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1.
Fam Syst Health ; 42(1): 137-138, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38647499

RESUMO

The author describes how she has earnestly struggled to find her fit in providing mental health services to Hispanic/Latino clients and the Latino communities that she belongs to. She wonders, if no one belongs, then who stands up for historically marginalized Latino communities? Personal and systemic biases and arbitrary criteria for being enough to serve Latino patients hurt providers and clients alike. Her work reminds her of the need to charge against stereotyping and racism to meet patients' needs regardless of skin color or linguistic abilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Assuntos
Hispânico ou Latino , Humanos , Hispânico ou Latino/psicologia , Serviços de Saúde Mental/tendências , Racismo/psicologia , Feminino
2.
BMC Prim Care ; 23(1): 77, 2022 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-35421949

RESUMO

BACKGROUND: Over 100 million Americans have chronic pain and most obtain their treatment in primary care clinics. However, evidence-based behavioral treatments targeting pain-related disability are not typically provided in these settings. Therefore, this study sought to: 1) evaluate implementation of a brief evidence-based treatment, Focused Acceptance and Commitment Therapy (FACT-CP), delivered by an integrated behavioral health consultant (BHC) in primary care; and 2) preliminarily explore primary (self-reported physical disability) and secondary treatment outcomes (chronic pain acceptance and engagement in valued activities). METHODS: This mixed-methods pilot randomized controlled trial included twenty-six participants with non-cancer chronic pain being treated in primary care (54% women; 46% Hispanic/Latino). Active participants completed a 30-min individual FACT-CP visit followed by 3 weekly 60-min group visits and a booster visit 2 months later. An enhanced treatment as usual (ETAU) control group received 4 handouts about pain management based in cognitive-behavioral science. Follow-up research visits occurred during and after treatment, at 12 weeks (booster visit), and at 6 months. Semi-structured interviews were conducted to collect qualitative data after the last research visit. General linear mixed regression models with repeated measures explored primary and secondary outcomes. RESULTS: The study design and FACT-CP intervention were feasible and acceptable. Quantitative analyses indicate at 6-month follow-up, self-reported physical disability significantly improved pre-post within the FACT-CP arm (d = 0.64); engagement in valued activities significantly improved within both the FACT-CP (d = 0.70) and ETAU arms (d = 0.51); and chronic pain acceptance was the only outcome significantly different between arms (d = 1.04), increased in the FACT-CP arm and decreased in the ETAU arm. Qualitative data analyses reflected that FACT-CP participants reported acquiring skills for learning to live with pain, consistent with increased chronic pain acceptance. CONCLUSION: Findings support that FACT-CP was acceptable for patients with chronic pain and feasible for delivery in a primary care setting by a BHC. Results provide preliminary evidence for improved physical functioning after FACT-CP treatment. A larger pragmatic trial is warranted, with a design based on data gathered in this pilot. TRIAL REGISTRATION: clinicaltrials.gov, NCT04978961 (27/07/2021).


Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Dor Crônica/terapia , Feminino , Humanos , Masculino , Manejo da Dor , Projetos Piloto , Atenção Primária à Saúde
3.
BMJ Open ; 11(2): e044012, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526503

