Coordination Intervention Research Articles

Care coordination challenges between a high-volume center and rural physicians treating patients with pancreatic cancer.

58 Background: Pancreatic cancer (PC) patients treated at high-volume centers (HVCs) benefit from specialty services that may not be accessible to rural patients: complex treatment planning, advanced surgical and chemo-radiation options, and multidisciplinary team-based care. As a result, rural PC patients often seek treatment at multiple locations for different episodes of care (i.e., chemotherapy and surgery). The facilitators and barriers to coordinating care between rural physicians and HVCs for rural PC patients treated by both types of providers are not well-understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two co-authors independently coded the interview transcripts to develop a thematic account of HVC-rural physician care coordination barriers and facilitators. Results: Initial interactions between PC specialists and rural PC patients often require duplication of diagnostic testing (i.e., imaging) due to inadequate transfer of medical records at the time of consultation. This is partly due to inefficient phone communication between HVCs and rural physicians. Such inefficiencies often discourage two-way communication between HVCs and rural physicians, and this can hinder development of a shared understanding of patients’ treatment plans. Specialists suggested a dual-approach may help to improve care coordination in this context: (a) developing better personal relationships with rural physicians to facilitate information-sharing and “closing-the-loop” on patients’ treatment plans; and (b) implementing data systems that permit physicians to share patients’ records across organizations. Several specialists acknowledged the benefit of having a dedicated care coordinator who could help patients connect with specialists, navigate the different healthcare systems, and relay information between providers. Conclusions: Given the challenges that can complicate the PC treatment process for rural patients, it is important to consider opportunities to address these issues. Taking steps to improve efficiency in communication may help facilitate the development of cohesive treatment plans and promote team-based care. Further studies are needed to examine the effects of care coordination interventions, like the use of care coordinators, on improving care for rural PC patients.

Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America.

Healthcare coordination is considered key to improving care quality. Although participatory action research (PAR) has been used effectively to bridge the gap between evidence and practice in other areas, little is known about the key success factors of its use in healthcare organizations. This article analyses the factors influencing the implementation of PAR interventions to improve clinical coordination from the perspective of actors in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. A qualitative, descriptive-interpretative study was conducted in each country’s healthcare network. Focus groups and semi-structured individual interviews were conducted to a criterion sample of: local steering committee (LSC) (29), professional platform (PP) (28), health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and themes. The PAR process led by the LSC covered the return of baseline results, selection of problems and interventions and design, implementation and adjustment of the intervention, with PP. Interventions were implemented to improve communication and clinical agreement between primary and secondary care. Results reveal that contextual factors, the PAR process and the intervention’s content influenced their implementation, interacting across time. First, institutional support providing necessary resources, and professionals’ and managers’ willingness to participate, emerge as contextual pivotal factors, influenced by other factors related to: the system (alignment with policy and political cycle), networks (lack of time due to work overload and inadequate working conditions) and individuals (not knowing each other and mutual mistrust). Second, different characteristics of the PAR process have a bearing, in turn, on institutional support and professionals’ motivation: participation, flexibility, consensual decision-making, the LSC’s leadership and the facilitating role of researchers. Evidence is provided that implementation through an adequate PAR process can become a factor of motivation and cohesion that is crucial to the adoption of care coordination interventions, leading to better results when certain contextual factors converge.

“Escole” : Programa de intervención para la atención en el déficit de la comprensión lectora

The deficit of reading comprehension is a problem that is evident in students from primary level and even up to higher level. The ESCOLE project proposes various strategies to improve the levels of reading comprehension (literal, inferential, and reflective) based on the recreation and dramatization of short Peruvian stories: Paco Yunque and El Nino de Along the Sky.This program develops an integrated intervention in coordination with all educational agents. Its purpose is to carry out activities that allow students to enhance reading skills that include all the levels required for comprehension. That is to say, it is intended to develop their capabilities in a comprehensive way so that they become competent in all academic areas.ESCOLE is aimed at students in the first year of secondary education; however, it can be applied to any human group, as it is versatile, entertaining and does not require sophisticated materials for its execution.

