Factors Contributing to Posttraumatic Growth Following Bereavement.

Multiple factors have been studied to determine their relationship to posttraumatic growth, with findings suggesting the importance of resiliency (Bensimon, 2012), social support (Tedeschi & Calhoun, 2004), event centrality (Taku et al., 2014), religious coping (Pargament et al., 2006), relationship to the deceased (Oginska-Bulik, 2015), and the circumstance of passing (Feigelman et al., 2009). This study investigated the relationship of these identified factors with posttraumatic growth in a sample of 165 bereaved individuals. Regression results indicated that the overall model predicted scores on posttraumatic growth (R2 = .473, R2 adj = .456, F (5, 159) = 28.51, p < .001), with most robust effects found in social support (ß = .281), religious commitment (ß = .289), and event centrality (ß = .410). This indicates bereavement experiences can result in significant growth in individuals, particularly those who seek social support, identify the event as an essential part of their experience, and identify religion as an important aspect of their routine.

Recovery in Mind: A Recovery College's journey through the Covid-19 pandemic.

INTRODUCTION: The Covid-19 restrictions of 2020-2021 are known to have undermined the UK population's mental health. Working alongside staff, peer trainers and students at Recovery in Mind (RiM), a Recovery College (RC) in West Berkshire, England, this mixed-methods study is amongst the first to investigate how an RC has responded to the pandemic. METHODS: Working in co-production with RiM staff and peer-trainers, this study employed a mixed-methods design, gathering Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) well-being outcome measures by questionnaire and student experience, learning and co-production by interviews. FINDINGS: This research found that RiM continued to produce demonstrable improvements in student mental health. Students welcomed the way that RiM adapted to offering online and socially distanced provisions. Students valued the skills that RiM taught and the way that RiM courses reinforced prior learning; above this, however, they valued the mutual support and sense of community that participation provided. CONCLUSION: This study underlines the value of RCs maintaining 'hidden curriculums' of peer support and community involvement. This research emphasizes co-production as not only a tool for empowerment or service improvement but as a valuable skill for personal mental health recovery. Even when operating under the most unforeseen or challenging of conditions, RCs should always endeavour to prioritize and maintain co-production. PATIENT OR PUBLIC CONTRIBUTION: In accordance with the RC ethos, this was an entirely co-produced study, with academic researchers and RiM staff and peer trainers working democratically in partnership with one another to design and manage the study and to write up and disseminate findings. To ensure the independence and rigour of findings, data analysis was undertaken by external academic researchers.

Methodology for the Development of the Australian National Nursing and Midwifery Digital Health Capability Framework.

Internationally healthcare organisations and governments are grappling with the issue of upskilling healthcare workforces in relation to digital health. Significant research has been undertaken in relation to documenting essential digital health capability requirements for the workforce. In 2019 the Australian Digital Health Agency funded work by the Australasian Institute of Digital Health to develop a National Nursing and Midwifery Digital Health Capability Framework. This paper describes the methodological approach used in the development of the Framework.

Implementing a healthy food retail policy: a mixed-methods investigation of change in stakeholders' perspectives over time.

OBJECTIVES: To investigate (i) changes in stakeholder commitment and (ii) perceptions of the purpose, challenges and benefits of healthy food and beverage provision in community sports settings during the stepwise implementation of a healthy beverage policy. DESIGN: Convergent, parallel, mixed-methods design complemented (i) repeat semi-structured interviews with council stakeholders (n 17 interviews, n 6 interviewees), with (ii) repeat quantitative stakeholder surveys measuring Commitment to Organisational Change; (iii) weekly sales data examining health behaviour and revenue effects (15 months pre-intervention; 14 months post-intervention); (iv) customer exit surveys (n 458); and (v) periodic photographic audits of beverage availability. Interviews were analysed inductively. Stakeholder surveys, sales data, customer surveys and audits were analysed descriptively. SETTING: Four local government-owned sports and recreation centres in Melbourne, Australia, completed a 3-month trial to increase the availability of healthy beverages and decrease the availability of unhealthy beverages in food outlets. PARTICIPANTS: Interviews were conducted with council managers and those involved in implementation (September 2016-October 2017). Customers were surveyed (September-October 2017). RESULTS: Interviews and surveys indicated that stakeholders' commitment to policies varied such that, over time, optimism that changing beverage availability could increase the healthiness of customers' purchases became more widespread among interviewees. Stakeholder focus generally progressed from anticipatory concern to solutions-focused discussions. Sales, audit and customer survey data supported interview findings. CONCLUSIONS: We found a general increase in optimism regarding policy outcomes over time during the implementation of a healthy beverage policy. Stepwise trials should be further explored as an engagement tool within community retail settings.

