Healing Thyself: What Barriers Do Psychologists Face When Considering Personal Psychotherapy and How Can They Be Overcome?

Most mental health professionals seek personal psychotherapy at least once in their careers (Phillips, 2011), and at a much higher rate than the general population (Norcross & Guy, 2005). While one-fourth of the general adult population has received mental health services, three-fourths of mental health professionals have done so (Bike, Norcross, & Schatz, 2009; Norcross & Guy, 2005). A wealth of studies have explored why psychologists have sought personal psychotherapy — often for the same reason that the rest of the world seeks therapy, such as coping with loss, dealing with depression or anxiety, or struggling with a personal crisis. However, more research is needed about the potential barriers that psychologists may experience when considering such treatment. In this article, we discuss the research exploring why psychologists may benefit from psychotherapy and report on the findings of our own national survey, which explored independent practitioners\u27 perceived barriers to psychological care

Cell-Cycle Perturbations Suppress the Slow-Growth Defect of spt10Δ Mutants in Saccharomyces cerevisiae

Spt10 is a putative acetyltransferase of Saccharomyces cerevisiae that directly activates the transcription of histone genes. Deletion of SPT10 causes a severe slow growth phenotype, showing that Spt10 is critical for normal cell division. To gain insight into the function of Spt10, we identified mutations that impair or improve the growth of spt10 null (spt10Δ) mutants. Mutations that cause lethality in combination with spt10Δ include particular components of the SAGA complex as well as asf1Δ and hir1Δ. Partial suppressors of the spt10Δ growth defect include mutations that perturb cell-cycle progression through the G1/S transition, S phase, and G2/M. Consistent with these results, slowing of cell-cycle progression by treatment with hydroxyurea or growth on medium containing glycerol as the carbon source also partially suppresses the spt10Δ slow-growth defect. In addition, mutations that impair the Lsm1-7−Pat1 complex, which regulates decapping of polyadenylated mRNAs, also partially suppress the spt10Δ growth defect. Interestingly, suppression of the spt10Δ growth defect is not accompanied by a restoration of normal histone mRNA levels. These findings suggest that Spt10 has multiple roles during cell division

Hypospadias and prenatal exposure to atrazine via drinking water: A geographic analysis

This dissertation uses a disease ecology framework to investigate the etiology of hypospadias, a relatively common birth defect affecting the male genitourinary tract. It begins by considering the spatial distribution of hypospadias in North Carolina and whether that spatial distribution can be explained by either compositional or contextual risk factors. It then focuses on a potential contextual risk factor of interest: atrazine, one of the most widely used herbicides in the United States. An endocrine disruptor, atrazine breaks down slowly in soils and water, suggesting that mothers could be exposed to atrazine via contaminated drinking water. This research uses data from the North Carolina Birth Defects Monitoring Program and the National Birth Defects Prevention Study. Three different methods are used to estimate maternal exposure to atrazine via drinking water: total atrazine applied to maternal county of residence; sampling data maintained by the United States Environmental Protection for compliance monitoring; and outputs from surface water and groundwater models from the United States Geological Service. After concluding that the surface and groundwater modeling metric is most appropriate for our dataset, this research concludes by incorporating maternal population and behavioral characteristics into analyses of hypospadias and maternal exposure to atrazine via drinking water. Results indicate statistically significant spatial autocorrelation of hypospadias in eastern central North Carolina, which persists when controlling for compositional risk factors, and which suggests that contextual factors may influence the spatial distribution of hypospadias. Results further suggest possible role played by atrazine in a multi-factorial etiology of hypospadias. When controlling for maternal demographic and behavioral characteristics, hypospadias is found to be marginally significantly associated with daily maternal atrazine consumption during the critical window of genitourinary development (odds ratio = 1.03; p = 0.054). This reinforces the utility of a disease ecology framework in research of diseases of unknown or multifactorial etiology. It also suggests that further research is needed to evaluate the potential teratogenic properties of atrazine. Doctor of Philosoph

Barriers to Psychologists Seeking Mental Health Care

Professional psychologists provide help to people in need, but how freely do psychologists seek psychotherapy themselves when facing personal challenges and struggles? What obstacles make it difficult for professional psychologists to seek psychotherapy? A survey of 260 professional psychologists (52% response rate) was conducted to investigate the frequency of various stressors impacting professional psychologists and the barriers they experience in seeking mental health services. Though none of the stressors were rated with particularly high frequencies, burnout was identified as the most frequent problem. Difficulty finding a psychotherapist and a lack of time were identified as the greatest obstacles to seeking psychotherapy. Practice and training implications are discussed as well as future research directions

Guidelines: The dos, don'ts and don't knows of remediation in medical education.

