Digital Commons Network^™

Celiac Is A Social Disease: Family Challenges And Strategies, Gonzalo Bacigalupe, Aleksandra Plocha

Gonzalo Bacigalupe, EdD, MPH

Celiac disease is the most common autoimmune inherited disorder in the United States, affecting approximately 1% of the population. Little research exists on the impact of family processes on adherence to a gluten-free diet (GFD), the only treatment for celiac disease. The objective of this qualitative study was to examine the barriers that families with a celiac child face and the strategies they use to adhere to the recommended diet. In-depth interviews were conducted with 10 families with a child between the ages of 6 and 12 diagnosed with celiac disease. Grounded theory and narrative analysis were used to analyze …

Pain Characteristics Associated With The Onset Of Disability In Older Adults: The Maintenance Of Balance, Independent Living, Intellect, And Zest In The Elderly Boston Study, Suzanne G. Leveille, Laura H.P. Eggermont

Suzanne G. Leveille

OBJECTIVES: To determine the effects of chronic pain

on the development of disability and decline in physical

performance over time in older adults.

DESIGN: Longitudinal cohort study with 18 months of

follow-up.

SETTING: Urban and suburban communities.

PARTICIPANTS: Community-dwelling older adults aged

65 and older (N = 634).

MEASUREMENTS: Chronic pain assessment consisted of

musculoskeletal pain locations and pain severity and pain

interference according to the subscales of the Brief Pain

Inventory. Disability was self-reported as any difficulty in

mobility and basic and instrumental activities of daily living

(ADLs, IADLs). Mobility performance was measured using the Short Physical Performance Battery …

Cultural Conversations With Brazilian And Dominican Transnationals: Implications For Health And Wellbeing, Cristina Brinkerhoff, Carlos Eduardo Siqueira, Rosalyn Negrón, Amanda Reich, Linda Sprague Martinez

C. Eduardo Siqueira

This poster summarizes the results of several cultural conversations with Brazilian and Dominican immigrants in Massachusetts, held during 2014.

Health Profile Of Brazilian Mothers In Massachusetts In The Twenty First Century, Carlos Eduardo Siqueira, Teresa Roberts, Fernanda Lucchese

C. Eduardo Siqueira

This paper describes the health profile of Brazilian mothers in Massachusetts according to data collected through Massachusetts Standard Certificate of Live Births (1989 revision) filed with the Massachusetts Registry of Vital Records and Statistics during 1999 and 2009. To our knowledge this is the first time that such information is reviewed with a focus on Brazilian immigrants. The findings of this article suggests that Brazilian mothers who gave birth in Massachusetts between 1999 and 2009 fared better than all mothers in Massachusetts in most obstetric health indicators considered.

The Impact Of Exercise On Suicide Risk: Examining Pathways Through Depression, Ptsd, And Sleep In An Inpatient Sample Of Veterans, Collin L. Davidson, Kimberly A. Babson, Marcel O. Bonn-Miller, Tasha Souter, Steven D. Vannoy

Steven D Vannoy

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this associ- ation, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was …

E-Health Innovations, Collaboration, And Healthcare Disparities: Developing Criteria For Culturally Competent Evaluation, Gonzalo Bacigalupe, Sabrina Askari

Gonzalo Bacigalupe, EdD, MPH

E-Health alters how health care clinicians, institutions, patients, caregivers, families, advocates, and researchers collaborate. Few guidelines exist to evaluate the impact of social technologies on furthering family health and even less on their capacity to ameliorate health disparities. Health social media tools that help develop, sustain, and strengthen the collaborative health agenda may prove useful to ameliorate health care inequities; the linkage should not, however, be taken for granted. In this article we propose a classification of emerging social technologies in health care with the purpose of developing evaluative criteria that assess their ability to foster collaboration and positively impact …

Characteristics, Management, And Depression Outcomes Of Primary Care Patients Who Endorse Thoughts Of Death Or Suicide On The Phq-9, Amy M. Bauer, Ya-Fen Chan, Hsiang Huang, Steven D. Vannoy, Jurgen Unuzter

