RESUMO
OBJECTIVE: The purpose of the article is to evaluate an innovative education program in which medical students were trained in cognitive behavior therapy (CBT) and provided CBT treatments under supervision to uninsured individuals with depressive, anxiety, adjustment, and trauma-based disorders. METHODS: The authors assessed improvements in trainees' CBT knowledge using the Cognitive Therapy Awareness Scale before and after their didactic training. CBT supervisors rated trainees' clinical competencies utilizing standardized checklist evaluations based upon supervision reports. The authors employed mixed effects ANOVA and regression modeling to test the association between the addition of CBT to treatment as usual (TAU) and improvements in patients' depressive and anxious symptom severity. The authors collected feedback and self-assessment of functioning with a Psychotherapy Feedback Questionnaire. RESULTS: Medical students showed increases in CBT knowledge that were maintained six months later and demonstrated satisfactory competency in CBT techniques. The addition of CBT to TAU was associated with greater improvements in depressive, but not anxious, symptom severity. However, among the TAU + CBT group, there was an association between the number of CBT sessions received and the magnitude of improvement in anxious symptoms from baseline. Patients gave positive feedback to medical student CBT providers and reported improvements in broad domains of psychosocial functioning. CONCLUSIONS: Medical students can provide competent and clinically beneficial CBT treatments for depression and anxiety disorders. These findings have implications for medical training and support the use of medical students to deliver care for individuals with limited access to psychotherapy.
Assuntos
Terapia Cognitivo-Comportamental , Estudantes de Medicina , Humanos , Depressão/terapia , Terapia Cognitivo-Comportamental/métodos , Transtornos de Ansiedade/terapia , Psicoterapia , Ansiedade , Resultado do TratamentoRESUMO
The COVID-19 pandemic brought widespread and notable effects to the physical and mental health of communities across New York City with disproportionate suffering Black/African American and Hispanic/Latino communities alongside additional stressors such as racism and economic hardship. This report describes the adaptation of a previously successful evidence-based community engagement health education program for the deployment of resilience promoting workshop program in faith-based organizations in BIPOC communities in New York City. From June 2021 to June 2022, nine faith-based organizations implemented 58 workshops to 1,101 non-unique workshop participants. Most of the workshops were delivered online with more women (N = 803) than men (N = 298) participating. All organizations completed the full curriculum; the workshop focused on self-care and physical fitness was repeated most frequently (N = 13). Participants in the workshops ranged from 4 to 73 per meeting and were largely female. The Building Community Resilience Project is an easy and effective way to modify an existing, evidence-based community health education program to address new and relevant health needs such as resilience and stress amidst the COVID-19 pandemic among faith communities serving BIPOC populations. More research is needed regarding the impact of the workshops as well as adaptability for other faith traditions.
Assuntos
COVID-19 , Serviços de Saúde Comunitária , Organizações Religiosas , Educação em Saúde , Pandemias , Feminino , Humanos , Masculino , Negro ou Afro-Americano , COVID-19/epidemiologia , Cidade de Nova Iorque/epidemiologia , Hispânico ou Latino , Organizações Religiosas/estatística & dados numéricos , Educação , Promoção da Saúde , InternetRESUMO
Security officers in health systems are subject to high levels of stress and current support interventions do not necessarily target their needs. To address this gap, a resilience center at a major urban tertiary care hospital utilized community engagement principles to adapt and implement resilience and mental health awareness workshops, which were informed by initial piloting. The program consisted of twelve short briefings in which officers were provided psychoeducation on psychological first aid and adaptive coping. The program reached 107 security officers (89.5% men, 95.2% people of color); both qualitative and quantitative feedback indicated a generally positive reception. Further efforts to support security officers are warranted given their high exposure to patient crises and under-acknowledgement as frontline workers in healthcare.
