RocHealthData.org: Development and usage of a publicly available, geographic source of social determinants of health data.

Access to local, population specific, and timely data is vital in understanding factors that impact population health. The impact of place (neighborhood, census tract, and city) is particularly important in understanding the Social Determinants of Health. The University of Rochester Medical Center's Clinical and Translational Science Institute created the web-based tool RocHealthData.org to provide access to thousands of geographically displayed publicly available health-related datasets. The site has also hosted a variety of locally curated datasets (eg., COVID-19 vaccination rates and community-derived health indicators), helping set community priorities and impacting outcomes. Usage statistics (available through Google Analytics) show returning visitors with a lower bounce rate (leaving a site after a single page access) and spent longer at the site than new visitors. Of the currently registered 1033 users, 51.7% were from within our host university, 20.1% were from another educational institution, and 28.2% identified as community members. Our assessments indicate that these data are useful and valued across a variety of domains. Continuing site improvement depends on new sources of locally relevant data, as well as increased usage of data beyond our local region.

Implementation and Evaluation of a National Well-Being Curriculum for KL2 Scholars.

Introduction: The study aimed to pilot test a well-being curriculum for KL2 scholars to be used across the Clinical and Translational Science Award consortium. Methods: Between November 2022, and May 2023, 36 KL2 scholars from 25 hubs participated in the program. The General Well-Being Index for U.S. Workers and the Patient Reported Outcomes Measurement Information System (PROMIS-29) were completed by scholars before and after the program. Results: Postparticipation, there was a trend of improvement in the domains of well-being, sleep, anxiety, and fatigue. Conclusion: Implementing a virtual synchronous well-being curriculum allowed the scholars to connect across the consortium and improve their well-being.

Exploring the impact of mindfulness-based training on the well-being of physical therapists.

Introduction: Experimental evidence is needed to evaluate interventions that curtail burnout for physical therapists. The goal of this research was to assess the impact of mindfulness-based training (MBT) on the well-being of physical therapists. We hypothesized physical therapists would demonstrate greater work engagement, empathy, and job satisfaction, and lower depression, anxiety, stress, and moral distress following MBT. Methods: Thirteen physical therapists (10 female/3 male; 35.38 ± 9.32 years old) completed this two-arm embedded mixed-methods pilot study. The control group (n = 4) was followed while the intervention group (n = 9) completed six MBT sessions over 3 months. Sessions were assigned a representative topic area (meaning in physical therapy, situational- and self-awareness, compassion fatigue/burnout, implicit biases, establishing boundaries and managing conflict, self-care) with relevant reflective writing, small group discussions, and mindfulness strategies. Non-parametric statistics compared quantitative outcomes across and within groups, and a thematic framework matrix was established by way of qualitative description for data analysis. Results: Physical therapists in the intervention group had improved pre- to post-scores for work engagement, mental health, and moral distress (p ≤ 0.043). Inability to effect change contributed to compassion fatigue/burnout, whereas difficulty prioritizing self/limited personal time impeded self-care. "I realized how easy it is to get caught up in life and in helping out those around you, you completely forget to take time to check in with how you are doing (Physical Therapist 3)." Conclusion: Implementing an MBT program demonstrates promise and may benefit the well-being of physical therapists while simultaneously enhancing employee retention and improving patient care.

What is well-being? A scoping review of the conceptual and operational definitions of occupational well-being.

Well-being is a multifaceted construct that is used across disciplines to portray a state of wellness, health, and happiness. While aspects of well-being seem universal, how it is depicted in the literature has substantial variation. The aim of this scoping review was to identify conceptual and operational definitions of well-being within the field of occupational health. Broad search terms were used related to well-being and scale/assessment. Inclusion criteria were (1) peer-reviewed articles, (2) published in English, (3) included a measure of well-being in the methods and results section of the article, and (4) empirical paper. The searches resulted in 4394 articles, 3733 articles were excluded by reading the abstract, 661 articles received a full review, and 273 articles were excluded after a full review, leaving 388 articles that met our inclusion criteria and were used to extract well-being assessment information. Many studies did not define well-being or link their conceptual definition to the operational assessment tool being used. There were 158 assessments of well-being represented across studies. Results highlight the lack of a consistent definitions of well-being and standardized measurements.

Mindful practice with medical interpreters.

