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1.
Cells ; 9(2)2020 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-32024251

RESUMO

Micronuclei are small, extranuclear bodies that are distinct from the primary cell nucleus. Micronucleus formation is an aberrant event that suggests a history of genotoxic stress or chromosome mis-segregation events. Accordingly, assays evaluating micronucleus formation serve as useful tools within the fields of toxicology and oncology. Here, we describe a novel micronucleus formation assay that utilizes a high-throughput imaging platform and automated image analysis software for accurate detection and rapid quantification of micronuclei at the single cell level. We show that our image analysis parameters are capable of identifying dose-dependent increases in micronucleus formation within three distinct cell lines following treatment with two established genotoxic agents, etoposide or bleomycin. We further show that this assay detects micronuclei induced through silencing of the established chromosome instability gene, SMC1A. Thus, the micronucleus formation assay described here is a versatile and efficient alternative to more laborious cytological approaches, and greatly increases throughput, which will be particularly beneficial for large-scale chemical or genetic screens.

2.
J Intensive Care Med ; : 885066619899653, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31950870

RESUMO

INTRODUCTION: Cancer is associated with significant health-care expenditure, but few studies have examined the cost of patients with cancer in the intensive care unit (ICU). We aimed to describe the costs and outcomes of patients admitted to the ICU with cancer. METHODS: We conducted a retrospective cohort study of patients admitted between 2011 and 2016 to 2 tertiary-care ICUs. We included patients with a cancer-related most responsible diagnosis using International Classification of Disease, 10th Revision, Canada codes. We compared costs and outcomes of patients having cancer with noncancer controls matched for age, sex, and Elixhauser comorbidity score. We used logistic regression to determine predictors of mortality among patients with cancer. RESULTS: There were 1022 patients with cancer during the study period. Mean age was 63.2 years and 577 (56.5%) were male. Inhospital mortality for all patients with cancer was 24.0%. Total cost per patient was higher for patients with cancer compared to noncancer patients (CAD$57 084 vs CAD$40 730; P < .001) but there were no differences in the cost per day (CAD$2868 vs CAD$2887; P = .76) or ICU cost (CAD$30 495 vs CAD$29 382; P = .42). Among patients with cancer, the cost per day was higher for nonsurvivors (CAD$3477 vs CAD$2677; P < .001). Liver disease (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.22-7.81), mechanical ventilation (OR: 1.73; 95% CI: 1.25-2.39), hematologic malignancy (OR: 3.88; 95% CI: 2.31-6.54), and unknown primary site (OR: 2.13; 95% CI: 1.36-3.35) were independently associated with mortality in patients with cancer. CONCLUSION: Patients admitted to the ICU with cancer did not differ in cost per day, ICU cost, or mortality compared to matched noncancer controls. Among patients with cancer, nonsurvivors had significantly higher cost per day compared to survivors. Hematologic and unknown primaries, liver disease, and mechanical ventilation were independently associated with mortality in patients with cancer.

3.
Ann Behav Med ; 54(1): 49-60, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31116365

RESUMO

BACKGROUND: Expressing emotions effectively is central to social functioning and has links to health and cardiovascular disease (CVD) risk. Previous work has linked the ability to smile to lower CVD risk in men but has not studied other expressions or considered the context of these skills. PURPOSE: To test whether the ability to express fear, anger, sadness, happiness, and disgust cross-sectionally predict CVD risk in both genders and whether links are moderated by the ability to decode others' emotional signals. METHODS: A community sample of 125 men and women (30-75 years) provided trait emotion data before a laboratory visit where blood was drawn and performance-based assessments of the ability to signal and decode emotions were administered. Expressive accuracy was scored using FaceReader software. Projected CVD risk was calculated using Framingham, a New Zealand (NZ) specific, and Atherosclerosis CVD (ASCVD) risk algorithms. RESULTS: Accuracy expressing happiness predicted lower projected risk, whereas greater accuracy expressing fear and sadness predicted higher risk. Gender frequently moderated these links; greater accuracy expressing happiness predicted lower risk in men but not women. Conversely, greater accuracy expressing fear predicted higher risk in men, whereas greater accuracy expressing sadness predicted lower risk in women but, again, higher risk in men. The ability to accurately decode others' emotions moderated some links. CONCLUSIONS: The ability to signal emotion has complex links to health parameters. The ability to flexibly regulate expressions in accordance with gender norms may be one useful way of thinking about adaptive expressive regulation.

