Representation of Racial and Ethnic Minorities in Nephrology Clinical Trials: A Systematic Review and Meta-Analysis.

SIGNIFICANCE STATEMENT: Racial and ethnic disparities in clinical trial enrollment are well described. However, whether these disparities are present in nephrology randomized clinical trials has not been previously reported. We performed a systematic review and meta-analysis of 380 randomized clinical trials involving different aspects of kidney disease published between 2000 and 2021. Our results indicate that worldwide reporting of race and ethnicity is poor and that White individuals account for most of the randomized participants with decreased enrollment of Black participants in more recent trials. However, trials conducted in the United States have representation of Black and Hispanic participants consistent with the population prevalence of disease and under-representation of Asian participants. BACKGROUND: Under-representation of racial and ethnic minorities in clinical trials could worsen disparities, but reporting and enrollment practices in nephrology randomized clinical trials have not been described. METHODS: PubMed was searched to capture randomized clinical trials for five kidney disease-related conditions published between 2000 and 2021 in ten high-impact journals. We excluded trials with <50 participants and pilot trials. Outcomes of interest were the proportion of trials reporting race and ethnicity and the proportions of enrolled participants in each race and ethnicity category. RESULTS: Among 380 trials worldwide, race was reported in just over half and ethnicity in 12%. Most enrolled participants were White, and Black individuals accounted for ≤10% of participants except in dialysis trials where they accounted for 26% of participants. However, Black participants were enrolled at high proportions relative to disease and population prevalence in US CKD, dialysis, and transplant trials representing 19% of participants in AKI, 26% in CKD, 44% in GN, 40% in dialysis, and 26% in transplant trials. Enrollment of Asian participants was low worldwide except in GN trials with marked under-representation in US CKD, dialysis, and transplant trials. Hispanic individuals represented only 13% of participants in US dialysis trials compared with 29% of US dialysis population. CONCLUSION: More complete reporting of race and ethnicity in nephrology trials is needed. Black and Hispanic patients are well-represented in kidney disease trials in the United States. Asian patients are poorly represented in kidney trials both globally and in the United States.

Lesbian, gay or bisexual identity as a risk factor for trauma and mental health problems in Northern Irish students and the protective role of social support.

Background: People identifying as lesbian, gay or bisexual (LGB) have been shown to experience more trauma and poorer mental health than their heterosexual counterparts, particularly in countries with discriminatory laws and policies. Northern Ireland is a post-conflict region with high rates of trauma and mental health problems, as well as significant levels of prejudice against the LGB community. To date, no studies in Northern Ireland have compared trauma exposure, social support and mental health status of LGB students to their heterosexual peers. Objective: The present study aimed to assess whether LGB status was associated with more trauma exposure and poorer mental health, and whether social support mediated these associations. Method: The sample was comprised of 1,116 university students. Eighty-nine percent (n = 993) identified as heterosexual and 11% (n = 123) identified as LGB. Path analysis was used to test the hypotheses. Results: LGB status was significantly associated with increased trauma exposure and with symptoms of PTSD, depression and anxiety, but not with problematic alcohol use. These associations were mediated by social support from family only. Conclusions: These results evidence vulnerabilities among Northern Irish students identifying as LGB in relation to trauma and mental health compared with their heterosexual peers. However, social support from family has the potential to mitigate risk. Educational initiatives should raise awareness of the importance of familial support for LGB youth, and those young people who lack family support should be considered an at-risk group, warranting particularly intensive targeting by relevant supports.

Antecedentes: Se ha demostrado que las personas que se identifican como lesbianas, gays o bisexuales (LGB) experimentan más traumas y peor salud mental que sus contrapartes heterosexuales, particularmente en países con leyes y políticas discriminatorias. Irlanda del Norte es una región post-conflicto con altas tasas de trauma y problemas de salud mental, así como niveles significativos de delitos de odio dirigidos a la comunidad LGB. Hasta la fecha, ningún estudio en Irlanda del Norte se ha propuesto específicamente comparar la exposición al trauma y el estado de salud mental de los estudiantes LGB con sus pares heterosexuales.Objetivo: El presente estudio tuvo como objetivo evaluar si la condición LGB estaba asociada con tasas más altas de exposición al trauma y peor salud mental, y si el apoyo social mediaba estas asociaciones.Método: La muestra estuvo compuesta por 1.116 estudiantes universitarios de Irlanda del Norte. El ochenta y nueve por ciento (n = 990) se identificó como heterosexual y el 11% restante (n = 126) identificándose como LGB. El análisis de pautas se usó para probar las hipótesis de estudio.Resultados: el estado LGB se asoció con una mayor exposición al trauma y síntomas de TEPT, depresión y ansiedad, pero no con el consumo problemático de alcohol. Las asociaciones significativas fueron mediadas solamente por el apoyo social de miembros de la familia. El apoyo familiar se asoció con niveles más bajos de exposición al trauma y síntomas de salud mental para los jóvenes LGB.Conclusiones: los estudiantes de Irlanda del Norte que se identifican como LGB tienen vulnerabilidades en relación con el trauma y la salud mental en comparación con sus compañeros heterosexuales. Sin embargo, el apoyo social de la familia tiene el potencial de mitigar esta relación. Las iniciativas educativas deberían crear conciencia sobre la importancia del apoyo familiar para los jóvenes LGB, y aquellos jóvenes que carecen de apoyo familiar deberían considerarse un grupo en riesgo, garantizándoles un apoyo particularmente intensivo por terceros significativos.

