Implementing a National Navigation Service for Perinatal and Infant Mental Health: Early Learnings from the ForWhen Model.

ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues.

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review.

Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.

La meta de Navegación del Paciente (PN) es mejorar el acceso a tiempo a servicios de cuidado de salud por medio de ayudar a los pacientes a "navegar" los complejos esquemas de provisión de servicios. Los modelos PN han sido aplicados en diversos escenarios de cuidados de salud incluyendo la salud mental perinatal (PMH). Sin embargo, los modelos de la práctica e implementación de programas PN varían ampliamente, y su impacto en la participación de los servicios PMH no ha sido sistemáticamente investigada. Este estudio de revisión narrativa sistemática se propuso 1) identificar y describir modelos PMH PN existentes, 2) comprender su eficacia para mejorar la participación en el servicio y resultados clínicos, 3) examinar las percepciones de pacientes y proveedores, y 4) explorar factores facilitadores y barreras al éxito del programa. Se llevó a cabo una sistemática investigación de artículos/reportes publicados que describen modelos que proveen programas/servicios de PMH PN con enfoque en los padres en el período desde la concepción hasta los 5 años posteriores al parto. En total, se identificaron 19 artículos que describían 13 programas. Los análisis dieron como resultado un número de puntos comunes y diferencias a través de la composición de los programas, la población a la cual se dirigían, y el ámbito del papel del navegador. A pesar de que se observó una evidencia prometedora para apoyar la efectividad clínica y el impacto sobre la utilización del servicio de programas PN para PMH, la base actual de la evidencia es escasa. Es necesaria una posterior investigación para evaluar la efectividad de tales servicios, y puntos que los faciliten o barreras al éxito de éstos.

La Navigation du Patient (abrégé ici NP en français) a pour but d'améliorer l'accès rapide aux soins de santé en aidant les patients à « naviguer ¼ un paysage complexe d'offre de services. Les modèles NP ont été appliqués dans divers contextes de soins de santé y compris la santé mentale périnatale (SMP en français ici). Cependant les modèles de pratique et de mises en place de programmes NP varient grandement, et leur impact sur l'engagement avec des services SMP n'a pas encore été examiné systématiquement. Cette étude narrative systématique s'est donnée pour but de 1) identifier et décrire les modèles NP existants, 2) comprendre leur efficacité à améliorer d'engagement du service et ses résultats cliniques, 3) passer en revue les perceptions du patient et du prestataire, et 4) explorer ce qui facilite et fait obstacle au succès du programme. Une recherche systématique d'articles/rapports publiés décrivant des modèles de prestation de NP SMP visant des parents dans la période de la conception à 5 ans postpartum a été faite. En tout 19 articles décrivant 13 programmes ont été identifiés. L'analyse a produit un nombre de points communs et de différences au travers des contextes des programmes, des populations ciblées et de la portée du rôle de navigateur. Bien qu'il y ait des preuves promettantes soutenant l'efficacité clinique et l'impact de l'utilisation de services des programmes NP pour la SMP la base de preuves actuelle est éparse. Des recherches supplémentaires évaluant l'efficacité de tels services ainsi que les facteurs de facilitation et les barrières au succès sont nécessaires.

ForWhen Australian perinatal and infant mental health navigation programme: evaluation protocol.

INTRODUCTION: Many parents and carers experience mental health challenges during pregnancy and early postpartum years, and there are cumulative shortfalls in the identification, follow-up, and treatment of those experiencing perinatal and infant mental health (PIMH) challenges. ForWhen is a new national navigation programme in Australia that aims to improve outcomes for families by supporting parents and carers to access PIMH services that best meet their needs. This paper presents the protocol of an evaluation of the ForWhen programme, to be conducted over the first 3 years of its implementation. The specific objectives of the evaluation include examining the characteristics of navigation service delivery, its implementation and clinical impact, and identifying potential moderators of change. METHODS AND ANALYSIS: Utilising a mixed-methods design, this evaluation will incorporate three phases that reflect the stages of the programme life-cycle: (1) programme description, (2) implementation evaluation and (3) outcomes evaluation. The evaluation will use a mix of quantitative and qualitative data including deidentified routinely collected service data, participant observations, semistructured interviews, surveys and questionnaires, and a resource audit. DISCUSSION: Evaluation findings will be used to inform the development of a refined clinical navigation model, identify barriers and facilitators to successful navigation programme implementation, examine the impact of the ForWhen programme on client clinical outcomes and health service utilisation, understand how the programme is/can be best embedded in the evolving service system, and assess the cost-effectiveness and sustainability of a national navigation programme in improving health outcomes for PIMH in Australia. ETHICS AND DISSEMINATION: This research was approved by South Western Sydney Local Health District Human Research Ethics Committee (2021/ETH11611). This study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622001443785). Results will be disseminated at conferences, in scientific journals, and in a final evaluation report.

DPP4 inhibition impairs senohemostasis to improve plaque stability in atherosclerotic mice.