INTRODUCTION: Two developing forces have achieved prominence in medical education: the advent of competency-based assessments and a growing commitment to expand access to medicine for a broader range of learners with a wider array of preparation. Remediation is intended to support all learners to achieve sufficient competence. Therefore, it is timely to provide practical guidelines for remediation in medical education that clarify best practices, practices to avoid, and areas requiring further research, in order to guide work with both individual struggling learners and development of training program policies. METHODS: Collectively, we generated an initial list of Do's, Don'ts, and Don't Knows for remediation in medical education, which was then iteratively refined through discussions and additional evidence-gathering. The final guidelines were then graded for the strength of the evidence by consensus. RESULTS: We present 26 guidelines: two groupings of Do's (systems-level interventions and recommendations for individual learners), along with short lists of Don'ts and Don't Knows, and our interpretation of the strength of current evidence for each guideline. CONCLUSIONS: Remediation is a high-stakes, highly complex process involving learners, faculty, systems, and societal factors. Our synthesis resulted in a list of guidelines that summarize the current state of educational theory and empirical evidence that can improve remediation processes at individual and institutional levels. Important unanswered questions remain; ongoing research can further improve remediation practices to ensure the appropriate support for learners, institutions, and society

Diarrheal disease risk in rural Bangladesh decreases as tubewell density increases: a zero-inflated and geographically weighted analysis

Abstract Background This study investigates the impact of tubewell user density on cholera and shigellosis events in Matlab, Bangladesh between 2002 and 2004. Household-level demographic, health, and water infrastructure data were incorporated into a local geographic information systems (GIS) database. Geographically-weighted regression (GWR) models were constructed to identify spatial variation of relationships across the study area. Zero-inflated negative binomial regression models were run to simultaneously measure the likelihood of increased magnitude of disease events and the likelihood of zero cholera or shigellosis events. The aim of this study was to examine the effect of tubewell density on both the occurrence of diarrheal disease and the magnitude of diarrheal disease incidence. Results In Matlab, households with greater tubewell density were more likely to report zero cholera or shigellosis events. Results for both cholera and shigellosis GWR models suggest that tubewell density effects are spatially stationary and the use of non-spatial statistical methods is appropriate. Conclusions Increasing the amount of drinking water available to households through increased density of tubewells contributed to lower reports of cholera and shigellosis events in rural Bangladesh. Our findings demonstrate the importance of tubewell installation and access to groundwater in reducing diarrheal disease events in the developing world

Impact of the Urban Reproductive Health Initiative on family planning uptake at facilities in Kenya, Nigeria, and Senegal

Abstract Background The 2012 London Summit on Family Planning set ambitious goals to enable 120 million more women and adolescent girls to use modern contraceptives by 2020. The Urban Reproductive Health Initiative (URHI) was a Bill & Melinda Gates Foundation funded program designed to help contribute to these goals in urban areas in India, Kenya, Nigeria, and Senegal. URHI implemented a range of country-specific demand and supply side interventions, with supply interventions generally focused on improved service quality, provider training, outreach to patients, and commodity stock management. This study uses data collected by the Measurement, Learning & Evaluation (MLE) Project to examine the effectiveness of these supply-side interventions by considering URHI’s influence on the number of family planning clients at health facilities over a four-year period in Kenya, Nigeria, and Senegal. Methods The analysis used facility audits and provider surveys. Principal-components analysis was used to create country-specific program exposure variables for health facilities. Fixed-effects regression was used to determine whether family planning uptake increased at facilities with higher exposure. Outcomes of interest were the number of new family planning acceptors and the total number of family planning clients per reproductive health care provider in the last year. Results Higher program component scores were associated with an increase in new family planning acceptors per provider in Kenya (β = 18, 95% CI = 7–29), Nigeria (β = 14, 95% CI = 8–20), and Senegal (β = 7, 95% CI = 3–12). Higher scores were also associated with more family planning clients per provider in Kenya (β = 31, 95% CI = 7–56) and Nigeria (β = 26, 95% CI = 15–38), but not in Senegal. Conclusions Supply-side interventions have increased the number of new family planning acceptors at facilities in urban Nigeria, Kenya, and Senegal and the overall number of clients in urban Nigeria and Kenya. While tailoring to the local environment, programs seeking to increase family planning use should include components to improve availability and quality of family planning services, which are part of a rights-based approach to family planning programming

Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool

Objectives: To develop and validate a tool to predict the risk of an older adult experiencing medication-related harm (MRH) requiring healthcare use following hospital discharge. Design, setting, participants: Multicentre, prospective cohort study recruiting older adults (65 years) discharged from five UK teaching hospitals between 2013 and 2015. Primary outcome measure: Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information; hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH, and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated. Results: 1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases (‘possible’ and ‘probable’) were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced ‘definite’ MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge; age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool’s discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches. Conclusions: The PRIME tool could be used to identify older patients at high risk of MRH requiring healthcare use following hospital discharge. Prior to clinical use we recommend the tool’s evaluation in other settings

Choice of a family planning outlet in urban areas: The role of distance and quality of services in Kenya and Uganda

Introduction Quality of care and physical access to health facilities affect facility choice for family planning (FP). These factors may disproportionately impact young contraceptive users. Understanding which components of service quality drive facility choice among contraceptive users of all ages can inform strategies to strengthen FP programming for all potential users of FP. Methods This study uses data from Population Services International's Consumer's Market for Family Planning (CM4FP) project, to examine drivers of facility choice among female FP users. The data collected from female contraceptive users, the outlet where they obtained their contraceptive method, and the complete set of alternative outlets in select urban areas of Kenya and Uganda were used. We use a mixed logit model, with inverse probability weights to correct for selection into categories of nonuse and missing facility data. We consider results separately for youth (18–24) and women aged 25–49 in both countries. Results We find that in both countries and across age groups, users were willing to travel further to public outlets and to outlets offering more methods. Other outlet attributes, including signage, pharmacy, stockouts, and provider training, were important to women in certain age groups or country. Discussion These results shed light on what components of service quality drive outlet choice among young and older users and can inform strategies to strengthen FP programming for all potential users of FP in urban settings