Massive Transfusion Protocol Adherence: Relationship to Trauma Patient Outcomes.

BACKGROUND: Ongoing evaluation of massive transfusion protocol adherence is critical to ensure better trauma patient outcomes. OBJECTIVE: This quality improvement initiative aimed to determine provider adherence to a recently revised massive transfusion protocol and its relationship to clinical outcomes among trauma patients requiring massive transfusion. METHODS: A retrospective, descriptive, correlational design was used to determine the association between provider adherence to a recently revised massive transfusion protocol and clinical outcomes in trauma patients with hemorrhage treated at a Level I trauma center from November 2018 to October 2020. Patient characteristics, provider massive transfusion protocol adherence, and patient outcomes were assessed. Patient characteristics and massive transfusion protocol adherence associations with 24-hr survival and survival to discharge were determined using bivariate statistical methods. RESULTS: A total of 95 trauma patients with massive transfusion protocol activation were evaluated. Of the 95, 71 (75%) survived the initial 24 hr following massive transfusion protocol activation and 65 (68%) survived to discharge. Based on protocol applicable items, the median massive transfusion protocol overall adherence rate per patient was 75% (IQR = 57.1-85.7) for the 65 survivors and 25% (IQR = 12.5-50.0) for the 21 nonsurvivors to discharge whose death occurred at least 1 hr after massive transfusion protocol activation (p < .001). CONCLUSION: Findings indicate the importance of ongoing evaluations of adherence to massive transfusion protocols in hospital trauma settings to target areas for improvement.

Problematic internet use in adolescents and implementation of a social media hygiene protocol.

PURPOSE: This quality improvement project aimed to evaluate whether a social media hygiene education intervention designed for adolescents with problematic internet use (PIU) receiving treatment at a pediatric outpatient mental health clinic reduced PIU and/or improved mental health outcomes in adolescents. METHODS: Participants were 28 adolescents (71.4% females, mean age = 14.2 years) with PIU seeking outpatient mental health treatment. The most common associated diagnoses were anxiety (42.9%) and attention-deficit activity disorder (28.6%). A within-adolescent pre-post design was used to evaluate changes in PIU severity measured by the Generalized Problematic Internet Use Scale-2 (GPIUS-2), depression and anxiety severity was assessed by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS), and screen time defined as the average hours/day during past 7-days recorded of the adolescent's smartphone. The practice change was an ad hoc social media hygiene education intervention conducted by their provider over five, once-a-week, one-hour telehealth sessions. RESULTS: A significant reduction in screen time (paired t = 10.14, df = 27, p < 0.001), severity of PIU (paired t = 12.07, df = 27, p < 0.001), and severity of depression and/or anxiety symptoms (paired t = 8.3, df = 27, p < 0.001) was demonstrated. Large effect sizes were observed (Cohen d = 1.6 to 2.3). Attendance for each session was 100% for Weeks 1, 2 and 5, 93% for Week 3 and 89% for Week 4. CONCLUSION: The findings suggest administration of a social-media hygiene protocol conducted via telehealth may reduce the severity of PIU and improve mental health outcomes in adolescents seeking outpatient mental health treatment.

Dissemination of doctor of nursing practice project findings: Benefits and challenges associated with publishing in healthcare journals.

BACKGROUND: Doctor of Nursing Practice (DNP) programs require a project to improve outcomes in a health care setting. However, dissemination methods vary. PURPOSE: This evaluation examined benefits and challenges associated with submitting project manuscripts to a peer-reviewed health care journal in a DNP program with this requirement. METHODS: Benefits and challenges were assessed with surveys completed by 85 DNP program alumni and 28 DNP mentors and by interviewing 5 faculty who teach in the DNP program and 5 editors of nursing journals. FINDINGS: Benefits of completing a manuscript included sharing knowledge to improve health care outcomes and enhancing nursing scholarship. Among alumni, 81% reported manuscript development was beneficial and 69% published their work. Most students, most faculty, and all editors endorsed the requirement with alternatives for projects lacking rigor or innovation. Challenges included need for faculty involvement and editorial/statistical resources. DISCUSSION: Despite challenges, there are benefits of publishing rigorous and innovative DNP work.

Use of Apfel Simplified Risk Score to Guide Postoperative Nausea and Vomiting Prophylaxis in Adult Patients Undergoing Same-day Surgery.

