Suicide prevention programming across ecological levels: Recommendations from Latinx immigrant origin youth and their parents.

INTRODUCTION: Latinx immigrant-origin youth (IOY) have unique risks for suicidal thoughts and behaviors. It has been suggested that these risks should be addressed from an ecological perspective, addressing cultural and family context as well as structural and systemic barriers to prevention. This study sought to explore perspectives of immigrant-origin Latinx adolescents and their caregivers on suicide and its prevention, including the potential impact of stressors specific to immigrant status. METHOD: Focus groups were conducted in 2018-2019 with Latinx immigrant-origin caregivers (N = 41, 97.5% female) and adolescents (ages = 14-19, N = 56, 50% female). Participants were recruited from community-based organizations in two different cities. A codebook approach to thematic analysis was used to identify themes, which were subsequently mapped onto levels of the Center for Disease Control's Social-Ecological Framework for Violence Prevention. RESULTS: Participants identified both contributors to suicidal behavior and potential components of prevention programming across ecological levels. Specific recommendations for suicide prevention included engaging in recreation, parenting education and support, enhancing academic supports for adolescents, and enhancing school-family communication. Structural barriers (e.g., caregiver work schedules) to implementing recommendations were described. DISCUSSION: Our results highlight the potential role of access to school and community-based supports as public health-oriented suicide prevention strategies and suggest a need to address barriers faced by immigrant families in accessing these supports alongside addressing barriers to mental health treatment. Policies impacting immigrant families' financial stability and increasing the availability of recreational and academic opportunities may promote mental health and prevent suicidal thoughts and behavior among IOY. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Processes of Care Redesign: Direct Observation of Group Well-Child Care.

We sought to describe processes of psychosocial screening and discussion with immigrant Latino families in the context of group well-child care. We conducted longitudinal direct observations of the 1-, 2-, 4-, and 6-month visits of 7 group well-child care cohorts at an academic pediatric clinic using unstructured observations of visit and group processes as well as structured observations to code facilitators' behavior. A range of psychosocial and social determinants of health topics were incorporated into discussions. In general, providers skillfully navigated group discussions, but inconsistently introduced the visit purpose. Asking participants to define psychosocial terms (eg, stress) and conversations about managing fussy infants were effective strategies to engage families in psychosocial discussions (eg, about postpartum depression). Some challenges with workflow were identified. Strategies to enhance screening and discussion of psychosocial topics may benefit from adaptation to maximize the effectiveness of this care mechanism.

Depredación, reproducción y desarrollo de la catarina Hippodamia convergens (Coleoptera: Coccinellidae) / Predation, reproduction, and development of the lady beetle Hippodamia convergens (Coleoptera: Coccinellidae)

Introducción: Mantener poblaciones de insectos depredadores en el agroecosistema ofreciéndoles presas y recursos alimenticios provenientes de las plantas es importante para mejorar el control biológico y contribuir con la conservación. Objetivo: Determinar si el consumo de presas y recursos alimenticios florales potencia los atributos biológicos del depredado Hippodamia convergens. Métodos: Las larvas de Hippodamia convergens fueron alimentadas con dos especies de áfidos, mientras que los adultos fueron alimentados con áfidos, espigas de maíz y dos especies de plantas no cultivadas. La presencia de azúcar en el intestino del depredador se comprobó mediante la prueba de antronas frías, y la presencia de polen mediante el método de acetólisis. Los experimentos demográficos se realizaron durante los primeros 40 días después de la emergencia de la hembra bajo condiciones controladas (25 °C ± 0.5; 75 % ± 1.75 HR; L12:D12). Resultados: H. convergens no consumió fructosa de Sorghum halepense, Parthenium hysterophorus o Zea mays, sino únicamente polen. En condiciones controladas (25 °C ± 0.5, 75 % ± 1.75 HR), el tiempo de desarrollo (huevo-adulto) del depredador fue más corto (21.36 días) cuando consumió Rhopalosiphum maidis en lugar de Uroleucon nigrotibium (24.6 días), mientras que la supervivencia (L1- adulto) y la proporción sexual no cambió. La fecundidad promedio fue mayor (55.5 huevos / 40 días) al consumir U. nigrotibium con polen de P. hysterophorus, que solo U. nigrotibium (22.5 huevos / 40 días), o R. maidis con polen de Zea mays (11 huevos / 40 días). La tasa intrínseca de crecimiento natural fue mayor al consumir U. nigrotibium con polen de P. hysterophorus (0.055), que U. nigrotibium (0.034) o R. maidis con polen de Z. mays (0.019). La tasa de depredación (L1-L5) fue mayor al consumir R. maidis (0.65) que U. nigrotibium (0.51). Conclusiones: Las especies de áfidos y su combinación con polen de plantas no cultivadas afectan de manera diferente el tiempo de desarrollo, reproducción y tasa de depredación de H. convergens.

Introduction: Keeping populations of predatory insects in the agroecosystem by offering them prey, as well as food resources from plants, is important for enhancing conservation biological control. Objective: To determine if the consumption of prey and floral food resources enhances the biological attributes of the predator Hippodamia convergens. Methods: We fed the beetle larvae two species of aphids; and the adults were fed aphids, maize tassels, and two non-cultivated plant species. We checked gut sugar in the predator by the cold anthrone test and pollen presence by the acetolysis method. Demographic experiments were done in the first 40 days after female emergence, under controlled conditions (25 °C ± 0.5; 75 % ± 1.75 Relative Humidity; Light 12 h: Darkness 12 h). Results: H. convergens did not consume fructose, but only pollen from Sorghum halepense, Parthenium hysterophorus or Zea mays. Developmental time (egg-adult) of the predator was shorter (21.4 days) when it consumed Rhopalosiphum maidis than Uroleucon nigrotibium (24.6 days); survival (L1-adult) and sex ratio did not change. Average fecundity was higher (55.5 eggs / 40 days) when consuming U. nigrotibium with pollen from P. hysterophorus, than U. nigrotibium (22.5 eggs / 40 days) or R. maidis with pollen from Zea mays (11 eggs / 40 days). The intrinsic rate of natural growth was higher when consuming U. nigrotibium with pollen from P. hysterophorus (0.055), than U. nigrotibium (0.034) or R. maidis with pollen from Z. mays (0.019). Predation rate (L1-L5) was higher when consuming R. maidis (0.65) than U. nigrotibium (0.51). Conclusions: Aphid prey species and its combination with pollen from maize and non-cultivated plants affected development time, reproduction, and predation rate of H. convergens.

"The First Step to Changing Something": Addressing Latinx Childhood Obesity through Photovoice.

BACKGROUND: Latinx children in immigrant families have disproportionately high obesity rates; effective obesity treatment for this subset of Latinx children is critically needed. OBJECTIVES: To inform the development of weight management interventions we explored: 1) community facilitators and barriers to achieving childhood healthy weight through photovoice; and 2) participant reflections on the photovoice process. METHODS: Photovoice was conducted using established methods in a local church. After photovoice, participants completed semi-structured interviews to reflect on their experience. Transcripts were analyzed using a general thematic analysis approach to arrive at preliminary themes, which were presented to participants for validation. Participant input was used to finalize the themes. RESULTS: Six adults and two youth Latinx immigrants identified photograph themes over seven sessions. Four themes emerged regarding community barriers and facilitators to achieving childhood healthy weight: 1) family habits, 2) cultural influences on food, 3) built environment, and 4) food marketing. Participant reflections revealed they were motivated to participate in photovoice to learn more about health, recognized personal growth as a result of group sharing, valued representation as a community, and felt empowered to be role models. CONCLUSIONS: Findings from both photovoice and participant reflections reinforced the need for multi-level approaches to treating childhood obesity. Though participant reflections were gathered to inform continued engagement of Latinx families, they ultimately had a significant impact on our conclusions about priority intervention components.

Group well-child care model for Latino children in immigrant families: Adapting to and learning from the coronavirus disease 2019 (COVID-19) context.

