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Objective: Cancer‐related fatigue (CRF) and fear of cancer recurrence (FCR) are two common concerns experienced by cancer survivors. However, the relationship between these two concerns is poorly understood, and whether CRF and FCR influence each other over time is unclear. Methods: Data were from a national, prospective, longitudinal study, the American Cancer Society's Study of Cancer Survivors‐I (SCS‐I). Surveys were completed by 1395 survivors of 10 different cancer types at three time‐points, including assessment 1.3 years (T1), 2.2 years (T2) and 8.8 years (T3) following their cancer diagnosis. CRF was assessed using the fatigue‐inertia subscale of the Profile of Mood States, and FCR by the FCR subscale of the Cancer Problems in Living Scale. Multiple group random intercepts cross‐lagged panel models investigated prospective associations between CRF and FCR. Results: For younger participants (at or below median age of 55 years, n = 697), CRF at T1 and T2 marginally and significantly predicted FCR at T2 and T3, respectively, but no lagged effects of FCR on subsequent CRF were observed. Cross‐lagged effects were not observed for survivors over 55 years of age. Conclusion: Both CRF and FCR are debilitating side effects of cancer and its treatments. Given that CRF may be predictive of FCR, it possible that early detection and intervention for CRF could contribute to lowering FCR severity. [ABSTRACT FROM AUTHOR]

Predictors of retention of participants in a longitudinal study and heterogeneity between communities were investigated using a multilevel logistic regression model. Data from the longitudinal outcome study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families program and information on communities participating in the evaluation were used to examine retention of participants at 6-, 12-, 18-, and 24-month follow-up interviews. Findings revealed that both child and family characteristics and community characteristics significantly influenced participation for up to 24-month follow-up. Specifically, behavioral and emotional problems at intake, referral source, proportion of total staff devoted to interviewers, and total amount of incentive paid out at baseline influenced retention of participants. In addition, significant random effects at both Level 2 and Level 3 indicated that retention varied significantly between communities and among children even after controlling for child and family characteristics.

The longitudinal comparison study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program assesses factors in service delivery systems that may shape the impact of systems of care. We evaluated the extent to which services embodying the principles of a system of care, as measured by the System-of-Care Practice Review (SOCPR), affect clinical outcomes for children being served in federally-funded systems of care and matched comparison communities. The participants included 75 children and families selected for participation in the SOCPR. Results indicated that experience of services embodying system-of-care principles at a high level was associated with lower symptom and impairment scores one year after entry into services. Children in systems of care were rated to have experienced high levels of system-of-care principles implemented within their services, and their symptom severity and functional impairment did not vary as a function of their experiences. Children in matched comparison communities had more variable rated experiences of system-of-care principles within their services, and their symptom severity and functional impairment decreased as their experiences of the principles increased.

Youth suicide remains a significant public health problem in the United States. In 2004, the Garrett Lee Smith Memorial Act provided states and tribes with funding to implement and evaluate youth suicide prevention programs. The Tennessee Lives Count project was developed through a collaborative model at the state level and delivers an enhanced version of the Question, Persuade, Refer gatekeeper training program to individuals working with youth across the state. This article describes the development of the project and preliminary outcomes of 416 participants in child welfare, juvenile justice, health, and education systems at pretest, posttest, and 6-month follow-up. The findings suggest the training has an immediate and long-term impact on perceived knowledge of suicide prevention, self-efficacy, and attitudes about the inevitability of suicide. Policy and practice implications are presented. Keywords: suicide prevention, gatekeeper training, child welfare, juvenile justice, public health nursing, education