PURPOSE: The quality improvement (QI) project implemented a postoperative nausea and vomiting (PONV) risk screening tool and introduced a risk-tailored prophylactic guideline to identify patients at risk for PONV and aimed to minimize PONV adverse events. DESIGN: This project represents the initial PDSA (Plan-Do-Study-Act) cycle for quality improvement with use of a pre-post design with two independent groups designed to compare PONV rates before and after implementation of an Apfel Simplified Risk Score screening and prophylactic guideline intervention. METHODS: The project implemented the screening of patient PONV risk using the Apfel Simplified Risk Score and a combination antiemetic drug class prophylactic guideline for adult patients undergoing elective same-day surgery procedures. An online education module was provided to anesthesia professionals and was reviewed in-person with the relevant anesthesia professional team prior to surgery. Pre-implementation (N=107) PONV outcomes were collected. Data collected from a retrospective chart review was used to compare pre- and post-implementation PONV rates (N=96) and determine post-implementation anesthesia professional adherence to guideline recommendations. FINDINGS: Forty percent of screened patients were identified as having an increased PONV risk with an Apfel Simplified Risk Score of 3 or 4. The PONV rates for the pre-group (19.6%) and post-group (22.9%) did not significantly differ (P=.5567). Anesthesia professional adherence to administration of the recommended number of antiemetic drug classes was 89.6%. A Spearman point-biserial correlation analysis indicated a significant positive relationship between Apfel Simplified Risk Score and PONV onset in the post-group (rs=0.21, P=.0428). CONCLUSIONS: The Apfel Simplified Risk Score and prophylactic guideline increased identification of patients at risk for PONV but did not affect PONV rate despite a high anesthesia professional adherence to the guideline recommendations.

Pain and Self-Efficacy Among Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study.

BACKGROUND: Pain is one of the most common symptoms affecting patients with systemic sclerosis; however, little is known about the relationship between self-efficacy and pain and changes in pain over time. OBJECTIVES: The purpose of this study was to describe the relationships between self-efficacy and pain in patients with systemic sclerosis, as well as determine whether changes in self-efficacy mediate changes in pain. METHODS: A prospective longitudinal study was conducted using data from the Scleroderma Patient-Centered Intervention Network Cohort. The baseline sample included 1,903 adults, with a trajectory subsample of 427 who completed 3-month assessments across 3 years. Hierarchical (sequential) forward multivariable regression, covarying for participant characteristics, was conducted to determine the association between self-efficacy and patient characteristics on pain outcomes. Trajectory models, covarying for participant characteristics, were used to examine changes in self-efficacy and pain outcomes across time and whether self-efficacy mediated the pain trajectories. RESULTS: Mean time since diagnosis was 9.5 years, with 39.2% diagnosed with diffuse cutaneous systemic sclerosis. Greater self-efficacy was associated with less pain interference and intensity. Increasing age, female gender, finger ulcers, and small joint contractures were related to greater pain interference and intensity. Esophageal gastrointestinal symptoms were associated with more pain interference. Self-efficacy and pain trajectories remained stable across time, and self-efficacy did not mediate the pain trajectories. DISCUSSION: This study identified self-efficacy, age, gender, finger ulcers, small joint contractures, and esophageal gastrointestinal symptoms as important correlates associated with pain in patients with systemic sclerosis. In addition, this study found that self-efficacy and pain outcomes remained stable over time, providing important insights into the longitudinal pain experiences of patients with systemic sclerosis.

On the Move clinic: A fall prevention nurse practitioner-driven model of care.

Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.

Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study.

