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1.
J Fam Violence ; : 1-14, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34720393

RESUMO

Relatively few studies have considered the impact of the COVID-19 pandemic on intimate partner violence (IPV) advocates or the agencies where they work. In this study, based on United States IPV advocates' experiences working with survivors during the COVID-19 pandemic, we conducted interviews to explore: 1) personal challenges and resilience working as IPV advocates during the COVID-19 pandemic; 2) how agencies adapted to the pandemic to support IPV survivors and advocates; and 3) specific needs and challenges of culturally-specific agencies. We conducted semi-structured interviews with 53 IPV advocates from June to November 2020. Participants were included if they worked directly with survivors, identified as an IPV advocate, worked at a US-based agency, and spoke and understood English. We created a sampling matrix to ensure adequate representation from IPV advocates serving survivors from communities which have been marginalized. Interviews were conducted through a virtual platform by a trained member of the research team. We used an inductive thematic analysis approach, with weekly coding meetings to resolve discrepancies in coding. Five themes emerged from the data: 1) IPV advocates described how working as an IPV advocate during the COVID-19 pandemic impacted them personally; 2) agencies developed new methods of addressing IPV advocates' needs; 3) agencies developed new solutions to address pandemic-related client needs; 4) transitioning advocacy work to virtual formats created challenges but also opportunities and; 5) pandemic limitations and impacts compounded pre-pandemic challenges for culturally specific agencies. IPV advocates are frontline workers who have played essential roles in adjusting services to meet survivor needs during the COVID-19 pandemic while simultaneously coping with pandemic impacts on themselves and their agencies. Developing inter-agency collaborations and promoting advocates' safety and wellbeing during future public health crises will help support IPV survivors.

2.
Behav Res Methods ; 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34731426

RESUMO

For decades, psychology has relied on highly standardized images to understand how people respond to faces. Many of these stimuli are rigorously generated and supported by excellent normative data; as such, they have played an important role in the development of face science. However, there is now clear evidence that testing with ambient images (i.e., naturalistic images "in the wild") and including expressions that are spontaneous can lead to new and important insights. To precisely quantify the extent to which our current knowledge base has relied on standardized and posed stimuli, we systematically surveyed the face stimuli used in 12 key journals in this field across 2000-2020 (N = 3374 articles). Although a small number of posed expression databases continue to dominate the literature, the use of spontaneous expressions seems to be increasing. However, there has been no increase in the use of ambient or dynamic stimuli over time. The vast majority of articles have used highly standardized and nonmoving pictures of faces. An emerging trend is that virtual faces are being used as stand-ins for human faces in research. Overall, the results of the present survey highlight that there has been a significant imbalance in favor of standardized face stimuli. We argue that psychology would benefit from a more balanced approach because ambient and spontaneous stimuli have much to offer. We advocate a cognitive ethological approach that involves studying face processing in natural settings as well as the lab, incorporating more stimuli from "the wild".

4.
Artigo em Inglês | MEDLINE | ID: mdl-34747659

RESUMO

Background: The disproportionately high prevalence of poor reproductive and sexual health outcomes among American Indian and Alaska Native (AI/AN) women is related to histories of colonization, oppression, and structural racism. Intimate partner violence (IPV) and sexual violence (SV) contribute to these health outcomes. Materials and Methods: Narrative interviews were conducted with AI/AN women from four tribal reservation communities. Interviews explored connections among sexual and reproductive health, IPV, SV, reproductive coercion (RC), and pregnancy experiences as well as women's experiences of healing and recovery. Results: Among the 56 women interviewed (aged 17-55 years, 77% were aged 40 years and younger), all described multiple exposures to violence and highlighted lack of disclosure related to sexuality, childhood abuse, SV, and historical trauma. Access to confidential reproductive health services and contraceptive education was limited. Almost half (45%) reported experiencing RC in their lifetime. Use of substances occurred in both the context of SV and for surviving after exposure to violence. Women underscored the extent to which IPV, SV, and RC are embedded in histories of colonization, racism, and ongoing oppression. Interventions that incorporate AI/AN traditions, access to culturally responsive reproductive health and advocacy services, organizations, and services that have AI/AN personnel supporting survivors, public discussion about racism, abuse, sexuality, and more accountable community responses to violence (including law enforcement) are promising pathways to healing and recovery. Conclusions: Findings may advance understanding of AI/AN women's reproductive health in the context of historical trauma and oppression. Intervention strategies that enhance resiliency of AI/AN women may promote reproductive health.

