The Bronchopulmonary Dysplasia score: A predictive model for bronchopulmonary dysplasia or death in high-risk preterm infants.

AIM: Progressive respiratory deterioration in infants at high risk of bronchopulmonary dysplasia (BPD) is associated with patent ductus arteriosus (PDA) exposure. This study aimed to design an early predictive model for BPD or death in preterm infants using early echocardiographic markers and clinical data. METHODS: Infants born with gestational age (GA) ≤ 29 weeks and/or birth weight (BW) < 1500 g at Cork University Maternity Hospital, Ireland were retrospectively evaluated. Those with echocardiography performed between 36 h and 7 days of life were eligible for inclusion. Exclusion criteria were pulmonary hypertension and major congenital anomalies. The primary outcome was a composite of BPD and death before discharge. RESULTS: The study included 99 infants. A predictive model for the primary outcome was developed, which included three variables (BW, Respiratory Severity Score and flow pattern across the PDA), and yielding an area under the curve of 0.98 (95% CI 0.96-1.00, p < 0.001). Higher scores were predictive of the primary outcome. A cut-off of -1.0 had positive and negative predictive values of 89% and 98%, and sensitivity and specificity of 98% and 88%, respectively. CONCLUSION: Our prediction model is an accessible bedside tool that predicts BPD or death in premature infants.

Serious Psychological Distress, Substance Use Disorders, and Social Issues Among Men and Women in the United States During the COVID-19 Pandemic.

PURPOSE: This study assesses the association between SUD, economic hardship, gender, and related risk and protective factors on serious psychological distress (SPD) during the COVID-19 pandemic. DESIGN: Quantitative cross-sectional design. SETTING: National Survey on Drug Use and Health (NSDUH). SAMPLE: Data were from the NSDUH (2020) N = 25,746, representing 238,677,123 US adults, who identified as 18 or older and either male or female. MEASURES: SPD measured as scoring a 13 or more on the Kessler (K6) distress scale. SUDs were determined using DSM5 criteria. Sociodemographic and socioeconomic variables included in analyses. ANALYSIS: Logistic regressions evaluated the association between gender, protective, and risk factors on SPD. RESULTS: After controlling for sociodemographic and related factors of SPD, having a SUD was the strongest correlate of SPD. Other significant correlates of SPD included female gender and an income level at or below the federal poverty threshold. Gender stratified regressions illustrated that religiosity, self-identifying as Black, and high levels of education were protective against SPD for women but not men. Poverty level was more associated with SPD for women than men. CONCLUSION: In the United States, individuals with SUDs were nearly four times more likely to report SPD than those without SUDs, controlling for economic hardship and markers of social support during 2020. Effective social interventions to reduce SPD among individuals with SUDs are needed.

Long-Acting Injectable Antipsychotic Medications in Pregnancy: A Review.

BACKGROUND: Long-acting injectable antipsychotic medications (LAIs) are an evidence-based treatment option for people with severe mental illness. While women with severe mental illness who are prescribed LAIs can become pregnant, there is a dearth of research examining the safety of these medication formulations during pregnancy. OBJECTIVE: This article summarizes available literature on the use of LAIs in pregnancy to help inform clinical decisions and guide future research. METHODS: PubMed literature searches were completed using combinations of keywords including "antipsychotic" and "long-acting injectable" or "depot," or generic or brand names of LAIs with "pregnancy." Pregnancy outcomes were compared across studies. RESULTS: Twelve relevant case reports of 13 pregnancies were identified. Six cases did not report any negative birth or infant outcomes, including prematurity, infants being born small for gestational age, congenital anomalies, and extrapyramidal symptoms. No cases reported abnormal Apgar scores, infants being born large for gestational age, or negative long-term developmental outcomes after exposure to LAIs during pregnancy. Cesarean section rate was comparable to the general population. Specific adverse outcomes included one infant with multiple congenital anomalies, 3 infants with minor congenital anomalies, and one infant with possible extrapyramidal symptoms. One infant was born prematurely, one infant was born small for gestational age, and 2 infants were born both prematurely and small for gestational age. CONCLUSIONS: There is little research specifically examining the use of LAIs in pregnancy, so risks must be extrapolated from studies on oral antipsychotics in pregnancy. While the few published case reports examining LAIs in pregnancy somewhat align with research examining oral antipsychotics, these findings are inconclusive due to the inherently limited nature of case reports. Further investigation into the use of LAIs in pregnancy is warranted.