Steven D Vannoy

BACKGROUND: With increasing emphasis on integrat- ing behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts. OBJECTIVE: To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depres- sion outcomes in a primary care-based mental health program. DESIGN: Observational analysis of data collected from a patient registry. PARTICIPANTS: Eleven thousand fifteen adults en- rolled in the Mental Health Integration Program (MHIP). INTERVENTIONS: MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model …

Activity Scheduling As A Core Component Of Effective Care Management For Late-Life Depression, Genevieve Riebe, Ming-Yu Fan, JüRgen UnüTzer, Steven D. Vannoy

Steven D Vannoy

Background: Activity scheduling is an established component of evidenced-based treatment for late-life depression in primary care. We examined participant records from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial to identify activity scheduling strategies used in the context of successful depression care management (CM), associations of activity scheduling with self-reported activity engagement, and depression outcomes. Methods: This study used observational mixed methods analysis of 4335 CM session notes from 597 participants in the intervention arm of the IMPACT trial. Grounded theory was used to identify 17 distinct activity categories from CM notes. Logistic regression was used to evaluate associations …

Management Of Persistent Pain In Older Adults: The Mobilize Boston Study, Suzanne G. Leveille, Carrie Stewart

Suzanne G. Leveille

OBJECTIVES: To describe the prevalence of pharmacological (PS) and nonpharmacological (NPS) pain management approaches used by older adults with persistent pain and to identify characteristics associated with use of these approaches.

DESIGN: Population-based cohort.

SETTING: Urban and suburban communities in the

Boston, Massachusetts, area.

PARTICIPANTS: Seven hundred sixty-five adults aged 64

and older underwent a home interview and clinic examination. Those reporting any persistent pain were included in this analysis (N = 599).

MEASUREMENTS: All prescription and nonprescription

medications were recorded during the home interview.

NPS modalities for pain management were assessed using

a modification of the Pain Management Inventory. …

Evaluating The Impact Of Patients’ Online Access To Doctors’ Visit Notes: Designing And Executing The Opennotes Project, Suzanne G. Leveille

Suzanne G. Leveille

Abstract

Background: Providers and policymakers are pursuing strategies to increase patient engagement in health care.

Increasingly, online sections of medical records are viewable by patients though seldom are clinicians’ visit notes

included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We

hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes

would not lead to significant disruptions to doctors’ practices.

Methods/Design: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse

healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; …

Immigrant Worker Conference Report, Carlos Eduardo Siqueira

C. Eduardo Siqueira

No abstract provided.

Anatomia Da Privatização Neoliberal Do Sistema Único De Saúde: O Papel Das Organizações Sociais De Saúde, Fabiano Tonaco Borges, Suzely Abas Saliba Moimaz, Carlos Eduardo Siqueira, Cléa Abas Saliba Garbin

C. Eduardo Siqueira

O objetivo da elaboração desta obra foi dissecar as partes

que compõem o processo de privatização do Sistema Único de Saúde (SUS). Para isto, utilizou-se, metaforicamente, o termo anatomia para descrever as estruturas do corpo chamado privatização do SUS. Importante ressaltar que o termo público se

sobressai em todo o texto numa referência ao povo, termo mais apropriado do que estatal na contraposição à coisa particular, de domínio privado.

Partiu-se do princípio que a dependência externa dos países em desenvolvimento propicia condições para a exportação do modelo privado de saúde a partir dos países desenvolvidos, em particular, os Estados Unidos. …

Vocational Health Schools (Etsus) In Brazil: Regulation Of The Integration Of Teaching-Service-Administrative Sustainability Of Etsus, Fabiano Tonaco Borges, Cléa Ada Saliba Garbin, Carlos Eduardo Siqueira, Artênio Jósé Crispin Garbin, Najara Barbosa Da Rocha, Luíz Fernando Lolli, Suzely Adas Saliba Moimaz

C. Eduardo Siqueira

The scope of this study was to discuss the administrative sustainability of Brazil’s Vo- cational Health Schools (ETSUS) based on the principle of teaching and service integration, which brings a new dimension to healthcare work as yet unregulated by Brazilian public adminis- tration. It was a qualitative study using case study methodology. The research involved a semi-struc- tured questionnaire given to ETSUS managers addressing institutional, administrative, and work management aspects. The sample was composed of 6 ETSUS that belong to the Network of Vocational Health Schools (RET-SUS). The ETSUS showed centralized planning and management, and decentralized implementation of their core …

Community-University Research Partnerships For Workers' And Environmental Health In Campinas Brazil, Maria Inês Monteiro, Carlos Eduardo Siqueira, Heleno Rodrigues Correa-Filho

C. Eduardo Siqueira

Three partnerships between the University of Campinas, community, and pubLic health care services are discussed in this article. A theoretical framework underpins the critical reviews of their accomplishments following criteria proposed by scholars of community-university partnerships and community-based participatory research. The article concludes that despite the significant achievements, there still remain important barriers for their development due to performance criteria that do not value research that partner with communities, health care services, or labor unions.

A Learning Collaborative Of Cmhcs And Chcs To Support Integration Of Behavioral Health And General Medical Care, Steven D. Vannoy, Barbara Mauer, John Kern, Kamaljeet Girn, Charles Ingoglia, Jeannie Campbell, Laura Galbreath, JüRgen UnüTzer

Steven D Vannoy

Objective: Integration of general medical and mental health services is a growing priority for safety-net providers. The authors describe a project that established a one-year learning collaborative focused on integration of services between community health centers (CHCs) and community mental health centers (CMHCs). Specific targets were treatment for general medical and psychiatric symptoms related to depression, bipolar dis- order, alcohol use disorders, and metabolic syndrome. Methods: This ob- servational study used mixed methods. Quantitative measures included 15 patient-level health indicators, practice self-assessment of resources and support for chronic disease self-management, and participant satisfaction. Results: Sixteen CHC-CMHC pairs were selected for …

Hopelessness And Suicidal Ideation In Iraq And Afghanistan War Veterans Reporting Subthreshold And Threshold Posttraumatic Stress Disorder, Matthew Jakupcak, Katherine D. Hoerster, Alethea Varra, Steven D. Vannoy, Bradford Felker, Stephen Hunt

Steven D Vannoy

Abstract: We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N 􏰀 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of elevated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more …

Suicide-Related Discussions With Depressed Primary Care Patients In The Usa: Gender And Quality Gaps. A Mixed Methods Analysis, Steven D. Vannoy, Lynne S. Robins

Steven D Vannoy

Objective: To characterise suicide-risk discussions in depressed primary-care patients. Design: Secondary analysis of recordings and self reports by physicians and patients. Descriptive statistics of depression and suicide-related discussion, with qualitative extraction of disclosure, enquiry and physician response. Setting: 12 primary-care clinics between July 2003 and March 2005. Participants: 48 primary-care physicians and 1776 adult patients. Measures: Presence of depression or suicide-related discussions during the encounter; patient and physician demographics; depression symptom severity and suicide ideation as measured by the Patient Health Questionnaire (PHQ9); physician’s decision-making style as measured by the Medical Outcomes Study Participatory Decision-Making Scale; support for autonomy as …

Opportunities And Challenges Of Implementing Collaborative Mental Health Care In Post-Katrina New Orleans, Wayne Bentham, Steven D. Vannoy, Katrina Badger, Ashley Wennerstrom, Benjamin F. Springgate

Steven D Vannoy

Increased community need for mental health resources and a desire to provide high quality, evidence-based, cost-effective care prompted REACH NOLA to create the Mental Health Infrastructure and Training (MHIT) program.

Mental Health Infrastructure And Training Project. Building Community Resilience Through Mental Health Infrastructure And Training In Post-Katrina New Orleans, Benjamin F. Springgate, Ashley Wennerstrom, Diana Meyers, Charles E. Allen, Steven D. Vannoy, Wayne Bentham, Kenneth B. Wells

Steven D Vannoy

No abstract provided.

