Mental Health Service Use, Barriers, and Service Preferences During COVID-19 among Low-Income Housing and Market-Rate Housing Residents of Harlem in New York City

This study examined the differences in mental health service use, barriers, and service preferences among 393 low-income housing (LIH) and market-rate housing (MRH) Harlem residents in New York City. One-third (34.6%) endorsed the need for professional support for psychological issues, 27.2% and 15.8% reported using counseling services and psychotropic medication, with no differences between housing types. LIH residents (21.6-38.8%) reported significantly higher use of all types of mental health resources (e.g., websites, anonymous hotlines, self-help tools) compared with MRH residents (16.1-26.4%). Eighty-six percent reported barriers to mental health access, with LIH residents reporting more than double the barriers. Particularly, LIH residents reported greater difficulty getting time off work (34.1% vs. 14%), lack of health insurance (18.7% vs. 9.8%), lack of trust in mental health providers (14.6% vs. 4.7%), and stigma (12.2% vs. 5.1%) compared with MRH residents. Residents most preferred places of services were health clinics and houses of worship; provided by healthcare and mental health providers; and services delivered in-person and phone-based counseling. In contrast, residents least preferred getting support at mental health clinics; from family/friends; and by the Internet. No differences were found between service preferences by housing type. LIH residents reported higher use of mental health services and resources, but they face significantly more barriers to mental health care, suggesting a need to address specific barriers. Preferences for mental health services suggest a need for expanding mental health services to different settings given the low preference for services to be delivered at mental health clinics.

Mental Health Concerns During COVID-19: An Observational Study Among a Predominantly Black Community in New York City

PURPOSE

This study examined the prevalence of mental health concerns and its association with COVID-19, selected social determinants of health, and psychosocial risk factors in a predominantly racial/ethnic minoritized neighborhood in New York City.

METHODS

Adult Harlem residents (N = 393) completed an online cross-sectional survey from April to September 2021. The Patient Health Questionnaire (PHQ-4) and the Post-Traumatic Stress Disorder (PC-PTSD) were used to evaluate mental health concerns. Poisson regression with robust variance quantified the associations of interests via prevalence ratios (PR) and 95% confidence intervals (CI).

RESULTS

Two-thirds (66.4%) of the residents reported experiencing mental health concerns, including PTSD (25.7%), depression (41.2%), and anxiety (48.1%). Residents with low-income housing status (PR = 1.16; 95% CI 1.01, 1.34), alcohol misuse (PR = 1.68; 95% CI 1.40, 2.01), food insecurity (PR = 1.23; 95% CI 1.07, 1.42), exposure to interpersonal violence (PR = 1.33; 95% CI 1.08, 2.65), and experience of discrimination (PR = 1.53, 95% CI 1.23-1.92) were more likely to report mental health concerns. Better community perception of the police (PR = 0.97, 95% CI 0.95, 0.99) was associated with fewer mental health concerns. No associations were observed for employment insecurity, housing insecurity, or household COVID-19 positivity with mental health concerns.

CONCLUSIONS

This study showed a high prevalence of mental health concerns in a low-income racial/ethnic minoritized community, where COVID-19 and social risk factors compounded these concerns. Harlem residents face mental health risks including increased financial precarity, interpersonal violence, and discrimination exposure. Interventions are needed to address these concurrent mental health and psychosocial risk factors, particularly in racial/ethnic minoritized residents.

Substance Use Patterns and Their Association with Depression and Social Factors During COVID-19 Among Harlem Residents in New York City

