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Youth violence prevention program can be integrated into emergency and primary care settings

Jacob Scott

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Opportunities to reach teens who are at risk for violence and substance use are rare. There may be only a small window of time to prevent often life-threatening violent injuries.


Researchers have long been interested in learning how to intervene during this critical time when young people are at an elevated risk for violence but before they are stuck in a perpetual cycle that leads to devastating consequences for them and their families.


“SafERteens,” an evidence-based behavioral intervention, is designed to engage youth at this high-risk time and reduce their involvement with violence. Two recently published studies demonstrate that this intervention, considered best practice by the Centers for Disease Control and Prevention, can be successfully integrated as a part of routine medical care delivery in both emergency and primary care settings.


Health care providers are disheartened, witnessing youth return repeatedly to emergency departments for injuries due to violence, said Jessica Roche., M.P.H., managing director of the U-M Institute for Firearm Injury Prevention.


They recognize these deaths and injuries are preventable and are asking for what additional help they can provide to high-risk youth to prevent these injuries from occurring in the first place. The SafERteens intervention allows clinical staff the ability to intervene early in the cycle of violence to prevent these violent injuries.”


Jessica Roche., M.P.H., managing director, U-M Institute for Firearm Injury Prevention


SafERteens was developed in 2006 by Rebecca Cunningham, M.D., and Maureen Walton, Ph.D., M.P.H.. The intervention is designed for a trained therapist to work with a teen for 30 minutes during their emergency department visit to identify positive life goals and ways they can reduce their own involvement in violence, as well as other behaviors that increase violence risk, such as alcohol use.


The intervention was rigorously tested in multiple clinical trials and demonstrated that the approach could significantly reduce violence behaviors among youth that received it. Subsequent analyses showed that this approach was cost effective, especially if implemented widely throughout trauma centers, given that the program’s costs are much lower than the expense of providing medical treatment for severely injured teenagers.


The original research studies showed that SafERteens was effective in reducing violence, but a particular challenge is how to ensure these types of evidence-based programs move into routine clinical practice once research studies end.


“The focus of the current research was on trying to identify ways to accelerate the normal timeline for implementing evidence-based research programs into routine clinical practice while retaining the successful elements from the original intervention.” said Patrick Carter, M.D., lead author of the emergency department-based study, director of the CDC-funded U-M Injury Prevention Center, co-director of the U-M Institute for Firearm Injury Prevention, and associate professor of emergency medicine at Michigan Medicine.


Youth violence intervention in the emergency department, primary care clinics


Carter, Walton and a team of researchers created a web-based toolkit containing the intervention components, as well as key training resources, to help emergency staff at Hurley Medical Center in Flint, Mich., roll out the intervention as a component of routine clinical care. The toolkit, Walton notes, was developed based on working with teens and using feedback from clinical staff in these medical settings.


The research team tested different methods of implementing SafERteens within clinical care, including delivery by on-site hospital staff and delivery using a telehealth program by a remotely located therapist. Teens coming to emergency departments that screened positive for violence were split between receiving in-person or remote SafERteens intervention and two parallel control groups.


The findings, published in the Journal of Emergency Medicine, reveal a majority of teenagers completed the program and 85% who took the post-test survey felt it was very helpful to talk to a health counselor about ways to reduce fighting and stay safe in their neighborhoods. Both groups receiving SafERteens interventions demonstrated a greater increase in self efficacy to avoid fighting and decreases in pro-violence attitudes. The remote-delivered intervention was also associated with less violence and subsequent consequences than the group not receiving the intervention (the control group).


“This study demonstrates that despite the challenges of a busy clinical setting, this type of preventative intervention can be delivered during an emergency department visit and has the potential for critical impact on long-term violence outcomes for youth if implemented broadly throughout emergency departments across the country,” Carter said.


Researchers used a similar framework for SafERteens at primary care clinics in Ypsilanti, Mich., where behavioral health clinicians delivered the interventions. Due to the shorter nature of primary care visits, the intervention was delivered either online or in-person after the initial appointment.


Participants receiving the intervention demonstrated greater reductions in violence and consequences related to substance use, according to results published in Injury Prevention.


“Both the clinic staff and youth participating in the program found usefulness in the intervention,” said Golfo Tzilos Wernette, Ph.D., co-author of the paper and associate professor in the Michigan Medicine Department of Family Medicine. “The primary care setting is underutilized for prevention programs addressing behavioral risks among youth, including violence, and results from these staff members showed there is effective work that can have an impact.”


Barriers to success for violence prevention


Despite all the successful interventions and positive feedback from both providers and teens, the availability of staff and cost emerged as barriers for widespread implementation. After the support of the research team was taken away, delivery of SafERteens declined at the three sites, as providers struggled to maintain robust screening and intervention delivery in competition with other clinical demands. Carter notes the combination of limited resources, and a busy clinical setting were clearly factors.


