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BACKGROUND AND PURPOSE: Although the prevalence of dissociative disorders (DDs) is up to 10 percent of the general population, psychiatric-mental health (PMH) registered nurses lack education on how to care for individuals diagnosed with these disorders. METHOD: Sixty-two PMH nurse educators completed an anonymous online survey about their perceptions of teaching DDs to nursing students. Braun and Clarke's six-phase framework was used to conduct an inductive, reflexive thematic analysis of the data. RESULTS: Three primary themes were identified: lack of resources, differing opinions on the value of teaching DDs, and stigma. CONCLUSION: Though roughly 75 percent of participants reported that they teach DDs to their nursing students, they endorsed concerning misperceptions about the diagnoses. By failing to properly educate future PMH RNs about DDs, individuals with DDs are at risk of receiving inadequate and inappropriate nursing care and experiencing poor outcomes.
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BACKGROUND: The therapeutic relationship serves as a cornerstone in psychiatric mental health nursing practice, providing a basis for implementing various interventions. AIMS: This study aimed to explore the perspectives of psychiatric mental health nurses regarding factors that facilitate and impede the therapeutic nurse-patient relationship. METHODS: A descriptive study was conducted among psychiatric mental health nurses employed at two community psychiatric hospitals in the northeast area of the United States. A list of facilitators and barriers was developed based on an extensive literature review and subsequently validated by three experts in the field of psychiatric mental health nursing. Participants rated these factors on a 10-point scale. RESULTS: The study included 74 registered nurses from two psychiatric hospitals, yielding a 24% response rate. The highest-ranked facilitator was awareness that the relationship enables collaborative goal setting with patients. The most significant barrier was insufficient time due to administrative tasks. CONCLUSIONS: This study highlights the importance of understanding facilitators and barriers in the therapeutic nurse-patient relationship. Replicating the study nationally on a larger scale among psychiatric mental health nurses is recommended.
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OBJECTIVE: Brief interpersonal psychotherapy (IPT-B) has been shown to be effective in treating perinatal depression and in preventing depressive relapse among socioeconomically disadvantaged women. Yet, it is unclear how IPT-B alleviates depression. Previous research has suggested four possible change mechanisms derived from IPT's interpersonal model: decreasing interpersonal stress, facilitating emotional processing, improving interpersonal skills, and enhancing social support. This study explored how women who received IPT-B or enhanced maternity support services (MSS-Plus) evaluated their respective experiences. METHODS: A qualitative study was conducted with 16 women who had been recruited from public health clinics to participate in a larger, randomized controlled trial of women with major depression or dysthymia and who had been assigned to receive IPT-B or MSS-Plus. The sample was 63% non-Hispanic White, had an average age of 31.6 years, and was balanced in intervention group assignment, posttraumatic stress disorder status, and depression improvement. Telephone interviews included semistructured, open-ended questions eliciting participants' experiences with depression treatment. Predetermined, conceptually derived codes were based on the four postulated IPT change mechanisms. RESULTS: Thematic coded excerpts were collected and discussed. Excerpts lent support to the role of IPT-B in helping women decrease their interpersonal stress; identify, reflect on, and regulate their emotions; and improve their social skills. Evidence for increasing social support was mixed but highlighted the importance of the therapeutic relationship. CONCLUSIONS: Including qualitative findings into training in public health and other clinical settings will help illuminate the role of the provider in facilitating the change mechanisms that may lead to improved mental health among clients.
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Transtorno Depressivo Maior , Psicoterapia Interpessoal , Psicoterapia Breve , Transtornos de Estresse Pós-Traumáticos , Adulto , Depressão , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Relações Interpessoais , Gravidez , Psicoterapia , Resultado do TratamentoRESUMO
OBJECTIVE: An adult faces many challenges; however, one experience that is often taken for granted by neurotypical individuals is building intimate relationships. The purpose of this article is to discuss the barriers for healthy intimate relationships for an individual with autism, strategies to overcome these barriers, recommendations for future practice and research, and resources to improve knowledge of this important yet overlooked topic. METHOD: Data collection was done using research journals and databases such as EBSCO, SAGE Knowledge, MEDLINE, and CINAHL. The reviewed articles were published from 2015 to the present time. During the search process, the following key phrases were used: autism spectrum disorder, intimate relationships, sexuality education, and social skills. In total, 1,400 articles were found with an additional 52 sources found through other sources, of which 31 met inclusion criteria and were subsequently reviewed. RESULTS: Although those with autism have many strengths and talents, deficits in communication and social interaction can affect the formation of healthy adult relationships, including friendships and romantic relationships. In addition to social challenges, a lack of education regarding safe and healthy relationships can put an individual with autism at risk. CONCLUSIONS: It is imperative that that individuals with autism, their families, and health care professionals are educated about the barriers and able to access educational resources and specialized curricula on this topic.
