A Strategy To Support Perinatal Mental Health By Collaborating With Tribal Communities In Montana.

Among Indigenous women and birthing people, reported rates of perinatal mental health complications are consistently higher than in the general US population. However, perinatal mental health programs and interventions tend to focus on the general population and do not account for the unique experiences and worldviews of Indigenous Peoples. We highlight a collaborative strategy employed by a Montana nonprofit to engage Tribal communities in completing a statewide online resource guide designed to help pregnant and parenting families find resources, including mental health and substance use treatment options, within and beyond their local communities. Based on this strategy, cultural resources relevant to Tribal communities were added to the resource guide. Agencies committed to addressing perinatal mental health disparities among Indigenous populations should consider similar strategies to share power with Tribal communities and collaboratively create culturally congruent programs and interventions.

Structural Reassignment and Absolute Stereochemistry of Madurastatin C1 (MBJ-0034) and the Related Aziridine Siderophores: Madurastatins A1, B1, and MBJ-0035.

The madurastatins are pentapeptide siderophores originally described as containing an unusual salicylate-capped N-terminal aziridine ring. Isolation of madurastatin C1 (1) (also designated MBJ-0034), from Actinomadura sp. DEM31376 (itself isolated from a deep sea sediment), prompted structural reevaluation of the madurastatin siderophores, in line with the recent work of Thorson and Shaaban. NMR spectroscopy in combination with partial synthesis allowed confirmation of the structure of madurastatin C1 (1) as containing an N-terminal 2-(2-hydroxyphenyl)oxazoline in place of the originally postulated aziridine, while absolute stereochemistry was determined via Harada's advanced Marfey's method. Therefore, this work further supports Thorson and Shaaban's proposed structural revision of the madurastatin class of siderophores (madurastatins A1 (2), B1 (3), C1 (1), and MBJ-0036 (4)) as N-terminal 2-(2-hydroxyphenyl)oxazolines.

Uncontrolled pilot study of an Acceptance and Commitment Therapy and Health at Every Size intervention for obese, depressed women: Accept Yourself!

Depression and obesity frequently co-occur, but providing adequate treatment to depressed obese women is challenging because existing treatments for each problem in isolation are suboptimal, and treatments to address one problem may exacerbate the other. This study used an uncontrolled, pretreatment-to-posttreatment design, with 3-month follow-up, to evaluate the feasibility and outcome of a novel, self-acceptance-based treatment for obese women with depression, "Accept Yourself!" Accept Yourself! is an 11-week manualized, group-based intervention that integrates Health At Every Size (an evidence-based paradigm to enhance physical health) and Acceptance and Commitment Therapy (an evidence-based psychotherapy often used to treat depression and eating-related concerns) to improve the physical and mental health of obese, depressed women without encouraging weight loss. Twenty-one obese women with Major Depressive Disorder received the intervention; 18 completed at least seven sessions, a minimal dose of the intervention. Depressive symptoms, depression diagnosis, physical health outcomes (including physical activity and blood pressure), and obesity-related quality of life were assessed at baseline, posttreatment, and 3-month follow-up. Weight was also monitored. Depression, blood pressure, and obesity-related quality of life significantly improved from pretreatment to posttreatment, and improvements were sustained over a 3-month follow-up. Participants did not gain significant weight during the intervention or at follow-up. These data, although preliminary and nonexperimental, suggest that Accept Yourself! could be a promising treatment for obese, depressed women, and support the value of larger randomized controlled trials. (PsycINFO Database Record

Reliability and validity of goniometric iPhone applications for the assessment of active shoulder external rotation.

PURPOSE/HYPOTHESIS: The purpose of this study was to determine the reliability and validity of two smartphone applications: (1) GetMyROM - inclinometery-based and (2) DrGoniometry - photo-based in the measurement of active shoulder external rotation (ER) as compared to standard goniometry (SG). PARTICIPANTS: Ninety-four Texas Woman's University Doctor of Physical Therapy students from the School of Physical Therapy - Houston campus, were recruited to participate in this study. MATERIALS/METHODS: Two iPhone applications were compared to SG using both novice and experienced raters. Active shoulder ER range of motion was measured over two time periods in random order by blinded novice and experienced raters. RESULTS: Intra-rater reliability using novice raters for the two applications ranged from an intraclass correlation coefficient (ICC) of 0.79 to 0.81 with SG at 0.82. Inter-rater reliability (novice/expert) for the two applications ranged from an ICC of 0.92 to 0.94 with SG at 0.91. Concurrent validity (when compared to SG) ranged from 0.93 to 0.94. There were no significant differences between the novice and experienced raters. CONCLUSION: Both applications were found to be reliable and comparable to SG. A photo-based application potentially offers a superior method of measurement as visualizing the landmarks may be simplified in this format and it provides a record of measurement. CLINICAL RELEVANCE: Further study using patient populations may find the two studied applications are useful as an adjunct for clinical practice.

