Obesity and mortality in critically ill COVID-19 patients with respiratory failure.

BACKGROUND: Patients with obesity are at increased risk of severe COVID-19, requiring mechanical ventilation due to acute respiratory failure. However, conflicting data are obtained for intensive care unit (ICU) mortality. OBJECTIVE: To analyze the relationship between obesity and in-hospital mortality of ICU patients with COVID-19. SUBJECTS/METHODS: Patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) were included retrospectively. The following data were collected: comorbidities, body mass index (BMI), the severity of ARDS assessed with PaO2/FiO2 (P/F) ratios, disease severity measured by the Simplified Acute Physiology Score II (SAPS II), management and outcomes. RESULTS: For a total of 222 patients, there were 34 patients (15.3%) with normal BMI, 92 patients (41.4%) who were overweight, 80 patients (36%) with moderate obesity (BMI:30-39.9 kg/m2), and 16 patients (7.2%) with severe obesity (BMI ≥ 40 kg/m2). Overall in-hospital mortality was 20.3%. Patients with moderate obesity had a lower mortality rate (13.8%) than patients with normal weight, overweight or severe obesity (17.6%, 21.7%, and 50%, respectively; P = 0.011. Logistic regression showed that patients with a BMI ≤ 29 kg/m2 (odds ratio [OR] 3.64, 95% CI 1.38-9.60) and those with a BMI > 39 kg/m2 (OR 10.04, 95% CI 2.45-41.09) had a higher risk of mortality than those with a BMI from 29 to 39 kg/m2. The number of comorbidities (≥2), SAPS II score, and P/F < 100 mmHg were also independent predictors for in-hospital mortality. CONCLUSIONS: COVID-19 patients admitted to the ICU with moderate obesity had a lower risk of death than the other patients, suggesting a possible obesity paradox.

Mental health services for African Americans: a cultural/racial perspective.

African Americans have made consistent progress toward first-class citizenship since 1965. Nonetheless, mental health services for this population have been biased, incomplete, and deficient because similarities to European Americans have been emphasized whereas differences were largely ignored. This article addresses some differences, including cultural/racial identity and the cultural self, that affect assessment, psychiatric diagnoses, and psychotherapy or other interventions. An assessment-intervention model illustrates how cultural information can inform service delivery and improve services to African Americans. Cultural/racial perspectives on mental health in a multicultural society suggest innovations in the design of these services and access to them that can increase utilization by African Americans.

Racial identity and the MMPI in African American male college students.

The relation of the Minnesota Multiphasic Personality Inventory (MMPI) to the Racial Identity Attitude Scale--Black, Short Form (RIAS-B) was examined among 50 African American male college students in a reanalysis of unpublished MMPI data described in R. H. Dana (1993). This permitted study of relationships between MMPI scores and specific psychological variables hypothesized to produce cultural differences among African Americans. Results indicated RIAS-B scale scores functioned as predictors of MMPI scale scores. Similar research with the MMPI-2 incorporating larger samples that more adequately represent African American heterogeneity is needed. Methodological implications of these findings for MMPI-2 research with ethnic and racial groups are discussed, emphasizing the importance of research to depathologize African American racial and cultural identity.

A report on myself: the science and/or art of assessment.

Disregarding my empirically documented warnings to generations of students, I am ultimately succumbing to my own eisegesis. In this article, I proffer a personal exemplar of low- and high-inference interpretation of significant persons, events, and products during my professional lifetime. These selected bits of data are contained in childhood and educational experiences, three chronological periods, three 1949 Thematic Apperception Test (Murray, 1943) stories, and bits of several poems. These data coalesce in an interpretive statement, analogous to an assessment report but ultimately something more and something less than an optimal report. As an interpretive schema, a hierarchal model of clinical inference illustrates and exemplifies employment of distinct levels to increase the reliability of high-inference interpretation. While inadequately equipped as a psychologist assessor for such self-scrutiny, this narrative may provide a case history exemplar of a process that has relevance for myself, for the Society of Personality Assessment, and for understanding personality within a human science aegis.

Methodological issues in cross-cultural and multicultural rorschach research.

Hermann Rorschach researched the utility of his inkblot experiment to understand psychopathology and cultural differences. Contemporary research with the Rorschach has evaluated its utility as a test, although it may more properly represent a clinical method with somewhat different evaluation criteria. Recent controversy regarding the adequacy of the Rorschach as a test and the adequacy of its normative data has at times distorted and oversimplified important methodological issues inherent in the study of cultural difference. Cultural processes remain a central and inadequately examined variable in Rorschach research; an important emergent area of inquiry is the Rorschach's clinical utility as a cross-cultural assessment instrument. We review multicultural and cross-cultural methodological issues intrinsic to contemporary Rorschach research here. Consideration of cultural issues enlarges and enriches the Rorschach clinical utility debate and suggests underexplored research strategies that can contribute to its resolution.

A teaching method for multicultural assessment: psychological report contents and cultural competence.

An earlier training model emphasized systematic feedback on accuracy of concepts contained in student assessment reports prepared with common data sets from standard tests. This feedback resulted in consistent increments in concept agreements between reports prepared by students and more experienced assessors. This model was applied in courses with multicultural students by contrasting standard and multicultural assessment and using data sets from multicultural assessees. These students experienced greater difficulty in demonstrating consistent increments of agreement in report concepts due to uneven knowledge of specific cultures, inapplicability of available norms, and interpretation issues. The effectiveness of combining standard and multicultural training should be compared with conventional standard training followed by culturally focused specialized assessment courses.

Mental health services for african americans: a cultural/racial perspective

Os afro-americanos vêm progredindo muito em direçäo a uma verdadeira cidadania desde 1965. Contudo, os serviços de saúde mental para essa populaçäo têm sido tendenciosos, incompletos e deficientes, porque as similaridades com os euro-americanos têm sido enfatizadas, ao passo que as diferenças têm sido largamente ignoradas. Este artigo aborda algumas dessas diferenças, incluindo a identidade cultural/racial e o 'eu cultural' que afetam a avaliaçäo, os diagnósticos psiquiátricos e a psico-terapia ou outras intervençöes. Um modelo de avaliaçäo-intervençäo ilustra como a informaçäo cultural pode melhorar o atendimento aos afro-americanos. Esse modelo exemplifica uma aplicaçäo de psicologia cultural que pode contribuir para uma mudança na prática profissional, no treinamento e na pesquisa dentro de uma sociedade multi-cultural. Sugestöes de diretrizes que emergem desse modelo apontam para áreas que necessitam ser enfatizadas no atendimento e na pesquisa

El impacto de las nuevas tecnologías en el futuro de las técnicas de evaluación psicológica clínica / The impact of new technologies on the future of clinical psychological assessment techniques

En este trabajo se presentan reflexiones desde distintas perspectivas acerca del futuro de la Evaluación Psicológica y el papel que las tecnologías informáticas tendrán en ella. En la actualidad, es innegable la importancia que ha alcanzado la informática dentro de las actividades académicas y profesionales en torno a la Evaluación Psicológica. La capacidad cada vez mayor de las computadoras facilitó las tareas de investigación, desarrollo, y aplicación de tests psicológicos. Parece altamente previsible que en el futuro la informática tendrá un lugar aún mayor en el auxilio del psicólogo evaluador. Algunas posibles consecuencias futuras son expuestas y debatidas por los diferentes autores de este trabajo, incluyendo las ventajas y limitaciones de la administración y la interpretación asistidas por computadora, y el impacto transcultural de las redes mundiales de conexión.