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Patients with right hemisphere damage (RHD) may exhibit mild unilateral spatial neglect (USN), which is difficult to detect in general assessments performed during driving rehabilitation. We compared driving simulator performance, practical driving performance, and neuropsychological test results between patients with RHD who were able and unable to return to driving to predict driving fitness based on driving simulator performance. This unmatched case-control study included 29 patients with RHD who were able (return-to-driving group, n = 16) and unable (non-return-to-driving group, n = 13) to return to driving. Patient demographics, motor function, attention, driving simulator performance (participants' reaction time and rate to green lamps appearing in any of the three displays and average lane position), and practical driving performance were compared between the groups. Receiver operating characteristic (ROC) analysis was performed to examine the predictive performance of driving fitness in reaction rate and paper-and-pencil tests. The non-return-to-driving group had a significantly lower reaction rate than the return-to-driving group (p = 0.027; 95% confidence interval [CI], 0–7; r = 0.407). No significant difference in reaction time or lane position in either the left or right lane during driving simulation was observed. ROC analysis of the reaction rate in the driving simulator task showed sensitivity of 0.692, specificity of 0.812, and area under the curve of 0.738 [95% CI, 0.541–0.935]. Decreases in reaction rates during simulated driving assessments are associated with an inability to resume driving in patients with RHD. Such assessments may aid in predicting fitness for driving in these patients. [ABSTRACT FROM AUTHOR]

Pictograms may improve user-friendliness and comprehension of written or verbal health information. This paper describes a method to modify pictograms to improve their visual clarity, appeal and overall interpretive complexity in order to reduce the cognitive load on the viewer during comprehension. Nine pictograms previously tested for comprehension were selected for modification. In phase 1, two participatory design workshops were conducted with (a) three limited literacy, first-language isiXhosa-speaking participants and (b) four university students. Opinions and ideas for improving interpretation were discussed. In phase 2, revised visuals were generated by the graphic artist and subsequently modified in an intensive, multistage, iterative process. As no guidelines for pictogram modification exist, a modification schema was developed based on the process described in this study. Adopting a participatory approach combined with a systematic, intensive modification process enabled the opinions and preferences of the end-users to be heard, ensuring cultural relevance and contextual familiarity of the final product. Careful scrutiny of all individual visual elements of each pictogram, considerations of space, and thickness of lines all contributed to improving the legibility of visuals. The methodology for designing and modifying existing pictograms using a participatory process resulted in nine final pictograms that were approved by all design team members and considered good candidates for subsequent comprehension testing. The methodological schema presented in this paper provides guidance to researchers intending to design or modify pictograms. [ABSTRACT FROM AUTHOR]

This study is an attempt to bridge the gap between the understanding of strengths and challenges of people with autism to operationalize a strength-based approach to serve people with autism effectively. By virtue of being based on firsthand accounts by parents and practitioners the people who spend prolonged periods with people with autism in natural settings, and are privy to direct observation of abilities and challenges, the study yields in-depth information that addresses a continued gap in the existing literature on the subject. Twenty participants (13 parents and seven practitioners) took part in the study through a semi-structured questionnaire and face-to-face interviews. Data were analyzed following qualitative thematic analysis methodology. Strengths and related challenges experienced were extracted as the broad themes, based on which support needs were derived and future directions recommended. The paper recommends strategic home–school collaborations with crucial, concurrent roles played by parents and practitioners. [ABSTRACT FROM AUTHOR]

During health crisis, individuals need information to comprehend their circumstances. Channel complementarity theory posits that in meeting their informational needs, people will use different sources in a complementary fashion. This paper puts to test the main tenet of channel complementarity theory by focusing on information scanning (i.e. routine health information exposure) in the context of the COVID-19 pandemic in Chile. A survey was conducted among a sample of Chilean adults (N = 2,805). The questionnaire addressed information scanning across six sources (television, radio, internet, social media, family, and friends or coworkers) and explores how socioeconomic and demographic variables, as well as COVID-19 perceived risk related to scanning. Latent class analysis was employed to identify patterns of complementarity across channels. The analysis yielded a solution of five classes, namely 'high complementarity and high frequency' (21%), 'high complementarity and low frequency' (34%), 'high frequency on television and digital media' (19%), 'mass media predominant' (11%), and 'no scanning' (15%). Educational attainment, age, and COVID-19 perceived risk were associated with scanning. Television was a central channel for information scanning during the pandemic in Chile and more than half of participants scanned COVID-19 information complementarily. Our findings expand channel complementarity theory to information scanning in a non-US context and provide guidelines for designing communication interventions aiming at informing individuals during a global health crisis. [ABSTRACT FROM AUTHOR]

