Impact of interprofessional education about psychological and medical comorbidities on practitioners’ knowledge and collaborative practice: mixed method evaluation of a national program

BACKGROUND Many patients with chronic physical illnesses have co-morbid psychological illnesses, which may respond to interprofessional collaborative care. Continuing education programs frequently focus on skills and knowledge relevant for individual illnesses, and unidisciplinary care. This study evaluates the impact of “Mind the Gap”, an Australian interprofessional continuing education program about management of dual illnesses, on practitioners’ knowledge, use of psychological strategies and collaborative practice. METHODS A 6-h module addressing knowledge and skills needed for patients with physical and psychological co-morbid illnesses was delivered to 837 practitioners from mixed health professional backgrounds, through locally-facilitated workshops at 45 Australian sites. We conducted a mixed-methods evaluation, incorporating observation, surveys and network analysis using data collected, before, immediately after, and three months after training. RESULTS Six hundred forty-five participants enrolled in the evaluation (58 % GPs, 17 % nurses, 15 % mental health professionals, response rate 76 %). Participants’ knowledge and confidence to manage patients with psychological and physical illnesses improved immediately. Among the subset surveyed at three months (response rate 24 %), referral networks had increased across seven disciplines, improvements in confidence and knowledge were sustained, and doctors, but no other disciplines, reported an increase in use of motivational interviewing (85.9 % to 96.8 %) and mindfulness (58.6 % to 74 %). CONCLUSIONS Interprofessional workshops had an immediate impact on the stated knowledge and confidence of participants to manage patients with physical and psychological comorbidities, which appears to have been sustained. For some attendees, there was a sustained improvement in the size of their referral networks and their use of some psychological strategies.This project was funded by the Australian Medicare Local Alliance, through a grant from the Department of Veterans Affairs

Repeat Victimisation, Retraumatisation and Victim Vulnerability

Abstract: This study explores the contribution that traumatic experiences and psychological post-traumatic stress symptoms make to predicting subsequent revictimisation in a sample of violent crime victims. In addition, the timing of first trauma exposure was also explored. Fifty-four adult victims (27 male and 27 female) of police recorded violent crime were interviewed and their traumatic exposure history, trauma symptomology, age at first trauma exposure as well as psychological and psychosocial functioning were assessed. These victims were followed longitudinally and subsequent revictimisation between six and twelve months post index victimisation measured. A greater number of types of trauma exposure was related lower emotional stability, higher trauma symptomology and revictimisation. Those victims with childhood traumatic exposure reported more trauma symptomology exposure than those without prior exposure. The implications for law enforcement and victim services are discussed

Assessing victim risk in cases of violent crime

Purpose: There is a body of evidence that suggests a range of psychosocial characteristics demarcate certain adults to be at an elevated risk for victimisation. To this end, the aim of the current study was to examine consistency between one police force, and a corresponding victim support service based in England, in their assessment of level of risk faced by victims of violent crime. Methodology: This study explored matched data on 869 adult victims of violent crime gathered from these two key services in Preston, namely Lancashire Constabulary and Victim Support, from which a sub-group of comparable ‘domestic violence’ cases (n=211) were selected for further examination. Findings: Data analyses revealed methodological inconsistencies in the assessment of victimisation resulting in discrepancies for recorded levels of risk in domestic violence cases across these two agencies. Practical implications: These findings provide a compelling argument for developing a more uniformed approach to victim assessment and indicate a significant training need. Value: This paper highlights areas of good practice and forwards several recommendations for improved practice that emphasises the integration of empirical research conducted by psychologists to boost the validity and reliability of risk assessment approaches and tools used

