support if needed. The sample consists of a total of 35,797 men (16,035) and women (19,762) drawn from the Nord-Trøndelag Health Study 3 (HUNT3), aged 20-89, with a fully completed short version of the Eysenck Personality Questionnaire (EPQ) including a complete response to questions regarding perceived social support. A multinomial logistic regression model was used to investigate the association between the three-category outcomes (high, medium, and low) of perceived social support. The Chi-square test detected a significant (p < 0.001) association between personality, sense of community, civic participation, self-rated health, living arrangement, age groups, gender, and perceived social support, except between perceived social support and loss of social network, in which no significance was found. The crude and adjusted multinomial logistic regression models show a relation between medium and low scores on perceived social support, personality, and sources of social support. Interactions were observed between gender and self-rated health. There is an association between the level of perceived social support and personality, sense of community in the neighbourhood, and civic participation. Even if the interaction between men and self-reported health decreases the odds for low and medium social support, health professionals should be aware of men with poor health and their lack of social support.

Staff's person-centredness in dementia care in relation to job characteristics and job-related well-being: a cross-sectional survey in nursing homes.

PubMed

Willemse, Bernadette M; De Jonge, Jan; Smit, Dieneke; Visser, Quirijn; Depla, Marja F I A; Pot, Anne Margriet

2015-02-01

To explore the role of nursing staff's person-centredness caring for people with dementia in relation to their work environment and job-related well-being. Given the development towards person-centred care and labour force issues, research has recently focused on the effect of person-centredness on nursing staff's well-being. Findings from occupational stress research suggest that employees' personal characteristics, such as person-centredness, can moderate the impact particular job characteristics have on their job-related well-being. Cross-sectional survey. A national survey was conducted among healthcare staff (n = 1147) in 136 living arrangements for people with dementia in the Netherlands (2008-2009). Hierarchical regression analyses were used. Person-centredness moderates the relationship between coworker support and three outcomes of job-related well-being and between supervisor support and two of these outcomes. For highly person-centred nursing staff, coworker support was found to have a weaker impact and supervisor support to have a stronger impact on their job-related well-being. In addition, direct effects showed that person-centredness was weakly associated with more job satisfaction, more emotional exhaustion and more strongly with more personal accomplishment. Nursing staff's person-centredness does play a modest role in relation to job characteristics and job-related well-being. Findings indicate that person-centredness is not only beneficial to residents with dementia as found earlier, but also for nursing staff themselves; specifically, in case nursing staff members feel supported by their supervisor. Since a more person-centred workforce feels more competent, further implementation of person-centred care might have a positive impact on the attractiveness of the profession. © 2014 John Wiley & Sons Ltd.

The Effects of School-Based Maum Meditation Program on the Self-Esteem and School Adjustment in Primary School Students

PubMed Central

Yoo, Yang Gyeong; Lee, In Soo

2013-01-01

Self-esteem and school adjustment of children in the lower grades of primary school, the beginning stage of school life, have a close relationship with development of personality, mental health and characters of children. Therefore, the present study aimed to verify the effect of school-based Maum Meditation program on children in the lower grades of primary school, as a personality education program. The result showed that the experimental group with application of Maum Meditation program had significant improvements in self-esteem and school adjustment, compared to the control group without the application. In conclusion, since the study provides significant evidence that the intervention of Maum Meditation program had positive effects on self-esteem and school adjustment of children in the early stage of primary school, it is suggested to actively employ Maum Meditation as a school-based meditation program for mental health promotion of children in the early school ages, the stage of formation of personalities and habits. PMID:23777717

Supporting the self-concept with memory: insight from amnesia.

PubMed

Grilli, Matthew D; Verfaellie, Mieke

2015-12-01

We investigated the extent to which personal semantic memory supports the self-concept in individuals with medial temporal lobe amnesia and healthy adults. Participants completed eight 'I Am' self-statements. For each of the four highest ranked self-statements, participants completed an open-ended narrative task, during which they provided supporting information indicating why the I Am statement was considered self-descriptive. Participants then completed an episodic probe task, during which they attempted to retrieve six episodic memories for each of these self-statements. Supporting information was scored as episodic, personal semantic or general semantic. In the narrative task, personal semantic memory predominated as self-supporting information in both groups. The amnesic participants generated fewer personal semantic memories than controls to support their self-statements, a deficit that was more pronounced for trait relative to role self-statements. In the episodic probe task, the controls primarily generated unique event memories, but the amnesic participants did not. These findings demonstrate that personal semantic memory, in particular autobiographical fact knowledge, plays a critical role in supporting the self-concept, regardless of the accessibility of episodic memories, and they highlight potential differences in the way traits and roles are supported by personal memory. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Emotions while awaiting lung transplantation: A comprehensive qualitative analysis

PubMed Central

Brügger, Aurelia; Aubert, John-David

2014-01-01

Patients awaiting lung transplantation are at risk of negative emotional and physical experiences. How do they talk about emotions? Semi-structured interviews were performed (15 patients). Categorical analysis focusing on emotion-related descriptions was organized into positive–negative–neutral descriptions: for primary and secondary emotions, evaluation processes, coping strategies, personal characteristics, emotion descriptions associated with physical states, (and) contexts were listed. Patients develop different strategies to maintain positive identity and attitude, while preserving significant others from extra emotional load. Results are discussed within various theoretical and research backgrounds, in emphasizing their importance in the definition of emotional support starting from the patient’s perspective. PMID:28070345

Effective strategies for behavior change.