Revealing what is distinct by recognising what is common: distinguishing between complex PTSD and Borderline Personality Disorder symptoms using bifactor modelling.

Background: Despite concerns of conceptual similarity, increasing evidence supports the discriminant validity of Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD). However, all studies to date have assumed a categorical model of psychopathology. In contrast, dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology model (i.e. HiTOP model), recognise shared vulnerability across supposedly discrete disorders. Accounting for shared vulnerability between CPTSD and BPD symptoms may help to better reveal what is unique about these constructs. Objective: To identify the distinct and shared features of CPTSD and BPD via the application of dimensional modelling procedures. Method: Confirmatory bifactor and confirmatory factor analysis were employed to identify the optimal latent structure of CPTSD and BPD symptoms amongst a convenience sample of Israeli adults (N = 617). Additionally, structural equation modelling was used to identify risk factors associated with these constructs. Results: The latent structure of CPTSD and BPD symptoms was best explained by a bifactor model including one 'general' factor (i.e. vulnerability to all symptoms) and three 'specific' correlated factors (i.e. vulnerability to PTSD, DSO, and BPD symptoms, respectively). CPTSD symptoms were more readily distinguished from the general factor whereas BPD symptoms were not as easily distinguished from the general factor. CPTSD symptoms reflecting a negative self-concept and BPD symptoms reflecting an alternating self-concept were the most distinctive features of CPTSD and BPD relative to the general factor, respectively. Most of the risk factors were associated with the general vulnerability factor, consistent with the predictions of dimensional models of psychopathology regarding shared risk across supposedly distinct psychiatric constructs. Conclusion: Consistent with a dimensional model of psychopathology, CPTSD and BPD shared a common latent structure but were still distinguishable. CPTSD and BPD symptoms may be most effectively distinguished based on the phenomenology of self-concept symptoms.

Antecedentes: A pesar de las consideraciones sobre la similitud conceptual, cada vez hay más pruebas que respaldan la validez para diferenciar el trastorno de estrés postraumático complejo (TEPT-C) del trastorno límite de personalidad (TLP). Sin embargo, todos los estudios hasta la fecha han asumido un modelo categórico de psicopatología. Por el contrario, los modelos dimensionales de psicopatología, como el modelo de taxonomía jerárquica de psicopatología (el modelo HiTOP), reconocen la vulnerabilidad compartida entre trastornos supuestamente distintos. Tener en cuenta la vulnerabilidad compartida entre los síntomas de TEPT-C y TLP puede ayudar a revelar mejor qué es lo particular de estos constructos.Objetivo: Identificar las características distintivas y compartidas de TEPT-C y TPL mediante la aplicación de procedimientos de modelado dimensional.Método: Se emplearon análisis de factores confirmatorios y bifactoriales para identificar la estructura latente óptima de los síntomas de TEPT-C y TLP entre una muestra por conveniencia de adultos israelíes (N = 617). Además, se utilizó el modelado de ecuaciones estructurales para identificar los factores de riesgo asociados con estos constructos.Resultados: La estructura latente de los síntomas de TEPT-C y TLP se explicó mejor mediante un modelo bifactorial que incluye un factor 'general' (es decir, vulnerabilidad a todos los síntomas) y tres factores correlacionados 'específicos' (es decir, vulnerabilidad a los síntomas de TEPT, DSO y TLP respectivamente). Los síntomas de TEPT-C se distinguieron más fácilmente del factor general, mientras que los síntomas de TLP no se distinguieron tan fácilmente del factor general. Los síntomas de TEPT-C que reflejan un autoconcepto negativo y los síntomas de TLP que reflejan un autoconcepto alterno fueron las características más distintivas de TEPT-C y TLP en relación con el factor general, respectivamente. La mayoría de los factores de riesgo se asociaron con el factor de vulnerabilidad general, en consonancia con las predicciones de los modelos dimensionales de psicopatología con respecto al riesgo compartido entre constructos psiquiátricos supuestamente distintos.Conclusión: De acuerdo con un modelo dimensional de psicopatología, el TEPT-C y el TLP compartían una estructura latente común, pero aún eran distinguibles. Los síntomas de TEPT-C y TLP se pueden distinguir de manera más efectiva según la fenomenología de los síntomas del autoconcepto.

