Addressing Mental Health Needs for Deaf Patients Through an Integrated Health Care Model.

Deaf individuals struggle with accessing mental health services because of language and cultural discordance. Our project's purpose was to design and pilot an accessible, integrated mental health program for the Deaf population, scalable for other health centers interested in serving these individuals. Our team addressed several identified barriers to care. The addition of a language-concordant mental health clinician and telemental health appointments helped us better manage Deaf patients' mental health needs. Individual and clinic level data were collected and analyzed. Results demonstrated a significant improvement in the patients' depression and anxiety scores from their baseline to their last documented visit. Patient satisfaction overall was high. Telemental health appears to be a feasible tool to address some of the mental health gaps in the Deaf community. Further studies are needed to demonstrate how this program can be effective within a larger geographical area.

Effects of a Mediterranean Diet Intervention on Anti- and Pro-Inflammatory Eicosanoids, Epithelial Proliferation, and Nuclear Morphology in Biopsies of Normal Colon Tissue.

This randomized trial evaluated the effects of intervention with either a Healthy Eating or a Mediterranean diet on colon biomarkers in 120 healthy individuals at increased colon cancer risk. The hypothesis was that eicosanoids and markers of proliferation would be favorably affected by the Mediterranean diet. Colon epithelial biopsy tissues and blood samples were obtained at baseline and after 6 mo of intervention. Colonic eicosanoid concentrations were evaluated by HPLC-MS-MS, and measures of epithelial proliferation and nuclear morphology were evaluated by image analysis of biopsy sections. There was little change in proinflammatory eicosanoids and in plasma cytokine concentrations with either dietary intervention. There was, however, a 50% increase in colonic prostaglandin E3 (PGE3), which is formed from eicosapentanoic acid, in the Mediterranean arm. Unlike PGE2, PGE3, was not significantly affected by regular use of non-steroidal anti-inflammatory drugs at baseline, and normal weight subjects had significantly higher colon PGE3 than overweight or obese subjects. Increased proliferation in the colon at baseline, by Ki67 labeling, was associated with morphological features that defined smaller nuclei in the epithelial cells, lower colon leukotriene concentrations and higher plasma cytokine concentrations. Dietary intervention had little effect on measures of epithelial proliferation or of nuclear morphology. The increase in PGE3 with a Mediterranean diet indicates that in normal colon, diet might affect protective pathways to a greater extent than proinflammatory and proliferative pathways. Hence, biomarkers from cancer models might not be relevant in a true prevention setting.

Youth Perspectives regarding the Regulating of Bathroom Use by Transgender Individuals.

Regulations regarding bathroom use by transgender people affect youth across the United States. This study examines youth opinions on bathroom use regulations. Data were obtained from MyVoice, a weekly text messaging survey of youth aged 14-24 years. Youth were recruited nationally at community events and online; Southeast Michigan was overrepresented. Mixed methods analysis was performed using grounded theory methodology. The majority of respondents (n = 683) were white (71.4%) and had education beyond high school (56.5%). Most (79%) stated that bathroom use by transgender people should not be restricted, rationalizing: 1) bathroom use is private and should be a personal decision; 2) choosing bathrooms is a matter of equality, freedom, and human rights; 3) transgender people are not sexual perpetrators; and 4) forcing transgender people to use particular bathrooms puts them at risk. Contrary to the current policy in many schools, respondents do not support restrictions on bathroom use by transgender people.

Family Physicians and Provision of Immediate Postpartum Contraception: A CERA Study.

BACKGROUND AND OBJECTIVES: The Centers for Disease Control and Prevention (CDC) support the provision of intrauterine devices (IUDs) and the contraceptive implant to women immediately after childbirth. We aimed to assess perceived training needs and barriers to immediate postpartum contraceptive service delivery among US family physicians. METHODS: We contributed items regarding postpartum contraception to the 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey of a national cohort of family medicine educators. We assessed self-estimated adequacy of training to insert IUDs and implants immediately postpartum, how often these services are provided, and barriers to service provision. RESULTS: Our sample of 409 respondents who provide labor and delivery maternity care was primarily Caucasian (79.9%) and female (56.0%). Significantly fewer respondents felt comfortable counseling about long-acting reversible contraception (LARC), inserting an IUD, and inserting an implant immediately postpartum compared to at 6+ weeks postpartum (all comparisons P<0.001). Fewer respondents felt adequately trained to insert an immediate postpartum IUD (36.4%) than an implant (58.7%; P<0.001). Most respondents had never placed an immediate postpartum IUD (81.17%) or implant (80.1%). Device unavailability was the most commonly cited reason for never having placed an immediate postpartum IUD (67.8%) or implant (71.2%) at one's institution. CONCLUSIONS: As reimbursement for immediate postpartum contraception becomes more common, family physicians are on the front lines to make these services available to patients who desire them. Training is necessary to enable family physicians to provide this evidence-based option to women.