Correlates of tobacco cessation counseling among Hispanic physicians in the US: a cross-sectional survey study.

BACKGROUND: Physician advice is an important motivator for attempting to stop smoking. However, physicians' lack of intervention with smokers has only modestly improved in the last decade. Although the literature includes extensive research in the area of the smoking intervention practices of clinicians, few studies have focused on Hispanic physicians. The purpose of this study was to explore the correlates of tobacco cessation counseling practices among Hispanic physicians in the US. METHODS: Data were collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians practicing in New Mexico, and who were members of the New Mexico Hispanic Medical Society in the year 2001. Domains of interest included counseling practices, self-efficacy, attitudes/responsibility, and knowledge/skills. Returned surveys were analyzed to obtain frequencies and descriptive statistics for each survey item. Other analyses included: bivariate Pearson's correlation, factorial ANOVAs, and multiple linear regressions. RESULTS: Respondents (n = 45) reported a low level of compliance with tobacco control guidelines and recommendations. Results indicate that physicians' familiarity with standard cessation protocols has a significant effect on their tobacco-related practices (r = .35, variance shared = 12%). Self-efficacy and gender were both significantly correlated to tobacco related practices (r = .42, variance shared = 17%). A significant correlation was also found between self-efficacy and knowledge/skills (r = .60, variance shared = 36%). Attitudes/responsibility was not significantly correlated with any of the other measures. CONCLUSION: More resources should be dedicated to training Hispanic physicians in tobacco intervention. Training may facilitate practice by increasing knowledge, developing skills and, ultimately, enhancing feelings of self-efficacy.

El socialismo europeo en la encrucijada : Debates sobre cuestión nacional y revolución social en la Segunda Internacional

Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

El socialismo europeo en la encrucijada : Debates sobre cuestión nacional y revolución social en la Segunda Internacional

Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

El socialismo europeo en la encrucijada : Debates sobre cuestión nacional y revolución social en la Segunda Internacional

Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

El socialismo europeo en la encrucijada : Debates sobre cuestión nacional y revolución social en la Segunda Internacional

Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

Cultivating Care: Understanding Intimate Partner Violence Experiences of Undocumented Latinas in Washington State

Thesis (Ph.D.)--University of Washington, 2016-06

A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

Background
The OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.

Methods
The OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.

Results
Despite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.

Conclusions
The OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.

L’intervention en médiation familiale en présence de violence conjugale : dépistage, pratiques d’intervention, défis et préoccupations

Au Québec, la médiation familiale en contexte de violence conjugale est controversée, mais la pratique est très peu documentée et est donc mal connue. L’objectif principal de ce mémoire est de comprendre comment les médiateurs familiaux composent avec la présence de violence conjugale dans le cadre de leur pratique. Les objectifs spécifiques sont les suivants : (1) connaître comment les médiateurs familiaux dépistent la violence conjugale ; (2) savoir comment ils interviennent en présence de violence conjugale une fois cette violence dépistée ; et (3) identifier les défis et les préoccupations rencontrées par les médiateurs dans ces dossiers. Cette étude qualitative fut menée auprès de 8 médiateurs issus des domaines juridique et psychosocial. Les participants furent rencontrés dans le cadre d’entrevues semi-dirigées. Les médiateurs rencontrés insistent sur l’importance d’offrir une formation avancée portant sur la problématique de la violence conjugale et sur les outils de dépistage à tous les médiateurs au Québec et de bonifier la formation actuelle en adressant la dangerosité, le risque de récidive et d'aggravation de la violence et l’appréciation du risque d’homicide conjugal. Les résultats de l’étude suggèrent également l’importance de bien différencier le terrorisme conjugal de la violence situationnelle et de mettre en place des pratiques d’interventions spécifiques à chacun de ces types de violence. La médiation familiale en présence de violence conjugale devrait être un champ de pratique spécialisé et le travail de collaboration avec les ressources spécialisées en violence conjugale nécessiterait d’être renforcé.

L’intervention en médiation familiale en présence de violence conjugale : dépistage, pratiques d’intervention, défis et préoccupations

Au Québec, la médiation familiale en contexte de violence conjugale est controversée, mais la pratique est très peu documentée et est donc mal connue. L’objectif principal de ce mémoire est de comprendre comment les médiateurs familiaux composent avec la présence de violence conjugale dans le cadre de leur pratique. Les objectifs spécifiques sont les suivants : (1) connaître comment les médiateurs familiaux dépistent la violence conjugale ; (2) savoir comment ils interviennent en présence de violence conjugale une fois cette violence dépistée ; et (3) identifier les défis et les préoccupations rencontrées par les médiateurs dans ces dossiers. Cette étude qualitative fut menée auprès de 8 médiateurs issus des domaines juridique et psychosocial. Les participants furent rencontrés dans le cadre d’entrevues semi-dirigées. Les médiateurs rencontrés insistent sur l’importance d’offrir une formation avancée portant sur la problématique de la violence conjugale et sur les outils de dépistage à tous les médiateurs au Québec et de bonifier la formation actuelle en adressant la dangerosité, le risque de récidive et d'aggravation de la violence et l’appréciation du risque d’homicide conjugal. Les résultats de l’étude suggèrent également l’importance de bien différencier le terrorisme conjugal de la violence situationnelle et de mettre en place des pratiques d’interventions spécifiques à chacun de ces types de violence. La médiation familiale en présence de violence conjugale devrait être un champ de pratique spécialisé et le travail de collaboration avec les ressources spécialisées en violence conjugale nécessiterait d’être renforcé.

