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Facial feminization surgery (FFS) is a form of gender-affirming care for the transgender population that is currently a highly debated topic both inside and outside of the medical community. Currently, a paucity of information is available in plastic surgery literature on ethical issues surrounding FFS. In this paper, we discuss 5 major ethical considerations for plastic surgeons with regard to FFS: (1) how society's changing view of gender has impacted the importance of FFS; (2) whether FFS is medically necessary and should be covered by insurance; (3) to what extent resources should be invested in removing barriers to access FFS; (4) how patient selection criteria should address the irreversibility of the procedure and age of consent; and (5) how femininity and beauty standards contribute to each other and whether they can be disentangled. This paper aims to analyze the arguments made for and against each of these 5 nuanced issues and to expand these debates from the theoretical to the practical by suggesting approaches for reconciliation. [ABSTRACT FROM AUTHOR]

Background Developing age-friendly communities is a significant global policy issue. The WHO (2007) age-friendly cities and communities initiative has had a significant influence on the development of Ireland's Age-Friendly Programme. With research on such programmes still at an early stage, this paper critically examines the utilisation of the WHO age-friendly planning framework in an Irish context. It explores older adults' experience of living in two towns in an 'age-friendly' county and, in parallel, examines stakeholders' perspectives on the development of the county's age-friendly programme. This multi-perspectival approach facilitates an assessment of how the age-friendly county programme addresses older residents' needs, and illustrates how the WHO conceptual and planning framework has worked in an Irish context. Methods The paper reports on a study which employed a mixed-method, qualitative case-study research design, using a constructivist grounded theory approach to explore the lived experience of older adults, and a case-study framework for the stakeholder perspective. Results The research identifies salient social and cultural dimensions of the day-to-day lived experience of older people which, although they impact on the age-friendliness of the places in which they live, are neglected in the WHO framework. It also identifies a unique combination of economic, political, cultural, and organisational factors which have impacted on age-friendly programme development in Ireland. Conclusion In critically analysing use of the WHO age-friendly model, the paper suggests ways in which the model can be modified to better accommodate the diverse experience of older adults not only in Ireland, but also in other geographic and cultural contexts. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measure (PROM) data are increasingly being collected over the internet or on a smart device by means of electronic versions (e-PROMs). Limited evidence exists about factors influencing e-PROM implementation in outpatient clinics.Objectives: The authors sought to identify barriers to collection of PRO data from different locations (home or cosmetic surgery office) by means of different modes (paper vs e-PROM) from the perspective of patients, plastic surgeons, and clinic administrative staff; and to explore patient preferences for the design of e-PROM platforms.Methods: Semistructured interviews were conducted with 11 patients, 3 cosmetic surgeons, and administrative staff. Patients were shown 1 of the 3 PROMs (ie, the BODY-Q Satisfaction with Body scale, BREAST-Q Augmentation Module Satisfaction with Breast scale, or FACE-Q Satisfaction with Facial Appearance scale). The formats included paper and electronic (REDCap and TickiT) on a tablet and laptop computer. The interviews were audio-recorded and transcribed verbatim. Qualitative descriptive analysis was conducted.Results: Patients and providers preferred electronic over paper format. The flexibility of the hardware, data entry point (remote location vs point-of-care), and the privacy of the data were the most recurring themes from the patient's perspective. The objective of collecting PROM data, role in peer-benchmarking, and return on investment were key to surgeons and administrative staff.Conclusions: The e-PROMs were well accepted in the community setting by the patients and plastic surgeons alike. The design and interface features of e-PROMs were explored in this study, which may be useful for future, mixed method studies evaluating the implementation of e-PROMs. [ABSTRACT FROM AUTHOR]

Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed. [ABSTRACT FROM AUTHOR]

Community participation in health (CPH) has been advocated as a health-improving strategy for many decades. However, CPH comes in many different forms, one of which is the use of health facility committees (HFCs) on which there is community representation. This paper presents the findings of a systematic literature review of: (a) the evidence of HFCs' effectiveness, and (b) the factors that influence the performance and effectiveness of HFCs.Four electronic databases and the websites of eight key organizations were searched. Out of 341 potentially relevant publications, only four provided reasonable evidence of the effectiveness of HFCs. A further 37 papers were selected and used to draw out data on the factors that influence the functioning of HFCs. A conceptual model was developed to describe the key factors. It consists of, firstly, the features of the HFC, community and facility, and their interactions; secondly, process factors relating to the way HFCs are established and supported; and finally, a set of contextual factors.The review found some evidence that HFCs can be effective in terms of improving the quality and coverage of health care, as well as impacting on health outcomes. However, the external validity of these studies is inevitably limited. Given the different potential roles/functions of HFCs and the complex and multiple set of factors influencing their functioning, there is no ‘one size fits all’ approach to CPH via HFCs, nor to the evaluation of HFCs. However, there are plenty of experiences and lessons in the literature which decision makers and managers can use to optimize HFCs. [ABSTRACT FROM PUBLISHER]

