Mental Health Literacy: a Critical Target for Narrowing Racial Disparities in Behavioral Health

One of the most persistent and troubling health disparities is the underutilization of mental health services, particularly for depression and anxiety, commonly occurring behavioral health concerns. The gap between individuals who need mental health care and those who receive care is large, and identified barriers to treatment include poor mental health and insurance literacy, as well as stigmatizing attitudes toward mental health disorders. The present study presents the results of an inquiry into the mental health literacy, insurance literacy, internalized stigma, and mental health symptoms. Results suggest that mental health literacy is poor and associated with higher rates of depression, anxiety, stress, internalized stigma, and caregiver burden. Implications of poor mental health literacy, as well as demographic disparities in literacy, are discussed.

Thematic Analysis of Parent-Child Conversations About COVID-19: "Playing It Safe"

Caregivers have primary responsibility for teaching their children self-protective behaviors, including those behaviors recommended by the Center for Disease Control (CDC) to prevent the spread of COVID-19. Parents have an important role in scaffolding adherence to the CDC recommendations and in managing stress and regulate their emotions to adaptively cope during uncertain times like those facing communities nationwide. The present study is a qualitative, thematic analysis of parent-reported (n = 210; 64.8% female; average age = 39.33; 14.3% ethnic/racial minority) interactions with children (focal child age: 25.2% birth to 5 years old, 36.7% 6 to 11 years old, 37.6% 12 to 18 years old) about topics associated to COVID-19-related viral transmission suppression guidelines and stress/coping behaviors. Themes included discussions about personal and social hygiene, and parent reported sources of child stress, and child stress management efforts. Findings from our thematic analysis indicate parents are motivated to make scaffolding personal hygiene fun and engaging, signaling a positive, developmentally appropriate native approach to their role as sources of coping socialization. These findings also underscore the importance of providing information to parents in ways that can be translated to children in developmentally appropriate conversations about viral transmission suppression activities and stress management during disasters.

Initial Challenges of Caregiving During COVID-19: Caregiver Burden, Mental Health, and the Parent-Child Relationship

Research confirms that the mental health burdens following community-wide disasters are extensive, with pervasive impacts noted in individuals and families. It is clear that child disaster outcomes are worst among children of highly distressed caregivers, or those caregivers who experience their own negative mental health outcomes from the disaster. The current study used path analysis to examine concurrent patterns of parents' (n = 420) experience from a national sample during the early months of the U.S. COVID-19 pandemic. The results of a multi-group path analysis, organized by parent gender, indicate good fit to the data [X²(10) = 159.04, p < .01]. Results indicate significant linkages between parents' caregiver burden, mental health, and perceptions of children's stress; these in turn are significantly linked to child-parent closeness and conflict, indicating possible spillover effects for depressed parents and compensatory effects for anxious parents. The impact of millions of families sheltering in place during the COVID-19 pandemic for an undefined period of time may lead to unprecedented impacts on individuals' mental health with unknown impacts on child-parent relationships. These impacts may be heightened for families whose caregivers experience increased mental health symptoms, as was the case for fathers in the current sample.

Hospital-Acquired Infections in Intensive Care Unit Patients An Overview with Emphasis on Epidemics

Surveillance activities for the detection of nosocomial infections at the University of Virginia Hospital (Charlottesville, Virginia) and at hospitals participating in the Virginia Statewide Infection Control Program have focused on outbreaks and device-related infections which are potentially preventable. Eleven outbreaks of nosocomial infections were identified at the University of Virginia Hospital between January 1, 1978 and December 31, 1982 (9.8 outbreaks/100,000 admissions). Ten of the 11 were centered in critical care units. The 269 patients involved in the epidemics represented 0.2% of all hospital admissions and 3.7% of all patients who developed nosocomial infections. Eight of the 11 outbreaks involved infection of the bloodstream, and the 90 patients who developed a bloodstream infection as part of an epidemic represented 8% of all patients with nosocomial bloodstream infections identified during the five-year study period. The reservoir of the 11 outbreaks involved devices (5), contaminated cocaine (1), probable blood products (1), other patients (3), and nursing personnel (1). Forty-one percent of all nosocomial bloodstream infections and 41% of all nosocomial pneumonias occurred in intensive care units (ICUs).