PubMed

Coleman, Mary Thoesen; Pasternak, Ryan H

2012-06-01

Strategies that are most effective in both prevention and management of chronic disease consider factors such as age, ethnicity, community, and technology. Most behavioral change strategies derive their components from application of the health belief model, the theory of reasoned action/theory of planned behavior, transtheoretical model, and social cognitive theory. Many tools such as the readiness ruler and personalized action plan form are available to assist health care teams to facilitate healthy behavior change. Primary care providers can support behavior changes by providing venues for peer interventions and family meetings and by making new partnerships with community organizations. Copyright © 2012 Elsevier Inc. All rights reserved.

Towards a Community-Based Dementia Care Strategy: A Perspective from Quebec.

PubMed

Godard-Sebillotte, Claire; Vedel, Isabelle; Bergman, Howard

Morton-Chang et al. highlighted in their article the key strategic pillars of a community-based dementia care strategy: put "people first," support informal caregiving and enable "ground up" innovation and change. In our commentary, we draw upon our experience as authors of the Quebec Alzheimer Plan and evaluators of its implementation by the Quebec Ministry of Health and Social Services (MSSS). To us, a sustainable dementia care strategy entails a patient-centred approach, grounded in primary care, caring for persons with dementia at every stage of the disease. Implementation of such a strategy requires an ongoing effort to allow innovation adoption by clinicians and organizations.

A diagnostic approach to increase reusable dinnerware selection in a cafeteria.

PubMed

Manuel, Jennifer C; Sunseri, Mary Anne; Olson, Ryan; Scolari, Miranda

2007-01-01

The current project tested a diagnostic approach to selecting interventions to increase patron selection of reusable dinnerware in a cafeteria. An assessment survey, completed by a sample of 43 patrons, suggested that the primary causes of wasteful behavior were (a) environmental arrangement of dinnerware options and (b) competing motivational variables. A functional relation between environmental arrangement and reusable product selection was demonstrated in a reversal design. However, the largest effect occurred as function of a multicomponent intervention involving environmental arrangement, employee involvement, and personal spoken prompts with motivational signs. The results support the use of informant assessments when designing community interventions.

A Diagnostic Approach to Increase Reusable Dinnerware Selection in a Cafeteria

PubMed Central

Manuel, Jennifer C; Anne Sunseri, Mary; Olson, Ryan; Scolari, Miranda

2007-01-01

The current project tested a diagnostic approach to selecting interventions to increase patron selection of reusable dinnerware in a cafeteria. An assessment survey, completed by a sample of 43 patrons, suggested that the primary causes of wasteful behavior were (a) environmental arrangement of dinnerware options and (b) competing motivational variables. A functional relation between environmental arrangement and reusable product selection was demonstrated in a reversal design. However, the largest effect occurred as function of a multicomponent intervention involving environmental arrangement, employee involvement, and personal spoken prompts with motivational signs. The results support the use of informant assessments when designing community interventions. PMID:17624069

Emotions while awaiting lung transplantation: A comprehensive qualitative analysis.

PubMed

Brügger, Aurelia; Aubert, John-David; Piot-Ziegler, Chantal

2014-07-01

Patients awaiting lung transplantation are at risk of negative emotional and physical experiences. How do they talk about emotions? Semi-structured interviews were performed (15 patients). Categorical analysis focusing on emotion-related descriptions was organized into positive-negative-neutral descriptions: for primary and secondary emotions, evaluation processes, coping strategies, personal characteristics, emotion descriptions associated with physical states, (and) contexts were listed. Patients develop different strategies to maintain positive identity and attitude, while preserving significant others from extra emotional load. Results are discussed within various theoretical and research backgrounds, in emphasizing their importance in the definition of emotional support starting from the patient's perspective.

Librarians in Evidence-Based Medicine Curricula: A Qualitative Study of Librarian Roles, Training, and Desires for Future Development.

PubMed

Maggio, Lauren A; Durieux, Nancy; Tannery, Nancy H

2015-01-01

This study aims to describe librarians' roles in evidence-based medicine (EBM) from the librarian perspective, identify how librarians are trained to teach, and highlight preferences for professional development. A multiinstitution qualitative study was conducted. Nine medical librarians identified by their faculty as integrated into EBM training were interviewed. Participants' descriptions indicated that they were active in curriculum development, deployment (including teaching activities), and assessment to support EBM. Participants identified direct experience and workshop participation as primary methods of learning to teach. Participants desired continuing development as teachers and requested opportunities for in-person workshops, shadowing physicians, and online training.

Are There Any Differences in Personality Traits and Life Satisfaction between Future Preschool and Primary School Teachers?

ERIC Educational Resources Information Center

Vorkapic, Sanja Tatalovic; Cepic, Renata; Šekulja, Ivana

2016-01-01

The main aim of this study was to examine personality traits and life satisfaction of future preschool and primary school teachers and to examine if there are differences between these two groups of students. The study was conducted on a sample of 290 students of the University of Rijeka attending Early and Preschool Education and Teacher…

A Field Study of a Rural Ungraded Primary School with a Statistical Analysis of Reading Achievement and Personality Adjustment.