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Transtorno do Espectro Autista , Transtorno Autístico , Adulto , Humanos , Relações Interpessoais , Comportamento Sexual , Parceiros SexuaisRESUMO
BACKGROUND: Both antenatal and postpartum depression have adverse, lasting effects on maternal and child well-being. Socioeconomically disadvantaged women are at increased risk for perinatal depression and have experienced difficulty accessing evidence-based depression care. The authors evaluated whether "MOMCare,"a culturally relevant, collaborative care intervention, providing a choice of brief interpersonal psychotherapy and/or antidepressants, is associated with improved quality of care and depressive outcomes compared to intensive public health Maternity Support Services (MSS-Plus). METHODS: A randomized multisite controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System. From January 2010 to July 2012, pregnant women were recruited who met criteria for probable major depression and/or dysthymia, English-speaking, had telephone access, and ≥18 years old. The primary outcome was depression severity at 3-, 6-, 12-, 18-month postbaseline assessments; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care. RESULTS: All participants were on Medicaid and 27 years old on average; 58% were non-White; 71% were unmarried; and 65% had probable PTSD. From before birth to 18 months postbaseline, MOMCare (n = 83) compared to MSS-Plus participants (n = 85) attained significantly lower levels of depression severity (Wald's χ(2) = 6.09, df = 1, P = .01) and PTSD severity (Wald's χ(2) = 4.61, df = 1, P = .04), higher rates of depression remission (Wald's χ(2) = 3.67, df = 1, P = .05), and had a greater likelihood of receiving ≥4 mental health visits (Wald's χ(2) = 58.23, df = 1, P < .0001) and of adhering to antidepressants in the prior month (Wald's χ(2) = 10.00, df = 1, P < .01). CONCLUSION: Compared to MSS-Plus, MOMCare showed significant improvement in quality of care, depression severity, and remission rates from before birth to 18 months postbaseline for socioeconomically disadvantaged women. Findings suggest that evidence-based perinatal depression care can be integrated into the services of a county public health system in the United States. CLINICAL TRIAL REGISTRATION: ClinicalTrials.govNCT01045655.
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Depressão Pós-Parto/terapia , Transtorno Depressivo Maior/terapia , Transtorno Distímico/terapia , Avaliação de Resultados em Cuidados de Saúde , Complicações na Gravidez/terapia , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Adulto , Comportamento Cooperativo , Feminino , Humanos , Medicaid , Pobreza , Gravidez , Método Simples-Cego , Estados Unidos , Populações Vulneráveis , Adulto JovemRESUMO
Carbon nanotube (CNT) field emission displays (FEDs) are currently in the product development stage and are expected to be commercialized in the near future because they offer image quality and viewing angles comparable to a cathode ray tube (CRT) while using a thinner structure, similar to a liquid crystal display (LCD), and enable more efficient power consumption during use. To address concerns regarding the environmental performance of CNT-FEDs, a screening-level, cradle-to-grave life cycle assessment (LCA) was conducted based on a functional unit of 10,000 viewing hours, the viewing lifespan of a CNT-FED. Contribution analysis suggests the impacts for material acquisition and manufacturing are greater than the combined impacts for use and end-of-life. A scenario analysis of the CNT paste composition identifies the metal components used in the paste are key contributors to the impacts of the upstream stages due to the impacts associated with metal preparation. Further improvement of the manufacturing impacts is possible by considering the use of plant-based oils, such as rapeseed oil, as alternatives to organic solvents for dispersion of CNTs. Given the differences in viewing lifespan, the impacts of the CNT-FED were compared with a LCD and a CRT display to provide more insight on how to improve the CNT-FED to make it a viable product alternative. When compared with CRT technology, CNT-FEDs show better environmental performance, whereas a comparison with LCD technology indicates the environmental impacts are roughly the same. Based on the results, the enhanced viewing capabilities of CNT-FEDs will be a more viable display option if manufacturers can increase the product's expected viewing lifespan.
