Evaluation of a Virtual Health Equity Training for Mid-Career Primary Healthcare Providers.

OBJECTIVES: Providing cultural competence training is recommended as a way to improve patient-centered care and reduce health disparities. Increasing awareness of implicit biases and understanding internal motivations for overcoming these biases can influence provider decisions and communications with patients. This study aims to provide a health equity and implicit bias training to healthcare providers and assess knowledge and attitude gains. METHODS: Mid-career primary healthcare providers (n = 21) with at least 5 years of primary care experience participated in the training as a prerequisite for providing patient care in a telehealth primary care practice that overwhelmingly serves patients of color. RESULTS: There was a significant increase in knowledge (p < .001) as well as attitudes (p < .001) in healthcare providers from pretest to posttest. Almost none (4.5%) of the providers were distracted during the training, which may be due to the interactive nature of the training that included group-based reflection discussions. CONCLUSION: A virtual training for primary healthcare providers on health equity and implicit bias improved knowledge and equitable attitudes and had high satisfaction. Additional research is needed to determine if this type of training can influence providers' ability to actively address known disparities in care.

Transcriptomic Analysis of Glycosylation and Neuroregulatory Pathways in Rodent Models in Response to Psychedelic Molecules.

The potential for psychedelic molecules in impacting cognitive flexibility has long been supported and acknowledged across scientific reports. In the current study, an approach leveraging knowledge-based gene-set information analysis has been adopted to explore the potential impact of psychedelic molecules on both glycosylation, (a post-translational modifications (PTM)) and on neuro-regulatory pathways. Though limitations and restrictions rise from the scarcity of publicly available 'omics' data, targeted analysis enabled us to identify a number of key glycogenes (Hexb, Hs6st2, Col9a2, B3gat2, Mgat5, Bgn) involved the structural organization of extracellular matrix and neuroprotective factors (Kl, Pomc, Oxt, Gal, Avp, Cartpt) which play vital roles in neuron protection, development as well as synaptic stability. In response to psychedelic molecules, we found that these genes and associated pathways are transcriptional altered in rodent models. The approach used indicates the potential to exploit existing datasets for hypothesis generation and testing for the molecular processes which play a role in the physiological response to psychedelic molecule effects. These reported findings, which focused on alterations in glycogenes and neuro-regulatory factors may provide a novel range of biomarkers to track the beneficial, as well as potential toxicological effects of psychedelic molecules.

Psychological adjustment to initial treatment for low-risk thyroid cancer: Preliminary study.

BACKGROUND: Low-risk papillary thyroid carcinoma (LR-PTC) can be managed by immediate surgery (IS) or active surveillance (AS). We compare the psychological impact of these treatments on patients with LR-PTC. METHODS: Psychological data were collected over 1 year, with assessments at the time of treatment decision (T1), at 6 months (T2) and 12 months (T3) follow-up. Assessments included 13 validated psychological tools. RESULTS: Of 27 enrolled patients, 20 chose AS and 7 chose IS. The average times to T2 and T3 were 5.7 and 11.3 months, respectively. For both groups, Impact of Events Scale scores significantly decreased (p = 0.001) at T2, and depressive/anxiety symptoms remained low. CONCLUSIONS: This study demonstrates the feasibility of assessing psychological outcomes among patients treated for LR-PTC. Further studies are needed to evaluate the impact of AS versus IS on quality of life and changes that patients experience over longer time periods following their treatment decision.

New York State 1115 Demonstration Independent Evaluation: Interim Report.

The broad goals of New York State's Medicaid Section 1115 Waiver are to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. The RAND Corporation was competitively selected as the independent evaluator to assess two components under this 1115 Demonstration Waiver: the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy, which guarantees enrollees Medicaid coverage regardless of changes in income in the 12 months after eligibility determination and enrollment. This final interim evaluation examines whether these two components have helped achieve the program's goals. The RAND team's analyses show that the Demonstration has expanded access to managed care through mandatory MLTC enrollment and 12-month continuous eligibility. The team found no evidence of a significant change in patient safety or quality of care. The authors note that, although this means that there is no evidence the Demonstration achieved the goal of improving quality of care, increasing access without compromising quality of care is a success in its own right.

Comparison of Missing School Meals among Public Schools: How Did New York State Do during COVID-19?