Executive functions have both direct and indirect effects on reading comprehension. Previous studies have shown that people with hearing loss (HL) perform poorly on executive functions and reading comprehension tasks. This scoping review explored the current state of the literature relating executive function and reading comprehension in children and adolescents with cochlear implants. Searches were carried out in five databases to identify empirical studies related to executive functions, reading comprehension, and children and/or adolescents with cochlear implants. All results were analysed by peer-reviewers. A systematic search only found four studies in the field. We carried out our narrative review of these papers, with a focus on the mediating role of oral language on the relationship between executive functions and reading comprehension. [ABSTRACT FROM AUTHOR]

This paper discusses the role of mediation as it arose in developing and teaching two online American Sign Language (ASL) courses for parents of deaf children during the COVID-19 pandemic. Deaf children and their families who are still acquiring ASL have ongoing learning needs that are most often not met in mainstream educational systems, and these inequities have deepened during the pandemic. Combining reception, production, and interaction, mediation is a mode of language activity in the Common European Framework of Reference for Languages (CEFR) that involves "languaging" to develop ideas and facilitate understanding and communication. In this nine-month study, intensive parent ASL courses were adapted and developed for rapid implementation of online instruction in order to meet the second or additional language ASL learning needs of parents of deaf children. Online questionnaire, interview, observational, and assessment data were gathered regarding participating parents' learning processes and experiences. As study findings reveal, a main theme that arose was the role of mediation in terms of alleviating various barriers for participants and facilitating the linguistic and cultural dimensions of parents' online ASL learning and understanding through cognitive and relational means. [ABSTRACT FROM AUTHOR]

Background: Appropriate supports and instructional practices contribute to the development of self-determination. Also, research shows that the promotion of skills related to self-determination has been linked to the achievement of desired outcomes over the different life stages. Advances in self-determination require the development of assessment instruments because there is a reciprocal relationship between assessment and instruction. The purpose of this paper is to provide a description of the AUTODDIS Scale, along with evidence of its reliability and external validity. Method: A sample of 541 people with intellectual disabilities aged from 11 to 40 was used to validate the scale. Results: The reliability results indicate that the AUTODDIS Scale shows high internal consistency. The total score and subscale scores indicate moderate inter-rater reliability. The scores were also moderately to highly associated with other related measures of self-determination and quality of life (QoL). Conclusion: Our results demonstrate that consistent and valid information can be obtained from the AUTODDIS Scale. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have a key role in palliative care provision for patients with advanced cancer. Continuity is valued by patients with such needs but is limited within current primary care systems. Exploration of the facilitators of and barriers to continuity in this complex context is required. Aim: To identify facilitators of and barriers to continuity with GPs in primary palliative care among people with advanced cancer and/or their close persons. Design: Mixed-methods systematic review with content and thematic analyses. Data sources: Keyword searches were carried out in five databases (Ovid MEDLINE(R), Ovid EMBASE(R), CINAHL, Web of Science, and Cochrane), policy documents and grey literature search engines in December 2020. Evidence was reviewed using relevant quality appraisal tools; data were extracted and tabulated. Findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the review was prospectively registered on PROSPERO. Results: Seventeen studies were included. Six studies originated from the UK; six from Europe; three from Canada; and two from Australia. Two studies were mixed-methods, four presented quantitative data, and 11 papers reported on qualitative studies. Four themes were developed: (1) the role of GPs in facilitating continuity; (2) the role of patients and/or close persons in facilitating continuity; (3) changing needs throughout the disease trajectory; and (4) the organisational context in primary care. Conclusions: Facilitators of and barriers to continuity in primary palliative care are outlined. Further research is required to explore how patients and/or their close persons experience continuity in primary palliative care. Specifically, the work required of them to achieve their desired level of continuity, and their capacity for action in this context, needs further attention. [ABSTRACT FROM AUTHOR]

Spatial reasoning, recognised as playing a critical role across STEM disciplines, is gaining prominence in mathematics education, not only as fundamental to mathematics, but also as embodied mathematical activity. In this paper, we discuss spatial reasoning and its embodiment in mathematics. We then present a systematic review of the topics as researched and related to deaf and general education from 2010 to 2019. Publication trends during the ten years reveal similarities and differences across both fields. Based on the findings, we share insights, prospects, and provocations for promoting spatial reasoning in mathematics with an emphasis on research and pedagogy for deaf education. [ABSTRACT FROM AUTHOR]

