Immunoglobulin M (IgM) antibody to hepatitis C core antigen (anti-HCV-core) was tested by enzyme immunoassay against a synthetic peptide representing amino acids 1 to 62 of the core protein. Of 214 patients with different categories of histological activity, 193 (90%) showed positive results for IgM anti-HCV-core, and 207 (97%) had HCV RNA; most cases (186, 87%) had both markers detectable simultaneously. No differences in the frequency of IgM anti-HCV-core were observed with respect to epidemiological, biochemical, or histological parameters. In 175 interferon alfa (IFN-alpha) recipients, and in 39 untreated controls, pretreatment IgM anti-HCV-core frequencies were similar: 28 of 32 (88%) in sustained responders; 55 of 61 (90%) in responders with relapse; 72 of 82 (88%) in nonresponders; and 38 of 39 (97%) in untreated controls. After IFN-alpha therapy, IgM anti-HCV-core levels became undetectable with significantly greater frequency in sustained responders (P = .014); a similar trend was observed for HCV RNA (P < .0001). IgM anti-HCV-core levels decreased after therapy in responders (P < .001) but increased in nonresponders. Fifty-one cases were longitudinally tested in relation to long-term disease outcome. Both markers remained detectable in most nonresponders with persistent liver disease, in most responders before relapse, and in all but one case at the time of biochemical relapse. IgM anti-HCV-core and HCV RNA became undetectable in most sustained responders, but reappeared despite a long-lasting transaminase normalization, behaving as asymptomatic HCV carriers; the possibility that disease reactivation may take place years afterwards cannot be excluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract Background/Introduction: The purpose of this study is to examine the feasibility of engaging African American (AA) men as Citizen Scientists (CSs) to support the engagement, recruitment, and retention of AA men in a prostate cancer (PCa) study to validate a new biomarker, Prostate Health Index (PHI) in AA men. AA men are traditionally under-represented in PCa research. Additionally, PCa screening studies that have sought to validate innovative ways of improving the screening of PCa often exclude or do not intentionally focus on the engagement of AA men. Using a Community Engaged Participatory Research (CBPR) model, this study purposes to engage the social networks of AA men trained as CSs to engage and recruit a cohort of healthy controls as a low-cost first step in validating PHI as a PCa screening test in AA men. Methods: Building upon the social networks of the multi-PI team from 3 academic medical institutions and 2 community-based organizations, we sought to identify, recruit, and train 8-12 AA men as CSs. A CS training curriculum was developed and adapted from other CS training models to meet the specific needs of AA men engaged in PCa research. A training series of 5 two-hour modules was developed for the CSs; module 5 is a booster. Validated surveys and post-training evaluations were administered to CSs to assess medical mistrust, cancer knowledge, and adverse childhood experiences. Post-training questionnaires were used to assess quality of training and areas for improvement. Sessions were conducted using CBPR principles to allow CSs to inform the recruitment and retention approaches for AA men in the CSs social network. CSs and PIs collaboratively developed a series of recruitment events within their social networks. IRB approval was obtained across the three academic partners involved. Results: Nine AA men from the social networks of the multi-PI team have been identified. The 9 CSs include 3 PCa survivors, 2 faith-based leaders, 1 fraternity order member, 1 civic leader, 1 barber, and 1 community social worker. The CSs have completed 3 of 5 modules. All the 9 CSs have completed CITI IRB training and are key personnel in the research protocol. Attendance at meetings ranged from 75-100%. Medical mistrust was high among AA CSs. All CSs strongly agreed that their contribution to AA health equity was a reason for their participation. To date, one pilot community event has been developed from the social network of the faith-based and civic CSs. Six events have been planned for summer/fall 2018 to reach Year 1 recruitment goals. Conclusion: Early outcomes indicate that it is feasible to engage/train AA men as CSs to conduct PCa disparities research. Attendance and survey data suggest that AA male CSs are willing to support AA-focused PCa disparities research. Pending the assessment of the recruitment feasibility of AA men, this represents a potentially scalable model for engaging AA men in cancer disparities research and for leveraging social networks to support recruitment and retention of AA men in cancer disparities research. Citation Format: Karriem S. Watson, Josef Ben Levi, Tiffany McDowell, Alfreda Beth-Holloway, LeAndre Moore, Ivanhoe Hall, Alexander Kimbrough, Pooja Gogana, Robert A. Winn, Marcus Murray, Adam Murphy. Engaging African American men as citizen scientist to validate a prostate cancer biomarker [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A036.

