Plenty of Fish in the Ocean: How do Traits Reflecting Resiliency Moderate Adjustment After Experiencing a Romantic Breakup in Emerging Adulthood?

Breakups are common but often one of the most distressing experiences that young people can have. Poor adjustment to relationship loss is linked to depressive symptoms and rumination. This study assessed traits that reflect resiliency and that might comprise protective factors that ameliorate depressive symptoms and rumination. Online survey participants included 866 male and female late adolescents (18-22 years; Mean age = 20.7; 62% female; 82% White/Caucasian; 7% Asian/Southeast Asian; 6% Black/African American) who recently had experienced the breakup of a romantic relationship. Analyses assessed whether optimism, grit, and self-esteem moderated the breakup-adjustment relationship. After controlling for gender and current relationship status, higher optimism, self-esteem, and grit were expected to be associated with lower levels of depressive symptoms and rumination for those who had experienced a breakup in the three months prior to the study, and for the most part, these predictions were confirmed. These findings can be reinforced in education and counseling programs to better support individuals suffering the aftermath of a breakup. The findings add to the literature on adolescents' development of interpersonal functioning and skills required in intimate relationships.

A person-centred analysis of teacher-child relationships in early childhood.

BACKGROUND: Previously, the nature of teacher-child relationships (TCRs) has been explored through dimensions of close, conflicted, and dependent. However, this variable-centred approach is limited, as many relationships can be characterized by more than one characteristic or trait. A person-centred approach would allow for a greater understanding of the types of relationships that are formed and improved interpretation of the students' socio-emotional outcomes associated with that relationship. AIMS: The primary goal of this study was to examine the socio-emotional functioning of young children who formed distinct types of TCRs. SAMPLE: Participants were n = 202 kindergarten children (98 girls, 104 boys, Mage = 64.12 months, SD = 4.86). METHOD: Multi-source assessment was employed with data collected from parent ratings, teacher reports, child interviews, and naturalistic observations in the classroom. Using quartile cut-offs, we identified children who formed conflicted, dependent, and 'combined' (conflicted and dependent) TCRs. RESULTS: Results indicated distinct patterns of socio-emotional functioning for each TCR group. For example, whereas children in conflicted TCRs evidenced greater externalizing difficulties, children with dependent TCRs had greater internalizing difficulties. Children who evidenced high levels of both conflicted and dependent TCRs displayed the most pervasive socio-emotional difficulties. CONCLUSIONS: Children who form TCRs characterized by high levels of both conflict and dependency displayed the most pervasive adjustment difficulties. Further investigation is needed to improve our understanding of this group and to assess the plausibility of early intervention strategies.

Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Multiple treatment alternatives exist for localised prostate cancer, with few high-quality studies directly comparing their comparative effectiveness and costs. The present study is the most comprehensive cost-effectiveness analysis to date for localised prostate cancer, conducted with a lifetime horizon and accounting for survival, health-related quality-of-life, and cost impact of secondary treatments and other downstream events, as well as primary treatment choices. The analysis found minor differences, generally slightly favouring surgical methods, in quality-adjusted life years across treatment options. However, radiation therapy (RT) was consistently more expensive than surgery, and some alternatives, e.g. intensity-modulated RT for low-risk disease, were dominated - that is, both more expensive and less effective than competing alternatives. OBJECTIVE: To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model. PATIENTS AND METHODS: A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis. RESULTS: Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6-10.5 for intermediate-risk patients and 7.8-9.3 for high-risk patients. There were no statistically significant differences among surgical methods, which tended to be more effective than RT methods, with the exception of combined external beam + brachytherapy for high-risk disease. RT methods were consistently more expensive than surgical methods; costs ranged from $19 901 (robot-assisted prostatectomy for low-risk disease) to $50 276 (combined RT for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. CONCLUSIONS: Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions about strategies to improve efficiency of treatment selection for localised prostate cancer.

A persistent, symptomatic urinary tract infection with multiple "negative" urine cultures.

While urinary tract infections (UTIs) are often suspected on the basis of clinical symptoms and the finding of pyuria on urinalysis, the documentation of a bacterial UTI is based on the significant growth ofa uropathogen on an agar medium incubated at 35-37 degrees C. The recommended length of time for incubation has ranged from 24 to 48 hours. We present a case of a UTI associated with the slow-growing, gram-negative organism, Oligella ureolytica which was finally documented after incubation of an agar medium for more than 48 hours.

Assessing Eye Health and Eye Care Needs Among North American Native Individuals.

