A study of the effectiveness of telepsychiatry-based culturally sensitive collaborative treatment of depressed Chinese Americans

<p>Abstract</p> <p>Background</p> <p>Chinese American patients with Major Depressive Disorder (MDD) tend to underutilize mental health services and are more likely to seek help in primary care settings than from mental health specialists. Our team has reported that Culturally Sensitive Collaborative Treatment (CSCT) is effective in improving recognition and treatment engagement of depressed Chinese Americans in primary care. The current study builds on this prior research by incorporating telemedicine technology into the CSCT model.</p> <p>Methods/Design</p> <p>We propose a randomized controlled trial to evaluate the acceptability and effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention targeted toward Chinese Americans. Patients meeting the study's eligibility criteria will receive either treatment as usual or the intervention under investigation. The six-month intervention involves: 1) an initial psychiatric interview using a culturally sensitive protocol via videoconference; 2) eight scheduled phone visits with a care manager assigned to the patient, who will monitor the patient's progress, as well as medication side effects and dosage if applicable; and 3) collaboration between the patient's PCP, psychiatrist, and care manager. Outcome measures include depressive symptom severity as well as patient and PCP satisfaction with the telepsychiatry-based care management service.</p> <p>Discussion</p> <p>The study investigates the T-CSCT model, which we believe will increase the feasibility and practicality of the CSCT model by adopting telemedicine technology. We anticipate that this model will expand access to culturally competent psychiatrists fluent in patients' native languages to improve treatment of depressed minority patients in primary care settings.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00854542">NCT00854542</a></p

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Las Secuelas Psicológicas y las Necesidades en Salud Mental Para las Víctimas de la Dictadura: Una Mirada Crítica a los Servicios de PRAIS

Although the violent and repressive military dictatorship in Chile led by Augosto Pinochet officially ended in 1990, the psychological repercussions for the direct victims of human rights violations and their family members remain. PRAIS (the Program of Reparations and Comprehensive Healthcare), was created as a government response to the physical and mental health consequences of the human rights violations committed by the state. PRAIS beneficiaries include former political prisoners and their families, the families of those who were detained-disappeared or executed, people fired from their jobs for political reasons, and other victims of human rights violations committed during the dictatorship from 1973 to 1990. In addition to free public medical healthcare, PRAIS beneficiaries are also eligible to receive mental healthcare in the form of therapy (individual, group, family, and marital) and “self-help” groups. The aim of this investigation was to study the long-term psychological consequences of state repression during the dictatorship and to evaluate the mental health services of PRAIS that the government provides as a form of reparations for victims and their family members. The study focused on the PRAIS teams in Valparaíso and Viña del Mar: interviews were conducted with PRAIS beneficiaries, including directors of organizations of PRAIS beneficiaries, and PRAIS professionals (including psychologists and an administrator) from both cities. Research results found that nearly all of the victims (direct and indirect) of human rights violations included in this study continue to suffer from a diverse array of psychological consequences that have a negative impact on their daily lives. However, few had made use of the PRAIS psychological services and several were unaware that PRAIS offers psychological services at all. The investigation also found that overall, PRAIS beneficiaries are dissatisfied with many aspects of PRAIS, including the psychological services that PRAIS offers. In order to make demands of PRAIS, many beneficiaries have organized into groups of PRAIS users. The PRAIS beneficiaries in this study were especially dissatisfied with the self-help groups that PRAIS claims to offer: in Valparaíso these groups are not well-publicized or managed effectively, and in Viña del Mar they do not exist at all. In order to improve the functioning of PRAIS so that it most effectively serves its beneficiaries, what is needed are more specially trained mental health professionals, better communication between the PRAIS team and the groups of PRAIS users, and most importantly, improved self-help groups. Although therapy is accessible to those who want it, traditional psychotherapy may not be the most effective form of psychological support for PRAIS users because of a stigma associated with psychotherapy, an unwillingness to acknowledge a psychological problem, and a lack of trust in the PRAIS mental health professionals. Unfortunately, both the PRAIS users and professionals reported that as Chile’s “culture of impunity” continues, there is a limit to what PRAIS can achieve in terms of alleviating the victims’ negative psychological consequences of the human rights violations they suffered

