Search

Rationale & Objective: Peritoneal dialysis (PD) is a home-based kidney replacement therapy used by a growing number of patients with kidney failure. This qualitative study explores the impact of remote management technologies on PD treatment priorities of patients, their care partners, and clinicians. Study Design: Qualitative study, designed and conducted in collaboration with a stakeholder panel that included patients, patient advocates, care partners, and health care professionals. Setting & Participants: 13 health care providers, 13 patients, and 4 care partners with at least 3 months experience with PD were recruited from the United States and United Kingdom through postings in PD clinics, websites, and social media. Methodology: Semi-structured telephone interviews with a purposive sample of participants. Analytical Approach: Inductive thematic development adapted from a grounded theory approach through analysis of interview transcripts by 3 independent coders. Results: 4 main themes about PD treatments emerged that enabled evaluation of remote management: (1) impact of PD on everyday life, (2) simplifying treatment processes, (3) awareness and visibility of at-home treatments, and (4) support for managing treatments. The relative importance of these themes differed between patients/care partners and health care providers and by use of remote management cyclers. Limitations: Remote management is new to PD, mirrored in the limited penetration of use in the study sample, suggestive of findings reflecting early adoption. Conclusions: Participants welcomed technological advances such as remote management for PD, although priorities differed by stakeholder group. Remote management could potentially influence health care provider decisions about patient suitability for PD, while patients/care partners prioritized pre-emptive and early treatment adjustments. Currently, decisions about access to remote management are outside the control of patients and families, but this may change with more widespread use. Index Words: Peritoneal dialysis, remote management, qualitative, patient-centered reporting

Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.

Background: Persistent racial disparities in breastfeeding show that African American women breastfeed at the lowest rates. Return to work is a critical breastfeeding barrier for African American women who return to work sooner than other ethnic groups and more often encounter unsupportive work environments. They also face psychosocial burdens that make breastfeeding at work uniquely challenging. Participants share personal struggles with combining paid employment and breastfeeding and suggest workplace and personal support strategies that they believe will help continue breastfeeding after a return to work. Objective: To explore current perspectives on ways to support African American mothers’ workplace breastfeeding behavior. Methods: Pregnant African American women (n = 8), African American mothers of infants (n = 21), and lactation support providers (n = 9) participated in 1 of 6 focus groups in the Greater Detroit area. Each focus group audiotape was transcribed verbatim. Thematic analysis was used to inductively analyze focus group transcripts and field notes. Focus groups explored thoughts, perceptions, and behavior on interventions to support African American women’s breastfeeding. Results: Participants indicate that they generally believed breastfeeding was a healthy option for the baby; however, paid employment is a critical barrier to successful breastfeeding for which mothers receive little help. Participants felt breastfeeding interventions that support working African American mothers should include education and training for health care professionals, regulation and enforcement of workplace breastfeeding support policies, and support from peers who act as breastfeeding role models. Conclusion: Culturally appropriate interventions are needed to support breastfeeding among working African American women.

Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.

State- and local-level mental health administrators and practitioners can work collaboratively to provide effective early childhood mental health consultation (ECMHC) services that address the growing need in communities to promote healthy socioemotional functioning in infants and young children and prevent longer term mental health challenges. This article describes one state's model of ECMHC, the Child Care Expulsion Prevention Program (CCEP), as well as preliminary evaluation findings on consultants' fidelity to the developed approach to service within 31 counties in Michigan. The CCEP approach is flexible, yet adheres to six cornerstones which are essential to effectively and consistently carrying out services across local projects, including the provision of relationship-based programmatic and child/family-centered consultation, hiring and supporting high-quality consultants through professional development and reflective supervision, ongoing provision of state-level technical assistance, use of evidence-based practices, and collaboration with other early childhood service providers. In addition to the overview of CCEP's approach and effectiveness, lessons learned are provided to guide those engaged in policy development, practice, and applied research pertaining to ECMHC. Abstracts translated in Spanish, French, German, and Japanese can be found on the abstract page of each article on Wiley Online Library at http://wileyonlinelibrary.com/journal/imhj.

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA‐supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers and the analysts of this program discuss its development, its content, and the results of its evaluation.

Women who experienced abuse or neglect as children are more likely to have health problems during pregnancy and postpartum, but can be reluctant to seek help due to a lack of trauma-informed services. As part of a larger mixed method study, this component aimed to obtain qualitative data from trauma-exposed new mothers about their health care preferences during the perinatal period with the ultimate goal to design personalized, supportive interventions. Fifty-two trauma-exposed mothers completed a semi-structured interview at seven months postpartum about health care preferences including ideas for programs that promote wellness, thoughts about the influences of being a new mother and possible names for a program serving trauma-exposed mothers. Interviews were transcribed and coded using N-Vivo. Participants described ambivalence about seeking help but also a sincere desire for healing, coupled with hope for the future. This tension was apparent in the discussions highlighting the importance of access to experienced, nonjudgmental, and knowledgeable health and social care staff and volunteers, the wish for both formal, integrated physical and mental health services, and for informal opportunities to meet other trauma-exposed mothers in a non-stigmatizing, child-friendly setting. Finally, positive relationship-building, respect, and safety were identified as key elements of services critical to counteract trauma-related shame and mistrust in others. Services for trauma-exposed mothers should acknowledge the normal ambivalence surrounding seeking help, but promote hope-affirming practices in a family-centered, safe, non-clinical setting that involves children, builds social support, and provides peer interaction. Program names should reflect optimism and healing rather than trauma.

