Assessing contextual factors for implementing evidence-based care in a middle income country in the wake conflict: the Colombian mental health system

The negative impact, or burden of disease, for mental health problems is high across the globe, especially in low- and middle-income countries (LAMICs) in the aftermath of violent conflicts. Evidence-based psychological treatments (EBPTs) are time-limited and cost-effective and potentially could be implemented across mental health service delivery systems in LAMICs. In addition, EBPTs that are culturally-adapted have been shown to be effective at alleviating mental health symptoms and improving individuals’ functioning in LAMICs. Colombia has recently emerged from over 50 years of war, resulting in the largest number of internally displaced persons in any one country and 8 million officially recognized victims. As a result, the Colombian leadership has passed legislation to address the mental health needs of victims. The current study aimed to identify perceptions of EBPTs as well as barriers and facilitators that may impact wide-scale dissemination of EBPTs in Colombia for victims of the armed conflict who suffer from anxiety, mood, and traumatic stress symptoms. Data were gathered from 35 stakeholders (e.g., leaders, providers, victims) from the Colombian health care system utilizing mixed-methods of qualitative (i.e., semi-structured interviews) and quantitative measurement (i.e., questionnaires). Findings indicate that, at the individual level, victims of the armed conflict face many barriers to care (e.g., economic hardship; internalized stigma impairing treatment seeking). At the system-level, victims face barriers to access to care (e.g., few available services). In addition, system-level barriers include ineffectual applications of laws and policies for victims’ care, ineffective quality checks for services, high turnover of providers and moderately unfavorable view of EBPTs at the provider and leader levels. Some mitigating factors that may facilitate care for victims include demonstrated satisfaction with treatment by victims as well as laws that ensure provision of care. At present, barriers outweigh facilitators to providing services, including EBPTs, to victims of the armed conflict. These barriers and facilitators should be taken into account when implementing services and should be the subject of future research and policy development to best provide highly needed services to the many victims of the armed conflict in Colombia

Study of immune response and uptake of lipid-soluble vitamins by dairy cattle

Vitamin A, D and E are lipid-soluble nutrients essential for many physiologic and immune functions. Effects of active metabolites of vitamin A and D, retinoic acids (RA) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D 3), respectively, are mediated by their nuclear receptors. Because of the well-known roles of these vitamins, they are fed to periparturient cows and neonatal calves at levels that exceed NRC requirements by several fold. There are concerns that feeding greater than the NRC requirements of these vitamins might have deleterious effects on their uptake and on the functional capacity of the immune system. The objective of the first two studies was to evaluate the in vitro effects of 1,25(OH)2D3, two synthetic analogues of vitamin D, and all-trans-, 9-cis-, 13-cis-, and 9,13-dicis-RA on interferon-gamma (IFN-gamma) secretion by mononuclear leukocytes (MNL) from postparturient cows and nulliparous heifers. We showed that 1,25(OH)2D3 and its fluorinated analog (Delta22-26-F3-1,25(OH)2 D3) inhibited IFN-gamma secretion. Our results showed that individual RA isomers had no effect on IFN-gamma secretion whereas combinations of all-trans-RA with 9-cis-, 13-cis-, or 9,13-dicis-RA and of 9-cis-RA with 13-cis- or 9,13-dicis-RA as well as 1,25(OH)2D3 with 9-cis-RA inhibited IFN-gamma secretion. These results and those indicating 1,25(OH)2D3 and RA potentiate IgM production by bovine MNL, suggest that these vitamins may selectively promote differentiation of bovine T-cell subsets toward a Th2-like phenotype. In the third study, we evaluated feeding 20- to 40-fold the NRC requirements of vitamin A and two forms of vitamin E (alcohol and acetate ester) on the uptake of vitamin E by plasma lipoproteins in newborn calves. Our results showed that feeding greater than the NRC requirement of vitamin A decreases concentrations of vitamin E in plasma lipoproteins. Because of the critical antioxidant role of vitamin E, the health-related consequences associated with depression of lipoprotein vitamin E must be investigated. The form of vitamin E had no effect on concentrations of vitamin E associated with plasma lipoproteins suggesting the more stable and less costly RRR-alpha-tocopheryl acetate be used as a dietary supplement in calves

