A Strategic Framework for Community Engagement in Oceans and Human Health.

Over the past two decades, scientific research on the connections between the health and resilience of marine ecosystems, and human health, well-being, and community prosperity has expanded and evolved into a distinct "metadiscipline" known as Oceans and Human Health (OHH), recognized by the scientific community as well as policy makers. OHH goals are diverse, and seek to improve public health outcomes, promote sustainable use of aquatic systems and resources, and strengthen community resilience. OHH research has historically included some level of community outreach and partner involvement; however, the increasing disruption of aquatic environments and urgency of public health impacts calls for a more systematic approach to effectively identify and engage with community partners to achieve project goals and outcomes. Herein, we present a strategic framework developed collaboratively by community engagement personnel from the four recently established U.S. Centers for Oceans and Human Health (COHH). This framework supports researchers in defining levels of community engagement and in aligning partners, purpose, activities, and approaches intentionally in their community engagement efforts. Specifically, we describe: (1) a framework for a range of outreach and engagement approaches; (2) the need for identifying partners, purpose, activities, and approaches; and (3) the importance of making intentional alignment among them. Misalignment across these dimensions may lead to wasting time or resources, eroding public trust, or failing to achieve intended outcomes. We illustrate the framework with examples from current COHH case studies, and conclude with future directions for strategic community engagement in OHH and other environmental health contexts.

"You Gotta Choose Your Words Carefully": Findings from Interviews with Environmental Health Scientists about Their Research Translation Perceptions and Training Needs.

Scientists are trained to communicate research in a technical manner but often lack the skills to communicate scientific findings to the general public. Effective communication and research translation are increasingly important competencies for researchers and have broader benefits to scientists and society. The aim of the study was to assess the perceptions, experiences, and training needs relative to science communication and research translation of project investigators associated with the Center for Oceans and Human Health and Climate Change Interactions at the University of South Carolina. In-depth, semi-structured interviews were conducted with the Center's investigators. Interview transcripts were coded and analyzed for emergent themes related to science communication and research translation. Investigator descriptions of their research varied in length, and researchers mentioned multiple target audiences. Most investigators preferred in-person and written communication channels and felt "comfortable" communicating uncertain findings to the public despite no formal science communication training. Investigators suggested training focused on plain language development for target communities, assessment of audience needs, and formatting research findings for various groups. Working with multiple target audiences that have preferred communication channels necessitates a comprehensive approach to science communication training to enhance two-way communication between scientists and stakeholders.

Perspectives on diet and physical activity among urban African Americans with serious mental illness.

African Americans are burdened by high rates of obesity that contribute to chronic disease and early mortality. To tailor a weight loss intervention to meet the needs of African Americans with serious mental illness, a community-based participatory research (CBPR) team comprised primarily of African Americans with serious mental illness guided qualitative research to understand factors that affect weight and interventions that may diminish obesity. Data from five focus groups (n = 55) were analyzed to better understand this group's needs. Participants voiced individual, social, and structural barriers to maintaining and achieving a healthy weight and provided perspectives on potential solutions.

Anesthetic-specific electroencephalographic patterns during emergence from sevoflurane and isoflurane in infants and children.

BACKGROUND: Devices that monitor the depth of anesthesia are increasingly used to titrate sedation and avoid awareness during anesthesia. Many of these monitors are based upon electroencephalography (EEG) collected from large adult reference populations and not pediatric populations (Anesthesiology, 86, 1997, 836; Journal of Anaesthesia, 92, 2004, 393; Anesthesiology, 99, 2003, 34). We hypothesized that EEG patterns in children would be different from those previously reported in adults and that they would show anesthetic-specific characteristics. METHODS: This prospective observational study was approved by the Institutional Review Board, and informed written consent was obtained. Patients were randomized to receive maintenance anesthesia with isoflurane or sevoflurane. EEG data collection included at least 10 min at steady-state maintenance anesthesia. The EEG was recorded continuously through emergence until after extubation. A mixed model procedure was performed on global and regional power by pooled data analysis and by analyzing each anesthetic group separately. Statistical significance was defined as P < 0.05. RESULTS: Thirty-seven children completed the study (ages 22 days-3.6 years). Isoflurane and sevoflurane had different effects on global and regional EEG power during emergence from anesthesia, and frontal predominance patterns were significantly different between these two anesthetic agents. CONCLUSIONS: The principal finding of the present study was that there are anesthetic-specific and concentration-dependent EEG effects in children. Depth-of-anesthesia monitors that utilize algorithms based on the EEGs of adult reference populations therefore may not be appropriate for use in children.

