Anesthesiologists and Community Engagement: A Scoping Review of the Literature.

Millions of individuals require anesthesia services each year. Although anesthesia-associated mortality rates have declined, anesthetic-related morbidity remains high, particularly among vulnerable populations. Disparities in perioperative screening, optimization, surveillance, and follow-up contribute to worse outcomes in these populations. Community-engaged collaborations may be the essential ingredient needed for anesthesiologists to improve disparities in anesthetic outcomes and prioritize the needs of patients and communities. This scoping review seeks to examine the available literature on community engagement among anesthesiologists to identify gaps and seek opportunities for future work. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). OVID MEDLINE, Scopus, and Web of Science Core Collection were searched to identify sources that used or recognized community-engaged strategies and involved the work of anesthesiologists. Sources were selected based on inclusion criteria and consistent data were extracted from each paper for compilation in a data chart. The initial search generated 1230 articles of which 16 met criteria for inclusion in the review. An updated search of the literature and reference scan of included sources resulted in 7 additional articles being included. The sources were grouped according to overarching themes and methods used and ultimately categorized according to the spectrum of public participation developed by the International Association for Public Participation (IAP2). This spectrum includes 5 levels: inform, consult, involve, collaborate, and empower. This review identified 5 sources at the inform level, 8 studies in consult, 0 in involve, 7 in collaborate, and 3 in empower. Results indicate that most initiatives representing deeper levels of community engagement, at the collaborate or empower level, occur internationally. Efforts that occur in the United States tend to emphasize engagement of individual patients rather than communities. There is a need to pursue deeper, more meaningful community-engaged efforts within the field of anesthesiology at a local and national level.

Parenting measurement, normativeness, and associations with child outcomes: Comparing evidence from four non-Western cultures.

This study compared parenting across four non-Western cultures to test cross-cultural commonality and specificity principles in three aspects: measurement properties, parenting normativeness, and their associations with child outcomes. Both mothers and fathers (N = 1509 dyads) with preschool-aged children (M = 5.00 years; 48% girls) from urban areas of four countries (Malaysia, N = 372; China, N = 441; Turkey, N = 402; and Japan, N = 294) reported on four parenting constructs (authoritative, authoritarian, group harmony socialization, and intrusive control) and their sub-dimensions using modified culturally relevant measures. Teachers reported on children's internalizing, externalizing, and prosocial behaviors. The commonality principle was supported by two sets of findings: (1) full measurement invariance was established for most parenting constructs and sub-dimensions, except that intrusive control only reached partial scalar invariance, and (2) no variations were found in associations between parenting and any child outcomes across cultures or parent gender at the construct level for all four parenting constructs and at the sub-dimensional level for authoritarian and intrusive control sub-dimensions. The specificity principle was supported by the other two sets of findings: (1) cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, and (2) at the sub-dimensional level, the authoritative parenting and group harmony socialization sub-dimensions were differently associated with child outcomes across cultures and/or parent gender. The findings suggested that examining specific dimensions rather than broad parenting constructs is necessary to reflect cultural specificities and nuances. Our study provided a culturally-invariant instrument and a three-step guide for future parenting research to examine cross-cultural commonalities/specificities. RESEARCH HIGHLIGHTS: This is the first study to use an instrument with measurement invariance across multiple non-Western cultures to examine the commonality and specificity principles in parenting. Measurement invariance was achieved across cultures for authoritative and authoritarian parenting, group harmony socialization, intrusive control, and their sub-dimensions, supporting the commonality principle. Cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, supporting the specificity principle. Both commonalities and specificities were manifested in associations between parenting and child outcomes across cultures.

Marital quality over the life course and child well-being from childhood to early adolescence.

