Greater Peace Of Mind Research Articles

Psychometric evidence of a perception scale about covid-19 vaccination process in Peruvian dentists: a preliminary validation

BackgroundIn the current pandemic context, dental professionals have greater occupational risks due to their healthcare activity, placing their expectations on the vaccine as a means of protection and at the same time hoping that the immunization process will be safe, reliable and comfortable, giving them greater peace of mind when they return to work. Therefore, the aim of the present study was to develop and provide a preliminary validation of a scale to measure perception of the COVID-19 vaccination process in Peruvian dental professionals.MethodsCross-sectional study with instrumental design. The scale was self-administered virtually. It was distributed through social networks to 220 dental professionals from two universities in the Peruvian capital between June and August 2021. The Aiken V was used for content analysis, while descriptive statistics such as mean, variance, kurtosis and skewness were used for construct validation, in addition to Pearson’s correlation matrix for analysis of the 18 items. Subsequently, a Parallel Analysis based on minimum rank factor analysis was performed. Finally, the reliability of the total scale and its dimensions was evaluated with Cronbach’s alpha.ResultsThe Aiken V coefficient values were favorable for all items. Parallel analysis indicated the existence of three dimensions. Principal component analysis with rotation suggested grouping eight items for the first dimension, six items for the second dimension and four items for the third dimension. These dimensions showed good reliability, as Cronbach’s alpha was 0.87, (95% confidence interval [CI]: 0.84–0.90), 0.80 (95% CI: 0.75–0.84) and 0.82 (95% CI: 0.78–0.86), respectively. In addition, the overall reliability of the scale was 0.89 (95% CI: 0.86–0.91), being acceptable.ConclusionsThe perception scale of the COVID-19 vaccination process in dental professionals proved preliminarily to be a valid and reliable scale that can be used for research purposes. However, it is recommended to extend its application and evaluate its metric properties in other health professionals.

In Whose Best Interest? Parental Hesitancy toward the COVID-19 Vaccine for Children in Japan: A Literature Survey Study

In early February 2022, the Japanese government sent COVID-19 vaccine vouchers to children ages 5–11. Using keywords obtained from the voucher, the frequently asked questions section, and experts, we descriptively analyzed the advantages and disadvantages of vaccination for children and their parents through a web-based literature survey of media articles and government homepage statements in Japan. For children, vaccination helps prevent severe symptoms and may be particularly beneficial for children in low-income families by lowering the rate of suicide and at-home child abuse. For parents, not vaccinating their child allows them to fulfill a more traditional role as a parent (mothers in particular), reduces the gender gap for mothers, and provides greater peace of mind about their child’s future fertility. We also examined the governmental vaccination campaigns targeting children from public health perspectives. We argue that the letter accompanying the vaccine voucher should clearly emphasize that further transmission will be prevented, reducing domestic infection. In addition to the biological dimensions of COVID-19 in Japan, we emphasize cultural issues and hope that these can be useful for other countries as they create their own vaccination strategies. Public health in Japan could be promoted if all citizens, regardless of age, acquired fundamental knowledge and skills, the motivation to learn, and the ability to utilize knowledge and skills and think, judge, and express personal ideas.

MO1054: Development of Home Dialysis Patient Support System Using Cloud System II––Addition of Exercise Therapy Function

