Molecular and physiologic changes in the SpaceX Inspiration4 civilian crew.

Human spaceflight has historically been managed by government agencies, such as the NASA Twins Study1, but new commercial spaceflight opportunities have opened spaceflight to a broader population. In 2021, the SpaceX Inspiration4 mission launched the first-ever all civilian crew to low Earth orbit, which included the youngest American astronaut (age 29), novel in-flight experimental technologies (handheld ultrasound imaging, smartwatch wearables, and immune profiling), ocular alignment measurements, and new protocols for in-depth, multi-omic molecular and cellular profiling. Here we report the primary findings from the 3-day spaceflight mission, which induced a broad range of physiological and stress responses, neurovestibular changes indexed by ocular misalignment, and altered neurocognitive functioning, some of which match long-term spaceflight2, but almost all of which did not differ from baseline (pre-flight) after return to Earth. Overall, these preliminary civilian spaceflight data suggest that short-duration missions do not pose a significant health risk, and moreover present a rich opportunity to measure the earliest phases of adaptation to spaceflight in the human body at anatomical, cellular, physiologic, and cognitive levels. Finally, these methods and results lay the foundation for an open, rapidly expanding biomedical database for astronauts3, which can inform countermeasure development for both private and government-sponsored space missions.

A randomized controlled trial of cognitive behavioral group therapy for bipolar disorder.

BACKGROUND: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. METHODS: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. RESULTS: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (χ(2) = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = -2.554; p = 0.011). CONCLUSIONS: Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.

Clinical relevance of anthropological and cross-cultural research: concepts and strategies.

The author presents a method through which findings from anthropological and cross-cultural research can be applied to problems affecting patient care. The clinical social science approach emphasizes the distinction between disease and illness and cultural influences on the ways "clinical reality" is conflictingly construed in the ethnomedical models of patients and the biomedical models of practitioners. The relevance of such research extends beyond special clinical concerns arising from ethnic differences to ubiquitous problems that result from cultural influences on all aspects of health care. Consultation-liaison psychiatry is a particularly appropriate vehicle for introducing clinical social science into medical and psychiatric teaching and practice.

A critical review of epidemiological studies of Puerto Rican mental health.

Through a review of the epidemiological literature on the mental health of Puerto Ricans and other Hispanics, the authors argue that lack of attention to cultural issues in epidemiological studies leaves many questions unanswered and raises concerns about the validity of studies in this area. The authors point out that the mental health status of Puerto Ricans in New York City is still poorly understood after 30 years of research. The roles of cultural response styles and of culturally meaningful expressions of distress in shaping responses to research interviews should be central concerns in developing research in cross-cultural psychiatry.

Depression and somatization: a review. Part II.

In Part I, the authors described the relationship between somatization and depression and the extent and rate of misdiagnosis of the problem of depression in primary care. A conceptual model was developed to explain the patient's selective perception and focus on the somatic manifestation of depression and the resulting misdiagnosis. In the first section, the sociocultural and childhood experience were reviewed as two major factors influencing the ability of the patient to perceive affective changes. In this second part, the authors review the influence of the developmental stage of the patient's cognitive mechanisms and the effect of the environmental systems in which the patient dwells, i.e., medical care, family and social network, work/disability and the sociopolitical institutions, on the recognition of affective, cognitive and somatic symptoms.

Depression and somatization: a review. Part I.

The authors describe the relationship between the major depressive disorder and somatization. A literature review documenting the incidence and prevalence of depression in primary care and the rate of misdiagnosis is presented. Evidence is collated that points to several factors in misdiagnosis. The patient often selectively complains about the somatic manifestations of depression, minimizes the affective and cognitive components and is treated symptomatically. This is due to the physician's lack of recognition that the patient may have major depressive disorder and yet not recognize and report the mood component. The authors develop a conceptual; model that elucidates the mechanism behind the selective perception and focus by the patient on the somatic manifestations of depression. In this first part, the influence of sociocultural and childhood experience on the ability of the patients to recognize and report mood changes is delineated. Understanding this model is crucial in preventing misdiagnosis and potential iatrogenic harm to the patient.

Psychopathology and clinical course of schizophrenia: a cross-cultural perspective.

The authors critically review the existing literature on the outcome of schizophrenia in non-Western countries. Compared to studies conducted in Europe and North America, the majority of these non-Western longitudinal followup studies indicated significantly better outcome. Such cross-national variations in the outcome of schizophrenia have been substantiated by two large-scale multicentered studies sponsored by the World Health Organization. Along with this literature review, the authors also discuss potential methodological problems of these studies and examine in detail several key hypotheses concerning mediating factors that could differentially influence the fate of schizophrenic patients in divergent cultural settings. Finally, specific suggestions are made for future research directions.

Culture, personality, and psychopathology.

