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Older women with HIV (WWH) confront significant biopsychosocial challenges that may be exacerbated by the COVID-19 pandemic. Between May 2020 and April 2021, following a resiliency intervention conducted as part of a randomized parent trial, 24 cisgender WWH (M = 58 years old) completed quantitative assessments and qualitative interviews exploring the impact of COVID-19 on mental health. Qualitative data were analyzed via rapid analysis. Most participants were Black (62.5%) and non-Hispanic or Latina (87.5%). Emergent themes included (1) increased anxiety and depression; (2) a loss of social connectedness; (3) fear of unknown interactions among COVID-19, HIV, and other comorbidities; and (4) the use of largely adaptive strategies to cope with these issues. Findings suggest that older WWH face significant COVID-19-related mental health challenges, compounding existing stressors. As the pandemic persists, it will be important to assess the impact of these stressors on wellbeing, identify effective coping strategies, and provide increased support to mitigate COVID-19-related mental health issues over time.Trial Registration: ClinicalTrials.gov identifier: NCT03071887.

Background Older patients with advanced chronic kidney disease often do not understand treatment options for renal replacement therapy, conservative kidney management, and advance care planning. It is unclear whether both clinicians and patients have similar perspectives on these treatments and end-of-life care. Thus, the aim of this study was to explore clinician and patient/caregiver perceptions of treatments for end-stage renal disease and advance care planning. Methods This was a qualitative interview study of nephrologists ( n  = 8), primary care physicians ( n  = 8), patients ( n  = 10, ≥ 65 years and estimated glomerular filtration rate < 20), and their caregivers ( n  = 5). Interviews were conducted until thematic saturation was reached. Transcripts were transcribed using TranscribeMe. Using Nvivo 12, we identified key themes via narrative analysis. Results We identified three key areas in which nephrologists’, primary care physicians’, and patients’ expectations and/or experiences did not align: 1) dialysis discussions; 2) dialysis decision-making; and 3) processes of advance care planning. Nephrologist felt most comfortable specifically managing renal disease whereas primary care physicians felt their primary role was to advocate for patients and lead advance care planning discussions. Patients and caregivers had many concerns about the impact of dialysis on their lives and did not fully understand advance care planning. Clinicians’ perspectives were aligned with each other but not with patient/caregivers. Conclusions Our findings highlight the differences in experiences and expectations between clinicians, patients, and their caregivers regarding treatment decisions and advance care planning. Despite clinician agreement on their responsibilities, patients and caregivers were unclear about several aspects of their care. Further research is needed to test feasible models of patient-centered education and communication to ensure that all stakeholders are informed and feel engaged.

The integration of behavioral health and primary care has received much attention in the literature. Behavioral health providers (BHPs) in integrated settings are faced with different treatment constraints than those who work in specialty mental health. The existing literature focuses on what BHPs should do in primary care settings; however, little research exists specifying what BHPs are actually doing. This study provides a glimpse into what types of interventions BHPs are using, and what types of patients they are seeing, in primary care. A chart review was conducted of patients ( N  = 180) seen by BHPs in five Veterans Affairs primary care clinics. Depression was the most common diagnosis, while less common presenting problems included substance abuse/dependence, psychosis, and bipolar disorder. Common interventions used were medical management, psycho-education, elements of cognitive-behavioral therapy (CBT), and supportive psychotherapy. Future research should examine the efficacy of brief interventions in primary care settings.

It is important to find ways to identify prevalent co-occurring health risk factors to help facilitate treatment programming. One method is to use electronic medical record (EMR) data. Funderburk et al. (J Behav Med 31:525–535, 2008 ) used such data and latent class analysis to identify three classes of individuals based on standard health screens administered in Veterans Affairs primary care clinics. The present study extended these results by examining the health-related outcomes for each of these identified classes. Follow-up data were collected from a subgroup of the original sample ( N  = 4,132). Analyses showed that class assignment predicted number of diagnoses associated with the diseases that the health screens target and number of primary care behavioral health, and emergency room encounters. The findings illustrate one way an EMR can be used to identify clusters of individuals presenting with multiple health risk factors and where the healthcare system comes in contact with them.

