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Bise CG, Schneider M, Freburger J, Fitzgerald GK, Switzer G, Smyda G, Peele P, Delitto A. First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization. Phys Ther 2023; 103:pzad067. [PMID: 37379349 DOI: 10.1093/ptj/pzad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/03/2022] [Accepted: 03/23/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and largely depend on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. We sought to examine the association between the first provider seen and health care utilization. METHODS Using 2015-2018 data from a large insurer, this retrospective analysis focused on patients (29,806) seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider. RESULTS The primary outcome was the timing and use of health care resources. Total health care use was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care use was seen in those patients who chose the emergency department. CONCLUSION Overall, there appears to be an association between the first choice of provider and future health care use. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources. This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP. IMPACT The first provider seen for an acute episode of LBP influences immediate treatment decisions, the trajectory of a specific patient episode, and future health care choices in the management of LBP.
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Affiliation(s)
- Christopher G Bise
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Health Plan, Department of Health Economics, Pittsburgh, Pennsylvania, USA
| | - Michael Schneider
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Freburger
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - G Kelley Fitzgerald
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Garry Smyda
- UPMC Health Plan, Department of Health Economics, Pittsburgh, Pennsylvania, USA
| | - Pamela Peele
- UPMC Health Plan, Department of Health Economics, Pittsburgh, Pennsylvania, USA
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony Delitto
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Health and Rehabilitation Science, Office of the Dean, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rick AM, Copp E, Buckley A, Yanowitz T, Martin J, Shaikh N, Switzer G, Hooven T, Beigi R. Categorical Risk Stratification for Neonatal Early Onset Sepsis using Suspected Intraamniotic Infection and the Newborn Exam. Res Sq 2023:rs.3.rs-2838294. [PMID: 37577707 PMCID: PMC10418552 DOI: 10.21203/rs.3.rs-2838294/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Objective To determine test characteristics of categorical risk stratification for early onset sepsis (EOS) using maternal criteria for suspected intraamniotic infection (IAI) and/or newborn exam and compare them to the EOS calculator. Study Design Retrospective 1:3 case-control study of late preterm/term infants with bacterial culture growth obtained <72 hours of life. For categorical approach, infants of mothers with suspected IAI or equivocal/ill appearing were presumed high-risk for EOS and blood culture obtained. For calculator, estimated probability of EOS and care recommendations were recorded from online calculator. Test characteristics were compared with McNemar's test; recommendation for blood culture was considered a "positive" test. Result 52 cases and 172 controls were included. Compared to the calculator, the categorical approach had higher sensitivity 90%(95%CI:79-96%) vs 67% (95%CI:54-79%) but lower specificity 85%(95%CI:78-89%) vs. 92%(95%CI:87-96%). 10% of cases were not identified by either. Conclusion A categorical approach using suspected IAI/newborn exam offers good EOS discrimination and is comparable to the calculator.
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March CA, Hill A, Kazmerski TM, Siminerio L, Switzer G, Miller E, Libman I. School Nurse Confidence with Diabetes Devices in Relation to Diabetes Knowledge and Prior Training: A Study of Convergent Validity. Pediatr Diabetes 2023; 2023:2162900. [PMID: 37929232 PMCID: PMC10624001 DOI: 10.1155/2023/2162900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Objective The Diabetes Device Confidence Scale (DDCS) is a new scale designed to evaluate school nurse confidence with diabetes devices. We hypothesized that DDCS score would be associated with related constructs of school nurse diabetes knowledge, experience, and training. Research Design and Methods In a cross-sectional study, we co-administered the DDCS and Diabetes Knowledge Test 2 (DKT2) questionnaires to school nurses in Pennsylvania. We summarized DDCS scores (range 1-5) descriptively. We evaluated the relationship between DKT2 percent score and DDCS mean score with the Spearman correlation coefficient. Simple linear regression examined school nurse characteristics as predictors of DDCS score. Results A total of 271 completed surveys were received. Mean DDCS score was 3.16±0.94, indicating moderate confidence with devices overall. School nurses frequently reported low confidence in items representing specific skills, including suspending insulin delivery (40%), giving a manual bolus (42%), knowing when to calibrate a continuous glucose monitor (48%), changing an insulin pump site (54%), and setting a temporary basal rate (58%). Mean DKT2 score was 89.5±0.1%, which was weakly but not significantly correlated with DDCS score (r=0.12, p=0.06). Formal device training (p<0.001), assisting ≥5 students with diabetes devices in the past 5 years (p<0.01), and a student caseload between 1000-1500 students (p<0.001) were associated with higher mean DDCS score. Conclusions DDCS score is related to prior training and experience, providing evidence for the scale's convergent validity. The DDCS may be a useful tool for assessing school nurse readiness to use devices and identify areas to enhance knowledge and practical skills.