Culture needs to be made more central to the understanding of personality and psychopathology. New anthropological views describe cultural influences on personality and psychopathology by focusing on the effect of social change in local contexts on sociosomatic and sociopsychological processes. This view discloses the cultural biases built into dominant North American professional models of diagnosis and contrasts with past uses of culture in cross-cultural research. Examples from Chinese and Puerto Rican societies illustrate how indigenous interpersonal models of personality and psychopathology that focus on social processes can augment the cross-cultural validity of clinical formulations.

Cultural psychiatry. Theoretical, clinical, and research issues.

As a discipline, cultural psychiatry has matured considerably in recent years and the ongoing quality of its theoretical, clinical, and research development holds great promise. The contemporary emphasis on culture as process permits a deeper analysis of the complexities of sociosomatics--the translation of meanings and social relations into bodily experience--and, thus, of the social course of illness. We also are learning a great deal more about cultural processes that affect therapy, including ethnopharmacologic and culturally valid family interventions that are directly relevant to patient care and mental health policy. And an important set of studies is examining the trauma experienced by refugees and immigrants. But at the same time many disquieting findings still point to the limited impact of cultural psychiatry on knowledge creation and clinical application in psychiatry. The failure of the cultural validation of DSM-IV is only the most dismaying. The persistent misdiagnosis of minority patients and the continued presence of racial bias in some treatment recommendations are also disheartening, as is the seeming contempt of many mainstream psychiatrists for culturally defined syndromes and folk healing systems. Widespread inattention to ethnic issues in medical ethics is another source of dismay. It is for these reasons that the culture of psychiatry itself becomes as important as the culture of patients as a topic for research and intervention. Most of the world still suffers from a terrible lack of basic mental health services, including life-saving medications and hospital beds. In the face of these limitations, and because of the increasing multicultural and pluralistic reality of contemporary life, the growing interpretive bridges linking indigenous systems of illness classification and healing to Western nosologies and therapeutic modalities become even more essential and the reluctance of mainstream clinicians to explore folk healing methods more incomprehensible. Psychiatry needs new ways of delivering culturally appropriate care to the disenfranchised and the destitute, for whom mainstream approaches are often too expensive, foreign, and centralized. As a profession, we also have much to learn from indigenous diagnosticians and therapists. Finally, psychosomatic, mind-brain, behavioral health, and psychopathologic investigations need to configure the social world in their paradigms of research if we are to understand better the sources and consequences of mental illness. Psychiatry can no more afford to be contextless than it can afford to be mindless or brainless.

Psychiatry's identity crisis: a critical rational remedy.

Psychiatry has several partial identities reflecting its biologic, psychoanalytic, and social subspecialities. It has, however, no encompassing professional identity. This identity requires three features: (a) a common language and procedure for assessing psychopathology, (b) a common method for evaluation and use of knowledge from outside psychiatry, and (c) a common set of values regarding clinical and research activities. The authors discuss the clinical, biologic, and sociocultural psychiatric traditions to identify the roots and consequences of psychiatry's fragmented state. Psychiatry's identity problems cannot be solved by ignoring them or simply becoming more "medical." Rather, the authors propose a remedy--critical rationality--to help resolve the crisis. Critical rationality requires a discimplined approach to psychiatric knowledge that underscores the necessity of methodologic rigor, practicality, and mid-range theorizing (rationality); and the equal necessity for systematic self-criticism, reform, self-awareness, and attention to the ethical dimensions in teaching, practice, and research (critical).

Psychiatric consultation-liaison service: patients, requests, and functions.

Prospective data were gathered from 388 psychiatric consultations performed in a general hospital setting. Data included demographic, medical, psychiatric, and illness behavior characteristics of the patients seen, as well as consultant functions and recommendations. Results indicate that consulted patients suffer from a wide variety of medical problems, are frequently taking psychoactive medications before the consultation, and experience a spectrum of psychosocial problems in coping with their disease. Primary physicians infrequently provided any psychiatric data or reasons for referral other than for depression. Consultants determined what they felt were the motivating reasons for referral and besides patient psychopathology found a significant amount of maladaptive illness behavior and staff/patient conflict. Comparison with other studies supports the high incidence of primary (21%) and secondary (18%) depression in this population and the active involvement in its treatment by consultation-liaison psychiatrists. Research, training, and clinical issues generated by the findings are discussed.

Medicine betrayed: hemophilia patients and HIV in the US.

The contamination of blood products by HIV in the early 1980s resulted in thousands of deaths among people with hemophilia in the United States and elsewhere. In the US, industry, government, physicians, and advocacy groups were implicated in this tragedy. In response to pleas from members of the US hemophilia community, the Institute of Medicine (IOM) of the National Academy of Science convened a public hearing to identify the institutional determinants of the HIV/AIDS epidemic among US hemophilia patients. The resulting IOM Report (1995) established a narrative of the crisis and indicated necessary improvements to the management of the US blood supply. The Report, however, failed to address the hemophilia community's demands for accountability and retribution. In this paper we explore the moral and social dimensions of this tragedy through narrative analysis of the original testimonies of hemophilia sufferers, interviews with some patients and their families, and a re-examination of the text of the IOM Report itself. We examine the process by which this crisis was addressed--through the discourses of science and law--and how it was ultimately framed as a failure of management and oversight rather than a moral failure of the for-profit health-care system. Thus, while the Report and its aftermath demonstrate powerfully how testimonials of suffering can influence public policy, by not addressing what is at stake for the victims--failure to protect patients in an era of increasingly commodified health care--it led to an exculpatory solution that obfuscated the moral dimensions of suffering.