BACKGROUND AND AIMSThe number of patients requiring home dialysis in Japan is increasing due to COVID-19 and the aging of the population. Home haemodialysis has been performed in Japan since the 1960s. However, as of March 2019, there were 720 home haemodialysis patients in Japan, which is only 0.2% of the total number of dialysis patients. The possible causes are as follows.The number of home haemodialysis patients has not increased markedly due to safety concerns as home haemodialysis patients perform dialysis at home, and the out-of-pocket costs are high. In addition, patients and caregivers must be able to manage themselves, and the burden on both patients and caregivers is heavy. Therefore, the Ministry of Health, Labour and Welfare (Japan) has advocated the need for home patients to share information with medical institutions to improve their quality of life, including COVID-19 measures. We have built a system to support home dialysis patients. Here, we have added an exercise therapy function to this system to encourage patients to continue exercising.METHOD The items recorded/displayed in the patient's home peritoneal dialysis support system included records such as time, blood pressure, blood glucose level, urine volume, meal content, replacement start time, dialysate/plasma ratio, drainage volume, injection volume, water content and water removal and drainage. These inputs were entered via drop-down menus and displayed visually in graphs or by uploading images. The medical staff could see photographs of the affected areas and of meals entered by the patient. Patients could also share their opinions and treatment schedules with the medical staff at the medical institution. In addition, when exercising, the patients used an ergometer that allowed them to sit or lie down. The developed system incorporates records of the patient's exercises. Data were captured directly from the ergometer into the developed system in CSV format and could also be entered manually via drop-down menus.RESULTSUsing the developed system, we were able to enter and view patients’ vital data and display photographs showing the color and volume of the drainage pack. By viewing these photographs, the medical staff could confirm the photographs of the affected areas, the color of the packs and the contents of the patients’ meals. In addition, displaying the patient's vital records in a graph allowed for visual evaluation over time, which was useful when giving advice to patients. Using the two-way communication function, patients were also able to share their opinions and treatment schedules with the medical staff of the medical institution. Patients can now consult with medical staff, making their homes more like part of the hospital and giving them greater peace of mind.Figure 1 shows an example of the display of the developed system. Figure 2 shows an example of the patient's pedaling exercise results input from the ergometer. The amount of pedal movement performed by the patient was conserved through the dynamo and used to charge mobile devices. This allows the patient to charge their mobile devices while exercising, thus encouraging them to continue exercising.CONCLUSION We have developed a support system for home haemodialysis patients that allows the input and display of patients’ vital records and consultation with medical staff online. We have added a function to the system to encourage home haemodialysis patients to continue exercising. By using the developed system, patients can now perform home dialysis, including continuous exercise safely and with peace of mind, and healthcare professionals can access all medical information of patients, including changes over time.This research was supported in part by Gakushin Kaken (JP18K19710, JP20H03982).

Understanding consumer and clinician perceptions of a potential Lyme disease vaccine.

Each year, over 450 000 Lyme disease diagnoses are estimated to occur in the United States, and current preventive measures have been insufficient to stem the rising incidence. An effective human Lyme disease vaccine could be a powerful intervention for population-level impact. In advance of new Lyme disease vaccines coming to market, this study explored barriers to acceptability and motivations for the uptake of a new Lyme disease vaccine. Researchers conducted 9 online focus groups among consumers who may potentially benefit from the vaccine and 30 in-depth interviews among clinician groups who may provide the vaccine. All participants were recruited from three US regions of high Lyme disease incidence. Researchers found that participants shared common motivators to either recommend (clinicians) or accept (consumers) a Lyme disease vaccine, largely driven by perceived benefits of the vaccine, the lack of current effective preventive measures and a greater peace of mind. The concern about the challenges associated with diagnosing and treating Lyme disease is a primary motivator for clinicians to recommend the vaccine, while the concern about getting Lyme disease is a primary motivator for consumers to desire the vaccine.

Facility and Family Communication during the COVID-19 Visit Restriction: Early Perspectives of Family Members

ABSTRACT During the COVID-19 pandemic, family concerns regarding residents in long-term care facilities (LTCFs) increased due to a high proportion of COVID cases and deaths among residents and restrictions that made it impossible to visit. These changes created numerous challenges for facilities communicating with families, and between families and residents. However, little is known about how these facilities addressed these communication challenges and how those communication strategies were related to family perceptions about the facility. We implemented an online survey of family members or friends of residents in LTCFs from April 28 to June 19, 2020, using convenience sampling. A total of 174 responses nationwide reported the types of communications used, frequency of communication and alternative visits, and whether respondents had peace of mind, would recommend the facility, or were considering removing the resident from the facility. The results of our hierarchical logistic regression showed that respondents felt greater peace of mind when there were multiple communication channels to contact the resident. Also, respondents had more negative perceptions of a facility when they were not informed about confirmed COVID cases. Our findings suggest multiple communication channels and transparency about COVID status were effective in keeping positive family perceptions about the facility.

