Exposure to nature may reduce stress in low-income parents. This prospective randomized trial compares the effect of a physician's counseling about nature with or without facilitated group outings on ...stress and other outcomes among low-income parents.
Parents of patients aged 4-18 years at a clinic serving low-income families were randomized to a supported park prescription versus independent park prescription in a 2:1 ratio. Parents in both groups received physician counseling about nature, maps of local parks, a journal, and pedometer. The supported group received additional phone and text reminders to attend three weekly family nature outings with free transportation, food, and programming. Outcomes measured in parents at baseline, one month and three months post-enrollment included: stress (using the 40-point Perceived Stress Scale PSS10); park visits per week (self-report and journaling); loneliness (modified UCLA-Loneliness Scale); physical activity (self-report, journaling, pedometry); physiologic stress (salivary cortisol); and nature affinity (validated scale).
We enrolled 78 parents, 50 in the supported and 28 in the independent group. One-month follow-up was available for 60 (77%) participants and three-month follow up for 65 (83%). Overall stress decreased by 1.71 points (95% CI, -3.15, -0.26). The improvement in stress did not differ significantly by group assignment, although the independent group had more park visits per week (mean difference 1.75; 95% CI 0.46, 3.04, p = 0.0085). In multivariable analysis, each unit increase in park visits per week was associated with a significant and incremental decrease in stress (change in PSS10-0.53; 95% CI -0.89, -0.16; p = 0.005) at three months.
While we were unable to demonstrate the additional benefit of group park visits, we observed an overall decrease in parental stress both overall and as a function of numbers of park visits per week. Paradoxically the park prescription without group park visits led to a greater increase in weekly park visits than the group visits. To understand the benefits of this intervention, larger trials are needed.
ClinicalTrials.gov NCT02623855.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
This article describes the importance of identifying inflammation‐inducing conditions in the dental office that are prevalent in the population and have significant systemic health risks ...for the patient. The role of the dental biofilm will be presented, as will the clinical protocols for treating an unhealthy biofilm. Methods for testing and maintaining a healthy biofilm are also presented.
Clinical Considerations
Periodontal disease, dental caries, and periapical infections are inflammation‐inducing diseases that can be identified in the dental office. Additionally, sleep apnea has been linked to chronic systemic inflammation. Dentists can identify risk factors and provide treatments that lower the risk of serious systemic outcomes, such as atherosclerosis, cardiac arrest, and stroke.
Conclusions
A thorough dental examination, including a comprehensive periodontal evaluation, can provide important information that can be used to improve or maintain a patient's systemic health. Treatments provided to improve oral health have been shown to improve systemic indicators of cardiovascular health. This is the basis of integrative oral medicine, a collaboration between the medical and dental providers, which can offer patients the best opportunity for improved health outcomes.
Clinical Significance
Periodontal disease, caries, periapical infections, and sleep apnea all have negative systemic health consequences for the patient (DiMatteo, Inside Dent, 2017, 13, 30; Nakano, Oral Microbiol Immunol, 2009, 24, 64; El Ouarti, BMC Oral Health, 2021, 21, 124; Lamberg, Steve). Periodontal disease, caries, and root end infections influence the health of the oral biofilm. If the biofilm becomes pathogenic the host inflammatory response can be stimulated, resulting in a cascade of inflammatory processes that damage the supporting structures of the teeth and harm the patient's overall health. A thorough dental exam that includes a comprehensive periodontal evaluation will identify patients with active inflammation or oral conditions that contribute to chronic inflammation. Dentists can integrate this information into treatment strategies that reduce the inflammatory burden and assist in better overall health outcomes.
Pool-riffle sediment and flow dynamics have been studied for many years, but relatively little work has investigated how variations in flow and sediment regimes might lead to a diversity of ...pool-riffle morphologies. In this letter we analyze a database of quantitative and qualitative measurements from sites where pool-riffle morphologies have been studied and assess the sites relative to morphologic transitions and mobility thresholds. Results show that pool-riffle sites are stretched over a morphologic gradient of predicted bar types from scrolls to chutes and a modelled mobility gradient from threshold to low transport channels. Flow- and sediment-driven phenomenon that are relevant for pool-riffle mechanics are discussed in this context.
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•Pool-riffles presented in the literature have some features in common but show an important diversity•Studied sites are predominantly located in channels with threshold to low mobility and scroll to mixed scroll/chute bars•Regime diagrams systematize diversity and may help to avoid extending site-specific findings to inappropriate environments
Abstract Background Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention ...for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol. Methods Behavioral change theory and environmental education literature informed the intervention. Outcomes were selected after review of the literature and field tested procedures to determine what was feasible and ethical in a busy clinic serving vulnerable populations. Design We designed a randomized controlled trial to examine two levels of intensity in behavioral counseling about the health benefits of nature. Dyads consisting of a caregiver and a child aged 4 to 18 who access our pediatric primary care center are eligible. All dyads receive a pediatrician's recommendation to visit parks to experience nature and written resources (a
“
park prescription
”
). The intervention group receives added case management and an invitation to three group outings into nature with transportation, meals and activities provided. Primary outcomes measured at baseline, one month and three months post-enrollment are caregiver stress measured by PSS-10 score and salivary α-amylase; secondary outcomes are park prescriptions adherence, physical activity recorded by pedometer and journaling, loneliness, family cohesion and affinity to nature as measured by a validated scales. Both groups receive incentives to participation. Discussion Our intervention represents a feasible integration of recent research findings on the health benefits of nature and primary care practice.
