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1.
Arthritis Care Res (Hoboken) ; 72(2): 184-192, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31595710

RESUMO

OBJECTIVE: To describe and compare triennial rates of physicians' recommendations for physical therapy (PT), lifestyle counseling, and pain medication for knee osteoarthritis (OA) and to identify patient, physician, and practice factors associated with each treatment recommendation. METHODS: We conducted a cross-sectional analysis examining data between 2007 and 2015 from the National Ambulatory Medical Care Survey. Visits to orthopedists and primary care physicians for knee OA were identified and assessed for the following: PT referral, lifestyle counseling, nonsteroidal antiinflammatory drug (NSAID) prescriptions, and narcotics prescriptions. Triennial rates for each treatment were calculated. We examined associations between patient (e.g., race, insurance), physician, and practice factors (e.g., ownership, location) and treatments prescribed using multivariate logistic regression that accounted for complex sampling design. RESULTS: A total of 2,297 physician visits related to knee OA (~67 [±4] million weighted visits) were identified. For visits to orthopedists, PT and lifestyle recommendation rates declined (158 to 88 of 1,000 visits and 184 to 86 of 1,000 visits, respectively), while NSAID and narcotics prescriptions increased (132 to 278 of 1,000 visits and 77 to 236 of 1,000 visits, respectively) over time (P < 0.05). For visits to primary care physicians, there were no significant changes in rates of PT, lifestyle counseling, and narcotics prescriptions over time, while NSAIDs prescriptions increased (221 to 498 of 1,000 visits; P < 0.05). Treatment recommendations were associated with nonclinical factors, including practice type, location, and type of provider. CONCLUSION: In patients with knee OA, PT and lifestyle counseling seem underutilized, while pain medication prescriptions increased during the investigated timeframe. Variation in treatment choices were associated with nonclinical factors. Future research is necessary to examine ways to improve PT and lifestyle utilization and reduce variation in care for knee OA.


Assuntos
Analgésicos/administração & dosagem , Aconselhamento/tendências , Osteoartrite do Joelho/terapia , Manejo da Dor/tendências , Modalidades de Fisioterapia/tendências , Comportamento de Redução do Risco , Idoso , Instituições de Assistência Ambulatorial , Estudos de Coortes , Aconselhamento/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/tendências , Osteoartrite do Joelho/diagnóstico , Manejo da Dor/métodos , Inquéritos e Questionários
2.
BMC Health Serv Res ; 19(1): 548, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382958

RESUMO

BACKGROUND: Analysis of Medicare data is often used to determine epidemiology, healthcare utilization and effectiveness of disease treatments. We were interested in whether Medicare data could be used to estimate prevalence of tobacco use. Currently, data regarding tobacco use is derived from Behavioral Risk Factor Surveillance System (BRFSS) survey data. We compare administrative claims data for tobacco diagnosis among Medicare beneficiaries to survey (BRFSS) estimates of tobacco use from 2001 to 2014. METHODS: Retrospective cross-sectional study comparing tobacco diagnoses using International Classification of Disease, Ninth Revision (ICD-9) codes for tobacco use in Medicare data to BRFSS data from 2001 to 2014 in adults age ≥ 65 years. Beneficiary data included age, gender, race, socioeconomic status, and comorbidities. Tobacco cessation counselling was also examined using Healthcare Common Procedure Coding System codes. RESULTS: The prevalence of Medicare enrollees aged ≥65 years who had a diagnosis of current tobacco use increased from 2.01% in 2001 to 4.8% in 2014, while the estimates of current tobacco use from BRFSS decreased somewhat (10.03% in 2001 vs. 8.77% in 2014). However, current tobacco use based on Medicare data remained well below the estimates from BRFSS. Use of tobacco cessation counselling increased over the study period with largest increases after 2010. CONCLUSIONS: The use of tobacco-related diagnosis codes increased from 2001 to 2014 in Medicare but still substantially underestimated the prevalence of tobacco use compared to BRFSS data.