BACKGROUND: Very low birth weight (VLBW) infant thermal instability upon neonatal intensive care unit admission has been associated with respiratory morbidity; however, the association between ongoing thermal instability and respiratory morbidity remains unclear. METHODS: A longitudinal data analysis was conducted on 12 VLBW infants. Chronic respiratory morbidity risk was defined as supplemental oxygen requirement (FiO2) or scheduled diuretic dosing at 36 weeks post-menstrual age. Acute respiratory morbidity was quantified as desaturations (SpO2<90%), bradycardia with desaturations (HR<100 and SpO2<90%), apnea, increase in FiO2 requirement, or increase in respiratory support. Multi-level, mixed-effects models and regression analysis examined the relationships between body temperature over the first 14 days of life and respiratory morbidities. RESULTS: Body temperature was not associated with chronic respiratory morbidity risk (p=0.2765). Desaturations, bradycardia with desaturations, increased FiO2 requirement, and increased respiratory support were associated with decreased body temperature (p<0.05). Apnea was associated with increased body temperature (p<0.05). The covariate-adjusted risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increase in FiO2 requirement (aOR=1.2), and increase in respiratory support (aOR=1.2) were significantly greater during episodes of hypothermia. CONCLUSION: VLBW infants are dependent on a neutral thermal environment for optimal growth and development. Therefore, the significant associations between hypothermia and symptoms of acute respiratory morbidity require further study to delineate if these are causal relationships that could be attenuated with clinical practice changes, or if these are concurrent symptoms that cluster during episodes of physiological instability.

Sleep-Wake States and Feeding Progression in Preterm Infants.

BACKGROUND: Previous studies demonstrated a short-term relationship between infant sleep-wake states and oral feeding performance, with state being an indication of infants' neurobehavioral readiness for feeding. However, the relationship between sleep-wake states and feeding skills has not been evaluated longitudinally during hospitalization. OBJECTIVES: The purpose of this study was to examine preterm infants' sleep-wake state developmental trajectories and their associations with feeding progression during hospitalization. METHODS: This descriptive and exploratory study was a secondary analysis using data from a longitudinal two-group, randomized controlled trial evaluating the effects of early and late cycled light on health and developmental outcomes among extremely preterm infants who were born ≤28 weeks of gestational age. Sleep-wake states were assessed for two 2-hour interfeeding periods per day (day and night hours), 30 weeks postmenstrual age, and every 3 weeks until discharge. Occurrences of active sleep, quiet sleep, and waking were recorded every 10 seconds. Feeding progression was assessed based on an infant's postmenstrual age at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. Trajectory analyses were used to describe developmental changes in sleep-wake states, feeding progression patterns, and associations between feeding progression and sleep-wake trajectories. RESULTS: Active sleep decreased while waking, and quiet sleep increased during hospitalization. Two distinct feeding groups were identified: typical and delayed feeding progression. In infants with delayed feeding progression, rates of active and quiet sleep development during the day were delayed compared to those with typical feeding progression. We also found that infants with delayed feeding progression were more likely to be awake more often during the night compared to infants with typical feeding progression. DISCUSSIONS: Findings suggest that delays in sleep-wake state development may be associated with delays in feeding progression during hospitalization. Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.

Application of Behavioral Risk Factor Surveillance System Sampling Weights to Transgender Health Measurement.

BACKGROUND: Obtaining representative data from the transgender population is fundamental to improving their health and well-being and advancing transgender health research. The addition of the Behavioral Risk Factor Surveillance System (BRFSS) gender identity measure is a promising step toward better understanding transgender health. However, methodological concerns have emerged regarding the validity of data collected from transgender participants and its effect on the accuracy of population parameters derived from those data. OBJECTIVES: The aim of the study was to provide rationale substantiating concerns with the formulation and application of the 2015 BRFSS sampling weights and address the methodological challenges that arise when using this surveillance data to study transgender population health. METHODS: We examined the 2015 BRFSS methodology and used the BRFSS data to present a comparison of poor health status using two methodological approaches (a matched-subject design and the full BRFSS sample with sampling weights applied) to compare their effects on parameter estimates. RESULTS: Measurement error engendered by BRFSS data collection procedures introduced sex/gender identity discordance and contributed to problematic sampling weights. The sex-specific "raking" algorithm used by BRFSS to calculate the sampling weights was contingent on the classification accuracy of transgender by participants. Because of the sex/gender identity discordance of 74% of the transgender women and 66% of transgender men, sampling weights may not be able to adequately remove bias. The application of sampling weights has the potential to result in inaccurate parameter estimates when evaluating factors that may influence transgender health. DISCUSSION: Generalizations made from the weighted analysis may obscure the need for healthcare policy and clinical interventions aimed to promote health and prevent illness for transgender adults. Methods of public health surveillance and population surveys should be reviewed to help reduce systematic bias and increase the validity of data collected from transgender people.

Identifying Individuals With Intellectual Disability Within a Population Study.

