scholarly journals Seeking a pot of gold with integrated behavior therapy and research to improve health equity: insights from the RAINBOW trial for obesity and depression

2021 ◽  
Author(s):  
Elizabeth M Venditti ◽  
Lesley E Steinman ◽  
Megan A Lewis ◽  
Bryan J Weiner ◽  
Jun Ma
Keyword(s):  
Mental Health ◽  
Behavioral Medicine ◽  
Behavior Therapy ◽  
Chronic Conditions ◽  
The United States ◽  
Multiple Chronic Conditions ◽  
Dissemination And Implementation ◽  
Physical And Mental Health ◽  
Medicine Research ◽  
Increased Risk

Abstract More than one third of adults in the United States (U.S.) live with multiple chronic conditions that affect their physical and mental health, functional outcomes, independence, and mortality. The COVID-19 pandemic has exposed not only an increased risk for infection, morbidity, and mortality among those with chronic conditions but long-standing health inequities by age, race, sex, and other social determinants. Obesity plus depression represent one such prevalent comorbidity for which few effective integrated interventions exist, prompting concern about the potential for secondary physical and mental health pandemics post COVID-19. Translational behavioral medicine research can play an important role in studying integrated collaborative healthcare approaches and advancing scientific understanding on how to engage and more effectively treat diverse populations with physical and mental health comorbidities. The RAINBOW (Research Aimed at Improving Both Mood and Weight) clinical trial experience offers a wealth of insights into the potential of collaborative care interventions to advance behavior therapy research and practice. Primary care patients with co-occurring obesity and depression were assigned to either Integrated Coaching for Mood and Weight (I-CARE), which blended Group Lifestyle Balance (GLB) for weight management and the Program to Encourage Active Rewarding Lives (PEARLS) for depression, or usual care, to examine clinical, cost-effectiveness, and implementation outcomes. This commentary highlights the empirical findings of eight RAINBOW research papers and discusses implications for future studies, including their relevance in the U.S. COVID-19 context. Organized by key principles of translational behavioral medicine research, the commentary aims to examine and embrace the heterogeneity of baseline and intervention response differences among those living with multiple chronic conditions. We conclude that to prevent health and healthcare disparities from widening further, tailored engagement, dissemination, and implementation strategies and flexible delivery formats are essential to improve treatment access and outcomes among underrepresented populations.

Individual and Organizational Factors Associated With Hospital Readmission Rates: Evidence From a U.S. National Sample

2019 ◽  
Vol 39 (10) ◽  
pp. 1153-1158 ◽  
Author(s):  
Kyaien O. Conner ◽  
Hongdao Meng ◽  
Victoria Marino ◽  
Timothy L. Boaz
Keyword(s):  
Hospital Readmission ◽  
Chronic Conditions ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
Severity Of Illness ◽  
Organizational Factors ◽  
The United States ◽  
Multiple Chronic Conditions ◽  
Important Indicator ◽  
Increased Risk

Objective: Hospital readmission rate is an important indicator for assessing quality of care in the acute and postacute settings. Identifying factors that increase risk for hospital readmissions can aid in the recognition of potential targets for quality improvement efforts. The main objective of this brief report was to examine the factors that predict increased risk of 30-day readmissions. Method: We analyzed data from the 2013 National Readmission Database (NRD). Results: The main factors that predicted increased risk of 30-day readmission were number of chronic conditions, severity of illness, mortality risk, and hospital ownership. Unexpectedly, discharge from a for-profit hospital was associated with greater risk for hospital readmission in the United States. Discussion and Conclusion: These findings suggest that patients with severe physical illness and multiple chronic conditions should be the primary targets for hospital transitional care interventions to help reduce the rate of unnecessary hospital readmissions.

