M-FISH evaluation of chromosome aberrations to examine for historical exposure to ionising radiation due to participation at British nuclear test sites.

Veterans of the British nuclear testing programme represent a population of ex-military personnel who had the potential to be exposed to ionising radiation through their participation at nuclear testing sites in the 1950s and 1960s. In the intervening years, members of this population have raised concerns about the status of their health and that of their descendants, as a consequence. Radiation dose estimates based on film badge measurements of external dose recorded at the time of the tests suggest any exposure to be limited for the majority of personnel, however, only ∼20% of personnel were monitored and no measurement for internalised exposure are on record. Here, to in-part address families concerns, we assay for chromosomal evidence of historical radiation exposure in a group of aged nuclear test (NT) veterans, using multiplexin situhybridisation (M-FISH), for comparison with a matched group of veterans who were not present at NT sites. In total, we analysed 9379 and 7698 metaphase cells using M-FISH (24-colour karyotyping) from 48 NT and 38 control veteran samples, representing veteran servicemen from the army, Royal Airforce and Royal Navy. We observed stable and unstable simple- and complex-type chromosome aberrations in both NT and control veterans' samples, however find no significant difference in yield of any chromosome aberration type between the two cohorts. We do observe higher average frequencies of complex chromosome aberrations in a very small subset of veterans previously identified as having a higher potential for radiation exposure, which may be indicative of internalised contamination to long-lived radionuclides from radiation fallout. By utilising recently published whole genome sequence analysis data of a sub-set of the same family groups, we examined for but found no relationship between paternal chromosome aberration burden, germline mutation frequency and self-reported concerns of adverse health in family members, suggesting that the previously reported health issues by participants in this study are unlikely to be associated with historical radiation exposure. We did observe a small number of families, representing both control and NT cohorts, showing a relationship between paternal chromosome aberrations and germline mutation sub-types which should be explored in future studies. In conclusion, we find no cytogenetic evidence of historical radiation exposure in the cohort of nuclear veterans sampled here, offering reassurance that attendance at NTs sites by the veterans sampled here, was not associated with significant levels of exposure to radiation.

Ensuring our exstrophy-epispadias complex patients and families thrive.

Individuals with bladder exstrophy-epispadias complex (EEC) need long-term integrated medical/surgical and psychosocial care. These individuals are at risk for medical and surgical complications and experience social and psychological obstacles related to their genitourinary anomaly. This care needs to be accessible, comprehensive, and coordinated. Multiple surgical interventions, reoccurring hospitalizations, urinary and fecal incontinence, extensive treatment regimens for continent diversions, genital differences, and sexual health implications affect the quality of life for the EEC patient. Interventions must include psychosocial support, medical literacy initiatives, behavioral health services, school and educational consultation, peer-to-peer opportunities, referrals to disease-specific camps, mitigation of adverse childhood events (ACEs), formal transition of care to adult providers, family and teen advisory opportunities, and clinical care coordination. The priority of long-term kidney health will necessitate strong collaboration among urology and nephrology teams. Given the rarity of these conditions, multi-center and global efforts are paramount in the trajectory of improving care for the EEC population. To achieve the highest standards of care and ensure that individuals with EEC can thrive in their environment, multidisciplinary and integrated medical/surgical and psychosocial services are imperative.

Work-Related Flow Inventory: Evidence of Validity of the Brazilian Version / Inventário de Flow no Trabalho: Evidências de Validade da Versão Brasileira / Inventario de Flow en Trabajo: Evidencia de Validez de la Versión Brasileña

Abstract Flow in work is constituted by the positive experiences and mental state experienced during the day-to-day occupational activities. This study aims to adapt and assess the psychometric properties of the Brazilian Version of the Work Related Flow Inventory (WOLF). Participants were a nationwide sample of 640 professional (74% women), aged 19 to 73 years (M = 35.9, SD = 10.5). Confirmatory factor analyses (CFA) supported the oblique three-factor structure (absorption, work enjoyment and intrinsic work motivation) as being the most reliable to the data. Multigroup CFA achieved full measurement invariance for the gender and employment status (autonomous and non-autonomous). Flow dimensions were positively related to occupational self-efficacy and job satisfaction. WOLF presented adequate psychometric properties, suggesting its usefulness in evaluating flow at work in the Brazilian context.

