Models of care: Opportunities and challenges.

Perinatal mental health models can broadly be described by scope and structure. Within these two broad domains lies an array of diverse methodologies that have attempted to increase access and coordination of care. These efforts have uncovered many opportunities that, if addressed, may improve our current parent and infant outcomes within our healthcare system and community. Furthermore, there are several opportunities that, if addressed, will result in more equitable, inclusive care. These include being attentive to the unique needs of vulnerable populations, emphasizing community efforts, and closing the current gaps in legislation.

Genetic Mapping and Phenotypic Analysis of GstE14 E.4.1 on Eye and Antennae Development in Drosophila melanogaster.

Genetic screens are valuable for identifying novel genes involved in the regulation of developmental processes. To identify genes associated with cell growth regulation in Drosophila melanogaster , a mutagenesis screen was performed. Undergraduate students participating in Fly-CURE phenotypically characterized the E.4.1 mutant which is associated with rough eyes and antennae overgrowth. Following complementation analysis and subsequent genomic sequencing, E.4.1 was identified as a novel mutant allele of GstE14 , a gene involved in ecdysone biosynthesis important for the timing of developmental events. The abnormal eye and antenna phenotypes observed resulting from the loss of GstE14 suggest its role in tissue growth.

Planned cesarean delivery vs planned vaginal delivery: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: There are over 145 million births worldwide, with over 30 million cesarean deliveries yearly. There are limited data comparing the perinatal and maternal outcomes between planned cesarean delivery and planned vaginal delivery. This study aimed to evaluate perinatal and maternal morbidity and mortality by meta-analysis of randomized controlled trials that randomly assigned patients to either planned cesarean delivery or planned vaginal delivery. DATA SOURCES: Scopus, PubMed, CINAHL, Cochrane Library, and the World Health Organization clinical trial databases were searched from inception through August 2022. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials that compared planned cesarean delivery with planned vaginal delivery at any gestational age and for any delivery indication were included. METHODS: Two authors independently extracted data. PRISMA guidelines were used for data extraction and quality assessment. The primary outcome was perinatal mortality. The summary measures were reported as relative risks or as mean differences with 95% confidence intervals. Pooled odds ratios and 95% confidence intervals were calculated using Mantel-Haenszel random-effects models for outcomes. RESULTS: In 15 primary randomized controlled trials, 3265 patients were randomized to planned cesarean delivery and 3353 to planned vaginal delivery. The incidence of perinatal deaths was not different (1.3% vs 1.3%; relative risk, 0.71; 95% confidence interval, 0.33-1.52). Planned cesarean delivery was associated with lower neonatal incidences of low umbilical artery pH (0.3% vs 2.4%; relative risk, 0.18; 95% confidence interval, 0.05-0.67), birth trauma (0.3% vs 0.7%; relative risk, 0.46; 95% confidence interval, 0.22-0.96), tube feeding requirement (2.5% vs 7.1%; relative risk, 0.36; 95% confidence interval, 0.19-0.66), and hypotonia (0.4% vs 3.5%; relative risk, 0.11; 95% confidence interval, 0.03-0.47), compared to planned vaginal delivery. Chorioamnionitis was less frequent in the planned cesarean delivery group (0.3% vs 1.0%; relative risk, 0.27; 95% confidence interval, 0.08-0.98). Wound infection was more common in the planned cesarean delivery group (1.9% vs 1.1%; relative risk, 1.61; 95% confidence interval, 1.04-2.52). Lower rates were observed in the planned cesarean delivery group for urinary incontinence at both ≤3 months (8.7% vs 12.2%; relative risk, 0.71; 95% confidence interval, 0.59-0.85) and 1 to 2 years (16.9% vs 22%; relative risk, 0.77; 95% confidence interval, 0.67-0.88) and for a painful perineum at 2 years (4% vs 6.2%; relative risk, 0.64; 95% confidence interval, 0.47-0.87) compared to planned vaginal delivery. Among singleton pregnancies, planned cesarean delivery was associated with a lower rate of perinatal death (0.69% vs 1.81%; relative risk, 0.45; 95% confident interval, 0.21-0.93). CONCLUSION: Planned cesarean delivery and planned vaginal delivery were associated with similar rates of perinatal and maternal mortality in this meta-analysis of randomized controlled trials. Planned cesarean delivery was associated with significant decreases in adverse neonatal outcomes such as low umbilical artery pH, birth trauma, tube feeding requirement, and hypotonia, and significant decreases in chorioamnionitis, urinary incontinence, and painful perineum. Planned vaginal delivery was associated with significant decreases in need for general anesthesia and wound infection. Further randomized trials are needed to assess the risks and benefits of planned cesarean delivery vs planned vaginal delivery in lower-risk patients and in the general population.

Prevalence, pattern and determinants of substance abuse among youths in a rural community of Osun State, Southwest Nigeria.

