Discussion : Among women who quit smoking during pregnancy, a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks. IntroductionApproximately one third of female smokers quit once they learn that they are pregnant ( Fingerhut, Kleinman, & Kendrick, 1990 ;Floyd, Rimer, Giovino, Mullen, & Sullivan, 1993 ;LeClere & Wilson, 1997 ;Severson, Andrews, Lichtenstein, Wall, & Zoref, 1995 ), but up to two thirds of women who stop smoking during pregnancy relapse within 6 months after delivery ( Colman & Joyce, 2003 ;Fingerhut et al., 1990 ;Martin et al., 2008 ;McBride & Pirie, 1990 ;McBride, Pirie, & Curry, 1992 ;Ratner, Johnson, Bottorff, Dahinten, & Hall, 2000 ). Women who remain tobacco abstinent after delivery experience health benefi ts that include protection of infants from secondhand smoke exposure, lower risk of poor pregnancy outcomes in subsequent pregnancies, and decreased personal risk of tobacco-related health problems ( Mullen, 2004 ). To increase the proportion of women who maintain tobacco abstinence after delivery, it is necessary to understand the modifi able factors associated with postpartum relapse to smoking.In the general population, depression, anxiety, and stress are more common among smokers than nonsmokers; these factors are barriers to smoking cessation and triggers for relapse AbstractIntroduction : The aim of this prospective repeated measures, mixed-methods observational study was to assess whether depressive, anxiety, and stress symptoms are associated with postpartum relapse to smoking.Methods : A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks. Surveys administered at baseline and at 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and stress (Perceived Stress Scale [PSS]). In-depth interviews were conducted with women who reported smoking.Results : Although 92% of the participants reported a strong desire to stay quit, 47% resumed smoking by 24 weeks postpartum. Baseline factors associated with smoking at 24 weeks were having had a prior delivery, not being happy about the pregnancy, undergoing counseling for depression or anxiety during pregnancy, and ever having struggled with depression ( p < .05). In a repeated measures regression model, the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers ( − 0.12 vs. +0.11 units/week, p = .03). The slope of PSS scores also differed between nonsmokers and smokers ( − 0.05 vs. +0.08 units/week, p = .04). In qualitative interviews, most women who relapsed attributed their relapse and continued smoking to negative emotions.

The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record

Purpose-The purpose of this study was to compare patient perceptions about medication management to principles underlying American Diabetes Association (ADA) published treatment algorithms.Methods-Six focus groups (4 English and 2 Spanish) were conducted with 50 patients with type 2 diabetes. Patients were asked about their prior experiences with initiating and changing oral medicines. They were also shown a medication plan for a hypothetical patient depicting future potential changes to achieve glycemic control. Coded responses were mapped to 3 concepts implicit in the ADA recommended treatment algorithm: (1) prescribing medicines to achieve A1c goal is beneficial, (2) medical regimens are generally intensified, and (3) intensification should be timely.Results-Patient perceptions contrasted markedly with the treatment algorithm: (1) most patients had negative perceptions of medication initiation, viewing this event as evidence of personal failure and an increased burden; (2) patients equated medication intensification with increased risk for diabetes-related complications (rather than a step to reduce future risk) and viewed deescalation as a primary goal; and (3) no patients expressed concerns about delays in medication intensification. Patients responded very favorably to an individualized medication plan depicting future potential changes.Conclusions-Patients in this study described a conceptual model for medication therapy that contrasted in critical ways from the principles of current treatment guidelines. Underscoring the key role of patient-provider communication, the results suggest that effective counseling should also include an informed discussion of future medication intensification.The incidence of type 2 diabetes (T2D) is increasing in the United States, particularly among Latinos. 1-3 Glycemia and related risk factors such as hypertension remain suboptimally controlled despite clear clinical trial evidence that effective treatment reduces both microvascular-and macrovascular-associated complications. 4,5 Despite an increasing number of approved medications, evidence from clinical practice reveals that there are frequent delays in medication initiation and regimen intensification over time. 6,7 This delay in optimizing treatment has been attributed to barriers at the level of the care system (eg,

The effects of patient and spouse mental and physical health quality of life on their own as well as their partner's relationship satisfaction differed across time which will inform psychosocial interventions for couples with prostate cancer. Copyright © 2015 John Wiley & Sons, Ltd.