Local coalitions can advance public health initiative but have not been widely used or well-studied in low- and middle-income countries. This paper provides (i) an overview of an ongoing matched-pairs community-randomized controlled trial in 28 communities in Armenia and Georgia (N = 14/country) testing local coalitions to promote smoke-free policies/enforcement and (ii) characteristics of the communities involved. In July–August 2018, key informants (e.g. local public health center directors) were surveyed to compare their non-communicable disease (NCD) and tobacco-related activities across countries and across condition (intervention/control). More than half of the informants (50.0–57.1%) reported their communities had programs addressing hypertension, diabetes, cancer and human papilloma virus, with 85.7% involving community education and 32.1% patient education programs. Eleven communities (39.3%) addressed tobacco control, all of which were in Georgia. Of those, all included public/community education and the majority (72.7–81.8%) provided cessation counseling/classes, school/youth prevention programs, healthcare provider training or activities addressing smoke-free environments. Informants in Georgia versus Armenia perceived greater support for tobacco control from various sectors (e.g. government, community). No differences were found by condition assignment. This paper provides a foundation for presenting subsequent analyses of this ongoing trial. These analyses indicate wide variability regarding NCD-related activities and support across communities and countries. [ABSTRACT FROM AUTHOR]

Background Frailty is an important marker of adverse outcomes for older people accessing the Emergency Department (ED). Older patients with frailty have a higher attendance rate to the ED, spend longer in the ED and have a higher rate of admission (HSE, 2017). Frailty Intervention Therapy Teams (FITT) are designed to screen and assess this population in the ED setting, with the aim of early assessment to help decrease length of stay or avoid admission. Two different FIT Teams have recently been formed within the Cork-Kerry region. The aim of this study was to evaluate staff's experience of these teams. Methods This was a mixed methods study. Structured surveys were developed to collect qualitative and quantitative data. The surveys were constructed using themes listed by Proctor et al. (2011) around implementation and service outcomes. Ward and ED staff were provided with paper surveys within the hospital setting and community staff were surveyed via post. Quantitative survey data was analysed using descriptive statistics and qualitative data was analysed with thematic content analysis. Results Data from 117 surveys was included for analysis (response rate 49%). Results showed that the majority of staff (89%) reported ED was a suitable setting for the FITT, with 85% reporting the information collected by the FITT impacted their involvement. Other themes emerging from staff's experience included timeliness, safety and comprehensive assessment. Conclusion Overall, staff reported the FITT provided a timely service that assisted with decision making and planning. This involved earlier comprehensive assessment, prompt identification of issues which lead to decreased workload for ward staff. It also created an increased volume of referrals to community and ward staff received in a timelier manner. [ABSTRACT FROM AUTHOR]

Background Day care is an important service for some people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia specific day-care centres and generic centres that cater for people with dementia to various degrees. In this paper we map the geographic variation in the supply of day care services for people with dementia relative to potential need. Methods Using a national HSE survey of day care centres, we estimate the current supply of day care services for people with dementia in both generic and dementia specific centres by combining a number of qualitative and quantitative measures. To identify the variation in supply, we map day care provision at local and regional levels to the number of people with dementia in the area. To consider geographic accessibility, we map and analyse the population living outside the catchment area of the day care centres. Results There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia varies from 9 to 16 across the Community Health Organisation areas. We show that 20 per cent of people with dementia are not living within a 15km radius of a day care centre that caters for people with dementia. Conclusion Day care has a place in the menu of service for people with dementia living in the community. As the number of people with dementia grows, investment in day care centres needs to be targeted to areas of greatest need. In many parts of the country, the current day care centres have limited capacity to provide a service for people with dementia that live in their catchment area. There is considerable geographical inequity in day care provision for people with dementia across the country. [ABSTRACT FROM AUTHOR]

Background Determinants of hypertension diagnosis and/or awareness and control among older adults are understudied in Albania, a former communist country in South Eastern Europe, which is experiencing rapid demographic, socioeconomic and epidemiological transition. This paper examines the association of individual, interpersonal, organizational and community factors with hypertension awareness and control among older adults in Tirana, the Albanian capital. Methods Using 2012 International Mobility in Aging Study data on older adults from Albania's capital city (n = 393) and the socioecological model as a conceptual framework, multinomial regression models identified factors associated with controlled, uncontrolled and undiagnosed hypertension. Results For hypertension, 17.3% participants had none, 23.4% were controlled, 48.4% were uncontrolled and 10.9% were undiagnosed/unaware. Compared to those with controlled hypertension, in multivariable models, a high level of friend support was negatively associated with uncontrolled (OR: 0.4; 95% CI: 0.2–0.9) and undiagnosed (OR: 0.2; 95% CI: 0.1–0.6) hypertension. A high level of perceived neighbourhood safety was negatively associated with uncontrolled (OR: 0.6; 95% CI: 0.3–1.0) and undiagnosed (OR: 0.4; 95% CI: 0.2–1.0) hypertension. Compared to those with no hypertension, children's social support was positively associated with uncontrolled (OR: 2.2; 95% CI: 1.1–4.3) and undiagnosed (OR: 3.6; 95% CI: 1.3–9.6) hypertension. Conclusion This study provides new insights about distinct risk factors for inadequate hypertension management in Albania. It highlights the importance of community-level factors (safety) and interpersonal factors (family and friend ties) to hypertension diagnosis/awareness and control, which may provide novel intervention opportunities for hypertension programs. [ABSTRACT FROM AUTHOR]

