Recovery-oriented practice in a hospital mental health service.

As part of mental health reform in Australia, new policies were introduced to support recovery-oriented practice; however, little has changed in hospital settings focused on managing risk and remediating acute symptoms. Previous studies have indicated that patients' experiences of personal recovery, during a hospital admission, may not mirror that of people living in the community, with patients being more likely to experience disconnection, hopelessness and disempowerment. Using a Participatory Health Research approach, eight mental health professionals, a patient advocate and an external researcher formed a research partnership to answer the question: How can staff enhance recovery-oriented practice in a hospital-based mental health service? The COREQ checklist was used for reporting the methods, analysis and findings. The methods comprised patient focus groups (n = 16 participants), interviews with managers (n = 7) and an online survey for staff (n = 17). Researchers analysed the feedback from the consultations using inductive thematic analysis, identifying two themes: relational recovery and recovery interventions. The findings indicate that relational recovery is key to recovery during a hospital admission and interventions that increase connectedness or reduce the impact of symptoms enhance personal recovery.

Periodontal status and oral hygiene practices among adults in a peri-urban fishing community in Ghana.

Introduction: fisherfolk play a major role in emerging economies such as Ghana. While many fishing communities are noted to be underdeveloped, fisherfolk are considered to neglect their oral hygiene, while being prone to certain conditions due to peculiar risks. The purpose of this study was to determine the periodontal health status of adults in a selected fishing community in Ghana. Methods: a descriptive cross-sectional study was carried out to assess the periodontal status of adults in Jamestown, a peri-urban area in Ghana. Data acquisition was by means of a structured questionnaire and periodontal examination. Information obtained consisted of demographic data (age, sex, education and occupation category) oral hygiene practices (type of teeth cleaning materials, methods of tooth cleansing, frequency of dental visits and reasons for the visit) and periodontal clinical parameters (plaque index, and community periodontal index of treatment needs). Results: a total of 276 participants were included in the study, with ages ranging from 21 to 70 years. The participants were made up of 138 fisherfolk and 138 non-fisherfolk. Males had worse scores for periodontal disease compared to females. Plaque score did not vary among age groups, but changed significantly between educational level and occupational categories. CPITN varied significantly between educational levels, age categories and occupational categories. Conclusion: the study found inhabitants of the fishing community of Jamestown to have a generally unsatisfactory periodontal status, but worse for the fisherfolk in the community.

Effect of Cocoa Beverage and Dark Chocolate Consumption on Blood Pressure in Those with Normal and Elevated Blood Pressure: A Systematic Review and Meta-Analysis.

Cocoa is a major dietary source of polyphenols, including flavanols, which have been associated with reduced blood pressure (BP). While earlier systematic reviews and meta-analyses have shown significant effects of cocoa consumption on systolic BP, limitations include small sample sizes and study heterogeneity. Questions regarding food matrix and dose of polyphenols, flavanols, or epicatechins remain. This systematic review and meta-analysis aimed to investigate the effects of ≥2 weeks of cocoa consumption as a beverage or dark chocolate in those with normal or elevated (< or ≥130 mmHg) systolic BP measured in the fasted state or over 24-h. A systematic search conducted on PubMed and Cochrane Library databases up to 26 February 2022 yielded 31 suitable articles. Independent of baseline BP, cocoa consumption for ≥2 weeks was associated with reductions in systolic and diastolic BP (p < 0.05, all). Compared with cocoa, chocolate lowered the weighted mean of resting systolic BP (−3.94 mmHg, 95% CI [−5.71, −2.18]) more than cocoa beverage (−1.54 mmHg, 95% CI [−3.08, 0.01]). When the daily dose of flavanols was ≥900 mg or of epicatechin ≥100 mg, the effect was greater. Future, adequately powered studies are required to determine the optimal dose for a clinically significant effect.

Examination of Substance Use, Risk Factors, and Protective Factors on Student Academic Test Score Performance.

BACKGROUND: School administrators and teachers face difficult decisions about how best to use school resources to meet academic achievement goals. Many are hesitant to adopt prevention curricula that are not focused directly on academic achievement. Yet, some have hypothesized that prevention curricula can remove barriers to learning and, thus, promote achievement. We examined relationships among school levels of student substance use and risk and protective factors that predict adolescent problem behaviors and achievement test performance. METHODS: Hierarchical generalized linear models were used to predict associations involving school-averaged levels of substance use and risk and protective factors and students' likelihood of meeting achievement test standards on the Washington Assessment of Student Learning, statistically controlling for demographic and economic factors known to be associated with achievement. RESULTS: Levels of substance use and risk/protective factors predicted the academic test score performance of students. Many of these effects remained significant even after controlling for model covariates. CONCLUSIONS: Implementing prevention programs that target empirically identified risk and protective factors has the potential to have a favorable effect on students' academic achievement.