Assuntos
Aconselhamento/tendências , Abandono do Uso de Tabaco/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Uso de Tabaco/prevenção & controle , Estados Unidos/epidemiologia
3.
J Couns Psychol ; 66(6): 726-735, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31368721

RESUMO

The 2016 U.S. national election brought increased anxiety, relationship conflict, and counseling utilization for many Americans, especially among women, millennials, racial and ethnic minority (REM) members, and economically disadvantaged persons. The present study examined psychological symptoms, interpersonal tension, and counseling service requests over 36 months of data (April 2015-March 2018) from 56 clients and 14 therapists engaged in a routine outcomes monitoring project at a training community counseling center. Clients resided in a Democratic-leaning area in a Republican-voting state, and 78% were women, 53% were under 30 years of age, 33% were an REM, and 92% earned below the median state income level. Symptoms did not show an association with the political climate, and interpersonal problems reduced during counseling. Although interpersonal conflict decreased prior to the election, it increased afterward, largely due to problems of dominance and control in relationships. Younger and REM individuals showed larger increases in interpersonal tension after the election than did older and non-REM persons. Alliances decreased over the entire data-collection period. Counseling intakes increased after the election, although potentially due to seasonal patterns. With attention to the effect of political events on individuals, the field of counseling psychology may be able to help clients and the larger society manage difficult interactions around real differences in political opinions and disparities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Aconselhamento/métodos , Política , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Idoso , Aconselhamento/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/terapia , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Couns Psychol ; 66(5): 577-587, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31259575

RESUMO

Although the importance of religion in the help-seeking processes of Latinx populations has been discussed (e.g., Moreno & Cardemil, 2013), few studies have considered the effects of religious and cultural factors on Mexican American women's underutilization of professional mental health services and less willingness to seek counseling. To address this gap in the literature, this study focuses on religious cultural values reported by Mexican American college women and how sociocultural factors, such as spiritual and biological etiology beliefs and self-stigma, can shape their willingness to seek counseling, using the cultural influences on mental health (CIMH) theoretical framework (Hwang, Myers, Abe-Kim, & Ting, 2008). Using structural equation modeling, we tested 2 theoretically and empirically derived models of willingness to seek counseling among 276 Mexican American college women at a large Hispanic-serving university in the Southwest. The findings highlighted the direct and indirect ways in which religious cultural values related to willingness to seek counseling and the importance of accounting for etiology beliefs and self-stigma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Aconselhamento/tendências , Americanos Mexicanos/psicologia , Religião e Psicologia , Estigma Social , Estudantes/psicologia , Universidades/tendências , Adolescente , Adulto , Características Culturais , Feminino , Humanos , Serviços de Saúde Mental/tendências , Adulto Jovem
5.
Holist Nurs Pract ; 33(4): 204-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192832

RESUMO

Cardiovascular disease (CVD) is often caused by modifiable risk factors related to diet and lifestyle behaviors. Counseling patients to adopt lifestyle changes for CVD risk-reduction is needed. Using the 5As strategy (ask, assess, advise, agree, assist) can help patients incorporate positive behavior changes and reduce CVD risk factors.


Assuntos
Doenças Cardiovasculares/diagnóstico , Aconselhamento/métodos , Educação em Saúde/métodos , Papel do Profissional de Enfermagem , Doenças Cardiovasculares/epidemiologia , Aconselhamento/tendências , Comportamentos Relacionados com a Saúde , Educação em Saúde/normas , Humanos , Fatores de Risco
6.
J Couns Psychol ; 66(5): 534-549, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30998053

RESUMO

The development and initial validation of a client-rated measure of therapist cultural comfort (the Therapist Cultural Comfort Scale [TCCS]) is reported. The first phase of the study involved content validation of the initial pool of items via consultation with (a) focus groups of doctoral student therapists and (b) experts in the field of multicultural counseling and psychotherapy. A 56-item pool generated during this phase, together with instruments used to gauge convergent and incremental validity, were administered to a community adult sample of current psychotherapy clients (N = 889). Exploratory factor analysis suggested 2 subscales representing negative and positive indicators of therapist cultural comfort. Item response theory principles guided final selection of subscale items. Analyses suggested good factor stability and reliability of the 13-item TCCS as well as strong measurement invariance across racial/ethnic minority status and gender. Total and subscale scores related as expected with other measures of multicultural constructs (cultural humility, missed cultural opportunities, and multicultural competencies). Generally, TCCS total and subscale scores also predicted working alliance and treatment progress above and beyond the effects of therapist general comfort. There were few differences in clients' perceptions of therapist cultural comfort based on client demographic characteristics. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Aconselhamento/normas , Competência Cultural/psicologia , Diversidade Cultural , Grupos Minoritários/psicologia , Relações Profissional-Paciente , Psicoterapia/normas , Adolescente , Adulto , Idoso , Grupos de Populações Continentais/psicologia , Aconselhamento/tendências , Grupos Étnicos/psicologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia/tendências , Reprodutibilidade dos Testes , Estudantes/psicologia , Adulto Jovem
7.
Public Health Rep ; 134(2): 141-149, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794761

