Postpartum care fails to provide women with key recommended services

UMass Amherst researchers analyzed data from 20 million postpartum care visits

UNIVERSITY OF MASSACHUSETTS AMHERST

Research News

 

IMAGE: KIMBERLEY GEISSLER IS AN ASSISTANT PROFESSOR OF HEALTH POLICY AND MANAGEMENT IN THE UMASS AMHERST SCHOOL OF PUBLIC HEALTH AND HEALTH SCIENCES. view more 

CREDIT: UMASS AMHERST

Most women are receiving fewer than half the services recommended during their comprehensive postpartum medical checkup, according to a study by University of Massachusetts Amherst researchers.

"These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period," concludes the study, published Nov. 10 in JAMA Network Open. "There is substantial room to improve the delivery of postpartum care."

Authors Kimberley Geissler and Laura Attanasio, both assistant professors of health policy and management in the School of Public Health and Health Sciences, were joined in the study by graduate student Brittany Ranchoff and undergraduate Michael Cooper. The study received funding from the National Heart, Lung and Blood Institute and the Agency for Healthcare Research and Quality.

"This research is very important because we were able to look at care that was actually provided and really understand what happened during health care visits, not just that the visits are happening. This information is critical for improving the quality of care," says Geissler.

The medical visits averaged about 17 minutes, the researchers found, which may help explain the incomplete postpartum care. "Is that enough time to provide these services? I don't know," Geissler says. "The pressure to see more patients in an increasingly short time is a known issue in the U.S. health care system, so it's not surprising we see that here, too."

In one of the most startling findings, despite an increased awareness of perinatal depression, only one in 11 patients received a screening for depression, part of the assessment of physical, social and psychological well-being recommended by the American College of Obstetricians and Gynecologists (ACOG).

"We need to look at why depression screening is not happening," Attanasio says. "This is an important factor in women's health for the rest of their lives. Even if you're missing some of the recommended services, this one should be universal among this population."

Previous studies have shown that women with Medicaid insurance receive fewer preventive services than women with private insurance, leading the UMass Amherst team to examine insurance type in their review. "We hypothesized recommended services would be less frequently provided during postpartum visits for women with Medicaid insurance compared to women with other coverage types," the researchers write.

However, Attanasio says, "we found that there were not significant differences in the services received between women with Medicaid coverage and private insurance. That could reflect the fact that a lot of these services were not provided to most of the women."

The researchers analyzed data from the National Ambulatory Medical Care Survey, which represented more than 20 million postpartum office visits to an ob-gyn or family medicine doctor from 2009 to 2016.

Recommended services include blood pressure screening; depression screening; pelvic exam; pap test; breast exam; blood glucose exam; contraceptive counseling or provision; counseling for weight reduction, exercise, stress management, diet/nutrition, and/or tobacco use; medication review; and referral to another physician, if needed.

The study calculated the percentage of visits during which the recommended postpartum care services were provided, including the following:

• Blood pressure, 91.1%
• Depression screening, 8.7%
• Pelvic exam, 47.3%
• Pap test, 15.9%
• Breast exam, 21.9%
• Contraceptive counseling or provision, 43.8%

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Diabetes epidemic detected among Xavante indigenous community in Central Brazil

Researchers examine retinas and find high prevalence of type 2 diabetes as well as ocular problems caused by the disease.

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

Research News

 

IMAGE: RESEARCHERS EXAMINE RETINAS AND FIND HIGH PREVALENCE OF TYPE 2 DIABETES AS WELL AS OCULAR PROBLEMS CAUSED BY THE DISEASE view more 

CREDIT: FERNANDO KORN MALERBI

The Xavante, one of the indigenous communities most vulnerable to SARS-CoV-2 in Brazil, are suffering from an epidemic of diabetes, a "silent" disease considered a risk factor for severe COVID-19.

A group of researchers affiliated with the Federal University of São Paulo's Medical School (EPM-UNIFESP) and the University of São Paulo's Ribeirão Preto Medical School (FMRP-USP) examined the retinas of 157 individuals before the COVID-19 pandemic and found a high prevalence of type 2 diabetes and eye disorders caused by the disease.

The study was supported by São Paulo Research Foundation - FAPESP (https://bv.fapesp.br/en/auxilios/28693), and the results are published (https://www.sciencedirect.com/science/article/abs/pii/S0168822720306331) in Diabetes Research and Clinical Practice, the official journal of the International Diabetes Federation.

"Ninety-five of the 157 Xavante we examined [60.5%] were diagnosed with diabetes," Fernando Korn Malerbi (https://bv.fapesp.br/en/pesquisador/47115/fernando-korn-malerbi), a postdoctoral researcher in the Ophthalmology Department of EPM-UNIFESP and first author of the article published on the study.

According to Malerbi, diabetes can cause ocular problems such as retinopathy. Diabetic retinopathy develops when high blood sugar levels damage blood vessels in the retina, leading to vision loss if left untreated.

