Identifying Patient Strengths Instruments and Examining Their Relevance for Chronic Disease Management: A Systematic Review.

INTRODUCTION: Most health care focuses on patients' deficits to encourage behavior change. A strengths-based approach, which relies on identifying patient strengths, has great potential to facilitate behavior change for chronic disease management. Little is known about instruments used to assess patient strengths. We conducted a systematic review to identify validated instruments that assess personal strengths by using a theory elaboration approach. METHODS: We searched 8 databases including Web of Science, Cumulative Index of Nursing and Allied Health (CINAHL), and PsycINFO (through July 2019) to identify peer reviewed, English-language studies that described strength-based instruments. Thereafter, we evaluated the validity and reliability of the instruments according to 18 Scientific Advisory Committee of the Medical Outcome Trust (SACMOT) criteria, and used an inductive, iterative editing process to identify constructs measured by the instruments. RESULTS: We identified 26 instruments that met our inclusion criteria. The instruments were validated in various clinical and nonclinical populations. Only 4 instruments met most of the SACMOT criteria for validation. We extracted 91 unique constructs that fell into 3 domains: inner strengths (49), external strengths (13), and personality constructs (29). CONCLUSION: A limited number of reliable and valid instruments are available to assess strengths for the adult population, particularly for clinical populations. Internal strengths can be leveraged to improve patient health; however, the development and validation of additional instruments to capture personal strengths is necessary to examine the multilevel influence of external strengths on individual behaviors and well-being.

Depicting "the system": How structural racism and disenfranchisement in the United States can cause dynamics in community violence among males in urban black communities.

BACKGROUND: A complex system of factors interacting across time shapes community violence. It is not well understood how features of persons, institutions and communities interact as a "system" to produce escalating community violence. We aimed to integrate theoretical and experiential knowledge among young African-American urban males to develop a concept model of key causal structures driving dynamics of community violence escalation over time in a context of historical racism. METHODS: We analyzed three published sources (two documentary films and one ethnography) containing lived experience perspectives on community violence escalation among African American males in three U.S. cities experiencing civil unrest due to structural racism. Qualitative descriptive analysis identified features in three key thematic categories: racialized policies and practices, economic and social disenfranchisement, and intrapsychic factors. We used causal loop diagramming, a system dynamics method designed for depicting dynamic hypotheses about the system structure producing observed trends over time, to represent the dynamic relationships among identified individual and community variables. RESULTS: The concept model contained key feedback structures capable of generating exponential growth in violence - providing detailed dynamic hypotheses about how violence can beget more violence ("violence escalation") within a community. Referred to as reinforcing feedback loops, these dynamics involved development of kill-or-be-killed norms, civil unrest emerging from racially oppressive policies, internalizing the code of the streets to seek outward displays of power, and processes that get one "stuck" or not able to break out of the system of violence. CONCLUSIONS: Qualitative system dynamics methods offered an approach to uncover and hypothesize the complex, dynamic relationships between variables shaping violence escalation trends. The resulting causal loop diagram hypothesized dynamic mechanisms capable of creating and perpetuating racial disparities in community violence escalation, that can be tested in future research to inform action to break observed cycles of community violence.

Consolidated Framework for Collaboration Research derived from a systematic review of theories, models, frameworks and principles for cross-sector collaboration.

Cross-sector collaboration is needed to address root causes of persistent public health challenges. We conducted a systematic literature review to identify studies describing theories, models, frameworks and principles for cross-sector collaboration and synthesized collaboration constructs into the Consolidated Framework for Collaboration Research (CFCR). Ninety-five articles were included in the review. Constructs were abstracted from articles and grouped into seven domains within the framework: community context; group composition; structure and internal processes; group dynamics; social capital; activities that influence or take place within the collaboration; activities that influence or take place within the broader community; and activities that influence or take place both in the collaboration and in the community. Community engagement strategies employed by collaborations are discussed, as well as recommendations for using systems science methods for testing specific mechanisms of how constructs identified in the review influence one another. Researchers, funders, and collaboration members can use the consolidated framework to articulate components of collaboration and test mechanisms explaining how collaborations function. By working from a consolidated framework of collaboration terms and using systems science methods, researchers can advance evidence for the efficacy of cross-sector collaborations.

Understanding Discourse on Work and Job-Related Well-Being in Public Social Media.

We construct a humans-in-the-loop supervised learning framework that integrates crowdsourcing feedback and local knowledge to detect job-related tweets from individual and business accounts. Using data-driven ethnography, we examine discourse about work by fusing language-based analysis with temporal, geospational, and labor statistics information.

