Factors Associated with High Risk Infant Follow-Up Attendance

Prematurity is a significant public health problem and preterm infants face well described risks of adverse neurodevelopmental outcomes. Bronfenbrenner’s bioecological theory of development describes interactions between biological and environmental factors and explains how these interactions can impact development. Systematic follow-up of preterm, high-risk infants is recommended for early identification of problems and provision of interventions and support services. Most research on follow-up attendance has involved small, single sites. A retrospective analysis of population based data available in the California Children’s Services High Risk Infant Follow-up Quality of Care Initiative (HRIF-QCI) data system was performed to examine factors associated with attendance at the second recommended visit. Applying the bioecological theory of development to the high-risk infant population reveals the numerous biologic, family, social, cultural, and political factors that influence development. This theory supports the provision of early intervention services to this population. Only 74% of those infants seen for the first visit attended the second recommended visit. Infants with birth weights equal to or less than 750 grams were almost twice as likely to attend the visit compared with those with birth weights greater than 1,250 grams. Private insurance, two parents as caregivers, completion of the first visit during the recommended interval and enrollment in early intervention during the first visit were all associated with higher attendance rates. Public insurance, a single parent as caregiver, or maternal race of Black or Asian were all associated with decreased attendance. Infants with maternal race of Black were 45% less likely to attend the second visit, and the factor with the strongest association with lack of visit two attendance. Rural residence was associated with decreased HRIF attendance (they were 30% less likely to attend) and there were marked differences between the rural and non-rural population, with rural caregivers being younger, less educated, and with lower rates of employment. There were marked differences in attendance rates between different HRIF programs, with risk-adjusted rates ranging from 34.4% to 89.9%. These findings offer new knowledge into factors associated with HRIF clinic attendance and suggest future research opportunities to improve clinical practice with this population

Obesity Prevention Toolkit to Combat Weight Gain Related to Sedentary Behavior and Dietary Habits in College Students: An Evidence-Based Project

Abstract Background: Forty percent of the US population ages 20-39 are categorized as obese, their BMI is over 30, and 35% of college age students are obese or overweight. Issues related to obesity cost the US $147 billion annually. Between 40%-50% of college students are reported to be inactive. Inactivity can lead to increased morbidity and mortality related to increased risks of cardiovascular disease, diabetes, hypertension, musculoskeletal issues, and depression. Providing dietary and physical activity education and access to nutritional information promotes behavior change in young adults. Aims of Service Change: This evidence-based project proposal aims to provide a toolkit that can be utilized in higher education institutions with incoming students to increase self-efficacy related to positive dietary choices and increased physical activity amongst college age students. Ultimately, this has the potential to reduce the incidence of poor outcomes later in life. Details of Innovation: This toolkit includes: dietary education using online resources, physical activity recommendations in accordance with the Centers for Disease Control and Prevention (CDC), and access to nutritional information digitally. This will be offered over a three-month period and results will be tracked throughout the term.Outcomes: Implementation of an evidenced-based structured toolkit can provide benefits to higher education institutions by proactively addressing the ramifications of unhealthy lifestyles, weight gain and sedentary behavior which in turn has medical cost saving potential and increased retention rates

Screening for Resilience in Pediatric Primary Care

Introduction: Adversity in childhood increases risk for physical and mental health problems. Children who undergo adverse events can still flourish, due to the concept of resilience. Literature shows that resilience influences health more than adversity, and screening for resilience may improve practice. Method: A valid screening tool for resilience, The CD-RISC, was given to children twelve and above during their well visit during February 2021 at a clinic in Oceanside, CA. Scores were categorized into four quartiles. Children responding in the lowest two quartiles received provider follow up. Results: 97 surveys were scored: 39 scoring in the lowest quartile, 19 in the second lowest, and 39 in the top two quartiles. Only 11 out of the 39 children in the lowest quartile were previously identified at their well visit as having any mental health concerns. Discussion: Screening for resilience provides an opportunity for providers to identify children who would benefit from interventions aimed to foster resilience

Improving Pediatric Provider Preparedness for Postpartum Depression Screening

Background: Postpartum depression (PPD) is one of the most common complications of childbirth, affecting approximately 10-20% of mothers within the child’s first year of life with negative impact on both mother and child. . Pediatric primary care providers have frequent contact over the infant’s first year of life. The American Academy of Pediatrics (AAP) recommends screening mothers for PPD at the 1, 2, 4, and 6-month well-baby visits, yet due to barriers, pediatric providers are not consistently screening for PPD. Barriers include lack of preparedness and knowledge of resources and inadequate time. Aims of Service Change: To improve pediatric provider preparedness to screen for PPD at a large multi-site pediatric group practice in Southern California and lead to increased screening, detection, and treatment of PPD. Details of Innovation: The core intervention was provider education regarding recommendations for postpartum depression screening. Provider education also included provider responsibility in identifying PPD, community resources, and an overview of PPD diagnostic criteria. This project assessed provider preparedness using a pre-post education online anonymous survey. Outcome: Implementation of provider education increased self-reported preparedness to screen for PPD at well-baby visits with an increase of average score in all categories. Knowledge of resources and provider confidence had the most substantial increases. Discussion: Implementing provider education regarding screening for PPD at well-baby visits is a simple and cost-effective intervention. This leads to improved provider preparedness, potential increased identification of PPD in mothers, and improved overall outcomes for mothers and babies

Weight Reduction Motivation in Osteoarthritis Patients Through Nurse Practitioner Driven Education and Follow-Up: A Pilot Project