In 38 hospitals in the state of Virginia with ICUs and practitioners who voluntarily reported surveillance data between June 1,1980 and May 31,1982, there were 264,757 patients admitted and a crude infection rate of 3%. Of note is that 1,867 of the 7,407 nosocomial infections (25%) occurred in the ICU patients. Several factors point to a compelling argument that the highest priority in infection control resources be assigned to the prevention and control of ICU infections: ICU patients often have serious device-related infections and may be identified as high risk prior to infection. Furthermore, they are at risk of being infected as part of a major outbreak. Such characteristics define a population of hospitalized patients, many of whose infections are preventable.

NMR investigation of ferricytochrome c unfolding: detection of an equilibrium unfolding intermediate and residual structure in the denatured state

Horse ferricytochrome c (cyt c) undergoes exchange of one of its axial heme ligands (Met-80) for one or more non-native ligands under denaturing conditions. We have used (1)H NMR spectroscopy to detect two conformations of paramagnetic cyt c with non-native heme ligation through a range of urea concentrations. One non-native form is an equilibrium unfolding intermediate observed under partially denaturing conditions and is attributed to replacement of Met-80 with one or more Lys side chains. The second non-native form, in which the native Met ligand is replaced by a His, is observed under strongly denaturing conditions. Thermodynamic analysis of these data indicates a relatively small DeltaG (17 kJ/mol) for the transition from native to the Lys-ligated intermediate and a significantly larger DeltaG (47 kJ/mol) for the transition from native to the His-ligated species. Although CD and fluorescence data indicate that the equilibrium unfolding of cyt c is a two-state process, these NMR results implicate an intermediate with His-Lys ligation.

Discordance of prolactin gene transcription, mRNA storage, and hormone release in individual mammotropes

The mammotrope has traditionally been a favored model for studies of hormonal gene expression, biosynthesis, and release. However, the primary site(s) at which these processes are coordinated and integrated remains to be established. Because there is considerable indirect evidence to suggest that the rate of prolactin (PRL) secretion is dictated, in large part, at the level of transcription, the relative contribution of other putative regulatory foci has received less attention. The purpose of the present study was to test the primacy of transcriptional regulation at the single-cell level. To this end, we quantified within individual mammotropes the relationship between PRL gene transcription, mRNA storage, and hormone release. This was accomplished by the combined application of "real-time" measurement of gene expression, in situ hybridization cytochemistry, and reverse hemolytic plaque assay, respectively. Our results demonstrate a quantitative dissociation among these variables, suggesting that control mechanisms besides transcription play a primary role in integrating and coordinating flow through the PRL secretory pathway.

Effect of premature myocardial infarction in men on the eating habits of spouses and offspring

OBJECTIVE

To investigate whether family members comply with a healthier diet after the father has had a myocardial infarction.

DESIGN

Cohort study with administration of a dietary history questionnaire.

SETTING

Outpatient lipid research clinic, Cincinnati, Ohio.

SUBJECTS

Male subjects (referred to as father) who had had myocardial infarction before age 56 years were recruited along with their spouse and at least one offspring (myocardial infarction [MI] group; n = 136). Control families (comparison group; n = 237) were also recruited.

STATISTICAL ANALYSES

The t test, analysis of covariance, analysis of variance, least-squares means, chi 2, and Kruskal-Wallis.

RESULTS

Significant differences in dietary intake were found for percentage of energy from total and saturated fat (P < .0001), ratio of polyunsaturated fat to saturated fat (P:S ratio) (P < .0001), and cholesterol intake (P = .001) between fathers in the MI and comparison groups. The fathers in the MI group consumed 4.5% and 2.6% less energy from total and saturated fat, respectively, and less cholesterol (135 vs 151 mg/1,000 kcal) and demonstrated a higher P:S ratio (0.76 vs 0.62) than the fathers in the comparison group. Spouses in the MI group consumed less total energy (P = .02) and less energy from fat and saturated fat than spouses in the comparison group (P = .04 and P = .004, respectively). When spouses were grouped by time since the father's myocardial infarction, no differences were found in energy from saturated fat intake between the comparison population and those spouses 3 years or more after the myocardial infarction. The diet of the offspring in the MI group closely resembled that of the offspring in the comparison group.

CONCLUSIONS/APPLICATIONS

Fathers who had experienced a myocardial infarction complied with a diet lower in fat and cholesterol than did fathers in a control comparison group. Spouses only complied with an improved diet for an initial period after the cardiac event. The cardiac event demonstrated little to no effect on the diet of the offspring. Offspring who have a high risk for cardiovascular disease, as well as the parents, need to be educated about the importance of establishing and maintaining a proper dietary regimen.

The new food label, type of fat, and consumer choice. A pilot study

OBJECTIVES

To determine how frequently lay consumers evaluate both the front label of a product package and other nutritional information on the back label of the package; whether the nutritional descriptors on the front label that concern fat affect consumer choice; to what degree information on the back label redirects this choice; and how well consumers understand the percent daily value on the new food label.

