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Objective: Despite recognized benefits, engagement in Advance Care Planning (ACP) remains low. Research into peer-facilitated, group ACP interventions is limited. This study investigated the acceptability of community-led peer-facilitated ACP workshops for the public and whether these workshops are associated with increased knowledge, motivation and engagement in ACP behaviors. Methods: Peer-facilitators from 9 community organizations were recruited and trained to deliver free ACP workshops to members of the public with an emphasis on conversation. Using a cohort design, workshop acceptability and engagement in ACP behaviors was assessed by surveying public participants at the end of the workshop and 4–6 weeks later. Results: 217 participants returned post-workshop questionnaires, and 69 returned follow-up questionnaires. Over 90% of participants felt they gained knowledge across all 6 learning goals. Every ACP behavior saw a statistically significant increase in participant completion after 4–6 weeks. Almost all participants were glad they attended (94%) and would recommend the workshop to others (95%). Conclusion: This study revealed an association of peer-facilitated ACP workshops and completion of ACP behaviors in public participants. Innovation: This innovative approach supports investment in the spread of community-based, peer-facilitated ACP workshops for the public as important ACP promotion strategies.

Objective: This study aimed to describe the social determinants of health influencing obesity for the aged in a community context and based on the perspectives of various stakeholders. Methods: This was qualitative content analysis study using data from the focus group, individual in-depth interview, and observation. The study population was domiciled in Pakpoon Village, Mung District, Nakhon Si Thammarat Province, a tight-knit settlement typical of most retirement communities. Data were collected through two focus group discussions, direct observation, and in-depth interviews with 19 participants. Respondents represented key community groups: local nurses and public health officers, elderly residents, family caregivers (family members), and village health volunteers. Results: The participants shared similar perspectives about the social determinants of health influencing obesity in the aged, which spanned three themes. These were: 1) neighborhood food environment (easy access to unhealthy food, no choice to recruit healthy food); 2) social networks influencing obesity (family affects food choices and prohibitions on exercise; belief, and socially imposed body image perceptions contributing to obesity in the aged); and 3) knowledge, attitudes, and beliefs behind lifestyle choices that cause obesity in the elderly (lack of awareness, personal attitudes, job and familial duties as barriers to engaging in physical activities; over-consumption behaviors lead to obesity in older people). Conclusion: These three themes were the root causes of obesity in the elderly in Pakpoon’s retirement community. This finding suggests that policymakers and nurses can create healthy environments, both to treat and prevent obesity, by raising awareness in younger generations, providing aging the provision of healthy food choices for older adults, encouraging health care professionals to share knowledge, and by modifying the attitudes and beliefs of both caregivers and older adults.

The connection that young people have to their local neighbourhood and community has been shown to impact on health and wellbeing, particularly for those living in the most deprived areas. We report on a qualitative participatory study using photo elicitation methods undertaken in three deprived neighbourhoods across London exploring concepts of community and social connection, with young people aged 13–24 years, against the backdrop of the COVID-19 pandemic. The construct of social capital, referring to the extent of solidarity and connection between groups, has been shown to impact on pandemic related outcomes, and is used in this study as a lens to enhance understanding of young people's experience of the pandemic.Young people created heterogenous physical social ties across class, ethnicity, and geographical area which were important during the pandemic, although these may be jeopardised by a range of factors including fear of violence, mistrust of those in power, parental control and place-based inequity. The isolation and localism enforced by the pandemic encouraged young people to pay more attention to the value of local connections they built up both with people and place.Place-based research needs to continue a dialogue with young people, acknowledging and drawing on existing networks, community assets and cultural beliefs. The impact of COVID-19 on accentuating existing inequalities means that the need for place-based action, addressing the social determinants of health and involving the experiences and input of the young, is more vital than ever.

Objective: This study explored the approaches for community-based flood disaster management for older adults in Southern Thailand. It sought to understand community culture for supporting older adults and promoting community strength in case of flood disaster. Method: This was a qualitative content analysis study using data from observation, in-depth interviews, secondary data, and focus group discussion. One hundred and twenty-seven people in total were selected specifically for the study, including Local Administration Organization (LAO), community leaders, public sector officers, civil groups, and older adult groups and family caregivers. Results: The results of this study were two main themes, focusing on 1) approaches to community-based flood disaster management for older adults as follows: eight approaches in the phase of prevention and preparedness in flood disaster management for older adults, eight approaches in the phase of response in flood disaster management for older adults, and six approaches in the phase of recovery and rehabilitation in flood disaster management for older adults; and 2) factors contributing to success in flood disaster management for older adults has four factors, including the human factor, the work factor, the data factor, and the resource factor. Conclusion: The findings showed significant roles in improving the potential and strength in community-based flood disaster management for older adults and providing suggestions for community nurses and health practice personnel involving in flood disaster management to mitigate the potential influence on older adults in the community.