Background A growing body of research has found that participating in choir singing can increase positive emotions, reduce anxiety and enhance social bonding. Consequently, group singing has been proposed as a social intervention for people diagnosed with mental health problems. However, it is unclear if group singing is a suitable and effective adjunct to mental health treatment. The current paper systematically reviews the burgeoning empirical research on the efficacy of group singing as a mental health intervention. Methods The literature searched uncovered 709 articles that were screened. Thirteen articles representing data from 667 participants were identified which measured mental health and/or wellbeing outcomes of group singing for people living with a mental health condition in a community setting. Results The findings of seven longitudinal studies, showed that while people with mental health conditions participated in choir singing, their mental health and wellbeing significantly improved with moderate to large effect sizes. Moreover, six qualitative studies had converging themes, indicating that group singing can provide enjoyment, improve emotional states, develop a sense of belonging and enhance self-confidence in participants. Conclusion The current results indicate that group singing could be a promising social intervention for people with mental health conditions. However, these studies had moderate to high risk of bias. Therefore, these findings remain inconclusive and more rigorous research is needed. [ABSTRACT FROM AUTHOR]

The role of evidence and expertise in policy-making has been of interest to public health professionals and political scientists alike. The public health community often sees its efforts as part of a linear knowledge transfer process and tends to blame itself for inadequate communication or translation of its arguments to policy-makers' language when its efforts fail. Political science, especially theories of the policy process, offer alternative perspectives to explain the success or failure of experts' preferred policy goals. This paper focuses on the concept of epistemic communities (groups of experts with a common policy goal derived from their shared knowledge) in policy-making, drawing on examples from the field of health technology assessment in Europe. By combining the parsimony and the central focus on experts of the linear knowledge transfer model with the recognition of complexity of political science, the epistemic communities concept provides a useful structure for the public health community to analyze its efforts to influence policy. [ABSTRACT FROM AUTHOR]

Background Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT—which is the Turkish parliament and unicameral Turkish legislature—1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians. [ABSTRACT FROM AUTHOR]

Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care. [ABSTRACT FROM AUTHOR]

Debates surrounding the ostensibly ‘transformative’ potential of personalisation for social work services, and service users, have variously illustrated the risks and opportunities this presents, although the implications for criminal justice social work services have received comparatively limited attention. By extending the concept of ‘service user’ to include not only offenders, but wider stakeholders (victims and communities), this paper considers the practical application of theories of personalisation and co-production by reviewing proposed and extant strategies for maximising stakeholder involvement in criminal justice services. It is argued that, in progressing beyond the more individualistic interpretations of this somewhat controversial reform agenda—in prioritising not only the individual, their rights, strengths and subjective identities, but locating the individual in situ, in the concrete realities and textures of their lives and communities—the strength of the personalisation agenda rests in its potential to develop and strengthen the collective organisation of service users, service providers and communities in a co-productive endeavour. It is argued that both this reading and the principles underpinning it resonate more widely with the empirical and theoretical literature on just and effective penal practices and, in so doing, this paper exposes the complexities that lie behind the apparent simplicity of this argument. [ABSTRACT FROM PUBLISHER]

This paper presents the results of our corroborated study of grassroots Internet sites and authors in the nation of Kyrgyzstan, exceptional in Central Asia for its deregulated Internet policy. The study presents a set of semistructured interviews with notable grassroots Internet authors and activists, including bloggers, forum participants, and journalists, and analyzes this data via a critical communication and media studies lens to point to significant implications on emergent social, cultural, and political movements in the nation. [ABSTRACT FROM AUTHOR]

This paper documents women's experiences of relinquishing a child for adoption in Ireland. This group have long been silenced and largely invisible. The focus of the research on which this paper is based was to provide a means for the women to share their experiences of the process of concealment and ostracism and to review the socially sanctioned solutions particular to Irish society. The issues that emerge encompass personal, cultural and societal influences and the implications for future policy and practice are explored. [ABSTRACT FROM AUTHOR]

Our understanding of the burden and drivers of cholera mortality is hampered by limited surveillance and confirmation capacity. Leveraging enhanced clinical and laboratory surveillance in the cholera-endemic community of Uvira, eastern Democratic Republic of Congo, we describe cholera deaths across 3 epidemics between September 2021 and September 2023 following mass vaccination. [ABSTRACT FROM AUTHOR]

Background The application of antiseptic skin agents prior to incision minimizes the rate of surgical site infection. Despite their ubiquity, the optimal skin preparation agent remains uncertain. A retrospective economic analysis was conducted to complement the results from the NEWSkin Prep trial which prospectively compared three preparation agents. Methods A cost and cost-effectiveness analysis was performed from a healthcare service perspective to compare chlorhexidine with 70% ethanol, and aqueous povidone-iodine, against povidone-iodine with 70% ethanol. Resource use estimates accounted for hospital admissions, readmissions associated with surgical site infection, outpatient and general practitioner attendances, visits from community nurses and therapeutic consumables. The measure of effectiveness comprised the net difference in number of patients with surgical site infections per 1000 patients. Costs were compared using a two-sample Welch's t -test. Deterministic and probabilistic sensitivity analyses were performed to evaluate the incremental cost-effectiveness ratio. Results The null hypothesis that the mean costs for the trial arms were significantly different was not rejected (Welch's t -test P value: 0.771 for chlorhexidine with 70% ethanol against povidone-iodine with 70% ethanol; and 0.955 for aqueous povidone-iodine against povidone-iodine with 70% ethanol). Based on bootstrap averages, the chlorhexidine with 70% ethanol intervention generated 8.0 fewer surgical site infections per 1000 patients and net cost savings of €151,698 (Euros) per 1000 patients compared with povidone-iodine with 70% ethanol, and aqueous povidone-iodine produced a net cost saving of €37,494 per 1000 patients but generated an additional 11.6 surgical site infections per 1000 patients compared with povidone-iodine with 70% ethanol. The comparison of chlorhexidine with 70% ethanol to povidone-iodine with 70% ethanol was sensitive to the inclusion of cost outliers, while the comparison of aqueous povidone-iodine to povidone-iodine with 70% ethanol was sensitive to the estimated cost per surgical site infection. Conclusion Based on the outcomes from the NEWSkin Prep study, this economic analysis found no definitive evidence in favour of any one of the study comparators. Future model-based economic analyses of alternative skin preparations should critically address the quality of evidence and integrate the results from the NEWSkin Prep study. [ABSTRACT FROM AUTHOR]

