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BACKGROUND Hypertension management of priority populations (e.g., African American/Black) in primary care is highly relevant. However, evidence on whether or how data-driven approaches can help to improve hypertension management in primary care remains scarce. OBJECTIVE This review aims to examine data-driven approaches aiming to improve hypertension management in priority populations, specifically to 1) identify and categorize the different kinds of interventions or approaches that exist and 2) to identify how data inform these approaches. METHODS A search strategy based on the PICO guidelines was utilized to query and identify peer-review articles on the Web of Science and PubMed databases. The search strategy was based on terms related to priority populations, hypertension, primary care, and data-driven interventions. Articles were excluded if the focus was not hypertension management in priority populations or if there was no mention of data utilization. RESULTS A total of 26 articles were included in this analysis. In all of these studies, the data-driven approaches were based on the electronic health record (EHR). The EHR was used to identify patients (n=26), drive the intervention (n=19), and monitor results and outcomes (n=14). Most often, data-driven approaches were used for health coaching interventions, disease management programs (DMPs), and clinical decision support systems (CDS) like best practice alerts (BPA). However, out of 8 data-driven health coaching interventions, only 4 have been reporting significant results. In contrast, all included studies related to DMPs and CDS/BPA applications reported some significant results with respect to improving hypertension management. CONCLUSIONS In primary care, data-driven approaches can meaningfully contribute to improving cardiovascular health conditions, including hypertension in priority populations. However, to date, there is no unified concept of what exactly “data-driven” means and how data-driven approaches can be systematically implemented in healthcare. Instead, data-driven aspects are included in a wide variety of health interventions, including target health coaching, DMPs, or BPAs. Future research should address this gap and, in particular, systematize the application of clinical routine data (EHR data) for data-driven approaches to improve the quality of care. CLINICALTRIAL None

OBJECTIVES: Sensitive parenting requires modulation of emotions in order to effectively organize and orient behavioral responses. There is considerable evidence that psychological distress can impair sensitive parenting practices, and also that psychological distress is associated with deficits in emotion regulation capacities. The negative effect that psychological distress has on parents’ emotion regulation capacities may be a mechanistic pathway through which psychological distress impacts parenting, as dysregulated emotions may be more proximal to parenting behaviors than distress itself; however, this specific link between psychological distress, emotion regulation, and parenting is not often examined in parenting models. METHODS: The current study tested these relations in a high sociodemographic risk community-sample, oversampled for violence exposure, of caregivers of preschoolers. Caregivers self-reported on their psychological distress and emotion regulation difficulties. Parent sensitivity was assessed via observations of parent-child interactions. RESULTS: Results indicated that difficulties in emotion regulation were a mediator for the relation between parents’ psychological distress and sensitive parenting behaviors. Difficulties in emotion regulation predicted decreased sensitivity above and beyond the effect of psychological distress. CONCLUSIONS: These findings emphasize the importance of regulation of emotional reactions in order to orient and engage in sensitive parenting behaviors. Additionally, they suggest clinically that supporting parents’ emotion regulation capacities specifically may promote more sensitive parenting in contexts of parental psychological distress.

Utilizing a two-dimension model of parenting emphasizing both 1) proximity-seeking and 2) exploration, consistent with a conceptual framework rooted in attachment theory, the relations between parental insightfulness, observed parenting, and child cognitive outcomes were investigated in a low-income sample of 64 of caregivers and their young 3- to 5-year-old children. Specifically, observed parental sensitivity (proximity-seeking) and intrusiveness (exploration) and parental insightfulness assessed dimensionally to capture Positive Insight and Focus on Child were examined in relation to child cognitive outcomes. Parental intrusiveness was negatively correlated with cognitive performance; however, parental sensitivity was not associated with child cognitive outcomes. Parents’ capacity to remain child-focused during the Insightfulness Assessment was negatively correlated with observed intrusiveness and was associated with child cognitive performance. These results suggest unique contributions of dimensions of parental insightfulness and parenting behaviors to child cognitive outcomes – specifically, parents’ capacity to remain focused on children’s experience during the Insightfulness Assessment and non-intrusive parenting behavior, which may reflect strategies to support children’s exploration.

Background: The Center for Disease Control recommends case management begin at a blood lead level of 5 μg/dL, yet Indiana does not take action until a blood lead level of 10 μg/dL. Low levels of lead can cause irreversible neurological damage in children. The goal of this study was to design a scalable, low-cost Home Lead Test Kit to proactively find lead in homes. Methods: Individuals were recruited through community partnerships, community lead testing events, and flyers. Qualitative data was recorded during home visits as participants used the kit. An x-ray fluorescence analyzer was used in the field and laboratory to analyze lead levels of samples. Results were blinded during the analysis. Results: To date, 40 homes have been recruited, and 20 have been completed. The average completion time of the kit was 23.45 minutes. Of the 8 pre-1950 homes 100% had elevated lead results, of the 7 1950-1978 homes 43% had elevated lead results, and of the 5 post 1978 homes 0% had elevated lead results. Conclusion and Potential Impact: The study is ongoing. Preliminary results support the hypothesis that pre-1950 homes have a high risk of lead exposure, and post 1978 homes have minimal to no levels of lead. Feedback from study participants regarding kit usability has been positive. Future plans are to produce a kit to be scaled up in St. Joseph County with the goal of a statewide model. This kit may allow citizens to identify lead hazards to prevent children from lead exposure.