Visceral hypersensitivity is the leading complaint of functional bowel disorders. Central sensitization mediated by glutamate receptor activation is implicated in pathophysiology of visceral pain. The glial glutamate transporter EAAT2 is the principal mediator of glutamate clearance to terminate glutamate-mediated responses. Transgenic mice overexpressing human EAAT2 (EAAT2 mice), which exhibited a twofold enhanced glutamate uptake, showed 39% less writhing response to intraperitoneal acetic acid than nontransgenic littermates. Moreover, EAAT2 transgenic mice showed a 53-64% reduction in visceromotor response (VMR) to colorectal distension (CRD) in assessments of the response to graded increase in pressures. Corroborating the involvement of enhanced glutamate uptake, wild-type mice treated for 1 wk with ceftriaxone, an EAAT2 expression activator, showed a 49-70% reduction in VMR to CRD. Moreover, systemic pretreatment with the selective EAAT2 transporter blocker dihydrokainate reversed the ceftriaxone-blunted nociceptive response to CRD. However, the enhanced VMR to CRD produced by intracolonic ethanol was not significantly attenuated by 1-wk ceftriaxone pretreatment. The data suggest that enhanced glutamate uptake provides protective effects against colonic distension-induced nociception and represents an exciting new mechanistic approach leading to better therapeutic options to visceral pain disorders. colon; pain; gastrointestinal; excitatory amino acids

Background: eHealth interventions can help cancer survivors self‐manage their health outside the clinic. Little is known about how best to engage and assist survivors across the age and cancer treatment spectra. Methods: The American Cancer Society conducted a randomized controlled trial that assessed efficacy of, and engagement with, Springboard Beyond Cancer, an eHealth self‐management program for cancer survivors. Intent‐to treat analyses assessed effects of intervention engagement for treatment (on‐treatment vs completed) overall (n = 176; 88 control, 88 intervention arm) and separately by age (<60 years vs older). Multiple imputation was used to account for participants who were lost to follow‐up (n = 41) or missing self‐efficacy data (n = 1) at 3 months follow‐up. Results: Self‐efficacy for managing cancer, the primary outcome of this trial, increased significantly within the intervention arm and for those who had completed treatment (Cohen's d = 0.26, 0.31, respectively). Additionally, participants with moderate‐to‐high engagement in the text and/or web intervention (n = 30) had a significantly greater self‐efficacy for managing cancer‐related issues compared to the control group (n = 68), with a medium effect size (Cohen's d = 0.44). Self‐efficacy did not differ between the intervention and control arm at 3 months post‐baseline. Conclusions: Study results suggest that cancer survivors benefit variably from eHealth tools. To maximize effects of such tools, it is imperative to tailor information to a priori identified survivor subgroups and increase engagement efforts. This randomized controlled trial assessed the efficacy of the Springboard Beyond Cancer eHealth program in a sample of 176 cancer survivors. Results demonstrate significant improvement in self‐efficacy for managing cancer issues among the intervention group and no significant change among the control group. [ABSTRACT FROM AUTHOR]

The site specificity of the interactions between serotonin (5-HT) and thyrotropin-releasing hormone (TRH) was investigated using prototypical selective agonists of the serotonin to delineate the mechanisms of the interactions. The results suggested that an augmentation of the TRH-analog induced increment in the response to gastric acid through activation of 5-carboxyamidotryptamine and 5-HT2 receptors may have come from the 5-HT in the dorsal vagal complex (DVC). The results further suggested that the TRH analog behavior at the DVC may have been inhibited by the 5-HT4 receptor activation.

Systemic serotonin (5-HT) inhibits gastric acid secretion via a basolateral pathway that is not affected by the enteric and external autonomic nervous control. Prostaglandins, gastric mucosal blood flow and adrenal factors did not alter 5-HT-mediated inhibition of pentagastrin-stimulated gastric acid secretion. Furthermore, reductions in blood supply to the gastric mucosa did not alter the inhibitory action of 5-HT on the gastric mucosa.

5-hydroxytryptamine (5-HT) selectively alters gastric acid secretion, motility and cytoprotection by stimulating the thyrotropin releasing hormone (TRH) analogue in the dorsal vagal complex (DVC). The administration of 5-HT into the DVC enhances the secretion of gastric acid and inhibits gastric cytoprotection, but leaves the gastric antral contractility unaffected through its effect on the TRH receptors.

Rat pancreatic polypeptide (PP) strongly stimulates gastric emptying by rats. In comparison, the effects of bovine PP is small or non-existent, depending on the method of administration. Researchers injected rat PP, bovine PP, or placebo either intracisternally or into the dorsal vagal complex (DVC) of rats. When injected intracisternally, bovine PP had little or no effect, but that of rat PP was marked. Reaction to DVC injection was measurable but smaller for both rat and bovine PP, and the bovine PP response was much smaller. PP probably acts as a circulating hormone by stimulating gastric voiding through a vagal cholinergic-dependent mechanism.

