RESUMO
Physical comorbidities associated with mental health conditions contribute to high health care costs. This study examined the impact of having a usual source of care (USC) for physical health on health care utilization, spending, and quality for adults with a mental health condition using Medicaid administrative data. Having a USC decreased the probability of inpatient admissions and readmissions. It decreased expenditures on emergency department visits for physical health, 30-day readmissions, and behavioral health inpatient admissions. It also had a positive effect on several quality measures. Results underscore the importance of a USC for physical health and integrated care for adults with mental health conditions.
Assuntos
Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Adulto , Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estados Unidos , Adulto JovemRESUMO
The purpose of this study was to determine the relationships among preconception stressful life events (PSLEs), women's alcohol and tobacco use before and during pregnancy, and infant birthweight. Data were from the Early Childhood Longitudinal Study-Birth Cohort (n = 9,350). Data were collected in 2001. Exposure to PSLEs was defined by indications of death of a parent, spouse, or previous live born child; divorce or marital separation; or fertility problems prior to conception. Survey data determined alcohol and tobacco usage during the 3 months prior to and in the final 3 months of pregnancy. We used staged multivariable logistic regression to estimate the effects of women's substance use and PSLEs on the risk of having a very low (<1,500 g, VLBW) or low (1,500-2,499 g, LBW) birthweight infant, adjusting for confounders. Women who experienced any PSLE were more likely to give birth to VLBW infants (adjusted odds ratio [AOR] = 1.35; 95 % confidence interval [CI] = 1.10-1.66) than women who did not experience any PSLE. Compared to women who never smoked, women who smoked prior to conception (AOR = 1.31; 95 % CI = 1.04-1.66) or during their last trimester (AOR = 1.98; 95 % CI = 1.56-2.52) were more likely to give birth to LBW infants. PSLEs and women's tobacco use before and during pregnancy are independent risk factors for having a lower birthweight baby. Interventions to improve birth outcomes may need to address women's health and health behaviors in the preconception period.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Acontecimentos que Mudam a Vida , Cuidado Pré-Concepcional , Gestantes/psicologia , Fumar/epidemiologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Fumar/psicologia , Estresse Psicológico/psicologia , Adulto JovemRESUMO
OBJECTIVE: To determine the impact of children's cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families. STUDY DESIGN: Data were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the children's behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the children's behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes. RESULTS: At age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the children's behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the children's behaviors were assessed by their primary nonparental care providers. CONCLUSION: Caring for a child with a cognitive delay influences maternal depressive symptoms in part through the child's behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the children's behavior.
Assuntos
Transtornos do Comportamento Infantil/psicologia , Transtornos Cognitivos/psicologia , Depressão/epidemiologia , Deficiências do Desenvolvimento/psicologia , Mães/psicologia , Adolescente , Adulto , Pré-Escolar , Estudos de Coortes , Depressão/diagnóstico , Feminino , Humanos , Estudos Longitudinais , Masculino , Estado Civil , Classe Social , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: We sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage. METHODS: We drew our data from the Early Childhood Longitudinal Study, Birth Cohort (2001-2002; n = 9300). We created a neighborhood disadvantage index (NDI) using county-level data from the 2000 US Census. We grouped the NDI into tertiles that represented advantaged, middle advantaged, and disadvantaged neighborhoods. Stratified multinomial logistic regressions estimated the effect of PSLEs on birth weight, controlling for confounders. RESULTS: We found a gradient in the relationship between women's exposure to PSLEs and having a very low birth weight (VLBW) infant by NDI tertile; the association was strongest in disadvantaged neighborhoods (adjusted odd ratio [AOR] = 1.62; 95% confidence interval [CI] = 1.04, 2.53), followed by middle (AOR = 1.39; 95% CI = 1.00, 1.93) and advantaged (AOR = 1.29; 95% CI = 0.91, 1.82) neighborhoods. We observed a similar gradient for women with chronic conditions and among minority mothers. CONCLUSIONS: Women who experienced PSLEs, who had chronic conditions, or were racial/ethnic minorities had the greatest risk of having VLBW infants if they lived in disadvantaged neighborhoods; this suggests exacerbation of risk within disadvantaged environments. Interventions to reduce rates of VLBW should focus on reducing the deleterious effects of stressors and on improving neighborhood conditions.
