Tailoring Trauma-Sensitive Yoga for High-Risk Populations in Public-Sector Settings

2021 ◽  
Author(s):  
Jordan E. Cattie ◽  
Lucy J. Allbaugh ◽  
Katherine H. Visser ◽  
Ilana Ander ◽  
Nadine J. Kaslow
Keyword(s):  
High Risk ◽  
Low Income ◽  
Interpersonal Violence ◽  
Group Intervention ◽  
Suicide Attempts ◽  
Culturally Adapted ◽  
Evidence Based Treatments ◽  
History Of ◽  
High Risk Populations ◽  
Group Members

Abstract Low-income, racial-minority, high-risk populations have limited access to evidence-based treatments for posttraumatic stress disorder (PTSD), and their acceptance of complementary interventions is unknown. Trauma Center Trauma-Sensitive Yoga (TC-TSY), which has demonstrated efficacy in community samples, has not yet been widely used with ethnic minority low-income individuals. This article presents a culturally tailored version of a TC-TSY intervention delivered as a drop-in service in a public hospital–based clinic to patients with histories of interpersonal violence and suicide attempts. TC-TSY was iteratively tailored to meet the unique clinical needs of individuals within this setting. Group facilitator observations are summarized; they describe a successful initial implementation and culturally informed adaptation of the group intervention. The facilitators’ observations illustrated that group members accepted the integration of this structured, gentle yoga practice into outpatient behavioral health programming and identified site-specific modifications to inform formal study. The process by which TC-TSY was adapted and implemented for Black individuals with a history of interpersonal trauma at risk for suicidal behavior can serve as a guide for tailoring other complementary, integrative interventions to meet the needs of unique clinical settings. This process is offered as a foundation for future systematic testing of this complementary, integrated, culturally adapted trauma therapy in high-risk clinical populations.

scholarly journals Determinants for undetected dementia and late-life depression

2013 ◽  
Vol 203 (3) ◽  
pp. 203-208 ◽  
Author(s):  
Ruoling Chen ◽  
Zhi Hu ◽  
Ruo-Li Chen ◽  
Ying Ma ◽  
Dongmei Zhang ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Low Income ◽  
Late Life ◽  
Female Gender ◽  
Service Development ◽  
Late Life Depression ◽  
History Of ◽  
High Risk Populations ◽  
Low Levels

BackgroundDeterminants for undetected dementia and late-life depression have been not well studied.AimsTo investigate risk factors for undetected dementia and depression in older communities.MethodUsing the method of the 10/66 algorithm, we interviewed a random sample of 7072 participants aged ⩽60 years in six provinces of China during 2007–2011. We documented doctor-diagnosed dementia and depression in the interview. Using the validated 10/66 algorithm we diagnosed dementia (n= 359) and depression (n= 328).ResultsWe found that 93.1% of dementia and 92.5% of depression was undetected. Both undetected dementia and depression were significantly associated with low levels of education and occupation, and living in a rural area. The risk of undetected dementia was also associated with ‘help available when needed‘, and inversely, with a family history of mental illness and having functional impairment. Undetected depression was significantly related to female gender, low income, having more children and inversely with having heart disease.ConclusionsOlder adults in China have high levels of undetected dementia and depression. General socioeconomic improvement, associated with mental health education, targeting high-risk populations are likely to increase detection of dementia and depression in older adults, providing a backdrop for culturally acceptable service development.

Mortality in Prisons: The Experience of the Bureau of Legal Medicine of Milan (Italy) (1993–2017)

2021 ◽  
Vol 61 (1_suppl) ◽  
pp. 67-76
Author(s):  
Guendalina Gentile ◽  
Marta Nicolazzo ◽  
Rachele Bianchi ◽  
Paolo Bailo ◽  
Michele Boracchi ◽  
...  
Keyword(s):  
High Risk ◽  
Suicide Attempts ◽  
Early Death ◽  
Healthcare Services ◽  
Psychiatric Disease ◽  
Quality Healthcare ◽  
History Of ◽  
The University ◽  
Different Characteristics ◽  
Detention Facilities

We undertook a retrospective analysis of deaths that took place in prisons in Milan between 1993 and 2017, by identifying cases from a total of 24,101 autopsies that were performed at the Section of Forensic Medicine of the University of Milan. From the archives of this institution, we found 227 autopsy reports relating to deaths that had taken place in one of Milan’s three detention facilities. These deaths were divided into two types: natural deaths ( n=135; 59.5%) and violent deaths ( n=92; 40.5%). The groups have different characteristics: while natural deaths mostly resulted from cardiovascular diseases, suicides were mainly the result of hanging. Further, people who died by suicide often had a history of psychiatric disease and/or drug abuse, and over a quarter of them had previous suicide attempts and/or had declared suicidal intentions. This study confirms the need for good quality healthcare services for prisoners, given that they remain a population at high risk of early death.