Assuntos
COVID-19 , Resiliência Psicológica , Masculino , Humanos , Feminino , Pandemias , Saúde Mental , HospitaisRESUMO
BACKGROUND: The Great East Japan Earthquake and the resulting tsunami and nuclear disaster on March 11, 2011 have had a profound and lasting effect on residents of Japan's Fukushima Prefecture, particularly among evacuees. While there continues to be extensive news coverage and academic study of Fukushima Prefecture's recovery, there has been little exploration of individual narratives. This study aims to illuminate some individual stories of medical students at Fukushima Medical University (FMU) who lived in the Prefecture at the time of the Earthquake. METHODS: A qualitative approach was taken in order to investigate individuals' experiences with the goal of adding a personal dimension to quantitative studies on the subject. 10 open-ended ethnographic interviews were conducted with medical students at FMU in years 1-5 who lived in Fukushima Prefecture at the time of the Great East Japan Earthquake. All interviews were audio recorded and transcribed. Transcriptions were reviewed using inductive thematic analysis under the lens of ethnographic anthropology. RESULTS: Three major themes emerged from these interviews: first, that the events following the Earthquake influenced not only these students' decisions to pursue careers in medicine, but the ways in which they hope to practice medicine in the future. Second, that these students were motivated to share their experiences by a want to change Fukushima Prefecture's public image. And lastly, that the students viewed the opportunity to discuss their experiences through these interviews as healing, both for themselves and for the future. CONCLUSIONS: While multiple factors undoubtably contributed these students' medical education, they cite the Earthquake as essential to their approach to their medical careers. Additionally, opportunities for the participants to discuss their experiences following the Earthquake appear to be rare but valued, as the students view their stories as their "legacies." The enduring, burdening effects of the Earthquake appear to have galvanized the participating students to act on behalf of their communities and their Prefecture. Further qualitative studies in more generalizable populations are needed to improve and deepen our understanding of the societal, cultural, and personal impacts of the Great East Japan Earthquake.
Assuntos
Desastres , Terremotos , Acidente Nuclear de Fukushima , Estudantes de Medicina , Humanos , JapãoRESUMO
BACKGROUND: Safety-net clinics are an important source of low-cost or free mental healthcare to those with limited financial resources. Such clinics are often staffed by trainees in early stages of their career. Only limited data exist on best practices in treatment-implementation and on clinical outcomes attained in such clinics. The primary purpose of this article is to describe the design of an outpatient psychiatry student-run free clinic (SRFC) serving uninsured individuals in New York City's East Harlem neighborhood and to analyze the quality of services provided and the clinical outcomes attained. METHODS: The authors conducted a retrospective chart review of n = 69 patients treated in the EHHOP Mental Health Clinic (E-MHC) to describe the demographic and clinical characteristics of the study population. Utilizing Health Effectiveness Data and Information Set metrics, they estimated the likelihoods of patients meeting metric quality criteria compared to those in other New York State (NYS) insurance groups. The authors derived linear mixed effect and logistic regression models to ascertain factors associated with clinical outcomes. Finally, the authors collected patient feedback on the clinical services received using a customized survey. RESULTS: Almost all patients were of Hispanic ethnicity, and about half of patients had more than one psychiatric disorder. The clinical service performance of the E-MHC was non-inferior on most measures examined. Factors associated with symptom improvement were the number of treatment sessions and certain demographic and clinical variables. Patients provided highly positive feedback on the mental healthcare services they received. CONCLUSIONS: SRFCs can provide quality care to vulnerable patients that leads to clinically meaningful reductions in psychiatric symptoms and is well-received by patients.
Assuntos
Clínica Dirigida por Estudantes , Estudantes de Medicina , Instituições de Assistência Ambulatorial , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Saúde Mental , Estudos RetrospectivosRESUMO
This narrative review aims to summarize initiatives developed during the COVID-19 pandemic to support healthcare workers' emotional well-being within the context of a pre-existing framework of occupational mental health guidelines. This occupational mental health framework integrates principles from multiple disciplines to optimize prevention and management of mental health issues among employees. We conducted an online search on Medline/PubMed, Cochrane Library, and Embase for studies that reported on design or execution of medical institution-based interventions, aiming to support healthcare worker mental health during the COVID-19 pandemic. Inclusion criteria was intentionally broad in order to incorporate as many types of interventions at varying stages of development or evaluation. We included 31 studies in our review that reported on newly designed psychological support interventions for healthcare workers (HCW) during the COVID-19 pandemic. We found that most programs commonly supported HCW mental health through offering one or more of the following initiatives: expanded basic need resources/services, additional workplace training programs that bolstered professional preparedness while also indirectly boosting HCW emotional health, and/or expanded psychological support programs, such as peer support programs, psychoeducational or counseling services. Most programs, however, did not consider methods to ensure program longevity or sustainability. The COVID-19 pandemic has underscored the acuity of HCW mental health issues and is likely to leave long lasting mental health strains among HCW. This pandemic is a critical point in time to catalyze much needed progress in reducing stigma and expanding HCW mental health care access.