Educação social e relação de ajuda: Representações dos educadores sociais sbre as suas práticas

Neste estudo, parte-se dos discursos dos educadores sociais, produzidos no grupo de discussão, para se conhecer as suas representações face à relação de ajuda que desenvolvem com as populações. Problematizou-se o conceito, analisaram-se os discursos buscando os paradigmas que orientam as intervenções, as definições de relação de ajuda, os seus objectivos, e o perfil dos educadores sociais que desenvolvem esta modalidade de intervenção. As conclusões apontam para a necessidade de a reflexão acompanhar a acção do educador social; para a coexistência de diferentes concepções sobre a relação de ajuda, variando de acordo com as orientações paradigmáticas do educador, a sua própria experiência profissional, o eu perfil pessoal e profissional. Surge reforçada a ideia de que é na relação teoria-prática que se vão configurando as práticas de intervenção, adequando-as aos sujeitos com quem se desenvolvem e activando processos internos, ao nível das capacidades e competências, pessoais e interpessoais, dos educadores sociais. /ABSTRACT: The starting point in this study is the social educators' speeches produced in the discussion group, to let us know how they view the helping relationship they develop with the populations. The concept was held as a problem needing clarification, and the speeches were analysed with a view to making understandable the paradigms, the objectives and the definitions of the helping relationship that guide their interventions; the profiles of the professionals in the group that develop this modality of intervention were also analysed. The conclusions point to the need of reflection going along with the social educator's acting. They also point to the presence in the group of different conceptions of the helping relationship, varying with the educator's paradigmatic orientation, her/his own professional experience, her/his personal and professional profile. One strong idea emerges: the intervention practices get their configuration in the relation theory-practice, in the process of making them adequate to the subjects with whom they are developed, and also because they activate the social educators' internal processes, at the level of capacities and competences, both personal and interpersonal.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

The perceptions of best mentoring practices in an early literacy intervention project: A case study of nine coaches

There is significant national evidence the language development of four year-olds is a critical area for later school success (Brooks-Gunn, Fuligni, & Berlin, 2003; Cunningham, & Stanovich, 1998). This study originated as part of Literacy Intervention X (LIX), a larger national study conducted to examine the effectiveness of early literacy curricula implemented in subsidized childcare centers. The professional development of childcare center providers is key to improving the quality of subsidized care. In exploring the mentoring practices of nine LIX literacy coaches, the researcher investigated the perceptions of what best mentoring practices facilitated the implementation of literacy curricula by childcare providers. A qualitative case study was conducted using a combination of participant observer notes, document analysis, and focus group semi-structured interviews. The researcher is a participant observer, one of the nine Literacy Coaches. The best mentoring practices from the perspective of the literacy coaches are related to building relationships including trust, mutual respect, support, empathy, and encouragement with the childcare providers, the center directors, and with fellow literacy coaches. Clear, constant, and consistent communication with the childcare providers was a vital mentoring practice in building a relationship between the literacy coach and childcare provider. Another best mentoring practice in building a relationship with the childcare provider was the perceptions of the literacy coaches as co-learners in the mentoring process. The best mentoring practices highlighted in this study exemplified the kind of effective professional development that builds on the strengths of the childcare providers and does not disrupt the childcare centers or the services provided by the subsidized childcare programs that meet the needs of children and families. The experience of these nine literacy coaches, including their perceptions of effective mentoring practices, along with lesson learned about relationships, mentoring team structures, and general project design sheds light on the challenge of mentoring subsidized childcare providers in future literacy intervention projects.

Searching for best practices to build an inclusive intervention. The international project ENABLIN+ aproach

The project ENABLIN+ is an international partnership for the period of 01/01/2014 to 31/12/2016. It's addressed to the needs of children and youth with complex and intense support needs (CISN), their caregivers and supporters. It wants to develop a system of interdisciplinary in-service training, where professionals and parents of various professional backgrounds learn together, with the aim of improving inclusion, promoting de-institutionalization and enhancing quality of life of the children with CISN, at various age levels. ENABLIN+ promotes an inclusive intervention, not only in social life, but also in education. In this context, this work aims to present and discuss the concept of “best practices” in inclusive intervention based in real world cases. To study that subject we prepare a seminar, where 12 cases of “best practices” in inclusive intervention was presented.

Self-Directed Behavioral Family Intervention for Parents of Oppositional Children in Rural and Remote Areas

Twenty-four parents of oppositional preschoolers were randomly assigned to either a self-directed behavioral family intervention condition (SD) or to a waitlist control group (WL). The self-directed parent training program based on self-regulation principles, consisted of a written information package and weekly telephone consultations for 10 weeks. At posttest, in comparison to the WL group, children in the SD group had lower levels of behavior problems on parent report measures of child behavior. At posttreatment, parents in the SD condition reported increased levels of parenting competence and lower levels of dysfunctional parenting practices as compared to parents in the WL condition. In addition, mothers reported lower levels of anxiety, depression, and stress as compared to mothers in the WL condition at posttreatment. Using mother's reports, gains in child behavior and parenting practices achieved at posttreatment were maintained at 4-month follow-up.