Evaluating Workforce Mental Health and Well-Being: A Review of Assessments

OBJECTIVE

Given the importance of mental health and well-being assessments to employers' efforts to optimize employee health and well-being, this paper reviews mental health assessments that have utility in the workplace.

DATA SOURCE

A review of publicly available mental health and well-being assessments was conducted with a primary focus on burnout, general mental health and well-being, loneliness, psychological safety, resilience, and stress.

INCLUSION CRITERIA

Assessments had to be validated for adult populations; available in English as a stand-alone tool; have utility in an employer setting; and not have a primary purpose of diagnosing a mental health condition.

DATA EXTRACTION

All assessments were reviewed by a minimum of two expert reviewers to document number of questions, subscales, fee structure, international use, translations available, scoring/reporting, respondent (ie, employee or organization), and the target of the assessment (ie, mental health domain and organizational or individual level assessments.

DATA SYNTHESIS & RESULTS

Sixty-six assessments across the six focus areas met inclusion criteria, enabling employers to select assessments that meet their self-identified measurement needs.

CONCLUSION

This review provides employers with resources that can help them understand their workforce's mental health and well-being status across multiple domains, which can serve as a needs assessment, facilitate strategic planning of mental health and well-being initiatives, and optimize evaluation efforts.

Assessing the commensurability of theories of consciousness: On the usefulness of common denominators in differentiating, integrating and testing hypotheses

How deep is the current diversity in the panoply of theories to define consciousness, and to what extent do these theories share common denominators? Here we first examine to what extent different theories are commensurable (or comparable) along particular dimensions. We posit logical (and, when applicable, empirical) commensurability as a necessary condition for identifying common denominators among different theories. By consequence, dimensions for inclusion in a set of logically and empirically commensurable theories of consciousness can be proposed. Next, we compare a limited subset of neuroscience-based theories in terms of commensurability. This analysis does not yield a denominator that might serve to define a minimally unifying model of consciousness. Theories that seem to be akin by one denominator can be remote by another. We suggest a methodology of comparing different theories via multiple probing questions, allowing to discern overall (dis)similarities between theories. Despite very different background definitions of consciousness, we conclude that, if attention is paid to the search for a common methological approach to brain-consciousness relationships, it should be possible in principle to overcome the current Babylonian confusion of tongues and eventually integrate and merge different theories.

Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females

Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.

Linking live animals and products: traceability

It is rarely possible to successfully contain an outbreak of an infectious animal disease, or to respond effectively to a chemical residue incident, without the use of a system for identifying and tracking animals. The linking of animals at the time they are slaughtered--through the use of identification devices or marks and accompanying movement documentation--with the meat produced from their carcasses, adds further value from the perspective of consumer safety. Over the past decade, animal identification technology has become more sophisticated and affordable. The development of the Internet and mobile communication tools, complemented bythe expanded capacity of computers and associated data management applications, has added a new dimension to the ability of Competent Authorities and industry to track animals and the food they produce for disease control, food safety and commercial purposes.

P5-12-05: (In-)Efficiencies in the Preoperative Imaging Evaluation of the Medicare Breast Cancer Patient

Introduction: Breast cancer evaluation requires a combination of physical examination and imaging for preoperative diagnosis and assessment of surgical treatment options. While imaging remains a critical component of that assessment, the burden of patient (pt) return visits for imaging is unknown.

Methods: Medicare claims linked to Surveillance Epidemiology End Results data were reviewed for women developing breast cancer between 1992 and 2005. The preoperative interval was defined as the period from the first physician encounter for a breast-related diagnosis until therapeutic surgery. Pts without ≥6 mos of data prior to that interval, those having DCIS or Stage IV disease, and those having preoperative chemotherapy or radiotherapy were excluded. Imaging modality counts exclude image-guidance claims for biopsies.

