Does Practice Make Perfect? A Randomized Control Trial of Behavioral Rehearsal on Suicide Prevention Gatekeeper Skills

Suicide is the third leading cause of death among 10-24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are discussed.     

Hypotension--does it Make Sense in Family Practice?

In general practice many diagnostic labels are used that arerelated to cultural background rather than a scientific basis.To estimate the use of diagnoses like ‘hypotension’and depression, a cross-sectional survey in German and BritishGPs' surgeries was performed. Prevalence of related symptoms,socio-demographic and medical data were recorded as well asactual and previous blood pressure levels. In German generalpractice, where ‘hypotension’ is an establishedentity, 17% of all patients attending were reported as hypotensiveeither by their doctor or by themselves. The proportion wastwice as high among women than among men. It was more commonamong the young. One-quarter of these patients were on medicationto raise their blood pressure. Actual and previous blood pressurelevels failed to explain the occurrence of symptoms like tiredness,dizziness, headache etc. Demographic characteristics of patientsdiagnosed as depressed were similar in both countries. Presumablyfor economic reasons there is a tendency for German GPs to usemore diagnostic labels of any kind. It was concluded that diagnosticlabels attached to vague but frequently presented symptoms varyconsiderably between countries. They often lack a physiologicrationale. Nevertheless they often support the tendency to somatizecommon problems.     

Continuous Quality Improvement: Does It Make a Difference?

A corporate benefits consultant suggests that dynamic leadership is needed to bring about a serious commitment to continuous quality improvement in the health care field.     

Knowledge of Diabetes Mellitus: Does Gender Make a Difference?

Objective

Diabetes mellitus (DM) is a chronic disease considered an important public health problem. In recent years, its prevalence has been exponentially rising in many developing countries. Chronic complications of DM are important causes of morbidity and mortality among patients, which impair their health and quality of life. Knowledge on disease prevention, etiology, and management is essential to deal with parents, patients, and caregivers. The aim of this study was to evaluate the knowledge regarding DM in an adult population from a Middle-western Brazilian city.

Methods

This was a cross-sectional study covering 178 adults, aged 18–64 years, who answered a diabetes knowledge questionnaire. In order to identify the difference between groups, analysis of variance was used.

Results

Higher knowledge scores were found regarding the role of sugars on DM causality, diabetic foot care, and the effects of DM on patients (blindness, impaired wound healing, and male sexual dysfunction). However, lower scores were found amongst types of DM, hyperglycemic symptoms, and normal blood glucose levels. Females tended to achieve better knowledge scores than males.

Conclusion

Women had better knowledge regarding types of DM, normal blood glucose values, and consequences of hyperglycemia revealed that diabetes education should be improved.     

Obesity and Postpartum Depression: Does Prenatal Care Utilization Make a Difference?

To identify (1) the association between pre-pregnancy BMI (PP-BMI) and PPD symptoms, and (2) the association between PP-BMI and PPD symptoms after considering PNC utilization as a moderating variable. Data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed from 15 states. The study design utilized two risk-adjustment approaches. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach, through a sensitivity analysis, modified the design of the study by truncating the sample to include only women with healthy pregnancies. An initial association was seen between obesity and PPD symptoms, and PNC and PPD symptoms in the multivariate analyses. However, the inclusion of case-mix variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. Results also revealed that many of the women were significantly affected by a variety of high-risk maternal morbidity (case-mix) variables. Although PNC is important for the health of mothers and babies, it does not appear to moderate the association of PP-BMI and PPD symptoms. However, since this study revealed associations between several high-risk maternal morbidities (included as case-mix variables), and PPD symptoms, it is recommended that future research further investigate the possible association of these morbidities with PPD symptoms. For practice, it is suggested that PNC providers focus on their patients, and establish suitable interventions accordingly.     

Does the School Nurse‐to‐Student Ratio Make a Difference?

Public schools must provide an appropriate education for students with complex health needs. Chronic illnesses such as asthma and diabetes, social morbidities, injuries, and conditions that limit learning such as poor vision commonly affect school-aged children. School nurses often assume a leadership role in providing services for these children. However, although a national standard for school nurse/student ratio has been proposed, little research has examined the relationship between different school nurse-to-student ratios, level of health services provided in schools, and student outcomes. This study examined data in a 21-county region in eastern North Carolina served by a regional school nurse consultant. The school nurse-to-student ratio in these counties ranged from 1:451 to 1:7,440 based on full-time equivalencies. Two systems offered no school nursing services. Data from school years ending in 2000-2002 were considered in the analysis. A significant correlation was found between the increased presence of school nurses and services provided to children with diabetes (r = -.52, p = .000) and asthma (r = -.43, p = .002). Schools with better ratios provided more counseling services to children for social conditions such as depression and unintended pregnancy (r = -.38, p = .006), and more follow-up for school-related injuries (r = -.43, p = .003), and a higher percentage of children with vision problems received follow-up care (r = -.37, p = .007). A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides further evidence that school nurses make a difference.     

