Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis.

OBJECTIVE: Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis. METHOD: We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity). RESULTS: Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective. CONCLUSIONS: Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.

Spirituality and Willingness to Participate in Health-Related Research Among African Americans.

African Americans remain underrepresented in health-related research. We examined the association between spirituality using the Self-Rating Spirituality Scale (range 6-24) and self-reported willingness to participate in health-related research studies among African Americans. Covariates included gender, education level, employment status, and previous research experience. Adjusted associations were calculated with logistic regression models, with multiple imputation to account for missing data. Results from the logistic regression model show that each one-point increase in the Self-Rating Spirituality Scale was associated with a 24% increase in the odds of being very likely to participate in research (OR: 1.24, 95% CI: 1.07-1.44). Those with less than a college degree (OR: 3.59, 95% CI: 1.51-8.54), who were unemployed (OR: 2.34, 95% CI: 1.03-5.33), and had previous research experience (OR: 2.92, 95% CI: 1.22-6.99) reported increased willingness to participate. This work offers new insight for developing recruitment initiatives within African American spiritual communities.

Spirituality and Physical Activity and Sedentary Behavior among Latino Men and Women in Massachusetts.

INTRODUCTION: To examine the relationships between spirituality and physical activity and sedentary behavior in a sample of Latino adults in Massachusetts. DESIGN: This is a cross-sectional analysis of the Lawrence Health and Well Being Study; a study that was conducted among patients at the Greater Lawrence Family Health Center (GLFHC) in Lawrence, Massachusetts. PARTICIPANTS: 602 Latino or Hispanic adults aged 21 to 85 years completed the study. RESULTS: There was a significant negative relationship between spirituality and sedentary behavior (ß= -.12, p = .004). Although not statistically significant, higher spirituality was associated with increased odds of engaging in physical activity. There were no significant associations between spirituality and physical activity among men or women. Men with greater spirituality were significantly less sedentary (ß = -.17, P = .005). There was no relationship between sedentary behavior and spirituality among women. CONCLUSIONS: This study found that individuals who are more spiritual are also less sedentary, and this association was stronger in men than women. Findings provide insight for developing future interventions to promote activity in this high-risk population, which has been greatly understudied. Future research endeavors should consider investigating the impact of spirituality-based messages to reduce sedentary behavior among Latinos.

Worksite environmental interventions for obesity control: an overview.

In 2004, the National Heart, Lung, and Blood Institute funded seven independent research projects to test the effectiveness of multicomponent weight control interventions at worksites that include environmental changes alone or in combination with individually targeted strategies (Pratt et al, Obesity. 2007;15:2171-2180). The studies were conducted in a variety of worksites across the United States. This supplement to the Journal of Occupation and Environmental Medicine includes a series of manuscripts that evaluate various aspects of the funded studies, including environmental and cost-related findings, process evaluation, and the impact of acute and chronic psychosocial work stressors on body mass index.

Developing and implementing the Massachusetts Comprehensive Cancer Control Coalition Survivorship Summit.

Cancer survivors face numerous medical and psychosocial challenges, which the medical and public health systems are ill-equipped to deal with. In May 2008, the Massachusetts Comprehensive Cancer Control Coalition conducted a Survivorship Summit to elicit input from cancer survivors and professionals on developing system-level action plans for cancer survivorship issues. We describe how health care and public health professionals can implement similar events. Our results suggest that a cancer survivorship summit can be a valuable tool for cancer coalitions and advocacy organizations in determining survivorship agendas and action plans.

Comprehensive cancer screening in a primary care population: Gender differences in the impact of ambulatory care system factors.

There is a great deal to be learned about how factors within the context of primary care influence the provision of comprehensive preventive services. This study assessed the prevalence of cancer screening among a primary care population of men and women and examined the association of characteristics of the patient-physician relationship, the healthcare facility, and type of health insurance. Findings suggest that prevalence of comprehensive cancer screening is low, particularly among men. Characteristics of the patient-physician relationship are an important predictor of screening among women but not men. Among men, however, greater contact with the medical care system is important.

Screening for colorectal cancer on the front line.

OBJECTIVE: The aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening. METHODS: We surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening. RESULTS: Most agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong. CONCLUSIONS: Most providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence.