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Barriers and potential solutions for effective integration of depression care into non-communicable diseases clinics in Malawi: a qualitative end-point evaluation of the SHARP randomized controlled trial
Get PDFBackground The sub-Saharan African Regional Partnership for mental health and capacity building (SHARP) study was a clinic-randomized trial of two implementation strategies for integrating depression screening and treatment into non-communicable diseases’ (NCD) clinics in Malawi between 2019 and 2022. We report on the barriers to implementing depression care integration at SHARP study sites and potential solutions. Methods N = 39 in-depth interviews with participants from all ten sites were conducted, recorded, transcribed, coded in NVivo 12 and analyzed by qualitative experts. We used thematic analysis to identify implementation challenges and potential solutions. The Consolidated Framework for Implementation Research helped to develop guides and organize the results. Results Outer setting barriers included high workload (due to high patient volume, increased paperwork, shortage of staff), the effects of coronavirus disease 2019 (COVID-19) pandemic, staff turnover and negative provider attitudes. Limited clinic space arose as an inner setting barrier. Workload can be overcome by increasing the number of NCD personnel, decentralizing the depression/NCD services and integrating mental health and NCD documents (implementation process). The COVID-19 pandemic presented unique challenges including fear of interpersonal contact and changes in scheduling staff that were difficult to overcome in the short term. To deal with the effects of staff turnover, participants identified the need for continuous depression training to new providers. Lobbying for more rooms from leadership can address concerns of limited space. To reduce negative provider attitudes, participants urged facility leadership to make themselves available for consultations and mentorship and to provide continuous learning opportunities such as refresher trainings. Conclusion The experience in the SHARP study highlights the need for a culture of continuous learning and adaptation in healthcare settings, enabling the development of strategies to overcome evolving challenges. Planning for the integration of mental health and NCD care should extend beyond immediate challenges and consider long-term goals and sustainability.Trial registrationThis study reports part of the findings from the endpoint evaluation of the SHARP clinical trial that is registered at ClinicalTrials.gov, NCT03711786 first posted 20,181,018
The Effects of Dual Language Education on Young Bilingual Children’s Learning: A Systematic Review of Research
Get PDFIn the last decade, a growing number of schools have begun implementing dual language education (DLE), and studies have shown evidence of the benefits of DLE for elementary education students. However, existing research syntheses do not focus on DLE in the early years (pre-Kindergarten and Kindergarten), considering young bilingual children’s development and learning characteristics. In this paper, a novel conceptual framework is used to explore the extant literature on DLE in the early years moving beyond Bronfenbrenner’s ecological systems theory to consider additional characteristics relating to bilingual children’s development and learning. A systematic literature review was conducted following a rigorous procedure, resulting in nine studies that met the inclusion criteria. Information about each study was coded and analyzed. The results describe the studies’ sample characteristics, research design, and findings organized by students’ academic skills (i.e., language, literacy, and mathematics), dual language classroom practices, and parents’ perceptions of DLE. This paper highlights current knowledge of DLE programs in the early years, identifies gaps, and offers recommendations for future research, policy, and practice
Learning Maps as Cognitive Models for Instruction and Assessment
Get PDFThis paper describes large, fine-grained, intentionally inclusive, research-based cognitive models called learning maps. Learning maps are the product of an intensive research synthesis process to develop formal learning models that better reflect the diversity of how learners can learn and be assessed on academic content. Students begin at different places and learn at different rates, and they may have cognitive disabilities or may face a variety of barriers that pose challenges when learning content. Learning maps provide numerous starting points and pathways by which students can acquire and demonstrate knowledge, skills, and understandings. Our work in developing learning maps relies on principles of Universal Design for Learning (UDL), which provides a foundation of flexibility and inclusivity to accommodate students with a wide range of cognitive, linguistic, physical, and sensory profiles. In this paper, we describe learning map design, development, and both qualitative and quantitative methods for the evaluation of map structure. In addition, we offer reflections on our experiences with implementing learning maps as the cognitive architecture for assessments and educational interventions through our work on a variety of projects. With examples from these projects, we describe evidence that shows how learning maps can be useful tools for improving instruction and assessment for all learners. We identify areas where further research and inquiry could prove fruitful and conclude with a discussion of potential areas of extension and offer suggestions for the ongoing refinement of learning maps