Research on marital quality and child well-being is currently limited by its common use of geographically constrained, homogenous, and often cross-sectional (or at least temporally limited) samples. We build upon previous work showing multiple trajectories of marital quality and data from the National Longitudinal Survey of Youth-1979 (NLSY79) regarding mothers and their children (inclusive of ages 5-14). We examine how indicators of child well-being are linked to parental trajectories of marital quality (happiness, communication, and conflict). Results showed children whose parents had consistently poor marital quality over the life course exhibited more internalizing and externalizing problems, poorer health, lower quality home environments, and lower math and vocabulary scores than children of parents in consistently higher-quality marriages. Group differences remained stable over time for child health, home environment, and vocabulary scores. Group differences for internalizing problems declined over time, whereas group differences increased for externalizing problems and math scores. Initial advantages for females across nearly all indicators of child well-being tended to shrink over time, with boys often moving slightly ahead by mid adolescence. We discuss the implications of these findings in regard to children's development and well-being and suggest treating marriage as a monolithic construct betrays important variation within marriage itself.

The Silence of Food Insecurity: Disconnections Between Primary Care and Community Organizations.

PURPOSE: Food insecurity is a prominent issue in the United States, and it is well established that food insecurity is linked to health and chronic illnesses. Studies show that screening for food insecurity is not yet part of standardized practice among all primary care physicians, nor are care providers comfortable with how to proceed with a patient who presents with this issue. Food insecurity is often handled by community-based organizations (CBOs) such as food pantries. Family medicine and pediatric clinics (FMPC) and CBOs hold unique relationships with their clients and can benefit from partnerships with each other to improve health in their community. The goal of this research was to better understand the connections between primary care and community organizations in addressing food insecurity. METHODS: Focus groups and key informant interviews with FMPC providers and members of local CBOs (2 food pantries) were held from 2018 to 2019. Perceptions of participants regarding food insecurity were collected and analyzed concurrently using a grounded theory approach. Focus groups were transcribed and data analyzed for theme emergence. RESULTS: A total of 39 participants took part in 4 focus groups (each with 8-10 participants) and 4 individual key informant interviews. The following themes emerged in both FMPC and CBO, in parallel yet separate ways: meaningful relationships; stigma; conversation starters; having the answers; safe spaces; and purposeful training. CONCLUSIONS: There is a disconnect between primary care and community organizations in regard to addressing food insecurity. FMPC and CBO could work together to create intentional intersections to address food insecurity and health in their shared populations.

The Manchurian candidate: chiropractors as propagators of neoliberalism in health care.

The rise of neoliberalism has influenced the health care sector, including the chiropractic profession. The neoliberal infiltration of market justice behavior is in direct conflict with the fiduciary agreement to serve the public good before self-interests and has compromised the chiropractor, who now may act as an agent of neoliberalism in health care. The purpose of this paper is to present an overview of the impact of neoliberalism on the chiropractic profession and provide recommendations for a professional philosophical shift from a market justice model to a communal and social justice model.

Incorporating Community Engagement in Primary Care Research Training: Eleven-Year Outcomes.

BACKGROUND: In response to a local workforce need for community-engaged scholars, a community-based participatory research (CBPR) curriculum was incorporated into an established primary care research fellowship. The program prepares researchers to partner with at-risk communities to address root causes and cultural, linguistic, and systems barriers that contribute to health disparities. OBJECTIVES: To describe the context, design, implementation and evaluation of the Academic Fellowship in Primary Care and Community-Engaged Research. METHODS: The traditional primary care research curriculum was enhanced with expanded enrollment, including social scientists with complementary expertise to physician fellows; a structured CBPR seminar series; involvement of fellows in mentored community-academic partnership projects with progression to independence; and relevant teaching and mentoring experiences. EVALUATION: Between 2007 and 2016, 22 fellows enrolled, with 16 in the CBPR track. Fellows demonstrated significant prepost gain in self-assessed competency in CBPR. During their 2- to 3-year training period, each CBPR fellow developed at least one community-academic partnership project, and they collectively produced more than 50 articles and 70 regional or national presentations, and mentored 29 medical student projects. Graduates have assumed leadership positions in academia, and have improved institutional capacity for community-engaged research, teaching, and practice. CONCLUSIONS: Important factors related to success and feasibility of CBPR training within a 2- to 3-year timeframe were having dedicated, experienced faculty mentors with existing authentic, trusted community partners, and dedicated funding for new community-academic partnership projects. This model can prepare primary care researchers and teachers to genuinely collaborate with vulnerable communities to address important health priorities and advance health equity.

Feasibility of using thermal response to Ka band millimeter wave heating to assess skin blood flow.

