An Exploratory Model of Shared Decision-Making in Women\u27s Reproductive Health in Indiana: A Cross-Sectional Study

Ecological approaches to shared decision-making (SDM) are underexplored in women’s reproductive health. The purpose was to identify ecological factors important to women in contraceptive and prenatal care SDM. In this cross-sectional study, women (18-45 years) living in Indiana who had sought reproductive healthcare completed an online survey (N=432). Multiple linear regression was utilized to identify predictors of SDM. Furthermore, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were conducted to explore ecological factors associated with SDM in contraception and prenatal care. Healthcare professional type was associated with decreased contraceptive SDM scores, but not prenatal care SDM scores. Access, social support, and patient-healthcare professional relationship demonstrated good global fit in confirmatory factor analysis. Path coefficients suggested significant relationships between these ecological factors and contraceptive and prenatal care SDM scores. Additionally, the ecological factors demonstrated good global fit for contraceptive and prenatal care SDM. Social support had a significant, strong, and inverse relationship with both contraceptive and prenatal care SDM in the models. Findings further SDM work by moving beyond option discussion and toward increased attention to women’s contexts and relationships. Taking a holistic approach to SDM and the patient experience ensures that women’s multi-faceted needs, influences, and preferences are met across healthcare settings

A Qualitative Investigation of Individual, Interpersonal, and Institutional Contributions to Postpartum Work-Family Balance

Managing personal and professional responsibilities may be challenging during the postpartum period, as employees navigate new roles, responsibilities, and family dynamics. The purpose of this paper was to understand the work/life balance experiences of diverse stakeholders and identify opportunities to improve the work environment. We conducted a series of in-depth focus groups with faculty, staff, and graduate students (n = 22), and in-depth interviews with administrators (n = 10) at a research-intensive university in the United States. A six-phase thematic analysis approach was used to examine the experiences and perspectives of individuals with different roles. Three themes with subsequent subthemes emerged: 1) employee role shapes perspectives on campus policies and practices; 2) confusion about policies exacerbates return-to-work issues; and 3) coworkers and supervisors are the primary sources of postpartum support in this workplace. Employees in our study expressed strong desires for clear, consistent institutional policies to ensure employees’ postpartum return-to-work experiences were not dependent on informal arrangements with coworkers and supervisors. Faculty, staff, and graduate student postpartum needs are shaped by individual, interpersonal, and community factors. Clear communication between individuals who make policy decisions and those who are subject to the policies may reduce employee issues during the postpartum period

Associations between antibullying policies and bullying in 25 states

Importance Bullying is the most widespread form of peer aggression in schools. In an effort to address school bullying, 49 states have passed antibullying statutes. Despite the ubiquity of these policies, there has been limited empirical examination of their effectiveness in reducing students' risk of being bullied. Objective To evaluate the effectiveness of antibullying legislation in reducing students' risk of being bullied and cyberbullied, using data from 25 states in the United States. Design, Setting, and Participants A cross-sectional observational studywas conducted using a population-based survey of 63 635 adolescents in grades 9 to 12 from 25 states participating in the 2011 Youth Risk Behavior Surveillance System study (September 2010-December 2011). Data on antibullying legislation were obtained from the US Department of Education (DOE), which commissioned a systematic review of state laws in 2011. The report identified 16 key components that were divided into the following 4 broad categories: purpose and definition of the law, district policy development and review, school district policy components (eg, responsibilities for reporting bullying incidents), and additional components (eg, how policies are communicated). Policy variables from 25 states were linked to individual-level data from the Youth Risk Behavior Surveillance System on experiencing bullying and cyberbullying. Analyses were conducted between March 1, 2014, and December 1, 2014. Exposure State antibullying legislation. Main Outcomes and Measures Exposure to bullying and cyberbullying in the past 12 months. Results There was substantial variation in the rates of bullying and cyberbullying across states. After controlling for relevant state-level confounders, students in states with at least 1 DOE legislative component in the antibullying law had a 24%(95%CI, 15%-32%) reduced odds of reporting bullying and 20%(95%CI, 9%-29%) reduced odds of reporting cyberbullying compared with students in states whose laws had no DOE legislative components. Three individual components of antibullying legislation were consistently associated with decreased odds of exposure to both bullying and cyberbullying: statement of scope, description of prohibited behaviors, and requirements for school districts to develop and implement local policies. Conclusions and Relevance Antibullying policiesmay represent effective intervention strategies for reducing students' risk of being bullied and cyberbullied in schools. Copyright 2015 American Medical Association. All rights reserved