Abstract Glutamate is a neurotransmitter critical for spinal excitatory synaptic transmission and for generation and maintenance of spinal states of pain hypersensitivity via activation of glutamate receptors. Understanding the regulation of synaptically and non-synaptically released glutamate associated with pathological pain is important in exploring novel molecular mechanisms and developing therapeutic strategies of pathological pain. The glutamate transporter system is the primary mechanism for the inactivation of synaptically released glutamate and the maintenance of glutamate homeostasis. Recent studies demonstrated that spinal glutamate transporter inhibition relieved pathological pain, suggesting that the spinal glutamate transporter might serve as a therapeutic target for treatment of pathological pain. However, the exact function of glutamate transporter in pathological pain is not completely understood. This report will review the evidence for the role of the spinal glutamate transporter during normal sensory transmission and pathological pain conditions and discuss potential mechanisms by which spinal glutamate transporter is involved in pathological pain.

Proposes that it is more useful for industrial arts/technology teacher education to adopt than to ignore the concept of liberal learning. Argues that the goals of liberal learning are not only compatible, they are complementary, useful, and necessary. Includes recommendations for selecting courses for industrial arts/technology teacher education programs. (JOW)

Objective: The American Cancer Society and the National Cancer Institute launched and evaluated a personalized online program leveraging behavioral science principles to help people self-manage physical and emotional symptoms, improve communication skills, and lead healthier lives during and after a cancer diagnosis.Methods: Cancer survivors were recruited from an academic medical and a community clinical setting (N = 40) to complete in-person user testing of the Springboard Beyond Cancer website, which included action decks and content to promote self-management. Action decks were printable or savable collections of information and action steps related to a cancer topic or treatment side effect. Participants performed structured tasks to evaluate the program's content and usability. Comments and reactions were recorded, and qualitative thematic analyses were conducted.Results: Most participants successfully found information about fatigue (95%), pain (83%), sexual side effects (90%), and support groups (85%). Survivors, particularly those in treatment, found information on the site to be clear, concise, and meeting their needs. Use of action decks to create self-management plans was inconsistent. Survivors reported needing more instruction and support within the program on how to best utilize enhanced functionality in action decks to prioritize their most pressing concerns.Conclusions: Early stakeholder engagement throughout the multiple phases of prototyping and deployment are needed to fully maximize end user engagement. Providing actionable self-management content and activating tools to cancer survivors via an eHealth program is a feasible and scalable approach to increasing access to self-management tools and addressing cancer survivor needs. [ABSTRACT FROM AUTHOR]

Background: Despite demonstrated utility of Bandura's social cognitive theory for increasing physical activity among cancer survivors, the validity of the originally hypothesized relationships among self-efficacy, outcome expectations, and physical activity behavior continues to be debated.Purpose: To explore the temporal ordering of outcome expectations and self-efficacy as they relate to moderate-to-vigorous physical activity behavior.Methods: Longitudinal data from cancer survivors (N = 1,009) recently completing treatment were used to fit six cross-lagged panel models, including one parent model, one model representing originally hypothesized variable relationships, and four alternative models. All models contained covariates and used full information maximum likelihood and weighted least squares mean and variance adjusted estimation. Tests of equal fit between the parent model and alternative models were conducted.Results: The model depicting Bandura's originally hypothesized relationships showed no statistically significant relationship between outcome expectations and physical activity (p = .18), and was a worse fit to the data, compared with the parent model [Χ2 (1) = 5.92, p = .01]. An alternative model showed evidence of a reciprocal relationship between self-efficacy and outcome expectations, and was statistically equivalent to the parent model [Χ2(1) = 2.01, p = .16].Conclusions: This study provides evidence against Bandura's theoretical assertions that (a) self-efficacy causes outcome expectations and not vice versa, and (b) outcome expectation has a direct effect on physical activity. Replication within population subgroups and for other health behaviors will determine whether the social cognitive theory needs modification. Future trials should test whether differential construct ordering results in clinically meaningful differences in physical activity behavior change. [ABSTRACT FROM AUTHOR]