Nine Psychiatric Inpatients who Leaped from a Height*

1984 ◽  
Vol 29 (2) ◽  
pp. 129-131 ◽  
Author(s):  
Gary W. Small ◽  
Jerrold F. Rosenbaum
Keyword(s):  
High Risk ◽  
Social Isolation ◽  
Suicide Attempts ◽  
Treatment Plan ◽  
Psychiatric Inpatients ◽  
Recent Change ◽  
Hospital Treatment ◽  
Common Features ◽  
History Of ◽  
Chronic Psychosis

The authors describe nine psychiatric inpatients from the same hospital who leaped from a height. Common features included youth, social isolation, diagnosis of schizophrenia, and chronic psychosis despite neuroleptic therapy. All had prolonged hospitalizations and a history of assaults, suicide attempts, or both. The authors suggest that these characteristics in conjunction with a recent change in hospital treatment plan or loss of social sup-ports may identify patients at high-risk for violent self-destructive acts.

scholarly journals Assessment of hepatitis B in high risk people of Gachsaran city, Iran

2017 ◽  
Vol 5 (3) ◽  
pp. 888
Author(s):  
Mona Khajavian ◽  
Asghar Sharifi
Keyword(s):  
High Risk ◽  
Hepatitis B ◽  
Drug Users ◽  
Educational Status ◽  
Risk Groups ◽  
Infection Prevalence ◽  
Serum Samples ◽  
Major Health Problem ◽  
History Of ◽  
High Risk Populations

Background: Hepatitis B virus (HBV) is a major health problem throughout the world. The aim of this study determines the rate of prevalence of molecular and Seroepidemiological hepatitis B infections high risk populations in the Gachsaran city, according to factors such as age, sex, employment status, educational status etc.Methods: In a descriptive and analytical study, blood samples have been collected from 500 high risks individuals, from February 2015 to July 2016 in Gachsaran. The serum samples were tested by ELISA and PCR method was used to confirm the diagnosis. Data were analyzed by SPSS statistical program.Results: HBsAg was detected in 5 out of the 500 individuals, giving an overall prevalence of 1%. All the positive samples were in males. The rate of infection among the individuals with a history of unprotected sexual contact was 8% and was 0% among the individuals who experienced a needle stick. Four out of the five infected persons with hepatitis didn’t receive any vaccination and one of them received only one dose of vaccine.Conclusions: The results showed 1% infection at high-risk groups in the Gachsaran city. Age rising, maleness, unemployment, low educational level and suspicies sexual partners have been the factors of increasing HBV infection prevalence. Full vaccination has a strong and meaningful relationship with hepatitis B in the target groups, which requires all people at risk to be vaccinated completely. Government cooperation to identify and treat injecting drug users and encourage them to follow the preventive methods is beneficial.

Gender and Racial Differences for Suicide Attempters and Ideators in a High-Risk Community Corrections Population

Crisis ◽  
2013 ◽  
Vol 34 (1) ◽  
pp. 50-62 ◽  
Author(s):  
Cheryl B. McCullumsmith ◽  
C. Brendan Clark ◽  
Adam Perkins ◽  
Jessaka Fife ◽  
Karen L. Cropsey
Keyword(s):  
Risk Factors ◽  
African American ◽  
High Risk ◽  
Psychotropic Medication ◽  
Suicide Attempts ◽  
Community Corrections ◽  
History Of ◽  
And Gender ◽  
Gender Groups ◽  
Corrections Population