This study aimed to identify the prevalence of substance use before and during COVID-19; and examined its association with depression and social factors among 437 residents from the neighborhood of Harlem in Northern Manhattan, New York City. Over a third of respondents reported using any substance before COVID-19, and initiating/increasing substance use during COVID-19. The most common substances used before COVID-19 and initiated/increased during COVID-19 were smoking (20.8% vs. 18.3%), marijuana (18.8% vs. 15.3%), and vaping (14.2% and 11.4%). The percentages of any hard drug use were 7.3% and 3.4%, respectively. After adjustment, residents with mild (Prevalence Ratio [PR] = 2.86, 95% CI 1.65, 4.92) and moderate (PR = 3.21, 95% CI 1.86, 5.56) symptoms of depression, and housing insecurity (PR = 1.47, 95% CI 1.12, 1.91) had at least a 47% greater probability of initiating and/or increasing substance use. Conversely, respondents with employment insecurity (PR = 0.71, 95% CI 0.57, 0.88) were 29% less likely to report such patterns. No association was found between substance use initiation and/or increase and food insecurity. High prevalence of substance use during COVID-19 may lead residents to turn to substance use as a coping mechanism for psychosocial stressors. Thus, it is essential to provide accessible and culturally sensitive mental health and substance use services.

Passive acoustic monitoring using smartphones reveals an alarming gibbon decline in a protected area in the central Annamite Mountains, Vietnam

Monitoring populations is critical for understanding how they respond to anthropogenic disturbance and for management of protected areas. The use of passive acoustic monitoring can improve monitoring efforts as it allows for collection of data on vocal animals at spatial and temporal scales that are difficult using only human observers. In this study, we used a multiseason occupancy model to monitor occurrence, apparent extinction, and colonization probabilities of a northern yellow-cheeked gibbon, Nomascus annamensis population with acoustic data collected from mobile smartphones in Dakrong Nature Reserve, Vietnam. Forty-five sites were randomly selected for repeated surveys in 2019 and 2022. At each site, a mobile smartphone was attached to a tree and recorded sounds for 4.2 days and 3.89 days on average, in 2019 and 2022, respectively. We manually annotated spectrograms for the presence of gibbon calls, and we detected gibbons at 24 and 12 recording posts in 2019 and 2022, respectively. Estimated local apparent extinction from occupancy models was high with 67% of occupied sites in 2019 becoming unoccupied in 2022. Apparent colonization was low with ~25% of unoccupied sites in 2019 becoming occupied in 2022. As a result, the apparent occurrence probability declined from 0.58 in 2019 to 0.30 in 2022. If the absence of calls indicates that cells are unoccupied this would mean an alarming decline of the gibbon population in the nature reserve. We suggest that in the areas with high hunting pressure, monitoring intervals should be shortened to at least yearly. In addition, urgent actions, such as patrolling, or gun confiscation, should be implemented to conserve the gibbon populations in Dakrong Nature Reserve and other protected areas with the same management context.

Alcohol Misuse, Binge Drinking, and their Associations with Psychosocial Factors during COVID-19 among Harlem Residents in New York City

This study examined alcohol misuse and binge drinking prevalence among Harlem residents, in New York City, and their associations with psycho-social factors such as substance use, depression symptom severity, and perception of community policing during COVID-19. An online cross-sectional study was conducted among 398 adult residents between April and September 2021. Participants with a score of at least 3 for females or at least 4 for males out of 12 on the Alcohol Use Disorders Identification Test were considered to have alcohol misuse. Binge drinking was defined as self-reporting having six or more drinks on one occasion. Modified Poisson regression models were used to examine associations. Results showed that 42.7% used alcohol before COVID-19, 69.1% used it during COVID-19, with 39% initiating or increasing alcohol use during COVID-19. Alcohol misuse and binge drinking prevalence during COVID-19 were 52.3% and 57.0%, respectively. Higher severity of depression symptomatology, history of drug use and smoking cigarettes, and experiencing housing insecurity were positively associated with both alcohol misuse and binge drinking. Lower satisfaction with community policing was only associated with alcohol misuse, while no significant associations were found between employment insecurity and food insecurity with alcohol misuse or binge drinking. The findings suggest that Harlem residents may have resorted to alcohol use as a coping mechanism to deal with the impacts of depression and social stressors during COVID-19. To mitigate alcohol misuse, improving access to mental health and substance use disorder services, and addressing public safety through improving relations with police could be beneficial.

