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ABSTRACT: Gatekeepers play a pivotal role in protecting individuals under their care and are central to keeping people safe and away from harm. In the field of nonsuicidal self-injury (NSSI), a range of gatekeepers exist, including those who protect access to vulnerable research participants, those who protect school children, those charged with making decisions about funding priorities, and those in charge of clinical care for people who self-injure. The aim of this commentary is to outline the roles these different gatekeepers have in protecting access to research participants, access to NSSI knowledge, and access to clinical care for individuals who self-injure. We provide examples in which gatekeepers may present barriers and offer solutions for how to work with gatekeepers for mutual benefit.
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Comportamento Autodestrutivo , Criança , Humanos , Tomada de DecisõesRESUMO
BACKGROUND: We aimed to identify profiles of ambivalence among individuals with a history of non-suicidal self-injury (NSSI) and tested whether profiles differed across various theoretically informed constructs: NSSI-related characteristics, cognitive (outcome expectancies, self-efficacy to resist NSSI), emotional (psychological distress, difficulties in emotion regulation), personality, and incentives to engage/not engage in NSSI. METHODS: Individuals with a lifetime history of NSSI (n = 224) reported the extent to which they wanted to and did not want to engage in NSSI and completed well-validated measures of the constructs of interest. RESULTS: Latent profile analysis indicated four ambivalence profiles (avoid: n = 39; moderately ambivalent: n = 85; highly ambivalent: n = 30; approach: n = 70). The profiles differed across a number of NSSI-related characteristics, cognitive, emotional, and incentive-related variables. Differences between the ambivalence profiles and the avoid/approach profiles varied across constructs. For example, the ambivalence and approach profiles were similar for NSSI-related outcome expectancies, but the ambivalence and avoidance profiles were similar for self-efficacy to resist NSSI. CONCLUSION: Findings highlight variation between the desire to engage or not engage in NSSI that are consistent with the notion of ambivalence. Understanding these differences may allow for a more person-centered approach in treatment for NSSI.
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Regulação Emocional , Comportamento Autodestrutivo , Humanos , Emoções , Comportamento Autodestrutivo/psicologia , Afeto , PersonalidadeRESUMO
OBJECTIVE: This study examined the overlap between considering oneself to have stopped nonsuicidal self-injury (NSSI) and the actual cessation of the behavior in terms of days self-injured in the last month and last year, and how these operationalizations are associated with constructs related to NSSI recovery. METHODS: A cross-sectional survey including measures of coping, emotion dysregulation, psychological distress, general self-efficacy, and self-efficacy in resisting NSSI was answered by 144 adults aged 17-81 years (Mage [SD] = 21.43 [7.32]). RESULTS: Having self-injured for ≥5 days in the last year was overly inclusive of individuals who currently considered themselves as having stopped NSSI (39.02%). Considering oneself to have stopped NSSI was associated with better emotion regulation (Cohen's d = 0.45), and higher general self-efficacy and higher self-efficacy to resist NSSI (d = 0.59-0.64) than behavioral cessation. Not actually engaging in NSSI was only associated with self-efficacy to resist NSSI in risk contexts, such that fewer days self-injured in the last year increased confidence (partial η2 = 0.085). CONCLUSION: Accounting for whether an individual considers themselves as having stopped NSSI or not may complement estimates of behavioral cessation, and strengthen outcomes associated with NSSI recovery.
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Comportamento Autodestrutivo , Adulto , Humanos , Estudos Transversais , Comportamento Autodestrutivo/psicologia , Adaptação Psicológica , Saúde Mental , AutoeficáciaRESUMO
BACKGROUND: Due to cognitive and emotional differences between individuals who have and have not stopped self-injuring, we explored these in the context of desire to stop. METHOD: Australian university students (n = 374) completed cognitive and emotional measures. Comparisons were made between those who had self-injured in the past 12 months and those who had not, and between individuals who reported wanting to stop self-injuring and those who did not. RESULTS: Approximately 20% of participants did not want to stop self-injuring. Cognitive emotional factors (psychological distress, self-efficacy to resist, difficulties regulating emotion, interpersonal functions, and outcome expectancies) differentiated individuals who had and had not stopped, but could not explain differences in desire to stop. CONCLUSION: Factors associated with desire to stop are not the same as factors underlying behavioural cessation. Motivational approaches to changes in self-injurious behaviour would be beneficial for clinicians and their clients.
