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Social workers frequent interprofessional healthcare teams. However, there are no identified systematic reviews to analyze efforts in social work education to engage in healthcare-focused interprofessional education (IPE). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for a systematic scoping review were utilized for reporting purposes. Arksey and O’Malley’s methodological framework was used to 1) identify the research question, 2) identify relevant studies, 3) select relevant studies, 4) chart the data, and 5) report results. The final analysis included 49 articles. During data extraction, the following categories were utilized to organize findings: 1) Attitudes, 2) Infrastructure development, 3) Descriptive articles, and 4) Outcomes studies. Most of the IPE interventions include IPE courses, events, and fellowships. The majority of studies provided favorable results for IPE. Infrastructure and institutional support is critical to successful IPE implementation. More research is needed utilizing rigorous designs to assess the longitudinal efficacy of IPE interventions. [ABSTRACT FROM AUTHOR]

The article focuses on exploring mindfulness as a non-pharmacological treatment for migraine, particularly examining the role of pain catastrophizing and cognitive fusion in mediating therapeutic outcomes. Topics include the effectiveness of mindfulness-based cognitive therapy (MBCT) in reducing headache-related disability, the surprising findings regarding cognitive fusion's stability during treatment.

Title X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients' use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers. This article draws on 2015–2017 and 2017–2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months' supply for those using oral contraceptives. In 2015–2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; p =.004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015–2017 [ p =.023] and AOR, 2.59 in 2017–2019 [ p =.003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015–2017 [ p =.007] and AOR, 3.04 in 2017–2019 [ p =.001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015–2017 [ p =.008] and AOR, 2.61 in 2017–2019 [ p =.043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal. Patterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time. [ABSTRACT FROM AUTHOR]

Objective: The literature review reports on programs and interventions that address postpartum depression (PPD) in African American women. African American women are at a higher risk of developing PPD compared to white women. The review will highlight and recommend approaches that may render positive outcomes in the future for this population. Methods: A systematic scoping literature review was conducted using Academic Search Complete, CINAHL, APA PsycArticles, APA PsychInfo, PubMed, Social Services Abstracts, and Social Work Abstracts. Keywords used in the search included "postpartum depression," "African American," and "interventions OR programs OR therapy OR treatment." Fourteen studies were selected, analyzed, and included in the review. Results: Group psychosocial, individual psychosocial, internet-based, and integrated care interventions were included. While many articles noted within group changes in depression symptoms, fewer studies documented between group differences. Studies that investigated subsamples of "high risk" participants or those that used "culturally tailored" approaches showed promise. Conclusion: The literature review yielded some examples of programs/interventions that target postpartum depression in African American women; however, results were mixed. More research is needed to confirm the most effective interventions to address postpartum depression in African American women. Significance: The data shows a limited number of public health interventions tailored to address and reduce postpartum depression in this marginalized population. The recommendations included in the review highlight the need for public health professionals to develop programs to support African American women during the postpartum period. [ABSTRACT FROM AUTHOR]

Purpose: State Title V programs collaborate with diverse partners to improve maternal and child health. Since 2014, the National Maternal and Child Health Workforce Development Center has trained Title V leaders in facilitating system change. This article describes aspects of initial collaborative readiness differentiating state and jurisdiction teams that later reported meeting their goals to greater or lesser degrees. Description: We used quantitative data from initial team leader reports to characterize readiness to collaborate with external partners, and their responses twelve months later to a prompt about how fully they had accomplished their goals. In addition, we coded excerpts from team leader accounts six and twelve months into their work with the Center, and retrospective coach perspectives, to identify collaborative readiness patterns. Assessment: Teams whose leaders reported higher goal accomplishment twelve months after beginning work with the Center had initially reported higher levels of collaboration with key partners. Our analyses suggest that such teams were also better able to use their cohort experience with the Center to improve collaboration, including information sharing with external stakeholders. Challenges working with Medicaid were reported both by teams with more and less goal accomplishment. Conclusions: Title V teams with lower levels of initial collaborative readiness may benefit from additional support in skill development, connections to key partners, and convening power. Given the crucial and increasing role of Medicaid in maternal and child health systems, more attention may be warranted to supporting all Title V programs in partnering with this funder. Significance: What is already known on this subject?: Prior research has identified the ability to convene diverse stakeholders as key to achieving partnership synergies, and in turn improved community outcomes. What this study adds: State and territorial Title V programs may achieve greater synergies with external partners by initially assessing and strategically enhancing collaborative readiness. Training and technical assistance providers might enhance partnership synergies through focused assistance to states with lower initial levels of external collaboration. Title V leaders may improve outcomes by leveraging their strongest collaborations to foster relationships with additional stakeholders. Title V programs in general could benefit from support cultivating relationships with Medicaid. [ABSTRACT FROM AUTHOR]