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Equipamentos e Provisões Elétricas , Meio Ambiente , Nanotubos de Carbono/química , Modelos Teóricos , IncertezaRESUMO
The American Nurses Association advocates for nursing professional development (NPD) specialists to have an earned graduate degree, as well as educational and clinical expertise. However, many NPD specialists have limited exposure to adult learning theory. Limited exposure to adult learning theory may affect NPD educational practices, learning outcomes, organizational knowledge transfer, and subsequently, the professional development of the nurses they serve and quality of nursing care. An examination of current teaching practices may reveal opportunities for NPD specialists to enhance educational methods to promote learning, learning transfer, and organizational knowledge and excellence. This article, the first in a two-part series, examines best practices of adult learning theories, nursing professional development, curriculum design, and knowledge transfer. Part II details the results of a correlational study that examined the effects of four variables on the use of adult learning theory to guide curriculum development for NPD specialists in hospitals.
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Educação Continuada em Enfermagem/métodos , Educação Continuada em Enfermagem/normas , Recursos Humanos de Enfermagem/educação , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/normas , Adulto , Currículo , Humanos , Guias de Prática Clínica como AssuntoRESUMO
This article, the second in a two-part series, details a correlational study that examined the effects of four variables (graduate degrees in nursing education, professional development training in adult learning theory, nursing professional development [NPD] certification, and NPD specialist experience) on the use of adult learning theory to guide curriculum development. Using the Principles of Adult Learning Scale, 114 NPD specialists tested the hypothesis that NPD specialists with graduate degrees in nursing education, professional development training in adult learning theory, NPD certification, and NPD experience would use higher levels of adult learning theory in their teaching practices to guide curriculum development than those without these attributes. This hypothesis was rejected as regression analysis revealed only one statistically significant predictor variable, NPD certification, influenced the use of adult learning theory. In addition, analysis revealed NPD specialists tended to support a teacher-centered rather than a learner-centered teaching style, indicating NPD educators are not using adult learning theory to guide teaching practices and curriculum development.
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Currículo , Educação de Pós-Graduação em Enfermagem/métodos , Docentes de Enfermagem , Desenvolvimento de Pessoal/métodos , Adulto , Coleta de Dados , HumanosRESUMO
Importance: Chronic pain after traumatic brain injury (TBI) is prevalent and associated with poor outcomes. By providing multidisciplinary care through expert consultation, a collaborative care (CC) treatment approach may reduce pain interference. Objective: To compare CC with usual care (UC) in decreasing pain interference. Design, Setting, and Participants: This randomized clinical trial was conducted from July 2018 through April 2021 at 2 hospital-based academic rehabilitation medicine clinics in Seattle, Washington. Participants included adults with mild-to-severe TBI (at least 6 months before enrollment) and chronic pain. Data analysis was performed from March 30, 2022, to August 30, 2023. Intervention: The CC intervention (called TBI Care) included up to 12 in-person or telephone visits over 16 weeks with a care manager (CM) who provided person-centered cognitive behavioral treatment. The CM met weekly with members of the expert team to review participants and discuss recommendations to optimize treatment. Main Outcomes and Measures: The primary outcome was pain interference on the Brief Pain Inventory at treatment conclusion (4 months after randomization). Secondary outcomes included pain interference at 8 months; pain severity; symptoms of depression, anxiety, and sleep disturbance; pain-related emergency department visits; community participation; and participant satisfaction. Linear mixed-effects regression was used for analysis. Results: A total of 1379 individuals were screened for eligibility, and 158 were randomized (79 to CC and 79 to UC). The participants were mostly women (92 participants [58%]) with a mean (SD) age of 46.8 (13.2) years and a mean (SD) of 15.3 (3.0) years of education. TBI occurred a mean (SD) of 4.0 (5.9) years (median [IQR], 1.9 [0.8-4.5] years) before enrollment. All TBI severities were included, and of 149 participants for whom TBI severity was known, the majority (97 participants [65%]) had mild TBI. In the CC group, 71 participants (90%) completed at least 11 sessions, and, at 4 months, this group had significantly lower pain interference scores compared with the UC group (mean [SD], 3.46 [2.17] vs 5.03 [2.28]). This difference was maintained at 8 months after randomization, with mean (SD) TBI care pain interference scores of 3.61 (2.22) for CC vs 4.68 (2.51) for UC. At 4 months, there was significantly lower pain severity in the CC group vs UC group (mean [SD] score, 3.63 [1.95] vs 4.90 [1.96]), as well as symptoms of depression (mean [SD] score, 8.07 [5.34] vs 11.31 [6.37]) and anxiety (mean [SD], 6.20 [5.17] vs 9.58 [6.00]). Satisfaction with pain treatment (mean [SD] score, 2.99 [1.23] vs 2.52 [1.25]), clinical care (mean [SD] score, 3.28 [1.00] vs 2.84 [1.26]), and overall health care (mean [SD] score, 3.25 [0.88] vs 2.82 [1.00]) were significantly higher in the CC group vs the UC group; global impression of change was significantly lower in the CC group vs the UC group (mean [SD] score, 2.74 [1.02] vs 3.47 [1.26]) (lower scores denote a better impression of change). Conclusions and Relevance: In this randomized clinical trial of CC compared with UC for patients with TBI, CC was effective at reducing pain interference and was sustained at 8-month follow-up. Further research is needed to examine the implementation and cost-effectiveness of CC for TBI in other health care settings. Trial Registration: ClinicalTrials.gov Identifier: NCT03523923.