The complexity of trauma exposure and response: Profiling PTSD and CPTSD among a refugee sample.

OBJECTIVE: This study investigated the latent dimensional and categorical structure of ICD-11 complex posttraumatic stress disorder (CPTSD) within a refugee sample. METHOD: A subsample that identified as refugee (n = 308) was selected from the National Epidemiological Survey on Alcohol and Related Conditions. Factor mixture modeling (FMM) was employed to establish the dimensional structure of CPTSD symptomology and the categorical distribution of these dimensions. It was then evaluated whether trauma history could differentiate between the distribution of trauma response profiles. RESULTS: A correlated 6-factor model with 5 latent classes was the best fitting model. Two classes were characterized by symptom profiles that were consistent with ICD-11 CPTSD and PTSD formulations. The remaining classes were characterized by nonspecific variation across dimensions. CPTSD class membership was predicted by traumas that were predominantly interpersonal in nature (serious neglect, physical assault, and sexual assault), whereas PTSD class membership was predicted by situational traumatic experiences (unarmed civilian in a conflict environment and a serious accident). A distinct dose-response effect was evident between cumulative traumatic exposure and CPTSD class membership. CONCLUSION: FMM class profiles distinguished between PTSD and CPTSD symptom formulations. Moreover, class membership was determined by specific trauma-exposure histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT).

In this paper we present a description of the Horizon2020, Marie Sklodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology.

En este artículo presentamos una descripción de un nuevo programa de investigación y formación, Horizon2020, con fondos de Marie Sklodowska-Curie Action, llamado CONTEXT o 'Red coordinadora para la formación y la excelencia en psicotraumatología'. Se presentan los tres objetivos del programa y cada uno de los cuales hace referencia a un componente clave del programa CONTEXT. Primero, resumimos los doce proyectos individuales de investigación que se llevarán a cabo en tres poblaciones prioritarias: (i) refugiados y solicitantes de asilo, (ii) personal de respuesta en emergencias y (iii) perpetradores y sobrevivientes de violencia infantil y de género. En segundo lugar, detallamos el programa de tutoría y formación, eje central de CONTEXT. Finalmente, describimos cómo la investigación, junto con la formación, contribuirá a una mejor política, directrices y práctica en el campo de la psicoterapia.

Lives in the Asylum Record, 1864 to 1910: Utilising Large Data Collection for Histories of Psychiatry and Mental Health.

This article examines the research implications and uses of data for a large project investigating institutional confinement in Australia and New Zealand. The cases of patients admitted between 1864 and 1910 at four separate institutions, three public and one private, provided more than 4000 patient records to a collaborative team of researchers. The utility and longevity of this data and the ways to continue to understand its significance and contents form the basis of this article's interrogation of data collection and methodological issues surrounding the history of psychiatry and mental health. It examines the themes of ethics and access, record linkage, categories of data analysis, comparison and record keeping across colonial and imperial institutions, and constraints and opportunities in the data itself. The aim of this article is to continue an ongoing conversation among historians of mental health about the role and value of data collection for mental health and to signal the relevance of international multi-sited collaborative research in this field.

Connections and divergences: lunatic asylums in New Zealand and the homelands before 1910.

This article argues for the blending of local, national, and transnational perspectives to explore comparative issues relating to asylum developments and provisions in New Zealand. It also aims to highlight some issues preoccupying authorities of the time and in doing so focuses on three key areas that generated comparative comment among medical officials in the nineteenth and twentieth centuries: asylum provision and funding, statistics, and forms of committal. These areas were of concern due to claims that insane patients were deliberately being shipped to New Zealand: that the colony had high admission and recovery rates; and that asylums in the colony were overcrowded. The findings presented here suggest that not only were certain aspects of New Zealand's asylum provision and population distinctive from the homelands, but there were also differences between asylums in the colony.