RESUMO

INTRODUCTION: 'Task-shifting' or 'task-sharing' is an effective strategy for delivering behavioural healthcare in lower resource communities. However, little is known regarding the actual steps (methods) in carrying out a task-shifting project. This paper presents a protocol for a systematic review that will identify steps in adapting an evidence-based psychological treatment for delivery by lay/non-licenced personnel. METHODS AND ANALYSIS: A systematic review of peer-reviewed, published studies involving a non-licenced, non-specialist (eg, community health worker, promotor/a, peer and lay person) delivering an evidence-based psychological treatment for adults will be conducted. Study design of selected articles must include a statistical comparison (eg, randomised controlled trials, quasiexperimental trials, pre-post designs and pragmatic trials). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases including PubMed, the Cochrane Library, Cochrane Central Register of Controlled Trials, SCOPUS, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo and Google Scholar will be searched from 2000 to 2020. Risk of bias will be assessed using the Cochrane Collaboration's Risk of Bias (RoB 2) tool, and publication bias will be evaluated with the Cochrane GRADE approach. A narrative synthesis will be conducted for all included studies, and a summary table following Proctor's framework for operationalising implementation strategies will be included. This protocol was developed following the 2015 guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. ETHICS AND DISSEMINATION: This review will analyse data from published studies only; thus, it will not require institutional board review. Findings will be presented at conferences, to the broader community via the Community Health Worker Translational Advisory Board and social media, and the final systematic review will be published in a peer-reviewed journal.


Assuntos
Atenção à Saúde , Mão de Obra em Saúde , Adulto , Agentes Comunitários de Saúde , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
J Homosex ; 66(7): 989-1013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30095375

RESUMO

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.


Assuntos
Avaliação das Necessidades , Minorias Sexuais e de Gênero , Adolescente , Adulto , Idoso , Feminino , Identidade de Gênero , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , South Carolina , Inquéritos e Questionários , Adulto Jovem
5.
Rehabil Psychol ; 63(2): 267-275, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29878831

RESUMO

OBJECTIVE: This study sought to explore relationships between sexual satisfaction, sexual communication and relationship satisfaction in people living with multiple sclerosis (MS). Specifically, sexual satisfaction was evaluated as a moderator between sexual communication and relationship satisfaction. DESIGN: Individuals diagnosed with MS and being treated in a hospital-based MS clinic in the southeastern United States (n = 58) completed measures of sexual satisfaction, sexual communication, sexual dysfunction, relationship quality, depression, level of disability, and frequency of sex-related communication and behaviors in a cross-sectional survey design. RESULTS: Sexual satisfaction moderated the relationship between quality of sexual communication and relationship quality, controlling for depression and frequency of sexual behavior and sexual communication. Directionality was examined in a 2nd regression analysis, in which the predictor and outcome variables were switched, which was also significant. Additionally, depression most strongly predicted relationship dissatisfaction. CONCLUSIONS: Findings help to establish sexual satisfaction as a moderator between sexual communication and relationship satisfaction, although directionality cannot be supported. Results also highlight the role of depression in overall relationship functioning and support the biopsychosocial model of care for treatment of sexual dysfunction in people living with MS. (PsycINFO Database Record


Assuntos
Comunicação , Relações Interpessoais , Esclerose Múltipla/psicologia , Satisfação Pessoal , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adaptação Psicológica , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Sudeste dos Estados Unidos , Adulto Jovem
6.
Contemp Clin Trials ; 66: 28-35, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29414142

RESUMO

Most of the 100 million Americans with persistent pain are treated in primary care clinics, but evidence-based psychosocial approaches targeting pain-related disability are not usually provided in these settings. This manuscript describes the rationale and methods for a protocol to pilot test the feasibility and effectiveness of Acceptance and Commitment Therapy (ACT), an evidence-based psychological treatment for persistent pain, delivered by a Behavioral Health Consultant in primary care. Eligible patients are identified through electronic health record registries and invited to participate via secure messaging, letters and a follow-up phone call. Participants are also recruited with advertising and clinician referral. Patients agreeing to participate are consented and complete initial assessments, with a target of 60 participants. Randomization is stratified based on pain severity with participants assigned to either ACT or Enhanced Treatment as Usual (E-TAU). ACT participants receive one standardized Behavioral Health Consultation visit followed by three ACT-based group visits and one group booster visit. All patients attend six assessment visits, during which the E-TAU patients are provided with educational pain management handouts based on standard cognitive behavioral treatment of pain. The study aims to determine feasibility and effectiveness of brief ACT for persistent pain delivered by an integrated behavioral health clinician in primary care from pre- to post-treatment, and to examine mechanisms of change in ACT participants. This study, in a "real-world" setting, will lay groundwork for a larger trial. If effective, it could improve treatment methods and quality of life for patients with persistent pain using a scalable approach.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Dor Crônica/terapia , Manejo da Dor/métodos , Atenção Primária à Saúde , Terapia Cognitivo-Comportamental , Humanos , Projetos Piloto
7.
Arch. argent. pediatr ; 116(1): 56-59, feb. 2018. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1038399