Evaluation of a Community-Based Harm Reduction Intervention Aimed at Adjudicated College Students.

The purpose of this study was to develop, test, and use an instrument to measure the effectiveness of a community-based, mandated drug education intervention program, Youthful Offenders Program (YOP), targeting college students at risk. A total of N = 350 students voluntarily agreed to participate in an evaluation of program effectiveness using the Alcohol Use Disorders Identification Test (AUDIT) and a newly developed measure to compare changes in substance related behaviors over time. Results revealed sound psychometric structure for the new scale for use in program evaluation; results suggest that YOP significantly enhanced safety practices and reduced hazardous drinking and recidivism, but not avoidance of risky behaviors.

Seroprevalence study of SARS-CoV-2 antibodies in healthcare workers following the first wave of the COVID-19 pandemic in a tertiary-level hospital in the south of Ireland.

OBJECTIVE: This study investigated seroprevalence of SARS-CoV-2-specific IgG antibodies, using the Abbott antinucleocapsid IgG chemiluminescent microparticle immunoassay (CMIA) assay, in five prespecified healthcare worker (HCW) subgroups following the first wave of the COVID-19 pandemic. SETTING: An 800-bed tertiary-level teaching hospital in the south of Ireland. PARTICIPANTS: Serum was collected for anti-SARS-CoV-2 nucleocapsid IgG using the Abbott ARCHITECT SARS-CoV-2 IgG CMIA qualitative assay, as per the manufacturer's specifications.The groups were as follows: (1) HCWs who had real-time PCR (RT-PCR) confirmed COVID-19 infection (>1-month postpositive RT-PCR); (2) HCWs identified as close contacts of persons with COVID-19 infection and who subsequently developed symptoms (virus not detected by RT-PCR on oropharyngeal/nasopharyngeal swab); (3) HCWs identified as close contacts of COVID-19 cases and who remained asymptomatic (not screened by RT-PCR); (4) HCWs not included in the aforementioned groups working in areas determined as high-risk clinical areas; and (5) HCWs not included in the aforementioned groups working in areas determined as low-risk clinical areas. RESULTS: Six of 404 (1.49%) HCWs not previously diagnosed with SARS-CoV-2 infection (groups 2-5) were seropositive for SARS-CoV-2 at the time of recruitment into the study.Out of the 99 participants in group 1, 72 had detectable IgG to SARS-CoV-2 on laboratory testing (73%). Antibody positivity correlated with shorter length of time between RT-PCR positivity and antibody testing.Quantification cycle value on RT-PCR was not found to be correlated with antibody positivity. CONCLUSIONS: Seroprevalence of SARS-CoV-2 antibodies in HCWs who had not previously tested RT-PCR positive for COVID-19 was low compared with similar studies.

Child maltreatment severity, chronic substance abuse, and disability status.

PURPOSE: Biological theories explain how exposure to child maltreatment and chronic substance abuse result in significant health reductions, often years or decades after the maltreatment and substance abuse end. Relationships among these variables are known to exist; however, the relative impact of each risk factor on disability status is not clear. METHOD: Adults receiving inpatient treatment for a substance use disorder (SUD) were assessed for chronic illness and disability (CID), years abusing substances, and child maltreatment severity using the Child Trauma Questionnaire (n = 112). A logistic regression model classified participants by CID status based on criterion variables; using transformed data and model parameters, the odds and probabilities were calculated for each criterion variable to determine the clinical impact of each risk factor on CID. RESULTS: The majority (52.7%) of participants reported CID; the majority screened positively for child maltreatment (87.4%). Our model was significant and demonstrates that the odds for CID increase as a function of maltreatment severity; years abusing substances did not significantly increase the odds. For those reporting the most severe levels of maltreatment, the odds of experiencing CID translates to odds ratio (OR) = 1.92, with an associated probability of 66%. IMPLICATIONS: Child maltreatment severity is an important predictor of CID status, and was more likely to explain CID than years abusing drugs and alcohol in our clinical sample. Trauma-informed concurrent treatment for 3 clinical conditions of CID, childhood maltreatment, and SUD is needed for the majority of individuals seeking treatment for SUD. (PsycINFO Database Record

Improving Rates of Screening for Anemia in Infancy.