Characteristics Of Chronic Pain Associated With Sleep Difficulty In Older Adults: The Maintenance Of Balance, Independent Living, Intellect, And Zest In The Elderly (Mobilize) Boston Study, Suzanne G. Leveille Phd, Qian Chen Bsn, Rn

Suzanne G. Leveille

OBJECTIVES: To evaluate pain severity and distribution

in relation to sleep difficulty in older adults.

DESIGN: Population-based cross-sectional study.

SETTING: Community within a 5-mile radius of the study

center at the Institute for Aging Research, Hebrew Senior-

Life (HSL), Boston.

PARTICIPANTS: Seven hundred sixty-five participants of

the Maintenance of Balance, Independent Living, Intellect,

and Zest in the Elderly (MOBILIZE) Boston Study aged 64

and older.

MEASUREMENTS: Pain severity was measured using the

Brief Pain Inventory (BPI) Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, two or more sites, and widespread pain

(upper and lower …

Advantages Of Using Estimated Depression- Free Days For Evaluating Treatment Efficacy, Steven D. Vannoy, Patricia Arean, JüRgen UnüTzer

Steven D Vannoy

Objective: Several common methods for measuring treatment response present a snapshot of depression symptoms. The construct of estimated depression-free days (DFDs) simultaneously captures treatment outcome and estimates the patient’s experience of depression over time. The study compared this measure with traditional measures used in depression treatment research. Methods: This secondary data analysis was based on data from the Improving Mood—Promoting Access to Collaborative Treatment trial, a multisite depression treatment study conducted in 18 primary care clinics in five states and representing eight health care sys- tems. The sample of older adults (N=906) had been randomly assigned to receive collaborative care …

Chapter Four: Parenting An Emerging Adult - 101, Varda Konstam

Varda Konstam

Parents of emerging adults are exploring terra incognito. It’s not that there are no rules; it’s that the rules are obsolete. They no longer fit today’s realities. For reasons we’ve discussed (and for others that we will discuss), it’s just not as easy for emerging adults today to jump into the river of adulthood as it was for previous generations. That means parents are likely to remain active parents for longer than ever before. And most of us are pretty clueless about how to make it work. Anxiety is inevitable given the lack of guidance and certainty. However, we can …

“They Don't Want Anything To Do With You”: Patient Views Of Primary Care Management Of Chronic Pain., Gonzalo Bacigalupe

Gonzalo Bacigalupe, EdD, MPH

No abstract provided.

Community Violence As Psychosocial Stressor: The Case Of Childhood Asthma In Boston, Gonzalo Bacigalupe, Takeo Fujiwara, Sabrina Selk, Meghan Woo

Gonzalo Bacigalupe, EdD, MPH

Childhood asthma is a critical public health problem of urban centers in the United States and other industrialized nations. Population-based and laboratory research studies indicate that psychosocial stress differentially affects asthma expression. Witnessing or experiencing community violence is a psychosocial stressor that results in long-term biological changes that may in turn contribute to asthma morbidity. This is a review of the literature that examines the exposure to violence as a psychosocial stressor that is independently associated with asthma morbidity even after adjustment for income, housing, and other adverse life events. In addition to acting as a physiological trigger for the …

Suicide Inquiry In Primary Care: Creating Context, Inquiring, And Following Up, Steven D. Vannoy, Tonya Fancher, Caitlyn Meltvedt, JüRgen UnüTzer, Paul Duberstein, Richard L. Kravitz

Steven D Vannoy

ABSTRACT PURPOSE We wanted to describe the vocabulary and narrative context of pri- mary care physicians’ inquiries about suicide. METHODS One hundred fifty-two primary care physicians (53% to 61% of those approached) were randomly recruited from 4 sites in Northern California and Rochester, New York, to participate in a study assessing the effect of a patient’s request for antidepressant medication on a physician’s prescribing behavior. Standardized patients portraying 2 conditions (carpal tunnel syndrome and major depression, or back pain and adjustment disorder with depressed mood) and 3 antidepressant request types (brand-specific, general, or none) made 298 unan- nounced visits to …