ERIC Educational Resources Information Center

McCoy, Edwardine Cordell

The purpose of this field study was to develop a rural ungraded primary school with an accompanying design and appropriate materials for use by educators interested in this innovation. Pretests and posttests measured the effects of ungradedness on the reading achievement and personality development of the 177 students. Implemented by a $50,000…

Hospitalisation Rates for Ambulatory Care Sensitive Conditions for Persons with and without an Intellectual Disability--A Population Perspective

ERIC Educational Resources Information Center

Balogh, R.; Brownell, M.; Ouellette-Kuntz, H.; Colantonio, A.

2010-01-01

Background: There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was…

Help seeking in a support group for recipients of implantable cardioverter defibrillators and their support persons.

PubMed

Dickerson, S S; Posluszny, M; Kennedy, M C

2000-01-01

To understand shared meanings of help-seeking experiences in support groups of people with implantable cardioverter defibrillator (ICD) and their support persons. ICD support group at an urban medical center. Fifteen individuals with ICD and 9 support persons. Six related themes and 1 constitutive pattern emerged. Themes included hearing and telling stories, help seeking encouraged by triggers, seeking meaningful information, forming a therapeutic friendship through group camaraderie, gaining assistance from the facilitator, and the sharing of a similar view by support persons. The constitutive pattern is coping with the possibility of death. Health care providers may recommend storytelling as the central mechanism of interactions in support groups that assist in coping with daily anxieties of living with an ICD. Nurses would be appropriate facilitators to guide discussion, to provide technical information, and to promote anticipatory guidance in coping with potential firing events.

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers

PubMed Central

Moosa, Shabir; Wojczewski, Silvia; Hoffmann, Kathryn; Poppe, Annelien; Nkomazana, Oathokwa; Peersman, Wim; Willcox, Merlin; Derese, Anselme; Mant, David

2014-01-01

Background Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. Aim To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Design and setting Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Method Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. Results The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Conclusions Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. PMID:24868069

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers.

PubMed

Moosa, Shabir; Wojczewski, Silvia; Hoffmann, Kathryn; Poppe, Annelien; Nkomazana, Oathokwa; Peersman, Wim; Willcox, Merlin; Derese, Anselme; Mant, David

2014-06-01

Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. © British Journal of General Practice 2014.

The Online Social Support Scale: Measure development and validation.

PubMed

Nick, Elizabeth A; Cole, David A; Cho, Sun-Joo; Smith, Darcy K; Carter, T Grace; Zelkowitz, Rachel L

2018-05-21

A new measure, the Online Social Support Scale, was developed based on previous theory, research, and measurement of in-person social support. It includes four subscales: Esteem/Emotional Support, Social Companionship, Informational Support, and Instrumental Support. In college and community samples, factor analytic and item response theory results suggest that subtypes of in-person social support also pertain in the online world. Evidence of reliability, convergent validity, and discriminant validity provide excellent psychometric support for the measure. Construct validity accrues to the measure vis-à-vis support for three hypotheses: (a) Various broad types of Internet platforms for social interactions are differentially associated with online social support and online victimization; (b) similar to in-person social support, online social support offsets the adverse effect of negative life events on self-esteem and depression-related outcome; and (c) online social support counteracts the effects of online victimization in much the same way that in-person friends in one social niche counterbalance rejection in other social niches. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The influences of perceived social support and personality on trajectories of subsequent depressive symptoms in Taiwanese youth.

PubMed

Lien, Yin-Ju; Hu, Jhih-Ning; Chen, Chia-Yi

2016-03-01

Little is known about the combined effect of personality and social support on trajectories of depressive symptoms among youth. This study aims to investigate the influence of social support in different contexts on the development of depressive symptoms during adolescence and whether the association is moderated by adolescents' personality. The data using in this study is selected from the Taiwan Educational Panel Survey (TEPS), a longitudinal panel study since the year 2000 (at age 13) and three more waves (at ages 15, 17, and 18). A total of four waves of students' data (N = 4163) are analyzed using the latent growth models. The results indicate that the depressive symptom trajectory of Taiwan adolescents gradually grows in a quadratic curve. Social support in family context rather than school context was associated with depressive symptoms, while only a positive association is found between maternal support and depressive symptoms at the start. Meanwhile, increased extroversion personality is associated with the decreased initial level, increased linear changes, and decreased non-linear quadratic changes of adolescents' depressive symptoms. Further analyses show that a significant interaction between maternal support and extroversion personality is associated with increased non-linear quadratic growth curve of adolescents' depressive symptoms. In conclusion, adolescents' extroversion personality might moderate the effect of maternal support on developmental trajectory of depressive symptoms. Intervention that improves social support should take account for adolescent's personality, which may alter trajectory of psychological distress during adolescence. Copyright © 2016 Elsevier Ltd. All rights reserved.

The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual. Methods/Design The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective treatments. Trial registration Clinical Trial.gov: NCT01512602. PMID:24885904

Transferrin saturation phenotype and HFE genotype screening for hemochromatosis and primary iron overload: predictions from a model based on national, racial, and ethnic group composition in central Alabama.