The majority of Australian Aboriginal and Torres Strait Islander (hereafter referred to as "Aboriginal") people live in urban centres. Otitis media (OM) occurs at a younger age, prevalence is higher and hearing loss and other serious complications are more common in Aboriginal than non-Aboriginal children. Despite this, data on the burden of OM and hearing loss in urban Aboriginal children are limited. This project was initiated following a request from urban Aboriginal people who felt the focus on more remote communities often meant urban communities were forgotten. This paper describes the development of an urban Aboriginal birth cohort study of OM that is culturally secure, outlines the process of community consultation and establishment of an Aboriginal Community Advisory Group to provide cultural governance, and presents preliminary results. Djaalinj Waakinj is an ongoing study being conducted in Perth, Western Australia, on Noongar Boodja (country). Aboriginal researchers visit people's homes to collect sociodemographic and environmental data at enrolment of babies aged <3 months; otoscopy and tympanometry are conducted by an Aboriginal research assistant or a nurse at ages 2–4, 6–8 and 12–18 months, and full audiological assessment conducted at 9–12 months. To date, 125 participants have been enrolled; 39% of 71 children aged 2–4 months and 52% of 44 children aged 6–8 months had evidence of OM. To our knowledge, this is the first prospective cohort study aiming to determine the prevalence and risk factors associated with OM in Aboriginal infants residing in an urban area. [ABSTRACT FROM AUTHOR]

Background: Healthcare provider (HCP) interactions with pediatric patients and their parents requires methods of communication differing from the HCP/adult patient experience. Gaps remain in understanding strategies and tactics that HCPs might use during pediatric patient interactions. For instance, research is needed to differentiate HCP/pediatric patient interactions among distinct groups such as infants, young children, pre-adolescents, and adolescents. Similarly, HCP beliefs about how an interaction should flow may not match those of parents – with possible consequences regarding compliance with treatment. Methods: This paper reviews research into HCP/pediatric patient interactions and presents survey results that show where expectations align or differ between HCPs and parents. Results: HCPs and parents generally approach the pediatric encounter with similar expectations. However, differences in specific situations are informative. HCPs are more focused on patients than parents. They are more sensitive than parents to situations involving difficult topics and change their approach for different age groups or developmental statuses. HCPs are more responsive to patients than parents for scenarios that involve delicate content, more so for scenarios that require being forthright with their patients. Parents prefer more thorough explanations when reasonable, and want to take part in discussions even when HCPs are more focused on their pediatric patients, especially for adolescents. Conclusion: Having a fuller understanding of the expectations that HCPs and parents hold implies changes in how students in healthcare fields are trained; having better insight into this relationship will prepare them for interacting with pediatric patients while still addressing the needs of parents. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence for music-based interventions in neurorehabilitation, improving mood and functional outcomes. In response, there is growing interest from health-care providers in setting up Neurologic Music Therapy (NMT) services. This paper presents some preliminary data on the feasibility and acceptability of NMT in the acute stroke, multidisciplinary team setting, about which little is known. Objectives: To assess the feasibility and acceptability of a two-day per-week NMT service over 24 months. Methods: Data were collected on the number of referrals received, sessions attended, sessions declined and reasons why. Staff completed questionnaires, and collected them from patients and their relatives, rating interventions: 1. Not helpful, 2. Quite helpful, 3. Helpful, 4. Very helpful. Patients completed the Visual Analogue Mood Scale (VAMS) pre-/post- a single session. Results: Of 201 patients referred, 177 received treatment and 675 sessions were delivered. Twenty-four patients were discharged before sessions were scheduled and 28 sessions were declined, predominantly due to fatigue. Mean scores (SD) from questionnaire data were: patients (n = 99) 3.34 (0.825), relatives (n = 13) 3.83 (0.372), staff (n = 27) 3.85 (0.388). Mean, post-session VAMS data (n = 52) showed a non-significant reduction in 'Sad' (7.5, p =.007, CI = 2.1, 12.9) and an increase in 'Happy' (+ 6.2, p =.013, CI = −11.0, −1.4). Conclusions: Data suggest the service was feasible and helpful, particularly for patient mood, possibly improving engagement in rehabilitation. Research to determine generalizability in different stroke environments and treatment effects within them is warranted. [ABSTRACT FROM AUTHOR]

