Search

In many emergency medical services (EMS) systems, a direct medical oversight physician is available to paramedics for mandatory and/or elective consultations. At the time of this study, a clinical support desk (CSD) was being implemented within the medical communications center of a provincial EMS system in addition to the physician resource. The CSD was initially staffed with a registered nurse or an advanced care paramedic. The objective of the current study was to compare CSD "peer to peer" consults versus physician consults with regards to consultation patterns, transport dispositions, and patient safety measures.This retrospective cohort study analyzed 2 months before (September 1 to October 31, 2012) and 2 months after (September 1 to October 31, 2013) implementation of the CSD. In the before period, all clinical consults were fielded by the direct medical oversight physician. In the after period, consults were fielded by the physician, CSD or both. EMS databases were queried, and manual chart review and abstraction of audio recordings were done. Relapses back to EMS within 48 hours of non-transport were measured.1621 consults were included, with 764 consults in the before period and 857 after (p = 0.02). The number of physician consults decreased from 764 before to 464 after (39.2%, p 0.001), with the CSD taking 325 (37.9%) consults. The CSD was consulted more for police custody and trip destination. The physician was consulted more for cease resuscitation and clinical consults prior to medication administration. Overall non-transport rates were 595/764 before (77.9%), and 646/857 after (75.4%) (p = 0.2). Non-transports were 233/325 (71.7%) via the CSD, 364/464 (78.4%) via the physician, and 49/68 (72.1%) when both were involved (p = 0.07). Rate of relapse to EMS was similar before (25/524, 4.8%) and after (26/568, 4.6%) (p = 0.76), and between CSD (12/216, 5.5%) and physician consults (13/325, 4.0%) in the after period (p = 0.41).The introduction of a novel "peer-to-peer" consult program was associated with an increased total number of consults made and reduced call volume for direct medical oversight physicians. There was no change in the patient safety measure studied.

Risk perceptions are key constructs in some theories of health behavior. A tripartite model of risk perception, the TRIRISK model, was developed to assess deliberative, affective, and experiential components of risk perception. The current paper attempts to replicate the factor structure of the TRIRISK measure for cancer and extend the structure to respiratory illness.Participants 18 or older were recruited using an address-based sample in New York State to participate in a Web-based survey. We employed the TRIRISK questionnaire with respect to cancer and respiratory illness. Confirmatory Factor Analyses were conducted in Mplus to validate the TRIRISK model in our sample. TRIRISK model fit across demographic and behavioral groups was tested using multiple-group models.Of the 704 people included in the analysis, the mean age of participants was 46.9, the majority reported being female (58.5%), and most were White (81.7%). For cancer and respiratory illness, items loaded on the respective constructs as expected. Overall, the TRIRISK model framework fits well across differing subgroups, suggesting that this is a valid model of risk perception to use in a general population sample.These results provide further evidence that the TRIRISK model is a good model to use for risk perceptions in tobacco control research. The TRIRISK model can be used to communicate risk to encourage positive health behaviors among most sociodemographic groups.

Programs of All-Inclusive Care for the Elderly (PACE) are an effective approach to improve care quality and delay institutional admissions especially for Black and Hispanic older adults who have seen a disproportionate rise in nursing home use. Guided by Andersen's Behavioral Model of Health Services Use and employing focus groups and one-on-one interviews, we qualitatively examined factors influencing access to and use of PACE by Black and Hispanic older adults. The study sample consisted of thirty-two PACE enrollees, six marketing-team members, and four family-caregivers from three PACE sites in a northeast urban city. Informed knowledge, cultural beliefs, and attitudes toward PACE were found to affect access. Community resources, available services, and care quality facilitated enrollment/participation. Barriers identified included poor dissemination of information and inadequate emphasis on staff's sensitivity to enrollees' cultural and disability differences. Findings will help healthcare leaders capitalize on facilitators and address barriers to enhance access and use of PACE by racial and ethnic minority older adults.

To examine the pain experiences of women in midlife with existing health conditions, including changes from prior to the COVID-19 pandemic through the first 6 months of the crisis.Women ages 40-60 with health conditions (e.g., hypertension;Pain occurrence (yes/no), number of locations, and intensity.Women reported pain at 35% of surveys, particularly after waking and before bed compared to the middle of the day. The occurrence of pain decreased over time, whereas pain intensity decreased between pre-COVID-19 and stay-at-home orders but then remained stable. The number of pain locations decreased between stay-at-home orders and reopening, and pain was more variable during the pandemic than prior to its onset (Women experienced decreased pain frequency and intensity from prior to during the COVID-19 pandemic, though pain was less predictable during (vs. prior to) the pandemic. This information may be useful for informing care in this at-risk group, to prevent the development of chronic pain.

Since the early 1990s, federal and state legislation restricting the residency options of convicted sex offenders has been justified on the basis of protecting vulnerable populations while deterrin...

This project explores in/visibility, publicity, and politics in the infrastructural imaginary of Spruce Pine, a mining town in the US state of North Carolina. Through participant observation and ot...

The current understanding of sexual consent negotiation is grounded in research conducted with heterosexual populations, and little is understood about how non-heterosexual men (bisexual, bi-curiou...

The emergence of COVID-19 as a global pandemic has necessitated the cooperation and collaboration of public health, public administration, and GIS professionals in order to keep the public informed...

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, plus) people, compared to their heterosexual and/or cisgender (non-transgender) counterparts, are more likely to be discriminated against based o...

Few sexual health studies have examined subgroup differences in youth risk behaviors that sufficiently account for sexual orientation and gender identity. This study used 2017 New York City Youth R...

