Perspectives on the Professional Communication Profile and Needs of Emerging Occupational Therapists of the Millennial Generation: A Comparison Study

Background: Millennials, born between 1982­ and 2000, became the largest share of the American workforce in 2015. As of 2014, 23.9% of American occupational therapists were under the age of 30. Positive traits ascribed to millennials include: highly educated, ambitious, confident, and optimistic. However, indicators of challenges for managing millennials emerge from media and anecdotal evidence, including stereotypes of disloyalty, entitlement, dependency, and casualness. Relevant for supporting professional development is a call to understand and enhance professional communication. Method: This study analyzed how emerging millennial occupational therapists self-describe their professional communication profile and needs, compared to the perspective of managers, while aiming to describe the accuracy of communication stereotypes. Occupational therapy managers and emerging occupational therapists of the millennial generation completed an online researcher-created survey. Results: Comparison of means revealed statistically significant differences, with the most significance noted on items reflecting professional communication skills of millennial occupational therapists. Conclusion: Analysis of results suggested support for some stereotypes and inaccuracy of others, painting a unique picture of the professional communication profile of millennial occupational therapists. Results from this small-population survey study may inform professional development opportunities for academic and fieldwork educators and occupational therapy managers related to the communication profile and needs of emerging occupational therapists through the lens of generational theory

The Effectiveness of Cognitive Behavioral Therapy on Management of Symptoms in Rheumatoid Arthritis Patients

Objectives: To carry out a systematic review of literature examining the effectiveness of cognitive behavioral therapy (CBT) alongside pharmacological treatment of rheumatoid arthritis (RA) symptoms compared to pharmacological treatments (standard care) without CBT. Methods: The Iowa Model of Evidence-Based Practice to Promote Quality Care was used as the theoretical framework for this review of literature. Databases utilized: CINAHL, OneSearch, PubMed, and MedLine. The inclusion criteria for this search were: CBT as an intervention, articles published within 2006-2016, and English full text articles. Exclusion criteria were: participants less than 18 years of age, interventions other than CBT, or any other type of arthritis that was not RA. Out of 96 articles found, 10 were included in this review of literature. Results: Out of the 10 articles chosen for this review, included were: 51 randomized controlled trials, 31 studies, 47 transcripts, and 5,345 participants. In seven articles pain and depression symptoms showed improvement with CBT; six articles showed fatigue and physical activity improved. However, only one demonstrated evidence that CBT improved anxiety symptoms. Conclusion: This review of literature focused on how CBT in combination with standard care for RA (pharmacological therapy) would affect symptom management. Evidence suggests that CBT is an effective treatment intervention alongside pharmacological therapy on management of symptoms in RA. Research evaluating the long-term effects, overall quality of life, and maintenance therapy related to CBT should be explored further

Time for change: a new training programme for morpho-molecular pathologists?

The evolution of cellular pathology as a specialty has always been driven by technological developments and the clinical relevance of incorporating novel investigations into diagnostic practice. In recent years, the molecular characterisation of cancer has become of crucial relevance in patient treatment both for predictive testing and subclassification of certain tumours. Much of this has become possible due to the availability of next-generation sequencing technologies and the whole-genome sequencing of tumours is now being rolled out into clinical practice in England via the 100 000 Genome Project. The effective integration of cellular pathology reporting and genomic characterisation is crucial to ensure the morphological and genomic data are interpreted in the relevant context, though despite this, in many UK centres molecular testing is entirely detached from cellular pathology departments. The CM-Path initiative recognises there is a genomics knowledge and skills gap within cellular pathology that needs to be bridged through an upskilling of the current workforce and a redesign of pathology training. Bridging this gap will allow the development of an integrated 'morphomolecular pathology' specialty, which can maintain the relevance of cellular pathology at the centre of cancer patient management and allow the pathology community to continue to be a major influence in cancer discovery as well as playing a driving role in the delivery of precision medicine approaches. Here, several alternative models of pathology training, designed to address this challenge, are presented and appraised

Improvements in the South African HIV care cascade: findings on 90-90-90 targets from successive population-representative surveys in North West Province.

IntroductionTo achieve epidemic control of HIV by 2030, countries aim to meet 90-90-90 targets to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population-representative surveys.MethodsData were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi-stage cluster sample included 46 enumeration areas (EA), a target of 36 dwelling units (DU) per EA, and a single resident aged 18 to 49 per DU. Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time.ResultsOverall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV (PLHIV) remained similar at 68.7% (95% Confidence Interval (CI) = 60.9-75.6) in 2014 and 72.8% (95% CI = 63.6-80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9-87.4) to 91.5% (95% CI = 84.4-95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6-70.4) in 2014 to 81.4% (95% CI = 72.0-90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8-80.1) of women and 45.8% (95% CI = 27.0-64.7) of men achieved viral suppression by 2016.ConclusionsOver a period during which fixed-dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90-90-90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men

Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster-randomized trial.