Objective: This paper reports a qualitative study of a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education in the patient's home. The aims of the current report are to investigate patient perceived benefits of and barriers to using the telerehabilitation system at home. Methods: We used a qualitative study design that involved in-depth semi-structured interviews with 13 participants who were patients in the subacute phase after stroke and had completed a six-week intervention using the home-based telerehabilitation system. Thematic analysis was conducted to analyze the data. Results: Participants mostly reported positive experiences with the telerehabilitation system. Benefits included observed improvements in limb functions, cognitive abilities, and emotional well-being. They also perceived the system easy to use due to the engaging experience and the convenience of conducting sessions at home. Meanwhile, participants pointed out the importance of considering technical support and physical environment at home. Further, family members' support helped them sustain in their rehabilitation. Finally, adjusting difficulty levels and visualizing patients' rehabilitation progress might help them in continued use of the telerehabilitation system. Conclusion: Telerehabilitation systems can be used as an efficient and user-friendly tool to deliver home-based stroke rehabilitation that enhance patients' physical recovery and mental and social-emotional wellbeing. Such systems need to be designed to offer engaging experience, display of recovery progress, and flexibility of schedule and location, with consideration of facilitating and social factors. [ABSTRACT FROM AUTHOR]

Background: The use of technologies in health is changing the relationship between patients and their conditions. In the case of chronic pain, social media are offering these individuals a new way to talk about their experience. The objective of this paper is to identify how and why patients are using these online platforms for pain communication. Particularly, this study analyses self-expression practices of this disease on Instagram. Method: A sample of posts was selected from the platform following a multistage sampling strategy (n = 350). These publications were examined through a qualitative analysis based on multiple categories related to the experience of chronic pain. Results: Patients are using Instagram to give visibility to illnesses such as fibromyalgia or endometriosis. Moreover, these individuals talk about their condition in terms of chaos and uncertainty, using the narratives to construct a world that gives meaning to their chronic pain. However, men are largely absent from these online practices. Ninety-four percent of the publications included in the sample were shared by women (n = 329). Conclusion: Findings indicate that Instagram is changing the way patients live with their chronic pain. Considering the complexity of this condition, care providers could improve the assessment of chronic pain by paying more attention to the self-expression practices of these individuals. [ABSTRACT FROM AUTHOR]

Background: The degree of difficulty of skills of paretic upper limbs in daily life has not been investigated. Objective: To determine the internal validity and level of difficulty of items of the Functional Skills Measure After Paralysis (FSMAP), which can be used to evaluate the functional skills of daily living for stroke patients. Method: A total of 105 first-stroke patients were assessed using the FSMAP. The evaluation system consists of 65 items in 15 categories. We examined the internal validity and level of difficulty of these items using Rasch analysis. In this study, an item with either infit or outfit of ≥1.5 was defined as underfit. Results: Rasch analysis showed that 8 items were underfit. The highest infit and outfit logits were 2.47 for "Trouser donning/doffing" and 8.44 for "Paper manipulation". "Shirt donning/doffing" was the easiest item and "Coin manipulation" was the most difficult, with difficulty logits of −35.8 and 41.5, respectively. Conclusion: The therapist can confirm items that the patient can or cannot perform. By understanding the level of difficulty of each item, the most appropriate functional skill to focus on acquiring next can be identified. [ABSTRACT FROM AUTHOR]

Introduction Research in palliative care (PC) is often regarded as challenging due to the vulnerability of the population and other peculiarities. We aim to systematically identify barriers to research in PC in the literature. Methods The electronic databases CINAHL, MEDLINE were searched for papers published in the last 25 years. Citations and then abstracts were screened for inclusion. Original papers were included on first-level analysis. On a second level reviews, reports, and position papers were analyzed. Papers containing a direct patient report were specifically analyzed. Barriers were categorized (ethical considerations, financial and time expenses, study design and methodology, human resources and politics) and results quantified. Results Twenty-one original papers and 65 other papers were included. Five studies involved patients directly, five were systematic reviews, three were study experiences, and seven were surveys or workshop reports. Most papers originated from UK, USA, or Norwegian Universities. Ethics and methods were the most often mentioned categories on both levels. Accrual, attrition, and gatekeeping were frequently named barriers. Complex invasive studies or possible side effects hinder patients' participation, as patients are often willing to participate for altruistic motivations. Discussion Barriers to PC research are ethical concerns and methodological challenges. Possible strategies to overcome methodological barriers include international collaborative efforts to include more patients and improve study designs. Ethical barriers indicate the need for patient involvement in the research development process and tailoring research specifically to the PC population. [ABSTRACT FROM AUTHOR]