Background A growing number of studies have underlined the relationship between socioeconomic status and health. Following that literature, we explore the causal effect of financial hardships on changes in health at older ages. Rather than traditional measures of socioeconomic variables, we study the role of financial hardships. The declarative measurement of financial hardships is particularly relevant for assessing the impact of short-term financial difficulties on health among older adults. Methods In this study, we use data from the Lausanne cohort 65+. Participants are community-dwelling older adults representative of the population aged 65–70 years in 2004 and living in Lausanne (Switzerland) (n  = 1352). We use longitudinal annual data with 11 years of follow-up (2006–16) to estimate dynamic panel models on several indicators measuring older adults' health (self-rated health, number of medical conditions, depressive symptoms, difficulties with daily living activities). Results We find evidence of causal effects of financial hardships on self-rated health (coef. = 0.059, P  < 0.10) and on depressive symptoms (coef.=0.060, P  < 0.05). On the other hand, we find no evidence of causality running from financial hardships to the number of medical conditions and the difficulties in daily living activities. Conclusion These results make a contribution to the literature where nearly all previous research on associations between financial hardship and health does not establish causal relationships. Our results support the need to integrate health policies that mitigate the potential adverse health effects of financial hardship for older adults. [ABSTRACT FROM AUTHOR]

The article comments on a systemic review and meta-analysis which looked at complex interventions for independent living of older people with frailty. It points out the effectiveness of holistic assessment along with coordinated, multidisciplinary care and follow-up for older people with frailty, the prevention of poor health outcomes, reduced mortality and improved cognition. It stresses the need to have a better understanding of which patients are likely to benefit from holistic treatment.

Objective Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries. Methods Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible. Results The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97-15.48) and 3.55 (1.56-8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51-10.38) and 3.37 (1.78-6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality. Conclusion There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended. [ABSTRACT FROM AUTHOR]

Background Ebola is a haemorrhagic disease with high fatality rates between 25 and 90%. The 2013–16 Ebola outbreak in West Africa was the largest to date with >28 000 cases and >11 000 fatalities. This outbreak exposed inadequacies in public health agencies and has spurred health officials to re-evaluate the way Ebola virus disease (EVD) epidemics are co-ordinated and communicated. Methods This project compares, using the systematic review method, differences in the communication of EVD in Nigeria and Liberia with data from selected articles analyzed using thematic analysis. Results The most successful communication strategies were community engagement and targeted health-communication to the most at-risk groups. We also highlight the importance of a multi-modal strategy to effectively communicate prevention and management of EVD to affected communities. Secondary to these findings included the relevance of the media, particularly social media tools in managing such serious outbreak situations. Conclusion This study provides the basis for the development of a theory-based framework to effectively communicate EVD and reduce the negative outcomes observed during the 2013–16 EVD outbreak. [ABSTRACT FROM AUTHOR]

Problematic content on social media can be countered through objections raised by other community members. While intended to deter offenses, objections can influence the surrounding audience observing the interaction, leading to their collective approval or disapproval. The results of an experiment manipulating seven types of objections against common types of offenses indicate audiences' support for objections that implore via appeals and disapproval of objections that threaten the offender, as they view the former as more moral, appropriate, and effective compared to the latter. Furthermore, audiences tend to prefer more benign and less threatening objections regardless of the offense severity (following the principle of "taking the high road") instead of objections proportionate to the offense ("an eye for an eye"). Taken together, these results show how objections to offensive behaviors may impact collective perceptions on social media, paving the way for interventions to foster effective objection strategies in social media discussions. [ABSTRACT FROM AUTHOR]

Digital literacy research and practice typically presume certain conditions, such as an urban orientation and adequate, affordable access to connectivity and devices. But these conditions are not universal; for example, people in small, rural/remote Indigenous communities may seek to balance connectivity challenges and digital innovations with land-based living specific to place and community. Drawing on efforts to broaden critical digital literacies to support Indigenous sovereignty, we consider how overlapping contexts of places, communities, and infrastructures intersect in the cocreation of appropriate digital literacy. Specifically, we discuss a series of virtually facilitated, participatory workshops that utilize "hacker literacies" and "infrastructure literacy" to reimagine connectivity infrastructure and demonstrate the potential of community networking in, with, and by rural/remote Indigenous communities. We also reflect on limitations of this work and identify lessons for future projects. [ABSTRACT FROM AUTHOR]

Trachoma, a disease caused by Chlamydia trachomatis , is the leading infectious cause of blindness. To fight it, endemic East African countries adopted the World Health Organization's SAFE Strategy, targeting surgery, antibiotics through mass drug administration (MDA), facial cleanliness and environmental improvement. Trachoma persists among nomadic communities along the Kenya–Uganda and Kenya–Tanzania borders. To address this, Kenya, Tanzania and Uganda launched synchronized MDA campaigns, simultaneously treating populations across borders. Successes included joint planning, community involvement and intergovernmental cooperation, although challenges remained in resourcing MDA cross-border focal points and in addressing coverage and funding. Novel strategies like synchronized joint cross-border MDA with community engagement are vital for sustainable trachoma elimination in these nomadic settings. [ABSTRACT FROM AUTHOR]

