Search

Background: The gut microbiome is an important determinant of health and disease in preterm infants. Objectives: The objective of this article was to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols, aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants. Methods : This prospective, longitudinal study planned to recruit 160 preterm infants born <32 weeks gestational age or weighing <1,500 g and admitted to one of two Level III/IV neonatal intensive care units. During the neonatal intensive care unit period, the primary measures included events of early life pain/stress, gut microbiome, host genetic variations, and neurobehavioral assessment. During follow-up visits, gut microbiome; pain sensitivity; and medical, growth, and developmental outcomes at 4, 8-12, and 18-24 months corrected age were measured. Discussion : As of February 14, 2020, 214 preterm infants have been recruited. We hypothesize that infants who experience greater levels of pain/stress will have altered gut microbiome, including potential adverse outcomes such as necrotizing enterocolitis and host genetic variations, feeding intolerance, and/or neurodevelopmental impairments. These will differ from the intestinal microbiome of preterm infants who do not develop these adverse outcomes. To test this hypothesis, we will determine how alterations in the intestinal microbiome affect the risk of developing necrotizing enterocolitis, feeding intolerance, and neurodevelopmental impairments in preterm infants. In addition, we will examine the interaction between the intestinal microbiome and host genetics in the regulation of intestinal health and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This paper investigates a community-based intervention for young fathers, FatherWorks, compared to care-as-usual, 24/7 Dads. We hypothesized that utilizing the FatherWorks intervention (a 15 session parenting intervention, 13 session employment class, paid internship, case management, and access to behavioral health services) will assist in readiness to use condoms and increase condom usage, which may differ by race/ethnicity. Methods: Eligible males (n = 328) were enrolled into a Randomized Control Trial. Participants were 15–24 years old and had fathered one or more children with a female under the age of 21. A survey was taken at baseline and at 15 weeks following the intervention. Results: Analyses of changes indicated that intervention participants improved from the pre-contemplation stage of condom usage towards contemplation, and from preparation to action. The pattern of improvement in the condom use stage of change was different in African-American versus Hispanic participants. Changes in condom use during last intercourse were not significant. Conclusions: Study findings indicate that FatherWorks is successful in increasing the intent to use condoms, with the effect manifesting differently in African-American and Hispanic young fathers. Future work with minority fathers indicates a need for cultural adaptation of the intervention. [ABSTRACT FROM AUTHOR]

Background: There has been a marked increase in the number of Schenck knee dislocation (KD) I injuries reported in the multiligament knee (MLK) injury (MLKI) and KD literature. Purpose: To examine the heterogeneity of the Schenck KD I classification in the MLKI and KD literature. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search of PubMed, CINAHL, Scopus, Web of Science, EMBASE, and Cochrane Library was conducted for all studies that investigated KDs and/or MLKIs, utilized the Schenck or an MLKI classification system, and included patients with KD I or MLK 1 injuries. Pooled analysis determined the total number of KD I or MLK 1 injuries and the specific ligamentous tear patterns. Binary meta-analyses of the studies that reported neurovascular injury within each Schenck KD class compared the pooled odds ratio (OR) of vascular and neurological injury in unicruciate (KD I) and bicruciate (KD II-IV) injuries. Results: Included were 50 studies in which 3460 KD I injuries were reported out of 7872 KDs and MLKIs (43.9%). Of the 2912 patients reported to have had a Schenck KD I injury, 26 patients (0.9%) had a clinically and/or radiographically confirmed tibiofemoral KD. The overall prevalence of Schenck KD I injury with documented tibiofemoral KD was 26 of 7872 (0.3%). A total of 22 studies (n = 1702 patients) reported the specific ligamentous tear patterns; the most common patterns were posterior cruciate ligament (PCL)/lateral collateral ligament (LCL) (n = 526; 30.9%), anterior cruciate ligament (ACL)/LCL (n = 488; 28.7%), ACL/medial collateral ligament (MCL) (n = 408; 24.0%), and PCL/MCL (n = 198; 11.6%). Meta-analyses demonstrated that when compared with bicruciate KD or MLKI, unicruciate KD or MLKI was significantly less likely to have concomitant vascular injury (OR, 0.28; 95% CI, 0.15-0.51; P <.0001) and concomitant neurologic injury (OR, 0.49; 95% CI, 0.37-0.65; P <.00001). Conclusion: The number of true, clinically and/or radiographically confirmed unicruciate KDs was extremely rare, representing <1% of all reported Schenck KD I injuries. A misappropriation of these injury patterns as true KDs may be taking place, affecting outcome studies and potentially biasing published clinical results. An MLKI classification system must document whether a confirmed KD has occurred. [ABSTRACT FROM AUTHOR]

In a 2023 sequential explanatory mixed-methods study in four US states, we identified barriers and facilitators experienced by Vaccines for Children (VFC) program providers in reporting vaccination data to state immunization information systems (IISs). We found the following: VFC providers value accurate, robust, and widely used IISs. IIS reporting is easier with but does not require an electronic health record. Negative interactions with IISs and VFC officials and limited practice capacity are barriers to reporting. The COVID-19 pandemic highlighted the need for a nationwide vaccination database. (Am J Public Health. 2024;114(6):569–574. https://doi.org/10.2105/AJPH.2024.307638) [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a common sequela in individuals with a diagnosis of head and neck cancer. However, the prevalence and predicting factors for pretreatment dysphagia have not been well identified in the literature. A priori knowledge of the presence of a pretreatment dysphagia is advantageous and can have clinically significant implications for management of this patient population. The ability to predict pretreatment dysphagia in this population would allow more targeted interventions and potential improvements in clinical outcomes. Participants: This pilot study investigated the prevalence and predicting factors of pretreatment dysphagia in 67 veterans with head and neck cancer through the West Haven, CT, Veterans Affairs cancer database. Method: Data for this study were acquired via retrospective medical record review. Results: The prevalence of pretreatment dysphagia in our sample was found to be 49.3%. Age and pretreatment percutaneous endoscopic gastrostomy placement were found to have a statistically significant relationship with pretreatment dysphagia. Stage of cancer diagnosis and the diagnosis of pretreatment dysphagia were found to have a statistically significant relationship with posttreatment dysphagia. Conclusions: Findings offer important preliminary data and clinical considerations about this issue and serve as a foundation for future research. There are a limited number of factors associated with pretreatment dysphagia, and clinicians should consider a conservative referral approach when considering the need for dysphagia assessment prior to the initiation of oncologic treatment. [ABSTRACT FROM AUTHOR]

