Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
7,164
result(s) for
"Brown, Roger"
Sort by:
Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing
Background
The impact of early adversity increases the risk of poor outcomes across the life course. Identifying factors that protect against or contribute to deleterious life outcomes represents an important step in resilience promotion among children exposed to adversity. Informed by resilience science, we hypothesized that family resilience mediates the relationship between adverse childhood experiences (ACEs) and child flourishing, and these pathways vary by race/ethnicity and income.
Methods
We conducted a secondary data analysis using the 2016–17 National Survey of Children’s Health data reported by parents/guardians for 44,686 children age 6–17 years. A moderated-mediation model estimated direct, indirect, and total effects using a probit link function and stacked group approach with weighted least square parameter estimates.
Results
The main variables were related in expected directions. Family resilience partially mediated the ACEs-flourishing association. Although White and socioeconomically advantaged families were more likely to maintain family resilience, their children functioned more poorly at high-risk levels relative to Black and Hispanic children and across income groups.
Conclusion
Children suffer from cumulative adversity across race/ethnicity and income. Partial mediation of family resilience indicates that additional protective factors are needed to develop comprehensive strategies, while racial/ethnic differences underscore the importance of prevention and intervention programs that are culturally sensitive.
Impact
The key message of the article reinforces the notion that children suffer from cumulative adversity across race/ethnicity and income, and prevention of ACEs should be the number one charge of public policy, programs, and healthcare.
This is the first study to examine family resilience in the National Survey Children’s Health (NSCH) data set as mediating ACEs-flourishing by race/ethnicity and family poverty level.
Examining an ACEs dose–response effect using population-based data within the context of risk and protective factors can inform a public health response resulting in a greater impact on prevention efforts.
Journal Article
Consensus Definition of Sport Specialization in Youth Athletes Using a Delphi Approach
A single, widely accepted definition of sport specialization does not exist. A consensus definition is necessary to guide youth sport stakeholders on issues associated with sport specialization.
The aim of this study was to develop a consensus definition of youth sport specialization and to identify elements that support the construct of specialization.
Delphi Study Setting: Directed Surveys Patients or Other Participants: A consensus panel of 17 experts was created to provide a broad multidisciplinary perspective on sport specialization in youth athletes.
The final definition was developed per an iterative process that involved four rounds of review. A comprehensive review of literature and expert input supported our initial proposed umbrella definition that included six additional elements. The study team reviewed the results after each round and changes were made to the definition based on panel feedback.
Panel members were provided with the definition and six elements and then asked to rate each specific to importance, relevance, and clarity using a 4-point Likert scale.
In four Delphi consensus rounds, 17 experts reviewed the umbrella definition and six elements before consensus was reached. The umbrella definition and three of the initial six elements achieved >80% agreement for importance, relevance, and clarity after the fourth round of review. The remaining 3 components did not reach >80% agreement even after iterative edits and were removed. The process resulted in a final consensus definition: Sport specialization is intentional and focused participation in a single sport for a majority of the year that restricts opportunities for engagement in other sports and activities.
A consensus-based conceptual definition for sport specialization has been developed using a Delphi method. This definition has important implications for clinicians and sports medicine professionals who support youth athletes.
Journal Article
Venom : the complete collection
One of comics' wildest writers takes on the symbiotic super hero! Flash Thompson, the Secret Avenger called Agent Venom, faces Daimon Hellstrom and the Monsters of Evil in a battle to save his soul! But when Venom's psychopathic off spring targets the Microverse, Flash and the new Scarlet Spider must put their rivalries aside to handle the madness of Carnage! Venom says farewell to New York and heads to Philadelphia - but Toxin follows soon after. And the pair of lethal symbiotes may unwittingly unleash something even more deadly! Can Flash battle side-by-side with the original Venom, Eddie Brock, to save the City of Brotherly Love? Plus underworld boss Lord Ogre! The killer called Crossbones! And...a symbiotic sidekick?! Cullen Bunn's explosive Venom run is collected in full!
Book
A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study
ABSTRACT
BACKGROUND
Work conditions in primary care are associated with physician burnout and lower quality of care.
OBJECTIVE
We aimed to assess if improvements in work conditions improve clinician stress and burnout.
SUBJECTS
Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study.
