Community Health Improvement and the Community Psychology Competencies

Community health improvement initiatives are strongly influenced by the local context in which they take place. Community coalitions of diverse stakeholders are expected to determine the needs of their population of interest, select an appropriate strategy, implement with quality, and evaluate for effectiveness. Many public health initiatives look toward behavioral scientists with experience in collaborating with community members. The competencies that community psychologists possess make them particularly useful contributors in these initiatives, especially when the projects explicitly focus on increasing health equity. This paper describes how community psychologists can contribute to community health improvement work by sharing our experiences in the Spreading Community Accelerators through Learning and Evaluation (SCALE) initiative funded by the Robert Wood Johnson Foundation. As part of SCALE, community coalitions are expected to develop appropriate aims and corresponding driver diagrams as well as implement quality improvement projects to help reach those aims. We demonstrate how community psychologists operationalize SCALE by working with communities of color in three distinct settings with different contextual factors: the Proviso Partners for Health (Chicago, IL), Boston Medical Center’s Vital Village Network (Boston, MA), and the San Gabriel Valley Healthy Cities Collaborative (Los Angeles, CA). We also describe how community psychologists contribute to the formative evaluation of the entire SCALE project. We note that specific community psychology competencies are applicable across diverse settings in community health improvement work. Consequently, community psychologists can contribute significantly to improving community health and advancing health equity

Community Health Improvement and the Community Psychology Competencies

Community health improvement initiatives are strongly influenced by the local context in which they take place. Community coalitions of diverse stakeholders are expected to determine the needs of their population of interest, select an appropriate strategy, implement with quality, and evaluate for effectiveness. Many public health initiatives look toward behavioral scientists with experience in collaborating with community members. The competencies that community psychologists possess make them particularly useful contributors in these initiatives, especially when the projects explicitly focus on increasing health equity. This paper describes how community psychologists can contribute to community health improvement work by sharing our experiences in the Spreading Community Accelerators through Learning and Evaluation (SCALE) initiative funded by the Robert Wood Johnson Foundation. As part of SCALE, community coalitions are expected to develop appropriate aims and corresponding driver diagrams as well as implement quality improvement projects to help reach those aims. We demonstrate how community psychologists operationalize SCALE by working with communities of color in three distinct settings with different contextual factors: the Proviso Partners for Health (Chicago, IL), Boston Medical Center’s Vital Village Network (Boston, MA), and the San Gabriel Valley Healthy Cities Collaborative (Los Angeles, CA). We also describe how community psychologists contribute to the formative evaluation of the entire SCALE project. We note that specific community psychology competencies are applicable across diverse settings in community health improvement work. Consequently, community psychologists can contribute significantly to improving community health and advancing health equity

Positive psychosocial factors and the development of symptoms of depression and posttraumatic stress symptoms following acute myocardial infarction

Introduction: Acute myocardial infarction (MI) is a potentially fatal condition, leading to high psychological distress and possibly resulting in the development of depressive symptoms and posttraumatic stress symptoms (PTSS). The aim of this study was to investigate the association of clusters of positive psychosocial factors (resilience, task-oriented coping, positive affect and social support) with both MI-induced depressive symptoms and PTSS, independent of demographic factors. Methods: We investigated 154 consecutive patients with MI, 3 and 12 months after hospital discharge. All patients completed the short version of the German Resilience Scale, the Coping Inventory for Stressful Situations (CISS), the Enriched Social Support Inventory (ESSI) and the Global Mood Scale (GMS). The level of interviewer-rated MI-induced posttraumatic stress disorder (PTSD) symptoms at 3- and 12-months follow-up was evaluated through the Clinician-Administered PTSD Scale (CAPS). Depressive symptoms were assessed at 3- and 12-month follow-up with the Beck Depression Inventory (BDI-II). Results: Three different clusters were revealed: (1) lonely cluster: lowest social support, resilience and average task-oriented coping and positive affect; (2) low risk cluster: highest resilience, task-oriented coping, positive affect and social support; (3) avoidant cluster: lowest task-oriented coping, positive affect, average resilience and social support. The clusters differed in depressive symptoms at 3 months (F = 5.10; p < 0.01) and 12 months follow-up (F = 7.56; p < 0.01). Cluster differences in PTSS were significant at 3 months (F = 4.78, p < 0.05) and 12 months (F = 5.57, p < 0.01) follow-up. Differences in PTSS subscales were found for avoidance (F = 4.8, p < 0.05) and hyperarousal (F = 5.63, p < 0.05), but not re-experiencing, at 3 months follow-up. At 12 months follow-up, cluster differences were significant for re-experiencing (F = 6.44, p < 0.01) and avoidance (F = 4.02, p < 0.05) but not hyperarousal. Discussion: The present study contributes to a better understanding of the relationships among different positive psychosocial factors, depressive symptoms and PTSS following acute MI. Future interventions may benefit from taking into account positive psychosocial factors to potentially reduce patients’ depressive symptoms and PTSS after MI

Longitudinal association between positive affect and blood lipids in patients following acute myocardial infarction.

