School Social Workers\u27 Role in Supporting Parents of a Child with Autism

This quantitative research study explored the role of the school social worker in supporting parents of a child with autism spectrum disorder (ASD). Surveys were emailed to members of the Minnesota School Social Workers Association. Participants were asked to complete the survey if they worked as a school social worker and supported students with ASD. The survey investigated the impact of an ASD diagnosis on the parental stress and what role school social workers had in supporting parents\u27 needs. The objective of this study was to gain a better understanding of the school social workers\u27 role and identify what supports are being utilized and which are not. The three most common supports were connecting parents to community resources, acting as a liaison between school and home and emotional support. Respondents reported parents most frequently report stress relating to behavior, educational needs and lack of resources. Some respondents reported certain areas of stress in which they did not feel it was their place to provide supports such as parent support groups. These findings also uncover implications for future research. There is a need for more detailed research investigating the role school social workers have in supporting parents of a child with ASD. It is important to identify what stressors these parents are experiencing in order to develop best practice and interventions

School Social Workers’ Role in Supporting Parents of a Child with Autism

This quantitative research study explored the role of the school social worker in supporting parents of a child with autism spectrum disorder (ASD). Surveys were emailed to members of the Minnesota School Social Workers Association. Participants were asked to complete the survey if they worked as a school social worker and supported students with ASD. The survey investigated the impact of an ASD diagnosis on the parental stress and what role school social workers had in supporting parents’ needs. The objective of this study was to gain a better understanding of the school social workers’ role and identify what supports are being utilized and which are not. The three most common supports were connecting parents to community resources, acting as a liaison between school and home and emotional support. Respondents reported parents most frequently report stress relating to behavior, educational needs and lack of resources. Some respondents reported certain areas of stress in which they did not feel it was their place to provide supports such as parent support groups. These findings also uncover implications for future research. There is a need for more detailed research investigating the role school social workers have in supporting parents of a child with ASD. It is important to identify what stressors these parents are experiencing in order to develop best practice and interventions

Introducing First Year Medical Students to Personalized Medicine Concepts in a Small Group Activity

Presented as a Poster Presentation at 2020 IUSM Education Day.An individuals’ genetic profile is becomingly an increasingly important parameter in healthcare decisions. This small group activity was developed to introduce first year medical students in the Molecules to Cells and Tissues course to the concept and significance of Pharmacogenomics and personalized medicine. Additionally, this activity provided students with an opportunity to work with a large dataset and use the information to impact clinical decision making. This activity has two cases, takes student groups approximately 2 hours to complete, and requires internet access. Case materials are available through the learning management system Canvas, and include open-ended questions to guide students through the cases. In these cases students explore the functional significance of different alleles of a panel of cytochrome P450 genes. The group activity has the students examine a large data set of cytochrome P450 genes and cognate alleles to determine their prevalence in the local population and calculate the individuals’ gene scores. The students are then asked to explain the impact of the genotype (or gene score) on the resulting patient phenotype (i.e. the functional significance of the genotype). The first case involves a breast cancer survivor support group in which patients taking Taxol discuss lack of adequate pain relief from opioids and the potential impact of concomitant use of natural compounds/supplements on drug metabolism. The second case involves a patient presenting with recurrent stroke-like symptoms despite being on the anticoagulant medication clopidogrel. The patient is initially suspected to be non-compliant, but is later determined to be a poor metabolizer of the anticoagulant clopidogrelto its active form thus decreasing its efficacy. The expertise of the IUSM Medical Genetics research faculty was leveraged to provide a large data set of cytochrome P450 genes and cognate alleles. The selection of cytochrome P450 was based upon delivering content focused on the biochemistry of the enzyme system and provided an opportunity to highlight the drug interaction database available through IUSM Clinical Pharmacology (The FlockhartTable™ ; https://drug-interactions.medicine.iu.edu/). The addition of natural compounds was to draw students’ attention to the Natural Medicines database, which is the recommended source for evidence-based data on complementary and alternative medicine. Natural Medicines is available through the Ruth Lilly Medical Library and can be searched by substance or condition. It provides both a summary of the literature available on substances as well as the level of evidence or quality of studies done on the substance