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Affiliation(s)
- Christine A March
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Amber Hill
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Linda Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Ingrid Libman
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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March CA, Hill A, Kazmerski TM, Siminerio L, Miller E, Libman I, Switzer G. Development and psychometric analysis of the Diabetes Device Confidence Scale for school nurses. Pediatr Diabetes 2022; 23:820-830. [PMID: 35661517 DOI: 10.1111/pedi.13375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/04/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND School nurses need to be equipped to help students with diabetes devices. No existing tools assess school nurse self-efficacy in using devices. OBJECTIVE To develop and evaluate the psychometric properties of a novel scale to measure school nurse confidence with diabetes devices. RESEARCH DESIGN AND METHODS We generated a list of items with community partners and examined logical validity. We then revised and distributed the item set to school nurses in Pennsylvania to examine aspects of structural validity, convergent validity, and internal consistency reliability. We used item response theory to refine the scale. RESULTS Facilitated discussion with collaborators generated an initial list of 50 potential items. Based upon the item-content validity index, we revised/eliminated 13 items. School nurses (n = 310) in Pennsylvania completed an updated 38-item scale; the majority had experience with insulin pumps or continuous glucose monitors. Exploratory factor analysis identified a one-factor solution, suggesting a unidimensional scale. We eliminated 13 additional items based upon significant inter-item correlation or skewed response patterns. Item response theory did not identify additional candidate items for removal. Despite a high degree of redundancy (Cronbach's alpha > 0.90), we retained all remaining items to maximize the future utility of the scale. CONCLUSION The 25-item, unidimensional Diabetes Device Confidence Scale is a new tool to measure school nurse confidence with diabetes devices. This scale has future clinical, programmatic, and research applications. Combined with knowledge assessments, this scale can serve to evaluate school nurse device use readiness, assess training gaps, and tailor interventions.
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Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amber Hill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Linda Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ingrid Libman
- Division of Pediatric Endocrinology, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Health Equity Research and Promotion, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kruckenberg KM, Shenai N, Dew MA, Switzer G, Hughes C, DiMartini AF. Transplant-related trauma, personal growth and alcohol use outcomes in a cohort of patients receiving transplants for alcohol associated liver disease. Gen Hosp Psychiatry 2021; 72:73-80. [PMID: 34311144 DOI: 10.1016/j.genhosppsych.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Liver transplantation (LT) is stressful experience which can cause psychological trauma but also positive growth. We examined the prevalence of transplant related post-traumatic stress disorder symptoms (PTSD) and post-traumatic growth (PTG) in a cohort of alcohol-associated liver disease (ALD) LT recipients. We also examined whether PTG or PTSD symptoms were associated with post-LT alcohol use. METHODS Cross sectional survey of 51 ALD LT recipients one-year post-LT assessed PTSD symptoms, PTG, stress, self-efficacy, social support, and alcohol use. RESULTS 18% endorsed symptoms of PTSD; 59% endorsed high PTG. PTSD symptoms and PTG were not associated. 18% drank alcohol; 10% returned to health harmful use. Neither PTSD symptoms nor PTG were associated with alcohol use. Less self-efficacy to abstain and thoughts of drinking were associated with alcohol use. CONCLUSIONS A substantial percentage of ALD LT patients had transplant-related PTSD symptoms and high PTG. Alcohol use was not associated with PTSD symptoms or PTG. Lower self-efficacy to abstain from alcohol use may provide a valuable clinical measure to assess risk for post-LT use. Clinical screening for PTSD would be beneficial as effective treatments for PTSD exist. Whether PTG can be facilitated in transplant recipients would be a valuable future line of inquiry.
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Affiliation(s)
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Psychology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Epidemiology and Biostatistics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Galen Switzer
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Christopher Hughes
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Andrea F DiMartini
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
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6
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Kidd KM, Hill A, Sequeira GM, McMillan C, Switzer G, Rofey D, Miller E, Montano GT. Development and Psychometric Analysis of the Transgender Family Acceptance To Empowerment (TransFATE) Scale. J Adolesc Health 2021; 68:1096-1103. [PMID: 33268218 PMCID: PMC8053728 DOI: 10.1016/j.jadohealth.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Parent and caregiver support can reduce health disparities experienced by gender diverse youth (GDY). Parent and caregiver empowerment improves health outcomes for children with medical and mental health diagnoses, but no existing scale measures this construct in families of GDY. We aimed to develop a scale measuring empowerment in parents and caregivers of GDY. METHODS We adapted two existing scales and added investigator-derived items to create a survey instrument. We revised using input from focus groups and experts assessing face and content validity. Using the revised scale, we surveyed parents and caregivers of GDY from across the U.S. to assess the construct validity through exploratory and confirmatory factor analyses, internal consistency, and convergent validity. RESULTS The initial 67 items were reduced to 42 items after face and content validity analyses. Parents and caregivers (n = 309) from 31 states completed the revised measure. Most participants were white (81.4%), mothers (69.3%), and parenting a gender diverse child who identifies on the binary (transmasculine, male, transfeminine, or female; 91.3%). Exploratory factor analyses showed a two-factor solution: Factor 1 having 10 items (Cronbach's alpha = .86) and Factor 2 having six items (Cronbach's alpha = .86). Our confirmatory factor analysis demonstrated good fit (Comparative Factor Index = .972, Tucker-Lewis Index = .968, Root Mean Square Error of Approximation = .060 [90% confidence interval = .410-.078], and Standardized Root Mean Square Residual = .062). CONCLUSIONS The Transgender Family Acceptance To Empowerment (TransFATE) scale demonstrates face, content, and construct validity among a geographically diverse sample of GDY's parents and caregivers. This scale has the potential to aid in developing and evaluating programs focused on building stronger social supports for GDY through increased family empowerment.
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Affiliation(s)
- Kacie M Kidd
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Amber Hill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gina M Sequeira
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Calvin McMillan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dana Rofey
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gerald T Montano
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Panch SR, Logan B, Sees JA, Bo-Subait S, Savani B, Shah NN, Hsu JW, Switzer G, Lazarus HM, Anderlini P, Hematti P, Confer D, Pulsipher MA, Shaw BE, Stroncek DF. Shorter Interdonation Interval Contributes to Lower Cell Counts in Subsequent Stem Cell Donations. Transplant Cell Ther 2021; 27:503.e1-503.e8. [PMID: 33823169 DOI: 10.1016/j.jtct.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Approximately 7% of unrelated hematopoietic stem cell donors are asked to donate stem cells a subsequent time to the same or a different recipient. Recent studies have shown that donation-related symptoms for second donations are similar to those for the first donation. Little is known about differences in stem cell mobilization and yields for subsequent peripheral blood stem cell (PBSC) and bone marrow (BM) collections. We hypothesized that CD34+ cell yields and total nucleated cell (TNC) concentrations for subsequent PBSC or BM donations are lower than those at the first donation. We also evaluated the factors influencing stem cell yields in healthy unrelated second-time donors. Data were gathered from the Center for International Blood and Marrow Transplant Research database on 513 PBSC and 43 BM donors who donated a second time between 2006 and 2017 through the National Marrow Donor Program. Among the second-time PBSC donors, we found significantly lower preapheresis peripheral blood CD34+ cell counts (68.6 × 106/L versus 73.9 × 106/L; P = .03), and collection yields (556 × 106 versus 608 × 106; P = .02) at the second donation compared to the first. This decrease at the subsequent donation was associated with a shorter interdonation interval, lower body mass index (BMI), and a lower total G-CSF dose. In most instances, suboptimal mobilizers at their first donation donated suboptimal numbers of stem cells at their subsequent donations. Among repeat BM donors, the TNC concentration was lower at the second donation. The small size of this group precluded additional analysis. Overall, when considering repeat donations, increasing the interdonation intervals and evaluating for BMI changes should be considered to optimize stem cell yields. Some of these parameters may be improved by increasing G-CSF dose in PBSC donors within permissible limits.
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Affiliation(s)
- Sandhya R Panch
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, Maryland
| | - Brent Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Stephanie Bo-Subait
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Jack W Hsu
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh Medical Center-Cancer Center, Pittsburgh, Pennsylvania
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Dennis Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - David F Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, Maryland
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Cashion W, Gellad WF, Sileanu FE, Mor MK, Fine MJ, Hale J, Hall DE, Rogal S, Switzer G, Ramkumar M, Wang V, Bronson DA, Wilson M, Gunnar W, Weisbord SD. Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare. Clin J Am Soc Nephrol 2021; 16:437-445. [PMID: 33602753 PMCID: PMC8011004 DOI: 10.2215/cjn.10020620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Many kidney transplant recipients enrolled in the Veterans Health Administration are also enrolled in Medicare and eligible to receive both Veterans Health Administration and private sector care. Where these patients receive transplant care and its association with mortality are unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective cohort study of veterans who underwent kidney transplantation between 2008 and 2016 and were dually enrolled in Veterans Health Administration and Medicare at the time of surgery. We categorized patients on the basis of the source of transplant-related care (i.e., outpatient transplant visits, immunosuppressive medication prescriptions, calcineurin inhibitor measurements) delivered during the first year after transplantation defined as Veterans Health Administration only, Medicare only (i.e., outside Veterans Health Administration using Medicare), or dual care (mixed use of Veterans Health Administration and Medicare). Using multivariable Cox regression, we examined the independent association of post-transplant care source with mortality at 5 years after kidney transplantation. RESULTS Among 6206 dually enrolled veterans, 975 (16%) underwent transplantation at a Veterans Health Administration hospital and 5231 (84%) at a non-Veterans Health Administration hospital using Medicare. Post-transplant care was received by 752 patients (12%) through Veterans Health Administration only, 2092 (34%) through Medicare only, and 3362 (54%) through dual care. Compared with patients who were Veterans Health Administration only, 5-year mortality was significantly higher among patients who were Medicare only (adjusted hazard ratio, 2.2; 95% confidence interval, 1.5 to 3.1) and patients who were dual care (adjusted hazard ratio, 1.5; 95% confidence interval, 1.1 to 2.1). CONCLUSIONS Most dually enrolled veterans underwent transplantation at a non-Veterans Health Administration transplant center using Medicare, yet many relied on Veterans Health Administration for some or all of their post-transplant care. Veterans who received Veterans Health Administration-only post-transplant care had the lowest 5-year mortality.