Results: Among 353,265 Medicare pts developing breast cancer between 1992 and 2005, 67,751 women >65 y of age had invasive, nonmetastatic breast cancer, and simultaneous breast surgery (lumpectomy or mastectomy) with lymph node staging. Median age was 75 y and preoperative interval length was 27 d. In the 6 mos before the preoperative interval, mammograms (MMGs), breast ultrasounds (USs), and breast MRIs were performed exclusive of the preoperative interval in 34,192 (50.5%), 16,936 (25.0%), and 180 (0.3%) pts respectively, while during the preoperative interval, MMGs, USs, and MRIs were performed in an additional 30,414 (44.9%), 17,983 (26.5%), and 1,409 (2.1%) respective pts. Imaging was performed on ≥2 separate dates during the preoperative interval in 4.9% of pts in 1992, rising to 19.4% in 2005 (trend, p<0.0001). During that interval, there were ≥2 encounter dates for MMGs in 7.0% of pts, rising from 3.9% in 1992 to 8.8% in 2005 (trend, p<0.0001); for US, 3.6% overall, rising from 0.2% in 1992 to 6.6% in 2005 (trend, p<0.0001). Multiple MRI encounters were rare, occurring in 0.2% overall, and increasing to 0.6% in 2005 (trend, p<0.0001), while single MRI use increased from <0.1% in 1994 to 8.3% in 2005 (trend, p<0.0001). In the preoperative interval, use of more than one imaging modality on any given date increased from 4.3% in 1992, to 27.1% in 2005. Among those with imaging, there was low correlation between number of imaging dates and number of modalities on any given date (rs= 0.13, p<0.0001). MMGs accounted for 71.9% of the days where one modality was performed alone, but MRI was performed alone 94.1% of the time. The total number of imaging dates in the preoperative interval was inversely related to age (p<0.0001). Differences in the mean number of imaging dates by race and stage were minor and all <0.3 days.

Conclusion: Preoperative Medicare breast imaging claims on multiple dates have been increasing substantially since 1992, suggesting that the patient's time burden for such evaluation is increasing. This trend is present despite the fact that multiple imaging modalities are being performed more frequently on the same date. Efforts to further consolidate preoperative breast imaging visits to lower that burden should be undertaken where possible in the Medicare population, for whom advanced age, in itself, may provide its own challenges.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-12-05.

The prognostic significance of human epidermal growth factor receptor correlations in squamous cell cervical carcinoma

The aim of this study was to investigate the expression and prognostic influence of HER1 (EGFR), HER2 (c-erb-B2), HER3 (c-erb-B3) and HER4 (cerb-B4) in squamous cell cervical carcinomas (SCC) and the importance of receptor correlations.

PATIENTS AND METHODS

78 SCC were stained immunohistochemically for HER1-HER4. HER2 gene amplification was determined using fluorescence in situ hybridization (FISH). Parametric correlations were performed between the four receptors and tumor characteristics. Overall survival was evaluated by uni- and multivariate analyses.

RESULTS

Overexpression was found in 63% of SCC for HER1, in 21.8% for HER2, in 74.4% for HER3 and in 79.5% for HER4. Correlations were observed between HER1 and HER4 (p = 0.019). Survival analyses revealed a significant association of HER1 overexpression with favorable outcome (p = 0.016), while overexpression of HER2 and HER3 was associated with poor prognosis (p = 0.006; p = 0.05, respectively). HER1 remained significant in multivariate analysis.

CONCLUSION

These data suggest that the prognostic relevance of the different HER receptors is influenced by the balance between the various receptors, especially of HER4.

Current use of HER2 tests

Reliable detection of HER2 overexpression is important for the success of trastuzumab (Herceptin) therapy. Several methods are available for measuring HER2 expression at the DNA, RNA or protein level. The method most frequently employed is immunohistochemical (IHC) detection of the HER2 receptor in paraffin sections. Advantages include the precise localization of the HER2 protein, the availability of paraffin material and the ease of the procedure. However, IHC can be influenced by the sensitivity/specificity of the antibody, tissue treatment and, in particular, subjective assessment. These disadvantages do not exist in the detection of gene amplification by fluorescence in situ hybridization (FISH) or polymerase chain reaction. However, FISH requires expensive equipment that is not widely available in pathology laboratories. Another approach quantitates shed HER2 antigen in the serum by an enzyme-linked immunosorbent assay. The key advantage of this method is the ease of sampling blood, however, serum HER2 concentrations do not accurately reflect the tumor status. Furthermore, this method does not register single-cell expression, which is important for therapeutic decision making. For routine diagnostics, the combination of IHC and FISH is useful. In addition to improving the accuracy and comparability of HER2 assays, these optimized protocols may further enhance the efficacy of trastuzumab therapy by selecting those patients most likely to respond.

