A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials.

CONTEXT: Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions. EVIDENCE ACQUISITION: This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018. EVIDENCE SYNTHESIS: Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%). CONCLUSIONS: Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.

Development and Implementation of U.S. Army Guidelines for Managing Soldiers at Risk of Suicide.

OBJECTIVES: Despite significant efforts in suicide prevention over the past several years, suicide rates in the U.S. Army remain largely unchanged. This paper describes a collaborative effort between line-unit leaders, medical personnel, and installation services to synchronize suicide risk identification and communication between these disparate entities. METHODS: Under the direction of the Installation Director of Psychological Health at Joint Base Lewis-McChord, a Behavioral Health Process Action Team was chartered to identify best practice and formulate policy for identifying and managing service members at risk for suicide. RESULTS: Compliance with the new policy reached 100% within 6 months of implementation, as measured by peer review of records. This installation policy was subsequently identified as a best practice and adopted Army-wide as the standard of practice. DISCUSSION: Knowledge transfer of research findings into policy and practice is crucial for suicide prevention. The current policy shows good integration of current research with practice in military settings. CONCLUSIONS: Combined efforts in crafting policy for risk identification and communication resulted in a policy that was acceptable and feasible from the perspective of commanders and clinicians. Synchronization efforts between commanders, clinicians, and support services are crucial to ensure effective intervention to prevent suicide behavior.

Videoconferenced Telebehavioral Health Referral Process Adherence.

Background: In 2015, the Army mandated 100% digital storage of telehealth consent forms (DA4700) in the Health Artifact and Image Management Solution (HAIMS) system, and a telebehavioral health (TBH) hub clinic set an aim to accomplish this by improving adherence to referral procedures essential to expanding patient access to videoconferenced (VC) behavioral health care. Methods: The Knowledge-to-Action (KTA) planned action framework underpinned development of a two-phase, PDSA (Plan-Do-Study-Act) quality improvement project to increase the rates of TBH new intake consent form completeness and upload adherence. First, a provider education initiative addressed form uploads. Second, TBH consultants prepared (signed and sent) intake forms to referring sites for their patients to finalize during the initial VC encounter. A chart review of consecutive new intake encounters compared data extracted from CY2015 Q1 baseline records (n = 65) with data from CY2016 Q1 improvement period records (n = 40). A total of 352 forms were reviewed. Results: Referrals (N = 118) that resulted in kept new VC TBH intake visits (n = 105), originated from three military behavioral health clinic referral sites. In CY2016 Q1, all DA4700 consent forms were uploaded to HAIMS. Telehealth treatment and medication consent form upload adherence increased from 94% and 68%, respectively, to 100% (p > 0.05). Form completeness increased from 36% to 95% (p < 0.001), and multiple linear regression analysis predicted an average 59% increase across the three referral sites (sr2 = 0.54). Conclusion: Consultant preparation of telehealth new intake consent forms effectively improved form completeness and increased adherence to new intake referral processes essential to this hub clinic expanding patient access to TBH care.

Does the U Stand for Useless? The Urine Drug Screen and Emergency Department Psychiatric Patients.

BACKGROUND: Behavioral emergencies account for a significant portion of emergency department (ED) visits in the United States. Substance abuse is common in this population and may precipitate or exacerbate preexisting psychiatric illness. Contrary to ED policy guidelines, many behavior health centers (BH) require a urine drug screen (UDS) in stable patients prior to transfer. OBJECTIVE: We sought to determine the role of the UDS in ED length of stay (LOS), cost, and charges to patients and inpatient psychiatric care. METHODS: We performed a retrospective chart review of all patients transferred to an in-network BH from September 1-30, 2014. Clinical data were extracted and analyzed from our electronic medical record, including records from both the ED visit and the BH stay. RESULTS: There were 205 patient encounters identified; 89 patients had a UDS performed in the ED and 89% were obtained after the ED medical clearance. LOS were similar between the two groups, however, time to ED departure from time of medical clearance was delayed in the UDS group. BH providers mentioned UDS results < 25% of the time and no confirmatory tests were performed. There was no difference in BH LOS or discharge diagnosis of substance-abuse disorder. Patient charges for UDS over the month totaled $21,093. CONCLUSION: The UDS did not seem to have any significant effect on inpatient psychiatric care; whereas ED LOS and cost were both negatively affected. Based on these results, the UDS seems to be of little-to-no benefit in the setting of acute psychiatric illness.

