bluuebunny/crossref_metadata_2025 huggingface dataset:
A Field Evaluation of Construction Workers’ Activity, Hydration Status, and Heat Strain in the Extreme Summer Heat of Saudi Arabia
Authors: Al-Bouwarthan Mohammed , Quinn Margaret M , Kriebel David , Wegman David H
Published: March 2020

Objectives

Assess the impact of summer heat exposure (June–September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain.

Methods

Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called ‘heat stress exceedance’ (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined.

Results

The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020).

Conclusions

Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks.
GenoPheno: cataloging large-scale phenotypic and next-generation sequencing data within human datasets
Authors: Gutiérrez-Sacristán Alba , De Niz Carlos , Kothari Cartik , Kong Sek Won , Mandl Kenneth D , Avillach Paul
Published: March 2020

Precision medicine promises to revolutionize treatment, shifting therapeutic approaches from the classical one-size-fits-all to those more tailored to the patient’s individual genomic profile, lifestyle and environmental exposures. Yet, to advance precision medicine’s main objective—ensuring the optimum diagnosis, treatment and prognosis for each individual—investigators need access to large-scale clinical and genomic data repositories. Despite the vast proliferation of these datasets, locating and obtaining access to many remains a challenge. We sought to provide an overview of available patient-level datasets that contain both genotypic data, obtained by next-generation sequencing, and phenotypic data—and to create a dynamic, online catalog for consultation, contribution and revision by the research community. Datasets included in this review conform to six specific inclusion parameters that are: (i) contain data from more than 500 human subjects; (ii) contain both genotypic and phenotypic data from the same subjects; (iii) include whole genome sequencing or whole exome sequencing data; (iv) include at least 100 recorded phenotypic variables per subject; (v) accessible through a website or collaboration with investigators and (vi) make access information available in English. Using these criteria, we identified 30 datasets, reviewed them and provided results in the release version of a catalog, which is publicly available through a dynamic Web application and on GitHub. Users can review as well as contribute new datasets for inclusion (Web: https://avillachlab.shinyapps.io/genophenocatalog/; GitHub: https://github.com/hms-dbmi/GenoPheno-CatalogShiny).
Favipiravir and Zanamivir Cleared Infection with Influenza B in a Severely Immunocompromised Child
Authors: Lumby Casper K , Zhao Lei , Oporto Macarena , Best Tim , Tutill Helena , Shah Divya , Veys Paul , Williams Rachel , Worth Austen , Illingworth Christopher J R , Breuer Judy
Published: March 2020

A combination of favipiravir and zanamivir successfully cleared influenza B infection in a child who had undergone bone marrow transplant for X-linked severe combined immunodeficiency, with no recovery of T lymphocytes. Deep sequencing of viral samples illuminated the within-host dynamics of infection, demonstrating the effectiveness of favipiravir in this case.
Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial
Authors: Kortela Elisa , Kanerva Mari J , Puustinen Juha , Hurme Saija , Airas Laura , Lauhio Anneli , Hohenthal Ulla , Jalava-Karvinen Päivi , Nieminen Tuomas , Finnilä Taru , Häggblom Tony , Pietikäinen Annukka , Koivisto Mari , Vilhonen Johanna , Marttila-Vaara Minna , Hytönen Jukka , Oksi Jarmo
Published: March 2020

Background

Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB.

Methods

Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi–specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months.

Results

Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was −3.9 in the doxycycline group and −3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, −.59 to .92], which is within the prespecified equivalence margins of −1 to 1 units). Participants in both groups improved equally.

Conclusions

Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB.

Clinical Trials Registration

NCT01635530 and EudraCT 2012-000313-37.
Low-density lipoprotein-cholesterol target attainment according to the 2011 and 2016 ESC/EAS dyslipidaemia guidelines in patients with a recent myocardial infarction: nationwide cohort study, 2013–17
Authors: Allahyari Ali , Jernberg Tomas , Lautsch Dominik , Lundman Pia , Hagström Emil , Schubert Jessica , Boggs Robert , Salomonsson Stina , Ueda Peter
Published: March 2020

Aims

To assess low-density lipoprotein cholesterol (LDL-C) treatment target attainment among myocardial infarction (MI) patients according to the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines from 2011 (LDL-C < 1.8 mmol/L or ≥50% LDL-C reduction) and 2016 (LDL-C < 1.8 mmol/L and ≥50% LDL-C reduction).