In light of increasing pressure to deliver climate action targets and the growing role of citizens in raising the importance of the issue, deliberative democratic processes (e.g. citizen juries and citizen assemblies) on climate change are increasingly being used to provide a voice to citizens in climate change decision-making. Through a comparative case study of two processes that ran in the UK in 2019 (the Leeds Climate Change Citizens’ Jury and the Oxford Citizens’ Assembly on Climate Change), this paper investigates how far citizen assemblies and juries are increasing citizen engagement on climate change and creating more citizen-centred climate policymaking. Interviews were conducted with policymakers, councillors, professional facilitators and others involved in running these processes to assess motivations for conducting these, their structure and the impact and influence they had. The findings suggest the impact of these processes is not uniform: they have an indirect impact on policy making by creating momentum around climate action and supporting the introduction of pre-planned or pre-existing policies rather than a direct impact by truly being citizen-centred policy making processes or conducive to new climate policy. We conclude with reflections on how these processes give elected representatives a public mandate on climate change, that they help to identify more nuanced and in-depth public opinions in a fair and informed way, yet it can be challenging to embed citizen juries and assemblies in wider democratic processes. [ABSTRACT FROM AUTHOR]

Using the 2009/2010 National Survey of Children with Special Health Care Needs (CSHCN), we investigated the impact of medical home-consistent care and child condition on five outcomes for CSHCN (n = 32,299). Models suggested that medical home-consistent care predicted increased odds of preventive services receipt, no unmet health or family support needs, ease of use of community-based services, and shared decision-making. Despite these positive effects, disparities persisted based on insurance, condition complexity, and household income. These findings illustrate the positive impacts of medical home-consistent care on children yet remind health professionals of the unique family circumstances that ultimately impact health and wellbeing. [ABSTRACT FROM AUTHOR]

Exclusionary housing policies concentrate housing inequities, disproportionately exposing Black communities to environmental pollutants, and isolating them from essential health resources (Dimick et al. 2013). For this study, a literature review was conducted to explore how environmental racism has contaminated Black lives and to understand the policy failures that have perpetuated these inequities. Using case study methodology, this paper highlights three specific events to illustrate the contamination of Black lives: toxic wells in Dickinson County, Tennessee; coke plants in North Birmingham, Alabama; and the water crisis in Flint, Michigan. The central policy failures in these cases were delayed response, misinformation, weak enforcement of regulations, and inadequate solutions provided by environmental health officials. Future research should focus on the intersection of environmental hazards, community trust, and the effectiveness of prevention strategies in Black communities. Environmental health officials should focus on transparency, accountability, and equal protection for all lives. [ABSTRACT FROM AUTHOR]

Introduction: The Wilder Collaboration Factors Inventory is a free, publicly available questionnaire about the quality and context of community collaboration. The purpose of this article is to share lessons from using this questionnaire in a North Carolina maternal and child health initiative. Methods: In 2015, the State's General Assembly funded five local health departments to implement evidence-based strategies for improving maternal and child health. Each health department formed a community action team for this purpose. Members of each community action team completed the Wilder Collaboration Factors Inventory (Inventory) in the first year of funding and again 1 and 2 years later. Technical assistance coaches also asked community action team conveners to complete a brief questionnaire annually, and used these as well as Inventory results to plan for improvements. Results: During the first year, community action teams emerged as strong in seeing collaboration in their self-interest. A primary challenge noted by conveners was engaging consumers on the community action teams. Strategies to address this included using social media and compensating consumers for attending meetings. By the second year, teams' average scores in engaging multiple layers of participation increased, and eight additional factors became strengths, which generally continued in year three. The most consistent challenge was supporting community action teams administratively. Discussion: The Wilder Collaboration Factors Inventory provided a feasible tool for identifying opportunities for improvement in several local, cross-sector partnerships, suggesting promise for other communities seeking to enhance their collective impact on maternal and child health. [ABSTRACT FROM AUTHOR]

To identify whether medical homes in FQHCs have advantages over other group and individual medical practices in caring for people with severe mental illness. Models estimated the effect of the type of medical home on monthly service utilization, medication adherence, and total Medicaid spending over a 4-year period for adults aged 18 or older with a major depressive disorder (N = 65,755), bipolar disorder (N = 19,925), or schizophrenia (N = 8501) enrolled in North Carolina's Medicaid program. Inverse probability of treatment weights (IPTW) were used to adjust for nonrandom assignment of patients to practices. Generalized estimating equations for repeated measures were used with gamma distributions and log links for the continuous measures of medication adherence and spending, and binomial distributions with logit links for binary measures of any outpatient or any emergency department visits. Adults with major depression or bipolar disorders in FQHC medical homes had a lower probability of outpatient service use than their counterparts in individual and group practices. The probability of emergency department use, medication adherence, and total Medicaid spending were relatively similar across the three settings. This study suggests that no one type of medical practice setting—whether FQHC, other group, or individual—consistently outperforms the others in providing medical home services to people with severe mental illness. [ABSTRACT FROM AUTHOR]

