One more wall to cross: The role of psychologists in addressing integrated health among undocumented Latinx immigrants in inpatient medical settings

Over the past decade, there has been increased attention to the benefits of an integrated health-care care model in which psychologists play a vital role collaborating with other health providers to deliver services in inpatient medical settings, such as emergency departments and acute care medical units. Psychologists working in inpatient medical settings can facilitate access to mental health services and referrals, reduce mental health stigma, improve health outcomes associated with insight into psychosocial factors that affect health and illness, improve communication between patients and providers, and increase sensitivity in addressing the health needs of diverse patients. Psychological services in inpatient medical units can be particularly valuable for marginalized populations, such as undocumented Latinx immigrants, who may not otherwise have access to services that can address the compounded effect that psychosocial stressors may have on their physical health. We illustrate the critical role that psychologists can play in inpatient medical settings to address the complex health needs of Latinx immigrants. In this case study, an undocumented young woman presented to an emergency department with acute liver failure. We focus on psychologists' specific contributions as part of the integrated medical team and how it may have impacted treatment effectiveness. We also provide practical assessment and treatment recommendations, along with proposing advocacy efforts to facilitate access to culture and context sensitive treatments for undocumented immigrants with complex health issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Lessons learned from undocumented Latinx immigrants: How to build resilience and overcome distress in the face of adversity

Living under chronic uncertainty, fear, and isolation is the experience of many undocumented immigrants particularly under the recent sociopolitical climate. Yet, despite facing chronic adversity and an uncertain future, undocumented immigrants are highly resilient. This paper draws upon the clinical and research expertise of leading Latinx psychologists working with diverse undocumented communities across the United States. Qualitative data from seven focus groups with undocumented Latinxs and 15 in-depth interviews with key informants were used to complement clinical insights to identify and highlight strategies of undocumented Latinxs that promote their resilience. Overall, six primary strategies emerged including cognitive reframing, behavioral adaptability, acceptance, sociability, courage, and ancestral or cultural pride. Within each of these primary strategies, two-to-five additional facets emerged. We also identified the positive effects of the aforementioned strategies, including the fostering of meaning, purpose, and hope. Our findings are essential to address biases and stigmatization against undocumented immigrants, as well as to inform strength-based interventions and services, as well as culturally and contextually sensitive resources. Health services providers working with undocumented Latinxs can identify and build on strengths in their patients to demonstrate accurate cultural understanding and also to support resilience. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

'Remain In Mexico': Stories Of Trauma And Abuse

Two families' stories-a separation at the border and an assault in a migrant shelter-show the horrific dimensions of US migration policy.

Family separation and attachment in young adults who were once left behind by caregiver migration

This study examined young adults' attachment with their mothers and fathers after experiencing separation from these caregivers in childhood due to one or more caregivers migrating out of the family's home country. From 774 respondents, 110 reported parental migration. Participants (M = 20.98; SD = 3.12; 68.1% female) were recruited from Latin American universities. Regarding maternal attachment, young adults who experienced separation from their mothers due to maternal migration were not significantly different from young adults who had not experienced such separation. In contrast, young adults who experienced separation from their fathers due to paternal migration (n = 79) reported higher alienation from their fathers, as well as lower attachment security, communication, and trust, than respondents who had not experienced separation. These differences were significant and moderately sized. Respondents who had frequent phone/video contact with their fathers after separation reported higher attachment security than respondents who did not maintain frequent contact with their fathers. This effect was strongest when respondents were older at the time of their fathers' migration. Findings suggest that the effects of separation from fathers on attachment persist into young adulthood, even when the separation occurred, on average, nearly 15 years earlier.

A tale of two crises: The compounded effect of COVID-19 and anti-immigration policy in the United States

The COVID-19 pandemic is highlighting some important sources of health disparities that assail our society's most vulnerable people, particularly undocumented immigrants and asylum seekers. The focus of this commentary is on uncovering those sources of health disparities and making a call for action. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Trauma and cultural values in the health of recently immigrated families

This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.

