Need, Access, and the Reach of Integrated Care: A Typology of Patients

Introduction: In this paper, we report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also describe the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). Method: A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Results: Hierarchical and k-means cluster analyses revealed three groups: (1) Well-served patients, characterized by high perceived need for services, high service utilization, and low barriers to service use (40%); (2) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (3) Subclinical patients, characterized by low perceived need, low service utilization, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. Discussion: We found primary care patients could be grouped into three categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health settings. IBHC may be a promising approach for extending the reach of mental health care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service delivery model

Regulation of expression of the cytochrome d terminal oxidase in Escherichia coli is transcriptional.

The cytochrome d complex is one of the two terminal oxidases in the aerobic respiratory system of Escherichia coli. This enzyme is not present in cells grown with high levels of dissolved oxygen in the culture medium but accumulates after mid-exponential growth, reaching high levels in stationary-phase cells. In this study, the transcriptional activity of the cyd operon, encoding the two subunits of the enzyme, was examined under a variety of growth conditions. This was accomplished by the use of a chromosomal operon fusion, cyd-lacZ, generated in vivo by a lambda plac-Mu hopper bacteriophage and also by the use of a cyd-lacZ protein fusion created in vitro on a plasmid, transferred onto a lambda transducing phage, and examined as a single-copy lysogen. Transcription of the gene fusions was monitored by determination of beta-galactosidase activity. The data clearly show that cyd is transcriptionally regulated and that induction is observed when the culture reaches a sufficient cell density so as to substantially reduce the steady-state levels of dissolved oxygen. The transcriptional activity is also regulated by other growth conditions, including the carbon source. The turn-on of cyd under semianaerobic conditions does not require the fnr gene product, cyclic AMP, or the cyclic AMP-binding protein

Cognitive behavioral therapy tools for clients with limited functional literacy.

The current article describes the effectiveness of cognitive behavioral interventions in treating a variety of mental and behavioral health concerns. Cognitive Behavioral Therapies (CBTs) are collaborative and empirically based, and make use of client data in order to assist people in making quick and clinically meaningful change. CBT clinicians are likely to have a sizeable portion of clients who struggle with literacy. The effectiveness of CBT may be reduced because of limited literacy. Our own clinical work suggests more attention should be paid to this underserved population and to creating CBT materials that can be readily utilized with clients who struggle with literacy. We hope others will join us in sharing resources and adaptations that have been effective with other clinicians so access to this family of evidence-based treatments is not limited to just those who can read and comprehend well. The bulk of clinicians in our survey reported believing limited literacy decreases the effectiveness of CBT for adult clients, and reported they would be less likely to provide psychoeducational handouts or tracking sheets and worksheets to clients who struggle with literacy

A mutation in reverse transcriptase of bis(heteroaryl)piperazine-resistant human immunodeficiency virus type 1 that confers increased sensitivity to other nonnucleoside inhibitors.

Several nonnucleoside inhibitors of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) have been described, including Nevirapine, thiobenzimidazolone (TIBO) derivatives, pyridinone derivatives such as L-697,661, and the bis(heteroaryl)piperazines (BHAPs). HIV-1 resistant to L-697,661 or Nevirapine emerges rapidly in infected patients treated with these drugs, and the resistance is caused primarily by substitutions at amino acids 181 and 103 of RT that also confer cross resistance to the other nonnucleoside inhibitors. We describe derivation and characterization of two BHAP-resistant HIV-1 variants that differ from this pattern of cross resistance. With both variants, HIV-1 resistance to BHAP RT inhibitors was caused by a RT mutation that results in a proline-to-leucine substitution at amino acid 236 (P236L). Rather than conferring cross resistance to other RT inhibitors, this substitution sensitized RT 7- to 10-fold to Nevirapine, TIBO R82913, and L-697,661 without influencing sensitivity to nucleoside analogue RT inhibitors. This sensitization caused by P236L was also observed in cell culture with BHAP-resistant HIV-1. The effects of the P236L RT substitution suggest that emergence of BHAP-resistant virus in vivo could produce a viral population sensitized to inhibition by these other nonnucleoside RT inhibitors