Background Palliative care and rehabilitation both aim to support patients to live as actively as possible. Goal setting has been identified in health policy and clinical guidelines as a mechanism to achieve this. While goal setting is well established in traditional rehabilitation, it is unclear how it should be implemented within palliative care where people are faced with diminishing abilities. Aim To identify and synthesize published literature regarding goal setting in palliative care. Method Electronic searches were carried out on MEDLINE, PSYCHINFO, EMBASE, CINAHL, ASSIA, and Google Scholar databases between November 2010 and January 2011. Papers were included if they focused on patient-centred goal setting in palliative care. No restrictions were placed on study design or type of paper. Papers were classified according to the type and design and research papers were quality appraised. Papers were read and analysed using framework analysis. Findings Sixteen papers met the inclusion criteria. Three themes were identified: 1. Definitions, process, and functions of goal setting; 2. The challenges of delivering goal setting; 3. Theories underpinning goal setting. Conclusions Goal setting is recognized as an important component of patient-centred palliative care, but there is no agreement regarding 'best practice' and clinicians face particular challenges when trying to set goals with patients in this context. Little attention has been paid to developing a robust, theory-based approach to goal setting in this setting. Hope theory and theories of how people adapt to life-threatening illness could inform the process of goal setting in palliative care. [ABSTRACT FROM AUTHOR]

Background Michigan ranks as the sixth lowest state for registered organ donors. To increase enrollment, the Health Resources and Services Administration (HRSA) funded the addition of a social networking component to enhance the existing traditional Wolverine–Buckeye Challenge campaign. The goal for all campaign materials was to heighten students' social identification by featuring college images (football helmets) on materials directing students to a webpage where they could register as an organ donor and 'score a point' for their school. This paper reports the number of registrations for the campaign as well as the relative effectiveness of traditional materials (i.e. print) vs. social networking routes (i.e. Facebook). Method The number of registrations in which individuals 'credited' the University of Michigan for their online registration during the campaign periods was recorded by the Michigan Secretary of State to determine the source through which individuals learned of organ donation. These daily registration values were used to compare the registrations in different time periods of the campaign. In addition, data from Google Analytics were used to determine whether visitors clicked on a link to the signup page from a networking route or whether they visited the webpage directly. The mean number of visits to the signup pages for the various portions of the campaign was compared. Results In the baseline year of the Wolverine–Buckeye Challenge, there were 224 signups, 451 in the second year, and 1756 in the third. There was no significant difference between direct and social network routes for visits to the organ donation registration page. Discussion Social networking was effective in enhancing the campaign. This paper presents lessons learned to benefit others running social networking-enhanced health campaigns including partnerships with existing Facebook fan pages. [ABSTRACT FROM AUTHOR]

Over the last quarter century many new cyberspace platforms have emerged that facilitate communication across time, geographical distance and now even language. Whereas brick-and-mortar communities are defined by geographically local characteristics, a virtual community is an online community of individuals who socialize and connect around a common interest or theme using the Internet. Community-based participatory research (CBPR) is a public health approach that requires equitable partnerships between community members and researchers. Virtual communities abound on the Internet today, yet their application to CBPR is rarely considered. We examine three case studies to explore the advantages and challenges of virtual communities for CBPR, as well as several of the online tools CBPR practitioners can use to facilitate virtual community participation. There is a potential utility of virtual communities in supporting CBPR efforts as they reduce the effects of geographical barriers, maximize the growth potential of the community, and provide portable and affordable channels for real-time communication. Some caveats indicated in our case studies are: technological challenges, difficulty in crediting members’ contributions and determining ownership of content, no face-to-face interaction may hinder relationship formation, cohesion, and trust resulting in lower engagement. The paper concludes with recommendations for the use of virtual communities in CBPR projects, such as in the coordination of statewide health care policy initiatives and in the dissemination of best public health practices. [ABSTRACT FROM PUBLISHER]

