Search

There is a lack of information on effective burn prevention strategies. The objective of this study was to examine a safe fireplace program, as a method of burn prevention, in a resource-limited setting. We conducted a qualitative, phenomenological study at a community health and development program for a rural population in Kenya. Semistructured, in-depth interviews were conducted with a purposive sample of community health workers involved with the safe fireplace program. Data were reviewed iteratively and coded independently by two researchers using NVivo 12. The study included five participants. Reflections from participants fell into three main domains: (1) effective methods of education, (2) strategies to incorporate stakeholders, and (3) implementation challenges. The results of this study emphasize the importance of community engagement in implementing a successful burn injury prevention program in a resource-limited setting. The participants involved in this study reported that rather than focusing on resources outside the community, effective methods of education and strategies for incorporating stakeholders depended on involving peers and community leaders. The challenges to the program were similarly specific to community concerns about resources and maintenance. These findings provide information to guide future community health programs in creating successful models for burn prevention strategies in resource-limited areas. [ABSTRACT FROM AUTHOR]

Background Physical activity improves physical and psychological health in cancer survivors. This study evaluated Active Living After Cancer (ALAC), a community-based program to improve physical activity, physical function, and quality of life (QOL) in minority and medically underserved cancer survivors and their caregivers. Methods Participants completed 12 weekly ALAC sessions and assessments of physical activity, physical functioning, and QOL at baseline and follow-up (week 12). Paired samples t tests were used to assess changes in outcomes over time. Results A total of 540 cancer survivors (mean age = 61.1 [SD = 11.3] years) and 87 caregivers (mean age = 62.3 [SD = 13.1] years) were enrolled. Most were women (91.4%), Hispanic (61.1%) or non-Hispanic Black (19.3%), and medically underserved (86.4%). The percent of cancer survivors meeting physical activity recommendations increased from 28.9% to 60.2% (d  =   0.75), and the number of sit-to-stand repetitions in a 30-second period increased from 12.3 to 14.3 (d  =   0.39) from 0-12 weeks. Cancer survivors reported statistically significant improvements in physical (t score Δ = 1.7, d  =   0.06) and mental (t score Δ = 2.3, d  =   0.31) health–related QOL. Caregivers also improved their physical activity, physical function, and QOL, and there were no statistically significant differences between breast and other cancer survivors and between cancer survivors and caregivers. Conclusions The ALAC program demonstrated increased physical activity, physical function, and QOL in medically underserved cancer survivors and their caregivers. Furthermore, ALAC was successfully implemented by community partners and serves as a good model for reaching medically underserved cancer survivors and improving survivorship. Additional efforts are warranted to further extend reach, improve cancer survivorship, and reduce cancer health disparities among underserved cancer survivors. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis (LF) is a significant public health issue in India. Despite 10–15 rounds of mass drug administration (MDA) in India, the global LF elimination target of 2030 appears challenging. To strengthen the program, community and provider perspectives on ways to bridge a gap in MDA are needed. Through the motivation–opportunity–ability–behaviour (MOAB) lens, we systematically reviewed the facilitators and barriers encountered in LF elimination in India. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched PubMed, Embase, ProQuest and Google Scholar databases to explore factors related to MDA program implementation in India through 30 June 2021. We analysed the data using a thematic framework. We identified 576 studies; of these, 20 studies were included. This review revealed that the public health system for distributing MDA drugs in India created a better enabling environment, including zero out-of-pocket expenditure, door-step distribution of medicines and ample capacity-building training and follow-up. However, community members were unaware of the rationale for drug consumption, leading to a gap in drug distribution and consumption. Motivation is required among community members, which suggests capacity-building training for service providers to counsel the community. [ABSTRACT FROM AUTHOR]