5.
J Adolesc Health ; 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34620545

RESUMO

PURPOSE: Obtaining affirmative consent, a hallmark of sexual violence prevention education on college campuses, may influence sexual communication and behaviors such as condom use. This study examined the relationship between self-efficacy to obtain sexual consent with sexual health communication and behaviors among a sample of U.S. college students. METHODS: Data were from 2,291 students enrolled in a cluster-randomized controlled trial conducted on 28 college campuses from 2015 to 2017. Students reported their self-efficacy to obtain sexual consent, communication about sexual health, and sexual health behaviors. Multivariable logistic regression, adjusted for school clustering, history of violence victimization, and sexually transmitted infection history, estimated odds ratios and 95% confidence intervals (CIs) for sexual consent self-efficacy and sexual health communication. RESULTS: Females (n = 1,150) reported higher self-efficacy to obtain consent than males (b1 = .32, 95% CI = .23, .41), but lower odds of communication about condom use (adjusted odds ratio [AOR] = .75, 95% CI = .60, .96) and HIV prevention (AOR = .63, 95% CI = .48, .81). Black and other race students reported higher odds of HIV/sexually transmitted infection prevention communication than white students. Odds of consistent condom use were highest among students reporting condom use communication and high self-efficacy to obtain sexual consent (AOR = 1.99, 95% CI = 1.58, 2.51). CONCLUSIONS: Campus sexual assault prevention education that focuses narrowly on obtaining sexual consent may be missing an opportunity to enhance sexual health communication broadly, including condom and contraceptive use discussion to promote overall sexual health.

6.
J Child Neurol ; : 8830738211041824, 2021 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-34657501

RESUMO

OBJECTIVE: To explore perspectives of pediatric neurologists regarding sexual and reproductive health care for adolescent women with epilepsy (WWE) and intellectual disability. METHODS: We interviewed pediatric neurologists regarding sexual and reproductive health for WWE with intellectual disability. We audio-recorded and transcribed interviews and conducted qualitative analysis. RESULTS: 16 pediatric neurologists participated. Themes included the following: (1) Pediatric neurologists have differing perspectives about how intellectual disability affects WWE's sexual and reproductive health needs, (2) pediatric neurologists provide sexual and reproductive health counseling variable in content and frequency to this population, (3) pediatric neurologists tend to recommend longer-term methods of contraception for this population, and (4) pediatric neurologists are asked to be involved in decision-making around sterilization, yet express ethico-legal reservations. CONCLUSION: Our findings suggest pediatric neurologists provide variable, often suboptimal, sexual and reproductive health care for WWE and intellectual disability. Themes reveal ethical concerns among neurologists about sexual and reproductive health practices including sterilization. More tailored clinical guidelines and provider training on sexual and reproductive health for this population may be beneficial.

7.
Cancers (Basel) ; 13(19)2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34638266

RESUMO

As immunotherapies targeting the PDL1 checkpoint have become a mainstay of treatment for a subset of head and neck squamous cell carcinoma (HNSCC) patients, a detailed understanding of the mechanisms underlying PDL1-mediated immune evasion is needed. To elucidate factors regulating expression of PDL1 in HNSCC cells, a genome-wide CRISPR profiling approach was implemented to identify genes and pathways conferring altered PDL1 expression in an HNSCC cell line model. Our screen nominated several candidate PDL1 drivers, including Toll-like Receptor 2 (TLR2). Depletion of TLR2 blocks interferon-γ-induced PDL1 expression, and stimulation of TLR2 with either Staphylococcus aureus or a bacterial lipopeptide mimetic, Pam3CSK4, enhanced PDL1 expression in multiple models. The data herein demonstrate a role for TLR2 in modulating the expression of PDL1 in HNSCC models and suggest that microbiota may directly modulate immunosuppression in cancer cells. Our study represents a step toward disentangling the diverse pathways and stimuli regulating PDL1 expression in HNSCC and underscores a need for future work to characterize the complex microbiome in HNSCC patients treated with immunotherapy.