Abstract Introduction: The low specificity of PSA in prostate cancer (PCa) screening has caused excessive biopsies and PCa over-detection. PHI is more specific for clinically significant (cs) PCa (i.e. Gleason >6 PCa) and includes serum PSA, [-2]proPSA, and free PSA in its formula. Validation studies in diverse populations have suggested that PHI should be used as a reflex test and the optimal cutoffs for PHI vary across ethnic groups, but have not been determined in Black men. We sought to 1) assess the distributions of PHI and PSA in healthy controls and men with high-grade PCa and 2) assess the accuracy of PHI vs. PSA for detection of csPCa in Black men with elevated PSA. Methods: The present study population consists of two biopsy-naïve cohorts. The first cohort serves as healthy controls and includes Black men with PHI and PSA drawn at community screening events through the social networks of eight lay Black male Citizen Scientists. The second PHI Biopsy Study cohort consists of Black men referred with elevated PSA and/or abnormal digital rectal exam (DRE) who had PHI drawn immediately before prostate biopsy. We excluded men with prior biopsies or known PCa. Distributions of PHI and PSA were compared across controls and men with negative biopsies, Gleason 6 PCa and csPCa. Among men with biopsy, we compared the area under the receiver operating characteristics curves (AUC) for PSA and PHI for detecting csPCa and assessed specificity at selected sensitivities as a proxy of avoided biopsies. We descriptively assessed theoretically avoided biopsies and missed csPCa at previously established PHI cut points [27.0, 28.6, 29.9, and 35.0]. Results: For the first objective, 139 men (42.5%) were included as controls from the Citizens Scientist Study and 188 (57.5%) were from the PHI Biopsy Study cohort, out of which 82 (43.6%) had a negative biopsy for PCa, 40 (21.1%) had low-grade PCa, and 66 (35.1%) had a Gleason >6 PCa. Compared to the healthy control group, the PHI Biopsy Study cohort was older (median age 61 vs. 55 years), with higher PSA levels (7.1ng/mL vs. 0.9ng/mL) and PHI scores (61.1 vs. 20.1), and more commonly had a family history of PCa (19.4% vs. 5.0%) and benign prostatic hyperplasia diagnosis (21.3% vs. 2.2%) (all p<0.001). Relative to PSA, PHI has a higher degree of overlap in the distribution between controls and csPCas (p <0.05), suggesting PHI would not perform well as a primary screening test in Blacks. In men with PSA between 4-10, PHI outperformed PSA in the detection of HGPCa with an AUC of 0.70 (95% CI: 0.59-0.81) compared to 0.57 (95% CI: 0.46-0.69). As a reflex test in men with PSA of 4-10ng/mL and normal DRE, a PHI cutoff of 35.0 would spare 20 (27.8%) low-risk men a biopsy while missing 2 (7.4%) csPCas. Conclusion: PHI should not be used for primary screening but has higher accuracy and specificity than PSA in Black men with PSA levels of 4-10ng/mL as a reflex test. At a cutoff of 35.0, 28% of low-risk men avoid biopsy while missing 7% of csPCas. Citation Format: Samuel Carbunaru, Oluwarotimi Nettey, Edward M Schaeffer, Peter H Gann, Michael Abern, Courtney M.P Hollowell, Karriem Watson, Tiffany McDowell, Rick A Kittles, Adam B Murphy. Performance of the prostate health index (PHI) assay in black men [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A066.

