Psychosocial issues and quality of life of parenting partners of young women with breast cancer.

PURPOSE: Data are lacking about the association between quality of life (QOL) and psychosocial issues of partners of young women with breast cancer who co-parent dependent children. METHODS: We conducted a cross-sectional analysis of partners of women with breast cancer diagnosed at age ≤ 40. Among those partners reporting at least one dependent child under 18 years old at the time of diagnosis, we used multiple linear regression to examine associations between partner QOL and sociodemographic and psychosocial factors, and the patient's cancer stage and time since diagnosis. RESULTS: Of the 219 parenting partners, all identified as male with a median age of 44 years; 96% (204/213) reported working full-time at the time of the survey. Fifty-four percent endorsed behaviors indicating maladaptive coping. In adjusted analyses, less than full-time employment (ß = - 8.76; 95% CI = - 17.37, - 0.14), younger age (ß = - 0.35; 95% CI = - 0.069, - 0.02), greater parenting concerns (ß = 0.56; 95% CI = 0.36, 0.75), clinically relevant anxiety symptoms (ß = 13.79; 95% CI = 10.24, 17.35), lower post-traumatic growth score (ß = - 0.33; 95% CI = - 0.51, - 0.16), lower social support (ß = - 0.21; 95% CI = - 0.29, - 0.12), lower sexual satisfaction (ß = - 0.40; 95% CI = - 0.62, - 0.19), and breast cancer stages 3 (ß = 7.61; 95% CI = 0.19, 15.02) and 4 (ß = 12.63; 95% CI = 1.91, 23.34), when compared to stage 0, were associated with lower partner QOL. CONCLUSION: Parenting partners of young women with breast cancer have substantial unmet psychosocial needs. Interventions are needed to enhance QOL and promote adaptive coping for this population.

Optimal Staffing Models To Care For Frail Older Adults In Primary Care And Geriatrics Practices In The US.

Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geriatric care, we assessed whether different configurations were associated with better or worse performance on a number of standard process measures indicative of comprehensive, high-quality primary care. Practices with a large concentration of MDs had the highest estimated labor costs. Practices high in NPs and physician assistants (PAs) were most common in states that grant full scope of practice to NPs. The high-NP/PA configuration was associated with a 17-percentage-point greater probability of facilitating patient visits and a 26-percentage-point greater probability of providing the full bundle of primary care services compared with the high-MD model. Team-based configurations had a 27.7-percentage-point greater probability of providing the full bundle of primary care services. The complex needs of older adults may be best served by team-based practices with a broad provider mix that can provide a range of services in the office and the community.

Classifying Adverse Events in the Dental Office.

BACKGROUND: Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as "unnecessary harm due to dental treatment." In this research, we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office. METHODS: Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in previous work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews, and AEs identified were used to evaluate and modify these newly developed classifications. RESULTS: A total of 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AEs were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 73% of the cases reviewed (56% and 17%, respectively) and 88% were found to cause temporary, moderate to severe harm to the patient. CONCLUSIONS: Adverse events found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.

Partners of young breast cancer survivors: a cross-sectional evaluation of psychosocial concerns, coping, and mental health.

PURPOSE: Evaluation of psychosocial concerns, coping style, and mental health in partners of young (diagnosed at ≤40 years) survivors of early-stage breast cancer (BC). DESIGN: Cross-sectional; partners participated in a one-time survey. SAMPLE: 289 participants; most were male, white, working full-time, college educated, with median age of 43 years, parenting children <18 years old. METHODS: Logistic regression was used to explore associations with anxiety and depression (≥8 on Hospital Anxiety and Depression sub-scales). FINDINGS: Overall, 41% reported symptoms of anxiety, 18% reported symptoms of depression, and 44% identified maladaptive coping. Multivariable regression analyses revealed: lower social support and poorer quality of life significantly associated with depression (p < .05); maladaptive coping, fulltime employment, poorer caregiver QOL, and less education significantly associated with anxiety. CONCLUSIONS: Partners of young BC survivors who use more maladaptive coping strategies, report less social support, work fulltime, and/or who have lower education levels experience negative mental health outcomes. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY: Enhancing constructive coping and ensuring all partners have access to supportive resources may improve partners' emotional adjustment.

