Improving Parkinson's Disease Care through Systematic Screening for Depression.

BACKGROUND: Depression is common in Parkinson's disease (PD) but is underrecognized clinically. Although systematic screening is a recommended strategy to improve depression recognition in primary care practice, it has not been widely used in PD care. METHODS: The 15-item Geriatric Depression Scale (GDS-15) was implemented at 5 movement disorders clinics to screen PD patients. Sites developed processes suited to their clinical workflow. Qualitative interviews with clinicians and patients provided information on feasibility, acceptability, and perceived utility. RESULTS: Prior to implementation, depression screening was recorded in 12% using a formal instrument; 64% were screened informally by clinical interview, and no screening was recorded in 24%. Of 1406 patients seen for follow-up care during the implementation period, 88% were screened, 59% using the GDS-15 (self-administered in 51% and interviewer administered in 8%), a nearly 5-fold increase in formal screening. Lack of clinician or staff time and inability to provide the GDS-15 to the patient ahead of the visit were the most commonly cited reasons for lack of screening using the GDS-15; 378 (45%) patients completing the GDS-15 screened positive for depression, and 137 were enrolled for a 12-month prospective follow-up. Mean GDS-15 scores improved from 8.8 to 7.0 (P < 0.0001) and the 39-item Parkinson's Disease Questionnaire emotional subscore from 42.2 to 36.7 (P = 0.0007). CONCLUSIONS: Depression screening in PD using a formal instrument can be achieved at much higher levels than is currently practiced, but there are barriers to implementing this in clinical practice. An individual site-specific process is necessary to optimize screening rates.

Examining the "White Health Advantage" Effect among Latinos in the United States.

There is consensus regarding the socio-political roots of the concept of race (and ethnicity) in the United States (US). However arbitrary, the US societal constructions of race have meant racial/ethnic minorities experience disproportionate health burdens. The present study examined the so-called "white health advantage" effect in a large sample of US respondents, comparing Latinos (non-White and White) with non-Latino Whites. This cross-sectional study used deidentified data from the Dynata Global COVID Symptoms map project, collected between July 7-14, 2020 (n = 135,075). A dichotomous health status variable was created with respondents answering yes/no to any COVID-19 symptoms (difficulty breathing, coughing, fatigue, fever, and loss of taste or smell). We included relevant predisposing (age, gender, number of children, race, ethnicity, marital status, and education) and enabling factors (housing conditions, income, employment status, business ownership, and number of cars owned - a proxy measure for wealth). Multivariate logistic regression models showed significant differences in health status (as measured by COVID-19 symptoms) when comparing Latinos (non-White, White) and non-Latino Whites. For instance, higher socioeconomic status had a protective effect only among non-Latino Whites. In turn, being married/living with a partner was only associated with COVID-19 symptoms among White Latinos, indicating that the apparent benefits of this "improving" socio-political location are somewhat limited. Our study found significant differences in COVID-19 symptoms when comparing Latinos (non-White, White) and non-Latino Whites. Our findings underscore the importance of further examining health outcomes by racial identities of US Latinos, which can help inform future health equity efforts.

The Impact of Community Engagement in the Design and Implementation of the Flint Registry.

BACKGROUND: The Flint water crisis (FWC) was a public health tragedy caused by crumbling infrastructure, subverted democracy, and indifference toward a predominantly poor and Black community that resulted in lead-in-water exposure, Legionnaires' disease, and emotional and health-related trauma. Through the cooperation of community partners, the Flint Registry (FR) was conceived to track long-term health and improve public health via service connections. OBJECTIVES: This study sought to share the FR's community-partnered, multi-tiered engagement strategy and determine the efficacy of this strategy to engage the community and reach Flint residents. METHODS: Community engagement and impact were measured by collecting and describing feedback from the community engagement strategies and by comparing the demographics of the enrollees recruited through community-engaged recruitment (CER) and non-CER methods. Enroll-ees indicated how they heard about the FR; CER involved direct interaction with a community member. RESULTS: Community engagement strategies incorporated approximately 1,200 people and 7 funded organizations, impacting 22 key areas of FR design and implementation. More than 50% of enrollees heard about the FR through CER methods. They were, on average, more likely to be younger, female, Black/African American, and living outside of Flint during the FWC. CONCLUSIONS: Community engagement elevated voices of those impacted by the FWC. CER methods were as effective as non-CER methods. Although there were no differences in screened measures of social vulnerability, there were in age, gender, and race. CER methods may increase participation and build trust in populations which historically are hesitant to participate in public health efforts.

An intranasal nanoparticle vaccine elicits protective immunity against Mycobacterium tuberculosis.

Mucosal vaccines have the potential to elicit protective immune responses at the point of entry of respiratory pathogens, thus preventing even the initial seed infection. Unlike licensed injectable vaccines, mucosal vaccines comprising protein subunits are only in development. One of the primary challenges associated with mucosal vaccines has been identifying and characterizing safe yet effective mucosal adjuvants that can effectively prime multi-factorial mucosal immunity. In this study, we tested NanoSTING, a liposomal formulation of the endogenous activator of the stimulator of interferon genes (STING) pathway, cyclic guanosine adenosine monophosphate (cGAMP), as a mucosal adjuvant. We formulated a vaccine based on the H1 antigen (fusion protein of Ag85b and ESAT-6) adjuvanted with NanoSTING. Intranasal immunization of NanoSTING-H1 elicited a strong T-cell response in the lung of vaccinated animals characterized by (a) CXCR3+ KLRG1- lung resident T cells that are known to be essential for controlling bacterial infection, (b) IFNγ-secreting CD4+ T cells which is necessary for intracellular bactericidal activity, and (c) IL17-secreting CD4+ T cells that can confer protective immunity against multiple clinically relevant strains of Mtb. Upon challenge with aerosolized Mycobacterium tuberculosis Erdman strain, intranasal NanoSTING-H1 provides protection comparable to subcutaneous administration of the live attenuated Mycobacterium bovis vaccine strain Bacille-Calmette-Guérin (BCG). Our results indicate that NanoSTING adjuvanted protein vaccines can elicit a multi-factorial immune response that protects from infection by M. tuberculosis.

REDCap to Epic interfaces create an efficient hybrid software solution for a public health registry.

A public health registry and intervention was created in response to the Flint water crisis to identify and refer exposed individuals to public health services to ameliorate the deleterious impact of lead exposure. Traditional technology architecture domains, funded scope of work, as well as community input were considered when defining the requirements of the selected solutions. A hybrid software solution was created using Research Electronic Data Capture (REDCap) to deploy an open participant survey and bypass requirements to create user accounts, and Epic to manage deduplication and participant communication and tracking. To bridge the two software systems, REDCap to Epic unidirectional ADT and Documentation Flowsheet interfaces were built to automate creation of subject records in Epic identical to those created in REDCap and to copy key protocol-driving variables from REDCap to Epic. The interfaces were critical to deliver a successful hybrid solution in which the desired features of each software could be leveraged to satisfy specific protocol requirements and community input. Data from the start of survey administration (December 2018) through 31 December 2020 are reported to demonstrate the usefulness of the interfaces.

Combined Effect of Maternal Separation and Early-Life Immune Activation on Brain and Behaviour of Rat Offspring.

Adversity during early life, a critical period for brain development, increases vulnerability and can have a lasting impact on the brain and behaviour of a child. However, the long-term effects of cumulative early-life stressors on brain and behaviour are not well known. We studied a 2-hit rat model of early-life adversity using maternal separation (MS) and immune activation (lipopolysaccharide (LPS)). Rat pups underwent MS for 15 (control) or 180 (MS) minutes per day from postnatal day (P)2-14 and were administered saline or LPS (intraperitoneal) on P3. Open-field (OFT) and object-place recognition tests were performed on rat offspring at P33-35 and P42-50, respectively. The pre-frontal cortex (PFC) and hippocampus were removed at the experimental endpoint (P52-55) for mRNA expression. MS induced anxiety-like behaviour in OFT in male and reduced locomotor activity in both male and female offspring. LPS induced a subtle decline in memory in the object-place recognition test in male offspring. MS increased glial fibrillary acidic protein (GFAP) and brain-derived neurotrophic factor expression in PFC and ionised calcium-binding adapter molecule-1 expression in male hippocampus. MS and LPS resulted in distinct behavioural phenotypes in a sex-specific manner. The combination of MS and LPS had a synergistic effect on the anxiety-like behaviour, locomotor activity, and GFAP mRNA expression outcomes.

