Association Between Lack of Access to a Neighborhood Park and High Blood Pressure in the Philadelphia Metropolitan Area.

INTRODUCTION: Studies have shown a lower risk of high blood pressure (HBP) among people who live near parks; however, little information exists on how feeling safe and comfortable visiting the park affects blood pressure. We identified associations between neighborhood park access, comfort visiting a park, and HBP to understand how these factors may contribute to disparities in HBP prevalence. METHODS: The 2018 Southeastern Pennsylvania Household Health Survey of 3,600 residents in the Philadelphia metropolitan area asked if respondents had ever been told they had HBP and whether they had a neighborhood park or outdoor space that they were comfortable visiting during the day. To assess the association between park access and HBP, we built multilevel logistic models to account for variation in HBP by zip code. We examined the effect modification of perceptions of park access (having a neighborhood park, not having a neighborhood park, or having a neighborhood park but not comfortable visiting it) and HBP by race, education, and poverty status. RESULTS: Both not having a neighborhood park and having a park but not feeling comfortable visiting it were associated with higher unadjusted odds of HBP, 70% and 90%, respectively, compared with having a neighborhood park. Adjusted odds ratios for the lack-of-park responses remained significant (no neighborhood park, adjusted odds ratio [aOR] = 1.4; 95% CI, 1.1-1.7; neighborhood park but not comfortable visiting, aOR = 1.4; 95% CI, 1.03-2.0). A significant gradient was observed for Black respondents compared with White respondents with odds of HBP increasing by perceptions of park access (aOR = 1.95 for people with a park; aOR = 2.69 for those with no park; aOR = 3.5 for people with a park that they are not comfortable visiting). CONCLUSION: Even accounting for other risk factors for HBP, not having a neighborhood park or not feeling comfortable visiting one may influence individual HBP. Neighborhood factors that deter park access may contribute to racial disparities in HBP.

Measurement of social norms for entertainment-education.

BACKGROUND: While there has been a marked increase in measurement and scholarship surrounding social norms in recent years, there is little evidence related to social norms measurement in the context of health campaigns utilizing entertainment-education. Entertainment-education goals and objectives have shifted over time to include social norms and an update is needed to merge contemporary practice with the most recent measures from the literature. The aim of the present study was to analyze commonly used quantitative measures and their properties for social norms and entertainment-education, specifically on the topic of family planning, to bolster ongoing research and practice efforts by validating items for social norms measurement in entertainment-education programs. METHODS: The study used data from a survey conducted with 438 married women aged 19-34 in the Central Province of Zambia in 2019 who were exposed to the entertainment-education initiative Kwishilya (Over the Horizon), a Bemba-language, 156-episode radio program designed to shift social norms on family planning. Multiple items were included to measure descriptive norms, injunctive norms, and outcome expectations. Exploratory factor analysis and estimates of scale reliability were conducted to understand the properties and structure of the social norms items. RESULTS: Results showed a five-factor solution best fit the data, which accounted for 45.7% of the variance, exhibited fair reliability, and loaded largely as expected. CONCLUSIONS: This study provides a useful tool for practitioners and scholars to use globally to measure important social norms constructs in entertainment-education.

Semantic Memory and Creativity: The Costs and Benefits of Semantic Memory Structure in Generating Original Ideas.

Despite its theoretical importance, little is known about how semantic memory structure facilitates and constrains creative idea production. We examine whether the semantic richness of a concept has both benefits and costs to creative idea production. Specifically, we tested whether cue set-size-an index of semantic richness reflecting the average number of elements associated with a given concept-impacts the quantity (fluency) and quality (originality) of responses generated during the alternate uses task (AUT). Across four studies, we show that low-association, sparse, AUT cues benefit originality at the cost of fluency compared to high-association, rich, AUT cues. Furthermore, we found an interaction with individual differences in fluid intelligence in the low-association AUT cues, suggesting that constraints of sparse semantic knowledge can be overcome with top-down intervention. The findings indicate that semantic richness differentially impacts the quality and quantity of generated ideas, and that cognitive control processes can facilitate idea production when conceptual knowledge is limited.