Physician and nurse practitioner perceptions of social worker and community health worker roles in primary care practices caring for frail elders: Insights for social work.

Social workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of SW and CHW in primary care practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Physician and nurse practitioner clinicians were randomly selected within practices, stratifying by practice staffing and presence/absence of geriatric clinicians; our final sample for this analysis included 341 practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession.

Impact of an Interprofessional Primary Care Training on Fear of Cancer Recurrence on Clinicians' Knowledge, Self-Efficacy, Anticipated Practice Behaviors, and Attitudes Toward Survivorship Care.

There are an estimated 15.5 million cancer survivors in the United States, with numbers projected to increase. Many cancer survivors are receiving survivorship care in primary care settings, yet primary care providers report a need for additional training on addressing medical and psychosocial concerns of cancer survivors. This paper presents findings from a pilot study on the effectiveness of a novel training for interprofessional primary care providers on the clinically significant issue of fear of cancer recurrence. The on-site training was provided to a total of 46 participants, including physicians (61%), physician assistants (11%), nurse practitioners (7%), nurses (17%), and social workers (4%) in six different primary care practices. The average number of years of professional experience was 18.8, with standard deviation of 10.9. Results of paired-sample t tests indicated that the training increased knowledge and self-efficacy of providers in identifying and addressing FCR. The training was well-received by participants, who had high confidence in implementing practice behavior changes, although they also identified barriers. Results suggest the feasibility of a brief training for continuing education and have implications for models of care delivery in cancer survivorship.

Administrators' Perceptions of Oral Health Care and Cancer Screening in Long-Term Care Nursing Facilities.

An estimated 1.7 million adults in the United States more than the age of 65 reside in long-term care nursing facilities (LTCNFs), and only 17% of them receive dental care. More than 83% of LTCNF residents require assistance with oral care. Adequate dental care is a preventative behavior for oral cancer. Adults more than age 65 will account for 60% of oral cancer-related deaths, despite an 80% cure rate for early diagnosis. This study sought to expand knowledge of the perceived benefits, barriers, and ability to perform or provide for oral health care and oral cancer screening as reported by Administrators and Directors of Nursing in LTCNFs. Findings indicate that competing demands for resources make oral health a low priority issue and low knowledge about oral cancer risk among nursing home residents, family members, and staff is a barrier. Potential interventions suggested by participants are discussed.

Oral health and cancer screening in long-term care nursing facilities: Motivation and opportunity as intervention targets.

OBJECTIVE: The objective of this study is to propose empirically and conceptually supported interventions that might increase the capability and opportunity to provide of oral hygiene care and oral cancer screening in long-term nursing care facilities. BACKGROUND: Improving the oral health in the older adult population is a priority of the Healthy People 2020 initiative. Poor oral health disproportionably affects older populations, which indicates lower participation in regular oral health care (OHC) that includes screening and early detection of oral cancer. MATERIAL AND METHODS: A rigorous recruitment protocol yielded a purposive sample of nursing home Administrators and Directors of Nursing who participated in nine discrete focus groups (n = 34) in several regions of Massachusetts. Interview data were integrated with a conceptual framework of the Health Belief Model and the "capability," "opportunity," "motivation" and "behavior" of the COM-B system to identify potential interventions to increase oral health and oral cancer screening. We used NVivo to identify conceptual themes related to potential intervention targets. RESULTS: Participants identified several impediments to oral hygiene and cancer screening in the context of the conceptual model. High barriers, low opportunities and low motivation were themes identified as potential targets for intervention. CONCLUSIONS: Our findings suggest that the intervention likely to increase OHC and consequently oral cancer screening include: training certified nurses' aides using dental students and volunteers; educating family members about OHC and oral cancer screening, and increasing oral cancer awareness.

Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors.

