Dengue Virus (DENV) Neutralizing Antibody Kinetics in Children After Symptomatic Primary and Postprimary DENV Infection
The immune response to dengue virus (DENV) infection is complex and not fully understood. Using longitudinal data from 181 children with dengue in Thailand who were followed for up to 3 years, we describe neutralizing antibody kinetics following symptomatic DENV infection. We observed that antibody titers varied by serotype, homotypic vs heterotypic responses, and primary versus postprimary infections. The rates of change in antibody titers over time varied between primary and postprimary responses. For primary infections, titers increased from convalescence to 6 months. By comparing homotypic and heterotypic antibody titers, we saw an increase in type specificity from convalescence to 6 months for primary DENV3 infections but not primary DENV1 infections. In postprimary cases, there was a decrease in titers from convalescence up until 6 months after infection. Beginning 1 year after both primary and postprimary infections, there was evidence of increasing antibody titers, with greater increases in children with lower titers, suggesting that antibody titers were boosted due to infection and that higher levels of neutralizing antibody may be more likely to confer a sterilizing immune response. These findings may help to model virus transmission dynamics and provide baseline data to support the development of vaccines and therapeutics.
Cadmium, a heavy metal dispersed in the environment as a result of industrial and agricultural applications, has been implicated in several human diseases including renal disease, cancers, and compromised bone health. In the general population, the predominant sources of cadmium exposure are tobacco and diet. Urinary cadmium (uCd) reflects long-term exposure and has been frequently used to assess cadmium exposure in epidemiological studies; estimated dietary intake of cadmium (dCd) has also been used in several studies. The validity of dCd in comparison with uCd is unclear. This study aimed to compare dCd, estimated from food frequency questionnaires, to uCd measured in spot urine samples from 1,002 participants of the Women's Health Initiative. Using linear regression, we found that dCd was not statistically significantly associated with uCd (beta=0.006, P-value=0.14). When stratified by smoking status, dCd was not significantly associated with uCd both in never smokers (beta=0.006, P-value=0.09) and in ever smokers (beta=0.003, P-value=0.67). Our results suggest that because of the lack of association between estimated dCd and measured uCd, dietary estimation of cadmium exposure should be used with caution in epidemiologic studies.
SSRI-antipsychotic combination in psychotic depression: sertraline pharmacokinetics in the presence of olanzapine, a brief report from the STOP-PD study
OBJECTIVE: We recently reported an unexpected interaction between olanzapine and sertraline in a population being treated for psychotic depression. Contrary to knowledge of cytochrome p450 interactions sertraline increased apparent clearance of olanzapine by 30%. Here we examined the pharmacokinetics of sertraline in the same population. Existing studies suggest that sertraline apparent clearance is significantly increased in male subjects and suggested an age/sex interaction.
METHODS: We studied subjects undergoing combination of sertraline/olanzapine treatment for psychotic depression in the Study of the Pharmacotherapy of Psychotic Depression. Nonlinear mixed effect modelling software was used to examine the sertraline pharmacokinetics, evaluating age, sex, race, and olanzapine exposure as covariates.
RESULTS: Eighty-seven subjects (median age 62 years, 28 male subjects, 11 African-Americans) provided 138 samples for sertraline concentration. Olanzapine exposure had a 14.8-fold range. A one compartment model with combined residual error described the sertraline concentration data adequately. Half-life and sex effect on sertraline apparent clearance (males averaging 50% higher (p < 0.005); 96.6 l/h vs 64.8 in female subjects) were similar to previous reports. No other covariate (age, race or olanzapine exposure) had a significant impact on apparent clearance, and no age/sex interaction emerged.
CONCLUSION: Sertraline pharmacokinetics were similar to historical descriptions in populations not taking antipsychotics. Unlike our unexpected finding that sertraline increases olanzapine apparent clearance, olanzapine exposure had no impact on sertraline pharmacokinetics.