Introduction: Screening for colorectal cancer in average-risk adults is recommended beginning at age 50 years and continuing until age 75 years. This study was conducted to provide evidence for the effectiveness of an American Cancer Society grant program promoting colorectal cancer screening by implementing evidence-based interventions proven to increase screening rates.Methods: Analysis compared colorectal cancer screening rates in 77 grant-funded federally qualified health centers between 2013 and 2015 to those of a sample of 77 nonfunded federally qualified health centers selected using a genetic matching technique. The Uniform Data System from 2013 to 2015 provided data used in the analysis performed in 2016.Results: Funded grantees differed significantly from nongrantees on several indicators at baseline. Genetic matching resulted in good-quality matched samples. Both matched samples increased colorectal cancer screening rates over time. Grantees increased their colorectal cancer screening rates significantly more than nongrantees, especially between 2013 and 2014, where funded federally qualified health centers increased by 9% and nonfunded federally qualified health centers increased by 3%. Across the 3 years, increases were 12% and 9%, respectively.Conclusions: The findings suggest grant funding was effective in promoting improvements in colorectal cancer screening rates in funded federally qualified health centers, and these improvements exceed those of nonfunded federally qualified health centers. Funding that results in targeted, intensive efforts supported by technical assistance and accountability for data and reporting, can result in improved system policies and practices that, in turn, can increase screening rates among uninsured and underserved populations. [ABSTRACT FROM AUTHOR]

Objectives. To assess the impact of a large-scale place-based intervention on obesity prevalence in Black communities. Methods. The Racial and Ethnic Approaches to Community Health across the United States (REACH US) project was conducted in 14 predominantly Black communities in California, Illinois, Massachusetts, New York, Ohio, Pennsylvania, South Carolina, Virginia, Washington, and West Virginia. We measured trends from 2009 to 2012 in the prevalence of obesity. We used Behavioral Risk Factor Surveillance System data to compare these trends with trends among non-Hispanic Whites and non-Hispanic Blacks in the United States and in the 10 states where REACH communities were located, and with a propensity score-matched national sample of non-Hispanic Blacks. Results. The age-standardized prevalence of obesity decreased in REACH US communities (P = .045), but not in the comparison populations (P = .435 to P = .996). The relative change was -5.3% in REACH US communities versus +2.4% in propensity score-matched controls (P value for the difference = .031). The net effect on the reduction of obesity prevalence was about 1 percentage point per year for REACH. Conclusions. Obesity prevalence was reduced in 14 disadvantaged Black communities that participated in the REACH project. [ABSTRACT FROM AUTHOR]

Predictors of retention of participants in a longitudinal study and heterogeneity between communities were investigated using a multilevel logistic regression model. Data from the longitudinal outcome study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families program and information on communities participating in the evaluation were used to examine retention of participants at 6-, 12-, 18-, and 24-month follow-up interviews. Findings revealed that both child and family characteristics and community characteristics significantly influenced participation for up to 24-month follow-up. Specifically, behavioral and emotional problems at intake, referral source, proportion of total staff devoted to interviewers, and total amount of incentive paid out at baseline influenced retention of participants. In addition, significant random effects at both Level 2 and Level 3 indicated that retention varied significantly between communities and among children even after controlling for child and family characteristics. [ABSTRACT FROM PUBLISHER]

Youth with serious emotional disturbance involved in juvenile justice systems have complex needs that often are best addressed through collaborative systems that coordinate the efforts of individual agencies. This study examines the effectiveness of a system-of-care-grant-funded community in Birmingham, AL compared to a matched comparison community in Montgomery, AL in reducing youth contact with the juvenile justice system. Logistic regression results demonstrate greater reductions in the likelihood of juvenile justice involvement among youth served in systems of care over time compared to those served in a services-as-usual environment. These findings show the benefits of the incorporation of system-of-care principles for youth with a multitude of needs. [ABSTRACT FROM AUTHOR]