RESUMO

OBJECTIVES: Despite increased awareness of obesity-related health risks and myriad treatment options, obesity still affects more than one-third of persons in the United States and is a substantial public health problem. Studies show that physicians play a key role in obesity prevention and treatment. The objective of this study was to examine the extent to which obesity is diagnosed and treated at the level of patient-physician interaction. METHODS: We used data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of US physician office visits. We estimated the number of obesity diagnoses and prescriptions of weight-loss management solutions (exercise counseling, diet counseling, or weight-loss drugs) in clinical practice from 1996 through 2014. We also calculated rates of obesity diagnosis and compared these rates with national rates of obesity based on body mass index data from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. RESULTS: The estimated number of weight gain-related physician office visits increased from 2.3 million in 1996 to a peak of 7.6 million in 2012, and then fell to 4.5 million in 2014. National estimates of obesity diagnoses resulting from physician office visits ranged from 7.1 million in 1996 to 12.7 million in 2014 and substantially outnumbered the estimates for weight gain-related physician office visits throughout the study period. Estimates of exercise counseling and diet counseling and weight-loss medication prescriptions resulting from physician office visits fluctuated over time but never exceeded obesity diagnoses. When compared with national rates of obesity from the BRFSS, rates of obesity diagnoses resulting from physician office visits were substantially lower in the NAMCS (17%-30% vs 1%). National trends for weight-loss medication prescriptions closely mirrored those of weight gain-related physician office visits, even though fluctuations were substantial. CONCLUSIONS: Our results suggest that obesity is largely underdiagnosed and undertreated in clinical encounters. Future studies should investigate the structural changes needed to better engage physicians in obesity prevention and care. Practitioners should also reflect on their biases in treating obesity as a chronic disease.


Assuntos
Medicalização/tendências , Obesidade/diagnóstico , Obesidade/terapia , Visita a Consultório Médico/tendências , Padrões de Prática Médica/tendências , Depressores do Apetite/administração & dosagem , Sistema de Vigilância de Fator de Risco Comportamental , Índice de Massa Corporal , Doença Crônica , Aconselhamento/tendências , Dieta , Exercício , Feminino , Humanos , Masculino , Papel do Médico , Relações Médico-Paciente , Estados Unidos
8.
BMC Psychiatry ; 19(1): 39, 2019 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-30678676

RESUMO

BACKGROUND: Web-based mental health applications may be beneficial, but adoption is often low leaving optimal implementation and payment models unclear. This study examined which users were interested in extended access to a web-based application beyond an initial 3-month trial period and evaluated if an additional 3 months of access was beneficial. METHODS: This study was a concealed extension of a multi-center, pragmatic randomized controlled trial that assessed the benefit of 3 months of access to the Big White Wall (BWW), an anonymous web-based moderated, multi-component mental health application offering self-directed activities and peer support. Trial participants were 16 years of age or older, recruited from hospital-affiliated mental health programs. Participants who received access to the intervention in the main trial and completed 3-month outcome assessments were offered participation. We compared those who were and were not interested in an extension of the intervention, and re-randomized consenting participants 1:1 to receive extended access or not over the subsequent 3 months. Use of the intervention was monitored in the extension group and outcomes were measured at 3 months after re-randomization in both groups. The primary outcome was mental health recovery as assessed by total score on the Recovery Assessment Scale (RAS-r), as in the main trial. Linear mixed models were used to examine the time by group interaction to assess for differences in responses over the 3-month extension study. RESULTS: Of 233 main trial participants who responded, 119 (51.1%) indicated an interest in receiving extended BWW access. Those who were interested had significantly higher baseline anxiety symptoms compared to those who were not interested. Of the 119, 112 were re-randomized (55 to extended access, 57 to discontinuation). Only 21 of the 55 extended access participants (38.2%) used the intervention during the extension period. Change in RAS-r scores over time was not significantly different between groups (time by group, F(1,77) = 1.02; P = .31). CONCLUSIONS: Only half of eligible participants were interested in extended access to the intervention with decreasing use over time, and no evidence of added benefit. These findings have implications for implementation and payment models for this type of web-based mental health intervention. TRIAL REGISTRATION: Clinicaltrials.gov NCT02896894 . Registered retrospectively on September 12, 2016.