Background: African American men (AAM) are underrepresented in prostate cancer (PCa) research despite known disparities. Screening with prostate-specific antigen (PSA) has low specificity for high-grade PCa leading to PCa over diagnosis. The Prostate Health Index (PHI) has higher specificity for lethal PCa but needs validation in AAM. Engaging AAM as citizen scientists (CSs) may improve participation of AAM in PCa research. Objectives: Assess feasibility of mobilizing CSs to recruit AAM as controls for PHI PCa validation biomarker study. Methods: We highlight social networks/assets of stakeholders, CSs curriculum development/implementation, and recruitment of healthy controls for PHI validation. Results and Lessons Learned: Eight CSs completed all training modules and 139 AAM were recruited. Challenges included equity in research leadership among multiple principal investigators (PIs) and coordinating CSs trainings. Conclusions: Engaging AAM CSs can support engaging/recruiting AAM in PCa biomarker validation research. Equity among multiple stakeholders can be challenging, but proves beneficial in engaging AAM in research.

This article is an expansion on Rasmussen’s and Moore & McDowell’s articles on parenting, offering the opportunity to increase clinicians’ cultural competency in appreciating the distinctive experiences of Mexican American communities. This article raises awareness of the tension points and resiliency of Mexican immigrant families and promotes social inclusion at a time when the United States has become increasingly hostile toward people of Mexican descent. Adler’s progressive assertions have encouraged many to consider diversity factors essential to tailoring the treatment of patients and their families. Further, his theory has allowed for clinicians to argue that in the treatment of parenting reorientation, one style of parenting does not fit well with all families. The lead author uses personal anecdotes to highlight themes addressed in this article. Last, we provide suggestions for clinicians to consider both in and outside of treatment.

Descendants of the African Diaspora have encountered different challenges to wellbeing within their respective countries. In Cuba, it appears that while the Cuban Revolution attempted to level the outcomes for all citizens, Black Cubans remain marginalised and targets of discrimination. We, three African American and one Black Cuban women researchers, used a roundtable approach to analyse our experiences in Cuba. Using our individual reflections as data, the four of us sought to make meaning of cultural identity and expression within Cuba, and impact on well-being. Implications of this work can inform interventions for well-being of multiple African Diasporic populations in North and South America.

This article highlights historical and contemporary obstacles for African Americans toward parenting. The authors’ hope is to move beyond the “neutrality” or the “one size fits all” dialogue within the traditional Adlerian parenting model that has been discussed by several authors in the field. The authors use their personal experience to explore obstacles present in parenting through domains such as encouragement, belonging, and shame. In each of these domains, tension points exist when two or more possibilities are seemingly opposed to one another and both have hefty consequences to consider. The authors outline tension points for each domain and offer questions that African American parents may have in regard to overcoming these obstacles. They suggest nuances that traditional Adlerian parenting education may not consider. In conclusion, the authors recommend expanding Adlerian parenting education by incorporating an ecological model using interventions targeting the macro-, meso-, and micro-level.

Background: A community academic partnership was developed to implement a community-based participatory research project within Chicago's Englewood community.Objectives: We explain how Mental Health Impact Assessment (MHIA) ensures that mental health and health inequities are considered in decision making by using a systematic process that engages populations most likely to be impacted by those decisions.Methods: We report on the process of developing an MHIA by engaging community partners to evaluate and predict potential mental health outcomes of an employment policy.Lessons Learned: We describe the principle of working through bound liberation, resulting in a bidirectional engagement between academics and community partners. We highlight lessons and challenges of our engagement process.Conclusions: Effectively joining in solidarity with community partners was critical for project success, but community capacity needs to be increased to support future projects.

Purpose. To investigate the health needs of a rapidly growing Latino community and understand priorities for developing culturally sensitive health promotion strategies. Approach. A participatory research approach was selected to understand health challenges and opportunities for health engagement in the community. Setting. Norwood, Ohio, a small community in southwest Ohio. Participants. Latino adults living, working, or accessing services in Norwood. Method. Trained community researchers collected survey data from 198 participants at multiple community “points of contact” and door-to-door in more isolated neighborhoods. Survey data were aggregated using descriptive statistics. Two focus groups were conducted with 25 community members, transcribed, and analyzed using principles of thematic analysis. Participants' health concerns, health behaviors, and access to/experiences with health care were assessed. Results. Findings indicated significant health concerns, including overweight (43.2%) and obesity (28.6%), mental health challenges (anxiety 15.7%; depression 15.0%), and oral health concerns (23.0%). In addition, community members described barriers to accessing health care and strategies for preventing health problems and promoting positive health. Participants also discussed perceived discrimination and the need to address isolation within their community. Conclusion. Methods and findings from the ¡Hazlo Bien! participatory needs assessment are likely to be useful to those designing health promotion programs in quickly growing Latino communities where there are limited health services and few existing social support networks.