Using an Implementation Research Framework to Identify Potential Facilitators and Barriers of an Intervention to Increase HPV Vaccine Uptake

Background: Although the incidence of cervical cancer has been decreasing in the United States over the last decade, Hispanic and African American women have substantially higher rates than Caucasian women. The human papillomavirus (HPV) is a necessary, although insufficient, cause of cervical cancer. In the United States in 2013, only 37.6% of girls 13 to 17 years of age received the recommended 3 doses of a vaccine that is almost 100% efficacious for preventing infection with viruses that are responsible for 70% of cervical cancers. Implementation research has been underutilized in interventions for increasing vaccine uptake. The Consolidated Framework for Implementation Research (CFIR), an approach for designing effective implementation strategies, integrates 5 domains that may include barriers and facilitators of HPV vaccination. These include the innovative practice (Intervention), communities where youth and parents live (Outer Setting), agencies offering vaccination (Inner Setting), health care staff (Providers), and planned execution and evaluation of intervention delivery (Implementation Process). Methods: Secondary qualitative analysis of transcripts of interviews with 30 community health care providers was conducted using the CFIR to code potential barriers and facilitators of HPV vaccination implementation. Results: All CFIR domains except Implementation Process were well represented in providers\u27 statements about challenges and supports for HPV vaccination. Conclusion: A comprehensive implementation framework for promoting HPV vaccination may increase vaccination rates in ethnically diverse communities. This study suggests that the CFIR can be used to guide clinicians in planning implementation of new approaches to increasing HPV vaccine uptake in their settings. Further research is needed to determine whether identifying implementation barriers and facilitators in all 5 CFIR domains as part of developing an intervention contributes to improved HPV vaccination rates

Study of diffusion weighted MRI as a predictive biomarker of response during radiotherapy for high and intermediate risk squamous cell cancer of the oropharynx: The MeRInO study

Introduction and background: A significant proportion of patients with intermediate and high risk squamous cell cancer of the oropharynx (OPSCC) continue to relapse locally despite radical chemoradiotherapy (CRT). The toxicity of the current combination of intensified dose per fraction radiotherapy and platinum based chemotherapy limits further uniform intensification. If a predictive biomarker for outcomes from CRT can be identified during treatment then individualised and adaptive treatment strategies may be employed. Methods/design: The MeRInO study is a prospective observational imaging study of patients with intermediate and high risk, locally advanced OPSCC receiving radical RT or concurrent CRT Patients undergo diffusion weighted MRI prior to treatment (MRI_1) and during the third week of RT (MRI_2). Apparent diffusion coefficient (ADC) measurements will be made on each scan for previously specified target lesions (primary and lymph nodes) and change in ADC calculated. Patients will be followed up and disease status for each target lesion noted. The primary aim of the MeRInO study is to determine the threshold change in ADC from baseline to week 3 of RT that may identify the sub-group of non-responders during treatment. Discussion: The use of DW-MRI as a predictive biomarker during RT for SCC H&N is in its infancy but studies to date have found that response to treatment may indeed be predicted by comparison of DW-MRI carried out before and during treatment. However, previous studies have included all sub-sites and biological sub-types. Establishing ADC thresholds that predict for local failure is an essential step towards using DW-MRI to improve the therapeutic ratio in treating SCC H&N. This would be done most robustly in a specific H&N sub-site and in sub-types with similar biological behaviour. The MeRInO study will help establish these thresholds in OPSCC

The prevalence of hepatitis C virus among people of South Asian origin in Glasgow: results from a community based survey and laboratory surveillance