Introduction: Medical interpreters experience emotional burdens from the complex demands at work. Because communication access is a social determinant of health, protecting and promoting the health of medical interpreters is critical for ensuring equitable access to care for language-minority patients. The purpose of this study was to pilot a condensed 8-h program based on Mindful Practice® in Medicine addressing the contributors to distress and psychosocial stressors faced by medical sign and spoken language interpreters. Methods: Using a single-arm embedded QUAN(qual) mixed-methods pilot study design, weekly in-person 1-h sessions for 8 weeks involved formal and informal contemplative practice, didactic delivery of the week's theme (mindfulness, noticing, teamwork, suffering, professionalism, uncertainty, compassion, and resilience), and mindful inquiry exercises (narrative medicine, appreciative interviews, and insight dialog). Quantitative well-being outcomes (mean±SEM) were gathered via survey at pre-, post-, and 1-month post-intervention time points, compared with available norms, and evaluated for differences within subjects. Voluntary feedback about the workshop series was solicited post-intervention via a free text survey item and individual exit interviews. A thematic framework was established by way of qualitative description. Results: Seventeen medical interpreters (46.2 ± 3.1 years old; 16 women/1 man; 8 White/9 Hispanic or Latino) participated. Overall scores for teamwork (p ≤ 0.027), coping (p ≤ 0.006), and resilience (p ≤ 0.045) increased from pre- to post-intervention and pre- to 1-month post-intervention. Non-judging as a mindfulness component increased from pre- to post-intervention (p = 0.014). Compassion satisfaction (p = 0.021) and burnout (p = 0.030) as components of professional quality of life demonstrated slightly delayed effects, improving from pre- to 1-month post-intervention. Themes such as workshop schedule, group size, group composition, interactivity, topics to be added or removed, and culture are related to the overarching topic areas of intervention logistics and content. Integration of the findings accentuated the positive impact of the intervention. Discussion: The results of this research demonstrate that mindful practice can serve as an effective resource for medical interpreters when coping with work-related stressors. Future iterations of the mindful practice intervention will further aspire to address linguistic and cultural diversity in the study population for broader representation and subsequent generalization.

Mapping the distribution of health equity research and practice across a university: a network analysis.

Introduction: Health equity research spans various disciplines, crossing formal organizational and departmental barriers and forming invisible communities. This study aimed to map the nomination network of scholars at the University of Rochester Medical Center who were active in racial and ethnic health equity research, education, and social/administrative activities, to identify the predictors of peer recognition. Methods: We conducted a snowball survey of faculty members with experience and/or interest in racial and ethnic health equity, nominating peers with relevant expertise. Results: Data from a total of 121 individuals (64% doing research on extent and outcomes of racial/ethnic disparities and racism, 48% research on interventions, 55% education, and 50% social/administrative activities) were gathered in six rounds of survey. The overlap between expertise categories was small with coincidence observed between education and social/administrative activities (kappa: 0.27; p < 0.001). Respondents were more likely to nominate someone if both were involved in research (OR: 3.1), if both were involved in education (OR: 1.7), and if both were affiliated with the same department (OR: 3.7). Being involved in health equity research significantly predicted the centrality of an individual in the nomination network, and the most central actors were involved in multiple expertise categories. Conclusions: Compared with equity researchers, those involved in racial equity social/administrative activities were less likely to be recognized by peers as equity experts.

Experiences of Sign Language Interpreters and Perspectives of Interpreting Administrators During the COVID-19 Pandemic: A Qualitative Description.

OBJECTIVE: Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and interpreting administrators upon transitioning from on-site to remote work. METHODS: From March through August 2021, we conducted focus groups with 22 sign language interpreters in 5 settings, 1 focus group for each setting: staff, educational, community/freelance, video remote interpreting, and video relay services. We also conducted 5 individual interviews with interpreting administrators or individuals in positions of administrative leadership in each represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) years, 18 were female, 17 were White, all identified as hearing, and all worked a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked participants about the positive and negative consequences of transitioning from on-site to remote at-home interpreting. We established a thematic framework by way of qualitative description for data analysis. RESULTS: We found considerable overlap across positive and negative consequences identified by interpreters and interpreting administrators. Positive consequences of transitioning from on-site to remote-at-home interpreting were realized across 5 overarching topic areas: organizational support, new opportunities, well-being, connections/relationships, and scheduling. Negative consequences emerged across 4 overarching topic areas: technology, financial aspects, availability of the interpreter workforce, and concerns about the occupational health of interpreters. CONCLUSIONS: The positive and negative consequences shared by interpreters and interpreting administrators provide foundational knowledge upon which to create recommendations for the anticipated sustainment of some remote interpreting practice in a manner that protects and promotes occupational health.