Assuntos
COVID-19 , Pandemias , Pessoal de Saúde/psicologia , Humanos , Saúde Mental , Pandemias/prevenção & controleRESUMO
For medical students first entering the clinical space in July 2020, the unique challenges related to the coronavirus pandemic threatened to amplify the psychological distress associated with clerkship rotations. This study aimed to characterize the mental health of third-year medical students starting clinical clerkships in the midst of a pandemic by assessing symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) as well as risk, coping, and protective factors associated with psychological outcomes. Of 147 third-year medical students at the Icahn School of Medicine at Mount Sinai in New York City, 110 (75%) participated in this prospective survey-based study with 108 included in the final analysis. 43 (39.8%) respondents screened positive for symptoms of either MDD, GAD, or PTSD. Multiple regression analyses revealed that greater overall symptom severity was associated with more avoidant coping, more traumatic events witnessed, poorer student and leisure functioning, lower trait emotional stability, and lower social support. Worries related to COVID-19 did not significantly influence outcome variables. To better understand the role of the pandemic on psychological outcomes in third-year medical students, additional research should focus on the trajectory of these outcomes over the year during the coronavirus pandemic.
Assuntos
COVID-19 , Estágio Clínico , Transtorno Depressivo Maior , Estudantes de Medicina , Depressão/psicologia , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Prospectivos , SARS-CoV-2 , Estudantes de Medicina/psicologiaRESUMO
Those who work with immigrants in detention centers may be at increased risk of secondary trauma. This study used Photovoice to capture reflections on how the lives of volunteers are affected by their work on behalf of immigrant family detainees. Participants were recruited over a two-month period in 2018 from amongst the volunteers of a non-governmental organization that provides legal services to the detainees at one immigration detention center. Participants submitted photos and captions that explored their experiences with their work. Thirteen volunteers consented to participate and submitted 44 photos with captions to the project. Major themes included emotional challenges of the work, frustrations with the U.S. government, comparison of their experiences to those of their clients', and finding uplifting moments. Our findings regarding the significant emotional challenges of this work are of particular importance given the increasing coverage of immigration detention in the media and the increased interest in volunteer opportunities to support this population.
Assuntos
Emigrantes e Imigrantes/legislação & jurisprudência , Emigrantes e Imigrantes/psicologia , Emigração e Imigração/legislação & jurisprudência , Emoções , Fotografação , Voluntários/psicologia , Humanos , Masculino , Estados UnidosRESUMO
The successful treatment of depressive disorders critically depends on adherence to prescribed treatment regimens. Despite increasing rates of antidepressant medication prescription, adherence to the full treatment course remains poor. Rates of antidepressant non-adherence are higher for uninsured patients and members of some marginalized racial and ethnic communities due to factors such as inequities in healthcare and access to insurance. Among patients treated in a free, student-run and faculty-supervised clinic serving uninsured patients in a majority Hispanic community in East Harlem, adherence rates are lower than those observed in patients with private or public New York State health insurance coverage. A prior study of adherence in these patients revealed that difficulty in obtaining medications from an off-site hospital pharmacy was a leading factor that patients cited for non-adherence. To alleviate this barrier to obtaining prescriptions, we tested the effectiveness of on-site, in-clinic medication dispensing for improving antidepressant medication adherence rates among uninsured patients. We found that dispensing medications directly to patients in clinic was associated with increased visits at which patients self-reported proper adherence and increased overall adherence rates. Furthermore, we found evidence that higher rates of antidepressant medication adherence were associated with more favorable treatment outcomes. All patients interviewed reported increased satisfaction with on-site dispensing. Overall, this study provides promising evidence that on-site antidepressant dispensing in a resource-limited setting improves medication adherence rates and leads to more favorable treatment outcomes with enhanced patient satisfaction.
Assuntos
Antidepressivos , Pessoas sem Cobertura de Seguro de Saúde , Antidepressivos/uso terapêutico , Prescrições de Medicamentos , Humanos , Adesão à Medicação , Satisfação do PacienteRESUMO
On March 11, 2011 ("3/11"), a magnitude 9.0 earthquake in Northeastern Japan triggered a tsunami and nuclear power plant meltdown that killed 16,000 people and displaced more than 470,000 people. Since 2012, a group of volunteer docents from the September 11th Families Association in New York City has traveled throughout Northeastern Japan and held organized meetings where 9/11 and 3/11 survivors share their experiences and stories of trauma as part of an intercultural exchange to promote posttraumatic recovery. We sought to elucidate whether participating 9/11 docents developed a sense of increased resiliency by participating in this international outreach. This study employed photo-taking as well as framing questions, which were developed by 9/11 docents from the August 2016 trip. These questions guided photo-taking and resulting photographs informed discussion in individual and group sharing sessions. This process helped identify codes that guided analysis. Participants acquired a deeper appreciation of their own ability to overcome adversity and experienced a gratifying desire to help 3/11 survivors better cope with their experiences. This narrative photo-taking and group sharing experience demonstrates that a cross-cultural exchange between survivors of different disasters can instill feelings of resilience among participants. It additionally provides early evidence of the efficacy of such an exchange in benefitting disaster survivors in the long term.
