Pre-Exposure Prophylaxis in a Reproductive Health Setting: A Quality Improvement Project.

INTRODUCTION: Although pre-exposure prophylaxis (PrEP) is recommended by the Centers for Disease Control and Prevention, there is a practice gap in treatment at Planned Parenthood of Illinois. This project evaluated a clinical practice alert and evidence-based patient education script to determine if the intervention increased the number of appointments to discuss or initiate PrEP in patients at risk for acquiring HIV. METHOD: From October to December 2018, a clinical practice alert and evidence-based patient education script were implemented at one Planned Parenthood of Illinois health center. Aggregate data collected included the number of times the clinical alert was generated, the number of times staff read the script, the number of scheduled appointments to discuss PrEP, and the number of times PrEP was prescribed. Qualitative data were collected from clinic staff to further evaluate the intervention. RESULTS: Eleven patients triggered the alert and staff read the education script nine times during the 8-week implementation period. One patient scheduled an appointment to discuss PrEP; no new prescriptions were initiated. One identified patient scheduled an appointment with a provider to initiate PrEP on a date after the implementation period ended. Staff found the alert and script helpful to initiate conversations with patients. CONCLUSIONS: This intervention established a system for clinic staff to identify patients at risk for acquiring HIV in order to discuss accurate, evidence-based PrEP information. Findings are limited to this particular setting due to a small sample size, which eliminated the possibility for statistical analysis.

Obligatory exercise and coping in treatment-seeking women with poor body image.

PURPOSE: Obligatory exercise is characterized by continued exercise despite negative consequences, and intense negative affect when unable to exercise. Research suggests psychosocial differences between individuals that exercise in an obligatory manner and those that do not. It also has been speculated that obligatory exercise may serve coping and affect regulation functions, yet these factors have not been routinely examined in community women with poor body image. The purpose of the current study was to investigate psychosocial differences between obligatory and non-obligatory exercisers, and to examine the use of obligatory exercise as an avoidant coping strategy in a sample of women with poor body image. METHODS: Women (n = 70) seeking treatment for body dissatisfaction were divided into obligatory and non-obligatory exercise groups based on their scores on the Obligatory Exercise Questionnaire. Participants then completed an assessment battery about eating pathology, body image, reasons for exercise, coping strategies, and negative affect. RESULTS: Independent t test analyses indicated that obligatory exercisers had significantly greater eating disorder symptomatology, avoidant coping, and appearance- and mood-related reasons for exercise than non-obligatory exercisers. Multiple regression analyses revealed that eating disorder symptomatology and avoidant coping were significant predictors of obligatory exercise. CONCLUSIONS: There are distinct psychosocial differences between women with poor body image who exercise in an obligatory fashion and those who do not. The current study suggests that obligatory exercise may serve as an avoidant coping strategy for women with poor body image. Enhancing healthy coping strategies may be an important addition to body image improvement programs. LEVEL OF EVIDENCE: V, cross-sectional descriptive study.

Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study.

OBJECTIVE: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement. METHOD: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program. RESULTS: The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen's d = 0.84). CONCLUSION: MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general.

Expectations and outcomes with gastric bypass surgery.

BACKGROUND: Bariatric surgery is widely accepted as the effective treatment option for morbid obesity. However, the extant literature does not provide mental health clinicians with consistent guidance for evaluating candidates for surgery, nor for preparing patients for postsurgical adjustment. Among both bariatric clinicians and patients, there are commonly endorsed expectations about who will do well postoperatively and what the psychosocial impact of the surgery and weight loss will be. The current study surveyed our patient population regarding the accuracy of these expectations. METHODS: Medical charts were reviewed and surveys mailed to all 194 patients who had undergone the Roux-en-Y gastric bypass (RYGBP) at University of New Mexico Hospital prior to April 2003. Surveys explored patients' expectations and actual experiences with RYGBP and the subsequent changes in their physical and psychosocial status. RESULTS: Completed surveys received from 47.9% of the patients reported significant improvements in physical health, emotional status, and binge eating. These improvements were seen across the entire sample, regardless of the presence of preoperative psychological distress, and were unrelated to the degree of weight loss. Professional and non-romantic relationships benefited from the impact of weight loss, but romantic relationships appeared unaffected. There were no significant changes in occupational status. CONCLUSION: The impact of bariatric surgery appears sufficiently potent to negate whatever preoperative differences might otherwise affect weight management. It may be time for the field to cease its search for surgical outcome predictors and focus instead on improving postoperative support.

Different strokes for different folks: why overweight men do not seek weight loss treatment.

Despite health risks associated with male-pattern obesity, few men utilize weight management programs. Strikingly missing from the literature are studies that ask, "Why?" Seventy-two overweight males were surveyed regarding what might motivate them to seek treatment, and which treatment characteristics might appeal to them. Respondents indicated that health problems and the desire to improve appearance are primary motivators. In contrast to the programs most widely available, respondents preferred individualized, athletics-based programs that allow autonomy in food selection. It was concluded that both a modified program and marketing approach are needed if the clinical community is to help overweight men.