Models of outpatient neuropalliative care for patients with amyotrophic lateral sclerosis.

OBJECTIVE: To describe some current models of outpatient neuropalliative care (NPC) available to patients with amyotrophic lateral sclerosis at different institutions within the United States. METHODS: Six NPC physicians were asked to contribute written descriptions about the PC available in their ALS clinics. Descriptions were then compiled and assessed for similarities and differences. RESULTS: All clinics are multidisciplinary, with regular appointments every 3 months and similar appointment times for new visits (60-120 minutes) and follow-up visits (20-45 minutes). Four clinics have an NPC specialist embedded within the ALS clinic, 1 institution has a separate clinic for NPC, and 1 institution has both. The NPC physician at 5 institutions is a neurologist with formal palliative care training and at 1 institution is an internist with formal palliative care training. NPC is part of routine care for all patients at 2 institutions, and the primary reasons for consultation are goals of care (GOC) and severe symptom management. CONCLUSION: NPC is provided to patients with ALS heterogeneously throughout the United States with some variation in services and delivery, but all clinics are addressing similar core needs. Given the poor prognosis and high PC needs, those with ALS are the ideal patients to receive NPC. Future studies are necessary given the paucity of data available to determine best practices and to better define meaningful outcomes.

Implementation of an intimate partner violence screening program in a university health care clinic.

Objectives: To examine whether an intimate partner violence (IPV) screening program is related to a positive change in health care providers' knowledge, attitudes, and self-efficacy of IPV screening. Participants: Eleven health care providers at a university health care clinic participated in the IPV screening program. Methods: A one-group pretest-posttest design was used to examine whether an IPV screening program was related to a change in health care providers' knowledge, attitudes, and self-efficacy of IPV screening. Results: Findings indicated that there was a significant difference (p < 000) between the posttest scores and the pretest scores on the Domestic Violence Healthcare Provider Survey Scale. Domain analysis of the scale revealed a significant difference in perceived self-efficacy (p = .001), system support (p = <.002), victim provider safety (p = .015), and beliefs of blaming victims (p = <.004). No statistical difference was found in professional role resistance/fear of offending (p = .158). Conclusions: A university health care clinic IPV screening program was related to a positive change in health care providers' knowledge, attitudes, and self-efficacy of IPV screening.

Intervenciones para la salud mental de estudiantes universitarios durante la pandemia por COVID-19. Síntesis rápida. / Mental health interventions for college students during the COVID-19 pandemic. Rapid Synthesis

En esta síntesis se consideran las siguientes cuatro acciones concretas: 1. Lineamientos generales en salud mental de universitarios. 2. Promoción y prevención en salud mental. 3. Atención de síntomas mentales. 4. Adaptaciones pedagógicas con énfasis en salud mental. En general, se encontró que la sugerencia más frecuente es el diseño de un programa estructurado específico para el tema de salud mental en las universidades. En este programa se integran todas las demás acciones por lo que los desarrolladores de estas propuestas sugieren que sea diseñado por un grupo multidisciplinario de profesionales en salud mental, pedagogos y personal administrativo. Además, debe ser incluyente en el sentido de que incorpore siempre la visión de los mismos estudiantes (36). Debe ser dinámico de manera que se ajuste y actualice según se vaya monitoreando las necesidades y barreras emergentes; y, finalmente, este programa ser sensible a la cultura, pues las estrategias de afrontamiento pueden ser distintas (20) de ahí que cada universidad debe diseñarlo pensando en sus particularidades.

An Electronic Medical Record Alert Intervention to Improve HPV Vaccination Among Eligible Male College Students at a University Student Health Center.

This pilot study aims to improve HPV vaccination for college aged males at a student health center. The first part of the study consisted of a focus group that assessed the barriers and facilitators of HPV vaccination among healthcare providers and clinic staff (N = 16). Providers reported missed opportunities for HPV vaccination. For the second part of the study, providers and staff reviewed medical records of patients ages 18-26 with student health insurance and with < 3 doses of the HPV vaccine at baseline (12/1/2014 to 7/31/2015) and follow-up (12/1/2015 to 7/31/2016). A computer-automated EMR alert was generated in the medical record of eligible male patients (N = 386). Z-scores were estimated for two-sample proportions to measure change in HPV vaccine rates at baseline and follow-up for males and females. HPV vaccine initiation rates increased among males (baseline: 5.2% follow-up: 25.1%, p < 0.001). This study shows that EMR alerts improved HPV vaccine initiation rates among insured college-aged males.

