Risk and Protective Factors for Secondary Traumatic Stress and Burnout Among Home Visitors

The overarching goal of this study was to understand the context of home visitor secondary traumatic stress and burnout, and how this might affect intention to quit among home visitors, particularly focusing on potential risk factors and supportive strategies identified by the home visitors. All home visitors providing services in the state in which the research was conducted (N = 27) completed a structured interview and a quantitative survey at two time points, 6 months apart. Results indicated that more than two-thirds of the home visitors experienced either medium or high levels of secondary traumatic stress and burnout over the course of the study. Approximately one quarter of home visitors indicated thinking of leaving their present positio. Qualitative data indicated that risk factors associated with burnout included those related to both direct and non-direct services. Risk factors associated with secondary traumatic stress included traumatic stress of families, inability to recognize one’s own experiences of secondary traumatic stress, and unhealthy work culture. In terms of protective factors, home visitors strongly emphasized the importance of having a supportive supervisor who they could trust and communicate with openly

Developing a Cognition Scale Using Items from Three Federally Mandated Assessments in Post-Acute Care

The purpose of this work is to create a cognitive measure detecting change in cognitive deficits for post-acute stroke patients. Many individuals with stroke experience cognitive impairment contributing to ongoing disability. Identifying change in cognitive skills in response to treatment is important for demonstrating the value of rehabilitation services. Yet, the ability of federally mandated post-acute assessments to detect change has not been described. A total of 147 stroke patients in post-acute care receiving rehabilitation services were assessed using 26 cognition items from the federally mandated assessments. Rasch analysis, using the partial credit model, was conducted to evaluate the construct validity of these items. The standardized effect size (ES), response mean (SRM), and minimal detectable change (MDC) were calculated using MedCalc. Six items created a logical hierarchy for the cognition construct. Two items--long-term and short-term memory—represented the easiest and hardest items, respectively. The remaining items are problem-solving, memory, decision-making, and cognitive function. Evidence of good construct validity: Eigenvalue=2.13, unexplained variance in first contrast=7.5%, and person separation reliability of 0.87, person strata=3.8. Evidence of person-item alignment: adequate person fit, moderate ceiling effect, and person mean=1.53. Evidence of responsiveness: improvers (n=74) large ES 0.72, large SRM 1.19, 10% of patients made a change beyond the MDC. The six identified cognitive items from the federally mandated post-acute care assessment tools represents a continuum of cognitive performance areas, from foundational arousal skill through higher level problem-solving. Advancing meaningful, precise cognitive assessment will help identify effective occupation-based cognitive skill training strategies for stroke survivors

Classroom Level Effects of Children’s Prior Participation in Child Care

Previous research indicates that children who spend many hours in early child care exhibit more externalizing behavior problems than children who spend less time in child care. Concern has been expressed regarding the cumulative effect of these problem behaviors on elementary school classes. We collected information about children’s child-care histories from parents of first through fourth graders (N = 429) and about classroom functioning from their teachers (N = 31). We analyzed associations between the proportion of children in the class who had spent many hours in care prior to school entry and teachers’ reports of the time they spent in instruction and management, the difficulty they had in teaching and managing the class and the frequency of students’ positive and negative behavior in the classroom. No significant associations were found to support the contention that prior child-care participation negatively affects classroom functioning

Centrosome amplification induces high grade features and is prognostic of worse outcomes in breast cancer

Table S1. Patient characteristics. Table S2. Hazard ratios from multivariate analysis. Table S3. Sequences of primers used for qRT-PCR. Figure S1. Distribution of average centrosome number per cell in the breast cancer patients represented in our TMA. Figure S2. Correlations between centrosome amplification and nodal status, patient age, and tumor size. Figure S3. Centrosome clustering but not structural abnormalities correlate with worse outcomes in breast cancer. Figure S4. CIN is prognostic of worse breast cancer-related survival. Figure S5. Centrosome amplification correlates with adverse clinical factors. Figure S6. CA correlates with higher ploidy and CIN. (DOCX 6223 kb

Evaluation of Online Consumer Health Information for Idiopathic Scoliosis Identified by a Google Search

Introduction. This study sought to assess the quality of online consumerhealth information about idiopathic scoliosis. Previous studiesshowed that quality of online health information varies and oftenlacks adherence to expert recommendations and guidelines. Nevertheless,72% of internet users seek health information online. A 2005analysis of online scoliosis information found that the informationwas limited and of poor quality. Methods. Two reviewers vetted the top 10 websites resulting from aGoogleTM search for “scoliosis.” Content was organized into categoriesand rated by three physician evaluators using a 1 - 5 scale basedon quality, accuracy, completeness of information, readability, andwillingness to recommend. Additional information, such as numberof ads and Flesch-Kinkaid reading level, also was collected. Results. The average overall physician score was 47.6 (75 possible).All websites included content that was mostly accurate but varied incompleteness. Physicians unanimously recommended Mayo Clinic,MedicineNet, and Kids Health; none recommended the GoogleTMKnowledge Graph. The Scoliosis Research Society website reachedthe highest overall physician score. Readability ranged from 7th gradeto college level; only that of Kids Health was below 10th grade level. Conclusions. Most essential information provided by the websiteswas accurate and generally well rated by physicians. Website rankingby physicians was inconsistent with the ranking order by GoogleTM,indicating that health seekers reviewing the top GoogleTM-rankedwebsites may not be viewing the websites rated highest by physicians.Physicians should consider patient literacy in website recommendations,as many have an above average literacy level.Kans J Med 2018;11(4):95-101

Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care

OBJECTIVE: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. METHODS: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. FINDINGS: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. CONCLUSION: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient-provider communication regarding the importance placed on different conditions

Perceptions of Dry Eye Disease Management in Current Clinical Practice

To assess the perceptions of eye care providers regarding the clinical management of dry eye