Epigenetic mechanisms, T-cell activation, and CCR5 genetics interact to regulate T-cell expression of CCR5, the major HIV-1 coreceptor.

T-cell expression levels of CC chemokine receptor 5 (CCR5) are a critical determinant of HIV/AIDS susceptibility, and manifest wide variations (i) between T-cell subsets and among individuals and (ii) in T-cell activation-induced increases in expression levels. We demonstrate that a unifying mechanism for this variation is differences in constitutive and T-cell activation-induced DNA methylation status of CCR5 cis-regulatory regions (cis-regions). Commencing at an evolutionarily conserved CpG (CpG -41), CCR5 cis-regions manifest lower vs. higher methylation in T cells with higher vs. lower CCR5 levels (memory vs. naïve T cells) and in memory T cells with higher vs. lower CCR5 levels. HIV-related and in vitro induced T-cell activation is associated with demethylation of these cis-regions. CCR5 haplotypes associated with increased vs. decreased gene/surface expression levels and HIV/AIDS susceptibility magnify vs. dampen T-cell activation-associated demethylation. Methylation status of CCR5 intron 2 explains a larger proportion of the variation in CCR5 levels than genotype or T-cell activation. The ancestral, protective CCR5-HHA haplotype bears a polymorphism at CpG -41 that is (i) specific to southern Africa, (ii) abrogates binding of the transcription factor CREB1 to this cis-region, and (iii) exhibits a trend for overrepresentation in persons with reduced susceptibility to HIV and disease progression. Genotypes lacking the CCR5-Δ32 mutation but with hypermethylated cis-regions have CCR5 levels similar to genotypes heterozygous for CCR5-Δ32. In HIV-infected individuals, CCR5 cis-regions remain demethylated, despite restoration of CD4+ counts (≥800 cells per mm(3)) with antiretroviral therapy. Thus, methylation content of CCR5 cis-regions is a central epigenetic determinant of T-cell CCR5 levels, and possibly HIV-related outcomes.

Understanding and Addressing the Needs of Students in Special Education Through a Trauma-Informed Resilience Curriculum.

This school program evaluation aims to highlight the mental health needs of students in special education with behavioral and emotional challenges and describe the implementation of a resilience curriculum with this population. We evaluated district mental health data from a convenience sample of 814 students in grades 5-12 special education to identify risk for mental health symptoms, violence exposure, and substance use. School social workers provided feedback on the implementation of the resilience curriculum to inform program evaluation. Students reported significant risk for traumatic stress, anxiety, and depressive symptoms, and high rates of violence exposure and substance use. School social workers described adaptations to the resilience curriculum and gave recommendations for future implementation. Students receiving special education services for behavioral and emotional challenges had high mental health need, including high rates of violence exposure, and may benefit from a trauma-informed school-based resilience curriculum adapted for their needs.

Mitigating COVID-19 Risk and Vaccine Hesitancy Among Underserved African American and Latinx Individuals with Mental Illness Through Mental Health Therapist-Facilitated Discussions.

BACKGROUND: Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness. METHODS: Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre- and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine. RESULTS: There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Post-intervention documented that more than 57% of each group had been vaccinated, with another 11-15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine. CONCLUSION: This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.

The role of resilience and gender: Understanding the relationship between risk for traumatic stress, resilience, and academic outcomes among minoritized youth.

