Facilitators of and Barriers to Mental Health Treatment among Adolescents in an Integrated HealthCare Setting

Background: The high incidence of mental health disorders among adolescents, accompanied by low treatment utilization, is a major public health problem. Including mental health treatment in primary care medical settings through an integrated health care model offers an opportunity for early intervention and easier treatment uptake for adolescents with mental health diagnoses. Methods: This thesis examined the barriers to and facilitators of implementing a mental health referral system with the support of a quality improvement project within a single clinic. Results: Qualitative analysis revealed key facilitators to be provider education; communication among team members; a shared EHR and electronic referral orderset; ongoing monitoring, evaluation, and improvement of the system; and social workers. Barriers included workflow challenges; lack of protocols; and fewer available services. Quantitative data analyses showed significant improvement in mental health utilization rates since the implementation of the project. Conclusion: The findings from this thesis can be used to inform future integrated models for adolescent mental health care in primary care settings. Expanding integrated models has public health implications for increasing treatment utilization among adolescents in need of mental health services, ultimately leading to improved quality of life throughout adulthood

The transition to early fatherhood: National estimates based on multiple surveys

This study provides systematic information about the prevalence of early male fertility and the relationship between family background characteristics and early parenthood across three widely used data sources: the 1979 and 1997 National Longitudinal Surveys of Youth and the 2002 National Survey of Family Growth. We provide descriptive statistics on early fertility by age, sex, race, cohort, and data set. Because each data set includes birth cohorts with varying early fertility rates, prevalence estimates for early male fertility are relatively similar across data sets. Associations between background characteristics and early fertility in regression models are less consistent across data sets. We discuss the implications of these findings for scholars doing research on early male fertility

Predictors of Preterm Birth in New Mexico: outcomes from 377,770 pregnancies over fifteen years

Background: Preterm birth (PTB) is a significant health problem both in New Mexico and nationally. It accounts for significant infant morbidity and mortality and it poses an economic burden to both individuals and the state. The goal of this study is to elucidate maternal risk factors for PTB in New Mexico, a poor state with a unique ethnic background. By doing this we hope to be able to identify women at increased risk and invite further study into targeted interventions among these high risk populations. Methods: This was a cross-sectional analysis of 377,770 singleton live births in the state of New Mexico from 1991-2005. The medical risk factors tracked were pulmonary, renal, cardiac, diabetes, eclampsia, oligo/polyhydramnios, hypertensive disorders, cervical incompetence, previous preterm delivery, tocolysis and isoimmunization. Gestational age of less than 37 weeks was defined as PTB. Multiple gestations and congenital anomalies were excluded. The Kotelchuck Index was used as a measure for level of prenatal care described as inadequate, intermediate, adequate, and intensive. Multivariate logistic regression was conducted using SAS 9.1 statistical software. Results: Of the live births analyzed, 28,036 of these were preterm (7.4%). Overall the PTB rate has risen from 1991-2005 at a rate of 0.18 percent per year. This was statistically significant (p = \u3c0.00004). Among patients with medical risk factors, PTB rate had a direct inverse relationship with an intensive level of prenatal care. High risk patients with intensive care were less likely to have a PTB delivery with an odds ratio of 0.74 than similar patients with low levels of care. The nadir for risk of PTB is among women aged 25-29 with significant increases in risk among women \u3c15 and \u3e40 years of age. Other risk factors are unmarried status, education less than high school,tobacco/alcohol use, Black, Asian, and White Hispanic ethnicity and the presence of one or more medical risk factors. Statistically significant protective factors for PTB are age 25-29, education surpassing high school, and Native American race. Counties with rising adjusted PTB rates are Chaves, Dona Ana, Grant, Hidalgo, Lea, Lincoln, McKinley, Mora, Otero, Rio Arriba, San Juan and San Miguel. Counties with decreasing PTB rates are Sandoval and Santa Fe counties. Conclusion: Even adjusted for known risk factors PTB is still a significant problem in New Mexico. A lack of prenatal care was a significant predictor of PTB in high risk patients. Other predictors include the known risk factors of age \u3c15 and \u3e40, single, tobacco/alcohol use, being of low socioeconomic status and White Hispanic, Asian and Black ethnicities. Interestingly, Native American patients have a lower PTB rate compared to other groups, even though this group is traditionally one of low socioeconomic status in New Mexico

The Sad State of Healthcare in New Mexico: Healthcare Worker Suicide in New Mexico 2004-2005