To diagnose cases of diabetic retinopathy and other possible eye disorders, the researchers examined members of the Xavante community on the Volta Grande and São Marcos Reservations in the state of Mato Grosso in Brazil's Center-West region. They used a smartphone-controlled retinal photography system developed by Phelcom Technologies (https://phelcom.com.br/en/company/) via a project (https://bv.fapesp.br/en/auxilios/105359) supported by FAPESP's Innovative Research in Small Business Program (PIPE (https://bv.fapesp.br/en/3/)).

Called the Eyer, the handheld retinograph is an optical device that produces precise images of the retina to detect back-of-the-eye (fundus) disease at a far lower cost than conventional methods. In addition, it has the advantage of being usable for remote diagnosis by an ophthalmologist via telemedicine.

The optical device is connected to a smartphone. It lights up and images the retina, and a specially written software application sends the images over the internet to Eyer Cloud, which stores and manages patient files.

In the absence of Wi-Fi or a 3G or 4G network, the images are stored in the smartphone and sent to the cloud when a broadband internet connection becomes available (read more at: agencia.fapesp.br/30784 (https://agencia.fapesp.br/portable-device-can-be-used-to-diagnose-eye-disease-remotely/30784/)).

Malerbi personally examined the Xavante volunteers and promptly gave them his diagnosis. "When retinal damage suggesting a risk of blindness was observed via the handheld retinograph, we informed the subjects via an interpreter and referred them to the local indigenous health service for follow-up and treatment," he said.

Of the 95 individuals with diabetes who underwent the complete ocular imaging protocol, 23 (24.2%) had ungradable images owing to cataract-caused media opacities that precluded evaluation of retinopathy in at least one eye.

Images from the remaining 72 subjects (75.8%) were good enough for diabetic retinopathy to be detected. The researchers found that 16 had the disease, and it was severe enough to be sight-threatening in seven.

"We proved that screening for diabetic retinopathy with a portable retinograph is feasible and economically viable because the technology is inexpensive and can be used in remote communities such as Indian reservations, where the population is usually dispersed in several villages," Malerbi said.

Deteriorating health

A previous study of eye problems among the Xavante reported diabetic retinopathy prevalence of 19.3% in the same locations. The higher level of prevalence found in this latest study may be due to the superior quality of the retinal camera images compared with the indirect ophthalmoscopy method used in the earlier study.

Another hypothesis is that the health of this indigenous population - one of the largest in Brazil, comprising some 17,000 Indians living on nine reservations - has deteriorated in the intervening years, the researchers surmised.

A previous study showed that 66.1% of 932 members of the Xavante community had metabolic syndrome, defined as a condition in which risk factors for cardiovascular disease and diabetes mellitus occur in the same individual.

For the researchers, the situation reflected changes in health profile and diet in recent decades, especially the consumption of industrialized foods and sedentary living (read more at: agencia.fapesp.br/22624 (https://agencia.fapesp.br/two-thirds-of-an-indigenous-community-have-metabolic-syndrome-and-are-obese/22624/)).

"The Xavante were traditionally hunter-gatherers but have become more sedentary. They've also changed their diet in recent decades, consuming new foodstuffs with high sugar content," Malerbi said.

Besides the Xavante, the researchers also examined the retinas of 33 Bororo - another community endangered by both COVID-19 and the bush fires that destroyed much of the Pantanal this year. Seven Bororo were found to have diabetes. One of these was diagnosed with severe diabetic retinopathy and referred to a health service for treatment.

CAPTION

Researchers examine retinas and find high prevalence of type 2 diabetes as well as ocular problems caused by the disease

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at http://www.fapesp.br/en and visit FAPESP news agency at http://www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.

Representation of female authors in family medicine academic journals is trending upward

Has female authorship distribution in family medicine research evolved over time?

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Research News

 

Representation of Female Authors in Family Medicine Academic Journals is Trending Upward

After decades of underrepresentation in medicine, women are now entering many specialties in the United States, including family medicine, at higher rates than men. Despite the rising proportion of female physicians in family medicine, they continue to be underrepresented in the highest levels of professional attainment, particularly in academic settings. This study from the Robert Graham Center examines female authorship of research published in three leading U.S. family medicine journals over time. They found a statistically significant increase in female authorship of published research over time, with a 13-point jump in original research with female senior authors, from 29 percent in 2008 to 42 percent by 2017. In that same time period, the gender composition of the journals' editorial boards remained roughly the same. Published research was more likely to be male led if it did not have grant funding or if there were no other co-authors. This study's authors discuss the importance of increasing female representation in peer-reviewed publications, closing the gender gaps in the highest levels of academic medicine, and ensuring appropriate representation of thoughts and ideas in the field of family medicine.