DESIGN

Preliminary cross-sectional survey.

SETTING

General community and university setting.

PARTICIPANTS

Volunteer sample of 200 men and women.

METHODS/RESULTS

Participants were first asked to choose between two fabricated cookie packages, one with a "low fat" and the other with a "no saturated fat" front label. Eighty-four percent of participants made their product choice without turning the package to view the back label. Thirty-six percent chose the product with the low fat front label, while 64% chose the product with the no saturated fat front label. In contrast, when respondents were subsequently presented with two cake products that contained no front-label descriptors (which resulted in 100% of subjects turning the package to view the back label), 53% chose the product with a label indicating 6 g of total fat (none saturated), while 47% chose the product with a label indicating 4 g of total fat (all saturated). Thirty-two of the 94 respondents who chose the no saturated fat cookie (only viewing the front label and giving fat content as the reason for their choice) chose a cake product in which the fat was all saturated, based on back-label nutrition information. Finally, 56% of participants could not accurately use the new percent daily value component to calculate saturated fat content.

CONCLUSIONS

The data from this pilot study suggest that consumers make product choices based on only viewing the front-label information; health claims on the front label that are related to fat do affect product choice; a choice made based on the information on the front label is potentially altered once the back label is viewed; and approximately one half of our population could not clearly understand the percent daily value. We conclude that current consumer choice may be overly influenced by industry-directed claims placed on the front of a product package.

Efficacy of psyllium in reducing serum cholesterol levels in hypercholesterolemic patients on high- or low-fat diets

OBJECTIVES

To determine the efficacy of psyllium in reducing serum cholesterol levels in patients on high- or low-fat diets.

DESIGN

Double-blind, placebo-controlled, 16-week parallel trial. The study included an 8-week baseline period and an 8-week treatment period.

PATIENTS

Healthy men and women, 21 to 70 years old, with primary hypercholesterolemia (total serum cholesterol > or = 5.7 mmol/L [220 mg/dL]). Thirty-seven participants followed a high-fat diet and 81 participants followed a low-fat diet.

INTERVENTION

Participants were randomly assigned to either psyllium, 5.1 g twice a day, or placebo.

MEASUREMENTS

Fasting lipid and apolipoprotein concentrations, including direct low-density lipoprotein (LDL) cholesterol quantification; nutritional analyses of 4 days of 7-day food records to monitor dietary compliance; and physical examinations, clinical chemistry and hematologic studies, and urinalysis to assess treatment safety.

MAIN RESULTS

Psyllium recipients in both the high- and low-fat diet groups showed small but significant decreases (P < 0.05) in total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Total cholesterol and LDL cholesterol levels decreased 5.8% and 7.2%, respectively, in psyllium recipients on high-fat diets and 4.2% and 6.4%, respectively, in psyllium recipients on low-fat diets. No significant difference was seen in LDL cholesterol response when psyllium recipients on low- and high-fat diets were compared (P > 0.2). No significant reductions in lipid levels were observed in placebo recipients. Based on the National Cholesterol Education Program LDL cholesterol classification system, 39% of the psyllium recipients improved in LDL cholesterol classification (P < 0.0001) compared with 20.3% of placebo recipients (P > 0.2).

CONCLUSIONS

Psyllium produces a modest but significant improvement in total cholesterol and LDL cholesterol levels in persons on either low-fat or high-fat diets. Psyllium, when added to a prescribed low-fat diet, may obviate the need for typical lipid-lowering medications or may prove to be a valuable adjunct to other treatments in patients with moderately elevated LDL cholesterol levels.

What if the health-care worker is the one infected with HIV or HBV?

1. The recent limited number of reports of HBV transmission from HCWs to patients may reflect the adoption of universal precautions and increased use of HBV vaccine. 2. Since nurses rarely perform the types of exposure-prone procedures described by the CDC, a nurse would not likely be associated with transmission of HIV to a patient, and HBV transmission most likely would not occur. 3. Agencies employing HCWs who perform exposure-prone procedures should establish expert review panels.