BACKGROUND: Growing numbers of cancer survivors are receiving healthcare through primary care practitioners, who often lack cancer-specific expertise to effectively treat survivors' concerns. Addressing that gap, this study aimed to develop content for a training on fear of cancer recurrence (FCR), a common concern in survivorship. METHODS: Grounded in naturalistic inquiry, 42 key-informant interviews were conducted, transcribed, and analyzed for themes. Participants were healthcare professionals, researchers, and cancer survivors Results: Results included themes ranging from: rich conceptualizations of FCR, opportunities and challenges for addressing FCR in healthcare settings, interventions to address FCR, and important information to include in a training on FCR. CONCLUSIONS: This paper provides content for an interprofessional training and highlights the importance of developing trainings for interprofessional teams, given identified barriers that physicians face in addressing FCR and other psychosocial concerns of survivors in primary care.

Decreasing hazards of Alzheimer's disease with the use of antidepressants: mitigating the risk of depression and apolipoprotein E.

OBJECTIVE: Alzheimer's disease (AD) is a neurodegenerative disease, manifesting in clinically observable deficits in memory, thinking, and behavior that disproportionately affects older adults. Susceptibility genes, such as apolipoprotein ε4, have long been associated with an increased risk of AD diagnosis. Studies have shown associations between depression and increased risk of AD development. Furthermore, findings from previous investigations suggest mixed effects in the use of psychotropic medication in older adults. The hypothesis for this study is that antidepressant use modifies the increased hazard of depression or such that a non-significant hazard will result with respect to eventual AD development. METHODS: Utilizing data from the National Alzheimer's Coordinating Center, we examined evaluations of 11,443 cognitively intact participants. Survival analysis was used to explore relationships between depression, apolipoprotein E, AD diagnosis, and antidepressant use. RESULTS: An analytical sample of 8732 participants with normal cognition was examined. Among users of antidepressant medication, the hazard, in most cases, was no longer statistically significant. One generic medication showed protective benefits for users (p < 0.001). In addition, there was a statistically significant relationship between recent depression (n = 2083; p < 0.001), lifetime depression (n = 2068; p < 0.05), and ε4 carrier status (n = 2470; p < 0.001) and AD development. CONCLUSIONS: The findings suggest that a mechanism related to antidepressant use may reduce the hazard of eventual AD. Furthermore, the findings reinforce the association between depression, apolipoprotein E (APOE) ε4, and AD diagnosis. This study contributes to the emerging literature exploring interventions aimed at decreasing the risk of AD by targeting potentially modifiable psychosocial risk factors such as depression. Copyright © 2017 John Wiley & Sons, Ltd.

Psychosocial risk factors and Alzheimer's disease: the associative effect of depression, sleep disturbance, and anxiety.

OBJECTIVES: Alzheimer's disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions. METHODS: Data from the National Alzheimer's Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models. RESULTS: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations. CONCLUSION: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Advancing Social Work Education for Health Impact.

Social work education plays a critical role in preparing social workers to lead efforts that improve health. Because of the dynamic health care landscape, schools of social work must educate students to facilitate health care system improvements, enhance population health, and reduce medical costs. We reviewed the existing contributions of social work education and provided recommendations for improving the education of social workers in 6 key areas: aging, behavioral health, community health, global health, health reform, and health policy. We argue for systemic improvement in the curriculum at every level of education, including substantive increases in content in health, health care, health care ethics, and evaluating practice outcomes in health settings. Schools of social work can further increase the impact of the profession by enhancing the curricular focus on broad content areas such as prevention, health equity, population and community health, and health advocacy.

The Social Security Administration's Compassionate Allowances Initiative: Condition Spotlight on Rubinstein-Taybi Syndrome.

The Social Security Administration (SSA) Compassionate Allowances List (CAL) was created in 2008, generating a mechanism within SSA for identifying diseases and other medical conditions that by definition meet social security's standards for disability benefits. Currently, over 200 conditions are included in this expedited review program, though few of them are neurodevelopmental in nature. Exploration of a novel method for inclusion of additional conditions on CAL was undertaken using one condition as an exemplar. Peer-reviewed literature available in academic databases was reviewed and used as empirical evidence to demonstrate whether Rubinstein-Taybi syndrome (RTS) invariably met the three disability criteria set forth by SSA. After in-depth exploration of the empirical literature, RTS was found to meet SSA's definition, suggesting this condition should receive consideration as an addition to the Compassionate Allowances Initiative.

Health Care Resources and Mental Health Service Use Among Suicidal Adolescents.