Reflections on How a University Binge Drinking Prevention Initiative Supports Alcohol Screening, Brief Intervention, and Referral for Student Alcohol Use.

What's Your Cap: Know When to Put a Lid on Drinking (WYC) is a student-led and research-based binge-drinking prevention campaign at the University of Saskatchewan, Canada. It was formed to encourage a culture of alcohol moderation on the university campus through peer-to-peer engagement that emphasizes promotional items and activities of interest to students. Since its development in 2011, WYC has been guided by a logic model that promotes: 1) perceived and actual student drinking norms on campus; 2) benefits of a student-led initiative; and 3) merits of working with community partners. With the release of a clinical guide in Canada for alcohol screening, brief intervention, and referral (SBIR) in 2013, WYC was prompted to consider whether it is a form of population-based SBIR. SBIR is commonly undertaken in the substance use field by health care practitioners, and this paper shares the potential for a student-based SBIR modification on a university campus.

Development of a community pharmacy human papillomavirus vaccine program for underinsured university students along the United States/Mexico border.

OBJECTIVE: To describe the development and implementation of a human papillomavirus (HPV) vaccine patient assistance program (PAP) for university students, and to acquire information on the number who accessed the program and completed the series. SETTING: University of Texas at El Paso University Student Health Clinic Pharmacy, Fall 2011-Spring 2014. PRACTICE DESCRIPTION: A community pharmacy located within the university student health clinic providing services to an underinsured student population. PRACTICE INNOVATION: Existing evidence shows the benefit of using PAP in community pharmacies but is nonspecific regarding the use of PAP for vaccines in an uninsured and underinsured Hispanic student population. The implementation of this unique HPV vaccine program in a community setting aims to increase awareness, access, and rates. MAIN OUTCOME MEASURES: Primary measures included results from a needs-assessment questionnaire that were used to implement the HPV vaccine program. After implementation, utilization data were collected on the number of students who qualified and enrolled in the HPV PAP and the number of students who completed the HPV series. RESULTS: The preliminary data from a needs assessment indicated that a majority (72.1%, n = 80) of students did not understand how HPV is transmitted. A total of 89 students qualified for PAP. The majority were women (81%). A total of 71 students (79.8%) received their second dose and 43 (48.3%) completed the series. CONCLUSIONS: Although pharmacists continue to provide vaccine services, minorities such as the Hispanic population continue to be underimmunized. Students may not be taking the proper precautions to prevent the acquisition of HPV. For these reasons services such as this HPV vaccine program are warranted. Pharmacists need to continue to educate and advocate on the importance of vaccines and how they prevent disease.

Care of the college student.

There are approximately 20 million students in U.S. colleges and universities. Although this population is characterized as having good health, 600,000 students report some form of disability or some type of medical problem, including attention-deficit/hyperactivity disorder, learning disabilities, psychiatric disorders, and chronic illnesses, among others. Physicians can enhance youth transition to an adult model of health care; the use of self-care skills checklists is one recommended method to assist with the transition. Stimulant medications are effective for treating adults with attention-deficit/hyperactivity disorder, but physicians should use caution when prescribing stimulants to college students because of the high rates of medication diversion in this population. Depression, anxiety, posttraumatic stress disorder, sleep problems, and eating disorders are common in college students and can significantly impact performance. Emphasis on immunization of students for influenza, meningococcus, and pertussis is necessary because of the low rates of compliance. Screening and interventions for obesity, tobacco use, and substance abuse are important because of the high prevalence of these problems in college students. Screening for alcohol abuse facilitates identification of students with problem drinking behaviors. Students who are war veterans should be monitored for suicidal ideation and posttraumatic stress disorder. Lesbian, gay, bisexual, transgender, and questioning students are at risk of harassment and discrimination. Caution should be exercised when prescribing medications to college athletes to avoid violation of National Collegiate Athletic Association eligibility rules.

SBIRT goes to college: interdisciplinary screening for alcohol use.

Although risky/harmful drinking, in the form of binge drinking, remains a national problem, only recently have health services in universities systematically screened for drinking, drug use, and smoking. This article recounts "lessons learned" in two nurse-directed, interdisciplinary health services, which adapted the National College Depression Partnership model to include screening and brief intervention (SBIRT) for risky/harmful alcohol use in the form of binge drinking. Using a planned change model, nurse leaders worked with university administrators, providers, and health service staff to screen all students seeking health services for risky drinking. The outcomes suggest that this process may increase staff and student awareness of the importance of alcohol consumption to health, show the ease of using SBIRT screening along with standard screening tools, and yield information on the normalization of high-risk drinking in collegiate settings. Project findings indicate that common perceptions in college students minimize negative outcomes and stress the importance of additional quality assurance initiatives that review the efficacy of combinations of standardized screening tools.