In public health, it has long been observed that "place"--specifically, where one lives--affects individual health, with the main research question distinguishing between the effects of "context" (defined as area characteristics) and "composition" (the characteristics of inhabitants) on health outcomes. There have been many studies in which the spatial patterning of disease has been explored, but they were often ecological in design, used broad census geographic levels, lacked individual-level data, or when available, did not simultaneously analyze community- and individual-level risk factors using appropriate modeling techniques. The paper by Diez-Roux et al. (Am J Epidemiol. 1997;146(1):48-63) represents an important expansion of the literature in terms of analytic methods used and level of geography studied. The authors demonstrated that both neighborhood- and individual-level measures of socioeconomic status work together to play an important role in shaping disease risk. Analyses incorporating both levels of data have the potential to provide epidemiologists with a deeper understanding of the divergent pathways via which neighborhood affects health. [ABSTRACT FROM AUTHOR]

Background Community health workers in Dangme-West district, Ghana, treated children aged 2–59 months with fever with either artesunate–amodiaquine (AAQ) or AAQ plus amoxicillin (AAQ + AMX) within a cluster-randomized controlled trial (registration no. TDR/UNDP Trial registration A: 20189). The intervention was introduced in a stepped-wedge manner. The aim of the study was reduction of mortality. This paper reports on the reduction of morbidity, notably anaemia, severe anaemia and severe illness. Clusters of 100 children were randomized in to AAQ, AAQ + AMX and pre-intervention arms. Six months later the pre-intervention clusters were randomized in to the AAQ and AAQ + AMX arms. Methods Data were collected in eight cross-sectional surveys. Using stratified sampling, 10 clusters were randomly selected per survey. Blood samples were taken to assess haemoglobin. Caregivers were interviewed about diseases (signs and symptoms) among their children in the preceding 14 days. Multivariate logistic regression analysis was used to determine the impact on anaemia, severe anaemia and severe illness. Results Compared with the pre-intervention clusters, anaemia was reduced in the AAQ (OR = 0.20, 95% CI 0.12–0.33) and AAQ + AMX (OR = 0.23, 95% CI 0.15–0.36) clusters, severe anaemia was reduced in the AAQ (OR = 0.20, 95% CI 0.09–0.45) and AAQ + AMX (OR = 0.12, 95% CI 0.04–0.31) clusters and severe illness was reduced in the AAQ (OR = 0.46, 95% CI 0.26–0.80) and AAQ + AMX (OR = 0.38, 95% CI 0.22–0.63) clusters. No significant differences were found in outcome variables between the AAQ and AAQ + AMX clusters. Conclusions Treating fever with antimalarials significantly reduced the prevalence of anaemia, severe anaemia and severe illness. We found no significant reduction in outcomes when the AAQ and AAQ+AMX clusters were compared. [ABSTRACT FROM PUBLISHER]

Objective This paper identifies, ranks and compares perceptions of insured and uninsured households in Ghana on health care providers (quality of care, service delivery adequacy, staff attitudes), health insurance schemes (price, benefits and convenience) and community attributes (health ‘beliefs and attitudes’ and peer pressure). In addition, it explores the association of these perceptions with household decisions to voluntarily enrol and remain in insurance schemes.Methods First, data from a household survey of 3301 households and 13 865 individuals were analysed using principal component analysis to evaluate respondents’ perceptions. Second, percentages of maximum attainable scores were computed for each cluster of perception factors to rank them according to their relative importance. Third, a multinomial logistic regression was run to determine the association of identified perceptions on enrolment.Results Our study demonstrates that scheme factors have the strongest association with voluntary enrolment and retention decisions in the National Health Insurance Scheme (NHIS). Specifically these relate to benefits, convenience and price of NHIS. At the same time, while households had positive perceptions with regards to technical quality of care, benefits of NHIS, convenience of NHIS administration and had appropriate community health beliefs and attitudes, they were negative about the price of NHIS, provider attitudes and peer pressure. The uninsured were more negative than the insured about benefits, convenience and price of NHIS.Conclusions Perceptions related to providers, schemes and community attributes play an important role, albeit to a varying extent in household decisions to voluntarily enrol and remain enrolled in insurance schemes. Scheme factors are of key importance. Policy makers need to recognize household perceptions as potential barriers or enablers to enrolment and invest in understanding them in their design of interventions to stimulate enrolment. [ABSTRACT FROM AUTHOR]

One constant refrain in evaluations and reviews of decentralization is that the results are mixed. But given that decentralization is a complex intervention or phenomenon, what is more important is to generate evidence to inform implementation strategies. We therefore synthesized evidence from the literature to understand why, how and under what circumstances decentralization influences health system equity, efficiency and resilience. In doing this, we adopted the realist approach to evidence synthesis and included quantitative and qualitative studies in high-, low- and middle-income countries that assessed the the impact of decentralization on health systems. We searched the Medline and Embase databases via Ovid, and the Cochrane library of systematic reviews and included 51 studies with data from 25 countries. We identified three mechanisms through which decentralization impacts on health system equity, efficiency and resilience: 'Voting with feet' (reflecting how decentralization either exacerbates or assuages the existing patterns of inequities in the distribution of people, resources and outcomes in a jurisdiction); 'Close to ground' (reflecting how bringing governance closer to the people allows for use of local initiative, information, feedback, input and control); and 'Watching the watchers' (reflecting mutual accountability and support relations between multiple centres of governance which are multiplied by decentralization, involving governments at different levels and also community health committees and health boards). We also identified institutional, socio-economic and geographic contextual factors that influence each of these mechanisms. By moving beyond findings that the effects of decentralization on health systems and outcomes are mixed, this review presents mechanisms and contextual factors to which policymakers and implementers need to pay attention in their efforts to maximize the positive and minimize the negative impact of decentralized governance. [ABSTRACT FROM AUTHOR]