Assuntos
Esperança , Fotografação , Crescimento Psicológico Pós-Traumático , Resiliência Psicológica , Sobreviventes/psicologia , Comparação Transcultural , Terremotos , Humanos , Japão , Desastres Naturais , Ataques Terroristas de 11 de Setembro , Inquéritos e Questionários , Viagem , Tsunamis , Estados UnidosRESUMO
Childhood sexual abuse (CSA), a global public health problem, is often underreported especially in low-income countries such as El Salvador, and prevention efforts are needed. The purpose of this study was to examine knowledge, attitudes and experiences of CSA prevention and characteristics related to greater knowledge and openness to engaging in child abuse prevention among Salvadoran parents. Salvadoran parents (N = 478) completed questionnaires regarding demographics, definition and signs and symptoms of child abuse, personal experiences of CSA, CSA prevention training, and knowledge, attitudes and practices about preventing CSA. Most parents were knowledgeable about CSA, viewed CSA prevention as their responsibility, and had talked with their children about CSA, although 65.7% incorrectly believed that children are more likely to be abused by strangers. Parents with lower income were less knowledgeable and willing to participate in CSA prevention. CSA programing needs to involve parents and specifically target low-income parents.
Assuntos
Abuso Sexual na Infância/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pais , Pobreza , Adulto , Criança , El Salvador , Feminino , Humanos , MasculinoRESUMO
Minority groups experience higher depression but lower treatment rates. Student-run free mental health (MH) clinics, such as the East Harlem Health Outreach Partnership (EHHOP) MH clinic, address this disparity. This study scrutinized EHHOP MH's depression treatment by measuring adherence to antidepressants. Pharmacy data from seventy-nine patients were reviewed according to HEDIS criteria. Results compare EHHOP MH to New York State (NYS) Medicaid and NYS commercial insurance providers. In the acute treatment phase, EHHOP MH performed similarly to NYS Medicaid. In all other comparisons, EHHOP MH had lower adherence rates. Physician notes were reviewed to identify reasons for low adherence.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Auditoria Clínica , Centros Comunitários de Saúde Mental , Feminino , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Cidade de Nova Iorque , Faculdades de Medicina , Estudantes de Medicina , Estados Unidos , Adulto JovemRESUMO
Unmet needs in mental health care are high in low and middle-income countries like India. We propose recruiting community health workers (CHWs) to provide mental health services and address the treatment gap, but there is limited data available on the training needs for this potential role. The aim of this study is to help determine what type of formal mental health training and programming could most benefit CHWs in India. This was a cross sectional study design. Self-administered surveys were conducted amongst CHWs in the villages of Vadodara District, Gujarat, India. Statistical analyses included two tailed t-tests using Microsoft Excel 2011. The most common causes for mental illness were attributed to anxiety (61%) and brain disease (61%) followed by stress (45%) and alcohol use disorder (38%). CHWs were dismissive of faith healers ability to treat mental illness (72.9%) showing a strong approval for recommending psychiatric care for the mentally ill (84.4%). Over 50% of participants believed that mentally ill have a lower IQ and that they were unpredictable, but at the same time asserted that people with mental illness can live in the community (80.8%), and recover if given treatment and support (91.8%). Results are promising with CHWs displaying basic knowledge of the etiology and treatment of disease harboring positive attitudes towards psychiatrist's ability to treat mental illness. Future direction should focus on training CHWs towards minimizing stigmatizing views and increasing their knowledge of mental illness in order to scale up mental health services in these low resource communities.