The Chicago Police Department's community policing program partners with several LGBTQ service providers in and around Chicago's white middle class "gayborhood." These organizations make strange bedfellows for law enforcement, given that many of their clients are queer and trans people of color (QTPOC) and, indeed, targets of policing and gentrification projects. This study draws on eighteen months of ethnography and in-depth interviews to examine motivations and consequences of these inter-agency unions. The study finds that non-governmental organizations (NGOs) are incorporated into racialized policing strategies through mechanisms ranging from contractual agreement to implicit expectation. While NGOs resist directly criminalizing their QTPOC clients, some discourage them from lingering around service centers, effectively making them invisible in the white gayborhood. Findings demonstrate that in a post-welfare police state, sexual health governance is racially and economically circumscribed, as well as mediated, by institutional intimacies between governmental and non-governmental agencies. I argue that LGBTQ service provision is situated within a multilevel monitoring system, a structure I term "serv/eillance." Providing services to LGBTQ+POC becomes conditioned on state surveillance, while receiving services is conditioned on being surveilled, by police or by proxy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate whether burn survivors have lower adherence compared to non-burned control individuals during a 6-month community-based exercise program. In burn survivors, we sought to answer if there was a relation between the size of the burn injury and dropout frequency. Fifty-two burn survivors and 15 non-burned controls (n = 67) were recruited for a 6-month community-based (ie, non-supervised), progressive, exercise training program. During the exercise program, 27% (ie, 4 of the 15 enrolled) of the non-burned individuals dropped out of the study, while 37% (ie, 19 of the 52) of the burn survivors dropped out from the study. There was no difference in the percentage of individuals who dropped out between groups (P =.552). There was no difference in size of the burn injury, expressed as percent body surface area burned (%BSA) between the burn survivors that dropped out versus those who completed the exercise regimen (P =.951). We did not observe a relation between %BSA burned and dropouts (log odds = −0.15–0.01(%BSA), B = −0.01, SE = 0.015, P =.541). There was no effect of %BSA burned on the probability of dropout [Exp (B) = 0.991, 95% CI (0.961, 1.020)] and there were no differences in the percentage of individuals who dropped out of the study based on %BSA burned (χ 2(1) = 0.44, P =.51). These data demonstrate that burn survivors have similar exercise adherence relative to a non-burned group and the extent of a burn injury does not affect exercise program adherence. [ABSTRACT FROM AUTHOR]

This paper reviews, applies, and extends recently proposed methods based on double machine learning (DML) with a focus on programme evaluation under unconfoundedness. DML-based methods leverage flexible prediction models to adjust for confounding variables in the estimation of (a) standard average effects, (b) different forms of heterogeneous effects, and (c) optimal treatment assignment rules. An evaluation of multiple programmes of the Swiss Active Labour Market Policy illustrates how DML-based methods enable a comprehensive programme evaluation. Motivated by extreme individualised treatment effect estimates of the DR-learner, we propose the normalised DR-learner (NDR-learner) to address this issue. The NDR-learner acknowledges that individualised effect estimates can be stabilised by an individualised normalisation of inverse probability weights. [ABSTRACT FROM AUTHOR]

Effective responses to rapid environmental change rely on observations to inform planning and decision-making. Reviewing literature from 124 programs across the globe and analyzing survey data for 30 Arctic community-based monitoring programs, we compare top-down, large-scale program driven approaches with bottom-up approaches initiated and steered at the community level. Connecting these two approaches and linking to Indigenous and local knowledge yields benefits including improved information products and enhanced observing program efficiency and sustainability. We identify core principles central to such improved links: matching observing program aims, scales, and ability to act on information; matching observing program and community priorities; fostering compatibility in observing methodology and data management; respect of Indigenous intellectual property rights and the implementation of free, prior, and informed consent; creating sufficient organizational support structures; and ensuring sustained community members' commitment. Interventions to overcome challenges in adhering to these principles are discussed. [ABSTRACT FROM AUTHOR]

The European Society of Cardiology (ESC) recognised the important role of patients in shaping practice with the establishment of the Patient Forum in 2018. To be effective, patient advocacy in policy must be grounded in the experiences and perspectives of patients themselves. Patient advocacy is an important aspect of healthcare policymaking; patients are the primary stakeholders in healthcare, and their voices and perspectives must be considered when developing healthcare policies. [Extracted from the article]

