Development of a Clinical Guide to Enhance Care for Suicidal Patients

Suicidal thoughts and behavior are common among mental health patients and are a source of stress for clinicians, who typically receive limited formal training on suicide. The U.S. Air Force initiated a project to enhance care and increase practitioner confidence when working with suicidal patients. A clinical guide was developed containing 18 recommendations for assessing and managing suicidality, strategies for meeting the recommendations, and clinical tools to facilitate quality care. Training opportunities and marketing efforts accompanied distribution of the guide. This initial article reviews the guide\u27s development, content, and evaluation plan as a model that other health care systems, clinics, or training programs can follow to enhance care for suicidal patients. Outcome data will be presented in a follow-up article

Comparative Analysis of Serine/Arginine-Rich Proteins across 27 Eukaryotes: Insights into Sub-Family Classification and Extent of Alternative Splicing

Alternative splicing (AS) of pre-mRNA is a fundamental molecular process that generates diversity in the transcriptome and proteome of eukaryotic organisms. SR proteins, a family of splicing regulators with one or two RNA recognition motifs (RRMs) at the N-terminus and an arg/ser-rich domain at the C-terminus, function in both constitutive and alternative splicing. We identified SR proteins in 27 eukaryotic species, which include plants, animals, fungi and “basal” eukaryotes that lie outside of these lineages. Using RNA recognition motifs (RRMs) as a phylogenetic marker, we classified 272 SR genes into robust sub-families. The SR gene family can be split into five major groupings, which can be further separated into 11 distinct sub-families. Most flowering plants have double or nearly double the number of SR genes found in vertebrates. The majority of plant SR genes are under purifying selection. Moreover, in all paralogous SR genes in Arabidopsis, rice, soybean and maize, one of the two paralogs is preferentially expressed throughout plant development. We also assessed the extent of AS in SR genes based on a splice graph approach (http://combi.cs.colostate.edu/as/gmap_SRgenes). AS of SR genes is a widespread phenomenon throughout multiple lineages, with alternative 3′ or 5′ splicing events being the most prominent type of event. However, plant-enriched sub-families have 57%–88% of their SR genes experiencing some type of AS compared to the 40%–54% seen in other sub-families. The SR gene family is pervasive throughout multiple eukaryotic lineages, conserved in sequence and domain organization, but differs in gene number across lineages with an abundance of SR genes in flowering plants. The higher number of alternatively spliced SR genes in plants emphasizes the importance of AS in generating splice variants in these organisms

A novel approach for mental health disease management: the Air Force Medical Service\u27s interdisciplinary model

Mental health disorders are one of the most substantial public health problems affecting society today, accounting for roughly 15% of the overall burden of disease from all causes in the United States. Although primary care (PC) has the potential to be the frontline for recognition and management of behavioral health conditions, this has been a challenge historically. In order to more effectively address the broad scope of behavioral health needs, the Air Force Medical Service (AFMS) established a new model of behavioral health care. Through a series of coordinated steps, the AFMS ultimately placed trained behavioral health providers into PC clinics to serve as consultants to PC providers (PCPs). Behavioral Health Consultants (BHCs) provide focused assessments, present healthcare options to patients, and deliver brief collaborative interventions in the PC setting. BHCs see patients at the request of the PCP, in 15-30-min appointments. In the pilot study, patients averaged 1.6 visits to the BHC. Over 70% of patients fell into six categories of presenting problems: situational reactions, depressive disorders, adjustment disorders, anxiety disorders, health promotion, and obesity. Patient data (n = 76) suggest 97% of patients seen were either satisfied or very satisfied with BHC services, and 100% of the PCPs (n = 23, 68% response rate) were highly satisfied and indicated they would definitely recommend others use BHC services for their patients. Both the implications and the limitations of this pilot study are discussed

A low-intensity intervention to prevent annual weight gain in active duty Air Force members

Elevated body weight among active duty Air Force (ADAF) members is a substantial and growing problem, and typically results from gaining small amounts of weight each year over many years. We designed a strategy to prevent annual weight gain in ADAF members using self-directed behavior change booklets followed by weekly e-mails about diet and physical activity for a year. The intervention was universally offered to ADAF members meeting selection criteria at five U.S. Air Force bases (n = 3,502); members at 60 other U.S. Air Force bases served as controls (n = 65,089). The intervention was completely effective at preventing weight gain in a subgroup of men (those above the lowest three ranks, with baseline weight above maximum allowable) and in women, while controls continued to gain weight. Since the intervention did not require personalized contact, this approach has promise for large-scale population-based efforts aimed at preventing weight gain in working adults

Development of a clinical guide to enhance care for suicidal patients

Suicidal thoughts and behavior are common among mental health patients and are a source of stress for clinicians, who typically receive limited formal training on suicide. The U.S. Air Force initiated a project to enhance care and increase practitioner confidence when working with suicidal patients. A clinical guide was developed containing 18 recommendations for assessing and managing suicidality, strategies for meeting the recommendations, and clinical tools to facilitate quality care. Training opportunities and marketing efforts accompanied distribution of the guide. This initial article reviews the guide\u27s development, content, and evaluation plan as a model that other health care systems, clinics, or training programs can follow to enhance care for suicidal patients. Outcome data will be presented in a follow-up article