How Should Health Care Professionals Address Social Determinants of Refugee Health?
In the case scenario, RJ is a resettled refugee teenager who presents to his physician with vitamin B12 deficiency, anemia, and symptoms of mental illness. This commentary considers social determinants of refugee health and the moral importance of freedom to achieve well-being. The capabilities framework is used to analyze this case because it offers an ethical framework for understanding and evaluating social determinants of refugee health that either promote or diminish freedom to achieve well-being. By using this framework to consider social isolation as a negative social determinant of refugee health, clinicians and institutions can be caregivers as well as advocates for social justice, fulfilling 2 core ethical obligations to refugee communities.
Aultman Julie M
AMA journal of ethics
2019
2019-03
<a href="http://doi.org/10.1001/amajethics.2019.223" target="_blank" rel="noreferrer noopener">10.1001/amajethics.2019.223</a>
A new zygodactylid species indicates the persistence of stem passerines into the early Oligocene in North America.
Time Factors; Animals; Species Specificity; Fossils; Body Size; Skull/anatomy & histology; *Phylogeny; Geography; North America; *Paleobiogeography; *Paleogene; *Passeriformes; *Zygodactylidae; Extremities/anatomy & histology; Feathers/anatomy & histology; Passeriformes/*classification; Spine/anatomy & histology
BACKGROUND: The lake deposits of the informal Ruby Paper Shale unit, part of the Renova Formation of Montana, have yielded abundant plant fossils that document Late Eocene - Early Oligocene global cooling in western North America. A nearly complete small bird with feather impressions was recovered from this unit in in 1959, but has only been informally mentioned. RESULTS: Here we describe this fossil and identify it as a new species of Zygodactylus, a stem lineage passerine with a zygodactyl foot. The new taxon shows morphological traits that are convergent on crown Passeriformes, including an elongate hallux, reduced body size, and a comparative shortening of proximal limb elements. The fossil documents the persistence of this lineage into the earliest Oligocene (~ 33 Ma) in North America. It is the latest occurring North American species of a group that persists in Europe until the Miocene. CONCLUSIONS: Eocene-Oligocene global cooling is known to have significantly remodeled both Palearctic and Nearctic mammal faunas but its impact on related avifaunas has remained poorly understood. The geographic and temporal range expansion provided by the new taxon together with avian other taxa with limited fossil records suggests a similar pattern of retraction in North America followed by Europe.
Hieronymus Tobin L; Waugh David A; Clarke Julia A
BMC evolutionary biology
2019
2019-01
<a href="http://doi.org/10.1186/s12862-018-1319-6" target="_blank" rel="noreferrer noopener">10.1186/s12862-018-1319-6</a>
Academic Health Department Partnerships: Bridging the Gap Between Town and Gown.
Keck C William
American journal of public health
2019
2019-05
<a href="http://doi.org/10.2105/AJPH.2019.305039" target="_blank" rel="noreferrer noopener">10.2105/AJPH.2019.305039</a>
Association Between Hospitalization and Delivery of Assisted Outpatient Treatment With and Without Assertive Community Treatment
Assertive community treatment; Outpatient commitment
OBJECTIVE: This study examined hospitalizations for individuals receiving assisted outpatient treatment (AOT), some of whom also received assertive community treatment (ACT). We examined whether participation in AOT, as well as in AOT paired with ACT services, was associated with reduced hospitalizations. METHODS: Data were collected for 74 people who were receiving AOT for at least 6 months. Comparisons were made between those receiving AOT with ACT and those receiving AOT without ACT. Changes were examined in number and days of hospitalization before, during, and after AOT on an annualized basis. RESULTS: AOT was associated with reduced hospitalizations and hospital days during and after the court order. Participating in AOT without ACT was associated with fewer hospitalizations during and after AOT and fewer days hospitalized after the court order ended. CONCLUSIONS: Individuals whose needs can be met with less intensive services while under an AOT order may not require ACT.
Munetz Mark R; Ritter Christian; Teller Jennifer L S; Bonfine Natalie
Psychiatric Services (Washington, D.C.)