Non-prescribed use of stimulant medications among college students, such as Ritalin®, and Adderall®, has become a public health concern. Expectancies, which are beliefs that individuals hold regarding the consequences of engaging in a particular behavior, are known to play a prominent role in the initiation and maintenance of alcohol and drug use. This study had two aims: (1) to determine if an expectancy challenge could reduce participants' academic performance expectancies related to non-prescribed use of stimulant mediations, and (2) to determine if change in expectancies mediates consumption of the drug. Seventy-eight undergraduate students were randomized to either the expectancy challenge (EC) condition, the psychoeducation (PE) condition, or the assessment only (AO) condition. Results from two separate hierarchical linear models (HLM) indicated that there were no significant group differences between the EC and PE conditions with regards to change in expectancies (γslope = 0.19, t(43) = 1.97, p = 0.055) or consumption (γslope = 0.06, t(43) = 1.75, p = 0.09). When the two treatment conditions were combined, results from the HLM analyses found a significant effect of treatment over control for both expectancies (γ slope = -0.25, t(76) = -3.64, p < 0.001) and consumption (γslope = -0.07, t(76) = -2.07, p = 0.04). The mediation analysis indicated a non-significant relationship between the mediating variable (i.e., change in academic expectancies) and the outcome variable (change in consumption; γslope = 0.0004, t(76) = 0.098, p = 0.992), indicating that mediation was not present. Due to an inferior placebo manipulation, the EC did not produce the anticipated results. However, results from the study suggest that the didactic component of the EC and PE conditions was effective in modifying expectancies and reducing consumption.

Substance use disorders (SUDs) are prevalent, complex medical conditions that are frequently encountered in primary care, mental health, and specialty care settings. Individuals with SUDs vary considerably in clinical severity, accompanying medical sequelae, and degree of functional impairment, and often struggle with comorbid psychiatric conditions. Cognitive behavioral therapy (CBT) is an intuitive, theory-driven psychotherapeutic approach that has been shown to be effective in reducing the harm associated with substance use and increasing the chances of remission. This chapter highlights the theoretical rationale for cognitive behavioral interventions for SUD, describes how to implement CBT based on a simplified model of substance use behavior, and provides an illustrative case example of using CBT to treat SUD. As periods of relapse are common along the path to full remission and recovery from SUD, ongoing behavioral management and monitoring using cognitive behavioral approaches is likely to be helpful.

Substance use and substance use disorders (SUD), including alcohol, are a serious public health concern. SUD presentation in clinical practice is highly heterogeneous and can be challenging to treat. Potentially complicating SUD treatment is the co-occurrence of a chronic medical condition. To illustrate these complications and how to address them effectively using cognitive–behavioral interventions, this chapter is divided into six sections: (1) the prevalence, clinical presentations, and complications of having a comorbid alcohol or other substance use disorder across five common medical conditions; (2) description of cognitive and behavioral approaches to addressing alcohol and other drug use disorders in medical settings; (3) a brief overview of the empirical support for CBT approaches for alcohol and other substance use disorders; (4) implementation of CBT in addressing these clinical challenges; (5) reducing harm caused by substances when abstinence is clinically unfeasible; and (6) a case example that highlights CBT principles and techniques in practice.

Climate change causes significant alterations in precipitation and temperature regimes that are predicted to become more extreme throughout the next century. Microorganisms are important members within ecosystems, and how they respond to these changing abiotic stressors has large implications for the functioning of ecosystems, the recycling of nutrients, and the health of the aboveground plant community. Drought stress negatively impacts microbial activity, but the magnitude of this stress response may be dependent on above- and belowground interactions. This study demonstrates that beneficial associations between plants and microbes can enhance tolerance to abiotic stress. Drought stress negatively impacts microbial activity, but the magnitude of stress responses is likely dependent on a diversity of belowground interactions. Populus trichocarpa individuals and no-plant bulk soils were exposed to extended drought (∼0.03% gravimetric water content [GWC] after 12 days), rewet, and a 12-day “recovery” period to determine the effects of plant presence in mediating soil microbiome stability to water stress. Plant metabolomic analyses indicated that drought exposure increased host investment in C and N metabolic pathways (amino acids, fatty acids, phenolic glycosides) regardless of recovery. Several metabolites positively correlated with root-associated microbial alpha-diversity, but not those of soil communities. Soil bacterial community composition shifted with P. trichocarpa presence and with drought relative to irrigated controls, whereas soil fungal composition shifted only with plant presence. However, root fungal communities strongly shifted with drought, whereas root bacterial communities changed to a lesser degree. The proportion of bacterial water-stress opportunistic operational taxonomic units (OTUs) (enriched counts in drought) was high (∼11%) at the end of drying phases and maintained after rewet and recovery phases in bulk soils, but it declined over time in soils with plants present. For root fungi, opportunistic OTUs were high at the end of recovery in drought treatments (∼17% abundance), although relatively not responsive in soils, particularly planted soils (<0.5% abundance for sensitive or opportunistic). These data indicate that plants modulate soil and root-associated microbial drought responses via tight plant-microbe linkages during extreme drought scenarios, but trajectories after extreme drought vary with plant habitat and microbial functional groups. IMPORTANCE Climate change causes significant alterations in precipitation and temperature regimes that are predicted to become more extreme throughout the next century. Microorganisms are important members within ecosystems, and how they respond to these changing abiotic stressors has large implications for the functioning of ecosystems, the recycling of nutrients, and the health of the aboveground plant community. Drought stress negatively impacts microbial activity, but the magnitude of this stress response may be dependent on above- and belowground interactions. This study demonstrates that beneficial associations between plants and microbes can enhance tolerance to abiotic stress.