scholarly journals Are all homebound older adults frail?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 777-778
Author(s):  
Orla Sheehan ◽  
Karen Bandeen-Roche ◽  
Christine Ritchie ◽  
Shang-En Chung ◽  
Jeremy Walston ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
The United States ◽  
Health Conditions ◽  
Multiple Chronic Conditions ◽  
Physical And Mental Health ◽  
Social Stressors ◽  
Services Utilization ◽  
Homebound Older Adults ◽  
Lower Educational Attainment

Abstract Seven million adults in the United States are homebound and suffer the negative, powerful synergies of multiple chronic conditions, functional impairment, social stressors, and limited social capital. The prevalence of frailty in this vulnerable homebound population is unknown. Using representative data from the National Health and Aging Trends study (NHATS) study linked to Medicare claims (n=4756) we sought to assess the prevalence of frailty in the homebound population (n=361). Among the homebound, 68.5% met the frailty criteria compared to 12.3% of the non-homebound population. The frail homebound had lower educational attainment, were more likely to live alone, self-reported poorer health and more chronic physical and mental health conditions than the non-frail homebound (p<0.05 for all). Frail homebound older adults utilized more health services utilization than non-frail homebound and were twice as likely to be hospitalized (49.8% versus 28.0%, p=0.004).

scholarly journals Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity

2021 ◽  
Vol 18 (5) ◽  
pp. 2615
Author(s):  
Hankyung Jun ◽  
Emma Aguila
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Race And Ethnicity ◽  
Chronic Conditions ◽  
Private Insurance ◽  
The United States ◽  
Mental Illnesses ◽  
Multiple Chronic Conditions

Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.

scholarly journals Perspective: Characterization of Dietary Supplements Containing Calcium and Magnesium and Their Respective Ratio—Is a Rising Ratio a Cause for Concern?

2020 ◽  
Author(s):  
Rebecca B Costello ◽  
Andrea Rosanoff ◽  
Qi Dai ◽  
Leila G Saldanha ◽  
Nancy A Potischman
Keyword(s):  
Dietary Supplements ◽  
Total Mortality ◽  
The United States ◽  
Multiple Chronic Conditions ◽  
Range Data ◽  
Increased Risk ◽  
High Calcium ◽  
Liquid Products ◽  
Calcium And Magnesium ◽  
Ratio Range

ABSTRACT Low magnesium intakes coupled with high calcium intakes and high calcium-to-magnesium (Ca:Mg) intake ratios have been associated with increased risk for multiple chronic conditions such as cardiovascular disease and metabolic syndrome, as well as some cancers (colorectal, prostate, esophageal), and total mortality. A high dietary Ca:Mg ratio (>2.60) may affect body magnesium status while, on the other hand, high intakes of magnesium could adversely impact individuals with an exceedingly low dietary Ca:Mg ratio (<1.70). Thus, a Ca:Mg ratio range of 1.70–2.60 (weight to weight) has been proposed as an optimum range. Data from NHANES surveys have shown the mean Ca:Mg intake ratio from foods alone for US adults has been >3.00 since 2000. One-third of Americans consume a magnesium supplement with a mean dose of 146 mg/d, and 35% of Americans consume a calcium supplement with a mean dose of 479 mg/d. Our review of Ca:Mg ratios in dietary supplements sold in the United States and listed in NIH's Dietary Supplement Label Database (DSLD) found a mean ratio of 2.90 across all calcium- and magnesium-containing products, with differences by product form. The ratios ranged from a low of 0.10 in liquid products to a high of 48.5 in powder products. Thirty-one percent of products fell below, 40.5% fell within, and 28.3% fell above the ratio range of 1.70–2.60. Our findings of calculated Ca:Mg ratios from dietary supplements coupled with food-intake data suggest that, in individuals with high calcium intakes from diet and/or supplements, magnesium supplementation may be warranted to establish a more favorable dietary Ca:Mg ratio in their total diet. Additional research may provide greater insight into whether the Ca:Mg ratio is a biomarker of interest for moderating chronic disease and which population groups may derive benefit from moderating that ratio.