Parenting Coordination Law in the U.S. and Canada: A Review of the Sources and Scope of the PC's Authority

The development of parenting coordination has continued from its informal beginnings in the 1980s to the present where more than twenty states and provinces have enacted statutes or rules regarding parenting coordinator appointments. Parenting coordination evolved as a tool for courts attempting to manage the conflicts between parents that placed children of divorce and parental separation at risk for behavioral, emotional, and psychological problems. Use of parenting coordinators (PCs) in some form now occurs in almost every jurisdiction, even those with no formal statute or rule. This review examines the legal foundations for court authority to order parenting coordination interventions as well as the legal efforts to define the scope of the PC's authority in individual cases. Included is the examination of the statutes, rules, and case law illustrating many of the controversies and psycholegal flashpoints in the field. AFCC's updated Guidelines for Parenting Coordination (2019) reflect maturation and professionalization of the intervention via suggestions for training, professional competence, and ethical guidance. The authors offer assistance and suggestions for those working to develop or improve legal parenting coordination frameworks.

Effect of a Comprehensive Cardiovascular Risk Reduction Intervention in Persons With Serious Mental Illness

Persons with serious mental illness have a cardiovascular disease mortality rate more than twice that of the overall population. Meaningful cardiovascular risk reduction requires targeted efforts in this population, who often have psychiatric symptoms and cognitive impairment. To determine the effectiveness of an 18-month multifaceted intervention incorporating behavioral counseling, care coordination, and care management for overall cardiovascular risk reduction in adults with serious mental illness. This randomized clinical trial was conducted from December 2013 to November 2018 at 4 community mental health outpatient programs in Maryland. The study recruited adults with at least 1 cardiovascular disease risk factor (hypertension, diabetes, dyslipidemia, current tobacco smoking, and/or overweight or obesity) attending the mental health programs. Of 398 participants screened, 269 were randomized to intervention (132 participants) or control (137 participants). Data collection staff were blinded to group assignment. Data were analyzed on the principle of intention to treat, and data analysis was performed from November 2018 to March 2019. A health coach and nurse provided individually tailored cardiovascular disease risk reduction behavioral counseling, collaborated with physicians to implement appropriate risk factor management, and coordinated with mental health staff to encourage attainment of health goals. Programs offered physical activity classes and received consultation on serving healthier meals; intervention and control participants were exposed to these environmental changes. The primary outcome was the change in the risk of cardiovascular disease from the global Framingham Risk Score (FRS), which estimates the 10-year probability of a cardiovascular disease event, from baseline to 18 months, expressed as percentage change for intervention compared with control. Of 269 participants randomized (mean [SD] age, 48.8 [11.9] years; 128 men [47.6%]), 159 (59.1%) had a diagnosis of schizophrenia or schizoaffective disorder, 67 (24.9%) had bipolar disorder, and 38 (14.1%) had major depressive disorder. At 18 months, the primary outcome, FRS, was obtained for 256 participants (95.2%). The mean (SD) baseline FRS was 11.5% (11.5%) (median, 8.6%; interquartile range, 3.9%-16.0%) in the intervention group and 12.7% (12.7%) (median, 9.1%; interquartile range, 4.0%-16.7%) in the control group. At 18 months, the mean (SD) FRS was 9.9% (10.2%) (median, 7.7%; interquartile range, 3.1%-12.0%) in the intervention group and 12.3% (12.0%) (median, 9.7%; interquartile range, 4.0%-15.9%) in the control group. Compared with the control group, the intervention group experienced a 12.7% (95% CI, 2.5%-22.9%; P = .02) relative reduction in FRS at 18 months. An 18-month behavioral counseling, care coordination, and care management intervention statistically significantly reduced overall cardiovascular disease risk in adults with serious mental illness. This intervention provides the means to substantially reduce health disparities in this high-risk population. ClinicalTrials.gov Identifier: NCT02127671.

Client Outcomes From a Multilevel Intervention to Support Persons Living With HIV and Returning to the Community After Incarceration in Puerto Rico.

The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to address the social and structural determinants of health in incarcerated populations. A Special Programs of National Significance grant supported a Puerto Rican community-based organization to implement the evidence-informed Transitional Care Coordination intervention among incarcerated persons living with HIV, targeting changes at the individual, organization, and systems levels. After implementation (November 2015-July 2018; n = 69), 93.1% of eligible clients were linked to community-based HIV care, 86.3% remained in care for 6 months, and 78.6% remained for 12 months. A greater proportion reported consistent HIV care, ART adherence, food security, and transportation to access care. Integrating HIV case management with housing and employment services, and developing buy-in and collaboration from partners across systems of care, including after a natural disaster, led to positive client outcomes. This intervention shows promise for adaptation to other HIV care and service delivery systems.