Objectives: Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance–based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. Methods: We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. Results: Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P =.02). Conclusions: A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationship between Health Action Process Approach (HAPA) postintentional constructs (maintenance self-efficacy, recovery self-efficacy, action planning, coping planning) and medication adherence among phase II cardiac rehabilitation (CR) patients. Purposive sampling was used to recruit 91 phase II CR patients age 50 years and over. All respondents completed paper and pencil questionnaire examining HAPA postintentional constructs (action planning, coping planning, maintenance self-efficacy, recovery self-efficacy), medication adherence, and demographic characteristics. Validity and reliability were confirmed for all scales included in the questionnaire. Descriptive statistics were used to describe respondents’ characteristics. Bivariate statistics (correlation, Mann-Whitney U-test, Kruskal Wallis test) were used to examine associations between medication adherence and each HAPA postintention construct as well as medication adherence and respondent demographic characteristics. Better medication adherence was associated with greater maintenance self-efficacy (r = −.290, p = .006) and better action planning skills (r = −.233,p = .027) and coping planning skills (r = −.277,p = .008) as indicated by higher scores on the maintenance self-efficacy, action planning, and coping planning scales. There was no significant linear relationship between medication adherence and recovery self-efficacy (r = −.103,p = .335) or medication adherence and any of the respondents’ demographic characteristics (p > .05). Only maintenance self-efficacy remained significant in a multivariate model predicting medication adherence. Greater maintenance self-efficacy was associated with increased medication adherence; health professionals working in CR settings might consider opportunities to enhance maintenance self-efficacy for medication adherence. Additional research is needed to identify strategies for promoting maintenance self-efficacy for medication adherence. [ABSTRACT FROM AUTHOR]

Background: Extant research suggests that disparities in healthcare utilization and experiences of mental health disorders such as depression exist across sociodemographic groups. One understudied pathway that may have significant implications for these disparities is the role of family functioning. How families interact, communicate, and adapt may vary, but these relationships remain integral for vulnerable subsets of the population due to their seemingly protective properties. Yet, few studies have examined the relationship between family functioning and health. Objective: The aim of this study was to explore family functioning as a predictor for healthcare utilization and depression among young mothers and as a moderator of disparities for each of these outcomes. Design/methods: This analysis uses data from a prospective cohort study which was conducted with 296 pregnant young women recruited from obstetrics clinics in Connecticut between July 2007 and February 2011 and followed 1-year postpartum. Logistic regression models were used to assess family functioning, race/ethnicity, and immigrant status as predictors of healthcare utilization and depression. Family functioning was evaluated as a moderator for both outcomes. Results: Black and Latina mothers had decreased odds of using physical healthcare services (odds ratioBlack = 0.13, p < 0.001; odds ratioLatina = 0.31, p = 0.02). Family functioning was associated with decreased odds of using mental healthcare services (odds ratio = 0.97, p = 0.04) and had a protective effect against depression (odds ratio = 0.96, p = 0.003). Family functioning significantly moderated the relationship between immigrant status and physical healthcare utilization, Black race/ethnicity and physical healthcare utilization, and Other race/ethnicity and depression. Conclusion: Family functioning is a significant factor associated with both healthcare utilization and depression among young mothers. It should be a strongly considered component within healthcare settings to mitigate risks among vulnerable populations. [ABSTRACT FROM AUTHOR]

Highly effective direct-acting antiviral (DAA) treatments for hepatitis C have led to strategic goals promoting hepatitis C virus (HCV) cure particularly in focus populations including persons with HIV/HCV coinfection. Implementing treatment more broadly requires both clinic-level and public health approaches such as those inherent in Data to Care (D2C) originally developed to improve the treatment cascade for persons with HIV (PWH). We used D2C methods to characterize and improve HCV treatment for persons with HIV/HCV coinfection among 11 HIV clinics in Connecticut cities with high PWH prevalence. Providers who were local champions in HCV treatment were recruited to participate along with clinic data staff and were key to quality improvement via practice transformation. We developed a methodology whereby clinic-generated lists of PWH receiving care from 2009 to 2018 were matched by CT Department of Public Health (DPH) against the state-wide HCV surveillance system. The resultant coinfection list was reviewed by clinical staff who designated HCV treatment status, enabling creation of individual clinic-level HCV treatment cascades. Data from DPH, especially current residency and deaths, enabled better characterization and allowed for refinement of longitudinal cascades. There were 1,496 patients with HIV/HCV coinfection. Sustained virologic response (SVR) rates varied by clinic (range, 44%–100%) with an aggregate SVR rate of 71% in September 2020. SVR rates improved during the project through a combination of increased treatment initiation/completion as well as data clean-up including serial updates of patient treatment status. Lack of treatment initiation was associated with being female (odds ratio [OR] = 2.18) and not having HIV viral suppression (OR = 3.24). [ABSTRACT FROM AUTHOR]

Perturbations to acoustic speech feedback have been typically localized to specific phonetic characteristics, for example, fundamental frequency (F0) or the first two formants (F1/F2), or affect all aspects of the speech signal equally, for example, via the addition of background noise. This paper examines the consequences of a more selective global perturbation: real-time cochlear implant (CI) simulation of acoustic speech feedback. Specifically, we examine the potential similarity between speakers’ response to noise vocoding and the characteristics of Lombard speech. An acoustic analysis of supra-segmental characteristics in speaking rate, F0 production, and voice amplitude revealed changes that paralleled the Lombard effect in some domains but not others. Two studies of speech intelligibility complemented the acoustic analysis, finding that intelligibility significantly decreased as a result of CI simulation of speaker feedback. Together, the results point to differences in speakers’ responses to these two superficially similar feedback manipulations. In both cases we see a complex, multi-faceted behavior on the part of talkers. We argue that more instances of global perturbation and broader response assessment are needed to determine whether such complexity is present in other feedback manipulations or if it represents a relatively rare exception to the typical compensatory feedback response. [ABSTRACT FROM AUTHOR]

Medical specialty camps can play an important role in the positive development of psychosocial outcomes for children and youth with sickle cell disease (SCD). This study examined how sense of mastery and attitude towards illness outcomes changed over 6 months for 100 campers aged 8–16 years with SCD. The outcomes were measured twice before and twice after camp. Latent growth curve modeling was used to analyze data. Results showed no changes in the outcomes for this study population. Implications for future research designs, populations, and outcomes are discussed, as are implications for communications about camp, and policy and practice. [ABSTRACT FROM AUTHOR]

Medication administration is a critical safety issue in hospitals and the community. Children are especially at risk because of their dependence on adults to safely administer medications. The purpose of this study was to examine non-compliance with state child care medication administration regulations and factors associated with improved compliance. The data included routine, unannounced inspections of child care programs by state licensing specialists collected in two time periods over 10 years. Factors potentially associated with regulatory compliance were included in this secondary analysis. Most child care center medication administration regulations showed decreased non-compliance between the two time periods. However, regulations pertaining to prescriber orders and parent permission revealed a significant increase in non-compliance (58.4%). Factors positively associated with medication administration regulatory compliance included: compliance with annual professional development (p < 0.0001 in both periods), achievement of accreditation (p = 0.0115 in Time 1), and among centers with children under 3 years of age, compliance with a weekly mandatory visit by a nurse consultant (p = 0.0004 in Time 2). Though family child care homes had a lower frequency of medication administration non-compliance, only 19% were administering medications in Time 1. High quality, safe, and affordable child-care is essential for all children including those with special health care needs. This study highlights the importance of medication safety practices in child care programs, national child care health and safety standards, federal and state policies regarding medication administration regulations, and the critical role of nurse child care health consultants in promoting safe medication administration in child care programs. [ABSTRACT FROM AUTHOR]