RESUMO

La tiroiditis de Hashimoto es la causa más común de bocio e hipotiroidismo en niños y adolescentes. Las manifestaciones clínicas y la evolución son variables. El objetivo de este trabajo es revisar las particularidades clínicas y evolutivas de la enfermedad de Hashimoto en población pediátrica. Se analizaron datos clínicos, analíticos, ecográficos, epidemiológicos y evolutivos de los pacientes con tiroiditis autoinmune del Hospital Universitario San Juan de Alicante desde enero de 2010 hasta enero de 2016. En el estudio, se incluyeron un total de 29 pacientes. Se observó una mayor prevalencia en niñas con una relación 2:1. El principal motivo de consulta fue la detección casual de una hormona estimulante de la tiroides elevada o de positividad de anticuerpos antitiroideos en una analítica por otro motivo. En la analítica inicial, el 53,3% de los pacientes presentaba hipotiroidismo subclínico y tan solo el 10% de ellos, hipotiroidismo franco. Dos de los pacientes desarrollaron cáncer de tiroides.


Hashimoto's thyroiditis is the most common cause of goiter and hypothyroidism among children and adolescents. Its clinical manifestations and course vary. The objective of this study was to review the clinical and evolutionary characteristics of Hashimoto's disease in the pediatric population. Clinical, analytical, ultrasound, epidemiological, and evolutionary data of patients with autoimmune thyroiditis seen at Hospital Universitario San Juan de Alicante between January 2010 and January 2016 were analyzed. A total of 29 patients were included in the study. A higher prevalence of girls was observed, at a 2:1 ratio. The main reason for consultation was the accidental detection of high thyroid stimulating hormone levels or positive anti-thyroid antibodies in a lab test done for other reason. In the initial analysis, 53.3% of patients had subclinical hypothyroidism and only 10% of them had frank hypothyroidism. Two patients developed thyroid cancer.


Assuntos
Humanos , Criança , Adolescente , Tireoidite Autoimune , Criança , Doença de Hashimoto , Hipotireoidismo
8.
Arch Argent Pediatr ; 116(1): 56-58, 2018 Feb 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29333819

RESUMO

Hashimoto's thyroiditis is the most common cause of goiter and hypothyroidism among children and adolescents. Its clinical manifestations and course vary. The objective of this study was to review the clinical and evolutionary characteristics of Hashimoto's disease in the pediatric population. Clinical, analytical, ultrasound, epidemiological, and evolutionary data of patients with autoimmune thyroiditis seen at Hospital Universitario San Juan de Alicante between January 2010 and January 2016 were analyzed. A total of 29 patients were included in the study. A higher prevalence of girls was observed, at a 2:1 ratio. The main reason for consultation was the accidental detection of high thyroid stimulating hormone levels or positive anti-thyroid antibodies in a lab test done for other reason. In the initial analysis, 53.3% of patients had subclinical hypothyroidism and only 10% of them had frank hypothyroidism. Two patients developed thyroid cancer.