Early Experience Using Tantalum-Loaded Nanocomposite Hydrogel Conformable Embolic for Upper Gastrointestinal Bleeding-Open-Sandwich Technique
Get PDFBackground/Objectives: To evaluate the efficacy and safety of using tantalum-loaded Obsidio conformable embolic (Ta-OCE) in gastroduodenal artery (GDA) embolization for upper gastrointestinal bleeding (UGIB), employing a novel “open-sandwich” technique. Methods: An institutional review board (IRB)-approved retrospective analysis was conducted on patients who underwent GDA embolization for UGIB using Ta-OCE between May 2023 and June 2024, using an “open-sandwich” technique. Briefly, the retrograde sources of flow, namely the right gastroepiploic artery (RGEA), was commonly embolized with a single, usually detachable, coil at its proximal aspect. Beginning within the proximal RGEA adjacent to the coil and distal to the site of extravasation and/or an endoscopically placed clip, Ta-OCE was then instilled in a continuous fashion to the origin of GDA. Technical success was defined as complete occlusion of the target vessel without immediate procedural complications. Clinical success was assessed as the absence of rebleeding within 4 weeks post-embolization. Adverse events were evaluated using Common Toxicity Criteria for Adverse Events (v.5). Results: Overall, a total of 10 patients, with a mean age of 67.3 years, underwent Ta-OCE embolization for UGIB. A technical success rate of 100% was achieved with no instances of immediate procedural complications. Clinical success was achieved in eight patients (80%). Re-intervention was required in two patients in whom the proximal GDA and distal GDA/proximal RGEA were not embolized adequately, respectively. A significant change in mean hemoglobin levels was observed 24 h pre- and post-embolization, with a mean increase of 1.47 g/dL. Conclusions: Despite the small sample size, lack of control group, and retrospective design, the “open-sandwich” technique combining Ta-OCE with a single coil appears to be an effective and safe method of GDA embolization in the setting of UGIB. Larger multicenter studies are needed to further evaluate the feasibility of this technique
Measuring the influence of depressive symptoms on engagement, adherence, and weight loss in an eHealth intervention
Get PDFBackground Digital behavior change interventions (eHealth, mHealth) are known to be capable of promoting clinically significant weight loss among some participants. However, these programs can struggle with declining engagement and adherence over time, which can hamper their effectiveness. This analysis examines the extent that depression symptoms may negatively influence engagement, adherence, and 6 month weight change in an eHealth intervention. Methods Structural equation modeling is applied to test the effects of baseline depression symptoms on weight change outcomes, mediated through latent constructs of engagement and adherence, respectively. These constructs were highly correlated within this dataset and necessitated two separate models to be tested. Engagement was indicated by 6 month sums of website logins, user-created goals, visiting various webpages, and posts on the online discussion boards. Adherence was indicated by 6 month sums of weeks exercise goals met, days weight logged, and days of complete dietary tracking. Results Depression symptoms showed no direct association with weight change (p’s ≥ 0.6), but were negatively associated with both constructs of engagement and adherence (p’s < 0.001), which in turn were negatively associated with weight change in both models (p’s < 0.001). It was determined depression symptoms had a positive indirect association with weight change fully mediated through these variables, meaning less weight loss or possible weight gain (p < 0.001). Discussion This analysis shows that depression symptoms had a significant, undesirable effect on weight loss outcomes within this eHealth intervention, fully mediated through measured participant engagement and adherence. Further research is needed to test these constructs within a longitudinal model to better understand their dynamic interrelationships, and consider means to address depression in future digital interventions
Differences in Discrimination, Violence, Mental Health, and Substance Use Outcomes by Cancer History Among LGBTQ+ Individuals in North Carolina