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Lesões Encefálicas Traumáticas , Dor Crônica , Humanos , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Feminino , Masculino , Dor Crônica/terapia , Dor Crônica/etiologia , Pessoa de Meia-Idade , Adulto , Manejo da Dor/métodos , Washington , Equipe de Assistência ao Paciente , Medição da Dor , Terapia Cognitivo-Comportamental/métodosRESUMO
Importance: Prenatal depression is prevalent with negative consequences for both the mother and developing fetus. Brief, effective, and safe interventions to reduce depression during pregnancy are needed. Objective: To evaluate depression improvement (symptoms and diagnosis) among pregnant individuals from diverse backgrounds randomized to brief interpersonal psychotherapy (IPT) vs enhanced usual care (EUC). Design, Setting, and Participants: A prospective, evaluator-blinded, randomized clinical trial, the Care Project, was conducted among adult pregnant individuals who reported elevated symptoms during routine obstetric care depression screening in general practice in obstetrics and gynecology (OB/GYN) clinics. Participants were recruited between July 2017 and August 2021. Repeated measures follow-up occurred across pregnancy from baseline (mean [SD], 16.7 [4.2] gestational weeks) through term. Pregnant participants were randomized to IPT or EUC and included in intent-to-treat analyses. Interventions: Treatment comprised an engagement session and 8 active sessions of brief IPT (MOMCare) during pregnancy. EUC included engagement and maternity support services. Main Outcomes and Measures: Two depression symptom scales, the 20-item Symptom Checklist and the Edinburgh Postnatal Depression Scale, were assessed at baseline and repeatedly across pregnancy. Structured Clinical Interview for DSM-5 ascertained major depressive disorder (MDD) at baseline and the end of gestation. Results: Of 234 participants, 115 were allocated to IPT (mean [SD] age, 29.7 [5.9] years; 57 [49.6%] enrolled in Medicaid; 42 [36.5%] had current MDD; 106 [92.2%] received intervention) and 119 to EUC (mean [SD] age, 30.1 [5.9] years; 62 [52.1%] enrolled in Medicaid; 44 [37%] had MDD). The 20-item Symptom Checklist scores improved from baseline over gestation for IPT but not EUC (d = 0.57; 95% CI, 0.22-0.91; mean [SD] change for IPT vs EUC: 26.7 [1.14] to 13.6 [1.40] vs 27.1 [1.12] to 23.5 [1.34]). IPT participants more rapidly improved on Edinburgh Postnatal Depression Scale compared with EUC (d = 0.40; 95% CI, 0.06-0.74; mean [SD] change for IPT vs EUC: 11.4 [0.38] to 5.4 [0.57] vs 11.5 [0.37] to 7.6 [0.55]). MDD rate by end of gestation had decreased significantly for IPT participants (7 [6.1%]) vs EUC (31 [26.1%]) (odds ratio, 4.99; 95% CI, 2.08-11.97). Conclusions and Relevance: In this study, brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics. As a safe, effective intervention to relieve depression during pregnancy, brief IPT may positively affect mothers' mental health and the developing fetus. Trial Registration: ClinicalTrials.gov Identifier: NCT03011801.