“Overall, the program is cost-effective in terms of savings to the medical system, and the findings suggest we should be reimbursing health care providers to deliver this service across multiple settings throughout the health system,” Carter said. “Reimbursing for these clinical services will allow for additional dedicated staff to be available to provide this service and reduce the potential for violence outcomes among at-risk youth.”


Future applications for SafERteens


The University of Michigan recently received a multi-million-dollar grant from the CDC that will, in part, help to disseminate this program by funding a multi-site implementation of SafERteens across six clinical sites in Muskegon and Grand Rapids, Mich. This effort is part of a collaboration between the Youth Violence Prevention Center, led by Marc Zimmerman, Ph.D., at the U-M School of Public Health, and community partners at multiple clinical sites within Muskegon.


“This project is designed to show whether broad implementation of the program across multiple clinical settings can cumulatively reduce community rates of youth violence by reaching a large number of at-risk youth accessing a diverse array of medical settings,” Carter said.


The funding, which is part of the U-M Institute for Firearm Injury Prevention, is part of a larger, five-year project focused on reducing youth firearm violence.

Source:
Journal reference:

Carter, P.M., et al. (2021) Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department. Journal of Emergency Medicine. doi.org/10.1016/j.jemermed.2021.09.003.

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Genetic bottlenecks could impact Wyoming toads’ ability to respond to new pathogens

Jacob Scott

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A new study from North Carolina State University examines immune system diversity in the critically endangered Wyoming toad and finds that genetic bottlenecks could impact a species’ ability to respond to new pathogens. The findings could inform captive breeding strategies for endangered animal populations.

The Wyoming toad, Anaxyrus baxteri, suffered a severe population decline throughout the latter part of the 20th century due to factors including habitat destruction and fungal infection. The toad was brought into a captive breeding program in the 1990s in order to save the species. Scientists estimate a current wild population of only 400 to 1,500 animals, meaning that the toad is considered critically endangered.

Population reduction in this species created a genetic bottleneck to begin with, meaning the level of genetic diversity is already very small. This is the first study to look specifically at genetic diversity in the immune systems of these toads and how it could impact them as a population.”

Jeff Yoder, professor of comparative immunology at NC State and co-corresponding author of paper

Yoder, with co-corresponding author Alex Dornburg of the University of North Carolina at Charlotte, performed RNA sequencing on immune tissues from three healthy, retired Wyoming toad breeders. Study co-author Michael Stoskopf, who was on the Wyoming Toad Recovery Implementation Team established in 2008, obtained the samples.

“We were focused specifically on sequences encoding toll-like receptors – TLRs – and the proteins of the major histocompatibility complex, or MHC, expressed in these tissues,” says Kara Carlson, first author of the study and current Ph.D. candidate at NC State. “These sets of genes are major components of the immune system.”

TLRs are the first responders of the immune system, and are similar, or well-conserved, between species. The MHC, on the other hand, is a large and diverse group of genes that varies between species and individuals. It can determine why one group is more resistant to a particular pathogen than another.

“MHC genes are some of the most rapidly evolving sequences in the genome,” Carlson says. “So in a healthy population there’s a lot of variety that gets passed along to descendants, enabling the species at large to adapt to different pathogens. However, if disease survivors do so because of their MHC, then that group would have a similar MHC.

“The Wyoming toads that were brought into captivity to save the species were all able to resist the fungus that had decimated the population, but that could mean that their immune diversity is reduced.”

The researchers compared the TLR and MHC of the three Wyoming toads to each other, as well as to samples from a common toad and a cane toad. Both the common toad and the cane toad showed more MHC diversity than the Wyoming toad, even though the cane toad underwent a similar genetic bottleneck.

“The small sample size in this study – which was unavoidable due to the endangered status of the toad – nevertheless lays an important framework for conservation,” Carlson says.

“Amphibians in general don’t have as many genomic resources as other organisms,” Yoder says. “And captive breeding from a small population further decreases genetic diversity. But while these toads may be better protected against the fungal infection that nearly wiped them out, they may not be equipped to deal with new pathogens down the road.”

“While we weren’t necessarily surprised by the lack of immunogenic diversity in the Wyoming toad, it does spark an important question,” Dornburg says. “How equipped are other species of conservation concern for a battle with an emergent pathogen?”

“By understanding the genetic diversity of the immune system we can inform captive breeding to increase the chance of a species to resist disease in the wild,” Yoder adds. “Studies like this one are invaluable for captive breeding practices going forward.”