Use of isosorbide dinitrate and hydralazine in African-Americans with heart failure 9 years after the African-American Heart Failure Trial.

The 2013 American College of Cardiology Foundation/American Heart Association guidelines recommend combined isosorbide dinitrate (ISDN) and hydralazine to reduce mortality and morbidity for African-Americans with symptomatic heart failure (HF) and reduced ejection fraction, currently receiving optimal medical therapy (class I, level A). Nitrates can alleviate HF symptoms, but continuous use is limited by tolerance. Hydralazine may mitigate nitrate tolerance, and the ISDN-hydralazine combination in the Vasodilators in Heart Failure Trial (V-HeFT) I improved survival and exercise tolerance in men with dilated cardiomyopathy or HF with reduced ejection fraction, most notably in self-identified black participants. In the subsequent V-HeFT II, survival was greater with enalapril than with ISDN-hydralazine in the overall cohort, but mortality rate was similar in the enalapril and ISDN-hydralazine groups in the self-identified black patients. Consequently, in the African-American Heart Failure Trial (A-HeFT) in self-identified black patients with symptomatic HF, adding a fixed-dose combination ISDN-hydralazine to modern guideline-based care improved outcomes versus placebo, including all-cause mortality, and led to early trial termination. Hypertension underlies HF, especially in African-Americans; the A-HeFT and its substudies demonstrated not only improvements in echocardiographic parameters, morbidity, and mortality but also a decrease in hospitalizations, potentially affecting burgeoning HF health-care costs. Genetic characteristics may, therefore, determine response to ISDN-hydralazine, and the Genetic Risk Assessment in Heart Failure substudy demonstrated important hypothesis-generating pharmacogenetic data.

Prevention system mediation of communities that care effects on youth outcomes.

This study examined whether the significant intervention effects of the Communities That Care (CTC) prevention system on youth problem behaviors observed in a panel of eighth-grade students (Hawkins et al. Archives of Pediatrics and Adolescent Medicine 163:789-798 2009) were mediated by community-level prevention system constructs posited in the CTC theory of change. Potential prevention system constructs included the community's degree of (a) adoption of a science-based approach to prevention, (b) collaboration on prevention activities, (c) support for prevention, and (d) norms against adolescent drug use as reported by key community leaders in 24 communities. Higher levels of community adoption of a science-based approach to prevention and support for prevention in 2004 predicted significantly lower levels of youth problem behaviors in 2007, and higher levels of community norms against adolescent drug use predicted lower levels of youth drug use in 2007. Effects of the CTC intervention on youth problem behaviors by the end of eighth grade were mediated fully by community adoption of a science-based approach to prevention. No other significant mediated effects were found. Results support CTC's theory of change that encourages communities to adopt a science-based approach to prevention as a primary mechanism for improving youth outcomes.

Variation in the Effect of Communities That Care on Community Adoption of a Scientific Approach to Prevention.

Tested and effective approaches are available to prevent mental, emotional, and behavioral problems in youth, but such approaches are underused. Communities That Care (CTC) is a coalition-based strategy that aims to increase the use of tested and effective programs by combining the use of scientific evidence and stakeholder consensus to support the community adoption of a scientific approach to preventing mental, emotional, and behavioral problems in youth. A community-randomized trial of CTC was conducted with a sample of 24 communities matched in pairs and assigned randomly to a control or an intervention condition. The findings demonstrate that CTC significantly increases the community-wide adoption of a science-based approach to prevention. Using a meta-analysis technique, this study shows that despite uniformly high-fidelity implementation of CTC in intervention communities, the effect of CTC on the adoption of a scientific approach to prevention varies significantly across the 12 community pairs. Understanding the extent of variation in the effect of CTC on adopting a science-based approach to prevention lays a foundation for identifying aspects of coalition structure, functioning, or capacity that not only may help explain variation in adoption, but may in turn be targeted to strengthen the effect of CTC on the adoption of a science-based approach to prevention within communities.

Measuring Dimensions of Coalition Functioning for Effective and Participatory Community Practice.

Social Work has a long history of community practice, but community practice models have been understudied. An important first step in conducting such studies is the establishment of psychometrically sound measures relevant for evaluations of community practice. In this paper, data are used from a community-randomized trial of Communities That Care (CTC), a coalition-based model of community practice shown to be effective at transforming communities and changing rates of youth problem behavior. Coalition functioning is reported by coalition members in 12 communities across intervention implementation phases. A four-dimensional model of coalition functioning (goal-directedness, efficiency, opportunities for participation, and cohesion) was confirmed using factor analysis and the dimensions were found to be invariant across time. One test of validity of these dimensions is conducted by correlating coalition members' ratings of coalition functioning with those of external observers.