Applying Critical Race Theory to Group Model Building Methods to Address Community Violence.

BACKGROUND: Group model building (GMB) is an approach to building qualitative and quantitative models with stakeholders to learn about the interrelationships among multilevel factors causing complex public health problems over time. Scant literature exists on adapting this method to address public health issues that involve racial dynamics. OBJECTIVES: This study's objectives are to (1) introduce GMB methods, (2) present a framework for adapting GMB to enhance cultural responsiveness, and (3) describe outcomes of adapting GMB to incorporate differences in racial socialization during a community project seeking to understand key determinants of community violence transmission. METHODS: An academic-community partnership planned a 1-day session with diverse stakeholders to explore the issue of violence using GMB. We documented key questions inspired by critical race theory (CRT) and adaptations to established GMB "scripts" (i.e., published facilitation instructions). The theory's emphasis on experiential knowledge led to a narrative-based facilitation guide from which participants created causal loop diagrams. These early diagrams depict how violence is transmitted and how communities respond, based on participants' lived experiences and mental models of causation that grew to include factors associated with race. CONCLUSIONS: Participants found these methods useful for advancing difficult discussion. The resulting diagrams can be tested and expanded in future research, and will form the foundation for collaborative identification of solutions to build community resilience. GMB is a promising strategy that community partnerships should consider when addressing complex health issues; our experience adapting methods based on CRT is promising in its acceptability and early system insights.

"Our commonality is our past:" a qualitative analysis of re-entry community health workers' meaningful experiences.

BACKGROUND: Re-entry community health workers (CHWs) are individuals who connect diverse community residents at risk for chronic health issues such as Hepatitis C virus and cardiovascular disease with post-prison healthcare and re-entry services. While the utilization of CHWs has been documented in other marginalized populations, there is little knowledge surrounding the work of re-entry CHWs with individuals released from incarceration. Specifically, CHWs' experiences and perceptions of the uniqueness of their efforts to link individuals to healthcare have not been documented systematically. This study explored what is meaningful to formerly incarcerated CHWs as they work with released individuals. METHODS: The authors conducted a qualitative thematic analysis of twelve meaningful experiences written by re-entry CHWs employed by the Transitions Clinic Network who attended a CHW training program during a conference in San Francisco, CA. Study participants were encouraged to recount meaningful CHW experiences and motivations for working with re-entry populations in a manner consistent with journal-based qualitative analysis techniques. Narratives were coded using an iterative process and subsequently organized according to themes in ATLAS.ti. Study personnel came to consensus with coding and major themes. RESULTS: The narratives highlighted thought processes and meaning related to re-entry CHWs' work helping patients navigate complex social services for successful re-integration. Six major themes emerged from the analysis: advocacy and support, empathy relating to a personal history of incarceration, giving back, professional satisfaction and responsibilities, resiliency and educational advancement, and experiences of social inequities related to race. Re-entry CHWs described former incarceration, employment, and social justice as sources of meaning for assisting justice-involved individuals receive effective, efficient, and high-quality healthcare. CONCLUSIONS: Health clinics for individuals released from incarceration provide a unique setting that links high risk patients to needed care and professionalizes career opportunities for formerly incarcerated re-entry CHWs. The commonality of past correctional involvement is a strong indicator of the meaning and perceived effectiveness re-entry CHWs find in working with individuals leaving prison. Expansion of reimbursable visits with re-entry CHWs in transitions clinics designed for re-entering individuals is worthy of further consideration.

Examining Benefits of Academic-Community Research Team Training: Rochester's Suicide Prevention Training Institutes.

BACKGROUND: Although community-engaged research (CER), including community-based participatory research (CBPR), is a growing approach in addressing health disparities, little scientific study on how to enhance its processes or products exists. These fields are built on practice-based case studies, evaluations, and qualitative examinations of principles in action. This gap is as an emerging priority in the clinical and translation sciences. OBJECTIVES: We designed a 5-day workshop for academic-community research teams in suicide prevention and health promotion, broadly defined. Seasoned academic and community partners developed and implemented curriculum at three training institutes from 2007 to 2010. We developed self-report tools to evaluate this training model for CER practice. We crafted and evaluated both mediating processes and outcome measures for academic and community partners to assess team CER development. METHODS: We analyzed post-training evaluation surveys completed late in 2010. We conducted exploratory factor analysis on survey data from 48 community or academic partners. These team members participated in at least one National Institutes of Health-funded CER training institute to advance suicide prevention, broadly defined. CONCLUSIONS: Partnership development measures that capture both academic and community perspectives demonstrate reliability and validity. Multidimensional latent constructs for inclusion in CER development models included partnership agency, personal knowledge and capacities, and benefits of collaborative research partnerships over time. We discuss the utility of findings to future CER training design and study.

Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills.

Suicide is the third leading cause of death among 10-24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are discussed.

Differential responses of Bacillus subtilis rRNA promoters to nutritional stress.

The in vivo expression levels of four rRNA promoter pairs (rrnp(1)p(2)) of Bacillus subtilis were determined by employing single-copy lacZ fusions integrated at the amyE locus. The rrnO, rrnJ, rrnD, and rrnB promoters displayed unique growth rate regulation and stringent responses. Both lacZ activity and mRNA levels were highest for rrnO under all growth conditions tested, while rrnJ, rrnB, and rrnD showed decreasing levels of activity. During amino acid starvation induced by serine hydroxamate (SHX), only the strong rrnO and rrnJ promoters demonstrated stringent responses. Under the growth conditions used, the rrn promoters showed responses similar to the responses to carbon source limitation induced by α-methyl glucoside (α-MG). The ratio of P2 to P1 transcripts, determined by primer extension analysis, was high for the strong rrnO and rrnJ promoters, while only P2 transcripts were detected for the weak rrnD and rrnB promoters. Cloned P1 or P2 promoter fragments of rrnO or rrnJ were differentially regulated. In wild-type (relA(+)) and suppressor [relA(S)] strains under the conditions tested, only P2 responded to carbon source limitation by a decrease in RNA synthesis, correlating with an increase in (p)ppGpp levels and a decrease in the GTP concentration. The weak P1 promoter elements remain relaxed in the three genetic backgrounds [relA(+), relA, relA(S)] in the presence of α-MG. During amino acid starvation, P2 was stringently regulated in relA(+) and relA(S) cells, while only rrnJp(1) was also regulated, but to a lesser extent. Both the relA(+) and relA(S) strains showed (p)ppGpp accumulation after α-MG treatment but not after SHX treatment. These data reveal the complex nature of B. subtilis rrn promoter regulation in response to stress, and they suggest that the P2 promoters may play a more prominent role in the stringent response.

Social support and self-reported health status of older adults in the United States.

OBJECTIVES: We determined whether a representative national probability sample of US community-dwelling older adults who reported less social support also reported poorer general health status, which is a robust predictor of prospective mortality among elders. METHODS: We analyzed 2 subsamples generated via random sampling with replacement from the full analytic sample of adults aged 60 years and older in the 1999-2002 National Health and Nutrition Examination Survey (n = 3476). We built multinomial logit models with the first analytic subsample (n = 1732). Then we tested the final models on the second subsample (n = 1744) to assess the differences in odds of reporting poor, fair, or good versus very good or excellent health. We fit the cross-validated final models to the full analytic sample. RESULTS: After we controlled for age, race, gender, and educational attainment, older persons across all analytic samples who reported that they needed more support also reported having poorer health compared with better health 2 times more often than did older persons who were satisfied with the support available to them (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.7, 3.4; P < .001). CONCLUSIONS: In the United States, older persons' satisfaction with the emotional support available to them is associated with better self-reported health status.

Expression of the bovine high affinity IL-12 receptor beta2.

Four fragments of the bovine IL-12 receptor beta2 were sequenced following generation by reverse transcriptase polymerase chain reaction (RT-PCR) amplification of RNA from mitogen-activated bovine peripheral blood mononuclear cells (PBMC). Primers were based on sequences within regions of the human IL-12Rbeta2 gene that displayed high levels of similarity with the mouse IL-12Rbeta2 gene sequence. The amplified bovine IL-12Rbeta2 fragments had 82-87% similarity at the nucleotide level with human IL-12Rbeta2 and 70-88% similarity at the predicted amino acid level. Bovine IL-12Rbeta2 gene expression was induced following culture of PBMC with Concanavalin A (Con A), with immobilized monoclonal antibody to CD3 or with human recombinant IL-12 p70 and correlated with interferon-gamma (IFN-gamma) production. Expression of bovine IL-12Rbeta2 by PBMC was detected by 2h of culture with Con A and sustained for at least 5 days when cultured with rHuIL-12. Expression, however, did not require cellular proliferation since IL-12 did not induce proliferation, although both Con A and anti-CD3 monoclonal antibody did do so. Addition of rHuIL-10 inhibited IFN-gamma production without abrogating bovine IL-12Rbeta2 gene expression.