Has Female Authorship Distribution in Family Medicine Research Evolved Over Time?
Yalda Jabbarpour, MD, et al
Robert Graham Center, Washington, D.C.
https://www.annfammed.org/content/18/6/496

Demolishing abandoned houses does not reduce nearby crime, study finds

Millions spent on efforts to curb illegal activity not effective

UNIVERSITY OF KANSAS

Research News

 

LAWRENCE -- Cities across the country have sought ways to improve neighborhood safety and in recent years have pointed to demolishing abandoned housing as a way to achieve the goal. While millions of dollars have been spent on the efforts, a recent University of Kansas study found a program demolishing more than 500 abandoned residential properties in Kansas City, Missouri, did not significantly reduce nearby violent or property crime.

Since the housing foreclosure crisis of 2007-08, the number of abandoned homes across the country has rapidly increased, drawing attention to dilapidated and abandoned residential properties and their effect on neighborhoods, including elevated crime rates. Hye-Sung Han, assistant professor of public affairs & administration at KU, conducted a study in which she examined 559 abandoned properties in Kansas City, Missouri, and nearby crime rates in the surrounding area. She found the demolition did not lead to a reduction in nearby crime and that localized socioeconomic and housing characteristics were much stronger predictors of any change in crime rates.

While scholars have long associated abandoned property and crime, there has been little research on whether demolishing abandoned properties reduces crime, even though police and city officials argue that demolition increases neighborhood safety and ease the burden on police by removing places for illegal activities.

"There is not much data out there on housing abandonment. Because of that, there aren't many studies done, and those that are, are mostly about how abandonment affects the neighborhood housing market," Han said. "But one other negative factor is crime and how it affects the quality of life it has for those still living in neighborhoods with abandoned housing. It has been pretty much proven that there is more crime where there is more abandoned housing."

Han said she decided to study the matter after hearing Kansas City's former police chief in 2016 touting a $10 million plan to demolish 800 dilapidated, abandoned homes to help reduce crime. The city has more than 10,000 abandoned properties, though not all have been deemed dangerous. Han identified 559 properties that were demolished between 2012 and 2016. Crime near the properties was compared to crime near another abandoned home that was not demolished. Her study, co-written with Scott Helm of the University of Missouri-Kansas City, was published in the journal Housing Policy Debate.

"I found out the crime around a property that was demolished did not change," Han said. "So, I looked at other explanations for crime going up or down. I think one of the reasons demolition doesn't make a difference is once you demolish the abandoned property, you are left a vacant lot. That is not necessarily better for neighborhood safety. In fact, I found that every single lot where the 559 properties were demolished was still vacant in 2020. Unkept vacant lots can encourage crime."

Han emphasized the study is not intended to criticize city officials or police but rather to shed light on whether programs using taxpayer funding to address crime are effective. Demolition is expensive, often costing $8,000 to $10,000 per home. The study focused on Kansas City, but similar demolition programs have taken place across the country, including cities such as Detroit, Philadelphia, Pittsburgh and Baltimore, some tearing down thousands of abandoned homes per year. One cannot assume the findings would be the same in other cities as they were in Kansas City, but Han said she feels similar results would be likely. There are differences among cities to consider, however, including types of properties being demolished, mostly single-family dwellings in Kansas City, while multiple-family rowhouses are more frequent targets for the wrecking ball in other cities, which carry a higher price tag.

The findings show that demolition of abandoned homes did not reduce nearby crime, which Han said indicates policymakers should consider holistic approaches to improve neighborhood safety. The focus should be on improving neighborhood social and physical characteristics, particularly in urban neighborhoods with high housing abandonment.

"In most cases, the very first thing that should happen is to get these houses and properties occupied," Han said. "So someone is at least living there and paying taxes, and so the city can provide more services."

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When kids watch a lot of TV, parents may end up more stressed

The more TV kids watch, the more ads they see and the more likely they are to ask for things on shopping trips, research shows

UNIVERSITY OF ARIZONA

Research News

 

There's bad news for parents who frequently plop their kids in front of the TV to give themselves a break: It might actually end up leaving moms and dads more stressed.

Why? Because the more television that kids watch, the more they're exposed to advertising messages. The more advertising they see, the more likely they are to insist on purchasing items when they go with their parents to the store - and perhaps make a fuss if told "no." All that, researchers say, may contribute to parents' overall stress levels, well beyond a single shopping trip.

The findings come from a University of Arizona-led study, published in the International Journal of Advertising, that explores the potential effects of children's television watching habits on their parents' stress levels.

"The more advertising children see, the more they ask for things and the more conflict is generated," said lead study author Matthew Lapierre, an assistant professor in the UArizona Department of Communication in the College of Social and Behavioral Sciences. "What we haven't looked at before is what the potential effect is on parents. We know kids ask for things, we know it leads to conflict, but we wanted to ask the next question: Could this be contributing to parents' overall stress?"

The study suggests that it could.

There are a few things parents can do, perhaps the most obvious of which is limiting screen time.

"Commercial content is there for a reason: to elicit purchasing behavior. So, if this is a problem, maybe shut off the TV," Lapierre said.

Of course, that can be easier said than done, he acknowledged.

Another thing parents can try, especially as advertising geared toward children ramps up around the holidays: Consider how they talk to their kids about consumerism.