The endogenous opioidergic system is critically involved in the cognitive modulation of pain. Slow-breathing-based techniques are widely used nonpharmacological approaches to reduce pain. Yet, the active mechanisms of actions supporting these practices are poorly characterized. Growing evidence suggest that mindfulness-meditation, a slow-breathing technique practiced by nonreactively attending to breathing sensations, engages multiple unique neural mechanisms that bypass opioidergically mediated descending pathways to reduce pain. However, it is unknown whether endogenous opioids contribute to pain reductions produced by slow breathing. The present double-blind, placebo-controlled crossover study examined behavioral pain responses during mindfulness-meditation (n = 19), sham-mindfulness meditation (n = 20), and slow-paced breathing (n = 20) in response to noxious heat (49°C) and intravenous administration (0.15 mg/kg bolus + 0.1 mg/kg/hour maintenance infusion) of the opioid antagonist, naloxone, and placebo saline. Mindfulness significantly reduced pain unpleasantness ratings across both infusion sessions when compared to rest, but not pain intensity. Slow-paced breathing significantly reduced pain intensity and unpleasantness ratings during naloxone but not saline infusion. Pain reductions produced by mindfulness-meditation and slow-paced breathing were insensitive to naloxone when compared to saline administration. By contrast, sham-mindfulness meditation produced pain unpleasantness reductions during saline infusion but this effect was reversed by opioidergic antagonism. Sham-mindfulness did not lower pain intensity ratings. Self-reported "focusing on the breath" was identified as the operational feature particularly unique to the mindfulness-meditation and slow paced-breathing, but not sham-mindfulness meditation. Across all individuals, attending to the breath was associated with naloxone insensitive pain-relief. These findings provide evidence that slow breathing combined with attention to breath reduces pain independent of endogenous opioids. [ABSTRACT FROM AUTHOR]

The article focuses on the need of early career physicians and fellows in headache medicine. Topics include residency and fellowship training are largely academic and hospital based; and the opportunity to establish a headache center provides an extraordinary chance to impart vision for headache management and headache training.

The article discusses the value of headache specific recommendations during COVID-19. Topics include providers have been asked to give guidance on additional treatment options; the COVID-19, treatments that may have been considered "too expensive" in the past for typical insurance coverage; and eliminate or minimize migraine medication copays given the financial impact of COVID on patients.

Care coordination is an increasingly popular strategy to help patients with complex health conditions manage their diseases more effectively. The purpose of the current study was to assess associations between patient-reported receipt of care coordination and their experiences of health, health care quality, and cost-related outcomes. Regression analyses of data from 431 patients across 13 Texas providers indicate that patients who reported receiving care coordination had higher odds of perceiving having enough information about how to manage their conditions (OR 2.02, P < .01), having information about education and treatments available (OR 1.87, P < .01), and reporting better access to care (beta = .27, P < .01). Receipt of care coordination was not associated with patients' reports of how up-to-date their doctors were about care from other providers, patients' health-related functioning, or patients' intention to return to the emergency department. Patients' reasons for intending to return to the emergency department included the speed of care there relative to alternatives and satisfaction with the quality of care they had received previously in the emergency department. Results suggest that care coordination in usual practice may improve patient preventive care, but not some other health or cost-related outcomes. [ABSTRACT FROM AUTHOR]

Mixed evidence of care management effectiveness raises questions about how these services are provided in practice. This study evaluates care management in nine provider settings using elements from two prominent models: The Chronic Care Model and the Care Transitions Program. Staff interviews addressed organizational and community resources. Patients were also surveyed about their experiences. Patients generally indicated actively managing their own care. However, patient interactions with care managers generally fell below recommended levels. This study suggests a need to examine the quantity of specific elements of care management that yield desired outcomes, such as improved disease self-management and health. [ABSTRACT FROM AUTHOR]

Introduction: Despite evidence that people with serious mental illness benefit from receiving primary care within mental health care settings, there is little research on this type of integration. The objective of this study was to characterize how providers and patients experienced implementation of primary care into specialty mental health services. Methods: During site visits, study team members interviewed staff and conducted focus groups with patients at 10 United States community mental health centres then beginning to integrate primary into their practices. One year later, follow up phone interviews with key centre staff informants validated and updated findings. Data analysis included thematic coding of results from staff interviews and patient focus groups. Results: Findings included the importance of the scope of primary care services provided on site, given limited alternatives available to patients; rapid scale-up; overcoming challenges in provider recruitment and retention; and adaptations to engage patients as well as to improve communication between mental health and primary care providers. Conclusion: Providers and patients perceived improvements through integrated care. However, the majority of patients were uninsured, and the funding was short term. The long-term viability of integrated care for community mental health centre patients may hinge on adequate, predictable public funding. [ABSTRACT FROM AUTHOR]

An editorial is presented on the value of the patient perspective in understanding the full burden of migraine. The article discusses that the recent explosion of headache research, we have more therapeutic choices to offer, including pharmacotherapies, devices, and behavioral interventions; and optimally using the expanding therapeutic armamentarium requires a holistic approach and nuanced understanding of the distinct ways in which migraine impacts our patients' lives.