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

OBJECTIVE: This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder). METHOD: Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest. RESULTS: In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESɢ: UP = −1.72; SDP = −1.98), social anxiety (ESɢ: UP = −1.33, −0.86; SDP = −1.60, −1.54), and depression (ESɢ: UP = −0.83; SDP = −0.84). Significant differences were not observed in between-group comparisons. CONCLUSIONS: Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.Please note the following financial disclosures/conflicts of interest: Dr. Barlow reported receiving royalties from Oxford University Press, United Kingdom (which includes royalties for the treatment manuals included in this study); Guilford Publications Inc., United States; Cengage Learning, United States; Pearson Publishing, United Kingdom. He reported receiving grants from the National Institute of Mental Health, United States (R01 MH090053) and the National Institute of Alcohol and Alcohol Abuse, United States (R01 AA023676). He reported serving as a consultant for and receiving honoraria from the Agency for Healthcare Research and Quality, United States; the Foundation for Informed Medical Decision Making, United States; the Department of Defense, United States; the Renfrew Center, United States; the Chinese University of Hong Kong, Hong Kong;Universidad Catolica de Santa Maria, Peru); New Zealand Psychological Association, New Zealand; Hebrew University of Jerusalem, Israel; Mayo Clinic, United States; and various American universities. (R01 MH090053 - National Institute of Mental Health, United States; R01 AA023676 - National Institute of Alcohol and Alcohol Abuse, United States)Accepted manuscrip

Relationship among blood indicators of lipomobilization and hepatic function during early lactation in high-yielding dairy cows

Blood indicators are used as a tool to diagnose metabolic disorders. The present work was conducted to study the relationships among blood indicators of lipomobilization and hepatic function in high-yielding dairy cows. Two groups of Holstein cows were studied: 27 early lactation cows and 14 mid lactation cows from four different herds with similar husbandry characteristics in Galicia, Spain. Blood samples were obtained to measure beta-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), triglycerides (TG), and the activity of aspartate transaminase (AST) and gamma-glutamyl transferase. Cows in early lactation had higher levels of BHB and NEFA than mid lactation cows. High lipomobilization (NEFA > 400 µmol/L) was detected in 67% and 7% of early lactation and mid lactation cows, respectively, while subclinical ketosis (BHB > 1.2 mmol/L) was detected in 41% and 28% of the early lactation and lactation cows, respectively. TG concentrations were low in all cows suffering subclinical ketosis and in 61% of the cows with high lipomobilization. During early lactation, 30% of cows suffered hepatic lipidosis as detected by levels of AST. Compromised hepatic function was observed in early lactation cows as shown by lower concentrations of glucose, total protein, and urea

Treating depressive disorders with the unified protocol: A preliminary randomized evaluation.

OBJECTIVES: This study aims to examine the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for individuals diagnosed with a depressive disorder. METHOD: Participants included 44 adults who met criteria for major depressive disorder, persistent depressive disorder, or another specified depressive disorder according to the Anxiety Disorder Interview Schedule (ADIS). These individuals represent a subset of patients from a larger clinical trial comparing the UP to single-disorder protocols (SDPs) for discrete anxiety disorders and a waitlist control (WLC) condition (Barlow et al., 2017); inclusion criteria for the parent study required participants to have a principal anxiety disorder. RESULTS: Significant reductions in depressive symptoms were observed within the UP condition across clinician-rated and self-report measures of depression from baseline to post-treatment, as well as to the 12-month follow-up assessment. Compared to the WLC group, individuals in the UP condition demonstrated significantly lower levels on our continuous, clinician-rated measure of depressive symptoms at post-treatment. There were no differences between the UP and SDP conditions on depressive symptoms at post-treatment or at the 12-month follow-up timepoint. CONCLUSIONS: In this exploratory set of analyses, the UP evidenced efficacy for reduction of depressive symptoms, adding to the growing support for its utility in treating depression.R01 MH090053 - NIMH NIH HHSAccepted manuscrip

Role of physically effective fiber and estimation of dietary fiber adequacy in high-producing dairy cattle

