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Objective To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. Data sources 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. Study design We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. Principal findings After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. Conclusions Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.

Whether and how to return individual genetic results to study participants is among the most contentious policy issues in contemporary genomic research.We surveyed corresponding authors of genome-wide association studies, identified through the National Human Genome Research Institute's Catalog of Published Genome-Wide Association Studies, to describe the experiences and attitudes of these stakeholders.Of 357 corresponding authors, 200 (56%) responded. One hundred twenty-six (63%) had been responsible for primary data and sample collection, whereas 74 (37%) had performed secondary analyses. Only 7 (4%) had returned individual results within their index genome-wide association studies. Most (69%) believed that return of results to individual participants was warranted under at least some circumstances. Most respondents identified a desire to benefit participants' health (63%) and respect for participants' desire for information (57%) as major motivations for returning results. Most also identified uncertain clinical utility (76%), the possibility that participants will misunderstand results (74%), the potential for emotional harm (61%), the need to ensure access to trained clinicians (59%), and the potential for loss of confidentiality (51%) as major barriers to return of results.Investigators have limited experience returning individual results from genome-scale research, yet most are motivated to do so in at least some circumstances.

Aim: The return of individual genetic research results has been identified as one of the most pressing ethical challenges warranting immediate policy attention. We explored the practices and perspectives of genome-wide association studies (GWAS) investigators on this topic. Materials & methods: Corresponding authors of published GWAS were invited to participate in a semistructured interview. Interviews (n = 35) were transcribed and analyzed using conventional content analysis. Results: Most investigators had not returned GWAS results. Several had experience returning results in the context of linkage/family studies, and many felt that it will become a larger issue in whole-genome/-exome sequencing. Conclusions: Research context and nature of the study are important considerations in the decision to return results. More nuanced ethical guidelines should take these contextual factors into account.

Objective: To determine the clinical effectiveness of a standardised behavioural medicine group intervention when implemented by different group leaders in 7 geographically diverse healthcare organisations (HCOs). Design: This study used longitudinal data collected for quality assurance purposes. Patients were asked to complete questionnaires measuring presenting problems (Initial Health Status questionnaire), health and functional status [Short Form-36 Health Survey (SF-36)], and physical [Medical Symptom Check List (MSCL)] and psychological distress [Brief Symptom Inventory (BSI)]. Intervention: The Personal Health Improvement Program™ (PHIP) designed to treat somatising high utilisers of general medical services. Participants: Patients enrolled in PHIP courses at 7 different HCOs. Complete data were collected from 1194 patients before the course, 787 immediately after the course and 467 at a 6-month follow-up. 39% of patients who finished the course completed questionnaires at all 3 time-points (times 1, 2 and 3, respectively). Of the 467 patients who provided data at all points, complete information was obtained for 356 patients (the study sample). Main outcome measures and results: Patients’ symptoms of anxiety, depression, hostility and somatisation, as well as overall psychological distress improved (p ≤ 0.001) after the course and at follow-up as determined by repeated measures by group analysis of variance (ANOVA). Results were similar for health status (SF-36), with significant improvements in all of the functional health measures between time 1 and time 3. The majority of participants completing the PHIP reported long term reductions in patterns of distress commonly associated with high levels of medical utilisation. Participants also reported improvements in functional status. In addition, the value of the programme was highly rated by participants. Conclusions: Despite the lack of a control group, the consistency of these findings across the sites are likely to be due to the clinical effectiveness of the course content. The PHIP is an effective and standardised programme, which can be taught to leaders in a short period of time and implemented across very different sites to different populations.

This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.