Defining Employment Specialist Competencies: Results of a Participatory Research Study.

The preponderance of research conducted on supported employment has focused on the structure of interventions with little empirical investigation into the contribution of employment specialists to work outcomes. Using a participatory approach, we identified competencies essential to the role of the employment specialists, operationalized and refined those competencies using the perspectives of experts, service recipients, and employment specialists themselves. We conducted an online survey with 34 candidate items and n = 142 respondents. Results suggested good psychometric properties, stability and coherence of the Vocational Practices and Relationship Scale. A total of n = 23 final items tapping the working alliance coalesced into a strong factor, as did strategies for promoting vocational recovery, suggesting that the scale warrants wide-scale testing for predictive validity. We consider these constructs and competencies to be a potential blueprint for training employment specialists, not only in technical skills and strategies, but also to increase the hope for vocational recovery among those they serve.

Empowerment of athletes with cardiac disorders: a new paradigm.

Athletes with cardiac disorders frequently pose an ethical and medical dilemma to physicians assessing their eligibility to participate in sport. In recent decades, patient empowerment has been gaining increasing recognition in clinical decision-making. Empowerment is a process through which people are involved over the decisions and actions that affect their own lives. In the context of a cardiac disorder, empowerment means giving an athlete the chance to participate in the decision about whether or not to remain active in competition. Three models of treatment decision-making are described in this article, with progressive levels of empowerment: the paternalistic model (the athlete has a passive role), the shared-decision making model (both athlete and physician participate in the decision), and the informed-decision making (the decision is made by the athlete while the role of the physician is solely to provide information). This article critically discusses the issues involved in disqualification of athletes with cardiovascular disorders and suggests possible ways of incorporating patient empowerment in potentially career-ending decisions. The authors propose a model of empowerment, which gives patients the opportunity to choose how much, and if, they would like to be involved in the decision-making process.

Isospora dromaii n. sp. (Apicomplexa, Eimeriidae) isolated from emus, Dromaius novaehollandiae (Casuariiformes, Casuariidae).

A new species of Coccidia (Protozoa: Apicomplexa: Eimeriidae) isolated from emus, Dromaius novaehollandiae, which was observed in Brazil is described and named. Oocysts of Isospora dromaii n. sp. are subspheroidal to ovoid in shape, measure 21.6 × 19.8 µm, and have a double and smooth wall thickness of approximately 1.4 µm. In this species, micropyle, oocyst residuum, and polar granules are absent. The sporocysts are slightly ovoid in shape and measure 13.7 × 10.0 µm. Nipple-like Stieda body and prominent sub-Stieda body are present. The sporocyst residuum is composed of small dispersed granules of varying sizes. The sporozoites are characterized by an oblong refractile body and one centrally located nucleus. This is the first description of isosporid coccidia infecting birds of the family Dromaiidae.

Metastatic BRAF V600E-Mutated Thyroid Carcinoma: Molecular/Genetic Profiling Brings a New Therapeutic Option.

We describe a case of a 46-year-old woman diagnosed with localized PTC 20 years ago, having already undergone several treatments with iodine-131 and then treatment with lenvatinib for metastatic disease, to which she developed intolerance. In 2020, in addition to pleural, thoracic, and abdominal lymph node metastasis, progression with symptomatic vertebral bone metastasis was detected, which led to the equation of new therapeutic options. In this context, a genetic/molecular test was carried out, which identified the BRAF V600E mutation and enabled the start of treatment with dabrafenib/trametinib since June 2020. This treatment allowed functional gain, symptomatic relief, and stabilization of the disease. It demonstrates how, in rare tumors, the personalized medicine approach can bring new treatment possibilities.

Superior vena cava syndrome caused by mediastinal lymphoma: A rare clinical case.

The superior vena cava syndrome refers to a medical emergency resulting from superior vena cava compression, which develops in 2%-4% of non-Hodgkin lymphomas. Primary mediastinal (thymic) large B-cell lymphoma is an unusual and aggressive non-Hodgkin lymphoma that can present with superior vena cava syndrome. We report the case of a Caucasian 21-year-old female, who presented with acute superior vena cava syndrome, having started 2 weeks before. Chest computerized tomography disclosed an anterior mediastinal mass (18 × 14 cm). Thoraco-abdominopelvic magnetic resonance imaging was performed in order to differentiate compression versus mass invasion. A gross anterior mediastinal mass (109 × 60 × 105 mm) occupying the totality of the prevascular space was found, extending from the sternal furcula to the pericardium, fully embedding the superior vena cava. A computerized tomography guided biopsy was performed. Histopathological and immunohistochemical analysis was consistent with Primary mediastinal (thymic) large B-cell lymphoma. Primary mediastinal (thymic) large B-cell lymphoma has unique clinicopathologic aspects and it should be considered in a young patient with Superior vena cava syndrome. Prompt recognition, a timely diagnosis and appropriate treatment are crucial for prognosis.