Highly fermentable diets require the inclusion of adequate amounts of fiber to reduce the risk of subacute rumen acidosis (SARA). To assess the adequacy of dietary fiber in dairy cattle, the concept of physically effective neutral detergent fiber (peNDF) has received increasing attention because it amalgamates information on both chemical fiber content and particle size (PS) of the feedstuffs. The nutritional effects of dietary PS and peNDF are complex and involve feed intake behavior (absolute intake and sorting behavior), ruminal mat formation, rumination and salivation, and ruminal motility. Other effects include fermentation characteristics, digesta passage, and nutrient intake and absorption. Moreover, peNDF requirements depend on the fermentability of the starch source (i.e., starch type and endosperm structure). To date, the incomplete understanding of these complex interactions has prevented the establishment of peNDF as a routine method to determine dietary fiber adequacy so far. Therefore, this review is intended to analyze the quantitative effects of and interactions among forage PS, peNDF, and diet fermentability with regard to rumen metabolism and prevention of SARA, and aims to give an overview of the latest achievements in the estimation of dietary fiber adequacy in high-producing dairy cattle. Recently developed models that synthesize the effects of both peNDF and fermentable starch on rumen metabolism appear to provide an appropriate basis for estimation of dietary fiber adequacy in high-producing dairy cows. Data suggest that a period lasting more than 5 to 6h/d during which ruminal pH is <5.8 should be avoided to minimize health disturbances due to SARA. The knowledge generated from these modeling approaches recommends that average amounts of 31.2% peNDF inclusive particles >1.18mm (i.e., peNDF(>1.18)) or 18.5% peNDF inclusive particles >8mm (i.e., peNDF(>8)) in the diet (DM basis) are required. However, inclusion of a concentration of peNDF(>8) in the diet beyond 14.9% of diet DM may lower DM intake level. As such, more research is warranted to develop efficient feeding strategies that encourage inclusion of energy-dense diets without the need to increase their content in peNDF above the threshold that leads to lower DM intake. The latter would require strategies that modulate the fermentability characteristics of the diet and promote absorption and metabolic capacity of ruminal epithelia of dairy cows

Health and Reproductive Performance of Lactating Dairy Cows with Mild Fatty Liver Receiving Exogenous Glucagon

The data demonstrate that mild fatty liver is associated with decreased general health and reproductive performance as evidenced by more days to first estrus and service, more days open, decreased conception, increased number of days with elevated body temperature at days 9 - 22 postpartum, and increased incidence of mastitis at days 32 – 150 postpartum. The latter two were decreased in dairy cows with mild fatty liver injected with 15 mg/d of glucagon during weeks 2 and 3 postpartum. Therefore, treatment of mild fatty liver with exogenous glucagon or better prevention of fatty liver might improve health and reproductive performance of lactating dairy cows, thereby preventing loss of income of dairy farmers

The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders a randomized clinical trial

IMPORTANCE: Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. OBJECTIVE: To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. DESIGN, SETTING, AND PARTICIPANTS: From June 23, 2011, to March 5, 2015, a total of 223 patients at an outpatient treatment center with a principal diagnosis of panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, or social anxiety disorder were randomly assigned by principal diagnosis to the UP, an SDP, or a waitlist control condition. Patients received up to 16 sessions of the UP or an SDP for 16 to 21 weeks. Outcomes were assessed at baseline, after treatment, and at 6-month follow-up. Analysis in this equivalence trial was based on intention to treat. INTERVENTIONS: The UP or SDPs. MAIN OUTCOMES AND MEASURES: Blinded evaluations of principal diagnosis clinical severity rating were used to evaluate an a priori hypothesis of equivalence between the UP and SDPs. RESULTS: Among the 223 patients (124 women and 99 men; mean [SD] age, 31.1 [11.0] years), 88 were randomized to receive the UP, 91 to receive an SDP, and 44 to the waitlist control condition. Patients were more likely to complete treatment with the UP than with SDPs (odds ratio, 3.11; 95% CI, 1.44-6.74). Both the UP (Cohen d, −0.93; 95% CI, −1.29 to −0.57) and SDPs (Cohen d, −1.08; 95% CI, −1.43 to −0.73) were superior to the waitlist control condition at acute outcome. Reductions in clinical severity rating from baseline to the end of treatment (β, 0.25; 95% CI, −0.26 to 0.75) and from baseline to the 6-month follow-up (β, 0.16; 95% CI, −0.39 to 0.70) indicated statistical equivalence between the UP and SDPs. CONCLUSIONS AND RELEVANCE: The UP produces symptom reduction equivalent to criterion standard evidence-based psychological treatments for anxiety disorders with less attrition. Thus, it may be possible to use 1 protocol instead of multiple SDPs to more efficiently treat the most commonly occurring anxiety and depressive disorders.This study was funded by grant R01 MH090053 from the National Institute of Mental Health. (R01 MH090053 - National Institute of Mental Health)First author draf

Cross-cultural equivalence of the Kessler Psychological Distress Scale (K10) across four African countries in a multi-national study of adults

The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all. Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confir- matory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries. Monte Carlo simulations showed a cor- relation of 0.998, a good replication of population values, indicating minimal noninvariance, or variation. Items “so nervous,” “lack of energy/effortful tasks,” and “tired” were consistently equivalent for intercepts and factor loadings, respectively. However, items “depressed” and “so depressed” consistently differed across study coun- tries (R2 = 0) for intercepts and factor loadings for both items