Assuntos
Internet/tendências , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Saúde Mental/tendências , Participação do Paciente/tendências , Terapia Assistida por Computador/tendências , Adulto , Aconselhamento/métodos , Aconselhamento/tendências , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Participação do Paciente/métodos , Participação do Paciente/psicologia , Estudos Retrospectivos , Terapia Assistida por Computador/métodos , Fatores de Tempo
9.
Drug Alcohol Depend ; 196: 51-56, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30665152

RESUMO

AIM: To investigate if more patients in the intervention group attended specialized alcohol treatment compared with a treatment-as-usual group (TAU). METHODS: Pragmatic randomized controlled trial where consecutive patients, admitted to somatic hospitals, filled out a lifestyle questionnaire with the Alcohol Use Disorder Identification Test (AUDIT) embedded. Patients scoring 8+ on AUDIT were included in the study. Included patients were randomized to either a Danish screening brief intervention and referral to treatment (SBIRT) called the Relay model or TAU depending on date of admission. The Relay group was offered a brief alcohol intervention by an outreach alcohol therapist. Patients scoring 16 points and above on the AUDIT test also received referral to alcohol treatment. Outcome was attendance at specialized outpatient alcohol treatment centres after discharge from hospital. Information on patients was gathered from municipal databases at 18 months follow-up. RESULTS: A total of 3534 patients completed the questionnaire, and 609 patients (17%) scored AUDIT 8+. 48 patients were lost to follow-up, and the final sample had 561 patients. Only 33 patients (6%) attended outpatient treatment at 18-months follow-up, but significantly more patients in the Relay group sought alcohol treatment than in the TAU group (OR = 2.5 [1.2;5.2] (p = 0.017)). Number needed to treat (NNT) was 20 [95% CI 11.2;112.3]. CONCLUSION: The Relay intervention was associated with more patients attending specialized treatment, but further research is needed to establish if general hospitals are an excellent platform for performing SBIRT.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/terapia , Centros Comunitários de Saúde/tendências , Hospitais Gerais/tendências , Encaminhamento e Consulta/tendências , Cuidado Transicional/tendências , Adulto , Alcoolismo/diagnóstico , Assistência Ambulatorial/métodos , Assistência Ambulatorial/tendências , Aconselhamento/métodos , Aconselhamento/tendências , Feminino , Seguimentos , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Método Simples-Cego , Inquéritos e Questionários , Resultado do Tratamento
10.
Behav Ther ; 50(1): 25-35, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30661564

RESUMO

Alcohol-induced amnesia ("blackout") is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and 1-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group-by-amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at 1-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.


Assuntos
Consumo de Bebidas Alcoólicas/terapia , Amnésia/terapia , Aconselhamento/tendências , Intervenção Médica Precoce/tendências , Retroalimentação Psicológica , Adolescente , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/psicologia , Amnésia/sangue , Amnésia/psicologia , Concentração Alcoólica no Sangue , Aconselhamento/métodos , Intervenção Médica Precoce/métodos , Retroalimentação Psicológica/fisiologia , Feminino , Seguimentos , Previsões , Humanos , Masculino , Estudantes/psicologia , Adulto Jovem
12.
Drug Alcohol Depend ; 195: 16-26, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30562676

RESUMO

BACKGROUND: HIV prevalence has increased among South African women who use alcohol and other drugs (AOD). However, HIV prevention and treatment efforts have not focused on this population. This study presents the efficacy of the Women's Health CoOp Plus (WHC+) in a cluster-randomized trial to reduce AOD use, gender-based violence, and sexual risk and to increase linkage to HIV care among women who use AODs, compared with HIV counseling and testing alone. METHODS: Black African women (N = 641) were recruited from 14 geographic clusters in Pretoria, South Africa, and underwent either an evidence-based gender-focused HIV prevention intervention that included HIV counseling and testing (WHC+) or HIV counseling and testing alone. Participants were assessed at baseline, 6-months, and 12-months post enrollment. RESULTS: At 6-month follow-up, the WHC+ arm (vs. HCT) reported more condom use with a main partner and sexual negotiation, less physical and sexual abuse by a boyfriend, and less frequent heavy drinking (ps < 0.05). At 12-month follow-up, the WHC+ arm reported less emotional abuse (p < 0.05). Among a subsample of women, the WHC+ arm was significantly more likely to have a non-detectable viral load (measured by dried blood spots; p = 0.01). CONCLUSION: The findings demonstrate the WHC+'s efficacy to reduce HIV risk among women who use AODs in South Africa. Substance abuse rehabilitation centers and health centers that serve women may be ideal settings to address issues of gender-based violence and sexual risk as women engage in substance use treatment, HIV testing, or HIV care.