Universal health insurance program for people living with HIV in Vietnam: an ambitious approach

International funding for HIV treatment and prevention drastically decreased when Vietnam transitioned from a low-income to a lower-middle-income country in 2010. Vietnam has attempted to fill the funding gap from both public and private sources to cover antiretroviral therapy (ART) treatment. However, policies that enable social health insurance to pay for ART treatment-related costs often exclude people living with HIV (PLHIV) without appropriate government documents from accessing the health insurance-funded ART program. The Vietnamese Ministry of Health might consider alternative approaches, such as implementing a universal health insurance program among PLHIV regardless of residency or documentation status, to expand coverage of ART treatment to achieve the UNAIDS 95-95-95 targets by 2030. This expanded universal care will increase the uptake of ART treatment among uninsured PLHIV as well as increase coverage of health insurance-funded ART among insured PLHIV. Most importantly, the proposed insurance scheme could significantly improve population health by reducing HIV new infections and providing economic benefits of ART treatment through increased productivity and decreased healthcare costs.

Monitoring occurrence, extinction, and colonization probabilities for gibbon populations

All gibbon species (Family: Hylobatidae) are considered threatened with extinction and recognized on the International Union for Conservation of Nature Red List of Threatened Species. Because gibbons are one of the most threatened families of primates, monitoring their status is now critically important. Long-term monitoring programs applying occupancy approaches, in addition to assessing occurrence probability, improves understanding of other population parameters such as site extinction or colonization probabilities, which elucidate temporal and spatial changes and are therefore important for guiding conservation efforts. In this study, we used multiple season occupancy models to monitor occurrence, extinction, and colonization probabilities for northern yellow-cheeked crested gibbon Nomascus annamensis in three adjacent protected areas in the Central Annamites mountain range, Vietnam. We collected data at 30 listening posts in 2012, 2014, and 2016 using the auditory point count method. Occurrence probabilities were highest in 2012 (0.74, confidence interval [CI]: 0.56-0.87) but slightly lower in 2014 (0.66, CI: 0.51-0.79) and 2016 (0.67, CI: 0.49-0.81). Extinction probabilities during the 2012-2014 and 2014-2016 intervals were 0.26 (0.14-0.44) and 0.25 (0.12-0.44), respectively. Colonization probabilities during 2012-2014 were 0.44 (0.19-0.73) and between 2014 and 2016 was 0.51 (0.26-0.75). Although local site extinctions have occurred, high recolonization probability helped to replenish the unoccupied sites and kept the occurrence probability stable. Long-term monitoring programs which use occurrence probability alone might not fully reveal the true dynamics of gibbon populations. We strongly recommend including multiple season occupancy models to monitor occurrence, extinction, and colonization probabilities in long-term gibbon monitoring programs.

An assessment of the impact of climate change on the distribution of the grey-shanked douc Pygathrix cinerea using an ecological niche model

Climate change can have many negative impacts on wildlife species, and species with narrow distributions are more likely to be significantly affected. In this study, we used ecological niche modeling for species (MaxEnt software) as well as species occurrence data and climate variables to assess the impacts of climate change on the distribution of the grey-shanked douc-an endemic and rare primate species of Vietnam. We used climate data at the current time and two future times (2050 and 2070). Climate data were generated for two climate scenarios RCP4.5 and RCP8.5, together with three climate models ACCESS1-0, GFDL-CM3, and MPI-ESM-LR. We predicted that the distribution of the grey-shanked douc would be sharply reduced by the effects of climate change. The species' suitable distribution range in the future tended to shift toward the center of their current range and to higher mountainous areas. A larger suitable area, in particular highly suitable areas to the north and west of its current potential distribution range, would become less suitable or even unsuitable in 2050 and 2070. Kon Cha Rang Nature Reserve and Kon Ka Kinh National Park should be given priority in conservation of the grey-shanked douc because they now support important populations of the species and are in the highly suitable area remaining for the species in the future. The establishment of a new protected area for grey-shanked douc conservation should be considered in Kon Plong District, Kom Tum Province, which will be the center of the species distribution range.