Background: Community corrections populations are a high-risk group who carry multiple suicide risk factors. Aims: To identify factors correlated with historical suicide attempts and ideation among African-American men, African-American women, White men, and White women in a community corrections population. Method: Self-report data from 18,753 enrollees in community corrections were analyzed. Multinomial logistic regression analyses were conducted to determine associations between historical suicidal ideation and attempts among the four demographic groups. Results: Participants with historical suicide attempts tended to be younger, White, female, be taking psychotropic medication, have a history of physical or sexual abuse, and meet criteria for dependence on alcohol, amphetamines, cocaine, opioids, or sedatives. Five variables were commonly associated with suicide attempts for all four race/gender groups: younger age, being on disability or retirement, taking psychotropic medication, history of sexual or physical abuse, and cocaine dependence. Other demographic variables had race or gender specificities as risk factors for suicide attempts. Conclusions: Participants had high rates of historical suicide attempts with unique correlates differentiating attempters from ideators among different racial and gender groups. Cocaine dependence was universal predictor of suicide attempts, while other substance dependencies show specific racial and gender profiles associated with suicide attempts.

Genetic counseling and testing of an underserved population at a large city hospital.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 38-38
Author(s):  
Kathie-Ann P. Joseph ◽  
Shubhada Dhage ◽  
Kenneth Rifkind
Keyword(s):  
Genetic Counseling ◽  
High Risk ◽  
Low Income ◽  
Breast Surgery ◽  
Personal History ◽  
Counseling And Testing ◽  
Number Of Patients ◽  
Risk Patients ◽  
History Of ◽  
Racial Ethnic

38 Background: Genetic counseling and testing for hereditary breast and ovarian cancer is underutilized in low-income and racial/ethnic women. We examine the number of patients referred for genetic counseling over from 2011-2012, clinic referral pattern, and number of patients tested in a population of largely underserved, immigrant patient population. Methods: The study was conducted in Bellevue Hospital. A retrospective review of patients referred to this institution’s high-risk clinic was analyzed. Demographics, insurance status, BRCA status, if tested, and source of referral were collected. Results: Between 2011-2012, 196 patients were referred for genetic counselling. The majority of the referrals came from specialty clinics: Breast Surgery (42%), Medical Oncology (24%) and Gyn (8.7%). 17.5% were classified as other. One percent of consults came from internal medicine, 0.5% from women’s clinic, 4% were referred from family members. Of those patients counseled, 83 were tested. Breast surgery had the highest yield with 49% of the patients tested, followed by med onc (33%). One patient refused testing. Forty-seven of our patients were able to receive genetic testing through Myriad hardship, thirty-three through Medicaid, two paid by Bellevue Hospital, and one by private insurance. Five patients were BRCA1 positive, five patients were BRCA2 positive (12% of patients tested); An additional five patients were BRCA2 MUS. Racial/ethnic breakdown of the BRCA positive patients were 40% Asian, 20% Latina, 30% African American, 10% White. Four patients had a personal history of BrCa, two patients personal history of OvCa, one patient personal history of BCa/OvCa, and three patients FHBCa/OvCa. Conclusions: Genetic testing for HBOC can be underutilized in low-income and racial/ethnic women due to lack of insurance and lack of education. It is possible to get many high-risk women tested and most patients are receptive to testing when the benefits of testing are clearly explained. Our results indicate that while cancer specialists are referring high-risk patients, there may be room for education on the part of primary care specialists to refer more unaffected high risk patients. This may afford patients the opportunity to make better informed screening and treatment decisions.

scholarly journals Adverse Outcomes, Polysubstance Use, and Polypharmacy in Older Veterans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 746-747
Author(s):  
Amy Byers
Keyword(s):  
High Risk ◽  
Suicide Prevention ◽  
Suicide Attempts ◽  
Late Life ◽  
Adverse Outcomes ◽  
Emergency Department Visits ◽  
Adverse Health Outcomes ◽  
Polysubstance Use ◽  
History Of ◽  
Sedative Hypnotics

