Adolescents' Sexual Encounters With Either Romantic or Casual Partners and the Quality of Their Romantic Relationships Four Years Later.

Adolescent sexual behavior was examined within a health perspective. Assuming a developmental perspective, the current study investigated the associations between sexual behavior in either stable relationships or in casual encounters, and the quality of romantic relationships and affect 4 years later. Data were collected from 144 Israeli adolescents aged 16-18 years (mean age 16.57 years). Participants completed diary data over a period of 10 days and reported on the quality of their romantic encounters and their emotions, and on their sexual behavior in stable relationships or casual encounters. Four years later, they were asked to complete diary data again for 10 consecutive days and report on the quality of their romantic relationships and their positive and negative affect. Findings indicate that involvement in sexual behavior in stable romantic relationships was associated only with future romantic partner support. In contrast, earlier involvement in casual sexual behavior was associated with a number of future indices: lower partner support, greater negative affect as well as greater relationship tension, and dyadic hurtful behavior 4 years later. The differential role of sexuality within a stable relationship or casual encounters among adolescents for their future romantic development is discussed within a developmental framework.

Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort.

OBJECTIVECollaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.SETTINGThis study included 63 VHA nursing homes enrolled in the "AHRQ Safety Program for Long-Term Care," which focused on practices to reduce CAUTI.METHODSChanges in CAUTI rates, catheter utilization, and urine culture orders were assessed from June 2015 through May 2016. Multilevel mixed-effects negative binomial regression was used to derive incidence rate ratios (IRRs) representing changes over the 12-month program period.RESULTSThere was no significant change in CAUTI among VHA sites, with a CAUTI rate of 2.26 per 1,000 catheter days at month 1 and a rate of 3.19 at month 12 (incidence rate ratio [IRR], 0.99; 95% confidence interval [CI], 0.67-1.44). Results were similar for catheter utilization rates, which were 11.02% at month 1 and 11.30% at month 12 (IRR, 1.02; 95% CI, 0.95-1.09). The numbers of urine cultures per 1,000 residents were 5.27 in month 1 and 5.31 in month 12 (IRR, 0.93; 95% CI, 0.82-1.05).CONCLUSIONSNo changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes. This low baseline rate is likely related to the VHA's prior CAUTI prevention efforts. While broad-scale collaborative approaches may be effective in some settings, targeting higher-prevalence safety issues may be warranted at sites already engaged in extensive infection prevention efforts.Infect Control Hosp Epidemiol 2018;820-825.

Predicting post-breakup distress and growth in emerging adulthood: The roles of relationship satisfaction and emotion regulation.

With a sample of emerging adults (N = 110; 72% female) this brief report utilized self-report measures to examine the role of relationship satisfaction and emotion regulation strategies assessed at age 20 in predicting breakup distress and posttraumatic growth three years later. Results showed that higher relationship satisfaction is associated with less future breakup distress. Emotion regulation explained the ways individuals cope with distress; cognitive appraisal (in contrast to emotional suppression) predicted higher growth after experiencing a breakup. Findings highlight the ways emotion regulation strategies can help emerging adults cope with relational stressors such as breakups.

Changes in rejection sensitivity across adolescence and emerging adulthood: Associations with relationship involvement, quality, and coping.

Using a sample of 110 Israeli youth (72% female), the present study investigates associations between initial levels of rejection sensitivity as well as changes in rejection sensitivity from age 16 to age 23 and relationship involvement, quality, and (growth following) coping with relationship stress. Results showed that rejection sensitivity generally decreased over time into the transition to adulthood. Furthermore, levels of rejection sensitivity at age 16 predicted whether young people were romantically involved by age 23, as well as the quality of their relationships. Yet, the change in level of rejection sensitivity over time explained far more the quality of later romantic relationships and competence in coping with relationship stress than the initial level of rejection sensitivity. These findings have important implications for examining the role of changes in personality attributes such as rejection sensitivity in the transition from adolescence to adulthood.