Get PDFBACKGROUND Health inequities among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+) are driven by anti-LGBTQ+ stigma and discrimination. However, there is limited research on the manifestations of stigma and discrimination among LGBTQ+ cancer survivors. METHODS Data were collected by the North Carolina Department of Health and Human Services via the 2023 North Carolina LGBTQ+ Health Needs Assessment. Differences in outcomes (i.e., discrimination, violence, homelessness, mental health, substance use, and overdose) between LGBTQ+ individuals by cancer history were assessed using Chi-squared tests. Further, multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals (CI) of the association of cancer with each outcome. RESULTS A total of N = 3170 LGBTQ+ individuals (n = 200 cancer survivors) took part in the survey. In adjusted analyses, cancer history was associated with an 8.1 to 19.1 percentage point increase in the probability of all discrimination, violence, and homelessness outcomes. The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2–29.8), followed by homelessness (AME: 19.1; 95% CI, 11.6–26.6), spouse or family violence (AME: 16.7; 95% CI, 9.3–24.1), LGBTQ+ violence (AME: 15.1; 95% CI, 7.8–22.5), sexual assault (AME: 14.1; 95% CI, 6.0–22.2), as well as nicotine product (AME: 9.0; 95%CI, 1.6–16.5) and cocaine use (AME: 8.9; 95% CI, 3.8–14.1). The most common barriers to mental health services were cost (36.0%) and health insurance (33.5%). LIMITATIONS The needs assessment was a convenience-based study, which limits the generalizability of our findings. CONCLUSIONS LGBTQ+ cancer survivors in North Carolina experience an elevated burden of discrimination, violence, suicide attempt, substance use, and accidental overdose in comparison to LGBTQ+ individuals without a cancer history
Transparency and accountability in healthcare: bridging antiracism and quality improvement to advance health equity
Get PDFThe terms transparency and accountability appear in various disciplines and frameworks as organizational ideals or guiding principles for governance, but there is limited cross-sector analysis of what these terms mean and how they may be employed to advance population health equity. Two models guiding current healthcare improvement processes, Learning Health Systems and High Reliability Organizations, reference transparency and accountability but lack an explicit emphasis on the role they play in eliminating racial disparities in healthcare. In this commentary, we examine ideas developed by community organizers such as the need for transparent communication across sociological levels (e.g. community, organization, and interpersonal levels) and accountability to historically and systematically oppressed groups by actively shifting power from institutions to community members. A multilevel view of transparency and accountability can guide healthcare systems as they navigate the complex task of undoing structural racism in their institutional policies and practices. The Veterans Health Administration, a national healthcare system committed to being a Learning Health Systems and High Reliability Organization, should draw lessons from community organizing to make transparency and accountability to Veterans from historically oppressed identity groups central principles guiding quality improvement efforts
Erratum to: Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus. Yanagihara TK, Tepper JE, Moon AM, et al. Pract Radiat Oncol. 2024 Mar-Apr;14(2):134-145
Get PDFErratum to: "Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus
IMPROVING CHILD FOOD SECURITY WITH SCHOOL MEAL PROGRAMS IN GRANVILLE AND VANCE COUNTIES, NORTH CAROLINA
Get PDFThis report is generated by the economic group for the commissioner's office and examines the critical issue of child food insecurity in Granville and Vance Counties in North Carolina. The contextual analysis evaluates teh current and historical socio-economic factors that contribute to food insecurity, a high-priority social determinant of health that has long-lasting impact on children's mental and physical health. A multifaceted approach was utilized for stakeholder mapping and engagement, analysis of past policies, and development of new potential policies. The design process utilized quality tools to develop the change idea, focusing on and enhancing the school meal program and enhancing local food access. The design process emphasized the feasibility, sustainability, and scalability of the school meal program by establishing a steering committee to oversee the implementation and iteration process. This comprehensive assessment aims to inform policy and practice to reduce child food insecurity and improve health outcomes. Master of Public Healt
IMPROVE READING SKILLS FOR 4TH GRADERS IN GRANVILLE AND VANCE COUNTIES, NORTH CAROLINA
Get PDFThis proposal highlights the urgent need to address the persistently low fourth-grade reading proficiency rates in Granville and Vance counties, North Carolina, where literacy levels lag significantly behind state averages. Recognizing education as an essential social determinant of health, this initiative emphasizes a comprehensive strategy that targets key areas of educational improvement. The proposed approach includes detailed data collection and analysis to accurately identify and monitor students' individual literacy challenges, the implementation of culturally responsive curricula that reflect students' diverse backgrounds and enhance engagement, strengthened partnerships with families and local communities to foster supportive reading environments outside the classroom, and extensive professional development for educators emphasizing evidence-based literacy instruction techniques. By systematically integrating these components, the initiative seeks to significantly raise reading proficiency, thereby improving long-term academic outcomes, reducing educational disparities, and promoting healthier communities throughout Granville and Vance counties.Master of Public Healt