In 2010, the American Academy of Pediatrics recommended universal screening for anemia at approximately 1 year of age. This quality improvement study sought to improve anemia screening in an ambulatory setting. In a large university-based setting, a best practice alert (BPA) was placed within the electronic health record. The primary outcome was overall screening rate in ambulatory family medicine (DFM) and pediatrics (PEDS) clinics. From 2545 pre-BPA clinic visits over a 12-month period, the screening rate was 48.2%. Among 2186 post-BPA clinic visits over an 8-month period, the screening rate improved to 72.7%, P < .0001. Follow-up over a second 7-month period demonstrated sustained improvements (70.8%) but was not higher after educational sessions between the periods. Screening rates were higher in PEDS than DFM at each time point; P < .0001. This technology-based intervention increased and maintained higher screening rates for anemia at 1 year, with higher rates in PEDS.

Potential and challenges for learning during acute medical/surgical placement for intellectual disability, mental health and midwifery students.

In Ireland nursing and midwifery degree programmes involve four pathways to registration. Three of which, intellectual disability and mental health nursing and midwifery require students to undertake acute medical/surgical placements offering learning opportunities caring for patients with complex needs in settings beyond their core discipline. This paper focuses on findings from a descriptive qualitative study exploring intellectual disability and mental health nursing and midwifery students experiences of such placements. Data analysis identified three themes: Getting ready, Navigating the way and Getting through. Feelings of stress and uncertainty are described by participants when moving from familiarity within a chosen discipline to an unfamiliar environment. Findings have influenced specific placement structures with local health service partners. While our study focuses on an Irish context, findings have relevance for student education in other jurisdictions. Enhancing preparation and support for students undertaking unfamiliar placements needs to be a constant endeavour. Such foundations will foster valuable experiences where students can feel part of a team, gain confidence, enhance skills and transfer meaningful learning to their core practice discipline. Further research is needed to explore the views of preceptors, ward managers and Clinical Placement Coordinators.

The Shared Etiology of Attentional Control and Anxiety: An Adolescent Twin Study.

We investigated the etiology of attentional control (AC) and four different anxiety symptom types (generalized, obsessive-compulsive, separation, and social) in an adolescent sample of over 400 twin pairs. Genetic factors contributed to 55% of the variance in AC and between 43 and 58% of the variance in anxiety. Negative phenotypic associations between AC and anxiety indicated that lower attentional ability is related to increased risk for all 4 anxiety categories. Genetic correlations between AC and anxiety phenotypes ranged from -.36 to -.47, with evidence of nonshared environmental covariance between AC and generalized and separation anxiety. Results suggest that AC is a phenotypic and genetic risk factor for anxiety in early adolescence, with somewhat differing levels of risk depending on symptomatology.

Realising the dream of becoming a nurse: Underrepresented BSc nursing students experiences.

BACKGROUND: This paper describes the experiences of underrepresented BSc nursing students in realising the dream of becoming a nurse in one university. In the past ten years, pre-registration nurse education has become established within higher education in Ireland. This development includes promoting access and inclusion of students from traditionally underrepresented groups in higher education. A third of nursing students currently access places on programmes through routes specifically designed for underrepresented groups. METHODS: A qualitative descriptive study design provided an opportunity for student voices to be heard. Ethical approval was sought and granted. Eleven students were interviewed nearing completion of a four year BSc Nursing programme. Data analysis followed a thematic approach, in generating themes. FINDINGS: Three themes emerged from the data: taking the first steps; finding a way and getting through. Findings highlight participants' challenges in balancing study, clinical practice and family life in achieving and realising their dream of becoming a nurse. CONCLUSION: This study illustrates the nature and complexities of participants' experiences throughout the BSc Nursing programmes towards becoming university graduates, eligible for registration as a nurse. Students from underrepresented groups bring rich and diverse life experiences in preparation for and becoming caring practitioners. It highlights the individuality within participants' experiences and draws attention to the value of personalised support for students. An opportunity to encourage the development of emotional intelligence needs to be fostered within nurse education programmes. Creating positive learning environments is critical to supporting student understanding of compassionate patient centred care. Findings have relevance for global curriculum design and structures to support individual student centred engagement. Further research is required to consider how best to support students from underrepresented groups.