Developing policies and interventions that increase rates of mental health service use for suicidal adolescents is crucial for suicide prevention. Data from a sample of suicidal youth (n = 1356) from the National Longitudinal Study of Adolescent Health (Add Health) were analyzed to examine whether type of insurance, receipt of routine medical care, and access to school-based mental health treatment predicted mental health service use cross-sectionally and longitudinally. Rates of mental health service use were low in cross-sectional analyses at all three waves (∼11%-30%), despite the fact that respondents were at high risk for suicide attempts and depression. With demographic factors and symptom severity controlled, only receipt of a routine physical predicted an increased likelihood of mental health service use at wave I and in longitudinal analyses. Implications discussed include the utility of universal suicide screenings and integrated behavioral health care as potential intervention strategies for this population.

Variability in Clinical and Anatomical Manifestation of Velocardiofacial Syndrome Presents Diagnostic and Policy Uncertainty.

OBJECTIVE: This study examined the complexity and myriad clinical manifestations and expressions of velocardiofacial syndrome (VCFS). It aimed to determine if VCFS invariably met the three disability criteria for the Compassionate Allowance List (CAL) program administered by the Social Security Administration (SSA). METHODS: A systematic evaluative review of the literature found in 10 academic databases was completed. Inclusion criteria of the search terms yielded 1,383 initial manuscripts. Only 77 of articles met higher-level inclusion criteria of explicit statements reporting observed severity of symptoms and disability that this study used as evidence. The three SSA CAL criteria include duration, severity, and impact of employment. The analysis systematically reviewed papers with the objective of determining if they met one, two, or all three of the SSA CAL criteria. Results The first criteria for the CAL require a condition to last beyond 12 months. From the 77 articles that met inclusion criteria, a total of 21 articles reported explicit statements that evidenced symptoms that were limited to the first criteria only. The second CAL criteria required that a condition also has negative impact on quality of life or death. Forty-nine articles demonstrated the first and second criteria, duration ≥12 months plus a negative impact on quality of life or death. The third criteria required that the condition prevents substantial gainful employment as well as duration ≥12 months plus a negative impact on quality of life or death. A total of seven articles reported all three criteria. CONCLUSIONS: The variability of symptoms related to VCFS makes it impossible to assert that all cases will meet the criteria for disability entitlements.

Smith-Magenis Syndrome and Social Security Administration's Compassionate Allowances Initiative: An Evaluative Review of the Literature.

The Social Security Administration (SSA) launched the Compassionate Allowances List (CAL) in 2008. This created a mechanism for expediting review and delivery of disability benefits, while decreasing application backlog. This study hypothesized that developmental disorders, such as Smith-Magenis syndrome, may meet criterion for inclusion. An evaluative review of the literature was undertaken to determine if the expedited review criterion was met. Ten databases were searched and articles meeting pre-defined criteria were coded according to the SSA definition of disability to determine if severity indices screen in or screen out certain severity levels or exclude Smith-Magenis syndrome entirely in relation to the CAL program. It was strongly recommended that Smith-Magenis syndrome receive consideration for inclusion in the CAL.

How dental team members describe adverse events.

BACKGROUND: Although some patients experience adverse events (AEs) resulting in harm caused by treatments in dentistry, few published reports have detailed how dental providers describe these events. Understanding how dental treatment professionals view AEs is essential to building a safer environment in dental practice. METHODS: The authors interviewed dental professionals and domain experts through focus groups and in-depth interviews and asked them to identify the types of AEs that may occur in dental settings. RESULTS: The initial interview and focus group findings yielded 1,514 items that included both causes and AEs. In total, 632 causes were coded into 1 of the 8 categories of the Eindhoven classification, and 882 AEs were coded into 12 categories of a newly developed dental AE classification. Interrater reliability was moderate among coders. The list was reanalyzed, and duplicate items were removed leaving a total of 747 unique AEs and 540 causes. The most frequently identified AE types were "aspiration and ingestion" at 14% (n = 142), "wrong-site, wrong-procedure, wrong-patient errors" at 13%, "hard-tissue damage" at 13%, and "soft-tissue damage" at 12%. CONCLUSIONS: Dental providers identified a large and diverse list of AEs. These events ranged from "death due to cardiac arrest" to "jaw fatigue from lengthy procedures." PRACTICAL IMPLICATIONS: Identifying threats to patient safety is a key element of improving dental patient safety. An inventory of dental AEs underpins efforts to track, prevent, and mitigate these events.