Our previous study showed that parents with mental health problems or substance abuse are at increased risk of having children removed from the home, primarily due to caregiving deficits, neglect, ...and prenatal exposure to substances, not physical abuse.
Using a larger sample and more rigorous analysis, the present study improves and expand upon the previous study, yielding more robust explanations for why these children are at increased risk of removal.
The study uses a sample of 4070 Structured Decision Making® assessments conducted by San Francisco's Child Welfare provider involving parents reported for the first time from 2007 to 2015.
Using structural equation modeling, mediation models were constructed to test the indirect effects of thirteen child safety threats on safety decision.
Four threats explained 95% of the effect of mental health problems on safety decision, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.26, p ≤ 0.01) and Previous Maltreatment (OR = 1.24, p ≤ 0.05). Seven safety threats explained 91% of the effect of co-occurring mental health problems and substance abuse, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.78, p ≤ 0.001) and Physical Harm (Drug-Exposed Infant; OR = 1.57, p ≤ 0.001).
As previously shown, parental mental health problems and substance abuse are not ipso facto safety threats. Rather, unmet child needs account for much of the increased risk of child removal in this population, underscoring the importance of timely resource referrals.
Rush University Medical Center is a 664-bed urban tertiary care hospital in Chicago, Illinois with an annual Emergency Department volume of 70,000 patients per year. The Rush University Medical ...Center institutional review board evaluated this project and approved it with a waiver of informed consent. Telemedicine can also reduce costs to patients and the healthcare system at-large 8. ...while we identified temporal trends in visit types, the data are only able to show trends and cannot demonstrate causality.
COVID-19 had a significant impact on Emergency Departments (ED) with early data suggesting an initial decline in avoidable ED visits. However, the sustained impact over time is unclear. In this ...study, we analyzed ED discharges over a two-year time period after the COVID-19 pandemic began and compared it with a control time period pre-pandemic to evaluate the difference in ED visit categories, including total, avoidable, and unavoidable visits.
This was a retrospective, cross-sectional study assessing the distribution of visits with ED discharges from two hospitals within a health system over a three-year time period (1/1/2019–12/31/2021). Visits were categorized using the expanded NYU-EDA algorithm modified to include COVID-19-related visits. Categories included: Emergent - Not Preventable/Avoidable, Emergent – Preventable/Avoidable, Emergent - Primary Care Treatable, Non-Emergent, Mental Health, Alcohol, Substance Abuse, Injury, and COVID-19. Chi-square testing was conducted to investigate differences within the time period before COVID-19 (1/1/2019–12/31/2019) and both initial (1/1/2020–12/31/2020) and delayed (1/1/2021–12/31/2021) COVID-19 time frames and ED visit categories, as well as post hoc testing using Fisher's exact tests with Bonferroni correction. ANOVA with post hoc Bonferroni testing was used to determine differences based on daily census for each ED visit category.
A total of 228,010 ED discharges (Hospital #1 = 126,858; Hospital #2 = 101,152) met our inclusion criteria over the three-year period. There was a significant difference in the distribution of NYU-EDA categories between the two time periods (pre-COVID-19 versus during COVID-19) for the combined hospitals (p < 0.001), Hospital #1 (p < 0.001), and Hospital #2 (p < 0.001). When examining daily ED discharges, there was a decline in all categories from 2019 to 2020 except for “Emergent - Not Preventable/Avoidable” which remained stable and “Substance Abuse” which increased. From 2020 to 2021, there were no differences in ED avoidable visits. However, there were increases in discharged visits related to “Injuries”, “Alcohol”, and “Mental health” and a decrease in “COVID-19”.
Our study identified a sustained decline in discharged avoidable ED visits during the two years following the beginning of the COVID-19 pandemic, which was partially offset by the increase in COVID-19 visits. This work can help inform ED and healthcare systems in resource allocation, hospital staffing, and financial planning during future COVID-19 resurgences and pandemics.
Objective
To investigate the relationship between maternal child‐feeding practices and child adiposity in an ethnically diverse sample by examining three categories of relationships: 1) mothers' ...weight status; 2) mothers' investment in eating‐related issues; and 3) mothers' concerns about child's weight. It was predicted that these variables would be related to mothers' use of restriction, monitoring, and pressure in child feeding, influencing child adiposity.
Design and Methods
A total of 563 mothers (306 Hispanic, 76 Asian, 36 Black, and 145 White) with children aged 2‐11 years completed the Child Feeding Questionnaire and Eating Attitudes Test. Analyses used structural equation modeling.
Results
Ethnic differences in the resulting models emerged. Mothers' weight status negatively predicted maternal control over child's eating; heavier mothers reported less control over child's eating. Greater concern about child's weight was associated with more maternal control of child's eating for all groups. Maternal control over child's eating was predictive of child's body mass index only in the White group.
Conclusions
Although maternal investment in eating‐related issues did predict maternal control over child's eating for White mothers, this relationship did not exist for Hispanics. Different maternal factors influence mothers' control over their child's eating in Hispanic and White groups. In ethnic minorities, maternal control over child's eating may not influence child adiposity.
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