'Ripple' effect on infant zBMI trajectory of an internet-based weight loss program for low-income postpartum women

BACKGROUND

Weight loss interventions can have positive 'ripple' effects on untreated partners in the home, but ripple effects on infants are unknown.

OBJECTIVE

To examine whether a 12-month internet-based weight loss intervention for postpartum mothers had a positive ripple effect on participants' infants.

METHODS

A 12-month cluster randomized, assessor-blind, clinical trial enrolling 371 postpartum women at 12 Women, Infants, Children clinics in CA. Clinics were randomized to standard Women, Infants, Children or an internet-based weight loss intervention for mothers.

RESULTS

A total of 333 of the 371 (89.8%) mothers assented for infant participation. Infants were 5.3 ± 3.2 months; 75.9% were Hispanic and 64% were breastfeeding. Infant retention was 272/333 (82.7%) at 6 months post enrollment and 251/333 (75.3%) at 12 months post enrollment. In intent-to-treat analysis, a significant interaction between group and time was observed (p = 0.008) with the offspring of intervention mothers exhibiting lower zBMI change from study entry through 6 months (0.23 [CI, 0.03, 0.44] vs. 0.65 [0.50, 0.79] zBMI change, respectively; p = 0.001) but was not significant through 12 months (p = 0.16). Regardless of group, maternal reports at the final assessment indicated that infants (aged =17.2 ± 3.4 months) consumed sweetened beverages (0.93 ± 1.5/week), juice (2.0 ± 1.4/day), 'junk food' (7.8 ± 5.4/week) and fast food (2/month), and 46.7% of the infants had a TV in their bedroom.

CONCLUSIONS

An internet-based weight loss program for low-income, postpartum mothers had a positive 'ripple' effect on the zBMI of infants in the home during the first 6 months of treatment.

Impairment of functioning and substance use in a Latino population

This study investigated the association of academic outcomes, romantic relationships, and substance use (tobacco, marijuana, cocaine) with alcohol dependence in a sample of Latino (N = 1,143) college students. Secondary data analysis was conducted on measures of grade point average in college, relationship satisfaction, drug use, and alcohol dependence. Latino college students who reported alcohol dependency had significant relational dissatisfaction and poor academic outcomes. Thus, lower grade point average and relationship dissatisfaction were associated with alcohol dependence. By focusing specifically on a Mexican American population, this study adds important information to current research regarding the commonality and differences across cultural groups regarding drug use and dependence and further clarifies the risk factors associated with substance use and dependency in a population that is vulnerable for at-risk behaviors. This study also offers insight into potential targets of treatment and intervention for this cultural group.

Comparison between retrograde intrarenal surgery and extracorporeal shock wave lithotripsy in the treatment of lower pole kidney stones up to 15 mm. Prospective, randomized study

INTRODUCTION

Extracorporeal Shock Wave Lithotripsy (ESWL) is currently the recommended treatment for intra-renal calculi smaller than 2 cm. However the low Stone Free Rate (SFR) in lower pole calculi gives rise to new techniques, such us retrograde intrarenal surgery (RIRS), for improve the surgery outcomes.

OBJECTIVE

To compare the efficacy of a treatment with ESWL with RIRS, in terms of SFR after surgery, in patients with kidney stones up to 15 mm in the lower pole.

MATERIAL AND METHODS

A prospective study was carried out in order to assess the results of ESWL and RIRS in patients with lower pole stones less than 15 mm. Among a total of 55 patients, 31 were underwent to ESWL (Group 1) and the remaining 24 to RIRS (Group 2). Clinical data recorded, including general characteristics of each patient, were: calculi size, side, operative time, complications according to Clavien scale, SFR and the presence of residual fragments at 2 months post-treatment assessed by a CT scan. STATA 11 was used to perform the statistical analysis.