Resumen: La gestión de la pandemia de COVID-19 ha dejado en segundo plano la participación comunitaria, a pesar de la evidencia de su importancia para la equidad y la promoción de la salud. Aun así, ha habido experiencias participativas que aportan claves de cara a cómo enfrentar posibles emergencias futuras incorporando un enfoque de promoción de la salud y determinantes sociales. El objetivo de este artículo es, a partir de la evidencia y las experiencias desarrolladas en España, hacer una reflexión crítica del papel de la participación comunitaria durante la pandemia y extraer aprendizajes de utilidad para estar mejor preparados en próximas crisis. Para ello, es fundamental construir y mantener redes comunitarias, identificar objetivos comunes y el rol que deben desempeñar los diferentes agentes comunitarios, adaptarse a los distintos contextos y evaluar participativamente. La acción comunitaria no se improvisa: requiere tiempo, recursos y voluntad política para hacerla eficaz y sostenible. Abstract: Community participation has been put as secondary due to the management of the COVID-19 pandemic. This is despite the evidence of its importance in relation to equity and health promotion. Even so, there have been a number of experiences of community participation that can give us clues towards how to confront potential future emergencies focusing on health promotion and social determinants. The main aim of this article is reflecting critically on the role of community participation during the pandemic as well as extracting a number of ideas which could be useful and ensure a better management of a future crisis. They arise from evidence and experiences undertaken in Spain. In order to do so, it is key to build and maintain community networks whilst identifying common goals and the role that different community agents must play, adapting to different contexts and participatory assessments. Community action cannot be improvised: it demands time, resources and specific political willingness to make it sustainable and efficient.

The association between non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) is now well established, as people with COPD are more likely to develop lung carcinoma. However, the evidence for this relationship is inconclusive and there is currently little information on the underlying molecular mechanisms. MicroRNAs (miRNAs) are one of the regulatory factors in NSCLC and COPD that their functions are widely studied in many chronic diseases and cancers. In this study, we applied systems biology approaches to identify and predict miRNAs that potentially play regulatory roles between COPD and NSCLC. We performed differential expression analysis on public miRNA and mRNA expression datasets, for both of diseases, and then we reconstructed two miRNA-mRNA co-expression networks and merged these two co-expression networks into a community co-expression network. Results indicated the existence of very common miRNAs (ex. hsa-miR-326 and hsa-miR-1293) and mRNAs (such as FAT2, ALOX5AP, and LDB2) between the two mentioned diseases. Moreover, we discovered specific miRNAs (hsa-miR-574-3p) that targeted common mRNAs. We utilized drug-target interaction networks to identify candidate drugs for common mRNAs, which can be considered in the treatment of two diseases (e.g. iloperidone). Generally, our study highlighted common miRNAs between COPD and NSCLC that as new signatures or biomarkers for therapeutic purposes. Investigating the miRNA biomarkers in this study improves our understanding about the shared mechanisms between COPD and NSCLC.

Accurate and effective local data collection systems are needed to inform community change on youth health behaviors such as physical activity (PA). Systematic methods are particularly important for understanding PA behaviors that may be influenced by individual, interpersonal, organizational, and regional factors. The purpose of this study was to describe a protocol for coordinating community stakeholders to implement an online youth PA surveillance instrument. The research team collaborated with local health departments (LHDs) from two rural communities to coordinate schools in implementing school-wide youth PA surveillance. A data sharing agreement was established between all partners. School administrators and teachers attended in-person training sessions for an online PA survey and how to use the data. Following the training, students were provided individualized logins to complete the survey once a semester over a two-year academic period. Across both communities, 23 teachers and administrators attended the training sessions that were facilitated by the LHDs and research team. In Year 1 (Y1), a total of 465 3rd through 6th grade students were enrolled in the participating schools (community 1 = 227; community 2 = 238). Survey response rates ranged from 86.1% to 95.4% completion, depending on the community and semester. In Year 2 (Y2), a total of 501 3rd through 6th grade students were enrolled (community 1 = 260; community 2 = 241). Response rates ranged from 86.3% to 89.6% in the fall term. A protocol for coordinating LHD and community stakeholders was an effective strategy for implementing population-level youth PA surveillance with high levels of reach.