BACKGROUND: The COVID-19 pandemic created barriers to participation in school meals. As a result, many students may have missed out on school meals. The objectives of this study are (1) to compare the number of school meals served by New York State public schools during the first spring and summer of the COVID-19 pandemic to the number served before the COVID-19 pandemic, and (2) to determine relationships between the number of meals served and the levels of school district need and urbanicity. METHODS: This study is a secondary analysis of administrative data. The percentage change in the number of school breakfasts and lunches served was calculated for each month and by school district need level and urbanicity level. RESULTS: The number of school meals served decreased during the first spring of the pandemic compared to the spring of the previous school year (-43% in April, -51% in May), while the number of school meals served increased during the first summer of the pandemic compared to the summer of the previous school year (+92% in July, +288% in August). CONCLUSIONS: Waivers may provide flexibility to increase participation in school meals, especially during the summer.

The Effect of a Low-Cost Body Weight-Supported Treadmill Trainer on Walking Speed and Joint Motion.

Background and Objectives: Gait training with body weight-support has been shown to improve the walking speed of individuals with movement disorders. The AccesSportAmerica Gait Trainer is a low-cost, pre-market gait rehabilitation device that alters the stride characteristics of participants walking on a standard treadmill. The purpose of this study was to examine the biomechanical outcomes that training on this device has for people with brain injuries that affect motor functioning. It was hypothesized that there would be an increase in walking speed post-intervention, and that there would be an increase in step length and joint range-of-motion. Materials and Methods: An intervention study was conducted with 11 people with ambulatory difficulty caused by post-stroke hemiparesis (n = 7), traumatic brain injury (n = 3), and cerebral palsy (n = 1). The average time using the AccesSportAmerica Gait Trainer was 34.5 (SD = 6.0) minutes per session for 36.9 (SD = 21.8) sessions. Gait speed, step length and time, and joint flexion were measured during the 10 Meter Walk Test. Results: From pre- to post-intervention, there was a mean increase in walking speed of 0.19 m/s (SD = 0.06, p = 0.016, d = 0.40) and a decrease in step time of both affected and unaffected legs (affected: p = 0.011, d = 0.37; unaffected: p = 0.004, d = 0.67). There was no significant change in stride length or joint angles. Conclusions: The AccesSportAmerica Gait Trainer has the potential to improve the walking speed of people with ambulatory difficulty.

The Implementation of Mental Health Policies and Practices in Schools: An Examination of School and State Factors.

BACKGROUND: Poor mental health outcomes persist among adolescent youth. Secondary schools play a critical role in fostering positive mental health by implementing policies and practices grounded in evidence. The factors associated with implementation, however, are unclear. This study examines which school- and state-level factors are associated with improved implementation of mental health policies and practices at secondary schools across the United States. METHODS: US Centers for Disease Control and Prevention data stemming from 3 datasets (School Health Policies and Practices, School Health Profiles, and Youth Risk Behavior Surveillance System) surveys were integrated and analyzed. RESULTS: Health educator certification, school use of data during school improvement planning, presence of a health/safety coordinator, presence of a health council and state-provided health educator professional development in mental health and suicide prevention were each significantly positively associated with schools' implementation of mental health policies and practices. CONCLUSIONS: To promote improved implementation of mental health policies and practices in schools and provide better support for youth mental health outcomes, the use of certified health educators and health-related supports should be considered. State health and education agencies should undertake evaluations of its mental health practices to ensure the assistance they offer to schools is evidence based.

Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools.

BACKGROUND: School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. METHODS: A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. RESULTS: There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. CONCLUSIONS: Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains.

Marketing Strategies Used to Promote Children's Medicine Sold on Internet Sites of Pharmaceutical Stores.

Retail sales of over the counter (OTC) medications have risen steadily over the years; however, these products are not without potential risk. The aim of this study was to describe the marketing strategies used to promote OTC medicines to children and their parents. Data were collected from 187 product packaging of fever reducer, allergy, and cough medicines posted on the Internet sites of three of the largest pharmacies in the United States. Specific marketing information was collected related to flavorings and pictures appearing on the packaging. There was no significant difference between the type of medicine and whether they were flavored or not, as almost every product (95.7 %) indicated that it resembles a food flavoring. On almost all the packaging (92.5 %) the flavor was also indicated by words in different font sizes. Most of the products (83.4 %) showed a picture of a food product on their packaging. There was a significant difference between the medicine types by picture, with fever medicines having more pictures of food than either cough or allergy medicine. Stronger regulations of marketing strategies of these products are needed.