The long-term effectiveness and acceptability of the retailer-led removal of unhealthy drinks from display in a self-service café.

OBJECTIVE: In 2015, beverages were removed from display at a self-service café within a major health service, resulting in fewer purchases of unhealthy beverages. This initiative was continued following initial evaluation of the results. The current study aimed to determine customer acceptability of the initiative, and whether healthier purchases had continued, at 18 months following implementation. DESIGN: Drinks were categorised as 'green' (best choices), 'amber' (choose carefully) and 'red' (limit), based on the state government nutrient profiling system, for intervention and analysis purposes. In 2015, unhealthy 'red' drinks were removed from display. In 2017, weekly beverage sales were counted, through stock-taking, for 6 weeks, and customer surveys were conducted over 2 days. SETTING: A café located within a major Victorian health service. PARTICIPANTS: Café customers (hospital staff, patients and visitors). RESULTS: Eighteen months after the implementation of the initiative, the proportion of 'red' beverages sold was 7 % of total drink sales (compared with 33 % before the removal of unhealthy beverages from display in 2015 (P < 0·001), and 10 % immediately following the removal of unhealthy beverages from display). Customer surveys revealed high levels of acceptability for the initiative and low levels of awareness of the initiative. CONCLUSIONS: The removal of unhealthy beverages from display can result in customers making healthier purchases, and this appears to continue over the long-term. Such interventions have the potential to contribute to the sustained shift in population purchases and consumption needed to make meaningful improvements to population health.

Exploring the Health Informatics Occupational Group in the 2018 Australian Health Information Workforce Census.

There has been no empirical evidence about the health informatics workforce in Australia produced in the last ten years. This study reports the findings from an analysis of a subset of the 2018 Australian Health Informatics Workforce Census data. Analysing 420 responses that were identified as the occupational group Health Informatics, the results indicate that whilst most of the workforce is classified as aged (>45 years), many respondents are still relatively early in their health informatics careers. Furthermore, most do not possess any formal education in health informatics and almost a quarter undertake their health informatics role alongside another health-related role. The broad range of position titles and functions demonstrates the breadth within this workforce. Ongoing monitoring of this occupational group is required to inform workforce reform and renewal.

Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population.

BACKGROUND: As of 2016, ≈1.4 million people in the United States identify as transgender. Despite their growing number and increasing specific medical needs, there has been a lack of research on cardiovascular disease (CVD) and CVD risk factors in this population. Recent studies have reported that the transgender population had a significantly higher rate of CVD risk factors without a significant increase in overall CVD morbidity and mortality. These studies are limited by their small sample sizes and their predominant focus on younger transgender populations. With a larger sample size and inclusion of broader age range, our study aims to provide insight into the association between being transgender and cardiovascular risk factors, as well as myocardial infarction. METHODS AND RESULTS: The Behavioral Risk Factor Surveillance System data from 2014 to 2017 were used to evaluate the cross-sectional association between being transgender and the reported history of myocardial infarction and CVD risk factors. A logistic regression model was constructed to study the association between being transgender and myocardial infarction after adjusting for CVD risk factors including age, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, smoking, and exercise. Multivariable analysis revealed that transgender men had a >2-fold and 4-fold increase in the rate of myocardial infarction compared with cisgender men (odds ratio, 2.53; 95% CI, 1.14-5.63; P=0.02) and cisgender women (odds ratio, 4.90; 95% CI, 2.21-10.90; P<0.01), respectively. Conversely, transgender women had >2-fold increase in the rate of myocardial infarction compared with cisgender women (odds ratio, 2.56; 95% CI, 1.78-3.68; P<0.01) but did not have a significant increase in the rate of myocardial infarction compared with cisgender men. CONCLUSIONS: The transgender population had a higher reported history of myocardial infarction in comparison to the cisgender population, except for transgender women compared with cisgender men, even after adjusting for cardiovascular risk factors.

Changes in the volatile profile of skim milk powder prepared under different processing conditions and the effect on the volatile flavor profile of model white chocolate.