Dialectical coping and well-being among Chinese college students: the mediating role of resilience

ABSTRACT Despite many studies focusing on coping strategies, there is a dearth of psychological research exploring indigenous coping from the East Asian culture. This study explored the relationship between dialectical coping and three well-being variables (somatization, peace of mind and meaning in life) and tested resilience as a potential mediator of these relationships using a Chinese university student sample (N = 644). Structural equation modeling was employed to examine mediation paths from a) endorsement of dialectical coping to b) resilience to c) peace of mind, somatization, and meaning in life. We found that resilience mediated the significant relationships between dialectical coping and the three well-being variables. Chinese college students who demonstrated higher endorsement of dialectical coping possessed higher resilience, which was then related to greater peace of mind and meaning in life and less somatization. Dialectical coping was also directly and positively associated with higher levels of meaning in life. Endorsement of dialectical coping is connected to Chinese college students’ resilience which, depending on the resilience level, can predict their well-being. Based on our findings and previous literature, we propose a nuanced conceptual understanding of dialectical coping, reflecting recent development in positive psychology. Implications for counseling are discussed.

Peace of mind among adolescents and young adults with cancer.

Adolescents and young adults (AYAs) with cancer have high rates of psychological distress and unmet support needs. Peace of mind is an important construct among older cancer patients and parents of children with cancer but has not been explored in AYAs. We sought to evaluate the extent to which AYAs with cancer experience peace of mind and to identify factors associated with greater peace of mind. We surveyed 193 AYAs with cancer aged 15 to 29 years within 12 weeks of diagnosis; 137 patients completed the same measures again 4 and 12 months after diagnosis. Patients were asked to report peace of mind, measured using items from the Functional Assessment of Chronic Illness, Spiritual Well-being scale (FACIT-Sp); anxiety and depression, using the Hospital Anxiety and Depression Scale (HADS); and experiences surrounding medical communication and decision making. Mean scores for peace of mind were 3.59 at diagnosis (range 1-5, standard deviation 0.84), with similar scores at 4 (3.53, P = .34) and 12 (3.59, P = .94) months. In a multivariable model adjusted for age and gender, patients who reported receiving high-quality information about their cancer had greater peace of mind at diagnosis (β = .25, P = .03), whereas those who reported holding a passive role in treatment decision making (β = -.47, P < .0001) or who had anxiety (β = -.64, P = .0003) or depression (β = -.51, P = .04) had lower peace of mind. Peace of mind did not improve significantly over time for AYAs with cancer. While high-quality communication may be associated with heightened peace of mind, further study is needed to clarify relationships between peace of mind and other psychological variables.

Technology Focus: Artificial Lift (March 2019)