Outcome measures (OMs) have been emphasized by healthcare professions to optimize patient examination; however, a lack of regular use of OMs exists. The purpose of this study was to describe the outcome of a knowledge translation (KT) intervention to increase the use of OMs by physical therapists in an inpatient rehabilitation setting. A quasi-experimental pre-post study design was used. A multi-component KT intervention including education, organizational support, documentation, and environmental changes to increase the use of five OMs was implemented. Audit and feedback (A&F) was added to the KT intervention at month 6. Documented use of OMs was determined through manual chart audit (n = 864) and electronically (n = 2599). Regression analyses were used to identify factors associated with OMs use across time and diagnoses. Following the addition of A&F to the KT intervention at month 6, there was a significant increase in the odds of OMs use across all time intervals (months 6–12, 12–18, 18–24)(Odds Ratio (OR) 5.9, 95% Confidence Interval (CI) 4.1–8.5; OR 8.5, 95% CI 6.0–12.1; OR 10.8, 95% CI 7.6–15). There was also a significant increase in the odds of documenting OMs on individuals with neurological diagnoses (OR 0.3, 95% CI 0.5–0.8). This KT intervention increased and sustained OMs use over 24-months. This intervention can be replicated to improve the evidence-based practices of physical therapists. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of distress and well-being of patients with cancer is not always documented or addressed in a clinical visit, reflecting a need for improved psychosocial screening. Methods: A multidisciplinary team completed process mapping for emotional distress assessment in two clinics. Barriers were identified through cause-and-effect analysis, and an intervention was chosen. Patient-reported outcomes were collected over 6 months using the validated National Comprehensive Cancer Network Emotional Distress Thermometer (EDT) paper tool. The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) measures were compared before and after intervention. Results: During 6 months, a total of 864 tools were collected from 1,344 patients in two ambulatory clinics (64%). Electronic medical record documentation of distress increased from 19.2% to 34% during the 6 months before and after intervention. QOPI measures showed an increase in emotional well-being documentation. Of 29 new and 835 return patients, 62% indicated mild distress (EDT, 0 to 3), 18% moderate (EDT, 4 to 6), and 11 % severe (EDT, 7 to 10). The average distress score of new patients was significantly higher than that of return patients (5.39 [n = 26] v 2.52 [n = 754]; P < .001). The top problems for patients with moderate and severe distress were worry, fatigue, pain, and nervousness; depression and sadness were particularly noted in patients reporting severe distress. Eleven percent of patients were referred to the social worker on site. Conclusion: A pilot intervention collecting Patient-reported outcomes in two ambulatory clinics led to increase in psychosocial distress screening followed by sustained improvement, indicated by both process and QOPI measures. [ABSTRACT FROM AUTHOR]

Diagnosis codes are used to study SARS-CoV2 infections and COVID-19 hospitalizations in administrative and electronic health record (EHR) data. Using EHR data (April 2020–March 2021) at the Yale-New Haven Health System and the three hospital systems of the Mayo Clinic, computable phenotype definitions based on ICD-10 diagnosis of COVID-19 (U07.1) were evaluated against positive SARS-CoV-2 PCR or antigen tests. We included 69,423 patients at Yale and 75,748 at Mayo Clinic with either a diagnosis code or a positive SARS-CoV-2 test. The precision and recall of a COVID-19 diagnosis for a positive test were 68.8% and 83.3%, respectively, at Yale, with higher precision (95%) and lower recall (63.5%) at Mayo Clinic, varying between 59.2% in Rochester to 97.3% in Arizona. For hospitalizations with a principal COVID-19 diagnosis, 94.8% at Yale and 80.5% at Mayo Clinic had an associated positive laboratory test, with secondary diagnosis of COVID-19 identifying additional patients. These patients had a twofold higher inhospital mortality than based on principal diagnosis. Standardization of coding practices is needed before the use of diagnosis codes in clinical research and epidemiological surveillance of COVID-19. [ABSTRACT FROM AUTHOR]

Data that inform preexposure prophylaxis (PrEP) implementation for women involved in criminal justice (WICJ) systems are scarce. In a survey of PrEP attitudes, acceptability, and barriers across the criminal justice system, incarcerated women (n = 48) were more likely than WICJ on probation (n = 125) to be eligible for PrEP (29% vs. 15%; p = .04) and willing to take PrEP if offered (94% vs. 78%; p = .01). In multivariate models, PrEP eligibility directly correlated with being incarcerated (adjusted odds ratio [aOR] 4.81, 95% confidence interval [CI] 1.76-13.1) and inversely correlated with Hispanic/Latina ethnicity (aOR 0.31; 95% CI 0.10-0.96). Recent partner violence exposure was associated with PrEP eligibility (aOR 3.29; 95% CI 1.54-7.02) and discordant risk perception (aOR 2.36; 95% CI 1.18-4.70). Findings demonstrate high potential for PrEP for all WICJ, though implementation efforts will need to address partner violence. [ABSTRACT FROM AUTHOR]

Asthma is a leading cause of chronic illness among school-aged children and adolescents. Current trends have led to school faculty and staff becoming increasingly responsible for managing student asthma, often without optimal training or resources. The purpose of this project was to establish whether facilitated access to personalized student asthma action plans (AAPs), education, proper use, and school nurse support improved reported self-efficacy regarding student asthma exacerbation prevention and management in elementary and preschool faculty and staff. Thirty-five participants from an urban, underserved Connecticut school were surveyed to determine perceived self-efficacy regarding student asthma exacerbation prevention and management. AAPs were then placed with students' asthma inhalers, and all participants were instructed on their use. Three months later, participants were resurveyed. A statistically significant difference after both the initial education and 3-month survey was identified. Providing elementary and preschool faculty and staff with facilitated access to student action plans and education on their use can improve perceived self-efficacy regarding student asthma exacerbation prevention and management. [ABSTRACT FROM AUTHOR]