OBJECTIVE: Minoritized students experience high trauma rates which can impact academic outcomes, and experiences may differ between males and females. We investigated the relationship between traumatic stress and academic outcomes by gender among predominantly minoritized students, and whether resilience-building assets can mediate the relationship between traumatic stress and academic outcomes. METHOD: School administrative data were linked to survey data from 9th graders in 2016-2018 across 37 West Coast schools. We examined the association between traumatic stress risk and academic outcomes by gender. Where significant associations were found, mixed effects regression models accounting for school-level variation were fit to assess the role of resilience-building assets as potential mediators of the relationship between traumatic stress risk and academic outcomes. RESULTS: Among 1,750 female and 2,036 male students, we found no significant association between traumatic stress risk and low attendance (<96% days attended). The odds of low grade point average (GPA <2.0) were significantly higher among female students with traumatic stress risk (OR = 1.46, 95% CI [1.16, 1.84]), with no association among males. In models controlling for resilience-building assets, the magnitude of the association between traumatic stress risk and GPA <2.0 among females was reduced. We identified significant mediation for 3 resilience measures: self-efficacy (21.20%; p < .05), school support (18.97%; p < .05), and total internal assets (27.84%; p < .01). CONCLUSIONS: Resilience-building assets may partially mediate the effect of traumatic stress on GPA among females. Resilience initiatives, especially among minoritized female students, may protect against the effect of trauma on academics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Benefits of Cardiac Rehabilitation on Functional Status and Mood Disorders in Elderly and Very Elderly Patients: A PROSPECTIVE COHORT STUDY.

PURPOSE: Patients ≥80 yr are not frequently referred for cardiac rehabilitation (CR). This study aimed to describe the benefit of CR in the very elderly population in comparison with patients ≤65 and 66-79 yr in terms of gain in functional status and improvement of mood disorders. METHODS: We conducted a prospective, cohort, single-center study. Physical performance was evaluated with a 6-min walk test (6MWT). Anxiety, depression, and overall psychological distress were evaluated with Hospital Anxiety and Depression Scale (HADS) scores. Primary outcomes were the percent improvement in the predicted distance and the reduction in the prevalence of anxiety, depression, and overall psychological distress. RESULTS: There were 45 (9%) patients ≥80 yr among 499 participants. There were no significant differences in the percent improvement of the predicted distance in the 6MWT among age groups, being +15 (7, 25)%, +15 (7, 25)%, and +10 (4, 26)% for ≤65, 66-79, and ≥80-yr groups, respectively (P = .11). The elderly group had a higher prevalence of depression, anxiety, and overall psychological distress (72%, 51%, and 38%, respectively). After CR, there was a significant improvement in HADS scores in all groups. The prevalence of depression was reduced by 38%, anxiety by 60%, and overall psychological distress by 58%. CONCLUSION: Patients ≥80 yr have decreased physical performance and a higher prevalence of mood disorders than their younger counterparts. Nevertheless, they improved significantly in all outcomes measured.

Rating Scales for Behavioral Health Screening System Within Pediatric Primary Care.

Barriers to conducting standardized behavioral health screening within pediatric primary care settings include engaging youth and families, limited time available for this activity, and difficulties related to obtaining behavioral health consultation and treatment from specialists. Child and adolescent psychiatrists may assist pediatric primary care practices with engaging youth and families around screening by assisting with identifying rating scales that have good psychometric characteristics across multiple languages and are validated in diverse samples and available within the public domain. Additionally, they may partner with pediatric primary care professionals to assist with optimizing screening workflows and linkage to specialized services.

Efectos de la rehabilitación cardiaca en el paciente cardiovascular con ansiedad y depresión / Effects of cardiac rehabilitation on the cardiovascular patient with anxiety

Resumen Objetivo: determinar el efecto de un programa de rehabilitación en los puntajes de ansiedad y depresión de pacientes con enfermedad cardiovascular. Materiales y métodos: se analizó la información de una cohorte retrospectiva de pacientes con enfermedad cardiovascular, admitidos a un programa de rehabilitación cardiaca. La ansiedad y depresión fueron medidas con la escala HADS (Hospital Anxiety and Depression Scale) y se categorizaron según el tratamiento de base recibido (médico o quirúrgico). Se comparó el cambio en los puntajes de ansiedad y depresión al ingreso y al final de la rehabilitación cardiaca mediante la prueba de Wilcoxon para muestras pareadas y la prueba de McNemar para evaluar el cambio de los porcentajes en cada subescala. Resultados: se incluyeron 1.221 pacientes. La mediana de edad fue 61 años, 68,30% eran hombres. Al ingreso, la mediana del puntaje de ansiedad y depresión fue 3, de los cuales 141 pacientes presentaron un trastorno de ansiedad (11,55%) y 67 un trastorno depresivo (5,49%). Al final de la rehabilitación cardiaca se obtuvo una mejoría en los puntajes de ansiedad y depresión tanto en pacientes en tratamiento médico (promedio -1,87 puntos 95% IC -2,14 a -1,60 p<0,01 y -1,46 puntos 95% IC -1,72 a -1,21 p<0,01 respectivamente) como quirúrgico (promedio -1,48 puntos 95% IC -1,78 a -1,18 p<0,01 y -1,83 puntos 95% IC -2,12 a -1,57 p<0,01). Conclusiones: los puntajes de ansiedad y depresión, en pacientes con enfermedad cardiovascular en tratamiento médico o quirúrgico, mejoraron luego de un programa integral de rehabilitación cardíaca.

Abstract Objective: To determine the effects of a rehabilitation program on the anxiety and depression scores of patients with cardiovascular disease. Materials and methods: An analysis was performed on the information collected from a retrospective cohort of patients with cardiovascular disease, admitted to a cardiac rehabilitation program. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and were classified according to the baseline treatment (medical or surgical) received. A comparison was made between the anxiety and depression scores on admission and at the end of the cardiac rehabilitation program using Wilcoxon test for paired samples and the McNemar test to evaluate the change in the percentages in each sub-scale. Results: A total of 1,221 patients were included. The median age was 61 years, and 68.3% were males. On admission, the median score was 3 on the anxiety and depression scale, with 141 (11.55%) patients having an anxiety disorder, and 67 (5.49%) with depressive disorder. An improvement was observed in the anxiety and depression scores at the end of the end of the cardiac rehabilitation, both in patients on medical treatment (mean difference minus 1.87 points, 95% CI; -2.14 to -1.60: P<.01, and -1.46 points, 95% CI; -1.72 to -1.21: P<.01, for anxiety and depression, respectively) and on surgical treatment (mean difference -1.48 points, 95% CI; -1.78 to -1.18, P<.01 and -1.83 points, 95% CI -2.12 to -1.57, P<.01, respectively). Conclusions: The anxiety and depression scores in patients with cardiovascular disease on medical or surgical treatment improved after an integrated cardiac rehabilitation program.

"I want your kidney!" Information seeking, sharing, and disclosure when soliciting a kidney donor online.

OBJECTIVE: This study investigates how people use the Internet to search for an altruistic kidney donor. Although many opinion pieces on this phenomenon have been written, this is the first qualitative study focused on online kidney solicitation from the potential recipient's point of view. METHODS: Eight participants - four who successfully found donors and four who were still searching - were interviewed, and inductive content analysis was performed. RESULTS: Three themes appear in our data: choosing to go online to find a donor, information hubs, and information flow. These themes emphasize the process of information seeking and disclosure when using the Internet to find an altruistic kidney donor. CONCLUSION: The benefits from searching online are not limited to the possibility of finding a kidney donor. Our participants also experience a wide variety of socially supportive activities from their online networks. Additionally, our participants felt that the potential benefits of finding a donor online outweighed risks to their privacy. PRACTICE IMPLICATIONS: Not all potential recipients will find a kidney donor online. Participants indicated that through sharing educational information, staying positive, and actively maintaining their online solicitation efforts they received numerous social benefits even if they did not find a kidney donor.

Exploración de la violencia sexual en la ciudad de Bogotá: una aplicación de técnicas de minería de datos / Exploration of sexual violence in the city of Bogota: aplication of a data mining technique / Exploração da violência sexual na cidade de Bogotá: uma aplicação das técnicas da mineração dos dados