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Affiliation(s)
- Winn Cashion
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Walid F. Gellad
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Florentina E. Sileanu
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Maria K. Mor
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michael J. Fine
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer Hale
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Daniel E. Hall
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Departments of Surgery, Anesthesia and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shari Rogal
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Galen Switzer
- Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mohan Ramkumar
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Medical Service, Renal Section, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Population Health Sciences and Department of Medicine, Duke University, Durham, North Carolina
| | - Douglas A. Bronson
- Department of Veterans Affairs, Veterans Health Administration, Washington, D.C
| | - Mark Wilson
- Department of Veterans Affairs, Veterans Health Administration, Washington, D.C
| | - William Gunnar
- Department of Veterans Affairs, Veterans Health Administration, Washington, D.C.,Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven D. Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Center for Health Equity Research and Promotion, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Medical Service, Renal Section, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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9
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Seftel MD, Kuxhausen M, Burns L, Chitphakdithai P, Confer D, Kiefer D, Lee S, Logan B, O'Donnell P, Pulsipher M, Shah NN, Switzer G, Shaw BE. Clonal Hematopoiesis in Related Allogeneic Transplant Donors: Implications for Screening and Management. Biol Blood Marrow Transplant 2020; 26:e142-e144. [PMID: 32147534 DOI: 10.1016/j.bbmt.2020.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Matthew D Seftel
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Kuxhausen
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Linda Burns
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Dennis Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Deirdre Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Stephanie Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brent Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul O'Donnell
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Pulsipher
- Section of Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Nirali N Shah
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Birru Talabi M, Clowse MEB, Blalock SJ, Switzer G, Yu L, Chodoff A, Borrero S. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatol 2019; 3:40. [PMID: 31660532 PMCID: PMC6805554 DOI: 10.1186/s41927-019-0091-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to develop an assessment tool, ReproKnow, to evaluate the reproductive health knowledge of women with a wide range of rheumatic diseases. Methods The 10-item multiple-choice questionnaire was developed with feedback from a panel of content experts and female patients with rheumatic diseases. Construct validity using known-groups analysis was evaluated through comparison of median total ReproKnow scores between rheumatology fellows and nurses. Female patients aged 18–50 years were recruited to take ReproKnow and demographic questionnaires in two outpatient clinics. Associations between patients’ mean total knowledge scores and demographic characteristics were assessed using independent-sample t-tests. Questions were also categorized by topical area, and the percentages were calculated. Results The completion rate of questions in ReproKnow was 100% across all users. Median ReproKnow scores were significantly higher among rheumatology fellows than among nurses (p = 0.045). The 153 patients recruited to the study had at least one of 15 rheumatic diseases. Patients’ mean knowledge score was 5.05 (SD 2.24) out of a possible high score of 10. Patients who were younger, White, and more educated had significantly higher scores than did other patients (p’s < 0.05). Patients who bore children after their disease diagnosis had higher knowledge scores than did women whose children were born prior to their diagnosis; in contrast, women with histories of surgical sterilization or hysterectomy had lower knowledge scores than other women. Knowledge scores of women who used potentially fetotoxic medications did not vary from the remainder of the sample. Patients demonstrated gaps in knowledge about birth outcomes, contraceptive efficacy, and breastfeeding safety. Conclusions Initial testing of ReproKnow suggests that it may be a promising tool to assess the reproductive health knowledge of women with diverse rheumatic diseases. Specific knowledge deficits elicited from ReproKnow may be important targets for future educational interventions.
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Affiliation(s)
- Mehret Birru Talabi
- 1Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261 USA
| | | | - Susan J Blalock
- 3University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC USA
| | - Galen Switzer
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Lan Yu
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Alaina Chodoff
- 5Division of General Internal Medicine, University of Pittsburgh and UPMC, Pittsburgh, PA USA
| | - Sonya Borrero
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA.,Veteran's Affairs Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA USA
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Zhang SH, Liu R, Siripong N, Kirkwood JM, Holtzman MP, Davar D, Najjar Y, Marshall K, Jackson Cullison SR, Houston NA, Switzer G, Ferris LK. Thick melanoma is associated with low melanoma knowledge and low perceived health competence, but not delays in care. J Am Acad Dermatol 2019; 83:587-590. [PMID: 31150702 DOI: 10.1016/j.jaad.2019.05.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Sophia H Zhang
- University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca Liu
- University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nalyn Siripong
- Clinical & Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Diwakar Davar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Yana Najjar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Keely Marshall
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Neil A Houston
- Department of Dermatology, University of Colorado, Aurora
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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12
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Borrero S, Callegari LS, Zhao X, Mor MK, Sileanu FE, Switzer G, Zickmund S, Washington DL, Zephyrin LC, Schwarz EB. Unintended Pregnancy and Contraceptive Use Among Women Veterans: The ECUUN Study. J Gen Intern Med 2017; 32:900-908. [PMID: 28432564 PMCID: PMC5515789 DOI: 10.1007/s11606-017-4049-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/24/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about contraceptive care for the growing population of women veterans who receive care in the Veterans Administration (VA) healthcare system. OBJECTIVE To determine rates of contraceptive use, unmet need for prescription contraception, and unintended pregnancy among reproductive-aged women veterans. DESIGN AND PARTICIPANTS We conducted a cross-sectional, telephone-based survey with a national sample of 2302 women veterans aged 18-44 years who had received primary care in the VA within the prior 12 months. MAIN MEASURES Descriptive statistics were used to estimate rates of contraceptive use and unintended pregnancy in the total sample. We also estimated the unmet need for prescription contraception in the subset of women at risk for unintended pregnancy. For comparison, we calculated age-adjusted US population estimates using data from the 2011-2013 National Survey of Family Growth (NSFG). KEY RESULTS Overall, 62% of women veterans reported current use of contraception, compared to 68% of women in the age-adjusted US population. Among the subset of women at risk for unintended pregnancy, 27% of women veterans were not using prescription contraception, compared to 30% in the US population. Among women veterans, the annual unintended pregnancy rate was 26 per 1000 women; 37% of pregnancies were unintended. In the age-adjusted US population, the annual rate of unintended pregnancy was 34 per 1000 women; 35% of pregnancies were unintended. CONCLUSIONS While rates of contraceptive use, unmet contraceptive need, and unintended pregnancy among women veterans served by the VA are similar to those in the US population, these rates are suboptimal in both populations, with over a quarter of women who are at risk for unintended pregnancy not using prescription contraception, and unintended pregnancies accounting for over a third of all pregnancies. Efforts to improve contraceptive service delivery and to reduce unintended pregnancy are needed for both veteran and civilian populations.