The current study investigates the relationship between intimate partner violence (IPV), childhood trauma, trait anxiety, depression, and anxious attachment in college students. Ninety-three male and 161 female undergraduate students at Fairfield University, ranging in age from 17 to 23, with a mean age of 18.8 years, participated. Participants completed five self-report inventories: The Conflict in Adolescent Dating Relationships Inventory (CADRI), the Childhood Trauma Questionnaire (CTQ), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Adult Attachment Scale (AAS). IPV perpetration in college dating relationships was related to childhood emotional and physical abuse, emotional and physical neglect, and trait anxiety. IPV victimization in college dating relationships was related to childhood emotional and physical abuse, childhood emotional and physical neglect, and an anxious attachment style. IPV perpetration and victimization were also significantly correlated with one another. Subscale analyses suggest that childhood emotional abuse was related to being both the perpetrator and victim of verbal or emotional abuse in dating relationships. Childhood physical abuse, physical neglect, and emotional abuse were related to both perpetration and victimization of physical IPV. Threatening behavior perpetration in dating relationships was related to childhood emotional abuse, emotional neglect, physical abuse, and physical neglect; however, being the victim of threatening behavior was only related to childhood emotional abuse, physical neglect, and emotional neglect, not childhood physical abuse. These results support the relationship between childhood trauma and dating violence in college students. They also support a role for anxiety in IPV, although trait anxiety was related to perpetration and an anxious attachment style was correlated with IPV victimization. In addition, they suggest that different experiences of childhood trauma may relate to different aspects of IPV in college dating relationships. [ABSTRACT FROM AUTHOR]

Graduate school environments are recognized for contributing to elevated stress levels among student populations. Purpose: The objective was to test whether a behavioral intervention, delivered through an online course on behavior change, is effective in preventing declining mental health. Methods: Data were collected via a quasi-experimental longitudinal study to observe the effect of self-directed behavioral interventions on mental health. Participants included students enrolled in a course on Health Behavior Change at the Yale School of Public Health (n = 45) and a control group (n = 33) of students in the same graduate program. Analyses were conducted to evaluate differences at post-intervention and at a 12-week follow-up assessment in indicators of mental and general health. Results: Enrolled students reported significantly improved mental health outcomes as compared to the control students. At follow-up, multiple differences persisted, with participants who had completed the course reporting sustained improvements in general and mental health. Discussion: Self-directed behavior change interventions are effective in promoting mental and physical health among graduate student populations. Translation to Health Education Practice: This curriculum-based intervention can support student wellbeing in a variety of academic programs. [ABSTRACT FROM AUTHOR]

Families' positive health service-related views and experiences are associated with improvements in physical and psychological well-being. Research has elucidated key differences in the experiences of caregivers and their children. More work is needed to better understand how families experience enrollment in systems of care (SOCs), given their unique service delivery approach. We compared the service-related views and experiences of 77 youth (Mage = 13.5 years, SD = 2.09, Range = 8 to 18) with severe emotional challenges and their caregivers enrolled in a school-based SOC. Youth and their caregivers reported positive views of service characteristics and related youth outcomes. However, caregivers reported significantly higher levels of perceived cultural sensitivity of services, general satisfaction with services, and active participation in services. Qualitative findings indicated that youth primarily reported improvements in their own psychological and behavioral functioning as the most helpful aspect of services, whereas caregivers tended to emphasize specific youth and family services that they received, such as counseling and psychiatric treatment. We discuss limitations and implications for future research. [ABSTRACT FROM AUTHOR]

This project was undertaken to reduce unneeded variation among practicing primary care clinicians participating in an accountable care organization (ACO) and to raise quality and reduce costs. This real-world, quasi-controlled experiment compared ACO target improvements between 3 participating geographic regions and members within the ProHealth ACO against nonparticipating regions and members. The authors used a novel care standardization initiative to engage participating providers. This was a 2-year longitudinal study with 6 rounds of serially measured provider care decisions and customized individual and group improvement feedback. Participating providers cared for online patient simulations as they would actual patients, and their care decisions were scored against evidence-based guidelines. This approach generated significant increases in evidence-based quality scores (+27%) and reductions in unneeded testing (-55%) in the patient simulations. Improvements in the online simulated patients correlated with improvements in patient-level ACO quality measures, which showed gains above and beyond the quasi-control group. Reductions calculated for spending on unneeded tests and specialist referrals exceeded $4.8 million. This study found that supporting practicing physicians in ACOs with evidence-based feedback significantly improved care and cost-efficiency. [ABSTRACT FROM AUTHOR]

Studies of relatively recently resettled refugees have noted social disconnection, linked to various physical and mental health outcomes, as a concern. Limited studies have examined whether social disconnection and its effects persists within refugee populations resettled more than 3 decades prior. The relationship between social disconnection and self-reported health was explored in a secondary analysis of a cross-sectional needs assessment survey with a snowball sample of 100 Cambodian refugees residing in Connecticut. Social disconnectedness and comorbid health conditions were prevalent. Lack of religious and community engagement were associated with poor health outcomes, while individuals with a lack of ethnic engagement reported better overall health. This study underscores the importance of understanding the specific risks that social disconnection poses to refugees who have resettled many years before and their offspring that may assist in better serving currently settling refugees within the United States. [ABSTRACT FROM AUTHOR]

This study investigates category goodness judgments of /r/ in adults and children with and without residual speech errors (RSEs) using natural speech stimuli. Thirty adults, 38 children with RSE (ages 7-16) and 35 age-matched typically developing (TD) children provided category goodness judgments on whole words, recorded from 27 child speakers, with /r/ in various phonetic environments. The salient acoustic property of /r/ - the lowered third formant (F3) - was normalized in two ways. A logistic mixed-effect model quantified the relationships between listeners' responses and the third formant frequency, vowel context and clinical group status. Goodness judgments from the adult group showed a statistically significant interaction with the F3 parameter when compared to both child groups (p < 0.001) using both normalization methods. The RSE group did not differ significantly from the TD group in judgments of /r/. All listeners were significantly more likely to judge /r/ as correct in a front-vowel context. Our results suggest that normalized /r/ F3 is a statistically significant predictor of category goodness judgments for both adults and children, but children do not appear to make adult-like judgments. Category goodness judgments do not have a clear relationship with /r/ production abilities in children with RSE. These findings may have implications for clinical activities that include category goodness judgments in natural speech, especially for recorded productions. [ABSTRACT FROM AUTHOR]

Limited research evaluates substance use prevention and intervention strategies for cultural sensitivity, appropriateness of content, patient/provider interactions, and implementation for racial and ethnic minority populations. This study uses the Consolidated Framework for Implementation Research (CFIR) to examine a community-based evaluation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for implementation among the Black community in a small, urban setting. Data were gathered through four separate focus groups, one for service providers (n = 7), one for community youth leaders (n = 8), and two for community members (n = 10). Findings suggest that a range of multi-level service needs and underlying mechanisms of implementation should be considered when administering SBIRT within community health settings serving Black populations. This community-involved evaluation of SBIRT responds to the call for the examination of implementation in specific settings, and suggests a need for further examinations of strategies that support engagement through SBIRT and other innovations. [ABSTRACT FROM AUTHOR]