BACKGROUND: Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID); thus, new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge. OBJECTIVE: Our objective was to describe the development of a new method for identifying individuals with ID within large, population-level studies not targeted on ID. METHODS: We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet the criteria of ID. The three criteria of ID (intellectual functioning, adaptive functioning, and disability originating during the developmental period) were derived from the definitions of ID used by the American Psychiatric Association and the American Association on Intellectual and Developmental Disabilities. The ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations included in the Add Health database from Waves I to III. RESULTS: This method identified 441 adolescents who met criteria of ID and had sampling weights. At Wave I, the mean age of this subsample of adolescents with ID was 16.1 years. About half of the adolescents were male and from minority racial groups. Their parents were predominately female, were married, had less than a high school education, and had a median age of 41.62 years. The adolescents' mean maximum abridged Peabody Picture Vocabulary Test standardized score was 69.6, and all demonstrated at least one adaptive functioning limitation. DISCUSSION: This study demonstrates the development of a data-driven method to identify individuals with ID using commonly available data elements in nationally representative population data sets. By utilizing this method, researchers can leverage existing rich data sets holding potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.

Trauma-related symptoms and severity among women in the Pacific Rim.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.

Psychosocial Correlates of Jordanian Adolescents' Help-Seeking Intentions for Depression: Findings From a Nationally Representative School Survey.

Little is known about help-seeking for depression among Jordanian adolescents who are a vulnerable population with high rates of depressive symptoms and few mental health services. The purpose of this study was to (1) explore Jordanian adolescents' helpseeking intentions for depression and (2) examine whether depression stigma, depression severity, or their interaction are associated with Jordanian adolescents' willingness to seek help for depression and the type of treatment they would seek. In collaboration with the Jordanian Ministry of Education, we conducted a nationally representative, school-based survey of adolescents aged 12-17 years ( N = 2,349). One fourth of the adolescents reported they would not seek professional help for depression, and those respondents had higher average depression scores. Among those adolescents willing to seek help, the most likely sources included family member (57%), school counselor (46%), psychiatrist (43%), religious leader (39%), and general health practitioner (28%). Lower stigma scores were associated with greater likelihood to seek psychotherapy or visit a psychiatrist, while higher stigma scores were associated with increased likelihood to seek help from a school counselor or a family member. Jordanian adolescents experience significant barriers to seeking professional help for depression. However, even among adolescents with greater depression severity and depression stigma, school counselors were identified as a key resource for help. These findings suggest that school-based interventions may fill a critical service need for adolescents with depression and other mental health problems. School nurses should be leveraged along with counselors to address mental health issues in this vulnerable population.

Multimedia Education Reduces Anxiety in Lung Transplant Patients.

CONTEXT: A significant contribution to the success of lung transplantation is the recipient's ability to self-manage a multidrug regimen and follow complex instructions. Effective education has always been an integral component of the process of preparing patients to care for themselves post lung transplant. Impaired cognition, anxiety, and psychological distress, however, can decrease the retention of posttransplant care information provided during education sessions. OBJECTIVE: This quality improvement project evaluated whether a multimedia education method compared to standard education method improves posttransplant care knowledge, anxiety, and satisfaction with the education experience in lung transplant patients and their caregivers. METHODS: Two education methods groups, comprised of transplant patients and their primary caregivers, were compared: (1) historic control group who received the standard education (n = 19 dyads) and (2) multimedia group who received the new multimedia education (n = 18 dyads). Knowledge of posttransplant care was evaluated in both groups before and after receiving the education. A satisfaction survey was administered at the end of the education program. RESULTS: A significantly higher percentage of patients receiving the multimedia method reported gains in posttransplant care knowledge ( P = .05), less anxiety about the transplant surgery ( P = .02), and satisfaction with the education method ( P = .02) when compared to those receiving the standard method. Caregivers and transplant team member also indicated that the multimedia method was more effective than the standard method. CONCLUSION: Multimedia methods decrease anxiety and increase satisfaction with the education experience when preparing patients for lung transplantation.

The prevalence of depressive symptoms among Arab adolescents: Findings from Jordan.

