Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Putting Families First: How the Opioid Epidemic is Affecting Children and Families, and the Child Welfare Policy Options to Address It

Abstract: Opioids and Child Welfare Across the country, placements in foster care are rising. In 2016, the U.S. Department of Health and Human Services reported that 273,539 children in the U.S. entered foster care. In 34 percent of those cases, parental drug abuse was one of the factors leading to the child’s removal from their family. Additionally, the U.S. Substance Abuse and Mental Health Services Administration estimates that 400,000 births nationally are affected by prenatal exposure to alcohol and illicit drugs, which represents 10 percent of all live births. As the opioid epidemic continues, increasing numbers of children are at high risk for developmental and behavioral disorders because of their prenatal substance and alcohol exposure. In addition, children who remain at home may endure the challenges and trauma resulting from impaired caregiving due to parental substance use disorders (SUDs). This article explores the intersection of the opioid epidemic and child welfare, examining current research and publicly available data to discuss policy opportunities for better serving families affected by parental SUDs, including: ensuring health and safety for infants prenatally exposed to substances; appropriate identification, diagnosis, and treatment of developmental and behavioral needs; ensuring parents have access to outpatient treatment and services that can allow families to stay together when safe and appropriate; and ensuring sufficient access to inpatient treatment options that can serve parents and children together

Solemate: A Music App for Runners

Solemate is a mobile application designed to enhance the running experience through music. Our feed-forward algorithm sets the runner’s pace by playing music that varies in tempo. By encouraging the user to match their steps to the beat, our application cultivates a run that feels natural and inspires intrinsic motivation, especially for the beginner runner

Creating a climate for food security: the business, people & landscapes in food production