INTRODUCTION: Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families. METHOD: Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance. RESULTS: Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (p = .087) and fewer friends and family members with COVID-19 (M = 1.0 vs. 5.1, p < .05) than those who did not attend. Women described virtual GWCC as acceptable and a source of social support. Some described differences in group dynamics compared with in-person groups and had privacy concerns. Providers noted scheduling and billing challenges affecting feasibility and sustainability. They reported that visits with good attendance were productive. Mothers and pediatric providers offered recommendations to improve feasibility and privacy and address sustainability. DISCUSSION: Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Addressing Psychosocial Topics in Group Well-Child Care: A Multi-Method Study With Immigrant Latino Families.

OBJECTIVE: Group Well-Child Care (GWCC) has been described as providing an opportunity to enhance well-being for vulnerable families experiencing psychosocial challenges. We sought to explore benefits and challenges to the identification and management of psychosocial concerns in Group Well-Child Care (GWCC) with immigrant Latino families. METHODS: We conducted a case study of GWCC at an urban academic general pediatric clinic serving predominantly Limited English Proficiency Latino families, combining visit observations, interviews, and surveys with Spanish-speaking mothers participating in GWCC, and interviews with providers delivering GWCC. We used an adapted framework approach to qualitative data analysis. RESULTS: A total of 42 mothers and 9 providers participated in the study; a purposefully selected subset of 17 mothers was interviewed, all providers were interviewed. Mothers and providers identified both benefits and drawbacks to the structure and care processes in GWCC. The longer total visit time facilitated screening and education around psychosocial topics such as postpartum depression but made participation challenging for some families. Providers expressed concerns about the effects of shorter one-on-one time on rapport-building; most mothers did not express similar concerns. Mothers valued the opportunity to make social connections and to learn from the lived experiences of their peers. Discussions about psychosocial topics were seen as valuable but required careful navigation in the group setting, especially when fathers were present. CONCLUSIONS: Participants identified unique benefits and barriers to addressing psychosocial topics in GWCC. Future research should explore the effects of GWCC on psychosocial disclosures and examine ways to enhance benefits while addressing the challenges identified.

From Clinic to Community: Adapting Evidence-Based Weight Management for Overweight Latinx Children to Better Address Social Determinants.

BACKGROUND: The U.S. Preventive Services Task Force recommends referral of all obese children to intensive weight management programs. When available, programs are limited to clinical settings and do not address social determinants of health barriers to healthy weight among Latinx immigrant families. Active and Healthy Families, a Spanish-language, culturally tailored group visit intervention has demonstrated effectiveness in decreasing child body mass index but does not address barriers to frequent engagement with the health care system nor social determinants other than immigration. Adapting the intervention for community-based delivery, and to address additional social determinants, may facilitate participation and increase acceptability and engagement among Latinx immigrant families. PURPOSE: To engage a stakeholder network in planning adaptations of an evidence-based weight management intervention for community-based implementation. METHOD: Guided by the intervention mapping-adapt process, we solicited feedback from a stakeholder network from August 2018 to March 2020. The stakeholder network assessed fit, planned adaptations and identified essential intervention components using photovoice, a Participatory Action Research method, and meetings incorporating user-centered design approaches. RESULTS: The stakeholder network membership included Latinx immigrant families, community leaders, health care delivery experts, and researchers. Planned adaptations included curriculum changes to discuss social determinants barriers to behavior change and goal setting to mitigate them. CONCLUSIONS: We successfully engaged a stakeholder network and, using a systematic process, identified adaptations of an evidence-based weight management intervention to allow for community-based implementation. Sustainably addressing obesity disparities for Latinx children also requires addressing structural factors to reduce social determinants of health barriers at the population level.

Community partnerships in emerging immigrant communities: Lessons learned addressing Latino childhood weight disparities.

