Ethical, legal, and policy dimensions and contentions for reanalysis and reinterpretation of clinical genetic testing results

The rapid evolution of genomic knowledge has made reanalysis and reinterpretation of clinical genetic testing results an ethical imperative to ensure optimal patient care. However, significant discrepancies persist between policies, laboratory practices, and stakeholder perspectives regarding the responsibility for initiating and communicating reclassified variants. This perspective examines the current landscape of ethical, legal, and practical challenges for laboratories, clinicians, and patients. We highlight the tension between the duty of care and resource constraints, finding that while the ethical importance of reinterpretation is acknowledged, the lack of standardized guidelines and legal clarity fuels uncertainty and discordant stakeholder views. To address these challenges, we propose an actionable, shared-responsibility framework that aligns duties with expertise. In this model, diagnostic laboratories are positioned to monitor new evidence and initiate updates for reinterpretation, while clinicians manage patient recontact and initiate case-level reanalysis, and health systems provide the necessary infrastructure. Realizing this framework through multidisciplinary collaboration and investment is crucial for establishing equitable best practices and integrating reinterpretation into the evolving standard of care

Estimating the Effects of Immigration Status on Mental Health Care Utilizations in the United States

Immigration status is a likely deterrent of mental health care utilization in the United States. Using the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006, multivariable logistic regressions were used to estimate the effects of immigration status on mental health care utilization among patients with depression or anxiety disorders. Multivariate regressions showed that immigrants were significantly less likely to take any prescription drugs, but not significantly less likely to have any physician visits compared to US-born citizens. Results also showed that improving immigrants’ health care access and health insurance coverage could potentially reduce disparities between US-born citizens and immigrants by 14–29% and 9–28% respectively. Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization. Targeted interventions should also focus on addressing immigrants’ language barriers, and providing culturally appropriate services

Qualitative evaluation of mental health services for clients with limited English proficiency

BACKGROUND: To meet federal requirements under Title VI of the Civil Rights Act, the state of California instituted policies requiring that comprehensive mental health services in native languages be made available to limited English proficiency (LEP) populations when concentrations exceed “threshold” levels. METHODS: This paper builds on promising results from quantitative evaluations by reporting on qualitative interviews with Latino and Vietnamese LEP clients in mental health services (N = 20) to examine the awareness, impact, and implications of these threshold language policies. RESULTS: Results suggest that, while individuals are often not aware of the policies themselves, the language-related services they receive that are prompted by the policies are critical to treatment initiation and retention. Results also convey the complexities of using interpreters for sensitive psychological topics, and suggest that, for LEP individuals seeking mental health treatment, providers who speak their native languages are generally preferred. CONCLUSIONS: Access to language-appropriate services seems to be an important part of why LEP populations seek mental health treatment. However, there are multiple variables that factor into the usage and usefulness of such services

Social health literacy: Existing evidence, research gaps, and future directions

Sentell T, Sentell T, Pitt R, et al. Social health literacy: Existing evidence, research gaps, and future directions. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2018;28(Suppl. 4):28