Search

The purpose of this qualitative study was to examine how counsellors narrate their experiences of assessing and counselling youth who are at risk for suicide, the challenges and opportunities they face, and the conditions that support them in working in a relational, ethical, and useful way. Our analysis focused on how counsellors described their experiences working with youth who are at risk for suicide, the prevailing discourses and institutional requirements shaping their accounts of their practice, and some of the potential effects of these ways of thinking, talking, and relating. Our findings show some of the specific ways that counsellors “work the tensions” in their therapeutic encounters with youth who are at risk for suicide. This involves compliance and critique as well as artful reinterpretation. We hope to make a useful contribution to a growing body of practice-based evidence that recognizes the value of flexible, relational, and reflexive approaches to counselling youth who are at risk for suicide.

Social work practice in a global context requires an understanding of the cross-cultural nature of practice settings in local communities and globally. One step to developing this understanding of the internationalisation of social work education, including the student internship, is to incorporate supervision by local practitioners and educators. A qualitative interview study of fourteen social work students from Australia, New Zealand, Europe and the USA completing internships in the Southwest Indian state of Kerala revealed themes of increased practice knowledge, practice skills, understanding of cross-cultural values and ethics, critical reflection and research skills development as a result of reflexive supervision provided to them by practitioners in their internship agencies and faculty from their host and home institutions. This challenging of views within one’s own culture, promoted by supervision, leads to increased capacity to engage in critical anti-oppressive practice amongst social workers.

To characterize adolescents' practical knowledge of asthma self-management and experiences during acute asthma episodes, and compare practical knowledge between minority and non-minority groups.We conducted a secondary analysis using a qualitative descriptive design of textual data collected from 126 adolescents that participated in a randomized controlled trial of an asthma self-management program. Directed content analysis was conducted using four constructs of asthma self-management including symptom prevention, symptom monitoring, acute symptom management, and symptom communication.Most of the adolescents knew how to prevent exercised-induced bronchoconstriction, but had limited understanding about how to assess and monitor the severity of acute symptoms, appropriately use bronchodilators, seek timely medical help, and communicate acute symptoms to caregivers or healthcare providers during a slow-onset and rapid-onset asthma attack. More minority participants monitored asthma using peak expiratory flow than non-minority participants, who often relied on symptom-based monitoring. Minority adolescents more frequently mentioned bronchodilator use to manage asthma attacks, while non-minority adolescents often reported use of complementary and alternative approaches. Minority youth mentioned accessing healthcare services for acute episodes more often than their non-minority counterparts. Minority participants mentioned communicating acute symptoms to their providers, or family members less frequently than non-minority youth.Adolescents have insufficient practical knowledge about ways to prevent and manage acute asthma. Periodic assessment of learning needs related to asthma attacks should be considered a routine part of clinical visits for adolescents to provide targeted information support to address their identified needs.

Background: Current outcomes for mental illness are widely regarded as poor. Since the introduction of psychotropic medications in the mid 1950's, previous psychosocial practices were minimized in favor of medication focused treatment. The majority of large U.S. state hospitals have closed with records destroyed or in storage, inaccessible to researchers. This creates barriers to studying and comparing outcomes before and after this shift in treatment practices. Aims: The study aim was to examine discharge outcomes in relation to length of stay and diagnosis in one U.S. state hospital. Methods: This case series study examined 5,618 medical records of participants admitted from 1945-1954, the decade prior to adoption of psychotropic medications. Results: Of the 3332 individuals who left the facility, over half (59.87%) of first episode hospitalizations were discharged within one year, and only 16.95% were hospitalized for more than five years. 46.17% of all admissions were discharged from hospital alive with no readmission. The most common diagnoses included schizophrenia, other forms of psychosis, and alcoholism. In the decade before the introduction of psychotropic medications, participants were often admitted for a single episode and returned to their homes within several years. Conclusions: This data challenges the erroneous assumption that prior to the introduction of psychotropic medications, participants were routinely hospitalized for years or decades and did not improve, never returning home.

Assessing workforce diversity is an increasing area of evolution. A comprehensive assessment of socioeconomic diversity is important in that it can help identify needs and enable planned inclusion across a range of students. Subsequently, a more comprehensive set of background indicators is needed. The purpose of this brief report is to describe the approach we are using to determine socioeconomic background among individuals participating in a behavioral health workforce program. By using 3 strategies to assess background, we were able to determine that 4 individuals reported being unable to pay for housing, 3 indicated they had sold plasma, and 1 had experienced homelessness since starting graduate school. Our findings provide a starting point for using a comprehensive set of indicators to guide the recruitment and selection process in workforce development programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This article describes an interprofessional workforce development program that aims to train current and future behavioral health professionals in culturally- and developmentally-appropriate, integ...

Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients.This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ.Across all visits, males (n = 150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n = 120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients.Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.