OBJECTIVE: Implementation of clinical guidelines for diagnosing peripheral artery disease will demand screening many millions of patients who are considered at-risk. This will require faster, easier screening technologies to identify patients with compromised blood flow to the extremities. APPROACH: The feasibility of using surface temperature response to Ka band (26.5-40 GHz) near-field irradiation to assess skin blood flow was explored using an animal model. Ears of domestic rabbits were subjected to low-power continuous wave radio frequency heating from an open-ended waveguide (WR-28) at f = 35 GHz. Three flow conditions were evaluated: (1) a baseline flow condition, (2) occluded flow and (3) reactive hyperemia. Surface temperatures were monitored continuously by means of an infrared thermography camera during each 2 min exposure. MAIN RESULTS: Ensemble average results showed significant differences (p < .05) at exposure times 30, 60, 90 and 120 s between baseline and occluded conditions, and between baseline and reactive hyperemia conditions. The occluded condition (N = 12) resulted in an average temperature increase of 21.4 °C ± 3.9 after 2 min, compared with an average increase of 12.1 °C ± 1.6 for baseline conditions (N = 9) and 4.7 °C ± 3.6 for post-occlusion/hyperemic conditions (N = 8). SIGNIFICANCE: Results are compared with the results of a simple two parameter mathematical model. These results suggest a method for non-invasive skin blood flow assessment to screen for peripheral artery disease and associated risk of cardiovascular events.

Children's hostile intent attributions and emotional distress: What do parents perceive?

Traditionally, assessments of social information processing and associated emotional distress have used children's self-reports. We posit that additional informants, such as parents, may help illuminate the association between these variables and aggression. Our sample was composed of 222 dual-parent families of fourth-grade children (103 boys; 119 girls). Children responded to instrumental and relational provocations and their parents read the same scenarios and responded the way they believed their child would. Peer nominations provided aggression scores. We explored how means differed by provocation type (relational vs. instrumental), informant (mother, father, and child), and gender of child. The results also suggest that parent perceptions may effectively predict children's participation in relational and physical aggression, above and beyond the child's self-reports.

Facilitating Factors and Barriers to Weight Management in Women: Physician Perspectives.

PURPOSE: The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients. METHODS: We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians who were recruited using a snowball sampling technique from two large urban institutions. Focus group discussions were transcribed verbatim. Responses were then codified and analyzed in frequency of occurrence using specialized computer software. RESULTS: Nine themes emerged from group discussions. These recurring themes reflected three overarching critical points: 1) potential utility of the primary care setting to address weight management; 2) the importance of positive patient-provider communication in supporting weight loss efforts; and 3) acknowledgement of motivation as intrinsic or extrinsic, and its role in obesity treatment. CONCLUSIONS: Physician perceptions of their own lack of education or training and their inability to influence patient behaviors play crucial roles in discussing weight management with patients.

Why Parents Seek Care for Acute Illness in the Clinic or the ED: The Role of Health Literacy.

OBJECTIVE: To explore the decision to seek care and decision-making regarding location of care among parents with low and adequate health literacy. METHODS: Parents of children 8 years old or younger who presented for 'sick child' visits at a clinic or a nonurgent emergency department (ED) visit (triage level 5) were interviewed. The Newest Vital Sign was used to categorize parental health literacy. Interviewers followed a semistructured interview guide to understand: 1) care-seeking for current illness, and 2) choice of clinic or ED. Themes emerged using a grounded theory process, facilitated by NVivo version 10.0 software (QSR International, Melbourne, Australia). Themes included the experiences of low and adequate health literacy in the clinic as well as in the ED. RESULTS: Fifty semistructured interviews were completed with parents who brought their child to the ED for a nonurgent visit (n = 30) and clinic parents (n = 20) with 56% possessing low health literacy. Parents with low health literacy were more inclined to overestimate severity of illness and seek care sooner to gain answers about the illness and treatment options, and visit the clinic only when an appointment was available within hours. Parents with adequate health literacy sought reassurance for their ongoing illness management and valued close relationships with their physician, and were willing to wait longer for an appointment. Fever, vomiting, and young child age prompted some parents to seek expedient care regardless of health literacy. CONCLUSIONS: Caregiving skills (eg, assessing and treating illness, understanding illness severity, and navigating the health care system) in addition to physician-parent relationships and perception of care seem to influence the behavior of parents managing their child's mild acute illness. These factors might be amenable to a future health literacy intervention.