8.
J Sch Nurs ; : 10598405211043872, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34647823

RESUMO

Chronic absenteeism is associated with poor health and educational outcomes. School nurses have great potential to address the health and educational needs that contribute to absenteeism. Through qualitative analysis of interviews with school nurses, we characterize their current role in reducing absenteeism and identify barriers 3 that limit their capacity to meet this goal, organized by the Framework for 21st Century School Nursing Practice. Interviewees (n = 23) identified actions perceived to reduce absenteeism aligned with domains of care coordination, leadership, quality improvement, and community and public health. Barriers perceived to limit the capacity of school nurses to address absenteeism were identified within these domains and ranged from student- and family-level to federal-level barriers. Specific healthcare system-level barriers included insufficient communication with community-based healthcare teams and the need for coordinated approaches across health and education sectors to address absenteeism. Strategic opportunities exist to address barriers to comprehensive school nursing practice and reduce absenteeism.

9.
BMJ Open ; 11(9): e045380, 2021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34588227

RESUMO

OBJECTIVES: In January 2020, the UK moved to a 1+1 schedule for the 13-valent pneumococcal conjugate vaccine (PCV13) with a single priming dose at 3-month and a 12-month booster. We modelled the impact on invasive pneumococcal disease (IPD) out to 2030/2031 of reductions in PCV13 coverage and population mixing associated with restrictions on non-essential healthcare visits and social distancing measures introduced in 2020/2021 to reduce SARS-CoV-2 transmission. DESIGN: Using an existing model of pneumococcal transmission in England and Wales, we simulated the impact of a 40% reduction in coverage and a 40% reduction in mixing between and within age groups during two lockdowns in spring 2020 and autumn/winter 2020/2021. More and less extreme reductions in coverage and mixing were explored in a sensitivity analysis. MAIN OUTCOME MEASURES: Predicted annual numbers of IPD cases under different coverage and mixing reduction scenarios with uncertainty intervals (UIs) generated from minimum and maximum values of the model predictions using 500 parameter sets. RESULTS: The model predicted that any increase in IPD cases resulting from a reduction in PCV13 coverage would be more than offset by a reduction in pneumococcal transmission due to social distancing measures and that overall reductions in IPD cases will persist for a few years after resumption of normal mixing. The net reduction in cumulative IPD cases over the five epidemiological years from July 2019 was predicted to be 13 494 (UI 12 211, 14 676) all ages. Similar results were obtained in the sensitivity analysis. CONCLUSION: COVID-19 lockdowns are predicted to have had a profound effect on pneumococcal transmission resulting in a reduction in pneumococcal carriage prevalence and IPD incidence for up to 5 years after the end of the lockdown period. Carriage studies will be informative in confirming the predicted impact of the lockdown measures after they have been lifted.


Assuntos
COVID-19 , Infecções Pneumocócicas , Controle de Doenças Transmissíveis , Inglaterra/epidemiologia , Humanos , Incidência , Lactente , Distanciamento Físico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , SARS-CoV-2 , País de Gales/epidemiologia
10.
J Pediatr ; 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34536494

RESUMO

We explored gender diverse youth's experiences seeking and receiving gender-affirming care in various health system locations. Results provide evidence for system-, clinic-, and provider-level improvements to promote the development of affirming environments and to improve health outcomes for gender diverse youth.