The researchers looked at the effectiveness of three types of parent-child consumer-related communication:

--Collaborative communication is when a parent seeks child input on family purchasing decisions - for example, saying things such as, "I will listen to your advice on certain products or brands."
--Control communication is when a parent exhibits total control in parent-child consumer related interactions - for example, saying things such as, "Don't argue with me when I say no to your product request."
--Advertising communication is when parents talk to their children about advertising messages - for example, saying things such as, "Commercials will say anything to get you to buy something."

They found that, in general, collaborative communication is associated with less parent stress. However, the protective effect of collaborative communication decreases as children's purchase initiation and coercive behaviors - such as arguing, whining or throwing temper tantrums - increase.

Both control communication and advertising communication are associated with more purchase initiations and children's coercive behavior, the researchers found, suggesting that engaging less in those communication styles could be beneficial.

However, when children have higher levels of television exposure, the protective effect of engaging in less advertising communication decreases.

"Overall, we found that collaborative communication between parents and children was a better strategy for reducing stress in parents. However, this communicative strategy shows diminishing returns when children ask for more products or engage in more consumer conflict with parents," said study co-author Eunjoo Choi, a UArizona doctoral student in communication.

The study is based on survey data from 433 parents of children ages 2 to 12. The researchers focused on younger children because they have less independent purchasing power and spend more time shopping with their parents than older kids, Lapierre said.

In addition to answering questions about their communication styles, the parents in the study also responded to questions designed to measure:

--How much television their child watches in a day.
--How often their child ask for or demands a product during shopping trips, or touches a product without asking.
--How often their child engages in specific coercive behaviors during shopping trips.
--Parent stress levels.

Advertisers Find a Way

Lapierre acknowledged that the way people consume entertainment is changing. With the rise of the DVR and streaming services, many viewers are no longer being exposed to the traditional advertising of network or cable TV. However, advertisers are finding creative ways around that, through tactics such as product placement and integrated branding - incorporating product or company names into a show's narrative - Lapierre said. And advertising toward children remains a multibillion-dollar industry.

"In general, more television exposure means more exposure to commercialized content. Even if I'm streaming, if I I'm watching more of it, I'm likely seeing more integrated branding," Lapierre said.

Advertising aimed at children - which often features lots of bright colors, upbeat music and flashy characters - can be especially persuasive, since, developmentally, children aren't fully capable of understanding advertising's intent, Lapierre said.

"Advertising for kids is generated to makes them feel excited. They do a lot of things in kids' advertising to emotionally jack up the child," Lapierre said. "Children don't have the cognitive and emotional resources to pull themselves back, and that's why it's a particular issue for them."

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Weight loss shouldn't be the goal of PE

New study shows kids' physical fitness is more important than BMI

UNIVERSITY OF GEORGIA

Research News

 

IMAGE: CHILDREN GET ACTIVE OUTSIDE UGA'S MCPHAUL CHILD DEVELOPMENT LAB. view more 

CREDIT: ANDREW DAVIS TUCKER/UGA

For adults, the goal of exercise is often to shed some pounds, but new research from the University of Georgia suggests the objective should be different for kids.

Physical education should focus on improving students' physical skills, knowledge of the benefits of exercise and motivation to be active. The goal should be to build students' cardiorespiratory endurance, a measure of how well the body handles long periods of exercise--not to help them lose weight, according to the study's authors. Kids can be overweight (as measured by the Body Mass Index, or BMI) and still able to reach the recommended 60 minutes of moderate to vigorous physical activity each day. And students who are more active during PE, despite their weight, are more likely to stay active after school as well.

"Research has shown that even in young children, people who are fitter in terms of cardiorespiratory endurance participate in more intense physical activities," said lead author Sami Yli-Piipari, an associate professor in UGA's Mary Frances Early College of Education. "It's not really your weight that matters. Children can be a little bit overweight but still be relatively fit."

The study followed 450 children, ages 10 through 12, who took 90 minutes of mandatory PE every week. The students wore an accelerometer on their right hip during the day to track their total physical activity for a week, and simple tests--such as being able to do a regular or modified pushup or crunch-- were used to determine their mastery of physical skills. The researchers also explored whether students enjoyed PE or participated out of obligation.

"Physical education matters," Yli-Piipari said. "It's not only where students learn the skills, abilities and motivation to be active; it's where students are having to do something active at a higher intensity than they probably would after school."

The study took place in Finland, where children have more PE on average than American students, and the class also focuses on the importance of exercise and how to incorporate it into everyday life. In keeping with previous research, boys tended to be more active than girls. But surprisingly, muscle strength and motor skills didn't play a role in activity levels. Neither did motivation--whether the child wanted to participate in PE--nor enjoyment of PE classes.

The students who didn't participate in after-school sports were also typically less active during their down time. For many of these students, PE was the only time they exercised hard enough to work up a sweat, which makes it even more important to use class time effectively in a way that will get students moving and motivated to keep it up.

To help children learn to be physically literate, Yli-Piipari suggests teaching them in a way that gets students up and active.