In the last two decades, Indigenous lobbies have pointed a harsh finger at the endemic overrepresentation of Indigenous individuals in prisons in Canada and abroad. In reaction to such a condemnatory critique, correctional authorities in Canada have sought to ‘aboriginalize’ prisons. This paper addresses some of the prison's adaptation schemes to shed light on three contradictory logics of risk-based management: (1) high-risk aboriginal offenders have little access to risk-reducing programmes; (2) aboriginality undergoes an ontological mutation that occurs during the process of risk assessment; and (3) aboriginal correctional staff play a contradictory role in the (re)production of ‘aboriginal risk’. To what extent, then, does the aboriginalization of prisons constitute a valuable transformation? [ABSTRACT FROM PUBLISHER]

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Home-based care (HBC) programmes in low- and middle-income countries have evolved over the course of the past two decades in response to the HIV epidemic and wider availability of antiretroviral therapy (ART). Evidence is emerging from small-scale and well-resourced studies that ART delivery can be effectively incorporated within HBC programmes. However, before this approach can be expanded, it is necessary to consider the lessons learned from implementing routine HBC programmes and to assess what conditions are required for their roll-out in the context of ART provision. In this paper, we review the literature on existing HBC programmes and consider the arguments for their expansion in the context of scaling up ART delivery. We develop a framework that draws on the underlying rationale for HBC and incorporates lessons learned from community health worker programmes. We then apply this framework to assess whether the necessary conditions are in place to effectively scale up HBC programmes in the ART era. We show that the most effective HBC programmes incorporate ongoing support, training and remuneration for their workers; are integrated into existing health systems; and involve local communities from the outset in programme planning and delivery. Although considerable commitment has so far been demonstrated to delivering comprehensive HBC programmes, their effectiveness is often hindered by weak linkages with other HIV services. Top-down donor policies and a lack of sustainable and consistent funding strategies represent a formidable threat to these programmes in the long term. The benefits of HBC programmes that incorporate ART care are unlikely to be replicated on a larger scale unless donors and policymakers address issues related to human resources, health service linkages and community preparedness. Innovative and sustainable funding policies are needed to support HBC programmes if they are to effectively complement national ART programmes in the long term. [ABSTRACT FROM AUTHOR]

Using ethnographic fieldwork, this paper examines the relation between practices of individuality and solidarity in an alternative spiritual gathering called “The Rainbow” in Israel. Following the “practice turn” in sociological theory, we chart the social situations in which solidarity and individuality are formed, and the ways in which their multiple uses frame their meanings. We demonstrate that though members use the communal arena to express their individuality, the self they celebrate is constantly molded by practices creating solidarity. Through institutionalized rituals, everyday metaphors and interactions, and the formation of friendships in the field, members both relate to the community as a site for the assertion of selfhood, and incorporate the communal into the very definition of the self—thus weaving them together in action. [ABSTRACT FROM PUBLISHER]

This paper concentrates on the issues of merit and diversity in social work. The principal focus is ethnic diversity, used as an example to illustrate a wider point about diversity. It is clear that ethnic diversity in particular has become a major political objective across the public sector as part of the 'community cohesion' initiative. Several benefits have been identified and linked to the achievement of ethnic diversity in the workforce; many of these have appeared in social work debate. The argument here is that while diversity has transformative potential, it must be located within a more radical agenda if it is to be successful. As a profession with a radical thread to its pedigree, social work is well placed to take this agenda forward. [ABSTRACT FROM AUTHOR]

Internet of Things (IoT) sensor networks are an emerging technology at the center of the datafication and optimization of far-reaching environmental infrastructures—from "smart cities" to workplace efficiencies. However, this low-power, low-cost technology is also well suited to local deployments in rural communities, which are often overlooked by digital development initiatives. Therefore, we used a social construction of technology approach to study how various U.S.-based IoT stakeholders—including designers and advocates as well as citizen stakeholders—understand and value sensor network technologies. Through observational methods, in-depth interviews, and participatory design research in a rural Upstate New York municipality, we worked to design sensor networks with rural community members to generate data about and for community members to further local knowledge. We found that designing rural sensor networks requires stakeholders to navigate obstacles of communication about sensors and communication through sensors to facilitate secure, ethical, and localized sensing in rural communities. [ABSTRACT FROM AUTHOR]