The objective of this work is to determine the extent to which changes in the skim milk powder (SMP) manufacturing process alter the volatile profile of SMP, and whether these changes are carried through to a final product when the SMP is used as an ingredient and subjected to further processing. The manufacture of SMP is a multistage process involving a preliminary concentration step, heat treatment, and a drying stage. However, the methods and conditions used by the industry are not standardized, and the inherent variability in the production of SMP has consequences for the end-users, such as the confectionery industry, where the SMP is used as an ingredient during the production of milk chocolate, white chocolate, and caramel. This study investigates the effect of each stage of the manufacturing process on the concentration of reducing sugars and available amino groups (as precursors of the Maillard reaction) as well as on the volatile products of the Maillard reaction and lipid degradation. Eight types of SMP were produced using combinations of different processing conditions: concentration (by evaporation or reverse osmosis), heat treatment (low heat or high heat), and drying (spray-drying or freeze-drying). Maillard precursors were quantified after each processing stage and volatile compounds were extracted using solid-phase microextraction, and analyzed by gas chromatography-mass spectrometry. The resulting SMP were incorporated into a model white chocolate system, produced under varying conching conditions. We demonstrate not only that changes in the SMP manufacturing conditions affect the volatile profile of SMP, but also that these differences can be carried through to a final product when the SMP is used to prepare a model white chocolate. Understanding these differences is important to the industry for controlling the flavor of the end product.

Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women.

Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.

Impact of the Skim Milk Powder Manufacturing Process on the Flavor of Model White Chocolate.

Milk powder is an important ingredient in the confectionery industry, but its variable nature has consequences for the quality of the final confectionary product. This paper demonstrates that skim milk powders (SMP) produced using different (but typical) manufacturing processes, when used as ingredients in the manufacture of model white chocolates, had a significant impact on the sensory and volatile profiles of the chocolate. SMP was produced from raw bovine milk using either low or high heat treatment, and a model white chocolate was prepared from each SMP. A directional discrimination test with naïve panelists showed that the chocolate prepared from the high heat SMP had more caramel/fudge character (p < 0.0001), and sensory profiling with an expert panel showed an increase in both fudge (p < 0.05) and condensed milk (p < 0.05) flavor. Gas chromatography (GC)-mass spectrometry and GC-olfactometry of both the SMPs and the model chocolates showed a concomitant increase in Maillard-derived volatiles which are likely to account for this change in flavor.

Towards public health surveillance of intensive care services in NSW, Australia.

OBJECTIVES: Outbreaks of known and novel pathogens causing very severe illness increase the risk to public health in a globalised community and alarm the public. Intensive care units (ICUs) may be an underused setting for public health surveillance. This study investigates the electronic Record for Intensive Care (eRIC), an electronic clinical information and management system being developed for New South Wales ICUs, and its surveillance opportunity offerings. METHODS: The surveillance benefits being introduced by the eRIC were evaluated through consultation with stakeholders and the eRIC program team. The consultation process involved providing stakeholders with background information about the eRIC system. Based on the consultation, a draft data and information model for surveillance was developed. The model was evaluated using guidelines from the US Centers for Disease Control and Prevention. RESULTS: Population health stakeholders confirmed that the eRIC offers an appealing surveillance data source for pathogens and other hazards causing severe illness. Suggested application of the surveillance included, for known hazards, seasonal and pandemic influenza, enterovirus 71, Murray Valley encephalitis virus, enterohaemorrhagic Escherichia coli 0104:H4 and parechovirus. The proposed surveillance model uses syndromic rather than specific-cause surveillance. It may offer greater timeliness and sensitivity than relying on reporting of diagnoses of specific pathogens. Five syndromes derived from clinical pathways in the eRIC are proposed: severe acute respiratory disease, severe acute neurological disease, sepsis or septicaemia, jaundice or hepatitis, and acute renal failure. CONCLUSION: New intensive care clinical information systems offer a largely untapped resource for continuous, mainstream, rapid ICU surveillance of severe illness. A continuous, mainstream, rapid ICU surveillance facility that will readily adapt to emergency situations would be a valuable resource for protecting population health. This study establishes a firm basis on which ICU surveillance can be developed.

The efficacy of gum chewing in reducing postoperative ileus: a multisite randomized controlled trial.