BACKGROUND: The lack of research regarding the current profile of adolescent depression in the Arab countries in general, and Jordan in particular, makes it difficult to design, implement, and disseminate effective interventions to improve the prevention, diagnosis, and treatment of adolescent depression in the region. The purpose of this study was to estimate a national prevalence of depressive symptoms among adolescents in Jordan, and to identify characteristics associated with severity of depression. METHODS: A descriptive, cross-sectional, nationally representative school survey was utilized. A total of 2,349 Jordanian adolescents aged 12-17 completed and returned the survey packets, which included the Beck Depression Inventory-II and measures of sociodemographics and health history. Participants represented all three regions in the country, with 34% from the northern (suburban) region, 43% from the central (urban) region, and 23% from the southern (rural) region. RESULTS: The majority of the adolescents were females (59%) and 15-17 years old (67%). Almost 14% reported having at least one chronic health problem, 15% reported having a mental health problem, 25% reported having academic difficulties, 8% reported that they had received a psychiatric diagnosis, and 22% reported that they had sought psychological help at some point in the past. The mean total depression score was 16.3 (SD = 11.2, 95% CI = 15.8-16.7), with 34% of the sample reporting moderate to severe depression. Depression was significantly higher among respondents who were female, ages 14-15 years, and living in families with low monthly incomes; and who reported having a chronic health problem, mental health problem, learning difficulty, a psychiatric diagnosis and/or seeking previous psychological help. CONCLUSIONS: Our findings should serve as an alarm, particularly given that rates of depression in the Arab countries are expected to increase rapidly in the context of the Arab Spring. Healthcare providers, researchers, and educators should focus attention on developing effective and culturally appropriate screening, prevention, and intervention approaches using evidence-based guidelines to promote Jordanian adolescent mental health, particularly for depression.

Adolescent Depression in Jordan: Symptoms Profile, Gender Differences, and the Role of Social Context.

The influence of gender and other individual and context characteristics on the prevalence and severity of depressive symptoms among Jordanian adolescents remains unclear. The aims of the current study were to: (a) characterize depressive symptoms profiles for Jordanian adolescents; and (b) examine gender differences in the type, severity, and correlates of depressive symptoms. Cross-sectional data were collected from 2,349 Jordanian adolescents ages 12 to 17 using a nationally representative school survey. The Beck Depression Inventory-II was used to assess the presence and severity of depressive symptoms. Female adolescents had significantly higher mean depression scores (17.9 [SD = 11.6], 95% confidence interval [CI] [17.3, 18.5]) than their male counterparts (13.8 [SD = 10.2], 95% CI [13.2, 14.5]). Approximately 41% of girls and 26% of boys reported scores indicating moderate to severe depression. Sex differences and socially constructed gender differences need to be adequately considered in the planning and delivery of mental health care for adolescent depression. If the risk for depression is gender-specific, prevention strategies cannot be gender-neutral. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 44-55.].

Trauma Exposure Among Women in the Pacific Rim.

PURPOSE: Healthcare professionals who provide services in the immediate or long-term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross-national and cross-cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community-based samples of women in the United States, Colombia, and Hong Kong. DESIGN: Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist-Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team. METHODS: Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community-based sample (location). Between-location differences were tested using Fisher's exact tests for categorical measures and general linear models with pairwise a posteriori least squares t-test for continuous measures. Responses to open-ended questions were translated and categorized. FINDINGS: Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed. CONCLUSIONS: Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied. CLINICAL RELEVANCE: This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women's lives.

Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized Controlled Trial.

Day-night cycled light improves health outcomes in preterm infants, yet the best time to institute cycled light is unclear. The hypothesis of this study was that extremely preterm infants receiving early cycled light would have better health and developmental outcomes than infants receiving late cycled light. Infants born at ≤28 weeks gestation were randomly assigned to early cycled light (ECL) starting at 28 weeks postmenstrual age [PMA] or late cycled light (LCL), starting at 36 weeks PMA. Daylight was 200-600 lux and night was 5-30 lux. Primary outcomes were weight over time and length of hospitalization. Secondary outcomes were hospital costs, sleep development, and neurodevelopment at 9, 18, and 24 months corrected age. Of 121 infants randomized, 118 were included in analysis. Weight gain in the two groups did not differ significantly but increased across time in both groups. In PMA weeks 36-44, the mean weight gain was 193.8 grams in the ECL group compared to 176.3 grams in the LCL group. Effect sizes for weight were Cohen d = 0.26 and 0.36 for 36 and 44 weeks PMA. Infants in the ECL group went home an average of 5.5 days earlier than the LCL group, but this difference was not statistically significant. There were no group differences on neurodevelopmental outcomes. Although statistically non-significant, clinically important differences of improved weight gain and decreased hospital stay were observed with ECL. The small observed effect sizes on weight during hospitalization should be considered in future cycled light research with extremely preterm infants. © 2017 Wiley Periodicals, Inc.

