Divergent Caregiver and Youth Perspectives Regarding Behavioral Health Needs and Psychosocial Functioning: An Exploratory Study

Background. To promote effectiveness in behavioral health treatment, the system of care framework and wraparound model accentuate inclusion of family and youth as important stakeholders, not just as consumers. This has challenged conventional practices; and youth and caregivers' perspectives have become integral to treatment planning and service delivery. This study explored caregivers and youth's perspectives of behavioral health needs and psychosocial functioning. Methods. This exploratory study utilized data collected in a Midwestern, suburban county as part of the national Child and Family Study of youth with complex behavioral health needs enrolled in the Child Mental Health Wraparound initiative. The sample consisted of 25 caregiver-youth pairs. Assessment measures included the Pediatric Symptom Checklist (PSC) and the Columbia Impairment Scale (CIS). Independent t-tests were used to examine differences in caregiver and youth perspectives. Results. Significant differences were identified in caregivers and youth's perspectives of youth's behavioral health on the PSC, but no significant differences between caregivers and youth on the CIS measure. Responses showed that compared to youth, caregivers perceived a higher level of functional impairment in interpersonal relationships, academic, and community functioning. Further, caregivers' views of severity of functional impairment varied based on the caregiver type. Conclusion. Divergent perspectives regarding youth's behavioral health needs and functioning between caregivers and youth have implications for behavioral health treatment planning and service delivery. Additional research is needed on collaborative assessments and implications of different views for practice and outcomes

Utilizing a Community-University Partnership to Meet Grandfamilies’ Needs: Development and Evaluation of a Grandchildren-mentoring Program

In response to the increasing rate of grandparent-headed homes and the needs of grandparents and grandchildren, we engaged in a community-university partnership to develop, implement, and evaluate a grandchildren-mentoring program. Prior to developing the grandchildren-mentoring program, a county needs assessment was conducted. The needs assessment revealed that grandparents wanted opportunities for mentorship of their grandchildren. As a result, we partnered with an undergraduate practicum course to create a new option of college students engaging with grandchildren. During our inaugural grandchildren-mentoring program, we conducted focus groups/interviews with grandparents (n = 5) and grandchildren (n = 7) at the end of the nine-month program. Data analysis of the focus group transcripts revealed that grandparents believed the two-hour weekly meetings (between the grandchildren and the student mentor) provided respite and grandparents would enjoy having a student again. Grandchildren commented they trusted their student mentors and did not like that they could not see them after the program ended. The grandchild-mentoring program was well received by grandparents and grandchildren and, although it was designed to support grandchildren, the program met a stated need of grandfamilies in our community. As a result, this program may be beneficial to both grandparents and grandchildren and other university-community partnerships should consider working with students to implement similar programming to support grandfamilies

Mental Health Stigma - Impact and Interventions

Research shows that negative stereotyping leads to social stigmatization of those with mental illness resulting in self-stigmatization, lower self-esteem, diminished self-efficacy, and limited access to social support and mental health services for those with mental illness. Few studies have been conducted to identify who is most predisposed to be supportive of those with mental illness and who may be willing to advocate for greater access to services. The purpose of this study is to clarify who is most open to support and advocate for those with mental illness. Responses from a sample of 48 volunteer college students to a researcher-developed survey of attitudes towards mental illness were analyzed to determine which demographic factors were related to more accepting attitudes of those with mental illness. Results yielded significant main effects for gender F (1, 47) = 5.49, p \u3c .05, and for those who have a relative with a mental illness, F (1, 47) = 17.82, p \u3c .01. Results suggest that females and relatives of those with mental illness are more accepting and could be targeted to help reduce mental health stigma by advocating for, and serving as allies to, those with mental illnesses

A Synthesis of Human-related Avian Mortality in Canada

Many human activities in Canada kill wild birds, yet the relative magnitude of mortality from different sources and the consequent effects on bird populations have not been systematically evaluated. We synthesize recent estimates of avian mortality in Canada from a range of industrial and other human activities, to provide context for the estimates from individual sources presented in this special feature. We assessed the geographic, seasonal, and taxonomic variation in the magnitude of national-scale mortality and in population-level effects on species or groups across Canada, by combining these estimates into a stochastic model of stage-specific mortality. The range of estimates of avian mortality from each source covers several orders of magnitude, and, numerically, landbirds were the most affected group. In total, we estimate that approximately 269 million birds and 2 million nests are destroyed annually in Canada, the equivalent of over 186 million breeding individuals. Combined, cat predation and collisions with windows, vehicles, and transmission lines caused > 95% of all mortality; the highest industrial causes of mortality were the electrical power and agriculture sectors. Other mortality sources such as fisheries bycatch can have important local or species-specific impacts, but are relatively small at a national scale. Mortality rates differed across species and families within major bird groups, highlighting that mortality is not simply proportional to abundance. We also found that mortality is not evenly spread across the country; the largest mortality sources are coincident with human population distribution, while industrial sources are concentrated in southern Ontario, Alberta, and southwestern British Columbia. Many species are therefore likely to be vulnerable to cumulative effects of multiple human-related impacts. This assessment also confirms the high uncertainty in estimating human-related avian mortality in terms of species involved, potential for population-level effects, and the cumulative effects of mortality across the landscape. Effort is still required to improve these estimates, and to guide conservation efforts to minimize direct mortality caused by human activities on Canada's wild bird populations. As avian mortality represents only a portion of the overall impact to avifauna, indirect effects such as habitat fragmentation and alteration, site avoidance, disturbance, and related issues must also be carefully considered

