In a study by Frangos and Chase of thirty-nine family practice residents, it was found that the majority had positive attitudes toward having a social worker associated with their future medical practice. Their findings, however, could have been positively skewed since their sample was small and from residents in only one program. This paper reports the findings of 159 board certified family practitioners surveyed in a national sample. This study also yielded positive findings but much less than those in Frangos and Chase's study. These and other findings related to family practitioners' attitudes and practices regarding social work involvement in their practices are reported and discussed.
Introduction: The mainstay of management of Hemophagocytic Lymphohistiocytosis (HLH) and Macrophage Activating Syndrome (MAS) is to decrease systemic inflammation. Therapies such as plasmapharesis, steroids, and chemotherapy leave patients vulnerable to life threatening infections. Here we present our experience of using Anakinra (Kineret®) a recombinant interleukin-1 receptor antagonist as a modality to decrease inflammation. Hypothesis: We hypothesized that Anakinra would be well tolerated and reverse some of the effects of the dysregulated immune system caused by HLH. Methods: A retrospective review of the management of eight children with HLH, treated at the PICU at Helen DeVos Chidren’s Hospital using various databases after IRB approval. Repeated measures ANOVA was used to analyze data (SPSS v. 17, 2008). Results: Eight patients with the median age of 14 years (5 males and 3 females) were administered Anakinra along with systemic steroids. The patients were admitted to the ICU for 9.3 days ±4.9. Indications for ICU admission were respiratory 50% (4/8), cardiovascular 37.5% (3/8) and chest pain 12.5% (1/8). Thirty three percent (3/9) of the patients received 4 courses of mechanical ventilation during their ICU stay. The median PRISM score was 9.5, with 3 patients having MODS on admission to the ICU. Clinical markers of HLH were assessed linearly to determine clinical course. Average serum ferritin at the start of Anakinra and steroids was 8864 ± 10891.8 ng/dL and by 5-7 days decreased to 3210 ± 3331.7 (p<0.173). CRP was 205.5 ± 130.9 mg/L at the start of Anakinra and decreased significantly by 67.1 % to 67.8 ± 94.3, (p<0.010). Fibrinogen increased: 119.2 ± 77.4 mg/dL to 158.4 ± 108.1 (p< 0.304) over the week of Anakinra therapy. Both ANC (p< 0.230), and ALC (p< 0.817) did not decrease significantly. None of the patients had any secondary infections despite surveillance cultures. Seven patients survived to Hospital discharge and 1 died months after stopping Anakinra of disseminated aspergillosis while receiving pre-HSCT chemotherapy. Conclusions: Anakinra administered with steroids was associated with a significant decrease in CRP in this small study and was not associated with immediate secondary infections.
Purpose: The “Protecting Children While Parents Work in Agriculture” project aims to establish safe and nurturing environments for farmworker children while their parents work. Access to good child care aids worker recruitment, improves retention, and boosts morale. However, childcare services are sometimes nonexistent, cost prohibitive, or not available when needed. Ensuring adequate services is best accomplished when childcare providers, agricultural employers, and farmworker parents work together. The Roadmap for Delivering Child Care in Agricultural Communities (Roadmap) was developed to facilitate this collaboration.Results/Findings: This project conducted focus groups, surveys, and interviews with agribusiness representatives, childcare providers, and farmworker parents. This formative research found that 90% of surveyed agribusinesses believe providing childcare services to employees’ children fosters a more stable workforce, improves employee morale, and enhances company reputation. About half indicated they need guidance on how to implement these services. Interviews with childcare providers indicated that access to child care could improve with representation by the grower community. Farmworker parents stated they were more likely to choose a job in a location with childcare services, and more women would choose to work if child care was available. With these findings, the project team drafted the Roadmap, a step-by-step guide for developing childcare facilities and improving existing childcare services and access to services. It also includes evidence supporting successful agricultural safety and health interventions and how adequate child care is a beneficial investment for agribusinesses and farmworkers alike. It was reviewed by childcare providers, growers, and farmworker advocates, who all agreed the Roadmap is a useful resource they recommend to others. The project team used their feedback to refine the Roadmap language and content and provide recommendations for dissemination. To promote this to key stakeholders, the team developed a promotional video, social media toolkit, and a media release.Practical Application: Growers and other stakeholders can use the Roadmap to facilitate improved access to childcare services for their employees, including creating new childcare options. Stakeholders are encouraged to distribute this handbook in regions with large numbers of hired agricultural workers and to facilitate linkages between growers and childcare providers.
Abstract Many physical problems presented to family physicians by their paticnts often involve psychosocial variables with stress being a major one. Though family rncdicine advocates a biopsychosocial focus, one that is compatible with social work, the psychosocial aspects of health are often ignored. Thc involvement of social workers in the private practices of family physicians to deal with such problems is discussed in this paper as a new area of specialization. Issues such as the medicine-social work gap and the financing of social work services in private family medical practice are also addressed. It is concluded that this should be considered a new area of specialization. However, social workers must take thc initiative in its development.