Assuntos
Infecções por HIV/epidemiologia , Delitos Sexuais/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Violência/tendências , Saúde da Mulher/tendências , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Análise por Conglomerados , Aconselhamento/métodos , Aconselhamento/tendências , Feminino , Infecções por HIV/psicologia , Infecções por HIV/terapia , Humanos , Masculino , Programas de Rastreamento/métodos , Sexo Seguro/psicologia , Autorrelato , Delitos Sexuais/psicologia , Comportamento Sexual/psicologia , África do Sul/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Violência/psicologia , Adulto Jovem
13.
J Stud Alcohol Drugs ; 79(5): 710-719, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30422784

RESUMO

OBJECTIVE: Driving after drinking (DAD) among college students remains a significant public health concern and is perhaps the single riskiest drinking-related behavior. Counselor-delivered and web-based Brief Alcohol Interventions (BAIs) have been shown to reduce DAD among college students, but to date no study has evaluated the efficacy of a single-session mobile phone-based BAI specific to DAD. The present study examined whether a driving-specific BAI delivered via mobile phone would significantly decrease DAD among college students compared to an informational control. METHOD: Participants were 84 college students (67.1% women; average age = 23; 52.4% White) who endorsed driving after drinking two or more drinks at least twice in the past 3 months. After completing baseline measures, participants were randomly assigned to receive either (a) DAD information or (b) DAD mobile BAI that included personalized feedback and interactive text messaging. Participants completed outcome measures at 3-month follow-up. RESULTS: Repeated-measures mixed modeling analyses revealed that students receiving the mobile phone-based BAI reported significantly greater reductions in likelihood of DAD (three or more drinks) and the number of drinks consumed before driving than students in the information condition at 3-month follow-up. CONCLUSIONS: These findings provide preliminary support for the short-term efficacy of a mobile phone-based BAI for reducing DAD among college students.


Assuntos
Consumo de Álcool na Faculdade/psicologia , Dirigir sob a Influência/prevenção & controle , Dirigir sob a Influência/psicologia , Retroalimentação Psicológica , Estudantes/psicologia , Mensagem de Texto , Adolescente , Adulto , Condução de Veículo/psicologia , Telefone Celular/tendências , Aconselhamento/métodos , Aconselhamento/tendências , Dirigir sob a Influência/tendências , Retroalimentação Psicológica/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Mensagem de Texto/tendências , Adulto Jovem
14.
Rev Bras Enferm ; 71(5): 2594-2598, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30304195

RESUMO

OBJECTIVE: to reflect on the medicalization process of childbirth and birth and its consequences based on a Brazilian audiovisual media artifact. METHOD: reflective and interpretive analysis of the documentary O Renascimento do Parto (The Rebirth of Childbirth) based on Critical Discourse Analysis. RESULTS: c-section emerges as an alternative to adverse conditions of pregnancy. However, it has become a routine and abusive practice of a medicalized obstetric care, thus becoming a social problem. In order to the incidence of c-sections decrease, women's protagonism must be restored, in addition to considering psychological, affective, emotional, spiritual, cultural, and contextual aspects in childbirth. CONCLUSION: childbirth is established as a material element and a mental phenomenon of social practices. We must interrupt the predominant model, allowing the body to express itself through the release of oxytocin, and decrease the segregation that c-section causes, thus enabling affective bonds.


