Telehealth: Could It Be an Avenue to Microvascular Breast Reconstruction for Patients with Geographical Barriers?

BACKGROUND: All women undergoing a mastectomy have the right to reconstruction. However, many women do not receive reconstruction and many more are not aware of all the reconstructive options available to them. Travel distance to a center that provides reconstruction and subsequent follow-up may be a contributing factor to this disparity especially among those who seek microsurgical options. Telehealth, which provides patients with remote video consultations and decreases the travel burden, may be a solution to optimize the accessibility of breast reconstruction for these patients. The purpose of this study was to discuss the efficacy and reliability of telehealth to overcome geographic barriers. METHODS: Patients who received breast reconstruction and participated in video telehealth visits between February and May 2020 were included in this study. Patient demographics, comorbidities, and clinical outcomes were collected. Video telehealth encounters were reviewed to determine specific concerns and questions discussed during these encounters. RESULTS: A total of 235 breast reconstruction surgery patient encounters were recorded for 4 plastic surgeons who offer microsurgical breast reconstruction. Eighty-eight patients (37.4%) were seen as telehealth visits, 20 (22.7%) of which were new patient visits. Eight (9.09%) patients were microsurgical breast reconstruction candidates and 25 (28.4%) were following-up after microsurgical breast reconstruction. The majority of telehealth visits included normally healing wounds in the postoperative patient. CONCLUSION: Telehealth provides an avenue for premastectomy consultation, second opinion visits, and postoperative follow-up for patients who have geographical barriers precluding them from reaching plastic surgeons who perform all types of breast reconstruction.

A Small-Scale Randomized Efficacy Trial of the Identity Project: Promoting Adolescents' Ethnic-Racial Identity Exploration and Resolution.

Adolescents' ethnic-racial identity (ERI) formation represents an important developmental process that is associated with adjustment. The Identity Project intervention, grounded in developmental theory, was designed to engage adolescents in the ERI processes of exploration and resolution. The current small-scale efficacy trial involved an ethnic-racially diverse sample of adolescents (N = 215; Mage  = 15.02, SD = .68) from eight classrooms that were randomly assigned by classroom to the intervention or attention control group. Differences between conditions in ERI exploration at Time 2 were consistent with desired intervention effects; furthermore, higher levels of ERI exploration at Time 2 predicted increases in ERI resolution at Time 3 only for youth in the treatment condition. Findings provide preliminary evidence of program efficacy.

Examining Discrimination, Ethnic-Racial Identity Status, and Youth Public Regard Among Black, Latino, and White Adolescents.

How positively adolescents believe others feel about their ethnic-racial group (i.e., public regard) is an important part of their ethnic-racial identity (ERI), which is likely informed by contextual and individual factors. Using cluster analyses to generate ERI statuses among Black, Latino, and White adolescents (n = 1,378), we found that associations between peer versus adult discrimination and public regard varied across ERI status and ethnic-racial group. However, among all adolescents, an achieved ERI (i.e., having explored ethnicity-race and having a clear sense about its personal meaning) buffered the negative association between adult discrimination and public regard, but not between peer discrimination and public regard. Implications for understanding the interplay between contextual and individual factors for public regard are discussed.

Considering Friends Within the Context of Peers in School for the Development of Ethnic/Racial Identity.

The importance of ethnicity/race for adolescents' identity (i.e., centrality), and how that importance changes over time, may in part be a function of the social contexts that they inhabit. Although centrality has shown to be an adaptive component of ethnic/racial identity, little is known about how centrality changes during adolescence in relation to these social contexts. The current study examined the role of same-ethnic/racial peers and friends in the longitudinal development of ethnic/racial identity centrality. Drawing on four waves of data over 2 years collected with a diverse sample of 350 adolescents (M age at W1 = 15.2; 69 % female), the findings indicated that when adolescents had a greater proportion of same-ethnic/racial friends, they reported feeling that their ethnic/racial identity was more central to their sense of self six months later. However, this effect was strongest among adolescents with a low proportion of same-ethnic/racial peers in school, and weakest among adolescents with a high proportion of same-ethnic/racial peers in school. The implications of these findings for our understanding of the joint effects of peer and friend diversity in relation to ethnic/racial identity are discussed.

"They were just making jokes": Ethnic/racial teasing and discrimination among adolescents.