Background/objective: High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of mild cognitive impairment (MCI) and Alzheimer's disease. While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation.Methods: 14 adults with MCI were randomized 2:1 to Mindfulness Based Stress Reduction (MBSR) or a wait-list control group. We conducted qualitative interviews with those who completed MBSR. Transcribed interviews were: a) coded using an emergent themes inductive approach informed by grounded theory; b) rated 0-10, with higher scores reflecting greater perceived benefit from, and understanding of, mindfulness meditation. Ratings were correlated with daily home practice times and baseline level of cognitive function.Results: Seven themes emerged from the interviews: positive perceptions of class; development of mindfulness skills, including meta-cognition; importance of the group experience; enhanced well-being; shift in MCI perspective; decreased stress reactivity and increased relaxation; improvement in interpersonal skills. Ratings of perceived benefit and understanding ranged from 2-10 (mean = 7) and of 0-9.5 (mean = 6), respectively. Many participants experienced substantial benefit/understanding, some had moderate, and a few had minimal benefit/understanding. Understanding the key concepts of mindfulness was highly positively correlated with ≥20 minutes/day of home practice (r = 0.90) but not with baseline cognitive function (r = 0.13).Conclusions: Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. Cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI. [ABSTRACT FROM AUTHOR]

Objectives As the U.S. healthcare system shifts toward collaboration, demand for leaders with interdisciplinary skills increases. Leadership competencies guide interdisciplinary training programs; however, identifying cost-effective methods for evaluating leadership competencies is challenging, particularly when interdisciplinary trainees have different areas of expertise and professional goals. Traditional pre-/post-testing, a common method for evaluating leadership competencies, is subject to response-shift bias, which can occur when participants' understanding of a construct changes between pre- and post-test. As a result, participants may rate their knowledge of the construct lower at post-test. Retrospective pre-tests are one method thought to reduce response-shift bias in pre-/post-tests. The current study explores the use of a retrospective pre-test to control for response-shift bias in an interdisciplinary training program. Methods Over three cohort years, thirty-four trainees from an interdisciplinary leadership program completed a self-assessment aligned with MCH leadership competencies. The traditional pre-test self-assessment was completed at the beginning of the training program. The retrospective pre-/post-test self-assessment was completed at the end of the training program. Results Retrospective pre/post-test scores indicate significant self-reported increases in all 24 leadership areas (p ≤ .001). Furthermore, participants' self-ratings were significantly higher on the traditional pre-test for all 24 areas than on the retrospective pre-test (p ≤ .001). Conclusions for Practice Retrospective pre-tests appeared to control for response-shift bias and may be a cost-effective way to evaluate trainee change within an interdisciplinary leadership program. These findings suggest the methodology's usefulness in interdisciplinary training and its potential use in the broader world of community-based MCH training initiatives. [ABSTRACT FROM AUTHOR]

Despite the compelling logic for integrating care for people with serious mental illness, there is also need for quantitative evidence of results. This retrospective analysis used 2013-2015 data from seven community mental health centers to measure clinical processes and health outcomes for patients receiving integrated primary care (n = 18,505), as well as hospital use for the 3943 patients with hospitalizations during the study period. Bivariate and regression analyses tested associations between integrated care and preventive screening rates, hemoglobin A1c levels, and hospital use. Screening rates for body-mass index, blood pressure, smoking, and hemoglobin A1c all increased very substantially during integrated care. More than half of patients with baseline hypertension had this controlled within 90 days of beginning integrated care. Among patients hospitalized at any point during the study period, the probability of hospitalization in the first year of integrated care decreased by 18 percentage points, after controlling for other factors such as patient severity, insurance status, and demographics (p < .001). The average length of stay was also 32% shorter compared to the year prior to integrated care (p < .001). Savings due to reduced hospitalization frequency alone exceeded $1000 per patient. Data limitations restricted this study to a pre−/post-study design. However, the magnitude and consistency of findings across different outcomes suggest that for people with serious mental illness, integrated care can make a significant difference in rates of preventive care, health, and cost-related outcomes. [ABSTRACT FROM AUTHOR]

Science journalism faces an issue that is part of a bigger picture of media change. The economic pressures which have seen shrinking resources available for reporting news are contrasted by the relentless rise of corporate communication and public relations. Institutional science communication has become a booming industry, operating, at least partially, by bypassing the traditional roles of journalists. To interrogate how science journalists perceive the impact of these changes on their professional roles, as well as how they navigate relationships with scientists and institutional science communicators, we conducted in-depth interviews with experienced South African science journalists. Our paper summarises the results of this study, including how journalists perceive changes in their professional identities and responsibilities. We analyse the interview data and explore the extent to which science journalists perceive themselves as "cheerleaders" for science, in contrast to critical investigators tasked with holding science and scientists to account, as well as how they operate in a world of well-endowed corporate science communication. We situate these interview findings against the theoretical background of boundary work and recent discussions about the blurring boundaries between science journalism and science communication. [ABSTRACT FROM AUTHOR]