Use of recreation activities as positive coping with chronic stress and mental health outcomes associated with unemployment of people with disabilities.

OBJECTIVE: This paper provides an outline of the complex relationship among stress, unemployment, mental health, and participation in recreation activities as a possible adaptive coping strategy for people with disabilities. METHODS: This paper is a result of a two-phase review of the literature. Phase one included review of articles that examined the relationship among unemployment, stress, and mental health outcomes for people with disabilities. Phase two included articles that examined the efficacy of recreation activities as a means of buffering stress. RESULTS: Research indicates a cyclical process that occurs when people with disabilities experience unemployment; this unemployment often leads to chronic stress which in turn leads to negative mental health, symptoms that create further barriers to unemployment. Recreation activities that are physically active, culturally relevant, and conducive to relaxation were found to be effective at reducing the types of stressors experienced with unemployment. CONCLUSIONS: A complex relationship among unemployment, stress, mental health, and participation in recreation activities as a possible adaptive coping strategy exists for people with disabilities. An understanding of the types of recreation activities that are likely to reduce specific stressors associated with unemployment may be beneficial to consider as part of a comprehensive treatment plan when working with individuals with disabilities as they engage in the job seeking process.

Examining differences in developmental work personality across disability category: Implications for individuals with psychiatric disabilities.

OBJECTIVE: The purpose of this exploratory study was to examine the differences in levels of work personality for persons with psychiatric disabilities compared to persons with other types of disabilities. PARTICIPANTS: Seventy one adults eligible to receive Vocational Rehabilitation services participated; 30 reported a physical disability, 26 reported a psychiatric disability, and 15 reported a learning disability. METHODS: Eligible participants were recruited through VR offices and volunteered to participate. RESULTS: Results indicate that persons with psychiatric disabilities scored significantly lower on the Work Task and Social Skills subscales of the Developmental Work Personality Scale (DWPS) when compared to individuals with physical disabilities, but scored higher than individuals with physical and learning disabilities on the Role Model subscale. CONCLUSIONS: The results of this study provide some initial clarity regarding developmental work personality differences among three broad categories of disability. Recommendations for future research are provided.

Medication timing errors for Parkinson's disease: perspectives held by caregivers and people with Parkinson's in new zealand.

Background. Common but seldom published are Parkinson's disease (PD) medication errors involving late, extra, or missed doses. These errors can reduce medication effectiveness and the quality of life of people with PD and their caregivers. Objective. To explore lay perspectives of factors contributing to medication timing errors for PD in hospital and community settings. Design and Methods. This qualitative research purposively sampled individuals with PD, or a proxy of their choice, throughout New Zealand during 2008-2009. Data collection involved 20 semistructured, personal interviews by telephone. A general inductive analysis of the data identified core insights consistent with the study objective. Results. Five themes help to account for possible timing adherence errors by people with PD, their caregivers or professionals. The themes are the abrupt withdrawal of PD medication; wrong, vague or misread instructions; devaluation of the lay role in managing PD medications; deficits in professional knowledge and in caring behavior around PD in formal health care settings; and lay forgetfulness. Conclusions. The results add to the limited published research on medication errors in PD and help to confirm anecdotal experience internationally. They indicate opportunities for professionals and lay people to work together to reduce errors in the timing of medication for PD in hospital and community settings.

The relationship between contextual work behaviours self-efficacy and work personality: an exploratory analysis.