Introduction: This study examined the effects of cigarette price on intention to quit, quit attempts, and successful cessation among African American smokers in the United States and explored whether price effects differed by income level and menthol use status. Price effects were further compared to White counterparts.Methods: We used pooled cross-sectional data from 2006 to 2007 and 2010 to 2011 Tobacco Use Supplements to the Current Population Survey to analyze 4213 African American recent active smokers. Three dependent variables were examined: any quit attempts in the past 12 months, successful cessation for at least 3 months, and intention to quit in the next 6 months. For each dependent variable, separate multiple logistic regression models were estimated to determine the impact of cigarette prices.Results: There was no indication that price was associated with quit attempts or successful cessation, but price was positively associated with increased odds of intending to quit among African American smokers (p < .001). In contrast, prices were positively associated with intention to quit and quit attempts for White smokers. The association between price and intention to quit was significantly positive for African American low-income and menthol smokers but was not statistically significant for African American high-income and non-menthol smokers. There was no evidence of a price effect on quit attempts and successful cessation for each subgroup of African Americans.Conclusions: Tobacco tax policy alone may not be enough to increase quit attempts or successful cessation among African Americans. Community-based cessation programs tailored toward African American smokers, especially low-income menthol smokers, are needed.Implications: The results revealed that, among African American smokers, particularly among low-income and menthol smoking African American smokers, price appears to be positively associated with intention to quit; nevertheless, this deterrent effect does not appear to translate to actualized quit attempts or successful cessation. Increasing cigarette prices as a standalone policy may not be independently effective in increasing quit attempts and successful cessation within the African American community. Community-based cessation interventions tailored for African Americans are needed to help further translate desired cessation into actualized quit attempts. [ABSTRACT FROM AUTHOR]

Background: To understand real-world human papillomavirus (HPV) vaccine impact, continuous evaluation using population-based data is critical. We evaluated the early impact of the school-based HPV immunization program on cervical dysplasia in women in British Columbia, Canada.Methods: Data linkage was performed using records from provincial cervical screening and immunization registries. Precancerous outcomes were compared between unvaccinated and HPV-vaccinated women born 1994-2005. Incidence rate, relative rate (RR), and vaccine effectiveness (VE), using unadjusted and adjusted Poisson regression of cytology (HSIL) and histopathology (CIN2, CIN3, and CIN2+) outcomes, were compared across vaccination status groups.Results: Women who received a complete series of vaccine on schedule between age 9 and 14 years had an adjusted RR = 0.42 (95% confidence interval [CI], 0.31-0.57) for CIN2+ over 7 years of follow-up compared to unvaccinated women, resulting in a VE of 57.9% (95% CI, 43.2%-69.0%). Adjusted RR for HSIL was 0.53 (95% CI, .43-.64), resulting in a VE of 47.1% (95% CI, 35.6%-56.7%).Conclusion: Women vaccinated against HPV have a lower incidence of cervical dysplasia compared to unvaccinated women. Immunization between 9 and 14 years of age should be encouraged. Continued program evaluation is important for measuring long-term population impact. [ABSTRACT FROM AUTHOR]

Objective: Current guidance for the assessment of cognitive decline for mild cognitive impairment or dementia lacks sufficient information for assessing neurodiverse populations (Janicki et. al, 2022), and standardized scores often have floor effects. This study investigated the utility of the Adaptive Behavior Scale-3rd Edition (ABAS-3) in characterizing age-related changes in daily functioning for individuals with autism and other intellectual and developmental disability (I/DD). Method: Participants (20–76 years old) resided in community-based residential programs (CBRPs) for individuals with I/DD. Aim 1 examined mean ABAS-3 raw scores for participants with at least 1 ABAS-3 (N = 171, autism n = 115, other I/DD n = 56). Aim 2 examined changes in ABAS-3 raw scores over 2 years (N = 61, autism n = 37, other I/DD n = 24). ABAS-3 scales included "home-living" (HL), "self-care" (SC) and "health and safety" (HS). Results: Aim 1 indicated variability within and across diagnostic groups, with lower performance for autistic versus other I/DD participants (p < 0.001, large effect size across all subscales). Aim 2 found varying patterns of loss, gain, and stable scores across timepoints. HL (autism loss 24.3%, gain 16.2%, stable 59.5%; I/DD loss 16.7%, gain 33.3%, stable 50.0%), SC (autism loss 29.7%, gain 16.2%, stable 54%; I/DD loss 12.5%, gain 33.3%, stable 54.2%), HS (autism loss 24.3%, gain 16.2%, stable 59.5%; I/DD loss 16.7%, gain 33.3%, stable 50.0%). Conclusions: This proof-of-concept study demonstrates feasibility in characterizing ADLs of individuals with autism and I/DD living in CBRPs. Future research will assess distal ABAS-3 raw score changes to track cognitive decline in individuals with autism and other I/DD. [ABSTRACT FROM AUTHOR]