The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities.

Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals.

Betrayals in Emerging Adulthood: A Developmental Perspective of Infidelity.

Infidelity is associated with considerable distress and discord in dating relationships. The current mixed methods study examined both the written narratives and survey responses of 104 (59.6% women) emerging adults to investigate reasons for engaging in infidelity (i.e., sexual and emotional infidelity). Emerging adults' reasons for engaging in infidelity were attributed primarily to their primary relationships and/or their romantic partners not fulfilling their needs for interdependence and thus feeling motivated to fulfill these needs elsewhere. Although the majority of participants provided independence and/or interdependence reasons for their infidelity, a large proportion of responses (40%) referenced alternative reasons. These responses included (a) the opportunity to become intimate with an infidelity partner while under the influence of alcohol, (b) attraction to an infidelity partner, and (c) the excitement and novelty that the infidelity experience provided. Those who reported engaging in infidelity because of unmet interdependence needs, and intimacy needs in particular, were more avoidantly attached than those who did not reference unmet interdependence needs. Those who reported engaging in infidelity because of unmet independence needs were more anxiously attached than those who did not reference unmet independence needs. Implications for the developmental importance of infidelity in terms of research and applied work are discussed.

The Symbolic Nature of Trust in Heterosexual Adolescent Romantic Relationships.

Trust contributes to young people's capacity for sustaining current and future successful relationships. To date, research has yet to examine the meaning of trust in early dating relationships and reasons for its deterioration. The present study focused on video-recorded conversations about trust between 34 heterosexual adolescent couples in dating relationships living in the U.S. Transcripts from these conversations were qualitatively analyzed using thematic analysis to identify adolescents' meanings of trust and reasons they provided for a lack of trust in their romantic partners. All 34 couples identified concerns specifically related to infidelity. Six major themes for not trusting romantic partners emerged. Results suggested that the lack of trust in romantic relationships might stem from several areas that are directly and indirectly related to the current relationship, including low self-esteem, the experience of betrayal in past romantic relationships, partners' extradyadic behaviors, and gossip among peers. Importantly, peers can play a defining role in influencing young people's perceptions of their romantic partners and developing or sustaining trust in their romantic relationships.

Rejection sensitivity and depressive symptoms: Longitudinal actor-partner effects in adolescent romantic relationships.

The present study utilizes the actor-partner interdependence model to examine the longitudinal relationship between rejection sensitivity and one's own and one's partner's depressive symptoms. The sample included adolescent romantic couples from the U.S. (N = 198 adolescents; 50% girls; 90.2% Caucasian) whose rejection sensitivity at Time 1 and depressive symptoms approximately one year later (Time 2) were assessed. Additionally, aggressive behaviors and maintenance behaviors that commonly associated with rejection sensitivity (e.g., self-silencing) are explored as mediators. Results indicate that boyfriends' rejection sensitivity at Time 1 predicted girlfriends' depressive symptoms at Time 2. Additionally, girls' rejection sensitivity predicted their own and their boyfriends' self-silencing. Developmental and clinical implications are discussed.

Access to Subspecialty Care And Survival Among Patients With Liver Disease.