BACKGROUND: Work personality and contextual work behaviours have been identified as constructs that play critical roles in developing the foundation for effective vocational and career behaviour for persons with disabilities. METHOD: For this study, we used a sample of 84 individuals with disabilities who were eligible to receive vocational rehabilitation services. Demographic variables and questions concerning work personality, contextual work behaviours self-efficacy, employment status and longest time employed were obtained and analysed to determine the relationship between contextual work behaviours self-efficacy, work personality and employment outcomes. RESULTS: The results indicate that work personality explained 24% (F = 2.73; p = 0.013) of the variance of contextual work behaviours self-efficacy with the subscale of Personal Presentation (ß = 0.466) making a significant and unique contribution to CWB total score. Results of a correlation between the work personality profile scale and the contextual work behaviours self-efficacy scale revealed a significant and positive relationship. Levels of work personality and contextual work behaviours self-efficacy were unable to discriminate between employed and unemployed individuals. However, a post-hoc regression analysis did find that work personality and contextual work behaviours self-efficacy accounted for approximately 24% of the variance of longest time employed. CONCLUSIONS: The results of this study provide initial support for the relationship between work personality and contextual work behaviours self-efficacy. Overall, work personality appears to be an important construct related to individual's confidence to meet the contextual demand of the work environment and length of employment tenure.

A prospective, multicenter study to validate use of the PUSH in patients with diabetic, venous, and pressure ulcers.

Monitoring wound progress is essential for evaluating and documenting treatment outcomes. The Pressure Ulcer Scale for Healing (PUSH) was developed to track pressure ulcer (PU) progress but information about its utility for other types of chronic wounds is limited. A 10-month, descriptive, multicenter study was conducted to examine the responsiveness and concurrent validity of the PUSH when used to monitor wound changes in diabetic foot (DFU), venous leg (VLU), and PU. Using a convenience sample of participants (n = 98, mean age 60 [range 20 to 89] years, the majority [85%] male), PUSH score and acetate wound surface area tracings were obtained at baseline and approximately 4 weeks later from 47 Stage II to Stage IV PU, 23 VLU, and 28 patients with a DFU. After an average of 32 days, wound surface area, total PUSH scores, and individual PUSH component scores decreased significantly between baseline and follow-up (P = 0.000). The mean PUSH score change was significantly different between healing and nonhealing wounds (P = 0.000). A strong relationship (r = .66) was found between total PUSH score and surface area. Results suggest the PUSH tool is a valid, responsive, evaluative tool to monitor and document wound progress of PU, VLU, and DFU. Additional studies to assess use of this tool for DFU and to ascertain the predictive validity of the PUSH tool are warranted.

Working alliance and vocational outcomes for cancer survivors: an initial analysis.

This study examines the sex differences in the perception of working alliance and the perceptions of optimism regarding future employment and job satisfaction with adult cancer survivors receiving vocational rehabilitation services. No significant differences were found between males and females in terms of the three components of the working alliance. However, examination of effect sizes indicated that the females reported higher levels of tasks (d=0.40) and goals (d=0.55) than their male counterparts. The three components of working alliance explained 60% of the variance with bonds (ß=0.865) making a significant and unique contribution to employment prospects. Working alliance was not associated with current job satisfaction in the employed group. Overall results of this study suggest that working alliance seems to be an important variable in the vocational outcomes for cancer survivors receiving vocational services.

Using attribution theory to examine community rehabilitation provider stigma.

This study builds on existing research investigating the stigma-reducing strategies specific to rehabilitation service providers by comparing differences in education levels and degree of contact among rehabilitation service providers. Rehabilitation service providers with master's level and bachelor level education showed significant differences in their stigmatizing tendencies on subscales of controllability and stability for different categories of disabilities. Specifically, service providers with a master's degree had more stigmatizing beliefs for psychosis and cocaine addiction, compared with service providers with a bachelor's degree. Service providers with either a bachelor's degree or master's degree reported lower levels of stigma overall for five of the six categories of disability compared with their community college student counterparts. No differences were found for length of time working with persons with psychiatric disabilities.

The role of developmental work personality in the employment of individuals with psychiatric disabilities.