Testing with feedback improves recall of information in informed consent: A proof of concept study.

OBJECTIVE: This study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented. METHODS: Undergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing. RESULTS: Participants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions. CONCLUSIONS: Inserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information. PRACTICAL IMPLICATION: Providing informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.

ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM.

OBJECTIVE: The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. METHODS: We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. RESULTS: Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. CONCLUSION: With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

Promoting weight loss methods in parenting magazines: Implications for women.

Weight gain before and after pregnancy is important for women's health. The purpose of this study was to assess articles and advertisements related to weight loss in three widely read parenting magazines, "Parenting School Years," "Parenting Early Years," and "Parenting," which have an estimated combined readership of approximately 24 million (mainly women readers). Almost a quarter (23.7%, n = 32) of the 135 magazine issues over a four year period included at least one feature article on weight loss. A variety of topics were covered in the featured articles, with the most frequent topics being on losing weight to please yourself (25.2%), healthy ways to lose weight (21.1%), and how to keep the weight off (14.7%). Less than half (45.9%) of the articles displayed author credentials, such as their degree, qualifications, or expertise. A fifth (20.0%, n = 27) of the magazines included at least one prominent advertisement for weight loss products. Almost half (46.9%) of the weight loss advertisements were for weight loss programs followed by weight loss food products (25.0%), weight loss aids (21.9%), and only 6.2% of the advertisements for weight loss were on fitness. Parenting magazines should advocate for healthy weight loss, including lifestyle changes for sustained health.

An Evaluation of the Effectiveness of School-Based Breastfeeding Education.

School-based interventions aimed at modifying the knowledge, attitudes, social norms, and intended future practice regarding breastfeeding may be an effective way of improving breastfeeding rates. A systematic review of relevant literature was conducted to identify scientifically rigorous studies on school-based interventions and promotion activities that focus on breastfeeding. Of the 1990 citations reviewed, only 6 empirical articles on school-based interventions to promote breastfeeding were found and these interventions vary greatly in terms of format, duration, outcome measures, and significance of the results. Overall, these studies demonstrated positive effects on perceptions and attitudes toward breastfeeding and increased behavioral intention of breastfeeding later in life. School-based breastfeeding promotion programs hold promise for increasing knowledge of breastfeeding and support for breastfeeding, promoting positive attitudes, creating a culture where breastfeeding is the norm, and increasing future intentions to breastfeed.

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer.

OBJECTIVE: This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings. DESIGN: Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators. MAIN OUTCOME MEASURES: Primary outcomes were depressive symptoms, sleep problems and quality of life indicators. RESULTS: Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes. CONCLUSIONS: Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

An examination of marketing techniques used to promote children's vitamins in parenting magazines.

More than a third of children and adolescents in the United States take vitamins even though professional medical organizations do not endorse their use in healthy children. Regardless of their efficacy, children's vitamin products are aggressively promoted. Therefore, the goal of this study was to describe and analyze advertisements related to vitamins in the following three popular parenting magazines, Parents, Parenting Early Years, and Parenting School Years. A total of 135 magazines across four years were reviewed.  There were 207 advertisements for children's vitamins, all in the form of chewy or gummy.  None of these advertisements included a dosage or a warning.  Almost all (92.3%) included a cartoon in the advertisement.  Almost a quarter (23.2%) of the advertisements promoted their product with the theme of prevention and more than half (51.2%) included the theme of peace of mind.  Parenting magazines are a popular medium for providing exposure to products geared towards children.  Companies that market children's vitamins in these magazines can increase awareness among parents of the risks by providing warning and dosage information in their advertisements.  Magazines can also play a role by encouraging responsible marketing and providing editorial content on children's vitamins and potential consequences of pediatric overdose.

College student perceptions on campus alcohol policies and consumption patterns.