11.
Artigo em Inglês | MEDLINE | ID: mdl-34472616

RESUMO

OBJECTIVE: Two-step questions to assess gender identity are recommended for optimizing care delivery for gender-diverse individuals. As gender identity fields are increasingly integrated into electronic health records, guidance is needed on how to analyze these data. The goal of this study was to assess potential approaches for analyzing 2-step gender identity questions and the impact of each on suicidal ideation. MATERIALS AND METHODS: A regional Youth Risk Behavior Survey in one Northeastern school district used a 2-step question to assess gender identity. Three gender measurement strategies (GMSs) were used to operationalize gender identity, (1) combining all gender-diverse youth (GDY) into one category, (2) grouping GDY based on sex assigned at birth, and (3) categorizing GDY based on binary and nonbinary identities. Mixed-effects logistic regression was used to compare odds of suicidal ideation between gender identity categories for each GMS. RESULTS: Of the 3010 participants, 8.3% were GDY. Subcategories of GDY had significantly higher odds (odds ratio range, 1.6-2.9) of suicidal ideation than cisgender girls regardless of GMS, while every category of GDY had significantly higher odds (odds ratio range, 2.1-5.0) of suicidal ideation than cisgender boys. CONCLUSIONS: The field of clinical informatics has an opportunity to incorporate inclusive items like the 2-step gender identity question into electronic health records to optimize care and strengthen clinical research. Analysis of the 2-step gender identity question impacts study results and interpretation. Attention to how data about GDY are captured will support for more nuanced, tailored analyses that better reflect unique experiences within this population.

12.
Menopause ; 28(11): 1313-1315, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34547001

RESUMO

Intimate partner violence (IPV) is a prevalent women's health problem that affects the health and well-being of midlife women. Clinicians who provide care to women have a responsibility to address IPV with their patients. Given the complexities surrounding IPV disclosure, the latest recommendations for IPV move beyond prior approaches that emphasize IPV screening and identification to that of universal education about IPV. Women experiencing IPV have indicated the utility of receipt of IPV information and resources regardless of disclosure. Further, a universal-education approach raises awareness about IPV for all patients to understand that IPV is prevalent, that IPV is associated with numerous negative health consequences, and that help is available.

13.
Sleep Health ; 7(5): 581-587, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34474988

RESUMO

OBJECTIVE: Few sleep promotion programs for adolescents have involved stakeholders as part of the intervention development, which may contribute to their limited accessibility, scalability, acceptability, and feasibility. Specifically asking stakeholders for their input on how to modify factors impacting sleep is critical, as is identifying strategies for motivating sleep behavior change. We report qualitative feedback from stakeholders interested in improving adolescent sleep, data collected specifically to inform the development of an adolescent sleep promotion program. PARTICIPANTS: We conducted 9 focus groups (3 each for young adults (n = 8, ages 21-25), parents of adolescents (n = 12), and healthcare providers working with adolescents (n = 29) following a semistructured approach. DESIGN: Participants reported on contributors to good and poor sleep; motivators for improving sleep; strategies for promoting and sustaining behavior change; and feasibility of a proposed sleep promotion program. We coded and thematically analyzed focus group transcripts using inductive and deductive approaches. RESULTS: Moderate engagement in activities (eg, a job, sports) was seen as a contributor to good sleep, while having too many or too few activities was thought to contribute to poor sleep. Linking improved sleep with personalized outcomes of interest can enhance motivation for changing sleep. Strategies for behavior change should rely on increasing internal motivation, personalizing intervention content, and having parents model desired behaviors. CONCLUSIONS: Key stakeholders are critical to the development of acceptable interventions that can be implemented effectively in real-world settings. Future work should test whether the identified themes contribute to increased feasibility, scalability, and effectiveness of sleep programs.

16.
Front Vet Sci ; 8: 692521, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34336979

RESUMO

Porcine proliferative enteropathy remains one of the most prevalent diseases in swine herds worldwide. This disease is caused by Lawsonia intracellularis, an intracellular bacterial pathogen that primarily colonizes the ileum. In this study, we evaluated changes to the microbiome of the ileal mucosa, ileal digesta, cecal digesta, and feces subsequent to challenge with L. intracellularis and to an oral live vaccine against L. intracellularis. Given that gut homogenates have been used since 1931 to study this disease, we also characterized the microbial composition of a gut homogenate from swine infected with L. intracellularis that was used as challenge material. The L. intracellularis challenge led to a dysbiosis of the microbiome of both the small and large intestine marked by an increase of pathobionts including Collinsella, Campylobacter, Chlamydia, and Fusobacterium. This microbiome response could play a role in favoring L. intracellularis colonization and disease as well as potentially predisposing to other diseases. Vaccination altered both small and large intestine microbiome community structure and led to a significant 3.03 log10 reduction in the amount of L. intracellularis shed by the challenged pigs. Vaccination also led to a significant decrease in the abundance of Collinsella, Fusobacterium, and Campylobacter among other microbial changes compared with non-vaccinated and challenged animals. These results indicate that L. intracellularis infection is associated with broad changes to microbiome composition in both the large and small intestine, many of which can be mitigated by vaccination.