Latino children have disproportionately high childhood obesity rates, and U.S.-born Latino children of immigrant parents experience higher overweight/obesity rates than other Latino children. Community-based participatory research (CBPR) to engage Latino immigrant families and Latino-serving community organizations is one mechanism to address the lack of effective and practical interventions addressing childhood obesity disparities among Latino children. We present lessons learned from applying CBPR methods to a partnership focused on developing a child obesity treatment program for Latino immigrant families in an emerging Latino immigrant destination to inform the use of CBPR methods in other partnerships in emerging immigrant communities. We encountered challenges working within the partnership related to entrenched sociopolitical hierarchies that were not inclusive of immigrant community leaders, capacity building for partners with limited literacy and administrative experience, and how best to use complementary methods and frameworks to support a community-engaged research process. This work is one way to promote shared learning among the community of researchers using CBPR and other engagement methods to partner with emerging immigrant communities. Together with our community partners, we can identify strategies to more effectively partner to promote health equity and work toward social justice for all members of our communities.

Partners' engagement in surveillance among survivors of colorectal cancer: A qualitative study.

OBJECTIVES: Following treatment of Stage III colorectal cancer, guidelines recommend 3-5 years of surveillance for recurrence. However, over half of the 1.2 million U.S. survivors of colorectal cancer fail to receive guideline-concordant surveillance. In light of growing recognition that members of couples are interdependent and influence each other's health behaviors, we sought to describe, in their own words, the perspectives of spouses/partners on their engagement in patients' surveillance. METHODS: We conducted in-person, semi-structured interviews with 10 survivors of stage III colorectal cancer and their partners, together and separately. Interviews were transcribed verbatim, iteratively coded, and analyzed to identify emergent themes pertaining to partner engagement. Findings were validated through triangulation between study team members and triangulation between dyadic and individual interviews, and through an extensive search of transcripts for disconfirming evidence. RESULTS: We identified three overarching domains of partner engagement in surveillance. First, psychosocial engagement included promoting patient participation in surveillance, showing care and concern, and attending to partner self-care. Second, information-seeking and dyadic communication focused on gathering information, staying informed about test results, and communicating about surveillance. Third, instrumental engagement referred to any explicit, objective activities such as scheduling appointments, attending appointments, and managing responsibilities at home. Participants shared strategies, examples, and in some cases unmet needs. CONCLUSIONS: This study generated new, clinically meaningful knowledge about the ways in which partners engage in patients' surveillance. Opportunities to leverage partners as informal resources in surveillance include development of dyadic interventions to help partners engage most effectively.

Using Health Systems Engineering Approaches to Prepare for Tailoring of Implementation Interventions.

BACKGROUND: Implementation of evidence-based practices often requires tailoring implementation strategies to local contextual factors, including available resources, expertise, and cultural norms. Using an exemplar case, we describe how health systems engineering methods can be used to understand system-level variation that must be accounted for prior to broad implementation. METHODS: Within the context of a single-center quality improvement activity, a multi-disciplinary stakeholder team used health systems engineering methods to describe how pre-endoscopy antithrombotic management was executed, and implemented a redesigned process to improve clinical care. The research team then conducted multiple stakeholder focus groups at four different health-care systems to describe and compare current processes for pre-endoscopy antithrombotic medication management. Detailed work flow maps for each health-care system were developed, analyzed, and integrated to develop an overarching current work flow map, identify key process steps, and describe areas of process variation. RESULTS: Five key process steps were identified across the four health systems: (1) place an endoscopy order, (2) screen for antithrombotic use, (3) coordinate medication management, (4) instruct the patient, and (5) confirm appropriate medication management before procedure. Across health systems, we found a high degree of variation in each step (e.g., who performed, use of technology, systematic vs. ad hoc process). This variation was influenced by two key system-level contextual factors: (1) degree of health system integration and (2) role and training level of available staff. These key steps, areas of variation, and contextual factors were integrated into an assessment tool designed to facilitate tailoring of a future implementation and dissemination strategy. CONCLUSIONS: Tools from health systems engineering can be used to identify key work flow process steps, variations in how those steps are executed, and influential contextual factors. This process and the associated assessment tool may facilitate broader implementation tailoring.

Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixed-methods study.