Relational aggression and marital quality: A five-year longitudinal study.

Relational aggression occurs in many different contexts, including in romantic relationships. The current study examined associations between two subtypes of relational aggression (love withdrawal and social sabotage) and marital quality over a 5-year time period. Participants consisted of 311 married couples who completed a number of questionnaires on relational aggression and relationship quality once a year over a 5-year period. Results revealed that relational aggression was highly stable over time and that women used more relational aggression than men. Men's use of social sabotage and love withdrawal were bidirectionally related to both partners' perceptions of poor marital quality over time. Conversely, only women's use of love withdrawal was related to her own perceptions of poor marital quality over time. Collectively, these results suggest that relational aggression by men may be less common, though particularly toxic in a marital relationship. Couples are encouraged to find healthier ways of coping with problems in relationships. (PsycINFO Database Record

Pow! Boom! Kablam! Effects of Viewing Superhero Programs on Aggressive, Prosocial, and Defending Behaviors in Preschool Children.

Many schools and parents try to motivate children to become defenders of victimized peers. Defending behavior is common in the media (particularly in superhero programs); however, no study has examined the effect of media on defending behavior. The aim of the study was to examine longitudinal associations between superhero engagement and a variety of aggressive, prosocial, and defending behaviors in preschool children. Participants consisted of 240 preschoolers (49% male) and their parents who reported on child media use and outcomes at 2 different time points. Preschooler's engagement with superheroes was related to increased physical and relational aggression 1 year later. Engagement with superheroes was not related to prosocial or defending behaviors. Implications of the results are discussed.

Towards a practical model for community engagement: Advancing the art and science in academic health centers.

INTRODUCTION: Community engagement (CE) has become more prevalent among academic health centers (AHCs), with significant diversity in practices and language. The array of approaches to CE contributes to confusion among practitioners. METHODS: We have reviewed multiple models of CE utilized by AHCs, Clinical and Translational Science Awards, and higher education institutions overall. Taking these models into consideration, we propose a comprehensive model of CE that encompasses a broader spectrum of activities and programs. RESULTS: The CE Components Practical Model includes 5 components: Community Outreach and Service, Education, Clinical Care, Research, and Policy and Advocacy. The components are supported by the foundational elements within administrative functions and infrastructure. CONCLUSIONS: This model will accomplish the following: (1) reduce confusion about CE; (2) provide a broader understanding of CE; and (3) increase the ability of CE practitioners to interact with each other through this common reference and engage in advancing CE scholarship.

Patient perceptions of weight loss: Implications for patients, providers, and trainees.

OBJECTIVES: The prevalence of overweight and obese individuals in the United States is growing, and primary health care represents a setting in which providers may address weight with their patients. However, many providers and medical trainees feel ill-prepared to address the full scope of complexities associated with weight loss. This study sought to investigate patients' perceptions of the barriers and facilitators they encountered in their weight loss journeys. The results of the mixed-methods study will be used to inform a better understanding among providers and medical students of how to address weight loss with their patients. This study was approved by the institutional review board of Medical College of Wisconsin. METHODS: Participants were selected from patient panels at a Family Medicine Residency Program. Participants who enrolled in the study completed a survey that collected attitudes and behaviors about weight loss and demographics. The patients also participated in a 60- to 90-min guided interview. Interviews were transcribed verbatim and analyzed using open-coding techniques and principles of grounded theory. RESULTS: To date, five participants completed the study. All were female with a mean age of 52 years. Two primary themes emerged from a grounded theory model. The first theme centered on individual's knowledge, attitudes, and behaviors to lost weight. The second theme emphasized that societal relationships serve as both a barrier and a facilitator to weight loss. CONCLUSION: The overarching conclusion of this study is that individuals often have the knowledge to make positive health behaviors changes, but multiple factors may prohibit this from occurring. When a supportive environment exists, healthy behavior changes are more attainable. Physicians, mid-level providers, and medical trainees and even medical systems can provide appropriate support to join the patient on their weight loss journey.