OBJECTIVE: To assess the effect of Helping Mothers Survive Bleeding after Birth training on postpartum hemorrhage (PPH) near miss and case fatality rates in Uganda. METHODS: Training was evaluated using a cluster-randomized design between June 2016 and September 2017 in 18 typical rural districts (clusters) in Eastern and Central Uganda of which nine districts were randomly assigned to the intervention. The main outcome was PPH near miss defined using the World Health Organization's disease and management-based approach. Interrupted time series analysis was performed to estimate the difference in the change of outcomes. RESULTS: Outcomes of 58 000 and 95 455 deliveries during the 6-month baseline and 10-month endline periods, respectively, were included. A reduction of PPH near misses was observed in the intervention compared to the comparison districts (difference-in-difference of slopes 4.19, 95% CI, -7.64 to -0.74); P<0.05). There was an increase in overall reported near miss cases (difference-in-difference 1.24, 95% CI, 0.37-2.10; P<0.001) and an increase in PPH case fatality rate (difference-in-difference 2.13, 95% CI, 0.14-4.12; P<0.05). CONCLUSION: This pragmatic cluster-randomized trial conducted in typical rural districts of Uganda indicated a reduction of severe PPH cases while case fatality did not improve, suggesting that this basic training needs to be complemented by additional measures for sustained mortality reduction. TRIAL REGISTRATION: PACTR201604001582128

The Tibetan Uterotonic Zhi Byed 11: Mechanisms of Action, Efficacy, and Historical Use for Postpartum Hemorrhage

Objective. To explore evidence for the traditional Tibetan medicine, Zhi Byed 11 (ZB11), for use as a uterotonic. Methods. The eleven ingredients in ZB11 were chemically analyzed by mass spectroscopy. A review was conducted of Western allopathic literature for scientific studies on ZB11's individual components. Literature from Tibetan and other traditional paradigms were reviewed. Results. Potential mechanisms of action for ZB11 as a uterotonic include laxative effects, a dose-dependant increase in smooth muscle tissue peristalsis that may also affect the uterus smooth muscle, and chemical components that are prostaglandin precursors and/or increase prostaglandin synthesis. A recent RCT demonstrated comparable efficacy to misoprostol in reducing severe postpartum hemorrhage (PPH) (>1000 mL) and greater effect than placebo. Historical and anecdotal evidence for ZB11 and its ingredients for childbirth provide further support. Discussion. ZB11 and its ingredients are candidates for potentially effective uterotonics, especially in low-resource settings. Further research is warranted to understand the mechanisms of action and synergy between ingredients

Adrenocortical attunement, reactivity, and potential genetic correlates among parent–daughter dyads from low-income families

Examining the multitude of influences on the development of adolescent stress responses, especially among low-income families, is a critical and understudied topic in the field. The current study examined cortisol attunement between adolescent girls and parents (mostly mothers) from predominantly low-income, single parent, ethnic minority families before and after an in-laboratory disagreement discussion task. The sample consisted of 118 adolescents (Mage = 13.79 years, 76.3% ethnic minorities, 23.7% European Americans) and primary caregivers (Mage = 40.62 years; Mdn yearly income = $24,000; 43.2% single parents; 50% living below poverty line). We investigated oxytocin receptor (OXTR rs53576) gene variations as a potential contributor to attunement within the dyad. Results showed that parents and adolescents showed stress system attunement across the disagreement task, but that parent and adolescent oxytocin receptor genotype did not impact attunement. Future studies should detail biological factors that contribute to the calibration of stress response systems of adolescents across a variety of samples, particularly those experiencing a combination of stressors

First Detection of Mycobacterium ulcerans DNA in Environmental Samples from South America

The occurrences of many environmentally-persistent and zoonotic infections are driven by ecosystem changes, which in turn are underpinned by land-use modifications that alter the governance of pathogen, biodiversity and human interactions. Our current understanding of these ecological changes on disease emergence however remains limited. Buruli ulcer is an emerging human skin disease caused by the mycobacterium, Mycobacterium ulcerans, for which the exact route of infection remains unclear. It can have a devastating impact on its human host, causing extensive necrosis of the skin and underlying tissue, often leading to permanent disability. The mycobacterium is associated with tropical aquatic environments and incidences of the disease are significantly higher on floodplains and where there is an increase of human aquatic activities. Although the disease has been previously diagnosed in South America, until now the presence of M. ulcerans DNA in the wild has only been identified in Australia where there have been significant outbreaks and in western and central regions of Africa where the disease is persistent. Here for the first time, we have identified the presence of the aetiological agent's DNA in environmental samples from South America. The DNA was positively identified using Real-time Polymerase Chain Reaction (PCR) on 163 environmental samples, taken from 23 freshwater bodies in French Guiana (Southern America), using primers for both IS2404 and for the ketoreductase-B domain of the M. ulcerans mycolactone polyketide synthase genes (KR). Five samples out of 163 were positive for both primers from three different water bodies. A further nine sites had low levels of IS2404 close to a standard CT of 35 and could potentially harbour M. ulcerans. The majority of our positive samples (8/14) came from filtered water. These results also reveal the Sinnamary River as a potential source of infection to humans. © 2014 Morris et al