4.
Disabil Rehabil ; : 1-13, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847621

RESUMO

Purpose: To investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions.Methods: In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement - Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers.Results: Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration.Conclusions: Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing - it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements - positive expectations and positive affect - to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement.Implications for rehabilitationEngagement, and its various elements, plays a central role in shaping how clients, parents, and clinicians value therapeutic encounters.Optimal therapy is often thought to include engagement, relationships, and collaboration; the importance of therapy expectations, positive affect, and perceptions of progress are frequently overlooked.Engagement and motivation may be maximized when youth and caregivers are asked explicitly about how they view their engagement in therapy.In addition to clarifying and aligning expectations with youth and caregivers, service providers can enhance engagement and motivation by intentionally creating enjoyable and meaningful interactions, developing relationships, negotiating consensus on goals and plans, and demonstrating therapy progress.Service providers can harness engagement and the system of related constructs by listening and communicating effectively, by entering the world of the client and family, and by being aware of, anticipating, and responding to engagement and disengagement.

5.
Transgend Health ; 4(1): 316-325, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31701013

RESUMO

Purpose: Gender-diverse individuals in India face considerable discrimination, stigma, and violence. There is a dearth of published literature describing experiences of violence among this population and potential links to mental health. Methods: A questionnaire was administered to 282 study participants, 18 years of age and older, who self-identified as hijra, kothi, double decker, or bisexual and were actively enrolled in a local HIV prevention program in Bangalore, India in 2012. Responses were used to calculate a composite depression/anxiety score. Associations between sociodemographic characteristics and experiences of physical and sexual violence in the previous six months were tested and differences in depression/anxiety score based on experiences of violence were explored. Results: Recent physical violence was common among study participants and was reported among 46% of nirvan (emasculated) hijras (transgender), 42% of akwa (not emasculated) hijras, and 25% of kothis (feminine acting males). Rape in the previous year was particularly common among akwa hijras (39%). Factors associated with being raped included younger age, less education, and employment in basti (blessings), sex work, chela (disciple of hijra guru), or at a community-based organization. Kothis had the highest depression/anxiety score. No significant difference in depression/anxiety score based on recent history of physical violence or rape was found. Conclusions: Physical violence and poor mental health are common among gender-diverse individuals in Bangalore, Karnataka. There is a need for services that cater to the unique mental health needs of gender-diverse individuals in India, following rights-based approaches that address the underlying roots of oppression they encounter.

6.
Ecol Evol ; 9(12): 7030-7046, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31380031

RESUMO

With increasing human activities and associated landscape changes, distributions of terrestrial mammals become fragmented. These changes in distribution are often associated with reduced population sizes and loss of genetic connectivity and diversity (i.e., genetic erosion) which may further diminish a species' ability to respond to changing environmental conditions and lead to local population extinctions. We studied threatened boreal caribou (Rangifer tarandus caribou) populations across their distribution in Ontario/Manitoba (Canada) to assess changes in genetic diversity and connectivity in areas of high and low anthropogenic activity. Using data from >1,000 caribou and nine microsatellite loci, we assessed population genetic structure, genetic diversity, and recent migration rates using a combination of network and population genetic analyses. We used Bayesian clustering analyses to identify population genetic structure and explored spatial and temporal variation in those patterns by assembling networks based on R ST and F ST as historical and contemporary genetic edge distances, respectively. The Bayesian clustering analyses identified broad-scale patterns of genetic structure and closely aligned with the R ST network. The F ST network revealed substantial contemporary genetic differentiation, particularly in areas presenting contemporary anthropogenic disturbances and habitat fragmentation. In general, relatively lower genetic diversity and greater genetic differentiation were detected along the southern range limit, differing from areas in the northern parts of the distribution. Moreover, estimation of migration rates suggested a northward movement of animals away from the southern range limit. The patterns of genetic erosion revealed in our study suggest ongoing range retraction of boreal caribou in central Canada.