PubMed

Barton, J C; Acton, R T

2000-01-01

There is interest in general population screening for hemochromatosis and other primary iron overload disorders, although not all persons are at equal risk. We developed a model to estimate the numbers of persons in national, racial, or ethnic population subgroups in Jefferson County, Alabama, who would be detected using transferrin saturation (phenotype) or HFE mutation analysis (genotype) screening. Approximately 62% are Caucasians, 37% are African Americans, and the remainder are Hispanics, Asians, or Native Americans. The predicted phenotype frequencies are greatest in a Caucasian subgroup, ethnicity unspecified, which consists predominantly of persons of Scotch and Irish descent (0.0065 men, 0.0046 women), and in African Americans (0.0089 men, 0.0085 women). Frequencies of the HFE genotype C282Y/C282Y > or = 0.0001 are predicted to occur only among Caucasians; the greatest frequency (0.0080) was predicted to occur in the ethnicity-unspecified Caucasian population. C282Y/C282Y frequency estimates were lower in Italian, Greek, and Jewish subgroups. There is excellent agreement in the numbers of the ethnicity-unspecified Caucasians who would be detected using phenotype and genotype criteria. Our model also indicates that phenotyping would identify more persons with primary iron overload than would genotyping in our Italian Caucasian, Hispanic, and African American subgroups. This is consistent with previous observations that indicate that primary iron overload disorders in persons of southern Italian descent and African Americans are largely attributable to non-HFE alleles. Because the proportions of population subgroups and their genetic constitution may differ significantly in other geographic regions, we suggest that models similar to the present one be constructed to predict optimal screening strategies for primary iron overload disorders.

Are Patient and Carer Experiences Mirrored in the Practice Reviews of Self-management Support (Prisms) Provider Taxonomy?

PubMed Central

Kenealy, Timothy; Kuluski, Kerry; McKillop, Ann; Parsons, John; Wong-Cornall, Cecilia

2017-01-01

Introduction: Patient self-management support is central to care for long term conditions and for integrated care. Patients and their carers are the final arbiter of whether support for self-management has been effective. A new taxonomy lists 14 categories of provider activities that support patient self-management (Practical Reviews in Self-Management Support, PRISMS). We asked whether we could recognise these provider activities in narratives from patients and carers. We sought to extend the theoretical framework of the taxonomy to include the view from patient and carers. Methods: We interviewed 28 patients and family carers in a case study of primary health care in New Zealand in 2015 to determine which components of the taxonomy were visible. We drew on interviews with clinicians and organisation persons to explain case study context. Results: We found, within patient and carer data, evidence of all 14 components of provider self-management support. The overarching dimensions of the taxonomy helped reveal an intensity and consistency of provider behaviour that was not apparent considering the individual components. Conclusions: Patient and carer data mapped to provider activities. The taxonomy was not explicit on provider relationships and engagement with, or separate support needs of, patients and carers. PMID:28970749

E-Health towards ecumenical framework for personalized medicine via Decision Support System.

PubMed

Kouris, Ioannis; Tsirmpas, Charalampos; Mougiakakou, Stavroula G; Iliopoulou, Dimitra; Koutsouris, Dimitris

2010-01-01

The purpose of the present manuscript is to present the advances performed in medicine using a Personalized Decision Support System (PDSS). The models used in Decision Support Systems (DSS) are examined in combination with Genome Information and Biomarkers to produce personalized result for each individual. The concept of personalize medicine is described in depth and application of PDSS for Cardiovascular Diseases (CVD) and Type-1 Diabetes Mellitus (T1DM) are analyzed. Parameters extracted from genes, biomarkers, nutrition habits, lifestyle and biological measurements feed DSSs, incorporating Artificial Intelligence Modules (AIM), to provide personalized advice, medication and treatment.

Job-Related Stress, Personality, Social Support and Burnout among College of Education Lecturers

ERIC Educational Resources Information Center

Salami, Samuel O.

2010-01-01

The main purpose of this study was to investigate the relationship of job stress, personality and social support to burnout among college of education lecturers. The second purpose was to examine the extent to which personality and social support can buffer the negative effects of stress on burnout. Design/methodology/approach--Survey methodology…

Predicting Social Support for Grieving Persons: A Theory of Planned Behavior Perspective

ERIC Educational Resources Information Center

Bath, Debra M.

2009-01-01

Research has consistently reported that social support from family, friends, and colleagues is an important factor in the bereaved person's ability to cope after the loss of a loved one. This study used a Theory of Planned Behavior framework to identify those factors that predict a person's intention to interact with, and support, a grieving…

Disaster Preparedness Planning and Facility Contingency Operations for Public Works

DTIC Science & Technology

1993-01-01

Forces Reporting Disaster Preparedness and Logistical Support 20-37 General Concept Manpower Planning, Protection and Support Personal Protection...their military mission, economical importance, geographical location, and personal and public safety. The organization, preparedness plans and facility...for emergency medical support). (5) Issue personal protective gear and equipment, if necessary. (6) Determine existi- g contract outcome. All

Who Lacks Support and Why? An Examination of Mothers' Personal Safety Nets

ERIC Educational Resources Information Center

Harknett, Kristen S.; Hartnett, Caroline Sten

2011-01-01

We use data from the Fragile Families and Child Wellbeing Study (N = 12,140 person-waves) to identify characteristics associated with mothers' having or lacking "personal safety net" support from family and friends. We focus on characteristics that are likely to increase the importance of having support available but may also interfere with the…