Assuntos
Recém-Nascido de muito Baixo Peso , Acontecimentos que Mudam a Vida , Pobreza , Características de Residência/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Doença Crônica , Comportamentos Relacionados com a Saúde , Humanos , Estudos Longitudinais , Fatores SocioeconômicosRESUMO
PURPOSE: In order to better understand how family caregiving may contribute to poor health outcomes, this study sought to determine (1) if and to what extent caregiving characteristics were associated with caregiver strain and health-related quality of life (HRQoL), and (2) whether caregiver strain mediated this association. METHODS: Data were from the 2008-2010 Survey of the Health of Wisconsin, a representative sample of Wisconsin adults aged 21-74 years. Participants completed questionnaires about their caregiving, sociodemographics, and HRQoL; 264 caregivers were identified. Staged generalized additive models assessed the associations among caregiving characteristics, caregiver strain, and HRQoL; survey weights were applied to account for the complex sampling design. RESULTS: More hours per week of care and greater duration of caregiving were associated with higher levels of strain. Greater caregiver strain was in turn associated with worse mental HRQoL. However, most caregiving characteristics were not directly associated with mental or physical HRQoL. CONCLUSIONS: The findings suggest a chains-of-risk model in which caregiving may increase strain, which may in turn adversely influence mental HRQoL. Using this perspective to refine interventions may improve our ability to support caregivers on practice and policy levels.
Assuntos
Cuidadores/psicologia , Nível de Saúde , Qualidade de Vida/psicologia , Estresse Psicológico/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Wisconsin , Adulto JovemRESUMO
The purpose of the study was to understand the association between stressful life events prior to conception (PSLEs) and women's alcohol and tobacco use prior to and during pregnancy, and the continuation of such use through pregnancy. Data were from the Early Childhood Longitudinal Study-Birth Cohort (n = 9,350). Data were collected in 2001. Exposure to PSLEs was defined by indications of death of a parent, spouse, or previous live born child, divorce or marital separation, or fertility problems prior to conception. Survey data determined alcohol and tobacco usage during the 3 months prior to and in the final 3 months of pregnancy. Weighted regressions estimated the effect of PSLEs on alcohol and tobacco use at each time point and on the continuation of use, adjusting for confounders. Experiencing any PSLE increased the odds of tobacco use prior to (adjusted odds ratio [AOR] 1.52, 95 % confidence interval (CI) 1.23-1.87) and during pregnancy (AOR 1.57, 95 % CI 1.19-2.07). Women exposed to PSLEs smoked nearly five additional packs of cigarettes in the 3 months prior to pregnancy (97 cigarettes, p = 0.011) and consumed 0.31 additional alcoholic drinks during the last 3 months of pregnancy than unexposed women. PSLEs are associated with tobacco use before pregnancy and alcohol and tobacco use during pregnancy. Alcohol and tobacco screening and cessation services should be implemented prior to and during pregnancy, especially for women who have experienced PSLEs.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Acontecimentos que Mudam a Vida , Gestantes/psicologia , Fumar/epidemiologia , Uso de Tabaco/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Análise Multivariada , Cuidado Pré-Concepcional , Valor Preditivo dos Testes , Gravidez , Fumar/efeitos adversos , Fumar/psicologia , Fatores Socioeconômicos , Fatores de Tempo , Uso de Tabaco/efeitos adversos , Uso de Tabaco/psicologia , Estados Unidos/epidemiologiaRESUMO
This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the US by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated cesarean section (C-section) deliveries. Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n = 9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-sections. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-sections, compared to vaginal delivery. 74.2 % of women had a vaginal delivery, 11.6 % had a non-medically indicated C-section, and 14.2 % had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we found salient differences between the risk factors for indicated and non-indicated C-sections. Surgical deliveries continue to occur at a high rate in the US despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short- and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.