Improving Selective Attention for All Students with Coordinative Bal-A-Vis-X Movement Breaks: A Pilot Study

ABSTRACT Brief coordinative movement breaks increase student attention and should be implemented by school-based occupational therapists to support the occupational potential of all students. Inattention is one of the most common reasons for student referrals to special education. Decreased physical activity is a contributing factor, yet movement opportunities are declining in schools. Despite these trends and the call from AOTA to support health promotion and prevention for all, 1:1 occupational therapy focusing on students identified with handwriting deficits continue to be prevalent in school-based practice. To remain a relevant service and keep pace with changing trends in special education and best practice, occupational therapists must broaden their scope to address inattention. This study explored Bal-A-Vis-X as an inclusive coordinative exercise intervention and found that 10-minutes of Bal-A-Vis-X twice per week for eight weeks improved attention in sixth grade students from d2 Test of Attention pretest to posttests. Immediate posttest improvements were statistically significant for processing speed (TN, t(27) = −7.27, p <.001), focused attention (TN-E, t(27) = −9.85, p <.001), concentration performance (CP, t(27) = −7.90, p <.001), and accuracy (E%, t(27) = 1.72, p = .048). Delayed posttesting was completed 90-minutes after the intervention with statistically significant improvements in processing speed (TN, t(21) = −10.37, p <.001), focused attention (TN-E, t(21) = −12.59, p <.001), concentration performance (CP, t(21) = −11.28, p <.001), and accuracy (E%, t(21) = 2.62, p = .008).

The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial.

BackgroundCancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)—a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy.ObjectiveThis study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy.MethodsA two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant’s life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated.ResultsA total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record.ConclusionsThe findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.

Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative

BackgroundRacial and socioeconomic disparities in breast cancer mortality persist. In Boston, MA, Black, Non-Hispanic women and Medicaid-insured individuals are 2–3 times more likely to have delays in treatment compared to White or privately insured women. While evidence-based care coordination strategies for reducing delays exist, they are not systematically implemented across healthcare settings. MethodsTranslating Research Into Practice (TRIP) utilizes community engaged research methods to address breast cancer care delivery disparities. Four Massachusetts Clinical and Translational Science Institute (CTSI) hubs collaborated with the Boston Breast Cancer Equity Coalition (The Coalition) to implement an evidence-based care coordination intervention for Boston residents at risk for delays in breast cancer care. The Coalition used a community-driven process to define the problem of care delivery disparities, identify the target population, and develop a rigorous pragmatic approach. We chose a cluster-randomized, stepped-wedge hybrid type I effectiveness-implementation study design. The intervention implements three evidence-based strategies: patient navigation services, a shared patient registry for use across academic medical centers, and a web-based social determinants of health platform to identify and address barriers to care. Primary clinical outcomes include time to first treatment and receipt of guideline-concordant treatment, which are captured through electronic health records abstraction. We will use mixed methods to collect the secondary implementation outcomes of acceptability, adoption/penetration, fidelity, sustainability and cost. ConclusionTRIP utilizes an innovative community-driven research strategy, focused on interdisciplinary collaborations, to design and implement a translational science study that aims to more efficiently integrate proven health services interventions into clinical practice.

Risk Factors for Neonatal/Maternal Morbidity and Mortality in African American Women with Placental Abruption.

