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Background: The North Carolina Community Research Partnership developed, implemented, and tested "weCare," a 12-month bilingual mHealth social media intervention designed to reduce missed HIV care appointments and increase viral suppression among racially/ethnically diverse gay, bisexual, and other men who have sex with men (GBMSM) and transgender women living with HIV by harnessing established social media platforms (i.e., Facebook, texting, and dating apps). Methods: We randomized 198 GBMSM and transgender women (mean age = 26) living with HIV to the "weCare" intervention (n = 100) or usual-care (n = 98) group. Inclusion criteria included being newly diagnosed or not in care. Participants completed structured assessments at baseline and 6-month postintervention follow-up (18 months after baseline data collection). HIV care appointment and viral load data were abstracted from each participant's electronic health record at baseline and follow-up. Follow-up retention was 85.5%. Results: Among participants, 94% self-identified as cisgender men, 6% as transgender, 64% as African American/Black, and 13% as Latine. Participants in both groups significantly reduced missed HIV care appointments and increased viral suppression at follow-up compared with baseline. However, there were no significant differences between weCare and usual-care participants for either outcome at follow-up. Conclusions: An intervention effect was not identified for our two primary outcomes. Several factors may have influenced the lack of significant differences between "weCare" and usual-care participants at follow-up, including intervention implementation (e.g., staffing changes and lack of fidelity to the intervention as originally designed by the partnership), data collection (e.g., data collection time points and retention strategies), and clinical (e.g., contamination) factors.

THE INNOVATION Based on safety and efficacy, mifepristone and misoprostol together remain the standard for medical management of early pregnancy loss (EPL) and first trimester abortion. (1,2) While misoprostol is [...]

Previous suicide attempts, psychopathology symptoms, and pain significantly increase risk of suicide, a leading cause of death. It is possible that patients across these three groups exhibit key differences that could provide insights into unique interventions for suicide-related outcomes. Data were collected using a standardized form at 432 emergency departments (EDs; 14,018 participants [females, n = 8,042; 57.4%; males, n = 5,976; 42.6%]). We conducted a series of ANOVAs to investigate if patients presenting for (1) suicide attempts (n = 33; 0.2%), (2) psychopathology symptoms (n = 1,104; 7.9%), or (3) pain (n = 12,881; 91.9%) varied across a variety of healthcare-relevant variables. Findings indicated that patients presenting with suicide attempts were seen with more urgency (F[2,12054] = 66.41, p <.001) and were more likely to be admitted to hospitalization (F[2,14015] = 187.296, p <.001), observation unit overall (F[2,14015] = 78.572, p <.001), or transferred to another hospital (F[2,14015] = 406.568, p <.001); they also required longer visits (F [2, 12054] = 66.41, p <.001) as compared to patients with psychopathology symptoms or pain. Notably, potentially important similarities between groups emerged: groups did not differ across leaving without medical screening, leaving against medical advice, or contact with healthcare providers in the long-term (i.e., twelve months) or short-term (i.e., 72 hours) preceding ED admission. These findings in particular indicate that there could be ample time (1) prior to admission to intervene and (2) during care in EDs to connect patients to goal-oriented, time-limited evidence based psychotherapies at a time when they may be particularly willing to engage in care. [ABSTRACT FROM AUTHOR]

Background and ObjectivesDesignMethodsResultsConclusionsSuicidal ideation (SI) during the postpartum phase is linked with suicide, a leading cause of death during this period. Antenatal depression and anxiety symptoms have both been linked with increased risk for postpartum SI. However, research aimed at examining the relative contributions of antenatal anxiety and depression symptoms towards postpartum SI remains nascent. In this study, we investigated the relative contribution of antenatal anxiety symptoms, depression symptoms, and SI towards postpartum SI.These data are from a longitudinal study in which American mothers were assessed during pregnancy and again at six- to eight weeks postpartum.Data were analyzed using correlations and logistic regression models.Antenatal anxiety symptoms and antenatal depression symptoms were significantly correlated with postpartum SI. Results from a logistic regression model indicated that antenatal anxiety symptoms (T1; OR = 1.185 [1.125, 1.245], p = .004), but not antenatal depression symptoms (T1; OR = 1.018 [0.943, 1.093], p = .812) or antenatal SI (T1; OR = 1.58 [0.11, 22.29], p = 0.73), were significantly associated with postpartum SI.Antenatal anxiety symptoms, depression symptoms, and SI were positively associated with postpartum SI. When examined simultaneously, anxiety symptoms during the antenatal phase (but not depression symptoms or SI) predicted SI in the postpartum phase. [ABSTRACT FROM AUTHOR]

Traumatic events are a serious public health concern, linked cross-sectionally and longitudinally with post-traumatic stress disorder (PTSD) and suicidal ideation (SI). While much research has focused on broadly defined traumatic events as they relate to PTSD and SI, fewer projects have investigated the disparate associations that specific traumatic events have with PTSD and SI. In this study of 1,829 adolescents held at the Cook County Juvenile Temporary Detention Center (measured during adolescence and again nine years later during adulthood), the cross-sectional and prospective links between various traumatic events (i.e. being physically assaulted, threatened with a weapon, sexually assaulted, in a serious accident, seeing someone be killed, experiencing a natural disaster, seeing a dead body, or being forced to fight), PTSD symptoms, and SI were investigated. Findings indicate that every traumatic event endorsed at baseline was cross-sectionally associated with increased PTSD symptoms and SI. Experiencing sexual assault or a serious accident during adolescence predicted greater SI at follow-up. Moreover, the positive association between PTSD symptoms at baseline and SI at follow-up was stronger among individuals who experienced sexual assault or a serious accident versus those who were not trauma exposed. Implications for justice-involved adolescents are discussed. [ABSTRACT FROM AUTHOR]

For 5 years, our family medicine clinic's physician-pharmacy team managed anticoagulation onsite. Now, against our recommendations and desires as a clinic, anticoagulation at our site is no longer managed by our local interdisciplinary team. Instead, it is being managed by our system's centralized anticoagulation team. Although some may point out that anticoagulation management is one small element of our practice, we believe eliminating this could open the door to other changes to our scope of practice. Anticoagulation belongs in primary care where comprehensive care, ongoing relationships between patients and care teams, and flexible office visit agendas optimize this service. Key words: anticoagulation; family practice; patient-centered care; patient care team; integrated health care delivery, Management of anticoagulation belongs in primary care. Family medicine physicians and pharmacists provide comprehensive, whole-person care. Family physicians are dedicated to the whole person and serve as guides to define [...]