Assuntos
Cesárea/psicologia , Cesárea/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Anestesia Obstétrica , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Obesidade/complicações , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The pathophysiological consequences of caregiving have not been fully elucidated. We evaluated how caregiving, stress, and caregiver strain were associated with shorter relative telomere length (RTL), a marker of cellular aging. Caregivers (n = 240) and some noncaregivers (n = 98) in the 2008-2010 Survey of the Health of Wisconsin, comprising a representative sample of Wisconsin adults aged 21-74 years, reported their sociodemographic, health, and psychological characteristics. RTL was assayed from blood or saliva samples. Median T and S values were used to determine the telomere-to-single copy gene ratio (T/S) for each sample, and log(T/S) was used as the dependent variable in analyses. Multivariable generalized additive models showed that RTL did not differ between caregivers and noncaregivers (difference in log(T/S) = -0.03; P > 0.05), but moderate-to-high levels of stress versus low stress were associated with longer RTL (difference = 0.15; P = 0.04). Among caregivers, more hours per week of care, caring for a young person, and greater strain were associated with shorter RTL (P < 0.05). Caregivers with discordant levels of stress and strain (i.e., low perceived stress/high strain) compared with low stress/low strain had the shortest RTL (difference = -0.24; P = 0.02, Pinteraction = 0.13), corresponding to approximately 10-15 additional years of aging. Caregivers with these characteristics may be at increased risk for accelerated aging. Future work is necessary to better elucidate these relationships and develop interventions to improve the long-term health and well-being of caregivers.
Assuntos
Cuidadores/psicologia , Estresse Psicológico/fisiopatologia , Encurtamento do Telômero , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Estudos de Casos e Controles , Senescência Celular , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Fatores de Risco , WisconsinRESUMO
BACKGROUND: Improved parental awareness of human papillomavirus (HPV) vaccines could increase uptake of vaccines early in the life course, thereby reducing adolescents' later risk for HPV infection and cancer. As such, we sought to determine factors related to parental awareness of HPV vaccines, using a nationally representative population-based sample. METHODS: We examined data on 5735 parents of preadolescents and adolescents aged 8 to 17 years from the 2010 National Health Interview Survey. Parents were asked if they had ever heard of HPV vaccines or shots. Multivariable logistic regression analyses were used to examine the odds of parental awareness of HPV vaccines, controlling for relevant covariates. RESULTS: Most US parents (62.6%) heard of HPV vaccines. Multivariable results revealed parents of children who were older, female, and insured were more likely to have heard of HPV vaccines; parents who were female, white (non-Hispanic), English speakers, born in the United States, married or living with a partner, more educated, and had higher income were also more likely to be aware of HPV vaccines. Notably, parents of children who had a well-child checkup in the last 12 months were significantly more likely to have heard of HPV vaccines (odds ratio, 1.23; 95% confidence interval, 1.04-1.46). CONCLUSIONS: Given the significant disparities in parental awareness of HPV vaccines, improving access to preventive pediatric health care could offer an opportunity to increase parental awareness. In addition, public health efforts that provide culturally sensitive information in a variety of languages may be an effective way to reach vulnerable groups.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Informação/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Pais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Conscientização , Criança , Etnicidade/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/etnologia , Pais/educação , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Vacinação/psicologiaRESUMO
OBJECTIVES: We investigated relationships among cognitive delay, community factors, and behavior problems over 2 years in early childhood with a national sample of US families. METHODS: Data were from 3 waves of the Early Childhood Longitudinal Study, Birth Cohort (2001-2005; n = 7650). We defined cognitive delay as the lowest 10% of mental scores from the Bayley Short Form-Research Edition, administered at 9 and 24 months. At 24 months, we classified children as typically developing or as having resolved, newly developed, or persistent cognitive delays. Behavior was measured at age 4 years with the Preschool and Kindergarten Behavior Scales (range = 0-36). Community factors included perceived neighborhood safety and an index of county disadvantage. RESULTS: Behavior scores at age 4 years (mean = 12.4; SD = 4.9) were higher among children with resolved (Β = 0.70; SE = 0.20), newly developed (Β = 1.92; SE = 0.25), and persistent (Β = 2.96; SE = 0.41) cognitive delays than for typically developing children. The interaction between county disadvantage and cognitive delay status was statistically significant (P < .01), suggesting that county disadvantage was particularly detrimental for children with persistent delays. CONCLUSIONS: The community context may provide an opportunity for public health interventions to improve the behavioral health of children with cognitive delays.
