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In this chapter, we examine the feasibility of adapting the Family Check Up (FCU), an evidence-based program to identify and manage behavioral concerns in children ages 4 and 5 years, within a pediatric primary care clinic with an integrated mental health professional. Methods: Caregivers attending their child’s 4 and 5 year-old well child visit were asked to complete a screening tool (Pediatric Symptom Checklist-17; PSC-17) measuring behavioral concerns as part of routine care. Families who screened positively, were referred to the FCU and asked to participate in a study evaluating the intervention. The FCU is a 2-session intervention during which information on home environment and parenting style was collected through tailored questionnaires, videotaped interactions, and a clinical interview. Feasibility was examined using portions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (REAIM) framework from the Dissemination and Implementation Science field. This study presents preliminary data on the domains of Reach and Adoption over the first 5 months of the FCU. Results: The number of families referred who attended at least one session (Reach) was 77.2%. Current data shows that use of the PSC-17 screening instrument (Adoption) is 91.4% for well child checks and 25% for acute visits. Adoption of those referred to the FCU is 84%, indicating most families screening positively for behavioral concerns were successfully referred to the FCU. Conclusion: Initial results suggest Reach and Adoption rates support the feasibility of adapting a behavioral intervention for delivery in the pediatric clinic. Notably, having an existing integrated care delivery model is a critical piece to this early success. Future directions will continue to explore feasibility of the remaining REAIM domains.

We report a case of left ventricular myxoma with embolization to the left posterior cerebral artery, causing acute visual loss. The tumor was successfully resected and a follow-up echocardiography after 21 months revealed no evidence of tumor recurrence. The patient also had a past history of testicular seminoma. We believe that this is the first case report of an association of cardiac myxoma and testicular seminoma.

The purpose of this study was to examine the feasibility of a behavioral health referral protocol and barriers to behavioral health care in a pediatric epilepsy clinic. A sample of 93 youth with epilepsy ages 10–17 and caregivers completed behavioral health and seizure severity measures during a routine epilepsy clinic visit. Key findings are that 47 (50.5%) of the youth screened positive for a behavioral health referral, and 35 of these youth were referred for behavioral health services. However, only 20% made and presented for the behavioral health appointment. The most commonly cited barrier for accessing and utilizing behavioral health care was stigma related- a mental health label for the child. The significance of this study lies in the revelation that solely screening for and educating caregivers about behavioral health symptoms and providing behavioral health referral information is not an ideal model. Instead, stigma related barriers point to the necessity of continued integrated physical and behavioral health care within the pediatric epilepsy visit.

<p>Endometrial cancer (EC) is one of the most common forms of cancer among women, and the rate of disease is expected to increase significantly in the next several years. Ethnically diverse EC survivors may be at increased risk for comorbidities or cancer recurrence because of lower physical activity participation and higher rates of obesity. A systematic review of physical activity interventions for overweight and obese female cancer survivors was conducted. The first study was a cross-sectional study, which assessed the differences between 62 active and inactive Bronx EC survivors for body mass index (BMI), quality of life and physical activity behavioral variables. The second study of this dissertation was a wait-list controlled trial for 28 obese to determine the feasibility of a 12-week physical activity intervention in this population. The primary findings from the systematic review were that center-based physical activity interventions were feasible and led to an increase in physical activity for overweight and obese female cancer survivors. The first study found that 65% of the sample was obese, and 47% reported being physically active. The Active group reported significantly higher quality of life of the Functional Assessment of Cancer Therapy ? Endometrial questionnaire (FACT-En: 154 ? 13 vs. 145 ? 20, d=0.57, p<0.05), compared to the Insufficiently Active group. BMI was 3.3 kg?m-2 lower in the active group (d=0.40, p=0.057). The active group also reported higher walking self-efficacy, barrier self-efficacy and outcome expectations (p<0.05). In the third study, adherence to the physical activity intervention was 60%, and the dropout rate was modest, indicating that the intervention was feasible. Participants who completed the program had significantly greater increase in six-minute walk test distance (+22 meters) and quality of life (+10 points) compared to the control p<0.05). These studies show that this population has an elevated need for physical activity interventions that can promote the adoption of physical activity. Physically active EC survivors have better health and employ in more behavioral processes than their Insufficiently Active counterparts. A 12-week physical activity intervention was feasible and supports the potential effectiveness of a physical activity interventions