Research in surgery faces intrinsic difficulties such as the lack of reproducibility of surgical operations, self-referring surgeons, decentralized data. Establishing a community of qualified researchers across surgeons is crucial. Clinical networks have been proposed as solutions to many challenges in surgical research, yet their implementation remains uncommon, especially for surgical trialists. The extent of literature produced by networks remains unclear, but fostering such collaborations could enhance the overall quality of surgical research. We conducted review focusing on research networks in colorectal surgery to assess their workload and impact in the literature and identify factors contributing to their durability. Following PRISMA guidelines, we searched for articles published through research networks. Networks were categorized by subspecialty, and specific items were retrieved for further classification. A survey was administered to twenty experts in colorectal surgery or research networking. A total of 2490 manuscripts were screened, and 397 networks identified. Of these, 96 were colorectal networks contributing to 492 publications, with 28 networks having five or more publications. Seventeen networks were affiliated with International or National societies, and only 5 conducted both prospective trials and RCTs. Twenty networks reported national or population-based data, and 26 networks lasted for more than 5 years. Sixteen experts participated in the survey, with an 80 % compliance rate, and 12 of them have been involved in creating a surgical network. The large majority of experts advocate the establishment of guidelines for networks creation in the surgical community., Competing Interests: Declaration of competing interest The authors declare no competing interests., (© 2024 Published by Elsevier Ltd.)

Promoting healthy eating and lifestyles among populations with limited resources is a complex undertaking that often requires strong partnerships between various agencies. In local communities, these agencies are typically located in different areas, serve diverse subgroups, and operate distinct programs, limiting their communication and interactions with each other. This study assessed the network of agencies in local communities that promote healthy eating and lifestyles among populations with limited resources. Network surveys were administered in 2016 among 89 agencies located in 4 rural counties in Michigan that served limited-resource audiences. The agencies were categorized into 8 types: K-12 schools, early childhood centers, emergency food providers, health-related agencies, social resource centers, low-income/subsidized housing complexes, continuing education organizations, and others. Network analysis was conducted to examine 4 network structures—communication, funding, cooperation, and collaboration networks between agencies within each county. Agencies had a moderate level of cooperation, but were only loosely connected in the other 3 networks, indicated by low network density. Agencies in a network were decentralized rather than centralized around a few influential agencies, indicated by low centralization. There was evidence regarding homophily in a network, indicated by some significant correlations within agencies of the same type. Agencies connected in any one network were considerably more likely to be connected in all the other networks as well. In conclusion, promoting healthy eating and lifestyles among populations with limited resources warrants strong partnership between agencies in communities. Network analysis serves as a useful tool to evaluate community partnerships and facilitate coalition building.

Soil microbial communities play a vital role in the biogeochemical cycling and ecological functioning of grassland, but may be affected by common land uses such as cattle grazing. Changes in microbial diversity and network complexity can affect key ecosystem functions such as nutrient cycling. However, it is not well known how microbial diversity and network complexity respond to grazing in the Northern Great Plains. Consequently, it is important to understand whether variation in grazing management alters the diversity and complexity of grassland microbial communities. We compared the effect of intensive adaptive multi-paddock (AMP) grazing and conventional grazing practices on soil microbial communities using 16S/ITS amplicon sequencing. Samples were collected from grasslands in 13 AMP ranches and 13 neighboring, conventional ranches located across the Canadian prairies. We found that AMP grazing increased fungal diversity and evenness, and led to more complex microbial associations. Acidobacteria, Actinobacteria, Gemmatimonadetes, and Bacteroidetes were keystone taxa associated with AMP grazing, while Actinobacteria, Acidobacteria, Proteobacteria, and Armatimonadetes were keystone taxa under conventional grazing. Besides overall grazing treatment effects, specific grazing metrics like cattle stocking rate and rest-to-grazing ratio affected microbial richness and diversity. Bacterial and fungal richness increased with elevated stocking rate, and fungal richness and diversity increased directly with the rest-to-grazing ratio. These results suggest that AMP grazing may improve ecosystem by enhancing fungal diversity and increasing microbial network complexity and connectivity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Objective: The objective of this work was to describe an efficient and sustainable outreach model in a resource-constrained environment, with a multifaceted approach focusing on national policy change, telemedicine, injury prevention, education and treatment of burns., Summary Background Data: Burn injury constitutes a significant portion of morbidity and mortality worldwide, particularly in children, and in low- and middle-income countries., Methods: We reviewed the impact of ten-years of a burn outreach program. Our focus was on clinical data on burn care within one region of Ukraine. We assessed knowledge of burn prevention/first aid utilizing a large survey, analyzed clinical data from our outreach clinic and telemedicine program, and analyzed data within a newly created burn repository within Ukraine., Results: A national burn prevention policy has been implemented through our efforts along with a burn prevention program. Educational efforts have led to improvements of major complication rates (wound infection [7% vs. 16%], pneumonia [2.4% vs. 0.3%], sepsis [1.6% vs. 0.6%], UTI [2% vs. 0.6%], and cellulitis [11% vs. 3.4%]), respiratory support of acutely ill patients [1.3% vs. 0.4%], and blood transfusion triggers., Conclusions: Broadly, our model could be an example of building sustainable outreach programs in resource-constrained environments. Through collaboration with local healthcare providers, we have developed and implemented an outreach program in a resource-constrained environment., (Copyright © 2021 Elsevier Ltd and ISBI. All rights reserved.)