Methods and results

Using nationwide registers, we identified 44 890 patients aged 21–74 admitted for MI, 2013–17. We included those attending follow-up visits at 6–10 weeks (n = 25 466) and 12–14 months (n = 17 117) after the event. Most patients received high-intensity statin monotherapy [84.3% (6–10 weeks) and 69.0% (12–14 months)] or statins with ezetimibe (2.7% and 10.2%). The proportion of patients attaining the 2011 LDL-C target was 63.8% (6–10 weeks) and 63.5% (12–14 months). The corresponding numbers for the 2016 LDL-C target were 31.6% (6–10 weeks) and 31.5% (12–14 months). At the 6- to 10-week follow-up, 37% of those not attaining the 2011 LDL-C target and 48% of those not attaining the 2016 target had an LDL-C level that was ≥0.5 mmol/L from the target. When comparing LDL-C measurements performed before vs. after the release of the 2016 guidelines, attainment of the 2016 LDL-C target increased from 30.2% to 35.0% (6–10 weeks) and from 27.6% to 37.6% (12–14 months).

Conclusion

In a nationwide register, one out of three patients with a recent MI had not attained the LDL-C target of the 2011 ESC/EAS guidelines and two out of three patients had not attained the LDL-C target of the 2016 guidelines.
An exclusive fine-needle biopsy approach to sampling solid lesions under EUS guidance: a prospective cohort study
Authors: Temnykh Lindsey M , Rahal Mahmoud A , Zia Zahra , Al-Haddad Mohammad A
Published: March 2020

Background

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is increasingly utilized to enhance the cytological yield of sampling solid lesions, but its superiority over existing fine-needle aspiration (FNA) platforms has not been clearly demonstrated. The aim of our study was to compare the diagnostic accuracy and procedural outcomes of FNB using a new Franseen-tip needle to that of a traditional FNA in sampling solid lesions under EUS guidance.

Methods

Consecutive patients with solid lesions referred for EUS-FNB sampling were included. Procedure-related outcomes were collected prospectively including patient demographics, number of passes performed, diagnostic sample adequacy, adverse events, and recovery time. The Acquire needle was used to sample all lesions in the study group. Consecutive EUS-FNA procedures performed to sample solid lesions using the Expect needle were utilized as controls.

Results

There were 180 patients undergoing EUS-FNB compared to 183 patients undergoing EUS-FNA procedures for solid-lesion sampling. The procedure time was significantly shorter in patients who underwent FNB compared to FNA (mean: 37.4 vs 44.9 minutes, P < 0.001). Significantly fewer passes were performed in the FNB cohort compared to the FNA group (mean: 2.9 vs 3.8, P < 0.001). The cytologic diagnostic yield was significantly higher in the FNB group compared to the FNA group (98.3% vs 90.2%, P = 0.003). No significant difference in the incidence of adverse events was observed between the FNB and FNA groups (1.1% vs 0.5%, P = 0.564).

Conclusions

An FNB-exclusive approach to sampling solid lesions under EUS guidance is safe and feasible, and may result in fewer overall passes, shorter procedure time, and improved diagnostic adequacy. FNB may replace FNA as the primary sampling modality of choice in all solid lesions.
The benefits of a historical–dialectical ontology to critical mental health promotion research
Authors: Laliberte Shari , Varcoe Colleen
Published: March 2020

In this article, we explore challenges and opportunities in research oriented to understanding the relations among elements of socio-economic life and mental health (MH) and the development and evaluation of mental health promotion (HP) initiatives. We review the population health intervention research (PHIR) literature and respond to recommendations regarding social determinants of health and health inequities-focused research. We discuss three inter-related issue areas: first, the continued dominance of linear and individually oriented theories within predominantly quantitative research approaches and the underdevelopment of ontological and theoretical perspectives that capture complexity; second, the inconsistent use of measures of socio-economic status and health with a lack of attention to taken for granted assumptions; and third, the continued focus on measuring MH challenges to the neglect of exploring the meaning of MH in a positive sense. We extend recommendations within the PHIR literature by sharing our application of a historical–dialectical ontological perspective within a process of social praxis with diverse Canadian young people with varying degrees of access to socio-economic resources. Young people were engaged to explore the relations among socio-economic processes, young people’s MH and implications for mental HP. We argue that this ontological perspective can support the development of structurally oriented critical qualitative research approaches in PHIR.
Indications for the use of highest priority critically important antimicrobials in the veterinary sector
Authors: Lhermie Guillaume , La Ragione Roberto Marcello , Weese J Scott , Olsen John Elmerdahl , Christensen Jens Peter , Guardabassi Luca
Published: March 2020

Background

Among the measures taken to preserve the clinical efficacy of highest priority critically important antimicrobials (HP-CIAs), the WHO has recommended avoiding their use in food-producing animals. Little is known regarding the indications for which different antimicrobial classes are used in animals, even in countries where data on antimicrobial use are available.