Este estudio ofrece una aproximación a la violencia sexual utilizando datos de fuente secundaria y aplicando algunas técnicas de minería de datos. La fuente de datos utilizada es el Instituto Nacional de Medicina Legal y Ciencias Forenses, y los algoritmos aplicados son Selección por Características, C5.0 y K-Means. Antes de la aplicación de dichas técnicas se hace una aproximación teórica a la violencia sexual, para apreciar la forma como se ha abordado este tipo de violencia y la manera como se ha analizado. Seguidamente se realiza la evaluación de la calidad de los datos y se aplican algunos tratamientos para su mejoramiento. Una vez se llega a un dataset adecuado para el procesamiento y análisis, se aplican técnicas de minería de datos y se establece como variable objetivo o respuesta la relación del presunto agresor con la víctima. Las salidas que ofrece el procesamiento llevan a un análisis que establece como centro los niveles de proximidad con la víctima y cuestiona los análisis basados en la estructura de parentesco tradicional, al mismo tiempo que valida la distinción que establece una clasificación de la violencia sexual entre abuso sexual y asalto sexual. Los análisis del ejercicio de minería de datos permiten plantear claramente la configuración de dos clusters a los que se les puede señalar con dicha clasificación. Estos están acompañados de un tercero que, si bien no está muy definido, empieza a dibujarse. Los tres clusters se han llamado violencia sexual en situación de incesto, violencia sexual en situación de anonimia y violencia sexual en situación de estructura familiar. Se termina con algunas sugerencias en procura del mejoramiento de la calidad de los datos y se plantean las posibilidades que este tipo de análisis tiene al intentar dar respuesta a la conflictividad, la violencia y el delito

This study offers an approach to sexual violence by using secondary source data and applying some data mining techniques. The data source used is the ‘Instituto Nacional de Medicina Legal y Ciencias Forenses’ (National Institute of Legal Medicine and Forensic Sciences), and the algorithms applied are Selection by Characteristics, C5.0, and K-Means.Prior to applying these techniques, a theoretical approximation to sexual violence is made in order to appreciate how this kind of violence has been approached and analyzed. ubsequently, data quality is assessed and some improvement treatments are applied. Upon having reached a proper dataset for processing and analysis, data mining techniques are applied, and the relationship of the alleged aggressor to the victim is established as a variable objective or answer. The issues or solutions offered by the above data processing lead to an analysis which establishes as a core the levels of proximity with the victim, and questions those studies based on the traditional kinship structure, while it simultaneously validates the distinction that establishes a sexual violence rating between abuse and assault. Analyses of the data mining exercise facilitate a clear statement of the configuration of two clusters that can be pointed at with said classification. They are accompanied by a third one that, although not well defined yet, begins to appear. The three clusters have been designated as sexual violence in an incest situation, sexual violence in an anonymity situation, and sexual violence in a family structure situation.Finally, some suggestions are given in seeking to improve data quality, while the opportunities this type of analysis opens at attempting to give an answer to conflictivity, violence and crime are outlined

Este estudo oferece uma aproximação à violência sexual usando dados da fonte secundária e aplicando algumas técnicas da mineração dos dados. A fonte dos dados usada é ao Instituto Nacional de Medicina Legal e Ciências Forenses, e os algoritmos aplicados são Seleção por Característica, C5.0 e K-Means. Antes que a aplicação destas técnicas, uma aproximação teórica à violência sexual é feita, para apreciar o jeito como este tipo de violência é abordado e a maneira como foi analisado. A avaliação da qualidade dos dados é feita em seguida e alguns tratamentos para sua melhoria são aplicados. Uma vez que o dataset adequado é alcançado para o processamento e a análise, as técnicas da mineração dos dados são aplicadas e a relação do suposto agressor com a vítima é estabelecida com a variável alvo ou a resposta. As saídas que fornece o processamento leva a uma análise que estabelece como o centro os níveis da proximidade com a vítima e questiona as análises baseadas na estrutura do parentesco tradicional, ao mesmo tempo em que valida à distinção que estabelece uma classificação da violência sexual entre o abuso sexual e o assalto sexual. As análises do exercício da mineração dos dados permitem expor claramente a configuração de dois clusters aos quais é possível assinalar com esta classificação. Estes são acompanhados de um terceiro que, embora não esteja bem definido, começam a extrair-se. Os três clusters foram chamados violência sexual na situação do incesto, violência sexual na situação de anonímia e a violência sexual na situação da estrutura familiar. Termina com algumas sugestões nas tentativas da melhoria da qualidade dos dados e expor as possibilidades que este tipo de análise tem ao tentar dar resposta aos conflitos, à violência e ao crime