Family Communication in a Population at Risk for Hypertrophic Cardiomyopathy

Encouraging family communication is an integral component of genetic counseling; therefore, we sought to identify factors impacting communication to family members at risk for Hypertrophic Cardiomyopathy (HCM). Participants (N = 383) completed an online survey assessing: 1) demographics (gender, genetic test results, HCM family history, and disease severity); 2) illness representations; 3) family functioning and cohesiveness; 4) coping styles; 5) comprehension of HCM autosomal dominant inheritance; and 6) communication of HCM risk information to at‐risk relatives. Participants were a national sample of individuals with HCM, recruited through the Hypertrophic Cardiomyopathy Association. Data from 183 participants were analyzed using a logistic regression analysis, with family communication as a dichotomous dependent variable. We found that female gender and higher comprehension of autosomal dominant inheritance were significant predictors of participants’ communication of HCM risk information to all their siblings and children. Our results suggest that utilizing interventions that promote patient comprehension (e.g., a teaching‐focused model of genetic counseling) are important and may positively impact family communication within families with HCM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147017/1/jgc40336.pd

The Effects of Green Exercise on Physical and Mental Wellbeing: A Systematic Review

We aimed to examine the evidence for the proposed additive effect of exercise in the presence of nature (green exercise) by systematically reviewing studies that investigated the effects of outdoor or virtual green exercise compared with indoor exercise. Our review updates an earlier review, whose searches were conducted in April 2010. Trials were eligible if: (a) participants in an outdoor or virtual exercise condition were exposed to views of nature (green exercise); (b) green exercise was compared with indoor exercise with no exposure to nature; (c) included an outcome related to physical or mental health; (d) used comparative or crossover trial design. We searched the following databases from 1st January 2010 to 28th June 2018: PubMed, CENTRAL, EMBASE, PsycINFO, GreenFile, and Sports DISCUS. We assessed risk of bias using the Cochrane “risk of bias” tool. Where possible we conducted a meta-analysis using the inverse variance random-effects method, and where this approach was not possible we presented the results qualitatively and in harvest plots. We identified 28 eligible trials. In a meta-analysis of just three longitudinal trials, the only statistical finding was slightly lower post-intervention perceived exertion with green versus indoor exercise (mean difference: −1.02; 95 confidence intervals: −1.88, −0.16). Compared with indoor exercise, acute bouts of outdoor green exercise may favorably influence affective valence and enjoyment, but not emotion, perceived exertion, exercise intensity, and biological markers. No other consistent statistical differences were observed, apart from a higher enjoyment of outdoor green versus virtual green exercise. We found a high risk of bias across trials and an overall low quality of evidence. In conclusion, there was limited evidence to support the view that green exercise offers superior benefits to exercise without exposure to nature. The low quality of evidence prohibits clear interpretation of trial findings. Future robust and rigorously designed trials are needed to evaluate the effects of long-term and multiple-bout exposure to nature during exercise compared with exercise indoors

Understanding the Role of Nature Engagement in Supporting Health and Wellbeing during COVID-19

The importance of natural environments in supporting health and wellbeing has been well evi-denced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications

Understanding the Role of Nature Engagement in Supporting Health and Wellbeing during COVID-19

The importance of natural environments in supporting health and wellbeing has been well evi-denced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications

The Humber and North Yorkshire Green Social Prescribing Programme Cohort Evaluation

There is a strong body of evidence that points to the mental health and wellbeing benefits of nature alongside a growing evidence base on the health and wellbeing benefits of green social prescribing (GSP). Central to the UK government’s commitment to transform mental health services, increase social prescribing (SP), and deliver personalised care, seven successful ‘test and learn’ GSP sites were identified across England, including the Humber and North Yorkshire (HNY) GSP programme. The aim of the ‘test and learn’ sites was to embed GSP into communities to improve mental health outcomes, reduce health inequalities, reduce demand on the health and social care system, and develop best practice in making green social activities more resilient and accessible. This report summarises the findings of the cohort evaluation, a key component of the HNY GSP programme, and reports on the mental health and wellbeing outcomes of participants who took part in nature-based activities linked to the GSP initiative. It discusses the findings in relation to the wider literature, key challenges identified by referring services involved in the cohort evaluation, alongside clinical implications, and future research opportunities in the area of GSP