A distance sampling approach to estimate density and abundance of gibbon groups

All 18 species of gibbons are considered threatened with extinction and listed on the IUCN Red List of Threatened Species. Because gibbons (Hylobatidae) are one of the most threatened primate families, a great need exists to determine and monitor their status effectively. To meet this need, we employed distance sampling methods to estimate the density and number of gibbon groups. We focused on southern yellow-cheeked crested gibbon in the Nam Cat Tien sector of Cat Tien National Park, Vietnam, from July to October, 2016. We used an auditory point count method at 48 listening posts to detect gibbon groups. We estimated our detection probability of calling groups of gibbons within 1,200 m of a listening post was 0.63 (95% CI: 0.54-0.74). In addition, we estimated the daily calling probability of a gibbon group to be 0.46 (95% CI: 0.33-0.59) and interpreted this as the probability that a group was available to be detected. We adjusted our group density and abundance estimates by both detection and availability probabilities. Ultimately we estimated 325 (95% CI: 232-455) gibbon groups in the Nam Cat Tien sector. Our results suggest that Cat Tien National Park contains one of the largest populations of southern yellow-cheeked crested gibbon in Vietnam. Our methods are one way of avoiding underestimation of gibbon group density and abundance by incorporating uncertainty in gibbon group availability and detection.

Effect of organoclay on morphology and properties of linear low density polyethylene and Vietnamese cassava starch biobased blend

Linear low density polyethylene (LLDPE)/thermal plastic starch (TPS) blend was studied to prepare the biobased nanocomposite material using organoclay nanofil15 (N15) modified by alkilammonium as the reinforced phase. The LLDPE/TPS blend and its nanocomposites were elaborated by melt mixing method at 160 °C for 7 min. And the compounded sample was filmed by blowing method at three different zones of temperature profile which are 160-170-165 °C. The good dispersion of clay in the polymer blend matrix is showed by X-ray diffraction (XRD) and transmission electronic microscopy (TEM), and a semi-exfoliated structure was obtained. The thermal and mechanical properties of materials are enhanced when N15 is added to the mixture. The effect of N15 on morphology and particles size of TPS phase is also investigated. The biodegradation test shows that more than 60% in weight of LLDPE/TPS film is degraded into CO2, H2O, methane and biomass after 5 months in compost soil.

Reduced turn-around time for Mycobacterium tuberculosis drug susceptibility testing with a proportional agar microplate assay

Multidrug-resistant tuberculosis is a major issue worldwide; however, accessibility to drug susceptibility testing (DST) is still limited in developing countries, owing to high costs and complexity. We developed a proportion method on 12-well microplates for DST. The assay reduced the time to results to <12 days and <10 days when bacterial growth was checked with the naked eye or a microscope, respectively. Comparison with the Canetti-Grosset method showed that the results of the two assays almost overlapped (kappa index 0.98 (95% CI 0.91-1.00) for isoniazid, rifampicin, streptomycin; and kappa index 0.92 (95% CI 0.85-0.99) for ethambutol). The sequencing of genes involved in drug resistance showed similar level of phenotype-genotype agreement between techniques. Finally, measurement of the MICs of rifampicin and ethambutol suggests that the currently used critical ethambutol concentration should be revised, and that the current molecular drug susceptibility tests for rifampicin need to be re-evaluated, as in vitro rifampicin-sensitive isolates could harbour drug resistance-associated mutation(s).

Abstract P5-08-02: New target in the resistant mechanism to trastuzumab

Her2 positive (Her2+) breast cancer (BC) accounts for 18-20% of all breast cancer subtypes and is associated with high risk of death. Trastuzumab, the first Food and Drug Administration-approved targeted therapy for BC, represents a key milestone in the personalized treatment of Her2+ metastatic disease (Her2+ MBC). However, the median duration of response is less than a year, due to either primary or acquired resistance to the therapy. In addition, there is currently no conclusive biomarker for the response of patients to trastuzumab. Therefore, understanding the development of resistance to trastuzumab is of our interest. Recent studies have proposed various potential mechanisms leading to the resistance, including p27 rapid degradation. Previously, our study and other research demonstrated that Jab1 degrades p27 in breast cancer. These findings suggest that Jab1 over-expression contributes to trastuzumab resistance by facilitating p27 degradation.