Assuntos
Transtornos do Comportamento Infantil/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Síndrome de Chilaiditi , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/psicologia , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Áreas de Pobreza , Testes Psicológicos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: We sought to determine if and to what extent a woman's exposure to stressful life events prior to conception (PSLEs) were associated with subsequent infant birth weight by using a nationally representative sample of US women. METHODS: We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort in 2001. Weighted regressions estimated the effect of exposure on very low and low birth weight, adjusting for maternal sociodemographic and health factors and stress during pregnancy. RESULTS: Twenty percent of women experienced any PSLE. In adjusted analyses, exposed women were 38% more likely to have a very low birth weight infant than nonexposed women. Furthermore, the accumulation of PSLEs was associated with reduced infant birth weight. CONCLUSIONS: This was the first nationally representative study to our knowledge to investigate the impact of PSLEs on very low and low birth weight in the United States. Interventions aimed to improve birth outcomes will need to shift the clinical practice paradigm upstream to the preconception period to reduce women's exposure to stress over the life course and improve the long-term health of children.
Assuntos
Peso ao Nascer , Acontecimentos que Mudam a Vida , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido de muito Baixo Peso , Masculino , Gravidez , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: We determined whether and to what extent a woman's exposure to stressful life events prior to conception (PSLEs) was associated with preterm birth and whether maternal age modified this relationship. METHODS: We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative sample of US women and children born in 2001, to investigate the impact of PSLEs on preterm birth in the United States. We estimated the effect of exposure on preterm birth with weighted logistic regression, adjusting for maternal sociodemographic and health factors and stress during pregnancy. RESULTS: Of the women examined, 10.9% had a preterm birth. In adjusted analyses, women aged 15 to 19 years who experienced any PSLE had over a 4-fold increased risk for having a preterm birth. This association differed on the basis of the timing of the PSLE. CONCLUSIONS: Findings suggest that adolescence may be a sensitive period for the risk of preterm birth among adolescents exposed to PSLEs. Clinical, programmatic, and policy interventions should address upstream PSLEs, especially for adolescents, to reduce the prevalence of preterm birth and improve maternal and child health.
Assuntos
Acontecimentos que Mudam a Vida , Idade Materna , Nascimento Prematuro/etiologia , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Estresse Psicológico/complicações , Estados Unidos/epidemiologia , Adulto JovemRESUMO
PURPOSE: Research suggests a relationship between caring for a child with cancer and psychological distress in caregivers. Less evident is the role which financial difficulties might play in this relationship. We sought to determine if caring for a child with cancer was related to clinically relevant depressive symptoms among parents, whether or not financial difficulties mediated this relationship, and if financial difficulties were independently associated with symptoms of depression among parents of children with cancer. METHODS: Data are from 215 parents of children diagnosed with cancer or brain tumors (n = 75) and a comparison group of parents of healthy children (n = 140). Multiple logistic regression analyses were used to assess the factors associated with reporting clinically relevant depressive symptoms. RESULTS: Caring for a child with cancer was associated with increased odds of clinically relevant depressive symptoms in parents (OR = 4.93; 95 % CI 1.97-12.30), controlling for covariates. The mediating effect of financial burden on this relationship was not statistically significant. However, among parents of children with cancer, negative financial life events increased the likelihood of reporting symptoms of depression (OR = 4.89; 95 % CI 1.26-18.96). CONCLUSIONS: Caring for a child with cancer was associated with depressive symptoms for parents. Financial difficulties were the strongest correlate of these symptoms among parents of children with cancer. Our results suggest that it may not only be the burden of caring for the child with cancer but also the associated financial difficulties that contribute to a higher likelihood of depressive symptoms in parents.
