The I-CARE Model provides a guiding structure to consider poverty related factors and their impact on people living in poverty. I-CARE encourages counselor trainees to internally reflect on one's own ...knowledge, experiences and unintended bias; develop strategies to cultivate relationships with clients; acknowledge realities of living in poverty; and explore interventions to remove barriers. We describe how the I-CARE model may be applied to training school counselors to serve students impacted by poverty. Implications of the model's use in school counselor preparation are explored, including practical suggestions and directions for future research.
The Connecticut Comprehensive School Counseling Framework was released in November 2020—8 months into the COVID-19 pandemic. The purpose of this mixed-methods study was to explore the progress made ...by principals and school counselors in implementing the new framework, and to understand the impact of the pandemic on their efforts to do so. We found significant overlap between the perceptions and priorities expressed by participating principals and school counselors. Particularly noteworthy was the fact that both groups described increased collaboration within their schools.
The consequences of adolescent drug and alcohol use may be serious and far-reaching, forecasting problematic use or addictive behaviors into adulthood. School counselors are particularly well suited ...to understand the needs of the school community and to seamlessly deliver sustainable substance use prevention. This pilot study with 46 ninth-grade students investigates the impact of the Making Choices and Reducing Risk (MCARR) program, a drug and alcohol use prevention program for the school setting. The MCARR curriculum addresses general knowledge of substances and their related risks, methods for evaluating risk, and skills for avoiding or coping with drug and alcohol use. Using a motivational interviewing framework, MCARR empowers students to choose freely how they wish to behave in relation to drugs and alcohol and to contribute to the health of others in the school community. The authors hypothesized that the implementation of the MCARR curriculum would influence student attitudes, knowledge, and use of substances. Results suggest that the MCARR had a beneficial impact on student attitudes and knowledge. Further, no appreciable increases in substance use during the program were observed. Initial results point to the promise of program feasibility and further research with larger samples including assessment of longitudinal impact.
We monitored positive pore water pressure in a clay slope in the Apennines to investigate how rainfall influences the pore pressure distribution along the soil profile and, consequently, affects ...slope stability conditions. Data refers to the first season of monitoring activities (August 2001–June 2002). The study site is located at the head of a complex landslide, where incipient shallow failures are visible along the slope.
The preliminary analysis of pressure data allowed to point out consistent trends, which manifested throughout 11 months. During the cold and wet season, saturation always extends close to the ground surface (<1 m) and pore water pressure measurements indicate a strong downward component of the flow, which is largely dominant over the downslope component, in any condition. Response to rainfalls at shallow depth (1 to 3 m) generally consists in a pressure pulse whose delay is relatively short if compared to low permeability of the soil and whose nature appears clearly transient. Although no failure occurred along the slope during the observation period, it is very likely such transient response would mimic the pore water pressure pattern capable to cause sliding.
The presence of prefertial flow path in the sub-surface can only explain anomalous response of some sensors or substantial differences between buried at similar depths.
BACKGROUNDLimited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was ...managed in these patients.
OBJECTIVESTo determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs.
DESIGNThis was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification.
PATIENTS AND SETTINGAdult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries.
MAIN OUTCOME MEASURESThe primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes.
RESULTSA total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure.
CONCLUSIONThe incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.
TRIAL REGISTRATIONThe study was registered at Clinicaltrials.gov, number NCT01601223.
Poverty has an impact on mental health and the counseling process in profound ways; however, counselors may fail to recognize the importance of poverty in clients' lives. The authors propose a model ...to help counselors navigate the complexities of counseling clients who are living in poverty. The I‐CARE Model may help counselors develop insight about personal biases, acknowledge harsh realities of poverty, remove barriers to growth, and expand on the clients' own strengths.