Collaboration with diverse partners is challenging but essential for the implementation of prevention programs and policies. Increased communication with partners from diverse sectors may help community coalitions overcome the challenges that diversity presents. We examined these issues empirically in a study of 17 substance use prevention coalitions in Mexico. Building on coalition and workgroup literatures, we hypothesized that sectoral diversity would improve outcomes but undermine coalition processes. Conversely, we expected uniformly positive effects from higher levels of intersectoral communication. Data are from a 2015 survey of 211 members within the 17 community coalitions. Regression models used sectoral diversity and intersectoral communication to predict coalition processes (cohesion, leader-member communication, efficiency) and outcomes (community support, community improvement, sustainability planning). Sectoral diversity was negatively associated with coalition processes and was not associated with coalition outcomes. Intersectoral communication was positively associated with two of the three measures of coalition outcomes but not associated with coalition processes. Our findings concur with those from prior research indicating that sectoral diversity may undermine coalition processes. However, more communication between sectors may facilitate the coalition outcomes of community support and sustainability planning. Skilled team leaders and participatory decision making may also help coalitions promote intersectoral communication, thereby engaging diverse community sectors to implement preventive interventions and actualize sustained public health impact. [ABSTRACT FROM AUTHOR]

Fat accumulation during liver steatosis precedes inflammation and fibrosis in fatty liver diseases, and is associated with disease progression. Despite a large body of evidence that liver mechanics play a major role in liver disease progression, the effect of fat accumulation by itself on liver mechanics remains unclear. Thus, we conducted ex vivo studies of liver mechanics in rodent models of simple steatosis to isolate and examine the mechanical effects of intrahepatic fat accumulation, and found that fat accumulation softens the liver. Using a novel adaptation of microindentation to permit association of local mechanics with microarchitectural features, we found evidence that the softening of fatty liver results from local softening of fatty regions rather than uniform softening of the liver. These results suggest that fat accumulation itself exerts a softening effect on liver tissue. This, along with the localized heterogeneity of softening within the liver, has implications in what mechanical mechanisms are involved in the progression of liver steatosis to more severe pathologies and disease. Finally, the ability to examine and associate local mechanics with microarchitectural features is potentially applicable to the study of the role of heterogeneous mechanical microenvironments in both other liver pathologies and other organ systems. [ABSTRACT FROM AUTHOR]

The goal of the current study was to better understand how deficits in emotional self-awareness (alexithymia) can disrupt social support in romantic relationships by extending past research in two ways. At the methodological level, we wanted to gather data from both partners of support interactions in order to examine whether the lowered levels of support reported by individuals with alexithymia are corroborated by partner reports. We also extended past research by investigating additional facets of social support: provision of support and expectations of support from romantic partners. We tested our hypotheses in a sample of 69 long-term committed relationships. Both partners completed self-report measures of alexithymia and indices of social support. Individuals with elevated scores on alexithymia reported receiving less support from their romantic partners and expected more negative forms of support from their partner. They also reported providing less support to their partner. In addition, there were a number of significant partner effects, such that partners of individuals with alexithymia reported providing and receiving less support from their partners, as compared to partners of non-alexithymics. Our pattern of results, based on self-report and partner report, suggest that alexithymic individuals have difficulty with many different aspects of everyday support exchanges. [ABSTRACT FROM AUTHOR]

Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. [ABSTRACT FROM AUTHOR]

Liver fibrosis contributes to many of the devastating complications of viral, toxic, fatty, and cholestatic liver disease. Understanding the cell populations that promote liver fibrosis and the molecular pathways through which they operate is essential for the development of antifibrotic therapies. The authors review the origins and functions of hepatic myofibroblasts, focusing on hepatic stellate cells, the main contributors to organ fibrosis, and portal fibroblasts, an insufficiently characterized population that may have a specialized function in promoting periductular fibrosis, but a limited role in overall organ fibrosis. They discuss the hypothesis that each fibrogenic cell population in the liver exerts specific functions, and whether cell type-specific antifibrotic strategies are required or whether one therapeutic strategy fits all. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory case study examines how school systems and other local organizations have been working within two major U.S. cities to improve high school graduation rates. Systematically assessing active interorganizational dropout prevention networks may reveal characteristics affecting communities’ capacity to support school completion. Research Method: This study included the local affiliates within two U.S. cities of national partners in a dropout prevention initiative. A survey and follow-up interview probed for each organization’s cooperation with the other local organizations. Social network analyses revealed how school superintendents’ offices and other local agencies cooperated, as well as which organizations were most central within each city’s dropout prevention network. Findings: School systems in both cities cooperated with the YMCA, Big Brothers Big Sisters, Boys and Girls Club, the mayor’s office, United Way, and Chamber of Commerce. Among the most central organizations in broader dropout prevention-related networks were the YMCA, Communities in Schools, mayor’s office, and the United Way. Implications for Research and Practice: An organizational network perspective can help school systems identify strategic opportunities to build local capacity for supporting youth. Working with key brokers may then offer a feasible way for schools to leverage local resources. [ABSTRACT FROM PUBLISHER]