Predictive validity of established cut points for risk and protective factor scales from the communities that care youth survey.

Community coalitions are a popular strategy to coordinate activities and resources to prevent adolescent substance use and delinquent behavior. Despite early evidence of their lack of effectiveness, a new generation of community coalitions has shown positive results in preventing youth substance use and delinquency. This success can be attributed to coalition decision making focused on reducing local risk factors and increasing local protective factors through the use of evidence-based prevention programs. A previous study using cross-sectional data established cut point values for scales measuring risk and protective factors on the Communities That Care Youth Survey (CTCYS) to identify high levels of risk and low levels of protection in communities on each scale. The current study extended this previous research by using longitudinal data to assess the validity of risk and protective factor cut point values in predicting substance use and delinquent behavior 1 year after risk and protection were measured. The findings demonstrate the predictive validity of cut points for risk and protective factor scales measured by the CTCYS and suggest their utility in guiding prevention efforts.

Sustainability of the Communities That Care prevention system by coalitions participating in the Community Youth Development Study.

PURPOSE: Community prevention coalitions are a common strategy to mobilize stakeholders to implement tested and effective prevention programs to promote adolescent health and well-being. This article examines the sustainability of Communities That Care (CTC) coalitions approximately 20 months after study support for the intervention ended. METHODS: The Community Youth Development Study is a community-randomized trial of the CTC prevention system. Using data from 2007 and 2009 coalition leader interviews, this study reports changes in coalition activities from a period of study support for CTC (2007) to 20 months following the end of study support for CTC (2009), measured by the extent to which coalitions continued to meet specific benchmarks. RESULTS: Twenty months after study support for CTC implementation ended, 11 of 12 CTC coalitions in the Community Youth Development Study still existed. The 11 remaining coalitions continued to report significantly higher scores on the benchmarks of phases 2 through 5 of the CTC system than did prevention coalitions in the control communities. At the 20-month follow-up, two-thirds of the CTC coalitions reported having a paid staff person. CONCLUSIONS: This study found that the CTC coalitions maintained a relatively high level of implementation fidelity to the CTC system 20 months after the study support for the intervention ended. However, the downward trend in some of the measured benchmarks indicates that continued high-quality training and technical assistance may be important to ensure that CTC coalitions maintain a science-based approach to prevention, and continue to achieve public health impacts on adolescent health and behavior outcomes.

Nonsuicidal self-injury and diminished pain perception: the role of emotion dysregulation.

Nonsuicidal self-injury (NSSI) is the deliberate destruction of one's own body tissue in the absence of suicidal intent (e.g., cutting or burning the skin). Previous studies have found that people with a history of NSSI display diminished pain perception. However, it remains unclear why this effect occurs. In the present study, we used a sample of participants with (n = 25) and without (n = 47) a history of NSSI to test the hypothesis that emotion dysregulation partially explains why NSSI is associated with diminished pain perception. Pain perception was quantified as pain threshold, pain tolerance, and pain intensity ratings assessed during the cold pressor task. Nonsuicidal self-injury was associated with increased emotion dysregulation and diminished pain perception. Results showed that emotion dysregulation was correlated with diminished pain perception within both groups, demonstrating that this association exists regardless of NSSI history. Results also specified that emotion dysregulation partially accounted for the association between NSSI and pain tolerance but not other pain variables. Overall, results were consistent with the hypothesis that emotion dysregulation may increase NSSI risk in part by increasing the willingness to experience the pain involved in self-injury. Studies are needed to more directly investigate this hypothesis.

Community-level Effects of Individual and Peer Risk and Protective Factors on Adolescent Substance Use.

The association between community-aggregated levels of peer and individual risk and protective factors and prevalence of adolescent substance use was examined in repeated cross-sectional data among youth in 41 communities ranging in population from 1,578 to 106,221. The association between community levels of these peer and individual risk and protective factors in 2000 and substance use 2 years later was examined by using within-cohort analyses (e.g., sixth grade in 2000 predicting eighth grade in 2002) and cross-cohort analyses (e.g., sixth grade in 2000 predicting sixth grade in 2002). In both within- and across-cohort analyses, community-aggregated levels of peer and individual risk and protective factors predicted the prevalence of adolescent substance use 2 years later, suggesting that focusing on elevated peer and individual risk factors and depressed peer and individual protective factors at the community level to guide the selection of preventive interventions may be a viable strategy for community efforts to prevent adolescent substance use community wide.

Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial.