Background and Objectives: Risk factors for neonatal/maternal morbidity and mortality in placental abruption have been incompletely studied in the current literature. Most of the research overlooked the African American population as mostly Caucasian populations are selected. We aimed to find which risk factor influence the neonatal and maternal outcome in cases of placental abruption occurring in African American pregnant women in an inner-city urban setting. Materials and Methods: We performed a retrospective cohort study at St. Joseph’s Regional Medical Center, NJ United States of America (USA), between 1986 and 1996. Inclusion criteria were African American race, singleton pregnancy with gestational age over 20 weeks and placental abruption. Maternal age, gravidity, parity, gestational age at delivery/occurrence of placental abruption and mode of delivery were collected. Risk factors for placental abruption such as placenta previa, hypertensive disorders of pregnancy, cigarette smoking, crack/cocaine and alcohol use, mechanical trauma, preterm premature rupture of membranes (PPROM), and premature rupture of membranes (PROM) were recorded. Poor neonatal outcome was considered when anyone of the following occurred: 1st and 5th minute Apgar score lower than 7, intrauterine fetal demise (IUFD), perinatal death, and neonatal arterial umbilical cord pH less than 7.15. Poor maternal outcome was considered if any of the following presented at delivery: hemorrhagic shock, disseminated intravascular coagulation (DIC), hysterectomy, postpartum hemorrhage (PPH), maternal intensive care unit (ICU) admission, and maternal death. Results: A population of 271 singleton African American pregnant women was included in the study. Lower gestational age at delivery and cesarean section were statistically significantly correlated with poor neonatal outcomes (p = 0.018; p < 0.001; p = 0.015) in the univariate analysis; only lower gestational age at delivery remained significant in the multivariate analysis (p = < 0.001). Crack/cocaine use was statistically significantly associated with poor maternal outcome (p = 0.033) in the univariate analysis, while in the multivariate analysis, hemolysis, elevated enzymes, low platelet (HELLP) syndrome, crack/cocaine use and previous cesarean section resulted significantly associated with poor maternal outcome (p = 0.029, p = 0.017, p = 0.015, p = 0.047). PROM was associated with better neonatal outcome in the univariate analysis, and preeclampsia was associated with a better maternal outcome in the multivariate analysis. Conclusions: Lower gestational age at delivery is the most important risk factor for poor neonatal outcome in African American women with placental abruption. Poor maternal outcome correlated with HELLP syndrome, crack/cocaine use and previous cesarean section. More research in this understudied population is needed to establish reliable risk factors and coordinate preventive interventions.

Care of children and young people who are dependent on technology.

British Journal of NursingVol. 29, No. 7 At A GlanceCare of children and young people who are dependent on technologyClaire Camara, Jane CallumClaire Camara(E-mail Address: [email protected])Graduate Tutor, Northumbria UniversitySearch for more papers by this author, Jane CallumSenior Lecturer, Northumbria University, Newcastle upon TyneSearch for more papers by this authorClaire Camara; Jane CallumPublished Online:11 Apr 2020https://doi.org/10.12968/bjon.2020.29.7.403AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Brenner M, Larkin PJ, Hilliard C, Cawley D, Howlin F, Connolly M. Parents' perspectives of the transition to home when a child has complex technological health care needs. Int J Integr Care. 2015;15(3):e035. https://doi.org/10.5334/ijic.1852 Crossref, Medline, Google ScholarCarnevale FA, Alexander E, Davis M, Rennick J, Troini R. 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Experiences and Insights from the Early US COVID-19 Epicenter: A Rapid Assessment Procedure Informed Clinical Ethnography Case Series

Objective The Coronavirus disease (COVID-19) outbreak has evolved into a pandemic crisis, with King County in Washington State emerging as the early US epicenter. A literature review revealed few reports providing front-line clinical and research teams guidance related to multilevel, rapidly evolving COVID-19 directives. Method The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method was used to develop a clinical case series and conduct participant observation during an ongoing comparative effectiveness trial of peer-integrated, patient-centered interventions after traumatic injury. Participants were patients enrolled in the intervention arm of the ongoing trial, as well as front-line clinicians, patient peer interventionists, and clinical research team members implementing the trial. All participants were exposed to the Washington State COVID-19 outbreak. Results Primary and secondary COVID-19 prevention strategies were feasibly integrated into ongoing care coordination and behavioral interventions for at-risk patients. Beyond the compilation of case studies, as an iterative method, RAPICE data collection naturalistically evolved to include observations of intervention team activity occurring within the larger pandemic epicenter context. A daily clinical research team huddle that flexibly accommodated virtual participation was also feasibly implemented. Conclusions Primary and secondary COVID-19 prevention strategies can be feasibly integrated into ongoing clinical interventions during the pandemic. Routine, proactive clinical and research team communication that transparently addresses ethical tensions and health-sustaining activities may promote well-being for providers grappling with rapidly evolving pandemic directives. Proactive assessments of individual provider vulnerabilities for severe COVID-19 related respiratory illness may also be a crucial element of the health care system pandemic responses.