PURPOSE: The purpose of this prospective, attention-controlled, randomized study was to determine whether postoperative gum chewing reduces the duration of postoperative ileus symptoms following elective open or laparoscopic sigmoid colectomy when compared with standard care or an attention-control intervention. SUBJECTS AND SETTINGS: Forty-seven subjects scheduled for either an open or laparoscopic colon resection participated in the study. Subjects were recruited preoperatively at the preadmission learning centers of the 2 acute care medical centers that comprised the study settings. METHODS: Subjects were randomized to 3 groups: (1) standard postoperative care (n = 18); (2) standard care and a silicone-adhesive patch applied to the deltoid region of the upper arm as an attention control (n = 16); and (3) standard care and gum chewing (n = 13). Standard postoperative care included removal of the nasogastric tube, early ambulation, nothing by mouth with ice chips only until the first passage of flatus, and then advancement of diet until tolerance of solid food. RESULTS: No statistically significant differences were found among the 3 study groups for the 4 postoperative outcome variables measured: (1) first passage of flatus; (2) first bowel movement; (3) return of hunger; and (4) ability to tolerate solid food for one meal. CONCLUSION: Postoperative gum chewing was not found to be more effective than standard postoperative care or our attention-control intervention in reducing the duration of postoperative ileus symptoms, length of stay, or complications among patients following open/laparoscopic sigmoid colectomy.

Designing an intervention to help people with colorectal adenomas reduce their intake of red and processed meat and increase their levels of physical activity: a qualitative study.

BACKGROUND: Most cases of colorectal cancer (CRC) arise from adenomatous polyps and malignant potential is greatest in high risk adenomas. There is convincing observational evidence that red and processed meat increase the risk of CRC and that higher levels of physical activity reduce the risk. However, no definitive randomised trial has demonstrated the benefit of behaviour change on reducing polyp recurrence and no consistent advice is currently offered to minimise patient risk. This qualitative study aimed to assess patients' preferences for dietary and physical activity interventions and ensure their appropriate and acceptable delivery to inform a feasibility trial. METHODS: Patients aged 60-74 included in the National Health Service Bowel Cancer Screening Programme (NHSBCSP) were selected from a patient tracking database. After a positive faecal occult blood test (FOBt), all had been diagnosed with an intermediate or high risk adenoma (I/HRA) at colonoscopy between April 2008 and April 2010. Interested patients and their partners were invited to attend a focus group or interview in July 2010. A topic guide, informed by the objectives of the study, was used. A thematic analysis was conducted in which transcripts were examined to ensure that all occurrences of each theme had been accounted for and compared. RESULTS: Two main themes emerged from the focus groups: a) experiences of having polyps and b) changing behaviour. Participants had not associated polyp removal with colorectal cancer and most did not remember being given any information or advice relating to this at the time. Heterogeneity of existing diet and physical activity levels was noted. There was a lack of readiness to change behaviour in many people in the target population. CONCLUSIONS: This study has confirmed and amplified recently published factors involved in developing interventions to change dietary and physical activity behaviour in this population. The need to tailor the intervention to individuals, the lack of knowledge about the aetiology of colon cancer and the lack of motivation to change behaviour are critical factors. TRIAL REGISTRATION: Current Controlled Trials ISRCTN03320951.

Factors associated with self-care activities among adults in the United Kingdom: a systematic review.

BACKGROUND: The Government has promoted self-care. Our aim was to review evidence about who uses self-tests and other self-care activities (over-the-counter medicine, private sector, complementary and alternative medicine (CAM), home blood pressure monitors). METHODS: During April 2007, relevant bibliographic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, PsycINFO, British Nursing Index, Allied and Complementary Medicine Database, Sociological Abstracts, International Bibliography of the Social Sciences, Arthritis and Complementary Medicine Database, Complementary and Alternative Medicine and Pain Database) were searched, and potentially relevant studies were reviewed against eligibility criteria. Studies were included if they were published during the last 15 years and identified factors, reasons or characteristics associated with a relevant activity among UK adults. Two independent reviewers used proformas to assess the quality of eligible studies. RESULTS: 206 potentially relevant papers were identified, 157 were excluded, and 49 papers related to 46 studies were included: 37 studies were, or used data from questionnaire surveys, 36 had quality scores of five or more out of 10, and 27 were about CAM. Available evidence suggests that users of CAM and over-the-counter medicine are female, middle-aged, affluent and/or educated with some measure of poor health, and that people who use the private sector are affluent and/or educated. CONCLUSION: People who engage in these activities are likely to be affluent. Targeted promotion may, therefore, be needed to ensure that use is equitable. People who use some activities also appear to have poorer measures of health than non-users or people attending conventional services. It is, therefore, also important to ensure that self-care is not used as a second choice for people who have not had their needs met by conventional services.