Social Determinants of Cardiovascular Diseases

Social determinants of health can be understood as the social conditions in which individuals live and work; conditions that are shaped by the distribution of power, income and resources, as much on a global and national level as on a local level. Social determinants of cardiovascular diseases are found largely outside the healthcare and preventative healthcare systems; but it is important to think in terms of chains of cause and effect, which enable us to see these determinants at work within the system of curative and preventative care, including the management of traditional risk factors. Taking a dynamic perspective on these social determinants of health, and in particular viewing them in a biological and epidemiological context, emphasizes the fact that intervention as early in life as possible is desirable in order to prevent cardiovascular diseases. It is important to act early, before childhood adversities in these critical periods are permanently or irrevocably recorded in the body. In terms of behaviour, focussing health education on adults runs counter to the fact that, with age, it is increasingly difficult to change our behaviour and to overcome biological damage already inflicted. In an area where attention has long been focussed on individual risk factors, underlining the fact that these factors act from infancy allows us to highlight the collective influences on the development of these diseases. Reflecting on health determinants in this way suggests that perhaps the population strategy proposed by Geoffrey Rose may lead to an increase in social inequalities if the modest decrease in risk factors, for example in terms of nutrition, involves the population categories initially most privileged

Campaigns as Gendered Institutions: A Case Study Between B.C. Premier and California Gubernational Campaigns

This paper will explore campaigns as gendered institutions using Acker’s framework of gendered organizations. Acker notes political institutions are defined by the absence of women, and campaigns are no different. This paper will explore two case studies: British Columbia’s 2017 Provincial Election and California’s 2010 Gubernational Race to identify how gendered institutions operate across electoral races. The framework of gendered institutions is applied by exploring how four components: the historical bias in job evaluation and candidate selection of the preferred “gender” traits; the decisions and procedures that control and construct hierarchies based on gender; the construction of symbols and gender ideology that give legitimacy to the institution and the process of “doing gender”. The case studies demonstrate that campaigns generally seem to be gendered in the same way with the exception of how campaign fundraising operates, which warrants further investigation. Additional research is needed to understand the extent to which campaigns as gendered institutions operate across political systems.

Effects of real versus phantom stock option plans on shareholder wealth

Helicobacter pylori causes chronic gastritis and avoids elimination by the immune system of the infected host. The commensal bacterium Lactobacillus acidophilus has been suggested to exert beneficial effects as a supplement during H. pylori eradication therapy. In the present study, we applied whole-genome microarray analysis to compare the immune responses induced in murine bone marrow-derived macrophages (BMDMs) stimulated with L. acidophilus, H. pylori, or both bacteria in combination. While L. acidophilus induced a Th1-polarizing response characterized by high expression of interferon beta (IFN-β) and interleukin 12 (IL-12), H. pylori strongly induced the innate cytokines IL-1β and IL-1α. In BMDMs prestimulated with L. acidophilus, H. pylori blocked the expression of L. acidophilus-induced IFN-β and IL-12 and suppressed the expression of key regulators of the Rho, Rac, and Cdc42 GTPases. The inhibition of L. acidophilus-induced IFN-β was independent of H. pylori viability and the virulence factor CagPAI; however, a vacuolating cytotoxin (vacA) mutant was unable to block IFN-β. Confocal microscopy demonstrated that the addition of H. pylori to L. acidophilus-stimulated BMDMs redirects intracellular processing, leading to an accumulation of L. acidophilus in the endosomal and lysosomal compartments. Thus, our findings indicate that H. pylori inhibits the development of a strong Th1-polarizing response in BMDMs stimulated with L. acidophilus by blocking the production of IFN-β in a VacA-dependent manner. We suggest that this abrogation is caused by a redirection of the endocytotic pathway in the processing of L. acidophilus. IMPORTANCE Approximately half of the world's population is infected with Helicobacter pylori. The factors that allow this pathogen to persist in the stomach and cause chronic infections have not yet been fully elucidated. In particular, how H. pylori avoids killing by macrophages, one of the main types of immune cell underlying the epithelium, remains elusive. Here we have shown that the H. pylori virulence factor VacA plays a key role by blocking the activation of innate cytokines induced by the probiotic Lactobacillus acidophilus in macrophages and suppresses the expression of key regulators required for the organization and dynamics of the intracellular cytoskeleton. Our results identify potential targets for the treatment of H. pylori infection and vaccination, since specific inhibition of the toxin VacA possibly allows the activation of an efficient immune response and thereby eradication of H. pylori in the host

Comprehensive School Reform: A Study on the Effectiveness of the High Schools That Work Program in Texas