• Don't just lecture and tell kids to do something. Take them to places, get them moving, and let them try different things themselves.
• Variety is key. Introduce children to multiple ways they can get their heart pumping and explain why it's important to stay active.
• Finally, model lifestyle and behaviors that show that physical activity and exercise have an important value for you. Help connect the dots from exercising to the positive physical and mental health effects it can have on an individual.

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This study, done in partnership with the University of Jyväskylä in Finland, and the LIKES Research Centre for Physical Activity and Health, was published in the Journal of Teaching in Physical Education.

Vocational rehabilitation helps lift people with disabilities out of poverty

Findings from the Substantial Gainful Activity Project reported in this special issue of the Journal of Vocational Rehabilitation

IOS PRESS

Research News

IMAGE: IMPACTS OF THE SGA PROJECT INNOVATIONS. CREDIT: JOURNAL OF VOCATIONAL REHABILITATION view more 

CREDIT: CSAVR, ROCKVILLE, MD, USA

Amsterdam, NL, November 10, 2020 - Social Security Disability Insurance (SSDI) benefits do not always keep individuals with disabilities out of poverty. To support these individuals' efforts to lift themselves out of poverty, the Substantial Gainful Activity (SGA) Project was piloted in Kentucky and Minnesota. It showed that individuals who engaged in a vocational rehabilitation services intervention were able to earn increased income above SGA-level earnings. The authors recommend expanding the project to other US state agencies.

In a special issue of the Journal of Vocational Rehabilitation Guest Editors Susan Foley, PhD, Institute for Community Inclusion (ICI), University of Massachusetts Boston, Boston, MA, USA, and Purvi Sevak, PhD, Mathematica, Princeton, NJ, USA, have assembled seven insightful reports on the SGA Project from early design through completion of randomized controlled trials in two states. Stephen Wooderson and John Connelly of the Council of State Administrators of Vocational Rehabilitation (CSAVR) were invited to author a paper about how vocational rehabilitation agency leaders view and value participation in research. Two additional papers report on recent related research.

The relationship between earnings and SSDI benefits receipt has been a major issue in the United States since the program began in 1956. One metric used to determine if a person is unable to engage in work is termed "substantial gainful activity," a monthly dollar amount calculated by the Social Security Administration. State vocational rehabilitation agencies provide employment services to people with disabilities including those receiving SSDI.

"We are in another economic downturn. It is not easy to predict what will happen and how this will affect people with disabilities, but if past is prologue, the next few years may see more applicants to poverty and disability insurance programs," explained Dr. Foley and Dr. Sevak. "During the coronavirus pandemic, vocational rehabilitation agencies are again innovating to consider more remote and virtual ways of connecting, expanding dual customer approaches to serve businesses and workers as clients, and looking for more tools to put in a practitioner's toolbox. Finding solutions to help people return to work and find work that can provide economic stability will be an important role for state vocational rehabilitation agencies."

The Rehabilitation Services Administration funded the SGA Project to identify vocational rehabilitation agency practices that lead to improved earnings for SSDI clients upon completion of vocational rehabilitation. It awarded a cooperative agreement to the Institute for Community Inclusion at the University of Massachusetts Boston and Mathematica Policy Research.

Working with more than 100 practitioners representing over 20 vocational rehabilitation agencies, the design phase of the SGA Project identified high performing agencies and key practices that might contribute to that performance with the ultimate goal of designing an effective intervention.

The testing phase of the project tested an intervention designed to improve earnings outcomes of SSDI beneficiaries who were clients of Kentucky and Minnesota state vocational rehabilitation agencies. Mathematica Policy Research assessed service, employment, and earnings outcomes, while ICI interviewed and followed SSDI clients who participated to understand why people seek work, what influences their choices about earnings levels, and how vocational rehabilitation services played a role in their decisions.

Frank Martin, PhD, and Purvi Sevak, PhD, both from Mathematica, Princeton, NJ, USA, review the implementation and impacts of the SGA Project demonstration in Kentucky, They describe the SGA Project model components, the implementation experience in Kentucky, and the impact of the innovations on vocational rehabilitation service and employment outcomes. Although results from the present study showed that participants did not consistently receive all components of the innovations, the innovations led to a 17 percentage point increase in clients with a signed individualized plan for employment (IPE) within 30 days of application, an 8 percentage point increase in closures with competitive employment, and a nearly 6 percentage point increase in the number of clients with earnings at or above the SGA level. The SGA earnings threshold for non-blind SSDI beneficiaries was $1,090 at the start of the testing phase in 2015 and $1,170 at the end of the testing phase in 2017.

A noteworthy aspect of the project was that it emphasized financial counseling, which required the hiring of work incentive coordinators, who were trained and certified to provide a much richer set of early and ongoing financial counseling. "Kentucky's successful implementation of an office-level random assignment design permitted a rigorous test of the SGA Project innovations," noted the authors. "Early, positive impacts on key outcomes suggest other agencies might use this approach to rigorously assess the effectiveness of new services and programs and for a broader set of vocational rehabilitation clients."