OBJECTIVES: The effects of peer-based discrimination are especially harmful for adolescents given the heightened role of social feedback during this period. The current study aimed to understand the unique expressions of discrimination that adolescents experience between close peers and friends, as well as the daily influence of such experiences. METHOD: Study 1 included semistructured interviews (10 interviews, 2 focus groups; Mage = 17.3) with an ethnic/racially diverse sample of adolescence. Study 2 (n = 79; Mage = 15.72) used a 21-day daily diary study with a different sample of ethnic/racially diverse adolescents. RESULTS: Study 1 found that, among close peers and friends, adolescents experienced "ethnic/racial teasing," a unique form of discrimination characterized by humor. Additionally, adolescents consistently dismissed the negative messages as innocuous based on the supposedly humorous nature of such interactions. Study 2 found that when adolescents were targeted for ethnic/racial teasing, individuals who were already anxious experienced increased daily anxiety, and that increases in social anxiety persisted across days. CONCLUSIONS: The current study suggests that among peers, ethnic/racial teasing is a common way that adolescents interact around ethnicity/race. Further, this study points to the complexity of these experiences; though they were largely considered normative and harmless, they also had negative psychological effects for some adolescents. Implications for our conceptual understanding of discrimination and teasing during adolescence are discussed.

The Everyday Implications of Ethnic-Racial Identity Processes: Exploring Variability in Ethnic-Racial Identity Salience Across Situations.

Given the social and developmental relevance of ethnicity-race during adolescence, it is important to understand the meaning of ethnic-racial identity in adolescents' everyday lives. The current study considered how individual differences in ethnic-racial identity exploration (i.e., the extent to which individuals have explored their ethnicity-race), and commitment (i.e., the extent which they have a clear sense of what it means to them) influenced variability versus stability in the awareness of ethnicity-race in a given situation (i.e., salience), and how this variability is related to mood in that situation. Within an ethnic/racially diverse sample of 395 adolescents (M age = 15; 63 % female; 12 % Black, 26 % Latino, 34 % Asian, 23 % White), results indicated that ethnic-racial identity exploration was unrelated to variability in salience, while commitment promoted stability in salience across situations. Further, among adolescents who were generally very aware of their ethnicity-race, increases in situational salience were related to decreased negative and anxious mood. Among adolescents who were generally not aware of their ethnicity-race, increases in situational salience were related to increased positive and decreased negative mood. Implications for understanding the developmental and everyday experiences of ethnic-racial identity are discussed.

School diversity and racial discrimination among African-American adolescents.

The study presented here examined school context as a moderator in the relation between daily perceptions of racial discrimination and depressive symptoms. The sample included 75 Black adolescents who completed daily surveys for 14 days. The results indicated that approximately 97% of adolescents reported experiencing at least one discriminatory experience over the 2-week period. During the daily diary period, the 2-week average was 26 discriminatory experiences with a daily average of 2.5 discriminatory events. The results indicated perceptions of racial discrimination were linked to increased depressive symptoms on the following day. This relation was apparent for Black youth attending predominantly Black and White high schools, but not for Black youth attending schools with no clear racial majority.

Intragroup contact and anxiety among ethnic minority adolescents: considering ethnic identity and school diversity transitions.

Everyday interactions with same-racial/ethnic others may confer positive benefits for adolescents, but the meaning of these interactions are likely influenced by individual differences and larger structural contexts. This study examined the situation-level association between contact with same-ethnic others and anxiety symptoms among a diverse sample of 306 racial/ethnic minority adolescents (Mage = 14 years; 66% female), based on (1) individual differences in ethnic identity centrality and (2) developmental histories of transitions in diversity between elementary, middle, and high school. The results indicated that at the level of the situation, when adolescents interacted with more same-ethnic others, they reported fewer anxiety symptoms. Further, for adolescents who had experienced a transition in school diversity, the positive benefits of contact with same-ethnic others was only conferred for those who felt that their ethnicity was very important to them. The importance of examining individual differences within larger developmental histories to understand the everyday experiences of ethnic minority adolescents are discussed.

Daily intragroup contact in diverse settings: implications for asian adolescents' ethnic identity.

This study examined the daily-level association between contact with same-ethnic others and ethnic private regard among 132 Asian adolescents (mean age = 14 years) attending four high schools ranging in ethnic composition diversity. The data suggest a positive daily-level association between contact with same-ethnic others and ethnic private regard for adolescents, who were highly identified with their ethnic group and who attended predominantly White or ethnically heterogeneous schools. In addition, using time lag analyses, contact with same-ethnic others yesterday was positively related to ethnic private regard today, but ethnic private regard yesterday was unrelated to contact with same-ethnic others today, suggesting that adolescents' identity is responsive to their environments. The implications of these findings for the development of ethnic identity are discussed.

CT angiography prior to DIEP flap breast reconstruction: a randomized controlled trial.