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Comportamento Autodestrutivo , Austrália , Cognição , Emoções , Humanos , Autoeficácia , Comportamento Autodestrutivo/psicologiaRESUMO
We have recently constructed tables of the estimated life expectancies of impaired lives on the basis of mortality ratios and the cohort life expectancy tables given in the 8th edition of the Ogden Tables, which are derived from the ONS 2018-based population projections for the United Kingdom.1,2 The life expectancy of impaired lives may also be estimated using excess death rates. In this paper, we give tables of life expectancies for impaired lives using a range of excess death rates for males and females from age 0 to age 100. As both mortality ratios and excess death rates are widely used in medical and legal settings, it is hoped that these additional tables of life expectancies will be of practical value.
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Expectativa de Vida , Projeção , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Tábuas de Vida , Masculino , Mortalidade , Reino Unido/epidemiologiaRESUMO
Projections of life expectancy are widely used in medicine, actuarial practice, and in the medicolegal and insurance fields. For individuals considered to have average future survival, nationally-derived life expectancy tables are available, referred to as the Ogden Tables. In the United Kingdom, updated tables (the 8th edition) were published in July 2020. We have calculated impaired projected life expectancies for the United Kingdom based on age and gender, derived from the 8th edition of the Ogden Tables together with various assumed lifelong mortality ratios.
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Expectativa de Vida , Mortalidade , Previsões , Humanos , Tábuas de Vida , Reino Unido/epidemiologia , Estados UnidosRESUMO
INTRODUCTION: Orthotopic liver transplantation (OLT) can be associated with significant bleeding requiring multiple blood product transfusions. Rotational thromboelastometry (ROTEM) is a point-of-care device that has been used to monitor coagulation during OLT. Whether it reduces blood loss/transfusions during OLT remains controversial. MATERIALS AND METHODS: We aim to compare ROTEM with conventional coagulation tests (aPTT, PT, INR, platelet count, fibrinogen) to guide transfusion of platelets, cryoprecipitate, and fresh frozen plasma (FFP) during OLT over 3 years. Thirty-four patients who had transfusions guided by ROTEM were compared to 34 controls who received transfusions guided by conventional coagulation tests (CCT). Intraoperative blood loss, type/ amount of blood products transfused, and direct costs were compared between the two groups. RESULTS: The ROTEM group had significantly less intra-operative blood loss (2.0 vs. 3.0 L, p = 0.04) and fresh frozen plasma (FFP) transfusion (4 units vs. 6.5 units, p = 0.015) compared to the CCT group (2.0L vs. 3.0L, p = 0.04). However, total number of patients transfused cryoprecipitate was increased in ROTEM (n = 25;73%) as compared to CCT (n = 19; 56%), p = 0.033. The direct cost of blood products plus testing was reduced in the ROTEM group ($113,142.89 vs. $127,814.77). CONCLUSION: In conclusion implementation of a ROTEM-guided transfusion algorithm resulted in a reduction in intra-operative blood loss, FFP transfusion and a decrease in direct cost during OLT. ROTEM is a useful and safe point of care device in OLT setting.