RESULTS

There were no differences for general descriptors among groups with the exception of a significantly longer operative time for RIRS. The rates of SFR and residual fragments lesser than 3 mm. were lower in the RIRS group than in ESWL ones. RIRS also showed a lower rate of clinically significant fragments (0% vs 42.3%. P < .05). In the subgroup of patients with stones between 10/15 mm RIRS showed higher SFR (75% vs. 41.2%) and a lower rate of stones>3 mm (0% vs. 58.8%), being statistically significant (P < .05). Clavien III or higher complications were not reported in any of the groups.

CONCLUSIONS

In the treatment of lower pole stone RIRS has the same results than ESWL in terms of SFR. Regarding absence of a clinically significant residual fragment, RIRS was superior to ESWL. A bigger sample size is required in order to confirm this results.

The association between personality traits and body mass index varies with nativity among individuals of Mexican origin

Personality traits have been associated consistently with health-related outcomes, but less is known about how aspects of the sociocultural environment modify these associations. This study uses a sample of participants of Mexican origin (N = 1013) to test whether exposure to the United States, indexed by nativity (Mexicans living in Mexico, foreign-born Mexican Americans, and U.S.-born Mexican Americans), moderates the association between personality traits and body mass index (BMI). Higher Conscientiousness was associated with lower BMI, regardless of nativity. In contrast, the association between Neuroticism and BMI was moderated by exposure to the U.S.: Neuroticism was associated with higher BMI among U.S.-born Mexican Americans (partial r = .15) but not among Mexican participants (partial r = .00), an effect strongest and most robust for the impulsivity facet of Neuroticism. This finding suggests that with more exposure to the United States, those who are more emotionally impulsive are at greater risk for obesity. More broadly, these findings suggest that social and psychological vulnerabilities interact to contribute to health outcomes.

Functional and molecular characterization of the K-Cl cotransporter of Xenopus laevis oocytes

The K-Cl cotransporters (KCCs) have a broad range of physiological roles, in a number of cells and species. We report here that Xenopus laevis oocytes express a K-Cl cotransporter with significant functional and molecular similarity to mammalian KCCs. Under isotonic conditions, defolliculated oocytes exhibit a Cl(-)-dependent (86)Rb(+) uptake mechanism after activation by the cysteine-reactive compounds N-ethylmaleimide (NEM) and mercuric chloride (HgCl(2)). The activation of this K-Cl cotransporter by cell swelling is prevented by inhibition of protein phosphatase-1 with calyculin A; NEM activation of the transporter was not blocked by phosphatase inhibition. Kinetic characterization reveals apparent values for the Michaelis-Menten constant of 27.7 +/- 3.0 and 15.4 +/- 4.7 mM for Rb(+) and Cl(-), respectively, with an anion selectivity for K(+) transport of Cl(-) = PO(4)(3-) = Br(-) > I(-) > SCN(-) > gluconate. The oocyte K-Cl cotransporter was sensitive to several inhibitors, including loop diuretics, with apparent half-maximal inhibition values of 200 and 500 microM for furosemide and bumetanide, respectively. A partial cDNA encoding the Xenopus K-Cl cotransporter was cloned from oocyte RNA; the corresponding transcript is widely expressed in Xenopus tissues. The predicted COOH-terminal protein fragment exhibited particular homology to the KCC1/KCC3 subgroup of the mammalian KCCs, and the functional characteristics are the most similar to those of KCC1 (Mercado A, Song L, Vazquez N, Mount DB, and Gamba G. J Biol Chem 275: 30326--30334, 2000).

Thiazide-sensitive cotransporter mRNA expression is not altered in three models of hypertension

BACKGROUND/AIMS

Several lines of evidence support that the kidney is involved in the increase of arterial blood pressure, and some genetic studies suggest that the thiazide-sensitive Na+:Cl- cotransporter could be implicated in the development of hypertension. In the present study, we analyzed the Na+:Cl- cotransporter mRNA levels in the kidney during the development of hypertension in three experimental models.

