Effects of the Family Check-Up 4 Health on Parenting and Child Behavioral Health: A Randomized Clinical Trial in Primary Care

The Family Check-Up 4 Health (FCU4Health) is an adaptation of the Family Check-Up (FCU) for delivery in primary care settings. While maintaining the original FCU’s focus on parenting and child behavioral health, we added content targeting health behaviors. This study evaluated whether the adapted FCU maintained positive effects on parenting (positive behavior support, limit setting, parental warmth) and child behavioral health (self-regulation, conduct problems, emotional problems). Pediatric (6–12 years) primary care patients with a BMI?≥?85^th%ile (n?=?240) were recruited from primary care clinics in Phoenix. Children were 75% Latino, 49% female, and 73% Medicaid recipients. This type 2 effectiveness-implementation hybrid trial compared families randomized to FCU4Health (n?=?141) or usual care (n?=?99). FCU4Health was delivered over a period of 6 months. This study focuses on a priori secondary outcomes included parenting and child behavioral health targets of the original FCU, assessed at baseline and 3, 6, and 12 months. Significant improvements were found for the FCU4Health condition, compared to usual care, in parenting from baseline to the 3-month assessment [β?=?.17 (.01; .32)]. Parenting predicted improvements in child self-regulation at 6-months [β?=?.17 (.03; .30)], which in turn predicted reductions in conduct problems [β?=?? .38 (? .51; ? .23)] and emotional problems [β?=?? .24 (? .38; ? .09)] at 12 months. Ethnicity and language of delivery (English or Spanish) did not moderate these effects. The FCU4Health can improve parenting and child behavioral health outcomes when delivered in primary care.

Trial Registration Trial registration number: NCT03013309 ClinicalTrials.gov

     

Preventing High-Risk Sexual Behavior in Early Adulthood with Family Interventions in Adolescence: Outcomes and Developmental Processes

Adolescent study participants who engaged in a brief, family-centered intervention (the Family Check-Up, FCU) were later assessed for the intervention’s effects on high-risk sexual behavior (HRSB) in early adulthood (age 22). Participants (N = 998 adolescents and their families) were randomly assigned to a family-centered intervention in sixth grade and were offered a gated, multilevel intervention that included (a) a school-based family resource center, (b) the FCU, and (c) more intensive, family-based treatment. All services were voluntary, but high-risk families were actively recruited into the FCU. Approximately 23 % of the intervention families engaged in the FCU and approximately 18 % engaged in more intensive treatment. Using an intent-to-treat design, we found that the direct effect of the FCU on HRSB was not significant; however, an analysis of the developmental processes indicated that intervention families demonstrated improved family relationship quality when compared to control families, which in turn resulted in lower levels of HRSB in early adulthood. Furthermore, the significant effect of family relationship quality on HRSB was mediated by differences in parental monitoring and early sexual activity, and these effects varied as a function of gender and ethnicity. Indirect effects of the FCU on HRSB were significant via multiple different pathways. The implications of these findings for enhancing the impact of family-centered interventions are discussed.

     

Preventing High-Risk Sexual Behavior in Early Adulthood with Family Interventions in Adolescence: Outcomes and Developmental Processes

Adolescent study participants who engaged in a brief, family-centered intervention (the Family Check-Up, FCU) were later assessed for the intervention’s effects on high-risk sexual behavior (HRSB) in early adulthood (age 22). Participants (N?=?998 adolescents and their families) were randomly assigned to a family-centered intervention in sixth grade and were offered a gated, multilevel intervention that included (a) a school-based family resource center, (b) the FCU, and (c) more intensive, family-based treatment. All services were voluntary, but high-risk families were actively recruited into the FCU. Approximately 23 % of the intervention families engaged in the FCU and approximately 18 % engaged in more intensive treatment. Using an intent-to-treat design, we found that the direct effect of the FCU on HRSB was not significant; however, an analysis of the developmental processes indicated that intervention families demonstrated improved family relationship quality when compared to control families, which in turn resulted in lower levels of HRSB in early adulthood. Furthermore, the significant effect of family relationship quality on HRSB was mediated by differences in parental monitoring and early sexual activity, and these effects varied as a function of gender and ethnicity. Indirect effects of the FCU on HRSB were significant via multiple different pathways. The implications of these findings for enhancing the impact of family-centered interventions are discussed.     