Objective: To examine changes that occur in infant and parent salivary oxytocin (OT) and salivary cortisol (SC) levels during skin-to-skin contact (SSC) and whether SSC alleviates parental stress and anxiety while also supporting mother–father–infant relationships. Methods: This randomized crossover study was conducted in the neonatal intensive care unit (NICU) with a sample of 28 stable preterm infants and their parents. Saliva samples were collected from infants, mothers, and fathers on Days 1 and 2 (1/parent) for OT and cortisol measurement pre-SSC, during a 60-min SSC session, and a 45-min post-SSC. Parental anxiety was measured at the same time points. Parent–infant interaction was examined prior to discharge on Day 3 via video for synchrony and responsiveness using Dyadic Mutuality Coding. Results: Salivary OT levels increased significantly during SSC for mothers (p < .001), fathers (p < .002), and infants (p < .002). Infant SC levels decreased significantly (p < .001) during SSC as compared to before and after SSC. Parent anxiety scores were significantly related to parent OT and SC levels. Parents with higher OT levels exhibited more synchrony and responsiveness (p < .001) in their infant interactions. Conclusion: This study addresses a gap in understanding the mechanisms linking parent–infant contact to biobehavioral responses. SSC activated OT release and decreased infant SC levels. Facilitation of SSC may be an effective intervention to reduce parent and infant stress in the NICU. Findings advance the exploration of OT as a potential moderator for improving responsiveness and synchrony in parent–infant interactions. [ABSTRACT FROM AUTHOR]

Background: Inpatient suicide is recognized by The Joint Commission as a preventable sentinel event associated with inadequate patient and environmental assessments. Strategies are needed to meet this Joint Commission requirement. Method: Community hospital nurses were provided with classes to increase knowledge of inpatient suicide, patient assessments, and appropriate care. Independent pre- and postclass assessments were performed to measure nurses' confidence when talking to patients about suicidal thoughts and to assess nursing knowledge of actions to take when an at-risk patient is identified. Results: Education significantly increased nurses' confidence talking to patients about three of four confidence measures and increased their knowledge of actions to take when suicidal thoughts are identified. Confidence was lower in nurses with more experience; therefore, experience does not appear to increase confidence, and education is needed. Conclusion: This study demonstrated that a focused in-service education program can increase nurses' confidence to dialogue with patients about suicidal thoughts and nurses' knowledge of actions to prevent inpatient suicide. [ABSTRACT FROM AUTHOR]

Objectives: For older adults coping with a spouse's chronic condition, greater marital satisfaction may not be entirely protective for psychological health. We examined marital satisfaction and gender as moderators of the association between perceived spousal suffering and daily emotional contagion. Based on empathy-altruism and interdependent self-construal theories, we hypothesized that high marital satisfaction and being female would heighten daily emotional contagion, or within-person associations between perceived spouse suffering and distress to spouse suffering. Method: Forty-five older adults who had a spouse with a musculoskeletal condition completed daily interviews. Participants reported their marital satisfaction once in the laboratory and then daily perceptions of their spouse's physical suffering and their own distress to spouse suffering via phone at home for 7 days. Results: Consistent with hypotheses, there were significant within-person effects such that highly satisfied wives experienced heightened emotional contagion on days when they perceived higher than average spouse suffering. Unexpectedly, men who were high in marital satisfaction experienced heightened daily distress irrespective of their perceptions of level of spousal suffering. Discussion: Marital satisfaction can increase daily emotional contagion to spousal suffering among older couples dealing with chronic conditions. Wives' distress may be more dependent on perceiving high levels of partner suffering compared with husbands' distress. [ABSTRACT FROM AUTHOR]

Although intimate partner violence ( IPV) is prevalent among women living with HIV and negatively impacts their health, few studies have examined the ability of AIDS service organisations ( ASOs) to address IPV. This study used a qualitative approach to identify facilitators of and barriers to addressing IPV in female clients of ASOs in the United States. In-depth interviews were conducted between March and August 2011 with 20 ASO staff members and 19 female clients who reported a current or past history of IPV. Interviews were audio recorded, transcribed and analysed using the constant comparative method. These data identify barriers to addressing IPV at the organisation, provider and client levels, and include suggestions from both clients and providers about improving access to care. Client and provider suggestions differed in some areas. While providers emphasised structural changes such as increased training on IPV provided by their organisation, clients highlighted the importance of trusting personal relationships with staff to increase client disclosure of IPV experiences. Given the differing opinions of clients and staff, ASOs should consider involving women with histories of IPV in the process of programme and policy development. ASOs have the unique opportunity to provide comprehensive and holistic care by addressing IPV. The extent to which ASOs are able to recognise and address IPV and strategies for increasing this ability warrant greater attention from funders, ASO administrators and researchers. [ABSTRACT FROM AUTHOR]

Objective To provide preliminary descriptive data on caregiver and child weight status, parenting styles, feeding styles, and feeding practices of a small American Indian sample. Methods Participants included a subsample of American Indian caregivers ( n = 23) identified from a larger study that was conducted in five states. Using previously validated instruments, means, standard deviations, and ranges for general parenting styles, feeding styles, and feeding practices were explored. Results In general, most caregivers reported healthy feeding practices. Most caregivers scored higher on responsive compared to restrictive or permissive in general parenting. Of the sample, 12 caregivers (52.2 %) were classified in the indulgent feeding style category, 5 caregivers (21.7 %) were classified as authoritative, 5 (21.7 %) uninvolved, and 1 (4.3 %) authoritarian. Conclusions More investigations are needed to explore questions raised by this study about using common tools that measure childhood obesity with American Indian families. [ABSTRACT FROM AUTHOR]