In 2015 the Gender Vectors research team received a major research grant to conduct research with and about trans-gender youth in the Greater Vancouver Area. A unique aspect of this research project involved combining social action research with the development of a prototype of a video game as a knowledge translation tool to depict the life experiences of trans youth. We draw on transformative gender just-ice theory to document and address the diminished life chances of and the need to promote resilience among trans youth in the region and more broadly, across Canada and the United States. This article provides an overview of the research project and concludes by identifying key insights relating to resiliency that resulted from 15 narrative interviews with trans-gender youth, focus group meetings with the Project’s Youth Advisory Council, and dialog from an inter-generational workshop for transgender youth and adult care/service providers and allies. These themes informed the creation of the prototype.

This editorial eulogy recognises the work of Dr Ruth Mann (1965–2020), a friend, colleague, mentor, pioneer and trailblazer in forensic psychology in the UK and internationally. Our field has lost ...

Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked.This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product.Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used.Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product.The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.

Little research exists in relation to the prevalence of special educational needs (SEN) in immersion education throughout the world. Parents are often dissuaded by educational professionals against...

In Lezione d'amore (2004), Patrizia Valduga voices a woman, who suggests she is a masochist, and her male partner as they progress through their sexual encounters. This essay makes three claims: fi...

In recent years, more college athletes have publicly identified as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). Our study seeks to move past media celebrations and controversies of "coming out" and examine actual experiences of LGBTQ athletes and their teammates. A survey of 259 LGBTQ athletes and teammates of LGBTQ athletes was conducted. We examined concerns about being or playing with LGBTQ athletes, sources of homophobic language, experiences and observations of discrimination, and perceived impact of being or playing with an LGBTQ athlete. Findings indicate that many fears associated with college athletes coming out are likely overstated. All participants reported low levels of concern, homophobia, and negative impact of being or playing with an LGBTQ teammate. However, there were some differences between LGBTQ and non-LGBTQ athletes with non-LGBTQ athletes reporting fewer concerns, but also hearing less homophobic language than their LGBTQ counterparts. programs.

Female adolescents are at greater risk for depression than males, and highschool students in upper grades use alcohol at higher rates than students in lower grades. We hypothesized that attributes ...

Approximately 25% of US older adults live with a mental health disorder. The mental health needs of this population are chiefly met by primary care providers. Primary care practices may have inadequate strategies to provide satisfactory care to mentally ill older adults. This study used Centers for Medicare and Medicaid Services data to identify factors, including racial/ethnic differences, associated with dissatisfaction with medical care quality among older adults diagnosed with a mental health disorder. Our findings suggest factors that can be addressed to improve satisfaction with medical care quality and potentially promote adherence and follow-up for mentally ill older adults.

While inclusion has generally been accepted as orthodoxy, a knowledge– practice gap remains which indicates a need to focus on inclusive pedagogy. This paper explores how teachers in the Republic of Ireland primary school were supported to develop inclusive pedagogy to meet the needs of learners with special educational needs (SEN). It is underpinned by a conceptual framework which combines an inclusive pedagogical approach and key principles of effective professional development (PD) arising from the literature, which informed the development of a professional learning community (PLC) for inclusive practice in a primary school. The impact of the PD on teachers’ professional practice was explored using an evidence-based evaluation framework. Analysis of interview and observation data evidenced that engagement with inclusive pedagogy in a PLC, underpinned by critical dialogue and public sharing of work, positively impacted teacher attitudes, beliefs, efficacy and inclusive practice. This research offers a model of support for enacting inclusive pedagogy.

Aim: To prospectively validate a pediatric clinical prediction model to identify children at low risk of clinically significant ingestions to prevent unnecessary pediatric intensive care un...

Background Childhood adversities can have a deleterious impact on mental health. Elevated levels of such adversities have been reported in veteran populations. Levels of resilience may be protective but early adverse experiences may impact on the development of resilience in the first instance. Objective This study aims to identify classes of childhood adversities among UK military veterans residing in Northern Ireland (NI) and explore levels of resilience and the mediating role resilience may play following such experiences in relation to mental health. Method The study utilizes data from the Northern Ireland Veterans’ Health and Wellbeing Study (n = 656). All participants were UK Armed Forces veterans who were residents of NI with an average age of 56 (586 males, 70 females). Results Four childhood adversity classes were revealed, with almost a half of the sample experiencing early adverse experiences. Individuals who experienced a range of adversities, particularly those related to maltreatment were more likely to have PSTD, depression and anxiety disorders and lower levels of resilience. However, those who experienced adversity related to family dysfunction had similar levels of resilience as the low risk class, suggesting tentatively that some adversity may be protective. Mediation analyses revealed that veterans with elevated levels of resilience were less likely to have psychological problems following negative childhood experiences. Conclusions The study highlights the importance of promoting resilience building programmes among military veterans, especially among those who experienced maltreatment as a child., HIGHLIGHTS UK Armed Forces veterans with elevated levels of resilience were less likely to have psychological problems following negative childhood experiences.

Heterosexist phrases on college campuses can contribute to negative consequences among lesbian, gay, bisexual, queer, and other sexual minority students (LGBQ+), however, their relationship to acad...

Sexual orientation microaggressions are common on college campuses and can contribute to negative outcomes; yet little is known about their relationship with substance use outcomes. Among a convenience sample of cisgender sexual minority college students (

I was born and grew up in Hartlepool, a small town in the north east of England. There was no theatre there to speak of, but once a year the Royal Shakespeare Company would bring productions from S...

Habitat assessments often require observers to estimate tree hollows in situ, which can be costly, destructive and prone to bias. An alternative is to count the number of trees above a spec...

This essay examines use of the metaphor ‘coming out of the closet,’ providing an overview of the origins of the metaphor and examples of scholarly and popular use. Several examples are pres...

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.