Objective Our objective was to assess the safety, feasibility, and effects of the standardized 8-week mindfulness-based stress reduction ( MBSR) course in adults with migraines. Background Stress is a well-known trigger for headaches. Research supports the general benefits of mind/body interventions for migraines, but there are few rigorous studies supporting the use of specific standardized interventions. MBSR is a standardized 8-week mind/body intervention that teaches mindfulness meditation/yoga. Preliminary research has shown MBSR to be effective for chronic pain syndromes, but it has not been evaluated for migraines. Methods We conducted a randomized controlled trial with 19 episodic migraineurs randomized to either MBSR (n = 10) or usual care (n = 9). Our primary outcome was change in migraine frequency from baseline to initial follow-up. Secondary outcomes included change in headache severity, duration, self-efficacy, perceived stress, migraine-related disability/impact, anxiety, depression, mindfulness, and quality of life from baseline to initial follow-up. Results MBSR was safe (no adverse events), with 0% dropout and excellent adherence (daily meditation average: 34 ± 11 minutes, range 16-50 minutes/day). Median class attendance from 9 classes (including retreat day) was 8 (range [3, 9]); average class attendance was 6.7 ± 2.5. MBSR participants had 1.4 fewer migraines/month ( MBSR: 3.5 to 1.0 vs control: 1.2 to 0 migraines/month, 95% confidence interval CI [−4.6, 1.8], P = .38), an effect that did not reach statistical significance in this pilot sample. Headaches were less severe, although not significantly so (−1.3 points/headache on 0-10 scale, [−2.3, 0.09], P = .053) and shorter (−2.9 hours/headache, [−4.6, −0.02], P = .043) vs control. Migraine Disability Assessment and Headache Impact Test-6 dropped in MBSR vs control (−12.6, [−22.0, −1.0], P = .017 and −4.8, [−11.0, −1.0], P = .043, respectively). Self-efficacy and mindfulness improved in MBSR vs control (13.2 [1.0, 30.0], P = .035 and 13.1 [3.0, 26.0], P = .035 respectively). Conclusions MBSR is safe and feasible for adults with migraines. Although the small sample size of this pilot trial did not provide power to detect statistically significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy, and mindfulness. Future studies with larger sample sizes are warranted to further evaluate this intervention for adults with migraines. This study was prospectively registered ( identifier NCT01545466). [ABSTRACT FROM AUTHOR]

Background Many unanswered questions remain regarding behavioral and mind/body interventions in the treatment of primary headache disorders in adults. Methods We reviewed the literature to ascertain the most pressing unanswered research questions regarding behavioral and mind/body interventions for headache. Results We identify the most pressing unanswered research questions in this field, describe ideal and practical ways to address these questions, and outline steps needed to facilitate these research efforts. We discuss proposed mechanisms of action of behavioral and mind/body interventions and outline goals for future research in this field. Conclusions Although challenges arise from the complex nature of the interventions under study, research that adheres to published study design and reporting standards and focuses closely on answering key questions is most likely to lead to progress in achieving these goals. [ABSTRACT FROM AUTHOR]

Abstract: US public child welfare agencies have faced increasing pressure in the first decade of this century to demonstrate efficiency and accountability, even as the Great Recession increased pressures on millions of families and undermined human service funding. This paper reports on analyses of the two cohorts of local public child welfare agencies from the National Survey of Child and Adolescent Well-Being to identify changes in their structure and practice. Local agency adaptations have included some structural integration and apparently increased use of subcontracting, including investigations. Collectively, these trends appear to be fostering a tighter coupling of local child welfare agencies with other service providers. Some of these connections may improve families' access to a range of services. However, the increased reliance on private providers may also undermine accountability and flexibility to respond to changing needs. [Copyright &y& Elsevier]