To determine if the addition of breast ultrasound in women with dense breasts finds cancers that otherwise would have been obscured. Retrospective chart review from five sites from October 2009 through December 2013. Data included: number of screening mammograms; number of screening ultrasounds; Breast Imaging Reporting Data System code results; biopsy results including type of lesion, size, nuclear grade, receptor and node status, and patient demographic data. Year 1, 2,706 ultrasound with 151 biopsies yielded 11 cancers, positive predictive value (PPV) 7.3%. Detection rate of 4.0/1,000. Year 2, 3,351 ultrasounds with 180 biopsies yielded 11 cancers and high risk lesions ( HRL), PPV 6.1%. Detection rate 3.3/1,000. Year 3, 4,128 ultrasounds with 148 biopsies yielded 13 cancers and HRL, PPV 8.8%. Detection rate 3.1/1,000. Year 4, 3,331 ultrasounds with 53 biopsies yielded 11 cancers and HRL, PPV of 20.1%. Detection rate of 3.3/1,000. Lesion size ranged 0.3-8.0 cm. Patient age 45-77 years. Three tumors nuclear grade 3 and 1 nuclear grade 2 had positive sentinel nodes. 8 patents had risk factors other than dense breasts. Cancers in patients with prior negative screening ultrasound measured 0.4-1.2 cm and were node negative. Breast ultrasound in women with dense breasts detects mammographically occult malignancy. Over 4 years, the PPV doubled indicating increased accuracy of lesions biopsied while rate of detection remained stable. Lesions were of all cancer types, grade and hormonal status. Only high grade cancers were sentinel node positive and women returning for yearly ultrasound had small lesions with no positive sentinel nodes. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe the frequency of systemic inflammatory response syndrome (SIRS) criteria in a cohort of patients hospitalised with purulent soft tissue infections and to determine their impact on clinical characteristics, microbiology and outcomes.MethodsRetrospective cohort study of adults hospitalised at the West Haven Veteran’s Hospital with purulent soft tissue infections between 1 October 2008 and 30 September 2013.ResultsA total of 173 patients were included with purulent soft tissue infections; 60 patients had no SIRS, 48 had one SIRS and 65 had ≥ 2 SIRS. Most clinical characteristics were similar between the different SIRS groups, although patients with SIRS were more likely to have severe sepsis and acute kidney injury and to already be on antibiotics at the time of hospitalisation. The microbiology of the infections was similar between SIRS groups. All patients received parenteral antibiotics when admitted and the majority of patients in all SIRS categories received antibiotics with broad Gram-negative activity. Outcomes were generally benign for all SIRS groups, although patients with SIRS had a longer length of stay and a trend towards more bacteremia.ConclusionsSIRS are common in patients hospitalised with purulent soft tissue infections, although one third had no systemic signs of infection. Severe sepsis and septic shock are rare. Clinical characteristics, microbiology and antibiotic use are similar among patients in different SIRS groups, although the group without SIRS had a shorter hospitalisation and no episodes of bacteremia. Over-use of antibiotics is common in all SIRS categories. [ABSTRACT FROM PUBLISHER]

Objectives: To assess longitudinal changes in occupational effort-reward imbalance (ERI) and demand-control (DC) scores across pregnancy and examine associations with blood pressure (BP) during pregnancy. Methods: A pilot repeated-measures survey was administered four times to a sample of working women across pregnancy using the ERI and DC instruments. Demographic data and blood pressure measurements were collected at each interval. Growth mixture modeling was used to examine trajectories of change in occupational characteristics. Associations with BP were examined using repeated-measures linear regression models. Results: ERI model components (effort, reward, and overcommitment) all declined across pregnancy while job control remained stable. Increasing ERI trajectory was associated with higher systolic BP (b = 8.8; p < 0.001) as was high overcommitment; declining ERI also showed a lesser association with higher BP. Associations between DC trajectories and BP were much smaller, and non-significant once controlled for overcommitment. Conclusions: Self-assessed efforts, rewards, and overcommitment at work decline across pregnancy in our participants, while job control remains stable. Replication in a more diverse pregnant working population is warranted to confirm these results. These preliminary data suggest that further investigation into the factors that may be linked with improved work psychosocial climate during pregnancy may be useful in order to improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objectives To determine frequency of non-compliance with child care regulations among family day care homes (FDCH) and identify the role of income in compliance. Methods We analyzed non-compliance in 746 routine, unannounced inspection and re-inspection reports of FDCH collected by the Connecticut Department of Public Health licensing specialists in 2007-2008 and linked results to median income of zip code data. We grouped the 83 state regulations into 12 regulation categories, analyzed 11 categories, and used latent class analysis to classify each FDCH as high or low compliance for each category. We used logistic regression analysis to estimate the odds ratios of low compliance. Results Among the 746 FDCH inspections (594 first inspections and 152 re-inspections), we found high rates of non-compliance in inspection regulations in immunizations (32.9 %), water temperature (35.6 %) and hazards (30.0 %). Among the 11 regulation categories, 4 categories (indoor safety, emergency preparedness, child/family/staff documentation, and qualifications of provider) had regulations with high non-compliance. Median household income of FDCH zip code was lower for re-inspection sites than for inspection sites ($34,715 vs. $57,118, p < 0.0001) and FDCH in the lowest quartile of income had greater odds of low compliance in indoor safety (OR 1.86, 95 % CI 1.04, 3.35, p < 0.05). Conclusions The majority of FDCH were in compliance with the majority of regulations, yet there are glaring non-compliance issues in inspections and re-inspections and there are income-based inequities that place children at higher risk who are already at high risk for suboptimal health outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the study that determined factors associated with sexting in emerging adult minority men and how sexting is associated with sexual risk. Findings discussed include increased likelihood of participants to sext with casual partners than with steady partners, multiple regression analyses revealed significantly more unprotected vaginal intercourse and oral sex for those who sent sexts to steady partners, and more partners for those who sent sexts to casual partners.

Background Posttraumatic stress disorder (PTSD) is an important and timely clinical issue particularly for combat veterans. Few pharmacologic options are available to treat PTSD, particularly among military personnel, and they are not based on rational neurobiology. The evidence for noradrenergic dysregulation in PTSD is strong, and the alpha-adrenergic agonist prazosin is one of the most promising medications to treat sleep disturbances associated with PTSD as well as PTSD symptoms among both veterans and civilians. Evidence also implicates noradrenergic dysregulation in the pathophysiology of alcohol dependence (AD); prazosin also may have efficacy in treating this disorder. The use of prazosin represents a rational and compelling approach for the treatment of PTSD and comorbid AD. Given the high rates of comorbid AD in trauma survivors with PTSD, and the enormous impact that these comorbid disorders have on psychosocial function and well-being, finding effective treatments for this population is of high clinical importance. Methods Ninety-six veterans with PTSD and comorbid AD were randomized to receive prazosin (16 mg) or placebo in an outpatient, randomized, double-blind, clinical trial for 13 weeks. Main outcomes included symptoms of PTSD, sleep disturbances, and alcohol use. Results Symptoms of PTSD improved over time, but contrary to the hypothesis, there was no medication effect on PTSD symptoms, or on sleep. Alcohol consumption also decreased over time, but there were no significant differences in outcomes between medication groups. Conclusions Prazosin was not effective in treating PTSD symptoms, improving sleep, or reducing alcohol consumption overall in this dually diagnosed group. This does not support the use of prazosin in an actively drinking population and suggests that the presence of a comorbid condition affects the efficacy of this medication. This study highlights the importance of conducting clinical trials in 'real-world' patients, as results may vary based on comorbid conditions. [ABSTRACT FROM AUTHOR]

A father's perception of his role or, how his partner views his role, at mealtimes influences his feeding practices is currently unknown. Therefore, the aim of this study was to evaluate the influence of father-reported maternal and paternal perceptions of the role of the father on child feeding practices, as well as child body weight. Biological fathers of varied racial, ethnic, education, and income backgrounds (n = 150) of preschool age children from a Northeastern state in the United States were interviewed one-on-one using the Role of the Father Questionnaire to assess a father's perception of his role and of his partner's perception of his role in mealtimes and The Child Feeding Questionnaire to assess paternal feeding practices. Height and weight for each father and child were measured. Linear regression was used to examine the relationship between the role of the father, paternal feeding practices and child BMI z-score. Overall, the findings revealed that only the father's perception of his role at mealtimes was associated with higher perceived responsibility for child feeding (β = .033, p = 0.020), and lower use of controlling feeding practices, including pressure to eat (β = −.048, p = 0.029) and restriction (β = −.030, p = 0.05) and was not moderated by the father's appraisal of his partner's perception of his role at mealtimes. Thus, a father's beliefs regarding his role at mealtimes, and not his views of the mother's perception, may be related to his own feeding practices. [ABSTRACT FROM AUTHOR]