Impact of community-based education on health care evaluation in patients with acute chest pain syndromes: the Wabasha Heart Attack Team (WHAT) project

BACKGROUND

Community education programmes focused on raising public awareness of the symptomatology of acute coronary syndromes have had mixed results.

OBJECTIVES

The Wabasha Heart Attack Team project, a unique multidisciplinary public education effort in Minnesota, sought to educate area citizens about signs and symptoms of acute myocardial infarction (MI).

METHODS

After an intensive 1-month education period, we compared presentations for emergency evaluation of chest pain during the study period with baseline data from the same seasonal period of the preceding year.

RESULTS

Visits to the Emergency Room for symptomatic heart disease increased significantly during the study period (56 patients versus 46 patients during the baseline period), as did the percentage of patients presenting with acute MI (18% versus 12%, P < 0.05). Use of emergency medical services for pre-hospital evaluation was significantly increased (41% versus 27%, P < 0.05).

CONCLUSION

A community education campaign can significantly increase use of pre-hospital emergency medical service resources and may increase the number of patients presenting with acute chest pain symptoms, including MI.

When there is no benchmark: designing a primary care-based chronic pain management program from the scientific basis up

Managed care has been accused of ignoring the patient with pain. The challenge for a health maintenance organization (HMO) was not just how to deliver state-of-the-art care, but how to deliver it to the 40,000 members who experience chronic pain at a reasonable cost and with enduring outcomes. This article describes how one managed care organization set about improving the care of patients with chronic pain. The article includes the design process, the model implemented, and some suggestions for transfer of this technology to others who might want to explore developing a similar model.

The identity of clones

A common concern with respect to cloning is based on the belief that cloning produces identical individuals. This is a fundamental misunderstanding of what type of identity-relation cloning involves. The concept "identity" is ambiguous, and the statement that cloning produces "identical" individuals is not meaningful unless the notion of identity is clarified. This paper distinguishes between numerical and qualitative; relational and intrinsic: logical and empirical identity, and discusses the empirical individuation of clones in terms of genetics, physiology, perception, cognition and personality. I argue that the only relation of identity cloning involves is qualitative, intrinsic and empirical: genetic indiscernibility, unlikely to include identity under other aspects mentioned. A popular argument against cloning claims our "right" to a "unique identity". This objection either implies (absurdly) the right not to be an identical twin, or assumes (incorrectly) that cloning involves identity other than genetic. Either way, the argument is untenable.

Calcium oxalate is associated with benign breast tissue. Can we avoid biopsy?

Breast biopsies are commonly performed for abnormal, usually clustered, calcifications detected by mammography. Calcium phosphate is the predominant form of calcium seen in breast tissue and is frequently associated with malignancy. Calcium oxalate, which can also be present in breast tissue, has been exclusively associated with benign lesions. Thus, if mammography could distinguish calcium phosphate from calcium oxalate, biopsy could be avoided in some patients. Pathologic findings and corresponding mammograms of 55 patients who underwent biopsy for abnormal calcifications were reviewed. The authors evaluated such pathologic features as type of calcification, anatomic location, and association with fibrocystic changes or carcinoma. Mammographically, calcifications were categorized by size, distribution, and morphology, and each was assigned a density rating of low, medium, or high. Of the 55 cases, 41 contained calcium phosphate only, 8 contained calcium oxalate only, and 6 contained both. If only calcium oxalate was present, the calcium was always associated with benign epithelium. Of 47 cases, calcium phosphate was associated with benign breast disease in 28 and with carcinoma in 19. Five of six cases with both calcium phosphate and calcium oxalate contained carcinoma; calcium phosphate was seen in the carcinoma area in all five. Radiologically, calcium phosphate was typically medium to high density, whereas calcium oxalate was characterized as amorphous, low to medium density. Other low-density calcifications were almost always benign, unless pleomorphic in shape. Although further work is necessary to confirm these findings, it appears that, radiologically, low-density, amorphous, calcifications, even if clustered, are associated with benign breast disease, and may represent calcium oxalate. Patients with such calcifications may be managed conservatively.

