Comparison of mindfulness interventions for healthcare professionals: A mixed-methods study.

OBJECTIVES: Burnout is increasingly a concerning problem in US Healthcare systems. Although the causes of burnout are not predominantly due to individual factors, mindfulness instruction is an evidence-based approach to counteracting burnout. Our health system initiated a multi-pronged approach to mindfulness instruction for our employees and community. We aimed to assess the impact of these varied programs. METHODS: Several mindfulness courses of different lengths were employed. Validated survey instruments were administered to participants before and after the courses to assess stress, mindfulness and burnout. Pre-course and post-course results were compared for each intervention. Free-text responses were also captured and analyzed in a qualitative fashion. RESULTS: Participants in MBIs demonstrated statistically significant improvement in burnout and perceived stress on post-course survey results. Several mindfulness domains also showed statistically significant improvement (awareness, non-react and observe). There was no difference in the observed results between the mindfulness interventions. Qualitative analysis yielded three themes: seeking help, symptoms, and changes in mindfulness practice. CONCLUSIONS: MBIs designed for employees of an academic medical center were associated with positive quantitative and qualitative results. All MBI participants achieved improvement in perceived stress and mindfulness as well as reduction in burnout, regardless of course length.

Childhood Adversity and Health After Physical Abuse.

BACKGROUND: Involvement with Child Protective Services (CPS) provides an opportunity to recognize those children at risk for ongoing adverse childhood experiences (ACEs). The relationship between ACEs and child health among CPS-involved children and the role of primary care providers (PCPs) in moderating this relationship is unknown. METHODS: We conducted a convergent mixed-methods study of caregivers of children age 2 to 12 years with a CPS finding of physical abuse, modeling the association between cumulative ACEs and child health-related quality of life (HRQoL) using the PedsQL4.0, a validated 23-item survey of multidimensional health, with and without the moderator of a patient-centered medical home. Interviews elicited descriptions of a child's experience with ACEs, the impact of ACEs on child health, and the role of a PCP in this context. RESULTS: One hundred seventy-eight surveyed caregivers reported a mean of 5.5 (±3.3) ACE exposures per child. In a fully adjusted model, each ACE resulted in a 1.3-point (95% confidence interval: 0.7-2.0) reduction in HRQoL, a clinically important difference in HRQoL associated with ACE exposures. This association was explained by reduced psychosocial HRQoL and was not moderated by a patient-centered medical home. Twenty-seven interviewed caregivers described the influence of ACEs on a child's health. Many felt that a trusted PCP could support a child's well-being after such experiences. CONCLUSIONS: Children with CPS involvement have ACE exposures that are associated with reduced HRQoL. Although PCPs are often unaware of CPS involvement or other ACEs, many caregivers welcome the support of a child's PCP in improving child well-being after adversity.

Evaluation of serum cystatin-C and symmetric dimethylarginine concentrations in dogs with heart failure from chronic mitral valvular insufficiency.

Reduction in glomerular filtration rate (GFR) is a common complication in advanced stages of heart failure (HF). The convenient and precise assessment for GFR would be useful for early detection of renal impairment in HF dogs. Our hypothesis of this study was the GFR would be reduced in advanced stages of HF from chronic mitral valvular insufficiency (CMVI), as indicated by renal markers including serum cystatin-C (Cys-C) and symmetric dimethylarginine (SDMA) concentrations. Forty-three client-owned dogs consisting of 33 dogs with different stages of HF from CMVI and 10 age-matched healthy dogs were enrolled in this study. Serum Cys-C and SDMA concentrations along with other renal (i.e., urea nitrogen and creatinine) and echocardiographic markers were evaluated in healthy and CMVI dogs. Serum Cys-C concentrations were 1.4 ± 0.4 mg/l in control, 2.1 ± 0.9 mg/l in ISACHC I, 2.9 ± 0.8 mg/l in ISACHC II and 3.6 ± 0.6 mg/l in ISACHC III dogs, whereas serum SDMA concentrations were 8 ± 2 µg/dl in control, 14 ± 3 µg/dl in ISACHC I, 18 ± 6 µg/dl in ISACHC II and 22 ± 7 µg/dl in ISACHC III dogs. There was close correlation of serum Cys-C and SDMA concentrations to serum creatinine, urea nitrogen and the severity of HF. Our study demonstrated that the GFR was decreased in dogs with CMVI having earlier stages of HF.

Evaluation of serum symmetric dimethylarginine in dogs with heartworm infection.

This study evaluated the circulating levels of serum symmetric dimethylarginine (SDMA) in 12 dogs with different severities of heartworm disease (HWD) and assessed the biochemical renal markers (blood urea nitrogen, creatinine). Dogs were classified into 2 groups based on the severity of clinical signs. Group A - asymptomatic to mild clinical signs, group B - moderate to severe clinical signs. The serum SDMA levels were higher in dogs in group B. Although the serum SDMA levels in dogs in group A were also higher than those of the control dogs, the difference was not statistically significant. There was a good correlation between renal markers and severity of clinical signs. This study demonstrated that the glomerular filtration rate was significantly decreased in dogs in group A; therefore, earlier detection of renal impairment is required for successful management of dogs with HWD.

La présente étude visait à évaluer les niveaux sériques de diméthylarginine symétrique (DMAS) chez 12 chiens atteints de maladie du vers du coeur (MVC) de différentes sévérités et d'examiner les marqueurs biochimiques rénaux (azote uréique sanguin, créatinine). Les chiens ont été classés en deux groupes sur la base de la sévérité des signes cliniques. Le Groupe A ­ asymptomatique à signes cliniques légers, groupe B ­ signes cliniques modérés à sévères. Les niveaux de DMAS sériques étaient plus élevés chez les chiens du groupe B. Chez les chiens du groupe A, bien que les niveaux sériques de DMAS étaient également plus élevés que ceux des chiens témoins, la différence n'était pas statistiquement significative. Il y avait une bonne corrélation entre les marqueurs rénaux et la sévérité des signes cliniques. Cette étude a permis de démontrer que le taux de filtration glomérulaire était diminué de manière significative chez les chiens du groupe A; ainsi, une détection précoce de déficience rénale est nécessaire pour la gestion réussie des chiens avec MVC.(Traduit par Docteur Serge Messier).

Bisphenol A affects early bovine embryo development and metabolism that is negated by an oestrogen receptor inhibitor.

Increasing evidence supports an association between exposure to endocrine disruptors, such as the xenoestrogen bisphenol A (BPA), a commonly used plasticiser, and the developmental programming of offspring health. To date however animal studies to investigate a direct causal have mainly focussed on supra-environmental BPA concentrations, without investigating the effect on the early embryo. In this study we investigated the effect of acute BPA exposure (days 3.5 to 7.5 post-fertilisation) at environmentally relevant concentrations (1 and 10 ng/mL) on in vitro bovine embryo development, quality and metabolism. We then examined whether culturing embryos in the presence of the oestrogen receptor inhibitor fulvestrant could negate effects of BPA and 17ß-oestradiol (E2). Exposure to BPA or E2 (10 ng/mL) decreased blastocyst rate and the percentage of transferrable quality embryos, without affecting cell number, lineage allocation or metabolic gene expression compared to untreated embryos. Notably, blastocysts exposed to BPA and E2 (10 ng/mL) displayed an increase in glucose consumption. The presence of fulvestrant however negated the adverse developmental and metabolic effects, suggesting BPA elicits its effects via oestrogen-mediated pathways. This study demonstrates that even acute exposure to an environmentally relevant BPA concentration can affect early embryo development and metabolism. These may have long-term health consequences on an individual.