This article evaluates a community-based effort aimed at reducing neonatal mortality. I use nationally representative data from Nepal, where 22 children per 1000 die within the first month of their birth, and evaluate the impact of Community-Based Neonatal Care Package. The identification is based on a before-and-after comparison of outcomes in program districts relative to those in non-program districts. I find that the program was successful in encouraging cleaner deliveries for births that took place at home and in increasing prenatal visits to the health center by pregnant women significantly. Despite these positive effects on intermediate outcomes, there is no evidence that the program reduced neonatal mortality. There is also no evidence that the program improved other intermediate outcomes, namely institutional or professional-attended deliveries. While the lack of an effect on a few of the outcomes may be mainly due to supply-side constraints, the findings also suggest the need for a broader examination of the role of the Female Community Health Volunteers. [ABSTRACT FROM AUTHOR]

The Life Esidimeni tragedy in South Africa showed that, despite significant global gains in recognizing the salience of integrated public mental health care during the past decade, crucial gaps remain. State and non-state mental health service collaboration is a recognized strategy to increase access to care and optimal use of community resources, but little evidence exist about how it unfolds in low- to middle-income countries. South Africa's Mental Health Policy Framework and Strategic Plan 2013-20 (MHPF) underlines the importance of collaborative public mental health care, though it is unclear how and to what extent this happens. The aim of the study was to explore the extent and nature of state and non-state mental health service collaboration in the Mangaung Metropolitan District, Free State, South Africa. The research involved an equal status, sequential mixed methods design, comprised of social network analysis (SNA) and semi-structured interviews. SNA-structured interviews were conducted with collaborating state and non-state mental health service providers. Semi-structured interviews were conducted with collaborating partners and key stake holders. Descriptive network analyses of the SNA data were performed with Gephi, and thematic analysis of the semi-structured interview data were performed in NVivo. SNA results suggested a fragmented, hospital centric network, with low average density and clustering, and high authority and influence of a specialist psychiatric hospital. Several different types of collaborative interactions emerged, of which housing and treatment adherence a key point of collaboration. Proportional interactions between state and non-state services were low. Qualitative data expanded on these findings, highlighting the range of available mental health services, and pointed to power dynamics as an important consideration in the mental health service network. The fostering of a well-integrated system of care as proposed in the MHPF requires inter-institutional arrangements that include both clinical and social facets of care, and improvements in local governance. [ABSTRACT FROM AUTHOR]

Decision makers are searching for reliable data and best practices to support the implementation and scale-up of the integrated community case management (iCCM) programs in underserved areas to reduce under-five mortality in low-income countries. This study assesses data quality and reporting systems of the World Health Organization supported Rapid Access Expansion program implementing iCCM in Abia and Niger States, Nigeria. This cross-sectional study used data from 16 primary health facilities in both states. Data were collected through review of registers and monthly summary reports of 140 community-oriented resource persons (CORPs), assessments of the five dimensions of the data reporting systems and 46 key informant interviews with stakeholders. Data quality was assessed by availability, completeness and consistency. Each component of the reporting system was assessed on a 3-point scale (weak, satisfactory and strong). Results show that both the structure, functions and capabilities, as well as data collection and reporting tools dimensions of the reporting system were strong, scoring (2.80, 2.73) for Abia and (2.88, 2.75) for Niger, respectively. Data management processes and links with national reporting system components scored low 2 s, indicating fair strength. Data availability, completeness and consistency were found to be good, an indication of adequate training and supervision of CORPs and community health extension workers. Indicator definitions and reporting guidelines were the weakest dimension of the system due to lack of data reporting guidelines in both states. In conclusion, the results indicate satisfactory data reporting systems and good quality data during early implementation of iCCM programs in the two states. Hence, countries planning to adopt and implement iCCM programs should first develop structures, establish national standardized tools for collecting and reporting data, provide for adequate training and supervision of community health workers and develop reporting guidelines for all reporting levels to ensure data quality. [ABSTRACT FROM AUTHOR]

Social planners have begun to recognize that communities are an important resource for solving many problems. Understanding local norms and values is thought to provide insight into how issues are defined and what interventions might be considered practical. Communities in this framework are not just the physical locations at which programs are targeted, but are actively constructed spaces that must be properly understood. In many ways, the field of public health has been sensitive to this understanding and has elevated the community in importance, thus emphasizing that significant features are variable and locally defined. Even in the new public health, however, empirical indicators are still often relied on, thereby leading to the increasing standardization of communities, rather than to openness to neighborhood particularities. For this reason, a community-based focus should guide future public health endeavors. Most important, this strategy underscores the importance of getting to know the communities in which symptoms, illness and care are defined, and allows for full participation by community members that make interventions both relevant and sustainable. [ABSTRACT FROM AUTHOR]