“They Aren’t Going to Do Jack Shit”: Text-Based Crisis Service Users’ Perceptions of Seeking Child Maltreatment-Related Support From Formal Systems

Many of the children reported to child protective services (CPS) exhibit signs and symptoms that allow others to recognize their abuse or neglect and intervene; others, especially adolescents, must disclose their experiences to be identified. Relatively little is known about young people’s disclosure experiences, but individual, interpersonal, and cultural factors appear to influence when and how young people disclose. Technology-facilitated approaches, such as text- or chat-based hotlines or crisis services, may be one way to help young people share their maltreatment experiences and seek help. The current study contributes to the small body of literature that includes nonsexual maltreatment disclosures and sheds some light on how to support young people during their disclosures. We conducted a qualitative content analysis of all conversations from a text-based crisis service that resulted in a report to CPS (n = 244). Many of the texters had previously sought support from their peers or parents, and some had engaged with more formal systems. Many young people were hesitant to reach out to formal systems in the future, in part because of negative experiences during past disclosure experiences. Young people may be more likely to seek support through their preferred communication medium, so providing text- and chat-based communication may be one way to encourage and facilitate disclosure. As these resources become increasingly available, determining best practices for receiving disclosures through technology-facilitated platforms will be critical

Musculoskeletal physiotherapists’ use of psychological interventions::A systematic review of therapists’ perceptions and practice

Background Research has demonstrated that incorporating psychological interventions within physiotherapy practice has numerous potential benefits. Despite this physiotherapists have reported feeling inadequately trained to confidently use such interventions in their day-to-day practice. Objective To systematically review musculoskeletal physiotherapists’ perceptions regarding the use of psychological interventions within physiotherapy practice.Data sources Eligible studies were identified through a rigorous search of AMED, CINAHL, EMBASE, MEDLINE and PsychINFO from January 2002 until August 2013.Study eligibility criteria Full text qualitative, quantitative and mixed methodology studies published in English language investigating musculoskeletal physiotherapists’ perceptions regarding their use of psychological interventions within physiotherapy practice.Study synthesis and appraisal Included studies were appraised for risk of bias using the Critical Appraisal Skills Programme qualitative checklist. Meta-analysis was not possible due to study heterogeneity.Results Six studies, all with a low risk of bias, met the inclusion criteria. These studies highlighted that physiotherapists appreciate the importance of using psychological interventions within their practice, but report inadequate understanding and consequent under utilisation of these interventions.Limitations These results should be noted with some degree of caution due to various limitations associated with the included studies and with this review, including the use of a qualitative appraisal tool for mixed methodology/quantitative studies.Conclusion These findings suggest that musculoskeletal physiotherapists are aware of the potential benefits of incorporating psychological interventions within their practice but feel insufficiently trained to optimise their use of such interventions; hence highlighting a need for further research in this area and a review of physiotherapist training

Mechanisms of Autoantibody-Induced Pathology

Autoantibodies are frequently observed in healthy individuals. In a minority of these individuals, they lead to manifestation of autoimmune diseases, such as rheumatoid arthritis or Graves' disease. Overall, more than 2.5% of the population is affected by autoantibody-driven autoimmune disease. Pathways leading to autoantibody-induced pathology greatly differ among different diseases, and autoantibodies directed against the same antigen, depending on the targeted epitope, can have diverse effects. To foster knowledge in autoantibody-induced pathology and to encourage development of urgently needed novel therapeutic strategies, we here categorized autoantibodies according to their effects. According to our algorithm, autoantibodies can be classified into the following categories: (1) mimic receptor stimulation, (2) blocking of neural transmission, (3) induction of altered signaling, triggering uncontrolled (4) microthrombosis, (5) cell lysis, (6) neutrophil activation, and (7) induction of inflammation. These mechanisms in relation to disease, as well as principles of autoantibody generation and detection, are reviewed herein