This multi-jail study examines the behavioral health needs and service use in a sample of 3,787 individuals in jail, to compare women in rural jails to their gender and geography counterparts (that is rural men, urban women, and urban men). Compared to urban women (17.9%, n = 677), rural men (18.2%, n = 690), and urban men (56.1%; n = 2,132), rural women (7.6%, n = 288) had significantly higher odds of serious mental illness and co-occurring mental health and substance use disorders. Rural woman were nearly 30 times more likely to receive jail-based mental health services; however, a discrepancy between screened mental health need (43.1%, n = 124) and jail-identified mental health need (8.4%, n = 24) shows rural women are severely under-identified compared to their gender/geography counterparts. These findings have implications for the changing nature of jail populations and suggests the need to improve behavioral health identification methods.

Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors have demonstrated kidney, cardiovascular and mortality benefits in the general population; however, the evidence is limited in solid organ transplant recipients. The aim of this systematic review was to evaluate the current efficacy and safety data of SGLT2 inhibitors in adult kidney, heart, lung, and liver transplant recipients with pre-existing type 2 or post-transplantation diabetes mellitus.We searched MEDLINE, MEDLINE Epub, CENTRAL, CDSR, EMBASE, CINAHL, and sources of unpublished literature. All primary interventional and observational studies on SGLT2 inhibitors in transplant recipients were included. Clinical outcomes included mortality, cardiovascular and kidney events, and adverse events such as graft rejection. Surrogate markers including hemoglobin A1c (HbA1c) and weight reduction were also evaluated.Of the 17 studies that were included in this systematic review, there were 15 studies on kidney transplant recipients (n = 2417 patients) and two studies on heart transplant recipients (n = 122 patients). There was only one randomized controlled trial which evaluated 49 kidney transplant patients over 24 weeks. Overall, studies were heterogeneous in study design, sample size, duration of diabetes, time to SGLT2 inhibitor initiation post-transplantation (ranging from 0.88 to 11 years post kidney transplant; five to 5.7 years post heart transplant) and follow-up (ranging from 0.4 to 5.25 years in kidney transplant patients; 0.75 to one year in heart transplant patients). Only one retrospective study evaluated mortality as a part of a composite outcome in kidney transplant patients; however, study limitations restrict generalizability of results. Overall, studies could not confirm clinical cardiovascular and kidney benefits in the transplant population. Findings suggested that SGLT2 inhibitors may improve glycemic control; however, they are associated with urinary tract infection. Diabetic ketoacidosis and acute kidney injury also occurred in these studies, with precipitating factors such as infection and acute heart failure exacerbation.While SGLT2 inhibitors are promising agents with expanding indications in the non-transplant population, these agents may not be suitable for all solid organ transplant recipients, and close monitoring (e.g. for urinary tract infections) and patient education (e.g. sick day management) are essential if these agents are initiated. Evidence is based on short-term findings and suggests an association with hemoglobin A1c reduction and increased adverse events. Further long-term randomized controlled trials are needed to evaluate the effect of SGLT2 inhibitors on clinically important outcomes, including mortality reduction, in solid organ transplant recipients.

The purpose of this article is to describe two innovative, interdisciplinary workforce development programs that aim to meet the needs of individuals who misuse opioids and may contend with mental ...

Background Conversations about death are often associated with fear, anxiety, avoidance and misunderstandings. Many adults feel that these discussions are inappropriate and confusing for young people. In this project, two fourth-year nursing students partnered with a local palliative care team to examine death education for children. The nursing students focused on children's understandings of death and their coping abilities, the lack of appropriate discussions about death with children, and the implementation of death education in public schools. Three online death education resources were identified and evaluated for use in public schools. This project fueled preliminary local discussions and advocacy efforts in the provision of death education for children. In the future, death education will need to be incorporated into education plans at local schools, and could be done in collaboration with the local palliative care team.

A striking feature of the Hunger Games trilogy is the way Suzanne Collins ties together issues of environmental exploitation and crisis with political issues of economic exploitation and inequality to provide an overarching dystopian critique of consumer culture. Additionally, she models solutions not only in the form of collective political action, but also in terms of individual lifestyle choices and communal practices. The books suggest that even small changes in mindset and lifestyle can make a difference to overwhelming social and environmental issues. The Hunger Games trilogy reveals exploitative and anthropocentric consumer-driven culture as a normative context in Western society, whilst simultaneously drawing attention to alternative place-based, bio-centric, communal and sustainable potential relationships to the environment.

Objectives: Work is a critical part of recovery for many people with chronic health conditions, including Substance Use Disorders (SUD). Individual Placement and Support (IPS) is an evidence-based practice designed initially for adults with mental illness. Although the evidence for using IPS with individuals with severe mental illness is well documented, less is known about the efficacy of using IPS with consumers with substance use disorders, and the results have yet to be systematically evaluated and organized. Key components of zero exclusion, rapid competitive job search, and incorporation with treatment services as well as benefits are components that make IPS a strong practice to incorporate into substance abuse treatment. This study aims to evaluate and organize the evidence base of using IPS with adults with substance use disorders. Results: A systematic review was conducted of meta-analyses, reviews, and individual studies from 2000 through 2019, measuring the efficacy of IPS with individuals with SUD or comorbid SUD. Databases searched were Scopus, PubMed, and PsychInfo. Experimental and quasi-experimental studies are reviewed and critiqued for their application to a SUD population. Then, barriers and facilitators of IPS implementation with this population are discussed. Conclusions/Importance: There is a high evidence to support to application of IPS for persons with SUD, both singly and when combined with a mental health disorder. Barriers to IPS implementation including episodic treatment, risk of relapse, and housing or criminal justice instability make the IPS program a useful best practice to consider for this population.