OBJECTIVE: To test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community-wide 6 years after installation of CTC and 1 year after study-provided resources ended. DESIGN: A community randomized trial. SETTING: Twenty-four small towns in 7 states, matched within state, randomly assigned to control or intervention condition in 2003. PARTICIPANTS: A panel of 4407 fifth-grade students was surveyed annually through 10th grade from 2004 to 2009. INTERVENTION: A coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors in the community, and implemented programs to address their community's elevated risks from a menu of tested and effective programs for youths aged 10 to 14 years, their families, and schools. OUTCOME MEASURES: Levels of risk and incidence and prevalence of tobacco, alcohol, and other drug use; delinquency; and violent behavior by grade 10. RESULTS: Mean levels of targeted risks increased less rapidly between grades 5 and 10 in CTC than in control communities and were significantly lower in CTC than control communities in grade 10. The incidence of delinquent behavior, alcohol use, and cigarette use and the prevalence of current cigarette use and past-year delinquent and violent behavior were significantly lower in CTC than in control communities in grade 10. CONCLUSIONS: Using the CTC system can produce enduring reductions in community-wide levels of risk factors and problem behaviors among adolescents beyond the years of supported implementation, potentially contributing to long-term public health benefits. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01088542.

Isotopic evidence for massive oxidation of organic matter following the great oxidation event.

The stable isotope record of marine carbon indicates that the Proterozoic Eon began and ended with extreme fluctuations in the carbon cycle. In both the Paleoproterozoic [2500 to 1600 million years ago (Ma)] and Neoproterozoic (1000 to 542 Ma), extended intervals of anomalously high carbon isotope ratios (δ(13)C) indicate high rates of organic matter burial and release of oxygen to the atmosphere; in the Neoproterozoic, the high δ(13)C interval was punctuated by abrupt swings to low δ(13)C, indicating massive oxidation of organic matter. We report a Paleoproterozoic negative δ(13)C excursion that is similar in magnitude and apparent duration to the Neoproterozoic anomaly. This Shunga-Francevillian anomaly may reflect intense oxidative weathering of rocks as the result of the initial establishment of an oxygen-rich atmosphere.

Effects of Communities That Care on the adoption and implementation fidelity of evidence-based prevention programs in communities: results from a randomized controlled trial.

This paper describes findings from the Community Youth Development Study (CYDS), a randomized controlled trial of the Communities That Care (CTC) prevention system, on the adoption and implementation fidelity of science-based prevention programming in 24 communities. Data were collected using the Community Resource Documentation (CRD), which entailed a multi-tiered sampling process and phone and web-based surveys with directors of community-based agencies and coalitions, school principals, service providers, and teachers. Four years after the initiation of the CTC prevention system, the results indicated increased use of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, and significant differences favoring the intervention communities in the numbers of children and families participating in these programs. Few significant differences were found regarding implementation quality; respondents from both intervention and control communities reported high rates of implementation fidelity across the services provided.

Prevention Service System Transformation Using Communities That Care.

This study examines prevention system transformation as part of a community-randomized controlled trial of Communities That Care (CTC). Using data from surveys of community leaders, we examine differences between CTC and control communities 4.5 years after CTC implementation. Significantly higher levels of adopting a science-based approach to prevention observed in CTC communities compared to controls in 2004 were maintained in 2007. Leaders in CTC communities expressed a willingness to contribute significantly more funds to prevention than did leaders in control communities in 2007. Significant differences in levels of community collaboration observed in 2004 were not maintained in 2007. Leaders in CTC communities with high poverty rates and large minority student populations reported higher levels of community norms against drug use and greater use of the social development strategy, respectively, than did leaders in control communities with similar characteristics.

The functions of nonsuicidal self-injury: support for cognitive-affective regulation and opponent processes from a novel psychophysiological paradigm.

Although research on the reasons for engaging in nonsuicidal self-injury (NSSI) has increased dramatically in the last few years, there are still many aspects of this pernicious behavior that are not well understood. The purpose of this study was to address these gaps in the literature, with a particular focus on investigating whether NSSI (a) regulates affective valence in addition to affective arousal and (b) serves a cognitive regulation function in addition to an affect regulation function. To elucidate these issues, the present study utilized a sample of 112 participants (33 controls, 39 no pain controls, 16 NSSI individuals, and 24 controls matching the affect dysregulation levels of the NSSI group), employed psychophysiological measures of affective valence (startle-alone reactivity) and quality of information processing (prepulse inhibition), and used experimental methods involving an NSSI-proxy to model the NSSI process. Results largely were consistent with predictions, supporting the hypotheses that NSSI serves to regulate cognitive processing and affective valence. On this latter point, however, the control groups also showed a decrease in negative affective valence after the NSSI-proxy. This unexpected finding is consistent with the hypothesis that opponent processes may contribute to the development of self-injurious behaviors (Joiner, 2005). Overall, the present study represents an important extension of previous laboratory NSSI studies and provides a fertile foundation for future studies aimed at understanding why people engage in NSSI.