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Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in practice, academic faculty have often experienced these 3 missions as competing rather than complementary priorities. This siloed approach has interfered with innovation as a learning health system in which the tripartite missions reinforce each other in practical ways. This paper presents a longitudinal case example of harmonizing academic missions in a large family medicine department so that missions and people interact in mutually beneficial ways to create value for patients, learners, and faculty. We describe specific experiences, implementation, and examples of harmonizing missions as a feasible strategy and culture. 'Harmonized' means that no one mission subordinates or drives out the others; each mission informs and strengthens the others (quickly in practice) while faculty experience the triparate mission as a coherent whole faculty job. Because an academic department is a complex system of work and relationships, concepts for leading a complex adaptive system were employed: (1) a 'good enough' vision, (2) frequent and productive interactions, and (3) a few simple rules. These helped people harmonize their work without telling them exactly what to do, when, and how. Our goal here is to highlight concrete examples of harmonizing missions as a feasible operating method, suggesting ways it builds a foundation for a learning health system and potentially improving faculty well-being. https://doi.org/10.1370/afm.3108, INTRODUCTION Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in l practice, carrying out this tripartite mission [...]

Background: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities. Methods: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities. Results: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White. Conclusions: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities. [ABSTRACT FROM AUTHOR]

Family functioning, family resilience, family health, and family flourishing are concepts used in research across multiple fields. One challenge of their interdisciplinary use is that there are a variety of definitions of each, with researchers sometimes creating their own definitions rather than using well‐established definitions. This can lead to different conceptualization of the same concept across studies. It is, therefore, necessary to develop a conceptual framework to understand the interplay between each of these family concepts, including their differences and overlap, to inform research, practice, and policy. In this article, we present the definitions, concepts, and common measurements of each concept. Based on the examination of the literature, we propose a conceptual framework of family well‐being that demonstrates the interplay of these concepts. We present empirical findings to understand how well some common measures differentiate between each other. Finally, we discuss the implications for research and practice. [ABSTRACT FROM AUTHOR]

This cross-sectional analysis of the Minnesota Now Everybody Together for Amazing Healthful Kids (NET-Works) study evaluated whether SNAP participation was associated with specific parental feeding styles and child eating behaviors. Associations between parent-reported feeding styles and child eating behaviors and SNAP participation were examined using multiple linear regression analyses and responses from 534 parent/child dyads (49.1% female children, 91.7% female parents). SNAP participation was not associated with specific feeding styles or child eating behaviors when adjusting for food insecurity, timing in SNAP cycle, and other covariates in this large, ethnically and racially diverse sample of predominantly mothers and preschool-aged children. Other factors, such as food insecurity, not SNAP participation, may influence parental feeding and child eating behaviors, and screening by health care providers is recommended. [ABSTRACT FROM AUTHOR]

Objective Background Method Results Conclusion Implications The objective of this study was to examine the variability of child health and psychosocial outcomes in the context of maternal role overload and maternal depression.Role overload, characterized as time‐based role stress, is commonly linked to depression in mothers. However, it remains uncertain whether maternal role overload poses a risk for negative child health and wellness. Although maternal depression is a known risk factor for poor child health and psychosocial outcomes, the outcomes themselves often reveal variability.This study aimed to investigate the heterogeneity of child health and psychosocial outcomes using latent profile analyses. Multinomial logistic regression analyses were conducted to examine differences in profile membership based on the child's experiences of maternal role overload and depression. Data were from 1,172 mother–child dyads from the Family Matters study.The analyses unveiled four distinct profiles (i.e., moderate health/psychosocial wellness, poor health/moderate psychosocial wellness, struggling health/poor psychosocial wellness, thriving health/psychosocial wellness), each associated with varying levels of health and psychosocial wellness. Both maternal role overload and depression were found to heighten the risk of poor health and psychosocial wellness in children.Children with struggling and poor health and psychosocial outcomes had higher odds of maternal depression and maternal role overload than children in the thriving profile. These findings suggest that maternal role overload is a potential risk to child health and psychosocial outcomes.These findings emphasize the importance of continuous depression screening in mothers and the implementation of solution‐focused interventions targeting maternal role overload. [ABSTRACT FROM AUTHOR]

Objective: Social determinants of health (SDoH), such as food and financial insecurity and food assistance, are potentially modifiable factors that may influence breastfeeding initiation and duration. Knowledge gaps exist regarding the relationship between these SDoH and infant feeding practices. We explored the relationships of food and financial insecurity and food assistance with the continuation of breastfeeding at four months postpartum among mothers and whether race and ethnicity modified these associations., Design: Mothers retrospectively reported food and financial insecurity and receipt of food assistance (e.g. Women, Infants and Children and Supplemental Nutrition Assistance Program) during pregnancy with their first child and infant feeding practices (exclusive/mostly breastfeeding v . exclusive/mostly formula feeding) following the birth of their first child. Sociodemographic-adjusted modified Poisson regressions estimated prevalence ratios and 95 % CI., Setting: Minneapolis-St. Paul, Minnesota., Participants: Mothers who participated in the Life-course Experiences And Pregnancy study (LEAP) ( n 486)., Results: Ten percent of mothers reported food insecurity, 43 % financial insecurity and 22 % food assistance during their pregnancies. At four months postpartum, 63 % exclusively/mostly breastfed and 37 % exclusively/mostly formula-fed. We found a lower adjusted prevalence of breastfeeding at four months postpartum for mothers who reported experiencing food insecurity (0·65; 0·43-0·98) and receiving food assistance (0·66; 0·94-0·88) relative to those who did not. For financial insecurity (aPR 0·92; 0·78, 1·08), adjusted estimates showed little evidence of an association., Conclusions: We found a lower level of breastfeeding among mothers experiencing food insecurity and using food assistance. Resources to support longer breastfeeding duration for mothers are needed. Moreover, facilitators, barriers and mechanisms of breastfeeding initiation and duration must be identified.