Key findings from the SGA Project include:

• Delivering services at a faster pace is feasible. The number of days to signed individual plan for employment (IPE) was reduced; the number of clients with a signed IPE within 30 days of their application increased by 17 percentage points. Quicker access to and progress through services allow people to maintain momentum in their search for work.

• SGA Project innovations can increase competitive employment. A combination of rapid client engagement, a faster pace of vocational rehabilitation services, financial and benefits planning, job placement services, and a coordinated team approach led to an 8 percentage point increase in employment and a 5.7 percentage point increase in the rate of SGA-level earnings for SSDI beneficiaries, potentially helping them on their path to higher income and financial independence.

• People with disabilities are able to return to work after receiving SSDI benefits. Researchers found that having a team of trusted individuals to provide accurate information, counsel clients, and help identify the types of jobs clients would like to do in their local labor market was a successful strategy.

• Partnerships between state vocational rehabilitation agencies and researchers in universities and private organizations are increasing knowledge about what will work to help people with disabilities advance economic opportunities.

• Randomized controlled trials of public vocational rehabilitation services, the gold standard to find out what works, while admittedly challenging to implement, are possible.

• Research that vocational rehabilitation agencies value and can use have a likelihood of improving outcomes for clients.

Writing about the Council of State Administrators of Vocational Rehabilitation (CSAVR), John Connelly, JD, and Stephen Wooderson, MS, both from CSAVR, Rockville, MD, USA, present the case for why researcher-vocational rehabilitation partnerships are an important strategy for innovation and provide suggestions for strengthening those partnerships.

CSAVR launched its Vision 2020 goals with an express interest in innovation. The CSAVR is a membership organization of the chief administrators of the 78 public vocational rehabilitation agencies. The Council's members and their agency staff assist some 1.2 million persons with disabilities to become or remain productive members of the workforce, as well as provide support to their business customers with such issues as recruitment and the provision of reasonable accommodations.

The authors describe CSAVR's investment in research and provide data from a survey of state vocational rehabilitation agencies on research participation. "Researchers can increase state vocational rehabilitation agency participation in their projects by involving the agency in study design, minimizing the time and resource burden on the agency, and demonstrating that the proposed research will yield products that benefit customers and improve staff competency," they commented. "Vocational rehabilitation agencies are motivated to engage in research that will clearly add value and improve operations with minimal burden. It is hoped that greater agency participation in research will yield better data to guide agencies in the future."

The Guest Editors point to some of the challenges encountered during the project. Access to work incentives counseling, finding high paying jobs through job placement services, and team communication across large geographic areas can create barriers to services for people receiving SSDI. Another challenge noted was that vocational rehabilitation staff may be skeptical in adopting the SGA model. "Because the pacing innovation was a major shift from their usual, more deliberate approach, some counselors initially resisted adopting the faster approach," they commented.

Dr. Foley and Dr. Sevak suggest that the rapid engagement coordinated team approach studied by the SGA Project is another tool in the toolbox to attain goals. "We are finding more and more practices that are showing promise. Team approaches, rapid response, and dual customer strategies that match talent to opportunity are evolving. Every worker gets a job, every job gets a worker," they concluded.

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Study of LGBTQ+ experience in the geosciences finds difficulties, dangers in fieldwork

UNIVERSITY OF KANSAS

 

IMAGE: UNTIL NOW, NO STUDY HAS FOCUSED ON FIELDWORK ACCESSIBILITY FOR LGBTQ+ GEOSCIENTISTS, IN SPITE OF OBVIOUS HAZARDS. FOR INSTANCE, ACCORDING TO NEWSWEEK, IN 2019 THERE WERE 71 COUNTRIES WHERE HOMOSEXUALITY... view more 

CREDIT: OLCOTT, ET AL.

LAWRENCE -- For a geoscientist, the benefits of performing fieldwork are countless. Researching in nature gives geoscientists firsthand contact with the earth's raw materials and a chance to test ideas and develop theories -- as well as to make new discoveries. For this reason, geoscientists often trek to faraway locations, negotiating difficult physical terrain and distinctive cultural landscapes to access geologic features vital to their research.

But there's a problem: For geoscientists from minority and underrepresented populations, fieldwork can prove daunting -- and even physically dangerous. Women scientists could face harassment or sexual assault; scientists with disabilities could find field sites impossible to access; racial minority researchers might face prejudice and bigotry.

But until now, no study has focused on fieldwork accessibility for LGBTQ geoscientists, in spite of obvious hazards. For instance, according to Newsweek, in 2019 there were 71 countries where homosexuality is illegal.

Recently, an investigation from University of Kansas researchers appeared in Eos, a publication of the American Geophysical Union, examining the challenges of fieldwork for LGBTQ geoscientists. Alison Olcott, associate professor of geology, and Matthew Downen, who recently earned his doctorate in geology from KU, surveyed the experience of LGBTQ scientists in "everything from wilderness treks, oceanographic cruises, and class field trips to museum and laboratory visits, trips to research centers, and attending conferences around the world."