IMPORTANCE: There are few population-level studies on ophthalmic conditions and services among North American Native individuals. OBJECTIVE: To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 100% Medicare fee-for-service (MFFS) enrollment data from the Vision and Eye Health Surveillance System (VEHSS) to examine ophthalmic conditions and service use in North American Native individuals and non-Hispanic White individuals in the US. In this study North American Native individuals included those who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data were analyzed from August 2020 to April 2021. INTERVENTIONS: Claims and sociodemographic characteristics were extracted and means computed for categories of ophthalmic conditions and select ophthalmic services. Ophthalmic conditions and services were defined in the VEHSS using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Logistic regression was used to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native individuals and non-Hispanic White individuals for each age cohort. Matching ophthalmic condition claim rates and ophthalmic service claim rates was performed to examine disparities by racial group. MAIN OUTCOMES AND MEASURES: Mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons. RESULTS: Claims were identified for 177 100 Native American Native individuals and 24 438 000 non-Hispanic White individuals. In 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates from non-Hispanic White individuals. There were higher ophthalmic condition claim rates but lower service claim rates for North American Native individuals (vs non-Hispanic White individuals) for refractive errors (ophthalmic condition, 17.2 vs 11.1; service, 48.3 vs 49.6, respectively; P < .001); blindness and low vision (ophthalmic condition, 1.48 vs 0.75: service, 19.2 vs 20.1, respectively; P < .001); injury, burns, and surgical complications (ophthalmic condition, 1.8 vs 1.7; service, 19.2 vs 20.1, respectively; P < .001); and orbital and external disease (ophthalmic condition, 15.7 vs 13.3; service, 48.3 vs 49.6, respectively; P < .001). For diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 vs 2.20) but no difference in service claim rates (14.4 vs 14.8; P = .26) compared with non-Hispanic White individuals. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, North American Native individuals had higher prevalence of ophthalmic conditions but no corresponding increase in services (treatment for most ophthalmic conditions) compared with non-Hispanic White individuals. These results suggest worse eye health and higher unmet eyecare needs for North American Native individuals with MFFS coverage compared with non-Hispanic White individuals with MFFS coverage.

Ensuring appropriate access to pulmonary arterial hypertension therapy.

Pulmonary arterial hypertension (PAH) is a progressive, complex disease. PAH is a type of pulmonary hypertension (PH) and can be further categorized into 7 subdivisions, representing a variety of causal and phenotypic factors. Patients with PH, including PAH, are typically fragile and experience multiple comorbidities; they therefore require individualized treatment plans based on their risk status and etiology. Based on a review of clinical evidence, a wide variety of treatment options exist for PAH, including general measures (eg, physical activity and oral anticoagulants), nonspecific pharmacologic intervention (eg, calcium channel blockers), and targeted pharmacologic intervention. Guidelines point to a flexible approach, frequently including upfront or sequential combination therapy, to mitigate disease progression. Payer-driven drug exclusion policies, including formulary restrictions and noncoverage policies, can detract from the ability of providers to offer treatments consistent with guidelines, as they limit access to the range of treatment options needed for individualized patients. Providers must be able to work with each patient to develop a tailored strategy through open access to treatments, leveraging all available options, to mitigate against exacerbation of comorbidities and optimize care.

Health anxiety, rumination, and negative affect: a mediational analysis.

OBJECTIVE: A ruminative cognitive style has been associated with a variety of mood and anxiety disorders. This study examined whether a ruminative cognitive style is associated with health anxiety, even when controlling for negative affect. METHOD: College students (N=198) completed measures of health anxiety, rumination, and negative affect and estimated the likelihood that ambiguous symptoms were indicative of catastrophic illnesses. These data were analyzed using structural equation modeling. RESULTS: A ruminative cognitive style was both indirectly associated with health anxiety via its strong relationship with negative affect and was also directly associated with health anxiety. Furthermore, catastrophizing ambiguous symptoms was also directly related to health anxiety. CONCLUSION: High health anxiety individuals not only hold dysfunctional beliefs about health and illness but they also think about their distress in a ruminative manner. A more complete cognitive-behavioral model of health anxiety should include not only cognitive contents ("what") but also cognitive style ("how").

Why classroom climate matters for children high in anxious solitude: A study of differential susceptibility.

The goal of the current study was to examine the complex links among anxious solitude, classroom climate, engagement, achievement, and gender. In particular, drawing upon the differential susceptibility hypothesis (Belsky, 1997), we investigated if children high in anxious solitude were particularly sensitive and responsive to the classroom environment. Participants were N = 712 children in Grade 3, drawn from the National Institute of Child and Human Development (NICHD) Study of Early Child Care and Youth Development data set. Classroom climate and engagement were assessed using the Classroom Observation Scale (NICHD, 1998). Teachers completed the Teacher Report Form (Achenbach, 1991) as a measure of anxious solitude and the Academic Rating Scale (NICHD, 2010) as a measure of achievement. Hypothesized associations among variables were tested by way of a moderated-mediation model. Among the results, engagement was found to mediate the relation between classroom climate and achievement. In addition, anxious solitude and gender were found to moderate the relation between classroom climate and engagement. Support for the differential susceptibility hypothesis was found, suggesting that children high in anxious solitude may be more reactive (both positively and negatively) to elements of the classroom environment. In addition, gender differences were observed, indicating that boys may be more responsive to the classroom environment as compared with girls. Implications for future research and educational policies are discussed. (PsycINFO Database Record

Teaching methods and an outcome tool for measuring cultural sensitivity in undergraduate nursing students.