Topical nonsteroidal anti-inflammatory medications for treatment of temporomandibular joint degenerative pain: a systematic review.

AIMS: To evaluate the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAID) to relieve temporomandibular joint (TMJ) degenerative joint disease (DJD) pain. METHODS: A search of the literature was made using electronic databases complemented with a manual search. Clinical trials comparing topical NSAID with either placebo or an alternative active treatment to treat TMJ DJD pain were identified. Outcomes evaluated were pain reduction/pain control and/or incidence of side effects. RESULTS: A single study (double-blind randomized placebo-controlled trial) with 20 patients was identified that evaluated the efficacy of a topically prepared NSAID over a 12-week duration, measuring functional pain intensity, voluntary and assisted mouth opening, pain disability index, and a brief pain inventory analysis. This study revealed a pain intensity decrease within treatment groups but no significant difference between treatment groups. CONCLUSION: Presently, there is insufficient evidence to support the use of topically applied NSAID medications to palliate TMJ DJD pain.

Nurse-delivered and doctor-delivered care in an attention deficit hyperactivity disorder follow-up clinic: a comparative study using propensity score matching.

BACKGROUND: Nurse prescribers may be a cost-effective alternative to doctors in managing attention deficit hyperactivity disorder, but to date there has been no study of their relative effectiveness, and there are concerns about their usage. We therefore undertook a direct comparison of nurse-delivered and doctor-delivered attention deficit hyperactivity disorder care in an attention deficit hyperactivity disorder follow-up clinic. METHOD: Seventy patients were identified between February 2005 and September 2006, 36 managed by an attention deficit hyperactivity disorder specialist nurse, 34 by doctors. Average age at referral was 7·1 years; their duration in the service was 5·5 years. Outcomes included changes since admission in the predicted diagnostic category from Strengths and Difficulties Questionnaire scores, the Commission for Health Improvement patient satisfaction questionnaire and a clinic-developed side-effect questionnaire. Propensity score matching and multiple imputation were used to manage selection bias and missing data. The impact of nurse management was estimated using the Average Treatment effect on the Treated statistic with 95% confidence intervals. RESULTS: All the Average Treatment effects on the Treated approximated zero. Inspecting the confidence intervals suggested that there was, at worst, 2·5% risk of nurses underidentifying emotional disorders with respect to doctors. CONCLUSIONS: There seems little to distinguish the quality of doctor- or nurse-delivered care in ordinary attention deficit hyperactivity disorder follow-up clinics. There seems no clinical impediment to using nurse prescribers to increase clinic capacity. It may be useful to add structured assessment of mood difficulties at follow-up if nurse prescribers are used.

Cybrid models of Parkinson's disease show variable mitochondrial biogenesis and genotype-respiration relationships.

Sporadic Parkinson's disease (sPD) is a nervous system-wide disease that presents with a bradykinetic movement disorder and frequently progresses to include depression and cognitive impairment. Cybrid models of sPD are based on expression of sPD platelet mitochondrial DNA (mtDNA) in neural cells and demonstrate some similarities to sPD brains. In sPD and CTL cybrids we characterized aspects of mitochondrial biogenesis, mtDNA genomics, composition of the respirasome and the relationships among isolated mitochondrial and intact cell respiration. Cybrid mtDNA levels varied and correlated with expression of PGC-1 alpha, a transcriptional co-activator regulator of mitochondrial biogenesis. Levels of mtDNA heteroplasmic mutations were asymmetrically distributed across the mitochondrial genome; numbers of heteroplasmies were more evenly distributed. Neither levels nor numbers of heteroplasmies distinguished sPD from CTL. sPD cybrid mitochondrial ETC subunit protein levels were not altered. Isolated mitochondrial complex I respiration rates showed limited correlation with whole cell complex I respiration rates in both sPD and CTL cybrids. Intact cell respiration during the normoxic-anoxic transition yielded K(m) values for oxygen that directly related to respiration rates in CTL but not in sPD cell lines. Both sPD and CTL cybrid cells are substantially heterogeneous in mitochondrial genomic and physiologic properties. Our results suggest that mtDNA depletion may occur in sPD neurons and could reflect impairment of mitochondrial biogenesis. Cybrids remain a valuable model for some aspects of sPD but their heterogeneity mitigates against a simple designation of sPD phenotype in this cell model.