Background As part of an online medical education project (www.idjournal.club), we surveilled the infectious diseases (ID) literature, selecting subsets of what we deemed the most clinically impactful articles on a monthly basis using a prespecified search algorithm. We used this resource to perform a broad overview of articles published in the field and examine factors associated with publication in higher tier journals and higher rates of public and ID community engagement. Methods We examined articles reviewed on www.idjournal.club between June and September 2018. For each article, we recorded the publishing journal, subfield of ID, study type, nation and degree of the lead author, and sample size, and we assigned the paper up to three topic keywords. Our outcomes of interest were the publishing journal's Scimago Journal Rank (SJR), a surrogate for journal tier, and the article's Altmetric score, a surrogate for audience engagement. Results Of 146 articles included in the analysis, the most common study types were retrospective observational (n = 47), randomized controlled trial (n = 23), in vitro (n = 20), and prospective observational (n = 19). The median sample size was 238; median sample sizes were higher for randomized controlled trials (n = 400) and lower for in vitro and pharmacokinetic/pharmacokinetic studies (n = 53 and n = 44). Lead authors were based in the United States in 38% of cases and in North America or Europe in 86% of cases. Physicians accounted for 65% of lead authors, PhDs 23%, and PharmDs 10%. The most commonly referenced pathogens were HIV, MDR Gram-negative bacteria, S. aureus , and C. difficile ; the most commonly referenced disease states were bacteremia, sexually transmitted infection, respiratory tract infection, and UTI. The mean SJR was 3.5 (SD 3.1) and the mean Altmetric score was 54.5 (SD 143). SJR and Altmetric score were associated with study type, sample size, and key topics; Altmetric score was also associated with publishing journal. In multivariate analysis, SJR was associated with study type and sample size, and Altmetric score was associated with ID subfield, journal, and sample size. Conclusion We present a descriptive overview of the ID literature and identify article factors associated with journal tier and audience engagement after publication. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Community empowerment initiatives are receiving increased interest as ways of improving health and reducing health inequalities. Purpose Longitudinally examine associations between collective control, social-cohesion and mental wellbeing amongst participants in the Big Local community empowerment initiative across 150 disadvantaged areas of England. Methods As part of the independent Communities in Control study, we analysed nested cohort survey data on mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale—SWEMWBS) and perceptions of collective control and social-cohesion. Data were obtained in 2016, 2018 and 2020 for 217 residents involved in the 150 Big Local areas in England. Adjusted linear mixed effect models were utilized to examine changes in SWEMWBS over the three waves. Subgroup analysis by gender and educational level was conducted. Results There was a significant 1.46 (0.14, 2.77) unit increase in mental wellbeing score at wave 2 (2018) but not in wave 3 (2020) (0.06 [−1.41, 1.53]). Across all waves, collective control was associated with a significantly higher mental wellbeing score (3.36 [1.51, 5.21]) as was social cohesion (1.09 [0.19, 2.00]). Higher educated participants (1.99 [0.14, 3.84]) and men (2.41 [0.55, 4.28]) experienced significant increases in mental wellbeing in 2018, but lower educated participants and women did not. Conclusion Collective control and social cohesion are associated with better mental wellbeing amongst residents engaged with the Big Local initiative. These health benefits were greater amongst men and participants from higher educational backgrounds. This suggests that additional care must be taken in future interventions to ensure that benefits are distributed equally. [ABSTRACT FROM AUTHOR]

In the crisis we are facing, the importance of solidarity, as a vital component of Alay Kapwa Spirituality , in evangelizing the people to practice their faith through care and concern for others is manifested. This is the true Christian way of life. We are Christians not just because we are praying together but because we are helping one another. When the pandemic ends, we can be assured that Alay Kapwa Spirituality is already animated in the lives of the people and when we face situations where solidarity seems to be needed, we will no longer wait for the extreme hardships of the poor to be manifested before we help them. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of community-based maternal and neonatal content, cadres and costs for health coverage. Topics discussed include an overview of neonatal and maternal health services, their cost-effectiveness, the drivers of their medical cost, and their efficiency in the community.

Background and Aims When plant communities are exposed to herbicide 'drift', wherein particles containing the active ingredient travel off-target, interspecific variation in resistance or tolerance may scale up to affect community dynamics. In turn, these alterations could threaten the diversity and stability of agro-ecosystems. We investigated the effects of herbicide drift on the growth and reproduction of 25 wild plant species to make predictions about the consequences of drift exposure on plant–plant interactions and the broader ecological community. Methods We exposed potted plants from species that commonly occur in agricultural areas to a drift-level dose of the widely used herbicide dicamba or a control solution in the glasshouse. We evaluated species-level variation in resistance and tolerance for vegetative and floral traits. We assessed community-level impacts of drift by comparing the species evenness and flowering networks of glasshouse synthetic communities comprised of drift-exposed and control plants. Key Results Species varied significantly in resistance and tolerance to dicamba drift: some were negatively impacted while others showed overcompensatory responses. Species also differed in the way they deployed flowers over time following drift exposure. While drift had negligible effects on community evenness based on vegetative biomass, it caused salient differences in the structure of co-flowering networks within communities. Drift reduced the degree and intensity of flowering overlap among species, altered the composition of groups of species that were more likely to co-flower with each other than with others and shifted species roles (e.g. from dominant to inferior floral producers, and vice versa). Conclusions These results demonstrate that even low levels of herbicide exposure can significantly alter plant growth and reproduction, particularly flowering phenology. If field-grown plants respond similarly, then these changes would probably impact plant–plant competitive dynamics and potentially plant–pollinator interactions occurring within plant communities at the agro-ecological interface. [ABSTRACT FROM AUTHOR]

The foundational role of health information exchanges (HIEs) is to facilitate communication between clinical partners in real time. Once this infrastructure for the secure and immediate flow of patient information is built, however, HIEs can benefit community public health and clinical care in myriad other ways that are in line with their mission, goals, patient privacy, and funding structures. We encourage the development of community-integrated HIEs and list specific steps that can be taken toward community integration. We give three examples of those steps in action from a community HIE in El Paso, TX. Each local partnership, in combination with technology innovation, resulted in the development of informatics tools to address community health needs and generated long-term benefits, especially for the most vulnerable patients. Two examples relate to different aspects of the COVID-19 pandemic and a third to the Afghan refugee evacuation. [ABSTRACT FROM AUTHOR]

Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models-made increasingly urgent by the COVID-19 pandemic-are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005-1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential. [ABSTRACT FROM AUTHOR]

Background Most households may have leftover, unwanted, unused and expired (UUE) medicines. The present research aimed to analyze feasibility of implementation of medicine take-back in select communities in Nepal. Methods Exploratory (i.e. feasibility) study was conducted among 400 adults from July 2017 to January 2018. Study sites and participants were selected by simple random sampling and respondents were interviewed about their awareness about medicine disposal, hazards and willingness to support take-back program using semi-structured questionnaire. Multinomial logistic regression analysis was applied to explore relationship of take-back related outcomes with the predictors. The P -value < 0.05 was statistically significant at 95% confidence level. Results Land pollution and effect on health of children was significantly related with inappropriate disposal of medicines such as site of disposal (P value < 0.01), river (P value, 0.02), garbage (P value, 0.04) and dumping site (P value, 0.01). Analysis of willingness to follow take-back program with the techniques of support showed significant relationship with the establishment of collection center and participation on seminar (P value < 0.01). Conclusion Most participants were interested to support take-back, if implemented in their community but main constraint was the budget. Take-back concept could be initiated and implemented on government funding or other sources. [ABSTRACT FROM AUTHOR]

Global changes such as atmospheric CO2 enrichment often facilitate exotic plant invasions and alter soil arbuscular mycorrhizal fungi (AMF) community. However, it is still unclear whether the effects of CO2 enrichment on exotic plant invasions are associated with its effects on root-AMF symbiosis of invasive and native plants. To address this issue, the annual invasive plant Xanthium strumarium and two phylogenetically related annual natives were compared under ambient and elevated CO2 concentrations for three consecutive years. Atmospheric CO2 enrichment increased AMF colonization rates for the species only in few cases, and the invader did not benefit more from CO2 enrichment in terms of AMF colonization. Under ambient CO2 concentration, however, the invader had a higher AMF colonization rate than the natives in the first year of the study, which disappeared in the second and third year of the study due to the increase of AMF colonization rates in the natives but not in the invader. The influences of species, CO2 concentrations and planting year on AMF colonization were associated with their effects on both soil nutrient and AMF community, and the former may be more important as it also influenced the latter. Our results indicate that the invader could more quickly form symbiosis with soil AMF, contributing to adaptation and occupation of new habitats, and that it is necessary to consider the roles of AMF and the effects of time when determining the effects of global changes such as atmospheric CO2 enrichment on exotic plant invasions. [ABSTRACT FROM AUTHOR]

Type 2 diabetes imposes a large and growing burden on the public’s health. This burden, combined with the growing evidence for primary prevention from randomized controlled trials of structured lifestyle programs leads to recommendations to include caloric reduction, increased physical activity and specific assistance to patients in problem solving to achieve modest weight loss as well as pharmacotherapy. These recommendations demand exploration of new ways to implement such primary prevention strategies through more integrated community organization, medical practice and policy. The US experience with control of tobacco use and high blood pressure offers valuable lessons for policy, such as taxation on products, and for practice in a variety of settings, such as coordination of referrals for lifestyle supports. We acknowledge also some notable exceptions to their generalizability. This paper presents possible actions proposed by an expert panel, summarized in Table 1 as recommendations for immediate action, strategic action and research. The collaboration of primary care and public health systems will be required to make many of these recommendations a reality. This paper also provides information on the progress made in recent years by the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC) to implement or facilitate such integration of primary care and public health for primary prevention. [ABSTRACT FROM PUBLISHER]

Summary: Community engagement is increasingly promoted in developing countries, especially in international health research, but there is little published experience. The Shoklo Malaria Research Unit (SMRU) conducts research with refugees, migrant workers, displaced people, and day migrants on the Thai-Burmese border, and has recently facilitated the set up of the Tak Province Border Community Ethics Advisory Board (T-CAB). Valuable lessons have been learnt from consultation with the T-CAB especially in the area of participant recruitment and the informed consent process. A lot of new research questions have emerged from consultation with the T-CAB. This paper describes our experience, lessons learnt and the unique challenges faced working with the T-CAB from its initial conception to date. We conclude that consultation with the T-CAB has made improvements in our research in particular operational and ethical aspects of our studies. [Copyright &y& Elsevier]

Since the launch of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000, more than 910 million people have received preventive chemotherapy for lymphatic filariasis (LF) and many thousands have received care for chronic manifestations of the disease. To achieve this, millions of community drug distributors (CDDs), community members and health personnel have worked together each year to ensure that at-risk communities receive preventive chemotherapy through mass drug administration (MDA). The successes of 20 y of partnership with communities is celebrated, including the application of community-directed treatment, the use of CDDs and integration with other platforms to improve community access to healthcare. Important challenges facing the GPELF moving forward towards 2030 relate to global demographic, financing and programmatic changes. New innovations in research and practice present opportunities to encourage further community partnership to achieve the elimination of LF as a public health problem. We stress the critical need for community ownership in the current Covid-19 pandemic, to counter concerns in relaunching MDA programmes for LF. [ABSTRACT FROM AUTHOR]