Introduction: Past research shows that structural racism contributes to disparities in cardiometabolic health among racially/ethnically minoritized populations., Methods: This cross-sectional study examined the correlation between census tract-level racialized economic segregation and child health metrics among a racially and ethnically diverse cohort of 350 children (ages 6.5-13.8) from Minneapolis-St. Paul, MN., Results: A consistent cardiometabolic and cortisol outcome gradient was observed across the index of concentration at the extremes tertiles, such that health risk factors increased as tract privilege decreased., Conclusion: Racialized economic segregation was associated with less favorable child health outcomes, underscoring the potential importance of place-based interventions for promoting children's health., (© Christopher P. Carr et al., 2024; Published by Mary Ann Liebert, Inc.)

Background: The COVID-19 pandemic and the subsequent need for social distancing required the immediate pivoting of research modalities. Research that had previously been conducted in person had to pivot to remote data collection. Researchers had to develop data collection protocols that could be conducted remotely with limited or no evidence to guide the process. Therefore, the use of web-based platforms to conduct real-time research visits surged despite the lack of evidence backing these novel approaches., Objective: This paper aims to review the remote or virtual research protocols that have been used in the past 10 years, gather existing best practices, and propose recommendations for continuing to use virtual real-time methods when appropriate., Methods: Articles (n=22) published from 2013 to June 2023 were reviewed and analyzed to understand how researchers conducted virtual research that implemented real-time protocols. "Real-time" was defined as data collection with a participant through a live medium where a participant and research staff could talk to each other back and forth in the moment. We excluded studies for the following reasons: (1) studies that collected participant or patient measures for the sole purpose of engaging in a clinical encounter; (2) studies that solely conducted qualitative interview data collection; (3) studies that conducted virtual data collection such as surveys or self-report measures that had no interaction with research staff; (4) studies that described research interventions but did not involve the collection of data through a web-based platform; (5) studies that were reviews or not original research; (6) studies that described research protocols and did not include actual data collection; and (7) studies that did not collect data in real time, focused on telehealth or telemedicine, and were exclusively intended for medical and not research purposes., Results: Findings from studies conducted both before and during the COVID-19 pandemic suggest that many types of data can be collected virtually in real time. Results and best practice recommendations from the current protocol review will be used in the design and implementation of a substudy to provide more evidence for virtual real-time data collection over the next year., Conclusions: Our findings suggest that virtual real-time visits are doable across a range of participant populations and can answer a range of research questions. Recommended best practices for virtual real-time data collection include (1) providing adequate equipment for real-time data collection, (2) creating protocols and materials for research staff to facilitate or guide participants through data collection, (3) piloting data collection, (4) iteratively accepting feedback, and (5) providing instructions in multiple forms. The implementation of these best practices and recommendations for future research are further discussed in the paper., International Registered Report Identifier (irrid): DERR1-10.2196/53790., (©Jasmin Sanchez, Amanda Trofholz, Jerica M Berge. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 14.05.2024.)

Background: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data., Objective: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence., Methods: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question "Overall, how difficult was it for you to fill out the surveys today?" on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden., Results: The burden was low at 1.2 (SD 1.14) indicating "a little" burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English-speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (β=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence., Conclusions: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives., (©Allan D Tate, Angela R Fertig, Junia N de Brito, Émilie M Ellis, Christopher Patrick Carr, Amanda Trofholz, Jerica M Berge. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.04.2024.)

Introduction: Studies in the United States have shown associations between family/shared meal frequency and child health and well-being. Less is known about family/shared meal characteristics (e.g., frequency, meal type, meal activities) in adults and international samples and whether there are protective associations between family/shared meal frequency and emotional well-being. Also unknown, is whether family meals provide protective associations for other family members in the household., Method: In a 2022 cross-sectional study, an online survey was administered in the United States, Italy, and Germany. One adult respondent (49.5% female; Mage = 45.6) from each household ( n = 1,983) reported on family/shared meals and well-being. A second family member (e.g., partner, child) responded in a subset of households ( n = 1,915). Descriptive statistics by country, Spearman correlations between meal frequency and well-being, and Kruskal-Wallis comparisons of mood indicators across countries were run., Results: The majority of adults across countries engaged in six or more family/shared meals per week, with more meals on weekends. Breakfast, lunch, and dinner family/shared meals were more common on weekends, and European countries reported engaging in a higher prevalence of all meal types. Higher frequency of family/shared meals was significantly correlated with fewer depressive symptoms, more connectedness, and higher levels of happiness in adults across countries and in a second household member., Discussion: Family/shared meals were beneficial across an international sample and may provide protective spillover effects for multiple household members. Clinicians and researchers who work with families may want to consider assessing for and intervening on family meal frequency. (PsycInfo Database Record (c) 2024 APA, all rights reserved).