Provision of Care by "Real World" Telemental Health Providers.

Despite its effectiveness, limited research has examined the provision of telemental health (TMH) and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy (CBT) in their remote practice. The most commonly used in-session and between-session (i.e., homework) exercises included coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine.

Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers.

Understanding what motivates mental health providers to use telemedicine (i.e., telemental health) is critical for optimizing its uptake, especially during unprecedented times (e.g., the COVID-19 pandemic). Drawing from the Technology Acceptance Model (TAM), this report examined the characteristics of telemental health providers and how the acceptability of telemedicine features contributes to their intention to use the technology more often in practice. Telemental health providers (N = 177) completed an online survey between March and May 2019. Most providers (75%) spent less than 25% of their work-week using telemedicine, but 70% reported an intention to use telemedicine more in the future. The belief that telemedicine affords greater access to patients, work-life balance, flexibility in providing care, and the opportunity to be at the forefront of innovative care were significant predictors of intentions to use the technology more in the future. Other significant predictors included needing assistance to coordinate insurance reimbursements, manage a successful telemedicine practice, and integrate the telemedicine program with other health IT software. Findings have important implications for increasing the frequency of telemedicine use among telemental health providers. Future research and practice should leverage providers' positive beliefs about telemedicine acceptability and consider their needs to enhance its uptake.

Fishing for ecosystem services.

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships.

Effectiveness evaluation of existing noise controls in a deep shaft underground mine.

Noise exposures and hearing loss in the mining industry continue to be a major problem, despite advances in noise control technologies. This study evaluated the effectiveness of engineering, administrative, and personal noise controls using both traditional and in-ear dosimetry by job task, work shift, and five types of earplug. The noise exposures of 22 miners performing deep shaft-sinking tasks were evaluated during 56 rotating shifts in an underground mine. Miners were earplug-insertion trained, earplug fit-tested, and monitored utilizing traditional and in-ear dosimetry. The mean TWA8 noise exposure via traditional dosimetry was 90.1 ± 8.2 dBA, while the mean in-ear TWA8 was 79.6 ± 13.8 dBA. The latter was significantly lower (p < 0.05) than the Mine Safety and Health Administration (MSHA) personal exposure limit (PEL) of 90 dBA. Dosimetry mean TWA8 noise exposures for bench blowing (103.5 ± 0.9 dBA), jumbo drill operation (103.0 ± 0.8 dBA), and mucking tasks (99.6 ± 4.7 dBA) were significantly higher (p < 0.05) than other tasks. For bench blowing, cable pulling, grinding, and jumbo drill operation tasks, the mean in-ear TWA8 was greater than 85 dBA. Those working swing shift had a significantly higher (p < 0.001) mean TWA8 noise exposure (95.4 ± 7.3 dBA) than those working day shift. For percent difference between traditional vs. in-ear dosimetry, there was no significant difference among types of earplug used. Reflective of occupational hearing loss rate trends across the mining industry, this study found that, despite existing engineering and administrative controls, noise exposure levels exceeded regulatory limits, while the addition of personal hearing protection limited excessive exposures.

Occupational heat strain in a hot underground metal mine.

OBJECTIVE: In a hot underground metal mine, this study evaluated the relationship between job task, physical body type, work shift, and heat strain. METHODS: Thirty-one miners were evaluated during 98 shifts while performing deep shaft-sinking tasks. Continuous core body temperature, heart rate, pre- and postshift urine specific gravity (USG), and body mass index were measured. RESULTS: Cutting and welding tasks were associated with significantly (P < 0.05) increased core body temperature, maximum heart rate, and increased postshift urine specific gravity. Miners in the obese level II and III body mass index categories, as well as those working night shift, had lower core body temperatures (P < 0.05). CONCLUSIONS: This study confirms that job task, body type, and shift are risk factors for heat strain.

The challenge of providing infertility services to a low-income immigrant Latino population.

OBJECTIVE: To provide insight into the experience of low-income immigrant Latino couples seeking infertility treatment. DESIGN: Qualitative interview study. SETTING: Infertility clinic at a university-affiliated urban public teaching hospital. PATIENT(S): Infertile low-income immigrant Latino couples (105 women and 40 men). INTERVENTION(S): In-depth, tape-recorded interviews. MAIN OUTCOME MEASURE(S): After transcription and translation, the interviews were coded and analyzed for thematic content. RESULT(S): Four major challenges to providing infertility services to this population were identified: [1] communication: language and cultural barriers resulted in patients having difficulty both in understanding diagnoses and treatments and in communicating their questions, concerns, and experiences to physicians; [2] continuity: because medical students and residents rotated frequently, patients usually saw a different physician at each visit; [3] bureaucracy: patients reported having difficulty with appointment scheduling, follow-up visits, and timed laboratory procedures; and [4] accessibility: patients faced issues of limited availability and affordability of treatment. CONCLUSION(S): At a large, urban, university-affiliated infertility clinic, challenges related to communication, comprehension, continuity, bureaucracy, accessibility, availability, and affordability impeded the delivery of optimal infertility care to many low-income immigrant Latino patients. A greater availability of translators and both patient and physician cultural orientations to address these health care barriers is recommended.