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1.  Collaboration With Behavioral Health Care Facilities to Implement Systemwide Tobacco Control Policies — California, 2012 
The California Tobacco Control Program (CTCP) administered 4 regional trainings in 2012 to staffers at CTCP-funded projects, tobacco control coalitions, several county departments of mental health and alcohol and drug, and administrators and providers from behavioral health care facilities. These trainings focused on the special tobacco use cessation needs and opportunities for cessation among persons with mental illness or substance abuse disorders, and they provided information about cessation and smoke-free policies. CTCP surveyed county and private behavioral health care programs to assess their readiness for adopting tobacco control strategies at treatment facilities. Between baseline and follow-up we found a decrease in the proportion of organizations at the precontemplation or contemplation stages of change and twice as many organizations at the action and maintenance stages of change. Significant obstacles remain to implementing policy: many agencies have concerns about going tobacco-free. But significant progress has been made, as evidenced by new policies and a growing number of tobacco-free coalitions consisting of public health agencies, behavioral health care agencies, and local hospitals.
doi:10.5888/pcd12.140350
PMCID: PMC4318685  PMID: 25654218
2.  An expanded opportunity to provide tobacco cessation services in primary care 
The Patient Protection and Affordable Care Act, and Centers for Medicare and Medicaid Services (CMS) decision on tobacco cessation counseling support the need for expanded cessation coverage. Primary care practices receiving CMS payments will soon be mandated to offer these services. This commentary discusses the salience of tobacco cessation policy in terms of opportunities for primary care, and anticipated issues in meeting healthcare reform requirements. Comments build upon recent federal policy and suggest areas to which primary care practices will need to attend when operationalizing tobacco cessation policies. Research supports efficacious tobacco cessation interventions delivered in a primary care context. To effectively implement tobacco cessation in primary care, practices will need to address coding and payment issues, define service offerings, identify reporting requirements, align with the medical home model, and increase provider buy-in.
doi:10.1007/s13142-010-0010-2
PMCID: PMC3717686  PMID: 24073030
Tobacco cessation; Prevention; Healthcare reform; Insurance benefits; Healthcare policy
3.  Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well-being of caregivers 
Bipolar disorders  2009;11(8):876-884.
Objectives
Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers’ health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year.
Methods
Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers’ perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36-item Short-Form Health Survey. Caregivers’ depression was evaluated using the Center for Epidemiological Studies of Depression Scale.
Results
Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one-year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers.
Conclusions
Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well-being. Treatments that focus on the health of caregivers must be developed and tested.
doi:10.1111/j.1399-5618.2009.00765.x
PMCID: PMC2796426  PMID: 19922556
bipolar disorders; caregivers; mental disorders; mood disorders; suicide
4.  Nutritional Knowledge and Eating Behaviors of Female, Collegiate Swimmers 
Background
Female athletes often have inadequate diets due to lack of nutritional knowledge and nutritional misconceptions. Poor nutrition may lead to an increased chance of developing the Female Athlete Triad, a trio of low energy availability, menstrual dysfunction, and low bone mass. Physical therapists, as part of a healthcare team, must be prepared to address nutritional issues, recognize signs and symptoms of the female athlete triad, and make the appropriate intervention or referral.
Objectives
The purpose of this study was to determine the nutritional knowledge of female collegiate swimmers and how effectively they apply their nutritional knowledge to their everyday eating habits.
Methods
Eighty-five female collegiate swimmers from six Michigan universities completed a nutritional knowledge questionnaire and a 24-hour food recall survey. Demographic, nutritional, and statistical data were analyzed.
Results
The mean score on nutritional knowledge test was 54.53/76 (71.75% correct). Mean total caloric intake of swimmers was 3229.10 calories per day. Ninety-five point nine percent did not meet the recommended dietary allowance (RDA) for all three macronutrients. No difference in total mean survey score existed between the three collegiate divisions.
Conclusion
This study suggests that athletes lack knowledge of nutrition, healthy food choices, components of a well-balanced diet, and the implications of nutrition on performance.
PMCID: PMC2953338  PMID: 21509109
nutrition; swimming; female athlete triad
5.  Genomic-Based High Throughput Screening Identifies Small Molecules That Differentially Inhibit the Antiviral and Immunomodulatory Effects of IFN-α 
Molecular Medicine  2008;14(7-8):374-382.
Multiple lines of evidence suggest that inhibition of Type I Interferons, including IFN-α, may provide a therapeutic benefit for autoimmune diseases. Using a chemical genomics approach integrated with cellular and in vivo assays, we screened a small compound library to identify modulators of IFN-α biological effects. A genomic fingerprint was developed from both ex vivo patient genomic information and in vitro gene modulation from IFN-α cell-based stimulation. A high throughput genomic-based screen then was applied to prioritize 268 small molecule inhibitors targeting 41 different intracellular signaling pathways. Active compounds were profiled further for their ability to inhibit the activation and differentiation of human monocytes using disease-related stimuli. Inhibitors targeting NF-κB or Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) signaling emerged as “dissociated inhibitors” because they did not modulate IFN-α anti-viral effects against HSV-1 but potently inhibited other immune-related functions. This work describes a novel strategy to identify small molecule inhibitors for the treatment of autoimmune disorders.
doi:10.2119/2008-00028.Chen
PMCID: PMC2376640  PMID: 18475307
6.  Family-Focused Treatment for Bipolar Disorder in Adults and Youth 
Journal of clinical psychology  2007;63(5):433-445.
Levels of familial expressed emotion during an acute episode are consistently associated with rates of recurrence among bipolar patients. This article briefly reviews the evidence for expressed emotion (EE) as a prognostic indicator and then illustrates family-focused treatment (FFT) with adults and adolescents suffering from bipolar disorder. FFT is a time-limited, modularized treatment consisting of psychoeducation, communication enhancement training, and problem-solving skills. Controlled trials indicate that FFT is an efficacious adjunct to pharmacotherapy for patients with bipolar disorder. We describe its recent application to early onset bipolar patients and include a clinical vignette.
doi:10.1002/jclp.20359
PMCID: PMC2194806  PMID: 17417810
bipolar disorder; expressed emotion; psychosocial treatment; family-focused therapy; adolescents; psychoeducation

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