Parkinson's disease brain mitochondria have impaired respirasome assembly, age-related increases in distribution of oxidative damage to mtDNA and no differences in heteroplasmic mtDNA mutation abundance.

BACKGROUND: Sporadic Parkinson's disease (sPD) is a nervous system-wide disease that presents with a bradykinetic movement disorder and is frequently complicated by depression and cognitive impairment. sPD likely has multiple interacting causes that include increased oxidative stress damage to mitochondrial components and reduced mitochondrial bioenergetic capacity. We analyzed mitochondria from postmortem sPD and CTL brains for evidence of oxidative damage to mitochondrial DNA (mtDNA), heteroplasmic mtDNA point mutations and levels of electron transport chain proteins. We sought to determine if sPD brains possess any mtDNA genotype-respiratory phenotype relationships. RESULTS: Treatment of sPD brain mtDNA with the mitochondrial base-excision repair enzyme 8-oxyguanosine glycosylase-1 (hOGG1) inhibited, in an age-dependent manner, qPCR amplification of overlapping ~2 kbase products; amplification of CTL brain mtDNA showed moderate sensitivity to hOGG1 not dependent on donor age. hOGG1 mRNA expression was not different between sPD and CTL brains. Heteroplasmy analysis of brain mtDNA using Surveyor nuclease(R) showed asymmetric distributions and levels of heteroplasmic mutations across mtDNA but no patterns that statistically distinguished sPD from CTL. sPD brain mitochondria displayed reductions of nine respirasome proteins (respiratory complexes I-V). Reduced levels of sPD brain mitochondrial complex II, III and V, but not complex I or IV proteins, correlated closely with rates of NADH-driven electron flow. mtDNA levels and PGC-1alpha expression did not differ between sPD and CTL brains. CONCLUSION: PD brain mitochondria have reduced mitochondrial respiratory protein levels in complexes I-V, implying a generalized defect in respirasome assembly. These deficiencies do not appear to arise from altered point mutational burden in mtDNA or reduction of nuclear signaling for mitochondrial biogenesis, implying downstream etiologies. The origin of age-related increases in distribution of oxidative mtDNA damage in sPD but not CTL brains is not clear, tracks with but does not determine the sPD phenotype, and may indicate a unique consequence of aging present in sPD that could contribute to mtDNA deletion generation in addition to mtDNA replication, transcription and sequencing errors. sPD frontal cortex experiences a generalized bioenergetic deficiency above and beyond aging that could contribute to mood disorders and cognitive impairments.

Exploring the clinical utility of the Development And Well-Being Assessment (DAWBA) in the detection of hyperkinetic disorders and associated diagnoses in clinical practice.

BACKGROUND: The clinical diagnosis of ADHD is time-consuming and error-prone. Secondary care referral results in long waiting times, but primary care staff may not provide reliable diagnoses. The Development And Well-Being Assessment (DAWBA) is a standardised assessment for common child mental health problems, including attention deficit/hyperactivity disorder (ADHD), which can be rapidly scored by skilled specialist clinicians, who may be remote from the interview, thus avoiding referral. METHOD: A representative clinic sample of routine cases suspected of ADHD underwent an assessment which included the DAWBA alongside a confirmatory assessment with a skilled clinician. Another clinician provided DAWBA-based diagnoses blind to the clinic view. Bayesian statistical modelling was used to include clinic diagnostic uncertainty in the analyses. RESULTS: Eighty-four cases were assessed. For ADHD, the predictive value of a positive or negative DAWBA diagnosis was greater than .8, with negligible bias. Non-hyperkinetic behaviour disorders had higher, emotional and autistic disorders lower predictive values, though all greater than .75: there was, however, evidence of bias. CONCLUSIONS: Diagnoses of ADHD based on senior clinician review of the DAWBA completed by parents, teachers and young people aged 11 plus may be sufficiently accurate to permit clinical diagnosis without direct patient contact by the diagnosing clinician. This could improve access to accurate diagnoses of ADHD in primary care while freeing up senior clinicians to focus on complex and refractory cases in secondary care.