OBJECTIVE Unfavorable blood lipid profiles are robust risk factors in predicting atherosclerotic disease. Studies have shown that positive affect (PA) is associated with a favorable lipid profile. However, longitudinal studies regarding the course of PA and lipid profiles in myocardial infarction (MI) patients are lacking. Therefore, the aim of this study was to prospectively explore the association between PA and blood lipid levels across three inv estigations over 12 months following acute MI. METHODS Patients following an acute MI were examined at hospital admission (n = 190), and at 3 months (n = 154) and 12 months (n = 106) thereafter. Linear mixed effect regression models were used to evaluate the relation between PA, assessed with the Global Mood Scale, and blood lipid levels. Potential confounding variables were controlled for in the analysis. RESULTS Higher PA was significantly associated with higher high-density lipoprotein cholesterol (HDL-C) levels and a lower total cholesterol (TC)/HDL-C ratio over time, independent of demographic factors, indices of cardiac disease severity, comorbidity, medication use, health behaviors, serum cortisol and negative affect (p≤0.040). No association was found between PA and the two blood lipids low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG). CONCLUSIONS Positive affect was independently associated with HDL-C levels and the TC/HDL-C ratio in patients up to 1 year after MI. The findings support a potential role of PA for cardiovascular health through an association with a favorable blood lipid profile

Positive psychosocial factors and the development of symptoms of depression and posttraumatic stress symptoms following acute myocardial infarction.

INTRODUCTION Acute myocardial infarction (MI) is a potentially fatal condition, leading to high psychological distress and possibly resulting in the development of depressive symptoms and posttraumatic stress symptoms (PTSS). The aim of this study was to investigate the association of clusters of positive psychosocial factors (resilience, task-oriented coping, positive affect and social support) with both MI-induced depressive symptoms and PTSS, independent of demographic factors. METHODS We investigated 154 consecutive patients with MI, 3 and 12 months after hospital discharge. All patients completed the short version of the German Resilience Scale, the Coping Inventory for Stressful Situations (CISS), the Enriched Social Support Inventory (ESSI) and the Global Mood Scale (GMS). The level of interviewer-rated MI-induced posttraumatic stress disorder (PTSD) symptoms at 3- and 12-months follow-up was evaluated through the Clinician-Administered PTSD Scale (CAPS). Depressive symptoms were assessed at 3- and 12-month follow-up with the Beck Depression Inventory (BDI-II). RESULTS Three different clusters were revealed: (1) lonely cluster: lowest social support, resilience and average task-oriented coping and positive affect; (2) low risk cluster: highest resilience, task-oriented coping, positive affect and social support; (3) avoidant cluster: lowest task-oriented coping, positive affect, average resilience and social support. The clusters differed in depressive symptoms at 3 months (F = 5.10; p < 0.01) and 12 months follow-up (F = 7.56; p < 0.01). Cluster differences in PTSS were significant at 3 months (F = 4.78, p < 0.05) and 12 months (F = 5.57, p < 0.01) follow-up. Differences in PTSS subscales were found for avoidance (F = 4.8, p < 0.05) and hyperarousal (F = 5.63, p < 0.05), but not re-experiencing, at 3 months follow-up. At 12 months follow-up, cluster differences were significant for re-experiencing (F = 6.44, p < 0.01) and avoidance (F = 4.02, p < 0.05) but not hyperarousal. DISCUSSION The present study contributes to a better understanding of the relationships among different positive psychosocial factors, depressive symptoms and PTSS following acute MI. Future interventions may benefit from taking into account positive psychosocial factors to potentially reduce patients' depressive symptoms and PTSS after MI

Longitudinal association between positive affect and blood lipids in patients following acute myocardial infarction

Objective: Unfavorable blood lipid profiles are robust risk factors in predicting atherosclerotic disease. Studies have shown that positive affect (PA) is associated with a favorable lipid profile. However, longitudinal studies regarding the course of PA and lipid profiles in myocardial infarction (MI) patients are lacking. Therefore, the aim of this study was to prospectively explore the association between PA and blood lipid levels across three inv estigations over 12 months following acute MI. Methods: Patients following an acute MI were examined at hospital admission (n = 190), and at 3 months (n = 154) and 12 months (n = 106) thereafter. Linear mixed effect regression models were used to evaluate the relation between PA, assessed with the Global Mood Scale, and blood lipid levels. Potential confounding variables were controlled for in the analysis. Results: Higher PA was significantly associated with higher high-density lipoprotein cholesterol (HDL-C) levels and a lower total cholesterol (TC)/HDL-C ratio over time, independent of demographic factors, indices of cardiac disease severity, comorbidity, medication use, health behaviors, serum cortisol and negative affect (p≤0.040). No association was found between PA and the two blood lipids low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG). Conclusions: Positive affect was independently associated with HDL-C levels and the TC/HDL-C ratio in patients up to 1 year after MI. The findings support a potential role of PA for cardiovascular health through an association with a favorable blood lipid profile