They found 55% of the geoscientists who identify as LGBTQ indicated they'd been in an area where they didn't feel safe due to their identity, expression or presentation -- while about a third have refused to do fieldwork due to concerns for personal safety related to their identity.

"There are many places with really excellent geological samples that might not be safe for an LGBTQ+ geologist to go travel," Olcott said. "It's something unrecognized in the field, by academic advisers in particular. It seemed like an unseen, unacknowledged problem in the geosciences, where we're dependent on where the rocks are -- but not everyone is equally safe to go to these places."

The impetus for the study came from Downen, inspired by his years attending a growing LGBTQ social event thrown each year at the Geological Society of America's conference.

"It used to just be a small dinner with maybe 10 to 15 people -- but in the last few years it just skyrocketed," he said. "One year, it was over 60 people, and not everybody could attend. I remember seeing so many new younger people, people my age. There were a lot of different identities and genders represented, and I was floored by all the incredible diversity."

Downen wondered about the experiences of the emerging LGBTQ community in the geosciences, so he began collecting data informally for a presentation to the KU chapter of the organization Out in STEM.

"I was curious to know who really is out there and what the community really looks like within geology," he said. "I also wanted to do this research because it's important for people in the LGBTQ+ community in geology to know there are other people out there like them."

Looking to improve the data, Downen and Olcott conducted a broader, more rigorous survey of geoscientists online. Their results revealed that "many of these scientists felt unseen, unheard and unsupported in their field."

Most striking, the KU researchers found that LGBTQ graduate students in geosciences often aren't adequately supported by faculty advisers, especially as "relative to faculty, students typically have far less control over their field site selection." Their survey found LGBTQ graduate students (29%) are significantly less likely than professors (57%) to have opted out of fieldwork in a specific locality because of safety fears.

"In geology, usually the graduate student is doing a project based off of the adviser's main project," Olcott said. "An adviser will likely say, 'Oh, I have this grant to go to to a field locality and look at these examples.' We were really struck that so many professors had not done a research project because of their identity, but it was only 29% of the graduate students. It seemed like graduate students were being put in a position where they were being made to do things where they felt unsafe, but couldn't say no or didn't feel comfortable saying, 'Hey, I'm not safe here because of who I am.'"

The authors suggest institutions and mentors should provide more resources to LGBTQ graduate students in the geosciences to ensure their security in the field. "People who are advising students and leading field trips or fieldwork need to better educate themselves and be more aware of different policies or just the attitudes in a certain area," Downen said.

Olcott and Downen said faculty mentors and institutions could provide travel guidance and resources geared to LGBTQ personnel prior to fieldwork. In the classroom, professors could confront homophobia by using inclusive language and students' preferred pronouns. Meantime, faculty and staff should offer supportive academic advising, visible allyship and diversity training.

Both authors stressed homophobia and barriers to fieldwork aren't limited to far-flung countries but often are faced much closer to home.

"We're not saying North America and Europe are awesome and everywhere else is terrible for LGBTQ+ geoscientists," Olcott said. "It's a more granular issue -- just because the place on the map is designated friendly, it doesn't mean necessarily that way everywhere."

"If you're traveling globally, a world map showing where your identity could be criminalized is just kind of the most basic thing," Downen said. "Even in the U.S., depending on where you go, it may not be friendly there, either -- that's where some LGBTQ+ geoscientists have reported their worst field experiences due to their LGBTQ+ identity."

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The study by Olcott and Downen soon will be republished in a double print-issue on "the Future of Geoscience" in Eos. In late October, Olcott presented their findings at the annual meeting of the Geological Society of America

Do neurosurgeons face sexual harassment in their profession?

JOURNAL OF NEUROSURGERY PUBLISHING GROUP

Research News

 

Charlottesville, VA (November 10, 2020). It's 2020, and as much as we wish it weren't so, sexual harassment is still with us. One need only look at social media or a steady stream of court cases: most recently, the #MeToo movement has cast a light on sexual harassment.

Sexual harassment isn't defined by social status, wealth, or educational experience. It affects both women and men. Sexual harassment can be found in the workplace, at social activities, and even in the home. It is also found in the medical specialties.

Do neurosurgeons face sexual harassment in their profession? Yes. We've known this for some time from anecdotal evidence. What we did not know, until now, is the depth and breadth of sexual harassment in this field.

At the behest of the One Neurosurgery Summit, which represents the major neurosurgical organizations in North America, a survey on this matter was developed and disseminated to members of the neurosurgical community. The results of this survey have been published in a new article in the Journal of Neurosurgery: "Toward an understanding of sexual harassment in neurosurgery" by Deborah L. Benzil, MD, and colleagues. "While the results of this study are distressing, having the information will allow us to start some important conversations and continue forward progress!" the lead author has remarked.

Broadly speaking, the survey was designed to elicit the following information: 1) respondents' perceived attitudes about systemic issues in neurosurgery that permit sexual harassment; 2) the prevalence and severity of sexual harassment in the field; and 3) populations at highest risk of experiencing sexual harassment and those most likely to perpetuate it.

