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6–11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact. [ABSTRACT FROM AUTHOR]

Summary: We estimated the short-term impact of fragility fractures on community-dwelling women in five countries. Women with fragility fractures reported significantly more difficulties performing activities of daily living and significantly higher levels of lost productivity and caregiver support than those without fractures; results highlight the multi-country indirect burden of fragility fractures. Introduction: To estimate the impact of fragility fractures on activities of daily living (ADL), productivity loss and caregiver support in women with a recent fragility fracture. Methods: This multi-centre cross-sectional study enrolled community-dwelling women aged ≥ 50 years in South Korea, Spain, Germany, Australia and the United States. The fragility fracture cohort consisted of women with an index fragility fracture in the past 12 months; the fracture free cohort consisted of women with no fracture in the 18 months prior to study enrolment. Study participants completed three validated questionnaires: Lawton Instrumental ADL (IADL), Physical Self-Maintenance Scale (PSMS) and iMTA Productivity Cost Questionnaire (iPCQ). Results: In total, 1,253 participants from 41 sites across the five countries were included. Compared with the fracture free cohorts, fragility fracture cohorts had significantly lower function and were more dependent on support (p < 0.05 in all countries for Lawton IADL, and in South Korea, Spain, Australia and the United States for PSMS), significantly higher hours of paid absenteeism (p < 0.05, Spain, Germany, Australia), significantly higher unpaid lost productivity (p < 0.05, South Korea, Spain, Germany), significantly more days of paid help received in the home (p < 0.05 South Korea, Spain and the United States), and significantly more days of unpaid help from family members or friends (p < 0.05, all countries). Conclusion: In this multi-national study, fragility fractures in community-dwelling ≥ 50 years women were associated with several outcomes indicating higher indirect burden and lower quality of life, including more difficulties performing ADL and higher levels of lost productivity and caregiver support. [ABSTRACT FROM AUTHOR]

Objectives: Oxidative stress level takes part in the development of cognitive decline. However, the association between total antioxidant capacity (TAC) from diet and cognitive function is controversial. The aim of this study was to investigate the relationship between TAC and the cognitive function of older adults in the U.S. Design: A cross-sectional study. Setting: National Health and Nutrition Examination Surveys database. Participants: 2712 older adults aged over 60 years. Measurements: TAC was calculated from 8 antioxidative vitamins based on the reference values for vitamin C equivalent antioxidant capacity obtained from individuals' 24 h dietary recall. Four memory-related assessments were employed [Immediate Recall test (IRT), Delayed Recall test (DRT), Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST)]. Results: Among the 2712 participants, the median age was 68 years, and 50.4% were women. Participants in the group with higher TAC levels had relatively higher IRT, AFT and DSST scores (P=0.025, P=0.008, P<0.001, respectively). In adjusted weighted linear regression, log-transformed TAC was positively associated with AFT (β=1.10, 95%CI: 0.51, 1.70) and DSST (β=2.81, 95%CI: 1.16, 4.45). Compared with the first quartile, the participants in the second (Q2 vs. Q1, OR=0.66, 95%CI: 0.43,1.02) and fourth quartile (Q4 vs. Q1, OR=0.47, 95%CI:0.28, 0.78) of log-transformed TAC showed a decreased risk of impaired cognitive function (ICF) after adjusting for confounders. The dose-response analysis indicated a gradual descent in the risk of ICF as TAC increases. Diabetes mellitus (DM) mediated part of the effect of TAC on ICF. The relationship between TAC and ICF was more pronounced in subjects with DM (Q4 vs Q1, OR=0.36, 95%CI:0.17, 0.74). Conclusion: Our findings support that higher dietary antioxidant potential was related to a decreased risk of cognitive dysfunction, particularly in the subjects with DM who may have oxidative injury. DM was one of the factors mediating the effect of TAC on ICF. [ABSTRACT FROM AUTHOR]

Objectives: To propose a measure for adverse maternal experiences (AMEs) and examine if AMEs are independently associated with delivery of a neonatal abstinence syndrome (NAS) diagnosed infant. Methods: Using the Pregnancy Risk Assessment Monitoring System (PRAMS) stressful life events questions, we constructed a composite measure of AMEs. We conducted a retrospective analysis of linked Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012–2018 using the composite measure. Our analytic sample included 6358 singleton deliveries. We calculated prevalence of NAS and AMEs and prevalence odds ratio (POR) for delivery of an NAS-diagnosed infant adjusting for maternal sociodemographic characteristics, pre-pregnancy depression, prescription medicine 12 months prior to pregnancy, and smoking during pregnancy. Results: The overall prevalence of NAS in Delaware during 2012–2018 was 2.2% (95% CI 1.8–2.6); 9.5% (95% CI 8.7–10.2) of women reported AMEs. After adjustment, women with AMEs had 1.1 times greater odds (aPOR 2.1; 95% CI 1.3–3.3) to deliver a NAS-diagnosed infant as compared with women without AMEs. Conclusions: Although the cross-sectional nature of the study limits drawing any causal inferences, there are co-occurring factors that support plausibility of an association between AMEs and delivering NAS-diagnosed infants. Addressing AMEs, mental health and substance use screening and treatment as part of preconception and prenatal care may mitigate risks. [ABSTRACT FROM AUTHOR]