OBJECTIVES: Access to subspecialty care may be difficult for patients with liver disease, but it is unknown whether access influences outcomes among this population. Our objectives were to determine rates and predictors of access to ambulatory gastrointestinal (GI) subspecialty care for patients with liver disease and to determine whether access to subspecialty GI care is associated with better survival. METHODS: We studied 28,861 patients within the Veterans Administration VISN 11 Liver Disease cohort who had an ICD-9-CM diagnosis code for liver disease from 1 January 2000 through 30 May 2011. Access was defined as a completed outpatient clinic visit with a gastroenterologist or hepatologist at any time after diagnosis. Multivariable logistic regression was used to determine predictors of access to a GI subspecialist. Survival curves were compared between those who did and those who did not see a specialist, with propensity score adjustment to account for other covariates that may affect access. RESULTS: Overall, 10,710 patients (37%) had a completed GI visit. On multivariable regression, older patients (odds ratio (OR) 0.98, P<0.001), those with more comorbidities (OR 0.98, P=0.01), and those living farther from a tertiary-care center (OR 0.998/mi, P<0.001) were less likely to be seen in clinic. Patients who were more likely to be seen included those who had hepatitis C (OR 1.5, P<0.001) or cirrhosis (OR 3.5, P<0.001) diagnoses prior to their initial visit. Patients with an ambulatory GI visit at any time after diagnosis were less likely to die at 5 years when compared with propensity-score-matched controls (hazard ratio 0.81, P<0.001). CONCLUSIONS: Access to ambulatory GI care was associated with improved 5-year survival for patients with liver disease. Innovative care coordination techniques may prove beneficial in extending access to care to liver disease patients.

Family enmeshment, adolescent emotional dysregulation, and the moderating role of gender.

Enmeshment plays a key role in many families' dysfunctional interactions and may be especially detrimental for adolescents. Sixty-four adolescents completed ratings of family enmeshment, perceived distress tolerance, an interpersonal challenge task, and mood ratings before and immediately after the task. Before and during the challenge task, adolescents' respiratory sinus arrhythmia (an indicator of cardiac vagal tone) was recorded. Associations were tested between adolescents' perceptions of family enmeshment and 3 aspects of adolescent emotional dysregulation. Adolescents who perceived higher family enmeshment also demonstrated greater emotional dysregulation in several domains: negative global appraisals of distress tolerance, stronger increase in subjective negative mood from baseline to postchallenge, lower baseline vagal tone, and vagal augmentation during the challenge task. Gender differences also emerged, such that girls reported more negative distress appraisals overall and enmeshed boys showed greater emotional dysregulation across analyses. Findings are discussed in terms of how clinicians may dynamically assess and treat enmeshment and emotional dysregulation in families with male and female adolescents.

Rejection sensitivity and adolescents' perceptions of romantic interactions.

Rejection sensitivity - the tendency to expect, perceive, and overreact to rejection by others - is linked with individuals' expectations that their romantic partners' behaviors have negative intent, even if, perhaps, such behaviors could be considered neutral when observed by another. The aim of the present study was to test this proposition, derived from rejection sensitivity theory, using a Video-Recall Procedure with adolescent couples in the US (N = 386 adolescents, 50% girls). We examined whether adolescents who were more sensitive to rejection perceived their romantic partners' behaviors as more conflictual than when viewed by trained, third-party observers. Findings suggest that, at the micro-analytic level, higher rejection sensitivity is associated with adolescents' heightened perception of their romantic partners as conflictual when compared to observers, who more often coded the same behaviors as neutral rather than conflictual. Implications for adolescent mental health and well-being are discussed.

Is sexual behavior healthy for adolescents? A conceptual framework for research on adolescent sexual behavior and physical, mental, and social health.

Although research has increasingly emphasized how adolescent sexual behavior may be associated with aspects of health beyond unwanted pregnancy and sexually transmitted infections, no current theoretical or conceptual model fully explains associations between sexual behavior and multiple facets of health. We provide a conceptual model that explicates possible processes of how adolescent sexual behavior may influence physical, mental, and social health. Next, we review the current literature consistent with this conceptual model, demonstrating that although early sexual behavior can be associated with some negative outcomes, sex may be, on average, a positive experience in late adolescence. Finally, we discuss important future directions for research in these areas, including how individuals' attitudes about and perceptions of sexual behavior influence outcomes of sex.

Employee attitudes about moving toward a smoke-free campus at a Veterans Affairs hospital.

