IntroductionVeteran death by suicide is a complex issue made up of many factors. Despite the high need for mental health treatment, and treatments that specifically target suicide, evidence-based psychotherapies (EBPs) are difficult to access, even more so in rural areas. In concordance with the 2018 National Strategy for Preventing Veteran Suicide, VA suicide prevention leadership developed Suicide Prevention 2.0 (SP 2.0) to implement a public health model that includes community-based prevention strategies and improves clinical interventions within VA. The Suicide Prevention 2.0 Clinical Telehealth program was implemented in each of VA’s 18 regional Clinical Resource Hubs and expanded clinical intervention strategies within VA by implementing four EBPs for Suicide Prevention (EBP-SP) via telehealth: the Safety Planning Intervention, Problem-Solving Therapy for Suicide Prevention, Cognitive Behavioral Therapy for Suicide Prevention, and Dialectical Behavior Therapy.MethodsA wide variety of implementation strategies were used (e.g., access new funding, training, consultation, create new clinical teams). The primary inclusion criterion for veteran referral to SP 2.0 Clinical Telehealth is a recent history of suicidal self-directed violence. Implementation was guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and RE-AIM was used as an evaluation framework.ResultsBy April 2023, SP 2.0 Clinical Telehealth services were available in all 18 regions and in 139 of 139 (100%) VA health care systems in the U.S. By the end of September 2024, the program had hired 137 therapists and retained 78.10% in their role, and 100% were trained in two or more EBP-SPs. By the end of September 2024, the program received 23,628 referrals nationwide. Increasing referral rates year over year suggests ongoing sustained reach.DiscussionSP 2.0 Clinical Telehealth represents the first and only enterprise-wide fully virtual evidence-based treatment program for veterans with a recent history of suicidal self-directed violence. The program’s implementation was successful in reaching all VISNs and all VA health care systems in the U.S. The SP 2.0 Clinical Telehealth program can be used as a model for other large health care systems looking to improve provision of evidence-based interventions for suicide prevention.
Schizophrenia and related psychoses occur in all human populations, with the highest rates of diagnosis among Black individuals and those of mainly African ancestry1. Decades of research have established a highly heritable and polygenic basis for schizophrenia, which is mostly shared across populations2-4. However, a recruitment bias towards European cohorts5 has led to discoveries that are poorly generalizable to African populations. This exclusion of the world's most genetically diverse populations narrows our understanding of disease biology and risks exacerbating health disparities. Here we show that electronic health records linked with genomic data from the Million Veteran Program (MVP)6-a national research programme that looks at the effects of genes, lifestyle, military experiences and exposures on the health and wellness of veterans-enable a comprehensive assessment of schizophrenia genetics in populations of African ancestry in the USA. We identify ancestry-independent associations in African populations and expand the catalogue of implicated regions by more than 100 loci. Through statistical fine-mapping and integrative transcriptomic analyses, we refine disease-associated signals to consensus genes with convergent neurobiological functions. These findings provide a much-needed view of schizophrenia's genetic architecture in populations of African ancestry, and offer biological insights that both extend previous work and broaden its global relevance.
Background: Evidence-based complementary and integrative health (CIH) therapies are now in clinical practice guidelines for common pain and pain-related conditions. Primary care providers (PCPs) are often the first point of contact for discussing CIH therapies as non-pharmacological health management. Yet, little is known about their decisions to recommend CIH therapies.Objective: To understand: (1) which CIH therapies PCPs recommend and for what health conditions, (2) reasons for their recommendations or lack thereof, and (3) possible solutions to improve appropriateness of recommendations.Methods: Semi-structured qualitative interviews were conducted with 40 PCPs from eight Veterans Health Administration (VA) hospitals offering eight evidence-based CIH therapies (acupuncture, medical massage therapy, yoga, Tai Chi, meditation/mindfulness, biofeedback, clinical hypnosis, guided imagery). A rapid qualitative analysis was performed using a matrix approach.Results: PCPs recommended patients use acupuncture, medical massage therapy, yoga, Tai Chi, and meditation/mindfulness the most and biofeedback, clinical hypnosis, and guided imagery the least. Pain was the main condition for referrals to all CIH therapies except clinical hypnosis and guided imagery, which were most recommended for smoking cessation and mental health, respectively. Decisions to recommend were largely driven by PCP's knowledge of CIH therapies' effectiveness for particular health conditions. Other factors were PCP's own beliefs about CIH therapies, their perceptions about patients' beliefs, patients' positive experiences, and organizational factors (e.g., understanding what therapies are covered for which conditions and the local referral process). PCPs wanted brief educational information containing many types of content, ranging from therapy descriptions to clinical practice guidelines and information on institutional policies on CIH therapy provision.Conclusions: Although some PCPs are appropriately recommending evidence-based CIH therapies, lack of knowledge is a critical barrier for many others. This could be addressed with the educational information tailored to the content and format that PCPs specifically requested.