Climate change affects vegetation differently on siliceous and calcareous summits of the European Alps

The alpine life zone is expected to undergo major changes with ongoing climate change. While an increase of plant species richness on mountain summits has generally been found, competitive displacement may result in the long term. Here, we explore how species richness and surface cover types (vascular plants, litter, bare ground, scree and rock) changed over time on different bedrocks on summits of the European Alps. We focus on how species richness and turnover (new and lost species) depended on the density of existing vegetation, namely vascular plant cover. We analyzed permanent plots (1 x 1 m) in each cardinal direction on 24 summits (24 x 4 x 4), with always four summits distributed along elevation gradients in each of six regions (three siliceous, three calcareous) across the European Alps. Mean summer temperatures derived from downscaled climate data increased synchronously over the past 30 years in all six regions. During the investigated 14 years, vascular plant cover decreased on siliceous bedrock, coupled with an increase in litter, and it marginally increased on higher calcareous summits. Species richness showed a unimodal relationship with vascular plant cover. Richness increased over time on siliceous bedrock but slightly decreased on calcareous bedrock due to losses in plots with high plant cover. Our analyses suggest contrasting and complex processes on siliceous versus calcareous summits in the European Alps. The unimodal richness-cover relationship and species losses at high plant cover suggest competition as a driver for vegetation change on alpine summits

Drivers of amphibian population dynamics and asynchrony at local and regional scales

Identifying the drivers of population fluctuations in spatially distinct populations remains a significant challenge for ecologists. Whereas regional climatic factors may generate population synchrony (i.e., the Moran effect), local factors including the level of density-dependence may reduce the level of synchrony. Although divergences in the scaling of population synchrony and spatial environmental variation have been observed, the regulatory factors that underlie such mismatches are poorly understood. Few previous studies have investigated how density-dependent processes and population-specific responses to weather variation influence spatial synchrony at both local and regional scales. We addressed this issue in a pond-breeding amphibian, the great crested newt (Triturus cristatus). We used capture-recapture data collected through long-term surveys in five T. cristatus populations in Western Europe. In all populations – and subpopulations within metapopulations – population size, annual survival and recruitment fluctuated over time. Likewise, there was considerable variation in these demographic rates between populations and within metapopulations. These fluctuations and variations appear to be context-dependent and more related to site-specific characteristics than local or regional climatic drivers. We found a low level of demographic synchrony at both local and regional levels. Weather has weak and spatially variable effects on survival, recruitment and population growth rate. In contrast, density-dependence was a common phenomenon (at least for population growth) in almost all populations and subpopulations. Our findings support the idea that the Moran effect is low in species where the population dynamics more closely depends on local factors (e.g. population density and habitat characteristics) than on large-scale environmental fluctuation (e.g. regional climatic variation). Such responses may have far-reaching consequences for the long-term viability of spatially structured populations and their ability to response to large-scale climatic anomalies

Novel MYH11 and ACTA2 mutations reveal a role for enhanced TGFβ signaling in FTAAD

BACKGROUND: Thoracic aortic aneurysm / dissection (TAAD) is a common phenotype that may occur as an isolated manifestation or within the constellation of a defined syndrome. In contrast to syndromic TAAD, the elucidation of the genetic basis of isolated TAAD has only recently started. To date, defects have been found in genes encoding extracellular matrix proteins (fibrillin-1, FBN1; collagen type III alpha 1, COL3A1), proteins involved in transforming growth factor beta (TGFβ) signaling (TGFβ receptor 1 and 2, TGFBR1/2; and SMAD3) or proteins that build up the contractile apparatus of aortic smooth muscle cells (myosin heavy chain 11, MYH11; smooth muscle actin alpha 2, ACTA2; and MYLK). METHODS AND RESULTS: In 110 non-syndromic TAAD patients that previously tested negative for FBN1 or TGFBR1/2 mutations, we identified 7 ACTA2 mutations in a cohort of 43 familial TAAD patients, including 2 premature truncating mutations. Sequencing of MYH11 revealed an in frame splice-site alteration in one out of two probands with TAA(D) associated with PDA but none in the series of 22 probands from the cohort of 110 patients with non-syndromic TAAD. Interestingly, immunohistochemical staining of aortic biopsies of a patient and a family member with MYH11 and patients with ACTA2 missense mutations showed upregulation of the TGFβ signaling pathway. CONCLUSIONS: MYH11 mutations are rare and typically identified in patients with TAAD associated with PDA. ACTA2 mutations were identified in 16% of a cohort presenting familial TAAD. Different molecular defects in TAAD may account for a different pathogenic mechanism of enhanced TGFβ signaling