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Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America
- M. Claire Greene, Gabrielle Wimer, Maria Larrea, Ingrid Mejia Jimenez, Andrea Armijos, Alejandra Angulo, Maria Esther Guevara, Carolina Vega, Emily W. Heard, Lina Demis, Lucia Benavides, Christine Corrales, Ale de la Cruz, Maria Jose Lopez, Arianna Moyano, Andrea Murcia, Maria Jose Noboa, Abhimeleck Rodriguez, Jennifer Solis, Daniela Vergara, Lena S. Andersen, Maria Cristobal, Milton Wainberg, Annie G. Bonz, Wietse Tol
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 11 / 2024
- Published online by Cambridge University Press:
- 08 March 2024, e32
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As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study’s intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.
17 Emotional and Instrumental Support as Protective Factors in Cognitive Aging Among Black and Hispanic/Latinx Older Adults
- Emily P Morris, A. Zarina Kraal, Shellie-Anne Levy, Franchesca Arias, Ruijia Chen, Dominika Seblova, Marcia P. Jimenez, Mateo Farina, Zvinka Zlatar, Marianne Chanti-Ketterl, Yi Lor, Evan Fletcher, Jennifer J. Manly, Maria Glymour
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 330-331
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Objective:
Social support may protect against Alzheimer’s disease and related dementias (ADRD), potentially through emotional or instrumental support elements. Black and Hispanic/Latinx older adults bear a disproportionate burden of ADRD. However, independent effects of emotional and instrumental support on cognition, a primary indicator of ADRD risk, are largely understudied in these groups. Guided by the differential vulnerability hypothesis – the theoretical framework which posits that systemic racism disadvantages Black and Hispanic/Latinx individuals’ health – we hypothesize that emotional and instrumental support may be particularly important to protect against worse cognition for Black and Hispanic/Latinx older adults, who often have fewer resources due to these inequalities (e.g., wealth, educational opportunities) to otherwise maintain health. Using the NIH Toolbox Emotion Module measures of emotional (e.g., the extent to which individuals can rely on others in challenging times) and instrumental support (e.g., the extent to which individuals can rely on others for assistance in daily activities), we aimed to identify positive social support factors (i.e., emotional and instrumental support) that may protect against ADRD risk (i.e., longitudinal executive function and memory performance) among Black and Hispanic/Latinx older adults.
Participants and Methods:Participants were 362 Black and 265 Hispanic/Latinx adults aged 65-89 (63% female, average age=75) from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study who completed baseline and up to two additional waves of assessments (every 1.5 years), including questionnaires, neuropsychological evaluations, and the NIH toolbox. Predictors included baseline covariates (i.e., age, language of test administration, gender, education, income, self-rated health) and NIH toolbox emotional and instrumental support variables. Outcomes were baseline and longitudinal memory (visual and verbal episodic memory) and executive functioning (verbal fluency and working memory) composites from the Spanish and English Neuropsychological Assessment Scales (SENAS). Latent growth curve models were conducted separately in Black and Hispanic/Latinx participants to estimate effects of emotional and instrumental support on baseline cognition and subsequent change in each domain.
Results:Black participants reported greater emotional support. There were no group differences in levels of instrumental support. Greater instrumental support was associated with better initial memory (standardized β= .194, 95%CI: [.063, .325]) among Black participants but not among Hispanic/Latinx participants. In Hispanic/Latinx participants, greater emotional support was associated with better initial executive functioning (standardized β= .215, 95%CI: [.079, .350]. Emotional support was not associated with either cognitive domain in Black participants. There were no associations between emotional or instrumental support on cognitive change in either group.
Conclusions:Results point to differences between Black and Hispanic/Latinx older adults in the impact of specific aspects of social support on different cognitive domains. Positive associations between instrumental support and baseline memory in Black participants and between emotional support and executive functioning in Hispanic/Latinx participants suggest unique cognitive consequences of social support across groups. Differences in the role of specific types of social supports may be useful in identifying intervention targets specifically for Black and Hispanic/Latinx older adults, who are disproportionately affected by ADRD. Future research will examine these constructs using multiple group models to test these associations more rigorously.