This study examines patterns of substance use among youth served in systems of care, and how these patterns relate to diagnosis and other youth characteristics using latent class analysis. Results indicated a four-class solution with the four groups differing in their probabilities of reporting the use of 10 different substances. Class 1 was defined by high probabilities of all drug use. Class 2 had high probabilities of alcohol, tobacco, marijuana use, and low for other drugs. Class 3 had moderate probabilities of alcohol, tobacco, marijuana use, and low probabilities for other drugs. Class 4 had a high probability of tobacco use and no other drug use. Youth who had a mood disorder diagnosis, were male, older, White and had previously run away from home were significantly more likely to be in Class 1 relative to other classes. These differences have implications for prevention and treatment. [ABSTRACT FROM AUTHOR]

This study examined outcomes for 320 youth in a Center for Mental Health Services system-of-care demonstration site. Youth received wraparound-only (n = 213),MST-only (n = 54),or wraparound + MST (n = 53). Participants were 12 years old on average and mostly White (90%), and 75% were Medicaid-eligible. Service use and functional and clinical outcomes were examined at 6-month intervals out to 18 months. All three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups. Youth in wrap + MST had higher baseline severity and experienced less clinical and functional change than the other two groups, despite more mental health service use. Targeted, evidence-based treatment may be more effective than system-level intervention alone for improving clinical symptoms among youth with serious emotional disorders served in community-based settings. New or amended approaches may be needed for youth with the most severe disorders. [ABSTRACT FROM AUTHOR]

There are three known high-affinity targets for cocaine: the dopamine transporter (DAT), the serotonin transporter (SERT), and the norepinephrine transporter (NET). Decades of studies support the dopamine (DA) hypothesis that the blockade of DAT and the subsequent increase in extracellular DA primarily mediate cocaine reward and reinforcement. Contrary to expectations, DAT knockout (DAT-KO) mice and SERT or NET knockout mice still self-administer cocaine and/or display conditioned place preference (CPP) to cocaine, which led to the reevaluation of the DA hypothesis and the proposal of redundant reward pathways. To study the role of DAT in cocaine reward, we have generated a knockin mouse line carrying a functional DAT that is insensitive to cocaine. In these mice, cocaine suppressed locomotor activity, did not elevate extracellular DA in the nucleus accumbens, and did not produce reward as measured by CPP. This result suggests that blockade of DAT is necessary for cocaine reward in mice with a functional DAT. This mouse model is unique in that it is specifically designed to differentiate the role of DAT from the roles of NET and SERT in cocaine-induced biochemical and behavioral effects. [ABSTRACT FROM AUTHOR]

This article explores the rates of co-occurring disorders in two large federally-funded programs that target youth. In the mental health treatment system, the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) supports the Comprehensive Community Mental Health Services for Children and Their Families Program. SAMHSA's Center for Substance Abuse Treatment (CSAT) supports a number of grant programs providing substance abuse treatment for adolescents. The data from these programs underscores the need for the use of systematic, validated, biopsychosocial assessment instruments for all youth entering either the substance abuse or mental health treatment systems. The current evidence base for models of co-occurring treatment for youth is discussed and recommendations made for future activity related to adolescent co-occurring treatment. [ABSTRACT FROM AUTHOR]

In this article we present an overview of descriptive and longitudinal outcome data collected by the national evaluation of the Comprehensive Community Mental Health for Children and Their Families Program. This program, supported by the federal Center for Mental Health Services at the Substance Abuse Mental Health Services Administration, has established systems of care for mental health services in 67 communities throughout the United States. Among the 22 communities receiving grants in 1993 and 1994, descriptive information was collected on 44,640 children who received services. Longitudinal outcome study enrollment included 18,884 children, with data collected on 2,580 children who continued in services through 24 months. The average age of children served was 12.1 years; 61.9% were boys, 54.7% were White, and 60.3% had annual household incomes below $15,000. Primary diagnoses included conduct-related disorders (29.3%), attention deficit hyperactivity disorder (13.6%), and depression or dysthymia (26%). Changes in children's behaviors and functioning were examined to 2 years in services; 44.6% of children exhibited clinically significant improvements in behavioral and emotional symptoms at 2 years, and 49.5% showed similar changes in functional impairment. [ABSTRACT FROM AUTHOR]