2019
2019-06
<a href="http://doi.org/10.1176/appi.ps.201800375" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.201800375</a>
Prevalence and Predictors of Benzodiazepine Monotherapy in Patients With Depression: A National Cross-Sectional Study
OBJECTIVE: Depression guidelines discourage benzodiazepine monotherapy and limit use to short-term adjunctive therapy with antidepressants; however, patients with depression continue to receive benzodiazepine monotherapy. The prevalence and predictors of this prescribing pattern have not been described previously and are warranted to assist clinicians in identifying patients at highest risk of receiving benzodiazepine monotherapy. METHODS: A national, cross-sectional analysis of the National Ambulatory Medical Care Survey from 2012 to 2015 was performed for adults treated for depression. Depression was identified using a survey item specifically assessing the presence of depression. Office visits involving patients with bipolar disorder, schizoaffective disorder, or pregnancy were identified by ICD-9 code or specific survey item and were excluded. The primary endpoint was benzodiazepine monotherapy prescribing rate defined as initiation or continuation of a benzodiazepine in the absence of any antidepressant agent. A multivariate logistic regression model was created to identify variables associated with benzodiazepine monotherapy. RESULTS: In total, 9,426 unweighted visits were eligible for inclusion. Benzodiazepine monotherapy was identified in 9.3% of patients treated for depression (95% CI, 8.2%-10.6%). Predictors of benzodiazepine monotherapy included age of 45-64 years (OR = 1.39; 95% CI, 1.01-1.91), epilepsy-related office visit (OR = 5.34; 95% CI, 1.39-20.44), anxiety-related office visit (OR = 1.67; 95% CI, 1.23-2.27), underlying pulmonary disease (OR = 1.43; 95% CI, 1.09-1.87), and concomitant opiate prescribing (OR = 2.86; 95% CI, 2.01-4.06). Psychiatrists were less likely to prescribe benzodiazepine monotherapy than were other providers (OR = 0.42; 95% CI, 0.29-0.61). CONCLUSIONS: Benzodiazepine monotherapy is utilized in nearly 1 in 10 patients treated for depression. Adults aged 45 to 65 years, patients prescribed opioids, patients seen by primary care providers, and those with underlying anxiety, epilepsy, or pulmonary disorders are at highest risk.
Soric Mate M; Paxos Chris; Dugan Sara E; Fosnight Susan M; Turosky Jodie Z; Sadana Prabodh; Emshoff Jessica B; Everly Lukas; Snyder Brittany M; Mistry Bhavin K; Bhat Shubha; Unruh Amy E; Safi Ismail M
The Journal of Clinical Psychiatry
2019
2019-05
<a href="http://doi.org/10.4088/JCP.18m12588" target="_blank" rel="noreferrer noopener">10.4088/JCP.18m12588</a>
Moving Beyond Moral Revulsion: A Deeper Analysis of Social Justice Within Clinical Ethics Training.
AT-risk people; CITIZENSHIP; CONCEPTUAL structures (Information theory); DECISION making; ETHICAL decision making; ETHICISTS; HEALTH services accessibility; MEDICAL ethics; PSYCHOSOCIAL factors; PUBLIC health; RESPONSIBILITY; SOCIAL justice; UNDOCUMENTED immigrants
The article offers information on social justice within clinical ethics training. Topics discussed include with a more deliberative effort toward a deeper understanding of justice as it relates to care, efficiency, and public health; mentions no theoretical approach or framework may resolve ethical dilemmas affecting undocumented patients; and also mentions medical education has emphasized the importance of justice and the fair treatment of patients.