The Occupational Health and Safety of Sign Language Interpreters Working Remotely During the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic has caused a dramatic shift in work conditions, bringing increased attention to the occupational health of remote workers. We aimed to investigate the physical and mental health of sign language interpreters working remotely from home because of the pandemic. METHODS: We measured the physical and mental health of certified interpreters who worked remotely 10 or more hours per week. We evaluated associations within the overall sample and compared separate generalized linear models across primary interpreting settings and platforms. We hypothesized that physical health would be correlated with mental health and that differences across settings would exist. RESULTS: We recruited 120 interpreters to participate. We calculated scores for disability (mean score, 13.93 [standard error of the mean (SEM), 1.43] of 100), work disability (mean score, 10.86 [SEM, 1.59] of 100), and pain (mean score, 3.53 [SEM, 0.29] of 10). Shoulder pain was most prevalent (27.5%). Respondents had scores that were not within normal limits for depression (22.5%), anxiety (16.7%), and stress (24.2%). Although disability was not associated with depression, all other outcomes for physical health were correlated with mental health (r ≥ 0.223, P ≤ .02). Educational and community/freelance interpreters trended toward greater adverse physical health, whereas educational and video remote interpreters trended toward more mental health concerns. CONCLUSION: Maintaining the occupational health of sign language interpreters is critical for addressing the language barriers that have resulted in health inequities for deaf communities. Associations of disability, work disability, and pain with mental health warrant a holistic approach in the clinical treatment and research of these essential workers.

A network analysis of dissemination and implementation research expertise across a university: Central actors and expertise clusters.

Background: Although dissemination and implementation (D&I) science is a growing field, many health researchers with relevant D&I expertise do not self-identify as D&I researchers. The goal of this work was to analyze the distribution, clustering, and recognition of D&I expertise in an academic institution. Methods: A snowball survey was administered to investigators at University of Rochester with experience and/or interest in D&I research. The respondents were asked to identify their level of D&I expertise and to nominate others who were experienced and/or active in D&I research. We used social network analysis to examine nomination networks. Results: Sixty-eight participants provided information about their D&I expertise. Thirty-eight percent of the survey respondents self-identified as D&I researchers, 24% as conducting D&I under different labels, and 38% were familiar with D&I concepts. D&I researchers were, on average, the most central actors in the network (nominated most by other survey participants) and had the highest within-group density, indicating wide recognition by colleagues and among themselves. Researchers who applied D&I under different labels had the highest within-group reciprocity (25%), and the highest between-group reciprocity (29%) with researchers familiar with D&I. Participants significantly tended to nominate peers within their departments and within their expertise categories. Conclusions: Identifying and engaging unrecognized clusters of expertise related to D&I research may provide opportunities for mutual learning and dialog and will be critical to bridging across departmental and topic area silos and building capacity for D&I in academic settings.

Making virtual health care accessible to the deaf community: Findings from the telehealth survey.

INTRODUCTION: To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits. METHODS: A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches. RESULTS: Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25). CONCLUSION: Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs.

Ditching the Driving: A Cross-Sectional Study on the Determinants of Remote Work From Home for Sign Language Interpreters.

Background: The coronavirus disease 2019 (COVID-19) pandemic dramatically impacted the working conditions for sign language interpreters, shifting the provision of interpreting services from onsite to remote. The goal of this cross-sectional study was to examine the perceptions of determinants of remote interpreting implementation from home by sign language interpreters during the pandemic. We hypothesized that interpreters working across the primary settings of staff (agency, government, business, or hospital employees), educational (K-12 or postsecondary), community/freelance (independent contractor), video remote (the two-way connection between onsite participants and remote interpreter), and video relay (three-way telecommunication) would present with differing experiences of the implementation process. Methods: The Determinants of Implementation Behavior Questionnaire was adapted for sign language interpreters (DIBQ-SLI) and administered to certified interpreters working remotely at least 10 h per week. The DIBQ-SLI included eight constructs (knowledge, skills, self-efficacy, perceived behavioral control, innovation characteristics, organizational resources and support, innovation strategies, and social support) and 30 items. Parametric statistics assessed differences in interpreters' perceptions across settings. Principal component analysis was conducted for data reduction and affirmation of the most critical constructs and items. Results: One hundred and six interpreters (37 video relay, 27 video remote, 18 educational, 11 community/freelance, 11 staff interpreters, and two from "other" settings) completed the DIBQ-SLI. The video relay and staff interpreters consistently demonstrated the most favorable and the educational interpreters demonstrated the least favorable perceptions. Of the total variance, 58.8% of interpreters' perceptions was explained by organizational (41%), individual (10.7%), and social (7.1%) dimensions. There were significant differences across settings for the organizational and individual principal components; however, no differences were detected for the social principal component. Conclusions: An administrative infrastructure devoted to ensuring that interpreters receive sufficient managerial support, training, materials and resources, experience with remote interpreting before having to commit, and insights based on the results of their remote work (organizational principal component) may be necessary for improving perceptions. Remote interpreting is expected to continue after the pandemic ends; thus, settings with the least favorable ratings across behavior constructs may borrow strategies from settings with the most favorable ratings to help promote perceptions of the contextual determinants of future remote interpreting implementation.

