Seizure Action Plans for Pediatric Patients With Epilepsy: A Randomized Controlled Trial.

OBJECTIVES: Seizure action plans help patients and caregivers better self-manage their epilepsy. We hypothesized that providing pediatric patients and their caregivers with a seizure action plan would reduce unplanned health care utilization and decrease the impact of epilepsy. METHODS: We developed a seizure action plan for use in pediatric epilepsy patients. A prospective cohort was randomly assigned to receive a seizure action plan in addition to standard epilepsy care or to standard epilepsy care alone. All caregivers were surveyed using the Modified Impact on Families (MIF) questionnaire at enrollment, 3 months, and 12 months. Health care utilization measures and Modified Impact on Families questionnaire scores were compared between the 2 groups. RESULTS: Fifty-four patients received a seizure action plan and standard care, whereas 48 received standard care alone. The groups had similar demographics. There was a significantly higher proportion of overall clinic appointment no shows in the standard care group vs the seizure action plan group (P = .04); however, other significant differences in health care utilization were not found. Among patients with low seizure frequency (12 or fewer seizures per year), Seizure comfort scores on the Modified Impact on Families questionnaire were significantly higher at 12 months among the seizure action plan group compared to the standard care group. SIGNIFICANCE: Caregivers for patients with epilepsy receiving a seizure action plan were more comfortable regarding seizure care and missed fewer appointments. However, differences in health care utilization were not present. The seizure action plan appears to have more impact in patients who experience lower seizure frequencies. Further studies evaluating the impact as well as assessing caregivers' perceptions of the seizure action plan using a larger sample are needed.

Impact of a Make-A-Wish experience on healthcare utilization.

OBJECTIVES: To evaluate the impact of receiving a wish from the Make-A-WishR Foundation on (1) patient healthcare utilization and (2) savings benefit measures. STUDY DESIGN: Make-A-WishR arranges experiences, or "wishes," to children with progressive, life-threatening, or life-limiting illness. A retrospective, case-control analysis was performed comparing patients who received or did not receive a wish and associated impact on healthcare utilization and costs across 2 years. Healthcare utilization was defined as visits to primary, urgent, emergent care, and planned/unplanned inpatient hospitalizations. We defined wish savings benefit as a decline in the cost of care from years 1 to 2, which exceeded the average cost of a wish in 2016, $10,130. RESULTS: From 2011 to 2016, 496 Nationwide Children's Hospital patients received a wish. We matched these patients to 496 controls based on age, gender, disease category, and disease complexity. Patients who received a wish were 2.5 and 1.9 times more likely to have fewer unplanned hospital admissions and emergency department visits, respectively. These decreases were associated with a higher likelihood (2.3-fold and 2.2-fold greater odds) of the wish achieving a savings benefit compared to hospital charges. CONCLUSIONS: Participation in the Make-A-WishR program may provide children quality of life relief while reducing hospital visits and healthcare expenditures.

Collegiate athletes' mental health services utilization: A systematic review of conceptualizations, operationalizations, facilitators, and barriers.

BACKGROUND: While mental health among collegiate athletes is receiving increased attention, research on factors surrounding collegiate athletes' decision to seek mental health services is limited. The goal of the present review was to analyze and synthesize the current literature concerning collegiate athletes' utilization of mental health services, including the facilitators of and barriers to use of these services. METHODS: The analysis was guided and organized using a socio-ecological framework, which considered the unique context in which collegiate athletes study and perform. A total of 21 articles, published between 2005 and 2016, which concern U.S. collegiate athletes' mental health services utilization (MHSU) were selected and included for the final analysis. Conceptualizations and operationalizations of MHSU were compared and contrasted. Facilitators of and barriers to athletes MHSU were examined and summarized while appropriately considering the proximity of each factor (facilitator or barrier) to the athletes. RESULTS: Results showed variations in conceptualizations and operationalizations of MHSU in the articles analyzed, which made interpretation and cross comparison difficult. Collegiate athletes are willing to utilize mental health services, but gender, perceived stigma, peer norms-for athletes and coaches-plus service availability impact their MHSU. CONCLUSION: Key stakeholders, administrators, and public health officials should partner to eliminate MHSU barriers, support facilitators, and generally empower collegiate athletes to actively manage their mental health.