Jab1/CSN5 (c-Jun activation domain-binding protein 1) is over-expressed in 50% of primary and 90% of metastatic breast cancers, while its expression is low or absent in normal adult breast tissues. We previously identified that high expression of Jab1 is associated with shorter progression-free survival in breast cancer patients. In this study, our preliminary data showed that the knockdown of Jab1 sensitizes the breast cancer cells to trastuzumab treatment in a dose-dependent manner. Mechanistically, we found that Jab1 over-expression is significantly correlated with the activation of Akt pathway in Her2+ breast cancer cells and xenograft model. Interestingly, activated Akt, due to PTEN loss or PI3K activating mutation has been widely implicated in the potential mechanism to trastuzumab resistance. Therefore, our results suggest that targeting Jab1 overcomes the resistance to trastuzumab via interfering with PI3K/Akt pathway.

In general, our study identifies Jab1 as a novel contributor to trastuzumab resistance and elucidates its potential mechanisms of actions. The successful completion of the study can potentially be translated to the clinic for the benefit of patients refractory to the therapy. Also our study suggests Jab1 expression level can be used as a predictive marker for trastuzumab treatment.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-08-02.

Effects of endophytic Fusarium oxysporum towards Radopholus similis activity in absence of banana

Four endophytic fungi (Fusarium spp.) isolated from the cortical tissue of surface-sterilised banana as well as from tomato roots were tested for their capacity of biological control towards the burrowing nematode Radopholus similis on banana. The pathogenic and parasitic capacities of endophytic fungi towards R. similis were tested in in vitro experiments. No parasitism of fungi on R. similis was observed. However, nematode activity decreased significantly in the presence of all endophytic fungi in vitro when compared to nematodes in the absence of fungi. The effects of fungi on R. similis activities in the soil were tested in the absence of plants. Nematode activities were reduced significantly by 16-30% by endophytic fungi when compared to untreated soil.

Oxidative stress as a mechanism of chronic cadmium-induced hepatotoxicity and renal toxicity and protection by antioxidants

The role of oxidative stress in chronic cadmium (Cd) toxicity and its prevention by cotreatment with antioxidants was investigated. Adult female Sprague-Dawley rats were injected sc with 5 micromol CdCl2/kg/day, 5 times a week, for up to 22 weeks. Serum alanine amino transferase and lactate dehydrogenase activities were elevated after 9 weeks of Cd administration, indicating hepatic damage. Renal toxicity, indicated by elevation in urinary lactate dehydrogenase activity and protein, was also observed around this time. Chronic Cd administration resulted in a gradual rise in hepatic as well as renal cortex glutathione levels. In spite of this, lipid peroxidation increased in both tissues, particularly during the second half of the Cd exposure period. Depletion of glutathione following buthionine sulfoximine administration at the end of Week 5, or inhibition of catalase by aminotriazole at the end of Week 7, resulted in the development of acute nephrotoxicity within 6 h. Coadministration of antioxidants, N-acetylcysteine (50-100 mg/kg, sc), or vitamin E (100-150 mg/kg, sc) with Cd, starting from the early phases of Cd exposure, controlled Cd-induced lipid peroxidation and protected the animals against hepatic as well as renal toxicity. A Japanese hepatoprotective drug, Stronger Neo-Minophagen C, containing glycyrrhizin, glycine, and cysteine, was also effective in reducing the chronic Cd nephrotoxicity. In conclusion, oxidative stress appears to play a major role in chronic Cd-induced hepatic and renal toxicity since inhibition of components of the antioxidant defense system accelerated and administration of antioxidants protected against Cd toxicity.