Resumo Flow no trabalho constitui-se pelas experiências positivas e estado mental vivenciados durante as atividades ocupacionais do dia a dia. Este estudo tem como objetivo adaptar e avaliar as propriedades psicométricas da versão Brasileira do Inventário de Flow no Trabalho (WOLF). Os participantes desta pesquisa foram uma amostra nacional de 640 profissionais (74% mulheres), idades entre 19 a 73 anos (M = 35,9, DP = 10,5). A análise fatorial confirmatória (AFC) evidenciou a estrutura de três fatores oblíquos (absorção, envolvimento e motivação intrínseca) como a mais adequada aos dados. A AFC Multigrupo demonstrou a invariância da escala para sexo e situação de trabalho (autônomo e não-autônomo). As dimensões de flow estiveram positivamente relacionadas à autoeficácia ocupacional e satisfação no trabalho. WOLF apresentou propriedades psicométricas satisfatórias, sugerindo a sua utilidade para avaliar flow no contexto brasileiro.

Resumen El flow en trabajo comprende una experiencia positiva y estado mental que pueden ocurrir durante las actividades laborales. Este estudio pretende adaptar y evaluar las propiedades psicométricas de la versión brasilera del Inventario de Flow en trabajo (WOLF). Los participantes fueron una muestra nacional de 640 profesionales (74% mujeres) con edades entre 19 a 73 años (M = 35,9, DE = 10,5). El análisis factorial confirmatorio (AFC) respaldó que la estructura oblicua de tres factores (absorción, implicación y motivación intrínseca) es la más confiable. El AFC multigrupo alcanzó invariancia de medida completa para sexo y status de empleo (autónomo y no autónomo). Las dimensiones del flow se relacionaron positivamente con autoeficacia ocupacional y satisfacción laboral. El WOLF presentó propiedades psicométricas adecuadas, lo que sugiere su utilidad en evaluar flow en el contexto brasilero.

Who, where, and why are patients lost to follow-up? A 20-year study of bladder exstrophy patients at a single institution.

INTRODUCTION: Individuals with bladder and cloacal exstrophy are at increased risk for kidney disease, renal failure, and bladder complications. Given the social implications and sensitive nature of the disease, these patients are also at risk for psychosocial problems. Lack of regular medical follow-up visits may pose serious risks to their long-term health status. The aim of this study is determine what factors place an affected individual at risk for limited long term follow up. MATERIALS AND METHODS: We identified all patients with bladder or cloacal exstrophy seen by the pediatric urology department at the Oklahoma University Health Sciences Center (OUHSC) between January 1996 and August 2016. Patient data included demographics, insurance coverage, distance from patient's home to the clinic, medical and surgical history, and the date of their last clinic visit. Two groups for comparison were (1) those that had been seen within the last 2 years, and (2) those that were counted as failing to maintain follow-up because 2 or more years had passed since their last clinic visit. These groups were compared using the Student t-test, the chi-square test, or the Fisher exact test and p < 0.05 was treated as significant for the purposes of discussion. RESULTS AND DISCUSSION: Ninety-one patients with bladder or cloacal exstrophy were seen by the pediatric urology department between January 1996 and August 2016. Of the 91 patients, 24 left the clinic for known reasons thus leaving 67 patients that were considered for analyses: 51 had been seen within the last 2 years while 16 were counted as lost to follow-up. These two groups (active and lost to follow-up) did not differ significantly for age at last clinic visit, distance between family's home and clinic, history of bladder reconstruction, sex, or insurance status. There was a significant difference between the two groups in the medical complexity of their condition. The group active in urological care had more patients with cloacal exstrophy and additional anomalies than the group lost to follow-up. CONCLUSIONS: Patients with bladder exstrophy and cloacal exstrophy are less likely to maintain annual follow-up visits with their urologist if they have a simpler diagnosis requiring fewer surgical interventions. For patients with exstrophy, regular clinic visits prioritizing education and psychosocial support may prevent hospitalizations, emergency interventions, and poor overall health outcomes. To maintain contact with the medical team and promote optimal health outcomes, a social worker or care coordinator/educator may play an integral part in addressing the unique needs of this population.

A framework for transitioning patients from pediatric to adult health settings for patients with neurogenic bladder.