Objective: Access to trauma-informed sexual and reproductive health services (SRHS) among persons with mental illness (MI) is inadequate and may contribute to health disparities among this population. This qualitative study investigated health professionals' perspectives of SRHS delivery to patients receiving care at a behavioral health hospital. Methods: Semi-structured interviews were conducted in a convenience sample of 26 mental health professionals recruited from one behavioral health hospital. Interviews assessed participants' perceptions of current SRHS offerings, barriers, and opportunities to implement patient-centered SRHS at the hospital. A constant comparison thematic analysis was employed. Results: Participants noted patients' overlapping sexual and reproductive health (SRH) and mental health needs. Most participants indicated clinical responsibility to address these needs. However, participants stated they infrequently provided SRHS because of structural barriers within the healthcare system. Barriers included a lack of hospital policy and health professional education on SRH. Some participants who navigated around these barriers reported using an existing SRH screening tool. Conclusions: Patients receiving care at this behavioral health hospital have unmet SRHS needs. This lack of care may undermine the health of patients with MI. Addressing system level gaps requires clinical re-prioritization. Promising approaches to address this gap include reverse-integrated care models and improved SRHS training of health professionals. [ABSTRACT FROM AUTHOR]

Aim: To determine whether statistically distinct classes of smokers exist according to mental health (MH) diagnoses within primary care and to evaluate whether class membership is associated with healthcare utilization. Subject and methods: Data were obtained from the US Department of Veterans Affairs (VA) electronic medical record for encounters between January 1, 2014, and December 31, 2014, from the New York/New Jersey region. Data from a subset of 25,713 smokers from a larger sample of 111,333 primary care patients were used. An exploratory latent class analysis (LCA) was conducted to determine the presence of distinct groups of smokers based on observed MH diagnosis, while a confirmatory LCA assessed for reliability of those distinct groups. Using group as a predictor, we then utilized regression to determine whether group membership was associated with elevated numbers of primary care, integrated primary care, and specialty care encounters. Diagnosis was based on primary care encounter codes. Results: Three independent groups of current smokers were established: those with no MH diagnoses (77.8%), those with depressive diagnoses (16.7%), and those with alcohol/substance use diagnoses (5.5%). Most smokers were in the non-MH group, which utilized the least healthcare services (e.g., 2.7 primary care visits per year). The depressed group had 3.6 primary care visits per year and were most likely to use integrated primary care. The alcohol/substance-use group utilized primary and specialty services significantly more often than the other two groups, with an average of 5.5 primary care visits per year. Conclusion: Distinct classes of smokers can be identified in primary care settings. [ABSTRACT FROM AUTHOR]

Background: Concerns exist about the ability of safety net health care organizations to participate in US health care reform. Primary care practices are key to several efforts, but little is known about how capabilities of primary care practices serving a high share of disadvantaged patients compare to other practices.Objective: To assess capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients.Design: We analyzed data from the National Survey of Healthcare Organizations and Systems (response rate 46.8%), conducted 2017-2018.Participants: A total of 2190 medical practices with at least three adult primary care physicians.Main Measures: Our key exposures are payer mix and federally qualified health center (FQHC) designation. We classified practices as safety net if they reported a combined total of at least 25% of annual revenue from uninsured or Medicaid patients; we then further classified safety net practices into those that identified as an FQHC and those that did not.Key Results: FQHCs were more likely than other safety net practices and non-safety net practices to offer early or late appointments (79%, 55%, 62%; p=0.001) and weekend appointments (56%, 39%, 42%; p=0.03). FQHCs more often provided medication-assisted treatment for opioid use disorders (43%, 27%, 25%; p=0.004) and behavioral health services (82%, 50%, 36%; p<0.001). FQHCs were more likely to screen patients for social and financial needs. However, FQHCs and other safety net providers had more limited electronic health record (EHR) capabilities (61%, 71%, 80%; p<0.001).Conclusion: FQHCs were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities. [ABSTRACT FROM AUTHOR]