BACKGROUND: Outpatient anticoagulation clinics were initially developed to care for patients taking vitamin K antagonists such as warfarin. There has not been a systematic evaluation of the barriers and facilitators to integrating direct oral anticoagulant (DOAC) care into outpatient anticoagulation clinics. METHODS: We performed a mixed methods study consisting of an online survey of anticoagulation clinic providers and semi-structured interviews with anticoagulation clinic leaders and managers between March and May of 2017. Interviews were transcribed and coded, exploring for themes around barriers and facilitators to DOAC care within anticoagulation clinics. Survey questions pertaining to the specific themes identified in the interviews were analyzed using summary statistics. RESULTS: Survey responses were collected from 159 unique anticoagulation clinics and 20 semi-structured interviews were conducted. Three primary barriers to DOAC care in the anticoagulation clinic were described by the interviewees: (a) a lack of provider awareness for ongoing monitoring and services provided by the anticoagulation clinic; (b) financial challenges to providing care to DOAC patients in an anticoagulation clinic model; and (c) clinical knowledge versus scope of care by the anticoagulation staff. These themes linked to three key areas of variation, including: (a) the size and hospital affiliation of the anticoagulation clinic; (b) the use of face-to-face versus telephone-based care; and (c) the use of nurses or pharmacists in the anticoagulation clinic. CONCLUSIONS: Anticoagulation clinics in the United States experience important barriers to integrating DOAC care. These barriers vary based on the clinic size, model for warfarin care, and staff credentials (nursing or pharmacy).

Periprocedural Antithrombotic Management from a Patient Perspective: A Qualitative Analysis.

BACKGROUND: Periprocedural antithrombotic medication management is a complex, often confusing process for patients and their providers. Communication difficulties often lead to suboptimal medication management, resulting in delayed or canceled procedures. METHODS: We conducted telephone surveys with patients taking chronic antithrombotic medications who had recently undergone an endoscopy procedure. In the survey, we sought to better understand the periprocedural process for patients taking antithrombotic medications. We conducted a content analysis of patients' unstructured responses from the periprocedural patient phone calls. We used a multistep group coding process to analyze responses. Relationships between different themes and categories were analyzed using original quotes and retrieving thematic segments from the transcripts. RESULTS: The survey was administered to 81 patients; 74/81 respondents (91%) said they understood the plan to manage their antithrombotics, but 21/81 respondents (26%) were not completely satisfied with the coordination, communication, and management of their medications. Five primary themes emerged from the content analysis as patient-centered design features affecting periprocedural care: (1) patients require accurate and timely information; (2) a patient's prior experience with antithrombotic therapy affects their understanding of the process; (3) patients prefer receiving their information from a single source, and (4) also prefer different methods of instruction; (5) finally, patients expect their clinician(s) to be available through the periprocedural management process. CONCLUSION: To optimize the periprocedural medication management communication process, patients desire timeliness, accuracy, and adaptiveness to prior patient experience while offering a single, consistently available point of contact.

Low levels of modern contraceptive use and associated factors in the Western Balkans.

OBJECTIVES: The objective of this research was to determine modern contraceptive use (MCU) and explore factors associated with MCU in the Western Balkans. METHODS: Multiple Indicator Cluster Survey (MICS) data from Bosnia and Herzegovina, Kosovo, Macedonia, Montenegro and Serbia, including the datasets from Roma settlements, were merged. Bivariate and multivariate analyses were used to assess which factors were associated with MCU among married women aged 15-49 in the region. RESULTS: Among the 11,381 women surveyed, 13.75% reported MCU and 23.74% justified domestic violence. While bivariate analysis indicated that women who expressed justification of domestic violence were less likely to report MUC, this was not the case after adjusting for sociodemographic factors. Multivariate analysis showed that Roma were less likely than non-Roma to engage in MCU. Additionally, increased education, increased wealth, and urban residency were significantly associated with increased likelihood of MCU. CONCLUSION: The results highlight the need for more attention from research, programming and policy communities in order to better understand and address the overall problematically low level of MCU and factors associated with low MCU. More efforts are needed to address the disparities in MCU among Roma women and women of lower socioeconomic status.