Purpose of Project: The ultimate goal of this short-term pilot project is for overweight or obese osteoarthritis patients to increase their knowledge on the benefits of weight loss and physical activity. Research shows that for every kilogram of weight lost, 2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to thirty to fifty percent and improve quality of life. Following education from the provider, patients will understand the correlation of osteoarthritis symptom management with weight loss. EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based Practice to Promote Quality Care. This addresses implementing practice change in a specialty care outpatient setting to improve patient outcomes. Evidence Based Interventions: This project provided an educational intervention to overweight or obese osteoarthritis patients seen in an ambulatory orthopedics clinic in an urban, Southern California city. A follow-up telephone intervention was conducted after one-month to assess their motivation for physical activity. A “smart phrase” will be available in EPIC™ (electronic health record) for future implementation. Evaluation/Results: At one-month, fifty percent of patients showed an improvement (or maintenance) in their readiness for physical activity. Implications for Practice: Both obesity and osteoarthritis can be debilitating to quality of life. This conservative approach to osteoarthritis management can be cost effective in preventing hospitalization and lost wages. Conclusion: Nurse practitioner education on the benefits of weight management and osteoarthritis increases patient education and readiness for physical activity

It\u27s More Than Just Baby Blues - Screening for Postpartum Depression in a Pediatric Setting

Abstract Background: Postpartum depression (PPD) is estimated to affect up to 1 out of 7 women. Evidence and American Academy of Pediatrics (AAP) guidelines support maternal screening for PPD in a pediatric setting during well-child visits. The pediatric office is frequently visited during the first year of life and is a suitable setting to perform screening. Aims of Service Change: Implement AAP recommended PPD screening at a busy primary care practice in Southern California using the Patient Health Questionnaire (PHQ-9). Details of Innovation: In this pilot project, mothers (who were not patients of the pediatric practice) consented to be screened for PPD using the PHQ-9 at 1,2,4, & 6 month well child visits. All mothers were supplied resource material on PPD and community resources. Those whose scores put them at risk for PPD were referred to community providers for mental health services. For safety purposes, resources were identified prior to implementation and a plan was in place in the event a woman was actively suicidal. The theoretical models used to drive this project were the ACE-Star Model and Lewin\u27s Change Theory. Outcomes: During the two-month pilot, 81 mothers were eligible for screening; 23 women, or 28% completed the screening. Three were high-risk and were referred to community providers for services. The remaining were not screened because the mother did not complete the PHQ-9. The pediatric primary care provider has an opportunity to identify PPD early and provide support and referral for appropriate service

Using term clouds to represent segment-level semantic content of podcasts

Spoken audio, like any time-continuous medium, is notoriously difficult to browse or skim without support of an interface providing semantically annotated jump points to signal the user where to listen in. Creation of time-aligned metadata by human annotators is prohibitively expensive, motivating the investigation of representations of segment-level semantic content based on transcripts generated by automatic speech recognition (ASR). This paper examines the feasibility of using term clouds to provide users with a structured representation of the semantic content of podcast episodes. Podcast episodes are visualized as a series of sub-episode segments, each represented by a term cloud derived from a transcript generated by automatic speech recognition (ASR). Quality of segment-level term clouds is measured quantitatively and their utility is investigated using a small-scale user study based on human labeled segment boundaries. Since the segment-level clouds generated from ASR-transcripts prove useful, we examine an adaptation of text tiling techniques to speech in order to be able to generate segments as part of a completely automated indexing and structuring system for browsing of spoken audio. Results demonstrate that the segments generated are comparable with human selected segment boundaries

AudioCOMMUNICATOR Reminder Phone Calls to Increase Attendance of Well Child Visits

Background: The American Academy of Pediatrics recommends six well child checks (WCC) between 2 to 15 months. A large pediatric clinic in Southern California has an attendance rate of 86% and a very mobile population. Reminder phone calls have been shown to improve WCC attendance. Aims of Service Change: Improve WCC attendance to \u3e90%. As an interim step, we implemented a pilot project and measured responses to AudioCOMMUNICATOR™ reminder calls. Outcome: In two months 148 calls were made, the majority,74%, went unanswered. 26% were able to schedule an appointment or discharge from the clinic. Discussion: Reminder calls provide a simple way to schedule visits or update information. This technology could be used for other health promotion activities including immunizations, school/sports physicals, developmental screenings, and ADHD follow ups. A system with e-mail and text message capabilities would provide patients and families with other options for reminders, visit scheduling, and updating information

Platinum bisphosphine complexes of 1,8-naphthosultone

Funding: Engineering and Physical Sciences Research Council (EPSRC)A series of three platinum (II) bisphosphine complexes 1-3 [Pt(1-(SO2),8-(O)-nap)(PR3)2] (where R3 = Ph3, Ph2Me, Me2Ph) have been prepared by metathesis from cis-[Pt(PR3)2Cl2)] and the dilithium salt of 1,8-naphthosultone. The novel compounds were fully characterised by X-ray crystallography, multinuclear NMR, IR and MS. The molecular structures of 1-3 were compared by measuring the peri-distance, splay angle magnitude, peri-atom displacement, naphthalene ring torsions, aromatic ring orientations and the geometry around the platinum centre. The platinum metal adopts a distorted square planar geometry in all three complexes which causes deformation of the naphthalene system. The degree of molecular deformation does not decrease upon going from 1 to 3 as anticipated, instead a competition between steric effects and intramolecular interactions causes 3 to display distortion intermediate of 1 and 2.PostprintPeer reviewe