La pobreza tiene un profundo impacto sobre la salud mental y el proceso de consejería; sin embargo, es posible que los consejeros no reconozcan la importancia de la pobreza en las vidas de sus clientes. Los autores proponen un modelo para ayudar a los consejeros a comprender las complejidades de los clientes que viven en la probreza. El Modelo I‐CARE puede ayudar a los consejeros a desarrollar su percepción de sesgos personales, reconocer las duras realidades de la probreza, eliminar barreras al crecimiento y ampliar las fortalezas de los clientes.
Objective To evaluate the effect of two different hormone therapy (HT) doses on fasting and post-methionine homocysteine levels, an independent risk factor for cardiovascular and thromboembolic ...diseases.
Methods Forty-eight women in natural postmenopause randomly received calcium 1 mg day (control group; n = 12) or calcium plus low dose (1 mg estradiol plus 0.5 mg norethisterone; n = 18) or high dose (2 mg estradiol plus 1 mg norethisterone; n = 18) HT in a 6-month randomized, controlled, prospective study.
Results Folate levels did not vary in any group, while levels of vitamin B12 significantly decreased after low- (−12.2 ± 6.6%; p < 0.04) or high-dose HT (−13.9 ± 6.1%; p < 0.01). Fasting homocysteine was reduced by either HT dose in a way that was inversely related to pretreatment homocysteine levels (−0.675x; r = 0.644; p < 0.0001). Modification of post-load homocysteine increase was influenced by the HT dose and inversely related to the homocysteine response to methionine observed at baseline. The regression slope observed with the low-dose HT (−1.637x; r = 0.57; p < 0.02) was significantly steeper (p < 0.001) than that observed with the high-dose HT (−0.304x; r = 0.554; p < 0.03) dose.
Conclusions Low- or high-dose HT similarly influences fasting homocysteine levels. Low-dose HT seems to be more effective than high-dose HT in reducing the post-methionine homocysteine increase.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Elevation of homocysteine is associated with an increased risk for bone fractures. Whether the risk is due to homocysteine or to the reduced levels of cofactors necessary for its ...metabolisation, such as folates or vitamin B12, is not completely clear. In this study we wanted to determine whether in postmenopausal women, levels of folates, homocysteine or vitamin B12 are predictive of the rate of vertebral bone mineral density (BMD) change. The study was conducted at the centre for the menopause of our university hospital. Between September 2001 and March 2002, 161 healthy postmenopausal women volunteered for a cross-sectional evaluation of BMD and levels of serum folates, homocysteine and vitamin B12. Women were recalled for a second evaluation of vertebral BMD after about 5 years. Women having used anti-resorptive therapies for more than 1 year were excluded. The analysis was possible in 117 postmenopausal women. The annual rate of vertebral BMD change was independently related to levels of folates (coefficient of regression (CR): 2.040; 95%CI: 0.483, 3.596; p = 0.011), and initial BMD values (CR: − 0.060; 95%CI: − 0.117, − 0.003; p = 0.040). No significant relation was found between the change of vertebral BMD and homocysteine or vitamin B12. BMD values at the first ( r = 0.225; p = 0.016) and the second ( r = 0.206; p = 0.027) evaluation were related to levels of folates, but not of homocysteine or of vitamin B12. These data suggest an important role for folates deficiency in the vertebral BMD decline of postmenopausal women.
Objective To evaluate whether endothelium-dependent vasodilatation is related to anthropometric parameters in 105 healthy postmenopausal women 47-68 years of age.
Methods Flow-dependent, ...endothelium-dependent vasodilatation was considered as the maximal dilatation following deflation of a cuff placed on the forearm and inflated to supra-systolic blood pressure values for 4 min. Endothelium-independent vasodilatation was considered as the maximal dilatation induced by sublingual nitroglycerine (400 μg).