Assuntos
Medicalização/métodos , Obstetrícia/tendências , Parto , Brasil , Aconselhamento/métodos , Aconselhamento/tendências , Feminino , Humanos , Gravidez
15.
J Stud Alcohol Drugs ; 79(4): 611-616, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30079877

RESUMO

OBJECTIVE: Alcohol- and drug-related car crashes are a leading cause of death for adolescents in the United States. This analysis tested the effects of a computer-facilitated Screening and Brief Advice (cSBA) system for primary care on adolescents' reports of driving after drinking or drug use (driving) and riding with substance-using drivers (riding). METHOD: Twelve- to 18-year-old patients (N = 2,096) at nine New England pediatric offices completed assessments only during the initial 18-month treatment-as-usual (TAU) phase. Subsequently, the 18-month cSBA intervention phase began with a 1-hour provider training and implementation of the cSBA system at all sites. cSBA included a notebook-computer with self-administered screener, immediate scoring and feedback, and 10 pages of scientific information and true-life stories illustrating substance-related harms. Providers received screening results, "talking points" for 2 to 3 minutes of counseling, and a Contract for Life handout. Logistic regression with generalized estimating equations generated adjusted relative risk ratios (aRRR) for past-90-day driving and riding risk at 3- and 12-month follow-ups, controlling for significant covariates. RESULTS: We found no significant effects on driving outcomes. At 3 months, cSBA youth were less likely than TAU to report riding with a drinking driver (aRRR = 0.70, 95% CI [0.49, 1.00]), and less likely to report riding with a driver who had used cannabis or other drugs (aRRR = 0.46, 95% CI [0.29, 0.74]). The effect was even greater (aRRR = 0.34, 95% CI [0.16, 0.71]) for riding with drinking drivers who were adult family members. All effects dissipated by 12-month follow-up. CONCLUSIONS: Screening and pediatrician brief advice shows promise for reducing adolescents' risk of riding with substance-using drivers.


Assuntos
Comportamento do Adolescente/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Aconselhamento/métodos , Dirigir sob a Influência/psicologia , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/tendências , Condução de Veículo/psicologia , Criança , Aconselhamento/tendências , Dirigir sob a Influência/prevenção & controle , Dirigir sob a Influência/tendências , Feminino , Humanos , Masculino , New England/epidemiologia , Papel do Médico/psicologia , Atenção Primária à Saúde/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
16.
J Couns Psychol ; 65(5): 539-555, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30160494

RESUMO

Critical consciousness (CC) has been heralded as an antidote to oppression. Developed by the Brazilian educator, Paulo Freire, CC represents the process by which individuals gain awareness of societal inequities and subsequently take action to dismantle the systems and institutions that sustain them. Empirically supported instruments intended to assess this important construct have only been recently introduced to the literature and have focused specifically on racism, classism, and heterosexism. The purpose of this project was to develop a psychometrically sound measure of CC that expands assessment into sexism, cissexism (genderism/transphobia), and ableism. Two studies with a total of 569 observations provided initial reliability and validity evidence on the Contemporary Critical Consciousness Measure II (CCCMII). Results from exploratory and confirmatory factor analyses suggest that the final 37-item CCCMII provides a general index of CC as well as assesses CC associated with sexism and ableism above and beyond the general factor. Results support the internal consistency and factor structure of the measure. Expected relationships between the CCCMII and existing measures of sexism, cissexism, and ableism provide evidence for the validity of the instrument. Limitations, future directions for research, and counseling implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Conscientização , Estado de Consciência , Sexismo/psicologia , Inquéritos e Questionários/normas , Adulto , Conscientização/fisiologia , Estado de Consciência/fisiologia , Aconselhamento/tendências , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Racismo/psicologia , Reprodutibilidade dos Testes
17.
J Assist Reprod Genet ; 35(9): 1613-1621, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30073435

RESUMO

PURPOSE: What are the experience, approach, and knowledge of US Obstetricians and Gynecologists' (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP). METHODS: A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP. RESULTS: Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18-34 years old, compared to 75.8% aged 35-44 years old (P < 0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P < 0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP. CONCLUSIONS: In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.


