Contextualizing Help-Seeking Attitudes and Help-Seeking Intention: The Role of Superwoman Schema among Black College Women.

Black women are less likely to seek psychological help and underutilize mental health services. Although help-seeking attitudes and intentions are associated in the general population, less is known about this relationship among Black women in college. In this cross-sectional study, we investigated the relationship between help-seeking attitudes and intention among 167 self-identified Black women in college. We also investigated if dimensions of the Superwoman Schema (i.e., an obligation to display strength, resistance to being vulnerable, an obligation to suppress emotions, an intense motivation to succeed despite limited resources, and an obligation to help others) moderated this relationship. Findings indicated a significant positive relationship between help-seeking attitudes and help-seeking intention. Regarding moderation, an obligation to suppress emotions, resistance to vulnerability, and an obligation to help others interacted with help-seeking attitudes in predicting help-seeking intention. Notably, low adherence to an obligation to suppress emotions, resistance to vulnerability, and an obligation to help others were associated with high levels of help-seeking intention. However, more favorable help-seeking attitudes improved help-seeking intention for participants high in adherence to these dimensions. Our findings suggest that understanding the relevance of the Superwoman Schema among Black women is critical for increasing help-seeking behavior.

Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area.

INTRODUCTION: Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care. METHODS: Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity. RESULTS: Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model. DISCUSSION: With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.

Assessing Hair Concerns and Physical Activity Measures Among African American Women: a Mixed-Method Exploratory Study.

OBJECTIVES: Research on the association between hair concerns and physical activity (PA) constructs among African American (AA) women is lacking. Demographics such as age and income are indicated to influence hair concerns. In this study, quantitative methods were used to assess demographic differences in hair concerns and associations between hair concerns and PA. Qualitative interviewing explored AA women's views about their hair and engagement in PA. METHODS: Participants (n = 48; M age = 37.57, SD = 13.72) completed a survey that included demographics, hair type and hairstyle management (HTHM), decisional balance (pros, cons), perceived benefits and perceived barriers scale, and level of physical activity. HTHM consists of six items measuring different factors related to hair concerns. 25 completed a qualitative interview. Chi-square or analysis of variance tests were conducted as appropriate. Qualitative data were analyzed using content analysis. RESULTS: Proportion differences were noted between age groups (≤ 32 vs. ≥ 33) and average cost of haircare per month (p = .048). A statistically significant effect was noted for average monthly haircare cost and pros (p = .05), and for alter behavior due to hair concerns and perceived benefits to physical activity (p = .05). For level of physical activity, proportion differences were noted between exercisers and non-exercisers for average minutes spent on hair care (p = .009). Qualitative results showed few participants view hair concern as an important barrier to PA. Some participants suggested strategies for overcoming hair concerns to exercise (e.g., braids, twists). CONCLUSION: Implications of findings including development of PA intervention approaches that may appeal to AA women are discussed.

Gendered racism, anxiety, and depression: the mediating roles of gendered racialized stress and social isolation.

OBJECTIVE: Black women experience unique stressors linked to the intersection of racism and sexism (i.e. gendered racism). While the negative effects of gendered racism are associated with Black women's health, less is known about factors that describe these relationships. DESIGN: Using data from 263 Black women, we used path analysis to examine direct and indirect effects of gendered racism on anxiety and depression through gendered racialized stress. We also examined the direct and indirect effects of gendered racialized stress on anxiety and depression through social isolation. RESULTS: After adjusting for covariates, gendered racism, and gendered racialized stress were not statistically significant predictors of anxiety and depression. However, gendered racism was a statistically significant predictor of gendered racialized stress. Also, social isolation mediated the relationships between gendered racism, gendered racialized stress, and anxiety, as well as depression. CONCLUSIONS: Stress from gendered racism is associated with loneliness, which can negatively impact Black women's mental health. Findings suggest that gendered racialized stress and social isolation is important for understanding the relationship between gendered racism and mental health outcomes, such as anxiety and depression.

Perinatal Complications, Poor Hospital Treatment, and Positive Screen for Postpartum Depressive Symptoms Among Black Women.