This article discusses how social conditions, cultural ethos and policies impact the mental health outcome of children in U.S. based armed gangs and child soldiers. Minority youth are disproportionately in gangs and enter the juvenile penal system. The penal system for juveniles fails to address pre-existing issues of abuse, and mental illness. Subsequently the overcrowded and poor conditions within the juvenile centers increase mental health problems. The focus on incarceration versus rehabilitation perpetuates problems and leads to worsening health disparities. By taking a human rights perspective and thus developing alternatives to costly punitive measures, mental health outcomes could improve among children vulnerable to gang influence as they do for child soldiers. This argument is very complex and this article’s goal is to raise provocative discussion that might lead to more investigation on behalf of mental health professionals and human rights activist in addressing the rights of youth in this country.

Research concerning therapeutic alliance and outcome is prevalent but relies heavily on data from individual treatment. In this article, the authors present data from cases in which an individual was seen and cases in which a couple was seen in order to investigate differences in therapeutic alliance and its trajectory depending on case type, therapist experience, and therapist sex. Participants included 96 couples and 52 individuals with 15 therapists from a large Midwestern training clinic for couple and family therapy. Data include the use of the Working Alliance Inventory–Shortened Version, and three-level models were estimated using hierarchical linear modeling. The results highlight differences in the trajectories of individual and couple clients' therapeutic alliance, including evidence for a curvilinear trend in work scores for individual clients but not couple clients. The results also highlight differences in the sources of variation for couple cases versus individual cases. There is clearly complexity in the building of alliance with clients in general, and even more so with couple clients.

Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N=195) during the initial stage of therapy at an on-campus training clinic. Self-rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.

Background: The large number of people who are obese in the United States has been observed in all racial, ethnic, gender, and age groups. However, racial and ethnic minority populations are disproportionally affected by obesity and at greater risk for many serious diseases. Purpose: The purpose is to reduce obesity and diabetes in African Americans who are members of faith-based organizations by sustaining and ensuring successful health ministry programs in the greater Cincinnati, Ohio area. Methods: A total of 142 African American females and males participated in a 20-week intervention. The mean age was 55 years. Ninety-seven percent of the participants were overweight/obese and 27% had diabetes. Results: Results of the cohort study showed that during year 2 participants showed better improvement in obesity and diabetic indicators than during year 1. Conclusions: A culturally sensitive Church-based wellness programs could be used to reduce obesity and diabetes in African Americans and sustained in the community.

The study uses 457 clients to investigate the impact of initial client factors on the development of therapeutic alliance. Data were collected longitudinally over the early portion of treatment. Cases included both individual and couple clients, allowing for examination of differences by case type. The study used the Working Alliance Inventory-Shortened Version (Tracey & Kokotovic, 1989) to measure therapeutic alliance. Initial factors considered included age, differentiation levels, prior stress, and depression. Couple clients showed differences from individual clients, and the variability prompted further investigation into relationship satisfaction and commitment as factors influencing the development of therapeutic alliance. Results highlight the increased complexity of developing an alliance with couples, and recommendations are provided for clinicians.

The purpose of this article is to report results of a qualitative investigation into the methods that HIV-positive men who have sex with men (MSM) use to initiate safer sex with casual sexual partners. In-depth, qualitative interviews were conducted with 57 HIV-positive adult MSM living in a large midwestern city. Using an inductive approach to data analysis, participants revealed a typology of safer sex strategies that can be placed into four primary categorizations: having a nonnegotiable sexual behavior policy, behaviorally controlling the interaction, being verbally direct, and being verbally indirect. Strategies varied by degree of explicitness and partner involvement. Men in this study often employed multiple strategies if their partner was not initially receptive to engaging in safer sex behaviors. The strategies described can be especially beneficial to those working in the area of HIV prevention. Providing MSM a variety of options to initiate safer sex may enhance current prevention efforts.