Update on Smoking Cessation: E-Cigarettes, Emerging Tobacco Products Trends, and New Technology-Based Interventions
Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can integrate these tools and other community-based resources into their practice.
Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease: A Literature Review
The authors aim to synthesize the current literature on the magnitude and impact of multimorbidity on clinical outcomes in older adults with cardiovascular disease (CVD). Most studies reported a significant association between the number of morbidities and the risk of dying. Multimorbidity was assessed either by counting the number of conditions or by use of the Charlson or Elixhauser indices. There are limited data available on the magnitude and impact of multimorbidity on clinical outcomes in patients with CVD and essentially no data on universal health outcomes (eg, health-related quality of life, symptom burden, and function).
The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis
The term axial spondyloarthritis (axSpA) now is used frequently to describe patients with predominantly axial symptoms who fit into the spectrum of a well-recognised rheumatic disease that continues to be known as ankylosing spondylitis (AS). The 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria, developed to identify patients with early or atypical disease which could not be classified by the 1984 modified New York (mNY) criteria for AS, have led to a differentiation between non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA, which is largely synonymous with AS. The main reason to distinguish between these ends of the spectrum of axSpA was that tumor necrosis factor (TNF) inhibitors (TNFi) approved for AS could obtain additional labelling for nr-axSpA and be used to treat all patients manifesting clinical features of axSpA. These two terms are distinguished by the degree of 'radiographic sacroiliitis' assessed by conventional radiography, according to the 1984 mNY criteria for AS. Since this differentiation has been shown to be not very reliable, we argue that the terms nr-axSpA and AS should only be used for classification of patients with axSpA and not as separate diagnoses. Therefore, we propose that only the term axSpA be used to diagnose patients, unless there is a meaningful medical reason to differentiate nr-axSpA from AS. The available data justify performing randomised controlled trials designed to obtain regulatory approval for therapeutic agents in patients across the entire spectrum of axSpA.
Peptidylarginine deiminase (PAD) enzymes convert histone tail arginine residues to citrulline resulting in chromatin decondensation. Our previous work found that PAD isoforms are expressed in female reproductive tissues in an estrous cycle-dependent fashion, but their role in the anterior pituitary gland is unknown. Thus, we investigated PAD expression and function in gonadotrope cells. The gonadotrope-derived LbetaT2 cell line strongly expresses PAD2 at the protein level compared with other PAD isoforms. Consistent with this, PAD2 protein expression is highest during the estrous phase of the estrous cycle and colocalizes with the LH beta-subunit in the mouse pituitary. Using the GnRH agonist buserelin (GnRHa), studies in LbetaT2 and mouse primary gonadotrope cells revealed that 30 minutes of stimulation caused distinct puncta of PAD2 to localize in the nucleus. Once in the nucleus, GnRHa stimulated PAD2 citrullinates histone H3 tail arginine residues at sites 2, 8, and 17 within 30 minutes; however, this effect and PAD2 nuclear localization was blunted by incubation of the cells with the pan-PAD inhibitor, biphenyl-benzimidazole-Cl-amidine. Given that PAD2 citrullinates histones in gonadotropes, we next analyzed the functional consequence of PAD2 inhibition on gene expression. Our results show that GnRHa stimulates an increase in LHbeta and FSHbeta mRNA and that this response is significantly reduced in the presence of the PAD inhibitor biphenyl-benzimidazole-Cl-amidine. Overall, our data suggest that GnRHa stimulates PAD2-catalyzed histone citrullination in gonadotropes to epigenetically regulate gonadotropin gene expression.
NETs serve to ensnare and kill microbial pathogens. However, NETs can at the same time contribute to tissue damage and excessive inflammation. Nicotine is a major toxic agent and has been associated with exacerbated inflammatory diseases. The current study aimed at investigating the role of nicotine, the addictive component of tobacco and electronic cigarettes, on triggering NET formation. We report that nicotine induces neutrophils to release NETs in a dose-dependent manner. Nicotine-induced NET formation is mediated via nicotine acetylcholine receptors, depends on Akt and PAD4 activation, but is Nox2-independent, as demonstrated by pharmacological inhibition of Nox2 and by use of Nox2-deficient mouse neutrophils. These findings demonstrate that nicotine induces NETs, which may in turn contribute to smoking-related diseases.
