A prominent need in the youth psychotherapy literature includes the examination of mechanisms of change within the context of "real world" clinical settings, where the practice of psychotherapy differs significantly from that in controlled clinical trials. In examining mechanisms of change in youth psychotherapy, variables related to parent functioning may be among the most important factors to consider in predicting and promoting good child outcomes. The purpose of the present study was to evaluate three important aspects of parent functioning—psychological symptom distress, interpersonal relations, and social role performance—as potential predictors of successful treatment outcomes in a traditional community outpatient treatment setting for children and adolescents. Further, this study examined whether parents indirectly benefited from their children receiving services, expanding our view on the scope and benefits inherent in youth psychotherapy. Parent Symptom Distress, Interpersonal Relations, and Social Role performance were measured using the domains of the Outcome Questionnaire 45 (OQ-45; Lambert et al., 2004), and youth treatment outcomes were measured using the parent and self-report versions of the Youth-Outcome Questionnaire (Y-OQ; Burlingame, Wells, Lambert, & Cox, 2004; Y-OQ-SR; Wells, Burlingame & Rose, 2003). Using Hierarchical Linear Modeling with this sample of 339 youth, aged 4-17 and their parents, this study examined the relationship between these parent domains and youth progress in therapy. Results revealed that parent Symptom Distress and Social Role performance improved significantly over the course of youth treatment. Further, Social Role performance at intake significantly predicted the rate of change in parent-reported youth outcome; and Interpersonal Relations at intake significantly predicted rate of change in youth-reported outcome. Finally, changes in parent Social Role performance were associated with changes in youth symptoms over the course of treatment. Examining the associations between these variables is an important step toward identifying potential mechanisms of change in youth mental health treatment. The results of this study provide valuable information on the importance of attending to parent functioning in the assessment and treatment of youth mental health issues.

What is the Primary Care Behavioral Health (PCBH) model of service delivery? Clinician innovators, administrators, and researchers have continued to refine the answer to this question. In the same way a recipe for mac n cheese provides the resources needed (i.e., ingredients), processes to make the dish, and expected outcomes (e.g., number of servings), a comprehensive operational definition for PCBH is needed to help improve the rigor of research being conducted. This recipe can also help clinicians/administrators identify a basic recipe for PCBH that standardizes the necessary components and amounts to achieve the expected outcomes. In this editorial, we provide a comprehensive operational recipe for PCBH based on current research. We are calling people to assist us by (a) utilizing the recipe to help improve the reporting and rigor of PCBH research and (b) applying the proposed operational definitions and targets within the recipe to help us refine and validate them. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This project focuses on persistent gaps in philosophies of the body: the enduring mindbody divide in accounts of phenomenology, the unfulfilled promises of representing and inhabiting the body in online and virtual spaces, and the difference between health as quantified in medical discourse versus health as lived experience. These tensions are brought to light through the electronic food journal genre where the difficulty in capturing pre-noetic, outsideconsciousness aspects of experience and embodied health are thrown into relief against circulating cultural discourses surrounding health, body size, self-surveillance, and self-care. The electronic food journal genre serves as a space for users to situate themselves and their daily practices in relation to medicalization, public policy, and the conflation of health and body size. These journals form artifacts reflecting life writing practices in digital spaces that model compliant self-surveillance as well as transgressive self-care. The journals instantiate the mind-body-technology interactivity of extended cognition, but also point toward a rupture in the feedback loops that promise to integrate pre-noetic aspects of being and experience. By exploring the tensions inherent in these online food journaling spaces, this project concludes by offering a PEERS heuristic/heuretic for assessing theories and technologies of embodiment and health for their ability to access what resides in the "remainder" of current embodiment philosophy and to identify the aspects of lived experience left unattended in USDA health policy, food journaling interfaces, and embodiment philosophy. The PEERS model can be used to evaluate existing technologies for their capacity to map true mind-body-technology interactivity and to build new theory that accounts for a fuller, more nuanced approach to understanding embodied reality and embodied health.

