Improving Research Quality to Achieve Mental Health Equity.

Inequities and the resulting disparities that exist in mental health for a variety of socially disadvantaged groups have roots in the history and ongoing processes of medical and mental health research, as well as in persisting implicit bias in our society and health care system. The inclusion of historically excluded communities in the research to practice pipeline is vital to ensuring that treatments and interventions are developed to increase equity in mental health. A research framework is proposed based on the integration of community-based participatory research and human-centered design as an avenue for removing inequities and barriers in mental health.

The Role of Prosocial Behavior in Promoting Physical Activity, as an Indicator of Resilience, in a Low-Income Neighborhood.

The purpose of this study was to examine the effect of prosocial behavior on physical activity, as an indicator of resilience, in a low-income neighborhood with adverse built environment and social conditions. Resilience is an important factor that promotes the ability for individuals to overcome hardships, and understanding resilience as it relates to health behavior is important in the efforts to improve the health and wellbeing of vulnerable communities. There are many constructs of resilience, and we selected physical activity as an indicator of resilience because of the role of physical activity in health promotion. A community based participatory research approach was utilized to conduct a door knock survey in a sample of 2,457 households in a low-income, historically African-American neighborhood. Fifty-seven percent of residents completed the survey. Physical activity was the dependent variable and we controlled for key demographics, resident health, primary mode of transportation and neighborhood safety. Prosocial behavior was the primary independent variable. We conducted descriptive, bivariate and multivariate analyses and found prosocial behavior was significantly correlated with moderate physical activity, despite adverse conditions. Our results indicate that prosocial behavior plays an important role in an individual's ability to engage in health-promoting behaviors, such as physical activity, despite challenges.

Ethical and Legal Challenges Associated with Public Molecular Autopsies.

There is a national movement supporting the retention and use of bio-specimens from deceased individuals for the purpose of genetic testing. This manuscript discusses the significance of postmortem genetic testing in the context of death determination by medical examiners (i.e., public molecular autopsies). We highlight distinctive concerns that are raised in the areas of consent, confidentiality, and return of results when genetic testing is performed as part of a public molecular autopsy. We believe our manuscript will contribute to the development of a robust ethical and legal framework for genetic testing in this context.

Altered Mucosal Microbiome Diversity and Disease Severity in Sjögren Syndrome.

There is mounting evidence that the microbiome has potent immunoregulatory functions. We assessed the effects of intestinal dysbiosis in a model of Sjögren syndrome (SS) by subjecting mice to desiccating stress (DS) and antibiotics (ABX). We characterized the conjunctival, tongue and fecal microbiome profiles of patients with SS. Severity of ocular surface and systemic disease was graded. 16S ribosomal RNA gene sequencing characterized the microbiota. ABX + DS mice had a significantly worse dry eye phenotype compared to controls, a decrease in Clostridium and an increase in Enterobacter, Escherichia/Shigella, and Pseudomonas in stool after ABX + DS for 10 days. Goblet cell density was significantly lower in ABX treated groups compared to controls. Stool from SS subjects had greater relative abundances of Pseudobutyrivibrio, Escherichia/Shigella, Blautia, and Streptococcus, while relative abundance of Bacteroides, Parabacteroides, Faecalibacterium, and Prevotella was reduced compared to controls. The severity of SS ocular and systemic disease was inversely correlated with microbial diversity. These findings suggest that SS is marked by a dysbiotic intestinal microbiome driven by low relative abundance of commensal bacteria and high relative abundance of potentially pathogenic genera that is associated with worse ocular mucosal disease in a mouse model of SS and in SS patients.

Legal Barriers to Adolescent Participation in Research About HIV and Other Sexually Transmitted Infections.

Whether adolescents can participate in clinical trials of pharmacologic therapies for HIV prevention, such as preexposure prophylaxis, without parental permission hinges on state minor consent laws. Very few of these laws explicitly authorize adolescents to consent to preventive services for HIV and other sexually transmitted infections. Unclear state laws may lead to research cessation. We have summarized legal, ethical, and policy considerations related to adolescents' participation in HIV and sexually transmitted infection prevention research in the United States, and we have explored strategies for facilitating adolescents' access.

Aqueous Tear Deficiency Increases Conjunctival Interferon-γ (IFN-γ) Expression and Goblet Cell Loss.

PURPOSE: To investigate the hypothesis that increased interferon-γ (IFN-γ) expression is associated with conjunctival goblet cell loss in subjects with tear dysfunction. METHODS: Goblet cell density (GCD) was measured in impression cytology from the temporal bulbar conjunctiva, and gene expression was measured in cytology samples from the nasal bulbar conjunctiva obtained from 68 subjects, including normal control, meibomian gland disease (MGD), non-Sjögren syndrome (non-SSATD)-, and Sjögren syndrome (SSATD)-associated aqueous tear deficiency. Gene expression was evaluated by real-time PCR. Tear meniscus height (TMH) was measured by optical coherence tomography. Fluorescein and lissamine green dye staining evaluated corneal and conjunctival disease, respectively. Between-group mean differences and correlation coefficients were calculated. RESULTS: Compared to control, IFN-γ expression was significantly higher in both ATD groups, and its receptor was higher in SSATD. Expression of IL-13 and its receptor was similar in all groups. Goblet cell density was lower in the SSATD group; expression of MUC5AC mucin was lower and cornified envelope precursor small proline-rich region (SPRR)-2G higher in both ATD groups. Interferon-γ transcript number was inversely correlated with GCD (r = -0.37, P < 0.04) and TMH (r = -0.37, P = 0.02), and directly correlated with lissamine green staining (r = 0.51, P < 0.001) and SPRR-2G expression (r = 0.32, P < 0.05). CONCLUSIONS: Interferon-γ expression in the conjunctiva was higher in aqueous deficiency and correlated with goblet cell loss and severity of conjunctival disease. These results support findings of animal and culture studies showing that IFN-γ reduces conjunctival goblet cell number and mucin production.