METHODS

The first model included 18 spontaneously hypertensive rats studied at 4, 10, and 16 weeks of age. The second model included 28 Wistar rats with two-kidney, one-clip Goldblatt hypertension studied at 7, 14, 21, and 28 days. The third model included 6 Wistar rats treated with N(G)-nitro-L-arginine methyl ester during 10 days. Respective controls were studied for all models. At the end of each experimental period, the systolic blood pressure was measured in the tail by plethysmography. Individual renal cortex total RNA was extracted, and the mRNA levels of the thiazide-sensitive Na+:Cl- cotransporter were assessed following a semiquantitative RT-PCR strategy.

RESULTS

All experimental models developed systemic hypertension. However, the level of mRNA expression of the Na+:Cl- cotransporter did not change in any of the models studied as compared with their respective controls.

CONCLUSION

Our results suggest that a change in mRNA levels of the thiazide-sensitive Na+:Cl- cotransporter is not associated with the development of hypertension in spontaneously hypertensive rats, in rats with renovascular hypertension, nor in rats with hypertension induced by nitric oxide synthesis inhibition.

Functional comparison of the K+-Cl- cotransporters KCC1 and KCC4

The K(+)-Cl(-) cotransporters (KCCs) are members of the cation-chloride cotransporter gene family and fall into two phylogenetic subgroups: KCC2 paired with KCC4 and KCC1 paired with KCC3. We report a functional comparison in Xenopus oocytes of KCC1 and KCC4, widely expressed representatives of these two subgroups. KCC1 and KCC4 exhibit differential sensitivity to transport inhibitors, such that KCC4 is much less sensitive to bumetanide and furosemide. The efficacy of these anion inhibitors is critically dependent on the concentration of extracellular K(+), with much higher inhibition in 50 mm K(+) versus 2 mm K(+). KCC4 is also uniquely sensitive to 10 mm barium and to 2 mm trichlormethiazide. Kinetic characterization reveals divergent affinities for K(+) (K(m) values of approximately 25.5 and 17.5 mm for KCC1 and KCC4, respectively), probably due to variation within the second transmembrane segment. Although the two isoforms have equivalent affinities for Cl(-), they differ in the anion selectivity of K(+) transport (Cl(-) > SCN(-) = Br(-) > PO(4)(-3) > I(-) for KCC1 and Cl(-) > Br(-) > PO(4)(-3) = I(-) > SCN(-) for KCC4). Both KCCs express minimal K(+)-Cl(-) cotransport under isotonic conditions, with significant activation by cell swelling under hypotonic conditions. The cysteine-alkylating agent N-ethylmaleimide activates K(+)-Cl(-) cotransport in isotonic conditions but abrogates hypotonic activation, an unexpected dissociation of N-ethylmaleimide sensitivity and volume sensitivity. Although KCC4 is consistently more volume-sensitive, the hypotonic activation of both isoforms is critically dependent on protein phosphatase 1. Overall, the functional comparison of these cloned K(+)-Cl(-) cotransporters reveals important functional, pharmacological, and kinetic differences with both physiological and mechanistic implications.

Na(+):K(+):ATPase mRNA expression in the kidney during adaptation to sodium intake and furosemide treatment