Technology Focus With all the emphasis placed on artificial-lift run-life improvement, you might wonder if there are any tricks left in that bag. I contend there is one really big secret left—and it is hiding in plain sight. That trick is to use international standards as the foundation of your reliability program. A Chinese proverb says, “The journey of a thousand miles begins with a single step.” There are many steps in the long journey toward maximizing run life, including proper installation, operation, training, surveillance, audits, service-quality reviews, teardowns, and root-cause analysis. But, the first step should be to identify the requirements for your artificial-lift system and to communicate those requirements effectively to the vendor. In many cases, this is the most challenging step, largely because operators and suppliers often speak different languages. Fortunately, international standards are there for us to bridge that language gap. The International Organization for Standardization (ISO) defines a standard as “a document that provides requirements, specifications, guidelines, or characteristics that can be used consistently to ensure that materials, products, processes, and services are fit for their purpose.” Today, the American Petroleum Institute (API) and the ISO provide such standards for electrical submersible pumps, progressing-cavity pumps, sucker-rod pumps, gas lift, and plunger lift, and API complements their standards with recommended practices that provide guidance from industry experts in the use of such technologies. A surprisingly small number of operators purchase monogrammed equipment or even reference the standards in their purchasing documents or contracts. This is unfortunate because standards can make everyone’s lives much easier, allowing operators and suppliers to speak the same language by providing consistent nomenclature, definitions, and performance ratings for equipment. Operators have greater peace of mind knowing their equipment is supported by sound engineering practices and will perform as promised. When standards are referenced in requests for proposal, vendors are able to provide responses that are more appropriate for the application, resulting in a greater chance of success in the field. Operators can also make an apples-to-apples comparison when evaluating the proposals they receive. Standards help level the playing field, enabling suppliers to segment the market more effectively. And they enable manufacturers to implement consistent, effective quality-assurance processes while avoiding the time and expense of custom solutions. So, who writes all of these standards, anyway? The short answer is that we all do. API and ISO committees are generally composed of subject-matter experts rep-resenting an equal number of operators and vendors, often from different parts of the world. You can join one of these committees to help improve a particular standard. The key to making standards work for all of us is to use them. The more we use standards in our business, the better they will become over time. Recommended additional reading at OnePetro: www.onepetro.org. SPE 190920 Visualizing Rod Design and Analysis Through the Wave Equation by Walter Phillips, 3DWellbore.com SPE 190950 Effect of Gas Lift Design in Unconventional Wells—A Delaware Basin Operator’s Perspective by Subash K. Kannan, Anadarko, et al. SPE 192511 ESP Run-Life Improvement Through Auditing of ESP Workshops by Tamer Edries, Khalda Petroleum, et al.

Intended and unintended consequences: Ethics, communication, and prognostic disclosure in pediatric oncology.

The majority of patients desire all available prognostic information, but some physicians hesitate to discuss prognosis. The objective of the current study was to examine outcomes of prognostic disclosure among the parents of children with cancer. The authors surveyed 353 parents of children with newly diagnosed cancer at 2 tertiary cancer centers, and each child's oncologist. Using multivariable logistic regression, the authors assessed associations between parental report of elements of prognosis discussions with the oncologist (quality of information/communication and prognostic disclosure) and potential consequences of these discussions (trust, hope, peace of mind, prognostic understanding, depression, and anxiety). Analyses were stratified by oncologist-reported prognosis. Prognostic disclosure was not found to be associated with increased parental anxiety, depression, or decreased hope. Among the parents of children with less favorable prognoses (<75% chance of cure), the receipt of high-quality information from the oncologist was associated with greater peace of mind (odds ratio [OR], 5.23; 95% confidence interval [95% CI], 1.81-15.16) and communication-related hope (OR, 2.54; 95% CI, 1.00-6.40). High-quality oncologist communication style was associated with greater trust in the physician (OR, 2.45; 95% CI, 1.09-5.48) and hope (OR, 3.01; 95% CI, 1.26-7.19). Accurate prognostic understanding was less common among the parents of children with less favorable prognoses (OR, 0.39; 95% CI, 0.17-0.88). Receipt of high-quality information, high-quality communication, and prognostic disclosure were not found to be significantly associated with more accurate prognostic understanding. The results of the current study demonstrate no evidence that disclosure is associated with anxiety, depression, or decreased hope. Communication processes may increase peace of mind, trust, and hope. It remains unclear how best to enhance prognostic understanding. Cancer 2018;124:1232-41. © 2017 American Cancer Society.