Results Among parameters such as height, weight, body mass index (BMI), waist, hip, waist hip ratio, lipids, glucose or insulin, only BMI, an indirect index of adiposity, was independently and directly related to baseline brachial artery diameter (b = 0.042, r = 0.269, p = 0.0055) and flow-mediated endothelium-dependent vasodilatation either expressed as net (b = 0.034, r = 0.315, p = 0.001) or percentage (b = 0.376, r = 0.202, p = 0.039) change. Stratification for BMI categories showed that women with BMI < 22 kg m2 had an endothelium-dependent vasodilatation, significantly lower than that of women with BMI ≥ 30 kg m2 (0.711 ± 0.076 mm vs. 1.107 ± 0.141 mm; p = 0.0114). BMI was not related to endothelium-independent vasodilatation.
Conclusions Present results show that, in healthy postmenopausal women, endothelium-dependent vasodilatation is related to BMI, arteries of slender women dilating less than those of their heavier counterparts. A low BMI does not appear to be beneficial for artery vasodilatation in healthy postmenopausal women.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
SummaryBackgroundAlthough international guidelines support the administration of hormone therapies with or without targeted therapies in postmenopausal women with hormone-receptor-positive, ...HER2-negative metastatic breast cancer, upfront use of chemotherapy remains common even in the absence of visceral crisis. Because first-line or second-line treatments, or both, based on chemotherapy and on hormone therapy have been scarcely investigated in head-to-head randomised controlled trials, we aimed to compare these two different approaches. MethodsWe did a systematic review and network meta-analysis with a systematic literature search on PubMed, Embase, Cochrane Central Register of Clinical Trials, Web of Science, and online archives of the most relevant international oncology conferences. We included all phase 2 and 3 randomised controlled trials investigating chemotherapy with or without targeted therapies and hormone therapies with or without targeted therapies as first-line or second-line treatments, or both, in postmenopausal women with hormone-receptor-positive, HER2-negative metastatic breast cancer, published between Jan 1, 2000, and Dec 31, 2017. Additional recently published randomised controlled trials relevant to the topic were also subsequently added. No language restrictions were adopted for our search. A Bayesian network meta-analysis was done to compare hazard ratios (HRs) for progression-free survival (the primary outcome), and to compare odds ratios (ORs) for the proportion of patients achieving an overall response (the secondary outcome). All treatments were compared to anastrozole and to palbociclib plus letrozole. This study is registered in the Open Science Framework online public database, registration DOI 10.17605/OSF.IO/496VR. FindingsWe identified 2689 published results and 140 studies (comprising 50 029 patients) were included in the analysis. Palbociclib plus letrozole (HR 0·42; 95% credible interval CrI 0·25–0·70), ribociclib plus letrozole (0·43; 0·24–0·77), abemaciclib plus anastrozole or letrozole (0·42; 0·23–0·76), palbociclib plus fulvestrant (0·37; 0·23–0·59), ribociclib plus fulvestrant (0·48; 0·31–0·74), abemaciclib plus fulvestrant (0·44; 0·28–0·70), everolimus plus exemestane (0·42; 0·28–0·67), and, in patients with a PIK3CA mutation, alpelisib plus fulvestrant (0·39; 0·22–0·66), and several chemotherapy-based regimens, including anthracycline and taxane-containing regimens, were associated with better progression-free survival than was anastrozole alone. No chemotherapy or hormone therapy regimen was significantly better than palbociclib plus letrozole for progression-free survival. Paclitaxel plus bevacizumab was the only clinically relevant regimen that was significantly better than palbociclib plus letrozole in terms of the proportion of patients achieving an overall response (OR 8·95; 95% CrI 1·03–76·92). InterpretationIn the first-line or second-line setting, CDK4/6 inhibitors plus hormone therapies are better than standard hormone therapies in terms of progression-free survival. Moreover, no chemotherapy regimen with or without targeted therapy is significantly better than CDK4/6 inhibitors plus hormone therapies in terms of progression-free survival. Our data support treatment guideline recommendations involving the new combinations of hormone therapies plus targeted therapies as first-line or second-line treatments, or in both settings, in women with hormone-receptor-positive, HER2-negative metastatic breast cancer. FundingNone.
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