The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Based on the profile of genetic alterations occurring in tumor samples from selected diffuse large B-cell lymphoma (DLBCL) patients, 2 recent whole-exome sequencing studies proposed partially overlapping classification systems. Using clustering techniques applied to targeted sequencing data derived from a large unselected population-based patient cohort with full clinical follow-up (n = 928), we investigated whether molecular subtypes can be robustly identified using methods potentially applicable in routine clinical practice. DNA extracted from DLBCL tumors diagnosed in patients residing in a catchment population of ∼4 million (14 centers) were sequenced with a targeted 293-gene hematological-malignancy panel. Bernoulli mixture-model clustering was applied and the resulting subtypes analyzed in relation to their clinical characteristics and outcomes. Five molecular subtypes were resolved, termed MYD88, BCL2, SOCS1/SGK1, TET2/SGK1, and NOTCH2, along with an unclassified group. The subtypes characterized by genetic alterations of BCL2, NOTCH2, and MYD88 recapitulated recent studies showing good, intermediate, and poor prognosis, respectively. The SOCS1/SGK1 subtype showed biological overlap with primary mediastinal B-cell lymphoma and conferred excellent prognosis. Although not identified as a distinct cluster, NOTCH1 mutation was associated with poor prognosis. The impact of TP53 mutation varied with genomic subtypes, conferring no effect in the NOTCH2 subtype and poor prognosis in the MYD88 subtype. Our findings confirm the existence of molecular subtypes of DLBCL, providing evidence that genomic tests have prognostic significance in non-selected DLBCL patients. The identification of both good and poor risk subtypes in patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) clearly show the clinical value of the approach, confirming the need for a consensus classification., (© 2020 by The American Society of Hematology.)

The nexus between law enforcement and public health represents a new and emerging policy field. Yet, most scholarly work has been devoted to police attitudes and interventions involving people affected by mental illness. This paper draws attention to a law enforcement - public health partnership in Amsterdam, the capital city of the Netherlands. We present a qualitative study based on interviews and some observations. Three major themes emerged from our fieldwork that involved policy makers, community police officers, and district nurses: how these officers and nurses perceive the problem of disorderly and confused people, how they work together in practice, and how they relate to a wider network of many other players. We argue that community police officers and district nurses have developed a kind of informal 'team play' consisting of three steps: receiving and analysing a signal, undertaking action, and providing aftercare. These steps offer a preventative approach aimed at avoiding and forestalling crisis situations. Difficulties arise in terms of tracing so-called 'care avoiders' (people who do not present a 'readiness for treatment'), hampered information exchange, and the governance of partners beyond our respondents' own organisations. In particular, we argue that today's society is not only governed through crime, but also through care. There is no such thing as a robust 'punitive complex' in which policing and criminal justice logics prevail. Rather, we witness a multi-agency network of police, public health, mental health, youth care housing associations and other nodal actors, each with their own bureaucratic logics and working methods tending to clash with, or even undermine, informal team play on the streets., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