7.
Am J Occup Ther ; 73(1): 7301205040p1-7301205040p11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30839259

RESUMO

OBJECTIVE: We explored the potential impact of mindfulness-based yoga (MBY) for youth with persistent concussion by examining occupation-based and neurophysiological outcomes. METHOD: In this case series design study, 6 youths ages 13-17 yr with concussion symptoms for >4 wk participated in an 8-wk MBY intervention, 1×/wk for 45 min. Participation, self-efficacy, and heart rate variability (24 hr) were collected before, after, and 3 mo after the intervention. Heart rate variability was also measured during each session. RESULTS: Trends of increased self-efficacy in academic, social, and emotional domains were found after MBY and maintained at 3-mo follow-up. Trends of increasing heart rate variability were also found pre- to postintervention and within the eight MBY sessions. CONCLUSION: Preliminary results reveal positive trends after a novel, safe intervention for youth with persistent concussion symptoms and the value of exploring both occupation-based and neurophysiological measures. Future research with a larger sample and control group is warranted.


Assuntos
Concussão Encefálica/terapia , Atenção Plena , Ioga , Adolescente , Emoções , Humanos , Projetos Piloto , Resultado do Tratamento
8.
Microbiol Insights ; 12: 1178636119827975, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30833813

RESUMO

Objectives: The purpose of this study was to describe and explore potential driving factors of trends in reported chlamydia infections over time in Manitoba, Canada. Methods: Surveillance and laboratory testing data from Manitoba Health, Seniors and Active Living were analysed using SAS v9.4. Kaplan-Meier plots of time from the first to second chlamydia infection were constructed, and Cox proportional hazards regression was used to estimate the risk of second repeat chlamydia infections in males and females. Results: Overall, the number of reported infections found mirrored the number of tests conducted. From 2008 to 2014, the number of first infections found among females decreased as the number of first tests conducted among females also decreased. Between 2008 and 2012, the number of repeat tests among females increased and was accompanied by an increase in the number of repeat positive results from 2009 to 2013. From 2008 to 2016, the number of repeat tests and repeat positive results increased steadily among males. Conclusions: Chlamydia infection rates consistently included a subset composed of repeat infections. The number of cases identified appears to mirror testing volumes, drawing into question incidence calculations that do not include testing volumes. Summary Box: 1) What is the current understanding of this subject? Chlamydia incidence is high in Manitoba, particularly among young women and in northern Manitoba.2) What does this report add to the literature? This report suggests that incidence calculated using case-based surveillance data alone does not provide an accurate estimate of chlamydia incidence in Manitoba and is heavily influenced by testing patterns.3) What are the implications for public health practice? In general, improving testing rates in clinical practices as well as through the provision of rapid services in non-clinical venues could result in higher screening and treatment rates. In turn, this could lead to a better understanding of true disease occurrence.

9.
Prev Med Rep ; 14: 100825, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30828539

RESUMO

The availability of near real-time data from Crisis Text Line (CTL) and other technology-based platforms on crisis events provides an opportunity for targeted interventions prior to serious mental health outcomes (e.g., suicide, self-harm). This study examined the association between the release of the popular Netflix series 13 Reasons Why (13RW) and CTL usage in a national sample of youth in the US. We implemented interrupted time-series, autoregressive integrated moving average (ARIMA) modeling to examine this association at a daily scale. We observed a significant but momentary rise in CTL conversation volume following the release of 13RW on April 5 and 6, 2017 followed by a significant reduction (12.7%) in conversation volume for the overall study period. This reduction in call volume was sustained for 49 days and is the most sustained reduction in conversation volume in the 365 day dataset. This unexpected trough in conversation volume is concerning in light of elevated search engine volume for terms indicating an increase in suicidal thoughts in the days following the release of the show (Ayers et al., 2017). CTL was featured by the show as a resource for viewers in the recently released Season 2, and our results highlight the reasoning and need for such promotion. Future work should explore whether the promotion of CTL in Season 2 positively impacted conversation volume, as there is a clear need to harness the power of these digital technologies to detect population-based trends in mental health and expand the reach of life saving services.