Background: Fear of physicians is associated with a variety of negative relationship and clinical outcomes. Culturally competent communication has been suggested as a way for physicians to reduce patient fear. Previous research has not, however, assessed whether patients’ perceptions of physicians’ cultural competence are associated with the level of felt fear. This study assessed associations between patients’ fear of physicians and their perceptions of physicians’ cultural competence in healthcare interactions. Method: In this cross-sectional study, a purposive sample of 306 patients were recruited from the patient base of a local clinic system with three locations, one rural, one suburban, and one urban in Appalachian Ohio. Using validated paper-and-pencil questionnaires, we assessed patients’ perceptions of physicians’ cultural competence in four domains (macro cultural issues, proxemics/chronemics, language issues, and patient-centeredness) as well as fear of physicians. Results: Fear of physicians was associated with perceptions that physicians’ accommodated cultural differences related to issues of personal space and time and with perceptions of physicians’ provision of patient-centered care. Other domains of intercultural competence indicated negative association, but were not significant. Conclusions: The findings of this study provide evidence that some forms of physician accommodation of cultural difference are associated with reduced fear of physicians. These findings have implications for promoting physicians' cultural competence in healthcare interactions. These implications, with a focus on patient-physician communication are discussed. [ABSTRACT FROM AUTHOR]

Background: Effective treatment strategies for post-stroke muscle spasticity are still a significant interdisciplinary issue and challenge for neurologists, neurosurgeons, physiatrists nurses and physiotherapists. Extracorporeal shock wave (ESW) treatment is a well-supported physical modality used in a wide range of musculoskeletal disorders. The list of justified indications for ESW treatment and scientific areas of investigations is continuously evolving and adapting to different pathologies, including spasticity after stroke. Objectives: To analyze the relevant available research and clinical studies demonstrated that the treatment potentials and effectiveness of ESW procedure including mechanisms of the anti-spastic action within hypertonic muscles after stroke. Literature Search: A computer research was performed using MEDLINE, PubMed, PEDro, CINAHL, and EMBASE databases. Assessment of eligibility of papers was determined by two independent reviewers. The inclusion criteria comprised: publication in peer-reviewed journals, studies published in the last 10 years, involving clinical trials, full-version available and written in English only. Discussion: A total of 91 articles were collected, 83 of which were non relevant. Ultimately, 8 clinical studies within a total of 195 patients met inclusion criteria for this review. Only one randomized controlled trial was found and then scored using the Cochrane-based assessment. The other studies involving were analyzed separately according to their methodological quality in a descriptive manner. Conclusions: ESW was found to be safe and effective. The mechanism of ESW action is still under investigation. [ABSTRACT FROM AUTHOR]

Background: Assessment of the health effects of low-level exposure to hydrogen sulfide (H2S) on humans through experiments, industrial, and community studies has shown inconsistent results.Objective: To critically appraise available studies investigating the effect of H2S on the central nervous system (CNS) and on respiratory function.Methods: A search was conducted in 16 databases for articles published between January 1980 and July 2014. Two researchers independently evaluated potentially relevant papers based on a set of inclusion/exclusion criteria.Results: Twenty-seven articles met the inclusion criteria: 6 experimental, 12 industry-based studies, and 10 community-based studies (one article included both experimental and industry-based studies). The results of the systematic review varied by study setting and quality. Several community-based studies reported associations between day-to-day variations in H2S levels and health outcomes among patients with chronic respiratory conditions. However, evidence from the largest and better-designed community-based studies did not support that chronic, ambient H2S exposure has health effects on the CNS or respiratory function. Results from industry-based studies varied, reflecting the diversity of settings and the broad range of H2S exposures. Most studies did not have individual measurements of H2S exposure.Discussion: The results across studies were inconsistent, justifying the need for further research. [ABSTRACT FROM AUTHOR]

Background: There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work. Objective: This paper describes our institution's experience devising practical solutions to research barriers in this setting. Method: Through concentrated efforts to overcome research barriers, such as by cultivating collaborative relationships and capitalizing on unanticipated benefits, we successfully facilitated conduct of five simultaneous inpatient stroke studies. Results: Tangible benefits realized include increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team. [ABSTRACT FROM AUTHOR]

Rural Appalachian Kentucky adolescents are less likely to receive age-appropriate vaccinations compared with other populations and these low vaccination rates represent a major public health risk. This study investigates parental acceptance of adolescent vaccinations by examining their knowledge, attitudes, and behaviors related to vaccinating their adolescents with both state required and recommended vaccines. Using the integrated behavioral model as a guiding framework, the researchers conducted 21 in-depth interviews with parents of 11-18-year-old children in Appalachian Kentucky. Three salient findings emerged. First, knowledge was not strongly related to a parent's behavior, as both vaccinating parents and non-vaccinating parents expressed varying degrees of accurate knowledge. Second, attitudes emerged as an important predictor of behavior, such that parents with positive preventive health attitudes had the desire to protect their children's future through vaccination, indicating risk protection behavior could precede knowledge acquisition. Third, opinion leaders in the community served as important motivators for parents vaccinating their children, contributing to the knowledge-attitude-practice gap in that their influence seemed to be enough to drive behavior. The paper concludes with a discussion of the findings and appropriate communication strategies to use with parents of adolescents and local healthcare providers in order to improve both state required and recommended vaccination rates. The implications from this study could provide insights for designing similar interventions in other underserved, rural areas. [ABSTRACT FROM AUTHOR]