BACKGROUND: Although Veterans Affairs (VA) hospitals have been smoke-free inside of buildings since 1991, smoke-free campuses have not been initiated. The purpose of this article is to describe staff attitudes regarding making the VA hospital a smoke-free campus except for the mandated smoking shelters. METHODS: In 2008, a cross-sectional, anonymous survey was conducted with a convenience sample of employees at a Midwestern VA (N = 397). RESULTS: Descriptive statistics showed that the vast number of employees were in support of a smoke-free campus (76%), relocating the smoking shelters (62%), and offering employees assistance to quit smoking (71%). Multivariate analyses showed that those who were nonsmokers, older, women, and higher educated were the greatest supporters of policies to support a smoke-free environment (p < .05). Write-in comments were generally favorable but also revealed employee resistance related to freedom, personal choice, and potential loss in productivity as smokers go further away from the building to smoke. CONCLUSIONS: VA hospitals have unique challenges in implementing smoke-free campus policies.

Early mortality and years of potential life lost among Veterans Affairs patients with depression.

OBJECTIVE: Substantial literature documents excess and early mortality among individuals with serious mental illness, but there are relatively few data about mortality and depression. METHODS: During fiscal year 2007, data from the U.S. Department of Veterans Affairs and the National Death Index were used to calculate mean age of death and years of potential life lost (YPLL) associated with 13 causes of death among veterans with (N=701,659) or without (N=4,245,193) depression. RESULTS: Compared with nondepressed patients, depressed patients died younger (71.1 versus 75.9) and had more YPLL (13.4 versus 10.2) as a result of both natural and unnatural causes. Depending on the cause of death, depressed patients died between 2.5 and 8.7 years earlier and had 1.5 to 6.1 YPLL compared with nondepressed patients. CONCLUSIONS: These findings have important implications for clinical practice, given that improved quality of care may be needed to reduce early mortality among depressed VA patients.

Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia.

OBJECTIVE: We examined cardiometabolic disease and mortality over 8 years among individuals with and without schizophrenia. METHOD: We compared 65,362 patients in the Veteran Affairs (VA) health system with schizophrenia to 65,362 VA patients without serious mental illness (non-SMI) matched on age, service access year and location. The annual prevalence of diagnosed cardiovascular disease, diabetes, dyslipidemia, hypertension, obesity, and all-cause and cause-specific mortality was compared for fiscal years 2000-2007. Mean years of potential life lost (YPLLs) were calculated annually. RESULTS: The cohort was mostly male (88%) with a mean age of 54 years. Cardiometabolic disease prevalence increased in both groups, with non-SMI patients having higher disease prevalence in most years. Annual between-group differences ranged from <1% to 6%. Annual mortality was stable over time for schizophrenia (3.1%) and non-SMI patients (2.6%). Annual mean YPLLs increased from 12.8 to 15.4 in schizophrenia and from 11.8 to 14.0 for non-SMI groups. CONCLUSIONS: VA patients with and without schizophrenia show increasing but similar prevalence rates of cardiometabolic diseases. YPLLs were high in both groups and only slightly higher among patients with schizophrenia. The findings highlight the complex population served by the VA while suggesting a smaller mortality impact from schizophrenia than previously reported.

Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with bipolar disorder.

BACKGROUND: Persons with bipolar disorder (BD) experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), contributing to decreased function and premature mortality. We describe the design, rationale, and baseline findings for the Self-Management Addressing Heart Risk Trial (SMAHRT), a randomized controlled effectiveness trial of an intervention (Life Goals Collaborative Care; LGCC) designed to reduce CVD risk factors and improve physical and mental health outcomes in patients with BD. METHODS: Patients with BD and at least one CVD risk factor were recruited from a VA healthcare system and randomized to either LGCC or usual care (UC). LGCC participants attended four weekly, group-based self-management sessions followed by monthly individual contacts supportive of health behavior change and ongoing medical care management. In contrast, UC participants received monthly wellness newsletters. Physiological and questionnaire assessments measured changes in CVD outcomes and quality of life (QOL) over 24 months. RESULTS: Out of the 180 eligible patients, 134 patients were enrolled (74%) and 118 started the study protocols. At baseline (mean age=54, 17% female, 5% African American) participants had a high burden of clinical risk with nearly 70% reporting at least three CVD risk factors including, smoking (41%) and physical inactivity (57%). Mean mental and physical HRQOL scores were 1.5 SD below SF-12 population averages. CONCLUSION: SMAHRT participants experienced substantial CVD morbidity and risk factors, poor symptom control, and decreased QOL. LGCC is the first integrated intervention for BD designed to mitigate suboptimal health outcomes by combining behavioral medicine and care management strategies.