Public performance and the challenge of local collective action strategies: Quebec’s experience with an Integrated Territorial Approach

Evaluating the performance of local environment activation strategies, set forth in many central policies, is an exercise fraught with challenges. Based on an analysis of 10 Integrated Territorial Approach initiatives, which were rolled out in Quebec’s fight against poverty, this article proposes a framework to better assess their various effects. These strategies are characterised by a partnership process and a collective focus. Performance occurs at micro-, meso- and macro-levels and is observable not only in the production of deliverables, but also on three other process dimensions, which are characteristic of such strategies: fostering the maintenance of local mobilisation drivers; improving the quality of locally productive elements; and learning strategic coherence. This understanding of collective performance takes public managers out of their comfort zone. Beyond having to develop collaborative skills, as is now well-documented in the literature, it leads them to develop an investor mindset and to become logisticians of the collective, not just efficient service providers. Points for practitioners Public managers sometimes feel disadvantaged in local collective action strategies because their performance depends on the contribution of a number of partners whose actions are driven by logics that differ from theirs. By outlining the many possible facets of performance in local collaborative strategies, the statements made in this article could give them greater peace of mind, as well as point out the systemic stumbling blocks that they may face.

Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible?

Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker’s stated aims for that spending to achieve.

Fumble.

Not Here by Choice: My Husband’s Choice About How and When to Die Phyllis Shacter This is a story that could be about you because illness and end of life issues and ultimately death come to all of us. I share this story about love, courage, advocacy and choice with you, with the hope that it contains information that will give you greater peace of mind. From a place of deep sadness, yet buoyed by the strength and commitment of our love for one another, I became my husband’s advocate so he could follow through with his decision to voluntarily stop eating and drinking (VSED) rather than live into the late stages and indignities of Alzheimer’s disease. This was his choice, and his right. I supported him every step of the way. After nine–and–a–half days of going through the VSED process, he died peacefully at home on April 19. 2013. Two weeks before he started the VSED process, he was sitting at the breakfast table and I noticed he was crying. I said, “Honey, what are you feeling?” He replied tearfully, “I’m not afraid of dying. I’ve lived a good life, but I want everyone to know about VSED.” I spontaneously replied, “You’ll just have to trust that I’ll be your vehicle.” We had a beautiful marriage for twenty–six years. It was based on mutual acts of cherishing, support, partnership, love and laughter. Alan was a brilliant man, a Harvard graduate who took the first computer course ever given in the world. He was a jazz pianist since his early youth. After retirement he did the training and certification necessary to become a Neuro–Linguistic Programming (NLP) trainer and practitioner. We both began to notice cognitive changes in Alan as early as 2007. In 2007 and 2009, a neuro–psychologist examined Alan and said he was fine. He was finally diagnosed with Alzheimer’s in November 2011. Both Alan and I were familiar with this disease. My father and mother–in–law each had it for more than ten years. I rescued my mother when she reached her limit in care giving. I had to place my father in a board and care home in 1987 at a time when there were few choices for Alzheimer’s patients. My mother–in–law died a shadow of a person with no physical capacities. We knew what lay ahead if Alan continued to live with Alzheimer’s, but we did not yet know that he had another choice. He was clear that he did not want to die of Alzheimer’s. In his Health Directive, he stated that he did not want to be treated for any illness, hoping that he would get an infection or pneumonia and would die from that. That never occurred. I contacted End of Life Washington (previously known as Compassion & Choices of Washington) to find out about the legal choices available to end one’s life for someone in Alan’s position. I inquired about the Death With Dignity Law, which was relatively new at the time in our state of Washington. Most importantly, I learned that Alzheimer’s and most neurological diseases do not qualify for the Death With Dignity law. Two qualifications for the Death With Dignity law are that the person has to be in the last six months of life and has to be mentally competent [End Page 94] and able to self–administer the lethal medication that would end his or her life. When an Alzheimer’s patient is in the last six months of life, he/she is no longer mentally competent. A volunteer chaplain from End of Life Washington suggested that I do some research about VSED, voluntary stopping eating and drinking, as a legal option for Alan to end his life. Neither Alan nor I had ever heard of it. Fortunately, I found Thaddeus Pope’s article online, written with Lindsey Anderson, on legal ways to die called, “Voluntary Stopping Eating and Drinking: A Legal Treatment Option at the End of Life,” October 7, 2010 accessed from http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1689049. I shared...