Personal and Perceived Depression Stigma among Arab Adolescents: Associations with Depression Severity and Personal Characteristics.

BACKGROUND: In Arab communities, the selection, utilization, and attitudes towards mental health services are substantially affected by existing mental illness stigma. However, little is known about how the stigma of depression manifests among Arab adolescents, which makes it difficult to design, implement, and disseminate effective anti-stigma interventions for this vulnerable population. Therefore, the purpose of this study was to determine levels of depression stigma among Arab adolescents. The specific aims were to (1) describe the severity of personal and perceived depression stigma among Arab adolescents and its relationship to severity of depression, and (2) determine characteristics associated with severity of depression stigma among Arab adolescents. METHODS: This study was conducted in Jordan, a Middle Eastern Arab country. A nationally representative, school-based survey was utilized. A total of 2349 Jordanian adolescents aged 12-17 completed and returned the survey packets, which included measures on individual characteristics, depression severity, and depression stigma. RESULTS: The majority of the adolescents (88%) reported scores indicating moderate to high depression stigma. Adolescents reported higher rates of perceived stigma than personal stigma. Depression stigma was not significantly associated with severity of depression, but with adolescent's sex, age, region of residence, parents' education, and history of mental health problem. CONCLUSIONS: This is the first Arab study to isolate the influence of adolescent depression and personal characteristics on personal and perceived depression stigmas, and highlight the presence of these distinctions early in adolescence. Such distinction can inform the design and implementation of policies and interventions to reduce both personal and perceived stigma. The study provides important recommendations on when, how, and why to utilize school settings for anti-depression stigma interventions.

Feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South.

As with many infectious diseases throughout history, stigma is a part of the trajectory of the HIV disease process. HIV-related stigma impedes women from being tested for HIV. Once infected, HIV-related stigma hinders women from disclosing their HIV status to sexual partners and health care providers, engaging in medical care, effectively self-managing the disease after infection, and adhering to anti-retroviral therapy. After three decades of the HIV epidemic, no evidenced-based, culturally relevant, gender-specific interventions exist to help women infected with HIV manage the stigma associated with HIV infection. This manuscript reports the feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South in a mixed-method, randomized clinical trial. Results from the study demonstrate that it is feasible to utilize an iPod touch device to deliver an HIV-related stigma intervention to women. Further, women report that the HIV-related stigma intervention is acceptable and meaningful.

Mental health service use among adolescents following participation in a randomized clinical trial for depression.

Major depressive disorder (MDD) is a common disorder among adolescents. The Treatment for Adolescents with Depression Study (TADS) was a randomized controlled trial to examine the efficacy of fluoxetine and cognitive-behavioral therapy (CBT), separately and together, compared with placebo, in adolescents 12 to 17 years of age. The Survey of Outcomes Following Treatment for Adolescent Depression (SOFTAD) was designed as a naturalistic follow-up of participants in TADS. The aims of the current analyses are to describe mental health service use during the SOFTAD period. There were 196 adolescents recruited from 12 TADS sites. The Schedule for Affective Disorders and Schizophrenia for School-Age-Children-Present and Lifetime Version was used for clinical diagnoses. Participants completed a psychiatric treatment log and the Child and Adolescent Services Assessment to assess service use. 58% received psychotherapy or nonstimulant psychotropic medication during SOFTAD. Youth with recurrent MDD had higher rates of treatment compared to youth without recurrent MDD (71% vs. 45%). However, nearly one third of the adolescents in the study did not receive treatment for a recurrent episode of depression. Service use differed by gender for those with recurrent MDD, with female participants (79%) receiving treatment at higher rates than male participants (55%), although there was no significant difference in depression severity between genders. Younger participants with recurrent MDD had higher odds of receiving psychotherapy. Use of psychotherapy and psychotropics following recurrence of depression appears to be influenced by age and gender. Even when youth respond well to treatment, a sizeable percentage are likely to experience a subsequent episode that may go untreated.