Interventions to Improve Hospital Admission and Discharge Management: An Umbrella Review of Systematic Reviews

The aim of this umbrella review was to summarize the research evidence on programs to improve the transition between ambulatory and hospital care. The MEDLINE database and the Cochrane library were searched. Systematic reviews of randomized controlled trials published between January 2000 and September 2018 in English or German were included. Studies were eligible if an assessment or coordination intervention had been evaluated and if patients had been transferred between hospital (defined as internal medicine, surgery, or unspecified hospital setting) and home (defined as any permanent residence). Risk of bias was assessed using the AMSTAR criteria. Results are presented descriptively and in table format. Thirty-nine systematic reviews comprising 492 different studies were included. More than half of these studies were conducted in the United States, the United Kingdom, Canada, and Australia. All studies evaluated strategies to improve discharge management (introduced after patients' arrival at the hospital); no study assessed strategies to improve admission management (initiated in primary care before patients' transition to hospital). The reviews included focused on a specific patient group, a specific intervention type, or a specific outcome. Overall, interventions focusing on elderly patients and high-intensity interventions seemed to be most effective. An overview of classifications of care transition strategies is provided. Future research should focus on hospital admission management programs.

Disparities in Service Use Among Children With Autism: A Systematic Review

Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services. We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to children with autism by race, ethnicity, and/or socioeconomic status. Medline, PsychInfo, Educational Resources Informational Clearinghouse, and the Cumulative Index to Nursing and Allied Health Literature were searched by using a combination of Medical Subject Headings terms and keywords related to autism, disparities, treatment, and services. Included studies addressed at least one key question and met eligibility criteria. Two authors reviewed the titles and abstracts of articles and reviewed the full text of potentially relevant articles. Authors extracted information from articles that were deemed appropriate. Treatment disparities exist for access to care, referral frequency, number of service hours, and proportion of unmet service needs. Evidence revealed that racial and ethnic minority groups and children from low-income families have less access to acute care, specialized services, educational services, and community services compared with higher-income and white families. We found no studies in which differences in intervention effectiveness were examined. Several studies revealed disparities such that African American and Hispanic families and those from low-income households reported lower quality of care. The body of literature on this topic is small; hence it served as a limitation to this review. The documented disparities in access and quality of care may further identify groups in need of outreach, care coordination, and/or other interventions.

The experience of care coordination for people living with multimorbidity at risk of hospitalisation: an interpretative phenomenological analysis

Objective: There is growing interest in improving the care of people living with multimorbidity who require care coordination to help manage their health and reduce risk of hospitalisation. There has been limited past research exploring experiences of care for people living with multimorbidity. This qualitative study sought to explore the care experience of people enrolled in a care coordination intervention.Design: We interviewed 23 people living with multimorbidity enrolled in a care coordination intervention to examine their perceptions of the care experience. We used interpretative phenomenological analysis to identify themes from participants’ perspectives of involvement in their care, using information to make decisions, and the meanings they made of their care experiences.Results: We identified three master themes of the participants’ experience of care: Needing expert guidance, Circle of care, and I want to be spoken to like a person. We discuss these findings in the context of the recent literature on person-centred care.Conclusion: Understanding participants’ experience of care reinforces the need for person-centred approaches. These findings suggest care coordination offered to people living with multimorbidity can be implemented through practical support and information alongside establishing a relationship of trust.

Identifying alternative models of healthcare service delivery to inform health system improvement: scoping review of systematic reviews

ObjectiveTo describe available evidence from systematic reviews of alternative healthcare delivery arrangements relevant to high-income countries to inform decisions about healthcare system improvement.DesignScoping review of systematic reviews.Data sourcesSystematic reviews of...

A state-of-the-art review of the experience of care coordination interventions for people living with multimorbidity.

To explore recent research on care coordination interventions for people living with multimorbidity, from the perspective of the person receiving care. Care coordination interventions for people living with multimorbidity show some effectiveness in improving management of their health and reducing potentially preventable hospitalisations. The experience of people enrolled in care coordination interventions requires further exploration. State-of-the-art review. A review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist where five databases (The Cochrane Library, PsycINFO, Scopus, CINAHL and MEDLINE) were searched for qualitative sources published from January 2008-March 2019. Two additional databases focused on multimorbidity and integrated care were included in the search. Titles, abstracts and full texts were screened using inclusion criteria. Reference lists of the included articles were hand-searched. Summary tables were developed for data extraction, and the data were mapped to the research question. Eighteen primary research articles were included. Three themes of participant experience were identified: (a) relationships built on trust, (b), a sense of safety and security and (c) feeling cared for and respected. The contribution of qualitative approaches to evaluating the experiences of care for people living with multimorbidity is growing. Participants' describe afocus on relationships formed with healthcare professionals during care coordination. Further research incorporating lived experiences of participants could illuminate these concepts further. People living with multimorbidity who require assistance via care coordination value trusting relationships with healthcare professionals, who respect their needs and provide a sense of security. Understanding participant experiences is important to shape care coordination interventions that incorporate person-centred approaches.

