Marianna LaNoue

Visual processing of facial affect

To evaluate the role of the fusiform gyrus in identifying and processing facial emotional expression in humans, MEG data were collected while six healthy subjects judged whether photographs of faces displayed emotion (happiness or disgust) compared to neutral faces and equiluminant scrambled faces. For all six subjects, a magnetic source localizing to right fusiform gyrus was evident ∼150 ms following presentation of face stimuli, but not following non-face stimuli. MEG source strength for this component was greatest for happy, intermediate for disgust, and lowest for neutral facial expressions, suggesting that activity in fusiform gyrus is sensitive to both face-specific stimuli and to the affective content of the face. These findings are considered in the context of a specialized neural face-dependent information system.

Adaptation and Implementation of Cognitive Behavioral Intervention for Trauma in Schools with American Indian Youth

American Indian adolescents experience higher rates of suicide and psychological distress than the overall U.S. adolescent population, and research suggests that these disparities are related to higher rates of violence and trauma exposure. Despite elevated risk, there is limited empirical information to guide culturally appropriate treatment of trauma and related symptoms. We report a pilot study of an adaptation to the Cognitive Behavioral Intervention for Trauma in Schools in a sample of 24 American Indian adolescents. Participants experienced significant decreases in anxiety and posttraumatic stress disorder symptoms, and avoidant coping strategies, as well as a marginally significant decrease in depression symptoms. Improvements in anxiety and depression were maintained 6 months postintervention; improvements in posttraumatic stress disorder and avoidant coping strategies were not.

Exploration and confirmation of the latent variable structure of the Jefferson scale of empathy.

Objectives: To reaffirm the underlying components of the JSE by using exploratory factor analysis (EFA), and to confirm its latent variable structure by using confirmatory factor analysis (CFA). Methods Research participants included 2,612 medical students who entered Jefferson Medical College between 2002 and 2012. This sample was divided into two groups: Matriculants between 2002 and 2007 (n=1,380) and between 2008 and 2012 (n=1,232). Data for 2002-2007 matriculants were subjected to EFA (principal component factor extraction), and data for matriculants of 2008-2012 were used for CFA (structural equation modeling, and root mean square error for approximation). Results The EFA resulted in three factors: “perspective-taking,” “compassionate care” and “walking in patient’s shoes” replicating the 3-factor model reported in most of the previous studies. The CFA showed that the 3-factor model was an acceptable fit, thus confirming the latent variable structure emerged in the EFA. Corrected item-total score correlations for the total sample were all positive and statistically significant, ranging from 0.13 to 0.61 with a median of 0.44 (p<0.01). The item discrimination effect size indices (contrasting item mean scores for the top-third versus bottom-third JSE scorers) ranged from 0.50 to 1.4 indicating that the differences in item mean scores between top and bottom scorers on the JSE were of practical importance. Cronbach’s alpha coefficient of the JSE for the total sample was 0.80, ranging from 0.75 to 0.84 for matriculatnts of different years. Conclusions Findings provided further support for underlying constructs of the JSE, adding to its credibility.

A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities.

Background: People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports. Methods: The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group. We present a preliminary program evaluation of this partnership using the framework of the patient-centered medical home and the “10 Essential Public Health Services.” Results: Preliminary program evaluation results suggest that this partnership is evolving to function as an integrated person-centered health home and an effective local public health monitoring system. Conclusion: The Pathways to Housing-PA/Jefferson Department of Family and Community Medicine partnership represents a community of solution, and multiple measures provide preliminary evidence that this model is feasible and can address the “grand challenges” of integrated community health services.

Direct and Indirect Effects of Childhood Adversity on Adult Depression

Exposure to adverse events in childhood is a predictor of subsequent exposure to adverse events in adulthood, and both are predictors of depression in adults. The degree to which adult depression has a direct effect of childhood adversity versus an indirect effect mediated by adult adversity has not previously been reported. We report data collected from 210 adult participants regarding childhood and adult adversity and current symptoms of depression. Mediation of the relationship between childhood adversity and adult depression by adult adversity was statistically assessed to evaluate the relative direct and indirect effects of childhood adversity on current depression levels in adults. Both the direct effect of childhood adversity on adult depression and the indirect effect, mediated by adulthood events, were significant. Therefore, partial mediation of the relationship between childhood adversity and adult symptoms of depression by adult adverse events was found in the sample. Implications for treatment are presented.