Due to the current demands of today's competitive and team-oriented workplaces, organizations are becoming increasingly dependent on assessing potential and current employee traits that go beyond skills and education. Contextual work behaviors, such as getting along with others, accepting supervision, and ability to adapt to changes, are proving to be salient factors in predicting overall successful employment outcomes. These contextual behaviors are often learned in childhood during the school years and by watching parents and role models demonstrate behaviors related to work. Individuals with psychiatric disabilities often have a harder time than individuals who do not experience symptoms of psychiatric disabilities demonstrating positive contextual work behaviors. This paper will outline the importance of evaluating work personality using the Developmental Work Personality Scale for individuals with psychiatric disabilities.

Low back pain among Irish farmers.

BACKGROUND: Despite farming being regarded as a high-risk activity for low back pain (LBP), little LBP research exists for this work sector. AIMS: To establish LBP prevalence, beliefs regarding LBP, perceived LBP risk factors, related health service utilization, awareness and participation in manual-handling training among farmers in Ireland. METHODS: A cross-sectional questionnaire survey was distributed to 200 farmers in Ireland via five Irish veterinary practices. Data were entered onto the Statistical package for the Social Sciences (version 12.0.1) and analysed using descriptive statistics while qualitative data were coded and analysed for common themes. RESULTS: The response rate was 52% (n = 104). Lifetime, annual and point prevalence of LBP was 74% (n = 77), 54% (n = 56) and 27% (n = 28), respectively. Of respondents with a history of LBP, 72% (n = 55) stated that farming had contributed to their problem. Sixty-three per cent (n = 31) identified lifting as a contributory factor to their LBP. The majority of respondents (86%, n = 66) with LBP sought some form of treatment, with 73% (n = 56) of these having attended a general practitioner (GP). Few respondents (13%, n = 14) had ever attended a manual-handling course. CONCLUSIONS: A high prevalence of LBP was found among farmers, with lifting being reported as the major contributing factor. GPs were the most commonly utilized healthcare practitioner for LBP. Farmers do not commonly attend manual-handling courses with many noting they were not widely accessible or adequately publicized. There is a need for high-quality studies to examine the effectiveness of different interventions to prevent LBP among the Irish farming population.

Integrin alpha6beta4-erbB2 complex inhibits haptotaxis by up-regulating E-cadherin cell-cell junctions in keratinocytes.

Keratinocyte integrins alpha6beta4 and alpha3beta1 bind laminin-5, a component of basement membranes. We previously demonstrated that in keratinocytes, haptotactic migration on laminin-5 was stimulated by anti-beta1 integrin-activating antibody TS2/16, whereas antibodies to alpha6 and beta4, respectively, blocked TS2/16-induced, alpha3beta1-dependent migration. Moreover, alpha6beta4-associated haptotaxis inhibition was linked to a phosphatidylinositol 3-kinase (PI3K) pathway and required erbB2 activation. erbB2, the ligand-less member of the epidermal growth factor receptor family, was shown to form a complex with the hemidesmosomal integrin alpha6beta4. Here, we demonstrate that alpha6beta4 inhibitory effects on haptotaxis are abolished by an anti-E-cadherin antibody, which interferes with cell-cell adhesion. Furthermore, antibodies to alpha6 and beta4 stimulated adhesion to an E-cadherin-Fc recombinant protein. In addition, anti-alpha6/beta4 antibodies increased colony size in plated cells, stimulated cell-cell aggregation, and up-regulated E-cadherin localization to cell-cell contacts. These effects were abolished when erbB2 or PI3K were blocked. These results indicate that stimulation of alpha6beta4 increases E-cadherin-mediated cell-cell adhesion and that this mechanism depends on erbB2 activation. The molecule that links alpha6beta4 with E-cadherin may be the small GTPase cdc42, an effector of PI3K, because dominant-negative cdc42 abolished the inhibitory effect of anti-alpha6/beta4 antibodies and increased basal migration, whereas constitutively active cdc42 prevented the TS2/16-induced increase in haptotaxis. These findings suggest a model whereby alpha6beta4 can augment cell-cell adhesion and slow down haptotaxis over laminin-5 and point to the alpha6beta4-erbB2 heterodimer as an important signaling complex for the formation of cohesive keratinocyte layers.