Background: Asperger syndrome (AS) may be difficult to distinguish from psychosis in the schizophrenia spectrum (PSS), as the two conditions share core features. Aim: The aim of this paper is to identify symptoms which are useful in the differential diagnostic process, and which symptoms cause confusion in the assessment. Methods: Twelve patients, consecutively referred to a specialized psychiatric inpatient unit for re-diagnostic assessment, were recruited in a 3-year period. The patients were systematically assessed for both AS and for psychotic disorder in the schizophrenia spectrum. Results: Symptoms that caused misdiagnosis in the present sample were especially idiosyncratic speech taken for delusions (or the reverse), dysfunction related to self-care, task solving, and relationships, and social impairment taken for negative symptoms (or the reverse). Useful areas were symptom onset, symptoms of disorganized speech, occurrence of hallucinations, and occurrence of relapses. The latter contributed to diagnostic clarity related to PSS only. Conclusion: Patients with both AS and PSS may show severe symptoms which usually are difficult to distinguish. When both AS and PSS are suspected in severely impaired adult patients, comprehensive assessment including both AS and PSS is required. Symptoms that may differentiate PSS from AS are age of onset, presence of hallucinations, presence of disorganized speech and behaviour, and occurrence of relapses. Confusing symptoms include social impairments, and idiosyncratic opinions in persons with AS, which may be mistaken for delusions (or the reverse). Also bizarre behaviour and general dysfunction may be wrongly attributed to AS or PSS. [ABSTRACT FROM AUTHOR]

Background The majority of deaths in the UK occur in acute hospitals, and older people have the highest hospital death rates. Improved palliative care for older people has been identified as an international priority, yet little is known about the profile of older patients with palliative care needs in hospitals. Objective To describe the profile of older hospital inpatients (≥85 years), and to explore the prevalence and nature of palliative care needs among this group. Methods A cross-sectional survey of palliative care need in older people was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Patients (or consultees) completed assessments of palliative care need. Subjects Data were collected for 654 consenting patients/consultees. This paper describes data from 110 patients aged ≥85 years. Results Forty per cent of the older patients were identified as having palliative care needs according to GSF criteria. Frailty was the most common indicator of palliative care need (16.7%). The most common reason for admission to hospital was general frailty (25.5%). Conclusions While this study is limited by its small sample size, the results suggest that older people with frailty conditions constitute a substantial proportion of hospital inpatients with palliative care needs. However, it is unclear whether a specialist palliative care framework is the most appropriate model for this group. The care provided to older people at the end of life may best be provided by generalists such as geriatricians, as part of a comprehensive generalist-led palliative care framework. [ABSTRACT FROM AUTHOR]

Background The background literature suggests that recruiting patients with advanced cancer from hospice day care to participate in a research study may be challenging. Aim This paper describes such challenges and considers whether those faced by researchers in this study reflect those recorded in the literature. Method Six hundred and twenty-six patients with advanced cancer from hospice day care units in the north-west region of England were recruited as part of a multi-centre mixed methods study to determine the prevalence, aetiology, and natural history of depression and demoralization. Results A number of challenges were reported (i) data collection sometimes presented researchers with ethical dilemmas, although the ability to respond appeared to be influenced by disciplinary background and training, (ii) emotional impact of the research may force researchers to face a variety of emotional responses, and (iii) dilemmas relating to the setting and maintenance of role boundaries included determining the level of emotional connection required to establish relationships of trust between researchers and participants, and imbalances in power and status. Discussion Many of the challenges faced by researchers to recruit patients with advanced cancer from hospice day care to participate in this research study were similar to those described in the literature. Conclusion Most researchers reported that the overall experience was positive, although a number of moral and ethical dilemmas required ongoing reflection and continuing support and supervision to resolve. It is hoped that other researchers engaging in similar forms of research in the future can learn from the challenges that have been identified. [ABSTRACT FROM AUTHOR]