AbstractBalancing human and environmental needs is urgent where food security and sustainability are under pressure from population increases and changing climates. Requirements of food security, social justice and environmental justice exacerbate the impact of agriculture on the supporting ecological environment. Viability of the Australian rural economy is intrinsically linked to food production and food security requiring systematic evaluation of climate change adaptation strategies for agricultural productivity.This food-systems research drew on global climate change literature to identify risks and adaptation. The transdisciplinary team applied specialist experience through collaboration in social science, economics and land-management to provide comprehensive methods to engage researchers and decision-makers making decisions across the food-system. Research focus on the dairy and horticulture sectors in the SW-WA and SEQld provided a comparative context in food-systems and regional economies. Expert knowledge was engaged through a series of panel meetings to test and challenge existing practice applying conceptual and empirical approaches in Structural Equation, Value-Chain, Supply-Chain modelling and Analytical Hierarchy modelling. This iterative action-research process provided immediate generation and transfer of expert knowledge across the involved sectors. The scenarios and adaptive strategies provide evidence-based pathways to strengthen food-systems; account for climate change mitigation and adaptation; and weather-proof regional economies in the face of climate change. Balancing human and environmental needs is urgent where food security and sustainability are under pressure from population increases and changing climates. Requirements of food security, social justice and environmental justice exacerbate the impact of agriculture on the supporting ecological environment. Viability of the Australian rural economy is intrinsically linked to food production and food security requiring systematic evaluation of climate change adaptation strategies for agricultural productivity.This food-systems research drew on global climate change literature to identify risks and adaptation. The transdisciplinary team applied specialist experience through collaboration in social science, economics and land-management to provide comprehensive methods to engage researchers and decision-makers making decisions across the food-system. Research focus on the dairy and horticulture sectors in the SW-WA and SEQld provided a comparative context in food-systems and regional economies. Expert knowledge was engaged through a series of panel meetings to test and challenge existing practice applying conceptual and empirical approaches in Structural Equation, Value-Chain, Supply-Chain modelling and Analytical Hierarchy modelling. This iterative action-research process provided immediate generation and transfer of expert knowledge across the involved sectors. The scenarios and adaptive strategies provide evidence-based pathways to strengthen food-systems; account for climate change mitigation and adaptation; and weather-proof regional economies in the face of climate change. The triple-bottom-line provided a comprehensive means of addressing social, economic and ecological requirements, and the modelling showed the interacting dynamics between these dimensions. In response to climate change, the agricultural sector must now optimise practices to address the interaction between economic, social and environmental investment. Differences in positions between the industry sector, the government and research sectors demonstrate the need for closer relationships between industry and government if climate change interventions are to be effectively targeted. Modelling shows that capacity for adaptation has a significant bearing on the success of implementing intervention strategies. Without intervention strategies to build viability and support, farm businesses are more likely to fail as a consequence of climate change. A framework of capitals that includes social components - cultural, human and social capital-, economic components -economic and physical capital - and ecological components -ecological and environmental capital - should be applied to address capacities. A priority assessment of climate change intervention strategies shows that strategies categorised as ‘Technology & Extension’ are most important in minimising risk from climate change impacts. To implement interventions to achieve ‘Food Business Resilience’, ‘Business Development’ strategies and alternative business models are most effective. ‘Research and Development’ interventions are essential to achieve enhanced ‘Adaptive Capacity’.The individual components of TBL Adaptive Capacity can be achieved through ‘Policy and Governance’ interventions for building ‘Social Capital’ capacity, ‘Research and Development’ will develop ‘Economic Capital’, and ‘Business Development’ strategies will build ‘Ecological Capital’.These strategic interventions will promote food security and maintain resilience in local food systems, agricultural production communities and markets, global industrial systems, and developing world food systems. Climate change mitigation and adaptation interventions reflect a rich conceptualisation drawing from the Australian context, but also acknowledging the moral context of global association.Please cite this report as:Wardell-Johnson, A, Uddin, N, Islam, N, Nath, T, Stockwell, B, Slade, C 2013 Creating a climate for food security: the businesses, people and landscapes in food production, National Climate Change Adaptation Research Facility, Gold Coast, pp. 144.Balancing human and environmental needs is urgent where food security and sustainability are under pressure from population increases and changing climates. Requirements of food security, social justice and environmental justice exacerbate the impact of agriculture on the supporting ecological environment. Viability of the Australian rural economy is intrinsically linked to food production and food security requiring systematic evaluation of climate change adaptation strategies for agricultural productivity.This food-systems research drew on global climate change literature to identify risks and adaptation. The transdisciplinary team applied specialist experience through collaboration in social science, economics and land-management to provide comprehensive methods to engage researchers and decision-makers making decisions across the food-system. Research focus on the dairy and horticulture sectors in the SW-WA and SEQld provided a comparative context in food-systems and regional economies. Expert knowledge was engaged through a series of panel meetings to test and challenge existing practice applying conceptual and empirical approaches in Structural Equation, Value-Chain, Supply-Chain modelling and Analytical Hierarchy modelling. This iterative action-research process provided immediate generation and transfer of expert knowledge across the involved sectors. The scenarios and adaptive strategies provide evidence-based pathways to strengthen food-systems; account for climate change mitigation and adaptation; and weather-proof regional economies in the face of climate change. The triple-bottom-line provided a comprehensive means of addressing social, economic and ecological requirements, and the modelling showed the interacting dynamics between these dimensions. In response to climate change, the agricultural sector must now optimise practices to address the interaction between economic, social and environmental investment. Differences in positions between the industry sector, the government and research sectors demonstrate the need for closer relationships between industry and government if climate change interventions are to be effectively targeted. Modelling shows that capacity for adaptation has a significant bearing on the success of implementing intervention strategies. Without intervention strategies to build viability and support, farm businesses are more likely to fail as a consequence of climate change. A framework of capitals that includes social components - cultural, human and social capital-, economic components -economic and physical capital - and ecological components -ecological and environmental capital - should be applied to address capacities. A priority assessment of climate change intervention strategies shows that strategies categorised as ‘Technology & Extension’ are most important in minimising risk from climate change impacts. To implement interventions to achieve ‘Food Business Resilience’, ‘Business Development’ strategies and alternative business models are most effective. ‘Research and Development’ interventions are essential to achieve enhanced ‘Adaptive Capacity’.The individual components of TBL Adaptive Capacity can be achieved through ‘Policy and Governance’ interventions for building ‘Social Capital’ capacity, ‘Research and Development’ will develop ‘Economic Capital’, and ‘Business Development’ strategies will build ‘Ecological Capital’.These strategic interventions will promote food security and maintain resilience in local food systems, agricultural production communities and markets, global industrial systems, and developing world food systems. Climate change mitigation and adaptation interventions reflect a rich conceptualisation drawing from the Australian context, but also acknowledging the moral context of global association