Neutrophil extracellular traps exacerbate Th1-mediated autoimmune responses in rheumatoid arthritis by promoting DC maturation
Aberrant formation of neutrophil extracellular traps (NETs) is a key feature in rheumatoid arthritis (RA) and plays a pivotal role in disease pathogenesis. However, the mechanism through which NETs shape the autoimmune response in RA remains elusive. In this study, we demonstrate that inhibition of peptidylarginine deiminases activity in collagen-induced arthritis (CIA) mouse model significantly reduces NET formation, attenuates clinical disease activity, and prevents joint destruction. Importantly, peptidylarginine deiminase 4 blocking markedly reduces the frequency of collagen-specific IFN-gamma-producing T helper 1 (Th1) cells in the draining lymph nodes of immunized mice. Exposure of dendritic cells (DCs) to CIA-derived NETs induces DC maturation characterized by significant upregulation of costimulatory molecules, as well as elevated secretion of IL-6. Moreover, CIA-NET-treated DCs promote the induction of antigen-specific Th1 cells in vitro. Finally, NETs from RA patients show an increased potential to induce the maturation of DCs from healthy individuals, corroborating the findings obtained in CIA mouse model. Collectively, our findings delineate an important role of NETs in the induction and expansion of Th1 pathogenic cells in CIA through maturation of DCs and reveal a novel role of NETs in shaping the RA-autoimmune response that could be exploited therapeutically.
Peptidylarginine deiminase 1-catalyzed histone citrullination is essential for early embryo development
Peptidylarginine deiminase (PADI) enzymes are increasingly being associated with the regulation of chromatin structure and gene activity via histone citrullination. As one of the PADI family members, PADI1 has been mainly reported to be expressed in the epidermis and uterus, where the protein in keratinocytes is thought to promote differentiation by citrullinating filament proteins. However, the roles of PADI1 in preimplantation development have not been addressed. Using a PADI1-specific inhibitor and Padi1-morpholino knockdown, we found that citrullination of histone tails at H4R3 and H3R2/8/17 were markedly reduced in the 2- and 4-cell embryos. Consistent with this observation, early embryo development was also arrested at the 4-cell stage upon depletion of PADI1 or inhibition of PADI1 enzyme activity. Additionally, by employing 5-ethynyl uridine (EU) incorporation analysis, ablation of PADI1 function led to a dramatic decrease in overall transcriptional activity, correlating well with the reduced levels of phosphorylation of RNA Pol II at Ser2 observed at 2- or 4-cell stage of embryos under Padi1 knockdown or inhibiting PADI1. Thus, our data reveal a novel function of PADI1 during early embryo development transitions by catalyzing histone tail citrullination, which facilitates early embryo genome transactivation.
Dengue virus (DENV), transmitted predominantly in tropical and subtropical regions by the mosquito Aedes aegypti, infects millions of people and leads to dengue fever and thousands of deaths each year. There are no direct-acting antivirals to combat DENV, and molecular and structural knowledge is required to develop such compounds. The dengue NS2B/NS3 protease is a promising target for direct-acting antivirals, as viral polyprotein cleavage during replication is required for the maturation of the viral particle. The NS2B/NS3 protease processes 8 of the 13 viral polyprotein cleavage sites to allow viral maturation. Although these sites share little sequence homology beyond the P1 and P2 positions, most are well conserved among the serotypes. How the other substrate residues, especially at the P' side, affect substrate recognition remains unclear. We exploited the tight-binding general serine protease inhibitor aprotinin to investigate protease-substrate interactions at the molecular level. We engineered aprotinin's binding loop with sequences mimicking the P' side of DENV substrates. P' residues significantly modulate substrate affinity to protease, with inhibition constants varying from nanomolar to sub-millimolar. Structural and dynamic analysis revealed the molecular basis of this modulation and allowed identifying optimal residues for each of the P' positions. In addition, isothermal titration calorimetry showed binding to be solely entropy driven for all constructs. Potential flaviviral P' side inhibitors could benefit from mimicking the optimal residues at P' positions and incorporate hydrophobicity and rigidity to maintain entropic advantage for potency.