A Call to Action for an Antiracist Clinical Science

Clinical psychological science is a field committed to reducing the negative impact of psychiatric illness through innovative research and psychological treatments. Unfortunately, the impact of racial injustices that pervade American society and permeate our academic institutions is felt not only by the individuals who work in our departments as faculty, staff, and students, but also by those who seek our services as mental health providers. Representing the collective work of numerous graduate students and postdoctoral trainees from multiple institutions, this call to action instantiates the need for prompt and consistent efforts towards dismantling institutionalized racism and inequity in clinical science. Specifically, we articulate the multiple roles our field plays in perpetuating racial oppression and outline concrete demands and recommendations for structural reform in the following key areas: (1) the mental health needs of Black, Indigenous, and People of Color (BIPOC) students, (2) clinical training and supervision, (3) curriculum and pedagogical approaches, (4) research and methods, and (5) the recruitment, retention, and success of graduate students and faculty

A review of planting principles to identify the right place for the right tree for ‘net zero plus’ woodlands: Applying a place‐based natural capital framework for sustainable, efficient and equitable (SEE) decisions

We outline the principles of the natural capital approach to decision making and apply these to the contemporary challenge of very significantly expanding woodlands as contribution to attaining net zero emissions of greenhouse gases. Drawing on the case of the UK, we argue that a single focus upon carbon storage alone is likely to overlook the other ‘net zero plus’ benefits which woodlands can deliver. A review of the literature considers the wide variety of potential benefits which woodlands can provide, together with costs such as foregone alternative land uses. We argue that decision making must consider all of these potential benefits and costs for the right locations to be planted with the right trees. The paper closes by reviewing the decision support systems necessary to incorporate this information into policy and decision making

Nanoparticles can cause DNA damage across a cellular barrier

The increasing use of nanoparticles in medicine has raised concerns over their ability to gain access to privileged sites in the body. Here, we show that cobalt–chromium nanoparticles (29.5 6.3 nm in diameter) can damage human fibroblast cells across an intact cellular barrier without having to cross the barrier. The damage is mediated by a novel mechanism involving transmission of purine nucleotides (such as ATP) and intercellular signalling within the barrier through connexin gap junctions or hemichannels and pannexin channels. The outcome, which includes DNA damage without significant cell death, is different from that observed in cells subjected to direct exposure to nanoparticles. Our results suggest the importance of indirect effects when evaluating the safety of nanoparticles. The potential damage to tissues located behind cellular barriers needs to be considered when using nanoparticles for targeting diseased states

X Chromosome Contribution to the Genetic Architecture of Primary Biliary Cholangitis.

BACKGROUND & AIMS: Genome-wide association studies in primary biliary cholangitis (PBC) have failed to find X chromosome (chrX) variants associated with the disease. Here, we specifically explore the chrX contribution to PBC, a sexually dimorphic complex autoimmune disease. METHODS: We performed a chrX-wide association study, including genotype data from 5 genome-wide association studies (from Italy, United Kingdom, Canada, China, and Japan; 5244 case patients and 11,875 control individuals). RESULTS: Single-marker association analyses found approximately 100 loci displaying P < 5 × 10(-4), with the most significant being a signal within the OTUD5 gene (rs3027490; P = 4.80 × 10(-6); odds ratio [OR], 1.39; 95% confidence interval [CI], 1.028-1.88; Japanese cohort). Although the transethnic meta-analysis evidenced only a suggestive signal (rs2239452, mapping within the PIM2 gene; OR, 1.17; 95% CI, 1.09-1.26; P = 9.93 × 10(-8)), the population-specific meta-analysis showed a genome-wide significant locus in East Asian individuals pointing to the same region (rs7059064, mapping within the GRIPAP1 gene; P = 6.2 × 10(-9); OR, 1.33; 95% CI, 1.21-1.46). Indeed, rs7059064 tags a unique linkage disequilibrium block including 7 genes: TIMM17B, PQBP1, PIM2, SLC35A2, OTUD5, KCND1, and GRIPAP1, as well as a superenhancer (GH0XJ048933 within OTUD5) targeting all these genes. GH0XJ048933 is also predicted to target FOXP3, the main T-regulatory cell lineage specification factor. Consistently, OTUD5 and FOXP3 RNA levels were up-regulated in PBC case patients (1.75- and 1.64-fold, respectively). CONCLUSIONS: This work represents the first comprehensive study, to our knowledge, of the chrX contribution to the genetics of an autoimmune liver disease and shows a novel PBC-related genome-wide significant locus.The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Published version, accepted versio