A taboo within a stigma? a qualitative study of managing incontinence with people with dementia living at home

PubMed Central

2011-01-01

Background Incontinence in people with dementia is one of the factors associated with the decision to move to a care home. Managing incontinence adds to carer burden and has been reported by family carers as more difficult to manage than behavioural symptoms. Active management strategies have been reported to be associated with less carer depression. The purpose of this study was to investigate carers' perceptions of the range of incontinence problems they helped their relative with and the strategies they employed to manage these. Methods Family carers of people with dementia living in their own homes were recruited through primary care, specialist community mental health services and voluntary organisations. Qualitative semi structured interviews were conducted either face to face or by telephone and thematically analysed. Results Thirty two carers were interviewed. They described a range of problems from supporting the person to remain independent in toileting, through to dealing with inappropriate behaviours, to containing and managing incontinence. All carers actively used problem solving strategies but sometimes these were not acceptable or understood by the person with dementia, particularly as the dementia progressed. Most carers reported protecting the person's dignity by not seeking health professionals help often until the point of a crisis. Once the carer has decided to seek help the responses from health professionals can be less than helpful, and carers report local health service policies on access to continence products to be inconsistent and often inappropriate to their circumstances. A few carers reported strategies for managing toileting and incontinence that have the potential for distress and harm to the person with dementia. Conclusions Primary care professionals could be more proactive in enquiry, repeated over time, about toileting and incontinence problems and in giving advice and information to reduce crisis and problems. PMID:22081876

Comprehensiveness of care from the patient perspective: comparison of primary healthcare evaluation instruments.

PubMed

Haggerty, Jeannie L; Beaulieu, Marie-Dominique; Pineault, Raynald; Burge, Frederick; Lévesque, Jean-Frédéric; Santor, Darcy A; Bouharaoui, Fatima; Beaulieu, Christine

2011-12-01

Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emotional and social aspects of a patient's health and considers the community context in their care." Among instruments that evaluate primary healthcare, two had subscales that mapped to comprehensive services and to the community component of whole-person care: the Primary Care Assessment Tool - Short Form (PCAT-S) and the Components of Primary Care Index (CPCI, a limited measure of whole-person care). To examine how well comprehensiveness is captured in validated instruments that evaluate primary healthcare from the patient's perspective. 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare. Scores were normalized for descriptive comparison. Exploratory and confirmatory (structural equation modelling) factor analysis examined fit to operational definition, and item response theory analysis examined item performance on common constructs. Over one-quarter of respondents had missing responses on services offered or doctor's knowledge of the community. The subscales did not load on a single factor; comprehensive services and community orientation were examined separately. The community orientation subscales did not perform satisfactorily. The three comprehensive services subscales fit very modestly onto two factors: (1) most healthcare needs (from one provider) (CPCI Comprehensive Care, PCAT-S First-Contact Utilization) and (2) range of services (PCAT-S Comprehensive Services Available). Individual item performance revealed several problems. Measurement of comprehensiveness is problematic, making this attribute a priority for measure development. Range of services offered is best obtained from providers. Whole-person care is not addressed as a separate construct, but some dimensions are covered by attributes such as interpersonal communication and relational continuity.

The experiences of support persons of people newly diagnosed with multiple sclerosis: an interpretative phenomenological study.

PubMed

Strickland, Karen; Worth, Allison; Kennedy, Catriona

2015-12-01

This study explores the experience of the diagnosis of Multiple Sclerosis for the support person and identifies the impact on their lives. At the time of diagnosis, the support person may not be readily identified in a traditional caring role; however, the diagnosis itself brings with it the possibility of changes to the roles in the relationship and possible consequences for biographical construction. A hermeneutic phenomenological study. A convenience sample of nine support persons was interviewed between December 2008-March 2010. The data were analysed using interpretative phenomenological analysis. The participants in this study were often not readily identifiable as 'carers'; however, the diagnosis of Multiple Sclerosis implied a shift towards a caring role at some point in the future. The uncertainty surrounding the nature and progression of the condition left this identity hanging, incomplete and as such contributed to a liminal way of being. This paper reveals that biographical disruption is not limited to the person diagnosed with Multiple Sclerosis but that the support person also undergoes a transition to their sense of self to that of 'anticipatory carer'. The findings provide insight into the biographical and emotional impact of Multiple Sclerosis on the support persons early in the development of the condition. © 2015 John Wiley & Sons Ltd.

Mortality among blacks or African Americans with HIV infection--United States, 2008-2012.

PubMed

Siddiqi, Azfar-e-Alam; Hu, Xiaohong; Hall, H Irene

2015-02-06

A primary goal of the National HIV/AIDS Strategy is to reduce HIV-related health disparities, including HIV-related mortality in communities at high risk for human immunodeficiency virus (HIV) infection. As a group, persons who self-identify as blacks or African Americans (referred to as blacks in this report), have been affected by HIV more than any other racial/ethnic population. Forty-seven percent of persons who received an HIV diagnosis in the United States in 2012 and 43% of all persons living with diagnosed HIV infection in 2011 were black. Blacks also experienced a low 3-year survival rate among persons with HIV infection diagnosed during 2003-2008. CDC and its partners have been pursuing a high-impact prevention approach and supporting projects focusing on minorities to improve diagnosis, linkage to care, and retention in care, and to reduce disparities in HIV-related health outcomes. To measure trends in disparities in mortality among blacks, CDC analyzed data from the National HIV Surveillance System. The results of that analysis indicated that among blacks aged ≥13 years the death rate per 1,000 persons living with diagnosed HIV decreased from 28.4 in 2008 to 20.5 in 2012. Despite this improvement, in 2012 the death rate per 1,000 persons living with HIV among blacks was 13% higher than the rate for whites and 47% higher than the rate for Hispanics or Latinos. These data demonstrate the need for implementation of interventions and public health strategies to further reduce disparities in deaths.

