Objective-To identify Emergency Medical Services (EMS) provider perceptions of factors that may affect the occurrence, identification, reporting, and reduction of near misses and adverse events in the pediatric EMS patient.Methods-This was a subgroup analysis of a qualitative study examining the nature of near misses and adverse events in EMS as it relates to pediatric prehospital care. Complimentary qualitative methods of focus groups, interviews, and anonymous event reporting were used to collect results and emerging themes were identified and assigned to specific analytic domains.Results-Eleven anonymous event reports, 17 semi-structured interviews, and 2 focus groups identified 61 total events, of which 12 (20%) were child-related. Eight (66%) of those were characterized by participants as having resulted in no injury, 2 (16%) resulted in potential injury, and 2 (16%) involved an ultimate fatality. Three analytic domains were identified which included the following five themes: reporting is uncommon, blaming errors on others, provider stress/discomfort, errors of omission, and limited training. Among perceived causes of events, participants noted factors relating to management problems specific to pediatrics, problems with procedural skill performance, medication problems/calculation errors, improper equipment size, parental interference, and omission of treatment related to providers' discomfort with the patient's age. Few participants spoke about errors they had themselves committed; most discussions centered on errors participants observed being made by others.Conclusions-It appears that adverse events and near misses in the pediatric EMS environment may go unreported in a large proportion of cases. Participants attributed the occurrence of errors to the stress and anxiety produced by a lack of familiarity with pediatric patients and to a reluctance to cause pain or potential harm, as well as to inadequate practical training and experience in caring for the pediatric population. Errors of omission, rather than those of commission, were perceived to predominate. This study provides a foundation on which to base additional studies of both qualitative * Note: Dr. O'Gara is now with Rochester General Hospital, Rochester, NY, and Dr. Pennington is now with Boston University/Boston Medical Center Department of Surgery, Boston, MA. and quantitative nature that will shed further light on the factors contributing to the occurrence, reporting, and mitigation of adverse events and near misses in the pediatric EMS setting.

Objectives: The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near-misses and adverse events in out-of-hospital care.Methods: This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near-misses and adverse events in out-of-hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated.Results: Fifteen in-depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near-misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (<19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a ''blame-and-shame'' culture.Conclusions: Adverse events and near-misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis-generating themes are generalizable to the EMS community as a whole.ACADEMIC EMERGENCY MEDICINE 2008; 15:633-640 ª

Objective This study sought to determine whether social integration, defined as number of social roles, is associated with better pulmonary function in the elderly and which roles are associated with greatest benefit. It also examined pathways that connect social integration to better lung health. Methods High functioning men (N = 518) and women (N = 629) ages 70-79 were recruited as part of the MacArthur Study of Successful Aging and data were collected on social roles as well as pulmonary function as assessed by peak expiratory flow rate (PEFR). Multiple regressions predicting PEFR from the number of social roles controlled for age, sex, race, education, weight and height. Physiological, behavioral, social and psychological factors were tested as mediators of the association between the number of social roles and PEFR. Results More social roles were associated with better PEFR. Analysis of specific roles indicated that marriage was the strongest positive correlate of PEFR. However, greater numbers of roles were also associated with better PEFR independent of marriage. Being a relative or friend were each also individually associated with better PEFR. Even so, greater numbers of social roles were associated with better PEFR independent of relative and friend. The data were consistent with greater happiness, not smoking, and more physical activity acting as pathways linking the number of roles to PEFR. Conclusions Number of social roles is an important correlate of healthy lung function in the elderly. This association may be driven by healthier behaviors and greater feelings of well-being.

We review evidence on the role of personality traits in immune function including studies of enumerative and functional immune markers and of host resistance to infectious illness. We begin by discussing a series of pathways through which traits may influence immunity: immune-altering behaviors; concomitant activation of physiological systems; aggravation or attenuation of the activating effects of environmental demands or stressors; or selection into environments that alter immunity. We focus on the “Big Five” personality factors—extraversion, agreeableness, neuroticism, conscientiousness, and openness to experience but also address other trait characteristics that do not cleanly fit into the Big Five typology including dispositional optimism, trait positive affect, hostility, and social inhibition. We conclude that the literature on personality and immunity is in its infancy and not developed enough to make any definitive conclusions. We can say that there is evidence of possible associations with immunity across all the traits, with existing data suggesting some reliable associations. We suggest the importance of future works being based in trait-specific theory and outline a number of important methodological concerns.

Little research has been undertaken to evaluate whether environmental factors other than bright light influence the individual's ability to initiate and maintain sleep. In the present analyses, nine meteorologic variables were evaluated for their possible relationship to selfreported sleep continuity in a sample of 43 subjects over a period of 105 days. In this preliminary analysis, high barometric pressure, low precipitation, and lower temperatures were significantly correlated with good sleep continuity. Interestingly, ambient light and lunar phase were not found to be strongly associated sleep diary measures.

Each additional social role reported at baseline was associated with less of a decline in lung function between baseline and the follow-up assessment four years later. The association withstood controls for demographics, weight, and height and was mediated by more positive and less negative affect and lower rates of cigarette smoking and more physical activity. Roles were mostly substitutable, with both high (spouse, parent, friends, relatives) and low (employee, religious service attendee, volunteer, members of other groups) intimacy roles independently contributing to less age-related decline in lung function. (PsycINFO Database Record

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