In 21st century social work education, faculty must build on student experiences to construct new learning opportunities. However, traditional academic approaches often struggle with this. ...

Study abroad programs are increasingly encouraged as a method for students to develop cross-cultural competence and awareness of how to practice in diverse and multi-national settings. Barr...

OBJECTIVE To characterize clinical, clinicopathologic, and hepatic histopathologic features and outcome for dogs with probable ketoconazole-induced liver injury. ANIMALS 15 dogs with suspected ketoconazole-induced liver injury that underwent liver biopsy. PROCEDURES Medical record data were summarized regarding signalment, clinical signs, clinicopathologic and hepatic histopathologic findings, concurrent medications, ketoconazole dose, treatment duration, and outcome. RESULTS Median age and body weight were 8.2 years (range, 5 to 15 years) and 13.0 kg (28.6 lb; range, 8.2 to 38.0 kg [18.0 to 83.6 lb]), respectively. The most common breed was Cocker Spaniel (n = 5). All dogs received ketoconazole to treat cutaneous Malassezia infections. Median daily ketoconazole dose was 7.8 mg/kg (3.5 mg/lb; range, 4.4 to 26.0 mg/kg [2.0 to 11.8 mg/lb]), PO. Treatment duration ranged from 0.3 to 100 cumulative weeks (intermittent cyclic administration in some dogs); 6 dogs were treated for ≤ 10 days. Common clinical signs included lethargy, anorexia, and vomiting. All dogs developed high serum liver enzyme activities. Hepatic histopathologic findings included variable lobular injury, mixed inflammatory infiltrates, and conspicuous aggregates of ceroid-lipofuscin–engorged macrophages that marked regions of parenchymal damage. Five dogs developed chronic hepatitis, including 3 with pyogranulomatous inflammation. Of the 10 dogs reported to have died at last follow-up, survival time after illness onset ranged from 0.5 to 165 weeks, with 7 dogs dying of liver-related causes. CONCLUSIONS AND CLINICAL RELEVANCE Findings for dogs with hepatotoxicosis circumstantially associated with ketoconazole treatment suggested proactive monitoring of serum liver enzyme activities is advisable before and sequentially after initiation of such treatment.

Heart transplantation is the standard of therapy for patients with end-stage heart disease. Since the first human-to-human heart transplantation, performed in 1967, advances in organ donation, surgical techniques, organ preservation, perioperative care, immunologic risk assessment, immunosuppression agents, monitoring of graft function and surveillance of long-term complications have drastically increased recipient survival. However, there are yet many challenges in the modern era of heart transplantation in which immunosuppression may play a key role in further advances in the field. A fine-tuning of immune modulation to prevent graft rejection while avoiding side effects from over immunosuppression has been the vital goal of basic and clinical research. Individualization of drug choices and strategies, taking into account the recipient's clinical characteristics, underlying heart failure diagnosis, immunologic risk and comorbidities seem to be the ideal approaches to improve post-transplant morbidity and survival while preventing both rejection and complications of immunosuppression. : The aim of the present review is to provide a practical, comprehensive overview of contemporary immunosuppression in heart transplantation. Clinical evidence for immunosuppressive drugs is reviewed and practical approaches are provided. Cardiac allograft rejection classification and up-to-date management are summarized. Expanding therapies, such as photophoresis, are outlined. Drug-to-drug interactions of immunosuppressive agents focused on cardiovascular medications are summarized. Special situations involving heart transplantation such as sarcoidosis, Chagas diseases and pediatric immunosuppression are also reviewed. The evolution of phamacogenomics to individualize immunosuppressive therapy is described. Finally, future perspectives in the field of immunosuppression in heart transplantation are highlighted.

Mental health and substance use disorders co-occur frequently, and are associated with poorer outcomes in life domains including housing, employment, health, and recovery. Finding evidence-based interventions for engagement and recovery can be a challenge for practitioners and organizations, as it involves accepting new interventions, and then implementing and measuring the results. However, practitioners frequently use their opinions or non-generalizable experiences rather than evidence-based findings to guide their practice. Medication-assisted therapy programs, especially for individuals with co-occurring mental health and substance use disorders, is an area of treatment where there are solid evidence-based outcome findings and where, nonetheless, many practitioners continue to use less-, or non-effective treatment approaches. Conflict between groups of staff using two different approaches can have serious negative impact on treatment outcome. These can be effectively addressed through a combination of education and interventions aimed at resolving intra-staff conflict.