We conducted an exploratory research study looking at fathering interactions as they relate to the wraparound care given by the Partnership for Kids or PARK Project, a school-based system of care in Bridgeport, Connecticut. The questions posed by our research focused on how fathers' positive interaction measured by their levels of engagement and accessibility can moderate the effect of the school-based system of care intervention on the mental health outcomes of children with serious emotional disturbances. We found that, although not statistically significant, children's access to their father did have a moderating effect on CBCL scores for internalizing behaviors and total problems. There was very small change in CBCL scores for externalizing behaviors. Further, the moderating effect of father accessibility and father engagement had a lasting effect as a moderator through 12 months into the intervention, especially with regard to internalizing behavior scores. [ABSTRACT FROM AUTHOR]

Human societies are unique in that our behavior is regulated by learned norms and influenced by cultural standards. The present article addresses one of the aspects of how normative culture affects individual's mental life. This study specifically examined the role of norm internalization in cultural consonance and individual psychological flourishing. The data, collected in New England in the winter of 2012, contained measures of individual's (n= 189) knowledge about a cultural model of a good, worthy life, the degree of internalization of the corresponding normative ideas, and self-reported information about each informant's lifestyle and individual mental health status. The results suggest that while stronger internalizers tend to have slightly better levels of psychological flourishing on average, they also suffer greater losses in positive mental health when they think that they are not conforming to the norms embedded in a cultural model. [ABSTRACT FROM PUBLISHER]

Objective The aim of the study is to determine the perceptions of end-of-life care practices and experience with infants who have died in the NICU among neonatologists, advanced practitioners, nurses, and parents, and also to determine perceived areas for improvement and the perceived value of a palliative care team. Study Design This descriptive, exploratory cross-sectional study using surveys consisting of 7-point Likert scales and free response comments was sent to all neonatologists (n = 14), advanced practitioners (n = 40), and nurses (n = 184) at Connecticut Children's Medical Center's neonatal intensive care units (NICUs) in April 2013 and to all parents whose infants died in these NICUs from July 1, 2011, to December 31, 2012 (n = 28). Results The response rates were 64.3% for physicians; 50.0% for practitioners; 40.8% for nurses; and 30.4% for parents. Most providers reported they feel comfortable delivering end-of-life care. Bereavement support, debriefing/closure conferences, and education did not occur routinely. Families stressed the importance of memory making and bereavement/follow-up. Consistent themes of free responses includemodalities for improving end-of-life care, inconsistency of care delivery among providers, and the importance of memory making and follow-up. Conclusion End-of-life experiences in the NICU were perceived as variable and end-oflife practices were, at times, perceived as inconsistent among providers. There are areas for improvement, and participants reported that a formalized palliative care teamcould help. Families desire memory making, follow-up, and bereavement support. [ABSTRACT FROM AUTHOR]

To determine if receiving a prescheduled appointment is associated with an increased likelihood of complying with follow-up eye care among individuals identified as at risk for glaucoma during community-based glaucoma screening in an urban underserved population. This study sampled 362 individuals aged ≥30 years without known glaucoma from low-income, predominantly black/Hispanic neighborhoods in New Haven, Connecticut presenting to one of twelve community-based glaucoma screening events from May 2010 to October 2012. A quasi-experimental design systematically assigned 63 individuals identified as at risk for glaucoma into either intervention or control group with a 1:2 ratio. Individuals in the control group ( n = 41) received counseling on glaucoma and a recommendation for obtaining a follow-up appointment at the eye department of a local community health center, which offers affordable health services with income-adjusted fee discounts to uninsured, low-income patients. Those in the intervention group ( n = 22) received the same counseling and a prescheduled appointment at the community health center. The overall rate of follow-up compliance within 3 months of screening was 30 % (41 % in the intervention group; 24 % in the control group). Multivariate logistic regression analysis adjusting for sex, age, ethnicity, health insurance status, car access, living situation, and smoking status found that follow-up compliance was significantly associated with intervention (adjusted odds ratio 4.8; 95 % confidence interval 1.1-20.9). Providing prescheduled appointments can improve follow-up compliance after community-based glaucoma screening. This finding may be potentially applicable to community-based health screening for other preventable diseases. [ABSTRACT FROM AUTHOR]