There are over five million people in the United States living with dementia. Most live at home and are cared for by family. These family caregivers often assume care responsibilities without education about the disease, skills training, or support, and in turn become at risk for depression, burden, and adverse health outcomes when compared to non-dementia caregivers. Despite over 200 caregiver interventions with proven benefits, many caregivers lack access to these programs. One approach to enhance access is to embed evidence-based caregiver support programs in existing community-based services for people with dementia such as adult day services (ADS). Here we describe the protocol for an embedded pragmatic trial designed to augment standard ADS known as ADS Plus. ADS Plus provides family caregivers with support via education, referrals, and problem-solving techniques over 12 months, and is delivered on-site by existing ADS staff. Embedding a program in ADS requires an understanding of outcomes and implementation processes in that specific context. Thus, we deploy a hybrid design involving a cluster randomized two-group trial to evaluate treatment effects on caregiver wellbeing, ADS utilization, as well as nursing home placement. We describe implementation practices in 30 to 50 geographically and racially/ethnically diverse participating sites. Clinical trial registration #: NCT02927821., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: During outbreaks of infectious diseases, transmission of the pathogen can form networks of infected individuals connected either directly or indirectly., Methods: Network centrality metrics were used to characterize hospital-acquired Middle East Respiratory Syndrome Coronavirus (HA-MERS) outbreaks in the Kingdom of Saudi Arabia between 2012 and 2016. Covariate-adjusted multivariable logistic regression models were applied to assess the effect of individual level risk factors and network level metrics associated with increase in length of hospital stay and risk of deaths from MERS., Results: About 27% of MERS cases were hospital acquired during the study period. The median age of healthcare workers and hospitalized patients were 35 years and 63 years, respectively, Although HA-MERS were more connected, we found no significant difference in degree centrality metrics between HA-MERS and non-HA-MERS cases. Pre-existing medical conditions (adjusted Odds ratio (aOR)=2.43, 95% confidence interval: (CI) [1.11-5.33]) and hospitalized patients (aOR=29.99, 95% CI [1.80-48.65]) were the strongest risk predictors of death from MERS. The risk of death associated with 1-day increased length of stay was significantly higher for patients with comorbidities., Conclusion: Our investigation also revealed that patients with an HA-MERS infection experienced a significantly longer hospital stay and were more likely to die from the disease. Healthcare worker should be reminded of their potential role as hubs for pathogens because of their proximity to and regular interaction with infected patients. On the other hand, this study has shown that while healthcare workers acted as epidemic attenuators, hospitalized patients played the role of an epidemic amplifier., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In the Network Era, with the emergence of various instant communication tools, the public are easier to be disseminators than ever. But we have often heard that silence is golden. Inspired by this fact, we investigate that whether the existence of disseminators is beneficial to promote cooperation in the provision of public culture services. To answer this interesting question, we classify disseminators as neutral disseminators, positive disseminators and negative disseminators. And four models are set up, namely, neutral disseminator model (MBD), positive disseminator model (MPD), negative disseminator model (MND) and silencer model (MS). By numerical simulations, it is observed that MND, MBD, MPD and MS perform best in 70%, 25%, 5% and 0% of cases, respectively. And the advantage of the best model is different in various situations. Our work highlights that criticizing instead of tolerating defection is always the best choice to promote cooperation, except the population is relatively large or the agent's reference range fluctuates violently. Besides, under the mechanisms of reputation and conformity, the organizer can not play a significant role on promoting cooperation by intervening information transfer in some conditions, especially when the link-neighbor degree is very low., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Glaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma., Methods: The RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions., Discussion: By targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17-19%) - a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive., Conclusions: Evaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

