The influence of ambient noise on maternal behavior in a Bornean sun bear (Helarctos malayanus euryspilus).

Anthropogenic noise has become a pervasive feature of both marine and terrestrial habitats worldwide. While a comprehensive understanding of the biologically significant impacts of noise on wildlife is lacking, concerns regarding its influence persist. Noise is also a common feature in the zoological setting, and much can be learned regarding the species-typical response to ambient noise by studying animals in captivity. Here we correlate behavioral and vocal patterns in a Bornean sun bear (Helarctos malayanus euryspilus) mother and cub with ambient noise levels during the 6-month post-partum period. We hypothesized that loud ambient noise would be correlated with changes in behavior, and predicted that noise would be negatively correlated with maternal care behavior, potentially masking cub vocalizations or providing a distraction to the mother. Contrary to expectation, we found that the mother spent significantly more time attending to her cub (P=0.03) on loud days. We also found that she tended to spend less time feeding (P=0.08); however her time spent resting was not affected. The cub was approximately twice as vocal on loud days, although these results were not statistically significant (humming: P=0.10; squawks/cries: P=0.14). Taken together, these results suggest that the behavioral response to ambient noise may have potential energetic costs, and as a result efforts should be made to reduce ambient noise exposure during the post-partum period.

Randomized trial of therapeutic group by teleconference: African American women with breast cancer.

BACKGROUND: The effects of a therapeutic group by teleconference for African American women with breast cancer have not been documented, although the benefits of therapeutic groups for European women are well established. African American women with breast cancer may experience social disconnection, a sense of being cut off from partners, family, and friends because of side effects of treatment and fatalistic beliefs about cancer. A therapeutic group by teleconference may counteract these problems and improve social connection. METHODS: A randomized trial design stratified by treatment type was used. Data were collected at baseline, at the end of the intervention, and 16 weeks from baseline. Repeated-measures, fixed-factor analyses of covariance were used for each outcome. The between-subject factors were group and replicate set, and the within-subject factor was time. Physical well being and educational level differed significantly between the 2 groups at baseline and were used as covariates. RESULTS: The mixed-model analysis of the outcome variables revealed significant changes over time for knowledge (P ≤ .001), with higher scores on knowledge observed for the control group. Group-by-time interactions were observed for fatalism (P = .0276), fear (P = .0163), and social connection (P = .0174) as measured by the Social Well Being subscale from the Functional Assessment of Cancer Treatment-Breast Cancer Version. No group-by-time interaction was observed for social connection as measured by the Social Support Questionnaire. Social connection measured with the Social Well Being subscale improved significantly in the intervention group, whereas fatalism and fear significantly decreased. CONCLUSIONS: In this study, the authors documented the benefits of a therapeutic group by teleconference, a novel way to provide support for African American women with breast cancer. Further research should include a behavioral outcome, such as treatment adherence.

Delivering Care to High-Cost High-Need Patients: Lessons Learned in the Development of a Complex Care Primary Care Team.

As part of a population health-focused primary care transformation, in 2019 a health system in Minnesota developed a primary care team to exclusively care for high-cost high-need patients. Through its development and implementation, the team has discovered several key lessons in delivering care to complex patients. These lessons include the benefits of more integrative team-based care, the need and advantages of designated complex care team members, the importance of teamwork both within and outside of the complex care team, the need for frequent communication, and the importance of identifying mental health needs. In addition, there are several areas that require ongoing research and exploration, such as determining when a patient is able to graduate out of the program, how to enhance access to the complex care team, determining appropriate visit characteristics, and model feasibility. While addressing the needs of high cost high need patients is essential to improving quality of care and decreasing health care costs, there are several unique challenges and opportunities that come with caring for this patient population. Although this highly integrated model of care continues to evolve, the initial lessons learned may inform other health systems and care teams undertaking the care of complex patients.

Successful subject recruitment for a prostate cancer behavioral intervention trial.

BACKGROUND: Inadequate participant recruitment, which may lead to unrepresentative study samples that threaten a study's validity, is often a major challenge in the conduct of research studies. PURPOSE: The purpose of this article is to describe the development and implementation of a recruitment plan and evaluate the different recruitment strategies for a prostate cancer behavioral intervention trial. METHODS: Our recruitment plan was based on a framework (The Heiney-Adams Recruitment Model) that we developed, which combines relationship building and social marketing. We evaluated the success of our model using several different recruitment sources including: mailed letters, physician referral, and self-referral. RESULTS: Recruitment rates ranged from 67% for a support services department mailing to 100% for physician referral. While our original list of contacted patients was comprised of only 13% African American (AA) men, 22% of our recruited participants were AA. LIMITATIONS: One of the strongest barriers to recruitment was strict patient eligibility. Another significant barrier was the lack of electronic records systems to allow for the identification of large numbers of potential participants. CONCLUSIONS: In conclusion, our model incorporating social marketing and relationship building was quite successful in recruiting for a prostate cancer behavioral study, particularly AA participants. In developing strategies, future researchers should attend to issues of staffing, financial resources, physician support, and eligibility criteria in the light of study accrual.

Integrating Local Knowledge into a National Programme: Evidence from a Community-Based Diabetes Prevention Education Programme.

Type 2 diabetes prevention is a major priority for healthcare services and public health. This study aimed to evaluate how a local authority in England piloted a diabetes prevention programme. The South Gloucestershire Diabetes Prevention (Pilot) Programme (SGDPP) comprised a group health education course over six weeks with subsequent support provision up to six months post-enrolment. Of the 300 patients invited onto the programme, 32% enrolled and 29% completed the full six-month programme. There was an attendance rate of 84% throughout group sessions and at a six-month follow-up. There were significant improvements across most measures at six months, including a 4 kg mean weight loss and a 3.45 mmol/mol mean HbA1c reduction. Clear goals, high quality organization and personal qualities of educators were identified as central for the programme's success. The unit costs were similar to pilots of other healthy lifestyle programmes. The evaluation found evidence of reduced type 2 diabetes risk markers, positive impacts for dietary and physical activity, and potential cost-effectiveness for this format of group-based diabetes prevention intervention. Feedback from multiple stakeholders provided insight on how to successfully embed and scale-up delivery of diabetes prevention work. This evidence enables the integration of learning in local service delivery and provides a basis to support development of the national diabetes prevention programme.

Efficacy of therapeutic group by telephone for women with breast cancer.

A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. ttests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.

Preparing children to be bone marrow donors.

PURPOSE/OBJECTIVES: To review literature regarding children as bone marrow donors and describe the evaluation of an individualized intervention to support children who will be donors for parents or siblings. DATA SOURCE: Research studies, abstracts, and clinical reports describing interventions or psychosocial issues related to child donors, parent interviews, and clinical experiences. DATA SYNTHESIS: Child marrow donors and caregivers benefit from interventions that illuminate the process and provide psychosocial support. Use of a teaching book enhances intervention and provides a tool for parents to use after transplantation. CONCLUSIONS: Psychosocial distress in child marrow donors and parents can be minimized through education and therapeutic interventions. Research is needed to validate the efficacy of interventions and determine whether psychosocial complications are decreased. IMPLICATIONS FOR NURSING: Child donors, especially those for parents, should receive support and attention for their unique psychosocial needs.