Sorting through life: evaluating patient-important measures of success in a medication for opioid use disorder (MOUD) treatment program.

BACKGROUND: Medication for opioid use disorder (MOUD) is the gold standard treatment for opioid use disorder. Traditionally, "success" in MOUD treatment is measured in terms of program retention, adherence to MOUD, and abstinence from opioid and other drug use. While clinically meaningful, these metrics may overlook other aspects of the lives of people with opioid use disorder (OUD) and surprisingly do not reflect the diagnostic criteria for OUD. METHODS: Authors identified items for a pilesorting task to identify participant-driven measures of MOUD treatment success through semi-structured interviews. Interviews were transcribed verbatim and coded in Nvivo using directed and conventional content analysis to identify measures related to treatment success and quality of life goals. Participants of a low-threshold MOUD program were recruited and asked to rank identified measures in order of importance to their own lives. Multidimensional scaling (MDS) compared the similarity of items while non-metric MDS in R specified a two-dimensional solution. Descriptive statistics of participant demographics were generated in SPSS. RESULTS: Sixteen semi-structured interviews were conducted between June and August 2020 in Philadelphia, PA, USA, and 23 measures were identified for a pilesorting activity. These were combined with 6 traditional measures for a total list of 29 items. Data from 28 people were included in pilesorting analysis. Participants identified a combination of traditional and stakeholder-defined recovery goals as highly important, however, we identified discrepancies between the most frequent and highest ranked items within the importance categories. Measures of success for participants in MOUD programs were complex, multi-dimensional, and varied by the individual. However, some key domains such as emotional well-being, decreased drug use, and attendance to basic functioning may have universal importance. The following clusters of importance were identified: emotional well-being, decreased drug use, and human functioning. CONCLUSIONS: Outcomes from this research have practical applications for those working to provide services in MOUD programs. Programs can use aspects of these domains to both provide patient-centered care and to evaluate success. Specifics from the pilesorting results may also inform approaches to collaborative goal setting during treatment.

Rasch analysis of the Jefferson Teamwork Observation Guide to improve student reflection after interprofessional education.

Interprofessional education is expanding and emerging as a focus of health profession education. The development of instruments to identify competency of students is needed to improve interprofessional collaboration in patient care. Our purpose was to investigate the individual Jefferson Teamwork Observation Guide (JTOG) to determine its psychometric properties. Health profession student data (814 surveys) were analyzed using Rasch Modeling to determine the item and person statistics, unidimensionality, scaling performance, and local independence. The psychometric properties of the instrument were strong, but the current model produced a significant ceiling effect. Adaptations to the instrument were recommended to improve the instruments ability to identify competency and provide individual feedback on performance using a Rasch model. The adapted JTOG has strong psychometric properties to help facilitate reflection and to promote collaborative practice competency.

Patient-centered simulation: Practicing interprofessional teamwork with standardized patients.

The simulation environment provides opportunities for students to practice interprofessional skills in an authentic, yet safe setting. We discuss an interprofessional learning activity called Team Care Planning designed to teach interprofessional teamwork using a simulated discharge meeting involving an elderly female patient who had a cerebral vascular accident (stroke) and her adult daughter, played by standardized patients Interprofessional teams of health professions students work together to discuss the discharge plan and meet with the patient/family. Teamwork is evaluated using the Jefferson Teamwork Observation Guide®, completed by the students, faculty observers, and standardized patients. Students also report their perception of knowledge and skills gained from the interprofessional activity in an electronic evaluation. Analysis of the data indicates the initial goals of the program are being met. Students report greater understanding of roles/responsibilities of team members; and students, faculty, and standardized patients rate the experience high in terms of the quality of the teamwork. Debriefing with faculty observers promotes student reflection on performance. Receiving feedback from the standardized patients informs student personal and professional development.

The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample.