Objectives

To outline, in a narrative review, the diseases for which HP-CIAs are used in veterinary medicine, highlighting incongruences with international guidelines and disease conditions where effective alternatives to HP-CIAs are missing.

Methods

Scientific literature, national reports and expert opinion were used to describe the indications for the use of HP-CIAs in the main food-producing (pigs, cattle and poultry) and companion (horses, dogs and cats) animal species.

Results

The most common indications for use of HP-CIAs are enteric and respiratory infections in pigs, cattle and poultry, urogenital infections in dogs and cats and respiratory infections in horses. In some instances, no valid and convenient alternatives to colistin and macrolides are available against certain porcine enteric and bovine respiratory pathogens. Effective, legal and convenient alternatives to HP-CIAs are also lacking for managing common infections in cats, for which oral administration is difficult, Rhodococcus equi infections in horses, some enteric and respiratory infections in poultry and MDR infections in all companion animal species.

Conclusions

Future research and stewardship programmes should focus on the disease conditions identified by this review to reduce the use of HP-CIAs in the veterinary sector.
Determination of Rifampin Concentrations by Urine Colorimetry and Mobile Phone Readout for Personalized Dosing in Tuberculosis Treatment
Authors: Szipszky Claire , Van Aartsen Daniel , Criddle Sarah , Rao Prakruti , Zentner Isaac , Justine Museveni , Mduma Estomih , Mpagama Stellah , Al-Shaer Mohammad H , Peloquin Charles , Thomas Tania A , Vinnard Christopher , Heysell Scott K
Published: March 2020

Background

Individual pharmacokinetic variability is a driver of poor tuberculosis (TB) treatment outcomes. We developed a method for measurement of rifampin concentrations by urine colorimetry and a mobile phone photographic application to predict clinically important serum rifampin pharmacokinetic measurements in children treated for TB.

Methods

Among spiked urine samples, colorimetric assay performance was tested with conventional spectrophotometric and the mobile phone/light box methods under various environmental and biologic conditions. Urine rifampin absorbance (Abs) was then determined from timed specimens from children treated for TB in Tanzania, and compared to serum pharmacokinetic measurements collected throughout the dosing interval.

Results

Both the mobile phone/light box and spectrophotometry demonstrated excellent correlation across a wide range of urine rifampin concentrations (7.8–1000 mg/L) in intra- and interday trials, 24-hour exposure to ambient light or darkness, and varying urinalysis profiles (all r ≥ 0.98). In 12 Tanzanian children, the urine mobile phone/light box measurement and serum peak concentration (Cmax) were significantly correlated (P = .004). Using a Cmax target of 8 mg/L, the area under the receiver operating characteristic curve was 80.1% (range, 47.2%–100%). A urine mobile phone/light box threshold of 50 Abs correctly classified all patients (n = 6) with serum measurements below target.

Conclusions

The urine colorimetry with mobile phone/light box assay accurately measured rifampin absorbance in varying environmental and biological conditions that may be observed clinically. Among children treated for TB, the assay was sensitive for detection of low rifampin serum concentrations. Future work will identify the optimal timing for urine collection, and operationalize use in TB-endemic settings.
EBV-associated mucocutaneous ulcer, a rare cause of a frequent problem
Authors: Hess Gabriel Fridolin , Menter Thomas , Boll Daniel , Steiger Jürg , von Strauss und Torney Marco
Published: March 2020