样品库PCR法检测大学生沙眼衣原体感染状况的研究

目的 了解大学中沙眼衣原体((Chlamydia Trachomatis,CT)感染状况,探索有效的CT筛查方法,为制定中国青少年中的STDs的预防措施提供科学依据。方法 于1999年在北京某综合性大学学生中,随机抽取2050人,进行间卷调查并调查人群中的Cr感染率。结果 在1935份有效尿样中,共检出阳性3例,检出率为1.6％。结论在低CT感染率人群中进行筛查,样品库(Pooling)法为一行之有效的筛查方法,并提示在大学生中,生殖健康之重点应为安全性知识、性道德的宣传。     

First catch urine sediment for Chlamydia trachomatis and Neisseria gonorrhoeae culture in adolescent males with pyuria

Traditionally, only symptomatic males or those with a history of exposure are tested for sexually transmitted diseases (STDs). Since urethral infections with Chlamydia trachomatis and Neisseria gonorrhoeae are frequently asymptomatic, a practical, sensitive, and acceptable screening method is desirable. Fifty sexually active males with pyuria (age 13 to 22 years old) diagnosed with 1+ or 2+ leukocyte esterase (LE) dipstick on first catch urine (FCU) were further evaluated by culture of urethral swabs and centrifuged FCU samples for N. gonorrhoeae and C. trachomatis. Eighty-six percent had one or more positive cultures: 17 (34%) N. gonorrhoeae, 18 (36%) C. trachomatis, and 8 (16%) both organisms. FCU culture for N. gonorrhoeae had a 100% sensitivity, specificity, and positive and negative predictive value when compared to urethral swab cultures. FCU culture for C. trachomatis had a 32% sensitivity, 95% specificity, 89% positive predictive value, and a 53% negative predictive value compared to urethral culture. On the basis of the results of this study, one urethral swab can be eliminated when evaluating male adolescents for urethritis by using spun FCU culture for N. gonorrhoeae. Continued efforts should be made to develop optimal tests to detect STDs which are reliable and encourage compliance in this high-risk group.     

An Adaptive Approach to Family-Centered Intervention in Schools: Linking Intervention Engagement to Academic Outcomes in Middle and High School

This study examined the impact of an adaptive approach to family intervention in public schools on academic outcomes from age 11 to 17. Students were randomly assigned to the three-session Family Check-Up (FCU), which is designed to motivate change in parenting practices by using an assessment-driven approach and strengths-based feedback. All services were voluntary, and approximately 25% of the families engaged in the FCU. Compared with matched controls, adolescents whose parents received the FCU maintained a satisfactory GPA into high school, and intervention engagement was associated with improved attendance. The highest-risk families were the most likely to engage in the family-centered intervention, suggesting the efficacy of integrating supportive services to families in the context of other schoolwide approaches to promote the success and achievement of vulnerable students.     

Engaging parents in the family check-up in middle school: longitudinal effects on family conflict and problem behavior through the high school transition

PurposeAdolescence is a time of significant developmental change. During this period, levels of problem behavior that had been relatively innocuous may escalate in the company of peers, with simultaneous reductions in parental monitoring and involvement. In this article, we report the results of a randomized controlled trial of the Family Check-Up (FCU), a family-centered, school-based intervention designed to forestall the escalation of adolescent problem behavior by promoting and motivating skillful parenting through the transition to high school.MethodsIn this study, 593 ethnically diverse families were randomized to be offered the FCU when their youth were in seventh and eighth grades of middle school. We used complier average causal effect analysis to examine change in family conflict, antisocial behavior, involvement with deviant peers, and alcohol use from sixth through ninth grades.ResultsAnalyses revealed that when compared with a matched control group, youths whose parents had engaged in the FCU demonstrated significantly lower rates of growth in family conflict (p = .052), antisocial behavior, involvement with deviant peers, and alcohol use.DiscussionOur results extend current research on the FCU and provide support for theory that links family conflict with a variety of youth problem behavior. These results and the extant research on the FCU suggest that traditional school-based service delivery models that focus on the individual child may benefit from a shift in perspective to engage parents and families.     

Predictors of Participation in the Family Check-Up Program: a Randomized Trial of Yearly Services from Age 2 to 10 Years

A key challenge of community-based prevention programs is engaging families in the context of services settings involving children and families. The Family Check-Up (FCU) program is designed to engage families in parenting support appropriate to their level of need by use of assessment-enhanced motivational interviewing. This study involved families screened for risk who were seeking services at women, infant, and children’s offices in three geographical regions (N?=?731). Families in the randomized intervention group (N?=?367) were offered the FCU yearly, from age 2 through 10. The results of multivariate modeling indicated that caregivers reporting high levels of perceived caregiving stress (i.e., depression, low parenting satisfaction, daily hassles) participated at a higher rate in two critical components (feedback and follow-up support interventions) of the FCU program over the 8-year trial period than caregivers reporting lesser degrees of stress. The implications of these findings are discussed in the context of family-centered programs for the prevention of child behavior problems and directions for future research.     