17.
HERD ; : 19375867211032931, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34355608

RESUMO

AIM: To review the latest qualitative literature on how the physical hospital environment affects palliative patients and their families. BACKGROUND: People with a life-limiting illness may receive palliative care to improve their quality of life in hospital and may have multiple admissions as their illness progresses. Yet, despite a preference for a death at home, more than half of the dying population will receive end-of-life care in hospital. The physical hospital environment consists of ambiance, aesthetics, and architectural factors, and it is well known that the hospital's acute wards are not a homely environment. Demand is increasing for the physical environment to be improved to better meet the needs and demands of palliative and end-of-life patients and their families. METHOD: Combining thematic analysis and meta-ethnography methodologies, 12 international qualitative papers were analyzed and synthesized by the three authors. RESULTS: Findings resulted in the development of the SSAFeR Place approach that incorporates the concepts that are important to palliative and end-of-life patients and their families by describing an environment within the acute or palliative care units that feels safe, is private, customizable, and accommodates family; is a space to share with others, is homelike in ambiance and aesthetics, and is conducive for reflection. The concepts of identity, belonging, and safety are connected to the notions of home. CONCLUSIONS: To provide person-centered care and to move the focus toward the palliative approach of comfort and quality of life, attention to room size, layout, aesthetics, and ambiance is needed.

18.
JMIR Hum Factors ; 8(3): e25568, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34383665

RESUMO

BACKGROUND: e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. OBJECTIVE: This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. METHODS: We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. RESULTS: Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. CONCLUSIONS: Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.

19.
School Ment Health ; : 1-11, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34377215

RESUMO

Adolescents living in low-income areas often have high need for mental health supports due to experiences of poverty and trauma, coupled with limited access and availability of such supports. This study investigated the implementation of a socio-emotional learning curriculum titled, "Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A)," which was integrated into health classes in a low-income high school. While preliminary evidence suggests that DBT STEPS-A can be effective in reducing mental health symptoms in high school students, this study is the first to explore the program's acceptability, appropriateness, and feasibility when implemented in a low-income school. The implementation presented here also diverged from recommended training protocols due to time and cost limitations. Quantitative and qualitative data were collected from 29 school stakeholders prior to implementation and from 23 school stakeholders post-implementation. Our results indicate that DBT STEPS-A is acceptable and feasible for teachers involved in offering the program and that more work is needed to address appropriateness of the content for racially and socio-economically diverse students, ease of implementing lessons, and support for teachers using DBT STEPS-A skills outside of class. We conclude with a discussion of key implementation challenges and solutions generated.

20.
J Infect ; 83(4): 483-489, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34348116

RESUMO

OBJECTIVES: To measure secondary attack rates (SARs) in prospectively followed household contacts of paediatric and adult cases of SARS-CoV-2 infection in England. METHODS: Self-taken nasal swabs from household contacts of PCR confirmed cases of COVID-19  and blood samples  on day 35 were tested for evidence of infection with SARS-CoV-2 virus. RESULTS: The secondary attack rate (SAR) among 431 contacts of 172 symptomatic index cases  was 33% (95% confidence intervals [CI] 25-40) and was lower from primary cases without respiratory symptoms, 6% (CI 0-14) vs 37% (CI 29-45), p = 0.030. The SAR from index cases <11 years  was  25% (CI 12-38). SARs ranged from 16% (4-28) in contacts <11 years old to 36% (CI 28-45) in contacts aged 19-54 years (p = 0.119). The proportion infected who developed symptoms (78%) was similar by age (p = 0.44) though <19 year olds had fewer mean number of symptoms than adults (p = 0.001) and fewer reported loss of sense of taste or smell (p = 0.0001). CONCLUSIONS: There are high risks of  transmission of SARS-CoV-2 virus in the home, including those where infection is introduced by a child. The risk of children acquiring infection was lower than that in adults and fewer developed typical symptoms of Covid-19 infection.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Criança , Características da Família , Humanos , Incidência , Estudos Prospectivos
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