Rehabilitation coordinator intervention versus control in psychiatric specialist care for return to work and reduced sick leave: study protocol of a randomised controlled trial

BackgroundMental disorders are the most common reason for sick leave in Sweden. Knowledge about effective methods to help these individuals to return to work (RTW)/entry into work or studies is limited. Rehabilitation coordinators (RC’s) have been introduced within healthcare with the purpose to promote cooperation, streamline the sick leave and rehabilitation process, and facilitate RTW for sick-listed patients. The function of RC’s has shown positive results by reducing sick leave within primary healthcare. However, the function has not been evaluated in terms of specialist psychiatry. This paper describes the design of a study to evaluate effects of a RC intervention on sick leave and RTW/entry in work or studies in patients with moderate to severe affective and/or moderate to severe anxiety disorders within specialist psychiatric care.MethodsA randomised controlled trial (RCT) comparing an intervention group receiving support from a RC with a control group receiving treatment as usual (TAU). The target group is patients on sick leave, treated for affective and/or anxiety disorder, aged 25–64, with or without employment.DiscussionThis study gives the possibility to evaluate a RC intervention for individuals with mental disorders. If the study has promising vocational outcomes, it may be of importance for the participants in many ways, e.g. increase participation in society, provide economic benefits and improve health and wellbeing. This would be valuable for the individual as well as for the society.Trial registrationThe study is registered at the Clinicaltrials.gov Register Platform (ID NCT03729050) in 2 November 2018.

Determining Whether Tennis Benefits the Updating Function in Young Children: A Functional Near-Infrared Spectroscopy Study

This study aimed at investigating the behavioral and neuro-electrical impacts of a coordinative exercise intervention on the updating function of the working memory (WM) in young children. Children in the experimental group was tested on the 1-back working memory task before and after a coordinative exercise program that involved a 60 min session twice per week for eight weeks (totally 16 sessions), while the control group underwent routine classroom activities with the same WM tests. The results showed that the hit rates of performing the 1-back task increased significantly in the experimental group compared with that of the control group. The experimental group demonstrated a larger decrease in both reaction time and false alarm rates from pre-test to post-test than the control group. Physical fitness improved after exercise intervention in the experimental group. Neural adaptations due to the exercise training were evaluated using functional near-infrared spectroscopy (fNIRS) and the results indicated that the experimental group experienced a greater cortical oxygenated hemoglobin (Oxy-Hb) increase in the prefrontal area after the intervention than the control group. These results suggest that coordinative exercises are beneficial for improving WM as well as reaction time and physical fitness in young children.

Psychosocial Impact of COVID-19 Lockdown on Mental Wellbeing among 11 States of India: A Markov Modeling Approach

Objectives: Amid unprecedented health and socioeconomic crisis emanating from COVID-19 pandemic lockdown in India with effect from 25th March 2020 extending into its fourth phase is a matter of great concern to mental health professionals. The present study aims to evaluate psychological impact during current pandemic in difficult to reach, autonomous process of community spread of COVID-19 in partially observable system using respondent driven system with hidden Markov modeling approach. Methods: The participants were asked to complete a demographic and clinical profile data form, psychological and behavioral changes in past 14 days, their stress levels, depression and anxiety was screened using standardized and validated DASS-21 Scale. Chi-square test, Mann Whitney U test and Pearson’s Correlation Coefficient was performed. Results: A total of 891 people responded from 11 different states across the country and majority (90%) of them were from five South Indian states. We observed the prevalence of 22% of depression, with 15% anxiety and 27.5% with either of them. Young age, widow/unmarried marital status, moderate level of education, students, non-working status during lockdown, past history of psychiatric illnesses, presence of physical symptoms related to COVID-19, hypochondriacal thoughts, fear of contamination, social contagion, were found to be significantly associated (p<0.05) with reference to presence and/or severity of depression and anxiety. Conclusion: Markov Modeling using respondent driven sampling is a innovative way of sampling method which can be used in difficult to reach out population in changing dynamic system. Findings of high prevalence of psychopathologies warrants appropriate planning and timely designing an intervention in coordination with mental health professionals to flatten curve in due course of time.