An Analytical Understanding Of Administrative Practices Minimizing Vicarious Traumatization In Domestic Violence Organizations I

Working within the field of domestic violence can result in the occurrence of vicarious traumatization. The literature supports that collegial support and supervision are effective tools organizations can implement to assist in minimizing vicarious trauma. This study, guided by constructive self development theory and feminist theory, examines whether the level of vicarious trauma is impacted by knowledge base, collegial support, and supervision. Staff within certified shelters in the state of Florida were surveyed using a research designed instrument and the Trauma and Attachment Belief Scale. A total of 112 participants were recruited using the Tailor Design Method of surveying. Findings indicate that uniquely none of the independent variables significantly impacted vicarious trauma symptoms. However, collectively knowledge base, collegial support and supervision did impact minimizing vicarious trauma. Further, five of the ten subscales of vicarious trauma showed a statistically significant relationship with the independent variables. Implications for domestic violence agencies, practitioners, and future research are drawn

Understanding pregnant smokers’ adherence to nicotine replacement therapy during a quit attempt: a qualitative study

Background: Pregnant smokers may be offered nicotine replacement therapy (NRT) alongside behavioral support to assist with a quit attempt. Yet trials of NRT have found adherence to be low among pregnant women, and this has made it difficult to determine the efficacy of NRT. The aim of this study is to understand the experience of pregnant women who use NRT but discontinue this early or do not use the medication as recommended. Methods: Semi-structured telephone interviews were conducted with 14 pregnant smokers who had recently been prescribed NRT, but self-reported poor NRT adherence or discontinuing treatment prematurely. Data were transcribed and analyzed using inductive thematic analysis. Results: There were four main themes identified; expectations of NRT, experience of using NRT, safety concerns and experience of using e-cigarettes. Some women intentionally used NRT to substitute a proportion of their cigarette intake and smoked alongside. Most women smoked while using NRT. Women who underutilized NRT did so as they experienced side effects, or were concerned that using NRT instead of smoking could actually increase their nicotine exposure and potential for increased nicotine dependence or fetal harm. Most women spoke about the use of e-cigarettes as a smoking cessation method but only a few had actually experienced using them during pregnancy. Conclusion: Many women underused NRT but simultaneously smoked. Challenging negative perceptions about NRT and educating women further about the risks of smoking may encourage them to use NRT products as recommended.Implications: These findings add to the research surrounding the efficacy of NRT during pregnancy by providing insight into how pregnant women use NRT during a quit attempt and how this may influence adherence. It may assist health professionals to support pregnant smokers by increasing their understanding about the differing ways in which women use NRT and help them address concerns women may have about the safety of NRT

Facebook as a recruitment tool for adolescent health research: A systematic review

BACKGROUND: Researchers are increasingly using social media to recruit participants to surveys and clinical studies. However, the evidence of the efficacy and validity of adolescent recruitment through Facebook is yet to be established. OBJECTIVE: To conduct a systematic review of the literature on the use of Facebook to recruit adolescents for health research. DATA SOURCES: Nine electronic databases and reference lists were searched for articles published between 2004 and 2013. STUDY ELIGIBILITY CRITERIA: Studies were included in the review if: 1) participants were aged 10 to 18 years, 2) studies addressed a physical or mental health issue, 3) Facebook was identified as a recruitment tool, 4) recruitment details using Facebook were outlined in the methods section and considered in the discussion, or information was obtained by contacting the authors, 5) results revealed how many participants were recruited using Facebook, and 6) studies addressed how adolescent consent and/or parental consent was obtained. STUDY APPRAISALS AND SYNTHESIS METHODS: Titles, abstracts, and keywords were scanned and duplicates removed by 2 reviewers. Full text was evaluated for inclusion criteria, and 2 reviewers independently extracted data. RESULTS: The search resulted in 587 publications, of which 25 full-text papers were analyzed. Six studies met all the criteria for inclusion in the review. Three recruitment methods using Facebook was identified: 1) paid Facebook advertising, 2) use of the Facebook search tool, and 3) creation and use of a Facebook Page. CONCLUSIONS: Eligible studies described the use of paid Facebook advertising and Facebook as a search tool as methods to successfully recruit adolescent participants. Online and verbal consent was obtained from participants recruited from Facebook

Modeling potential hydrochemical responses to climate change and increasing CO2 at the Hubbard Brook Experimental Forest using a dynamic biogeochemical model (PnET-BGC)