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Transtorno Depressivo Maior , Psicoterapia Breve , Adulto , Humanos , Feminino , Gravidez , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Resultado do Tratamento , Estudos ProspectivosRESUMO
The Earth's oceans are home to a diverse array of life, from large marine mammals to microscopic organisms. Among the most important are the marine phytoplankton, which comprise the basis of marine food webs, and also produce a large percentage of the Earth's oxygen through photosynthesis. Although the vast majority of phytoplankton are essential to ocean health, several dozen species produce potent toxins, and can form what are called Harmful Algal Blooms (HABs). This activity focuses on the importance of HABs, as well as the types of data scientists collect to understand blooms. In the classroom exercises, students will calculate the proportional abundance (% contribution) of five HAB species present in water samples, and use these data to create pie graphs to depict species composition. Students will then compare these results with levels of HAB toxins in water samples collected over the same time period. Thought questions challenge students to develop hypotheses regarding how changes in the HAB community may relate to observed trends in toxin concentrations. This activity was successfully taught to visually impaired students who were able to complete the pie charts and answer the thought questions.
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BACKGROUND: Identifying students' who are able to complete a rigorous course of study, graduate on time, and pass the NCLEX-RN© is a principle role of nursing program admissions teams. PURPOSE: To examine which preadmission factors predict students' success in the first semester of a baccalaureate nursing program. METHODS: Undergraduate students' data from the academic years 2013 to 2017 were analyzed (N = 927). Bivariate and multiple regression analyses were used to examine potential predictors of first semester course success, and scores on standardized NCLEX preparation exams. RESULTS: Preadmission cumulative GPA (OR = 3.82, 95% CI = 1.43-10.16) and prerequisite science GPA (OR = 2.57, 95% CI = 1.14-5.78) predicted success in the pathopharmacology course. Preadmission cumulative GPA (OR = 6.53, 95% CI = 1.59-26.85) and TEAS composite score (OR = 1.15, 95% CI = 1.09-1.22) predicted success in the health assessment course. Preadmission cumulative GPA (OR = 3.42, 95% CI = 1.18-9.92) and TEAS composite score (OR = 1.05, 95% CI = 1.01-1.10) predicted success in the foundations course. Higher preadmission cumulative GPA (B = 14.19, p < 0.01), prerequisite science GPA (B = 12.62, p < 0.01), and TEAS composite score (B = 0.48, p < 0.01) predicted a higher pathopharmacology-KAPLAN, Inc. test scores. Higher preadmission cumulative GPA (B = 62.52, p < 0.01), prerequisite science GPA (B = 61.18, p < 0.01), and TEAS composite score (B = 4.76, p < 0.01) predicted a higher fundamentals-HESI test scores. CONCLUSIONS: Preadmission cumulative GPA, prerequisite science GPA, and TEAS composite score were significant predictors of success in first semester courses and performance on standardized tests.
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Bacharelado em Enfermagem , Logro , Avaliação Educacional , Humanos , Licenciamento em Enfermagem , Critérios de Admissão EscolarRESUMO
The grass shrimp, Palaemonetes pugio, plays a large role in the marine ecosystem, serving as a vital link in the food web between many other species. Marine parasites such as the bopyrid isopod, Probopyrus pandalicola, reduce shrimp growth and reproductive output and may also cause P. pugio to be more vulnerable to the lethal effects of contaminants. The purpose of this study was to determine the toxicity of resmethrin and bifenthrin on the grass shrimp, P. pugio, infected with the bopyrid isopod, Probopyrus pandalicola. A 96-h static renewal test was conducted to determine the toxicity of the pyrethroid insecticides resmethrin and bifenthrin to grass shrimp, Palaemonetes pugio, parasitized with the bopyrid isopod, Probopyrus pandalicola. The results were then compared to similar tests utilizing unparasitized P. pugio. Parasitized P. pugio had lower 24-h LC(50) (1.08 microg/L) and 96-h LC(50) (0.43 microg/L) values for resmethrin than unparasitized P. pugio. However, LC(50) ratio tests found that there was no significant difference between parasitized and unparasitized shrimp when affected by resmethrin (p = 0.1751 and 0.1108, respectively). In contrast, an LC(10) ratio test indicated that there was a significant difference between parasitized and unparasitized P. pugio after 96 h (p < 0.0001). When subjected to bifenthrin, parasitized P. pugio had a higher 24-h LC(50) (0.049 microg/L6) than unparasitized P. pugio. The LC(50) ratio test established that the effects of bifenthrin on parasitized P. pugio when compared to unparasitized P. pugio were significantly different at 24 h (p = 0.0065). However, there were no significant differences between parasitized and unparasitized after 96 h (p = 0.4229). In conclusion, both resmethrin and bifenthrin are toxic to the grass shrimp, P. pugio, regardless of parasite presence, and parasitized shrimp may be more susceptible to lower doses of resmethrin (when exposed in the field).