Ferrocenyl-substituted curcumin: can it influence antioxidant ability to protect DNA?

The antioxidant capacities of ferrocenyl-substituted curcumin derivatives including 1,7-bis(p-hydroxy-m-methoxyphenyl)-4-ferrocenylidene-hepta-1,6-diene-3,5-dione (FCU), 1-(p-hydroxy-m-methoxyphenyl)-3-hydroxy-7-ferrocenyl-hepta-1,4,6-trien-5-one (FFT), and 1-(p-hydroxy-m-methoxyphenyl)-5-ferrocenyl-penta-1,4-dien-3-one (FDZ) were evaluated in 2,2′-azobis(2-amidinopropane hydrochloride) (AAPH), Cu²⁺/glutathione (GSH), and hydroxyl radical (OH)-induced oxidation of DNA, and in trapping 2,2′-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-azinobis(3-ethylbenzothiazoline-6-sulfonate) cationic radical (ABTS⁺), and galvinoxyl radicals. FCU, FFT, and FDZ protected DNA against Cu²⁺/GSH-induced oxidation, but promoted OH-induced oxidation of DNA. FCU, FFT, and FDZ scavenged 9.5, 5.7, and 4.7 radicals in protecting DNA against AAPH-induced oxidation. FCU can trap more DPPH and ABTS⁺ than FDZ and FFT, whereas FCU, FFT, and FDZ cannot react with galvinoxyl radical. Both phenolic hydroxyl groups and iron atom in ferrocenylidene curcumin derivatives play antioxidant role in this case.     

Baseline Targeted Moderation in a Trial of the Family Check-Up 4 Health: Potential Explanations for Finding Few Practical Effects

Not all participants will benefit equally from even well-established, evidence-based prevention programs. For this reason, the field of prevention science is beginning to embrace individual tailoring of interventions. The Family Check-Up was among the first prevention programs to tailor at the family level as opposed to the more prevalent focus on adapting programs for different cultures, genders, and other immutable participant characteristics. Despite tailoring, families with lower levels of stress and parental mental health issues, children with lower baseline conduct problems, and families living in an extremely deprived neighborhood benefitted less from the Family Check-Up. This study examined baseline targeted moderation (BTM) within a trial of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the Family Check-Up for primary care delivery and explicit targeting of obesogenic behaviors. Ethnically diverse, low-income families (N?=?240) with children ages 5.5 to 12 years identified in pediatric primary care with elevated body mass index (BMI) were enrolled and randomized to FCU4Health or usual care. Few BTM effects were found using single-variable-as-moderator and latent-class-as-moderator analytic approaches across the primary (child BMI, body composition) and secondary outcomes (family health routines; child eating behaviors, food choices, emotional problems, problem behaviors, quality of life; caregiver BMI and body composition), as well as hypothesized mediators (child self-regulation, parenting skills). The high-risk nature of the sample and the FCU4Health being individually tailored might have mitigated finding BTM effects. This trial was prospectively registered (NCT03013309 ClinicalTrials.gov).

     

Asymptomatic Chlamydia trachomatis infections in teenage males

This study examined the prevalence of Chlamydia trachomatis infections of the urethra in asymptomatic teenage males in a juvenile detention setting. Gonorrhea cultures, chlamydia smears using the direct immunofluorescent antibody (DFA) technique, and 15–20 ml of a first-catch urine (FCU) sample were obtained. Of the 227 adolescent males screened, 205 had experienced sexual intercourse. Twenty-seven (13.2%) of the sexually active adolescents had positive DFA smears for C. trachomatis. Three (1.5%) had positive Neisseria gonorrhoeae cultures. A urine leukocyte count of greater than 10 per high-power field gave a 91% specificity but only a 26% sensitivity for a positive DFA. The high prevalence of chlamydia in this population and the relative low cost of the DFA screen for chlamydia make this a useful procedure for discovering unsuspected disease, particularly in a high-risk population. The FCU screen for leukocytec was of limited value in identifying asymptomatic infection.     