Within the United States (US), 2.4 million individuals are living with chronic hepatitis B, but less than 20% are diagnosed. Isolated anti-hepatitis B core (iAHBc) antibodies indicate serology in an individual that is positive for anti-HBc antibodies, while negative for surface antigen (HBsAg) and surface antibodies (anti-HBs). A result of iAHBc could indicate a chronic occult bloodstream infection, necessitating further testing. This study assesses the prevalence and risk factors associated with anti-HBc and iAHBc within community high-risk screening in Greater Philadelphia. Participants (n = 177) were screened for HBsAg, anti-HBs, and anti-HBc during community screening events in 2022. Chi-square tables and Firth logistic regression were used to describe the data and to assess the odds of iAHBc. The findings indicate that there was an iAHBc prevalence of 7.3% (n = 13) within our study. The odds of anti-HBc were increased for immigrants from the Western Pacific (4.5%) and Africa (11.9%). Individuals born in Africa had 7.93 greater odds for iAHBc than those born in the Americas, and these odds are multiplied by 1.01 for every 1-year increase in age. Our data show a high burden of iAHBc within high-risk and often hard-to-reach communities. Triple panel screening should be incorporated into all HBV screening programs, in accordance with current Centers for Disease Control and Prevention (CDC) universal screening recommendations, to ensure a comprehensive picture of the disease burden and reduce the risk of missing people with occult hepatitis B and those at risk for viral reactivation or liver complications.

Trauma-informed interprofessional education: Preliminary evaluation of building student capacity for system-wide collaboration.

INTRODUCTION: In urban areas, numerous barriers exist for children and families to access needed behavioral health care. Compounding the general deficit of behavioral health workers in the United States is lack of access to culturally responsive care. Additional challenges include inherent racism and oppression in our health and human service systems and siloed approaches to behavioral health care training and practice. Integrated care is an emerging field nationally, yet training and education in integrated care is limited. This article provides an overview of the Child/Adolescent Interprofessional Practice and Education (CAIPE) program, a novel training approach in its first year of implementation for behavioral health students that prioritizes trauma-informed and social-justice oriented practice, integrated care, and interprofessional teamwork. METHOD: This study employs a mixed-methods approach to program evaluation. Data sources include program application materials (demographics and data related to clinical interests, student goals, and preparedness for interprofessional work). Data is also drawn from measures of student outcomes (self-efficacy navigating complex care patients, empathy, and complex care knowledge). RESULTS: Baseline data are reported for demographics, students' goals and interprofessional interests, and student outcomes. Information is also presented relevant to trainings conducted in the grant's first year and planned for subsequent years. Preliminary data and implementation suggest that the program has drawn diverse trainees who are committed to interprofessional, integrated care for underserved youth. DISCUSSION: Recruitment and program development challenges are discussed, along with grant goals' fit with students' interests and plans for future evaluation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Measuring interprofessional education and collaborative practice competencies: a content validity study of the Jefferson Teamwork Observation Guide®.

Collaborative practice (CP) is integral in meeting the Quadruple Aim of healthcare, with effective team-based practice linked to improving all four components. Evidence of the validity of tools measuring collaborative practice competencies is lacking in educational and practice settings. The Jefferson Teamwork Observation Guide® (JTOG®), a real-time, 360-degree competency-based assessment tool administered via mobile app, provides formative feedback to learners in educational settings and helps practitioners develop and refine team-based behaviors in clinical settings. This study examines content validity evidence in terms of the linkage of JTOG items with the four Interprofessional Education Collaborative (IPEC) core competencies, along with two additional domains of leadership and patient-centeredness. Results provide content validity evidence to support use of the JTOG in interprofessional collaborative practice (IPCP) settings. The Teams and Teamwork competency was linked with every item, which is consistent with JTOG as a measure of teamwork. Aligning with the 2016 IPEC update, the JTOG items are all intercorrelated and together represent coverage across all competency areas. While items were typically linked to multiple competencies, each item only had one primary linkage. Analyses revealed that there is sufficient evidence of content validity relative to the intended IPCP competencies, and the JTOG tool is promising in its role to fill a gap in extant literature to measure collaborative practice behaviors.

Evaluation of an Interprofessional Team Training Program to Improve the Use of Patient Safety Strategies Among Healthcare Professions Students.