Dynamic hydrochemical models are useful tools for understanding and predicting the interactive effects of climate change, atmospheric CO2, and atmospheric deposition on the hydrology and water quality of forested watersheds. We used the biogeochemical model, PnET-BGC, to evaluate the effects of potential future changes in temperature, precipitation, solar radiation, and atmospheric CO2 on pools, concentrations, and fluxes of major elements at the Hubbard Brook Experimental Forest in New Hampshire, United States. Future climate projections used to run PnET-BGC were generated specifically for the Hubbard Brook Experimental Forest with a statistical technique that downscales climate output (e.g., air temperature, precipitation, solar radiation) from atmosphere-ocean general circulation models (AOGCMs) to a finer temporal and spatial resolution. These climate projections indicate that over the twenty-first century, average air temperature will increase at the site by 1.7 degrees C to 6.5 degrees C with simultaneous increases in annual average precipitation ranging from 4 to 32 cm above the long-term mean (1970–2000). PnET-BGC simulations under future climate change show a shift in hydrology characterized by later snowpack development, earlier spring discharge (snowmelt), greater evapotranspiration, and a slight increase in annual water yield (associated with CO2 effects on vegetation). Model results indicate that under elevated temperature, net soil nitrogen mineralization and nitrification markedly increase, resulting in acidification of soil and stream water, thereby altering the quality of water draining from forested watersheds. Invoking a CO2 fertilization effect on vegetation under climate change substantially mitigates watershed nitrogen loss, highlighting the need for a more thorough understanding of CO2 effects on forest vegetation

A study of organizational alignment at a Boston area hospital and its effects on patient throughput in the peri-operative areas

Thesis (S.M.)--Massachusetts Institute of Technology, Sloan School of Management, 2007.Includes bibliographical references (p. 64).Capacity is an ongoing issue when managing hospital resources. Looking at the hospital as a supply chain of care services provided to the patient enables us to better evaluate problems such as delays on a systems level. A Boston Area Hospital has been experiencing delays in the operating rooms when moving patients into the post-anesthesia care unit (PACU). As the different services of the hospital are inherently reliant upon each other, this issue cannot be isolated and resolved in this one hospital area. As this is the initial year of this research collaboration, the purpose of this work is to serve as a map of the surgical patient's pathway through the hospital, with emphasis on the patients that move through the PACU, and identify areas that merit further research and study. Reasons behind delaying factors have been identified through interviews of different members of the organization and direct observation. Applying a the congruence model in evaluating the alignment of objectives, resources, critical tasks and vision is a useful model for identifying potential areas of disconnect in the system.(cont.) A pilot social networking survey was also conducted in the PACU and produced data that showed it is a useful tool in evaluating the informal communication structure and organization it relates to accomplishing critical tasks. Applying these tools and models will be useful in evaluating different areas of the hospital, identifying problem areas, and aligning the objectives of the different units, departments and professions to a more unified, strategic vision that fosters change.by Sarah K. Campbell.S.M

Understanding Pregnant Smokers’ Adherence to Nicotine Replacement Therapy During a Quit Attempt: A Qualitative Study

This is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/ntr/ntv205Background: Pregnant smokers may be offered nicotine replacement therapy (NRT) alongside behavioral support to assist with a quit attempt. Yet trials of NRT have found adherence to be low among pregnant women, and this has made it difficult to determine the efficacy of NRT. The aim of this study is to understand the experience of pregnant women who use NRT but discontinue this early or do not use the medication as recommended. Methods: Semi-structured telephone interviews were conducted with 14 pregnant smokers who had recently been prescribed NRT, but self-reported poor NRT adherence or discontinuing treatment prematurely. Data were transcribed and analyzed using inductive thematic analysis Results: There were four main themes identified; expectations of NRT, experience of using NRT, safety concerns and experience of using e-cigarettes. Some women intentionally used NRT to substitute a proportion of their cigarette intake and smoked alongside. Most women smoked while using NRT. Women who underutilized NRT did so as they experienced side effects, or were concerned that using NRT instead of smoking could actually increase their nicotine exposure and potential for increased nicotine dependence or fetal harm. Most women spoke about the use of e-cigarettes as a smoking cessation method but only a few had actually experienced using them during pregnancy. Conclusion: Many women underused NRT but simultaneously smoked. Challenging negative perceptions about NRT and educating women further about the risks of smoking may encourage them to use NRT products as recommended. Implications: These findings add to the research surrounding the efficacy of NRT during pregnancy by providing insight into how pregnant women use NRT during a quit attempt and how this may influence adherence. It may assist health professionals to support pregnant smokers by increasing their understanding about the differing ways in which women use NRT and help them address concerns women may have about the safety of NRT

Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys.

OBJECTIVE: Maternal mortality rates have decreased globally but remain off track for Millennium Development Goals. Good-quality delivery care is one recognised strategy to address this gap. This study examines the role of the private (non-public) sector in providing delivery care and compares the equity and quality of the sectors. METHODS: The most recent Demographic and Health Survey (2000-2013) for 57 countries was used to analyse delivery care for most recent birth among >330 000 women. Wealth quintiles were used for equity analysis; skilled birth attendant (SBA) and Caesarean section rates served as proxies for quality of care in cross-sectoral comparisons. RESULTS: The proportion of women who used appropriate delivery care (non-facility with a SBA or facility-based births) varied across regions (49-84%), but wealth-related inequalities were seen in both sectors in all regions. One-fifth of all deliveries occurred in the private sector. Overall, 36% of deliveries with appropriate care occurred in the private sector, ranging from 9% to 46% across regions. The presence of a SBA was comparable between sectors (≥93%) in all regions. In every region, Caesarean section rate was higher in the private compared to public sector. The private sector provided between 13% (Latin America) and 66% (Asia) of Caesarean section deliveries. CONCLUSION: This study is the most comprehensive assessment to date of coverage, equity and quality indicators of delivery care by sector. The private sector provided a substantial proportion of delivery care in low- and middle-income countries. Further research is necessary to better understand this heterogeneous group of providers and their potential to equitably increase the coverage of good-quality intrapartum care

Antenatal Clinic and Stop Smoking Services Staff Views on "Opt-Out" Referrals for Smoking Cessation in Pregnancy: A Framework Analysis.