Assuntos
Depressão/etiologia , Neoplasias/economia , Neoplasias/psicologia , Pais/psicologia , Adulto , Neoplasias Encefálicas/economia , Neoplasias Encefálicas/psicologia , Cuidadores/psicologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Depressão/economia , Depressão/psicologia , Feminino , Humanos , Masculino , Classe SocialRESUMO
PURPOSE: Informal caregivers play a critical role in the care of individuals who are aging or have disabilities and are at increased risk for poor health outcomes. This study sought to determine whether and to what extent: (1) global stress and health-related quality of life (HRQoL) differed between caregivers and non-caregivers; (2) global stress mediated the relationship between caregiving status and HRQoL; and (3) caregiver strain (i.e., stress attributable to caregiving) was associated with worse HRQoL after accounting for global stress. METHODS: Cross-sectional data were from the 2008-2010 Survey of the Health of Wisconsin, a representative sample of adults aged 21-74 years. Participants (n = 1,364) completed questionnaires about caregiving status, sociodemographics, global stress, and HRQoL. Staged generalized additive models assessed the impact of caregiving on HRQoL and the role of caregiver strain and global stress in this relationship. RESULTS: In the last 12 months, 17.2% of the sample reported caregiving. Caregivers reported worse mental HRQoL than non-caregivers (ß -1.88, p = 0.02); global stress mediated this relationship (p < 0.01). Caregivers with the highest levels of strain reported worse mental and physical HRQoL (ß -7.12, p < 0.01), and caregivers with the lowest levels of strain reported better mental HRQoL (ß 2.06, p = 0.01) than non-caregivers; these associations were attenuated by global stress (p < 0.01). CONCLUSION: Global stress, rather than caregiving per se, contributes to poor HRQoL among caregivers, above and beyond the effect of caregiving strain. Screening, monitoring, and reducing stress in multiple life domains presents an opportunity to improve HRQoL outcomes for caregivers.
Assuntos
Cuidadores/psicologia , Nível de Saúde , Saúde Mental/estatística & dados numéricos , Qualidade de Vida , Estresse Psicológico/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Doença Crônica/psicologia , Análise por Conglomerados , Estudos Transversais , Feminino , Indicadores Básicos de Saúde , Inquéritos Epidemiológicos , Humanos , Relações Interpessoais , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Perfil de Impacto da Doença , Fatores Socioeconômicos , Estresse Psicológico/psicologia , Inquéritos e Questionários , Wisconsin/epidemiologia , Adulto JovemRESUMO
Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n = 10); three examined stress during both the preconception and pregnancy periods (n = 3). Most studies examined the environmental domain (e.g. life events) only (n = 9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.
Assuntos
Complicações na Gravidez/psicologia , Resultado da Gravidez/epidemiologia , Estresse Psicológico/complicações , Feminino , Humanos , Gravidez , Complicações na Gravidez/etiologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologiaRESUMO
The objectives of this study were to determine if racial and ethnic differences in personal capital during pregnancy exist and to estimate the extent to which any identified racial and ethnic differences in personal capital are related to differences in maternal sociodemographic and acculturation characteristics. Data are from the 2007 Los Angeles Mommy and Baby study (n = 3,716). Personal capital comprised internal resources (self-esteem and mastery) and social resources (partner, social network, and neighborhood support) during pregnancy. The relationships between race/ethnicity and personal capital were assessed using multivariable generalized linear models, examining the impact of sociodemographic and acculturation factors on these relationships. Significant racial and ethnic disparities in personal capital during pregnancy exist. However, socioeconomic status (i.e., income and education) and marital status completely explained Black-White disparities and Hispanic-White disparities in personal capital, whereas acculturation factors, especially nativity and language spoken at home, partially mediated the disparities in personal capital between Asian/Pacific Islander women and White women. Findings suggest that the risks associated with low socioeconomic status, single motherhood, and low acculturation, rather than race or ethnicity, contribute to low personal capital for many pregnant women. As personal capital during pregnancy may influence subsequent maternal and child health outcomes, the development of interventions should consider addressing sociodemographic and acculturation factors in order to reduce racial and ethnic disparities in personal capital and ultimately in poor maternal and child health outcomes.