A major challenge facing the nursing profession is to educate and assist nurses to develop the skills to provide culturally relevant care. This article describes one school's multicultural curriculum for baccalaureate nursing students and a tool to measure changes in behaviors and attitudes. The article presents the psychometric properties of the Cross-Cultural Evaluation Tool that yields a cross-cultural interaction score. Successful teaching strategies are presented that are substantiated by increased student cross-cultural interaction score scores.

An overview of the Australian Physiotherapy Association accredited practice data collection.

The Accreditation Committee of the Australian Physiotherapy Association (APA) undertook a national survey of accredited private practices from September to November 1995. It aimed to describe patient and episodes of care characteristics, and provide accredited practices with large scale quality improvement opportunities. Of the private practices accredited in August 1995, 40.6 per cent (122) participated. Data were generated on 12,403 rooms-based patients. Practice-specific information on patient and episode characteristics was sent to each participant, allowing individual comparison with the group data. Lessons were learnt, not only in the administration of multi-centre studies, but also in the focus of future studies. This study highlighted the need to develop standard diagnosis coding and robust outcome measurements for use in private physiotherapy practice.

Effect of topical nasal corticosteroids on patients with chronic fatigue syndrome and rhinitis.

BACKGROUND: Chronic fatigue syndrome (CFS) is a disabling illness of persistent fatigue. Recent studies have shown that patients with CFS have an increased prevalence of nonallergic rhinitis. Inflammation of the nasal passages due to allergic rhinitis can cause nasal congestion resulting in an increased number of sleep disturbances and daytime fatigue. While topical nasal corticosteroids have been shown to alleviate nasal obstruction effectively in patients with rhinitis who do not have CFS, it is unknown whether topical nasal corticosteroids will reduce CFS symptoms. STUDY OBJECTIVE: The purpose of this study is to determine whether topical nasal corticosteroids will reduce daytime sleepiness in patients with CFS and rhinitis. METHODS: Twenty-eight of 31 subjects with rhinitis and a diagnosis of CFS completed the double-blind, randomized, placebo-controlled trial. Two subjects failed screening, and 3 subjects withdrew from the study prior to its completion. Subjects were randomized according to Balaam's crossover design, and one of the following interventions was used for each group in the study: 8-week treatment with a topical nasal corticosteroid, 8-week treatment with a placebo saline spray, 4-week treatment with a topical nasal corticosteroid followed by a 4-week treatment with a placebo saline spray, or a 4-week treatment with a placebo saline spray followed by a 4-week treatment with a topical nasal corticosteroid. Data focusing on rhinitis symptoms, severity of chronic fatigue symptoms, and quality of life were gathered at biweekly office visits and with daily diaries. RESULTS: The results indicated that daytime sleepiness was reduced when patients with rhinitis and CFS were treated with topical nasal corticosteroids. The severity of associated CFS symptoms, specifically fatigue, muscle pain, postexertional fatigue, and daily activity, did not improve with treatment. CONCLUSION: Treating the symptoms of rhinitis in patients with CFS does not appear to alleviate daytime fatigue or associated nasal, musculoskeletal, or cognitive complaints. Therefore, it is unlikely that aggressive treatment of such symptoms with topical nasal corticosteroids will provide significant benefit to patients with CFS who do not have allergic rhinitis. These results indicate that the nonallergic rhinitis seen in patients with CFS may arise from a mechanism other than chronic inflammation.

The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis.

Recent data suggested that daytime somnolence in patients with allergic rhinitis was secondary to disrupted sleep caused by nasal congestion. Medications, which decreased congestion, would be expected to improve sleep and daytime somnolence. Previously, we showed that nasal steroids improved all three symptoms. Presently, we have not performed objective sleep testing to determine if there is a correlation between subjective improvement of congestion, sleep, and daytime somnolence. The objective of this 8-week, double-blind, placebo-controlled study was to determine if topical nasal fluticasone is effective at decreasing subjective congestion and daytime somnolence and improving sleep and if this improvement correlated with a change in overnight sleep testing (polysomnography). We recruited 32 subjects with perennial allergic rhinitis and randomized them in a double-blinded, cross-over fashion, to receive placebo or fluticasone (50 micrograms a spray), 2 sprays each side everyday, using Balaam's design. Questionnaires, quality of life instruments, daily diary, Epworth Sleepiness Scale, and an overnight sleep test with polysomnograms were used as tools. The last 2 weeks of each 4-week treatment period were summarized, scored, and compared by PROC MIXED in SAS. Correlations between arousals on sleep tests and subjective tests were performed. Fluticasone improved subjective sleep when compared with placebo (p = 0.04); however, there was no difference in the apnea/hypopnea index in those that were treated. Daytime sleepiness and fatigue were decreased by > 10% in the treated group; however, this was not statistically significant. However, fluticasone used at approved doses improves subjective sleep in patients with perennial allergic rhinitis without a change in the apnea/hypopnea index.