Tender Point Count, Pain, And Mobility In The Older Population: The Mobilize Boston Study, Suzanne G. Leveille, Laura H.P. Eggermont

Suzanne G. Leveille

Abstract: Prevalence of tender points (TP), and widespread pain and fibromyalgia, as well as the relationship between TP and widespread pain and mobility, was examined in 585 community-dwelling older adults (mean age 78.2 years, 63.4% female). Pain was based on location (none, single site, multisite, widespread). Mobility was measured by the Short Physical Performance Battery (SPPB), gait speed, and self-reported (S-R) mobility difficulty. Tender-point count and health characteristics (ie, BMI, chronic conditions, analgesic use, number of medications, depression, and blocks walked per week) were assessed. Several participants had 3 or more TP (22.1%) although prevalence of criteria-based fibromyalgia was low …

Gender Differences In Presenting And Prodromal Stroke Symptoms, Eileen Stuart-Shor, Gregory A. Wellenius, Donna Dello Iacono, Murray A. Mittleman

Eileen Stuart-Shor

BACKGROUND AND PURPOSE: Prompt recognition of stroke symptoms is critical to timely treatment and women have increased delay to treatment. Women may be more likely to present with atypical symptoms, but this hypothesis has not been extensively evaluated.

METHODS: We examined gender differences in the prevalence of presenting and prodromal stroke symptoms among 1107 consecutive patients hospitalized with neurologist-confirmed acute ischemic stroke. Patient demographics, clinical variables, and stroke symptoms were abstracted from medical records by trained abstractors using standardized forms. Estimates were age-standardized to the age distribution of men and women combined. Presenting symptoms occurred within 24 hours of incident …

Course Of Suicide Ideation And Predictors Of Change In Depressed Older Adults, Kelly C. Cukrowicz, Paul R. Duberstein, Steven D. Vannoy, Thomas R. Lynch, Douglas R. Mcquoid, David C. Steffens

Steven D Vannoy

Background—Rates of suicide among older adults in the United States are higher than that of other age groups. Therefore, it is critically important to deepen understanding of the processes that drive suicide risk among at-risk older patients. To this end, we examined the longitudinal course of suicide ideation in a sample of treatment-seeking depressed adults 60 years of age or older. Methods—Secondary analyses were conducted with a longitudinal dataset including 343 older adults seeking treatment for depression in the context of a naturalistic treatment setting. Participants completed assessments of depressive symptoms and thoughts of suicide every three months for one …

Physical Activity And Executive Function In Aging: The Mobilize Boston Study, Suzanne G. Leveille, Laura H.P. Eggermont

Suzanne G. Leveille

OBJECTIVES: To determine the relationship between

physical activity and cognition, specifically executive function, and the possible mediating role of factors such as cardiovascular disease (CVD) and CVD risk factors, chronic

pain, and depressive symptoms.

DESIGN: Cross-sectional study.

SETTING: Population-based study of individuals aged 70 and older in the Boston area.

PARTICIPANTS: Older community-dwelling adults (n5

544; mean age 78, 62% female).

MEASUREMENTS: Presence of heart disease (self-reported

physician diagnosed), pain, and depressive symptomatology

were assessed using interviewer-administered questions.

Blood pressure was measured. Engagement in physical activity was determined using the Physical Activity Scale for

the Elderly (PASE). Cognitive function was …

Chronicmusculoskeletal Pain And The Occurrence Of Falls In An Older Population, Suzanne G. Leveille

Suzanne G. Leveille

Context Chronic pain is a major contributor to disability in older adults; however, the potential role of chronic pain as a risk factor for falls is poorly understood.

Objective To determine whether chronic musculoskeletal pain is associated with an increased occurrence of falls in a cohort of community-living older adults.

Design, Setting, and Participants The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study is a population-based

longitudinal study of falls involving 749 adults aged 70 years and older. Participants were enrolled from September 2005 through January 2008.

Main Outcome Measure Participants recorded falls on …