Occupational Therapy Practitioners’ Perspectives of Mental Health Practices With Clients in Stroke Rehabilitation

2018 ◽  
Vol 38 (3) ◽  
pp. 181-189 ◽  
Author(s):  
Emily K. Simpson ◽  
Narissa M. Ramirez ◽  
Brittany Branstetter ◽  
Aileen Reed ◽  
Evan Lines
Keyword(s):  
Mental Health ◽  
Occupational Therapy ◽  
Online Survey ◽  
Emotional Health ◽  
The United States ◽  
Health Needs ◽  
Physical And Mental Health ◽  
Mental Health Needs ◽  
Post Stroke ◽  
Mental Health Practices

Following a stroke, depression and anxiety may negatively affect recovery and decrease quality of life. Occupational therapy (OT) practitioners are distinctly qualified to address both the physical and psychosocial sequelae of a stroke, including clients’ mental and emotional health. This study explored the ways in which OT practitioners address the mental health needs of clients post stroke. A sequential explanatory mixed-methods design was used to collect both survey and focus group data. In all, 754 OT practitioners across the United States completed an online survey, and 10 practitioners participated in focus groups. Practitioners considered their clients’ mental health needs to be a priority (68.17%); however, only 56.64% were satisfied with the care they provided related to mental and emotional health. They identified barriers that included limited time, increased productivity standards, expectations related to physical recovery, and poor educational preparation. Practitioners are motivated to improve their provision of mental health services to clients post stroke. To address the conflict between practice realities and professional values, education programs should better integrate curricular components that focus on physical and mental health.

scholarly journals Older Adults in the United States and COVID-19: A Qualitative Study of Perceptions, Finances, Coping, and Emotions

2021 ◽  
Vol 9 ◽  
Author(s):  
R. Turner Goins ◽  
Elizabeth Anderson ◽  
Hannah Minick ◽  
Heather Daniels
Keyword(s):  
Mental Health ◽  
United States ◽  
Older Adults ◽  
News Media ◽  
Emotional Health ◽  
The United States ◽  
Stress Appraisal ◽  
Risk Of Death ◽  
Increased Risk ◽  
Precautionary Measures

Introduction: Older adults have the poorest coronavirus (COVID-19) prognosis with the highest risk of death due to complications, making their COVID-19 experiences particularly important. Guided by the stress-appraisal-coping theoretical model, we sought to understand COVID-related perceptions and behaviors of older adults residing in the United States.Materials and Methods: We used convenience sampling to recruit persons with the following inclusion criteria: Aged ≥ 65 years, English fluency, and U.S. residency. Semi structured in-depth interviews were conducted remotely and audio recorded between April 25, 2020 and May 7, 2020. Interviews were professionally transcribed with a final study sample of 43. A low-inference qualitative descriptive design was used to provide a situated understanding of participants' life experiences using their naturalistic expressions.Results: The mean age of participants was 72.4 ± 6.7. Slightly over half were female (55.8%), 90.6% were White, and 18.6% lived alone. The largest percentages of participants resided in a rural area (27.9%) or small city (25.6%). We identified four themes, including (1) risk perception, (2) financial impact, (3) coping, and (4) emotions. Most participants were aware of their greater risk for poor COVID-19 outcomes but many did not believe in their increased risk. Financial circumstances because of the pandemic varied with largely no financial impacts, while others reported negative impacts and a few reported positive impacts. Coping was problem- and emotion-focused. Problem-focused coping included precautionary efforts and emotion-focused coping included creating daily structure, pursuing new and/or creative activities, connecting with others in new ways, and minimizing news media exposure. Overall, emotional health was negatively affected by the pandemic although some participants reported positive emotional experiences.Conclusions: Perceiving themselves as high risk for COVID-19 complications, older adults used precautionary measures to protect themselves from contracting the virus. The precautionary measures included social isolation, which can negatively affect mental health. Older adults will need to be resourceful and draw on existing resources to cope, such as engaging in creative activities and new strategies to connect with others. Our findings underscore the importance of the preservation of mental health during extended periods of isolation by taking advantage of low-to-no-cost existing resources.