A Mobile-Based Tailored Recommendation System for Parents of Children with Overweight or Obesity: A New Tool for Health Care Centers.

Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children's age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children's eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents' perceptions of the child's weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann-Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child's excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child's weight with additional strategies.

Job Endings and Work Trajectories of Persons Receiving Supported Employment and Cognitive Remediation.

OBJECTIVE: This study examined job endings and work trajectories among participants in a study comparing the effects of adding cognitive remediation to supported employment among individuals who had not benefited from supported employment. METHODS: Data were from a controlled trial of 107 persons with serious mental illness enrolled in supported employment but who had not obtained or sustained competitive work. Participants were randomly assigned to enhanced supported employment only (with employment specialists trained to recognize cognitive difficulties and teach coping strategies) or to the Thinking Skills for Work program (enhanced supported employment plus cognitive remediation). For the 52 participants who worked, the two groups were compared on types of job endings, reasons for job endings, successful versus unsuccessful jobs, and work trajectories over the two-year study period. RESULTS: The two groups did not differ in types of job ending, although participants in Thinking Skills for Work were less likely than those in enhanced supported employment only to cite dissatisfaction with the job as a reason for the job ending. Participants in Thinking Skills for Work were also less likely to have an overall unsuccessful work trajectory, more likely to have only successful jobs, and more likely to be employed at the end of the study. CONCLUSIONS: The Thinking Skills for Work program appeared to help participants who had not benefited from supported employment stick with and master their jobs more effectively than those in enhanced supported employment only, resulting in better work trajectories over the course of the study.

Call for joint informed consent in athletes with inherited cardiac conditions.

Informed consent is of the utmost importance, especially in complex clinical situations where patients may be exposed to a life-threatening risk. A particularly complex example is the eligibility of competitive athletes with inherited cardiac conditions on medical grounds, especially when the risk is low or unquantifiable. The rationale and benefits of a joint informed consent for athletes to compete with potentially life-threatening cardiac conditions are discussed in this manuscript.

The peer support workforce: Results of a national survey.

OBJECTIVE: Given the burgeoning role of peer specialists in the mental health workforce, more information is needed about their work roles, tasks, settings, training, compensation, and work satisfaction. METHOD: Using both purposive and snowball sampling, the authors recruited a national sample of individuals employed as peer specialists and a variety of other peer provider positions. They conducted an online survey to query respondents about various aspects of their work life. A total of 608 participants completed the survey, of which 597 responses were usable for these analyses. RESULTS: Results suggest that individuals in the United States identifying themselves as peer specialists (or similar titles) work in a wide variety of settings and spend the majority of their work time providing direct peer support. However, a significant number of individuals also reported performing nondirect peer support tasks such as administrative work, teaching skills, and systems-level advocacy. Average compensation ranged from $10 to $20 per hour. Peer specialists reported a significant amount of satisfaction with their work but still perceive a lack of recognition for their roles. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results of this survey provide critical information about the job characteristics of peer specialists and data that should be informative for mental health authorities as they address the needs of this workforce. However, our findings also suggest that ambiguity remains regarding the roles, tasks, and training of peer specialists, which could benefit from further study that would help to clarify the unique role of these professionals within the mental health arena. (PsycINFO Database Record

Current status of psychiatric rehabilitation in Portugal: A national survey.

OBJECTIVE: This article reports on the current state of psychiatric rehabilitation in Portugal. METHOD: A paper-and-pencil survey was sent to 70 institutions to inquire about the provision of psychiatric rehabilitation services and programs. RESULTS: With a response rate of 40%, 14% of institutions indicated that supported education was provided, 36% offered nonmainstream vocational training, and 29% provided supported employment; none provided evidence-based Individual Placement and Support. Permanent group homes in the community (29%) followed by transitional group homes on institutional grounds (18%) were the most common residential services, with supported housing services (14%) offered less frequently. Finally, 93% of institutions offered occupational activities, 61% provided multifamily psychoeducation, and 36% provided single-family psychoeducation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Despite recent national initiatives promoting effective psychiatric rehabilitation services, supported employment, supported education, and supported housing are not widely implemented in Portugal. To achieve better outcomes for clients, it is critical that evidence-based and promising practices be extensively disseminated.

Family health: limits and possibilities for an integral primary care approach to health care in Brazil.