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Testes de Coagulação Sanguínea/economia , Coagulação Sanguínea , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/economia , Custos Hospitalares , Transplante de Fígado/economia , Monitorização Intraoperatória/economia , Tromboelastografia/economia , Algoritmos , Análise Custo-Benefício , Procedimentos Clínicos/economia , Feminino , Humanos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
To date, relatively little psychological research has focused on the experiences of lesbian, gay, bisexual, and transgender (LGBT) Latino/a immigrants to the United States. This qualitative study used face-to-face semi-structured interviews to explore the unique sources of stress, challenges, as well as opportunities and factors related to resilience among 13 gay Latino first- and second-generation immigrants. Iterative coding of interview transcripts revealed four key themes, each of which is illustrated with verbatim quotes: (1) feelings of connectedness to the LGBT community, (2) feelings of connectedness to the Latino/a community, (3) intersectional challenges and strategies, and (4) well-being, strength, and resilience. As suggested by these themes, gay Latino immigrants have distinct sources of stress and conflict, many of them associated with community memberships, but also draw on unique sources of support and adaptive thoughts and behaviors in facing stressors. Implications for studying risk and resilience factors among stigmatized populations, including LGBT individuals and immigrants, are discussed.
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Emigrantes e Imigrantes/psicologia , Hispânico ou Latino/psicologia , Homossexualidade Masculina/psicologia , Distância Psicológica , Resiliência Psicológica , Adulto , Hispânico ou Latino/etnologia , Homossexualidade Masculina/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Características de Residência , Estados Unidos , Adulto JovemRESUMO
Background: More than one-third of university students meet diagnostic criteria for a mental disorder, and three quarters experience role impairment in some aspect of their life. One determinant of whether young adults will experience mental health difficulties is their ability to regulate emotion. We conducted two pilot trials of a brief online program designed to teach emotion regulation skills to university students. Methods: In Study 1, we conducted an open-label trial (n = 104). In Study 2, we conducted a waitlist controlled trial (n = 167). In both studies, pre- and post-assessment of emotion regulation, psychological distress, and self-compassion were conducted. Results: In both trials, we observed improvements in emotion regulation, and reductions in symptoms of psychological distress. Acceptability and feasibility were also satisfactory. Conclusion: An online emotion regulation program may offer promise in improving emotion regulation and subsequent mental health concerns among university students. (ACTRN12620000390987; ACTRN12620000839909).
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Background: Hispanics in Lebanon and Reading, Pennsylvania, experience high levels of socioeconomic and health disparities in risk factors for chronic disease. In 2018, our community-academic coalition "Better Together" received a Racial and Ethnic Approaches to Community Health (REACH) award to improve healthy lifestyles. This report describes our work-in-progress and lessons learned to date from our REACH-supported initiatives in Lebanon and Reading. Methods: For the past 4 years, our coalition has leveraged strong community collaborations to implement and evaluate culturally-tailored practice- and evidence-based activities aimed at increasing physical activity, healthy nutrition, and community-clinical linkages. This community case report summarizes the context where our overall program was implemented, including the priority population, target geographical area, socioeconomic and health disparities data, community-academic coalition, conceptual model, and details the progress of the Better Together initiative in the two communities impacted. Results: To improve physical activity, we are: (1) creating new and enhancing existing trails connecting everyday destinations through city redesigning and master planning, (2) promoting outdoor physical activity, (3) increasing awareness of community resources for chronic disease prevention, and (4) supporting access to bikes for youth and families. To improve nutrition, we are: (1) expanding access to locally-grown fresh fruit and vegetables in community and clinical settings, through the Farmers Market Nutrition Program to beneficiaries of the Women, Infants, and Children (WIC) program and the Veggie Rx to patients who are at risk for or have diabetes, and (2) providing bilingual breastfeeding education. To enhance community-clinical linkages, we are training bilingual community health workers to connect at-risk individuals with diabetes prevention programs. Conclusions: Intervening in areas facing high chronic disease health disparities leads us to develop a community-collaborative blueprint that can be replicated across Hispanic communities in Pennsylvania and the United States.