Preoperative localization of breast lesions: tailored techniques and potential pitfalls

Preoperative needle localization procedures can be performed using a variety of devices and tailored approaches. Success in these endeavors can be optimized through communication and coordination among the radiologist, surgeon, and pathologist. Meticulous attention to performance and radiological-pathological correlation are required to ensure the best possible results.

Radial scar with microcalcifications: radiologic-pathologic correlation

Since it is widely recognized that a radial scar of the breast can mimic scirrhous carcinoma at mammography, criteria to differentiate the two lesions continue to be suggested. Mammographic features that have been described as occurring with radial scars include a radiolucent central core; elongated, radiating spicules; and absence of calcifications. Recent studies have documented the unreliability of the first two parameters; calcifications, however, have been reported to be unusual in mammograms of radial scar lesions. From recent case material, the authors present four cases of biopsy-proved radial scars associated with mammographically visible microcalcifications. The mammographic findings, with pathologic correlation, are reported to emphasize the occurrence of microcalcifications within radial scars. When a stellate lesion is seen at mammography in the absence of a surgical scar, biopsy should be performed promptly, since no reliable mammographic features exist to distinguish radial scars from scirrhous carcinomas.

Lipid cyst: classic and atypical appearances

Lipid cysts, a specific type of fat necrosis, frequently have a pathognomonic appearance on radiographs. This consists of a lucent lesion surrounded by a smooth rim that may or not be calcified. Occasionally, lipid cysts with unusual mammographic appearances are encountered. An appreciation of some of these appearances may prevent unnecessary biopsies.

Colitis: radiographic features and differentiation of idiopathic inflammatory bowel disease

It is important clinically to be able to differentiate ulcerative colitis from Crohn's colitis because they differ considerably in the nature of complications and prognoses. Radiographically, it is possible to render a specific diagnosis in the vast majority of cases using criteria described in this article. The problem of the underlying process in inflammatory bowel disease in elderly patients and indeterminate colitis is also discussed.

Imaging of questionable and unusual pelvic masses

Ultrasonography is usually the initial diagnostic examination performed for evaluating gynaecological conditions and pelvic masses. The authors' experience with 11 "problem cases" and a review of the literature of such enigmas has led to the following recommendations in the following order: a plain radiograph or repeat ultrasound study; ultrasound study with the water enema technique; gastrointestinal examination if the answer is still not apparent, followed by computed tomography or a real-time ultrasound study during a clinical pelvic examination.

CT sialography: utilising acinar filling

The technique of computed tomographic sialography (CTS) has been demonstrated to be valuable in the diagnosis of masses of the major salivary glands. Forty-one CT sialograms were performed in 35 patients using acinar glandular filling with oily contrast material. Twenty-two mass lesions and seven cases of inflammatory disease were identified. There were two instances of mild parotitis following the procedure. CTS performed with this technique was found to be a safe, accurate method for evaluating salivary gland masses.

Abdominal trauma

Abdominal injuries are an important cause of morbidity and mortality. In the face of more obvious traumatic lesions, life-threatening intra-abdominal injuries may be initially overlooked. Plain abdominal and chest radiographs may prove diagnostic for specific injuries. However, normal or equivocal studies should not exclude the diagnosis of significant abdominal trauma. In patients who are clinically stable in whom there is suspicion of abdominal injury, additional imaging procedures should be undertaken for more definitive evaluation. At this time, computed tomography is the examination of choice for the assessment of the liver, spleen, and kidneys. In all cases, direct consultation with the radiologist should lead to the most expeditious plan for evaluation of the traumatized patient.