Though mandatory screening for depression during pregnancy and the postpartum period is recommended, postpartum depression is still underdiagnosed and overlooked among Black women. Understanding risk factors during pregnancy and delivery that may increase the risk for postpartum depression is important for Black women. Thus, the purpose of this study is to examine the relationship between perinatal complications (i.e., preterm birth, low birth weight, gestational diabetes, unplanned cesarean section, undesired pregnancy, depression during pregnancy), poor hospital treatment, and postpartum depressive symptoms (i.e., depressed mood, anhedonia, and positive screen on PHQ-2) among Black women. Using the Listening to Mothers III survey, we conducted logistic regression analyses in a nationally representative sample of 368 Black women to examine the relationship between perinatal complications, poor hospital treatment, and positive screen for postpartum depressive symptoms, measured by the Patient Health Questionnaire-2 (PHQ-2). We also examined these factors in predicting anhedonia and depressed mood. Poor hospital treatment was associated with a positive screen for postpartum depression, anhedonia, and depressed mood. Perinatal complications, when measured continuously, were associated with a positive screen for depression and depressed mood. Gestational diabetes and preterm birth were associated with depressed mood while depression during pregnancy was associated with anhedonia. Perinatal complications during pregnancy and delivery may increase the risk for postpartum depression among Black women. When screening for postpartum depression, it may also be important to inquire about poor hospital treatment and stressors emanating from these experiences.

Clinicians' Perspectives on Racism and Black Women's Maternal Health.

Objective: The objective of this study was to explore clinician perceptions of how racism affects Black women's pregnancy experiences, perinatal care, and birth outcomes. Materials and Methods: We conducted 25 semi-structured interviews with perinatal care clinicians practicing in the San Francisco Bay Area (January to March 2019) who serve racially diverse women. Participants were primarily recruited through "Dear Perinatal Care Provider" email correspondences sent through department listservs. Culturally concordant, qualitatively trained research assistants conducted all interviews in person. The interviews ranged from 30 to 60 minutes and were audio-recorded and professionally transcribed verbatim. We used the constant comparative method consistent with grounded theory to analyze data. Results: Most participants were obstetrician/gynecologists (n = 11, 44%) or certified nurse midwives (n = 8, 32%), had worked in their current role for 1 to 5 years (n = 10, 40%), and identified as white (n = 16, 64%). Three themes emerged from the interviews: provision of inequitable care (e.g., I had a woman who had a massive complication during her labor course and felt like she wasn't being treated seriously); surveillance of Black women and families (e.g., A urine tox screen on the Black baby even though it was not indicated, and they didn't do it on the white baby when, in fact, it was indicated); and structural care issues (e.g., the history of medical racial experimentation). Conclusion: Clinicians' views about how racism is currently operating and negatively impacting Black women's care experiences, health outcomes, and well-being in medical institutions will be used to develop a racial equity training for perinatal care clinicians in collaboration with Black women and clinicians.

A national study of the influence of adverse childhood experiences on depression among Black adults in the United States.

BACKGROUND: There is a paucity of research examining the influence of adverse childhood experiences (ACEs) on depression among Black adults in the United States. This national study examined the influence of ten widely studied ACEs on past year major depressive episode (PY-MDE) among 6081 Black adults in the United States and in the context of other risk and protective factors. Other risk factors were intimate partner violence victimization, gender discrimination, and racial discrimination. Protective factors were religious service attendance and ethnic identity. METHODS: Data were drawn from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: Results from stratified analyses revealed that for both sexes, participants who reported any of the five types of child abuse/neglect or any of the five types of household dysfunction had greater odds of PY-MDE when controlling for other risk and protective factors. Some types of ACEs had a greater influence on PY-MDE than intimate partner violence, gender discrimination, or racial discrimination. LIMITATIONS: This study was cross-sectional. CONCLUSIONS: Findings document the long-term effects of ACEs on PY-MDE among Black adults nationally.

The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans.

This study investigates how mediating (e.g. history of health conditions) and moderating (e.g. self-rated health) factors are associated with nativity status on depression and anxiety in Mexican immigrants. Using data from the 2019 National Health Interview Survey (NHIS), results found a significant direct association between nativity status and anxiety and depression. Additionally, the association between nativity status and mental health was mediated by the history of health conditions, and self-rated health was a significant moderator in both mediation models. Study findings are discussed within the context of barriers to care, current literature, and strengths-based interventions. Future research can expand upon these findings by examining the specific types of physical and mental health conditions that may support the Hispanic Paradox, as well as how self-efficacy and internal locus of control are associated with the paradox within this population.