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Affiliation(s)
- Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA. .,Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Lisa S Callegari
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA
| | - Galen Switzer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151 C), Building #30, Pittsburgh, PA, 15240, USA.,Departments of Medicine, Psychiatry and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Zickmund
- VA HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Laurie C Zephyrin
- Women's Health Services, Department of Veterans Affairs, Washington, D.C., USA.,Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Bimla Schwarz
- Division of General Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Juengst SB, Switzer G, Oh BM, Arenth PM, Wagner AK. Conceptual model and cluster analysis of behavioral symptoms in two cohorts of adults with traumatic brain injuries. J Clin Exp Neuropsychol 2016; 39:513-524. [PMID: 27750469 DOI: 10.1080/13803395.2016.1240758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Behavioral changes often occur after moderate-to-severe traumatic brain injury (TBI) and can lead to poor health, psychosocial functioning, and quality of life. Challenges in evaluating these behaviors often result from the complexity and variability in the way they are conceptualized and defined. We propose and test a conceptual model that is specific to behavioral symptoms after TBI, to serve as a basis for better assessment and treatment. We hypothesized that clusters of individuals, with unique emotional, cognitive, and behavioral characteristics, would emerge that would illustrate this conceptual model. METHODS We conducted model-based cluster analyses in two cohorts, 6-months post-injury (n = 79) and >6 months post-injury (n = 62), of adults with moderate-to-severe TBI to explore the face validity of our conceptual model by evaluating how participants clustered with regard to emotional (Patient Health Questionnaire 9, Positive and Negative Affect Schedule), cognitive (neuropsychological test battery), and frontal behavioral (Frontal Systems Behavior Scale) symptoms. RESULTS In each cohort, unique clusters of participants emerged that differed significantly with regard to emotional state, cognition, and behavior (ps<.05). Those 6-months post-injury clustered along a general continuum of symptom severity in emotional and behavioral symptom domains, from no impairment to severe impairment. Clusters in the chronic cohort (>6 months) demonstrated a more complex pattern of symptoms; the most severe behavioral symptoms occurred in the context of severe emotional symptoms, even in the absence of cognitive impairment. However, problematic behavioral symptoms were also present in the context of severe cognitive impairment, even in the absence of emotional symptoms. CONCLUSIONS Emotional, cognitive, and behavioral characteristics were represented as expected, based on the proposed conceptual model of behavior. This conceptual model provides the basis for evaluating behavioral changes after moderate-to-severe TBI and identifying modifiable targets and relevant subpopulations for behavioral intervention, with the goal of improved evidence-based personalized medicine for this population.
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Affiliation(s)
- Shannon B Juengst
- a Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Galen Switzer
- b Department of Medicine , University of Pittsburgh , Pittsburgh , PA , USA.,c Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Byung Mo Oh
- d Department of Rehabilitation , Seoul National University Hospital , Seoul , South Korea
| | - Patricia M Arenth
- a Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Amy K Wagner
- a Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,e Center for Neuroscience , University of Pittsburgh , Pittsburgh , PA , USA.,f Safar Center for Resuscitation Research , University of Pittsburgh , Pittsburgh , PA , USA
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Kiguchi M, Leake A, Switzer G, Mitchell E, Makaroun M, Chaer RA. Perceptions of society for vascular surgery members and surgery department chairs of the integrated 0 + 5 vascular surgery training paradigm. J Surg Educ 2014; 71:716-725. [PMID: 25088369 DOI: 10.1016/j.jsurg.2014.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/18/2013] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION As the first generation of integrated (0 + 5) vascular surgery (VS) residents enter the job market, this survey sought to understand how the surgical community perceives this training paradigm. METHODS An anonymous online survey was e-mailed to surgery chairpersons (n = 193) and Society for Vascular Surgery (SVS) members (n = 2193) in the United States/Canada with 26% (n = 38) and 14% (n = 309) response rates, respectively. Respondents were asked about their practice background, residency program, hiring patterns, and perceptions of the 0 + 5 training. RESULTS Response rates were 26% (n = 38) and 14% (n = 309) for surgery chairpersons and SVS members, respectively. SVS respondents were from academic (62%) and private (38%) practices and included staff surgeons (62%), program directors (15%), and division chiefs (22%). Only 33% had a 0 + 5 program, and 57% had a VS fellowship. Overall, 94% were likely to hire a new vascular surgeon in the next 5 years. In some categories, SVS respondents believed 0 + 5 residents would be less prepared than 5 + 2 residents. Only 32% thought that 0 + 5 residents have the same level of surgical maturity, and 36% thought that they have the same level of open operative skills as 5 + 2 trainees. Another 34% thought 0 + 5 residents will need additional fellowship training in open surgery. However, there was also a general perception from SVS respondents that 0 + 5 residents would be prepared for clinical practice (67%) and would have equal endovascular skills to 5 + 2 trainees (92%). The chairpersons had similar perceptions as SVS members. Both SVS members (88%) and chairpersons (86%) would consider interviewing a 0 + 5 graduate for faculty position; 83% and 72%, respectively, would consider hiring. Moreover, 93% of SVS respondents who currently have a 0 + 5 program and 86% of SVS respondents who do not would consider hiring a 0 + 5 graduate. Both SVS members (62%) and chairpersons (50%) believed the 0 + 5 paradigm is essential for the advancement of VS. CONCLUSIONS Overall perceptions of 0 + 5 graduates were positive and indicated their likely acceptance into the VS workforce. Although there were some reservations regarding the 0 + 5 graduates' maturity level and open operative skills, the surgical community was willing to interview and hire these trainees for staff positions. Further follow-up will be required to evaluate their performance in clinical practice.