This report presents a 74-year-old renal transplant patient suffering of polymorphic-post-transplant-associated lymphoproliferative disease (P-PTLD) within an Eppstein-Barr Virus (EBV) associated mucocutaneous rectal ulcer (MCU). He was initially treated by stapled hemorrhoidopexy for a symptomatic grade III hemorrhoidal prolapse refractory to conservative treatment and rubber band ligations. This leads to severe urge, frequency and stool fragmentation. The symptoms were investigated with a number of interventions until a proctoscopy with biopsies finally revealed the diagnosis. The patient had triple therapy of tacrolimus, mycophenolate mofetil and prednisone initially after transplant several years ago with recent reduction to mycophenolate. The MCU was successfully treated with Retuximab and there was no sign of relaps after 6 months. As EBV-associated PTLD is a well known complication after renal transplant, rectum-MCU seems a rare and only recently described subform of this disease that should be excluded in case of ulcerating lesions in immunosuppressed patients.
Children's Health and Illness Recovery Program (CHIRP)
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Adolescents with chronic illness, particularly when accompanied by debilitating, painful, and/or fatiguing symptoms, face challenges that are disruptive to their normal physical, psychological, and social development. The Children’s Health and Illness Recovery Program (CHIRP) is an evidence-based program specifically designed to address the skills needed by adolescents with chronic illnesses to become more confident and independent in coping and managing their illness and lifestyle. The flexible 12-session format of CHIRP can be administered with individual teens and their families or conducted in teen groups with a parallel parent group component. CHIRP integrates and adapts effective treatment components from behavioral family systems therapy, cognitive behavioral therapy, coping strategies intervention, interpersonal psychotherapy, assertiveness training, among others, into therapeutic activities in the companion CHIRP Teen and Family Workbook. This CHIRP Clinician Guide provides detailed instructions for implementing the manualized treatment protocol in the workbook. CHIRP was developed from both a careful review of the evidence-based literature on treatments for adolescents with chronic physical illness and the authors’ more than six decades of combined experience in helping children and families improve their quality of life and independence while coping with a chronic illness. Clinical outcome data on teens who have completed CHIRP demonstrate significant improvement in independent functioning and reduction in symptoms of fatigue and chronic pain; longitudinal data suggest these improvements not only persist but that teens continue to make gains on these factors beyond the completion of treatment, allowing them to pursue meaningful life goals as they transition to young adulthood.
Introduction and Prep Session
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

This chapter provides the clinician with an overview of the clinical issues prevalent in working with teens with chronic illnesses and their families and the rationale and evidence supporting the Children’s Health and Illness Recovery Program (CHIRP) as an effective intervention designed to maximize teen functioning and independence. While many adolescents with chronic health problems are able to have normal developmental and social experiences, a number of factors related to having a chronic illness serve to adversely impact the teen’s ability to participate in crucial developmental experiences essential in preparing for the transition to young adulthood. The clinician is provided detailed background on the CHIRP model and strategies for conducting effective sessions with teens and parents to impart skills that can alter individual and family dynamics while supporting increased teen independence and self-confidence.
Session 1: Stress Identification and Management
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Session 1 of the Children’s Health and Illness Recovery Program (CHIRP) addresses the impact of illness- and non–illness-related stressors on teens with chronic illness and coping strategies needed to reduce stress. This chapter provides the clinician with techniques for guiding the teen in developing methods for identifying stressors and assessing the impact they may have on their symptoms and functioning. The importance of sleep and developing healthy sleep hygiene practices are introduced, along with instructions for the teen in completing a Sleep Log to assess their own sleep patterns and practices. Graduated physical activity is also assessed and encouraged. These data will be collected over the course of several sessions in order to facilitate more effective coping, stress management, and sleep hygiene practices.
Session 2: Problem-Solving Skills
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Session 2 of the Children’s Health and Illness Recovery Program (CHIRP) builds on the topic of stress and stress management by introducing the concept of reducing the impact of stressors via developing more effective coping strategies. In CHIRP, two specific forms of coping are emphasized: “Solving the Problem” coping and “Managing the Impact” coping. This session focuses on teaching the teen about these two forms of coping and learning the when and how of applying each, with the main emphasis being on developing active problem-solving skills in order to reduce stress by addressing and altering the situation.
Session 3: Relaxation Skills
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

When, for various reasons, the teen cannot alter the stressfulness of a challenging situation via active problem solving (“Solving the Problem”), such circumstances call for employing strategies to “Manage the Impact” of the stressor on their physical and emotional functioning. In Session 3 of the Children’s Health and Illness Recovery Program (CHIRP), the clinician instructs the teen in effective relaxation skills including diaphragmatic breathing and progressive muscle relaxation. These are introduced and practiced in the session, with homework practice assigned for skill development. Cognitive behavioral therapy skills are introduced to help the teen understand the bidirectional relationships between thoughts, emotional responses, and behavioral responses. Finally, thought-changing skills and activities are introduced from the CHIRP Workbook with the assignment of recoding stressful situations and their associated thoughts and feelings on a Thought Record sheet.
Session 4: Thought-Challenging and Thought-Changing Skills
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Employing information from their Thought Record homework, in Session 4 the teen is instructed in applying cognitive behavioral therapy (CBT) thought-challenging skills employing the “Challenging Your Thoughts” worksheet in the Children’s Health and Illness Recovery Program (CHIRP) Workbook. Common cognitive errors (e.g., hopelessness, catastrophizing, mind reading) are introduced and applied to the teen’s own identified automatic thoughts. For youth with chronic illness, the impact of their symptoms on their functioning can adversely impact on their expectations and willingness to set challenging yet appropriate goals for themselves. CBT skills in challenging and changing unsubstantiated and disabling beliefs and schema are crucial to overcoming these barriers.
Session 5: Time Management and Prioritization
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