A pilot test of clinician-rated validity of scores on a Correction Modified-Global Assessment of Functioning (CM-GAF) scale was performed by assessing a random sample of 60 adult male and female offenders at two correctional facilities. Pairs of trained clinicians assessed the offenders with the CM-GAF and GAF instruments. Regression analyses were conducted. Variables included in the analysis were demographic characteristics (age, gender, and race), criminal history (number of incarcerations, violent/non-violent offense, year of current incarceration), number of disciplinary reports (tickets), and Connecticut Department of Corrections (CDOC) risk scores. The model for the CM-GAF yielded one significant predictor variable, Presence of Pending Charges Risk Score (B = −7.25, p = .003), predicting 44.4% of the variance. This finding suggests that higher functioning offenders tend not to have pending charges, which may be a proxy for length of incarceration. Newly admitted offenders are more likely to have pending charges and more likely to exhibit disruptive and disorganized behaviors. Management of mentally ill persons who are incarcerated is facilitated when inter-professional frontline staff can communicate using a common language. Frequent assessment with an instrument that is understandable across disciplines has the potential to improve care, and as few standardized mental health instruments are modified and tested for use in the prison environment. Additional studies, refining scoring across subsamples by age, race, gender, diagnosis, and levels of security, are still needed. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) victimization and perpetration and power imbalances in parenting partners may result in poor outcomes for parents and children. Previous work in this area has focused on the maternal experiences, neglecting to examine paternal effects. The present study aimed to elucidate the role of IPV, power, and equity in parenting and child outcomes in an urban sample of adolescent parents. 159 male and 182 female parents in a relationship were recruited through university-affiliated hospitals. Power, equity, and IPV were measured at 6 months post-partum and were used as predictors for parenting and child outcomes 12 months post-partum using general estimating equations. Gender interactions and mediation effects of depression were also assessed. Higher perceived relationship equity was related to better infant temperament (B = 0.052, SE = 0.023, p = 0.02) whereas higher partner power was related to poorer social development (B = −0.201, SE = 0.088, p = 0.02) and fine motor development (B = −0.195, SE = 0.078, p = 0.01). IPV victimization was associated with poor infant temperament (B = −2.925, SE = 1.083, p = 0.007) and lower parenting competence (B = −3.508, SE = 1.142, p = 0.002). Depression mediated the relationship between IPV and parenting and IPV and infant temperament. No gender effects were found. IPV, inequities, and power imbalances were disadvantageous for parenting and child outcomes. Our results suggest that these dynamics may negatively affect both males and females. Interventions to reduce violence in both partners and promote equity in relationships could benefit couples and their children. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To examine the effects of a 12-week therapeutic yoga program on gait speed, postural control, and mobility in community-dwelling older adults. Design: Quasi-experimental study with a pretest/post-test design. Researchers evaluated changes over time (pretest to post-test) in all outcome measures. Paired t-tests were used to analyze normal and fast gait speed, Timed Up and Go test, and Timed Up and Go Dual Task. Wilcoxon signed-rank test was used to evaluate scores for the Mini-BESTest (MBT). Setting: Yoga classes were performed at a local senior center. Blind examiners who were previously trained in the outcome measures performed all pretests and post-tests at the site. Participants: Thirteen adults (12 women and 1 man, with a mean age±standard deviation of 72±6.9 years) completed the study. Research participants had minimal to no yoga experience. Interventions: A 12-week, 60-minute, biweekly Kripalu yoga class designed specifically for community-dwelling older adults. Outcome measures: Postural control (MBT), mobility (Timed Up and Go test), and gait speed (normal and fast) were assessed. Results: All 13 participants attended at least 19 of the 24 classes (80% attendance). Statistically significant improvements were seen in the MBT ( p=0.039), normal gait speed ( p=0.015), fast gait speed ( p=0.001), Timed Up and Go test ( p=0.045), and Timed Up and Go Dual-Task ( p=0.05). Conclusions: Improvements in postural control and mobility as measured by the MBT and Timed Up and Go gait as measured by fast gait speed indicate that research participants benefitted from the therapeutic yoga intervention. The yoga program designed for this study included activities in standing, sitting, and lying on the floor and may be effective in improving mobility, postural control, and gait speed in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Little research has been conducted on the prevalence of physical health problems in Cambodian refugees and the relationship between their mental and physical health. We identified the relationship between mental and physical health problems and barriers to healthcare access in Cambodian refugee adults. We used a cross-sectional survey design with a snowball sample of 136 Cambodian refugee adult residents of Connecticut and Western Massachusetts. 61 % reported being diagnosed with three or more physical conditions and 73 % with depression, posttraumatic stress disorder (PTSD) or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1.850 times more physical health problems than those without either condition ( p > .001; CI 1.334-2.566). Age moderated this relationship. Participants who had been diagnosed with both depression and PTSD reported a consistent number of health conditions across the age span while those who had no mental health conditions or only one of the two reported fewer health conditions when they were younger and more when they were older. These two groups were significantly different from the group reporting both. There is a significant relationship between chronic comorbid mental and physical health diseases affecting Cambodian refugees resettled in the US Having comorbid depression and PTSD puts Cambodian refugees at risk for physical health problems no matter their age. It is vital that those treating Cambodian genocide survivors identify and treat their prevalent comorbid health conditions. Language and transportation barriers must be addressed to improve access to mental and physical health care in this population. [ABSTRACT FROM AUTHOR]

Background:Nasal intermittent positive pressure ventilation (NIPPV) is becoming more important as a mode of ventilation in premature neonates predisposed to development of bronchopulmonary dysplasia (BPD). To the best of our knowledge, there have been no detailed studies characterizing neonates who fail NIPPV.Objective:To determine the differences between neonates who are successfully extubated to NIPPV and those who require re-intubation from NIPPV, and the impact of timing of NIPPV failure on BPD rates.Study Design:This was a retrospective cohort study in which we included infants with gestational age (GA) ⩽28 weeks and birth weight ⩽1000 g. χ2-test, analysis of variance and multivariate logistic regression models were used.Results:Two hundred and forty infants were studied; 180 failed NIPPV and of those, 33 (18%), 39 (22%) and 108 (60%) failed NIPPV within 0 to 6 h, ⩾6 to 24 h and ⩾24 h, respectively. Female sex and increased weight were protective against NIPPV failure (adjusted odds ratio (95% confidence interval): 0.28 (0.14 to 0.58), 0.04 (0.01 to 0.22)). Increased GA at extubation and female sex were both associated with increased time to failure (P=0.008, <0.001, respectively). Apnea was more likely the cause for failure ⩾24 h (P=0.015), whereas increased work of breathing/fraction of inspired oxygen requirements were more significant when NIPPV failure occurred earlier (P=0.001). Neonates who failed NIPPV within 24 h did not have any association with likelihood of developing BPD or severity of BPD, after adjusting for confounding variables.Conclusion:Significant differences in neonatal characteristics may help identify which neonates are more likely to fail NIPPV, and their timing of failure. [ABSTRACT FROM AUTHOR]

Despite new Hepatitis C virus (HCV) therapeutic advances, challenges remain for HCV testing and linking patients to care. A point-of-care (POC) HCV antibody testing strategy was compared to traditional serological testing to determine patient preferences for type of testing and linkage to treatment in an innovative mobile medical clinic (MMC). From 2012 to 2013, all 1,345 MMC clients in New Haven, CT underwent a routine health assessment, including for HCV. Based on patient preferences, clients could select between standard phlebotomy or POC HCV testing, with results available in approximately 1 week versus 20 min, respectively. Outcomes included: (1) accepting HCV testing; (2) preference for rapid POC HCV testing; and (3) linkage to HCV care. All clients with reactive test results were referred to a HCV specialty clinic. Among the 438 (32.6 %) clients accepting HCV testing, HCV prevalence was 6.2 % (N = 27), and 209 (47.7 %) preferred POC testing. Significant correlates of accepting HCV testing was lower for the 'baby boomer' generation (AOR 0.67; 95 % CI 0.46-0.97) and white race (AOR 0.55; 95 % CI 0.36-0.78) and higher for having had a prior STI diagnosis (AOR 5.03; 95 % CI 1.76-14.26), prior injection drug use (AOR 2.21; 95 % CI 1.12-4.46), and being US-born (AOR 1.76; 95 % CI 1.25-2.46). Those diagnosed with HCV and preferring POC testing (N = 16) were significantly more likely than those choosing standard testing (N = 11) to be linked to HCV care within 30 days (93.8 vs. 18.2 %; p < 0.0001). HCV testing is feasible in MMCs. While patients equally preferred POC and standard HCV testing strategies, HCV-infected patients choosing POC testing were significantly more likely to be linked to HCV treatment. Important differences in risk and background were associated with type of HCV testing strategy selected. HCV testing strategies should be balanced based on costs, convenience, and ability to link to HCV treatment. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article related to decreasing predominance of breast cancer on left side, in the previous issue.