Background South Asians often present late with HCV or HBV related liver disease which could have been avoided with early diagnosis and subsequent treatment; however the prevalence of HCV/HBV among South Asians in Glasgow is not known. Accordingly, to inform the need for case finding among this group we aimed to examine the prevalence of Hepatitis C virus (HCV) among South Asians living in Glasgow. Methods A community-based survey recruited individuals at six mosques and four community centres serving the South Asian community during 2009-2010; participants had predominantly never been HCV tested. Laboratory surveillance data involving all individuals tested for HCV during 1993-2009 were examined and South Asians were identified using Nam Pehchan software. Results In the community-based survey, 2.6% of 1288 participants tested HCV-antibody positive; the prevalence ranged from 0.6% among those born in the UK to 3.1% among those born in Pakistan. The odds of testing HCV-antibody positive were significantly raised among those who had surgery in South Asia (aOR: 5.0, 95% CI: 2.0-12.3) and had either medical/dental treatment or an injection in South Asia (aOR: 2.2, 95% CI: 1.0-5.0). Of 6404 South Asians identified from laboratory surveillance data, 9.3% tested HCV positive. An estimated 38% (330/870) of HCV-infected South Asians living in Glasgow remain undiagnosed. Conclusions South Asians living in Glasgow, particularly those born outside the UK are at greater risk of HCV infection than the general population. Efforts to increase awareness and testing in this population are warranted.</p

Psychosocial concerns and needs of cancer survivors treated at a comprehensive cancer center and a community safety net hospital

The number of cancer survivors in the United States is expected to grow to 18 million by 2020 because of improved cancer treatment outcomes and the aging of the population.[1] Many cancer survivors are at increased risk for cancer recurrence and other adverse long-term physical and psychosocial conditions.[2-5] Disparities in survival are associated with inadequate or no health insurance coverage because individuals are more likely to be diagnosed with cancer at later stages,[6] and higher incidence for some cancers among African Americans.[7] Few studies have examined psychosocial health disparities during cancer survivorship,[8-13] and little is known about how psychosocial factors subsequent to diagnosis affect survival and long-term outcomes. [4,14] While clinical care relevant to survivorship outcomes is advancing, [15, 16] optimal practices for preparing survivors for treatment and transitioning off treatment have yet to be defined. [11, 15, 17] Furthermore, guidance is needed for serving minority and underserved survivor populations where health disparities exist.[7] More data are needed about incidence of adverse outcomes and their determinants, overall and in disparity populations to inform development of best practices for preventive interventions. The purpose of this study was to identify similarities and differences among two groups of survivors in (1) sources of information at time of cancer diagnosis, (2) sources of support used during and after treatment, (3) stressors and challenges during and after treatment, and (4) coping strategies[18] used during and following cancer treatment. These factors might be associated with health services use,[19] and with survivorship disparities.[20] One group was treated at Vanderbilt-Ingram Cancer Center (VICC), an NCI-designated comprehensive cancer center, and the other at Meharry Medical College (MMC), its partner medical setting that serves patients who are mostly publicly-insured and uninsured. Secondary analysis of data from focus group participants was undertaken to address the four study topics and to guide future development of interventions tailored to preferences and needs of diverse survivors

Time from Screening Mammography to Biopsy and from Biopsy to Breast Cancer Treatment among Black and White, Women Medicare Beneficiaries Not Participating in a Health Maintenance Organization

Purpose There is a breast cancer mortality gap adversely affecting Black women in the United States. This study assessed the relationship between number of days between abnormal mammogram, biopsy, and treatment among Medicare (Part B) beneficiaries ages 65 to 74 and 75 to 84 years, accounting for race and comorbidity. Methods A cohort of non-Hispanic Black and non-Hispanic White women residing in the continental United States and receiving no services from a health maintenance organization was randomly selected from the Center for Medicare and Medicaid Services denominator file. The cohort was followed from 2005 to 2008 using Center for Medicare and Medicaid Services claims data. The sample included 4,476 women (weighted n = 70,731) with a diagnosis of breast cancer. Cox proportional hazard modeling was used to identify predictors of waiting times. Findings Black women had a mean of 16.7 more days between biopsy and treatment (p \u3c .001) and 15.7 more days from mammogram to treatment (p = .003) than White women. Median duration from abnormal mammogram to treatment exceeded National Quality Measures for Breast Centers medians regardless of race, age, or number of comorbidities (overall 43 days vs. the National Quality Measures for Breast Centers value of 28 days). Conclusions Medical care delays may contribute, in part, to the widening breast cancer mortality gap between Black women and White women. Further study, with additional clinical and social information, is needed to broaden scientific understanding of racial determinants and assess the clinical significance of mammogram to treatment times among Medicare beneficiaries