For teens with a chronic illness, setting reasonable and reachable personal expectations while titrating their activities in response to their disease/symptoms is often a major stressor. In Session 5 the teen is taught specific strategies to distinguish between desired (want to) and required (have to) activities and to create (and revise) personal schedules that address problems they may have with over- and/or underscheduling physical and social activities in their daily life. These issues are particularly important in working with teens who are on home-hospital/home-bound schooling or who are home-schooled and thus more likely to have less structure and peer social contact.
Session 6: Increasing Teen Independence
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Session 6 is intended to be a family-focused session, with the teen and parent(s) seen conjointly for all or at least a major portion of the session. This format allows the clinician to observe the ways in which the teen and parent(s) approach such issues as problem solving and decision making and to coach and provide feedback and guidance in developing family dynamics that increase teen confidence and skills in becoming more confident and independent. The mechanism for stimulating these discussions is generated from the Workbook exercises and Worksheets addressing the activity schedule of a healthy teen versus the teen with a chronic illness and together generating strategies for increasing teen independence that they will approach between sessions.
Session 7: Assertiveness and Relationships
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

In Session 7 the teen is introduced to the concept of avoidant coping and the pernicious impact this has on creating increased functional disability in multiple areas of one’s life physically, academically, and socially. Behavioral strategies to disrupt this cycle inevitably involve improving engagement behaviors such as increasing social contacts and improving school attendance, all of which call for improved interpersonal communication skills and assertive behaviors; that is, the behavioral antithesis of avoidance. The clinician will employ several worksheets in the Workbook in the process of increasing teen skills and comfort at communicating and asserting their wants and needs with others.
Session 8: Family Roles, Communication, and Support
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Session 8 is again focused primarily on family communication and dynamics for the purposes of identifying and addressing parenting behaviors and parent–teen dynamics that may unwittingly undermining teen confidence in becoming more independent in managing their illness and lifestyle. The clinician engages the family in a discussion of parental and teen roles within the family system and an examination of the impact of the teen’s illness on family members’ roles. Behavioral family systems concepts of “misguided support” and “strong beliefs” that family members hold, but that inadvertently may be serving to maintain a dependent or even overprotective/enmeshed family dynamic, are introduced and applied to the family situation, along with strategies for moving these dynamics in a more independence-engendering direction.
Children's Health and Illness Recovery Program (CHIRP)
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Being a teenager with a chronic illness can be challenging. The symptoms of an illness, particularly pain and fatigue, can interfere with just being a normal teen. The Children’s Health and Illness Recovery Program, or CHIRP, was developed to teach teens and their family strategies to help them live as normal a life as possible while coping with the effects of their chronic illness. The skills acquired in the CHIRP intervention are life skills almost every teen can use, and these skills can be especially valuable for those working to overcome the negative effects of chronic illness. The CHIRP Teen and Family Workbook provides evidence-based activities shown to improve coping skills, stress management, communication skills, and functioning in teens with chronic medical conditions. In addition, family-based activities included in CHIRP assist teens and parents in developing more effective ways to communicate about their illness and increase teen confidence and independence in both managing their illness and their lifestyle. These skills are important building blocks to help teens move toward recovery and improve functioning and quality of life as they approach young adulthood. The skills acquired in the program also serve as a guide and motivation for continuing the gains that teens and their families make in CHIRP.
Introduction and Prep Session
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