Clima organizacional y liderazgo transformador en la empresa lácteos del hogar personal en la ciudad de florencia caquetá

No aplicaLa presente investigación tuvo como Objetivo recomendar a la Empresa Lácteos del Hogar Proponer un plan de acción para el mejoramiento de habilidades de liderazgo en pro de mejorar la productividad y las relaciones laborales de los mismos. En cuanto a la metodología se implementó la elaboración de la investigación sobre el liderazgo; y para la recolección de datos se empleó como técnica a la encuesta cualitativa con un enfoque que se caracteriza en obtener amplitud de ideas e interpretaciones, la cual inicia formulando preguntas en analizar y evaluar el estado actual del clima organizacional, donde se tomó una muestra de 10 empleados de las diferentes áreas, dichas encuestas están conformadas por 10 ítems; para la cual se determinó utilizar la herramienta de formulario de Google. Para culminar se concluyó que es necesario que la empresa cree un plan de acción en fortalecer la comunicación interna, con el fin de promover la participación de los colaboradores, por lo cual si aumenta el liderazgo transformacional aumenta el desempeño labora en la empresa Lácteos del Hogar.The objective of this research was to recommend to the Lacteous del Hagar Company to propose an action plan to improve leadership skills in order to improve their productivity and labor relations. Regarding the methodology, the development of research on leadership was implemented; and for data collection, the qualitative survey was used as a technique with an approach that is characterized by obtaining breadth of ideas and interpretations, which begins by asking questions to analyze and evaluate the current state of the organizational climate, where a sample of 10 employees from different areas, these surveys are made up of 10 items; for which it was determined to use the Google form tool. To conclude, it was concluded that it is necessary for the company to create an action plan to strengthen internal communication, in order to promote the participation of collaborators, so if transformational leadership increases, work performance in the company Lacteous del Hagar increases

Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training

Abstract Background The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes of physicians and medical students. Methods A paper survey was mailed in mid-2012 to 3897 practicing physicians randomly selected from the American Medical Association Masterfile. An electronic survey was sent in early 2015 to all 5,992 students at 10 U.S. medical schools. Survey items measured attitudes toward cost-conscious care and perceived responsibility for reducing healthcare costs. Physician responses were first compared across age groups (30–40 years, 41–50 years, 51–60 years, and > 60 years) and then compared to student responses using Chi square tests and logistic regression analyses (controlling for sex). Results A total of 2,556 physicians (65%) and 3395 students (57%) responded. Physician attitudes generally did not differ by age, but differed significantly from those of students. Specifically, students were more likely than physicians to agree that cost to society should be important in treatment decisions (p < 0.001) and that physicians should sometimes deny beneficial but costly services (p < 0.001). Students were less likely to agree that it is unfair to ask physicians to be cost-conscious while prioritizing patient welfare (p < 0.001). Compared to physicians, students assigned more responsibility for reducing healthcare costs to hospitals and health systems (p < 0.001) and less responsibility to lawyers (p < 0.001) and patients (p < 0.001). Nearly all significant differences persisted after controlling for sex and when only the youngest physicians were compared to students. Conclusions Physician attitudes toward cost-conscious care are similar across age groups. However, physician attitudes differ significantly from medical students, even among the youngest physicians most proximate to students in age. Medical student responses suggest they are more accepting of cost-conscious care than physicians and attribute more responsibility for reducing costs to organizations and systems rather than individuals. This may be due to the combined effects of generational differences, new medical school curricula, students’ relative inexperience providing cost-conscious care within complex healthcare systems, and the rapidly evolving U.S. healthcare system.https://deepblue.lib.umich.edu/bitstream/2027.42/146517/1/12909_2018_Article_1388.pd