Routine use of screening and brief intervention for college students in a university counseling center.

This study provides preliminary evidence of the effectiveness of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and ASSIST-linked brief intervention in a college mental health clinic. Data are from a single group, pre-post evaluation study (2006-2009) at a university counseling center. Students deemed to be at risk for substance use problems were offered the ASSIST and the ASSIST-linked brief intervention. Staff therapists administered the ASSIST and intervention as part of routine care; 453 students (ages 18-24) participated in the evaluation and completed baseline and six-month follow-up interviews. Changes in alcohol and marijuana use were examined by McNemar's test of proportions and by paired t-tests for means. Slight reductions in the rates and number of days (in the prior 30 days) of binge drinking and marijuana use were found. Routine screening and brief intervention procedures in a mental health setting may reduce problematic substance use among college students.

Help seeking for mental health on college campuses: review of evidence and next steps for research and practice.

This article reviews what is known about help-seeking behavior for mental health problems in college populations and offers suggestions for the next steps that could be undertaken to improve knowledge and practice in this area. Our review suggests that traditional barriers, such as stigma, can only partially explain the high prevalence of untreated disorders. We discuss the conclusions and limitations of research on campus-based intervention strategies, including anti-stigma campaigns, screening programs, and gatekeeper trainings. In proposing new directions for research and practice, we consider insights from research on other health behaviors (e.g., diet and exercise) as well as innovative ideas from behavioral economics and cognitive psychology regarding behavior change.

Campus suicide prevention: bridging paradigms and forging partnerships.

Colleges and universities are increasingly recognizing the need to expand suicide-prevention efforts beyond the standard, clinical-intervention paradigm of suicide prevention, which relies on referral to, and treatment by, mental health services. These services frequently struggle, however, to provide effective, comprehensive care. After reviewing findings that support the need to adopt a broader, problem-focused paradigm, the article provides a framework for bridging this paradigm with the clinical-intervention approach and for conceptualizing a full continuum of preventive interventions. For each level of intervention (ranging from the individual to the ecological), we describe the goals and methods used, and provide examples to illustrate the role of psychiatrists and other campus mental health providers in the collaborative partnerships that must form to support a comprehensive, campus-wide suicide-prevention strategy.

[Fundamentals of socio-hygienic monitoring of environmental conditions for students of higher education schools].

Socioeconomic transformations and the poor environment of an industrial megalopolis negatively affected quality of life and morbidity rates in students (n = 2160). Academic intensity contributed to an increase in overall morbidity and morbidity from nervous system involvement. The regional sociohygienic monitoring of high-school training conditions within the framework of the surveillance system substantiates programs to prevent worse health and life quality in high school students.

The three Ts of adopting tobacco-free policies on college campuses.

This article describes a 3-pronged compliance strategy to implement a tobacco-free campus policy at 1 large, land grant public university in the South, and evaluates its impact on outcomes and costs. Although there has been a recent wave of tobacco-free colleges, policy restrictiveness and implementation vary, and compliance remains a challenge. The 3 Ts strategy (Tell-Treat-Train) involves regular, consistent communications, access to tobacco treatment medications and counseling, and ongoing training of supervisors and student leaders. Administrative support, access to tobacco treatment, campus buy-in, sustained communications, and careful implementation planning are critical to instituting a tobacco-free university policy.

A collaborative university model for employee wellness.

Universities are taking a more active approach in understanding and monitoring employees' modifiable health risk factors and chronic care conditions by developing strategies to encourage employees to start and sustain healthy behaviors. WellBama, the University of Alabama's signature health and wellness program, utilizes a collaborative model in partnership with select colleges and departments to implement strategies to improve employees' health status. The program provides onsite health screenings and assessments, timely health advising sessions, assistance in setting and monitoring individual health goals to promote improved health, and preventive examination referrals.

Alcohol screening and brief interventions for college freshmen.

This study examined the effectiveness of the Brief Alcohol Screening and Intervention for College Students using theory-driven harm reduction brief motivational interviewing (BMI) for decreasing high-risk drinking and negative consequences. Three surveys were administered to 102 volunteer freshmen college students at baseline and 3 months postintervention. The BMI intervention was administered at baseline and 2 weeks later. Descriptive statistics and summary graphs were used to determine longitudinal changes in drinking quantity, frequency, and negative outcomes. Number of drinks, hours of drinking, and negative consequences decreased, indicating a significant decrease in alcohol consumption and negative consequences. This study contributes valuable implications for the design of theory-driven harm reduction, evidence-based interventions for high-risk drinking among freshmen college students.