This chapter provides an explanation as to how having a chronic illness can start a cascading effect that results in the teen becoming more inactive and less involved in important life events experienced by healthy teens, and how this can actually worsen some of their symptoms and lead to more disability. The CHIRP interventions are introduced as a program specifically designed to provide teens, and their parents, with skills that can disrupt this process and allow the teen to more actively participate in life. A “Weekly Activity and Exercise Action Plan” Worksheet is provided to begin the process of gradually becoming more active at a level that is sensitive to the teen’s medical and health issues.
Session 2: Problem-Solving Skills
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Building on the stress and stress management information from the last session, Session 2 introduces two specific forms of coping with stress: “Solving the Problem,” which involves you engaging in actions that instrumentally reduce the stressors to which you are exposed (active problem-solving), and “Managing the Impact” coping, i.e., those skills that reduce the effects of stressors on you physically and emotionally (relaxation and cognitive-behavioral strategies). This session describes these two forms of coping and the “when” and “how” of applying each. In this session problem-solving skills are introduced as a strategy that can reduce stress by addressing and altering the situation, and specific steps in the problem-solving process are described and illustrated.
Session 4: Thought-Challenging and Thought-Changing Skills
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Session 4 builds on “Managing the Impact” coping skills by helping you learn to apply “Challenging Your Thoughts” skills to the stressful situations identified earlier and recorded on the “Thought-Changing Skills” Worksheet from the previous session. The goal of this session is to assist you in more accurately identifying those distortions in your assumptions, beliefs and thinking that underly distressful and uncomfortable emotions/feelings, which in turn can amplify unpleasant symptoms such as energy level and pain intensity. Common thinking errors such as hopelessness, catastrophic thinking, and mind reading are introduced and applied to your own identified automatic thoughts. This is followed by introducing strategies for challenging those often unsubstantiated and disabling thoughts that serve as barriers to setting goals, expectations, and motivation, which make it difficult to get your coping and lifestyle back on track.
Session 5: Time Management and Prioritization
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

In Session 5 you will learn specific strategies for determining what is a desired (want to) versus a required (have to) activity and how to create a more reasonable personal schedule. When dealing with a chronic illness, learning to conserve energy and make good decisions about daily activities is important. Also, being on home-bound/home-hospital or home-schooled academic schedules can result in a less structured daily schedule and decreased peer social contact. Over- and/or underscheduling physical and social activities can become a major problem and source of stress. Setting reasonable and reachable goals and expectations is very important and requires that you learn how to prioritize and adjust your schedule of activities in response to your symptoms and illness.
Session 6: Increasing Teen Independence
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Session 6 is a family-focused session. In these family sessions you and your parent(s) will be seen together for all, or at least a major part, of the session. When a teen has a chronic medical problem it affects everyone in the family. The activities for these sessions are designed to begin the process of helping you and your family better understand the importance of helping put medical challenges in perspective while balancing these needs with the important experiences for teens to have to remain confident and competent in their lives. Workbook exercises and worksheets are used to identify how your lifestyle and activity schedule have been affected by your medical condition. This information is then used to help you and your parent(s) generate ways for increasing your activities and independence so important to this stage of your life.
Session 7: Assertiveness and Relationships
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

In Session 7 you are introduced to the concept of avoidant coping. We all use avoidance at times in dealing with stressful, unpleasant and uncomfortable situations. However, if we use avoidance as the major way to cope with these challenges, it will have a negative impact on our ability to function physically, emotionally, and in school and social situations. In order to make sure we don’t fall into the trap of over-using avoidance in dealing with the challenges of a chronic medical problem, CHIRP uses activities that teach you strategies that can disrupt this cycle by improving your skills and confidence in dealing with stressful situations you may encounter socially and in your daily life. Key skills you will learn include improving interpersonal communication and assertive behaviors. Increasing your skills and comfort in communicating and asserting your wants and needs with others is a primary goal of this session.
Session 8: Family Roles, Communication, and Support
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Session 8 focuses on improving family communication, so important to improving your confidence in becoming more independent in managing both the challenges of your medical condition as well as you lifestyle as a teen. You and your family will be engaged in a discussion of parent and teen roles in the family and how the your illness has impacted and changed these roles. To expand on improving family communication skills, “misguided support” and “strong beliefs” are introduced and explored to better understand how these may unintentionally serve to make it harder to increase your feelings of confidence and skills in moving toward the greater independence needed for transitioning to young adulthood.
Sessions 10–12: Relapse Prevention
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

During the remaining Sessions 10–12 of the Children’s Health and Illness Recovery Program (CHIRP) no new skills or strategies are introduced. Rather, these sessions focus on continuing to practice the skills introduced in Sessions 1–9 so that they become positive habits and routines in the your and your family’s coping with their chronic illness while becoming more confident and competent in their movement toward more independence.
Motivational Interviewing Strategies
Authors: Amin Priyanka , Douaihy Antoine , Liu Gordon
Published: March 2020

