Implementation of the Primary Care Mental Health Integration (PCMHI) Model: Information for Patients

UVMMC Primary Care is transitioning to the Primary Care Mental Health Integration (PCMHI) model of care, in which behavioral health and/or psychiatric treatment is provided within a primary care setting via in-house consulting clinicians. There are currently no standardized informational materials to educate patients on the details of the PCMHI program, which is a new treatment model for most patients and clinicians involved. Development of educational materials, as well as broader public health implications of the PCMHI model of care, are addressed.https://scholarworks.uvm.edu/fmclerk/1798/thumbnail.jp

Steps toward Internationalization in Undergraduate Programs: The Use of Preflective Activities for Faculty International Experiences

If American universities and colleges desire to maintain a position at the forefront of global institutions of learning, they must work to create graduates who are able to demonstrate global competence. In the university setting, globalization is often addressed through strategies such as study abroad opportunities, travel courses, and globallyfocused courses. Aside from study abroad opportunities, faculty members bear the greatest responsibility for providing students with exposure to international content. The USDA-funded Teaching Locally, Engaging Globally (TLEG) project provides oneeffort to increase the international experience of faculty. In a qualitative study of this project, a diverse group of faculty members from one university were selected to participate in an international experience in Ecuador. Prior to the experience, participants were asked to complete a reflection activity regarding the attitudes and beliefs they had prior to visiting Latin America in order to provide awareness of potential assumptions and biases. Five main themes that emerged from the analysis (influences on pre-trip attitudes, the physical environment, social expectations, cultural identity and government) were found to be consistent with current research. It is therefore recommended that preflective activities be used when planning international faculty experiences

Identifying Best Practices for Engaging Faculty in International Agricultural Education Experiences

Universities are being called upon to internationalize curriculum as the need for a globally competent workforce increases. Without globally-competent faculty, international integration within higher education cannot occur. Literature indicates that participation in short-term international agricultural education experiences is important to increasing agricultural faculty members’ cultural awareness. However, the best way to design and implement such experiences for faculty is uncharted. The purpose of the study was to identify best practices for facilitating a short-term international agricultural education experience for faculty in the agricultural and life sciences that encouraged learning, discussion, and reflection leading faculty to further integrate international perspectives in their agricultural courses in the U.S. Through a qualitative research design, reflective observations and statements from a planning team conducting a shortterm international agricultural education experience in Ecuador were used to provide a thick, rich description of the successes/challenges faced while designing and implementing the experience. The results provided a list of best practices future planning team members can use to emphasize learning before, during, and after a short-term international agricultural education experience for faculty

Impact of COVID-19 on the mental health of children and young people: an umbrella review

Background: Over the past 3 years, a multitude of studies have highlighted the impact of the COVID-19 pandemic on the mental health of children and young people (CYP). In this umbrella review, we synthesise global evidence on the impact of COVID-19 on the mental health of CYP from existing systematic reviews with and/or without meta-analysis. Methods: Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we evaluated 349 citations and identified 24 eligible reviews with medium to high methodological quality to be reviewed narratively. Results: Most of the reviews reported a high prevalence of anxiety disorders, depression, suicidal behaviour, eating disorders and other mental health problems. Most studies that used data at multiple time points indicate a significant increase in mental health problems in CYP, particularly in females and older adolescents. Conclusions: Multipronged psychosocial care services, policies and programmes are needed to alleviate the burden of mental health problems in CYP as a consequence of the COVID-19 pandemic and associated global health measures. PROSPERO registration number: CRD42021276312

Impact of COVID-19 on the mental health of children and young people: An umbrella review

Background Over the past 3 years, a multitude of studies have highlighted the impact of the COVID-19 pandemic on the mental health of children and young people (CYP). In this umbrella review, we synthesise global evidence on the impact of COVID-19 on the mental health of CYP from existing systematic reviews with and/or without meta-analysis. Methods: Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we evaluated 349 citations and identified 24 eligible reviews with medium to high methodological quality to be reviewed narratively. Results: Most of the reviews reported a high prevalence of anxiety disorders, depression, suicidal behaviour, eating disorders and other mental health problems. Most studies that used data at multiple time points indicate a significant increase in mental health problems in CYP, particularly in females and older adolescents. Conclusions: Multipronged psychosocial care services, policies and programmes are needed to alleviate the burden of mental health problems in CYP as a consequence of the COVID-19 pandemic and associated global health measures. PROSPERO registration number: CRD42021276312