Discontinuation of antipsychotics in individuals with first-episode schizophrenia and its association to functional outcomes, hospitalization and death: a register-based nationwide follow-up study
- Anne Emilie Stürup, Merete Nordentoft, Espen Jimenez-Solem, Merete Osler, Josefine Winther Davy, Thomas Nordahl Christensen, Helene Speyer, Nikolai Albert, Carsten Hjorthøj
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- Journal:
- Psychological Medicine / Volume 53 / Issue 11 / August 2023
- Published online by Cambridge University Press:
- 12 July 2022, pp. 5033-5041
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Background
Discontinuation of antipsychotic medication may be linked to high risk of relapse, hospitalization and mortality. This study investigated the use and discontinuation of antipsychotics in individuals with first-episode schizophrenia in relation to cohabitation, living with children, employment, hospital admission and death.
MethodsDanish registers were used to establish a nationwide cohort of individuals ⩾18 years with schizophrenia included at the time of diagnosis in1995–2013. Exposure was antipsychotic medication calculated using defined daily dose and redeemed prescriptions year 2–5. Outcomes year 5–6 were analysed using binary logistic, negative binomial and Cox proportional hazard regression.
ResultsAmong 21 351, 9.3% took antipsychotics continuously year 2–5, 38.6% took no antipsychotics, 3.4% sustained discontinuation and 48.7% discontinued and resumed treatment. At follow-up year 6, living with children or employment was significantly higher in individuals with sustained discontinuation (OR 1.98, 95% CI 1.53–2.56 and OR 2.60, 95% CI 1.91–3.54), non-sustained discontinuation (OR 1.25, 95% CI 1.05–1.48 and 2.04, 95% CI 1.64–2.53) and no antipsychotics (OR 2.00, 95% CI 1.69–2.38 and 5.64, 95% CI 4.56–6.97) compared to continuous users. Individuals with non-sustained discontinuation had more psychiatric hospital admissions (IRR 1.27, 95% CI 1.10–1.47) and longer admissions (IRR 1.68, 95% CI 1.30–2.16) year 5–6 compared to continuous users. Mortality during year 5–6 did not differ between groups.
ConclusionMost individuals with first-episode schizophrenia discontinued or took no antipsychotics the first years after diagnosis and had better functional outcomes. Non-sustained discontinuers had more, and longer admissions compared to continuous users. However, associations found could be either cause or effect.
Toward a Change Among the Epidemiology of Catheter-Related Bloodstream Infections in Catalonia
- Oriol Gasch, Marta Andrés, Jordi Camara, L’Hospitalet de Llobregat, Dolors Domenech, Emili Jimenez, L'Hospitalet de Llobregat, Anna Marrón, Yolanda Meije, Virginia Pomar, Patrick Saliba, Esther Calbo
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s413
- Print publication:
- October 2020
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Background: Catheter-related bloodstream infections (CRBSIs) are one of the most frequent causes of heathcare-associated infections and an important cause of preventable death. Central venous catheters (CVC) have been considered the most worrisome origin of CRBSI. Implemented preventive measures at most hospitals and published guidelines for the prevention of vascular catheter infections have focused mostly on CVCs. However, peripherally inserted venous catheters (PIVC)–related bloodstream infections have increased in recent years and are currently among the top 10 patient safety concerns for 2019. Objective: We describe the changes in the epidemiology of catheter-related bloodstream infections among acute-care hospitals reporting at the VINCat program (Infection Control and Antimicrobial Stewardship Catalan Program) from 2008 to 2018. Methods: Data on 55 hospitals in Catalonia reporting all the episodes of CRBSI diagnosed according to standardized definitions during 2008–2018 were used for the analysis. Participating hospitals were classified into 3 groups according to size: group 1 (>500 beds), 9 hospitals; group 2 (500–200 beds), 17 hospitals; and group 3 (<200 beds), 29 hospitals. Catheters were classified in 3 categories: CVCs, PICVCs, and short peripheral venous catheters (PVCs). Rates of catheter-related bloodstream infection (CR-BSI) were obtained by adjusting the total number of episodes by 1,000 hospital stays. Simple linear regressions were performed. Values of P ≤ .05 were considered statistically significant. Results: During the study period, 8,221 nosocomial episodes of CRBSI were diagnosed among the 55 participating hospitals. In total, 37,587,967 hospital stays were counted. The CRBSI rate was 0.22 episodes per 1,000 hospital stays (group 1, 0.28; group 2, 0.15; and group 3, 0.16), following a downward trend from 2008 to 2018 from 0.28 to 0.21 per 1,000 hospital stays (P < .005). Among them, CVC-BSI showed a downward trend (from 610 annual episodes in 2008 to 312 in 2018), and PICVC and PVC showed an upward trend (from 51 and 120 annual episodes in 2008 to 130 and 312 in 2018, respectively). Annual rates of PICVCs and PVCs showed an upward trend, but CVCs showed a downward trend in 2018 (P < .05): 0.09 per 1,000 hospital stays for PICVCs; 0.07 per 1,000 hospital stays for PVCs, and 0.04 episodes per 1,000 hospital stays for CVCs (Fig. 1). Conclusions: PIVC-related bloodstream infections have increased in recent years, whereas bloodstream infections related to CVC have followed a downward trend. Our hospitals should implement preventive measures to specially address the prevention of PICVC infections.