Pretty as a Princess: Longitudinal Effects of Engagement With Disney Princesses on Gender Stereotypes, Body Esteem, and Prosocial Behavior in Children.

This study examined level of engagement with Disney Princess media/products as it relates to gender-stereotypical behavior, body esteem (i.e. body image), and prosocial behavior during early childhood. Participants consisted of 198 children (Mage  = 58 months), who were tested at two time points (approximately 1 year apart). Data consisted of parent and teacher reports, and child observations in a toy preference task. Longitudinal results revealed that Disney Princess engagement was associated with more female gender-stereotypical behavior 1 year later, even after controlling for initial levels of gender-stereotypical behavior. Parental mediation strengthened associations between princess engagement and adherence to female gender-stereotypical behavior for both girls and boys, and for body esteem and prosocial behavior for boys only.

Using group model building to understand factors that influence childhood obesity in an urban environment.

BACKGROUND: Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin. The coalition conducted a Group Model Building exercise to better understand root causes of childhood obesity in its community. METHODS: Group Model Building is a process by which a group systematically engages in model construction to better understand the systems that are in place. It helps participants make their mental models explicit through a careful and consistent process to test assumptions. This process has 3 main components: (1) assembling a team of participants; (2) conducting a behavior-over-time graphs exercise; and (3) drawing the causal loop diagram exercise. RESULTS: The behavior-over-time graph portion produced 61 graphs in 10 categories. The causal loop diagram yielded 5 major themes and 7 subthemes. CONCLUSIONS: Factors that influence childhood obesity are varied, and it is important to recognize that no single solution exists. The perspectives from this exercise provided a means to create a process for dialogue and commitment by stakeholders and partnerships to build capacity for change within the community.

Parenting, relational aggression, and borderline personality features: associations over time in a Russian longitudinal sample.

Crick, Murray-Close, and Woods (2005) encouraged the study of relational aggression as a developmental precursor to borderline personality features in children and adolescents. A longitudinal study is needed to more fully explore this association, to contrast potential associations with physical aggression, and to assess generalizability across various cultural contexts. In addition, parenting is of particular interest in the prediction of aggression or borderline personality disorder. Early aggression and parenting experiences may differ in their long-term prediction of aggression or borderline features, which may have important implications for early intervention. The currrent study incorporated a longitudinal sample of preschool children (84 boys, 84 girls) living in intact, two-parent biological households in Voronezh, Russia. Teachers provided ratings of children's relational and physical aggression in preschool. Mothers and fathers also self-reported their engagement in authoritative, authoritarian, permissive, and psychological controlling forms of parenting with their preschooler. A decade later, 70.8% of the original child participants consented to a follow-up study in which they completed self-reports of relational and physical aggression and borderline personality features. The multivariate results of this study showed that preschool relational aggression in girls predicted adolescent relational aggression. Preschool aversive parenting (i.e., authoritarian, permissive, and psychologically controlling forms) significantly predicted aggression and borderline features in adolescent females. For adolescent males, preschool authoritative parenting served as a protective factor against aggression and borderline features, whereas authoritarian parenting was a risk factor for later aggression.

Faculty perceptions of how community-engaged research is valued in tenure, promotion, and retention decisions.

PURPOSE: We assessed the perceptions of community core faculty in academic medical center institutions that received Clinical and Translational Science Awards (CTSA) about how these institutions consider community-engaged scholarship (CES) when tenure, promotion, and retention decisions are made. METHOD: An assessment tool was adapted to create an 18-item survey that was sent during November and December 2011 via the Internet to the 369 members of the community-engagement core mailing list of the CTSA. RESULTS: Fifty-nine responses were received which represented 37 of the possible 60 different funded institutions. The mean score was 48.14 (SD = 11.18); range of 23-74; and Cronbach's alpha was .91 About half reported that support for CES and its inclusion in the academic decision process increased since the institution was awarded a CTSA. Open-ended responses indicated some confusion with terminology although a definition of CES had been provided in the instrument instructions. CONCLUSION: Respondents overall agreed there was moderate support for CES in tenure, promotion, and retention decisions which may have been influenced by the CTSA application requirements. This survey could be used to identify if there are differences in institutional and departments and measure changes over time.