Corneal Sensitivity in Tear Dysfunction and its Correlation With Clinical Parameters and Blink Rate.

PURPOSE: To compare corneal sensitivity in tear dysfunction due to a variety of causes using contact and noncontact esthesiometers and to evaluate correlations between corneal sensitivity, blink rate, and clinical parameters. DESIGN: Comparative observational case series. METHODS: Ten normal and 33 subjects with tear dysfunction (meibomian gland disease [n = 11], aqueous tear deficiency [n = 10]-without (n = 7) and with (n = 3) Sjögren syndrome (SS)-and conjunctivochalasis [n = 12]) were evaluated. Corneal sensitivity was measured with Cochet-Bonnet and air jet esthesiometers and blink rate by electromyography. Eye irritation symptoms, tear meniscus height, tear break-up time (TBUT), and corneal and conjunctival dye staining were measured. Between-group means were compared and correlations calculated. RESULTS: Compared with control (Cochet-Bonnet 5.45 mm, air esthesiometer 3.62 mg), mean sensory thresholds were significantly higher in aqueous tear deficiency using either Cochet-Bonnet (3.6 mm; P = .003) or air (11.7 mg; P = .046) esthesiometers, but were not significantly different in the other groups. Reduced corneal sensitivity significantly correlated with more rapid TBUT and blink rate and greater irritation and ocular surface dye staining with 1 or both esthesiometers. Mean blink rates were significantly higher in both aqueous tear deficiency and conjunctivochalasis compared with control. Among all subjects, blink rate positively correlated with ocular surface staining and irritation and inversely correlated with TBUT. CONCLUSION: Among conditions causing tear dysfunction, reduced corneal sensitivity is associated with greater irritation, tear instability, ocular surface disease, and blink rate. Rapid blinking is associated with worse ocular surface disease and tear stability.

Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease.

PURPOSE: To evaluate the effectiveness of artificial tears and corticosteroids on mitigating the acute ocular surface response to low-humidity environments. DESIGN: Single-group, crossover clinical trial. METHODS: Twenty subjects with aqueous deficient dry eye were enrolled. Subjects meeting inclusion criteria at visit 1 were exposed to a baseline 90-minute low-humidity environment at visit 2. They then used artificial tears for 2 weeks prior to low-humidity exposure at visit 3, followed by 0.1% dexamethasone for 2 weeks prior to the final low-humidity exposure at visit 4. Outcome measures included corneal and conjunctival staining, blink rate, and irritation symptoms before and after each low-humidity exposure. Digital polymerase chain reaction (PCR) was performed to measure HLA-DR RNA transcripts in conjunctival cells taken by impression cytology at each visit. RESULTS: There was significantly less corneal and conjunctival epitheliopathy after the low-humidity exposure at visit 4 compared to after the low-humidity exposure at visit 3 (P = .003). Subjects reported significantly less eye irritation during the low-humidity exposure after using the dexamethasone (visit 4) compared to artificial tears (visit 3) (P = .01). HLA-DR transcripts significantly decreased after the stress at visit 4 (post dexamethasone) compared to visit 2. CONCLUSION: Our study demonstrates that corticosteroid eye drops mitigate the acute adverse effects of an experimental low-humidity challenge, likely owing to suppression of stress-activated inflammatory pathways. While extended use of corticosteroids is not indicated, other anti-inflammatory therapies with activity against stress-activated pathways may prove as effective.

Complications related to a cosmetic eye-whitening procedure.

PURPOSE: To report sight-threatening complications following extensive bulbar conjunctival resection and postoperative mitomycin C therapy for cosmetic eye-whitening in the United States. DESIGN: Retrospective noncomparative case series. METHODS: Multicenter report of 9 patients referred for evaluation and management of complications following bilateral cosmetic eye whitening. RESULTS: Seventeen eyes of 9 patients underwent cosmetic eye-whitening performed between 2 and 48 months prior to referral to one of the centers. Sixteen of the 17 eyes had persistent conjunctival epithelial defects, with 10 eyes requiring amniotic membrane grafting to facilitate re-epithelialization. Four eyes of 2 patients developed limbal stem cell compromise confirmed with in vivo confocal laser scanning microscopy. One patient developed infectious scleritis and diplopia resulting from Tenon capsule scarring. Another patient developed scleral necrosis, secondary infectious scleritis, and infectious endophthalmitis. This patient subsequently developed noninfectious scleritis that required 3-drug-regimen immunosuppression. CONCLUSION: Severe adverse effects can occur after extensive cosmetic conjunctival resection followed by topical mitomycin C application. Patients and physicians should be aware of the potential sight-threatening complications associated with this eye-whitening procedure.

Nonorganic visual loss in children.

NOVL in children is a relatively common problem for the comprehensive ophthalmologist. Although the etiology and pathophysiology of NOVL are variable, rare cases are because of physical or sexual abuse. Clinical tests can make the diagnosis of NOVL, and nonorganic is our preferred terminology for NOVL. Clinicians should be careful to establish a normal eye examination and prove that the vision is better than claimed before labeling a patient with NOVL. Rarely, the clinical examination is insufficient to establish the diagnosis of NOVL and electrophysiology may be helpful. Reassurance is generally all that is necessary for most children with NOVL, but some patients might benefit from formal psychiatric evaluation. The possibility of nonorganic overlay should also be considered in children with NOVL, and the combination of organic and NOVL is relatively common.