20 CFR 222.42 - When employee is contributing to support.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false When employee is contributing to support. 222... employee is contributing to support. (a) An employee is contributing to the support of a person if the employee gives cash, goods, or services to help support such person. Support includes food, clothing...

'It gave me a new lease of life … ': GPs' views and experiences of supervising foundation doctors in general practice.

PubMed

Sabey, Abigail; Harris, Michael; van Hamel, Clare

2016-03-01

General practice is a popular placement in the second year of Foundation training. Evaluations suggest this is a positive experience for most trainee doctors and benefits their perceptions of primary care, but the impact on primary care supervisors has not been considered. At a time when placements may need to increase, understanding the experience of the GP supervisors responsible for these placements is important. To explore the views, experiences and needs of GPs who supervise F2 doctors in their practices including their perceptions of the benefits to individuals and practices. A qualitative approach with GPs from across Severn Postgraduate Medical Education who supervise F2 doctors. Semi-structured interviews with 15 GPs between December 2012 and April 2013. GP supervisors are enthusiastic about helping F2 doctors to appreciate the uniqueness of primary care. Workload and responsibility around supervision is considerable making a supportive team important. Working with young, enthusiastic doctors boosts morale in the team. The presence of freshly trained minds prompts GPs to consider their own learning needs. Being a supervisor can increase job satisfaction; the teaching role gives respite from the demanding nature of GP work. Supervisors are positive about working with F2s, who lift morale in the team and challenge GPs in their own practice and learning. This boosts job and personal satisfaction. Nonetheless, consideration should be given to managing teaching workload and team support for supervision.

Toward an Emerging Role for Motivational Interviewing in Primary Care.

PubMed

Keeley, Robert; Engel, Matthew; Reed, Alex; Brody, David; Burke, Brian L

2018-05-18

Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care. Two trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs' MI-related language and patients' arguments for positive behavior changes, "change talk," appeared to explain the positive effects of MI training on depression outcome. MI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting "change talk" from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature.

Adolescents' Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study.

PubMed

Zieve, Garret G; Richardson, Laura P; Katzman, Katherine; Spielvogle, Heather; Whitehouse, Sandy; McCarty, Carolyn A

2017-07-20

Electronic health screening tools for primary care present an opportunity to go beyond data collection to provide education and feedback to adolescents in order to motivate behavior change. However, there is limited research to guide feedback message development. The aim of this study was to explore youth perceptions of and preferences for receiving personalized feedback for multiple health risk behaviors and reinforcement for health promoting behaviors from an electronic health screening tool for primary care settings, using qualitative methodology. In total, 31 adolescents aged 13-18 years completed the screening tool, received the electronic feedback, and subsequently participated in individual, semistructured, qualitative interviews lasting approximately 60 min. Participants were queried about their overall impressions of the tool, perceptions regarding various types of feedback messages, and additional features that would help motivate health behavior change. Using thematic analysis, interview transcripts were coded to identify common themes expressed across participants. Overall, the tool was well-received by participants who perceived it as a way to enhance-but not replace-their interactions with providers. They appreciated receiving nonjudgmental feedback from the tool and responded positively to information regarding the consequences of behaviors, comparisons with peer norms and health guidelines, tips for behavior change, and reinforcement of healthy choices. A small but noteworthy minority of participants dismissed the peer norms as not real or relevant and national guidelines as not valid or reasonable. When prompted for possible adaptations to the tool, adolescents expressed interest in receiving follow-up information, setting health-related goals, tracking their behaviors over time, and communicating with providers electronically between appointments. Adolescents in this qualitative study desired feedback that validates their healthy behavior choices and supports them as independent decision makers by neutrally presenting health information, facilitating goal setting, and offering ongoing technological supports. ©Garret G Zieve, Laura P Richardson, Katherine Katzman, Heather Spielvogle, Sandy Whitehouse, Carolyn A McCarty. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.07.2017.

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

PubMed

Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

House/ball culture and adolescent African-American transgender persons and men who have sex with men: a synthesis of the literature.

PubMed

Phillips, Gregory; Peterson, James; Binson, Diane; Hidalgo, Julia; Magnus, Manya

2011-04-01

Transgender persons and young men of color who have sex with men (YMSM of color) have been severely affected by HIV in the USA. Houses and balls in the USA have historically been a primary meeting ground for YMSM of color and transgender people, offering an opportunity for HIV prevention activities. Houses provide a familial structure for YMSM of color and transgender people, while balls provide them with events at which they can congregate for social support and entertainment. A comprehensive literature search was conducted using Scopus and PubMed, Internet websites, and HIV prevention and care resources for YMSM of color associated with a multisite evaluation. Houses and balls have been responsive to the HIV/AIDS epidemic and have developing networks that are critical in providing a social and familiar context for often-disenfranchised youth. The organizations have embraced the need for HIV prevention, and their methodology may be transferable to other prevention contexts. Future studies are needed to identify culturally appropriate and effective methods of integration of house/ball methods into HIV prevention services aimed at transgender persons and YMSM of color.