Association between superwoman schema, depression, and resilience: The mediating role of social isolation and gendered racial centrality.

OBJECTIVES: We examined dimensions of Superwoman Schema as predictors of both depression and resilience. We also investigated if social isolation and gendered racial centrality mediated these relationships. METHOD: We used path analysis to investigate the direct and indirect effects of an obligation to display an image of strength, emotional suppression, and resistance to vulnerability on depressive symptoms through social isolation. We also explored the direct and indirect effects of an intense motivation to succeed and an obligation to help others on resilience through gendered racial centrality. RESULTS: Emotional suppression and an obligation to help others were directly associated with depression. Emotional suppression, resistance to vulnerability, and an obligation to help others were indirectly associated with depression through social isolation. In contrast, an obligation to display an image of strength and an intense motivation to succeed was associated with resilience and gendered racial centrality. CONCLUSION: Findings highlight the unique complexity of Superwoman Schema as suggested within qualitative research. Black women's endorsement of Superwoman Schema may be both adaptive in navigating interlocking systems of oppression and psychologically distressing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Shannon D. Jones, MLS, MEd, AHIP, FMLA, Medical Library Association President, 2022-2023.

In this profile, Shannon D. Jones, MLS, MEd, AHIP, FMLA, Medical Library Association President, 2022-2023, MJ Tooey describes her as someone who "takes chances on people, valuing those others might not see as valuable". Jones embraces lifelong learning, and it shows up in her collegiate journey; she has been a student of leadership, a leader of institutions, especially within the Medical Library Association (MLA); and a leader in librarianship. She is a trailblazer, the second African American MLA president, and a champion of diversity, equity, inclusion, and belonging. Jones has been Director of Libraries & Professor at the Medical University of South Carolina (MUSC) for the past seven years and is also Director of Region 2 of the National Network of Libraries of Medicine, National Library of Medicine.

Psychological Distress and Attitudes Toward Seeking Professional Psychological Services Among Black Women: the Role of Past Mental Health Treatment.

Black women are one of the most underserved and undertreated minority groups in the USA. While Black women generally do not seek professional psychological services to manage psychological distress, recent findings suggest an openness to mental health treatment as a form of self-care. This study investigated the relationship among symptoms of anxiety, depression, and post-traumatic stress as a predictor of attitudes toward professional psychological help (i.e., psychological openness, help-seeking propensity, and indifference to stigma) in a sample of 205 Black women. We also examined if past mental health treatment (i.e., counseling or therapy) moderated these relationships. Results indicated that symptoms of anxiety, depression, and post-traumatic stress were all negatively associated with help-seeking propensity and indifference to stigma. Only symptoms of post-traumatic stress were negatively associated with psychological openness. Findings also demonstrated that past mental health treatment moderated the relationship among depressive symptoms and help-seeking propensity and indifference to stigma, respectively. Specifically, as depressive symptoms increased, help-seeking propensity significantly decreased among participants who had not reported past mental health treatment. Additionally, indifference to stigma decreased with increased symptoms of depression, though the decline in indifference to stigma was greater among those who did not report past mental health treatment. We also found similar results for symptoms of post-traumatic stress with regard to indifference to stigma. Findings suggest that Black women's past mental health treatment may be relevant to understanding attitudes toward seeking professional psychological services when experiencing high psychological distress.

Emotional Eating Predicts Weight Regain Among Black Women in the SisterTalk Intervention.