The social course of epilepsy: chronic illness as social experience in interior China.

Findings are reported from a collaborative research project on the experience of epilepsy and treatment among patients and family members in Shanxi and Ningxia Provinces in China. Family, marriage, financial and moral consequences of the social experience of epilepsy support the conceptualization of chronic illness as possessing a social course. Beyond traditional concern with stigma, application of concepts of delegitimation, sociosomatic processes, coping as resistance, contestation in the evaluation of efficacy and compliance, and the cultural ontology of suffering illustrate other ways that social theory is useful in research on chronic illness and disability.

Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context.

Suicide is a complex phenomenon--arguably a social and a moral deed--occurring within associated psychological, biological, and cultural contexts. We present data on suicide rates in China for 1988, 1990, and 1992 and provide an analysis of their social context. These figures, from the Chinese Public Health Annuals, have never before been publicly reported. These and other recent data indicate that suicide rates in China, although reportedly low in the past, are by global standards alarmingly high among certain demographic groups. They also reveal distinctive epidemiological patterns of suicide in China that contrast with the patterns characteristic of Western societies-for example, higher rates in rural than in urban areas and, among some demographic groups, higher among women than among men. As in the West, however, suicide among the elderly is a major problem in China. The sociocultural context of these data is examined as a means toward understanding their distinctive patterning.

Immediate loading of a single hydroxyapatite-coated threaded root form implant: a clinical report.

The successful results of endosseous root form implants in the treatment of partially and completely edentulous patients has been made possible by the application of standardized surgical and prosthetic protocols. Different techniques have been published in the literature with the purpose of reducing implant prosthetic rehabilitation times. This clinical case report describes a new surgical concept and a technique to fabricate screw-retained provisional crowns for immediate loading of free-standing single tooth implants. Further clinical and histologic studies are necessary in order to promote routine clinical application of this technique.

The social course of schizophrenia: local and societal factors.

In this paper, we propose a model of social course of schizophrenia based on cross-cultural research on the influence of family, wider social network, work, political economy, and legal and mental health care institutions on the experience of illness. We posit the way these ordinary arrangements of daily living organize the course of schizophrenia in part through cultural processes that affect the body-self in suffering and in part through social processes that establish an intersubjective matrix for the experience of illness. We believe this model can be generalized to other chronic illness such as depression, diabetes, asthma, osteoarthritis, chronic pain syndrome, chronic fatigue syndrome, and even heart disease and cancer. We develop the implications of this anthropological approach for research and practice.

The cultural meanings and social uses of illness. A role for medical anthropology and clinically oriented social science in the development of primary care theory and research.

Basic research that is conceptually and methodologically innovative and that fosters long-term research programs should play a role in the academic development of primary care, alongside more practical applied studies of specific clinical problems. A creative tension between the two has been a distinctive attribute of academic medicine and should be fostered in family medicine and other primary care disciplines. The biopsychosocial model offers a paradigm for the incorporation of clinically oriented social science research as one basic science approach in which primary care researchers can receive advanced training and pursue an academic career. The author briefly illustrates such a career with reference to studies (his own included) on the social uses and psychocultural meanings of illness. Somatization, a major problem in primary care, is illuminated by such a clinically applied social science research framework. Developing the scientific basis of an academic discipline involves intellectual education in systematic scholarship to create and critique concepts as much as it requires training in the application of rigorous research design and powerful statistical techniques.

Somatization in family practice: a biopsychosocial approach.

The family physician sees many patients who present physical symptoms that have primarily an emotional or psychosocial basis. This paper defines the concept of somatization, reviews its prevalence and consequences, and develops a conceptual model of somatization that includes cultural, childhood, psychological, and environmental factors. Physicians and the medical care system play a significant role in reinforcing somatization by patients. A biopsychosocial approach to the clinical assessment, diagnosis, and management of these patients is presented along with case examples that exemplify the utility of this approach.

An exploration of the dimensions of illness behavior.

Illness behavior is typically studied from the perspective of medical care practitioners. Problems for which people seek medical care are often deemed to be the universe of such ailments whereas actually they represent a small percentage of total illness experienced. This paper describes the rest of the iceberg of health problems. By using a health diary, all problems recorded by 107 participants over a three-week period were analyzed. A total of 348 problems (3.25 per person) were recorded with less than six percent of the problems receiving professional medical care. Stated differently, individuals were experiencing at least one health problem on approximately half of all study days. Health beliefs regarding selected problems were also obtained, along with non-orthodox practitioner (eg, chiropractors and naturopaths) utilization patterns.