Key actors in behavioral health services availability and accessibility research: a scoping review bibliometric analysis.

This bibliometric review aims to identify key actors in the behavioral health services availability/accessibility literature. Coalescing information about these actors could support subsequent research efforts to improve the availability and accessibility of behavioral health services. The authors used a scoping review method and a bibliometric approach. The articles came from Medline, Embase, Web of Science, CINAHL, and PsycINFO. Articles were included if they assessed behavioral health service availability or accessibility quantitatively and were written in English. The final sample included 265 articles. Bibliometric data were extracted, coded, and verified. The authors analyzed the data using univariate and social network analyses. Publishing in this area has become more consistent and has grown since 2002. Psychiatric Services and Graduate Theses were the most frequently used publication venues. The National Institute on Drug Abuse, National Institute of Mental Health, and the Veterans Administration funded the most research. The most frequently used keyword was "health services accessibility." The findings suggest that this literature is growing. There are a few clusters of researchers in this area. Government organizations primarily fund this research. The paper and supplementary materials list the top researchers, publication venues, funding sources, and key terms to promote further behavioral health availability/accessibility research.

Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic.

Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.

Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study.

OBJECTIVE: The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. METHODS: In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. RESULTS: Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. CONCLUSIONS: Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.

Initial Findings From an Acute Hospital Care at Home Waiver Initiative.

This cohort study assesses outcomes of patients treated during the initial 16 months of the Centers for Medicare & Medicaid Services Acute Hospital Care at Home initiative.

Learning to Prioritize Our Collaborative Opportunities: Overcoming the Bright Shiny Object Syndrome.

ABSTRACT: There are multiple opportunities to participate in team science, leading to long-term benefits (eg, research impact, novelty, productivity). Scholars are not well-trained in how to choose among these opportunities, often learning via trial and error. The ability to navigate collaborations is framed by several principles and considerations: (1) locus of control (what control we have over our own behavior) and how it affects academic job satisfaction; (2) the scarcity mindset that may manifest as a result of the fear of missing future opportunities; and (3) power dynamics and inequities (eg, among women and racial/ethnic minority individuals). To provide a more systematic approach to weighing academic opportunities, the authors offer 30 questions across six overlapping domains. The domains include: the big picture (eg, Is the opportunity a building block for your career?), context (eg, How much do you have on your plate?), person (eg, Who is asking?), team (eg, Is the team productive?), role (eg, Will you lead or assist?), and outcomes (eg, Might the opportunity lead to publications and/or grants?). We offer advice for decision-making. For example, when presented with an opportunity involving a significant time commitment, it is useful to allow at least 24 hours before deciding. The authors offer advice and sample language for communicating your decision. Although every situation is different, there are several fundamental issues and questions to consider when one is presented with a new opportunity-these questions are suggested for mentors and mentees.

DNA methylation networks underlying mammalian traits.

Using DNA methylation profiles (n = 15,456) from 348 mammalian species, we constructed phyloepigenetic trees that bear marked similarities to traditional phylogenetic ones. Using unsupervised clustering across all samples, we identified 55 distinct cytosine modules, of which 30 are related to traits such as maximum life span, adult weight, age, sex, and human mortality risk. Maximum life span is associated with methylation levels in HOXL subclass homeobox genes and developmental processes and is potentially regulated by pluripotency transcription factors. The methylation state of some modules responds to perturbations such as caloric restriction, ablation of growth hormone receptors, consumption of high-fat diets, and expression of Yamanaka factors. This study reveals an intertwined evolution of the genome and epigenome that mediates the biological characteristics and traits of different mammalian species.

Effects of Development on Bone Mineral Density and Mechanical Properties in the Aquatic Frog, Xenopus Laevis, and a Terrestrial Frog, Lithobates Catesbianus.

The limb bones of vertebrates have a critical role in supporting the weight of the body and transmitting forces that power locomotion. The loads that limb bones experience can vary in association with a range of factors, including locomotor environment or developmental stage. Limbed vertebrates that are habitually found in environments with low locomotor loads (e.g., water) might be predicted to also exhibit limb bones with less elevated mechanical properties, such as yield stiffness and yield stress. Frogs provide a distinctive case, in which these ideas can be tested as they experience changes in both locomotor style and habitat as they develop. However, while many frog taxa shift from aquatic to terrestrial habitats as they metamorphose, some lineages, such as pipids, maintain an aquatic lifestyle even after metamorphosis, providing a comparative framework for the effects of habitat shifts on developing limbs in vertebrates. This study compares the material composition and mechanical properties of the femur between frog species that are aquatic specialists (Xenopus laevis) vs generalists that spend considerable time both on land and in water (Lithobates catesbeianus) as they transition from metamorphic tadpoles to fully grown adults. MicroCT scanning was used to determine changes in bone density related to developmental stage and hindlimb use during swimming. Microindentation was then used to collect hardness values from the cortical bone of each femur, which was used to evaluate bone material properties. We found that aquatic frogs had less overall bone mineral density (BMD) than terrestrial frogs and that BMD was more elevated in the cortical region of the diaphysis than trabeculae and distal and proximal epiphyses. Despite its less elevated BMD, bone mechanical properties were not significantly different in aquatic specialist X. laevis than in more terrestrial L. catesbeianus. Our results suggest that the limb bones of aquatic frogs may experience compensatory effects through development to offset their lower BMD. Furthermore, changes in bone density and material properties across development may help to explain some of the differences in locomotor performance found between aquatic and terrestrial metamorphic frogs, providing insight into how environmental factors might correlate with bone ossification.

Zinc Deficiency: A Potential Hidden Driver of the Detrimental Cycle of Chronic Kidney Disease and Hypertension.

Globally, over 103 million individuals are afflicted by CKD, a silent killer claiming the lives of 1.2 million people annually. CKD is characterized by five progressive stages, in which dialysis and kidney transplant are life-saving routes for patients with end stage kidney failure. While kidney damage impairs kidney function and derails BP regulation, uncontrolled hypertension accelerates the development and progression of CKD. Zinc (Zn) deficiency has emerged as a potential hidden driver within this detrimental cycle of CKD and hypertension. This review article will (1) highlight mechanisms of Zn procurement and trafficking, (2) provide evidence that urinary Zn wasting can fuel Zn deficiency in CKD, (3) discuss how Zn deficiency can accelerate the progression of hypertension and kidney damage in CKD, and (4) consider Zn supplementation as an exit strategy with the potential to rectify the course of hypertension and CKD progression.

Deprescribing psychotropic medicines for behaviours that challenge in people with intellectual disabilities: a systematic review.

BACKGROUND: Clear evidence of overprescribing of psychotropic medicines to manage behaviours that challenges in people with intellectual disabilities has led to national programmes within the U.K. such as NHS England's STOMP to address this. The focus of the intervention in our review was deprescribing of psychotropic medicines in children and adults with intellectual disabilities. Mental health symptomatology and quality of life were main outcomes. METHODS: We reviewed the evidence using databases Medline, Embase, PsycINFO, Web of Science, CINAHL and Open Grey with an initial cut-off date of 22nd August 2020 and an update on 14th March 2022. The first reviewer (DA) extracted data using a bespoke form and appraised study quality using CASP and Murad tools. The second reviewer (CS) independently assessed a random 20% of papers. RESULTS: Database searching identified 8675 records with 54 studies included in the final analysis. The narrative synthesis suggests that psychotropic medicines can sometimes be deprescribed. Positive and negative consequences were reported. Positive effects on behaviour, mental and physical health were associated with an interdisciplinary model. CONCLUSIONS: This is the first systematic review of the effects of deprescribing psychotropic medicines in people with intellectual disabilities which is not limited to antipsychotics. Main risks of bias were underpowered studies, poor recruitment processes, not accounting for other concurrent interventions and short follow up periods. Further research is needed to understand how to address the negative effects of deprescribing interventions. TRIAL REGISTRATION: The protocol was registered with PROSPERO (registration number CRD42019158079).

Tacrolimus induces fibroblast-to-myofibroblast transition via a TGF-ß-dependent mechanism to contribute to renal fibrosis.

Use of immunosuppressant calcineurin inhibitors (CNIs) is limited by irreversible kidney damage, hallmarked by renal fibrosis. CNIs directly damage many renal cell types. Given the diverse renal cell populations, additional targeted cell types and signaling mechanisms warrant further investigation. We hypothesized that fibroblasts contribute to CNI-induced renal fibrosis and propagate profibrotic effects via the transforming growth factor-ß (TGF-ß)/Smad signaling axis. To test this, kidney damage-resistant mice (C57BL/6) received tacrolimus (10 mg/kg) or vehicle for 21 days. Renal damage markers and signaling mediators were assessed. To investigate their role in renal damage, mouse renal fibroblasts were exposed to tacrolimus (1 nM) or vehicle for 24 h. Morphological and functional changes in addition to downstream signaling events were assessed. Tacrolimus-treated kidneys displayed evidence of renal fibrosis. Moreover, α-smooth muscle actin expression was significantly increased, suggesting the presence of fibroblast activation. TGF-ß receptor activation and downstream Smad2/3 signaling were also upregulated. Consistent with in vivo findings, tacrolimus-treated renal fibroblasts displayed a phenotypic switch known as fibroblast-to-myofibroblast transition (FMT), as α-smooth muscle actin, actin stress fibers, cell motility, and collagen type IV expression were significantly increased. These findings were accompanied by concomitant induction of TGF-ß signaling. Pharmacological inhibition of the downstream TGF-ß effector Smad3 attenuated tacrolimus-induced phenotypic changes. Collectively, these findings suggest that 1) tacrolimus inhibits the calcineurin/nuclear factor of activated T cells axis while inducing TGF-ß1 ligand secretion and receptor activation in renal fibroblasts; 2) aberrant TGF-ß receptor activation stimulates Smad-mediated production of myofibroblast markers, notable features of FMT; and 3) FMT contributes to extracellular matrix expansion in tacrolimus-induced renal fibrosis. These results incorporate renal fibroblasts into the growing list of CNI-targeted cell types and identify renal FMT as a process mediated via a TGF-ß-dependent mechanism.NEW & NOTEWORTHY Renal fibrosis, a detrimental feature of irreversible kidney damage, remains a sinister consequence of long-term calcineurin inhibitor (CNI) immunosuppressive therapy. Our study not only incorporates renal fibroblasts into the growing list of cell types negatively impacted by CNIs but also identifies renal fibroblast-to-myofibroblast transition as a process mediated via a TGF-ß-dependent mechanism. This insight will direct future studies investigating the feasibility of inhibiting TGF-ß signaling to maintain CNI-mediated immunosuppression while ultimately preserving kidney health.

Multiomic prioritisation of risk genes for anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is a psychiatric disorder associated with marked morbidity. Whilst AN genetic studies could identify novel treatment targets, integration of functional genomics data, including transcriptomics and proteomics, would assist to disentangle correlated signals and reveal causally associated genes. METHODS: We used models of genetically imputed expression and splicing from 14 tissues, leveraging mRNA, protein, and mRNA alternative splicing weights to identify genes, proteins, and transcripts, respectively, associated with AN risk. This was accomplished through transcriptome, proteome, and spliceosome-wide association studies, followed by conditional analysis and finemapping to prioritise candidate causal genes. RESULTS: We uncovered 134 genes for which genetically predicted mRNA expression was associated with AN after multiple-testing correction, as well as four proteins and 16 alternatively spliced transcripts. Conditional analysis of these significantly associated genes on other proximal association signals resulted in 97 genes independently associated with AN. Moreover, probabilistic finemapping further refined these associations and prioritised putative causal genes. The gene WDR6, for which increased genetically predicted mRNA expression was correlated with AN, was strongly supported by both conditional analyses and finemapping. Pathway analysis of genes revealed by finemapping identified the pathway regulation of immune system process (overlapping genes = MST1, TREX1, PRKAR2A, PROS1) as statistically overrepresented. CONCLUSIONS: We leveraged multiomic datasets to genetically prioritise novel risk genes for AN. Multiple-lines of evidence support that WDR6 is associated with AN, whilst other prioritised genes were enriched within immune related pathways, further supporting the role of the immune system in AN.

Feasibility, Acceptability and Preliminary Implementation of the Cornerstone Program for Transition-Age Youth with Mental Health Conditions: A Mixed Methods Study.

Transition-age youth with mental health conditions from low socio-economic backgrounds often drop out of mental health services and, as such, do not receive therapeutic doses of treatment. Cornerstone is an innovative team-based, multi-component intervention designed to address the clinical needs of this understudied population through coordination and extensive provision of services in vivo (in the community). The present study used a convergent parallel mixed-methods design. Researchers collected quantitative and qualitative data during a small developmental trial, analyzing the two data types independently and then exploring them side-by-side to evaluate feasibility, acceptability, and preliminary implementation. Semi-structured interviews and quantitative surveys were conducted with transition-age youth, clinic staff, and policy makers. Qualitative interview guides were developed using the Consolidated Framework for Implementation Research to build understanding on implementation determinants alongside feasibility and acceptability. A two-group preliminary randomized trial was conducted to assess feasibility outcomes, such as recruitment, randomization, measurement performance, and trends in pre- to post- outcomes. Using grounded theory coding techniques, transcripts were coded by multiple coders, and themes were identified on acceptability and implementation. The team recruited fifty-six transition-age youth. Randomization was used in the study and the intervention was provided without incident. Results suggest individual components with both the social worker and mentor were more acceptable to participants than group-based approaches. Thematic analyses revealed themes associated with the inner, outer, and policy contexts describing a range of critical implementation determinants. Findings suggest that Cornerstone is feasible, acceptable, and promising for transition-age youth. It represents an innovative multi-component intervention worth exploring for transition-age youth with mental health conditions in a larger efficacy trial.Trial registration: The trial was registered at ClinicalTrials.gov (NCT02696109) on 22 April 16, Protocol Record R34-MH102525-01A1, New York University, Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial.

Big brown bats experience slower epigenetic ageing during hibernation.

Comparative analyses of bats indicate that hibernation is associated with increased longevity among species. However, it is not yet known if hibernation affects biological ageing of individuals. Here, we use DNA methylation (DNAm) as an epigenetic biomarker of ageing to determine the effect of hibernation on the big brown bat, Eptesicus fuscus. First, we compare epigenetic age, as predicted by a multi-species epigenetic clock, between hibernating and non-hibernating animals and find that hibernation is associated with epigenetic age. Second, we identify genomic sites that exhibit hibernation-associated change in DNAm, independent of age, by comparing samples taken from the same individual in hibernating and active seasons. This paired comparison identified over 3000 differentially methylated positions (DMPs) in the genome. Genome-wide association comparisons to tissue-specific functional elements reveals that DMPs with elevated DNAm during winter occur at sites enriched for quiescent chromatin states, whereas DMPs with reduced DNAm during winter occur at sites enriched for transcription enhancers. Furthermore, genes nearest DMPs are involved in regulation of metabolic processes and innate immunity. Finally, significant overlap exists between genes nearest hibernation DMPs and genes nearest previously identified longevity DMPs. Taken together, these results are consistent with hibernation influencing ageing and longevity in bats.

Simulating the role of knowledge brokers in policy making in state agencies: An agent-based model.

OBJECTIVE: To model children's mental health policy making dynamics and simulate the impacts of knowledge broker interventions. DATA SOURCES: Primary data from surveys (n = 221) and interviews (n = 64) conducted in 2019-2021 with mental health agency (MHA) officials in state agencies. STUDY DESIGN: A prototype agent-based model (ABM) was developed using the PARTE (Properties, Actions, Rules, Time, Environment) framework and informed through primary data collection. In each simulation, a policy is randomly generated (salience weights: cost, contextual alignment, and strength of evidence) and discussed among agents. Agents are MHA officials and heterogenous in their properties (policy making power and network influence) and policy preferences (based on salience weights). Knowledge broker interventions add agents to the MHA social network who primarily focus on the policy's research evidence. DATA COLLECTION/EXTRACTION METHODS: A sequential explanatory mixed method approach was used. Descriptive and regression analyses were used for the survey data and directed content analysis was used to code interview data. Triangulated results informed ABM development. In the ABM, policy makers with various degrees of decision influence interact in a scale-free network before and after knowledge broker interventions. Over time, each decides to support or oppose a policy proposal based on policy salience weights and their own properties and interactions. The main outcome is an agency-level decision based on policy maker support. Each intervention and baseline simulation runs 250 times across 50 timesteps. PRINCIPAL FINDINGS: Surveys and interviews revealed that barriers to research use could be addressed by knowledge brokers. Simulations indicated that policy decision outcomes varied by policy making context within agencies. CONCLUSIONS: This is the first application of ABM to evidence-informed mental health policy making. Results suggest that the presence of knowledge brokers can: (1) influence consensus formation in MHAs, (2) accelerate policy decisions, and (3) increase the likelihood of evidence-informed policy adoption.

Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non-clinical after-care program for hospital-treated deliberate self-poisoning.

INTRODUCTION: Active contact and follow-up interventions have been shown to be effective in reducing repetition of hospital-treated self-harm. The Way Back Support Service (WBSS) is a new service funded by the Australian government to provide three months of non-clinical after-care following a hospital-treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self-poisoning (DSP) and psychiatric hospital admissions over a 12-month follow-up period for a population of DSP patients within the Hunter (Australia) region. METHODS: A non-randomized, historical controlled (two periods) trial design with intention-to-treat analyses. Outcome data were drawn from hospital records. RESULTS: There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re-admissions for DSP in the follow-up period. For psychiatric admissions, the intervention cohort had a non-significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts. CONCLUSION: The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence-based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation.

DNA methylation predicts age and provides insight into exceptional longevity of bats.

Exceptionally long-lived species, including many bats, rarely show overt signs of aging, making it difficult to determine why species differ in lifespan. Here, we use DNA methylation (DNAm) profiles from 712 known-age bats, representing 26 species, to identify epigenetic changes associated with age and longevity. We demonstrate that DNAm accurately predicts chronological age. Across species, longevity is negatively associated with the rate of DNAm change at age-associated sites. Furthermore, analysis of several bat genomes reveals that hypermethylated age- and longevity-associated sites are disproportionately located in promoter regions of key transcription factors (TF) and enriched for histone and chromatin features associated with transcriptional regulation. Predicted TF binding site motifs and enrichment analyses indicate that age-related methylation change is influenced by developmental processes, while longevity-related DNAm change is associated with innate immunity or tumorigenesis genes, suggesting that bat longevity results from augmented immune response and cancer suppression.

A 60:40 split: Differential mass support in dogs.

Dogs have been bred for different sizes and functions, which can affect their locomotor biomechanics. As quadrupeds, dogs must distribute their mass between fore and hind legs when standing. The mass distribution in dogs was studied to determine if the proportion of supported mass on each limb couplet is dependent on body size. A total of 552 dogs from 123 breeds ranging in size from Chihuahua to Mastiff were examined. Each dog was weighed on a digital scale while standing, alternating foreleg, and hind leg support. The overall "grand" mean proportion of mass on the forelegs to the total mass was 60.4% (range: 47.6-74.4%). The data set indicated no significant change in the ratio with total mass but there was a significant difference by sex. When separated into American Kennel Club categories, no group was notably different from the grand mean or from each other, but when sex was also considered, there was a significant difference that was not specifically discerned by post hoc analysis. The mean for female Hounds was notably below the grand mean. For clades based on genetics, the mean for European origin mastiffs was notably greater than the grand mean and significantly different from UK origin herders and coursers. The mass of the head, chest, and musculature for propulsion could explain the mass support differential. Mass distribution and terrestrial locomotion in dogs shows substantial variation among breeds.

Investigation of glycaemic traits in psychiatric disorders using Mendelian randomisation revealed a causal relationship with anorexia nervosa.

Data from observational studies have suggested an involvement of abnormal glycaemic regulation in the pathophysiology of psychiatric illness. This may be an attractive target for clinical intervention as glycaemia can be modulated by both lifestyle factors and pharmacological agents. However, observational studies are inherently confounded, and therefore, causal relationships cannot be reliably established. We employed genetic variants rigorously associated with three glycaemic traits (fasting glucose, fasting insulin, and glycated haemoglobin) as instrumental variables in a two-sample Mendelian randomisation analysis to investigate the causal effect of these measures on the risk for eight psychiatric disorders. A significant protective effect of a natural log transformed pmol/L increase in fasting insulin levels was observed for anorexia nervosa after the application of multiple testing correction (OR = 0.48 [95% CI: 0.33-0.71]-inverse-variance weighted estimate). There was no consistently strong evidence for a causal effect of glycaemic factors on the other seven psychiatric disorders considered. The relationship between fasting insulin and anorexia nervosa was supported by a suite of sensitivity analyses, with no statistical evidence of instrument heterogeneity or horizontal pleiotropy. Further investigation is required to explore the relationship between insulin levels and anorexia.