Development and introduction of recombinant factor VIII - a clinician’s experience

In this review concerning the state of treatment for persons with haemophilia A leading up to the development and introduction of recombinant factor VIII products, and beyond, I vividly recall my own feelings at the time. When I began my fellowship training in paediatric haematology in the mid-1960s, we almost always had numerous boys in the hospital, receiving large volumes of fresh frozen plasma every 6–8 h for joint or large soft tissue haemorrhages. If they developed an inhibitor, there was little that we could do. A short time later, we were able to obtain cryoprecipitates, and then, by 1970, intermediate purity, lyophilized FVIII concentrates. These seemed wonderful, allowing out-patient treatment, and even surgical procedures! However, it soon became apparent that there was a price to be paid for the use of these plasmaderived products as most of our patients developed hepatitis, and by the early 1980s, AIDS. As a result, there were attempts to make the lyophilized, plasmaderived FVIII concentrates safer (improved donor screening, dry heat treatment, solvent-detergent treatment, pasteurization); however, by 1987, when recombinant FVIII concentrates became available for prelicensure clinical trials, there was genuine excitement! Excitement by me and most of my colleagues throughout the U.S. and abroad, and also a great deal of excitement by our patients, many of whom had affected family members or friends who had developed the acquired immunodeficiency syndrome (AIDS). In the 1950s and much of the 1960s, bleeding episodes in persons with haemophilia were treated with fresh frozen plasma (FFP), as no one had come up with a method for separating F VIII or F IX from plasma. Patients with bleeding episodes were frequently hospitalized for infusions of large volumes of FFP given every 6–8 h in an attempt to stop bleeding without pushing them into congestive heart failure from fluid overload. A major breakthrough came in 1965, when Dr. Judith Poole described a simple way of separating FVIII (and vWF) from plasma which had been frozen and then thawed in the cold [1]. Almost overnight, cryoprecipitates (cold insoluble precipitates) were being produced by blood collection facilities, for treatment of persons with haemophilia A. These cryoprecipitates had to be stored in the frozen state prior to use, and varied in the amount of FVIII contained. A short time later, two pharmaceutical companies had developed technologies to separate FVIII (and FIX) from large pools of donor plasma, resulting in freeze-dried, lyophilized FVIII concentrates [2]. These early, intermediate purity FVIII concentrates were easier to use, as they did not need to be frozen for storage, and each bottle was labelled with the amount of FVIII contained. However, neither cryoprecipitates or these intermediate purity plasmaderived concentrates were treated for blood-borne viruses. Once these lyophilized concentrates became available, treatment for bleeding episodes was much easier, haemostatic levels of FVIII could easily be achieved and, in the early 1970s, home treatment programs sprung up. The latter resulted in earlier treatment of joint bleeds, and a greater feeling of independence for those with haemophilia. Many referred to this period as the ‘golden age’ for haemophilia. However, this feeling was short-lived, as in 1981 the Communicable Disease Center (CDC) described the first three persons with haemophilia A who developed the acquired immunodeficiency syndrome (AIDS), and these three were followed by more and more individuals with haemophilia, many of whom died of its complications [3–5]. In addition, it had become increasingly apparent that many persons with haemophilia had been infected with hepatitis viruses [5] (hepatitis B and socalled, ‘non-A, non-B’ hepatitis, subsequently called hepatitis C after the HCV was identified). These serious complications of treatment resulted in increased efforts to make treatment safer. Lyophilized, intermediate purity concentrates were treated with dry heat [5]. Cryoprecipitates were no longer recommended for treatment of haemophilia A, being considered less safe than heat-treated products [6]. In 1981 Haemate P, a pasteurized FVIII and vWF concentrate became available in Germany. Predominantly used in Europe, this product was the first effectively virus-inactivated FVIII product [7]. Shortly thereafter, other products of Haemophilia (2012), 18, 483–486 DOI: 10.1111/j.1365-2516.2012.02804.x