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Inseticidas/toxicidade , Isópodes/fisiologia , Palaemonidae/efeitos dos fármacos , Palaemonidae/parasitologia , Piretrinas/toxicidade , Poluentes Químicos da Água/toxicidade , Animais , Relação Dose-Resposta a Droga , Isópodes/patogenicidade , Dose Letal Mediana , Fatores de TempoRESUMO
Marine phytoplankton comprise the foundation of oceanic food webs and generate most of the Earth's oxygen. Of the many phytoplankton species in the ocean, a few dozen produce potent toxins, and at high concentrations can form what are called Harmful Algal Blooms (HABs) or "red tides" that can discolor marine waters. Managers and scientists have been monitoring coastal waters and shellfish resources for HABs and their toxins to ensure seafood safety and understand why blooms occur. This educational activity focuses on a prominent HAB species that causes paralytic shellfish poisoning (PSP). Students will learn about the importance of HABs and PSP, as well as how scientists collect and use data to understand and predict blooms. Students will plot data on HAB species collected by scientists over multiple years of sampling. Students will also plot results over time and across regions, report on observed patterns, and complete grade-appropriate calculations. Lastly, group discussion will focus on determining whether geographic patterns exist that might influence where shellfish beds are closed. This activity is timely given the widespread wildlife mortalities and beach closures due to Florida red tide, as well as recent dog deaths attributed to exposure to freshwater cyanobacteria (blue-green algae) blooms.
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PURPOSE/OBJECTIVE: The ability to tolerate uncertainty about the future may be foundational to positive psychological adjustment. Conversely, intolerance of uncertainty (IU) has been shown to be a vulnerability factor for anxiety and depression. One stressor with a very high degree of uncertainty about the future is a new diagnosis of multiple sclerosis (MS). However, few psychological interventions in MS have directly targeted IU. Research Method/Design: Forty-eight participants with early MS and moderate levels of distress were randomized to receive either 6 sessions of a brief psychological intervention designed to improve the ability to tolerate uncertainty (n = 23) or treatment as usual (TAU; n = 25). Measures of mood, IU, and MS acceptance were administered at baseline and about 8 weeks later. Intervention effects were tested via linear regression controlling for baseline levels. RESULTS: Participants were primarily Caucasian (85%) women (73%) and had lived with an MS diagnosis for an average of 376.3 days. Groups did not differ at baseline on most demographic or outcome variables. The intervention was well-tolerated, and most participants (82.6%) completed all 6 sessions and reported benefit. Postintervention, those in the intervention group demonstrated lower levels of IU and more MS acceptance relative to the TAU group. There was no effect of the intervention on global anxiety. Decreases in IU were associated with increases in MS acceptance (r = -.63). Effect sizes for these changes were moderate. CONCLUSIONS/IMPLICATIONS: These pilot results demonstrate that IU is responsive to a brief psychological intervention, and improvement with IU is associated with positive psychological outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Atitude Frente a Saúde , Terapia Cognitivo-Comportamental/métodos , Ajustamento Emocional , Esclerose Múltipla/psicologia , Incerteza , Adulto , Feminino , Humanos , Masculino , Projetos PilotoRESUMO
BACKGROUND AND OBJECTIVES: Evidence-based pharmacological and behavioral interventions are often underutilized or inaccessible to persons with multiple sclerosis (MS) who have chronic pain and/or depression. Collaborative care is an evidence-based patient-centered, integrated, system-level approach to improving the quality and outcomes of depression care. We describe the development of and randomized controlled trial testing a novel intervention, MS Care, which uses a collaborative care model to improve the care of depression and chronic pain in a MS specialty care setting. METHODS: We describe a 16-week randomized controlled trial comparing the MS Care collaborative care intervention to usual care in an outpatient MS specialty center. Eligible participants with chronic pain of at least moderate intensity (≥3/10) and/or major depressive disorder are randomly assigned to MS Care or usual care. MS Care utilizes a care manager to implement and coordinate guideline-based medical and behavioral treatments with the patient, clinic providers, and pain/depression treatment experts. We will compare outcomes at post-treatment and 6-month follow up. PROJECTED PATIENT OUTCOMES: We hypothesize that participants randomly assigned to MS Care will demonstrate significantly greater control of both pain and depression at post-treatment (primary endpoint) relative to those assigned to usual care. Secondary analyses will examine quality of care, patient satisfaction, adherence to MS care, and quality of life. Study findings will aid patients, clinicians, healthcare system leaders, and policy makers in making decisions about effective care for pain and depression in MS healthcare systems. (PCORI- IH-1304-6379; clinicaltrials.gov: NCT02137044). This trial is registered at ClinicalTrials.gov, protocol NCT02137044.