Funding: None
Disclosures: None
Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior
- Ángela Velasco, Julia Rodríguez-Revuelta, Emilie Olié, Iciar Abad, Abel Fernández-Peláez, Aurélie Cazals, Sébastien Guillaume, Lorena de la Fuente-Tomás, Luis Jiménez-Treviño, Laura Gutiérrez, Paz García-Portilla, Julio Bobes, Philippe Courtet, Pilar A. Sáiz
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- Journal:
- European Psychiatry / Volume 63 / Issue 1 / 2020
- Published online by Cambridge University Press:
- 17 February 2020, e14
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Background.
Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality.
Methods.We evaluated 538 patients with MDD (mean age [standard deviation] = 43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA).
Results.Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p = 0.007), significantly younger (41.20 vs. 51.77 years; p < 0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p < 0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p = 0.001; 127.90 vs. 109.97, p = 0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (β = 0.489, p = 0.000; odds ratio [95% confidence intervals] = 1.631 [1.266–2.102]). We propose a cut-off value of NLR = 1.30 (sensitivity = 75% and specificity = 35%).
Conclusions.Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.
Contributors
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- By Mark S. Aloia, Ellemarije Altena, Peter Anderer, Christopher L. Asplund, Nitin Bangera, Jeroen S. Benjamins, Daniela Berg, Bohdan Bybel, Vincenza Castronovo, Suk-tak Chan, Michael W. L. Chee, Pietro Cortelli, Michael Czisch, Joseph T. Daley, Thien Thanh Dang-Vu, Yazmín de la Garza-Neme, Lourdes DelRosso, Derk-Jan Dijk, Maria Engström, Thorleif Etgen, Bruce J. Fisch, Ariane Foret, Patrice Fort, Steffen Gais, Anne Germain, Jana Godau, Andrew L. Goertzen, William A. Gomes, Ronald M. Harper, Seung Bong Hong, Romy Hoque, Scott A. Huettel, Yuichi Inoue, Alex Iranzo, Mathieu Jaspar, Zayd Jedidi, Alejandro Jiménez-Genchi, Eun Yeon Joo, Gerhard Klösch, Karsten Krakow, Rajesh Kumar, Caroline Kussé, Hans-Peter Landolt, Helmut Laufs, Jeffrey David Lewine, Camilo Libedinsky, Michael L. Lipton, Mordechai Lorberboym, Cheng Luo, Pierre-Hervé Luppi, Paul M. Macey, Pierre Maquet, Laura Mascetti, Christelle Meyer, Sarah Moens, Vincenzo Muto, Shadreck Mzengeza, Eric Nofzinger, Takashi Nomura, Daniela Perani, Jennifer R. Ramautar, Bernd Saletu, Michael T. Saletu, Gerda Saletu-Zyhlarz, Christina Schmidt, Monika Schönauer, Richard J. Schwab, Sophie Schwartz, Keivan Shifteh, Sanjib Sinha, Victor I. Spoormaker, Ryan P. J. Stocker, A. Jon Stoessl, Diederick Stoffers, A. B. Taly, Robert Joseph Thomas, Michael J. Thorpy, Emily Urry, Jason Valerio, Ysbrand D. Van Der Werf, Gilles Vandewalle, Hans P. A. Van Dongen, Eus J. W. Van Someren, Vinod Venkatraman, Frederic von Wegner, Thomas C. Wetter, Dezhong Yao
- Edited by Eric Nofzinger, University of Pittsburgh, Pierre Maquet, Université de Liège, Belgium, Michael J. Thorpy
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- Book:
- Neuroimaging of Sleep and Sleep Disorders
- Published online:
- 05 March 2013
- Print publication:
- 07 March 2013, pp viii-xii
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