Escenoterapia para la prevención de la violencia ocupacional

To achieve, through a training and preventive intervention, a significant change in the emotional experience of a group of health care professionals at risk of exposure to workplace violence. 143 Catalonian health professionals participated in a training course on occupational risk prevention that incorporated theatrical staging techniques and psychotherapeutic strategies, focused on the interpretation of emotional experiences associated with violence in the workplace. They participated voluntarily in the program and were selectedaccording to type of healthcare delivered and professional diversity. A pre- and post-course questionnaire was administered. Ninety-two percent of respondents claimed to have witnessed, and 85% had personally experienced, a violent episode in the previous five years. The comparison of mean scores before and after the training intervention revealed anincrease in the positive assessment of the effectiveness of one's own performance and communication skills (p< 0.001), and induced emotional experiences in line with a greater peace of mind (p< 0.005) and less anxiety (p< 0.005) with respect to the violent incident. Staging experiential stressful situations can be a useful learning tool for managing emotions, which increases the perceived degree of one's ability to manage communication, teamwork and professional stress itself.

The Impacts of the State Children's Health Insurance Program on Children Who Enroll: Findings from Ten States

Examine the extent to which enrollment in the State Children's Health Insurance Program (SCHIP) affects access to care and service use in 10 states that account for over 60 percent of all SCHIP enrollees. Surveys of 16,700 SCHIP enrollees were conducted in 2002 as part of a congressionally mandated study. Three domains of SCHIP enrollees were included: (1) children who were recently enrolled in SCHIP, (2) those who had been enrolled in SCHIP for 5 months or more, and (3) those who had recently disenrolled from SCHIP. Response rates varied across states and domains but were clustered between 75 and 80 percent. Five different types of indicators were examined: (1) service use; (2) unmet need; (3) parental perceptions about being able to meet their child's health care needs; (4) presence and type of a usual source of care; and (5) provider communication and accessibility. The experiences SCHIP enrollees have while on the program are compared with those a separate sample of children had before enrolling using a separate sample pretest and posttest design, controlling for observable characteristics of the children and their families. The sample was drawn based on a list frame of SCHIP enrollees. The survey was administered in English and Spanish, by Computer-Assisted Telephone Interviewing (CATI). Field follow-up was used to locate families who could not be reached by telephone and these interviews were conducted by cellular telephone. SCHIP enrollment was found to improve access to care along a number of different dimensions, other things equal, particularly relative to being uninsured. Established SCHIP enrollees were more likely to receive office visits, preventive health and dental care, and specialty care, more likely to have a usual source for medical and dental care and to report better provider communication and accessibility, and less likely to have unmet needs, financial burdens, and parental worry associated with meeting their child's health care needs. The findings are robust with respect to alternative specifications and hold up for individual states and subgroups. Enrollment in SCHIP appears to be improving children's access to primary health care services, which in turn is causing parents to have greater peace of mind about meeting their children's needs.