BACKGROUND: CT angiogram (CTA) has become the preferred method for the planning of abdominal-based microsurgical breast reconstruction to gather information about location, number, caliber and trajectory of the abdominal perforators and to decrease overall flap dissection and operating room time. However, the high-level evidence to support its utility has been limited to nonrandomized retrospective and prospective studies. METHODS: Patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction were prospectively randomized to preoperative CTA and no imaging groups. Patient demographics, operative times, selected row and number of perforators for flap harvest, agreement in perforator selection between radiologist and surgeon, and clinical outcomes data were collected. Two-way ANOVA, Fisher's exact and Student's t-tests were used for statistical analysis. RESULTS: Overall, 37 patients with 63 flaps were included in this study. Seventeen patients had CT scan prior to surgery. Mean age was 50.5 ± 9.6 years. Flap dissection time was significantly shorter in the CT group (150.8 ± 17.8 vs 184.7 ± 25.1 min and p< 0.001). Although overall odds ratio (OR) time was also shorter in the CT group, this only reached a statistical significance in bilateral surgeries (575.9 ± 70.1 vs 641.9 ± 79.6 min and p = 0.038). Hemiabdomen side, selected DIEP row, and the number of dissected perforators did not affect the overall dissection time. Complication rates were similar between the two groups. CONCLUSION: This prospective, randomized study demonstrates that preoperative CTA analysis of perforators decreases flap harvest and overall OR time with equivalent postoperative outcomes.

Longitudinal relations between ethnic/racial identity process and content: Exploration, commitment, and salience among diverse adolescents.

The present study bridges the process and content perspectives of ethnic/racial identity (ERI) by examining the longitudinal links between identity process (i.e., exploration, commitment) and a component of identity content, salience. Data were drawn from a 4-wave longitudinal study of 405 ethnically/racially diverse adolescents (63% female) from 9th to 10th grade. Results identified a transactional relation between identity process over the long-term and content in daily experiences: adolescents with stronger ERI commitment reported higher daily mean salience and less variability in salience 6 months later. At the same time, adolescents who reported more daily variability in salience engaged in more exploration 6 months later; this was particularly evident among youth who reported lower levels of mean salience. While centrality moderated some associations, most of the longitudinal associations did not vary by centrality. Building off long-standing theories of identity development that distinguish the independent effects of exploration and commitment, the data suggest that commitment predicts daily ethnic/racial salience experiences, while exploration is predicted by daily salience. Moreover, daily salience seems to serve as a developmental mechanism informing the construction of ERI over time. Implications for ERI development are discussed. (PsycINFO Database Record

Time-varying effects of family ethnic socialization on ethnic-racial identity development among Latino adolescents.

Previous research has established that family ethnic socialization messages promote ethnic-racial identity (ERI) development, yet it is unknown whether these effects remain constant throughout adolescence. The current study examined the time-varying effects of family ethnic socialization on ERI exploration and resolution among Latino adolescents (n = 323, Mage at T1 = 15.31, SDage = .76; 49.5% female). As adolescents progressed from middle to late adolescence, the relation between family ethnic socialization and exploration became stronger, while the relation between family ethnic socialization and resolution became weaker, with a significant difference between the magnitude of these associations emerging in late adolescence. The findings underscore the differential impact that family ethnic socialization messages can have on ERI developmental processes at different points in adolescence. In addition, the current study provides a useful illustration of how time-varying effects modeling can be used to examine how familial influences on youth development can change across developmental periods. (PsycINFO Database Record

Feeling (Mis)Understood and Intergroup Friendships in Interracial Interactions.

The present research investigated whether having out-group friends serves as a buffer for feeling misunderstood in interracial interactions. Across three experience sampling studies, we found that among ethnic minorities who have few White friends or are not interacting with White friends, daily interracial interactions are associated with feeling less understood. By contrast, we found that among ethnic minorities who have more White friends or are interacting with White friends, the relationship between daily interracial interactions and feeling understood is not significant. We did not find similar results for Whites; that is, having ethnic minority friends did not play a role in the relationship between daily interracial interactions and feeling understood. Together, these studies demonstrate the beneficial effects of intergroup friendships for ethnic minorities.

The Application of Experience Sampling Approaches to the Study of Ethnic Identity: New Developmental Insights and Directions.

In this article, we review how the application of experience sampling methods (ESM) has advanced knowledge of the developmental importance of ethnic identity for youth outcomes. In particular, ESM approaches have allowed researchers to explore the construct of salience, the context-dependent and fluid component of ethnic identity. We highlight new information on the importance of context for variability in ethnic identity salience, and the association between ethnic identity and psychological well-being.