10.
Qual Health Res ; 29(8): 1213-1226, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30741102

RESUMO

Interactionally, the workplace may be dilemmatic for a person with "invisible" chronic illness. Risks of stigmatization exist if they disclose their condition to colleagues. Meanwhile, not disclosing threatens well-being and entitlements. Using Bakhtin's dialogism as a theoretical framework, we explored these social aspects of illness: inductively analyzing narratives from 20 participants with multiple sclerosis (MS). Capitalizing on concepts from dialogical and conversation analysis, links between (in)visibility, knowledge, and belief were examined with respect to symptoms and co-worker judgment. Perceived medical legitimacy creates a core social dilemma. At the intersection of genre and action, participants systematically used parody to subvert the traditional workplace hierarchy. "Oh-prefaced" direct reported speech (OPDRS) was deployed to exaggerate workplace interactions, undermining managers/colleagues who misattributed (in)visible symptoms. Parodic OPDRS index emotive interactional dilemmas. As subversions of organizational power, OPDRS denote those very areas where employees feel disempowered. Sensitivity to OPDRS can provide diagnostic support and complement evaluation frameworks.


Assuntos
Doença Crônica/psicologia , Local de Trabalho/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Pesquisa Qualitativa , Estereotipagem , Reino Unido
11.
Psychol Health ; 34(6): 695-714, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30693807

RESUMO

OBJECTIVE: Our aim is to understand how to facilitate the job retention of employees with chronic illness. We focus on multiple sclerosis (MS) as a criterion chronic illness. DESIGN: An opportunity sample of 20 individuals of working age (13 female; 7 male) were recruited who had been in paid employment for over 28 months with a concurrent diagnosis of MS. Participants took part in one of three focus groups with a topic guide comprising keywords: work, coping, performance, support, future, expectations, sharing and symptoms. Data were analysed using dialogical analysis. MAIN OUTCOME MEASURES: As a qualitative study, no outcome measure was used. However, the specific focus of interest was to search for differential patterns of 'timespace' - chronotope - that people with chronic illness utilise to manage their condition in the workplace. RESULTS: Participants oriented to two distinct chronotope types: unsustainable epic (characterised by condensed time) and temporary idyll (characterized by condensed space). Perceived managerial discretion was identified as possibly influencing participants' chronotope preference. CONCLUSION: Identifying chronotope preference has practical implications for health psychologists and related professionals who provide and advise on support to facilitate people with chronic illness to thrive in the workplace.


Assuntos
Doença Crônica/psicologia , Fenômenos Cronobiológicos , Esclerose Múltipla/psicologia , Local de Trabalho/organização & administração , Adaptação Psicológica , Adulto , Emprego/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
12.
Int Psychogeriatr ; 31(3): 417-424, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29991360

RESUMO

ABSTRACTBackground:The current research sought to characterize current mood state profiles in healthy young versus older adults using 100-point visual analogue mood scales (VAMS), provide within-sample and new sample replication of age-group differences, assess sex differences, and compare with commonly used standardized symptom measures. METHODS: In two studies, six word-only VAMS (happy, sad, calm, tense, energetic, and sleepy) were administered in a laboratory setting. In Study 1, 22 young and 29 older males completed the VAMS six times (twice per day at weekly intervals). In Study 2, 60 young (30 males) and 60 older (30 males) adults completed on one occasion the VAMS, Beck Depression Inventory-II, State-Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index. RESULTS: VAMS scores showed that older adults had a tendency to indicate feeling happier, less sad, calmer, less tense, more energetic, and less sleepy than young adults. This pattern occurred across assessment points and irrespective of sex, except for the tense VAMS, which showed higher scores in females than males in young but not older adults. The standardized measures showed significant age-group differences for Trait Anxiety only (lower in older than young adults). CONCLUSIONS: These findings establish current mood state differences in young versus older adults. The absence of age-group differences in past studies may relate to the limited precision of the scales (only 7 points, in contrast to the 100-point scales used here).


Assuntos
Sintomas Afetivos/diagnóstico , Envelhecimento , Transtornos do Humor/diagnóstico , Afeto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Testes Psicológicos , Escala Visual Analógica , Adulto Jovem
13.
Disabil Rehabil ; 41(1): 86-97, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28891331