Cambios en el analista / Changes in the analyst

El autor se pregunta en qué consiste su práctica psicoanalítica y cuáles fueron sus motivaciones para que, a lo largo de sus años de ejercicio profesional, haya ido construyendo diversas respuestas a esa pregunta. Luego describe sus cambios en la tarea clínica de las últimas décadas. Enuncia algunas de las palabras que con frecuencia utiliza hoy y que, cree, simbolizan estos cambios, tales como confianza, intimidad, esperanza, paciencia, preocupación, acompañamiento, compromiso, espontaneidad, así como los verbos aguantar, posibilitar, acoger, jugar. Relaciona las nuevas maneras de trabajar en su clínica con las descripciones de la psicopatología de los consultantes actuales, frecuentemente próximos a la sexualidad compulsiva, alexitímicos, aburridos, vacíos, dependientes del consumo, que padecen depresiones vacías y más cercanos al trauma por ausencia de figuras estimulantes que al conflicto entre instancias psíquicas. Señala que su práctica implica un acercamiento al paciente resonando afectivamente con él y cuestionando la narrativa del mismo a través de un diálogo mayéutico, creando entre ambos un marco ético de seguridad y, dentro de este encuadre, toma en consideración el análisis de la historia del paciente a partir de la relación que se genera entre ambos. Sostiene que en ella se desarrollarán transferencias recíprocas reeditadas y/o novedosas (AU)

The author questions what constitutes his practice of psychoanalysis and what has motivated him to construct various answers to this question over his years in professional practice. He describes the changes he has made in the clinical task over recent decades. He enunciates some of the words he uses most often today and which, he believes, typify these changes; such as: trust, intimacy, hope, patience, worry or concern, accompaniment, commitment and spontaneity, and the verbs bear, enable, take in and play. He relates the new ways of working in his clinical practice with the descriptions of psychopathology of patients in consultation nowadays, which are frequently approximable to compulsive sexuality, alexithymic, bored, empty, consumption-dependent, suffering from empty depression and closer to trauma through an absence of stimulating figures than to the conflict between psychic instances. He notes that his clinical practice involves an approach to the patient by resonating affectively with him and challenging his narrative through maieutic dialogue, creating an ethical framework of security between the two. Within this frame-work, he considers the analysis of the patient´s history drawing from the relationship forged between the two. He argues that in this relationship reedited and/or original reciprocal transferences will be elaborated (AU)

Cultural adaptations of behavioral health interventions: a progress report.

OBJECTIVE: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. METHOD: Influential literature from the past decade was examined to identify points of consensus. RESULTS: There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. CONCLUSIONS: Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.

Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models.

Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.

Information technology and behavioral medicine: impact on autism treatment & research.

Families, clinicians and researchers involved with varying neurological disorders face amazing challenges to understand, treat, and assist the people they are serving. Autism brings unique challenges and serves as an important model for the application of important concepts in information technology and telemedicine. The rising incidence of autism with limited professional resources has led to more consideration for using information technology and related specialties to link families and professionals, and to implement strategies which implement information technology to improve the outcomes for individuals with autism and their families. These are reviewed in context of the unique health, education, and the research issues facing those dealing with autism.

Una revisión de los modelos explicativos de la relación entre el constructo hostilidad-ira-agresión y la enfermedad coronaria / A review of the explicative models which relate the construct hostility/anger/aggression to the coronary heart disease

El constructo hostilidad/ira/agresión (HIA) ha sido uno de los factores psicológicos que más se han estudiado en relación con la enfermedad coronaria (EC). A lo largo de las últimas décadas, la evidencia acumulada ha puesto de manifiesto la importancia de la hiperreactividad psicofisiológica como el mecanismo mediador entre el constructo HIA y la EC. Sin embargo, también se ha resaltado la importancia de factores socioambientales, constitucionales y comportamentales si se quiere comprender mejor cómo el constructo HIA puede llegar a provocar y/o agravar los procesos patofisiológicos de la EC. En este sentido, el objetivo del presente trabajo es hacer una breve exposición de los principales modelos que han servido de base para explicar el papel desempeñado por el constructo HIA en la EC: modelo de vulnerabilidad psicosocial, modelos de vulnerabilidad constitucional, modelo de salud conductual, modelo de reactividad psicofisiológica y modelo transaccional. Para concluir, finalizamos el trabajo presentando un modelo de síntesis que, además de resumir las principales aportaciones de los anteriores modelos, puede servir como punto de partida para el estudio de algunos aspectos que no han sido tratados anteriormente con la suficiente profundidad, como las características de especificidad o estereotipia individual. (AU)

[Systematic basis of analysis of action sequences in a "Binatest" device]. / Sistemnye osnovy analiza posledovatelnykh struktur povedencheskikh aktov v pribore "Binatest".

The paper presents a method for analysing and interpreting the results of patients' examination using a Binatest device. The examination was made in the situation of "optional choice" wherein multiple acts of choice from two alternative goal-oriented reactions lead only to positive results. The proposed analysis is based on the evaluation of previous quanta of behavior for further goal formation with limited analysis depth with three sequential events. The paper discusses what information may be derived from the analysis of monads, diads, and triads of step-by-step acts of choice. Four major parameters fit for the analysis and interpretation of the findings have been identified. These include diad asymmetry, runs, left and right stereotypies. Each parameter has its own value that is orthogonal towards the others, equal measurement limits, which are independent of their production, and fully determines the sequence of behavioral quanta at the depth of 3 events. It is shown that basic information on decision-making should be searched in the structure of sequential choice acts made by a patient during his/her examination rather than in the chosen behavioral acts themselves.