Preference Weighting of Health State Values: What Difference Does It Make,and Why?

Background

Most patient-reported outcome measures apply a simple summary score to assess health-related quality of life, whereby equal weight is normally assigned to each item. In the generic preference-based instruments, utility weighting is essential whereby health state values are estimated through preference elicitation and complex algorithms.

Third and Fourth Degree Perineal Injury After Vaginal Delivery: Does Race Make a Difference?

Severe perineal injury (third and fourth degree laceration) at the time of vaginal delivery increases the risk of fecal incontinence, chronic perineal pain, and dyspareunia.^1–5 Studies suggest the prevalence of severe perineal injury may vary by racial group.⁶ The purpose of the current study was to examine rates of severe perineal injury in different Asian and Pacific Islander subgroups. A retrospective cohort study was performed among all patients who had a vaginal delivery at Queens Medical Center in Honolulu, Hawai‘i between January 1, 2002 and December 31, 2003. Demographic and health related variables were obtained for each participant. Maternal race/ethnicity (Japanese, Filipino, Chinese, other Asian, Part-Hawaiian/Hawaiian, Micronesian, other Pacific Islander, Caucasian, multiracial [non-Hawaiian], and other) was self-reported by the patient at the time admission. The significance of associations between racial/ethnic groups and demographic and health related variables was determined using chi-square tests for categorical variables and analysis of variance for continuous factors. Multiple logistic regression was performed to adjust for potential confounders when examining severe laceration rates. A total of 1842 subjects met inclusion criteria. The proportion of severe perineal lacerations did not differ significantly between racial groups. In the multiple logistic regression analysis, operative vaginal delivery was related to both race and severe perineal laceration. However, despite adjusting for this variable, race was not associated with an increased risk of having a severe laceration (P = .70). The results of this study indicate the risk of severe perineal laceration does not differ based on maternal race/ethnicity.     

Parenting,Child Behavior,and Academic and Social Functioning: Does Ethnicity Make a Difference?

Background

Most research on the relation between parenting behaviors and child outcomes has not focused on cross-ethnic variation in these relations.

Objective

This study examined if ethnicity moderates associations between parenting, child agency/persistence, and child academic achievement and social competence.

Design

Participants included 608 parents and their 5-year-old children (96 African American, 117 Hispanic, and 395 European American). Parenting was assessed with the Parent Behavior Inventory (support/engagement, hostility/coercion) and a semi-structured interaction paradigm, the NICHD 3-Boxes Task (scaffolding). Child agency/persistence also was assessed with this task. The Social Skills Rating Scale was used to assess social competence (assertion, cooperation, responsibility, self-control). The Woodcock-Johnson-Achievement Test-3rd Edition was used to assess reading and math.

Results

Child agency/persistence was related to academic achievement and support/engagement and hostility/coercion were related to child social competence. Only a few interaction effects between parenting and ethnicity were significant. Higher levels of scaffolding were related to higher scores in reading and mathematics in African American, but not in European American children. Hostility/coercion was associated with lower reading scores in European American, but not in Hispanic children. Support/engagement was related to higher levels of responsibility in both European American and African American children, but this relation was stronger in European American families.

Conclusions

There are more similarities than differences in the effects of parenting and child variables in different ethnic groups. Higher levels of scaffolding are related to higher reading and math achievement in African American families; thus strategies to increase parental scaffolding may be effective in decreasing the “achievement gap.”     

Associations of Health Risk Behaviors With School Absenteeism. Does Having Permission for the Absence Make a Difference?

BACKGROUND: Nearly 10% of students enrolled in US public schools are absent daily. Although previous research has shown associations of school absenteeism with participation in risk behaviors, it is unclear if these associations vary by whether the absence was excused. The purpose of this study was to examine the associations of health risk behaviors with being absent from school with and without permission among high school students. METHODS: During spring 2004, questionnaires similar to the Youth Risk Behavior Survey questionnaire were completed by 4517 ninth- and eleventh-grade students. Responses to items assessing frequency of school absences during the past 30 days for any reason and without permission were combined to create a variable coded as absent on: 0 days; > or =1 day, all with permission (WP); and > or =1 day, at least 1 day without permission (WOP). Logistic regression analyses controlling for gender, grade, and race/ethnicity examined the association of risk behaviors with absenteeism. RESULTS: Controlling for demographic variables, compared to students who were absent 0 days, students who were absent WP had significantly higher odds of engaging in 25 of 55 risk behaviors examined and students who were absent WOP had significantly higher odds of engaging in 43 of the 55 behaviors. Students who were absent WOP also had approximately twice the odds of engaging in risk behaviors compared to students who were absent WP. CONCLUSIONS: School absenteeism, with and without permission, is associated with risk behaviors. Schools should recognize absenteeism for any reason as a warning sign for a variety of risk behaviors.