Intraoperative reported adverse events in children.

BACKGROUND: Significant intraprocedural adverse events (AE) are reported in children who receive anesthesia for procedures outside the Operating Rooms (NORA). No study, so far, has characterized AE in children who receive anesthesia in the operating rooms (ORA) and NORA when anesthesia care is provided by the same team in a consistent manner. OBJECTIVE/AIM: We used the same patient-specific Quality Assurance questionnaires (QAs), to elucidate incidences of intraoperative reported AE for children receiving anesthesia in NORA and ORA locations. Through multivariate logistic regression analysis, we assessed the association between patient's AE risk and procedure's location while adjusting for American Society of Anesthesiologists (ASA) status, age, and unscheduled nature of the procedure. METHODS/MATERIALS: After Institutional Review Board approval, we used returned QAs of patients under 21 years, who received anesthesia from our pediatric anesthesia faculty from May 1 2006 through September 30, 2007. We analyzed QA data on: service location, unscheduled/scheduled procedure, age, ASA status, presence, and type of AE. We excluded QAs with incomplete information on date, location, age, and ASA status. RESULTS: We included 8707 cases, with 3.5% incidence of reported AE. We had 1898 NORA and 6808 ORA cases with AE incidence of 2.5% and 3.7%, respectively. Multivariate regression analysis revealed that patients with higher ASA status or younger age had higher incidence of reported AE, irrespective of location or unscheduled nature of the procedure. The most common AE type, for both sites, was respiratory related (1.9%). CONCLUSIONS: Pediatric reported AE incidence was comparable for NORA and ORA locations. Younger age or higher ASA status are associated with increased risk of AE.

Basal and suppressed salivary cortisol in female Vietnam nurse veterans with and without PTSD.

It has been suggested that discrepant findings regarding low basal cortisol levels and enhanced suppression of cortisol in response to dexamethasone (DEX) administration in post-traumatic stress disorder (PTSD) may reflect individual differences in gender, trauma type, stage of development at trauma occurrence (e.g., childhood vs. adulthood), early pre-traumatic risk factors, or other individual differences. This study examined salivary cortisol levels at 08.00h and 16.00h as well as cortisol response to 0.50 mg DEX in 40 female Vietnam nurse veterans who had current, chronic PTSD (Current) vs. 43 who never had PTSD (Never). Repeated measures analyses of covariance did not reveal significant group differences in cortisol levels or cortisol suppression. Given that nurses who served in Vietnam had similar exposures, ages at exposure, and duration since exposure to previously studied male Vietnam combat veterans, the present lack of evidence for low cortisol and cortisol hyper-suppression in nurses with PTSD suggests that previous findings of low cortisol and cortisol hyper-suppression in male Vietnam veterans, females sexually abused as children, and other populations may reflect risk factors beyond simply having PTSD.

Physiologic reactivity to startling tones in female Vietnam nurse veterans with PTSD.

Posttraumatic stress disorder (PTSD) is associated with larger heart rate (HR), skin conductance (SC), and eyeblink responses to sudden, loud tones. The present study tested this association in female nurse veterans with PTSD related to witnessing patients' death, severe injury and/or suffering during their Vietnam service. Nurses with current, past but not current, or who never had PTSD listened to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with sudden onsets, while HR, SC, and eyeblink responses were measured. Nurses with current PTSD produced significantly larger averaged HR, but not SC or eyeblink responses across tone trials. A larger HR response to loud tones is one of the most robust physiologic findings in PTSD and may reflect increased defensive responding.

PTSD arousal and depression symptoms associated with increased right-sided parietal EEG asymmetry.

Researchers have proposed that depression and particular types of anxiety are associated with unique patterns of regional brain activation. The authors examined the relationship among posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms and frontal, temporal, and parietal EEG alpha asymmetry in female Vietnam War nurse veterans. The results indicate that PTSD arousal symptoms are associated with increased right-sided parietal activation. However, the combination of arousal, depression, and their interaction explain more than twice the variance in parietal asymmetry compared with arousal alone. The results support the contention that the association between anxiety and right-sided posterior activation is specific to the anxious arousal subtype. These findings underscore the importance of isolating, both theoretically and statistically, emotional subcomponents in studies of regional brain activation.