Community Violence and Youth: Affect, Behavior, Substance Use, and Academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research

Dataset identifying the posts and comments used in our

Dataset identifies the number of posts per day during our data collection efforts and the posts/comments included in our analysis</p

Factors Contributing to Filicide-Suicide: Differences Between Male and Female Perpetrators

Background: One-quarter of homicide-suicide deaths in the U.S. are children. Filicide-suicide, a subset of homicide-suicide involving parent or caregiver perpetrators, is the most common form of homicide-suicide involving children. While these incidents have significant impacts, relatively few studies examine modifiable factors that contribute to these incidents. Objectives: The purpose of this study was to identify patterns of circumstances and contributing factors for filicide-suicide deaths, focusing on the individual and interpersonal differences between male and female perpetrators. Participants: This study utilized data from the National Violent Deaths Reporting System (NVDRS), which included 76 filicide-suicide incidents reported to NVDRS in 32 U.S. states between 2013-2015. Methods: We conducted a qualitative content analysis, which was grounded in the Marzuk et al. (1992) framework. We reviewed the filicide-suicide narratives and engaged in conversations about codes or themes that emerged for the filicide-suicide narratives. Additional codes were added as needed, and narratives were retroactively coded to ensure codes were consistently applied. Results: Relationship conflict and mental health issues were common among male and female perpetrators, but the manifestation of these factors differed greatly. For female perpetrators, relationship conflict, mental health issues, and children’s chronic health issues commonly co-occurred. In contrast, relationship conflict, history of violence, and consequences of violence (e.g., legal issues, job problems) more commonly co-occurred among male perpetrators. Conclusion: Filicide-suicides are preventable acts of violence with numerous contributing factors. Our findings highlight the need for prevention efforts to be grounded in these interpersonal experiences, particularly the differences between male and female perpetrators differences

Interactions of adolescent social experiences and dopamine genes to predict physical intimate partner violence perpetration.

OBJECTIVES:We examined the interactions between three dopamine gene alleles (DAT1, DRD2, DRD4) previously associated with violent behavior and two components of the adolescent environment (exposure to violence, school social environment) to predict adulthood physical intimate partner violence (IPV) perpetration among white men and women. METHODS:We used data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health, a cohort study following individuals from adolescence to adulthood. Based on the prior literature, we categorized participants as at risk for each of the three dopamine genes using this coding scheme: two 10-R alleles for DAT1; at least one A-1 allele for DRD2; at least one 7-R or 8-R allele for DRD4. Adolescent exposure to violence and school social environment was measured in 1994 and 1995 when participants were in high school or middle school. Intimate partner violence perpetration was measured in 2008 when participants were 24 to 32 years old. We used simple and multivariable logistic regression models, including interactions of genes and the adolescent environments for the analysis. RESULTS:Presence of risk alleles was not independently associated with IPV perpetration but increasing exposure to violence and disconnection from the school social environment was associated with physical IPV perpetration. The effects of these adolescent experiences on physical IPV perpetration varied by dopamine risk allele status. Among individuals with non-risk dopamine alleles, increased exposure to violence during adolescence and perception of disconnection from the school environment were significantly associated with increased odds of physical IPV perpetration, but individuals with high risk alleles, overall, did not experience the same increase. CONCLUSION:Our results suggested the effects of adolescent environment on adulthood physical IPV perpetration varied by genetic factors. This analysis did not find a direct link between risk alleles and violence, but contributes to growing research indicating that if genetic factors contribute to perpetration, this relationship is likely complicated and the result of interactions with other factors