Social Ecological Approach to Factors Influencing Perinatal Mental Health Service Provision Among Providers in Bulloch County, GA

Perinatal mental illness pertains to pregnancy-related mental health complications, which could last as long as one year post-delivery. Despite the high prevalence of PMI, there remains a poor accessibility and utilization of mental health services, especially in the rural America. Hence, using the Social Ecological Model (SEM), we aim to identify factors influencing perinatal mental health service provision among providers in Bulloch County, GA. Using a random sampling method, we recruited 15 mental health providers in Bulloch County through professional networks who completed open-ended surveys between January 31 and March 5 of 2021. The open-ended survey was guided by the SEM constructs, which included Individual, Interpersonal, Organizational, Community, and Policy factors. The Qualitative thematic analysis was conducted using NVivo software. Major barriers among providers include lack of available resources and lack of rapport among patients and providers. Major facilitator themes included increase in mental health screening, rapport building, education, and awareness. This study suggests the introduction of group therapies in public communal areas is helpful. Findings from this study will be useful in developing tailored interventions to address barriers to perinatal mental health-care utilization experienced by both women and perinatal mental health-care providers

Red Blood Cell Folate and Cardiovascular Deaths Among Hypertensive Adults, an 18-year Follow-up of a National Cohort

A shift towards high folate concentration has emerged following folate fortification. However, the association between folate and health outcomes beyond neural tube defects remains inconclusive. To assess the relationship between red blood cell (RBC) folate and the risk of cardiovascular death among hypertensive patients, we analyzed the data of 2,986 adults aged 19 or older with hypertension who participated in the National Health and Nutrition Examination Survey (1991–1994) as the baseline examination and were followed up through December 31, 2010. After 32,743 person-years of follow-up with an average of 11.7 (standard error = 0.03) years, 1192 deaths were recorded with 579 cardiovascular deaths. The median survival time was significantly shorter in adults in the high folate quartile than in patients in the low folate quartile: 11.97 vs. 13.85 years for heart diseases and 13.37 vs. 14.82 years for myocardial infarction deaths. The cardiovascular mortality was 13.04, 16.95, and 26.61/1,000 person-years for the groups with low, intermediate and high folate quartiles, respectively. After adjustment for age, sex and other factors, a J-shaped association emerged. The hazard ratios (HRs) of all cardiovascular deaths in patients with low, intermediate, and high folate quartiles were 1.09 (0.94, 1.27), 1.00 (reference), and 1.44 (1.31, 1.58), respectively. The corresponding HRs of acute myocardial infarction were 1.13 (0.86, 1.50), 1.00, and 2.13 (1.77, 2.57), respectively. The estimates remained significant after adjustment for BMI and medication use. Compared to moderate RBC folate levels, high folate levels were significantly associated with an increased risk of cardiovascular deaths, especially acute myocardial infarction

Association Between Serum Folate and Cardiovascular Deaths Among Adults With Hypertension

Background A significant shift toward high folate concentrations has been taking place following the mandatory folate fortification. Yet the relationship between folate and health outcomes beyond neural tube defects remains understudied. We longitudinally examined relationships between serum folate and risk of cardiovascular death. Methods We analyzed data of 3116 adults aged ≥19 who participated in the Third National Health and Nutrition Examination Survey, 1991–1994 and were diagnosed with hypertension. Vital status was followed through December 31, 2010. Cox regression was used to estimate hazard ratios (HRs) of cardiovascular deaths for individuals with serum folate in the first quartile and fourth quartile compared with the patients with interquartile folate. Results After 33627 person years (p*ys) of follow-up, 1298 deaths were recorded with 638 cardiovascular disease (CVD) deaths (109 strokes and 529 heart diseases). A U-shaped association appeared after multivariable adjustment for heart disease, acute myocardial infarction, and overall CVD deaths. The mortality rate for heart disease in patients with low, moderate, and high folate were 12.18/1000 p*ys, 14.12/1000 p*ys, and 23.80/1000 p*ys, respectively, and the corresponding adjusted HRs were 1.79 (95% confidence interval, CI = 1.63–1.98), 1.00 (reference), and 1.31 (1.17–1.46). The HRs of acute myocardial infarction were 2.28 (1.80–2.88), 1.00 (reference), and 1.77 (1.42–2.20) for hypertensive patients with serum folate in low quartile, interquartile, and high quartile, respectively. Conclusions Among hypertensive adults, both low and high folate were associated with an elevated risk of dying from cardiovascular diseases compared with adults with moderate serum folate concentration

Investigating the association between multiple substance Use and dating violence involvement among U.S adolescents

Adolescent dating violence and substance use are clinical and public health concerns. Prior meta-analytic studies indicate that about 20% of adolescents reported having experienced physical dating violence (PDV) and 10% reported sexual dating violence (SDV). This study aims to assess the prevalence of dating violence, and the association between substance use and dating violence among adolescents. Our study population is derived from the 2019 Youth Risk Behavior Surveillance System (YRBSS)a cross-sectional, nationally representative survey of United States (U.S) adolescents. The sample comprised 13,677 adolescents between the ages of 13–19 years currently enrolled in school. Descriptive analysis estimated the prevalence of dating violence and substance use. Multiple logistic regression adjusted for confounders of the association between substance use and dating violence. The confounders adjusted for include sex, school grade, race, academic grade, and duration of night sleep. The prevalence of PDV and SDV was each 8.2%. Only 2.6% of this nationally representative sample had experienced both PDV and SDV. Adolescents who used three or more substances had 2.1 times higher odds of PDV (OR = 2.10, 95% CI = 1.27–3.47, p < 0.0001), and SDV (OR = 2.11, 95% CI = 1.34–3.34, p < 0.0001) respectively, and 2.8 (OR = 2.75, 95% CI = 1.34–5.61, p < 0.0001) times higher odds of both PDV and SDV in the past month. Multiple substance use increases the odds of dating violence. Policy and interventions should be focused on preventing substance use initiation among substance-naïve adolescents and to advocate abstinence and gradual reduction of substances used to mitigate the prevalence of dating violence