Isolated Voices: Perspectives of Teachers, School Nurses, and Administrators Regarding Implementation of Sexual Health Education Policy.

BackgroundComprehensive sexual health education (SHE) reduces risky sexual behavior and increases protective behavior in adolescents. It is important to understand how professionals responsible for implementing SHE policy interpret state and local policy and what influences their commitment to formal SHE policy implementation.MethodsThis descriptive study explored content and delivery of SHE policy in a rural, southwestern state with high levels of poverty, unintended adolescent pregnancy, and sexually transmitted infections. The social ecological model (SEM) was used to better understand levels of influence on the implementation of SHE policy.ResultsWe conducted telephone surveys with 38 teachers, 63 nurses, and 21 administrators in public secondary schools. There was substantial local variability in the scope and content of SHE curricula. Respondents identified significant barriers to the delivery of SHE content and minimal evaluation of whether educational objectives were met. Based on participant responses, community and organizational SEM levels had the greatest influence on SHE policy implementation, although examples of all SEM levels were identified.ConclusionsGiven perceived challenges regarding subject matter, successful SHE implementation at the local level requires committed stakeholders working in concert at the school and community levels, backed by strong policy commitment at the state level

Test–retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

BACKGROUND: Dyspnea is among the most common reasons for emergency department (ED) visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients. METHODS: Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154) completed the Multidimensional Dyspnea Profile (MDP) several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68). The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP) or at the time of administration (“now” MDP). The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA) with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficients (ICCs) for absolute agreement for individual items and domains. RESULTS: PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach’s alpha = .89 to .94; Emotional Response, 5 items; Cronbach’s alpha = .81 to .85). Test–retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66) and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively). CONCLUSIONS: During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for individual items and the two domains, that a time lag between arrival and questionnaire administration does not critically affect recall of perceptual and emotional characteristics immediately prior to the visit. However, test–retest reliability of recall over a 4- to 6-week interval is poor for individual items and significantly attenuated for the two domains

Resident and Facility Factors Associated with Rehospitalization from Skilled Nursing Facilities

ABSTRACT Older adults often require short-term nursing home care after an acute hospital stay to receive skilled nursing or rehabilitation services. Rehospitalization after a skilled nursing facility (SNF) admission is a potential indicator of poor nursing home quality that is associated with substantial risks of complications and increased costs of care. This study examined resident and facility factors associated with 30-day rehospitalizations during a one-year study period from SNFs in New Mexico. The Minimum Data Set 3.0 was used to explore resident factors and Nursing Home Compare data was used for facility factors. Among residents admitted to the SNF from an acute care hospital for 30-days or fewer (n = 2,370), 317 (13.4%) were rehospitalized. In bivariate analyses, several resident characteristics during their SNF stay were associated with significantly increased probability of rehospitalization, including an unhealed pressure ulcer, delirium, shortness of breath, and oxygen use. In multivariable models, the relative odds of rehospitalization were increased in those who identified as American Indian or Alaska Native, residents who rejected care, those with symptoms of delirium, and those who required greater mobility assistance with activities of daily living. The relative odds of rehospitalization were decreased in women and in residents with dementia. However, overall, none of the models improved prediction of rehospitalization. The Nursing Home Compare 5-star rating showed a decline in nurse staff ratings from 2015 to 2016. Policy implications include value-based penalties linked to high SNF rehospitalization rates and policies focused on reducing Medicare costs, while improving nursing home quality

Reliability and Validity of the Multidimensional Dyspnea Profile

Most measures of dyspnea assess a single aspect (intensity or distress) of the symptom. We developed the Multidimensional Dyspnea Profile (MDP) to measure qualities and intensities of the sensory dimension and components of the affective dimension. The MDP is not indexed to a particular activity and can be applied at rest, during exertion, or during clinical care. We report on the development and testing of the MDP in patients with a variety of acute and chronic cardiopulmonary conditions

Incontri, scontri, confronti Appunti sulla ricezione della xilografia nordica in Italia tra XV e XX secolo

Germany, France, Italy: the attribution of the first woodcut images has long been debated between several countries, to gain the technological primacy of the invention of reproductive printmaking, before Gutenberg’s movable type printing. Today we know how difficult it is, if not impossible, to establish a place and a date of origin of image printing in Europe. Impossible and probably unimportant. Printing was a European phenomenon in the 15th century, and we may ask ourselves whether a northern woodcut beyond the Italian borders was intended as something different than an Italian one. The contrast between northern and southern prints, which has been claimed by art historians from Vasari until the half of the 20th century, seems to be denied by early modern Italian sources. For example, a German woodcut from the first decades of the 15th century and a Florentine painting from the end of the 14th century can coexist as models for the illumination of the same manuscript. This unpublished case study of two Florentine 15th-century illuminations shows how a European cultural horizon was more common than we think today, and how much woodcut has been a fundamental tool for this broadening of horizons, since its very beginning

The need to research refractory breathlessness

High-quality research is needed to improve quality of life for people with chronic refractory breathlessness in COP

Personal growth, symptoms, and uncertainty in community-residing adults with heart failure.

BACKGROUND: Personal growth has not been studied extensively in heart failure (HF). OBJECTIVES: To characterize personal growth in HF and its relationships with symptom burden, uncertainty, and demographic and clinical factors. METHODS: Associations among personal growth, uncertainty, symptom burden, and clinical and demographic variables were examined in adult outpatients with HF using bivariate correlations and multiple regressions. RESULTS: Participants (N = 103; 76% male, mean age = 74 years, 97% New York Heart Association classes II and III) reported moderate levels of personal growth, uncertainty, and symptom burden. Personal growth was weakly correlated with age and symptom burden but not with other study variables. In a regression model, age, sex, ethnicity, disease severity, time since diagnosis, symptom burden, and uncertainty were not significant independent correlates of personal growth. CONCLUSIONS: Community-residing patients with HF report moderate personal growth that is not explained by uncertainty, symptom burden, or demographic and clinical variables