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Dor Crônica/etiologia , Dor Crônica/terapia , Depressão/etiologia , Depressão/terapia , Esclerose Múltipla/complicações , Equipe de Assistência ao Paciente/organização & administração , Terapia Comportamental/métodos , Avaliação da Deficiência , Fadiga/etiologia , Humanos , Cooperação do Paciente , Participação do Paciente , Assistência Centrada no Paciente/organização & administração , Qualidade de Vida , Projetos de PesquisaRESUMO
The grass shrimp, Palaemonetes pugio, is an important food source for many invertebrate and fish species, including several of commercial importance. The bopyrid Probopyrus pandalicola prevents reproduction in P. pugio by sexual sterilization. The purpose of our research was to determine bopyrid prevalence in grass shrimp over the course of a year. Shrimp were collected from 2 estuarine systems in South Carolina and 2 estuarine systems in Georgia and examined for parasite presence, sex, and gravidity. Site-specific monthly prevalence ranged from 0 to 6.3%. Country Club Creek had the maximum mean +/- SE prevalence of 3.1 +/- 0.3%, and Harbour Town had the minimum of 1.3 +/- 0.3%. Maximum prevalence was concurrent with peak gravidity for Moon River; thus, at this site the negative effect of this parasite on reproductive output may be greater. Reduced egg production may affect grass shrimp abundance and ultimately the recruitment success of its predators.
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Isópodes/fisiologia , Palaemonidae/parasitologia , Animais , Feminino , Georgia , Interações Hospedeiro-Parasita , Masculino , Palaemonidae/fisiologia , Reprodução , Rios , Estações do Ano , South CarolinaRESUMO
OBJECTIVE: The comorbidity of posttraumatic stress disorder (PTSD) with antenatal depression poses increased risks for postpartum depression and may delay or diminish response to evidence-based depression care. In a secondary analysis of an 18-month study of collaborative care for perinatal depression, the authors hypothesized that pregnant, depressed, socioeconomically disadvantaged women with comorbid PTSD would show more improvement in the MOMCare intervention providing Brief Interpersonal Psychotherapy and/or antidepressants, compared to intensive public health Maternity Support Services (MSS-Plus). METHODS: A multisite randomized controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System, July 2009-January 2014. Pregnant women were recruited who met criteria for a probable diagnosis of major depressive disorder (MDD) on the Patient Health Questionnaire-9 and/or dysthymia on the MINI-International Neuropsychiatric Interview (5.0.0). The primary outcome was depression severity at 3-, 6-, 12-and 18-month follow-ups; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care. RESULTS: Sixty-five percent of the sample of 164 met criteria for probable comorbid PTSD. The treatment effect was significantly associated with PTSD status in a group-by-PTSD severity interaction, controlling for baseline depression severity (Wald χ²1 = 4.52, P = .03). Over the 18-month follow-up, those with comorbid PTSD in MOMCare (n = 48), versus MSS-Plus (n = 58), showed greater improvement in depression severity (Wald χ²1 = 8.51, P < .004), PTSD severity (Wald χ²1 = 5.55, P < .02), and functioning (Wald χ²1 = 4.40, P < .04); higher rates of depression response (Wald χ²1 = 4.13, P < .04) and remission (Wald χ²1 = 5.17, P < .02); and increased use of mental health services (Wald χ²1 = 39.87, P < .0001) and antidepressant medication (Wald χ²1 = 8.07, P < .005). Participants without comorbid PTSD in MOMCare (n = 33) and MSS-Plus (n = 25) showed equivalent improvement on these outcomes. CONCLUSIONS: Collaborative depression care had a greater impact on perinatal depressive outcomes for socioeconomically disadvantaged women with comorbid PTSD than for those without PTSD. Findings suggest that a stepped care treatment model for high-risk pregnant women with both MDD and PTSD could be integrated into public health systems in the United States. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01045655.