Nephron tubular epithelium possesses the capacity of adaptation to any salt ingestion condition. The mechanism of adaptation is due in part to an increase in the activity of Na(+):K(+):ATPase at the basolateral membrane. The goal of the present study was to analyze the long-term regulation of the Na(+):K(+):ATPase alpha(1)-subunit mRNA expression during changes in NaCl metabolism. Male Wistar rats given a normal, high, or low NaCl diet, and intraperitoneal administration of the loop diuretic furosemide from 12 h to 7 days were studied. Rats were kept in metabolic cages 4 days before and throughout the study to determine daily urinary electrolyte excretion and osmolarity. At the end of each experimental period, creatinine clearance and serum electrolytes were also measured. Total RNA was extracted from each individual cortex or outer medulla and from pooled inner medullas using the guanidine/cesium chloride method. Na(+):K(+):ATPase alpha(1)-subunit mRNA expression was assessed by nonradioactive dot-blot analysis. Experimental maneuvers were well tolerated and all groups developed the appropriate renal response to each experimental condition. Urinary sodium excretion was significantly higher in rats administered a high sodium diet or furosemide and lower in rats treated with a low sodium diet after 7 days of treatment. Glomerular filtration rate was similar among all groups. However, the level of expression of the Na(+):K(+):ATPase alpha(1)-subunit did not change in any model. Nephron adaptation to the modification in NaCl intake or furosemide administration over 7 days did not include changes in Na(+):K(+):ATPase alpha(1)-subunit mRNA levels.

[Viral C hepatitis in patients with end stage renal disease. II. Viral genotypes]

BACKGROUND

The hepatitis C virus infection is highly prevalent in patients on chronic dialysis. There are more than 10 variants of the hepatitis C virus, with 55 to 72% of identity among them at the amino acid level. However, we do not know the specific genotype in dialysis patients in Mexico. Thus, the aim of the present study was to know the specific genotypes of the C virus in infected dialysis patients, to know the distribution of genotypes in the different dialysis techniques and to know the relation between genotype and hepatic disease stage.

METHODS

We performed a prospective, transversal and comparative study in patients in dialysis in three hospital centers in the south of Mexico City. The presence of C-type hepatitis infection was assessed by ELISA II and qualitative RT-PCR in blood samples. The genotype of the hepatitis C virus was determined by analysis of the restriction pattern of the RT-PCR product using Mva I, Hinf I, BstU I and ScrF I restriction enzymes. Variables analyzed were: age, gender, etiology of renal failure, kind and time in substitutive therapy, transfusion and hepatitis history, liver function test, blood urea, serum creatinine and blood cell count.

RESULTS

We studied 235 dialysis patients that were divided following their dialysis modality into: 132 in continue ambulatory peritoneal dialysis (CAPD), 17 in CAPD, but with history of hemodialysis (PD/HD) of at least one month and 86 on hemodialysis (HD). The hepatitis infection was detected in 24 of the 235 patients (CAPD = 4.5%, PD/HD = 41.1% and HD = 12.7%; p < 0.001). The most common genotype was 1B (12/24), followed by 1A and 2A (4/24 each one), and finally by 2B and 2C (2/24 each one). We detected no patients with genotypes 3 to 6. The patients with 2A genotype were older than those infected with 1A (p < 0.05). History of surgery, transfusions, and hepatitis was similar in all genotypes. Finally the time in dialysis was longer in patients with 2A genotype than others (2A = 60.5 +/- 71.5 months, vs. 1A = 11.5 +/- 11.3, 1B = 26 +/- 26.4 y 2B/C = 17.5 +/- 13.4), but the difference did not reach statistical significance. The genotype distribution between dialysis techniques showed that 1B genotype was the most frequent in all modalities. The 1A genotype was present in similar proportions in patients of the three dialysis groups, the 2C genotype was present only in patients with CAPD. Finally, the 2B was only found in hemodialysis patients.

DISCUSSION

The assessment of viral genotype revealed that 1B is the most common genotype in patients on chronic dialysis in Mexico City. The fact that the 1B and 1A genotypes were the most common types in our dialysis population suggest that transmission was similar to the general population, that is, probably by blood transfusions.

[Hepatitis C viral in patients with terminal chronic kidney failure. I. Prevalence]

BACKGROUND

The prevalence of hepatitis C in patients with end stage renal disease, under renal replacement therapy either with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), is higher than in the general population. The prevalence of hepatitis C in patients under dialysis, however, is unknown in Mexico. Thus, the major goals of the present study were to determine the prevalence of hepatitis C in our patients on dialysis, and the risk factors associated with it.