Behavioral and Mental Health in Nevada

The Nevada Division of Public and Behavioral Health is responsible for providing public and mental health services to people living in or visiting the State. The Division is organized into four branches: Community Services Branch, Regulatory and Planning Services Branch, Clinical Services Branch and Administrative Services Branch. The Clinical Services Branch provides statewide inpatient, outpatient, and community-based public and mental health services. State employees provide mental health services, and contract providers deliver substance use services. Mental health services are additionally organized by age and geography. Adults with mental disorders are treated statewide through the Division of Public and Behavioral Health. Children with mental disorders are served through the Division of Child and Family Services within the populous urban counties (Washoe, Clark and Carson City) and the Division of Public and Behavioral Health across the 14 rural and frontier counties. Services are supported through Medicaid, the Nevada General Fund, and Federal grants. The Division of Public and Behavioral Health is located within the Nevada Department of Health and Human Services, under the Executive Branch of the State, and serves as its Public Health Authority and Mental Health Commissioner. By statute, the Commission on Behavioral Health is responsible for the following: establishing policies to ensure development and administration of services for persons with mental illness, persons with intellectual disabilities and related conditions, and persons with substance use conditions; reviewing programs and finances of the Division; and providing reports to the Governor and Legislature regarding the quality of care and treatment provided to individuals with mental illness, intellectual disabilities, and substance use disorders [Nevada Revised Statutes (NRS) 433.314]. Historically, the governance structure of Nevada’s behavioral and mental health system has been centralized at the state level with limited involvement at regional and local levels. A policy study conducted during 2014 identified Nevada as one of only four states in the country that directly operates community-based mental health services (Kenny C. Guinn Center for Policy Priorities, Mental Health Governance: A Review of State Models & Guide for Nevada Decisions Makers, December, 2014). During that same year, the State began to consider ways to move from its centralized governance structure to a more localized model involving regional, county and city entities. A key consideration was a growing recognition that increasing the State’s responsiveness to the unique needs of individual communities is crucial. Nevada’s plan to restructure the governance of its state mental health system is not without challenges. For example, the numbers of Nevada residents covered by Medicaid benefits almost doubled when Medicaid coverage was expanded by Governor Brian Sandoval under the Affordable Care Act (ACA) during 2014, increasing from 351,315 persons in 2013 to 654,442 individuals in 2015 (Woodard and Nevada Division of Health Care Financing and Policy, 2016). On its face, the increase in numbers of residents covered by Medicaid benefits is a positive outcome. However, the existing mental health provider network was not adequate to serve the increase in numbers of individuals covered. As detailed in later sections in this chapter, the increase in health care coverage appears to have impacted the frequency with which Nevada residents used health care services, most notably hospital emergency departments and inpatient facilities. Thus, the dual influences of increased health care coverage, and limited access to appropriate and optimal mental health services are reflected in the dramatic increase in residents’ utilization of emergency department services for a wide range of mental health-related conditions during 2015, after the expansion of Medicaid during 2014. Also discussed in later sections is the fact that almost all of the State qualifies as a mental health professional shortage area (Health Resources and Services Administration, HRSA). Therefore, moving from a primarily centralized or state control model to a local control model will require accommodation for the shortages in mental health professionals within communities that lie outside the State’s urban centers