Human Trafficking: What is the Role of the Health Care Provider?

The article will address the global and local issue of human trafficking. An estimated 20,000 people are trafficked within the U.S. each year. Trafficked people are forced, defrauded and coerced into labor and sexual service for profit of others. Traffickers use individual vulnerabilities and immigration status, language ability and poor understanding of U.S. laws to identify future victims. One case in 2005 in Texas resulted in 100 victims being identified, none of whom revealed themselves to health care professionals. Health care professionals need contemporary and updated information and resources about health risks, screening methods, and identification of trafficked persons. Readers will learn about common medical problems experienced by individuals who are leaving trafficking situations. Legal and health care intersections will be explored. Implementation of a response protocol to assist those who may currently be enslaved will be introduced. Real case examples from trafficking survivors will be presented and discussed. Participants will learn how to reach out, look beneath the surface, provide assistance, and access resources to help victims, and gain a better understanding of the health challenges faced by trafficked victims

PREDICTORS OF INJURY ASSOCIATED WITH RAPE

The purpose of the study was to identify predictors of physical injury in adolescent and adult women, who have a medical history of rape. Severity of rape-related injury is linked to negative health consequences. Studying the impact of injury and the associated predictors expands the understanding of rape and the risks of long-term negative health consequences. Variables included regional setting, victim characteristics (age, ethnicity, and known or unknown perpetrator) and forensic characteristics (time from rape to examination, weapon presence, multiple perpetrators, and use of an evidence kit). Secondary analysis evaluated cross-sectional data of women (N = 3318) 13 to 89 years of age (M = 26.6; SD = 11.1) from three regions of the US: the northeast, the southern coast, and the west coast. The results of multiple logistic regression models included main and interaction effects, primarily involving setting and ethnicity variables. The forward stepwise model (chi-square [18] = 387.26, p = .001) demonstrated adequate fit based on the Hosmer-Lemeshow goodness-of-fit results (chi-square [7] = 5.72, p = .57), and was a slightly improved fit over the backward elimination model (chi-square [22] = 398.12, p = .001), which also had desirable Hosmer-Lemeshow chi-square results (chi-square [7] = 7.47 p = .38). The forward and backward models included ten significant interactions: Setting C by age, Setting C by examination time of >72 hours, Setting A by other ethnicity, Setting A by weapon presence, Setting A by examination time of 48-72 hours, and Setting A by multiple perpetrators, age by weapon presence, African American by examination time of 24-48 hours, African American by multiple perpetrators, other ethnicity by examination time of >72 hours, and unknown perpetrators by multiple perpetrators. Implications of this research emphasize the importance of location and ethnicity on documentation of injury and 1) can lead to refinement of data collection, 2) addresses the need for research in the acute time frame after rape, 3) informs tailored interventions, 4) links health and legal systems to improve forensic management, 5) emphasizes the need for multi-professional funding allocation for education, prevention and interventions to improve victim care

Disciplined Improvisation:Characteristics of inquiry in mindfulness-based teaching

Evidence for the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) is rapidly growing as interest in this field expands. By contrast, there are few empirical analyses of the pedagogy of MBSR and MBCT. Development of the evidence base concerning the teaching of MBCT or MBSR would support the integrity of the approach in the context of rapid expansion. This paper describes an applied conversation analysis (CA) of the characteristics of inquiry in the MBSR and MBCT teaching process. Audio-recordings of three 8-week MBCT and MBSR classes, with 24, 12, and 6 participants, were transcribed and systematically examined. The study focused on the teacher-led interactive inquiry which takes place in each session after a guided meditation practice. The study describes and analyzes three practices within the inquiry process that can be identified in sequences of talk: turn-taking talk involving questions and reformulations; the development of participant skills in a particular way of describing experience; and talk that constructs intersubjective connection and affiliation within the group. CA enables fine-grained analysis of the interactional work of mindfulness-based inquiry. Inquiry is a process of disciplined improvisation which is both highly specific to the conditions of the moment it took place in and uses repeated and recognizable patterns of interaction

Rehabilitation Intervention for Individuals With Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study

Objective: To investigate feasibility of recruitment, tablet use in intervention delivery, and use of self-report outcome measures and to analyze the effect of Energy Conservation plus Problem-Solving Therapy versus Health Education interventions for individuals with heart failure-associated fatigue. Methods: This feasibility study was a block-randomized controlled trial involving 23 adults, blinded to their group assignment, in a rural southern area in the United States. Individuals with heart failure and fatigue received the interventions for 6 weeks through videoconferencing or telephone. Participants were taught to solve their fatigue-related problems using energy conservation strategies and the process of Problem-Solving Therapy or educated about health-related topics. Results: The recruitment rate was 23%. All participants completed the study participation according to their group assignment, except for one participant in the Energy Conservation plus Problem-Solving Therapy group. Participants primarily used the tablet (n=21) rather than the phone (n=2). Self-report errors were noted on Activity Card Sort (n=23). Reported fatigue was significantly lower for both the Energy Conservation plus Problem-Solving Therapy (p=0.03, r=0.49) and Health Education (p=0.004, r=0.64) groups. The Health Education group reported significantly lower fatigue impact (p=0.019, r=0.48). Participation was significantly different in low-physical demand leisure activities (p=0.008; r=0.55) favoring the Energy Conservation plus Problem-Solving Therapy group. Conclusion: The recruitment and delivery of the interventions were feasible. Activity Card Sort may not be appropriate for this study population due to recall bias. The interventions warrant future research to reduce fatigue and decrease participation in sedentary activities (Clinical Trial Registration number: NCT03820674)

Polypharmacy in elderly women after myocardial infarction.