Objective To identify factors associated with triptan discontinuation among migraine patients. Background It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. Methods This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment ( MIDAS) scores and Beck Depression Inventory ( BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Results Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs 18%, P = .04) and were more likely to have ever used opioids for migraine treatment (57 vs 38%, P = .006) as well as higher MIDAS (mean 63 vs 37, P = .001) and BDI scores (mean 10.4 vs 7.4, P = .009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs 54%, P = .002) and were more likely to report headache resolution (53 vs 14%, P < .001) or a reduction in pain intensity (71 vs 28%, P < .001) most of the time from their triptan. On a 1-5 scale (1 = disagree, 5 = agree), triptan users felt they had more: control over their migraine attacks (2.9 vs 2.1), confidence in their prescribing provider (4.5 vs 4.0), and were more educated about triptan use (4.2 vs 3.7) compared with triptan discontinuers ( P < .001 for all comparisons). Although both current and prior users reported similar rates of side effects (48 vs 43%, P = .44), of those who discontinued use, the main reasons were for lack of effect (44%) and side effects (29%). Our multivariable modeling revealed that the strongest correlate of triptan discontinuation was lack of efficacy (odds ratio = 17, 95% confidence interval [8.8, 33.0]). Other factors associated with discontinuation included MIDAS > 24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1.3, 3.8]). Having a triptan prescribed by a specialist and using at least 1 other abortive medication with the triptan were associated with a decreased likelihood of triptan discontinuation (0.41, [0.2-0.7] and 0.44 [0.3, 0.8], respectively). Conclusions As expected, discontinuation was most correlated with lack of efficacy, but other important factors associated with those who had discontinued use included greater migraine-related disability, depression, and the use of opioids for migraine attacks. Compared with patients who had discontinued triptans, current triptan users felt more: educated about their triptan, control over their migraine attacks, and confidence in their prescribing provider. Current triptan users had their triptan prescribed by a specialist and used other abortive medications with their triptan more often compared with patients who had discontinued triptans. Given the cross-sectional nature of this study, we cannot determine if these factors contributed to triptan discontinuation or reflect the impact of such discontinuation. Interventions that address modifiable risk factors for triptan discontinuation may decrease the likelihood of triptan discontinuation and thus improve overall migraine control. Because lack of efficacy was most strongly associated with triptan discontinuation, future research should determine why triptans are effective for some patients but not others. [ABSTRACT FROM AUTHOR]

Highlights: [•] We conducted a randomized trial of meditation for mild cognitive impairment (MCI). [•] Meditation may increase functional connectivity in the default mode network in MCI. [•] Mediation may reduce hippocampal volume atrophy in MCI. [•] Meditation may have a positive impact on brain regions most related to dementia. [ • ] Further research with larger sample sizes and longer-follow-up are needed. [Copyright &y& Elsevier]

Abstract: Mechanical forces are essential to the development and progression of fibrosis, and are likely to be as important as soluble factors. These forces regulate the phenotype and proliferation of myofibroblasts and other cells in damaged tissues, the activation of growth factors, the structure and mechanics of the matrix, and, potentially, tissue patterning. Better understanding of the variety and magnitude of forces, the characteristics of those forces in biological tissues, and their impact on fibrosis in multiple tissues is needed and may lead to identification of important new therapeutic targets. This article is part of a Special Issue entitled: Fibrosis: Translation of basic research to human disease. [Copyright &y& Elsevier]

Abstract: Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers'' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed. [Copyright &y& Elsevier]

In order to bolster the public mental health safety net, we must first understand how these systems function on a day-to-day basis. This study explored how individual attributes and organizational interdependencies within one predominantly urban US county affected responses to individuals' needs during psychiatric crises. We interviewed clinicians and managers within the crisis response network about people at immediate risk of psychiatric hospitalization, what had happened to them during their crises, and factors affecting services provided ( N = 94 individuals and 9 agencies). Social network diagrams depicted patterns of referrals between agencies. Iterative coding of interview transcripts was used to contextualize the social network findings. Often, agencies saw crises through to resolution. However, providers also limited the types of people they served, leaving many people in crisis in limbo. This study illustrates how attributes of individuals with mental illness, service providers and their interactions, and state and federal policies intersect to shape the trajectories of individuals during psychiatric crises. Understanding both the structures of current local systems and their contexts may support continued evolution toward a more humane and robust safety net for some of our society's most vulnerable members. [ABSTRACT FROM AUTHOR]

Abstract: States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from the longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive. [Copyright &y& Elsevier]

A letter to the editor is presented which is concerned with research which investigated the use of meditation in adults with mild cognitive impairment.

Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services, including the level of outreach provided to the community. The current study examines how directors' interactions with external stakeholders affect substance abuse treatment units' provision of community outreach services. Methods: Cross-sectional logistic and Poisson regression analyses were conducted on a national sample of US outpatient substance abuse treatment units ( N = 547). Results: Findings suggest that the amount of time directors spent with licensing and monitoring associations was associated with provision of a greater number of community outreach services, while time spent with professional and occupational associations was associated with provision of off-site human immunodeficiency virus and hepatitis C testing. Several other director attributes and organizational characteristics also emerged as significant. Conclusions: External stakeholders with whom substance abuse treatment directors interact may influence community outreach through their effects on treatment directors' strategic priorities. Implications for policy and prevention efforts are discussed. [ABSTRACT FROM AUTHOR]

Nonpharmacological treatments may help many patients with headaches. This review addresses the most common questions about nondrug treatment options from the perspective of patients by (1) defining behavioral and mind/body treatments, (2) discussing the research evidence supporting their use, and (3) describing their role in the management of headaches. Research suggests that mind/body and behavioral treatments may decrease the frequency of migraine or tension-type headaches by 35-50%, an effect size comparable with those observed in medication trials but with fewer side effects than drugs. Most benefit seems to occur in those who combine medications with nonpharmacological treatments. Despite the fact that research evidence for behavioral treatment of headaches is stronger than that for specific mind/body treatments, research shows that adults with headache in the general population are more likely to use mind/body treatments. Nondrug treatments may have a longer time to onset of benefits than drugs, but their effect may be broader and more durable because they may improve stress, coping, and self-efficacy. Additional research is needed to address other questions that patients and their physicians may have about these interventions. [ABSTRACT FROM AUTHOR]