Structural and molecular analysis of a protective epitope of Lyme disease antigen OspA and antibody interactions
The murine monoclonal antibody LA-2 recognizes a clinically protective epitope on outer surface protein (OspA) of Borrelia burgdorferi, the causative agent of Lyme disease in North America. Human antibody equivalence to LA-2 is the best serologic correlate of protective antibody responses following OspA vaccination. Understanding the structural and functional basis of the LA-2 protective epitope is important for developing OspA-based vaccines and discovering prophylactic antibodies against Lyme disease. Here, we present a detailed structure-based analysis of the LA-2/OspA interaction interface and identification of residues mediating antibody recognition. Mutations were introduced into both OspA and LA-2 on the basis of computational predictions on the crystal structure of the complex and experimentally tested for in vitro binding and borreliacidal activity. We find that Y32 and H49 on the LA-2 light chain, N52 on the LA-2 heavy chain and residues A208, N228 and N251 on OspA were the key constituents of OspA/LA-2 interface. These results reveal specific residues that may be exploited to modulate recognition of the protective epitope of OspA and have implications for developing prophylactic passive antibodies.
Neuraminidase (NA) inhibitors are used for the prevention and treatment of influenza A virus infections. Two subtypes of NA, N1 and N2, predominate in viruses that infect humans, but differential patterns of drug resistance have emerged in each subtype despite highly homologous active sites. To understand the molecular basis for the selection of these drug resistance mutations, structural and dynamic analyses on complexes of N1 and N2 NA with substrates and inhibitors were performed. Comparison of dynamic substrate and inhibitor envelopes and interactions at the active site revealed how differential patterns of drug resistance have emerged for specific drug resistance mutations, at residues I222, S246, and H274 in N1 and E119 in N2. Our results show that the differences in intermolecular interactions, especially van der Waals contacts, of the inhibitors versus substrates at the NA active site effectively explain the selection of resistance mutations in the two subtypes. Avoiding such contacts that render inhibitors vulnerable to resistance by better mimicking the dynamics and intermolecular interactions of substrates can lead to the development of novel inhibitors that avoid drug resistance in both subtypes.
Massachusetts Population Health Information Tools: Tools for Community Health Needs Assessment and Planning
Staff from the Massachusetts Department of Public Health (MDPH) will conduct a training and discussion on available MDPH data and in-development tools for accessing those data for community engagement, planning and assessment efforts. The workshop will include the sharing of practical information on MDPH data and demonstrations of tools (for those with laptops, hands-on opportunities for data access may be possible).
-To learn about available MDPH data and data tools for community engaged research
-To understand possible MDPH roles in community engaged research
- To contribute to MDPH data access planning for meeting the needs of groups conducting community engaged research
In the spring of 2016, a partnership between two Massachusetts Department of Public Health (MDPH) bureaus, the Bureau of Environmental Health and the Bureau of Community Health and Prevention, and several MA hospital associations, embarked on a new project to make data more available for the purpose of helping to guide community partners in identifying community health needs and making decisions on resource allocation. The resulting Public Health Information Tool (PHIT) helps respond to two specific mandates requiring regular community needs assessments: (1) the Public Health Accreditation Board’s requirement of certified local health departments and (2) Affordable Care Act’s requirements of non-profit hospitals. The current vision of PHIT will incorporate expanded data and functionality so that it is applicable to local health, community health advocates, and academic institutions, among others. The project allows for the inclusion of many MDPH health indicators, including a focus on social determinants of health and identifying health disparities.