Background: In Papua New Guinea, TB is considered to be a major public health problem, but little is known about the prevalence and prognosis of presumed TB in children. Methods: As part of a prospective hospital-based surveillance on the northern coast of mainland Papua New Guinea, the authors investigated the admission prevalence and case fatality rate associated with presumed TB over a 6-year period (2011-2016). All children admitted who were diagnosed with TB were followed-up until discharge or death. Results: Of 8992 paediatric admissions, 734 patients (8.2%) were diagnosed with presumed TB and there were 825 deaths, with TB accounting for 102 (12.4%). Extrapulmonary TB was the final diagnosis in 384 admissions {prevalence 4.3% [384/8992 (95% CI 3.9-4.7)]} with a case fatality rate of 21.4% [82/384 (95% CI 17.4-25.9)]. TB meningitis, disseminated TB and pericardial TB had high case fatality rates of 29.0% (53/183), 28.9% (11/38) and 25% (4/16), respectively. Severe malnutrition was more common in patients with pulmonary compared with extrapulmonary TB (25.4% vs 15.6%; p<0.01). Conclusions: Improved community-based case detection strategies, routine BCG vaccinations and other effective forms of TB control need revitalization and sustainability to reduce the high case fatality rates associated with childhood TB in Papua New Guinea. [ABSTRACT FROM AUTHOR]

Widely adopted nutrition policies for afterschool programs (ASPs) focus on serving a fruit/vegetable daily and eliminating sugar-sweetened foods/beverages. The impact of these policies on the nutrient profile of snacks served is unclear. Evaluate changes in macro/micronutrient content of snacks served in ASPs. A 1-year group randomized controlled trial was conducted in 20 ASPs serving over 1700 elementary-age children. Intervention ASPs received a multistep adaptive framework intervention. Direct observation of snack served was collected and nutrient information determined using the USDA Nutrient Database, standardized to nutrients/100 kcal. By post-assessment, intervention ASPs reduced total kcal/snack served by 66 kcal (95CI −114 to −19 kcal) compared to control ASPs. Total fiber (+1.7 g/100 kcal), protein (+1.4 g/100 kcal), polyunsaturated fat (+1.2 g/100 kcal), phosphorous (+49.0 mg/100 kcal), potassium (+201.8 mg/100 kcal), and vitamin K (+21.5 μg/100 kcal) increased in intervention ASPs, while added sugars decreased (−5.0 g/100 kcal). Nutrition policies can lead to modest daily caloric reductions and improve select macro/micronutrients in snacks served. Long-term, these nutritional changes may contribute to healthy dietary habits. [ABSTRACT FROM AUTHOR]

The article reports on the 2013-2014 Senior Corps Study which examines the income, race, and ethnic composition of Foster Grandparents and Senior Companions.

Community-based maternal and newborn care interventions have been shown to improve neonatal survival and other key health indicators. It is important to evaluate whether the improvement in health indicators is accompanied by a parallel increase in the equitable distribution of the intervention activities, and the uptake of healthy newborn care practices. We present an analysis of equity improvements after the implementation of a Community Based Newborn Care Package (CB-NCP) in the Bardiya district of Nepal. The package was implemented alongside other programs that were already in place within the district. We present changes in concentration indices (CIndices) as measures of changes in equity, as well as percentage changes in coverage, between baseline and endline. The CIndices were derived from wealth scores that were based on household assets, and they were compared usingt-tests. We observed statistically significant improvements in equity for facility delivery [CIndex: -0.15 (-0.24, -0.06)], knowledge of at least three newborn danger signs [-0.026(-0.06, -0.003)], breastfeeding within 1 h [-0.05(-0.11, -0.0001)], at least one antenatal visit with a skilled provider [-0.25(-0.04, -0.01)], at least four antenatal visits from any provider [-0.15(-0.19, -0.10)] and birth preparedness [-0.09(-0.12, -0.06)]. The largest increases in practices were observed for facility delivery (50%), immediate drying (34%) and delayed bathing (29%). These results and those of similar studies are evidence that community-based interventions delivered by female community health volunteers can be instrumental in improving equity in levels of facility delivery and other newborn care behaviours. We recommend that equity be evaluated in other similar settings within Nepal in order to determine if similar results are observed. [ABSTRACT FROM AUTHOR]