<p> Preliminary studies suggest that martial arts participation may benefit children with Autism. Following on existing pilot studies, this investigation conceptualized mixed martial arts in terms of Applied Behavior Analysis and considered the impact of a mixed martial arts program designed for children with Autism on children's focus, attention, motor control, and social skills. This study followed two boys with Autism over the course of six weeks. Multiple behavioral observations, parent interviews, and instructor interview were conducted; Child Behavior Checklist and Gilliam Autism Rating Scale-2 were administered. One child, new to the program, evidenced dramatic gains in social skills, physical ability, respect, and overall attitude. A second child, participating in the program for more than a year, maintained previous gains in these same areas throughout the intervention. Results suggest that boys with Autism may benefit from participation in mixed martial arts training. Discussion considers advantages of martial arts over traditional behavior therapy for children with Autism, such as reduced cost, availability in most areas of the United States, and less stigmatization than a treatment setting.</p>

<p> Research studies show that work engagement is credited with having a positive effect on business outcomes. As health care leaders and administrators continue to make efforts to improve work engagement, the global nursing shortage has become a major problem that can affect registered nurses (RNs') work engagement and turnover intentions. RNs are important to the nation's well-being as everyone's health care needs involve the role of a nurse, but RNs currently in practice experience higher demands in an environment already constrained. This qualitative case study explored the perceptions of eight RNs in a long-term health care facility located in a Northeastern region of the United States utilizing semi-structured open-ended interviews. The study illustrated how RNs' work engagement could be improved and strengthened, turnover intentions minimized to make nurses' practice environment more attractive to motivate and retain nurses in long-term care setting. Study results suggest that nurses are highly engaged in their work though they encounter several issues including understaffing that creates work overload leading to burnout and job-related stress that challenge and undermine their engagement. Results also indicate that in order to improve RNs' practice environment and minimize turnover intentions and turnover, concerns regarding understaffing, job role stress, and nurse-management conflicts need to be addressed. Study results imply that to be effective as a nurse one has to be dedicated and committed to his or her work and the profession. Additionally, organizational leaders should make concerted effort to identify and address nurses' issues to create practice environments that attract and retain nurses.</p>

<p> This study evaluated the use of video self-evaluation and video feedback procedures to enhance the accuracy of yoga poses. In the self-evaluation intervention participants watched their behaviors via video and scored task analyses for feedback for each pose. In the video feedback intervention, the participants and the researcher together scored the task analyses for the behaviors along with practice during video recordings. The interventions were assessed in a multiple baseline across behaviors design. Results showed that both video self-evaluation increased the accuracy of all poses and video feedback further increased the accuracy on one pose for one participant</p>

The objective of this study was to examine weight status among southern Appalachian adolescents and to identify risk factors for obesity. We analyzed baseline data from the Team Up for Healthy Living study in 2012. Overall, 19.8% of the sample was overweight, and 26.6% was obese. Boys had higher rates of overweight/ obesity than girls (50.5% vs 42.3%). Being male (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.39-2.29), having a mother with a high school education or less (OR = 1.39; 95% CI, 1.05-1.83), or having a father with a high school education or less (OR = 1.57; 95% CI, 1.17-2.09) was associated with a higher prevalence of obesity and a higher body mass index z score (β = 0.131, 0.160, and 0.043, respectively, P < .05). Parental education could be used to identify adolescents with a higher likelihood of obesity.

Overexposure to the sun is associated with an increased risk of melanoma and nonmelanoma skin cancer, but indications of improvements in sun protection behavior are poor. Attempts to identify emerging themes in skin cancer control have largely been driven by groups of experts from a single field. In December 2016, 19 experts from various disciplines convened for Interdisciplinary Perspectives on Skin Cancer, a 2-day meeting hosted by the National Academy of Sciences. The group discussed knowledge gaps, perspectives on sun exposure, implications for skin cancer risk and other health outcomes, and new directions. Five themes emerged from the discussion: (1) The definition of risk must be expanded, and categories for skin physiology must be refined to incorporate population diversities. (2) Risky sun exposure often co-occurs with other health-related behaviors. (3) Messages must be nuanced to target at-risk populations. (4) Persons at risk for tanning disorder must be recognized and treated. (5) Sun safety interventions must be scalable. Efficient use of technologies will be required to sharpen messages to specific populations and to integrate them within multilevel interventions. Further interdisciplinary research should address these emerging themes to build effective and sustainable approaches to large-scale behavior change.