This chapter expands upon motivational interviewing (MI) techniques presented in the prior chapter. It helps practitioners tailor MI strategies based upon the level of motivation for change a patient has, on a continuum of low motivation to high motivation. This chapter covers how to also use MI skills and strategies to sustain a behavioral change after such change is implemented. The language of MI such as “sustain talk” and “change talk” is explored. It also describes challenges that may arise in caring for patients with HIV, including challenging clinical encounters such as nonadherence to antiretroviral therapy. The chapter provides strategies for navigating these encounters.
An Example Program of Motivational Interviewing–Informed Linkage to HIV Care
Authors: Flynn Risa , Bolan Robert
Published: March 2020

Chapter 6 applies motivational interviewing (MI) to promote linkage to HIV care after clients have been diagnosed. A number of factors influence linkage into HIV care, and rapid linkage is a critical component to gaining access to antiretroviral therapy and ultimately reaching and sustaining viral suppression. This chapter provides an example of experiences using MI to promote linkage to care through the Los Angeles LGBT Center’s Sexual Health and Education Program, in a busy HIV testing center. The program includes the coordination of linkage to care by the development of the position of a linkage to care specialist. Using an implementation science approach, intervention components are unpacked and lessons learned provided.
Incorporating Motivational Interviewing into Interventions to Address Adherence to Antiretroviral Therapy
Authors: Golin Carol , Uhrig Castonguay Breana , Bradley-Bull Steve , Grodensky Catherine
Published: March 2020

Chapter 7 focuses on the use of motivational interviewing (MI) to support antiretroviral adherence and to help clients address barriers to adherence. First, the authors discuss the rationale for using MI for this purpose and review existing evidence for the effects of MI on medication adherence, as well as related to the continuum of care. Second, the authors share lessons learned from their experience developing and implementing MI-based antiretroviral adherence interventions. Next, they review best practices for conducting MI-based adherence interventions. The chapter ends with a discussion of the future direction of MI interventions, including antiretroviral adherence interventions that use technology to conduct MI. In addition to the importance of MI-trained staff and measuring program fidelity, successful MI-based interventions provided supplemental materials throughout the MI intervention.
Lifestyle Changes and Motivational Interviewing
Authors: Martinez David A. , Champassak Sofie L.
Published: March 2020

To adequately manage and prevent HIV disease, it is important to address lifestyle behaviors such as substance use and risky sexual behaviors, which are considered as sexual behaviors that increase the risk of negative outcomes, such as condomless sex, multiple partners, sex under the influence of drug and alcohol, IV drug use, paying for sex, and untreated sexually transmitted illness, among others. Motivational interviewing (MI) has been shown to be effective in helping patients in HIV care reduce substance use and risky sexual behaviors. Using MI skills and strategies helps facilitate discussions and minimize barriers that prevent patients from having open conversations with their practitioners about stigmatized or “unhealthy” behaviors. MI is not a comprehensive intervention, but it is a tool that combines strategies and spirit to produce conversations that can help patients resolve their ambivalence in the direction of change and can be used in combination with other practical interventions approaches when addressing other areas of health promotion.
Comorbid Medical Problems and Motivational Interviewing
Authors: Connor Sharon , Welch Hanna K.
Published: March 2020

As HIV treatments become more effective and accessible, people living with HIV (PLWH) are achieving longer lifespans; however, this aging population also faces a greater risk of age-related co-morbidities. Many chronic diseases affect people living with HIV disproportionately, including diabetes, ischemic heart disease, and congestive heart failure. Patient-centered healthcare should aim to optimize quality and length of life while also considering the person’s value system. Motivational interviewing (MI) has been effective in helping PLWH to better manage chronic diseases requiring behavioral modification in both high- and low-resource settings. MI is a useful approach in the complex care of PLWH and medical co-morbidities. MI can promote self-management integrating HIV care as well as other co-morbidities in the context of social and cultural factors. This chapter discusses the application of MI to achieve better control of co-morbid medical conditions in PLWH.
Substance Use and Motivational Interviewing
Authors: Lin Liu yi , Frank Linda R. , Douaihy Antoine
Published: March 2020

People living with HIV (PLWH) who use drugs and alcohol are particularly likely to experience gaps across the HIV care continuum. People with co-occurring HIV and a substance use disorder face significant challenges in treatment. Substance use is well-known to be linked to important health behaviors and outcomes including adherence to antiretroviral and treatment, immunosuppression, and sexual risk behaviors. This chapter provides a review of the impact of substance use in PLWH and the role of motivational interviewing as part of an integrated approach to care of PLWH with co-occurring substance use disorders. The chapter concludes with a case example to illustrate the role that motivational interviewing can play the care of PLWH with a co-morbidity of substance use disorder.
Emotional Management, Psychological Issues, and Motivational Interviewing
Authors: Azzam Pierre N.
Published: March 2020

