The purpose of this descriptive study is to report findings from a nationally representative mail-in survey of nursing home social service directors (n = 1,071) who were asked if they had received at least one hour of training in six different areas of cultural competency in the past five years. Of the six areas, the lowest percentage of directors reported having training in homophobia. Three-fourths of the sample had not received even one hour of homophobia training over the past five years. Directors who were more recently educated were more likely to report having received homophobia training, as were directors with a college degree, and those who worked in nursing homes located in the West and South regions of the United States. Directors with the most experience were less likely to report having received training. Findings call for immediate development and dissemination of heterosexism and homophobia training of social service staff, policy changes within the nursing home, and policy advocacy priorities for social workers.

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Purpose To establish the sensitivity and specificity of cross-sectional scintigraphy [single photon emission computed tomography (SPECT)] combined with computed X-ray tomography (CT) in the detection of sacroiliac joint (SIJ) mechanical dysfunction and evaluate reproducibility of reporting. Methods Patients with pelvic girdle pain either on the basis of peri-partum SIJ dysfunction or trauma were included. These patients were imaged with bone scintigraphy with hybrid imaging with SPECT/CT. Results The study group comprised 100 patients (72 females, 28 males). Trauma accounted for 52 % and the remainder were patients with peri-partum pain. Average age was 43 years and average length of history was [2 years. The major finding was increased uptake in the upper SIJ and posterior soft-tissues/ligaments. Hybrid imaging had a sensitivity of 95 % and specificity of 99 %. Positive predictive value was 99 % and negative predictive value 94 %. Power of the test was 1.0. Reproducibility of the test was good with kappa values of 0.85. ConclusionHybrid imaging with SPECT/CT reproducibly demonstrates metabolic alterations around the SIJ in patients with SIJ dysfunction, which we have termed SIJ incompetence. The condition is more common than previously recognised and frequently occurs after trauma, which has not been reported previously.

Purpose: To explore associations between tissue abnormalities (bone marrow lesions, effusion, synovitis, cartilage loss and osteophytes) visualised by MRI, with both biomechanical impairments (proprioceptive inaccuracy, laxity, quadriceps and hamstrings weakness) and clinical symptoms (pain, stiffness, activity limitations and crepitus) in a cohort of patients with knee osteoarthritis (OA). Methods: Cross-sectional study in 105 patients with knee OA from the Amsterdam Osteoarthritis cohort. Multivariable regression analyses were used to explore associations between MRI features in each compartment with OA symptoms. Results: Associations were found between presence of synovitis with quadriceps weakness (p¼.004) and between severity of cartilage loss in the patellafemoral compartment with quadriceps weakness (p¼.035). No associations were found for proprioceptive inaccuracy, laxity and hamstrings weakness. Medial tibiofemoral cartilage loss was the only MRI feature associated with pain and activity limitations. In contrary, all MRI features, except for synovitis, were found to be associated with the presence of crepitus. Conclusions: As we far as we know, this is the first study to find a significant association between synovitis and quadriceps weakness. This relationship was independent of pain severity. It may imply that strategies that decrease inflammation might be valuable to prevent clinical deterioration in OA patients. Since inflammation had not been identified by physical examination in most cases with MRI-assessed synovitis, MRI can play an important role in clinical assessment of knee OA patients. METABOLIC DISTURBANCES IDENTIFIED BY SPECT-CT IN PATIENTS WITH A CLINICAL DIAGNOSIS OF SACROILIAC JOINT INCOMPETENCEThe sacroiliac joint (SIJ) as a source of lower back pain is a controversial issue. There is literature on its role as part of the pelvic girdle pain syndrome in the peri-partum period. In the absence of an adequate imaging test, firm clinical criteria for the diagnosis have been established. There is little literature on trauma as a cause of SIJ dysfunction. We examined the role of hybrid scintigraphic imaging in a population with SIJ dysfunction on the basis of both trauma and peri-partum lower back pain. Methods. Patients who fulfilled the published criteria for pelvic girdle syndrome either on the basis of peripartum SIJ dysfunction or trauma were entered into the trial prospectively. These patients were imaged with standard bone scintigraphy with the addition of hybrid imaging with SPECT/ CT. Studies were blindly reported together with a control group without lower back pain and a second group with non-specific low back pain.Results. The study group comprised 100 patients (72F, 28M) who fulfilled the criteria for SIJ dysfunction. Of these 52% gave a history of trauma and the remainder were patients with peri-partum pain. Average age was 43 years and average length of history was > 2 years. The major finding was of increased uptake in the upper SIJ and posterior soft-tissues/ ligaments. Hybrid...

Background: In response to the dramatic increase in the number of women incarcerated in the United Statesand a growing awareness that a small proportion of women enter prison pregnant and have unique health needs-some prisons have implemented policies and programs to support pregnant women (defined here as maternal and child health [MCH] policies and programs). Corrections officers (COs) are key stakeholders in the successful implementation of prison policies and programs. Yet, little empirical research has examined prison COs' knowledge and perspectives of MCH policies and programs, particularly the impact such policies and programs have on COs' primary job responsibility of maintaining safety and security. The objective of this mixed-methods study was to understand COs' knowledge and perspectives of MCH policies and programs in one state prison, with a specific emphasis on the prison's pregnancy and birth support (doula) program. Results: Thirty-eight COs at a single large, Midwestern women's prison completed an online survey, and eight of these COs participated in an individual, in-person qualitative interview. Results indicated that COs' perspectives on MCH policies and programs were generally positive. Most COs strongly approved of the prison's doula program and the practice of not restraining pregnant women. COs reported that MCH policies and programs did not interfere, and in some cases helped, with their primary job task of maintaining safety and security. Conclusions: Findings support expansion of MCH programs and policies in prisons, while underscoring the need to offer more CO training and to gather more CO input during program development and implementation. MCH services that provide support to pregnant women that are outside the scope of COs' roles may help reduce CO job demands, improve facility safety, and promote maternal and child health.