Preseason Anxiety and Depressive Symptoms and Prospective Injury Risk in Collegiate Athletes.

BACKGROUND: Psychological risk factors are increasingly recognized as important in sport-related injury prevention. Understanding how these psychological factors may affect the risk of injuries could help design effective prevention programs. PURPOSE: To determine the effect of reported preseason anxiety and depressive symptoms on the risk of injuries during a prospective season in a cohort of collegiate athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Collegiate athletes participating in 4 men's sports and 5 women's sports from 2 National Collegiate Athletic Association (NCAA) Division I universities were enrolled and prospectively followed during the 2007-2011 seasons. Preseason anxiety and depressive symptoms were measured at enrollment. Injuries occurring during the season were reported by certified athletic trainers. The injury incidence rate was calculated as the total number of injuries divided by the total number of athlete-exposures (ie, games and practices). RESULTS: Of 958 enrolled athletes (response rate of 90.3%), 389 (40.6%) athletes sustained a total of 597 injuries. At preseason, 276 (28.8%) athletes reported anxiety symptoms, and 208 (21.7%) reported depressive symptoms. Among athletes reporting any of these symptoms, 48.5% (n = 158) reported having both anxiety and depressive symptoms. Athletes with preseason anxiety symptoms had a significantly higher injury incidence rate compared with athletes without anxiety symptoms (rate ratio [RR], 2.3; 95% CI, 2.0-2.6), adjusting for age, race, body mass index, history of injuries 12 months before baseline, and university attended, and this was observed for both male and female athletes. Only male athletes who reported co-occurring preseason depressive and anxiety symptoms had a significantly increased injury risk (RR, 2.1; 95% CI, 1.6-2.6) compared with male athletes who reported no co-occurring symptoms. However, no such increase in the injury risk was observed among female athletes or male athletes who reported preseason depressive symptoms but no anxiety symptoms. CONCLUSION: Athletes with anxiety symptoms at preseason were at an increased risk of injuries during the prospective season. Targeted programs could focus on psychological health and injury prevention for athletes, especially for those exhibiting symptoms at preseason.

Early Lactation and Infant Feeding Practices Differ by Maternal Gestational Diabetes History.

BACKGROUND: Detailed data on lactation practices by gestational diabetes mellitus (GDM) history are lacking, precluding potential explanations and targets for interventions to improve lactation intensity and duration and, ultimately, long-term maternal and child health. OBJECTIVE: This study aimed to examine breastfeeding practices through 12 months postpartum by GDM history. METHODS: Women who delivered a singleton, liveborn infant at The Ohio State University Wexner Medical Center (Columbus, OH), in 2011 completed a postal questionnaire to assess lactation and infant feeding practices and difficulties. Bivariate and multivariate associations between GDM history and lactation and infant feeding practices were examined. RESULTS: The sample included 432 women (62% response rate), including 7.9% who had GDM during the index pregnancy. Women with GDM initiated breastfeeding (at-the-breast or pumping) as often as women without any diabetes but were more likely to report introduction of formula within the first 2 days of life (79.4% vs 53.8%, P < .01; adjusted odds ratio: 3.48; 95% confidence interval, 1.47-8.26). Women with GDM initiated pumping 4 days earlier than women without diabetes ( P < .05), which was confirmed in adjusted analyses. There was no difference in the proportion of women reporting breastfeeding difficulty (odds ratio: 2.08; 95% confidence interval, 0.78-5.52). However, there was a trend toward women with GDM reporting more formula feeding and less at-the-breast feeding as strategies to address difficulty compared with women without diabetes. CONCLUSION: Additional research is needed to understand why women with GDM engage in different early lactation and infant feeding practices, and how best to promote and sustain breastfeeding among these women.

Conflict and Stress in Hospital Nursing: Improving Communicative Responses to Enduring Professional Challenges.