OBJECTIVE: This study aimed to assess effects of emotional eating and stress on weight change among Black women in a culturally tailored weight-control program. METHODS: SisterTalk, a cable-TV-delivered weight-control randomized trial, included 331 Black women (aged 18-75 years; BMI ≥ 25 kg/m2) in Boston, Massachusetts. BMI and waist circumference (WC) were assessed at baseline and 3, 8, and 12 months post randomization. Frequency of "eating when depressed or sad" (EWD) and "eating to manage stress" (ETMS) (i.e., "emotional eating") and perceived stress were also assessed. Lagged analyses of data for intervention participants (n = 258) assessed associations of BMI and WC outcomes at each follow-up visit with EWD and ETMS frequency and stress measured at the most recent prior visit. RESULTS: At 3 months (immediately post intervention), BMI decreased for women in all EWD and ETMS categories but increased at later follow-up for women reporting EWD and ETMS always/often. In addition, 8-month EWD and ETMS predicted 12-month BMI change (both P < 0.05). Higher perceived stress was associated with higher EWD and ETMS; however, stress was not associated with lagged BMI or WC at any time. CONCLUSIONS: Addressing emotional eating and related triggers may improve weight maintenance in interventions with Black women.

Sialendoscopy and Sjogren's Disease: A Systematic Review.

OBJECTIVES/HYPOTHESIS: This study is a systematic review of the literature which seeks to estimate the expected treatment outcomes of a patient with Sjogren's syndrome (SS) undergoing therapeutic sialendoscopy. STUDY DESIGN: Systematic Review. METHODS: PubMed, Scopus, and Cochrane library databases were used to search for studies published as of August 2020 regarding the treatment outcomes of SS with sialendoscopy. The key search terms included "Sjogren's syndrome" and "sialendoscopy." Only studies in the English language involving more than one human patient were included. PRISMA guidelines were followed in study inclusion and data extraction. The primary outcome assessed was improvement in patient symptoms. RESULTS: Six studies met criteria and were analyzed in this review, including 125 patients undergoing sialendoscopy of parotid and/or submandibular glands as well as 25 controls. Of these patients, 90% were female with an age range of 18 to 79 years. There was significant diversity in outcome reporting tools. The outcomes of symptom improvement were pooled qualitatively based on improvement noted in each study. Outcomes were defined as partial improvement if the measured outcomes improved and complete improvement if measured outcomes resolved entirely. Despite the limited number of studies on this topic, this meta-analysis suggests that a similar study of therapeutic sialendoscopy could expect to provide at least temporary improvement of symptoms 90% to 99% of the time. CONCLUSIONS: This review provides support for the application of sialendoscopy in the treatment of SS salivary disease. Larger studies with consistent outcome reporting tools and control groups are needed to validate these results and provide a consistent therapy protocol. Laryngoscope, 131:1474-1481, 2021.

Prophylactic hemoclips in prevention of delayed post-polypectomy bleeding for ≥ 1 cm colorectal polyps: meta-analysis of randomized controlled trials.

Background and aim Studies evaluating the role of prophylactic hemoclips (HC) in prevention of delayed post-polypectomy bleeding (DPPB) have reported conflicting results. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the role of prophylactic HC placement in prevention of DPPB for polyps ≥ 1 cm in size. Methods We reviewed several databases to identify RCTs evaluating the role of HC in prevention of DPPB. The outcomes assessed included prevention of DPPB with polyps 1 to 1.9 cm, ≥ 2 cm, any polyp ≥ 1 cm, proximal colon polyps, distal colon polyps, and perforation. We analyzed data using a fixed effect model and reported summary pooled risk ratios (RR) with 95 % confidence intervals (CI). We assessed heterogeneity with the I 2 statistic. Results We included nine RCTs with 4550 patients. For polyps ≥ 2 cm, there was a statistically significantly lower risk of DPPB with use of HC; RR 0.55, 95 % CI 0.36, 0.86. There was also a statistically significantly lower risk for proximal colon polyps ≥ 2 cm; RR 0.41 (0.24, 0.70) but no significant difference for distal polyps; RR 1.23 (0.45, 3.32). There was also no significant difference in risk for polyps 1 to 1.9 cm; RR 1.07 (0.59, 1.97). There was no significant reduction in risk of perforation with HC use for any polyp size. Conclusions Prophylactic HC placement is effective in prevention of DPPB from proximal colon polyps ≥ 2 cm, but of no significant benefit for polyps 1 to 1.9 cm in size or for distal colon polyps ≥ 2 cm.

Death Anxiety, Religious Doubt, and Depressive Symptoms across Race in Older Adults.