PURPOSE: To assess whether our introductory TeamSAFE (Team Simulation and Fearlessness in Education) program improved student knowledge of effective teamwork skills; impacted their perception of their own teamwork skills and preparedness for teamwork in clinical practice; and augmented their understanding of the roles and responsibilities of different healthcare team members. METHODS: Students completed an online learning module, then attended a simulation-based workshop to practice patient safety and teamwork skills. A pre-post-test design was used to assess knowledge of TeamSTEPPS® concepts and perception of teamwork skills among 959 students from 7 health professions. We conducted a qualitative analysis of student responses to open-ended questions about their perceptions of teamwork skills. RESULTS: Qualitative analysis revealed three themes: 1) put patients first; 2) recognize that the whole is greater than the sum of its parts; and 3) embrace the unknown. Quantitative analysis suggested that students gained knowledge from the workshop. Item analysis using item response theory showed that items have difficulty and discrimination in the lower range. CONCLUSION: Findings suggest that the workshop was effective in improving knowledge of teamwork skills, improving student self-perception of teamwork skills and practice readiness, increasing understanding of the roles and responsibilities of students from different health professions, and understanding the importance of patient safety.

Self-efficacy and empathy development through interprofessional student hotspotting.

In the United States, similar to other high-income countries, patients with complex health and social needs comprise a disproportionate amount of healthcare costs. Despite their frequent inpatient and emergency room usage, these patients receive ineffective care for their medical, social and behavioral needs, which often result from social determinants of health (SDoH). As the international dialogue on the importance of SDoH on health outcomes peaks, innovative strategies for teaching learners how to deliver care to patients with complex health and social needs has emerged as a top priority for health professions training programs. Student hotspotting, in which interprofessional student teams provide personalized, hands-on, intensive team-based interventions largely targeting the SDoH to patients with complex health and social needs, is one such program. We conducted a 7-month pilot study to explore whether students who participated in student hotspotting experienced an increase in their knowledge of, comfort working with, and empathy toward medically and socially complex patients. Preliminary results indicate that student participants exhibit greater self-efficacy and empathy than a control group of nonparticipating students, with the gap in the latter widening over time. While further study is warranted given limitations in the sample size and from attrition, this pilot study suggests that student hotspotting may be an effective way to better prepare our healthcare workforce to provide patient-centered, team-based care to patients with complex health and social needs and to reduce healthcare expenditures.

Use or Consequences: Probing the Cognitive Difference Between Two Measures of Divergent Thinking.

Recent studies have highlighted both similarities and differences between the cognitive processing that underpins memory retrieval and that which underpins creative thinking. To date, studies have focused more heavily on the Alternative Uses task, but fewer studies have investigated the processing underpinning other idea generation tasks. This study examines both Alternative Uses and Consequences idea generation with a methods pulled from cognitive psychology, and a novel method for evaluating the creativity of such responses. Participants were recruited from Amazon Mechanical Turk using a custom interface allowing for requisite experimental control. Results showed that both Alternative Uses and Consequences generation are well approximated by an exponential cumulative response time model, consistent with studies of memory retrieval. Participants were also slower to generate their first consequence compared with first responses to Alternative Uses, but inter-response time was negatively related to pairwise similarity on both tasks. Finally, the serial order effect is exhibited for both tasks, with Consequences earning more creative evaluations than Uses. The results have implications for burgeoning neuroscience research on creative thinking, and suggestions are made for future areas of inquiry. In addition, the experimental apparatus described provides an equitable way for researchers to obtain good quality cognitive data for divergent thinking tasks.

On the Dependability and Feasibility of Layperson Ratings of Divergent Thinking.