Source:
Journal reference:

Carlson, K.B., et al. (2022) Transcriptome annotation reveals minimal immunogenetic diversity among Wyoming toads, Anaxyrus baxteri. Conservation Genetics. doi.org/10.1007/s10592-022-01444-8.

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Video conferencing hinders creativity

Jacob Scott

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In-person teamwork has now transformed into virtual collaboration due to the COVID-19 pandemic. But does this affect innovation and creativity?

An interesting study on virtual communication led by Dr. Melanie S. Brucks from Columbia University and Prof. Jonathan Levav from Stanford University is published in the journal Nature. The study examines whether videoconferencing affects creative idea generation.

Study: Virtual communication curbs creative idea generation. Image Credit: Andrey_Popov / Shutterstock

Communication and collaboration

Collaboration is essential for several workplace tasks. It leads to innovation and idea generation. Historically, these collaborations have been in-person and required sharing of the same physical space. The use of traditional communication technologies like letters, emails, and phone calls hinder the smooth exchange of information and limits collaboration.

Now, due to advances in audio-visual technology, face-to-face interaction is possible via videoconferencing, allowing virtual collaboration. Videoconferencing has replaced in-person interactions due to pandemic-driven social distancing. Video interaction and in-person interaction allow communication of the same information.

While videoconferencing replacing in-person interaction has been beneficial in the social scenario, does it come with a cost in the workplace scenario? For example, does it affect collaborative idea generation?

Experiments

The investigators performed a Laboratory experiment and a field experiment to test the difference between in-person interaction and videoconferencing in collaborative idea generation. First, they recruited participants and divided them into pairs: half of the pairs were assigned to an in-person setting, and the rest were assigned to a virtual setting.

Laboratory experiment

A total of 602 participants were recruited for the laboratory experiment and divided into pairs. The participants were in separate rooms in the virtual setting and communicated through videoconferencing. The pairs were allotted five minutes to generate creative uses for a frisbee (150 pairs) or bubble wrap (151 pairs) and then one minute to select their most innovative idea.

The pairs were evaluated by counting the number of creative ideas and ideas they generated. The virtual pairs generated significantly fewer total and creative ideas compared to in-person pairs.

So, virtual collaboration hampered creative ideas. This could be because the virtual space narrows the visual scope, which in turn narrows the cognitive scope. To assess the visual focus, two methods were used. Firstly, the participants had to recollect the individual props in the room and point them on a worksheet. Secondly, the participants’ eye gaze was recorded during the experiment.

The virtual pairs narrowed their focus to the screen. Compared to in-person pairs, they spent significantly more time looking directly at their partner and less time looking at the surrounding room, and remembered significantly fewer props in the surrounding room.

As a consequence, the virtual medium narrowed the visual focus and inhibited the generation of ideas.

However, these results are in the context of a controlled laboratory setting.

Field experiment

The experiment was repeated in ‘the field’ under actual work conditions within a large multinational telecommunications company to see if these results could be extrapolated to the real world. The field experiment was conducted in five country sites – in Europe, the Middle East, and South Asia. In this setting, the participants knew their partners and used video conferencing regularly for work. Moreover, it included domain experts highly invested in the outcome of the collaboration.

A total of 1,490 engineers were recruited to participate in an ideation workshop and randomly divided into pairs. The pairs were allotted an hour to generate product ideas and submit one idea as future product innovation for the company.

The engineer pairs who worked on the task virtually generated fewer total ideas and creative ideas than in-person pairs at all five sites.

However, the decision quality was not affected by virtual collaboration. The in-person pairs generated a significantly higher top-scoring idea, but the selected idea did not significantly differ in quality between the virtual pairs and in-person pairs.

Other reasons for reduced creativity

The could be other reasons why virtual collaboration negatively affected idea generation. Therefore, the investigators explored the alternative explanations.

More ideas

Since the in-person collaborators generated more total and creative ideas than the virtual collaborators, they could generate additional ideas similar to each other. However, upon semantic analysis, it was observed that they generated diverse and disconnected ideas.

Feelings of connection and trust

Studies have shown that feelings of connection and trust can foster team creativity. The virtual pairs may have reduced feelings of connection and trust toward their partner.

However, when assessed for subjective feelings of closeness, verbal and non-verbal behaviors, and mimicry, the virtual pairs were similar to in-person pairs in the laboratory experiment.

Thus, virtual and in-person interactions are very similar in terms of social connection or social behavior.

Communication coordination

Usually, there is a lack of coordination in a conversation in virtual interactions due to the absence of eye contact. However, it could not wholly explain the effect of virtual interaction on idea generation.

Interpersonal processes

This study also assessed the effect of interpersonal processes on idea generation. Interpersonal processes fear of evaluation, dominance, social facilitation, social loafing, social sensitivity, perceptions of performance, and production blocking were affected in virtual collaborations and these, in turn, affected idea generation.

