Medicine and Health Sciences Commons^™

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 …

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 …

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.

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 …

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 …

The Vida Verde Women's Coop:Brazilian Immigrants Organizing To Promote Environmental And Social Justice, David Gute, Carlos Eduardo Siqueira, Julia S. Goldberg, Heloisa Galvão, Monica Chianelli, Alex Pirie

C. Eduardo Siqueira

We reviewed the key steps in the launch of the Vida Verde Women’s Co-Op among Brazilian immigrant housecleaners in Somerville, MA. The co-op provides green housecleaning prod- ucts, encourages healthy work practices, and promotes a sense of community among its members. We conducted in-depth inter- views with 8 of the first co-op members, who reported a reduc- tion in symptoms associated with the use of traditional clean- ing agents and a new sense of mutual support. Critical to the co-op’s success have been the supportive roles of its academic partners (Tufts University and the University of Massachusetts, Lowell), effective media …

Care Management For Depression And Osteoarthritis Pain In Older Primary Care Patients: A Pilot Study, Ju ̈Rgen Unu ̈Tzer, Melinda Hantke, Diane Powers, Lori Higa, Elizabeth Lin, Steven D. Vannoy, Stephen Thielke, Ming-Yu Fan

Steven D Vannoy

Objective To establish the feasibility of and to generate preliminary evidence for the efficacy of a care management program addressing both physical and emotional pain associated with late-life depression and osteoarthritis. Methods Treatment development pilot study in three university affiliated primary care clinics. Participants were patients 60 years or older with depression and osteoarthritis pain. The intervention entailed a nurse administered care management program supporting depression and arthritis treatment by primary care physicians. Outcomes include depression, pain severity and functional impairment from pain assessed at baseline and 6 months. Results Fourteen patients participated in the pilot program. Between baseline and …

Professional Perspectives On Sexual Sadism, Julia E. Mclawsen, Rebecca L. Jackson, Steven D. Vannoy, Gregg J. Gagliardi, Mario J. Scalora

Steven D Vannoy

Significant controversy surrounds the diagnosis of sexual sadism. Research suggests that many characteristics attributed to sexual sadists fail to differentiate sexual offenders with and without this diagnosis. Furthermore, when there are differences between sadists and nonsadists, “sadistic” features are frequently associated with nonsadists. Finally, diagnosticians appear to use idiosyncratic methods to diagnose sexual sadism. These findings raise concerns about the reliability and validity of a diagnosis of sexual sadism, particularly with respect to how professionals conceptualize this diagnosis. This study examines how professionals understand the relative importance of behaviors associated with sadistic versus nonsadistic sexual offending. Professionals rated behaviors according …

Project Cobweb: A Report On Brazilian Immigrant Workers In Massachusetts, Carlos Eduardo Siqueira, Andrea Barbosa

C. Eduardo Siqueira

This second report focuses on Project COBWEB's occupational health and safety research findings, based on primary and secondary data collected in Massachusetts. The sources of data used in our analysis include:

• A survey of 626 Brazilian immigrant workers.
• 147 worker compensation cases of Work-Related injuries reported by Brazilian immigrant workers to the Brazilian Immigrant Center, located in Allston, Massachusetts.
• All 16 fatalities of Brazilian immigrant workers between 1999 and 2007. There is no record of fatalities of Brazilian workers prior to 1999.
• Blood samples of 61 Brazilian construction workers, collected at the Brazilian Immigrant Center in 2006 and 2007.

Integrating Mental Health And Primary Care, Stephen Thielke, Steven D. Vannoy, JüRgen UnüTzer

Steven D Vannoy

No abstract provided.

Let’S Not Talk About It: Suicide Inquiry In Primary Care, Mitchell D. Feldman, Peter Franks, Paul R. Duberstein, Steven D. Vannoy, Ronald Epstein, Richard L. Kravitz

Steven D Vannoy

ABSTRACT PURPOSE The purpose of this study was to ascertain physician characteristics associated with exploring suicidality in patients with depressive symptoms and the influence of patient antidepressant requests. METHODS Primary care physicians were randomly recruited from 4 sites in northern California and Rochester, NY; 152 physicians participated (53%-61% of those approached). Standardized patients portraying 2 conditions (major depres- sion and adjustment disorder) and 3 antidepressant request types (brand specific, general, or none) made unannounced visits to these physicians between May 2003 and May 2004. We examined factors associated with physician exploration of suicidality. RESULTS Suicide was explored in 36% of …

Models Of Care For Treating Late-Life Depression In Primary Care, Steven D. Vannoy, Diane Powers, JüRgen UnüTzer

Steven D Vannoy

No abstract provided.

The Relationship Between Suicide Ideation And Late-Life Depression, Steven D. Vannoy, Paul Duberstein, Kelly Cukrowicz, Elizabeth Lin, Ming-Yu Fan, Ju ̈Rgen Unu ̈Tzer

Steven D Vannoy

Objective: To describe the course of suicide ideation (SI) in primary-care based late-life depression treatment, identify predictors of SI, characterize the dynamic relationship between depression and SI, and test the hypothesis that collaborative care decreases the likelihood of reporting SI by decreasing the severity of depressive symptoms. Methods: This was a secondary analysis of a randomized controlled trial comparing collaborative care to usual care for late-life depression. Participants were 1,801 adults age 60 and older from eight diverse primary-care systems. Depression was measured using the Hopkins Symptoms Checklist (HSCL-20). SI was operation- alized using one item from the HSCL-20. Predictors …