National survey data were used to assess whether child welfare agency ties to behavioral health care providers improved placement stability for adolescents served by both systems. Adolescents initially at home who were later removed tended to have fewer moves when child welfare and behavioral health were in the same larger agency. Joint training of child welfare and behavioral health staff was negatively associated with numbers of moves and numbers of days out of home. [ABSTRACT FROM AUTHOR]

Although performance-based contracts have become increasingly popular in child welfare, administrators are developing these contracts with little empirically guided information about how internal work conditions may influence the services families receive. This study examines how child welfare caseworker role overload moderates associations between child welfare agencies' use of performance-based contracting and services provided to families. Analyses using data from the National Survey of Child and Adolescent Well-Being suggest that when caseworkers experience high role overload, use of performance-based contracts may decrease caregivers' likelihood of receiving necessary social and behavioral health services. These findings and their implications are discussed. [ABSTRACT FROM AUTHOR]

The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment. [ABSTRACT FROM AUTHOR]

The article examines patterns, reasons for, and correlates of complementary and alternative medicine (CAM) use by patients suffering from migraines or severe headaches. Findings showed that adults with migraines/severe headaches used CAM more often than those without; differences remained after adjustment. Patients most commonly resorted to mind-body therapies. More than 50% of patients had not properly discussed with their health care provider regarding the use of CAM.

Abstract: In response to liver injury or loss of liver mass, proliferation of mature liver cells is the first-line defense to restore liver homeostasis. In the setting of chronic liver disease, however, the ability of hepatocytes and cholangiocytes to proliferate is blocked and small bipotential progenitor cells are activated. Recent studies have established the role of these facultative progenitor cells in injury repair and fibrosis in patients with chronic liver disease and in experimental models. Several signaling pathways linking progenitor cell activation and fibrosis have been identified, and there is increasing evidence that cross-talk (both physical and via soluble factors) between progenitor cells and myofibroblasts is essential for both fibrosis and parenchymal regeneration. Even more exciting are new data examining the cellular components of the progenitor cell niche, demonstrating that both resident liver cells and circulating cells from the bone marrow can function as stem cells, suggesting that there is a surprising degree of phenotypic plasticity such that progenitor cells can contribute to the myofibroblast population and vice versa. We highlight here recent findings from the literature demonstrating the cellular and functional complexity of the progenitor cell niche, and emphasize some of the important questions that remain to drive future research. [ABSTRACT FROM AUTHOR]

Abstract: Policy makers and advocates are increasingly encouraging child-serving organizations to work together. This study examined how child welfare agency ties with substance abuse treatment providers and schools correlated with substance abuse treatment for adolescents receiving child protective services. A sample of adolescents with substance use risk was extracted from a national survey of families engaged with child welfare. Logistic regressions with adjustments for complex survey design used child welfare agency ties to substance abuse treatment providers and schools to predict treatment. As expected, adolescents were more likely to report treatment when child protective services and substance abuse treatment were in the same agency and when child welfare agency directors reported joint planning with schools. However, child welfare agency agreements with substance abuse treatment providers were negatively associated with treatment. This unexpected finding implies that agencies may sometimes cooperate to address problems and to improve service utilization. [ABSTRACT FROM AUTHOR]

Abstract: Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of inter-agency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies—jurisdiction, shared information systems, and overall connectivity—and youths'' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems. [Copyright &y& Elsevier]

Our objective was to determine patterns, reasons for, and correlates of complementary and alternative medicine (CAM) use in US adults with common neurological conditions. We compared CAM use between adults with and without common neurological conditions (regular headaches, migraines, back pain with sciatica, strokes, dementia, seizures, or memory loss) using the 2007 National Health Interview Survey of 23,393 sampled US adults. Adults with common neurological conditions used CAM more frequently than those without (44.1 vs. 32.6%, p < 0.0001); differences persisted after adjustment. For each CAM modality, adults with common neurological conditions were more likely to use CAM than those without these conditions. Nearly half of adults with back pain with sciatica, memory loss, and migraines reported use of CAM. Mind/body therapies were used the most; alternative medical systems were used the least. Over 50% of adults with common neurological conditions who used CAM had not discussed their use with their health care provider. Those with neurological conditions used CAM more often than those without because of provider recommendation, or because conventional treatments were perceived ineffective or too costly. Significant correlates of CAM use among adults with common neurological conditions include higher than high school education, anxiety in the prior year, living in the west, being a former smoker, and light alcohol use. CAM is used more frequently among adults with common neurological conditions than those without. More research on the efficacy of CAM use for common neurological conditions is warranted. [ABSTRACT FROM AUTHOR]