Trends in Telehealth versus On-site Clinical Genetics Appointments in Manitoba: A Comparative Study

Telehealth involves the use of information and communications technology to deliver health services to patients over distance. Canada is well suited to benefit from telehealth since many individuals live in remote, rural and isolated locations. Manitoba is the easternmost prairie province and MBTelehealth is an active Canadian program that currently has 105 sites in 73 communities. Although studies of patient satisfaction comparing telehealth to on-site clinical visits have been conducted, a comparative study of the types of genetics patients seen via these two modalities has not been performed previously. In this study we: (1) examined the uptake of telehealth in Genetics in Manitoba; (2) contrasted telehealth usage in Genetics with other clinical programs; and (3) performed a comparative study of the types of Genetics referrals seen in 2008 on-site versus via telehealth. Results indicate the uptake of telehealth is increasing and has made genetics outreach clinics unnecessary. The Program of Genetics and Metabolism is consistently one of the top ten utilizers of telehealth within the province. With respect to discipline, chi square analysis revealed the trends were not significantly different for on-site and telehealth encounters, with prenatal referrals being the most common and Hereditary Breast and Ovarian Cancer referrals being the least common. Referrals within each discipline varied depending on the need for fetal assessment and physical examination. Telehealth was utilized regularly for test results sessions across all disciplines.     

Examination of Negative Peer Contagion in a Residential Care Setting

There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a residential care program, and the extent to which caregiver experience and youth time-in-program mediated that relationship. The study used archival data for 1,438 first-time admissions to a large Midwestern out-of-home residential program for youth with emotional and behavioral problems. Hierarchical Linear Modeling was used to examine the relationship between daily reports of conduct and oppositional defiant disorder (CD/ODD) behaviors and the percentage of conduct disorder youth living in a home. Greater exposure to conduct disordered peers was not related to increased rates of CD/ODD behavior. CD/ODD behavior was directly related to direct care staff level of experience and youth time in program. Implications for residential care are discussed.     

Examining the relationship between family context and children’s physical activity beliefs: The role of parenting style

Objectives

Previous research studies examining parental influences on children’s physical activity (PA) have focused primarily on parents’ own PA behavior, as well as their PA-related beliefs and socially supportive behaviors. The present study, although aligned with this mainstream parental influence research, was grounded in a broader child development perspective to examine the influence of parenting style on children’s PA beliefs and quality of parent-child communication.

Method

Self-report questionnaires were administered to 173 children ranging in age from 9 to 12 years to assess their perceptions of parenting style, parent-child communication patterns, as well as their own perceptions of fitness competence, value, and goal orientation.

Results

Children’s constellation of beliefs and attitudes regarding PA as well as their perceptions of the parent-child communication process did vary as a function of the type of parenting style they perceived their parents to use. High challenge parenting style was linked to higher perceived fitness competence and value on the part of the children. High support parenting style was linked to more positive perceived parent-child communication patterns.

Conclusion

Parenting style may be a critical underlying family process variable that impacts children’s development of a positive constellation of beliefs about PA. Future work is needed to link parenting style and children’s PA beliefs to their PA behavior.     

The Argument from Skepticism for Contextualism

Epistemic contextualism was originally motivated and supported by the response it provides to skeptical paradox. Although there has been much discussion of the contextualist response to skeptical paradox, not much attention has been paid to the argument from skepticism for contextualism. Contextualists argue that contextualism accounts for the plausibility and apparent inconsistency of a set of paradoxical claims better than any classical invariantist theory. In this paper I focus on and carefully examine the argument from skepticism for contextualism. I argue not only that the prima facie advantage of contextualism is specious, but also that contextualism is in fact at a competitive disadvantage with respect to two classical invariantist views. I also argue that contextualism takes an arbitrary and unsatisfying strategy in its response to skepticism. That contextualism is alone in taking this arbitrary strategy marks a second competitive disadvantage for it. In addition, I argue that the contextualist response to skeptical paradox regenerates a skeptical paradox which contextualism is powerless to solve. Consequently, the argument from skepticism for contextualism fails. Furthermore, this feature of the contextualist response to skeptical paradox completely undermines the motivation and support for contextualism deriving from its treatment of skeptical paradox. I conclude that the argument from skepticism for contextualism fails, and that the contextualist response to skeptical paradox fails to motivate contextualism, pending the success of another argument for the contextualist thesis.     