scholarly journals QOL-51. LISTENING BEFORE WE SPEAK: A PATIENT-CENTERED APPROACH TO DEVELOPING RESOURCES FOR PEDIATRIC BRAIN TUMOR SURVIVORS AND THEIR FAMILIES

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii440-iii440
Author(s):  
Kathy Riley
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
United States ◽  
Brain Tumor ◽  
Mental Health Professionals ◽  
Pediatric Brain Tumor ◽  
The United States ◽  
Physical And Mental Health ◽  
Pediatric Brain

Abstract In the United States, more than 28,000 children and teenagers live with the diagnosis of a primary brain tumor (Porter, McCarthy, Freels, Kim, & Davis, 2010). In 2017, an estimated 4,820 new cases of childhood primary brain and other central nervous system tumors were expected to be diagnosed in children ages 0 – 19 in the United States (Central Brain Tumor Registry of the United States, 2017). Survivors suffer from lifelong side effects caused by their illness or by various treatments. Commonly identified late effects of treatment include a decline in intellectual functioning and processing speed, performance IQ deficits, memory deficits, psychological difficulties, deficits in adaptive functioning (daily life skills), and an overall decrease in health-related quality of life (Castellino, Ullrich, Whelen, & Lange, 2014). To address the ongoing challenges these survivors and their families face, the Pediatric Brain Tumor Foundation (PBTF) met extensively with working groups comprised of survivors and caregivers to develop the outline for a comprehensive Survivorship Resource Guidebook. In 2019, the PBTF published the guidebook which categorizes survivor and caregiver needs into three primary areas: physical and mental health, quality of life, and working the system. Expert authors included survivors and caregivers themselves in addition to medical and mental health professionals. Key outcomes discovered during the creation and production of this resource highlight how caregivers, survivors and professionals can collaborate to provide needed information and practical help to one segment of the pediatric cancer population who experience profound morbidities as a result of their diagnosis and treatment.

scholarly journals Baby Boomers Who Provide Informal Care for People Living with Dementia in the Community

2021 ◽  
Vol 18 (18) ◽  
pp. 9694
Author(s):  
Christina E. Miyawaki ◽  
Erin D. Bouldin ◽  
Christopher A. Taylor ◽  
Lisa C. McGuire
Keyword(s):  
Mental Health ◽  
Baby Boomers ◽  
Baby Boomer ◽  
Well Being ◽  
The United States ◽  
Health Condition ◽  
Behavioral Risk ◽  
Physical And Mental Health ◽  
Chi Square ◽  
Weighted Estimates

One in four Baby Boomers fills the informal caregiver role in the United States. The objectives of this study were to estimate the prevalence of Baby Boomers who are informal caregivers for people living with dementia and compare their physical and mental health status to caregivers for persons with conditions other than dementia using 2015–2018 Behavioral Risk Factor Surveillance System data (N = 10,602). We identified caregiving status (assisting a family member/friend with a long-term illness or disability in the past month, managing personal care, and not caring for a child/grandchild) and whether the care recipient’s major health condition was dementia. We calculated weighted estimates and used chi-square tests and log-binomial regression for comparisons of selected characteristics. Among Baby Boomer caregivers, 15.4% were caring for someone with dementia. Dementia caregivers were more likely to be female, caring for a parent/parent-in-law, and providing care longer than caregivers for persons without dementia. After adjusting for sociodemographic and caregiving characteristics, the prevalence of fair/poor health, frequent mental distress, and chronic conditions were similar across types of caregivers. Although no differences in caregiver’s physical and mental health by care recipient’s dementia status were found, we should underscore the importance of maintaining Baby Boomer caregivers’ health and well-being.

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