The Role of Qualitative Research in Clinical Trial Development: The EASE Back Study

This article outlines the rationale for adopting a mixed methods approach within randomized controlled trials (RCTs) and explores challenges associated in doing so. Taking the example of the EASE Back feasibility and pilot study (Evaluating Acupuncture and Standard care for pregnant womEn with BACK pain: ISRCTN49955124), we detail why and how we operationalized a concurrent-sequential mixed methods research design. We present key findings from the exploratory research (focus groups and interviews) and explain how these were integrated with descriptive findings (a national survey of physical therapists) in order to inform and refine the design of the explanatory phase (the pilot RCT). We conclude with a discussion of lessons learned and implications for future research design and conduct

Snake mortality and cover board effectiveness along exclusion fencing in British Columbia, Canada

We report on snake mortalities along exclusion fencing in southern British Columbia, showing Western Yellow-bellied Racer (Coluber constrictor mormon) deaths were disproportionately higher than our encounter rates with the species within the snake community. This suggests racers were susceptible to fence mortality more so than Northern Pacific Rattlesnakes (Crotalus o. oreganus) or Great Basin Gophersnakes (Pituouphis catenifer deserticola). Datalogger recordings revealed temperatures under cover boards were well above the tolerable temperatures of the three snake species, although the boards appeared to temper ambient heat more efficiently than natural vegetation. We caution that the effects of fencing and cover boards may vary across ecosystems and snake species

Evaluating acupuncture and standard care for pregnant women with back pain:the EASE Back pilot randomised controlled trial (ISRCTN49955124)

Background Low back pain (LBP) and pelvic girdle pain (PGP) during pregnancy are common and often accepted as a ‘normal’ part of pregnancy. Many women receive little in the way of treatment, and yet pain interferes with sleep, daily activities and work and leads to increasing requests for induction of labour or elective caesarean section. The aim of this study was to assess the feasibility of a full RCT evaluating the benefit of acupuncture for pregnancy-related back pain. Methods This study is a single-centre, three-arm pilot RCT in one large maternity unit and associated antenatal and physiotherapy clinics. Women were eligible if they had pregnancy-related LBP with or without PGP. Exclusions included a history of miscarriage, high risk of early labour or pre-eclampsia, PGP only and previous acupuncture. Interventions were standard care (SC): a self-management booklet with physiotherapy if needed. SC+TA: the booklet and physiotherapy comprising true (penetrating) acupuncture, advice and exercise. SC+NPA: the booklet and physiotherapy comprising non-penetrating acupuncture, advice and exercise. Remote telephone randomisation used a 1:1:1 allocation ratio stratified by gestational weeks. Three measures of pain/function were compared to inform the primary outcome measure in a full RCT: the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODI) and 11-point 0–10 numerical rating scale for pain. Analysis focused on process evaluation of recruitment, retention, descriptive information on outcomes, adherence to treatment, occurrence of adverse events and impact of physiotherapist training. Results One hundred twenty-five women were randomised (45% of those eligible) between April and October 2013; 73% (n = 91) provided 8-week follow-up data. Three of six recruitment methods accounted for 82% of total uptake: screening questionnaire at the 20-week scan, community midwives issuing study cards, and self-referral following local awareness initiatives. Physiotherapists’ self-confidence on managing pregnancy-related LBP improved post training. The PGQ is suitable as the primary outcome in a full trial. The average number of treatment sessions in both SC+TA and SC+NPA was six (in line with treatment protocols). No serious adverse events attributable to the trial treatments were reported. Conclusions A full RCT is feasible and would provide evidence about the effectiveness of acupuncture and inform treatment choices for women with pregnancy-related LBP

PTPN11 mosaicism causes a spectrum of pigmentary and vascular neurocutaneous disorders and predisposes to melanoma

Phakomatosis pigmentovascularis (PPV) is a diagnosis which denotes the coexistence of pigmentary and vascular birthmarks of specific types, accompanied by variable multisystem involvement including central nervous system disease, asymmetrical growth and a predisposition to malignancy. Using a tightly phenotyped group and high depth next generation sequencing of affected tissues we discover here clonal mosaic variants in gene PTPN11 encoding SHP2 phosphatase as a cause of PPV type III or spilorosea. Within an individual the same variant is found in distinct pigmentary and vascular birthmarks and is undetectable in blood. We go on to demonstrate that the same variants can cause either the specific pigmentary or vascular phenotypes alone, as well as driving melanoma development within the pigmentary lesion. Protein conformational modelling highlights that while variants lead to loss of function at the level of the phosphatase domain, resultant conformational changes promote longer ligand binding. In vitro modelling of the missense variants confirms downstream MAPK pathway overactivation, and widespread disruption of human endothelial cell angiogenesis. Importantly, PTPN11-mosaic patients theoretically risk passing on the variant to their children as the germline RASopathy Noonan syndrome with lentigines. These findings improve our understanding of the pathogenesis and biology of naevus spilus and capillary malformation syndromes, paving the way for better clinical management

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. Objective: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. Methods: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. Results: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. Conclusions: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method