Assuntos
Atitude do Pessoal de Saúde , Agentes Comunitários de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais , Serviços de Saúde Mental , Adulto , Agentes Comunitários de Saúde/educação , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Índia , MasculinoRESUMO
Harmful alcohol use encompasses a spectrum of habits, including heavy episodic drinking (HED) which increases the risk of acute alcohol-related harms. The prevalence of HED in Saint Vincent and the Grenadines (SVG) is 5.7% among the overall population aged 15 years and older and 10.2% among drinkers. Responsible Beverage Service interventions train alcohol servers to limit levels of intoxication attained by customers and decrease acute alcohol-related harms. The objectives of this study were to determine bar tenders' and rum shopkeepers' knowledge of and attitudes toward problem drinking and willingness to participate in server training. Researchers used convenience and purposive sampling to recruit 30 participants from Barraouile, Kingstown, and Calliaqua to participate in semi-structured interviews designed to explore study objectives. Results and conclusions were derived from grounded theory analysis. Heavy episodic drinking is common but not stigmatized. Heavy drinking is considered a "problem" if the customer attains a level of disinhibition causing drunken and disruptive or injurious behavior. Bartenders and rum shopkeepers reported intervening with visibly intoxicated patrons and encouraging cessation of continued alcohol consumption. Participants cited economic incentives, prevention of alcohol-related harms, and personal morals as motivators to prevent drunkenness. Respondents acknowledged that encouraging responsible drinking was a legitimate part of their role and were favorable to server training. However, there were mixed opinions about the intervention's perceived efficacy given absent community-wide standards on preventing intoxication and limitations of existing alcohol policy. Given respondents' motivation and lack of standardized alcohol server training in SVG, mandated server training can be an effective strategy when promoted as one piece of a multi-component alcohol policy.
Assuntos
Consumo de Bebidas Alcoólicas/etnologia , Intoxicação Alcoólica/etnologia , Alcoolismo/etnologia , Comércio , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adulto , Consumo de Bebidas Alcoólicas/prevenção & controle , Intoxicação Alcoólica/prevenção & controle , Alcoolismo/prevenção & controle , Humanos , Masculino , São Vicente e Granadinas/etnologiaRESUMO
Mental illness is a significant cause of disability worldwide, including here in the United States. Given the shortage of trained mental health professionals, a significant portion of patients needing care are managed in the primary care setting. Accountable Care Organizations (ACOs), for example, are seeking to improve the quality of care for this vulnerable population, but many are facing significant challenges relating to integration of new services. We sought to elucidate barriers faced by primary care practitioners (PCPs)-physicians, physician trainees and nurse practitioners-at a New York primary care clinic, which impede delivery of optimal care to those suffering from mental illness. The study was conducted with 32 PCPs in 2016-2017 at Mount Sinai Internal Medicine Associates in New York City. For the quantitative component of the study, a 54-item questionnaire was devised to assess their attitude, behavior and confidence in managing psychiatric patients. For the qualitative component, data was obtained from 3 open-ended questions. Responses were coded for salient themes. Analysis revealed a range of difficulties faced by PCPs. Overall, participants felt that the need to integrate mental health care into primary care was important, however they reported significant barriers in terms of lack of time, lack of resources, low confidence in treating more complex mental health conditions and difficulties with referring patient to mental health specialists. Despite a growing body of evidence that integration of mental health services in primary care leads to improved outcomes, addressing barriers to care will be key to ensuring feasibility of integration measures.
Assuntos
Atitude do Pessoal de Saúde , Prestação Integrada de Cuidados de Saúde , Clínicos Gerais , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Mental , Atenção Primária à Saúde , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Adulto JovemRESUMO
There is limited data on how community medical providers in India attempt to diagnose and treat depression, as well as on their general knowledge of and attitudes toward depression. A cross-sectional survey was conducted assessing knowledge and views of clinical depression with 80 non-psychiatric physicians and physician trainees recruited from community clinics and hospitals in Gujarat, India. Interviews were also held with 29 of the physicians to assess what they do in their own practices in regards to detection of and treatment of clinical depression. Although subjects showed a generally good basic understanding of the definition of clinical depression and its treatment, their responses reflected the presence of some negative and/or stigmatized attitudes toward clinical depression. Our findings raise the question of possible stigma among physicians themselves and underscore the importance of combatting physicians' stigma against and increasing awareness of how to detect and treat clinical depression.
