Effects of Sound Interventions on the Permeability of the Blood-Brain Barrier and Meningeal Lymphatic Clearance.

The meningeal lymphatic, or glymphatic, system is receiving increasing attention from the scientific community. Recent work includes noninvasive techniques to demonstrate relationships between blood-brain barrier (BBB) activity and the glymphatic system in the human central nervous system. One potential technique is the use of music/sound to enhance BBB permeability regarding the movement of small molecules in and out of the brain. However, there is minimal knowledge regarding the methodical investigation(s) of the uses of music/sound on BBB permeability and glymphatic clearance and the outcomes of these investigation(s). This review contains evidence discussing relationships between music/sound, BBB permeability, and meningeal lymphatic clearance. An overview of the anatomy and physiology of the system is presented. We discuss the uses of music/sound to modulate brain and body functions, highlighting music's effects on mood and autonomic, cognitive, and neuronal function. We also propose implications for follow-up work. The results showed that music and sound interventions do, in fact, contribute to the opening of the BBB and subsequently increase the function of the meningeal lymphatic system. Evidence also suggests that music/sound has the ability to reduce the collateral effects of brain injuries. Unfortunately, music/sound is rarely used in the clinical setting as a medical intervention. Still, recent research shows the potential positive impacts that music/sound could have on various organ systems.

Three-Tiered Advocacy: Using a Longitudinal Curriculum to Teach Pediatric Residents Advocacy on an Individual, Community, and Legislative Level.

BACKGROUND: Pediatricians play a critical role as health advocates. Teaching residents to advocate for their patients on an individual, community, and legislative level is a priority for residency training programs. This study examined the effects of a longitudinal curriculum teaching 3-tiered advocacy on pediatric residents' attitudes, knowledge, and practice. METHODS: This was a prospective pre- and postintervention study using an anonymous survey of pediatric residents (N = 78) in an urban academic children's hospital. The survey assessed advocacy on an individual level through comfort and experience in discussing social determinants of health (SDH), on a community level through comfort and practice referring patients to community resources, and on a legislative level through comfort and practice with legislative advocacy. Descriptive statistics and chi-square tests were used to analyze the data. RESULTS: Postimplementation, pediatric residents reported the curriculum changed their clinical practice (66%), encouraged them to take a more in-depth social history (46%), and helped them guide patients to more community resources (38%). Comfort in discussing SDH with patients in the ambulatory clinic increased (27% vs 76%; P = .001). Reported frequency in inquiring about SDH significantly improved in the following areas: income (39% vs 60%; P = .025), education (71% vs 93%; P = .008), and legal issues (13% vs 26%; P = .012). CONCLUSIONS: Most of the residents reported that the curriculum changed their clinical practice. Residents reported knowledge and comfort with advocating for their patients on an individual level improved. However, there was no significant difference on the community or legislative level. This curriculum raised awareness and armed residents with practical skills to be health advocates on an individual level. Further research is needed to explore effective means of creating 3-tiered advocates.

From Policy Statement to Practice: Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center.

Purpose: Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic. Methods: The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits. Discussion: Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.

Resident Documentation of Social Determinants of Health: Effects of a Teaching Tool in the Outpatient Setting.

Social determinants of health (SDH) significantly affect the health of children and thus, screening is important in pediatric primary care. We assessed the use of a formal social history taking tool after a 2-phase intervention. The first phase (P1) was a teaching module describing SDH and community resources and the second phase (P2) consisted of visual reminders to use the tool. Patient charts (n = 322) were reviewed pre- and postintervention. Residents had higher documentation rates of Women, Infants, and Children (WIC) program use and housing subsidies at post-P1 and at post-P(1 + 2) (WIC, P = .01 and P = .03, respectively; housing, P = .02 and P = .04, respectively), and higher documentation rates of food stamp utilization at post-P(1 + 2) ( P = .04), as compared with baseline. Implementation of a simple teaching tool in the outpatient setting enabled residents to document income benefits and housing. Further studies should be done to evaluate effective teaching methods to elicit other important SDH.