Assuntos
Aculturação , Saúde das Minorias , Classe Social , Apoio Social , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Estudos Transversais , Feminino , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Lineares , Los Angeles/epidemiologia , Estado Civil , Idade Materna , Paridade , Gravidez , Características de Residência , Autoimagem , Adulto JovemRESUMO
Many women with depression are untreated or undertreated for their condition. The quality of patient-provider communication may impact the receipt of depression treatment. We examine the relationship between patient-provider communication and receipt of adequate treatment for depression among women. The study sample consisted of women with depression who visited a provider in the previous 12 months in the 2002-2008 Medical Expenditure Panel Survey (N = 3,179). Multivariate regression was used to examine the independent contribution of sociodemographic characteristics, health care factors, patient-provider communication, and respondent language on depression treatment status (none, some, adequate). We found that more than one-third of women with depression in the United States did not receive adequate treatment. Women reporting that providers usually or always listened carefully were more likely to receive adequate treatment (OR = 1.59; 95% CI = 1.10-2.30 and OR = 1.55; 95% CI = 1.07-2.23, respectively). Non-English-speaking women were 50% less likely to receive adequate treatment (OR = 0.49; 95% CI = 0.30-0.80). Having a usual source of care was associated with an increased likelihood of receiving some and adequate treatment (OR = 1.84; 95% CI = 1.24-2.73 and OR = 2.22; 95% CI = 1.61-3.05, respectively). Effective provider listening behaviors may help increase the number of U.S. women with depression who receive adequate treatment. Efforts to improve language access for limited English-proficient women are likely critical for improving treatment outcomes in this population. Additionally, ensuring that women with depression have consistent access to health care services is important for obtaining adequate depression care.
Assuntos
Depressão/terapia , Idioma , Relações Médico-Paciente , Adolescente , Adulto , Idoso , Coleta de Dados , Depressão/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos , Adulto JovemAssuntos
Serviços de Saúde da Criança , Serviços de Saúde Materna , Criança , Saúde da Criança , Feminino , Humanos , Gravidez , Medição de Risco , Estados UnidosRESUMO
OBJECTIVE: This study aimed to determine if and to what extent (i) socioeconomic disparities exist in the health-related quality of life (QOL) of children with cancer or brain tumors and healthy children; and (ii) family functioning and burden mediate the relationship between socioeconomic status and children's QOL. METHODS: In this cross-sectional study, parents of children ages 2-18 with (n = 71) and without (n = 135) cancer or brain tumors completed in-person interviewer-assisted surveys assessing sociodemographics (including income and parental education), child QOL (measure: PedsQL), family functioning (measure: Family Adaptability and Cohesion Evaluation Scale IV) and burden (measure: Impact on the Family Scale). For children with cancer, clinical characteristics were captured through medical record abstraction. Multiple linear regression was used to determine the relationship between income and child QOL; the interaction between group status and income was assessed. Staged multivariate regression models were used to assess the role of family factors in this relationship among children with cancer. RESULTS: In multivariate analyses, the effect of income differed by cancer status; lower income was associated with worse QOL in children with cancer but not among healthy children. Among children with cancer, this relationship was significantly attenuated by family burden. CONCLUSIONS: Significant socioeconomic disparities exist in the QOL of children with cancer. Family factors partially explain the relationship between low income and poor QOL outcomes among these children. Lower-income families may have fewer resources to cope with their child's cancer. Increased support, monitoring, and referrals to reduce burden for these families may lead to improved QOL in children with cancer.
Assuntos
Neoplasias Encefálicas/psicologia , Família , Disparidades nos Níveis de Saúde , Neoplasias/psicologia , Qualidade de Vida , Adolescente , Adulto , Neoplasias Encefálicas/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Família/psicologia , Humanos , Renda/estatística & dados numéricos , Neoplasias/epidemiologia , Pais/psicologia , Qualidade de Vida/psicologia , Fatores SocioeconômicosRESUMO
PURPOSE: This review sought to identify and summarize the instruments adapted or developed for measuring HRQoL among young children (<8 years) living in resource-limited settings. METHODS: A review of the literature was conducted in two phases. Phase one searched the PubMed, PsycInfo, Web of Knowledge (Web of Science), African Index Medicus, and SocINDEX databases and identified widely used child HRQoL instruments. Phase two reviewed the articles using the selected HRQoL instruments and extracted information on their use in resource-limited settings including adaption processes. RESULTS: Seven instruments were identified that measured the HRQoL of young children. Six had been used in resource-limited settings. Of the 452 articles using these instruments, a total of 23 (5 %) studies used one of the identified HRQoL instruments in a resource-limited setting. Among these studies, 39 % employed an adaptation process for the use of that instrument. No instruments had been developed specifically for measuring the HRQoL of young children in resource-limited settings. CONCLUSIONS: If pediatric HRQoL instruments are to be used in resource-limited settings, it is critical that they be developed and adequately adapted to those settings. Only then will interventions lead to larger increases in the overall HRQoL and well-being of children.