RESUMO

PURPOSE: The Pediatric Rehabilitation Intervention Measure of Engagement-Observation (PRIME-O) version was designed to capture signs of affective, cognitive and behavioral involvement for clients and service providers and in the client-provider interaction. METHODS: Phase 1 examined interrater consensus and construct validity of a pilot version, using observer ratings of engagement indicators made while viewing videos of therapy sessions differing in high and low engagement (Sample 1). Phase 2 examined these properties in a 10-item version (Samples 2 and 3). Phase 3 examined the content validity of the 10-item version, using observed signs of child, youth and parent engagement, as reported in an interview study involving 10 service providers. RESULTS: There was excellent interrater consensus for both versions and ratings significantly discriminated between videos differing in high and low engagement, providing evidence for construct validity. Content validity was demonstrated by service provider reports of engagement signs. More behavioral signs were reported for children and more cognitive signs were reported for youth and parents, providing evidence for the developmental appropriateness of the PRIME-O. CONCLUSIONS: The PRIME-O provides a multifaceted view of affective, cognitive and behavioral components of engagement in pediatric rehabilitation. The PRIME-O has potential utility for research, clinical practice and continuing education. Implications for Rehabilitation Measures of engagement in therapy are needed to identify factors associated with successful therapy sessions and positive client outcomes. The PRIME-O is an observational measure that captures indicators of affective, cognitive and behavioral components of engagement for both clients and service providers. The PRIME-O may further help in understanding of the strategies service providers can use to facilitate an optimal state of engagement within a therapy session. Clinical practice may be enhanced by attending to the client's signals of engagement in therapy. The PRIME-O can help service providers to more accurately identify signs of engagement and disengagement, monitor their own success in creating an engaging intervention atmosphere, and instigate strategies to optimize engagement.


Assuntos
Técnicas de Observação do Comportamento/métodos , Assistência à Saúde , Participação do Paciente/métodos , Pediatria/métodos , Adolescente , Comportamento do Adolescente , Criança , Comportamento Infantil , Assistência à Saúde/métodos , Assistência à Saúde/normas , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Resultado do Tratamento , Gravação em Vídeo/métodos
14.
Disabil Rehabil ; : 1-10, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30426782

RESUMO

PURPOSE: Children's resiliency is seen as important in pediatric rehabilitation, but is seldom the focus of research or intervention. This article presents a resiliency framework to inform pediatric rehabilitation research, service design, and practice. METHODS: The development of the framework was guided by a transactional, life course perspective, and a review of self-constructs in the resiliency literature. RESULTS: The framework comprises health-related adversities, self-capacities, self-regulatory processes, and adaptive benefits. Four adaptive self-capacities are highlighted (activity self-efficacy, capacity to marshal resources and supports to achieve goals, capacity to adapt to changing life situations, and capacity to envision a positive future). These self-capacities are linked to common adversities experienced by children with disabilities, namely activity limitations, functioning and participation restrictions, transition issues, and anticipated future life challenges. The self-capacities are also associated with empowered, optimistic, adaptive, and hopeful mindsets, which influence accommodative and assimilative self-regulatory strategies affecting children's adaptive benefits. CONCLUSIONS: The framework can inform resiliency-related research exploring self-capacities and resiliency processes. The framework points to what is modifiable through intervention targeting the person-in-context, namely self-capacities, mindsets, and situated experiences. Implications for service design and delivery include providing opportunities and interacting with clients in ways that support the development of these self-capacities. Implications for rehabilitation Fostering resiliency means preparing children with disabilities to negotiate and navigate the adversities and challenges they will encounter over their lives. Important resiliency-related self-capacities include activity self-efficacy, capacity to marshal resources and supports to achieve goals, capacity to adapt to changing life situations, and capacity to envision a positive future. The resiliency framework suggests the importance of enhancing children's views of themselves as empowered, optimistic, adaptive, and hopeful. Practice will be enriched by acknowledging that a range of health concerns are relevant to practice, including issues of impairment, functioning, participation, and adaptation.

15.
Front Psychol ; 9: 1597, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30275817

RESUMO

[This corrects the article DOI: 10.3389/fpsyg.2017.00119.].

16.
Soc Sci Med ; 215: 69-79, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30216891

RESUMO

Nearly 3 out of 4 all lifelong mental disorders occur by the age of twenty-four. Remote crisis support holds great potential in filling a critical gap in complementing and expanding access to mental health services for acute episodes of mental distress in adolescents and young adults; yet little is understood about the individual factors that influence help-seeking behavior in this group. Recent evidence suggests technology-based mental health services have high acceptability among youth and may be used to treat anxiety and depression. The objective of this study was to examine county-level help-seeking behavior among adolescents and young adults using Crisis Text Line (CTL). CTL is a free, text-based crisis counseling service that has been available nationally since 2013. Spatial error regression was used to (1) identify the individual-level factors that correlate with help-seeking behavior for depression, anxiety, and suicidal thoughts and (2) to explore the geographic trends in text-based help-seeking behavior between adolescents and young adults across the rural-urban continuum. Increased rates of text-based help-seeking occurred in counties with higher mean household incomes, higher divorce rates, and lower residential stability. Rurality was the strongest predictor for low rates of help-seeking, and this finding is particularly concerning in light of elevated rates of suicide among rural counties. Rural communities, particularly those with low support-seeking behavior and comparatively high suicide rates, should be the target of future research and outreach.