Upper extremity biomechanics in native and non-native signers.

BACKGROUND: Individuals fluent in sign language (signers) born to non-signing, non-deaf parents (non-natives) may have a greater injury risk than signers born to signing, deaf parents (natives). A comprehensive analysis of movement while signing in natives and non-natives has not been completed and could provide insight into the greater injury prevalence of non-natives. OBJECTIVE: The objective of this study was to determine differences in upper extremity biomechanics between non-natives and natives. METHODS: Strength, 'micro' rests, muscle activation, ballistic signing, joint angle, and work envelope were captured across groups. RESULTS: Non-natives had fewer rests (p = 0.002) and greater activation (p = 0.008) in non-dominant upper trapezius. For ballistic signing, natives had greater anterior-posterior jerk (p = 0.033) and for joint angle, natives demonstrated greater wrist flexion-extension range of motion (p = 0.040). Natives also demonstrated greater maximum medial-lateral (p = 0.015), and greater minimum medial-lateral (p = 0.019) and superior-inferior (p = 0.027) positions. CONCLUSIONS: We observed that natives presented with more rests and less activation, but greater ballistic tendencies, joint angle, and envelope compared to non-natives. Additional work should explore potential links between these outcomes and injury risk in signers.

The Modified Strain Index: A Composite Measure of Injury Risk for Signers.

Up to 81% of individuals who are fluent in sign language (signers) report pain. Non-native signers (with non-signing, non-deaf parents) report greater pain than natives (≥1 signing, deaf parent). The goal of this study was to develop a composite measure of injury risk (the modified Strain Index for signers) based on previously identified biomechanics unique to signers and examine scores across sub-groups of natives and non-natives. Non-natives were hypothesized to have greater pain and higher composite scores than natives. Ten natives and 15 non-natives used a numeric scale to rate pain while signing. Measures included 'micro' rests, muscle activation, ballistic signing, non-neutral joint angle, and work envelope. Descriptive statistics were used to create categorical ratings and backward elimination multiple linear regression to establish rank order of the biomechanical tasks. Participant performance was rated, and the product of the multipliers across tasks created a score. Pain intensity was associated with the composite score (r = 0.46; p = 0.02), however there was no difference between natives (score = 13.39 ± 3.1) and non-natives (score = 19.55 ± 4.7; p = 0.34). This work presents an approach to incorporate multiple biomechanical factors into a single, composite measure unique to signers, however further evidence-based adjustments are needed to enhance its robustness.

Preadmission predictors of graduation success from a physical therapy education program in the southwestern United States.

PURPOSE: The field of physical therapy education is seeking an evidence-based approach to inform qualified applicant admission. A considerable amount of research exists; however, results represent an array of outcomes making practical application difficult. It aims to determine what preadmission criteria are predictors of graduation success. METHODS: Data from the 2013-2016 graduating cohorts (n=149) were collected. Predictors included verbal, quantitative and analytical Graduate Record Examination rank percentile), admissions interview, precumulative science grade point average (SGPA), precumulative grade point average (UGPA), and reflective essay. Measures of graduation success were identified as the National Physical Therapy Examination (NPTE) and grade point average at the time of graduation (GGPA). Two separate mixed effects models determined associations between preadmission predictors and NPTE, and preadmission predictors and GGPA. RESULTS: Overall, NPTE model fit comparison was significant (df=10; p=0.001) and within-cohort variance decreased 59.5%. The NPTE was associated with GGPA (ß=125.21; p=0.001), and verbal Graduate Record Examination (VGRE) rank percentile interview, essay and GGPA (p≤0.001) impacted model fit. Overall, GGPA model fit comparison was not significant (df=8; p=0.56) and within-cohort variance was decreased by 16.4%. The GGPA was associated with interview (ß=0.02; p=0.04) and UGPA (ß=0.25; p=0.04). VGRE rank percentile, interview, UGPA, and essay (p≤0.02) impacted model fit. CONCLUSION: Above findings suggest that GGPA predicts NPTE, and the interview and UGPA predict GGPA. The essay and VGRE rank percentile warrant attention because of their influence on model fit. It is recommended that admissions ranking matrices designate greater weight to the interview, UGPA, VGRE rank percentile, and essay.