PHIT is currently in beta-test mode and is not yet available to the public. However, PHIT is built on the infrastructure for an existing BEH web tool, the Massachusetts Environmental Public Health Tracking (EPHT) portal, which is a web-based data system available to the public. EPHT is part of a national effort by the Centers for Disease Control and Prevention (CDC) to make environmental and health data readily available to the public in customizable maps, tables and charts at the county, community and census tract levels. Currently, the EPHT website includes the latest available health data for asthma, birth defects, cancer, carbon monoxide poisoning, childhood lead poisoning, heart attack, heat stress, pediatric diabetes and reproductive outcomes. In addition, Community Profiles for all 351 cities and towns are available that present a compilation of select indicators.
EPHT reflects over a decade of program development, which has been easily adapted into the PHIT system. Both EPHT and PHIT will continually evolve to add content, improve performance, and enhance system capabilities to best fit the needs of an expanding array of external stakeholders. To that end, this session not only provides an opportunity to introduce these tools to an interested audience, but also serves as a forum for gathering critical feedback from potential users.
Community-based participatory research is growing. What is also growing is citizen science. There are useful lessons for the health field from this rapidly growing approach of citizen science. The National Institutes of Health and other health leaders such as Community Campus Partnerships for Health have begun encouraging cross-learning between those engaged in CBPR and those doing citizen science. There are many opportunities to spark innovation and problem solve by analyzing each others’ practices and incorporating relevant aspects into community health research. The purpose of this workshop is to share with participants some of the latest practices in citizen science and consider ways of adapting some of these strategies to solve some of the problems we encounter in community-researcher health partnerships. In developing the session I will draw on my work in CBPR projects in Massachusetts and Maine, my service as an advisory board member for health citizen science projects in the western U.S., my webinar and keynotes in CBPR/CS for the National Citizen Association and NIH, and my development of graduate courses on stakeholder-researcher partnerships.
Empowering Women in Underserved Communities: Using CBPR Approaches to Improve Health Literacy and Community Capacity
Moderator: Elena Carbone, DrPH RD, LDN, Associate Professor, Department of Nutrition, UMass Amherst
Jennifer Manganello, MPH, PhD
Janine M. Jurkowski, MPH, PhD
Elena T. Carbone, DrPH, RD, LDN
Promoting health literacy empowers individuals and communities to better navigate the health care system and health information environment, and allows for informed decision making for choices and actions that affect health. Empowerment Theory and health literacy are inherent in Community-Based Participatory Research (CBPR) with low-income and disadvantaged populations. In order for representatives to be engaged as equal participants in the research process, research and health capacity building need to occur. This breakout session will be presented in three parts. The first presentation will provide an overview and introduce how Empowerment Theory and health literacy can be used to build the capacity of community representatives and patient stakeholders. The other two presentations will highlight CBPR research projects currently underway or planned.
What is Health Literacy?
Presenter: Jennifer Manganello
Health literacy refers to a person’s ability to obtain and understand health information and navigate the health system, as well as the health care environment itself. Definitions of health literacy will be discussed, along with how health literacy is relevant at each of the levels of the socio-ecological model (i.e., individual vs. community). We will provide a brief overview about health literacy research conducted in community and clinical settings. This presentation will also discuss how health literacy is related to empowerment.
Communities for Health Living (CHL): A CBPR Childhood Obesity Prevention Intervention Guided by Empowerment Theory
Presenter: Janine M. Jurkowski
CHL is an intervention research project that uses a parent-centered community-based participatory research (CBPR) in an RCT scale up of a childhood obesity prevention intervention guided by Empowerment Theory. CHL recognizes parents as family experts, engages them as co-researchers and embeds the resulting empowerment-focused intervention into Head Start, a national system of care reaching over one million low-income families. Building on a successful pilot assessment CHL researchers are collaborating with Boston/Somerville/Cambridge Head Start serving over 2000 children to expand the CBPR approach by engaging parents, community representatives and Head Start staff to adapt CHL to a new, more diverse setting. CHL is rigorously testing its efficacy to prevent obesity in children. To ensure the timely translation of this work this study is a practical behavioral trial that maintains a rigorous assessment of program efficacy. Primary innovations of this study are its explicit incorporation of Empowerment Theory into its participatory approach and intervention, which deviates from the traditional model of nutrition education to address broader family realities.