Aultman Julie; Whipkey Andrew J
American Journal of Bioethics
2019
2019-04
<a href="https://doi.org/10.1080/15265161.2019.1572821">10.1080/15265161.2019.1572821</a>
Mental Illness as a Stigmatized Identity
appraisals; discrepancy; disorders; identity; internalized stigma; mental illness; modified labeling theory; people; reflected; self-esteem; Sociology; stigma
In this study, we examine the relationships among reflected appraisals, self-views, and well-being for individuals diagnosed with severe and persistent mental illness. We also test a perceptual control model of identity to determine whether discrepancies between stigmatized reflected appraisals and stigmatized self-views are associated with self-evaluation (self-esteem and self-efficacy) and psychological distress (depressive symptoms). We find that stigmatized self-views are significantly associated with lower self-esteem and self-efficacy and higher levels of depressive symptoms. Stigmatized reflected appraisals are also associated with lower self-efficacy and higher depressive symptoms but are not associated with self-esteem. As predicted, discrepancies between reflected appraisals and self-views are associated with lower levels of self-efficacy and higher levels of depressive symptoms; however, we do not find a relationship between identity discrepancy and self-esteem. We discuss the implications of our findings for identity and stigma research.
Marcussen K; Gallagher M; Ritter C
Society and Mental Health
2019
2019-07
<a href="http://doi.org/10.1177/2156869318810326" target="_blank" rel="noreferrer noopener">10.1177/2156869318810326</a>
Dispelling Myths about Antenatal TAPS: A Call for Action for Routine MCA-PSV Doppler Screening in the United States
anemia-polycythemia sequence; cerebral-artery; clinical guidelines; diagnostic-criteria; fetal; General & Internal Medicine; laser-surgery; MCA-PSV Doppler; middle; monochorionic diamniotic twin pregnancy; peak systolic velocity; perinatal management; placental echogenicity; prevalence; screening; TAPS; twin anemia-polycythemia sequence; twin transfusion syndrome
In the United States, routine middle cerebral artery peak systolic velocity (MCA-PSV) Doppler screening for the detection of antenatal twin anemia-polycythemia sequence (TAPS) is not recommended. The current and only national clinical guideline from the highly-influential Society for Maternal-Fetal Medicine states that, "There is no evidence that monitoring for TAPS with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes, so that this additional screening cannot be recommended at this time." We argue this recommendation has disproportionate influence on patients and the care they are offered and receive. We use current evidence to highlight and dispel pervasive myths surrounding antenatal TAPS and the value of routine MCA-PSV screening. An ethical framework that illustrates the importance of giving patients the opportunity for routine screening is presented. Findings demonstrate that: (1) both spontaneous and post-laser TAPS is a serious, potentially life-threatening complication, (2) treatment for TAPS is effective and includes expectant management, intrauterine transfusion (IUT), or surgery, (3) and routine MCA-PSV, which has satisfactory diagnostic accuracy, is currently the only way to provide early detection of TAPS. We conclude that routine TAPS screening is a medically proven valuable resource that should be offered to patients in need and to the clinicians who are trying to act toward their benefit.
Nicholas Lauren; Fischbein Rebecca; Aultman Julie; Ernst-Milner Stephanie
Journal of Clinical Medicine
2019
2019-07
<a href="http://doi.org/10.3390/jcm8070977" target="_blank" rel="noreferrer noopener">10.3390/jcm8070977</a>
AMPK‐SIRT1‐independent inhibition of ANGPTL3 gene expression is a potential lipid‐lowering mechanism of metformin.