Senescent vascular smooth muscle cells (VSMCs) accumulate in the vasculature with age and tissue damage and secrete factors that promote atherosclerotic plaque vulnerability and disease. Here, we report increased levels and activity of dipeptidyl peptidase 4 (DPP4), a serine protease, in senescent VSMCs. Analysis of the conditioned media from senescent VSMCs revealed a unique senescence-associated secretory phenotype (SASP) signature comprising many complement and coagulation factors; silencing or inhibiting DPP4 reduced these factors and increased cell death. Serum samples from persons with high risk for cardiovascular disease contained high levels of DPP4-regulated complement and coagulation factors. Importantly, DPP4 inhibition reduced senescent cell burden and coagulation and improved plaque stability, while single-cell resolution of senescent VSMCs reflected the senomorphic and senolytic effects of DPP4 inhibition in murine atherosclerosis. We propose that DPP4-regulated factors could be exploited therapeutically to reduce senescent cell function, reverse senohemostasis, and improve vascular disease.

Ageing Together: Interdependence in the Memory Compensation Strategies of Long-Married Older Couples.

People live and age together in social groups. Across a range of outcomes, research has identified interdependence in the cognitive and health trajectories of ageing couples. Various types of memory decline with age and people report using a range of internal and external, social, and material strategies to compensate for these declines. While memory compensation strategies have been widely studied, research so far has focused only on single individuals. We examined interdependence in the memory compensation strategies reported by spouses within 58 older couples. Couples completed the Memory Compensation Questionnaire, as well as an open-ended interview about their memory compensation practices. We found that internal, intra-individual memory compensation strategies were not associated within couples, but external, extra-individual strategies showed interdependence. Individuals' scores on material/technological compensation strategies were positively correlated with their partners'. Reported reliance on a spouse was higher for men and increased with age. Our open-ended interviews yielded rich insights into the complex and diverse resources that couples use to support memory in day-to-day life. Particularly evident was the extent of interaction and coordination between social and material compensation, such that couples jointly used external compensation resources. Our results suggest that individuals' reports of their compensation strategies do not tell the whole story. Rather, we propose that older couples show interdependence in their memory compensation strategies, and adopt complex systems of integrated material and social memory compensation in their day-to-day lives.

Teaching Elaborative Reminiscing to Support Autobiographical Memory and Relationships in Residential and Community Aged Care Services.

Memories of the past are critically important as we age. For older adults receiving formal care in a range of settings, reminiscing with care staff may provide frequent opportunities for recalling autobiographical memories with a supportive conversational partner. Importantly, prior research suggests that some reminiscing conversations are more supportive than others. In the developmental literature, a long tradition of sociocultural memory research has shown how children's autobiographical memory is scaffolded and supported by parents during reminiscing, when parents use a particular kind of conversational technique, known as "elaborative reminiscing". In the current project, we aimed to examine whether we could enhance conversations between staff and older people receiving aged care by teaching care staff about these beneficial conversational techniques and supporting them to reminisce more often with residents/clients. We also aimed to determine whether staff members' use of elaborative reminiscing techniques was associated with autobiographical memory details recalled by residents/clients during routine conversations. We conducted a workshop with 16 staff within a residential aged care and community care setting. We followed this with a 4-week training-and-feedback period during which staff recorded their conversations with residents and clients. Staff feedback indicated successful use of the scaffolding techniques overall, and benefits as well as barriers to their use in day-to-day practice. Analysis of the conversations demonstrated that the use of particular elaborative reminiscing techniques by staff was associated with increased recall of episodic and semantic autobiographical memory details by residents/clients. Overall, findings suggest that the principles of elaborative reminiscing may apply across the lifespan, and that the benefits of elaborative reminiscing for autobiographical memory may be particularly important in times of cognitive need. Practically, training aged care staff in specific and practical conversational tools can facilitate reminiscing for people receiving aged care.

Here's looking at you: eye gaze and collaborative recall.

In everyday life, we remember together often. Surprisingly, research reliably shows costs of collaboration. People remember less in groups than the same number of individuals remember separately. However, there is evidence that some groups are more successful than others, depending on factors such as group relationship and verbal communication strategies. To understand further the characteristics of more successful vs. less successful collaborative groups, we examined whether non-verbal eye gaze behaviour was associated with group outcomes. We used eye tracking glasses to measure how much collaborating dyads looked at each other during collaborative recall, and examined whether individual differences in eye- and face-directed gaze were associated with collaborative performance. Increased eye- and face-directed gaze was associated with higher collaborative recall performance, more explicit strategy use, more post-collaborative benefits, and increased memory overlap. However, it was also associated with pre-collaborative recall, indicating that gaze during collaboration may at least partially reflect pre-existing abilities. This research helps elucidate individual differences that underlie the outcomes of collaborative recall, and suggests that non-verbal communication differentiates more vs. less successful collaborative groups.

Reduction of lamin B receptor levels by miR-340-5p disrupts chromatin, promotes cell senescence and enhances senolysis.