Neuropsychiatric symptoms and Apolipoprotein E: Associations with eventual Alzheimer's disease development.

OBJECTIVE: Alzheimer's disease (AD) is the result of neurodegeneration, which manifests clinically as deficits in memory, thinking, and behavior. It was hypothesized that neuropsychiatric symptoms and the apolipoprotein E genotype increase the likelihood of Alzheimer's disease development. METHODS: Utilizing data from the National Alzheimer's Coordinating Center, information from evaluations of 11,453 cognitively intact participants was analyzed. Survival analysis was used to explore relationships between individual neuropsychiatric symptoms as determined by the Neuropsychiatric Inventory Questionnaire, apolipoprotein E, and eventual AD diagnosis. Cox proportional hazard models were utilized to explore the main effects and synergistic (additive and multiplicative) interactions. RESULTS: This study provided evidence for an increased hazard of developing AD among participants with any of the symptoms assessed by the NPI-Q. The hazard of developing AD was almost thirteen times higher for ε4 carriers with delusions and eleven times greater for those with apathy and disinhibition. Statistically significant hazards (p>0.001) were also realized by ε4 carriers with hallucinations; agitation; depression; anxiety; elation; apathy; irritability; and motor, sleep, and appetite disturbances. CONCLUSIONS: Findings suggest that neuropsychiatric symptoms are associated with eventual AD diagnosis among a group of cognitively asymptomatic participants at baseline. Many studies begin with a group of participants already impacted by AD diagnosis. The longitudinal analysis of a group of participants who, at baseline, demonstrated no observable signs of AD was a strength of this study. This investigation contributes to the literature exploring an increased hazard of AD due to potential modifiable risk factors and genetic biomarkers such as apolipoprotein E.

Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer's disease: dementia.

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative brain disease that causes cognitive impairment and dementia. Within the US, AD is the most common form of dementia in the elderly, affecting 1 in 10 people over the age of 65. Sleep disturbance has been called a "public health epidemic" and, like depression, is a prodromal symptom of AD but may also contribute to the risk of developing AD. It was hypothesized that sleep disturbance, depression, and the apolipoprotein E (APOE) genotype increase the likelihood of AD. METHODS: Utilizing data from the National Alzheimer's Coordinating Center, information from evaluations of 11,453 cognitively asymptomatic participants was analyzed. Survival analysis was used to explore the independent relationships between depression, sleep disturbance, and APOE genotypes with eventual AD diagnosis. Cox proportional hazard models were utilized to explore the main effects and synergistic effects of psychosocial factors as moderated by APOE genotypes. RESULTS: This study reinforced the association between APOE and AD. The hazard of developing AD was eight times higher for those with recent depression and the Ɛ4 homozygote (HR = 8.15 [3.70-17.95]). Among Ɛ4 carriers with clinician-verified depression, the hazard was ten times that of the reference group (HR = 10.11 [4.43-23.09]). The hazard for Ɛ4 carriers reporting sleep disturbance was almost 7 times greater than the reference group (HR = 6.79 [2.38-19.37]). CONCLUSION: Findings suggest that sleep disturbance, depression, and APOE Ɛ4 genotype are associated with AD during follow-up evaluations among a group of initially cognitively asymptomatic participants. This study contributes to the literature base exploring an increased hazard or risk of AD due to potential modifiable risk factors as well as genetic biomarkers, such as APOE.

Interdisciplinary medical social work: a working taxonomy.

Findings from a year-long exploratory study aimed at describing universal functions of medical social work with interdisciplinary teams in acute care settings are reported here. A universal taxonomy of interdisciplinary social work skills and competencies was empirically identified through a participatory action research framework. Findings support previous conceptual descriptions of medical social work's overarching and historical role to help interdisciplinary teams in acute care to consider patients' home environment, knowledge, beliefs, culture, and resources during assessment, treatment, and discharge planning. The empirically determined taxonomy reported is intended to provide social workers a framework with which to articulate and evaluate their core competencies on interdisciplinary medical teams.