A new system for subjective rating of responses to divergent thinking tasks was tested using raters recruited from Amazon Mechanical Turk. The rationale for the study was to determine if such raters could provide reliable (aka generalizable) ratings from the perspective of generalizability theory. To promote reliability across the Alternative Uses and Consequence task prompts often used by researchers as measures of Divergent Thinking, two parallel scales were developed to facilitate feasibility and validity of ratings performed by laypeople. Generalizability and dependability studies were conducted separately for two scoring systems: the average-rating system and the snapshot system. Results showed that it is difficult to achieve adequate reliability using the snapshot system, while good reliability can be achieved on both task families using the average-rating system and a specific number of items and raters. Additionally, the construct validity of the average-rating system is generally good, with less validity for certain Consequences items. Recommendations for researchers wishing to adopt the new scales are discussed, along with broader issues of generalizability of subjective creativity ratings.

Semantic search during divergent thinking.

Divergent thinking, as a method of examining creative cognition, has not been adequately analyzed in the context of modern cognitive theories. This article casts divergent thinking responding in the context of theories of memory search. First, it was argued that divergent thinking tasks are similar to semantic fluency tasks, but are more constrained, and less well structured. Next, response time distributions from 54 participants were analyzed for temporal and semantic clustering. Participants responded to two prompts from the alternative uses test: uses for a brick and uses for a bottle, for two minutes each. Participants' cumulative response curves were negatively accelerating, in line with theories of search of associative memory. However, results of analyses of semantic and temporal clustering suggested that clustering is less evident in alternative uses responding compared to semantic fluency tasks. This suggests either that divergent thinking responding does not involve an exhaustive search through a clustered memory trace, but rather that the process is more exploratory, yielding fewer overall responses that tend to drift away from close associates of the divergent thinking prompt.

Tracking the dynamics of divergent thinking via semantic distance: Analytic methods and theoretical implications.

Divergent thinking has often been used as a proxy measure of creative thinking, but this practice lacks a foundation in modern cognitive psychological theory. This article addresses several issues with the classic divergent-thinking methodology and presents a new theoretical and methodological framework for cognitive divergent-thinking studies. A secondary analysis of a large dataset of divergent-thinking responses is presented. Latent semantic analysis was used to examine the potential changes in semantic distance between responses and the concept represented by the divergent-thinking prompt across successive response iterations. The results of linear growth modeling showed that although there is some linear increase in semantic distance across response iterations, participants high in fluid intelligence tended to give more distant initial responses than those with lower fluid intelligence. Additional analyses showed that the semantic distance of responses significantly predicted the average creativity rating given to the response, with significant variation in average levels of creativity across participants. Finally, semantic distance does not seem to be related to participants' choices of their own most creative responses. Implications for cognitive theories of creativity are discussed, along with the limitations of the methodology and directions for future research.

Selective and nonselective serotonin antagonists block the aversive stimulus properties of MK212 and m-chlorophenylpiperazine (mCPP) in mice.

Serotonin(2C) (5-HT(2C)) receptors have been implicated to treat mood disorders such as depression and anxiety. In the present study, the capacities of two 5-HT(2C) agonists, MK212 and mCPP, to produce conditioned taste aversions in mice were evaluated. On two training days, Swiss-Webster male mice (19-34g) were trained to associate the flavor of a novel solution with the injection of various doses of MK212 or mCPP. On two alternate training days, mice were trained to associate a different flavored solution with an injection of saline. For testing, both flavored solutions were presented simultaneously and an avoidance of the MK212 or mCPP-paired solution indicated conditioned taste aversion. Robust conditioned taste aversions were observed to solutions paired with 1.0 or 10mg/kg MK212 or mCPP. Acquisition of conditioned taste aversions was blocked by nonselective serotonin antagonists cyproheptadine, bromo-LSD, metergoline, methysergide and mianserin. Selective 5-HT(2B/2C) antagonist SB206,553 blocked both MK212- and mCPP-induced conditioned taste aversion although selective 5-HT(2B/2C) antagonist SB200,646 only blocked mCPP-induced conditioned taste aversion. In a single-bottle procedure, MK212, bromo-LSD, and mianserin failed to alter acquisition rate of a LiCl-induced conditioned taste aversion. Taken together, these data indicate that the serotonin agonists MK212 and mCPP produce conditioned taste aversion and that these effects are mediated predominantly through 5-HT(2C) receptors.