Physician perceived barriers to smoking cessation counseling: A rural vs. urban perspective.

BACKGROUND: It has been well established that smoking is one of the primary causes of not only cardiovascular disease but many chronic diseases associated with both high morbidity and mortality. Smoking cessation is one of the few areas in which physician counseling has shown to be effective in eliciting patient lifestyle modifications.11, 12 However, physicians have been shown to do a very poor job of assessing a patients willingness to quit, counseling or assisting them in quitting, and arranging for follow up21 yet, it is not well documented why that is the case. We are interested the perceived barriers to smoking cessation counseling for physicians in New Mexico and whether or not there is a difference in those perceived barriers for rural and urban physicians. METHODS AND RESULTS: We conducted a survey by mail of rural and urban family practice and internal medicine physicians selected at random in the State of New Mexico to determine if frequencies of perceived barriers are different for urban and rural family practice physicians. The survey included a choice of five possible barriers a physician can encounter in counseling patients on smoking cessation. Survey forms were sent to 500 physicians, 101 urban and 98 rural surveys were returned. No statistically significant difference was found between the rural and urban groups for any of the barriers. However, the study was only powered to detect up to a 19% difference between the groups. Based on our calculated Confidence Intervals (ranging from -21-26%), up to a 26% difference could have been missed. Our study did show that for both rural and urban physicians \u27Lack of Time\u27 and \u27Patient\u27s Unwillingness to Change\u27 are central barriers to smoking cessation counseling. CONCLUSIONS: While the study was not powered to detect differences based on the response rate, there were actual differences between the groups as reported in percentages. These were very interesting and could indeed be important. Also, lack of time and patient\u27s unwillingness to change are central barriers to smoking cessation counseling for New Mexico physicians. More research is needed on ways to assist primary care physicians to overcome these identified barriers in order to implement effective smoking cessation interventions.\u2

The State of Personnel Preparation: Secondary Transition

Presentation at the CEC Division on Career Development and Transition (DCDT) Annual Conference

Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial

Summary: Background: Functional motor disorder—the motor variant of functional neurological disorder—is a disabling condition that is commonly associated with poor health outcomes. Pathophysiological models have inspired new treatment approaches such as specialist physiotherapy, although evidence from large randomised controlled trials is absent. We aimed to assess the clinical effectiveness of a specialist physiotherapy intervention for functional motor disorder compared with treatment as usual. Methods: In this pragmatic, multicentre, phase 3 randomised controlled trial at 11 hospitals in England and Scotland, adults with a clinically definite diagnosis of functional motor disorder, diagnosed by a neurologist, were included. Participants were randomly assigned (1:1, stratified by site) using a remote web-based application to either specialist physiotherapy (a protocolised intervention of nine sessions plus follow-up) or treatment as usual (referral to local community neurological physiotherapy). Individuals working on data collection and analysis were masked to treatment allocation. The primary outcome was the physical functioning domain of the 36-item short form health questionnaire (SF36) at 12 months after randomisation. The primary analysis followed a modified intention-to-treat principle, using a complete case approach; participants who were unable to receive their randomised treatment due to the suspension of health-care services during the COVID-19 pandemic were excluded from the primary analysis. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN56136713, and is completed. Findings: Recruitment occurred between Oct 19, 2018, and March 11, 2020, pausing during the COVID-19 lockdown, and resuming from Aug 3, 2021, to Jan 31, 2022. Of 355 participants who were enrolled, 179 were randomly assigned to specialist physiotherapy and 176 to treatment as usual. 89 participants were excluded from the primary analysis due to COVID-19 interruption to treatment (27 were assigned to specialist physiotherapy and 62 to treatment as usual). After accounting for withdrawals (n=11) and loss to follow-up (n=14), the primary analysis included data from 241 participants (138 [91%] assigned specialist physiotherapy and 103 [90%] assigned treatment as usual). Physical functioning, as assessed by SF36, did not differ significantly between groups (adjusted mean difference 3·5, 95% CI –2·3 to 9·3; p=0·23). There were no serious adverse events related to the trial interventions. 35 serious adverse events were recorded in the specialist physiotherapy group by 24 participants (17·0%), and 24 serious adverse events were recorded in the treatment as usual group by 18 participants (17·0%); one death occurred in the specialist physiotherapy group (cause of death was recorded as suicide). All were considered unrelated to specialist physiotherapy. Interpretation: Although more participants who were assigned specialist physiotherapy self-rated their motor symptoms as improved and had better scores on subjective measures of mental health, the intervention did not result in better self-reported physical functioning at 12 months. Both the specialist and community neurological physiotherapy appeared to be a safe and a valued treatment for selected patients with functional motor disorder. Future research should continue to refine interventions for people with functional motor disorder and develop evidence-based methods to guide treatment triage decisions. Funding: National Institute for Health and Care Research and Health Technology Assessment Programme

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

The National Physical Therapist Assistant Examination\u27s First Time Pass Rates and Their Relationship to Education Program Faculty Attributes

Background and Purpose. There is a paucity of published literature regarding the correlation between faculty attributes and education program pass rates on the National Physical Therapy Examination (NPTE) particularly regarding the physical therapist assistant (PTA). The purpose of this study was to 1) determine if there is a relationship between faculty attributes in PTA educational programs and program outcomes on the NPTE for Physical Therapist Assistants (NPTE-PTA) and 2) construct a prediction model for PTA program outcomes based on faculty attributes. Subjects. The 233United States’ PTA programs accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) in 2006 were studied. Methods. Using a retrospective design, data were obtained regarding the PTA programs from the dataset of CAPTE’s PTA annual accreditation report and the Federation of State Boards of Physical Therapy’s pass rate database. Selected faculty attributes (designation of highest degree conferred, years of teaching experience, employment status, license designation [physical therapist or physical therapist assistant] and clinical specialization) were correlated to first time program pass rates. Backward deletion regression was used to predict the first time pass rate on the NPTE-PTA.Results. Based on data from 190/233 PTA programs, seven attributes had a statistically significant relationship to the outcomes on the NPTE-PTA. They were the number of: 1) full-time faculty; 2) adjunct faculty with an associate’s degree; 3) full-time faculty with a terminal degree; 4) core faculty with a terminal degree; 5) all faculty with a terminal degree 6) years of teaching experience of the full-time faculty; 7) years of teaching experience of the core faculty. Backward deletion regression analyses demonstrated an overall model of two combined predictor factors (full-time faculty years of teaching and full-time faculty terminal degree) that significantly predicted the first time pass rate on the NPTE-PTAaccounting for 6.5% of the variance. Discussion and Conclusion. Faculty attributes of the institutions providing PTAprograms are associated with first time pass rates of their graduates. This study provides a foundation for future studies by identifying some of the faculty attributes that relate to NPTE-PTA outcomes

Brightmoor Community Marketing Plan

This report examined current trends and recommendations to rejuvenate the main commercial corridor in the neighborhood. Consisting of a socioeconomic analysis, a review of previous Brightmoor studies, an analysis of Strengths, Weaknesses, Opportunities, and Threats (S.W.O.T.), a comparative market study, parcel corridor evaluation of current physical conditions, and recommendations, this project is a valuable resource for communities interested in neighborhood rejuvenation