The Family Check Up and Adolescent Depression: An Examination of Treatment Responders and Non-Responders

The Family Check Up (FCU) is a family-centered intervention for reducing children’s problem behavior through improving parenting skills and family interactions. Although the FCU was designed to prevent conduct problems, we have also found the program to be effective in preventing escalating symptoms of depression in early adolescence. The current analyses examine heterogeneous patterns of response to treatment in an effort to identify factors associated with differential response to family intervention. We examined heterogeneity in trajectories of youth-reported depressive symptoms from grades 6 to 9, using a Latent Growth Mixture Modeling framework to identify patterns of treatment response and non-response. Three symptom trajectories were identified, including the following: (1) a large class exhibiting stable, low symptom levels, (2) a class exhibiting high and stable depressive symptoms, and (3) a class exhibiting low initial symptoms that increased over time. Significant intervention effects were identified only among the third class, as a preventive effect on depression from 7th to 9th grade for youth with low initial symptoms. No effect of intervention was observed in the other two classes. Comparisons of classes 2 and 3 suggested that class 3 members were more likely to be females with high baseline antisocial behavior, but lower initial levels of depression. The findings suggest the importance of exploring heterogeneity within a prevention design, as well as the importance of tailored approaches to the prevention of adolescent depression.     

The Family Check Up and Adolescent Depression: An Examination of Treatment Responders and Non-Responders

The Family Check Up (FCU) is a family-centered intervention for reducing children’s problem behavior through improving parenting skills and family interactions. Although the FCU was designed to prevent conduct problems, we have also found the program to be effective in preventing escalating symptoms of depression in early adolescence. The current analyses examine heterogeneous patterns of response to treatment in an effort to identify factors associated with differential response to family intervention. We examined heterogeneity in trajectories of youth-reported depressive symptoms from grades 6 to 9, using a Latent Growth Mixture Modeling framework to identify patterns of treatment response and non-response. Three symptom trajectories were identified, including the following: (1) a large class exhibiting stable, low symptom levels, (2) a class exhibiting high and stable depressive symptoms, and (3) a class exhibiting low initial symptoms that increased over time. Significant intervention effects were identified only among the third class, as a preventive effect on depression from 7th to 9th grade for youth with low initial symptoms. No effect of intervention was observed in the other two classes. Comparisons of classes 2 and 3 suggested that class 3 members were more likely to be females with high baseline antisocial behavior, but lower initial levels of depression. The findings suggest the importance of exploring heterogeneity within a prevention design, as well as the importance of tailored approaches to the prevention of adolescent depression.

     

Reducing Risk Behavior with Family-Centered Prevention During the Young Adult Years

Family-centered prevention is effective at reducing risk behavior throughout the life span and promoting healthy development. Despite research that suggests parents continue to play a significant role in the lives of their children during emerging adulthood, very few studies have examined effective family-centered strategies for preventing risk behavior in young adults. Typical prevention efforts for this age group have focused on college students and substance use prevention, with no integration of families or systems of support that may sustain the effects of the intervention. In this study, we evaluated a version of the Family Check-Up (FCU) that was adapted for young adults and their families, the Young Adult Family Check-Up (YA-FCU). Families were randomly assigned to receive the FCU or school as usual during the middle school years. Ten years later, they were offered the YA-FCU, which was adapted for families of emerging adult children. Intent-to-treat and complier average causal effect analyses were used to examine change in young adult risk behavior approximately 1 year after receiving the YA-FCU. Analyses indicated that random assignment alone or simple engagement was not associated with reductions in young adult risk behavior. However, dose-response analyses indicated that the more hours that youth and families were engaged in the YA-FCU, the greater the reductions in young adult risk behavior relative to those who did not engage or engaged very little in the intervention, resulting in a medium effect size of the YA-FCU on risk behavior.

     

The Validation of Macro and Micro Observations of Parent–Child Dynamics Using the Relationship Affect Coding System in Early Childhood

This study examined the validity of micro social observations and macro ratings of parent–child interaction in early to middle childhood. Seven hundred and thirty-one families representing multiple ethnic groups were recruited and screened as at risk in the context of Women, Infant, and Children (WIC) Nutritional Supplement service settings. Families were randomly assigned to the Family Checkup (FCU) intervention or the control condition at age 2 and videotaped in structured interactions in the home at ages 2, 3, 4, and 5. Parent–child interaction videotapes were micro-coded using the Relationship Affect Coding System (RACS) that captures the duration of two mutual dyadic states: positive engagement and coercion. Macro ratings of parenting skills were collected after coding the videotapes to assess parent use of positive behavior support and limit setting skills (or lack thereof). Confirmatory factor analyses revealed that the measurement model of macro ratings of limit setting and positive behavior support was not supported by the data, and thus, were excluded from further analyses. However, there was moderate stability in the families’ micro social dynamics across early childhood and it showed significant improvements as a function of random assignment to the FCU. Moreover, parent–child dynamics were predictive of chronic behavior problems as rated by parents in middle childhood, but not emotional problems. We conclude with a discussion of the validity of the RACS and on methodological advantages of micro social coding over the statistical limitations of macro rating observations. Future directions are discussed for observation research in prevention science.     