Screening university students for genital chlamydial infection: another lesson to learn.

BACKGROUND: Genital chlamydial infection is the most common bacterial sexually transmissible infection in Britain. However, the magnitude of the problem at a university setting has not been sufficiently explored. The objective of the present study was to assess the acceptability and the feasibility of Chlamydia trachomatis opportunistic screening at the University of Exeter, England, UK. METHODS: A cross-sectional study at the University of Exeter was performed. Study posters were placed in the campuses inviting the students to participate in the study. C. trachomatis screening flyers were offered to consecutive male and female students visiting the university health centre. Participants were given an information sheet and asked to complete a demographic and sexual health questionnaire. Following informed consent, a first void urine specimen was collected from male participants and a self-administered vaginal swab was collected from female participants. Specimens were tested for C. trachomatis using nucleic acid amplification test. RESULTS: Of the 250 students offered chlamydia study slips in the university health centre, 88 (35.2%) agreed to participate in the screening. Six of them were ineligible for the study. A further nine students volunteered to participate in the screening through reading study posters in the university campuses, and three of them were ineligible. A total of 88 students (66 female and 22 male) were screened for C. trachomatis and three of them (3.41%; 95% confidence interval 0.71%-9.64%) tested positive. All of the positive participants were offered treatment and partner notification. The majority of the screened students (96.5%) had had at least one sexual partner in the past 3 months. CONCLUSION: Opportunistic screening for C. trachomatis in the university can identify and treat infected students. However, the uptake rate was low. More efforts are needed to determine the best ways of engaging students in the screening.

Exploring perceptions of healthcare professionals in the implementation of a new professional role of clinical telehealth coordinator within a university integrated healthcare network.

OBJECTIVE: As telehealth networks develop across Canada, new professional roles start to emerge. A university healthcare center part of an integrated health network has identified the need to introduce a clinical coordinator for specialized telehealth programs. However, very little is found in the current literature about the description or core competencies that such a professional should possess as well as the ways to implement this role. The objective of this study was to explore how healthcare professionals (HCPs) involved in a specialized teleoncology program perceive a new clinical telehealth coordinator (CTC) role within a university integrated healthcare network (UIHN) in a metropolitan area in Québec, Canada. MATERIALS AND METHODS: A descriptive qualitative design was used and a purposive sample of nine HCPs, including physicians, nurses, and pharmacists who were members of a UIHN teleoncology committee, was recruited. RESULTS: The HCPs identified that the CTC was a multifaceted role. The core competencies identified by the HCPs included knowledge, expertise, and experience. Participants identified three key factors in the implementation of this role, namely, the structural support, having a common language, and making the implementation of this role relevant. CONCLUSIONS: The results suggest that this CTC role may be more complex than originally expected and that the diverse competencies suggest an expanded nature to this role. This has important implications for administrative strategies when addressing the key factors in the implementation of this role.

Screening for high-risk drinking in a college student health center: characterizing students based on quantity, frequency, and harms.

OBJECTIVE: This study examined characteristics of students who presented to a college health center and screened positive for the 5/4 definition of high-risk drinking (five or more drinks in a row for men, or four or more drinks in a row for women, on at least one occasion in the past 2 weeks) and analyzed the students' data according to their reporting of alcohol-related harms. METHOD: Secondary analysis of data obtained for an intervention study to reduce high-risk drinking in college students was used. Data on alcohol use and alcohol-related harms were obtained from Web-based Healthy Lifestyle Questionnaires and 30-day alcohol recall diaries (Timeline Followback calendar). Students (N = 363; 52% female) were classified as nonheavy, heavy, and heavy and frequent drinkers, based on their self-reported alcohol use. Alcohol-related harms were measured using the Rutgers Alcohol Problem Index and eight additional items derived from the Drinker Inventory of Consequences-2L. RESULTS: Students in the nonheavy, heavy, and heavy and frequent groups had mean Rutgers Alcohol Problem Index scores of 10, 14, and 23, respectively. The heavy-and-frequent drinking group comprised 20% of the sample but experienced 31% of the total harms. CONCLUSIONS: The 5/4 screening question accurately identified college students presenting to a college health center who were already experiencing significant alcohol-related harms. The addition of a frequency question (drinking 3 or more days per week) to the 5/4 screening question provided a simple method for identifying those students at highest risk and in greatest need of intervention.