The survey was performed using the SurveyMonkey platform, and all responses were collected confidentially and anonymously. To capture respondents from all levels of neurosurgery, emailed invitations were sent to active and resident members of the Society of Neurological Surgeons and the Congress of Neurological Surgeons (CNS), as well as to transitional, emeritus, and inactive members of the CNS. The emails were sent to 5166 persons; 622 (12%) completed the entire survey.

Twenty percent of the survey respondents were female, and this represents a greater percentage than that of women actively engaged in neurosurgery: 19% of residents and 8% of practicing neurosurgeons are female. Looking back over their neurosurgical careers, 62% of respondents reported that they had witnessed sexual harassment and 55% reported that the harassment had been directed against them.

Sexual harassment was demonstrated across several behaviors: "the telling of explicit or offensive jokes (49%) ... unwelcome flirtations (22%), inappropriate physical contact (16%), discussion about sex/personal life (18%), and inappropriate comments about the body (15%). Although rare, rape was reported by 2 individuals (< 1%)."

Of persons who had been subjected to sexual harassment, 78% experienced it during training, 49% during post-residency employment, and 17% while attending national professional or educational meetings. Disappointingly, 37% reported that they had experienced sexual harassment more than 10 times. One would like to believe that over the years such occurrences have become less frequent. Unfortunately, the authors tell us, "there was a fairly even distribution between less than 1 year and more than 10 years ago."

Fewer than one-third of respondents reported that they had addressed incidents of sexual harassment when they occurred, and 85% reported barriers to reporting incidents, such as fear of retaliation or retribution, negative impact on future careers, loss of reputation, and associated stress.

Given the predominance of men in the neurosurgical community, it is not surprising that men were identified far more often as perpetrators of the harassment (72%). Female neurosurgeons were more likely to report having witnessed or experienced harassment, but it does affect both women and men. People in positions of power (such as chairs, faculty members, or supervisors) (86%) were most often identified as the persons responsible for the harassment.

"Male dominance, a strong hierarchical structure, and a permissive environment" are associated with the risk of sexual harassment in institutions. Based on the responses to the survey, all three can be found in neurosurgery, despite the fact that the profession has made great strides in the last decade to attract and retain more women. One effect of sexual harassment is that it can deter talented people from following their professional goals. The authors worry that such an atmosphere can lead to female neurosurgeons experiencing burnout and having less involvement in the profession. As Dr. Benzil has commented, "We want the best and brightest to enter and succeed in neurosurgery. The data about sexual harassment suggests we still have work to do."

To counteract the negative behaviors revealed by the survey, the authors suggest a change in the culture of the neurosurgical profession, "starting with an improved awareness of unconscious bias in medical school and reaching every level of organized neurosurgery and leadership." Some practical steps are proposed, such as a profession-wide zero tolerance statement with regard to sexual harassment, fair and transparent mechanisms of reporting its occurrences, establishment of best practices for social events, and greater diversity in speakers, honored guests, and scientific panels.

This paper offers detailed tables showing responses to the survey questions broken down by age or gender, and abundant demographic information on the respondents. Supplemental online materials include the questionnaire itself as well as written responses by respondents on incidents of sexual harassment that they have faced. These personal accounts are well worth reading.

When asked about the article, Dr. Benzil responded, "Unfortunately, many of us knew how serious this problem was within neurosurgery, but we needed to make all aware of the depth and breadth of it. With this data in hand, we can build on the positive steps neurosurgery has made, face the problem and find effective solutions."

The article is accompanied by an editorial by Drs. Doug Kondziolka and Linda Liau, who discuss some findings of the survey and steps to address and overcome sexual harassment in the neurosurgical community.

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Article: Benzil DL, Muraszko KM, Soni P, Air EL, Orrico KO, Rutka JT: Toward an understanding of sexual harassment in neurosurgery. Journal of Neurosurgery, published ahead of print November 10, 2020. DOI: 10.3171/2020.6.JNS201649

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Editorial: Kondziolka D, Liau LM: Editorial: Sexual harassment in neurosurgery: #UsToo. Journal of Neurosurgery, published ahead of print November 10, 2020. DOI:

10.3171/2020.8.JNS202583.

Disclosures: The authors report no conflict of interest.

For additional information, please contact Ms. Jo Ann M. Eliason, Communications Manager, Journal of Neurosurgery Publishing Group, One Morton Drive, Suite 200, Charlottesville, VA 22903. Email: jaeliason@thejns.org; Phone: 434-982-1209.

For 76 years, the Journal of Neurosurgery has been recognized by neurosurgeons and other medical specialists the world over for its authoritative clinical articles, cutting-edge laboratory research papers, renowned case reports, expert technical notes, and more. Each article is rigorously peer reviewed. The Journal of Neurosurgery is published monthly by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group include the Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, Neurosurgical Focus, and Neurosurgical Focus: Video. All five journals can be accessed at http://www.thejns.org.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada, or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit http://www.AANS.org.