Assessing the value of clinical and translational research funding on accelerating the translation of scientific knowledge is a fundamental issue faced by the National Institutes of Health (NIH) and its Clinical and Translational Awards (CTSAs). To address this issue, the authors propose a model for measuring the return on investment (ROI) of one key CTSA program, the clinical research unit (CRU). By estimating the economic and social inputs and outputs of this program, this model produces multiple levels of ROI: investigator, program, and institutional estimates. A methodology, or evaluation protocol, is proposed to assess the value of this CTSA function, with specific objectives, methods, descriptions of the data to be collected, and how data are to be filtered, analyzed, and evaluated. This article provides an approach CTSAs could use to assess the economic and social returns on NIH and institutional investments in these critical activities.

Young people who transition from the foster care system face many challenges including lack of support and other educational barriers. They are less likely to graduate from high school than their counterparts and go on to college yet despite challenges, many succeed and take advantage of higher education programs. In Michigan, a state with one of the highest percentage of youth in foster care, Michigan State University developed a small scale, targeted intervention to help transitioning foster youth achieve their goals of pursuing higher education. Led by the School of Social Work in collaboration with other colleges and disciplines, it was demonstrated that a campus based learning program for transitioning foster youth can help contribute toward a perceived increase in knowledge and information about college life, funding and admissions procedures. The educational process involved peer support, role modeling, mentoring and active learning sessions led by the faculty and students who were often foster care alumni themselves. Leaders and speakers came from a range of disciplines, institutions and organizations. This approach and curriculum contributed to perceptions of the camp as enhancing life skills, self-concept, empowerment and sense of purpose. Consequently, this program contributed to the resilience of those who attended and potentially helped build steps from care to higher education.

Background In high risk, economically disadvantaged neighbourhoods, such as those primarily resident by black and minority ethnic groups (BME), teenage pregnancies are relatively more frequent. Such families often have limited access to and/or knowledge of services, including prenatal and post-partum physical and mental health support. Objective To explore preferences held by vulnerable young mothers of BME origin and those close to them about existing and desired perinatal health services. Design, setting and participants Drawing on a community-based participatory approach, a community steering committee with local knowledge and experience of teenage parenthood shaped and managed an exploratory qualitative study. In collaboration with a local agency and academic research staff, community research assistants conducted two focus groups with 19 members and 21 individual semi-structured interviews with young mothers of BME origin and their friends or relatives. These were coded, thematically analysed, interpreted and subsequently triangulated through facilitator and participant review and discussion. Results Despite perceptions of a prevalent local culture of mistrust and suspicion, a number of themes and accompanying recommendations emerged. These included a lack of awareness by mothers of BME origin about current perinatal health services, as well as programme inaccessibility and inadequacy. There was a desire to engage with a continuum of comprehensive and well-publicized, family-focused perinatal health services. Participants wanted inclusion of maternal mental health and parenting support that addressed the whole family. Conclusions It is both ethical and equitable that comprehensive perinatal services are planned and developed following consultation and participation of knowledgeable community members including young mothers of BME origin, family and friends.

The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.

Early Childhood Mental Health Consultation (ECMC) focuses on enhancing adults’ (e.g., parents) skills and abilities in order to improve children’s behavior. Limited research has examined parenting factors as mechanisms of change, which is important given the bidirectional nature of parent-child interactions. Parenting stress and its influence on children’s behavioral outcomes (behavior problems and protective factors) were investigated following the implementation of an Early Childhood Mental Health Consultation (ECMHC) program. Participants included parents that participated in the ECMHC program (n = 247) and a comparison group (n = 72) in the Midwest. Overall, parents in the ECMHC group experienced fewer dysfunctional parent-child interactions and less distress. Results indicated that parent-child dysfunctional interactions mediated the relationship between ECMHC and children’s behavior problems (CI = .001, .038) and protective factors (CI = -.061, -.001). Parental distress did not mediate the relationship between ECMHC and children’s behavior problems (CI = -.001, .016) or protective factors (CI = -.020, .001). Understanding the influence of stress and parent-child interactions is beneficial as these may be malleable and responsive to change if targeted in intervention. Examining mechanisms of change related to parents will allow for refinement of services and improved behavioral outcomes for children.

Victor Morrison Hawthorne attended school at Rutherglen Academy. His university entrance was delayed by the war, in which he served as a captain in the special services of the Royal Artillery in Burma. After graduating he worked as a general practitioner in Dunoon before joining the infectious disease unit at Ruchill Hospital in Glasgow. For his MD (with commendation) in 1963 he studied “tuberculosis in man, dog, and cat.” The most exotic aspect of his interest in TB transmission, however, was diagnosing the disease in a chest x-ray of Bobo the chimpanzee, star of Bertram Mills Circus when it visited Glasgow. Victor coordinated the mass miniature radiography team that screened more than 700 000 Glaswegians for tuberculosis in a celebrated five week campaign in 1957. His crucial insight at the time was that the same approach could be applied to chest and heart disease. He wrote that although hospital specialists could study patients, they were not well placed to study diseases in the community. Initially, the mass miniature radiography …