Challenges, rewards, and lessons learned from family and community caregivers of individuals with serious mental illness and cancer.

PURPOSE: The caregiving experience for individuals with serious mental illness (SMI) and cancer has not been explored in previous cancer caregiver research. This study assessed the challenges, rewards, and lessons learned from this unique population of caregivers. METHODS: We conducted qualitative interviews with 13 caregivers (9 family caregivers, 4 community caregivers) of patients recently diagnosed with head and neck, breast, lung, or gastrointestinal cancer and SMI who participated in a single-arm pilot of person-centered collaborative care. Interviews were transcribed and analyzed using inductive and deductive approaches. Investigators developed a coding scheme based on the interview guide. Interviews were double-coded and themes were identified via an iterative consensus process consistent with a content analysis framework. Comparisons between community and family caregiver experiences were explored. RESULTS: Caregiving challenges included the impact of mental health symptoms on timely diagnosis, treatment, and coordination of care and lack of resources specific to SMI and cancer caregiving. Family caregivers valued increased closeness and meaningfulness in their relationships. Family and community caregivers found it rewarding to be part of a person-centered care model that was effective for the patient. Lessons learned included tending to their own needs too, and the importance of advocacy and a team approach to decrease mental health stigma and coordinate care. CONCLUSIONS: This study highlights the complex challenges and rewards experienced by family and community caregivers for individuals with cancer and SMI. Tailored approaches to support caregivers as individuals are needed. Additional research on community caregiver-patient dyads and non-spousal family caregiver-patient dyads are needed to inform intervention development.

The impact of a didactic and experiential learning model on health profession students' knowledge, perceptions, and confidence in the use of telehealth.

BACKGROUND: Training of health profession students in telehealth is important to ensure proper implementation for healthcare delivery. This prospective study aimed to analyze the effects of didactic and experiential learning on knowledge, confidence, and attitudes of telehealth among health profession students (Survey 1). The perceptions of a mixed model telehealth platform were also considered among these students and community clients (Survey 2). MATERIALS AND METHODS: A quasi-experimental repeated-measure study was conducted on 153 university health profession students in physician assistant, physical therapy, occupational therapy, and nursing (NR) across the 2020-2021 academic year. Survey 1 was administered to students pre/postdidactic telehealth training and at two sequential points within two semesters of telehealth experiential learning. Survey 2 was distributed among students and a pool of 19 community clients at 4 time points across the experience. Survey data were analyzed using R software. RESULTS: There was a significant improvement in telehealth knowledge, confidence, and attitudes among all student disciplines after the didactic module with marginal means ranging 3.313/5-4.318/5 for pretest to posttest 1. Improvement continued through experiential learning with marginal means ranging 4.170/5-4.369/5 in posttest 3. There was also a significant student and client approval of the telehealth platform with a student mean high of 3.962/5 ± 0.527 and client mean high of 4.727/5 ± 0.238. CONCLUSION: A didactic training module combined with experiential learning is effective for health profession students' improvement in perception, knowledge, and attitudes toward telehealth. Health profession students and community clients approve a mixed model telehealth platform.

Exploring urban students' constructions about school, work, race, and ethnicity.

This qualitative study is an exploration of 32 urban high school students' narratives about the connection between school, work, and societal expectations of their future success related to their racial and ethnic background. The sample varied along 2 contextual dimensions: participation in a psychoeducational intervention (Tools for Tomorrow) and developmental status (i.e., half the sample were 9th-grade students and the other half were 12th-grade students). Using consensual qualitative research, the narratives revealed 3 major domains: future orientation; students' perceptions of society's expectations based on race and ethnicity; and students' perception of the role of their race and ethnicity in future success. Results reveal that the majority of students endorse a connection between school and work, believe that society holds low expectations for them based on their racial and ethnic background, and cannot predict their future success based on their background.

Vehicular air pollution, playgrounds, and youth athletic fields.

In spite of epidemiological evidence concerning vehicular air pollution and adverse respiratory/cardiovascular health, many athletic fields and school playgrounds are adjacent to high traffic roadways and could present long-term health risks for exercising children and young adults. Particulate matter (PM(1),0.02-1.0 microm diameter) number counts were taken serially at four elementary school athletic/playground fields and at one university soccer field. Elementary school PM1 measurements were taken over 17 days; measurements at the university soccer field were taken over 62 days. The high-traffic-location elementary school field demonstrated higher 17-day [PM1] than the moderate and 2 low traffic elementary school fields (48,890 +/- 34,260, 16,730 +/- 10,550, 11,960 +/- 6680, 10,030 +/- 6280, respective mean counts; p < .05). The 62-day mean PM1 values at the university soccer field ranged from 115,000 to 134,000 particles cm(-3). Lowest mean values were recorded at measurement sites furthest from the highway (approximately 34,000 particles cm(-3)) and followed a second-order logarithmic decay (R2 = .999) with distance away from the highway. Mean NO2 and SO2 levels were below 100 ppb, mean CO was 0.33 +/- 1.87 ppm, and mean O3 was 106 +/- 47 ppb. Ozone increased with rising temperature and was highest in the warmer afternoon hours (R = .61). Although the consequence of daily recess play and athletic activities by school children and young athletes in high ambient [PM1] conditions has not yet been clearly defined, this study is a critical component to evaluating functional effects of chronic combustion-derived PM exposure on these exercising schoolchildren and young adults. Future studies should examine threshold limits and mechanistic actions of real-world particle exposure.

Modulation of leukocyte recruitment and IL-8 expression by the membrane attack complex of complement (C5b-9) in a rabbit model of antigen-induced arthritis.

The complement system is thought to be a major physiological mediator of injury in a number of diseases including rheumatoid arthritis (RA). The membrane attack complex (MAC) of complement has been detected in RA tissue, suggesting that the MAC may be relevant to the pathogenesis of the disease. Deposition of sublytic concentrations of the MAC has been shown to promote the expression of proinflammatory mediators. In the present study, we utilized rabbits deficient in the complement protein C6 to elucidate the role of the MAC in mediating the pathogenesis of antigen-induced arthritis. Swelling, leukocyte accumulation, IL-8 expression, proteoglycan, and hydroxyproline content were assessed. Analysis of synovial tissue demonstrated a significant decrease in leukocyte influx and a parallel decrease in tissue associated IL-8 in joints of C6-deficient animals as compared to C6-sufficient animals. However, this did not correlate with the preservation of connective tissue. The results derived from this study provide evidence that the MAC has an important function in mediating leukocyte recruitment in antigen-induced arthritis but does not play a direct role in connective tissue breakdown.