Regional cerebral blood flow in the amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans with PTSD.

CONTEXT: Theoretical neuroanatomic models of posttraumatic stress disorder (PTSD) and the results of previous neuroimaging studies of PTSD highlight the potential importance of the amygdala and medial prefrontal regions in this disorder. However, the functional relationship between these brain regions in PTSD has not been directly examined. OBJECTIVE: To examine the relationship between the amygdala and medial prefrontal regions during symptom provocation in male combat veterans (MCVs) and female nurse veterans (FNVs) with PTSD. DESIGN: Case-control study. SETTING: Academic medical center. PARTICIPANTS: Volunteer sample of 17 (7 men and 10 women) Vietnam veterans with PTSD (PTSD group) and 19 (9 men and 10 women) Vietnam veterans without PTSD (control group). MAIN OUTCOME MEASURES: We used positron emission tomography and the script-driven imagery paradigm to study regional cerebral blood flow (rCBF) during the recollection of personal traumatic and neutral events. Psychophysiologic and emotional self-report data also were obtained to confirm the intended effects of script-driven imagery. RESULTS: The PTSD group exhibited rCBF decreases in medial frontal gyrus in the traumatic vs neutral comparison. When this comparison was conducted separately by subgroup, MCVs and FNVs with PTSD exhibited these medial frontal gyrus decreases. Only MCVs exhibited rCBF increases in the left amygdala. However, for both subgroups with PTSD, rCBF changes in medial frontal gyrus were inversely correlated with rCBF changes in the left amygdala and the right amygdala/periamygdaloid cortex. Furthermore, in the traumatic condition, for both subgroups with PTSD, symptom severity was positively related to rCBF in the right amygdala and negatively related to rCBF in medial frontal gyrus. CONCLUSIONS: These results suggest a reciprocal relationship between medial prefrontal cortex and amygdala function in PTSD and opposing associations between activity in these regions and symptom severity consistent with current functional neuroanatomic models of this disorder.

Selectively reduced regional cortical volumes in post-traumatic stress disorder.

Different subterritories of anterior cingulate cortex (ACC) and adjacent ventromedial frontal cortex have been shown to serve distinct functions. This scheme has influenced contemporary pathophysiologic models of psychiatric disorders. Prevailing neurocircuitry models of post-traumatic stress disorder (PTSD) implicate dysfunction within pregenual ACC and subcallosal cortex (SC), as well as amygdala and hippocampus. In the current study, cortical parcellation of magnetic resonance imaging data was performed to test for volumetric differences in pregenual ACC and SC, between women with PTSD and trauma-exposed women without PTSD. The PTSD group exhibited selectively decreased pregenual ACC and SC volumes. These results are consistent with contemporary schemes regarding functional and structural dissection of frontal cortex, and suggest specific regional cortical pathology in PTSD.

Event-related potentials to auditory stimuli in female Vietnam nurse veterans with posttraumatic stress disorder.

Individuals with posttraumatic stress disorder (PTSD) have been found to show several event-related brain potential (ERP) abnormalities including reduced target P3b amplitude, P50 suppression, and P2 amplitude/intensity slope. Female Vietnam nurse veterans with (n = 29) and without (n = 38) current PTSD completed P50 paired-click, three-tone "oddball" and four-tone stimulus-intensity modulation procedures. Opposite to previous findings, the current PTSD group had larger target P3b amplitudes and increased P2 amplitude/intensity slopes. Reduced P50 suppression was associated with increased severity of general psychopathology, but not with PTSD diagnosis. Findings suggest that target P3b amplitude and P2 amplitude/intensity slope abnormalities reflect different pathophysiological processes. Future research is needed to determine whether the opposite ERP abnormalities observed in this PTSD sample reflect gender-, trauma-, or sample-specific findings.

Absence of selected neurological soft signs in Vietnam nurse veterans with post-traumatic stress disorder.

This study examined eight neurological soft signs (NSSs), which had previously proved successful in discriminating medication-free post-traumatic stress disorder (PTSD) from non-PTSD combat veterans and sexually abused women, in 82 unmedicated female nurse Vietnam veterans, 32 with and 50 without PTSD. The increased NSSs observed in the previously studied PTSD samples were not found in the nurses with PTSD. The results fail to support the hypothesis that the stress of a traumatic event and/or resultant PTSD damages the nervous system.