'It Takes Me Half a Bottle of Whisky to Get through One of Your Assignments': Exploring One Teacher Educator's Personal Experiences of Dyslexia.

PubMed

Glazzard, Jonathan; Dale, Kirsty

2015-05-01

This article uses a life history approach to explore personal experiences of dyslexia of one higher-education lecturer and its impact on her professional identity. The informant is currently employed as a lecturer of initial teacher training in a UK university. She worked as a primary school teacher for over a decade prior to embarking on an academic career in teacher education. The informant draws on her own experiences as a pupil, teacher and lecturer, and additionally, she presents accounts of student teachers with dyslexia drawn from her current professional context. Although the data are not generalizable, the account nevertheless illustrates the positive impact of the social model of disability for the informant and her students who had been identified as dyslexic during their initial training as teachers. Additionally, the account also illustrates the ways in which teachers' personal experiences of dyslexia can shape professional identities in very positive ways. Implications for both teacher training and pedagogic approaches in schools to support learners with dyslexia are drawn out of the narrative. Copyright © 2015 John Wiley & Sons, Ltd.

Caregiver bodywork: family members' experiences of caring for a person with motor neurone disease.

PubMed

Ray, Robin A; Street, Annette F

2006-10-01

This paper reports a study of how family members caring for people living with motor neurone disease managed the deteriorating body, their own bodywork and the associated emotional labour. People living with the neurodegenerative condition of motor neurone disease face the prospect of dying in 3-5 years from progressive loss of voluntary muscle mass and function, culminating in respiratory failure. Theories concerning the body in illness have been used to illustrate patient perspectives; however, family caregivers' experiences of the body have been neglected. An ethnographic case study was undertaken with 18 primary family caregivers and six peripheral caregivers. Primary caregivers participated over 10 months in three face-to-face, semi-structured interviews which included mapping their support networks using ecomaps. Observational data were also recorded as field notes. Peripheral caregivers were interviewed once during the same time period. The data were generated between 2003 and 2004. Informal caregiving requires engagement in various aspects of bodywork. Three body concepts were identified: the visible body--how the disease affected the patient and caregivers; the dependent body--the resulting care requirements; and the social body--how living with motor neurone disease affected their social support networks. The visible body is a continual reminder of the ravages of the disease, while the dependent body demands physical and emotional care. Social interactions decline over time, depriving family caregivers of the much needed support for sustaining their commitment to the bodywork required in caregiving. The demands of bodywork for family caregivers are increased by the continual presence of emotional labour as they seek to implement the best way to support their relative with motor neurone disease. Nurses and allied healthcare workers need to assess each family situation, asking appropriate questions to establish the most appropriate interventions to facilitate supportive care.

The Role of Teen Mothers' Support Relationships in Maintenance of Contraceptive Use.

PubMed

Quinn, Deirdre A; Mitchell, Stephanie J; Lewin, Amy

2017-02-01

To explore interpersonal factors associated with maintaining contraceptive use over time among urban, African American teen mothers. Longitudinal study, 2011-2015. Six pediatric primary care sites in the same city, all of which primarily serve urban, low-income, African American families. Teen mothers accessing health services for their child at one of the six study sites. The current study was a secondary data analysis of data that were collected as part of a patient-centered medical home model intervention, that compared a group of teen mothers and their children who were participants in the intervention with mother-child dyads who were enrolled in standard community-based pediatric primary care. Structured interviews were conducted with teen mothers at baseline/enrollment, when their children were, on average, 3 months old, and again 12 months later. Maintenance of contraceptive use over time. Teen mothers who perceived any tangible support from their own mothers were significantly less likely to maintain contraceptive use over time (adjusted odds ratio [AOR] = .27). However, teens who perceived any emotional support from their own mothers were nearly four times more likely to maintain contraceptive use (AOR = 3.74). Teens who lived with their own mothers were more than 5 times more likely to maintain contraceptive use over time (AOR = 5.49). To better understand contraceptive discontinuation and thus to prevent repeat pregnancies among teen mothers, it might be necessary to further examine the role of support relationships in teen mothers' contraceptive decision-making. Secondary pregnancy prevention programs should include key support persons. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Exploring the Role of In-Person Components for Online Health Behavior Change Interventions: Can a Digital Person-to-Person Component Suffice?

PubMed

Santarossa, Sara; Kane, Deborah; Senn, Charlene Y; Woodruff, Sarah J

2018-04-11

The growth of the digital environment provides tremendous opportunities to revolutionize health behavior change efforts. This paper explores the use of Web-based, mobile, and social media health behavior change interventions and determines whether there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioral theories such as the theory of reasoned action, and the social cognitive theory, and further justified by the human support constructs of the model of supportive accountability. Overall, face-to-face and online behavior change interventions have their respective advantages and disadvantages and functions, yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behavior change interventions, and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behavior change. As the popularity of the online world grows, and the interest in using the digital environment for health behavior change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored. ©Sara Santarossa, Deborah Kane, Charlene Y Senn, Sarah J Woodruff. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.04.2018.