Principles of performance and interpretation of double-contrast gastrointestinal studies

Successful use of double-contrast techniques requires skill both in performing and interpreting the examination. To perform the examination properly, great care must be taken in evaluating the coating of the mucosal surface. An appropriate barium suspension designed for double-contrast radiography must be used. The necessity of varying the degree of gaseous distention for demonstrating certain types of lesions must also be appreciated. To interpret these examinations, the radiologist must understand the factors contributing to the radiographic image--the dependent and nondependent surfaces and the pool of barium. A firm understanding of both the uses and drawbacks of the pool of barium not only is helpful in the performance of the examination but also is essential for accurate interpretation. A knowledge of the differing appearances of structures on the dependent and nondependent surfaces is of the most utmost importance because this knowledge can be used to obtain a three-dimensional view of both elevated and depressed lesions. An accurate correlation of this picture with the gross pathologic appearance of a lesion is the aim of the double-contrast technique.

[Recurrent skin tumors following radiation injuries. Indication for cryotherapy]

Following skin damage resulting from radiotherapy, pancancerous conditions, carcinomas and basal cell carcinomas not rarely pose therapeutic problems. We encountered those problems severally after radiotherapy of the middle face, for instance for lupus vulgaris or basal cell carcinoma. Senile skin changed over the years by climatological influences may create similar problems. Disorders of blood supply and lack of "tissue material" as consequences of radiation-induced skin atrophy are the reasons for the failure of many attempts of plastic surgery aimed at tumor removal and defect repair. Besides that, the conditions for such operative procedures are progressively deteriorating with the number of tumor recurrences. In these instances cryotherapy offers an excellent therapeutic alternative by virtue of the favorable healing tendency of the cryonecrosis including the final, inconspicuous scar formation.

Double-contrast enema in pelvic endometriosis

The radiographic findings on barium enema in 42 patients with endometriosis were reviewed and correlated with those at surgical and laparoscopic examination. Radiographic abnormalities were detected in 27 patients. In nine patients, purely extrinsic mass effect was identified; bowel wall involvement in these patients was not present at laparoscopy. In 16 of 18 patients subsequently shown to have bowel wall involvement, mass effect with fine mucosal crenulation was identified. Annular or polypoid involvement was also noted. Mass effect with crenulation, although not entirely specific, appears to be a characteristic finding in patients with bowel wall involvement due to endometriosis.

Double-contrast enema examination for detection of rectal carcinoma

The role of the double-contrast enema examination (DCE) in the detection of rectal carcinoma was evaluated and compared to the proctoscopic examination. Records of 90 consecutive patients with a diagnosis of rectal carcinoma were reviewed. Sixty-six patients had a preoperative DCE. The correct diagnosis was either made or suggested in 91% of these patients. The proctoscopic examination was diagnostic in 86%. The causes of radiologic and proctoscopic error were evaluated. Findings confirm that the DCE is an accurate method for the diagnosis of rectal carcinoma. Careful examination of the rectum should be incorporated in all radiologic studies of the colon since a normal proctoscopic examination does not exclude the possibility of rectal carcinoma.

[Results of the converse otoplasty (author's transl)]

154 patients out of 317, who had undergone the Converse type of otoplasty in the ENT Department at Göttingen University, were assessed. Both subjective results and objective findings showed a successful operative outcome. Retractions of the concha were seldom seen and revision surgery was only necessary in 2 patients.

[Atresia of the larynx, a rare cause of postnatal respiratory distress (author's transl)]

An infraglottic atresia of the larynx with normally developed vocal cords necessitated postnatally an emergency tracheotomy after intubation attempts had failed. Laryngeal atresia is a very rare malformation. As in our example, it is in most cases accompanied by a tracheo-hypopharyngeal fistula which has to be interpreted ontogenetically. The survival chances of the newborn with this malformation are generally very poor.