BACKGROUND: Big data offers new opportunities to enhance healthcare practice. While researchers have shown increasing interest to use them, little is known about what drives research impact. We explored predictors of research impact, across three major sources of healthcare big data derived from the government and the private sector. METHODS: This study was based on a mixed methods approach. Using quantitative analysis, we first clustered peer-reviewed original research that used data from government sources derived through the Veterans Health Administration (VHA), and private sources of data from IBM MarketScan and Optum, using social network analysis. We analyzed a battery of research impact measures as a function of the data sources. Other main predictors were topic clusters and authors’ social influence. Additionally, we conducted key informant interviews (KII) with a purposive sample of high impact researchers who have knowledge of the data. We then compiled findings of KIIs into two case studies to provide a rich understanding of drivers of research impact. RESULTS: Analysis of 1,907 peer-reviewed publications using VHA, IBM MarketScan and Optum found that the overall research enterprise was highly dynamic and growing over time. With less than 4 years of observation, research productivity, use of machine learning (ML), natural language processing (NLP), and the Journal Impact Factor showed substantial growth. Studies that used ML and NLP, however, showed limited visibility. After adjustments, VHA studies had generally higher impact (10% and 27% higher annualized Google citation rates) compared to MarketScan and Optum (p<0.001 for both). Analysis of co-authorship networks showed that no single social actor, either a community of scientists or institutions, was dominating. Other key opportunities to achieve high impact based on KIIs include methodological innovations, under-studied populations and predictive modeling based on rich clinical data. CONCLUSIONS: Big data for purposes of research analytics has grown within the three data sources studied between 2013 and 2016. Despite important challenges, the research community is reacting favorably to the opportunities offered both by big data and advanced analytic methods. Big data may be a logical and cost-efficient choice to emulate research initiatives where RCTs are not possible.

Introduction: Pharmaceutical sales visit claims of drug efficacy can influence physician prescribing. Efficacy claims may be susceptible to exaggeration in promotions for drugs approved on the basis of surrogate outcomes. They may also be different in countries with different sales visit regulations. Objectives: To compare the frequency of physician-reported claims of serious morbidity or mortality benefit in promotions for drugs approved on the basis of surrogate outcomes (where claims are unwarranted) with those approved on the basis of serious morbidity or mortality. Additionally, to compare the frequency of unwarranted claims of serious morbidity or mortality benefit by country of promotion. Methods: From 2009 to 2010, primary care physicians in Canada, France, and the United States reported via pre-set questionnaires on claims of serious morbidity or mortality benefit in consecutive cardiovascular drug promotions. Promoted drugs were either 1) approved on the basis of surrogate outcomes, or 2) approved on the basis of serious morbidity or mortality. Using generalized estimating equations, the frequency of reported efficacy claims was compared between the two promotion types. The frequency of unwarranted claims drug benefit was also compared by country. Results: 448 promotions were analyzed. Claims of serious morbidity or mortality benefit were reported in 156/347 (45%) promotions for drugs approved on the basis of surrogate outcomes and 72/101 (71%) promotions for drugs approved on the basis of serious morbidity or mortality, p<0.001. Despite stricter sales visit regulations, unwarranted claims of serious morbidity or mortality benefit for drugs approved on the basis of surrogate outcomes were reported most frequently in France (59%) compared to Canada (46%), p=0.2 or the United States (26%), p=0.02. Conclusions: Across countries, unwarranted claims of drug benefit were frequently reported in promotions for drugs approved on the basis of surrogate outcomes. These claims amount to off-label promotion and contravene national sales visit regulations. / Thesis / Master of Science (MSc)