Intestinal lymph lipoproteins in rats fed diets enriched in specific fatty acids

Four groups of rats were fed test diets with fats providing 75% of fatty acids as palmitate, stearate, oleate or linoleate. Absorption of radiolabeled cholesterol and the specific triglyceride into intestinal lymph lipoproteins and the lipid and protein content and composition of intestinal lymph were compared. Cholesterol and triglyceride absorptions were correlated significantly and were less with the saturated fatty acid diets. The fatty acid patterns of triglyceride-rich lymph lipoproteins mirrored the diet. Exogenous cholesterol was recovered primarily in chylomicrons, except with linoleate. In contrast, radiolabeled saturated fatty acids were recovered primarily in very low density lipoproteins and unsaturated fatty acids were recovered in chylomicrons. Lymph chylomicron size and lipid content were greater with unsaturated fat diets. Triglyceride-rich intestinal lipoproteins of rats fed saturated fats were polygonal by electron microscopy, related to the cooling of lymph samples below body temperature. A-I apolipoproteins were increased in relation to C apoproteins as lipid absorption was greater. Plasma triglycerides in all groups increased compared to rats fed the stock diet. A diet enriched in one specific fatty acid has its unique effects on lymph lipoprotein formation presumably affecting some intestinal subcellular mechanisms. Diet-induced changes in plasma lipids and lipoproteins are not directly related to these as yet unknown mechanisms.

Dietary saturated fatty acid content affects lymph lipoproteins: studies in the rat

We examined effects on intestinal absorption of cholesterol and triglycerides and intestinal lipoprotein formation by feeding rats diets in which saturated fatty acids (palmitic plus stearic) comprised 78%, 68%, 48%, or 38% of triglyceride fatty acids. Absorption into lymph of radiolabeled cholesterol was proportional to triglyceride absorption. The rates of absorption of these lipids were related inversely to the % saturated fatty acids fed. The distribution of newly absorbed cholesterol and triglyceride into intestinal lipoproteins differed. With increasing cholesterol absorption more was recovered in very low density lipoproteins in contrast to the appearance preferentially in chylomicrons of larger quantities of fatty acid. Lymph lipid content did not reflect a consistent pattern in relation to the experimental diet fed. The fatty acid composition of triglyceride-rich lymph lipoproteins resembled the diet closely. One-quarter of the intestinal lymph particles from rats fed the highly saturated diets was flattened and polygonal as judged by electron microscopy if cooled to room temperature; whereas with the same diets, particles collected and isolated at 37 degrees C were round. Proportions of A-I and C apolipoproteins in triglyceride-rich intestinal particles varied inversely; apoA-I increased as fat/cholesterol absorption was greater. Diet-induced alterations in plasma lipoproteins and increased circulating triglycerides in this study in rats were unrelated to the variations in intestinal absorption or lymph lipoprotein formation.

Effects of tristearin, triolein and safflower oil diets on cholesterol balance in rats

Diets containing relatively homogeneous triglycerides composed of 18-carbon chain saturated, monounsaturated or polyunsaturated fatty acids were fed to rats. Cholesterol absorption and turnover were studied. Cholesterol absorption was significantly less in rats fed tristearin than in animals fed triolein or safflower oil. Cholesterol removal from plasma was fastest in rats fed tristearin and slowest with safflower oil and triolein. Plasma cholesterol levels were lowest with tristearin and highest with safflower oil. Increased cholesterol in high density lipoproteins was observed with tristearin and triolein. Lymph and hepatic cholesterol, and lymph triglycerides were highest with safflower oil, suggesting endogenous mobilization. Cholesterol production was least with triolein. Sterol synthesis was greatest with tristearin, perhaps attributable to decreased negative feedback analogous to effects of cholestyramine. Differences in lipoprotein composition observed with the various diets are important since effects on particle size and shape may influence removal mechanisms. The mechanisms underlying the different effects of dietary triglycerides on sterol absorption and metabolism remain to be elucidated.

Effects of diets of homogeneous saturated triglycerides on cholesterol balance in rats

The effects of a diet of 10% homogeneous triglycerides of 12 to 18-carbon chain saturated fatty acids on cholesterol absorption and turnover were studied in rats. Cholesterol absorption was successively significantly less in rats fed tristearin than in groups fed tripalmitin, trimyristin and trilaurin. Lesser fatty acid absorption may explain the differences in part, since cholesterol absorption was significantly correlated with fat absorption. Cholesterol removal from plasma was fastest in rats fed tristearin. Plasma cholesterol levels were increased with the trilaurin diet although the rate of cholesterol accumulation in lymph after gavage was slower with trilaurin. Lymph triglycerides were highest with trilaurin and trimyristin diets perhaps indicating endogenous mobilization of triglyceride for lipoprotein formation. Lymph triglycerides were, however, decreased with tristearin. Sterol turnover (production, absorption plus synthesis) was increased with tristearin or trilaurin by kinetic or balance methods.