The Culturally and Contextually Sensitive Assessment of Mental Health using a Structured Diagnostic Interview (MINI Kid) for Syrian Refugee Children and Adolescents in Lebanon: Challenges and Solutions

Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective paper aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview. We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N=119 Syrian refugee children (aged 8-17) resident in informal tented settlements in Lebanon. Qualitative data was derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: 1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); 2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); 3) cultural norms and meaning (impact of different meanings on answers); 4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and 5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improve accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies

Molecular and functional characterization of a novel cardiac-specific human tropomyosin isoform.

BACKGROUND: Tropomyosin (TM), an essential actin-binding protein, is central to the control of calcium-regulated striated muscle contraction. Although TPM1alpha (also called alpha-TM) is the predominant TM isoform in human hearts, the precise TM isoform composition remains unclear. METHODS AND RESULTS: In this study, we quantified for the first time the levels of striated muscle TM isoforms in human heart, including a novel isoform called TPM1kappa. By developing a TPM1kappa-specific antibody, we found that the TPM1kappa protein is expressed and incorporated into organized myofibrils in hearts and that its level is increased in human dilated cardiomyopathy and heart failure. To investigate the role of TPM1kappa in sarcomeric function, we generated transgenic mice overexpressing cardiac-specific TPM1kappa. Incorporation of increased levels of TPM1kappa protein in myofilaments leads to dilated cardiomyopathy. Physiological alterations include decreased fractional shortening, systolic and diastolic dysfunction, and decreased myofilament calcium sensitivity with no change in maximum developed tension. Additional biophysical studies demonstrate less structural stability and weaker actin-binding affinity of TPM1kappa compared with TPM1alpha. CONCLUSIONS: This functional analysis of TPM1kappa provides a possible mechanism for the consequences of the TM isoform switch observed in dilated cardiomyopathy and heart failure patients