Congestive Heart Failure: The Danger of Medical Jargon

Congestive heart failure (CHF) has shifted from a terminal diagnosis to a chronic disease. However, the nomenclature, specifically the inclusion of the term “failure”, leads patients to believe that the diagnosis is lethal and thus can cause anxiety and depression. Several cardiology foundations have called for a nomenclature change based on wide variations in pathophysiology of the disease and also on patient perceptions of the terminology (Patel et al. 2018; Stocker et al. 2017; Rogers et al. 2000; Tayler and Ogden 2005; Lehman et al. 2005). The purpose of this study was to gain further understanding of lay people’s perception of the disease congestive heart failure. Free listing interviews were conducted with 100 community members who were asked to list all thoughts and feelings regarding the term “congestive heart failure” and three other medical diagnoses. Data were cleaned and salience was derived using Smith’s S defined as: S = ((L − Rj + 1)/L)/N, where L is the length of each list, Rj is the rank of item J in the list, and N is the number of lists in the sample. Despite the fact that CHF, like high blood pressure or diabetes, is not a death sentence, terms like death, severe, and fear proved to be most salient when respondents were asked to reflect on CHF . Contrasted to this were diet, treatment, and family history which were among the salient terms collected when respondents reflected on diabetes or high blood pressure. Even though providers can help people process the diagnosis and defuse their immediate concerns, this study documents the impact language has on lay members of the community and supports a need for public health and healthcare professionals to address common perceptions of language

Perceptions of pregnant women about influenza vaccine: What do we know?

Seasonal influenza is a highly contagious disease which can lead to complications such as exacerbation of chronic conditions, hospitalization and even death. Influenza is particularly dangerous when it strikes those who are immunosuppressed, elderly, very young (children \u3c 6 months old) or pregnant. Vaccination is recommended for everyone and especially for these vulnerable populations. Despite recommendations, vaccine uptake is lower than recommended with only 53.6% of pregnant women reporting vaccination. A systematic review on this topic was performed by Yuen et al. in 2014. A rapid systematic review was conducted to update Yuen’s findings and shed light on which factors play a role in flu vaccine decision making for pregnant women. The review resulted in the identification of eleven papers published between 2014 and 2019. Data extraction was informed by the Health belief Model (HBM). Results were organized into 5 categories--perceived susceptibility, perceived severity, perceived benefits, perceived barriers and cues to action, all elements of the HBM. Results showed that women who perceived risk as “high”, had higher knowledge about disease, wanted to protect their babies and themselves from the disease, received a provider recommendation, along with an opportunity to receive the vaccine at the time of an office visit were more likely to be vaccinated. Unvaccinated women had more perceived barriers, such as lower knowledge, had concerns about safety of vaccine and perceived risk as low. Based on the findings, cues to action impacted vaccination status the most. To increase influenza vaccine uptake by pregnant women, health care providers need to recommend vaccination and offer it at the time of an office visit, additionally, providers need to provide education about vaccine safety, effectiveness and risks of the disease

Occupational Health and Safety Trainees Reflect on their Education and Future Careers During COVID-19.

Background: The National Institute for Occupational Safety and Health (NIOSH) funded Education and Research Centers (ERCs), located at 18 universities, with the mission to train occupational safety and health (OSH) leaders. The Florida Sunshine ERC has trained hundreds of students since its inception in 1997 through seven programs that collaboratively foster interdisciplinary education and applied research and practice. The COVID-19 pandemic has presented practical challenges for educators, students, and trainees, forcing institutions to move to remote learning. The pandemic also magnifies the importance of public health and OSH. Purpose: This evaluation elicited feedback from ERC trainees early in the pandemic (2020) and again in 2021 on how the pandemic affected their training, professional development, career plans, and wellbeing. Methods: Open-ended surveys were collected and focus groups were held with currently enrolled trainees from seven Sunshine ERC programs. Descriptive statistics were calculated, and qualitative transcripts were analyzed using MAXQDA software. Results: Through survey responses (45 respondents) and focus group discussions (9 participants), ERC trainees shared their perspectives on pandemic impacts in their performance and wellbeing, transition to remote learning, their respective OSH fields, and career plans during the pandemic. Programs should consider enhancing OSH curricula to respond to training needs and issues related to occupational stress and well-being, pragmatism and disaster response, and even more interdisciplinary training to prepare for emerging population-wide threats. Conclusions: OSH training will require shifts in teaching modalities and content to prepare OSH professionals for the future. Evaluation results informed teaching and training modifications to ensure that ERC objectives continue to be met and that trainees are well-prepared and supported