Abstract This session will provide information about adverse health outcomes, including suicide, suicide attempts and unintended death, that may be related to polysubstance use and polypharmacy in older adults, particularly older veterans. It will further provide information that will help support late-life suicide prevention and intervention efforts. Older veterans (age50 and older) have the highest number of lives lost to suicide, make up majority of the veteran population, and are highly likely to experience conditions (e.g., chronic pain, sleep disorders, musculoskeletal) associated with commonly prescribed medications that are potential markers for suicide risk (hereafter referred to as “high-risk” drug categories), including benzodiazepines, sedative-hypnotics, opioids, antidepressants, antipsychotics, and antiepileptics. The research presented in this session will highlight important patterns in high-risk drug prescribing and use and related outcomes in late life. The presentations will underscore various groups of older veterans that may be important to consider and, yet, neglected in the polysubstance and polypharmacy and suicide prevention conversation, including those who recently attempted suicide, veterans with late-life posttraumatic stress disorder (PTSD), and older veterans transitioning from prison to community. Drs. Maust and Morin will present findings on prescribing and use of high-risk medications in late life, including an overview of trends in polypharmacy and associations with suicide attempts. Drs. Byers and Barry will speak about older veterans with PTSD and those with a history of incarceration, with information on suicide, unintended death by overdose, and substance use disorder-related emergency department visits and hospitalizations, emphasizing importance of care transition models for prevention. Aging, Alcohol and Addictions Interest Group Sponsored Symposium.

Predictors of compliance in colposcopy clinic follow-up among the uninsured

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20511-e20511
Author(s):  
L. Wenzel ◽  
D. Chase ◽  
J. Hawk ◽  
K. Osann ◽  
K. Tewari
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Low Income ◽  
Pap Smear ◽  
Median Income ◽  
Screening Programs ◽  
Low Income Population ◽  
History Of ◽  
Colposcopy Clinic

e20511 Background: Despite successful screening programs for cervical cancer, ethnic disparities persist. The no-show rate for follow-up appointments after HPV-related abnormal pap smears approximates 50% in high risk populations. We sought to identify factors that may influence follow-up compliance in a multi-ethnic, low income population at risk for cervical cancer. Methods: A longitudinal cohort study was conducted by chart review for all patients identified as having had a colposcopy exam for HPV-associated cervical dysplasia at a southern California inner city clinic from 2006 to 2007. Compliance was defined as obtaining a pap smear within 3 to 14 months from the initial colposcopy. The following variables were evaluated in a multivariate logistic regression model to identify factors which predicted follow-up compliance: race, age, preferred language, insurance, income, marital status, cytology, histology, history of a LLETZ, and pregnancy status. Results: During the study period, 438 patients attended the colposcopy clinic. This approximates 52% of the 912 scheduled clinic appointments during 2006. Patients’ median age was 28 years, 41% were Spanish speaking, with an estimated median income of less than $20,000 for half of the sample. Approximately 71% of patients had temporary publically-funded insurance. Only 55% (239/438) returned for recommended follow-up pap smear. In univariate and multivariate analysis, neither language, Spanish surname, median income, age, histology, nor insurance status predicted adequate follow-up (p=ns). A history of having undergone a large loop excision of the transformation zone (LLETZ) was the only factor which significantly predicted compliance with recommended follow-up pap smear (OR=1.76; 95% CI 1.08–2.895). Conclusions: Follow-up compliance for this high-risk, low income population is very poor. Identifying factors which predict noncompliance could inform strategies to improve care. In this analysis a history of LLETZ was the only variable which predicted whether follow-up care occurred as recommended. Results suggest that intensive, culturally-sensitive colposcopy clinic-based educational interventions should be developed and evaluated. No significant financial relationships to disclose.

scholarly journals A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)

2006 ◽  
Vol 36 (12) ◽  
pp. 1747-1757 ◽  
Author(s):  
GUILHERME BORGES ◽  
JULES ANGST ◽  
MATTHEW K. NOCK ◽  
AYELET MERON RUSCIO ◽  
ELLEN E. WALTERS ◽  
...  
Keyword(s):  
High Risk ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Characteristic Curve ◽  
Risk Index ◽  
Parental Psychopathology ◽  
Risk Category ◽  
National Comorbidity Survey Replication ◽  
National Comorbidity Survey ◽  
History Of

Background. Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators.Method. The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, sociodemographics, parental psychopathology and 12-month DSM-IV disorders.Results. Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2·6, 0·7 and 0·4% respectively. Although ideators with a plan are more likely to make an attempt (31·9%) than those without a plan (9·6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators [area under the receiver operator characteristic curve (AUC)=0·88]. The distribution (conditional probability of attempt) of the risk index is: 19·0% very low (0·0%), 51·1% low (3·5%), 16·2% intermediate (21·3%), and 13·7% high (78·1%). Two-thirds (67·1%) of attempts were made by ideators in the high-risk category.Conclusions. A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.

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