Environmental strategies for colleges and universities to reduce alcohol consumption among their students include the development and enforcement of campus alcohol policies. This study examines students' knowledge and attitudes toward campus alcohol policies and how they relate to alcohol consumption and alcohol social norms. A sample of 422 freshman students was surveyed during their first month at a 4-year public college. Findings indicated that the majority of students (89%) were aware of campus policies, yet of those who were aware, less than half (44%) were accepting of these campus rules and regulations. In addition, the majority (79%) of students drank at social events, despite this behavior being in direct violation of campus alcohol policies. However, those who supported campus rules consumed significantly less alcohol at social events than those who opposed or had no opinion of the rules. Also, those who supported the rules perceived that their peers and students in general consumed significantly less alcohol at social events than those who were opposed or had no opinion. This outcome supports the premise established by several theories of behavior change including the theory of planned behavior, which state that behavior is influenced less by knowledge than by attitude and intention.

Genitourinary functioning and depressive symptoms over time in younger versus older men treated for prostate cancer.

BACKGROUND/PURPOSE: This study examined the relation of age to genitourinary functioning and depressive symptoms over time and examined how age influences the relation between genitourinary functioning and depressive symptoms over time in men treated for localized prostate cancer. METHODS: Participants were 234 men who completed interviews that assessed genitourinary functioning and depressive symptoms at 2, 4, 10 and 16 months after treatment. Analyses were statistically controlled for potential confounds. RESULTS: Compared with younger men (≤ 65.5), older men had significantly poorer sexual function and slower improvement. Level of urinary functioning was inversely associated with level of depressive symptoms regardless of age. Level of sexual functioning was inversely associated with level of depressive symptoms but only in younger men. CONCLUSION: Interventions may be particularly helpful for all men with urinary dysfunction and for younger men with sexual dysfunction in order to improve symptoms of depression.

Quality of life after thyroid cancer: an assessment of patient needs and preferences for information and support.

BACKGROUND: In this article, we describe the quality of life and central information and support needs of people with thyroid cancer. We also describes patients' preferences for services to address their needs. This report may help patients to anticipate how thyroid cancer will affect them and inform physicians on useful ways to help address their patients' needs. METHODS: We collected data through a survey (n = 62) of people who had been treated for thyroid cancer. RESULTS: Most respondents indicated that quality of life was quite good, and most of their information needs were adequately addressed during routine care. However, respondents also indicated a desire for ongoing access to information, including information about lifestyle factors that might affect risk of recurrence, signs and symptoms of recurrence, and recent developments in thyroid cancer diagnostics and treatments. They also reported some unmet social and emotional support needs. Respondents reported a strong preference for gaining access to information through convenient resources such as the Internet. CONCLUSIONS: Patient care following thyroid cancer treatment could be improved by providing ongoing education about lifestyle factors related to cancer risk, disease surveillance, and resources for treating and coping with cancer. Health care providers should become familiar with local and Internet-based sources of information and support related to thyroid cancer to improve patient access to this information.

On the positive relation between received social support and negative affect: a test of the triage and self-esteem threat models in women with breast cancer.

OBJECTIVE: There is a seemingly paradoxical positive relation between received social support and psychological distress in cancer patients. This study evaluates two models that explain this positive relation: (a) the triage model, which argues that more distressed people receive more support and (b) the self-esteem threat model, which argues that receiving support increases distress by undermining self-esteem. METHODS: Longitudinal survey data were collected from 71 women treated for breast cancer at 3- (T1) and 18-months (T2) post-diagnosis. RESULTS: Analyses did not disconfirm either model. Consistent with the triage model, there was a marginally significant (p=0.052) positive relation between T1 negative affect and T2 received support, controlling for T1-received support. Consistent with the self-esteem threat model, a significant positive relation between T1 received support and T2 negative affect, controlling for T1 negative affect, appeared to be mediated by T2 self-esteem. CONCLUSIONS: These findings suggest that people with cancer who are most distressed may receive the most social support, but the conveyance of support can have negative consequences for self-esteem and affect.

Social-cognitive correlates of adjustment to prostate cancer.

This study examined whether social support might enhance health-related quality of life in men (n=89) treated for localized prostate cancer by improving their ability to cognitively process their cancer experience. Data were collected using two, structured in-person interviews and abstracting medical records. The baseline interview was within several months (T1) after treatment for cancer, and follow-up was 3 months later (T2). Most men (61.8%) were treated by radical prostatectomy. Results showed that T1 social support was positively related to T2 mental functioning, and this relation appeared to be mediated by T1 indicators of cognitively processing, intrusive thoughts and searching for meaning. These findings suggest that supportive social relations may improve mental functioning by helping men cognitively process their prostate cancer experience.