Mpower: Empowering Mothers for Health
Presenter: Elena T. Carbone
This project responds to the WUN Shanghai Declaration and the United Nations General Assembly call to promote health literacy in parents and empower women as a global strategy to reduce non-communicable diseases (NCDs). Because many NCDs originate in early development and from health disparities, the maternal health literacy of women in poverty is especially vital. Maternal health literacy refers to the cognitive and social skills which determine the motivation and ability of mothers to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Despite its importance, preliminary results of two scoping reviews indicate that few studies have examined maternal health literacy; fewer still have focused on skill development or empowerment of women in poverty. This project is designed to develop a long-term and sustainable research plan to fill these gaps and is part of a five-stage approach to develop a universal research strategy to promote health literacy in parents and empower women globally. Moreover, this project introduces an innovative community-based participatory method to the field of health literacy; and focuses on critical health literacy skills, empowerment, and health literacy for health protection and promotion -- all of which have been largely ignored.
This presentation was prepared for the breakout session entitled: From the Community to the Classroom: Complementary Pathways to Service Learning and Community Engaged Research.
Students often have a genuine interest in contributing to the local community surrounding UMass Dartmouth through engaged research and learning. This presentation will highlight initiatives to nurture existing university-community partnerships to develop community-based research projects that provide opportunities for student involvement. Project-based service learning opportunities developed through collaboration with community organizations and agencies after identifying organizational needs, often with a goal to strengthen or refine existing services, will be presented. The critical role of institutional support in the execution of community-based research and service learning projects will also be highlighted. A community-based research project funded by UMass Dartmouth to investigate the translation of childhood obesity prevention best practices into early childcare centers within communities at risk will illustrate the interplay between the areas of research, teaching, and learning.
Putting Health Equity Front and Center in Community Health Improvement by Empowering, Listening to, and Respecting Community Voices
In 2012 the City of Worcester released the first Community Health Improvement Plan (CHIP), with the goal of making Worcester the Healthiest City in the Healthiest Region in the Commonwealth by 2020. Following tremendous success and leveraging lessons learned the Worcester Division of Public health, in collaboration with the Coalition for a Greater Healthy Worcester, UMass Memorial and Fallon Health released the 2016 CHIP, with the single goal of promoting health equity. During this session we will describe the comprehensive needs assessment process, research tools, long-term community engagement strategies and implementation practices that have created a community-driven movement across sectors to promote health equity.
The Ethics and Practice of Digital Storytelling as a Methodology for Community-Based Participatory Research in Public Health
Moderator: Alice Fiddian-Green, PhD student, Department of Health Promotion and Practice, School of Public Health and Health Sciences, University of Massachusetts Amherst.
Presenters and Session Titles:
“An Ethics Framework for Digital Storytelling as a Multi-Purposed Public Health Method”: Aline Gubrium, PhD
Applying the Ethics Framework in Two Projects: (1) Louis Graham, MPH, DrPH, and Sarah Lowe, MPW: “Stakeholder Engagement and Ethical Planning for Digital Storytelling: The MOCHA Moving Forward Project” (2) Mary Paterno, CNM, PhD: “Digital Storytelling as Health Promotion and Data: Ethical Considerations from a Peer-Mentor Based Project to Address Perinatal Substance Use Disorder in a Rural Community"
Public health often mislocates its lineage in the medical sciences. Being foremost about people and what happens when people live together, the field is equally rooted in the humanistic and social sciences. By providing a focus that is more open to the rich and variegated tapestry of health and wellbeing, participatory visual and digital approaches, such as digital storytelling, enhance understandings of health and well being. If carried out responsibly, digital storytelling has the potential to function both as a vehicle for community-based health promotion, and as a method for collecting culture-centered data that can assist researchers and practitioners in better serving local communities. Based on a Freirian model, which promotes active engagement as participants construct stories to promote change through a group process, the goal of our digital storytelling practice is to provide a creative forum for expressing the generative themes or collective issues of community members. Beyond being mere data points, digital stories enliven statistics, make research meaningful, and position research participants as experts in their own right by inviting them to define relevant issues, broaden the evidence base, and create an emotional product that attracts and influences policymakers and the public at large. Finally, digital stories can be re-purposed for use in health communication campaigns (on and offline) to effect broad reach.
