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Abstract Background Significant racial, ethnic, and socioeconomic disparities exist in access to evidence-based treatment services for children with autism spectrum disorder (ASD). Patient Navigation (PN) is a theory-based care management strategy designed to reduce disparities in access to care. The purpose of this study is to test the effectiveness of PN a strategy to reduce disparities in access to evidence-based services for vulnerable children with ASD, as well as to explore factors that impact implementation. Methods This study uses a hybrid type I randomized effectiveness/implementation design to test effectiveness and collect data on implementation concurrently. It is a two-arm comparative effectiveness trial with a target of 125 participants per arm. Participants are families of children age 15–27 months who receive a positive screen for ASD at a primary care visit at urban clinics in Massachusetts (n = 6 clinics), Connecticut (n = 1), and Pennsylvania (n = 2). The trial measures diagnostic interval (number of days from positive screen to diagnostic determination) and time to receipt of evidence-based ASD services/recommended services (number of days from date of diagnosis to receipt of services) in those with PN compared to and activated control -Conventional Care Management – which is similar to care management received in a high quality medical home. At the same time, a mixed-method implementation evaluation is being carried out. Discussion This study will examine the effectiveness of PN to reduce the time to and receipt of evidence-based services for vulnerable children with ASD, as well as factors that influence implementation. Findings will tell us both if PN is an effective approach for improving access to evidence-based care for children with ASD, and inform future strategies for dissemination. Trial registration NCT02359084 Registered February 1, 2015.

OBJECTIVE: Maternal depression is common among mothers of very low birthweight (VLBW) infants. In a cohort of mother–VLBW infant dyads followed to preschool age, the authors assessed the impact of maternal depression on mothers' perceptions of their children's social aptitude and reported participation in age-appropriate preschool activities. METHODS: Longitudinal multivariable analysis of a nationally representative sample of VLBW infants in the USA. Models were adjusted for children's developmental abilities according to the Bayley Scales of Infant Development, Mental Development Index. RESULTS: 800 VLBW singletons (mean gestational age 28.9 weeks) were analysed. During the preschool years, depressed mothers perceived their children's social abilities more negatively than non-depressed mothers. Specifically, they saw their children as less likely to be able to share with others (aOR 0.37, 95% CI 0.14 to 0.96), make friends (aOR 0.58, 95% CI 0.35 to 0.96) or play independently (aOR 0.30, 95% CI 0.16 to 0.58). These negative perceptions were not shared by the children's preschool teachers. Children of depressed mothers were also less likely to participate in age-appropriate preschool activities (aOR 0.30, 95% CI 0.16 to 0.58). Each of these associations either lost significance or were substantially attenuated in a separate population of former healthy term infants. CONCLUSION: Among former VLBW infants, maternal depression is associated with negative perceptions of children's social abilities and decreased participation in preschool activities. Maternal mental health should be considered in ongoing efforts to maximise the social-emotional development of preterm infants. [ABSTRACT FROM AUTHOR]

Every year in the State of Washington more than 50,000 workers experience a work related musculoskeletal disorder (WMSD), making up more than 30% of all worker compensation cases. In 2000, the Washington State Department of Labor and Industries (L&I) adopted a workplace ergonomics rule requiring employers to reduce worker exposure to hazards that cause or contribute to WMSDs. In 2003, the ergonomics rule was repealed by a margin of 53.5–46.5 in a statewide voter initiative.The official rulemaking record of approximately 100,000 pages, along with supplementary published and unpublished material, was reviewed. The relationship between scientific deliberation and the public policy process in adopting and repealing the ergonomics rule was assessed and described. The deliberative features of the regulatory, judicial, legislative, and ballot processes were compared.The ergonomics rule was successful in the regulatory and legal arenas where the process was most transparent and open to public involvement, differing views could be presented fully, and decision makers were expected to explain their decisions in light of the record. The rule fared most poorly in the legislature and at the ballot box when these features were lost and where considered deliberation was replaced by unconstrained political conflict. Additional checks and balances are needed. Am. J. Ind. Med. 50:391–401, 2007. © 2007 Wiley‐Liss, Inc. [ABSTRACT FROM AUTHOR]

ABSTRACT.: Pediatricians and family practitioners increasingly provide free picture books and anticipatory guidance about reading aloud as part of routine health supervision for infants and young children, and arrange for volunteers to read aloud to children in the waiting rooms. These interventions comprise the Reach Out and Read (ROR) model, which has been adopted by more than 2000 clinical sites nationally. To date, 12 published studies have evaluated ROR and its variations, including three prospective, controlled trials. All but one have shown associations between ROR and increased reading aloud; additionally, four studies have linked program exposure to clinically meaningful increases in child language. Nonetheless, conclusive evidence of efficacy is lacking. This article provides a systematic, critical review of the literature, focusing on theoretical assumptions, issues of study design and measurement, and directions for future research. [ABSTRACT FROM AUTHOR]