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Affiliation(s)
- Misaki Kiguchi
- University of Pittsburgh Medical Center (UPMC), Department of Surgery, Division of Vascular Surgery, Pittsburgh, Pennsylvania
| | - Andrew Leake
- University of Pittsburgh Medical Center (UPMC), Department of Surgery, Division of Vascular Surgery, Pittsburgh, Pennsylvania.
| | - Galen Switzer
- University of Pittsburgh, Department of General Internal Medicine, Pittsburgh, Pennsylvania
| | - Erica Mitchell
- Oregon Health and Sciences University, Department of Surgery, Portland, Oregon; SVS Education Committee, Chicago, Illinois
| | - Michel Makaroun
- University of Pittsburgh Medical Center (UPMC), Department of Surgery, Division of Vascular Surgery, Pittsburgh, Pennsylvania
| | - Rabih A Chaer
- University of Pittsburgh Medical Center (UPMC), Department of Surgery, Division of Vascular Surgery, Pittsburgh, Pennsylvania
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15
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Leake A, Kiguchi M, Switzer G, Mitchell E, Makaroun M, Chaer RA. A Survey of Society for Vascular Surgery Members and Surgery Department Chairs on the Integrated 0+5 Vascular Surgery Training Paradigm. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Abdel-Kader K, Dew MA, Bhatnagar M, Argyropoulos C, Karpov I, Switzer G, Unruh ML. Numeracy skills in CKD: correlates and outcomes. Clin J Am Soc Nephrol 2010; 5:1566-73. [PMID: 20507954 DOI: 10.2215/cjn.08121109] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Healthcare providers communicate the risks and benefits of treatments using frequencies, percentages, or proportions. However, many patients lack the numerical skills needed to interpret this information accurately to make informed choices. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We assessed numeracy, the capacity to use and comprehend numbers, in a prospective cohort study of 187 patients with stage 4 to 5 chronic kidney disease or ESRD. Patients completed a three-item numeracy test and were assessed for global mental status, cognitive function, type of hemodialysis access, and kidney transplant use. We examined the association of numeracy with healthcare use and other cognitive and sociodemographic variables. RESULTS Over 50% of patients answered one or fewer numeracy questions correctly. Although African Americans (P = 0.0001), women (P = 0.05), and the unemployed (P = 0.0004) demonstrated lower numeracy skills, numeracy deficits were prevalent in every subgroup. In analyses adjusted for demographics and length of follow-up, higher numeracy was significantly associated with receipt of a transplant or active waiting list status. Numeracy was not associated with dialysis modality or hemodialysis vascular access. CONCLUSION Similar to prior findings in the general population, these findings indicate that poor numeracy skills are very common in patients with advanced chronic kidney disease and end-stage renal disease. Additional research is needed to further explore whether poor numeracy is a barrier to receipt of a kidney transplant. Clinicians caring for patients with kidney disease should consider using tools to enhance communication and overcome limited numeracy skills.
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Affiliation(s)
- Khaled Abdel-Kader
- University of Pittsburgh, Renal- Electrolyte Division, Pittsburgh, PA 15261, USA.
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Rodriguez KL, Burkitt KH, Sevick MA, Obrosky DS, Aspinall SL, Switzer G, Mor MK, Fine MJ. Assessing processes of care to promote timely initiation of antibiotic therapy for emergency department patients hospitalized for pneumonia. Jt Comm J Qual Patient Saf 2009; 35:509-18. [PMID: 19886090 DOI: 10.1016/s1553-7250(09)35070-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A mixed-methods quality improvement (QI) project for patients with pneumonia hospitalized from the emergency department (ED) was undertaken to (1) delineate the basic steps in the flow of patient care from presentation in the ED to time to first antibiotic dose (TFAD), (2) identify perceived barriers to and facilitators of reduced TFAD within these steps, (3) describe QI strategies to improve TFAD rates, and (4) identify perceived strategies for facilities to enhance performance. METHODS The QI project was conducted at 10 lower- and 10 higher-performing Veterans Affairs hospitals on the basis of the proportion of patients whose TFAD was within four hours of presentation. An ED physician, an ED nurse, a radiologist, a pharmacist, and a quality manager from each site were invited to participate in a survey and focus group. RESULTS Of the 82 survey participants, 59 (72%) perceived that ordering and performing the chest radiograph was the step most frequently resulting in TFAD delays. Medical provider assessment, chest radiograph interpretation, ordering/obtaining blood cultures, and ordering/administering initial antibiotic therapy also caused TFAD delays. The most commonly perceived barriers were patient and x-ray equipment transportation delays and communication delays between providers. The most frequently used strategies to reduce TFAD were stocking antibiotics in the ED and physician education. Focus groups emphasized the importance of multifaceted QI approaches and a top-down hospital leadership style to improve TFAD performance. DISCUSSION TFAD relies on a series of complex, stepwise processes of care that involve numerous hospital departments and is often delayed by well-described barriers. Addressing these barriers, as well as involving facility leadership in setting institutional QI goals, could possibly improve performance on this pneumonia quality measure.
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Affiliation(s)
- Keri L Rodriguez
- Veterans Affairs Pittsburgh Healthcare System Center for Health Equity Research and Promotion and Geriatric Research, Education and Clinical Center, USA.