Characterization of surface electromyography using time domain features for determining hand motion and stages of contraction

Surface electromyography (SEMG) signals can provide important information for prosthetic hand control application. In this study, time domain (TD) features were used in extracting information from the SEMG signal in determining hand motions and stages of contraction (start, middle and end). Data were collected from ten healthy subjects. Two muscles, which are flexor carpi ulnaris (FCU) and extensor carpi radialis (ECR) were assessed during three hand motions of wrist flexion (WF), wrist extension (WE) and co-contraction (CC). The SEMG signals were first segmented into 132.5 ms windows, full wave rectified and filtered with a 6 Hz low pass Butterworth filter. Five TD features of mean absolute value, variance, root mean square, integrated absolute value and waveform length were used for feature extraction and subsequently patterns were determined. It is concluded that the TD features that were used are able to differentiate hand motions. However, for the stages of contraction determination, although there were patterns observed, it is determined that the stages could not be properly be differentiated due to the variability of signal strengths between subjects.     

A flexible design for multiple armed screening trials

The goal of a screening trial is to examine several treatments with the intention of selecting one or more treatment(s) for further testing. Such a trial frequently occurs in the phase II setting, with the intention that the selected treatment be formally compared to a standard treatment in a phase III clinical trial. In this framework it is not essential that the very best treatment is definitely selected (such a decision would require a formal phase III trial), rather it is important that a substantially inferior treatment is not selected when a superior treatment exists. The level of evidence required to select a treatment based on this standard is lower than the evidence required to definitively order treatments. This paper introduces a flexible design for such trials, the flexibility coming from the use of a particular decision rule. The proposed rule states that if the observed difference in the success rates of the treatments is larger than some prespecified quantity d, then the treatment with the highest observed success rate is selected. However, if the observed difference is less than or equal to d, other factors may be considered in the selection. The goal of this design is to mirror clinical practice, where a treatment's success probability is often only one of many considerations in determining a treatment recommendation for a particular patient.     

The analysis of neuronal discharge sequences: change-point estimation and comparison of variances

A key problem in neurophysiology is to determine whether, after presentation of a stimulus, there has been a modification in the discharge of a recorded neuron and if so, an attempt is made to estimate the latency of the response. The estimation problem can be considered as that of the estimation of a change-point in a sequence of random variables. The gamma distribution is adequate to model the distribution of intervals between action potentials for different types of neurons. Simulations show that the maximum likelihood estimator based on this model is efficient and robust. An additional problem, in the case of experiments in which a movement follows the stimulus, is to determine whether a response is related to the stimulus or to the movement. A test based on the comparison of marginal scales of a bivariate distribution is proposed. The whole procedure has been tested in simulation and with real examples.     

Telemedicine--education and practice

Telemedicine is most commonly associated with a "long-distance" surgery in macro or micro dimensions. An example is a doctor operating on a patient who is in space or on a submarine, while he himself is in a telemedicine center found thousands of kilometers away. The basis for telemedicine is the technological progress that we are observing in the last decade. Therefore, there is a need for cooperation between doctors and engineers in the fields of research, education and in offering medical services. Interdisciplinary character of telemedicine requires cooperation especially between medical and technical universities. The article presents already completed and just started telemedicine projects in Poland as a result of cooperation between Medical University of Gdansk and Gdansk University of Technology.     

The measurement of linear dimensions from the x-ray image on a video monitor

The proposed method for measuring the linear dimensions of viscera from their X-ray image on a video monitor is that a uniform X-ray contrast is placed on a recording screen, which fixes the image of a point object (for example, a catheter tip) which is situated in the plane of the required size. The patient is transferred in parallel with the screen at a given distance. Before and after transfer, a ratio of the scale change in the position of a point object image to its actual change is calculated. The ratio is used to measure any linear dimensions in the plane of an object.