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Doença Crônica , Diabetes Mellitus , Saúde Pública , Adolescente , Criança , Feminino , Humanos , Lactente , Doença Crônica/prevenção & controle , Diabetes Mellitus/prevenção & controle , Hispânico ou Latino , Pennsylvania , Estados UnidosRESUMO
INTRODUCTION: Patients with alcohol use disorders (AUD) are at increased risk of developing sepsis and have higher mortality. AUD are associated with higher cortisol and anti-inflammatory cytokine profile. Higher cortisol increases risk of death in septic patients. The relationship between AUD and cortisol in septic patients is unknown. We aimed to study this relationship and postulated that AUD would be associated with higher cortisol and anti-inflammatory cytokine profile. METHODS: This was a prospective cohort study of 40 medical intensive care unit (ICU) patients admitted with sepsis. Cortisol, anti-inflammatory interleukin (IL) 10, and pro-inflammatory IL1ß, IL6, tumor necrosis factor (TNF) α were measured. RESULTS: Thirteen (32%) out of 40 patients had AUD. AUD patients had higher cortisol by univariate (39 microg/dl versus 24, P = 0.04) and multivariable analyses (44 microg/dl versus 23, P = 0.004). By univariate analyses, AUD patients had higher IL10 (198 picog/dl versus 47, P = 0.02) and IL6 (527 picog/ml versus 156, P = 0.048), but similar IL1ß and TNFα. By multivariable analyses, AUD patients had higher IL10 (182 picog/dl versus 23, P = 0.049) but similar IL1ß, IL6, and TNFα. AUD patients had lower IL1ß/IL10 (univariate 0.01 versus 0.10, P = 0.04; multivariable 0.01 versus 0.03, P = 0.04), lower TNFα/IL10 (univariate 0.15 versus 0.52, P = 0.03; multivariable 0.11 versus 0.63, P = 0.01), but similar IL6/IL10. CONCLUSIONS: AUD are common diagnoses among medical ICU patients with sepsis. Patients with AUD have higher cortisol concentrations and have differences in cytokine expression. Future studies should seek to determine if these differences may explain the higher severity of illness seen in patients with sepsis and AUD. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00615862.
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Transtornos Relacionados ao Uso de Álcool/sangue , Citocinas/metabolismo , Hidrocortisona/metabolismo , Sepse/diagnóstico , APACHE , Adulto , Transtornos Relacionados ao Uso de Álcool/complicações , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Biomarcadores/metabolismo , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/complicações , Sepse/metabolismoRESUMO
A large proportion of patients with avian influenza A (H5N1) develop life-threatening manifestations, often including ARDS, acute renal failure and multiple organ failure that requires aggressive intensive care management. The pace of development of respiratory failure is often rapid and can occur in previously healthy hosts, mandating close observation and timely intervention of infected individuals. Use of standard, contact, droplet and airborne isolation precautions is recommended to protect healthcare workers. Key components of ARDS management encompass appropriate mechanical ventilation including limiting tidal volume to =6 mL/kg of predicted body weight, maintaining transpulmonary pressures =30 cm H(2)O, and utilizing positive end-expiratory pressure to limit alveolar deflation and to improve oxygenation. Additional strategies include conservative fluid management and using nutrition supplemented with antioxidants. Use of corticosteroids is controversial for both early and late ARDS and although often used for avian influenza, beneficial effects on outcomes have not been demonstrated for corticosteroids. Prone positioning can improve oxygenation temporarily and might be useful as rescue therapy for severe hypoxemia. Administration of inhaled nitric oxide and high frequency oscillatory ventilation can improve oxygenation but have not been demonstrated to improve survival in ARDS-their role in avian influenza is uncertain and availability limited. Management of multiple organ failure may include vasopressor support for septic shock and renal replacement therapy for acute renal failure.
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Cuidados Críticos , Virus da Influenza A Subtipo H5N1 , Influenza Humana/terapia , Insuficiência de Múltiplos Órgãos/terapia , Humanos , Influenza Humana/complicações , Insuficiência de Múltiplos Órgãos/virologiaRESUMO
Inspection bronchoscopy during percutaneous dilational tracheostomy has become the standard of care to reduce complications of the procedure. During bronchoscopy, anatomic defects can be visualized before performing the procedure. We describe a case of discovering herniated tracheal rings in preprocedure bronchoscopy and subsequent treatment of this rare finding.