To evaluate the methodologic quality of the evidence for the use of spinal manipulative therapy (SMT) with and without other therapies in the management of chronic obstructive pulmonary disease (COPD).A systematic review of the literature.Any participant of a primary research study that investigated the effect of SMT on COPD. Only studies with participants older than age 18 years with an existing diagnosis of COPD were included.Interventions included any form of high-velocity, low-amplitude spinal manipulation with or without other forms of manual therapy, exercise, and/or pharmacologic intervention.Six-minute walking test, forced expiratory volume in 1 second, forced vital capacity, residual volume, total lung capacity, Chronic Respiratory Questionnaire, St George's Respiratory Questionnaire, and the Hospital Anxiety and Depression Scale.Six articles met all of the inclusion criteria and were included in the review: three randomized controlled trials (RCTs), one pre-post observational study, one case series, and one single case study. Sample sizes varied from 1 to 33 participants ranging in age from 55 to 85 years. Risk of bias was low for the three RCTs and high for the other studies. All three RCTs used SMT in conjunction with exercise from a pulmonary rehabilitation program. Five of the six studies reported improvements in lung function and exercise performance following SMT intervention.This review provides a methodologic evaluation of the evidence for using SMT with and without other therapies in the management of COPD. While the quality of the evidence provided by three RCTs was high, they were all conducted on small sample sizes. These results highlight the need for further research into the use of SMT in conjunction with exercise on people with COPD.

This study employed a relational post-traumatic stress frame to explore the co-contribution of young children’s exposure to violence and caregiver insightfulness on child behavioral outcomes in a high-risk, non-referred sample of caregivers and preschoolers (n = 64; mean age 3.83 years, SD = .77). Caregiver insightfulness did not have a main effect on child outcomes but did moderate the relation between violence exposure and child behavior across all observed outcomes. Violence-exposed children with non-insightful caregivers demonstrated higher caregiver-rated internalizing and externalizing behaviors and observer-rated negative affect than all other groups. Among children not exposed to violence, insightfulness was not related to children’s behavior problems or negative affect, suggesting violence-specific processes. Though cross-sectional, results suggest that the effects of violence and caregiver insightfulness on child outcomes are contingent on one another and that caregiver insightfulness may play a protective role in contexts of violence.

High-resolution micro computed tomography has enabled measurement of bone architecture derived from 3D representations of cancellous bone. Twenty-eight vertebral bodies were obtained from four embalmed male cadavers. From 3D anaglyphs, trabecular rod thickness and length were measured and the trabecular rod Buckling index was calculated. From 3D voxel-based datasets, bone volume density, trabecular thickness, and trabecular separation were measured. Also, trabecular bone pattern factor, structural model index, connectivity density, and degree of anisotropy were calculated. Bone volume density alone explains 59% of the variability in trabecular rod Buckling index. The addition of connectivity density, trabecular separation, and structural model index, in a multiple regression statistical model, improves the explanatory power to 77%. The relationships between measures of cancellous bone architecture and a derived measure of trabecular rod strength were investigated. Morphological descriptors of cancellous bone provide a composite explanatory model of trabecular rod strength.

The Face-to-Face Still-Face paradigm (FFSF) has been used to investigate how infants react to stressful events. However, there is little developmental data on the FFSF effect, and whether it connects to a specific relationship (e.g., to a mother versus a stranger). This prospective longitudinal study aims to evaluate developmental changes in infant reaction to the FFSF presented by the mother or a stranger at 2, 4, 6, and 8 months of age (n=39). Results show that infant negativity was expressed less in relation to a stranger, the identity effect. Results further suggest that from 6 to 8 months of age, stranger induced protest flattens out; whereas mother induced protest decreases. The results are discussed in relation to different theories regarding infant responsiveness.

It is well-established that household and neighbourhood disadvantage and migrant background impact on children's cognitive, developmental and health outcomes. While participation in early childhood services and programs can mitigate the effects of such multiple disadvantages, there are barriers for families in accessing services, including local circumstances and the perceived risks of contact with services and programs. In this paper, we discuss data collected in a study that explored a supported playgroup initiative targeting parents and children from non-English-speaking backgrounds. The findings offer insights into the barriers that migrant-background families experience in accessing early childhood services and effective strategies for engaging and sustaining families within early childhood settings.