Study objectives: This study assessed the prevalence, patterns and factors associated with substance abuse among youths of Ejigbo community, Osun State, Nigeria. Method: This was a descriptive cross-sectional study which employed cluster sampling method to select 420 consenting youths (aged 15-24years). Data were collected using interviewer-administered, semi structured questionnaire. Descriptive and inferential statistics were carried out at p < 0.05. Results: The mean age (±SD) of the respondents was 19 ± 4.18 years. Majority (89%) of the respondents possessed good knowledge of substance abuse while 4% of them had a positive attitude towards it. Above a quarter (29.8%) of respondents had ever consumed alcoholic beverages while 12.3% of them had engaged in substance abuse. Besides alcohol, Shisha and tramadol were the most commonly abused substances in the study setting. Respondents' age (AOR=3.11;95%CI=1.67-5.24), gender (AOR=1.87;95%CI=1.53-9.25), attitude to substance use (AOR=5.90;95%3.45-10.23) and marital status (AOR=3.27;95%-CI=2.71-7.24) were the main determinants of substance abuse in the study setting. Conclusion: Respondents in the current study had good knowledge, predominantly negative attitude but a relatively high burden of substance abuse. There is urgent need for policy makers to upscale fights against the menace of substance abuse among rural Nigerian youths.

PCMH in a College Setting: A Brown Primary Care Transformation Initiative.

While the PCMH is the primary care model of choice for many healthcare systems, it is a relatively new area for college communities. The college health setting provides an important and challenging primary care platform because of developmental milestones that young adults face at this time of their lives. The Brown Primary Care Transformation Initiative (BPCTI) facilitated PCMH practice transformation efforts within a university center from 2013-2015. A mixed methods evaluative approach was used for baseline and follow-up periods as part of a broader transformation initiative that included interviews, surveys, focus groups, and observations. The college health practice was engaged in a number of other transformation activities concurrently. Results suggest that these multiple efforts, of which BPCTI's facilitation was one, together had a positive effect in this college health setting. This intervention provides a unique window into strengths and challenges for a college health practice as it seeks to transform its provision of primary care.

What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative.

OBJECTIVES: Patient-centered medical home transformation initiatives for enhancing team-based, patient-centered primary care are widespread in the United States. However, there remain large gaps in our understanding of these efforts. This article reports findings from a contextual, whole system evaluation study of a transformation intervention at eight primary care teaching practice sites in Rhode Island. It provides a picture of system changes from the perspective of providers, staff, and patients in these practices. METHODS: Quantitative/qualitative evaluation methods include patient, provider, and staff surveys and qualitative interviews; practice observations; and focus groups with the intervention facilitation team. RESULTS: Patient satisfaction in the practices was high. Patients could describe observable elements of patient-centered medical home functioning, but they lacked explicit awareness of the patient-centered medical home model, and their activation decreased over time. Providers' and staff's emotional exhaustion and depersonalization increased slightly over the course of the intervention from baseline to follow-up, and personal accomplishment decreased slightly. Providers and staff expressed appreciation for the patient-centered medical home as an ideal model, variously implemented some important patient-centered medical home components, increased their understanding of patient-centered medical home as more than specific isolated parts, and recognized their evolving work roles in the medical home. However, frustration with implementation barriers and the added work burden they associated with patient-centered medical home persisted. CONCLUSION: Patient-centered medical home transformation is disruptive to practices, requiring enduring commitment of leadership and personnel at every level, yet the model continues to hold out promise for improved delivery of patient-centered primary care.

Patient Engagement for Youth in Multiple Facets of Healthcare in Rhode Island.

Health reform strives to be patient-centered but often emphasizes institutional and financial well-being at the expense of patient responsiveness. Rhode Island is a pioneer, with innovative youth engagement programs in health care. The Youth Advisory Board of the Adolescent Patient-Centered Medical Home (PCMH) Initiative at Brown Family Medicine has brought together adolescents to gather feedback about participants' preferences for their health care and bring that feedback to health care providers. The Adolescent Leadership Council (TALC) of Hasbro Children's Hospital is comprised of adolescents with chronic medical illnesses and serves as an advisory group. The Rhode Island Department of Health's Office of Special Needs offers Dare to Dream, a youth leadership development program, a youth advisory council and a healthy lifestyles program. These youth engagement programs allow youth to help shape the health care system to meet their needs and contribute to youth empowerment in the state. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login].

Medical assistants' roles in electronic health record processes in primary care practices: the untold story.

The role of the medical assistant has been undervalued in the past. Many publications have detailed the integral role of the nursing staff and physicians, but the medical assistant role has come last in formal recognition. As healthcare settings move toward a more Patient-Centered Medical Home (PCMH) model, the attitudes of this model will need to be adopted, two of which are team-based care and adoption of the electronic health record (EHR). As the EHR continues to gain more traction in healthcare, a thorough understanding of it, by everyone, will be vital for its success. In this article, the medical assistant's relationship with the EHR is outlined through qualitative interviews and observations with medical assistants in PCMH programs. The data describe diverse EHR experiences and how these experiences are influenced by and reflected in workflow issues, training, patient care, and an expanding role of the medical assistant.