Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression

We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention’s implementation, involving infrastructure at the health centers, boundaries of the promotoras’ roles, and “turf” issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Nativity Status and Depressive Symptoms Among Hispanic Young Adults: The Role of Stress Exposure

This article documents nativity differentials in depressive symptoms among Hispanics during their initial years of adulthood and explores how ethnicity, sociodemographic characteristics, and exposure to stressful life events and changes in social roles help explain those differentials. Copyright (c) 2009 by the Southwestern Social Science Association.

Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: Choosing the right cell matters

Aims: The aim of this study was to assess the ability of optical coherence tomography (OCT) to guide recrossing during percutaneous coronary interventions in bifurcations and to reduce strut malapposition. Methods and results: Fifty-two patients undergoing elective treatment of bifurcation lesions using provisional stenting as default strategy were included in the study. Patients were divided into two groups: OCT-guided stent recrossing (group 1, n=12), and angiography-guided recrossing (group 2, n=40). Malapposition in the various bifurcation segments was compared in the two groups, using propensity score analysis to correct for confounders. In 4/12 patients (33%) of the OCT-guided group after the first attempt to recross the stent towards the SB the wire was found to have crossed in a proximal cell, requiring a second and in one case a third attempt to successfully cross through a distal cell. Patients who were treated using OCT-guided recrossing had a significantly lower number of malapposed stent struts, especially in the quadrants towards the SB ostium (9.5%[7.5-17.4%] vs 42.3%[31.2-54.7%] in the angiography-guided group, p<0.0001). Conclusions: The rate of strut malapposition was significantly reduced when OCT was used to confirm that wire recrossing was performed in a distal cell of the SB ostium. © Europa Edition 2012. All rights reserved.link_to_subscribed_fulltex

Prejudice Regarding Latinx-Americans

Despite the growing immigrant and native-born Latinx population in the United States, the documentation of Latinx experiences of oppression, prejudice, and discrimination is limited in the field of clinical psychology. The lack of information on multiracial, sexual minorities, and older Latinx populations is most pronounced. This chapter focuses on the research that has been done to document the prevalence of self-perceived discrimination and the deleterious effect of microaggressions on the mental health of Latinx individuals. In addition, this chapter emphasizes the lack of Latinx representation in professional domains and the growing need for social justice training in clinical psychology graduate programs. Recommendations are provided for assessing and conceptualizing experiences of oppression, prejudice, and discrimination for Latinx populations. Furthermore, this chapter argues that other fields of psychology have developed models and guiding frameworks that can help clinical psychology become more responsive to the needs of Latinx students, faculty, and clients