STUDY DESIGN
This was a cluster randomized controlled trial.
MEASURES
Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12–18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites.
INTERVENTIONS
Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects.
ANALYSIS
Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement.
RESULTS
Of 166 clinicians, 135 (81.3 %) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8 % vs 7.1 % less burned out,
p
= 0.01) and satisfaction (23.1 % vs 10.0 % more satisfied,
p
= 0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9,
p
= 0.02], and with targeted QI projects than in controls (OR 4.8,
p
= 0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1,
p
= 0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2,
p
= 0.06).
LIMITATIONS
We used heterogeneous intervention types, and were uncertain how well interventions were instituted.
CONCLUSIONS
Organizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.
Journal Article
Decisional Conflict During Major Medical Treatment Decision-making: a Survey Study
BackgroundBoth patients and surrogate decision-makers experience decisional conflict when making a major medical treatment decision with life or death implications. The relationship between health literacy and decisional conflict while making a major medical treatment decision is not understood.ObjectiveTo identify the prevalence of individuals making major medical treatment decisions for themselves or someone else and to explore the relationships between decisional conflict and circumstances of the decision as well as the decision-maker.DesignTwo-phase survey study: in phase 1, we screened for who made a major treatment decision; in phase 2, we asked eligible respondents about their experience making the decision.ParticipantsAddress-based random sample of 4000 Wisconsin residents; 1072 completed phase 1 and 464 completed phase 2.Main MeasuresWe asked respondents about types of decisions made, the most difficult decision made, and characteristics of the decision-maker and the decision. We included the Decisional Conflict Scale and four domains of the Health Literacy Questionnaire. Open-ended questions also allowed respondents to describe their experiences.Key ResultsAbout 43% of respondents reported making a major medical treatment decision. Decisions about major surgery and life support were regarded as the most difficult decisions. Respondents who made the decision for a spouse/partner (β = 6.65, p = 0.012), parent (β = 9.27, p < 0.001), or someone else (β = 10.7, p < 0.001) had higher decisional conflict. Respondents who reported higher ability to actively engage with healthcare providers (β = − 5.24, p = 0.002) and to understand health information well enough to know what to do (β = − 6.12, p = 0.001) had lower decisional conflict.ConclusionsThe need to make major treatment decisions is likely to increase and making decisions on someone else’s behalf appeared to be especially difficult. Improving communication to encourage patient and family engagement in the decision-making conversation, particularly for individuals with limited health literacy, may be helpful.
Journal Article
Where we work correlates with whether we receive cardiorespiratory preventive care services: Health and Retirement Study 2003–2018
Background
Uncontrolled dyslipidemia contributes to cardiovascular diseases, the leading cause of death among American workers, while influenza leads to significant absenteeism and presenteeism. Despite the potential productivity loss due to cardiorespiratory illness, few studies have examined occupational disparities in preventive care utilization. This study aimed to assess the influence of occupation and job characteristics on cholesterol screening and influenza vaccination utilization.
Methods
Data from the Health and Retirement Study (HRS) 2003–2018 were analyzed, representing past and current workers (
N
= 7,022). Occupation was coded based on the U.S. Census 1980 and 2000 and configured into five groups: management/science, social services, general services, health services, and industrial workforce. Participants who never reported job information were included in the sensitivity analysis. Job characteristics, including psychological and physical strains at work, ergonomic risk, lifting of heavy loads, and job stability, were based on self-reported questions. The influences of job category and job characteristics on cholesterol screening and influenza vaccination utilization were examined using multivariable logistic regression, multinomial logit model, and multinomial probit models.
Results
Industrial workers and general services workers were less likely to receive cholesterol screenings and influenza vaccinations than management and science workers after controlling for social-demographic and health statuses. Frequent job-related heavy lifting and lower job-related mental strain were linked to lower cholesterol screening rates. Higher job-related physical strain and job instability were associated with reduced influenza vaccination uptake. Those outside the labor force were also less likely to undergo periodic cholesterol screening and influenza vaccination.
Conclusion
This study demonstrated an underutilization of preventive care services among industrial and general services workers, as well as those outside the labor force. Our findings underscore the need to promote access to preventive care services while addressing cardiovascular disease awareness and vaccination hesitancy in these populations.
Journal Article