Nurses function as central figures of health teams, coordinating direct care and communication between team members, patients, and their families. The importance of nurses to health care cannot be understated, but neither can the environmental struggles nurses routinely encounter in their jobs. Organizational communication and nursing scholarship show conflict and stress as two visible and ongoing challenges. This case study aims to (a) explore the ways conflict communication and communicative stress are experienced and endure in nursing and (b) understand how nurses discursively (mis)manage conflict and stress. Open-ended survey comments from nurses (N = 135) employed at a large teaching and research hospital were qualitatively analyzed. Weick's model of organizing, specifically his notion of communication cycles, emerged as a conceptual lens helpful for understanding cyclical conflict and stress. Results show that exclusionary communication, specifically nonparticipatory and unsupportive messages, contribute to nurse conflict and stress. Nurses tend to (mis)manage conflict and stress using respectful and disrespectful discourse. These communication patterns can facilitate or prohibit positive change. Metaphorically, nurse communicative conflict and stress can be depicted as fire. Relationships can go up in flames due to out-of-control fires in the form of destructive conflict. However, conflict and stress, like fire, can be harnessed for positive ends such as organizational decision making and innovation. Findings suggest conveying respect may help nurses manage and even avoid flames of conflict and stress. Solutions are offered to mitigate the effects of conflict and stress while developing respectful organizational cultures.

Trends in breastfeeding initiation, continuation, and exclusivity by maternal prepregnancy weight: 2004-2011.

OBJECTIVE: To examine trends in breastfeeding initiation, continuation, and exclusivity by prepregnancy weight from 2004 to 2011 and the associations between these outcomes and prepregnancy weight. METHODS: Data from the 2004 to 2011 Pregnancy Risk Assessment Monitoring System, a survey of women with a recent live birth from 34 states and New York City, were used. Trends in breastfeeding initiation, continuation, and exclusivity at 12 weeks postpartum were evaluated by prepregnancy BMI. Logistic regression was used to identify the association between prepregnancy BMI and the breastfeeding outcomes. RESULTS: Among 244,196 women, with increasing BMI, a decreasing number of women initiated, continued, and breastfed exclusively. From 2004 to 2011, the rates of breastfeeding initiation increased significantly for women of all weight classes (P < 0.01), and the disparity between normal-weight women and women with obesity class III narrowed. Among all women, breastfeeding continuation increased significantly for women of almost all weight classes (P < 0.01), although the disparity between normal-weight women and women with obesity class III worsened. From 2009 to 2011, among all women, exclusive breastfeeding increased significantly among women with normal and overweight BMI (P < 0.01) but decreased among obese class III; the disparity between women with normal and obese class III BMI worsened. CONCLUSIONS: Our results highlight the need for more concentrated efforts on breastfeeding continuation and exclusivity, particularly for women with obesity.

Predicting Nurses' Turnover: The Aversive Effects of Decreased Identity, Poor Interpersonal Communication, and Learned Helplessness.

Through a social identity theoretical lens, this study examines how nurses' identification with their working small group, unit, or floor, nursing role (e.g., staff ER nurse, nurse practitioner), and nursing profession relate to nurses' interaction involvement, willingness to confront conflict, feelings of learned helplessness, and tenure (employment turnover) intentions. A cross-sectional survey (N = 466) was conducted at a large, quaternary care hospital system. Structural equation modeling uncovered direct and indirect effects between the five primary variables. Findings demonstrate direct relationships between nurse identity (as a latent variable) and interaction involvement, willingness to confront conflict, and tenure intentions. Feelings of learned helplessness are attenuated by increased nurse identity through interaction involvement and willingness to confront conflict. In addition, willingness to confront conflict and learned helplessness mediate the relationship between interaction involvement and nurses' tenure intentions. Theoretical extensions include indirect links between nurse identity and learned helplessness via interaction involvement and willingness to confront conflict. Implications for interpersonal communication theory development, health communication, and the nursing profession are discussed.

The conceptualization and communication of risk among rural appalachian adolescents.

This study uses a meta-theoretical perspective for examining risk perceptions and behavior in the rural Appalachian cultural context, an area that remains largely unexplored. The authors conducted in-depth interviews with 113 rural adolescents to describe how youth conceptualize risk and how risk is communicated in the rural environment. Analyses revealed adolescents viewed behavior as risky when they had personal or vicarious experiences resulting in a loss of control or physical harm. Elements of the rural Appalachian culture including activities, familism, and community ties can prevent and promote adolescent risk taking in various forms. This study demonstrates the conceptualization of risk and messages about risk are culturally situated and communicatively devised and enacted. The implications of these findings for adolescent risk prevention programs are discussed.