Introduction to special issue:New Times Revisited: Britain in the 1980s

The authors in this volume are collectively engaged with a historical puzzle: What happens if we examine the decade once we step out of the shadows cast by Thatcher? That is, does the decade of the 1980s as a significant and meaningful periodisation (equivalent to that of the 1960s) still work if Thatcher becomes but one part of the story rather than the story itself? The essays in this collection suggest that the 1980s only makes sense as a political period. They situate the 1980s within various longer term trajectories that show the events of the decade to be as much the consequence as the cause of bigger, long-term historical processes. This introduction contextualises the collection within the wider literature, before explaining the collective and individual contributions made

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Pediatric professional medical associations and industry guideline compliance.

BACKGROUND AND OBJECTIVES: There has been an increasing focus on the relationship between pediatric prescribers and the biomedical industry. There is a lack of research, however, on the biomedical industry\u27s relationship with the professional medical associations (PMAs) of pediatric prescribers. We developed a systematic method to assess this relationship by evaluating PMA transparency and compliance with a set of 2009 best practice guidelines (BPGs). METHODS: Nine PMAs rated as having the greatest influence on pediatric prescribers were examined. Two researchers independently coded publicly accessible information from the PMAs\u27 Web sites for transparency and compliance with 36 BPG recommendations. Using the coded data, an industry relationship index (IRI) score was developed to systematize comparisons across PMAs. RESULTS: The PMAs demonstrated transparency and compliance with less than one-half of the 2009 BPGs (mean ± SD: 30.2 ± 15.6; range: 8-51 on the 66-point IRI scale). Two PMAs clustered in the high IRI (more transparent and compliant) group, 3 in the medium group, and 4 in the low group. There was no significant association of IRI group status and the PMAs\u27 number of members or age. PMAs were least compliant with recommendations that prohibit or limit financial relationships with industry. CONCLUSIONS: PMAs with influence on pediatric prescribers have achieved only limited transparency and compliance with a set of 2009 BPGs, particularly with respect to financial separation from industry. Use of quantifiable standards of conduct facilitates comparisons between organizations and may enhance public trust in PMAs, preserving their ability to achieve organizational goals

Are children severely affected by autism spectrum disorder underrepresented in treatment studies? An analysis of the literature

Despite significant advances in autism research, experts have noted that children severely affected by autism spectrum disorder (ASD) appear to have been understudied. Rigorous analysis of this observation has been limited, and the representation of severity has not been well-described. We assessed three domains of severity (communication ability, cognitive functioning, and adaptive functioning) in 367 treatment studies of children with ASD published 1991–2013. We found that the proportion of studies that included the severely affected population decreased significantly over time, as well as wide variability in measurement and reporting. Inadequate representation of the full autism spectrum in the literature could lead to an unbalanced picture of ASD and leave behind those with arguably the greatest need

Contextualizing organizational frames: Teaching leadership to faculty in agricultural and natural resources

Possessing leadership skills has been determined to be an essential requirement within the workplace. A multi-level leadership program was designed to help provide undergraduates with more exposure to leadership principles. The program team was created through the collaboration of multiple universities found within the southeastern United States. Through a 14-week online training program followed by a field experience, participants were exposed to Bolman and Deal’s organizational frames. Participants then created cased studies grounded in this leadership framework and based on the data that was collected during their field experiences. This study quantitatively analyzed the consistency with which each of the frames were used. From the 16 published case studies on the multi-institutional project’s website, assessment questions were analyzed based on which frame/frames were being referenced. Findings from this study identified a similar use of each of the frames throughout all the case studies. Further research should be conducted to better understand each participant’s comprehension of the organizational frames prior to the development of their case studies