Introduction: UK guidance recommends routine exhaled carbon monoxide (CO) screening for pregnant women and "opt-out" referrals to stop smoking services (SSS) of those with CO ≥ 4 ppm. We explored staff views on this referral pathway when implemented in one UK hospital Trust. Methods: Seventeen semi-structured interviews with staff involved in the implementation of the new referral pathway: six antenatal clinic staff (before and after implementation); five SSS staff (after). Data were analyzed using framework analysis. Results: Two themes were identified: (1) views on implementation of the pathway and (2) impact of the pathway on the women. Generally, staff felt that following training, referrals were less arduous to implement and better received than expected. The majority believed this pathway helped engage women motivated to quit and offered a unique chance to impart smoking cessation knowledge to hard-to-reach women, who might not otherwise contact SSS. An unexpected issue arose during implementation-dealing with non-smokers with high CO readings. Conclusions: According to staff, the "opt-out" referral pathway is an acceptable addition to routine antenatal care. It can help engage hard-to-reach women and educate them about the dangers of smoking in pregnancy. Incorporating advice on dealing with non-smokers with high CO into routine staff training could help future implementations.This work was supported by the NIHR under its Programme Grants for Applied Research (RP-PG 0109-10020). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors are members of the UK Centre for Tobacco and Alcohol Studies. Funding to UKCTAS from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the National Institute of Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.This is the final version of the article. It first appeared from the Molecular Diversity Preservation International via https://doi.org/10.3390/ijerph1310100

Pregnant Women’s Experiences and Views on an “Opt-Out” Referral Pathway to Specialist Smoking Cessation Support: A Qualitative Evaluation

Introduction: Smoking in pregnancy remains an important and costly public health concern with policy makers worldwide researching methods to aid cessation. UK government guidelines recommend implementation of an ‘opt-out’ (i.e. whether requested or not) referral pathway for pregnant smokers to specialist smoking cessation support using carbon monoxide (CO) screening. This study explores the views of pregnant smokers who experienced this new pathway in one UK hospital trust. Methods Eighteen semi-structured telephone interviews with women who experienced the ‘opt-out’ pathway were undertaken. Data were analysed thematically. Results Three themes were identified relating to expectations, acceptability and impact of the pathway. Women were generally very accepting of the CO testing especially when it met their prior expectations and was perceived as being a routine component of antenatal care. They considered the visual feedback from the CO monitoring improved their motivation to quit. Views on the automatic referral for cessation support were divided with questions raised as to the removal of choice, with many women also expressing dissatisfaction about perceived lack of contact by Stop Smoking Services (SSS) following referral. Conclusion The ‘opt-out’ pathway is potentially an acceptable addition to current practice. The women considered CO monitoring to be the most valuable element of the pathway. Women keen to engage with SSS desired a more efficient system of contact.This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (RP-PG-0109-10020). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/ntr/ntv27

Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle-income countries.

OBJECTIVE: Family planning service delivery has been neglected; rigorous analyses of the patterns of contraceptive provision are needed to inform strategies to address this neglect. METHODS: We used 57 nationally representative Demographic and Health Surveys in low- and middle-income countries (2000-2013) in four geographic regions to estimate need for contraceptive services, and examined the sector of provision, by women's socio-economic position. We also assessed method mix and whether women were informed of side effects. RESULTS: Modern contraceptive use among women in need was lowest in sub-Saharan Africa (39%), with other regions ranging from 64% to 72%. The private sector share of the family planning market was 37-39% of users across the regions and 37% overall (median across countries: 41%). Private sector users accessed medical providers (range across regions: 30-60%, overall mean: 54% and median across countries 23%), specialised drug sellers (range across regions: 31-52%, overall mean: 36% and median across countries: 43%) and retailers (range across regions: 3-14%, overall mean: 6% and median across countries: 6%). Private retailers played a more important role in sub-Saharan Africa (14%) than in other regions (3-5%). NGOs and FBOs served a small percentage. Privileged women (richest wealth quintile, urban residents or secondary-/tertiary-level education) used private sector services more than the less privileged. Contraceptive method types with higher requirements (medical skills) for provision were less likely to be acquired from the private sector, while short-acting methods/injectables were more likely. The percentages of women informed of side effects varied by method and provider subtype, but within subtypes were higher among public than private medical providers for four of five methods assessed. CONCLUSION: Given the importance of private sector providers, we need to understand why women choose their services, what quality services the private sector provides, and how it can be improved. However, when prioritising one of the two sectors (public vs. private), it is critical to consider the potential impact on contraceptive prevalence and equity of met need