The aims of the study were to: (a) examine the number, absolute volume, and type of daily medications older women were taking 6 to 12 months post-myocardial infarction (MI); (b) describe the financial burden of cardiac medications; and (c) examine the relationship of age, education, and income to the number of medications. An analysis of a cross-sectional descriptive study of women >65 years of age who were post-MI was used. Most (89%; N = 83) were taking at least one cardiac medication, costs per day varied ($0.13–$6.75), and total number of pills taken per day was 1 to 19. Age, education, and income did not explain the number of medications. Consideration of the financial burden of medications is important to increase compliance and foster secondary prevention in older women

Fatigue and physical activity in older women after myocardial infarction.

Background Within 6 years of a myocardial infarction (MI) more women (35%) than men (18%) will have another MI. Participation in physical activity is one of the most effective methods to reduce cardiac risks; however, few older women participate. One of the most frequently reported barriers to physical activity is fatigue. Objectives The specific aims of this study were to (1) describe factors related to fatigue in older women after MI and (2) examine the relationship of fatigue to physical activity in older women after MI. Methods This descriptive correlational study examined the effects of age, body mass index, comorbidities, sleep, beta-blocker medication, depression, and social support on fatigue and physical activity in women (N = 84), ages 65 to 88 years old, 6 to 12 months post-MI. All women had their height and weight measured and completed (1) a health form on comorbidities, physical activity, and medication history; (2) the Geriatric Depression Scale; (3) the Epworth Sleepiness Scale; (4) the Revised Piper Fatigue Scale; and (5) the Social Provisions Scale. Results The majority (67%) of the women reported fatigue that they perceived as different from fatigue before their MI. Moderately strong correlations were noted among depression, sleep, and fatigue, and multivariate analysis indicated that depression and sleep significantly accounted for 32.7% of the variance in fatigue. Although only 61% of the women reported participating in physical activity for exercise, most were meeting minimal kilocalories per week for secondary prevention. Fatigue was not significantly associated with participation in physical activity. Conclusion Describing correlates to fatigue and older women’s participation in physical activity after MI are important to develop interventions targeted at increasing women’s participation in physical activity, thus decreasing their risk for recurrent MIs

The effects of hyperglycemia on length of stay with myocardial infarction

The influence of patients' co-morbidities and admission blood glucose on critical care and hospital length of stay was examined. The model significantly explained variance in hospital length of stay

Development of the McSweeney acute and prodromal myocardial infarction symptom survey.

Background/Objectives: Coronary heart disease (CHD) is the number one cause of death in women, yet, little is known about women's symptoms. Early symptom recognition of CHD in women is essential but most instruments do not assess both prodromal and acute CHD symptoms. Our aims were to develop an instrument validly describing women's prodromal and acute symptoms of myocardial infarction and to establish reliability of the instrument, the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Methods: Four studies contributed to the content validity and reliability of this instrument. Two qualitative studies provided the list of symptoms that were confirmed in study 3. The resulting instrument assesses 37 acute and 33 prodromal symptoms. In study 4, 90 women were retested 7 to 14 days after their initial survey. We used the kappa statistic to assess agreement across administrations. Results: The women added no new symptoms to the MAPMISS. The average kappa of acute symptoms was 0.52 and 0.49 for prodromal. Next we calculated a weighted score. The mean acute score for time 1 was 19.4 (SD = 14.43); time 2 was 12.4 (SD = 8.79) with Pearson correlation indicating stability (r = .84; P < .01). The mean prodromal score at time 1 was 23.80 (SD = 24.24); time 2 was 26.79 (SD = 30.52) with a Pearson correlation of r = .72; P < .01. Conclusions: The tool is comprehensive, has high content validity, and acceptable test-retest reliability. Low kappas were related to few women having those symptoms. The symptom scores remained stable across administrations

Predictors of the end of life in chronic kidney disease: A pilot study.

The aim of this pilot study was to describe indicators present at the end of life in persons with chronic kidney disease. Retrospective chart reviews of 10 randomly selected patients were conducted to describe demographic, physiological, and functional variables. Using a repeated measures ANOVA, The Palliative Performance Scale and the Braden Scale both showed significant differences during the death admission from previous admissions. These functional measures may provide useful insight in identifying the end of life in persons with chronic kidney disease