ABSTRACT Drought stress negatively impacts microbial activity, but the magnitude of stress responses is likely dependent on a diversity of belowground interactions. Populus trichocarpa individuals and no-plant bulk soils were exposed to extended drought (∼0.03% gravimetric water content [GWC] after 12 days), rewet, and a 12-day “recovery” period to determine the effects of plant presence in mediating soil microbiome stability to water stress. Plant metabolomic analyses indicated that drought exposure increased host investment in C and N metabolic pathways (amino acids, fatty acids, phenolic glycosides) regardless of recovery. Several metabolites positively correlated with root-associated microbial alpha-diversity, but not those of soil communities. Soil bacterial community composition shifted with P. trichocarpa presence and with drought relative to irrigated controls, whereas soil fungal composition shifted only with plant presence. However, root fungal communities strongly shifted with drought, whereas root bacterial communities changed to a lesser degree. The proportion of bacterial water-stress opportunistic operational taxonomic units (OTUs) (enriched counts in drought) was high (∼11%) at the end of drying phases and maintained after rewet and recovery phases in bulk soils, but it declined over time in soils with plants present. For root fungi, opportunistic OTUs were high at the end of recovery in drought treatments (∼17% abundance), although relatively not responsive in soils, particularly planted soils (<0.5% abundance for sensitive or opportunistic). These data indicate that plants modulate soil and root-associated microbial drought responses via tight plant-microbe linkages during extreme drought scenarios, but trajectories after extreme drought vary with plant habitat and microbial functional groups. IMPORTANCE Climate change causes significant alterations in precipitation and temperature regimes that are predicted to become more extreme throughout the next century. Microorganisms are important members within ecosystems, and how they respond to these changing abiotic stressors has large implications for the functioning of ecosystems, the recycling of nutrients, and the health of the aboveground plant community. Drought stress negatively impacts microbial activity, but the magnitude of this stress response may be dependent on above- and belowground interactions. This study demonstrates that beneficial associations between plants and microbes can enhance tolerance to abiotic stress.

In parts of Canada including Newfoundland and Labrador and among Aboriginal peoples, infants still consume evaporated milk (EM) formulas for cultural and economic reasons. At 3 and 6 months, full-term infants fed EM (n= 30) received low intakes of iron, thiamine, selenium and had higher weight velocity than breastfed (BF, n= 29) infants. EM infants had greater anemia, lowered transketolase activity (thiamine) and lowered glutathione peroxidase (selenium) activity (p<0.05). To determine the later effect of early feeding deficit on nutritional status, we examined these same infants at 18 months of age. At that time, there were no differences in dietary intakes of energy, protein, zinc, copper, selenium and iron, nor in plasma levels of zinc, copper, vitamin C, nor in red blood cell activity levels of glutathione reductase (riboflavin), transketolase, glutathione peroxidase, nor in Superoxide dismutase. However, EM infants weighed more and were more likely to visit a physician, have anemia, and have iron depletion than were BF infants. We conclude that infants consuming evaporated milk formulas should receive iron supplements throughout infancy. Dans plusieurs régions du Canada y compris Terre-Neuve et le Labrador, et parmi les peuples autochtones, les bébés sont toujours nourris de lait évaporé pour des raisons culturelles et économiques. À trois mois et à six mois, les bébés nés à terme, nourris de lait évaporé (n=30) recevaient de moindres quantités de fer, de thiamine, de sélénium et pesaient plus que ceux nourris de lait maternel (n=29). Les bébés nourris de lait évaporé souffraient plus souvent d'anémie, d'un niveau d'activité réduit de transcétolase (thiamine) et d'un niveau d'activité réduit de glutathion peroxydase (sélénium) (p<0,05). Afin de connaître les répercussions à long terme d'une alimentation déficiente chez le nourrisson, nous avons examiné les mêmes enfants à l'âge de 18 mois. À cet âge, il n'y avait aucune différence dans la consommation d'énergie, de protéine, de zinc, de cuivre, de sélénium et de fer, ni dans les niveaux de zinc, de cuivre, de vitamine C dans le plasma, ni dans les niveaux d'activité de glutathion réductase (riboflavine), de transcétolase, de glutathion, ni de Superoxide dismutase dans les cellules rouges du sang. Cependant, les bébés nourris au lait évaporé pesaient plus et avaient plus souvent besoin de soins médicaux, souffraient d'anémie et avaient des niveaux plus bas de fer en comparaison avec des enfants nourris de lait maternel. Nous en concluons que les bébés nourris au lait évaporé devraient recevoir des suppléments de fer pendant leur petite enfance.