Assuntos
Comportamento do Adolescente/psicologia , Mapeamento Geográfico , Comportamento de Busca de Ajuda , Transtornos Mentais/psicologia , Adolescente , Feminino , Linhas Diretas/métodos , Linhas Diretas/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/provisão & distribução , Suicídio/estatística & dados numéricos , Suicídio/tendências , Mensagem de Texto
17.
Artigo em Inglês | MEDLINE | ID: mdl-29872450

RESUMO

Background: Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health. Discussion: To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States. Conclusion: In this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science.

18.
Geospat Health ; 13(1): 629, 2018 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-29772877

RESUMO

Few studies have evaluated the benefits of reporting back participatory environmental monitoring results, particularly regarding participant motivation toward behavioural modification concerning workplace heat exposure. This study evaluated the individual data report-back for geo-located environmental temperature and time activity patterns in grounds maintenance crews in three geographic regions across the South-eastern United States. Surveys collected information on worker interpretation of their results and intended action(s) to reduce heat exposure. Worker response was highly positive, especially among more experienced workers who expressed a greater willingness to modify personal behaviour to reduce heat stress. Individual-level report-back of environmental data is a powerful tool for individuals to understand and act on their personal exposure to heat.


Assuntos
Participação da Comunidade , Exposição Ambiental/efeitos adversos , Monitoramento Ambiental/métodos , Temperatura Alta , Exposição Ocupacional , Humanos , Sudeste dos Estados Unidos
19.
Health Commun ; 33(11): 1377-1388, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-28872891

RESUMO

This study investigates patient resistance to doctors' treatment recommendations in a cross-national comparison of primary care. Through this lens, we explore English and American patients' enacted priorities, expectations, and assumptions about treating routine illnesses with prescription versus over-the-counter medications. We perform a detailed analysis of 304 (American) and 393 (English) naturally occurring treatment discussions and conclude that American and English patients tend to use treatment resistance in different prescribing contexts to pursue different ends. While American patients are most likely to resist recommendations for non-prescription treatment and display an expectation for prescription treatment in these interactions, English patients show a high level of resistance to recommendations for all types of treatment and display an expectation of cautious prescribing. These behavioral trends reflect broader structural forces unique to each national context and ultimately maintain distinct cultural norms of good-practice prescribing.


Assuntos
Comparação Transcultural , Cooperação do Paciente/psicologia , Relações Médico-Paciente , Padrões de Prática Médica , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Medicamentos sob Prescrição/administração & dosagem , Atenção Primária à Saúde , Reino Unido , Estados Unidos
20.
Health Commun ; 33(11): 1335-1344, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-28816510

RESUMO

From the earliest studies of doctor-patient interaction (Byrne & Long, 1976), it has been recognized that treatment recommendations may be expressed in more or less authoritative ways, based on their design and delivery. There are clear differences between I'm going to start you on X and We can give you X to try and Would you like me to give you X? Yet little is known about this variation, its contexts, or its consequences. In this paper, we develop a basic taxonomy of treatment recommendations in primary care as a first step toward a more comprehensive investigation. We take as our point of departure the observation that treatment recommendations such as those above represent not only different formulations but also different social actions. We distinguish five main treatment recommendation actions: pronouncements, suggestions, proposals, offers, and assertions. We ask: what are the main dimensions on which these recommendations vary and to what end? And what sorts of factors shape a clinician's use of one action type over another with respect to recommending a medication in the primary care context?


Assuntos
Atitude do Pessoal de Saúde , Comportamento de Escolha , Tomada de Decisões , Preferência do Paciente/psicologia , Padrões de Prática Médica , Humanos , Atenção Primária à Saúde , Gravação em Vídeo
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