The purpose of this study is to investigate the direct and indirect relationships among death anxiety, religious doubt, and depressive symptoms in older adults. This study also investigates race as a moderator for these relationships. This study used data from the Religion, Aging, and Health Survey. Participants identified as Christian, identified as Black or White, lived in a non-institutionalized household within the U.S., were retired, and spoke English. Using PROCESS, results revealed that religious doubt partially mediated the relationship between death anxiety and depressive symptoms. Furthermore, moderated mediation models revealed that race moderated the relationship between religious doubt and depressive symptoms. Specifically, there was significant, positive relationship between religious doubt and depressive symptoms for participants who identified as Black but not White. Results highlight how religious doubt can influence depressive outcomes among the geriatric communities of color. Limitations and future directions are also discussed.

Preparing for Practice: Strengthening Third-Year Medical Students' Awareness of Point-of-Care Resources.

This column describes the development and implementation of a responsive library course designed to train third-year medical students as they begin their clerkships. The course design consisted of a brief face-to-face introduction during third-year orientation and an online course developed in Canvas, an online learning management system. The objective of the course was to not only introduce students to the resources but also to teach them how to effectively use those resources at the point-of-care. Students evaluated the course to assess the overall effectiveness of the instruction. Course development and content, feedback provided by students, as well as suggestions for improvement are discussed.

Fine specificity of drug-dependent antibodies reactive with a restricted domain of platelet GPIIIA.

Drug-induced immune thrombocytopenia is caused by drug-dependent antibodies (DDAbs) that bind tightly to platelet glycoproteins only when drug is present. How drugs mediate this interaction is not yet resolved. Several studies indicate that sites recognized by DDAbs tend to cluster in specific structural domains, suggesting they may recognize a limited number of distinct epitopes. To address this issue, we characterized the binding sites for 16 quinine-dependent antibodies thought on the basis of preliminary studies to be possibly specific for a single epitope on glycoprotein IIIa (GPIIIa). Fourteen of the antibodies reacted with a 29-kDa GPIIIa fragment comprising only the GPIIIa hybrid and plextrin-semaphorin-integrin homology domains. However, studies with mutant GPIIIa and the blocking monoclonal antibody AP3 showed that the 14 DDAbs recognize at least 6 and possibly more distinct, but overlapping, structures involving GPIIIa residues 50 to 66. The findings suggest that even antibodies specific for restricted domains on a target glycoprotein may each have a slightly different fine specificity; ie, "unique" epitopes recognized by DDAbs may be rare or nonexistent. The observations are consistent with a recently proposed model in which drug reacts noncovalently with both target protein and antibody to promote binding of an otherwise nonreactive immunoglobulin.

Family History of Diabetes, Acculturation, and the Metabolic Syndrome among Mexican Americans: Proyecto SALSA.

BACKGROUND: The purpose of this study was to examine effect modifiers of the relationship between family history of diabetes, a proxy for genetic predisposition, and the metabolic syndrome. METHODS: Subjects were a cross-sectional sample of 205 Mexican-Americans patients of the San Ysidro Health Center in San Diego County. Self-reported parental history of diabetes was examined as a risk factor for individual metabolic syndrome traits (hyperglycemia, hypertension, abdominal obesity, hypertriglyceridemia and low HDL-cholesterol) and a composite phenotype, defined both by standard modified National Cholesterol Education Program- Adult Treatment Panel III (NCEP-ATPIII) criteria and using principal components analysis, in age and sex-adjusted multiple logistic and linear regression models. RESULTS: Family history of diabetes was most strongly associated with individual traits of hyperglycemia (P = .0002) and low HDL-C (P = .001) and conferred a significant increased odds of metabolic syndrome defined by both NCEP-ATPIII criteria (odds ratio 3.57, 95% confidence interval 1.82, 7.01; P = .0002) and by principal components analysis (P = 0.003). Moreover, the family history association with metabolic syndrome was modified by number of years living in the United States (interaction P = .04). This same effect was not seen for diabetes (P = .19). CONCLUSIONS: The results of our study support a common etiology for at least some components of the metabolic syndrome, especially hyperglycemia and low HDL-cholesterol, the basis of which may be genetic. Moreover, the effect of genes on these traits may be modified by longer duration in the United States, supporting the concept of gene-environment interaction in the development of the metabolic syndrome.