Background Current models of care for people with advanced chronic obstructive pulmonary disease (COPD) have been demonstrated to be inadequate, particularly in areas such as advance care planning, symptom control and psychosocial and spiritual care. Aim This paper aims to explore how a model of patient-centred care can incorporate a palliative approach to form a practical and useful framework for care that meets the needs of people with advanced COPD. Discussion There is increasing recognition of the need to provide active disease management at the same time as supportive care for people with chronic disease. A palliative approach can incorporate these two care imperatives but a number of barriers often make implementation problematic. A patient-centred care approach can help to address these barriers and is increasingly being seen as an appropriate framework for all healthcare service provision. Significant changes are required to health systems and service provision for this model of care to be implemented; specialist palliative care services can take a leading role in change management. Conclusion Patient-centred care provides an appropriate framework for the development of a model of care for advanced COPD. It allows for a need-based approach to service provision, rather than the current prognosis-based system and brings patient and carer needs and concerns to the forefront of care. [ABSTRACT FROM AUTHOR]

This paper reports a study of 15 participants with life-threatening illnesses staying in an inpatient hospice. The essence of their experience was categorized into nine themes: defining hospice for the older Chinese participant; burden of others; control and distress from being dependent; worry about family; dislike of hospital stay; fear of pain and suffering; being the voice of others - impact on communication; culture barrier; and relying on religion. The results of this study provide insights into the experiences of this specific group of older people to assist improvement in their care as they die. [ABSTRACT FROM AUTHOR]

Family caregivers are the primary caregivers of family members over the course of illness. Some caregivers exhibit elevated levels of distress following the death of the person for whom they were caring. Despite the practical relevance for providing supports and services to caregivers and families, pre- and post-bereavement, the effect of caregiving on bereavement is obscured. In examining the research literature on caregiving and bereavement, three methodological limitations were identified - caregivers' perspectives on preparing for the death of the person for whom they were caring is typically not assessed; the effect of caring on post-death adjustment tends to be assessed qualitatively, cross-sectionally, and retrospectively; and there is a lack of adequate comparison groups. This paper highlights the need to address two important gaps in understanding the effects of caregiving and bereavement: (1) caregivers' understandings and experiences of the anticipating and preparing for the death of the person for whom they are caring, and (2) the relationship between caregivers' pre-death grief and distress and post-death adjustment. Caregivers relieve significant costs from the health system, and improved support, pre- and post-bereavement, will continue to benefit them as well as society. Without significant research investment, palliative care services will continue to operate without a suitable evidence base to support their bereavement care efforts. [ABSTRACT FROM AUTHOR]

Background Chronic obstructive pulmonary disease (COPD) is a significant source of human and financial cost worldwide, yet practitioners seldom discuss prognosis or advance care planning (ACP) with these patients. The ascendency of more patient-centered models of care suggests a need for change in our traditional approaches to ACP. This paper offers some preliminary observations from a qualitative doctoral study to explore the question: What is required for meaningful, acceptable ACP in the context of advanced COPD? Methods Fifteen people (eight patients with advanced COPD plus seven informal caregivers) participated in two in-home sessions of ACP-related dialogue. Participants were asked about this ACP experience, with particular attention to effects on hope. Findings Despite initial resistance on the part of six out of eight patients, all were able to discuss end-of-life care concerns and appreciate some aspects of doing so. In general they appreciated the sessions as an opportunity to: (1) learn more about end-of-life care options; (2) consider/document end-of-life care preferences; (3) counter the silence around the subject; and/or (4) have their illness concerns and experiences heard. Conclusions Participant feedback suggests that they found the study ACP sessions acceptable and meaningful. All were able to consider/address end-of-life care concerns without affecting hope, and they felt cared for while doing so. ACP done as a sensitive, ongoing patient/family-centered process may enhance end-of-life care decision making, but just as importantly may be experienced as a mode of care at a time and by a population that often seems neglected on both counts. [ABSTRACT FROM AUTHOR]

The experiences of being a deaf role model have been little explored in the literature. This paper explores the role of the deaf role model as perceived by d/Deaf adults who carried out this role, when working with deaf young people, parents of deaf children, and professionals who work with them. The data were collected from part of the evaluation study of the National Deaf Children's Society's deaf role model project. Five focus groups were carried out with d/Deaf adults who were trained to be deaf role models across the UK. From deaf role models' perspective, five key issues were identified: the value of training; perceived benefits for families/deaf young people; managing parental expectations; addressing parental attitudes to deafness; and the personal impact of being a deaf role model. Recognizing and valuing d/Deaf adults' work with the families of deaf children/young people will benefit not only families and the other professionals who work with them, but also d/Deaf adults themselves. [ABSTRACT FROM AUTHOR]