Evaluation of a nurse practitioner disease management model for chronic heart failure: a multi-site implementation study.

While disease management appears to be effective in selected, small groups of CHF patients from randomized controlled trials, its effectiveness in a broader CHF patient population is not known. This prospective, quasi-experimental study compared patient outcomes under a nurse practitioner-led disease management model (intervention group) with outcomes under usual care (control group) in both primary and tertiary medical centers. The study included 969 veterans (458 intervention, 511 control) treated for CHF at six VA medical centers. Intervention patients had significantly fewer (p<0.05) CHF and all-cause admissions at one-year follow-up, and lower mortality at both one- and two-year follow-up. These data provide support for the potential effectiveness of the intervention, and suggest that the evidence from RCTs of disease management models for CHF can be translated into clinical practice, even without the benefits of a selected patient population and dedicated resources often found in RCTs.

Quality of general medical care among patients with serious mental illness: does colocation of services matter?

OBJECTIVE: This study was conducted to determine whether patients with serious mental illness receiving care in Veterans Affairs (VA) mental health programs with colocated general medical clinics were more likely to receive adequate medical care than patients in programs without colocated clinics based on a nationally representative sample. METHODS: The study included all VA patients with diagnoses of serious mental illness in fiscal year (FY) 2006-2007 who were also part of the VA's External Peer Review Program (EPRP) FY 2007 random sample and who received care from VA facilities (N=107 facilities) with organizational data from the VA Mental Health Program Survey (N=7,514). EPRP included patient-level chart review quality indicators for common processes of care (foot and retinal examinations for diabetes complications; screens for colorectal health, breast cancer, and alcohol misuse; and tobacco counseling) and outcomes (hypertension, diabetes blood sugar, and lipid control). RESULTS: Ten out of 107 (10%) mental health programs had colocated medical clinics. After adjustment for organizational and patient-level factors, analyses showed that patients from colocated clinics compared with those without colocation were more likely to receive foot exams (OR=1.87, p<.05), colorectal cancer screenings (OR=1.54, p<.01), and alcohol misuse screenings (OR=2.92, p<.01). They were also more likely to have good blood pressure control (<140/90 mmHg; OR=1.32, p<.05) but less likely to have glycosylated hemoglobin <9% (OR=.69, p<.05). CONCLUSIONS: Colocation of medical care was associated with better quality of care for four of nine indicators. Additional strategies, particularly those focused on improving diabetes control and other chronic medical outcomes, might be warranted for patients with serious mental illness.

Ratings of patient-provider communication among veterans: serious mental illnesses, substance use disorders, and the moderating role of trust.

Many individuals with a mental illness are not satisfied with their communication with their primary provider. The present study examined the relationship of serious mental illness (SMI), substance use disorder (SUD), and trust for the provider with provider communication. The sample included Veterans Administration (VA) patients throughout the United States who either had a SMI diagnosis (schizophrenia or bipolar disorder) or were in a random sample of non-SMI patients (total N=8,089). Latent class (LC) modeling identified three classes of provider communication ratings in the sample: very good, good, and poor. In LC regression, poor trust for the provider was associated with a decrease in the likelihood of being in the "very good" or "good" compared to the "poor" provider communication ratings group, and the decrease was significantly greater for VA patients with a SMI or SUD diagnosis than those without. Training providers on creating trust is particularly important for those who serve patients with SMI and SUD diagnoses.