Comment

Shostak and Ottman's article highlights the need for discussion and research on this important but complex issue. There are numerous biological, clinical, diagnostic, social, ethical, and legal aspects to examine, to understand how genetic testing can impact on individuals and families with epilepsy. Based on our experience over the last decade of applying recent discoveries to the clinical care of our patients, we believe the authors overemphasize the negative issues of genetic testing, suggesting it will exacerbate stigma and negative perceptions held by society. We wish to balance this discussion by emphasizing the significant medical, personal, familial, and social benefits that can result from genetic testing. In addition, many of the concerns raised in the article relate more to the realization that epilepsy may have a genetic basis than to the testing itself. At present, genetic testing is only possible for the small proportion of epilepsy syndromes that are single gene disorders; it can confirm a diagnosis, provide information regarding the risk to other children, and allow optimization of treatment. Importantly, confirmation of a diagnosis through genetic testing may render other invasive or expensive tests unnecessary. Finality in understanding the diagnosis and the cause enables families to constructively deal with the problem, rather than continuing the search for “answers.” In reality, families often seek out and welcome information about the genetic nature of their or their child's epilepsy. As highlighted by Shostak and Ottman, many families want to know why epilepsy has occurred. A positive test result, even without treatment implications, often gives them greater peace of mind. Similarly many parents blame themselves for their child's seizures, attributing them to an action or event that took place during pregnancy or infancy such as injury or vaccination. Understanding that the seizures have a genetic cause can allow parents to release this burden of guilt. Shostak and Ottman highlight the benefit that patients derive from understanding that they can control their seizures by lifestyle factors. This does not detract from the need to educate patients and families about the difference between the biological cause of their epilepsy and the triggers for their seizures. Emphasis on a spurious cause is unlikely to be helpful and reinforces long-standing myths surrounding epilepsy held by the community. Before genetic testing is offered, the individual or family concerned must appreciate that their epilepsy may have a genetic cause. Shostak and Ottman suggest that genetic testing compounds the stigma already associated with epilepsy, as epilepsy may be seen as an integral and enduring part of the person, and it may lead to other family members being affected by “courtesy stigma.” However, these social implications are associated with the realization that epilepsy is a familial condition, rather than with the actual result of gene testing. It is therefore essential to separate these two processes when evaluating the impact genetic information may have. Educating patients about the biology and genetics of epilepsy is critical if we are to prevent them from developing spurious belief systems. This will also lay the foundation for understanding the results of gene tests. Care needs to be taken to ensure families, who are desperate for an answer as to why their child has seizures, are not exploited and do not spend large amounts of money on irrelevant tests. This is where ethical guidelines are urgently needed to inform clinicians how, when, and by whom the tests should be ordered, and to clarify the role of genetic counseling. Individuals and families need to understand the genetic aspects of their disease, well before seeking a genetic test. Genetic tests offer tangible positive psychological and social outcomes, which are important considerations not to be dismissed in the development of genetic guidelines.

Stories that bring peace to the mind: Communication and the education of feelings

Communication not only elicits fleeting emotional reactions; it also influences how people learn to approach life emotionally. It does so by shaping perceptions and beliefs implicit in emotions, as well as ideas about the value and appropriateness of emotions. Furthermore, communicative experiences help develop people's capacity and inclination for particular feelings. This essay advances a concept of communication as education for the feelings, then examines the role of storytelling in this process. Four elements of storytelling have important consequences for listeners’ emotional lives: (a) narrative depiction of feelings, attitudes, and behavior; (b) the narrator's emotional stance; (c) listeners’ expectations; and (d) listeners’ emotional responses. The essay uses this analysis to examine how telling and hearing stories can help people learn to approach life with greater peace of mind.

Home use of rectal diazepam for cluster and prolonged seizures: Efficacy, adverse reactions, quality of life, and cost analysis

From 1982 through 1987, 128 families, who were instructed in the use of rectally administered diazepam (R-DZP) for the treatment of severe epileptic seizures, were surveyed. Sixty-seven families returned questionnaires and met inclusion/exclusion criteria; the results were used to analyze the medical, psychosocial, and economic impact of this program during the first year following instruction. Twenty-six families did not use R-DZP, primarily because of patient improvement. Among families using R-DZP, a total of 428 doses were administered to 41 children. R-DZP was effective in controlling seizures in 85% of patients. Adverse reactions usually were mild, consisting of drowsiness and/or behavioral changes. Compared to the year prior to instruction, emergency room visits decreased in both R-DZP-treated and -nontreated children; however, cost-savings were greater for the R-DZP group ($1,039.00 vs $420.00 per patient per year). Improvements in quality of life associated with the availability of R-DZP were observed by 58% of users and 27% of nonusers which included improved management of their children's seizures, increased flexibility in family activities, and greater peace of mind. R-DZP appears to be a practical method in the effective treatment of severe seizures at home.