THE SAD STATE OF HEALTH CARE IN NEW MEXICO: HEATHCARE WORKER SUICIDE IN NEW MEXICO 2004-2005. KL Bradley*, KD Martinez*, MB Barry**, S Lathrop**, K Fraser***, and K Peters**** * University of New Mexico School of Medicine, Albuquerque, NM, ** New Mexico Office of the Medical Investigator, Albuquerque, NM, *** University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, NM, **** New Mexico Bureau of Vital Records and Health Statistics, Santa Fe, NM PURPOSE. To determine if there is a statistically significant relationship between suicide and the healthcare occupations in New Mexico for the years 2004-2005. METHODS. We collected suicide and occupational data from the New Mexico Office of the Medical Investigator and the N.M. Bureau of Vital Records and Health Statistics for the years 2004-2005. Other data collected included race, age, veteran status, county of occurrence and residence, location, method, presence of suicide note, toxicology, and psychiatric, medical and other risk factors. Statistical analysis was performed on the data collected. RESULTS. Our database included 658 suicides, including 34 healthcare worker suicides during this two-year period. The suicide rate for healthcare workers (HCWs) in 2004 was higher than the suicide rate of the New Mexico adult population. The suicide rate for HCWs in 2005 was lower than that of the New Mexico adult population. There were significantly more women among the healthcare workers who committed suicide than among the non-healthcare workers. The most commonly represented healthcare professionals among the HCWs who committed suicide were: Nurses, Home Health Aides, Obstetrician/Gynecologists, Laboratory Technicians, Social Workers, and Medical Assistants. Healthcare workers who committed suicide in New Mexico in 2004 and 2005 were 3.7 times more likely to commit suicide by ingesting or injecting medication than the non-healthcare workers who committed suicide during this time frame. CONCLUSION. This study demonstrates that healthcare workers, particularly females, had a higher rate of suicide that the NM adult population in 2004, but not it 2005. Thus, we cannot comment on a trend at this time. Further investigation would be useful in determining the presence of a trend and guiding prevention efforts

An exploratory study of the variables impacting preterm birth rates in New Mexico

BACKGROUND: Preterm birth (PTB) is a substantial health problem that accounts for significant infant morbidity and mortality and poses an economic burden to both individuals and the state of residence. The goal of this study was to identify maternal risk factors for PTB in New Mexico, a poor state with a unique ethnic background, in order to identify populations at increased risk that would benefit from intervention. METHODS: This was a cross-sectional retrospective exploratory analysis of 377,770 singleton live births in the state of New Mexico from 1991-2005. Gestational age of less than 37 weeks was defined as PTB. The Kotelchuck Index was used as a measure for level of prenatal care described as inadequate, intermediate, adequate, and intensive. RESULTS: Of the live births analyzed, 28,036 of these were preterm (7.4%). Overall the PTB rate rose at a rate of 0.18% per year from 1991-2005. Among patients with medical risk factors, the absence of prenatal care was associated with higher odds for PTB as compared to adequate prenatal care. Other risk factors were unmarried status, education less than high school, tobacco/alcohol use, black, Asian, and white Hispanic ethnicity, and the presence of one or more medical risk factors. Statistically significant protective factors for PTB were age 25-29, education surpassing high school, and Native American race. CONCLUSIONS: This study identified several factors that correlate with increased PTB in New Mexico, in particular ethnicity and level of prenatal care. The finding that Native American patients have a lower PTB rate compared to other groups, even though this group is traditionally one of low socioeconomic status in New Mexico, signifies that other factors yet to be identified affect PTB

The Sloan Digital Sky Survey Reverberation Mapping Project: Technical Overview

The Sloan Digital Sky Survey Reverberation Mapping project (SDSS-RM) is a dedicated multi-object RM experiment that has spectroscopically monitored a sample of 849 broad-line quasars in a single 7 deg$^2$ field with the SDSS-III BOSS spectrograph. The RM quasar sample is flux-limited to i_psf=21.7 mag, and covers a redshift range of 0.1<z<4.5. Optical spectroscopy was performed during 2014 Jan-Jul dark/grey time, with an average cadence of ~4 days, totaling more than 30 epochs. Supporting photometric monitoring in the g and i bands was conducted at multiple facilities including the CFHT and the Steward Observatory Bok telescopes in 2014, with a cadence of ~2 days and covering all lunar phases. The RM field (RA, DEC=14:14:49.00, +53:05:00.0) lies within the CFHT-LS W3 field, and coincides with the Pan-STARRS 1 (PS1) Medium Deep Field MD07, with three prior years of multi-band PS1 light curves. The SDSS-RM 6-month baseline program aims to detect time lags between the quasar continuum and broad line region (BLR) variability on timescales of up to several months (in the observed frame) for ~10% of the sample, and to anchor the time baseline for continued monitoring in the future to detect lags on longer timescales and at higher redshift. SDSS-RM is the first major program to systematically explore the potential of RM for broad-line quasars at z>0.3, and will investigate the prospects of RM with all major broad lines covered in optical spectroscopy. SDSS-RM will provide guidance on future multi-object RM campaigns on larger scales, and is aiming to deliver more than tens of BLR lag detections for a homogeneous sample of quasars. We describe the motivation, design and implementation of this program, and outline the science impact expected from the resulting data for RM and general quasar science.Comment: 25 pages, submitted to ApJS; project website at http://www.sdssrm.or

Barrett's esophagus: natural history

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86834/1/j.1749-6632.2011.06057.x.pd

Absorptive capacity and market orientation in public service provision

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Journal of Strategic Marketing on 05.04.2012, available online at: http://www.tandfonline.com/10.1080/0965254X.2011.643915The application of market orientation to public organisations does not adequately account for the unique features of this context. Drawing on absorptive capacity literature, this is the first study to examine the role of the organisation's learning environment on the market orientation-performance interface for two opposing public management contexts. The research involved a national survey questionnaire to 1060 internal and external public leisure service providers in England. Empirical testing through structural equation modelling revealed that not all dimensions of market orientation are universally positive and marketing scholars should seek to examine and understand market orientation in the context of the organisation and its learning mechanisms, as absorptive capacity has clear and different moderation effects under different management contexts. © 2012 Copyright Taylor and Francis Group, LLC