Assuntos
Aconselhamento/tendências , Preservação da Fertilidade , Ginecologia/tendências , Inquéritos e Questionários , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Médicos/psicologia , Estados Unidos/epidemiologia
18.
J Couns Psychol ; 65(5): 653-660, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30024191

RESUMO

Student veterans experiencing mental health concerns could benefit from seeking counseling (Rudd, Goulding, & Bryan, 2011), though they often avoid these services. Self-affirmation interventions have been developed to increase openness to health-related behaviors (Sherman & Cohen, 2006), and may also help promote psychological help-seeking intentions. This study explored whether a self-affirmation intervention increased intentions to seek counseling in a sample of 74 student veterans who had not previously sought counseling services. Participants completed pretest (Time 1) measures of distress and help seeking (i.e., self-stigma, attitudes, and intentions to seek counseling). A week later (Time 2), participants completed one of two conditions: (1) a self-affirmation intervention before viewing a psychoeducational video and brochure or (2) only the psychoeducational video and brochure before completing the same help-seeking measures as Time 1. A week after the intervention (Time 3), participants again completed the help-seeking measures. A focused longitudinal mediation model was conducted, examining the effect of the self-affirmation experimental condition on help-seeking intentions. Compared with those in the psychoeducation-only group, student veterans who completed the self-affirmation intervention reported increased intentions to seek counseling both immediately postintervention (Time 2) and a week later (Time 3). (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Aconselhamento/métodos , Intenção , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudantes/psicologia , Veteranos/psicologia , Adolescente , Adulto , Aconselhamento/tendências , Feminino , Humanos , Masculino , Saúde Mental/tendências , Pessoa de Meia-Idade , Estigma Social , Universidades/tendências , Adulto Jovem
19.
BMC Musculoskelet Disord ; 19(1): 209, 2018 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-29960605

RESUMO

BACKGROUND: The aim of the study was to improve physical activity (PA), well-being and clinical outcome after total knee and hip arthroplasty through tailored activity counselling during inpatient rehabilitation. METHODS: 65 patients (aged 70.4 ± 7.3 years, BMI 28.5 ± 4.3) starting inpatient rehabilitation after primary knee or hip arthroplasty due to osteoarthritis were recruited and pseudo-randomized into an intervention (IG) and a control group (CG). Twice a week, the IG was encouraged to increase their daily step count by 5%. PA, e. g. number of steps, step frequency, or active minutes, was measured by step activity monitoring. Well-being and clinical outcome were assessed using the SF-36, Oxford Knee/Hip Score and Global rating of Change. Procedures were conducted at the onset of inpatient rehabilitation, and repeated one and 6 months after inpatient rehabilitation. RESULTS: Data sets were obtained from 49 patients (IG: n = 23, CG: n = 26). Both groups significantly increased their number of daily steps from the 1 month to the 6 months follow up after rehabilitation: CG: 9019 (95%CI: 7812, 10,226), IG: 9280 (7972, 10,588) and CG: 10921 (9571, 12,271), IG: 11326 (9862, 12,791) respectively. Additionally, well-being and clinical outcome improved significantly in both groups. No significant differences in physical activity, clinical outcome and well-being were found between the groups. CONCLUSIONS: PA counselling during inpatient rehabilitation does not improve PA, well-being and clinical outcome in patients with primary knee or hip arthroplasty in addition to the rehabilitation program. PA interventions may be more effective after the completion of the inpatient rehabilitation phase. TRIAL REGISTRATION: DRKS DRKS00012682 . Registered retrospectively on 03-07- 2017.


Assuntos
Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Aconselhamento/métodos , Exercício/fisiologia , Exercício/psicologia , Pacientes Internados/psicologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/tendências , Artroplastia do Joelho/tendências , Aconselhamento/tendências , Feminino , Humanos , Masculino , Centros de Reabilitação/tendências , Resultado do Tratamento
20.
J Clin Child Adolesc Psychol ; 47(6): 1023-1038, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30052089

RESUMO

This article aims to integrate theory and empirical findings about understanding and fostering the process of resilience and adaptation in children and families who live in poverty. In this article, we draw from multiple, somewhat distinct, scholarly streams to identify sources of protection, integrating across the literatures on stress and coping, psychophysiology, cultural identity development, and empowerment theory. Because living in poverty cuts across other dimensions of social differentiation and structural inequality, intersectionality theory frames our discussion of how to leverage poverty-affected youths' diverse experiences. We present a framework to guide intervention and research on resiliency promotion, describe the Building a Strong Identity and Coping Skills intervention stemming from the framework, and suggest possible avenues and next steps for both interventions and research.


Assuntos
Pesquisa Biomédica/tendências , Pobreza/prevenção & controle , Pobreza/tendências , Adaptação Psicológica/fisiologia , Adolescente , Pesquisa Biomédica/métodos , Criança , Aconselhamento/métodos , Aconselhamento/tendências , Previsões , Humanos , Fatores Socioeconômicos
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