Implications of the study

This study supports previous research suggesting that pairs perform better than large groups, both in-person and online. Therefore, this study recommends ideation in pairs and in person. Also, this study suggests that larger videoconferencing screens would not impact idea generation.

In-person collaborations offer a cognitive advantage. Now several workplaces are moving towards a hybrid setup. This study indicates that the creative idea generation should be reserved for in-person meetings.

Journal reference:
Brucks, M.S., Levav, J. (2022) Virtual communication curbs creative idea generation. Nature. https://doi.org/10.1038/s41586-022-04643-y, https://www.nature.com/articles/s41586-022-04643-y

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Gum Health Day 2022 calls for prevention, early detection, and effective treatment of gum diseases

Jacob Scott

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“Treat your gums” is the slogan for Gum Health Day 2022, a worldwide awareness campaign organized by the European Federation of Periodontology (EFP). The event aims to inform the public of the detrimental effects of gum diseases – gingivitis, periodontitis, peri-implant mucositis, and peri-implantitis – on both oral and overall health. The campaign calls for the prevention, early detection, and – where necessary – effective treatment of gum diseases.

Although still poorly acknowledged by the public, gum diseases are chronic inflammatory conditions affecting a high proportion of adults worldwide, causing tooth loss and other problems in the mouth. Crucially, gum diseases are also linked to major systemic health issues including diabetes mellitus, cardiovascular diseases, chronic kidney disease, adverse pregnancy outcomes, rheumatoid arthritis, Alzheimer’s disease, erectile dysfunction, certain forms of cancer, and more severe Covid-19 outcomes. This means that gum diseases and their prevention and treatment are of major importance not only for oral health, but also for the whole body.

This year’s campaign focuses heavily on the treatment part – we know that millions of people suffer from gum diseases that can be treated effectively. ‘Treat your gums’ calls for this treatment – with all the documented positive effects for the mouth and whole body – to actually happen.”

Moritz Kebschull, coordinator of Gum Health Day 2022

That is why the hashtag for the campaign is #TreatYourGums, and why the recent EFP-produced clinical practice guidelines on the treatment of periodontitis are a major part of the Gum Health Day 2022 initiative.

“The new EFP-produced clinical practice guidelines on the treatment of all four stages of periodontitis are a crucial development, as they are the first high-quality international guidelines to outline a structured and easily implemented pathway for the efficient and effective treatment of gum disease,” Prof. Kebschull says. “In a nutshell, gum disease treatment that works!”

He adds: “It is important to underline that gum disease is one of the most widespread chronic diseases in the worldwide adult population, and that it is usually painless, so its early detection and successful treatment depends heavily on how fast the patient takes action.”

A major innovation of Gum Health Day 2022 is an EFP-designed “customized content generator”, a feature that allows the federation’s 37 affiliated national societies of periodontology, their individual members – as well as practices, hospitals, and members of the public – to customise their own Gum Health Day 2022 materials, based on a series of graphic templates and catchphrases.

In the framework of Gum Health Day 2022, the EFP encourages periodontists, dentists, researchers, and other health-related professionals to sign and disseminate the EFP Manifesto: Perio and General Health, an international call to action for the prevention, early detection, and treatment of gum disease. Individuals and organisations are invited to endorse it and join the 1,200+ professionals, dental practices, companies, and universities that have so far supported it.


The European Federation of Periodontology (EFP, ww.efp.org) is a non-profit organization dedicated to promoting awareness of periodontal science and the importance of gum health. Its guiding vision is “periodontal health for a better life.”

Founded in 1991, the EFP is a federation of 37 national periodontal societies that represents more than 16,000 periodontists, dentists, researchers, and oral-health professionals from Europe and around the world. It supports evidence-based science in periodontal and oral health, and it promotes events and campaigns aimed at both professionals and the public.

The EFP organizes EuroPerio, the world’s leading congress in periodontology and implant dentistry, as well as other important professional and expert events such as Perio Master Clinic and Perio Workshop. The annual Gum Health Day on May 12, organized by the EFP and its member societies, brings key messages on gum health to millions of people across the world.

The EFP also organizes workshops and outreach campaigns with its partners: projects to date have covered the relationship between periodontal disease and diabetes, cardiovascular disease, and caries, as well as women’s oral health during pregnancy.

The EFP’s Journal of Clinical Periodontology is the most authoritative scientific publication in this field. The federation also publishes JCP Digest, a monthly digest of research, and the Perio Insight magazine, which features experts’ views and debates.

The EFP’s work in education is also highly significant, notably its accreditation programme for postgraduate education in periodontology and implant dentistry.

The EFP has no professional or commercial agenda.

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