METHODS

We performed a cross-sectional and comparative study in patients under dialysis in three hospital centers in the south of Mexico City. For every patient we evaluated: age, gender, etiology of the renal failure, modality and time in dialysis, transfusion and surgical history, serum albumin, aminotranferases, BUN, and serum creatinine. The presence of hepatitis C was assessed by ELISA II and qualitative RT-PCR in blood samples. In all patients diagnosed as having hepatitis C, RT-PCR to amplified part of the virus genome was also carried out in the dialysis fluid.

RESULTS

We studied 235 dialysis patients that were classified according to their dialysis modality in: 132 patients under CAPD, 17 under CAPD and history of HD (PD/HD) and 86 under HD. The time under dialysis was different between the study groups: CAPD 29.6 +/- 22.3 months, PD/HD 39 +/- 42.3 and HD 14.2 +/- 15.6 (p < 0.01). The presence of hepatitis C was detected in 24 of the 235 patients, for a global prevalence of 10.2%. In no case was viral RNA found in the dialysis fluid. The prevalence varied, however, according to the type of dialysis. It was in the CAPD group 4.5%, 12.7% in the HD group, and 41.1% in the PD/HD group (p < 0.001). The multivariate analysis showed that the risk factors for hepatitis C are transfusions before the year of 1991 (Odds Ratio = 6.4), and history of hepatitis (OR = 4.3). Since less patients are seen with transfusions before 1991, we constructed another model in which this variable was excluded. This new multivariate model showed that history of surgery (OR = 4.4), the use of HD as the dialysis modality (OR = 3.5), and prolonged time under dialysis (OR = 1.01) were all significantly associated with the presence of hepatitis.

DISCUSSION

Our results show that the prevalence of hepatitis C is lower in our patients that the prevalence reported by many others (average of other countries 18.5%). Since we found a higher prevalence in HD than in CAPD, even with the lower time under dialysis in the HD group, it is possible that our lower overall prevalence is secondary to the fact that CAPD is the most frequent mode of dialysis in our country. We observed the highest prevalence in the PD/HD group, that is probably due to longer exposure to the risk factors. The association with transfusions before 1991 indicates that the infection was acquired in some patients before dialysis was started. Our results showed that the CAPD is the dialysis technique with lower risk of hepatitis C infection.

Cloning and characterization of KCC3 and KCC4, new members of the cation-chloride cotransporter gene family

The K+-Cl- cotransporters (KCCs) belong to the gene family of electroneutral cation-chloride cotransporters, which also includes two bumetanide-sensitive Na+-K+-2Cl- cotransporters and a thiazide-sensitive Na+-Cl- cotransporter. We have cloned cDNAs encoding mouse KCC3, human KCC3, and human KCC4, three new members of this gene family. The KCC3 and KCC4 cDNAs predict proteins of 1083 and 1150 amino acids, respectively. The KCC3 and KCC4 proteins are 65-71% identical to the previously characterized transporters KCC1 and KCC2, with which they share a predicted membrane topology. The four KCC proteins differ at amino acid residues within key transmembrane domains and in the distribution of putative phosphorylation sites within the amino- and carboxyl-terminal cytoplasmic domains. The expression of mouse KCC3 in Xenopus laevis oocytes reveals the expected functional characteristics of a K+Cl- cotransporter: Cl--dependent uptake of 86Rb+ which is strongly activated by cell swelling and weakly sensitive to furosemide. A direct functional comparison of mouse KCC3 to rabbit KCC1 indicates that KCC3 has a much greater volume sensitivity. The human KCC3 and KCC4 genes are located on chromosomes 5p15 and 15q14, respectively. Although widely expressed, KCC3 transcripts are the most abundant in heart and kidney, and KCC4 is expressed in muscle, brain, lung, heart, and kidney. The unexpected molecular heterogeneity of K+-Cl- cotransport has implications for the physiology and pathophysiology of a number of tissues.