Introduction of intensive glycaemic control into a neurosurgical intensive care unit: a retrospective cohort study.

BACKGROUND: There is evidence that intensive glycaemic control decreases morbidity and mortality in surgical intensive care unit patients. In traumatic brain injury, hyperglycaemia is a prognostic indicator. OBJECTIVE AND STUDY DESIGN: This retrospective cohort study describes the blood glucose level outcomes before and after the introduction of an intensive insulin protocol to a neurosurgical ICU. METHODS: We analysed data on all patients admitted to a neurosurgical ICU during the year before, and the year after, the introduction in July 2003 of an intensive insulin protocol targeting patient blood glucose level (BGL) to 4.4- 6.1mmol/L. Patients who underwent fewer than 20 BGL measurements during the ICU admission were excluded. Data were obtained from an electronic clinical information system. RESULTS: 121 patients were enrolled: 64 before and 57 after introduction of the protocol. The groups were similar in sex, age, and severity of illness on ICU admission. After introduction of the protocol, BGL was significantly lower (weighted mean BGL, 6.73mmol/L v 7.77mmol/L before; P < 0.001), and proportion of BGL readings in the target range was greater (37% v 21% before; P < 0.001). In addition, BGL variability was greater (weighted mean standard deviation, 2.03 v 1.88 before; P < 0.001), hypoglycaemia was more common (0.58% of BGL readings v 0.20% before; P = 0.06), and ICU stay was significantly longer, but there was no difference in median Glasgow Coma Scale score or ICU discharge status (alive or dead). CONCLUSIONS: The intensive insulin protocol was effective in lowering blood glucose in neurosurgical ICU patients.

Flavor formation and character in cocoa and chocolate: a critical review.

Chocolate characters not only originate in flavor precursors present in cocoa beans, but are generated during post-harvest treatments and transformed into desirable odor notes in the manufacturing processes. Complex biochemical modifications of bean constituents are further altered by thermal reactions in roasting and conching and in alkalization. However, the extent to which the inherent bean constituents from the cocoa genotype, environmental factors, post-harvest treatment, and processing technologies influence chocolate flavor formation and relationships with final flavor quality, has not been clear. With increasing speciality niche products in chocolate confectionery, greater understanding of factors contributing to the variations in flavor character would have significant commercial implications.

Preliminary experience with nesiritide in pediatric patients less than 12 months of age.

The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Advances in recombinant technology have provided the opportunity for the exogenous administration of a recombinant form of B-type natriuretic peptide (nesiritide). To date, reports of its use in the pediatric population are limited, with limited information regarding its use in patients less than 12 months of age. We retrospectively reviewed our experience with nesiritide in infants less than 12 months of age to determine its efficacy and adverse effect profile. The study cohort included 22 patients, ranging in age from 4 days to 12 months. The starting dose of the nesiritide infusion ranged from 0.01 to 0.05 microg/kg/min (0.015+/-0.01microg/ kg/min) and was administered for a total of 3 to 264 hours (85.2+/-75.0 hours). Nesiritide resulted in a significant increase in urine output even in the face of decreased fluid intake. Mean urine output increased from 3.1+/-2.5 mL/kg/h before nesiritide to 5.7+/-4.5 mL/kg/h (P = .03) during the initial 24 hours after starting the infusion. Fluid intake before and after the infusion were 126 +/- 60 mL/kg/d and 108+/-56 mL/kg/d, respectively. There were no statistically or clinically significant changes in hemodynamic parameters (heart rate, blood pressure, and central venous pressure) during the nesiritide infusion. No change in electrolytes, blood urea nitrogen, and creatinine were noted. No adverse effects of the nesiritide infusion were noted. No infusion was stopped due to adverse effects. These data suggest that nesiritide is a safe method of improving urine output in pediatrics patients less than 12 months of age and that the adverse effect profile does not appear to be different than that reported in older children.