Despite concerted efforts to decrease costs and increase public health, the embattled U.S. health care system continues to struggle to alleviate these widespread issues. Because the problem of hospital utilizations among patients with heart failure is posited to increase as the population ages, innovative methodologies need to be explored to mitigate adverse events. Remote monitoring harnesses the strength of advanced information and communication technology to affect positive changes in health care quality and cost. By reaching across geographical boundaries, remote monitoring may support increased access to less costly services and improve the quality of home health care. The purpose of the study was to examine the home care quality effects of remote monitoring technology in patients with heart failure and to provide an economic justification for its adoption and diffusion. It compared remote monitoring as a potential intervention strategy to a standard no-intervention group (without remote monitoring). Specifically, it analyzed remote monitoring as a viable strategy to decrease hospital readmissions and emergency department visits. It also compared the cost of remote monitoring against the current standard-of-care. The theoretical framework of Donabedian's Quality Model was used in the evaluation of remote monitoring. A retrospective posttest only, case control study design was used to test the degree which remote monitoring was effective in promoting health care quality (hospital readmissions and decreased emergency department visits). Retrospective chart reviews were performed using electronic medical records (EMR). Analysis of Variance, Path Analysis, Automatic Interaction Detector Analysis (Dtreg), and Cost Outcomes Ratio were used to test the hypotheses and validate the proposed theoretical model. No significant difference was noted in remote monitoring and usual care groups. Results suggested that remote monitoring does not statistically lead to a decrease in heart failure-related hospital readmissions and all-cause emergency department visits. Results of the cost ratio analysis suggested that there was no statistically significant difference in the net income between usual care and remote monitoring; however, data suggest that there were significant increases in cost and intensity of nursing utilization for the remote monitoring intervention. The Automatic Interaction Detector Analysis showed that the unfavorable results in hospital readmissions were due to a decrease in collaborative care and patient education prior to the recommendation for hospitalization. The role of nursing care, whether in hospital or community-based care, in heart failure management is critical to quality outcomes. As the field continues to consider the use of technology in health care, decision makers should think through the process of patient care such that preventable hospital readmissions are decreased and patients received quality care.

No description available.

No description available.

Purpose: The purpose of this qualitative study was to highlight the lived experiences of Hispanic migrant workers seeking healthcare at a community care clinic in rural Appalachia with participation from student nurses learning about qualitative research methods. Design/method: A phenomenological qualitative study was approved by the institutional IRB. Senior BSN nursing students, community care clinic staff and interpreters, and nurse educators participated in structured interviews during healthcare visits from Hispanic migrant workers at a local community care clinic in rural Appalachia. An audit trail provided the process to highlight common themes on health from the lived experiences of the Hispanic migrant worker population. Results: Several barriers on healthcare viewed by the Hispanic migrant workers included transportation, financial resources, medication prescriptions, and language. Positive lived experiences included; resources, quality care, and trust. Discussion/conclusion: Surprisingly, this research highlighted strengths of the interpersonal connection between the rural clinic staff and the Hispanic migrant workers. Participants vocalized their satisfaction when trust was established through the clinic’s efforts in providing interpreters, extended hours after normal field work hours, and personnel’s attitudes toward the promotion of health. The Hispanic Worker Study findings parallel similar lived experiences of the culture among people from rural Appalachia. Implications: Healthcare members must establish ‘trust’ as one of the interpersonal relationship strategies with multiple and diverse populations in order to create holistic culturally competent healthcare.

The overutilization of cesarean deliveries is a major public health issue in the United States (U.S.). The rates of cesarean deliveries have increased substantially from the mid 1990s. Low-risk, defined as nulliparous, term, singleton, vertex (NTSV) pregnancies with no medical indication of need, and elective cesarean deliveries have been implicated as drivers of these increases. Elective cesarean deliveries are NTSV cesarean deliveries in which no trial of labor was attempted. There is a lack of clear rationale as to the noted increases in cesarean delivery rates as the evidence shows that these procedures provide no additional health benefits to mothers or infants. In fact, excessive use of cesarean sections has been associated with poorer health outcomes and quality of care, and higher health care expenditures. The purpose of this dissertation is to examine the current variation in NTSV and elective cesarean deliveries in the U.S., and further to examine the extent to which national trends are mirrored in Appalachia, a region disproportionately burdened by lack of health care resources and poor health outcomes. A repeated cross-sectional analysis of the prevalence of NTSV and elective cesarean deliveries in the U.S. between 2016 and 2020 was conducted using individual-level vital records data. Differences were examined by rurality and Appalachian designation. Logistic regression and marginal analyses were used to examine changes in the prevalence of these outcomes over time while adjusting for additional pertinent covariates. Approximately 25% of NTSV births are delivered via cesarean section, and 37% of those NTSV cesarean deliveries are elective. No practically significant differences in the prevalence of NTSV cesarean deliveries were noted based on rurality or Appalachian designation. However, there were significant variations in the prevalence of elective cesarean deliveries by geography. Rates of elective cesarean deliveries were significantly lower in rural communities compared to metropolitan, or urban, communities. Non-Appalachia had predominantly higher prevalence of elective cesarean deliveries compared to the Appalachian sub-regions. The findings of this dissertation suggest that while variations in health outcomes may be driven by geographic designations, variations in health services utilization are likely driven by other factors, such as institutional and provider characteristics.