Published literature on the ethics of community-based participatory research methods grounded in personal storytelling and participatory media approaches is in short supply, as are advanced training opportunities for public health researchers interested in these approaches (Gubrium & Harper, 2013; Gubrium, Hill, and Flicker, 2014; Gubrium, Hill & Fiddian-Green, 2016). Based on their previous research and practice experiences with digital storytelling, Gubrium and colleagues (2014) discuss the “situated practice of ethics” for participatory visual and digital methods in public health research and practice. Specifically, they write about six common challenges faced by researchers, advocates, and health promotion practitioners alike: the fuzzy boundaries that arise when negotiating between research, advocacy/action, and health promotion practice when using these methods; tensions related to recruitment of participants and consent to participate; the complex considerations specific to the release of the digital materials produced in workshops; power issues as they relate to the shaping of both stories and digital media content; the potential for reproducing harm in visual/digital representation; and the promise of confidentiality/anonymity to research participants.
The proposed breakout session will provide a brief overview of the digital storytelling process (including discussion of recruitment, informed consent and release of materials, standard activities in the digital storytelling process, follow-up semi-structured interviews with participants, pre/post measures used to evaluate the impact of the process on participants, data analysis, and strategic communications based on produced digital stories). The session will enable participants to understand the myriad ethical issues that can present when carrying out community-based participatory research that employs digital storytelling as a methodology. By the end of the session, participants will be able to demonstrate critically enhanced awareness of ethical issues surrounding participatory visual and digital methodologies and identify effective ways to address these issues.
Moderator: Andy Lowe, Director of Program Management Resources, Outer Cape Health Services
Marta “Dikke” Hansen, MSW, Director of Behavioral Health
Andrew Jorgensen, MD, Associate Medical Director
The Outer Cape Cod, Massachusetts region is famed for its beauty as a summer vacation destination. For many residents and migrant workers serving the tourism industry; however, the intersection of isolation, little affordable housing, and limited transportation options can exacerbate problems due to mental health, substance abuse, and co-occurring conditions. Police, emergency responders, and EDs encounter this at-risk population disproportionately. Outer Cape Health Services, the local FQHC, proposed a novel solution: a Community Resource Navigator (CRN) program. The CRN Navigator works with community partners to identify at-risk individuals, engage them right in the community, and guide them to appropriate services/treatment. A modified Self-Sufficiency Matrix based on evidence from other Navigator programs is used as a tool to prioritize needs. The Navigator then helps clients attach themselves to options that make sense. The CRN program is a departure from classical case management approaches that features a light touch, with contact in the community rather than requiring clients to “come in” to the health center. A unique approach is that the Navigator uses a community-donated bicycle to pedal her way around the narrow Provincetown streets which can become virtually impassable during the busy summer tourism season. In addition, the Navigator sees clients in safe, accessible public spaces such as the public library. A critical success factor is community engagement that builds effective relationships with community partners such as police, EMTs, councils on aging, community mental health providers, etc. Since beginning the CRN program, data has been collected that provides some unexpected insights into how the Community Navigator approach can be both an outcome- and cost-effective alternative to traditional case management or social worker-oriented interventions. In addition, the CRN program is proposed as the basis for a research initiative under the auspices of the University of Massachusetts Medical School Center for Clinical and Translational Science.