angiopoietin‐like 3; diabetes; dyslipidaemia; lipoprotein lipase; metformin
Objectives: Hypertriglyceridaemia enhances cardiovascular disease risk in patients with diabetes. Lipoprotein lipase (LPL) regulates plasma triglyceride levels by hydrolysing chylomicrons and very‐low‐density lipoprotein (VLDL). Metformin, an antidiabetic drug, improves plasma lipids including triglycerides. We examined metformin's regulation of angiopoietin‐like 3 (ANGPTL3), a liver‐derived secretory protein with LPL inhibitory property. Methods: Using HepG2 cells, a human hepatocyte cell line, the effects of metformin on ANGPTL3 gene and protein expression were determined. The role of AMPK‐SIRT1 pathway in metformin regulation of ANGPTL3 was determined using pharmacological, RNAi and reporter assays. Metformin regulation of ANGPTL3 expression was also examined in sodium palmitate‐induced insulin resistance. Key findings: Metformin and pharmacological activators of AMPK and SIRT1 inhibited the expression of ANGPTL3 in HepG2 cells. Pharmacological or RNAi‐based antagonism of AMPK or SIRT1 failed to affect metformin inhibition of ANGPTL3. AMPK‐SIRT1 activators and metformin exhibited distinct effects on the expression of ANGPTL3 gene luciferase reporter. Sodium palmitate‐induced insulin resistance in cells resulted in increased ANGPTL3 gene expression which was suppressed by pretreatment with metformin. Conclusions: Metformin inhibits ANGPTL3 expression in the liver in an AMPK‐SIRT1‐independent manner as a potential mechanism to regulate LPL and lower plasma lipids. [ABSTRACT FROM AUTHOR]
Lin Li; Burke Jamie; Venkatesh Sahana; Sadana Prabodh
Journal of Pharmacy & Pharmacology
2019
2019-09
<a href="http://doi.org/10.1111/jphp.13138" target="_blank" rel="noreferrer noopener">10.1111/jphp.13138</a>
Assessing The Determinants Of Primate Gait Kinematics In An Ecological And Phylogenetic Framework, Part I: Phylogenetic Methods For Biomechanics
Anthropology; Evolutionary Biology
Hieronymus T L; Shapiro L J; Dunham N T; McNamara A; Young J W
American Journal of Physical Anthropology
2019
2019-03
Journal Article or Conference Abstract Publication
n/a
Calculation of the Protein Turnover Rate Using the Number of Incorporated 2H Atoms and Proteomics Analysis of a Single Labeled Sample
Rate constant estimation with heavy water requires a long-term experiment with data collection at multiple time points (3-4 weeks for mitochondrial proteome dynamics in mice and much longer in other species). When tissue proteins are analyzed, this approach requires euthanizing animals at each time point or multiple tissue biopsies in humans. Although short-term protocols are available, they require knowledge of the maximum number of isotope labels (N) and accurate quantification of observed 2H-enrichment in the peptide. The high-resolution accurate mass spectrometers used for proteome dynamics studies are characterized by a systematic spectral error that compromises these measurements. To circumvent these issues, we developed a simple algorithm for the rate constant calculation based on a single labeled sample and comparable unlabeled (time 0) sample. The algorithm determines N for all proteogenic amino acids from a long-term experiment to calculate the predicted plateau 2H-labeling of peptides for a short-term protocol and estimates the rate constant based on the measured baseline and the predicted plateau 2H-labeling of peptides. The method was validated based on the rate constant estimation in a long-term experiment in mice and dogs. The improved 2 time-point method enables the rate constant calculation with less than 10% relative error compared to the bench-marked multi-point method in mice and dogs and allows us to detect diet-induced subtle changes in ApoAI turnover in mice. In conclusion, we have developed and validated a new algorithm for protein rate constant calculation based on 2-time point measurements that could also be applied to other biomolecules.
Ilchenko Serguei; Haddad Andrew; Sadana Prabodh; Recchia Fabio A; Sadygov Rovshan G; Kasumov Takhar
Analytical Chemistry
2019
2019-11-19
Journal Article
<a href="http://doi.org/10.1021/acs.analchem.9b02757" target="_blank" rel="noreferrer noopener">10.1021/acs.analchem.9b02757</a>
PMID: 31638786
Intestinal SIRT1 Deficiency Protects Mice from Ethanol-Induced Liver Injury by Mitigating Ferroptosis
Aberrant liver sirtuin 1 (SIRT1), a mammalian NAD+-dependent protein deacetylase, is implicated in the pathogenesis of alcoholic liver disease. However, the role of intestinal SIRT1 in alcoholic liver disease is presently unknown. This study investigated the involvement of intestine-specific SIRT1 in ethanol-induced liver dysfunction in mice. Ethanol feeding studies were performed on knockout mice with intestinal-specific SIRT1 deletion [SIRT1i knockout (KO)] and flox control [wild-type (WT)] mice with a chronic-plus-binge ethanol feeding protocol. After ethanol administration, hepatic inflammation and liver injury were substantially attenuated in the SIRT1iKO mice compared with the WT mice, suggesting that intestinal SIRT1 played a detrimental role in the ethanol-induced liver injury. Mechanistically, the hepatic protective effect of intestinal SIRT1 deficiency was attributable to ameliorated dysfunctional iron metabolism, increased hepatic glutathione contents, and attenuated lipid peroxidation, along with normalization of a panel of genes implicated in the ferroptosis process in the livers of ethanol-fed mice. This study demonstrates that ablation of intestinal SIRT1 protected mice from the ethanol-induced inflammation and liver damage. The protective effects of intestinal SIRT1 deficiency are mediated, at least partially, by mitigating hepatic ferroptosis. Targeting intestinal SIRT1 or dampening hepatic ferroptosis signaling may have therapeutic potential for alcoholic liver disease in humans.