La tiroiditis de Hashimoto es la causa más común de bocio e hipotiroidismo en niños y adolescentes. Las manifestaciones clínicas y la evolución son variables. El objetivo de este trabajo es revisar las particularidades clínicas y evolutivas de la enfermedad de Hashimoto en población pediátrica. Se analizaron datos clínicos, analíticos, ecográficos, epidemiológicos y evolutivos de los pacientes con tiroiditis autoinmune del Hospital Universitario San Juan de Alicante desde enero de 2010 hasta enero de 2016. En el estudio, se incluyeron un total de 29 pacientes. Se observó una mayor prevalencia en niñas con una relación 2:1. El principal motivo de consulta fue la detección casual de una hormona estimulante de la tiroides elevada o de positividad de anticuerpos antitiroideos en una analítica por otro motivo. En la analítica inicial, el 53,3% de los pacientes presentaba hipotiroidismo subclínico y tan solo el 10% de ellos, hipotiroidismo franco. Dos de los pacientes desarrollaron cáncer de tiroides.


Assuntos
Doença de Hashimoto , Adolescente , Criança , Pré-Escolar , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo
9.
Subst Use Misuse ; 53(6): 891-900, 2018 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-29303396

RESUMO

BACKGROUND: Smoking prevalence for lesbian, gay, bisexual, and transgender (LGBT) individuals is higher than for heterosexual, cisgender individuals. Elevated smoking rates have been linked to psychiatric comorbidities, substance use, poverty, low education levels, and stress. OBJECTIVES: This study examined mental health (MH) correlates of cigarette use in LGBT individuals residing in a metropolitan area in the southeastern United States. METHODS: Participants were 335 individuals from an LGBT health needs assessment (mean age 34.7; SD = 13.5; 63% gay/lesbian; 66% Caucasian; 81% cisgender). Demographics, current/past psychiatric diagnoses, number of poor MH days in the last 30, the Patient Health Questionnaire (PHQ) 2 depression screener, the Three-Item Loneliness Scale, and frequency of cigarette use were included. Analyses included bivariate correlations, analysis of variance (ANOVA), and regression. RESULTS: Multiple demographic and MH factors were associated with smoker status and frequency of smoking. A logistic regression indicated that lower education and bipolar disorder were most strongly associated with being a smoker. For smokers, a hierarchical regression model including demographic and MH variables accounted for 17.6% of the variance in frequency of cigarette use. Only education, bipolar disorder, and the number of poor MH days were significant contributors in the overall model. Conclusions/Importance: Less education, bipolar disorder, and recurrent poor MH increase LGBT vulnerability to cigarette use. Access to LGBT-competent MH providers who can address culturally specific factors in tobacco cessation is crucial to reducing this health disparities.


Assuntos
Transtorno Bipolar/epidemiologia , Fumar Cigarros/epidemiologia , Minorias Sexuais e de Gênero/psicologia , Adulto , Estudos de Casos e Controles , Comorbidade , Humanos , Masculino , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia , Adulto Jovem
10.
J Homosex ; 64(10): 1330-1349, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28467155

RESUMO

Changes in the language and terminology used to refer to individuals identifying as lesbian, gay, bisexual, and transgender (LGBT), as well as how best to discuss issues of sexual and gender identity, can prove challenging for health care providers due to (1) lack of training; (2) interdisciplinary issues; and (3) prejudices on personal and institutional levels. Given the importance of language in the relationship between health care provider and patient as well as the myriad ways in which language can reflect knowledge, skills, and attitudes, we contend that language is both a facilitator and inhibitor of competence. In this article, we discuss language as a means of exhibiting cultural competence as well as the barriers to facilitating this degree of competence. Communicative competence, a concept traditionally used in linguistics, is discussed as a framework for contextualizing LGBT-specific cultural competence in health care. Ideally, a professional will be considered competent once they (1) acquire a foundation in issues associated with LGBT individuals, as well as a basic understanding of appropriate vocabulary' (2) reconcile personal beliefs with their professional role; (3) create an inclusive healthcare environment such that the influence of personal biases does not negatively impact care; and (4) use identifiers suggested by the patient.