Catching Up With the HPV Vaccine: Challenges and Opportunities in Primary Care.

PURPOSE Data confirm that high rates of human papillomavirus (HPV) vaccination have not been achieved despite strong clinician endorsement of the vaccine. We conducted a study of primary care clinicians to assess the broad range of health care delivery, health policy, and attitudinal factors influencing vaccination uptake and opportunities for informed decision making. METHODS We implemented a mixed methods study in RIOS Net, a primary care practice–based research network in New Mexico. We first conducted qualitative, in-depth interviews with primary care clinicians, health policy makers, and immunization experts, and followed up with a confirmatory survey distributed to RIOS Net clinician members. RESULTS Health service delivery challenges emerged as the greatest barrier to HPV vaccination, specifically the lack of capacity to track and distribute reminders to eligible patients. Clinicians also reported variations in counseling approaches attributable to both age and emphasis on the cancer prevention benefits of the vaccine. There was no evidence of sociocultural influences on vaccine decision making, nor did concerns about perceived overprotection emerge. CONCLUSIONS Our findings, based on a long-term program of research, suggest that both patients’ attributes and health system delivery are most influential in HPV vaccination coverage challenges. Interventions targeting innovative communication techniques, as well as health system changes that build on efforts toward coordinated care and utilization of other venues to promote vaccination, will be necessary to address these challenges.

Negative Affect Predicts Adults’ Ratings of the Current, but Not Childhood, Impact of Adverse Childhood Events

Adverse childhood events (ACE’s) have been empirically related to a wide range of negative health and mental health outcomes. However, not all individuals who experience ACE’s follow a trajectory of poor outcomes, and not all individuals perceive the impact of ACE’s as necessarily negative. The purpose of this study was to investigate positive and negative affect as predictors of adults’ ratings of both the childhood and adult impact of their childhood adversity. Self-report data on ACE experiences, including number, severity, and ‘impact’ were collected from 158 community members recruited on the basis of having adverse childhood experiences. Results indicated that, regardless of event severity and number of different types of adverse events experienced, high levels of negative affect were the strongest predictor of whether the adult impact of the adverse childhood events was rated as negative. All individuals rated the childhood impact of events the same. Implications are discussed.

Health Care Integration for Formerly Homeless People With Serious Mental Illness

Objective: The primary objective of this study was to evaluate medical health and health care in a program of integrated primary and behavioral health care for people with experiences of homelessness and mental illness. Methods: Using a retrospective chart review, we examined health status and rates of health care quality indicators in a group of 123 Housing First participants with histories of chronic homelessness and diagnoses of serious mental illness, including a subgroup of 43 participants who received integrated medical and behavioral health care. Results: In addition to having serious mental illness, participants had high rates of comorbid chronic disease and risk behavior: 76% had at least one chronic disease, 59% had two or more chronic diseases, 6.5% had HIV, and 83% used tobacco. The integrated care program subgroup had relatively high rates of documentation of some health care quality indicators: 62% with body mass index, 73% with blood pressure, 77% with tobacco use history, 87% with substance use history. Conclusions: Our study confirms that people with experiences of homelessness and serious mental illness also have serious medical comorbidities and documents the feasibility of providing on-site integrated primary care and health screenings in supportive housing programs.

How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services

Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients’ perceptions of their own health, thereby impacting utilization.

Using Concept Mapping to Explore Barriers and Facilitators to Breast Cancer Screening in Formerly Homeless Women with Serious Mental Illness

Women with serious mental illness (SMI) have disproportionately worse breast cancer profiles than those of other women. The purpose of this project was to examine barriers to and facilitators of breast cancer screening, specifically in formerly homeless women with SMI using the participatory methodology of concept mapping. A series of three concept mapping focus groups were held with 27 women over the age of 40 with a diagnosis of a SMI who live in supportive housing programs, and with 16 housing program staff. Data from the focus groups were combined through multidimensional scaling to create a visual cluster map. Barriers and facilitators to mammography screening generated by the participants clustered into eight categories. Participants rated addressing educational issues as most important and feasible. Interventions designed to improve mammogram screening in this population should address patients’ perception of personal risk and should target education and support systems as modifiable factors.