Zhou Zhou; Ye Ting Jie; DeCaro Elizabeth; Buehler Brian; Stahl Zachary; Bonavita Gregory; Daniels Michael; You Min
The American Journal Of Pathology
2019
2019-10-11
Journal Article
<a href="http://doi.org/10.1016/j.ajpath.2019.09.012" target="_blank" rel="noreferrer noopener">10.1016/j.ajpath.2019.09.012</a>
PMID: 31610175
Specialty and Lifestyle Preference Changes during Medical School
Undergraduate medical education; Career choice; Curriculum development; Attitudes and psychosocial factors
Purpose: Medical student specialty choices have significant downstream effects on the availability of physicians and, ultimately, the effectiveness of health systems. This study investigated how medical student specialty preferences change over time in relation to their demographics and lifestyle preferences.Method: Students from ten medical schools were surveyed at matriculation (2012) and graduation (2016). The two surveys included questions about specialty and lifestyle preferences, demographics, educational background, and indebtedness. Student data from 2012 to 2016 were paired together and grouped into those whose specialty preferences remained constant or switched.Results: Response rates in 2012 and 2016 were 65% (997/1530) and 50% (788/1575), respectively. Fourth-year students ranked “enjoying the type of work I am doing” as less important to a good physician lifestyle than did first-year students (from 59.6 to 39.7%). The lifestyle factors “having control of work schedule” and “having enough time off work” were ranked as more important to fourth-year students than first-year students (from 15.6 to 18.2% and 14.8 to 31.9%, respectively). The paired dataset included 19% of eligible students (237/1226). Demographic and lifestyle factors were not significantly associated with specialty preference switching. Additionally, no significant association existed between changing lifestyle preferences and switching specialty preference (p = 0.85).Conclusions: During the course of medical school, lifestyle preferences became more focused on day-to-day factors and less on deeper motivational factors. Neither demographics nor lifestyle preferences appear to relate to a student’s decision to switch specialty preference during medical school. These findings represent an important step in uncovering causes of specialty preference trends.
Fischer Jonathan P; Clinite Kimberly; Sullivan Eric; Jenkins Tania M; Bourne Christina L; Chou Calvin; Diemer Gretchen; Dunne Dana; Hartung Paul J; Paauw Doug; Reddy Shalini
Medical Science Educator
2019
1905-07
Journal Article
<a href="http://doi.org/10.1007/s40670-019-00790-6" target="_blank" rel="noreferrer noopener">10.1007/s40670-019-00790-6</a>
The Hungry Child and the Corner Store
Socioeconomic status; Medicine; Poverty; Social Work; Medicine & Public Health; Health Psychology; Medical Sociology; Premedical Education; Food insecurity; Food preferences
Urban corner stores in Northeast Ohio have a reputation for contributing to neighborhood demise. Sales of liquor, cigarettes, lottery tickets, and other high-calorie low-nutrition foods along with high check-cashing fees have given corner stores titles such as “predatory” or “destructive.”