Post-Discharge Nutrition Care Instructions for Malnourished Adults

Malnutrition remains an insidious yet common ailment among hospitalized adults, with prevalence estimates ranging from 4-45%. Multiple studies confirm the adverse effects of malnutrition, which include prolonged length of stay, readmissions, higher hospitalization costs, and mortality. Malnutrition is frequently associated with chronic disease. For nutrition interventions to be successful, they must continue to support the long-term nutritional needs of patients beyond the hospital stay. Few studies, however, examine the receipt of recommendations for oral nutrition supplementation (ONS) or basic nutrition care instructions at the time of discharge. There is a need to better understand what post-discharge nutrition care instructions are documented in the electronic medical record (EMR) and how they are communicated to patients once they leave the hospital. This study sought to describe the malnourished adult patient population and the standard of nutrition-focused discharge care they receive at Christiana Hospital in Newark, DE. The investigation revealed that a majority of these patients received inappropriate or inadequate nutrition care instructions at time of discharge. Preliminary survey data suggest that some patients may be unaware of their malnutrition diagnosis, and may receive care instructions that are never documented. Clinician education and redesign of nutrition care options in the EMR may aid in the provision of discharge instructions to treat and prevent malnutrition after patients leave the hospital

Adolescent Refugees Resettled in Philadelphia: A Qualitative Study with Key Informants

More than 22.5 million refugees are currently displaced globally, with refugees below the age of 18 years old making up more than half of this population. More than 3,600 have been resettled in Pennsylvania as of 2016, 875 in Philadelphia County. These families have come to the United States from countries such as Burma, Thailand, Syria, Afghanistan, and Iraq. Forced displacement, relocation, and resettlement have been shown to have long-lasting effects on youth, and there are demonstrated mental health disparities in refugee adolescents resettled in the United States when compared to the general population of US youth. The relationship between resilience and protective factors related to mental health and wellness has been shown to be important in designing appropriate intervention and prevention strategies. Some of the most important determinants may be related to the post-migration experiences and with the appropriate understanding of the adolescent experience, may be modifiable after resettlement. An exploratory, qualitative study involving cross-sectional data and thematic analysis was performed. Six semi-structured interviews were conducted with key informants to better understand factors contributing to the experience of adolescent refugees in grades 9 through 12. Analysis highlighted five major themes in the key informant responses, health and social services, education, assimilation, connectedness, and emotional health. The data suggest room for fostering of resilience in these youth through better understanding of their specific needs and inherent vulnerabilities, improved utilization and access to health and social services, and the importance of understanding the unique impact of their identity as refugee adolescents on their development and daily experiences. The explanatory model developed based on the key informant data may be useful in informing future investigation and programming for the adolescent refugee community

Expressway to Cancer Clinical Trials: Reducing Administrative Barriers to Enrollment

This Notes from the Field piece provides information on the work of MCC\u27s cancer control priorities and the results of collaborative efforts to address them. The MCC\u27s Clinical Trials Workgroup was tasked with developing a project to support the Cancer Plan for Michigan’s Diagnosis and Treatment Goal in 2016

Collaborative Efforts to Improve Cancer Survivor Quality of Life

This Notes from the Field piece provides information on the work of MCC\u27s cancer control priorities and the results of collaborative efforts to address them. The MCC\u27s Survivorship Workgroup was tasked with developing a project to support the Cancer Plan for Michigan’s Quality of Life Goal

My bitterness is deeper than the ocean : understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers.

Background: It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers. Methods: We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma of Mental Illness Scale and Affiliated Stigma Scale. Scores from the two scales and number of text fragments were compared to identify consistency of responses using the two methods. Profiles from three family-dyads were analyzed to highlight the interactive aspect of stigma in a dyadic relationship. Results: Our analyses suggested that persons with schizophrenia and their caregivers both internalized negative valuation from their social networks and reduced engagement in the community. Participants with schizophrenia expressed a sense of shame and inferiority, spoke about being a burden to their family, and expressed self-disappointment as a result of having a psychiatric diagnosis. Caregivers expressed high level of emotional distress because of mental illness in the family. Family dyads varied in the extent that internalized stigma were experienced by patients and caregivers. Conclusions: Family plays a central role in caring for persons with mental illness in China. Given the increasingly community-based nature of mental health services delivery, understanding internalized stigma as a family unit is important to guide the development of cultural-informed treatments. This pilot study provides a method that can be used to collect data that take into consideration the cultural nuances of Chinese societies

Social Determinants of Health and What Mothers Say They Need and Want After Release From Jail.

Identifying the biopsychosocial needs of mothers who have been released from jail is critical to understanding the best ways to support their health and stability after release. In May through August 2014, we interviewed 15 mothers who had been released from an urban jail about their reentry experiences, and we analyzed transcripts for themes. Eight domains of community reentry emerged through analysis: behavioral health services, education, employment, housing, material resources, medical care, relationships with children, and social support. Participants defined barriers to successful reentry, which paralleled the social determinants of health, and shared suggestions that could be used to mitigate these barriers