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18
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Baker KS, Davies SM, Majhail NS, Hassebroek A, Klein JP, Ballen KK, Bigelow CL, Frangoul HA, Hardy CL, Bredeson C, Dehn J, Friedman D, Hahn T, Hale G, Lazarus HM, LeMaistre CF, Loberiza F, Maharaj D, McCarthy P, Setterholm M, Spellman S, Trigg M, Maziarz RT, Switzer G, Lee SJ, Rizzo JD. Race and socioeconomic status influence outcomes of unrelated donor hematopoietic cell transplantation. Biol Blood Marrow Transplant 2009; 15:1543-54. [PMID: 19896078 DOI: 10.1016/j.bbmt.2009.07.023] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/27/2009] [Indexed: 12/15/2022]
Abstract
Success of hematopoietic cell transplantation (HCT) can vary by race, but the impact of socioeconomic status (SES) is not known. To evaluate the role of race and SES, we studied 6207 unrelated-donor myeloablative (MA) HCT recipients transplanted between 1995 and 2004 for acute or chronic leukemia or myelodysplastic syndrome (MDS). Patients were reported by transplant center to be White (n = 5253), African American (n = 368), Asian/Pacific-Islander (n = 141), or Hispanic (n = 445). Patient income was estimated from residential zip code at time of HCT. Cox regression analysis adjusting for other significant factors showed that African American (but not Asian or Hispanic) recipients had worse overall survival (OS) (relative-risk [RR] 1.47; 95% confidence interval [CI] 1.29-1.68, P < .001) compared to Whites. Treatment-related mortality (TRM) was higher in African Americans (RR 1.56; 95% CI 1.34-1.83, P < .001) and in Hispanics (RR 1.30; 95% CI 1.11-1.51, P = .001). Across all racial groups, patients with median incomes in the lowest quartile (<$34,700) had worse OS (RR 1.15; 95% CI 1.04-1.26, P = .005) and higher risks of TRM (RR 1.21; 1.07-1.36, P = .002). Inferior outcomes among African Americans are not fully explained by transplant-related factors or SES. Potential other mechanisms such as genetic polymorphisms that have an impact on drug metabolism or unmeasured comorbidities, socioeconomic factors, and health behaviors may be important. Low SES, regardless of race, has a negative impact on unrelated donor HCT outcomes.
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Affiliation(s)
- K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
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Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health 2006; 96:2113-21. [PMID: 17077411 PMCID: PMC1698151 DOI: 10.2105/ajph.2005.077628] [Citation(s) in RCA: 466] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We provide a framework for health services-related researchers, practitioners, and policy makers to guide future health disparities research in areas ranging from detecting differences in health and health care to understanding the determinants that underlie disparities to ultimately designing interventions that reduce and eliminate these disparities. To do this, we identified potential selection biases and definitions of vulnerable groups when detecting disparities. The key factors to understanding disparities were multilevel determinants of health disparities, including individual beliefs and preferences, effective patient-provider communication; and the organizational culture of the health care system. We encourage interventions that yield generalizable data on their effectiveness and that promote further engagement of communities, providers, and policymakers to ultimately enhance the application and the impact of health disparities research.
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Affiliation(s)
- Amy M Kilbourne
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pa 15240, USA.
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Schreiber CA, Harwood BJ, Switzer G, Ness R, Reeves MF, Creinin MD. Training and attitudes about contraceptive management across primary care specialties: a survey of graduating residents. Contraception 2005. [DOI: 10.1016/j.contraception.2005.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The use of living donors in general is increasing, and there is evidence of increasing willingness among transplant centers to consider nondirected living donation (NDLD) as well. Yet few systematic data are available on the number of centers performing NDLD and the degree to which current policies and practices reflect existing guideline recommendations. We conducted a telephone survey of the 25 highest volume transplant centers and 25 highest volume organ procurement organizations (OPOs) to describe their NDLD-related policies and experiences. Survey responses revealed that inquiries about NDLD from interested potential donors are common, likely to increase, and generally not formally monitored. More than half of transplant centers surveyed currently perform or are willing to perform NDLD (14/25), and although only three OPOs currently facilitate NDLD, the majority of the remaining organizations reported that an NDLD policy was in development. Among those organizations that did facilitate NDLD, the majority applied current living-donor guidelines and practices to NDLDs. Most transplant centers performing NDLD distributed these donations to patients from their own waiting list by using United Network for Organ Sharing criteria. This preliminary description of current NDLD experiences suggests that although NDLD is growing, the policies and practices governing it are being developed on an ad hoc basis at the level of individual organizations. Additional research is needed to characterize the full range of NDLD activity at both higher and lower volume organizations, and to explore a broader range of questions about current NDLD policy and practice in the United States.
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Affiliation(s)
- Megan Crowley-Matoka
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
Second- and fourth-year medical students were surveyed about the influence of medical education on their attitudes towards indigent patients and its role in career planning.
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Affiliation(s)
- Thomas P O'Toole
- Johns Hopkins School of Medicine, Welch Center, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND Screening flexible sigmoidoscopy is an underused cancer prevention procedure. Physicians often cite patient discomfort as a reason for not requesting sigmoidoscopy, but patient experiences and attitudes toward sigmoidoscopy have not been well studied. OBJECTIVE To measure patient satisfaction and the determinants of satisfaction with screening sigmoidoscopy. METHODS An instrument to assess satisfaction with screening sigmoidoscopy was developed. Responses were evaluated with a factor analysis, tested for reproducibility and internal consistency, and validated against an external standard. RESULTS A total of 1221 patients (666 men and 555 women; mean age, 61.8 years) were surveyed after sigmoidoscopy. Examinations were performed by a nurse practitioner (n = 668), internist (n = 344), or gastrointestinal specialist (n= 184). More than 93% of the participants strongly agreed or agreed they would be willing to undergo another examination, and 74.9% would strongly recommend the procedure to their friends. Regarding pain and discomfort, 76.2% strongly agreed or agreed that the examination did not cause a lot of pain, 78.1% stated that it did not cause a lot of discomfort, and 68.5% thought that it was more comfortable than they expected. Fifteen percent to 25% of the patients indicated they had a lot of pain, great discomfort, or more discomfort than expected. Women were more likely to have significant pain or discomfort than men (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.3; P<.001). CONCLUSIONS Approximately 70% of individuals who undergo screening sigmoidoscopy are satisfied and find the procedure more comfortable than expected, whereas only 15% to 25% find the procedure unpleasant. Physicians should not project discomfort onto patients as a reason for not requesting screening sigmoidoscopy.