The article analyzes the implementation of the Family Health Strategy (FH) and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care. Four case studies were carried out in cities with high FH coverage (Aracaju, Belo Horizonte, Florianópolis e Vitória), using as sources: semi-structured interviews with managers and surveys with health care professionals and registered families. The integration analysis highlighted the position of FH Strategy in the health services network, the integration mechanisms and the availability of information for continuity of care. Intersectoriality was researched in relation to the fields of action, scope, sectors involved, presence of forums, and team initiatives. The results point to advances in the integration of FH to the health care network, strengthening basic services as services that are regularly sought and used as a preferential first contact services, although there are still problems in the access to specialized care. The intersectorial initiatives were broader when defined as integrated municipal government policy for the construction of interfaces and cooperation between the diverse sectors.

[Oocysts from Cryptosporidium spp. isolated from cattle: pleomorfism in relationship to diagnosis methodology]. / Oocistos de Cryptosporidium spp. isolados de bezerros bovinos: pleomorfismo em relação à metodologia de diagnóstico.

The aim of this study was to analyze the pleomorfism of Cryptosporidium spp. oocysts isolated from calves feces throughout the comparison of two diagnostic techniques. One hundred of cattle feces were collected and the samples were submitted to both flotation sucrose centrifugation and to Ziehl-Neelsen modified tests. The results obtained showed a statistically significant reduction on the size of the Cryptosporidium oocysts observed through Ziehl-Neelsen technique when compared to the flotation sucrose centrifugation technique, and that the difference on the diameter of the oocysts suggests the there were different species of Cryptosporidium circulating in the animals analyzed.

[Relative risk of infection of parasites from genus Cryptosporidium in cattle in North of Rio de Janeiro State, Brazil]. / Risco relativo da infecção por parasitos do gênero Cryptosporidium em bezerros bovinos no Norte do Estado do Rio de Janeiro, Brasil.

The aim of the study was to detect Cryptosporidium oocysts in calves feces throughout North of Rio de Janeiro State, Brazil, as well as to examine the risk factors involved in the animals infection. One hundred young calves on 13 dairy farms were analyzed for oocyst excretion. The samples were submitted to Ritchie and Ziehl-Neelsen modified tests, and the observation of the oocysts was made by using the optical microscope. The results obtained showed that Cryptosporidium was detected in 61% of the animals. Statistical analysis of the risk factors revealed that only three of them demonstrated a significant influence for infection: Animals bred under technical systems such as the use of milking equipment, milking cooler and farms that have water trough were more likely to be infected with the protozoan.

Saúde da família: limites e possibilidades para uma abordagem integral de atenção primária à saúde no Brasil / Family health: limits and possibilities for an integral primary care approach to health care in Brazil

The article analyzes the implementation of the Family Health Strategy (FH) and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care. Four case studies were carried out in cities with high FH coverage (Aracaju, Belo Horizonte, Florianópolis e Vitória), using as sources: semistructured interviews with managers and surveys with health care professionals and registered families.The integration analysis highlighted the position of FH Strategy in the health services network, the integration mechanisms and the availability of information for continuity of care. Intersectoriality was researched in relation to the fields of action, scope,sectors involved, presence of forums, and team initiatives. The results point to advances in the integration of FH to the health care network, strengtheningbasic services as services that are regularly sought and used as a preferential first contact services, although there are still problems in the access to specialized care. The intersectorial initiatives were broader when defined as integrated municipal government policy for the construction of interfaces and cooperation between the diverse sectors.

O artigo analisa a implementação da Estratégia Saúde da Família (SF) e discute suas potencialidades em orientar a organização do SUS no Brasil, a partir da análise da integração da SF à redeassistencial e atuação intersetorial, aspectos cruciais de uma atenção primária abrangente. Foram realizadosquatro estudos de caso de municípios com elevada cobertura por SF (Aracaju, Belo Horizonte, Florianópolis e Vitória) tendo como fontes: entrevistas semi-estruturadas com gestores e inquéritoscom profissionais de saúde e de famílias cadastradas. A análise da integração destacou a posição da Estratégia SF na rede assistencial, os mecanismos de integração e a disponibilidade de informações para continuidade da atenção. A intersetorialidade foi pesquisada quanto aos campos de atuação, abrangência, setores envolvidos, presença de colegiados, e iniciativas das equipes. Os resultados apontam avanços na integração da SF à rede assistencial, propiciando o fortalecimento dos serviços básicos como serviços de procura regular e porta de entrada preferencial, todavia permanecem dificuldades de acesso à atenção especializada. As iniciativas intersetoriais foram mais abrangentes quando definidas como politica integrada do governo municipal para a construção de interfaces e cooperação entre os diversos setores.