Assuntos
Atitude do Pessoal de Saúde , Medicina Comunitária , Depressão/epidemiologia , Depressão/psicologia , Estigma Social , Adulto , Estudos Transversais , Depressão/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
Six years after the March 2011 Triple Disaster, over 35,000 Japanese individuals remain in temporary housing. Evacuated residents, many of who are elderly, face mental health challenges. This study evaluates the well being of individuals living in temporary housing within Fukushima. Reactions to relocation were explored using Photovoice, a community-based participatory research method, in which a set of research questions are examined qualitatively through photographs and interviews. Seven participants (average age = 69.7) were provided cameras to answer a set of self-generated questions, a process that was repeated three times. An initial analysis found resilience among participants, which was explored using a theoretical framework of resiliency. Residents discussed how relocation has disrupted their lives and coping strategies they employ to ameliorate stressors. They were often optimistic and future-oriented, stating that they wanted to "live strong" after the disaster. These resilient mindsets were personified in action: all engaged in hobbies, critical for their emotional well being. Participants also emphasized the importance of community and familial support. The evidence of resilience in participants is encouraging, suggesting that these vulnerable elderly internally displaced residents are recovering from the disruption of relocation. These themes should be explored in larger temporary housing communities. Considering the number of relocated individuals today, understanding how to foster resilience could be used to inform the development of future temporary housing shelters.
Assuntos
Adaptação Psicológica/fisiologia , Serviços Comunitários de Saúde Mental/métodos , Vítimas de Desastres/psicologia , Acidente Nuclear de Fukushima , Saúde Mental , Resiliência Psicológica , Idoso , Vítimas de Desastres/reabilitação , Feminino , Humanos , Japão/epidemiologia , MasculinoRESUMO
Medical students often become involved as post-disaster emergency responders despite incomplete training, and in doing so may suppress their immediate experiences as victims and survivors. This experience, however, may lead them to increase their motivation to help others. We examined how cognitive and emotional reactions to disaster correlated with posttraumatic growth (PTG) in medical students in Fukushima, Japan after the Great East Japan Earthquake of March 11, 2011. To date, Fukushima continues to suffer from radiation concerns following the nuclear power plant meltdown. In a survey three years after the onset of a long-term disaster, with a cross-sectional research design, medical students (N = 494) reported their negative post-disaster reactions, desire to help, and demonstrations of capability, and completed the Posttraumatic Growth Inventory (PTGI). We conducted hierarchical regression analyses and found that the addition of variables pertaining to negative post-disaster reactions (e.g. confusion, anger, and sadness) led to the largest increase in predictive value for PTGI scores; students reporting a past traumatic experience were also more likely to experience PTG. Our results indicate that weathering stressful disaster circumstances created opportunities for positive personal growth and reinforcement at a crucial time in medical students' professional development.
Assuntos
Desastres , Terremotos , Emoções/fisiologia , Crescimento Psicológico Pós-Traumático , Transtornos de Estresse Pós-Traumáticos/psicologia , Estudantes de Medicina/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Adulto JovemRESUMO
The Icahn School of Medicine at Mount Sinai and the Saint Vincent/Grenadines Ministry of Health, Wellness and the Environment have been collaborating since 2012 in addressing the plight of alcoholism in Saint Vincent and the Grenadines (SVG). SVG is a middle-income country with few resources available for those who suffer from alcohol use disorders, and these efforts have centered on establishing and monitoring alcohol self-help groups based on the "Alcoholics Anonymous model" (AA model) in several communities in Saint Vincent and the Grenadines. In the summer of 2014, the efforts evolved to include an in-depth investigation of the experience of members of self-help group members via the qualitative research method known as Photovoice. Photovoice is a community based participatory research method in which a set of research questions are explored qualitatively through photographs, interviews, and focus groups. In June 2014, a Photovoice project was established with the longest running self-help group on the island of Saint Vincent in the fishing community of Barrouallie. This project consisted of three rounds of photo-taking, individual interviews, and focus groups, and analysis of the data revealed a number of broad themes relevant to perceptions about the impact of problematic drinking and about drinkers themselves; about the applicability of the AA model in SVG; and about factors that may perpetuate or mitigate problem drinking. It was evident that current and recovering alcoholics believed that there were different types of drinkers who because of their gender, public drinking or tendency for violence could be labeled as "irresponsible." These findings suggest areas for future interventions and research in SVG.
Assuntos
Alcoólicos Anônimos , Alcoolismo/etnologia , Alcoolismo/reabilitação , Pesquisa Participativa Baseada na Comunidade , Adulto , Humanos , Fotografação , Pesquisa Qualitativa , São Vicente e GranadinasRESUMO
Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts-or 17.2%-had a score of 14 or higher and met a 70% compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7%) and psychiatric diagnosis (21.6%). Explicit statement of medications initiated with dose and frequency occurred in 47.0% of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings.