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1.
Am J Infect Control ; 52(1): 139, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38135354
2.
J Behav Health Serv Res ; 47(4): 449-463, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32363490

RESUMO

A proof-of-concept practice-based implementation network was developed in the US Departments of Veteran Affairs (VA) and Defense to increase the speed of implementation of mental health practices, derive lessons learned prior to larger-scale implementation, and facilitate organizational learning. One hundred thirty-four clinicians in 18 VA clinics received brief training in the use of the PTSD checklist (PCL) in clinical care. Two implementation strategies, external facilitation and technical assistance, were used to encourage the use of outcomes data to inform treatment decisions and increase discussion of results with patients. There were mixed results for changes in the frequency of PCL administration, but consistent increases in clinician use of data and incorporation into the treatment process via discussion. Programs and clinicians were successfully recruited to participate in a 2-year initiative, suggesting the feasibility of using this organizational structure to facilitate the implementation of new practices in treatment systems.


Assuntos
Atenção à Saúde/organização & administração , Prática Clínica Baseada em Evidências/normas , Pessoal de Saúde/normas , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Atenção Primária à Saúde/organização & administração , Lista de Checagem , Objetivos , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Programas de Rastreamento/normas , Saúde Mental , Avaliação de Programas e Projetos de Saúde , Estudo de Prova de Conceito , Transtornos de Estresse Pós-Traumáticos , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologia
3.
Mil Med ; 181(2): e183-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26837089

RESUMO

Military sexual trauma (MST) is associated with high rates of post-traumatic stress disorder (PTSD) and multiple comorbid symptoms. In addition, women Veterans with MST report negative perceptions of social support, poor relationships, and difficulties in social and role functioning. Treatments for PTSD do not provide interventions to improve social or relationship functioning and do not consistently produce positive benefits regarding these outcomes. This article presents a series of case studies in which an intervention focused on building social support and relationship skills is delivered to Veterans with PTSD and MST. The intervention, Skills Training in Affective and Interpersonal Regulation (STAIR) promotes social engagement and skills that support greater role functioning. It can be used as a stand-alone treatment, as an adjunctive intervention to PTSD therapies or as part of a combination therapy in which skills precede trauma-focused work (STAIR Narrative Therapy). Further investigation is suggested to determine the added benefits of incorporating skills building to PTSD or other diagnosis-specific interventions.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Apoio Social , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adaptação Psicológica , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Narrativa/métodos , Delitos Sexuais/psicologia , Habilidades Sociais , Transtornos de Estresse Pós-Traumáticos/psicologia
4.
Mil Med ; 179(1): 12-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24402979

RESUMO

PTSD Coach is a mobile application (app) designed to help individuals who have post-traumatic stress disorder (PTSD) symptoms better understand and self-manage their symptoms. It has wide-scale use (over 130,000 downloads in 78 countries) and very favorable reviews but has yet to be evaluated. Therefore, this study examines user satisfaction, perceived helpfulness, and usage patterns of PTSD Coach in a sample of 45 veterans receiving PTSD treatment. After using PTSD Coach for several days, participants completed a survey of satisfaction and perceived helpfulness and focus groups exploring app use and benefit from use. Data indicate that participants were very satisfied with PTSD Coach and perceived it as being moderately to very helpful with their PTSD symptoms. Analysis of focus group data resulted in several categories of app use: to manage acute distress and PTSD symptoms, at scheduled times, and to help with sleep. These findings offer preliminary support for the acceptability and perceived helpfulness of PTSD Coach and suggest that it has potential to be an effective self-management tool for PTSD. Although promising, future research is required to validate this, given study limitations.


Assuntos
Aplicativos Móveis , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Satisfação do Paciente , Autocuidado , Estados Unidos
5.
J Sch Health ; 81(4): 185-93, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21392010

RESUMO

BACKGROUND: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner-city neighborhoods. METHODS: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow-up data were assessed in multiple domains among students and teachers. RESULTS: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.


Assuntos
Transtornos do Comportamento Infantil/prevenção & controle , Transtornos do Comportamento Infantil/terapia , Serviços Comunitários de Saúde Mental/métodos , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Adolescente , Criança , Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/diagnóstico , Pré-Escolar , Cidades , Serviços Comunitários de Saúde Mental/organização & administração , Docentes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transtornos Mentais/diagnóstico , Meio-Oeste dos Estados Unidos , Projetos Piloto , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Testes Psicológicos , Instituições Acadêmicas
6.
J Virol ; 84(17): 8975-9, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20592077

RESUMO

It is still unknown whether a noninfectious gammaherpesvirus vaccine is able to prevent or reduce virus persistence. This led us to use dendritic cells loaded with tumor B cells as a vaccine approach for the murine gammaherpesvirus 68 (gammaHV68) model of infection. Dendritic cells loaded with UV-irradiated latently infected tumor B cells induce broad, strong, and long-lasting immunity against gammaHV68. Dendritic cell vaccination prevents the enlargement of lymph nodes and severely limits acute infection and early latency but does not prevent gammaHV68 from establishing long-term latency. Our findings support the concept that attenuated viruses may be the best vaccine option for preventing gammaherpesvirus persistence.


Assuntos
Linfócitos B/imunologia , Vacinas Anticâncer/imunologia , Células Dendríticas/imunologia , Gammaherpesvirinae/fisiologia , Infecções por Herpesviridae/imunologia , Latência Viral , Animais , Linfócitos B/virologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Vacinas Anticâncer/administração & dosagem , Células Cultivadas , Células Dendríticas/virologia , Gammaherpesvirinae/genética , Gammaherpesvirinae/imunologia , Infecções por Herpesviridae/virologia , Humanos , Linfoma de Células B/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Vacinação
7.
J Virol ; 81(18): 9778-89, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17626106

RESUMO

The respiratory tract is a major mucosal site for microorganism entry into the body, and type I interferon (IFN) and dendritic cells constitute a first line of defense against viral infections. We have analyzed the interaction between a model DNA virus, plasmacytoid dendritic cells, and type I IFN during lung infection of mice. Our data show that murine gammaherpesvirus 68 (gammaHV68) inhibits type I IFN secretion by dendritic cells and that plasmacytoid dendritic cells are necessary for conventional dendritic cell maturation in response to gammaHV68. Following gammaHV68 intranasal inoculation, the local and systemic IFN-alpha/beta response is below detectable levels, and plasmacytoid dendritic cells are activated and recruited into the lung with a tissue distribution that differs from that of conventional dendritic cells. Our results suggest that plasmacytoid dendritic cells and type I IFN have important but independent roles during the early response to a respiratory gammaHV68 infection. gammaHV68 infection inhibits type I IFN production by dendritic cells and is a poor inducer of IFN-alpha/beta in vivo, which may serve as an immune evasion strategy.


Assuntos
Células Dendríticas/imunologia , Infecções por Herpesviridae/imunologia , Interferon-alfa/imunologia , Interferon beta/imunologia , Interferon gama/imunologia , Plasmócitos/imunologia , Infecções Respiratórias/imunologia , Rhadinovirus/imunologia , Animais , Movimento Celular/imunologia , Células Dendríticas/patologia , Modelos Animais de Doenças , Infecções por Herpesviridae/patologia , Pneumopatias/imunologia , Pneumopatias/patologia , Pneumopatias/virologia , Camundongos , Células NIH 3T3 , Plasmócitos/patologia , Infecções Respiratórias/patologia , Infecções Respiratórias/virologia
8.
J Immunol ; 179(1): 141-53, 2007 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-17579032

RESUMO

During infection with viruses that establish latency, the immune system needs to maintain lifelong control of the infectious agent in the presence of persistent Ag. By using a gamma-herpesvirus (gammaHV) infection model, we demonstrate that a small number of virus-specific central-memory CD8+ T cells develop early during infection, and that virus-specific CD8+T cells maintain functional and protective capacities during chronic infection despite low-level Ag persistence. During the primary immune response, we show generation of CD8+ memory T cell precursors expressing lymphoid homing molecules (CCR7, L-selectin) and homeostatic cytokine receptors (IL-7alpha, IL-2/IL-15beta). During long-term persistent infection, central-memory cells constitute 20-50% of the virus-specific CD8+ T cell population and maintain the expression of L-selectin, CCR7, and IL-7R molecules. Functional analyses demonstrate that during viral persistence: 1) CD8+ T cells maintain TCR affinity for peptide/MHC complexes, 2) the functional avidity of CD8+ T cells measured as the capacity to produce IFN-gamma is preserved intact, and 3) virus-specific CD8+ T cells have in vivo killing capacity. Next, we demonstrate that at 8 mo post-virus inoculation, long-term CD8+ T cells are capable of mediating a protective recall response against the establishment of gammaHV68 splenic latency. These observations provide evidence that functional CD8+ memory T cells can be generated and maintained during low-load gammaHV68 persistence.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/virologia , Citotoxicidade Imunológica/imunologia , Memória Imunológica/imunologia , Latência Viral/imunologia , Animais , Linfócitos T CD8-Positivos/metabolismo , Linfócitos T CD8-Positivos/patologia , Diferenciação Celular/genética , Diferenciação Celular/imunologia , Citotoxicidade Imunológica/genética , Epitopos de Linfócito T/imunologia , Gammaherpesvirinae/imunologia , Infecções por Herpesviridae/imunologia , Infecções por Herpesviridae/patologia , Homeostase/genética , Homeostase/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Células NIH 3T3 , Receptores de Antígenos de Linfócitos T/metabolismo , Receptores de Citocinas/biossíntese , Receptores de Citocinas/genética , Carga Viral
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