BACKGROUND: Adolescents with neurogenic bladder are a vulnerable population that severely lacks consistent transitional care from pediatric to adult urology settings. AIMS: Our practice determined that 100 patients with spina bifida and other neurogenic bladder conditions were not appropriately transferred to the adult setting once reaching adulthood. METHODS: We initiated a transitional program to establish a dedicated and formal process for adolescent patients to transition to adult urology. The REACH clinic implements a formalized staging framework to facilitate migration of adolescents and young adults to the adult health setting. A social worker was incorporated to act as a patient advocate, behavioral health consultant, and resource specialist. RESULTS: To date 45 patients have been enrolled in the transition program. We have identified and categorized according to the appropriate stage. The REACH clinic has appropriately outlined the goals and mission of the program and resources utilized are financially practical and feasible by conducting a monthly combined clinic. The program has been instrumental in improving tracking and monitoring of these patients through their transition period. CONCLUSION: Through the efforts of the pediatric and adult urology teams, the REACH program is a dedicated framework that provides structure for transition of the adolescent patient. The addition of a social worker has resulted in enriched rapport and will likely result in improved compliance. This program allows for surveillance and evaluation of patient outcome indicators in this patient population. We believe that early introduction and frequent encounters with the adult urologic team is crucial to successful transitions. Neurourol. Urodynam. 36:973-978, 2017. © 2016 Wiley Periodicals, Inc.

Convergent and criterion-related validity for a brief scale of the Five-Factor model / Validade convergente e baseada em critério externo para marcadores reduzidos de personalidade / Validez convergente y de criterio para los marcadores reducidos de la personalidad

This study sought evidence for the validity for the Reduced Markers Scale (EMR) in a population of university students (n=175, mean age=28.5, SD=7.4). The EMR is composed of 25 items that measure and evaluate personality according to the Five-Factor Model. For convergent validity, we analyzed the correlations between the EMR and the Bateria Fatorial de Personalidade (BFP). For the criteria-related validity, regression analyses were conducted for EMR and the Positive Mental Health Scale. The results indicated high significant correlations between the EMR and BFP, except for the factor of Sociability and Openness to Experiences. Both EMR and BFP showed similar abilities to explain the external criterion, and the BFP accounted for 10% of the residual variance. The EMR proved to be suitable for evaluating personality in this sample. However, we consider there are some limitations due to the amount of information provided by the instrument.(AU)

O presente estudo buscou evidências de validade para a Escala de Marcadores Reduzidos (EMR) em uma população de estudantes universitários (n=175, média de idade=28,5, DP=7,4). A EMR possui 25 itens que avaliam a personalidade baseados no Modelo dos Cinco Grandes Fatores. Para a validade convergente, analisaram-se as correlações entre a EMR e a Bateria Fatorial de Personalidade (BFP). Para a validade baseada em critério externo, realizaram-se regressões para a EMR junto à Escala de Saúde Mental Positiva. Os resultados indicaram correlações significativas altas entre a EMR e BFP, exceto para os fatores sociabilidade e abertura à experiência. Tanto EMR quanto BFP demonstraram semelhante capacidade para explicar o critério externo, e a BFP foi responsável por 10% da variância residual. A EMR mostrou-se indicada para avaliar a personalidade na amostra estudada. Entretanto, consideram-se algumas limitações na quantidade de informação fornecida pelo instrumento.(AU)

Este estudio buscó pruebas de validez de Escala Reducida Marcadores (EMR) en una población de estudiantes universitarios (n=175, edad media=28,5, DE=7,4). El EMR tiene 25 ítems que evalúan la personalidad basado en el modelo de los cinco grandes factores. Para la validez convergente, se analizaron las correlaciones entre el EMR y la Bateria Fatorial de Personalidade (BFP). Para la validez basada en criterio externo se llevó a cabo regresiones de EMR junto a escala de la salud mental positiva. Los resultados indican correlaciones significativas entre la EMR y BFP, con excepción de los factores sociabilidad y apertura a la experiencia. Tanto EMR como BFP mostró capacidad similar para explicar el criterio externo, y el BFP representó el 10% de la varianza residual. La EMR resultó ser adecuado para evaluar la personalidad en la muestra. Sin embargo, consideramos algunas limitaciones en la cantidad de información proporcionada por el instrumento.(AU)

Health care for gender variant or gender non-conforming children.

Most children explore various aspects of gender and sexuality as children. Youth with consistent, persistent, and insistent gender non-conformity or gender dysphoria are important to identify in the pre- and early-pubertal years as early intervention and support may be lifesaving. Those whose gender non-conformity persists into puberty and adolescence are most likely to identify as transgender. Blocking pubertal development at Tanner stage 2 for pre-pubertal, gender non-conforming children is a relatively new but reversible and highly beneficial strategy to delay puberty, giving patients and families time to come up with a transition plan. Early identification, collaborative support from healthcare providers and mental health clinicians, and supportive interventions for both children and families grappling with gender variance may improve social and mental health outcomes for what has traditionally been considered a high-risk, vulnerable population.