Assuntos
Antidepressivos/uso terapêutico , Depressão Pós-Parto/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Complicações na Gravidez/terapia , Psicoterapia Breve , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Populações Vulneráveis , Adulto , Terapia Combinada , Serviços Comunitários de Saúde Mental , Comorbidade , Depressão Pós-Parto/diagnóstico , Feminino , Seguimentos , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Apoio Social , WashingtonRESUMO
The bopyrid isopod Probopyrus pandalicola is a hematophagous ectoparasite that sexually sterilizes some palaemonid shrimps, including female daggerblade grass shrimp Palaemonetes pugio. The reproduction of parasitic isopods is thought to occur synchronously with host molting because the brood would be unsuccessful if molting occurred before the larvae were free swimming. Temperature affects the length of the molting cycle of shrimp, and therefore may also affect the incubation time of isopod broods. The purpose of the present study was to determine the effect of temperature on brood development of the parasite and on the degree of synchronization with the molting of its host. Parasitized P. pugio were monitored daily at 2 experimental temperatures, 23 and 15 C, in temperature-controlled chambers for the duration of a full parasite reproductive cycle. Developmental stage was determined by the visible coloration of the brood through the exoskeleton of the host, and was designated as egg, embryo I, embryo II, or epicaridium larvae. Temperature significantly affected median brood incubation time, which was only 11 days at 23 C, as compared to 35 days at 15 C. The final developmental stage (epicaridium larvae) was 3 times shorter at 23 C (median 3 days; n = 45) than at 15 C (median 9 days; n = 15). Temperature significantly affected the intermolt period of parasitized shrimp, which was shorter at 23 C (median 12 days) than at 15 C (median 37 days). A smaller percentage of the intermolt period elapsed between larval release and shrimp molting at 23 C (0.0%) than at 15 C (3.1%), indicating closer synchronization between host molting and parasite reproduction at the warmer temperature. At 15 C, the isopods utilized a smaller proportion of the time that was available for brood incubation during the intermolt period of their host. Brood size ranged from 391 to 4,596 young and was positively correlated with parasite and host size. Because development progressed more rapidly at 23 C, warmer temperatures could increase the prevalence of P. pandalicola. The corresponding reduction in the abundance of ovigerous grass shrimp as a result of sexual sterilization by bopyrids could adversely impact estuarine ecosystems, as grass shrimp are a crucial link in transferring energy from detritus to secondary consumers.
Assuntos
Isópodes/fisiologia , Muda/fisiologia , Palaemonidae/parasitologia , Análise de Variância , Animais , Feminino , Fertilidade , Água Doce , Interações Hospedeiro-Parasita , Isópodes/anatomia & histologia , Masculino , Palaemonidae/anatomia & histologia , Palaemonidae/fisiologia , Distribuição Aleatória , Temperatura , Fatores de TempoRESUMO
Probopyrus pandalicola is a bopyrid isopod that infects several palaemonid shrimp species, including the daggerblade grass shrimp Palaemonetes pugio . The parasite can have several negative effects on its host, including loss of hemolymph, reduced reproductive potential, and decreased molting frequency and growth. To date, there are conflicting reports on whether Probopyrus pandalicola affects the reproductive capability of both male and female daggerblade grass shrimp. The purpose of this study was to determine whether infection by Probopyrus pandalicola resulted in the sexual sterilization of Palaemonetes pugio , and if the reproductive capability of male and/or female shrimp was restored after the bopyrid was removed. We found that parasitized and deparasitized males were able to fertilize the eggs of unparasitized females successfully, as 18.9 ± 7.1% and 42.7 ± 5.2% of the females paired with them became ovigerous in 4 wk, respectively. Neither parasitized nor deparasitized females became ovigerous when placed with unparasitized males during the 4-wk period. However, 45.4 ± 20.6% of deparasitized females did become ovigerous within 10 wk. Despite the fact that female shrimp are able to reproduce again when no longer parasitized, the majority of females remain infected with the bopyrid for their entire lives. Therefore, the sexual sterilization of female shrimp could potentially have a significant impact on estuarine food webs, as grass shrimp are conduits of detrital energy and a food source for many recreationally and commercially important species in estuaries on the East Coast of the United States and in the Gulf of Mexico.