A major stress response influenced by microRNAs (miRNAs) is senescence, a state of indefinite growth arrest triggered by sublethal cell damage. Here, through bioinformatic analysis and experimental validation, we identified miR-340-5p as a novel miRNA that foments cellular senescence. miR-340-5p was highly abundant in diverse senescence models, and miR-340-5p overexpression in proliferating cells rendered them senescent. Among the target mRNAs, miR-340-5p prominently reduced the levels of LBR mRNA, encoding lamin B receptor (LBR). Loss of LBR by ectopic overexpression of miR-340-5p derepressed heterochromatin in lamina-associated domains, promoting the expression of DNA repetitive elements characteristic of senescence. Importantly, overexpressing miR-340-5p enhanced cellular sensitivity to senolytic compounds, while antagonization of miR-340-5p reduced senescent cell markers and engendered resistance to senolytic-induced cell death. We propose that miR-340-5p can be exploited for removing senescent cells to restore tissue homeostasis and mitigate damage by senescent cells in pathologies of human aging.

AUF1 ligand circPCNX reduces cell proliferation by competing with p21 mRNA to increase p21 production.

Mammalian circRNAs can influence different cellular processes by interacting with proteins and other nucleic acids. Here, we used ribonucleoprotein immunoprecipitation (RIP) analysis to identify systematically the circRNAs associated with the cancer-related protein AUF1. Among the circRNAs interacting with AUF1 in HeLa (human cervical carcinoma) cells, we focused on hsa_circ_0032434 (circPCNX), an abundant target of AUF1. Overexpression of circPCNX specifically interfered with the binding of AUF1 to p21 (CDKN1A) mRNA, thereby promoting p21 mRNA stability and elevating the production of p21, a major inhibitor of cell proliferation. Conversely, silencing circPCNX increased AUF1 binding to p21 mRNA, reducing p21 production and promoting cell division. Importantly, eliminating the AUF1-binding region of circPCNX abrogated the rise in p21 levels and rescued proliferation. Therefore, we propose that the interaction of circPCNX with AUF1 selectively prevents AUF1 binding to p21 mRNA, leading to enhanced p21 mRNA stability and p21 protein production, thereby suppressing cell growth.

Simulations of Asymmetric Membranes Illustrate Cooperative Leaflet Coupling and Lipid Adaptability.

Biological membranes are composed of lipid bilayers that are often asymmetric with regards to the lipid composition and/or aqueous solvent they separate. Studying lipid asymmetry both experimentally and computationally is challenging. Molecular dynamics simulations of lipid bilayers with asymmetry are difficult due to finite system sizes and time scales accessible to simulations. Due to the very slow flip-flop rate for phospholipids, one must first choose how many lipids are on each side of the bilayer, but the resulting bilayer may be unstable (or metastable) due to differing tensile and compressive forces between leaflets. Here we use molecular dynamics simulations to investigate a number of different asymmetric membrane systems, both with atomistic and coarse-grained models. Asymmetries studied include differences in number of lipids, lipid composition (unsaturated and saturated tails and different headgroups), and chemical gradients between the aqueous phases. Extensive analysis of the bilayers' properties such as area per lipid, density, and lateral pressure profiles are used to characterize bilayer asymmetry. We also address how cholesterol (which flip-flops relatively quickly) influences membrane asymmetries. Our results show how each leaflet is influenced by the other and can mitigate the structural changes to the bilayer overall structure. Cholesterol can respond to changes in bilayer asymmetry to alleviate some of the effect on the bilayer structure, but that will alter its leaflet distribution, which in turn affects its chemical potential. Ionic imbalances are shown to have a modest change in bilayer structure, despite large changes in the electrostatic potential. Bilayer asymmetry can also induce a modest electrostatic potential across the membrane. Our results highlight the importance of membrane asymmetry on bilayer properties, the influence of lipid headgroups, tails and cholesterol on asymmetry, and the ability of lipids to adapt to different environments.

Does collaboration with an intimate partner support memory performance? An exploratory case series of people with epilepsy or acquired brain injury.

BACKGROUND: Intimate couples can become cognitively interdependent over time. If one member of the couple has a neurological condition with associated cognitive impairments, their partner can support or 'scaffold' their cognitive functioning through collaboration. OBJECTIVE: We explored the phenomenon of 'collaborative memory' in a case series of 9 couples in which one member had a neurological condition, specifically an acquired brain injury (ABI; n = 7) or epilepsy (n = 2). METHODS: To investigate collaborative memory, we compared the performance of the patient when remembering alone versus their performance in collaboration with their partner on three memory tasks, assessing anterograde, semantic, and autobiographical memory. RESULTS: We found that across all tasks and participants, collaboration typically increased overall memory performance (total score), but the patient's contribution to the task was typically lower when they collaborated compared with when they performed the task alone. We identified two distinct styles of collaboration which we termed 'survival scaffolding' (where the healthy partner 'takes over' memory recall) and 'stability scaffolding' (where the healthy partner cues and structures the patient's recall). CONCLUSION: This exploratory case series contributes to the sparse literature on memory collaboration in people with neurological conditions. Our findings suggest that there are different styles of collaboration that can both help and hinder memory performance.