Mental health nurses' attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: systematic, integrative literature review.

PubMed

Dickens, Geoffrey L; Lamont, Emma; Gray, Sarah

2016-07-01

To establish whether mental health nurses responses to people with borderline personality disorder are problematic and, if so, to inform solutions to support change. There is some evidence that people diagnosed with borderline personality disorder are unpopular among mental health nurses who respond to them in ways which could be counter-therapeutic. Interventions to improve nurses' attitudes have had limited success. Systematic, integrative literature review. Computerised databases were searched from inception to April 2015 for papers describing primary research focused on mental health nurses' attitudes, behaviour, experience, and knowledge regarding adults diagnosed with borderline personality disorder. Analysis of qualitative studies employed metasynthesis; analysis of quantitative studies was informed by the theory of planned behaviour. Forty studies were included. Only one used direct observation of clinical practice. Nurses' knowledge and experiences vary widely. They find the group very challenging to work with, report having many training needs, and, objectively, their attitudes are poorer than other professionals' and poorer than towards other diagnostic groups. Nurses say they need a coherent therapeutic framework to guide their practice, and their experience of caregiving seems improved where this exists. Mental health nurses' responses to people with borderline personality disorder are sometimes counter-therapeutic. As interventions to change them have had limited success there is a need for fresh thinking. Observational research to better understand the link between attitudes and clinical practice is required. Evidence-based education about borderline personality disorder is necessary, but developing nurses to lead in the design, implementation and teaching of coherent therapeutic frameworks may have greater benefits. There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder. © 2016 John Wiley & Sons Ltd.

A cross-sectional exploration of the personality traits of dietitians.

PubMed

Ball, L; Eley, D S; Desbrow, B; Lee, P; Ferguson, M

2015-10-01

Personality traits refer to habitual patterns of behaviour, thought and emotions, and have been shown to influence health professionals' career decisions, career development, job satisfaction and retention. There is an opportunity to better understand and support the career pathways of dietitians by exploring their personality traits. The two primary aspects of personality are: (i) temperament traits, which determine automatic emotional responses to experiences, and are generally stable over lifetime, and (ii) character traits, which reflect personal goals and values, and tend to develop with life experience. The present study explored the levels of temperament and character traits of dietitians, as well as their relationship to demographic variables. The study comprised a cross-sectional online survey of 346 Australian dietitians [95% female; mean (SD) age 32 (10) years; mean (SD) time since graduation 7 (9) years]. Temperament and character traits were measured by the Temperament and Character Inventory. Key demographic variables were measured to describe career decisions and pathways of dietitians. Multivariate analyses of variance was used to investigate the relationship between demographic variables and personality traits. Levels of several traits were significantly associated with gender, age and highest level of education. In comparison to the general population, the dietitians displayed average levels of Novelty Seeking; high levels of Harm Avoidance, Reward Dependence, Persistence, Self-Directedness and Cooperativeness; and low levels of Self-Transcendence. The dietitians in the present study displayed levels of personality traits that were similar to other health professionals, although they differed from the general population. These findings are the precursor to further work that may inform recruitment strategies and career counselling in dietetics. © 2014 The British Dietetic Association Ltd.

Treatment dismantling pilot study to identify the active ingredients in personalized feedback interventions for hazardous alcohol use: randomized controlled trial.

PubMed

Cunningham, John A; Murphy, Michelle; Hendershot, Christian S

2014-12-10

There is a considerable body of evidence supporting the effectiveness of personalized feedback interventions for hazardous alcohol use-whether delivered face-to-face, by postal mail, or over the Internet (probably now the primary mode of delivery). The Check Your Drinking Screener (CYD; see www.CheckYourDrinking.net) is one such intervention. The current treatment dismantling study assessed which components of personalized feedback interventions were effective in motivating change in drinking. Specifically, the major objective of this project was to conduct a randomized controlled trial (RCT) comparing the impact of the normative feedback and other personalized feedback components of the CYD intervention in the general population. Participants were recruited to take part in an RCT and received either the complete CYD final report, just the normative feedback sections of the CYD, just the personalized feedback components of the CYD, or were assigned to a no-intervention control group. Participants were followed-up at 3 months to assess changes in alcohol consumption. A total of 741 hazardous drinking participants were recruited for the trial, of which 73 percent provided follow-up data. Analyses using an intent-to-treat approach found some evidence for the impact of the personalized feedback components of the CYD in reducing alcohol consumption on the variables, number of drinks in a week and AUDIT-C (p = .028 and .047 respectively; no impact on highest number of drinks on one occasion; p = .594). However, there was no significant evidence of the impact of the normative feedback components (all p > .3). Personalized feedback elements alone could provide an active intervention for hazardous drinkers, particularly in situations where normative feedback information was not available. ClinicalTrials.gov NCT01608763.

Older persons' experiences of a home-based exercise program with behavioral change support.

PubMed

Arkkukangas, Marina; Sundler, Annelie J; Söderlund, Anne; Eriksson, Staffan; Johansson, Ann-Christin

2017-12-01

It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons. This descriptive study used a qualitative inductive approach to describe older persons' experiences of a fall-preventive, home-based exercise program with support for behavioral change. Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed. Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise. With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age.