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1.
Gen Hosp Psychiatry ; 90: 124-131, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39178701

RESUMEN

OBJECTIVE: Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. METHODS: We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS: 1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. CONCLUSIONS: A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms.


Asunto(s)
Derivación y Consulta , Humanos , Derivación y Consulta/estadística & datos numéricos , Femenino , Adulto , Embarazo , Complicaciones del Embarazo/terapia , Complicaciones del Embarazo/diagnóstico , Trastornos Mentales/terapia , Trastornos Mentales/diagnóstico , Pacientes Internos/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/diagnóstico , Adulto Joven , Centros de Atención Terciaria , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Estudios Retrospectivos
2.
Clin Obstet Gynecol ; 67(1): 169-185, 2024 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-38281174

RESUMEN

Perinatal mood and anxiety disorders and substance use disorders are the primary causes of maternal mortality in the postpartum period and represent major public health concerns. Despite this, these conditions remain undertreated. Behavioral health integration in outpatient obstetric settings is necessary but insufficient to meet the needs of all patients. Inpatient behavioral health integration represents a promising avenue for addressing gaps in care. Results from recent program development indicate that needs assessment, stakeholder backing, collaboration with existing programs, and adaptability are key factors in successful implementation.


Asunto(s)
Pacientes Internos , Periodo Posparto , Embarazo , Femenino , Humanos , Desarrollo de Programa , Afecto , Mortalidad Materna
3.
Health Equity ; 3(1): 238-245, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31289784

RESUMEN

Purpose: There is increasing research on positive body image, but no studies to date have examined these constructs in lesbian, bisexual, and queer (LBQ) women. However, LBQ women are at increased risk for mental health concerns and disordered eating, and there is evidence that body appreciation might be both adaptive and protective. This study examined factors that could uniquely relate to body appreciation in LBQ women. Method: Women identifying as LBQ (N=150) completed demographics and measures of social support, resilience, self-esteem, and body appreciation. We tested a hypothesized mediational model of social support leading indirectly to body appreciation through resilience and self-esteem, controlling for body mass index. Results: All direct effects, except social support to body appreciation (p=0.696), were significant (ps=0.017-0.001), reflecting a full multiple mediation. As hypothesized, the effect of social support on body appreciation was indirect (p=0.011), through resilience and self-esteem. Conclusion: This is the first study to investigate factors that might facilitate positive body image in LBQ women. Although preliminary, results suggest social support, resilience, and self-esteem might be important targets of body image interventions with LBQ women.

4.
Am J Health Promot ; 32(4): 906-915, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29121792

RESUMEN

PURPOSE: Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. DESIGN: Cross-sectional online survey. SETTING: Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. PARTICIPANTS: Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. MEASURES: Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. ANALYSIS: Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. RESULTS: Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. CONCLUSION: Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Patient Protection and Affordable Care Act , Servicios Preventivos de Salud/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Aceptación de la Atención de Salud/psicología , Servicios Preventivos de Salud/legislación & jurisprudencia , Servicios de Salud Reproductiva/legislación & jurisprudencia , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
5.
Body Image ; 23: 114-125, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28965052

RESUMEN

Social media appear to contribute to body dissatisfaction in adolescents, although few empirical studies exist. This study used six focus groups (total N=38) to explore relations between social media use and body image in early adolescent girls (ages 12-14). Thematic analysis identified patterns in the data. In this sample, social media use was high. Girls endorsed some appearance concerns and social comparison, particularly with peers. However, they displayed high media literacy, appreciation of differences, and confidence, strategies that appeared helpful in mitigating the potential negative association between social media exposure and body image. Girls reported these characteristics were nurtured by positive parental influence and a supportive school environment. Results support an ecological approach to the prevention of body dissatisfaction. Although peer influence strengthens throughout adolescence, current findings suggest that parents and the school environment are associated with girls' attitudes and behaviors regarding social media and body image.


Asunto(s)
Actitud , Imagen Corporal/psicología , Grupo Paritario , Medios de Comunicación Sociales , Percepción Social , Adolescente , Niño , Femenino , Humanos , Masculino
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