In this article we argue for a community-based approach as a means of promoting a culture of evaluation. We do this by linking two bodies of knowledge - the 70-year theoretical tradition of community-based research and the trans-discipline of program evaluation - that are seldom intersected within the evaluation capacity building literature. We use the three hallmarks of a community-based research approach (community-determined; equitable participation; action and change) as a conceptual lens to reflect on a case example of an evaluation capacity building program led by the Ontario Brian Institute. This program involved two community-based groups (Epilepsy Southwestern Ontarioand the South West Alzheimer Society Alliance) who were supported by evaluators from the Centre for Community Based Research to conduct their own internal evaluation. The article provides an overview of a community-based research approach and its link to evaluation. It then describes the featured evaluation capacity building initiative, including reflections by the participating organizations themselves. We end by discussing lessons learned and their implications for future evaluation capacity building. Our main argument is that organizations that strive towards a community-based approach to evaluation are well placed to build and sustain a culture of evaluation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Children who have experienced physical abuse benefit from a multitude of community interventions including support programs to address emotional and behavioral stability. This pilot study evaluated the services of Bikers Against Child Abuse (BACA), a community of bikers lending intervention to abused children, using a pre/post exploratory design. Participants (N=154) were children who had been referred by parents/guardians for current or past physical and/or sexual abuse. Parents/guardians of children were interviewed four times over a course of one year. Results indicated children demonstrated substantial improvements in their overall levels of emotional distress, conduct concerns, hyperactivity, and behavioral and emotional functioning. Overall, results support the premise that services provided by BACA may serve as a unique intervention for children who have experienced abuse., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Dengue has emerged as one of the most important mosquito-borne, fatal flaviviral disease, apparently expanding as a global health problem. An estimated 3.6 billion people are at risk for dengue, with 50 million infections per year occurring across 100 countries globally. The annual number of dengue fever cases in India is many times higher than it is officially reported. This under reporting would play a major role in the government's decision-making. Underestimating of the disease in India encumbers its people from taking preventive measures, discourages efforts to ensnare the sources of the disease and deliberates efforts for vaccine research. In this article, we highlight the probable impediments of under reporting leading to its impact on national and global public health and also offer key remedies to effectively address the issues across the clinics to the community level., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In Nigeria, Aflasafe is a registered biological product for reducing aflatoxin infestation of crops from the field to storage, making the crops safer for consumption. The important questions are whether farmers will purchase and apply this product to reduce aflatoxin contamination of crops, and if so under what conditions. A study was carried out to address these questions and assess determinants of willingness to pay (WTP) for the product among maize and groundnut farmers in Kano and Kaduna states in Nigeria. A multistage sampling technique was used to collect primary data from 492 farmers. The majority of farmers who had direct experience with Aflasafe (experienced farmers) in Kano (80.7%) and Kaduna (84.3%) had a WTP bid value equal to or greater than the threshold price ($10) at which Aflasafe was to be sold. The mean WTP estimates for Aflasafe for experienced farmers in Kano and Kaduna were statistically the same. However, values of $3.56 and $7.46 were offered in Kano and Kaduna states, respectively, by farmers who had never applied Aflasafe (inexperienced farmers), and the difference here was significant (P < 0.01). Regression results indicate that contact with extension agents (P < 0.01) and access to credit (P < 0.05) positively and significantly influenced the probability that a farmer would be willing to pay more for Aflasafe than the threshold price. Lack of awareness of the importance of Aflasafe was the major reason cited by inexperienced farmers (64% in Kano state and 21% in Kaduna state) for not using the product. A market strategy promoting a premium price for aflatoxin-safe produce and creating awareness and explaining the availability of Aflasafe to potential users should increase Aflasafe usage.

Objective: In the Japanese Long-Term Care Insurance (LTCI) system, a community-based program for oral health and nutrition (OHN program) has been implemented with the aim of reducing incident disability and care costs. However, the effectiveness of this program has not been confirmed epidemiologically. The purpose of the present study was to test the hypothesis that the OHN program does reduce incident disability and care costs., Design: A prospective study with a 28-month follow-up period was conducted using data from administrative databases at Tagajo City, Japan. Among frail elderly persons (aged 65 years or more) who were enrolled in the LTCI program in Tagajo, 64 participants in the OHN program and 128 controls (nonparticipants) were selected by propensity score matching., Measurements: We used 2 types of outcome measure: composite outcome (incident disability and death) and care cost. Data on incident disability were retrieved from the public LTCI database. Care cost was defined as the total amount of LTCI service cost added to medical care cost., Results: The hazard ratio of composite outcome was significantly lower for the intervention group than for the control group (hazard ratio = 0.32, 95% confidence interval 0.12-0.82). Even when we set incident disability as an outcome, the hazard ratio for the intervention group did not change (hazard ratio = 0.33, 95% confidence interval 0.11-0.97). The mean cumulative care cost during the 28 months tended to be lower for the intervention group ($4893) than that for the control group ($5770), but this was not statistically significant by the gamma regression model (cost ratio = 0.85, P = .513). The mean care cost per unit follow-up period (1 month) for the intervention group was significantly lower (cost ratio = 0.54, P = .027)., Conclusions: The results of this study suggest that the OHN program is effective for preventing incident disability and, consequently, for saving care costs per unit survival period., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)