Assuntos
Competência Clínica , Competência Cultural , Atenção à Saúde/normas , Homossexualidade , Idioma , Minorias Sexuais e de Gênero , Pessoas Transgênero , Bissexualidade , Comunicação , Feminino , Identidade de Gênero , Humanos , Masculino , Relações Médico-Paciente , Preconceito , Transexualidade
11.
J Health Care Poor Underserved ; 28(1): 430-445, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28239011

RESUMO

Though advances in medical treatment have increased lifespans for those living with HIV, quality of life concerns often remain under-treated by health care providers. The integration of mental health services within the HIV medical setting can provide comprehensive care for patients, including brief screening, intervention, and appropriate follow-up. In this study, investigators examined mental health concerns identified during behavioral health screens at appointments in an Infectious Disease Clinic and compared them with previously published data from the same setting to assess changes in patient-reported problems. Results indicated shifts in identified problems, as well as demographic changes in the patient population from the previous study. Analyses suggested anger and goal-setting problems significantly contribute to reports of psychiatric symptoms, and suggested that adjustment to diagnosis, depression, and sleep concerns significantly contribute to the likelihood of engaging in a mental health consultation. Our findings highlight the importance of behavioral health screening to identify psychosocial concerns in integrated HIV care settings.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Programas de Rastreamento/organização & administração , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Idoso , Ira , Depressão/epidemiologia , Feminino , Objetivos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Qualidade de Vida , Sono , Fatores Socioeconômicos , Adulto Jovem
12.
Hisp Health Care Int ; 9(2): 82-90, 2011 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-24994949

RESUMO

This study explored feelings and attitudes with regard to HIV and sexual health among 82 monolingual Spanish-speaking, HIV-positive (n = 30) and at-risk women (n = 52), participating in the NOW en Español Project-a cognitive behavioral sexual risk-reduction intervention in Miami, Florida. Hispanic cultural values and beliefs, such as machismo, marianismo, and sexual silence, emerged throughout the intervention as important determinants of sexual behavior. Recommendations for integrating these culture-specific issues in sexual health interventions for Hispanic women are provided.

13.
AIDS Educ Prev ; 22(1): 61-8, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20166788

RESUMO

The purpose of this study was to investigate the extent to which intimate partner violence (IPV) influences antiretroviral medication adherence. Furthermore, it was hypothesized that adherence would differ for men and women based on degree of violence and coping strategies employed by each gender. A sample of HIV seroconcordant and serodiscordant heterosexual couples was recruited from the Miami area and assessed on rates of medication adherence, conflict resolution tactics, and coping strategies. Of these, 190 individual participants were prescribed antiretroviral medication. Baseline rates of adherence were 90.29% for men and 87.77% for women. Acts of violence were found to have negative effects on adherence for women but not for men. However, negative coping strategies were predictive of poor adherence for men but not women. Violence was found to be related to poor coping styles for both men and women. This study offers support for the inclusion of partners in conducting interventions. Furthermore, it underlines the importance of recognizing IPV as a barrier to medication adherence.


Assuntos
Adaptação Psicológica , Violência Doméstica , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/psicologia , Adesão à Medicação/psicologia , Parceiros Sexuais/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
14.
Am J Infect Dis ; 3(4): 240-247, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18668183

RESUMO

Antiretroviral (ARV) medication for substance users has been a controversial issue with respect to whether current substance users can successfully maintain their medication regimens. This study compared ARV adherence across current substance users, former substance users and those with no history or current use and the relative impact of a medication adherence intervention on all three groups. Of the 481 predominantly African American and Latina women from Miami, New York and New Jersey enrolled in the SMARTEST Women's Program, 338 participants were prescribed antiretroviral medication at study entry. All three groups, current users (n=60), former users (n=107) and never users (n=171), reported relatively high levels of adherence at baseline. Of those participants with less than 80% adherence at baseline, former users showed the most significant decrease in viral load post-intervention and at long term (two year) follow-up. These findings suggest former users to be the most reliable source of self-reported adherence and to profit most from the study intervention. They also suggest that additional research on targeted interventions for current substance users may be necessary to improve medication adherence for this group of women living with HIV.

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