"Mentally you don't function the same": a Qualitative Examination of the Normalization, Embodiment, and Psychological Impact of Everyday Racism.

Everyday racism consists of covert and oppressive practices that uphold systems of power and reproduce White supremacy through subtle forms of repetitive and normalized discriminatory actions. While attention to the material and physical damage everyday racism evokes upon Black Americans is receiving increased attention, inconsistencies regarding its conceptualization and operationalization are impeding our understanding of the impact of everyday racism. Utilizing critical race theory (CRT) as an analytical framework, this article intends to respond to gaps in the literature and deepen the understanding of the psychological burden experiences of everyday racism places upon a sample of (n = 40) Black Americans. We engaged with the racial realism and Whiteness as property tenets to analyze individual in-depth interviews and (1) enhance our interrogation of micro/macro-level interactions and (2) aid in the conceptualization of everyday racism. Three themes emerged from the data: hypervigilance and the normalization of everyday racism, mental preparation for navigating White spaces, and the mental health impact of everyday racism. Participant narratives reveal how the normalization of everyday racism impacts them on a psychological and corporeal (i.e., bodily) level. Their accounts also spoke to how Whiteness operates as a property right that exacerbates everyday racism and places invisible boundaries upon how they navigate space. This study provides conceptual clarity about the realities of racism, deeper awareness of structural and individual measures, and an in-depth understanding of how often taken for granted and assumed "normal" forms of racism generate pathways to negative mental health outcomes.

The impact of the Prime Time Sister Circles® (PTSC) on blood pressure of low-income mid-life African American women in the United States.

There is a pressing need to develop and evaluate culturally tailored, community-based interventions that address hypertension management among low-income African American women. We employed a randomized controlled trial to test the effectiveness of the Prime Time Sister Circles® Program in reducing blood pressure and body mass index among low-income African American women ages with hypertension. Study participants (N = 339) were African American women aged 40-75 years who were diagnosed with hypertension and received their primary care at government funded health centers in Washington, D.C. Compared to the usual care group, Prime Time Sister Circles® participation was associated with a reduction in systolic BP by - 2.45 (CI - 6.13, 1.23) mmHg, a reduction in diastolic BP by - 3.66 mmHg (CI - 6.32, - 0.99), and a change in BMI by - 0.26 (CI - 2.00, 1.48) from baseline to 15 months. The results suggest that culturally tailored community-based interventions can improve hypertension management in low-income women.

Child Mental Health Status in Flint, Michigan: A Worsening Health Inequity, 2018-2022.

Objectives. To determine the burden of mental health disorders among children enrolled in Michigan's Flint Registry in the context of a local public health crisis and a nationally declared pediatric mental health crisis. Methods. This survey-based study included 1203 children aged 3 to 17 years whose caregivers enrolled them in the Flint Registry between December 2018 and March 2020 and who completed a follow-up survey between October 2020 and March 2022. The baseline and follow-up surveys included caregiver reports of childhood anxiety and depression and overall mental health wellness. Results. At enrollment, Flint Registry caregivers reported significantly higher rates of anxiety and depression among their children than caregivers reported nationally (12.9% vs 9.4% and 8.2% vs 4.4%; P < .001). Flint Registry caregivers also reported declines in their children's overall mental health wellness at follow-up, t(1472) = -4.17; P < .001. Conclusions. Our findings reveal a disparate burden of pediatric mental health disorders and exemplify the health inequities vulnerable populations face. Public Health Implications. More proactive and preventive steps should be taken to lessen this burden, especially in chronically disadvantaged communities that experience public health crises. (Am J Public Health. 2023;113(12):1318-1321. https://doi.org/10.2105/AJPH.2023.307406).

Evaluating the Impact of the Prime Time Sister Circles® Intervention on Reducing Depressive Symptoms Among African American Women with Uncontrolled Hypertension.

BACKGROUND: The Prime Time Sister Circles®, a randomized controlled trial (PTSC-RCT), assessed the impact of a community-based peer support program on hypertension management among African American women 40-75 years of age. While the PTSC-RCT was designed to evaluate changes in blood pressure control, subsequent sub-analyses revealed a high proportion of self-reported depressive symptoms in our sample. Accordingly, we conducted an ancillary investigation of the PTSC intervention on depression to ascertain its impact on reduced depressive symptoms in the study population. METHOD: Depressive symptoms were measured using an adapted version of the Center for Epidemiologic Studies Depression Scale Revised (CES-D-10). We used unadjusted and adjusted fixed effect models. Data for this study came from the PTSC-RCT. We collected data between 2017 and 2018 in Washington, DC. We used a balanced analytical sample of 172 African American, English-speaking women between 40 to 75 years old with uncontrolled hypertension. INTERVENTION: The intervention group participated in a 2-h, peer-based support group once a week for 13 weeks. A trained PTSC facilitator facilitated sessions with experts who delivered content on various topics, including psychosocial wellness (e.g., stress, depressive symptoms, anxiety management, and self-esteem), physical health (e.g., hypertension, inflammation, and heart disease), physical activity, and healthy nutrition. RESULTS: Results from the fixed-effects models indicated that participants in the PTSC program exhibited a greater reduction in CES-D-10 score at three months (Coeff: -1.99, 95% CI: -3.49, -0.49) and at 15 months (Coeff: -2.38, 95% CI: -3.94, -0.83), as compared to those in the control group. CONCLUSIONS: Evidence suggests that the Prime Time Sister Circles® intervention reduced depressive symptoms among African American women with low socioeconomic status and hypertension. TRIAL REGISTRATION: NCT04371614.

Navigating a hyperracialized space: exploring the intersections of whiteness, social control, and mental health in st. louis county, missouri.

Places marred by a legacy of racial violence have contemporary implications for racial and ethnic minorities. However, there is limited work examining how racial and ethnic minorities perceive and navigate these spaces and how they may affect their health. We examine the daily lives of Black residents of St. Louis County, living in what we refer to as a hyperracialized space, or areas characterized by multiple forms of violence, to understand how navigating a hyperracialized space impacts how Black residents negotiate space and make meaning of their health. Qualitative interviews (n = 20) revealed three themes: (1) Whiteness and the maintenance of a hyperracialized space, (2) unspoken rules of police encounters and the embodiment of self-regulation, (3) and hypervigilance. Narratives reveal how individuals and institutions concretize a hyperracialized space through social control. Moreover, participants discussed how their environment influenced how they interacted with and navigated space, the toll of which elicited hypervigilance.

A Multidisciplinary Approach to Increase Compliance With Spontaneous Awakening Trials and Spontaneous Breathing Trials in the Medical Intensive Care Unit.

Prolonged mechanical ventilation can lead to undesirable outcomes, including reduced 6-month survival, increased hospital mortality, intensive care unit (ICU) length of stay, and physiological stress. A large academic medical center currently has a Spontaneous Awakening Trials/Spontaneous Breathing Trials (SAT/SBT) protocol with an SAT/SBT compliance goal of 80%; however, the medical intensive care unit's (MICU) SAT/SBT compliance rate was only 33% for FY2020. The Define-Measure-Analyze-Improve-Control (DMAIC) framework was used to guide this quality improvement project. Current processes and root causes for noncompliance were analyzed through chart reviews, a preimplementation staff survey, and meetings with stakeholders. Compliance rates were compared before and after implementation. Interventions included education, reminder fliers, weekly chart audits, and individualized weekly emails to noncompliant RNs and RTs. To achieve project sustainability, 2 unit champions were selected to continue the weekly emails and chart audits. Data were collected from 216 patients and 1063 patient ventilator days from October 2020 to October 2021. The SAT/SBT compliance steadily increased throughout the 13-month implementation period, except for 3 months. The preimplementation monthly SAT/SBT compliance rate was 26% in September 2020. After 13 months of project implementation, the SAT/SBT compliance rate was 64% in October 2021. There was no significant change in patient ventilator days pre- and post-quality improvement project. A multi-intervention implementation strategy consisting of education in-services, weekly chart audits, weekly emails to staff with current compliance rates, and reminder fliers can successfully increase SAT/SBT compliance rates. Utilizing unit champions provides sustainability.

Adapting Brief Behavioral Treatment for Insomnia for Former National Football League Players: A Pilot Study.

OBJECTIVES: Insomnia is highly prevalent among persons with chronic pain. Although cognitive behavioral therapy for insomnia is recommended as first-line treatment for insomnia, it is underutilized. We tested the feasibility of a potentially scalable alternative - Brief Behavioral Therapy for Insomnia (BBTI) for former National Football League (NFL) players, a group with a high prevalence of chronic pain. We assessed changes in sleep, pain, and psychological health. METHODS: Single-arm clinical trial of an adapted telephone-delivered BBTI intervention in 40 former NFL players with insomnia. We collected data on changes in sleep, pain, and psychological health outcomes. RESULTS: Among former players (30% racial/ethnic minorities), BBTI was both acceptable and feasible. BBTI was associated with improvements in sleep disturbance (primary exploratory sleep outcome, mean T-score change -6.2, 95% CI: -7.6, -4.8), sleep-related impairment (mean T-score change -5.7, 95% CI: -7.9, -3.5) and insomnia severity (mean change -5.3, 95% CI: -6.8, -3.5) post-intervention. Improvements were maintained at 2-months. BBTI was also associated with improvements in pain interference and intensity, but not psychological health. CONCLUSION: An adapted telephone-delivered BBTI is acceptable and feasible among retired players with a range of insomnia symptoms and shows promise for improving sleep and pain. These data support the need for future trials assessing BBTI's effect on both sleep and pain outcomes.

Racial Context and Health Behaviors Among Black Immigrants.

Testing the Racial Context Hypothesis (Read and Emerson 2005), we examine the relationship between racial context of origin and three health behaviors (smoking, drinking, and physical activity) among Black immigrants in the USA. We conduct multinomial logistic regression analyses using data from the 2000-2018 National Health Interview Survey (N = 248,401) to determine if racial context of origin is a mechanism of health differential between Black immigrants and US-born Black Americans. Supporting the Racial Context Hypothesis, we find that Black immigrants from racially mixed (Mexico, Central America, the Caribbean, South America) and majority-Black contexts (Africa) are significantly less likely to be current or former smokers and drinkers than US-born Black Americans. Black immigrants from majority-white (Europe) contexts, on the other hand, look more similar to US-born Black Americans - again supporting the premise that racial context of origin is consequential for health. After controlling for a host of covariates, Black immigrants do not significantly differ from US-born Black Americans in exercise status. Together, these findings suggest that the impacts of racism and white supremacy have lasting effects on people of color, where Black immigrants from majority-white contexts exhibit worse health behaviors than their counterparts from majority-Black and racially mixed regions.

A Qualitative Analysis on Sexual and Reproductive Health Needs and Issues During COVID-19 Using a Reproductive Justice Framework.

The COVID-19 pandemic exacerbated existing health inequities, further exposing the challenges in meeting the sexual and reproductive health (SRH) needs, particularly for Black, Indigenous and People of Color (BIPOC). We interviewed 11 key informants through three focus groups to explore barriers and pathways to SRH care for BIPOC during COVID-19 in the United States. Reimagining reproductive health practices requires holistic practices and multisector pathways, a comprehensive reproductive justice approach. This includes interventions across the sexual and reproductive health continuum. Using a deductive-dominant approach grounded in reproductive justice values, we explore themes around SRH during COVID-19. Five themes for advancing reproductive justice were identified: "supremacy of birth"; police violence as a determinant of SR mental health; addressing quality of care outside of hospital settings; digital redlining; and centering joy, liberation, and humanity.

Sleep duration is associated with Caudate volume and executive function.

The ineligible role of the caudate nucleus in sleep has been implicated. Previous literature showed that the caudate volume is associated with longer habitual sleep duration in older adults. However, the association between sleep duration and caudate volume remains unknown in the younger population. In this study, we examined the caudate volume in youth to older adults (10 to 85 years old) with a greater sample size (N = 464). The volumetric size of the caudate nucleus showed significantly positive association with habitual sleep duration, especially in younger population. Sleep duration showed a significant association with executive function performance. However, caudate volume did not significantly predict executive function. Our results suggested that sleep duration is associated with the caudate volume and executive function. It is also suggested that there are some external mechanisms that modulate executive function which prevent the caudate-sleep relation's effect on executive function.