Visual working memory supports the inhibition of previously processed information: evidence from preview search

In four experiments we assessed whether visual working memory (VWM) maintains a record of previously processed visual information, allowing old information to be inhibited, and new information to be prioritized. Specifically, we evaluated whether VWM contributes to the inhibition (i.e., visual marking) of previewed distractors in a preview search. We evaluated this proposal by testing three predictions. First, Experiments 1 and 2 demonstrate that preview inhibition is more effective when the number of previewed distractors is below VWM capacity than above; an effect that can only be observed at small preview set sizes (Experiment 2A) and when observers are allowed to move their eyes freely (Experiment 2B). Second, Experiment 3 shows that, when quantified as the number of inhibited distractors, the magnitude of the preview effect is stable across different search difficulties. Third, Experiment 4 demonstrates that individual differences in preview inhibition are correlated with individual differences in VWM capacity. These findings provide converging evidence that VWM supports the inhibition of previewed distractors. More generally, these findings demonstrate how VWM contributes to the efficiency of human visual information processing--VWM prioritizes new information by inhibiting old information from being reselected for attention.     

Six-Year Sustainability of Evidence-Based Intervention Implementation Quality by Community-University Partnerships: The PROSPER Study

There is a knowledge gap concerning how well community-based teams fare in implementing evidence-based interventions (EBIs) over many years, a gap that is important to fill because sustained high quality EBI implementation is essential to public health impact. The current study addresses this gap by evaluating data from PROSPER, a community-university intervention partnership model, in the context of a randomized-control trial of 28 communities. Specifically, it examines community teams' sustainability of implementation quality on a range of measures, for both family-focused and school-based EBIs. Average adherence ratings approached 90% for family-focused and school-based EBIs, across as many as 6 implementation cohorts. Additional indicators of implementation quality similarly showed consistently positive results. Correlations of the implementation quality outcomes with a number of characteristics of community teams and intervention leaders were calculated to explore their potential relevance to sustained implementation quality. Though several relationships attained statistical significance at particular points in time, none were stable across cohorts. The role of PROSPER's continuous, proactive technical assistance in producing the positive results is discussed.     

Maternal Depressive Symptoms and Child Social Preference During the Early School Years: Mediation by Maternal Warmth and Child Emotion Regulation

This longitudinal study examined processes that mediate the association between maternal depressive symptoms and peer social preference during the early school years. Three hundred and fifty six kindergarten children (182 boys) and their mothers participated in the study. During kindergarten, mothers reported their level of depressive symptomatology. In first grade, teachers rated children’s emotion regulation at school and observers rated the affective quality of mother-child interactions. During second grade, children’s social preference was assessed by peer nomination. Results indicated that mothers’ level of depressive symptomatology negatively predicted their child’s social preference 2 years later, controlling for the family SES and teacher-rated social preference during kindergarten. Among European American families, the association between maternal depressive symptoms and social preference was partially mediated by maternal warmth and the child’s emotion regulation. Although the relation between maternal depressive symptoms and children peer preference was stronger among African American families than Europrean American families, its mediation by the maternal warmth and child’s emotion regulation was not found in African American families.     

What is Happening With Bill and Jane?

In this comment I applaud Goldner’s ability to capture couple experience and dynamics while emphasizing that coupling involves more than attachment. In my view, couple conflict and therapy involves attending not only to attachment, which involves closeness and the threat of separation, but also to issues of identity, self-definition, and shame. I point out how some of the interactions and dynamics in the case discussed involve a threat to identity through invalidation more than to attachment by abandonment. As Goldner notes, mutual recognition between people is the cornerstone of the relational ideal, and it is for recognition through being seen, and validated for which Bill and Jane fight so hard, not closeness. In my view not everything in couples is about regulating attachment; rather everything is probably about regulating affect. Attachment is one, but only one, of the ways couples regulate their affect.