Stacey Gardner-Buckshaw
Health Disparities : Weaving A New Understanding Through Case Narratives
2019
2019
Journal Article
<a href="http://doi.org/10.1007/978-3-030-12771-8_18" target="_blank" rel="noreferrer noopener">10.1007/978-3-030-12771-8_18</a>
Pre-degenerative Accumulation of Superoxide and Hydroxide in a Chronic Mouse Model of Glaucoma
Jassim Assraa Hassan; Inman Denise M
Investigative Ophthalmology & Visual Science
2019
2019-07
Journal Article
<a href="https://iovs.arvojournals.org/article.aspx?articleid=2741311" target="_blank" rel="noreferrer noopener">https://iovs.arvojournals.org/article.aspx?articleid=2741311</a>
Upregulation of monocarboxylate transporter 2 protects retinal ganglion cells in glaucoma
Pappenhagen Nate; Harun-Or-Rashid Mohammad; Jaboori Assraa Jassim; Inman Denise M
Investigative Ophthalmology & Visual Science
2019
2019-07
Journal Article
<a href="https://iovs.arvojournals.org/article.aspx?articleid=2741271" target="_blank" rel="noreferrer noopener">https://iovs.arvojournals.org/article.aspx?articleid=2741271</a>
Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community Behavioral Health Systems
Community mental health services; Jails and prisons/mental health services
The overrepresentation of people with serious mental illness in the criminal justice system is a complex problem. A long-standing explanation for this phenomenon, the criminalization hypothesis, posits that policy changes that shifted the care of people with serious mental illness from psychiatric hospitals to an underfunded community treatment setting resulted in their overrepresentation within the criminal justice system. This framework has driven the development of interventions to connect people with serious mental illness to needed mental health and substance use treatment, a critical component for people in need. However, the criminalization hypothesis is a limited explanation of the overrepresentation of people with serious mental illness in the criminal justice system because it downplays the social and economic forces that have contributed to justice system involvement in general and minimizes the complex clinical, criminogenic, substance use, and social services needs of people with serious mental illness. A new approach is needed that focuses on addressing the multiple factors that contribute to justice involvement for this population. Although the authors' proposed approach may be viewed as aspirational, they suggest that an integrated community-based behavioral health system-i.e., intercept 0-serve as the focal point for coordinating and integrating services for justice-involved people with serious mental illness.
Bonfine Natalie; Wilson Amy Blank; Munetz Mark R
Psychiatric Services (Washington, D.C.)
2019
2019-12-04
Journal Article
<a href="http://doi.org/10.1176/appi.ps.201900453" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.201900453</a>
PMID: 31795858
Pharmacy and Medical Students' Mental Health Symptoms, Experiences, Attitudes and Help-Seeking Behaviors.
medical students; pharmacy students; help-seeking; mental health stigma; student mental health
Objective. To examine and compare the prevalence of mental health problems, help-seeking attitudes, and perceptions about mental health problems among US pharmacy and medical students. Methods. A cross-sectional analysis was conducted using existing, anonymous survey data collected in the Healthy Minds Study during the 2015-2016 academic year. The analysis included 482 students (159 pharmacy students and 323 medical students) from 23 institutions in the United States. Analyzed topics included demographic characteristics, mental health status and symptoms, substance abuse, stigma related to mental health, help-seeking behaviors and attitudes, and mental health treatment perceptions. Results. Pharmacy and medical students experienced similar rates of depression (18% met clinical cut-offs), but pharmacy students were more likely to meet clinical cutoffs for anxiety (21% vs 11%). Pharmacy students were less likely to seek help from student counseling services (only 11% vs 49%) and also less likely to know where to seek help on campus if needed. Pharmacy students also reported having higher levels of stigma regarding mental health treatment. Conclusion. There are differences between pharmacy and medical students with regards to their experience of mental health symptoms, willingness to seek help, and perception of stigma. Despite the small sample, this analysis of national data indicates that opportunities exist to improve campus-based mental health education and offerings for pharmacy and medical students.
Fischbein Rebecca; Bonfine Natalie
American journal of pharmaceutical education
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.5688/ajpe7558" target="_blank" rel="noreferrer noopener">10.5688/ajpe7558</a>