Background: The American Heart Association’s (AHA) Life’s Essential 8 (LE8) identifies essential metrics for cardiovascular disease prevention and includes blood glucose, blood lipids, blood pressure, nicotine exposure, physical activity, diet, sleep duration, and body mass index (BMI). While the LE8 has been linked to cardiovascular outcomes, associations with type 2 diabetes (T2D) remain less established, particularly in diverse populations. Objective: To examine the association between LE8 and incident T2D among postmenopausal women and to evaluate subgroups by race, ethnicity, and age. Methods: We included 19,403 postmenopausal women in the Women’s Health Initiative without T2D at baseline. The overall LE8 score (0–100) was calculated using AHA definitions and categorized as high (80–100), moderate (60–79), and low (0–59), with higher scores indicating a healthier lifestyle. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between LE8 and incident T2D, adjusted for potential confounders. Results: During a mean of 16.3 years of follow-up, 3921 cases of T2D were identified. Women in the highest LE8 category had a 57% lower risk of T2D compared with those in the lowest category (HR, 0.43, 95% CI [0.38, 0.49]). A 20-point higher LE8 score was associated with a 43% lower risk (0.57 [0.54, 0.60]). Among the individual LE8 metrics, per 20-point increase in blood glucose (0.61 [0.59, 0.63]) and BMI (0.88 [0.87, 0.90]) were most strongly associated with T2D, followed by smoking (0.96 [0.94–0.98]), blood lipids (0.95 [0.93–0.97]), and blood pressure (0.95 [0.93–0.96]). Diet, physical activity, and sleep were not significantly associated with T2D in this population. Subgroup analyses showed stronger associations among Hispanic/Latina women (0.58 [0.55, 0.62]) compared with non-Hispanic women (0.46 [0.41, 0.53]), per 20-point increase. Associations were also stronger among younger women, but did not vary by race. Conclusions: Higher LE8 scores were associated with reduced risk of T2D in postmenopausal women, with blood glucose and BMI having the strongest associations with T2D. LE8 may serve as a practical framework for risk assessment to reduce T2D incidence in aging women.
Gout is a chronic inflammatory disease characterized by the deposition of monosodium urate crystals in the joints. However, growing research suggests a more complex pathophysiology involving genetic susceptibility, metabolic stress, and environmental factors. Among emerging contributors, hypoxia-inducible factor 1 alpha (HIF-1α) has been proposed as a potential regulator that links these processes, though its role in gout remains underexplored. This review examines the emerging evidence supporting HIF-1α’s role in both urate production and inflammation, to offer a unifying framework connecting these contributors to gout pathogenesis. Systemically, HIF-1α has been shown to promote a metabolic shift towards glycolysis and purine metabolism, providing a plausible mechanism for hyperuricemia. Locally, metabolic priming helps sustain immune responses, particularly through the release of interleukin-1 beta. Environmental stressors, including hypoxia and pseudohypoxia (e.g., obstructive sleep apnea), can further stabilize HIF-1α and amplify inflammatory signaling. This framework supports a model in which HIF-1α links metabolic stress, immune activation, and environmental exposures, reframing gout as a disorder of metabolic maladaptation and suggesting HIF-1α as a potential therapeutic target.
