Primary Care Validation of a Single-Question Alcohol Screening Test

BACKGROUND Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings. OBJECTIVE To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). DESIGN Cross-sectional study. PARTICIPANTS Adult English-speaking patients recruited from primary care waiting rooms. MEASUREMENTS Participants were asked the single screening question, "How many times in the past year have you had X or more drinks in a day?", where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method. MAIN RESULTS Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics. CONCLUSIONS. The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.National Institute on Alcohol Abuse and Alcoholism (R01-AA010870

Qualitative Evaluation of Interprofessional Education Experiential Learning (IPEEL) for Health Professional Students

Interprofessional education (IPE) is critical for health professional students to form professional identities and develop collaborative skills. Although accrediting bodies mandate incorporating IPE, the effects of IPE programming on health professional students and the best pedagogical approach for achieving desirable outcomes are still unclear. In addition, specific effects of IPE within the context of experiential learning are not fully understood. That is, the literature has not presented a clear framework for structuring IPE programs, nor have outcome measures for IPE utilizing experiential learning (IPEEL) been established. The purpose of this study was to complete a grounded theory qualitative analysis of survey data from three cohorts of health professional students participating in an IPEEL elective course where students worked directly with children and their families. Pre- and post-survey responses identified how students perceived growth related to IPE competencies as a result of the IPEEL curriculum, as well as helped to develop a refined model of IPE specifically for experiential learning. Results indicated that overall students reported positive perceptions of IPE-related outcomes and positive outcomes related to the children and families they worked with, while confirming enabling and interfering factors that contribute to the IPE process. Future applications of the IPEEL model for IPE programming are recommended

Assessing localized prostate cancer post-treatment quality of life outcomes among gay men

Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Background: An estimated 2.3 million prostate cancer survivors reside in the United States, 50,000-70,000 of which are gay men. Fearing discrimination, stigma, or receipt of substandard care, gay men may not reveal their sexual orientation potentially affecting provider communication, treatment decision-making and post-treatment quality of life (QoL). Sexual orientation and other social factors may play an important role in men's QoL. Research suggests that functional impairments following treatment diminish QoL more for younger (i.e., age 50-64 years) than older men, while supportive partners can positively influence how men adapt to prostate cancer. Yet data are currently limited to heterosexual populations; it is unknown whether these effects are similar among gay prostate cancer survivors. Aims: To revise recent measures of prostate cancer QoL to include the experiences of gay men, assess the role of age and partnership status among gay men and compare QoL between gay and straight men. Methods: We administered a national QoL survey to gay prostate cancer survivors, including questions about sexual orientation disclosure and community rejection derived from qualitative interviews. Survey data were analyzed to assess the role of age and partnership status among gay men for four post-treatment prostate cancer QoL outcomes (masculine self-esteem, health worry, informed treatment decision and treatment regret) and QoL was then compared to straight prostate cancer survivors using data from a previous study to assess for differences based on sexual orientation. Results: Younger gay men experienced poorer QoL outcomes following treatment than older men; no association with partnership status was found. Comfort in revealing one's sexual orientation to a provider may result in better outcomes. Gay men reported more stigma, lower masculine self-esteem and more treatment regret following prostate cancer treatment than straight men. Conclusions: For gay men, greater sensitivity to stigma as a sexual minority may result in poorer QoL compared to straight men. While both gay and straight men struggle with similar QoL issues following localized prostate cancer treatment, gay men may have more difficulty due to sexual orientation. Further research is needed to better understand the role that sexual orientation and stigma play in prostate cancer QoL

Assessing localized prostate cancer post-treatment quality of life outcomes among gay men

Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Background: An estimated 2.3 million prostate cancer survivors reside in the United States, 50,000-70,000 of which are gay men. Fearing discrimination, stigma, or receipt of substandard care, gay men may not reveal their sexual orientation potentially affecting provider communication, treatment decision-making and post-treatment quality of life (QoL). Sexual orientation and other social factors may play an important role in men's QoL. Research suggests that functional impairments following treatment diminish QoL more for younger (i.e., age 50-64 years) than older men, while supportive partners can positively influence how men adapt to prostate cancer. Yet data are currently limited to heterosexual populations; it is unknown whether these effects are similar among gay prostate cancer survivors. Aims: To revise recent measures of prostate cancer QoL to include the experiences of gay men, assess the role of age and partnership status among gay men and compare QoL between gay and straight men. Methods: We administered a national QoL survey to gay prostate cancer survivors, including questions about sexual orientation disclosure and community rejection derived from qualitative interviews. Survey data were analyzed to assess the role of age and partnership status among gay men for four post-treatment prostate cancer QoL outcomes (masculine self-esteem, health worry, informed treatment decision and treatment regret) and QoL was then compared to straight prostate cancer survivors using data from a previous study to assess for differences based on sexual orientation. Results: Younger gay men experienced poorer QoL outcomes following treatment than older men; no association with partnership status was found. Comfort in revealing one's sexual orientation to a provider may result in better outcomes. Gay men reported more stigma, lower masculine self-esteem and more treatment regret following prostate cancer treatment than straight men. Conclusions: For gay men, greater sensitivity to stigma as a sexual minority may result in poorer QoL compared to straight men. While both gay and straight men struggle with similar QoL issues following localized prostate cancer treatment, gay men may have more difficulty due to sexual orientation. Further research is needed to better understand the role that sexual orientation and stigma play in prostate cancer QoL

Erratum to: Primary Care Validation of a Single-Question Alcohol Screening Test

BACKGROUND: Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings. OBJECTIVE: To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). DESIGN: Cross-sectional study. PARTICIPANTS: Adult English-speaking patients recruited from primary care waiting rooms. MEASUREMENTS: Participants were asked the single screening question, “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method. MAIN RESULTS: Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics. CONCLUSIONS: The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care