[Ca++ ion transport blockers as reversants of the drug resistance of malarial parasites. 1. The effect of verapamil on the resistance to chloroquine in vivo of Plasmodium berghei and in vitro of Plasmodium falciparum]

The reversing action of verapamil on the effect of chloroquine was found in in vivo experiments by using a model P. berghei resistant to chloroquine, an LNK65 isolate having a naturally lower resistance to the agent, and its polyresistant strain with the acquired resistance to chloroquine and fansidar, as well as by employing the chlorine-resistant P. falciparum isolates from the south of the Socialist Republic of Vietnam. The magnitude of this effect was related to the dose of verapamil, the frequency of administration of a combination of the agents in vivo, while that was associated to the concentration of verapamil and the level of isolate resistance to chloroquine in vitro which was the most pronounced. Taking into account the dose-dependent effect of verapamil, it can be suggested that increasing its concentration in combination with chloroquine can provide a more marked reversing action with lower chloroquine concentrations. The parameters accepted by the authors in evaluating the combined effect enable the effect of the verapamil/chloroquine concentration to be regarded as potentiation.

Screening donor blood for malaria by polymerase chain reaction

In countries where malaria is endemic, its transmission is a hazard of blood transfusion. The microscopical and immunological methods in current use for malaria diagnosis are unsatisfactory for low levels of parasitaemia in blood donations. The polymerase chain reaction (PCR) can be 100-fold more sensitive than thick blood film examination when appropriate primers are used and can detect and distinguish Plasmodium falciparum and P. vivax in a single tube. A study of 1506 blood donations in Ho Chi Minh City (3 of which were positive) suggests that PCR can provide an effective screen for P. falciparum under local conditions. Studies in a region of Viet Nam where malaria is common showed that PCR detects many more cases of low-level parasitaemia (19/30) than thick blood films (4/30).

Long-term evaluation of immune status in leprosy patients undergoing multiple drug therapy

A long-term survey of leprosy patients of all clinical types, starting at the time of diagnosis, was carried out to monitor clinical, bacteriological and immunological parameters at regular intervals during multiple drug therapy (MDT). The patients were assigned to two groups for treatment following WHO guidelines: paucibacillary (PB) and multibacillary (MB). Immunoglobulin levels, specific antibodies, skin-test responses to different soluble mycobacterial antigens (new tuberculins), and in vitro proliferative responses to mitogens and to antigens were measured during treatment, as were clinical changes, the bacterial index, and clinical improvement. No exact relations between disease activity and IgM antibody levels, both IgM immunoglobulin and specific IgM antibody to a species-specific antigen (ND-O-BSA), could be seen for MB patients. Changes in in vitro cell-mediated immunity and skin-test response seemed to be more directly related to the bacterial load and could reflect the improvement of bacteriological and clinical parameters during MDT.

[The clinical efficacy of and tolerance for lariam (mefloquine) in tropical malaria in the south of the Socialist Republic of Vietnam]

The study was performed in the area of distribution of tropical malaria resistant to 4-aminoquinolines (Vietnam) on 30 patients receiving lariam (mefloquine). The results were compared to the standard therapy with quinine and fansidar. They indicate a high efficacy of and a good tolerance to the drug tested. The use of lariam leads to a more rapid (as compared to the standard treatment) elimination of parasitemia and complete eradication of the disease relapses. The findings make it possible to recommend lariam for the prevention and treatment of tropical malaria.

[The efficacy of and tolerance for fansimef in the treatment of tropical malaria in the south of the Socialist Republic of Vietnam]

The efficacy of and tolerance to fancimef in 49 patients was compared to the efficacy of and tolerance to quinine in combination with fansidar in 33 patients with moderate P. falciparum malaria. A good tolerance to and a high efficacy of fancimef have been shown, which was manifested in rapid fever arrest, disappearance of parasitemia, absence of the disease relapses, which were observed in 2 patients on quinine combined with fansidar. The advantage of fansimef is one-time administration of the total course dose.