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Affiliation(s)
- R E Schoen
- Department of Medicine and the University of Pittsburgh Cancer Institute, University of Pittsburgh, PA, USA
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Fabes RA, Eisenberg N, Karbon M, Troyer D, Switzer G. The relations of children's emotion regulation to their vicarious emotional responses and comforting behaviors. Child Dev 1994; 65:1678-93. [PMID: 7859549 DOI: 10.1111/j.1467-8624.1994.tb00842.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of the present study was to examine the relations of children's emotional and behavioral regulation (as indexed by heart rate variability and coping styles) to their emotional and prosocial responses to a crying infant. Kindergarten and second-grade children's vicarious emotional responses (e.g., facial reactions and heart rate slope) and comforting behaviors were recorded while children heard a crying infant. The mothers of these children completed a measure designed to assess their children's coping responses when exposed to others in distress. It was found that children who were able to regulate their arousal (as assessed with heart rate variance) and typically responded instrumentally when exposed to others' needy states and conditions were relatively unlikely to become distressed and relatively likely to talk to and comfort the crying infant. Compared to boys, girls were found to be more responsive to the crying infant and were reported to engage in more direct, active coping responses when exposed to others in distress. The results are discussed in relation to research on emotion regulation and coping in interpersonal contexts.
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Affiliation(s)
- R A Fabes
- Department of Family Resources and Human Development, Arizona State University, Tempe 85287-2502
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Fabes RA, Eisenberg N, Karbon M, Troyer D, Switzer G. The Relations of Children's Emotion Regulation to Their Vicarious Emotional Responses and Comforting Behaviors. Child Dev 1994. [DOI: 10.2307/1131287] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Eisenberg N, Fabes RA, Carlo G, Speer AL, Switzer G, Karbon M, Troyer D. The relations of empathy-related emotions and maternal practices to children's comforting behavior. J Exp Child Psychol 1993; 55:131-50. [PMID: 8501423 DOI: 10.1006/jecp.1993.1007] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Examined are the relations of maternal empathy-related characteristics, maternal child-rearing practices, and children's vicarious emotional responding to kindergarteners' and third graders' comforting of a crying infant. Children who exhibited facial personal distress in reaction to the baby cry were less likely to help than were other children. In addition, children's distressed reactions to a different sympathy stimulus (a film) were positively correlated with their distressed reaction to the baby cry; children's self-reported reactions to the sympathy-inducing film also were related to their comforting behavior. For girls, maternal perspective taking was positively related to amount and quality (tone of voice) of comforting behavior. Moreover, maternal use of problem-solving and discussion when their daughters were distressed or anxious were associated with higher levels of girls' helping whereas maternal comforting/affirming in a distressing context was negatively related to helping. The only relation of maternal variables to comforting for boys was a positive correlation between maternal reinforcement and quality of boys' comforting.
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Eisenberg N, Fabes RA, Carlo G, Troyer D, Speer AL, Karbon M, Switzer G. The Relations of Maternal Practices and Characteristics to Children's Vicarious Emotional Responsiveness. Child Dev 1992. [DOI: 10.1111/j.1467-8624.1992.tb01648.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eisenberg N, Fabes RA, Carlo G, Troyer D, Speer AL, Karbon M, Switzer G. The Relations of Maternal Practices and Characteristics to Children's Vicarious Emotional Responsiveness. Child Dev 1992. [DOI: 10.2307/1131348] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Eisenberg N, Fabes RA, Carlo G, Troyer D, Speer AL, Karbon M, Switzer G. The relations of maternal practices and characteristics to children's vicarious emotional responsiveness. Child Dev 1992; 63:583-602. [PMID: 1600824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examined the relations of maternal vicarious emotional responding and child-rearing practices, as well as familial emotional environment, to 5-6 and 8-9-year-old children's vicarious emotional responding. There were some correspondences between mothers' and children's heart rate, facial, and self-reported reactions to a sympathy-inducing film. Maternal sympathy/perspective taking and reinforcement of sympathy/prosocial behavior, as well as negative subordinate emotion in the home, were associated with markers of girls' sympathy; mothers' personal distress (for girls), restrictiveness regarding displays of hurtful negative emotions (particularly for young girls), and negative dominant emotion in the home (for both sexes) were associated with markers of personal distress. Mothers' linking of the film character's experience to children's own experience was associated with children's responsiveness to the film, and mother's verbalizations during the film concerning her own emotional state and role taking were associated with boys' self-reported sympathy.
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Chin LP, LaRose PG, Tankin RS, Jackson T, Stutrud J, Switzer G. Droplet distributions from the breakup of a cylindrical liquid jet. ACTA ACUST UNITED AC 1991. [DOI: 10.1063/1.857919] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Hypotheses concerning the specific contexts in which an altruistic personality might be most apparent were investigated. College students completed questionnaires tapping components of an altruistic personality, emotionality, and social desirability. At a 2nd session, the emotional evocativeness and ease of escape from the helping situation were experimentally manipulated. Ss were exposed to a distressed woman, completed state sympathy and personal distress indexes, and were given an opportunity to assist the woman. High scorers on dispositional altruism were expected to assist most when escape was easy, particularly when the distress cues were obvious. Altruistic and emotionally reactive persons were also expected to help most in a psychologically "weak" environment. Both predictions were supported. The relations between helping and the other predictors were also examined.
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Affiliation(s)
- G Carlo
- Arizona State University, Tempe 85287
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