People living with HIV (PLWH) experience significant psychological distress and are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. This chapter summarizes and reviews the psychological issues and challenges experienced by PLWH and discusses the integration of motivational interviewing (MI) into the patient-centered multifaceted medical and psychological care of PLWH. In the closing section, the author looks at future directions for using MI to care for PLWH and suffering from depression, anxiety, and/or trauma-based disorders and argues that further studies are needed to elucidate the efficacy, advantages, and potential limitations of MI for mitigating emotional distress specifically in PLWH.
Motivational Interviewing in Global Practice Settings
Authors: Dewing Sarah , Mathews Cathy
Published: March 2020

Motivational interviewing (MI) in increasingly used to support people living with HIV around the world. When MI strategies represent a large departure from standard of care, learning and implementing MI can be challenging. Chapter 14 focused on experiences in Cape Town, South Africa, as counselors moved from more education/information-giving approaches to MI-informed approaches. In practice, the role of ongoing supervision and support is critically important. We emphasize the value of supervision in MI for the all MI-based interventions and particularly for these kinds of interventions in global health settings where they may be quite different from current norms.
Integration of Motivational Interviewing with Other Intervention Modalities in HIV Care
Authors: Holstad Marcia M.
Published: March 2020

Motivational interviewing (MI) has been effective in promoting HIV self-management behaviors in people (both adolescents and adults) living with HIV. The most frequently studied behaviors are medication adherence, safer sex, alcohol use, and substance use. MI has also been effectively used to reduce smoking and depression/anxiety. Often MI is combined with other modalities such as cognitive behavior therapy, health education techniques, group methods, and emerging technology. This chapter discusses MI in combination with other modalities and provides examples for providers to incorporate MI into patient communication to promote self-management behaviors.
Ethical Challenges in the Applications of Motivational Interviewing in HIV Care
Authors: Black Isra , Forsberg Lisa
Published: March 2020

This chapter engages with ethical challenges of using motivational interviewing (MI) and MI-based interventions in HIV care. The chapter first outlines 2 general ethical worries in respect of MI use. The authors argue that the relational and technical components of MI provide insufficient ethical action guidance and ethical safeguards, respectively. It is necessary to consider factors external to the method of MI to establish the ethical permissibility of its applications. The authors subsequently consider the ethics of MI in the context of HIV care, specifically in relation to pre-exposure prophylaxis, medication adherence, and disclosure of HIV/AIDS diagnosis/prognosis. This framework for discussion of these specific issues may be relevant to other applications of MI in HIV care.
Mayo Clinic Strategies To Reduce Burnout
Authors: Swensen Stephen , Shanafelt Tait
Published: March 2020

Many believe burnout of health care professionals to be the result of individual weakness when, in fact, burnout is primarily the result of health care systems that take emotionally healthy, altruistic people and methodically squeeze the vitality and passion out of them. In this book, we tell the story of burnout of health care professionals, although we chose not to dwell on negative aspects of the story. Instead, we emphasize nurturing positivity and a hope for professional fulfillment, well-being, and joy and meaning in work. Realizing this narrative requires that health care professionals and administrative leaders work together to co-create the ideal workplace. Our aim was to provide the blueprint—eight Ideal Work Elements and 12 actions of an Intervention Triad (Agency, Coherence, and Camaraderie) designed to achieve this goal. The ultimate aspiration is esprit de corps—the common spirit existing in members of a group that inspires enthusiasm, loyalty, camaraderie, and engagement. This book provides a method for creating esprit de corps among health care professionals and, in so doing, provides strategies to reduce burnout.
Introduction
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Burned-out professionals are exhausted, jaded, demoralized, and isolated, and they have lost their sense of meaning and purpose. Frequently, these individuals are shamed and blamed by leaders who suggest they should sleep longer, meditate, and become more resilient even as they expect them to work harder, see more patients, embrace rapidly changing technology, stay abreast of new medical advances, and provide quality health care. We will show you how the current vicious cycle of cognitive dissonance, moral injury, and shame-and-blame can be transformed into a virtuous cycle: a cycle where one beneficial change in the health care workplace leads to another and, ultimately, to esprit de corps—a common spirit existing in members of a group that inspires enthusiasm, devotion, loyalty, camaraderie, engagement, and strong regard for the welfare of the team.