This mixed methods, sequential explanatory research study evaluated the effectiveness of a comprehensive school reform program titled High Schools That Work (HSTW). High schools were tasked with having students meet passing standards on high-stakes assessments or face sanctions. This study was necessary because, as Herman et al. (2008) said, “unfortunately, the research base on effective strategies for quickly turning around low-performing schools is sparse” (p. 4). Quantitative and qualitative data were collected to determine if schools improved after the HSTW program was implemented. First, Academic Excellence Indicator System reports on Texas HSTW program schools were downloaded from the Texas Education Agency’s website. At least 3 consecutive years of data from 2005–2012 was needed. Demographic and performance data were used to determine which schools to include. Second, administrator and teacher surveys were distributed online to participants. Third, a basic interpretive and descriptive qualitative study was conducted in which 5 administrators were interviewed regarding HSTW experiences. Data from all 3 sources were linked and conclusions were drawn about HSTW implementation and its impact on students’ academic performance. Results from the study yielded positive results for the HSTW program. On average, 10th grade students’ academic performance improved in the areas of English language arts (ELA) and mathematics for all students and for subpopulations in Year 5 after implementation. Limited English proficient and economically disadvantaged subpopulations’ scores improved, but the special education subpopulation demonstrated the greatest increase. 6 of 10 HSTW key components assessed from surveying administrators and teachers included guidance, keeping score, teachers working together, academic studies, program of study, work-based learning, and students actively engaged. Administrators, teachers, and parents were committed to implementing HSTW. High levels of collaboration with peers and tri-level support (school administrators, district administrators, and HSTW staff) resulted in increased buy-in. 5 administrators were interviewed and the following themes emerged: implementation, support for implementation, change culture, structure and preplanning, monitoring and feedback, and data gathering. 4 of 5 administrators had positive experiences with implementing HSTW. Responses from interviews were similar to survey responses indicating that a high level of support and collaboration was instrumental in program effectiveness. Connecting themes revealed convergent patterns that emerged from collecting multiple forms of data. Results suggested that HSTW was an effective comprehensive school reform when implemented with fidelity. HSTW was most successful in closing achievement gaps between special education students’ average assessment scores and all students’ scores. Administrators and teachers collaborated and received tri-level support creating experiences that led to commitment to the program. Relationships fostered buy-in to implementing the program, inevitably leading to program success. Replicating the current study is feasible for evaluating the effectiveness of other Comprehensive School Reform programs

A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses

International audienceAdverse childhood experiences (ACEs) have emerged as a major research theme. They make reference to an array of potentially harmful exposures occurring from birth to eighteen years of age and may be involved in the construction of health inequalities over the lifecourse. As with many simplified concepts, ACEs present limitations. They include diverse types of exposures, are often considered cumulatively, can be identified using prospective and retrospective approaches, and their multidimensional nature may lead to greater measurement error. From a public health perspective, ACEs are useful for describing the need to act upon complex social environments to prevent health inequalities at a population level. As the ACEs concept becomes popular in the context of policy interventions, concerns have emerged. As a probabilistic and population-level tool, it is not adapted to diagnose individual-level vulnerabilities, an approach which could ultimately exacerbate inequalities. Here, we present a critique of the ACEs framework, discussing its strengths and limits

Predictors of engagement with support services in a sample of UK victims of violent crime.

Research suggests that engagement with support services after criminal victimisation is low. With this in mind, this study investigated predictors of engagement with Victim Support, in a sample of victims of violent crime. All violent crimes recorded by Lancashire Constabulary for two postcode areas (PR1 and PR2), who were referred to Victim Support (Preston) between April 2013 and September 2013 (n=869) were assessed, with a follow-up undertaken in 2014. Two percent of victims booked or attended a face-to-face meeting with Victim Support, and just over one fifth engaged over the telephone on at least one occasion across a range of support options at the initial data collection point. Engagement with Victim Support was not significantly related to future victimisation. When revictimisation since the first data collection period was inspected against demographic and crime-related variables, previous victimisation, regardless of the type of crime experienced, was the strongest predictor of being victimised again. This was despite the fact that such victims were more likely to be identified as high risk, and actively engaged with Victim Support at the initial time of victimisation. Suggestions for further research are made in light of the changes generally to victim services in the UK