BACKGROUND The significance in terms of the cardiovascular outcome of different patterns of blood pressure (BP) response to community-based activities has not been previously studied. The aim of our study was to evaluate the relationship between changes of BP observed during a community-based program and long-term rate of cardiovascular disease (CVD) events. METHODS A program focused on the prevention of CVDs was implemented in a small city in Argentina over a 6-year period (1997–2003). The program was evaluated using a cohort of 1,526 randomly selected individuals. The population’s mean systolic BP (SBP) decreased approximately 5mm Hg, but BP changes were heterogeneous. Eight years after the intervention had stopped, 1,124 individuals of the cohort were surveyed to evaluate incident CVD events. The sample was divided into 3 SBP change categories during the intervention: decrease (< −5mm Hg), no change (−5 to 5mm Hg) and increase (> 5mm Hg). Cox models were used to estimate the hazard ratio (HR) of CVD events for each category adjusted for age, sex, and baseline BP. RESULTS At the end of the intervention, individuals who had increased their SBP showed an adjusted HR for CVD that was double those whose SBP levels decreased or did not change. An inverse relationship between baseline SBP and ΔSBP was observed: individuals with an increase in BP during the intervention had lower SBP at the beginning of the study. CONCLUSIONS BP increase during the community-based program was an independent predictor of CVD events. [ABSTRACT FROM AUTHOR]

This article describes the development and continuing work of the Community Mobiliser Service in Milton Keynes, United Kingdom. It presents selected findings from two qualitative evaluation studies. The findings suggest that the Milton Keynes approach has much to offer as a community development initiative, having successfully stimulated community mobilization and participation on several estates in Milton Keynes for nearly ten years. This article presents a snapshot of the service from the perspectives of parents, young people, and other community members. It is shown that the service has been instrumental in supporting individuals and groups of community members to strive towards personal goals, develop community-based initiatives, and reduce dependency on services. This article concludes by outlining elements of effective practice in building communities collaboratively. [ABSTRACT FROM PUBLISHER]

This article describes the development of community-based integrated fire management planning in response to destructive forest fires on national forests in east-central Honduras. These pine–oak forests are co-managed by a complex of community interests that include local peoples, a forestry cooperative, development agencies and national authorities. The pine–oak forests of Honduras form the largest eco-region in a country with the highest deforestation rates in Central America. A case study is presented that describes a community-based initiative situated within the context of community-based natural resource issues of power, participation, and local management. Insights are drawn from experiences in managing pine–oak forests within a complicated institutional framework with an aim to understand the socio-ecological landscape and to contribute to the ongoing dialogue regarding the role and definition of local community. [ABSTRACT FROM PUBLISHER]

Abstract: Hypertension is the most common cause of cardiovascular diseases, accounting for at least half of haemorrhagic and ischaemic strokes, heart failure and renal failure in sub-Saharan Africa. However, population-based data to inform policies are scarce. Using the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based nationwide survey was conducted on participants aged 25–64 years in Malawi. Detailed findings on the burden of hypertension are presented in this paper. Blood pressure (BP) was measured in 3727 participants. The age-standardised prevalence of hypertension (BP ≥140/90mmHg) was 33.2% (95% CI 30.9–35.6%). Hypertension was more frequent in males than females (36.9% vs 29.9%), alcohol drinkers than non-drinkers (40.9% vs 31.6%), overweight than non-overweight (41.5% vs 30.7%) and increased with increasing age (21.4% in 25–34 years old vs 59.2% in 55–64 years old). Three-quarters of the participants said they never had their BP measured before and 94.9% of those with hypertension said they were not aware that they had such a medical problem. High prevalence of hypertension and its risk factors calls for the implementation of primary healthcare approaches such as the WHO package for essential non-communicable diseases to promote healthy lifestyles, early detection, treatment and control. [Copyright &y& Elsevier]

African-American and low-income older adults have heightened risk for cardiovascular disease (CVD). Culturally and socially congruent community-based programs can promote risk-reduction behaviors, including physical activity (PA), and can demonstrate durability. The purpose was to increase lifestyle PA and promote self-management of CVD risk factors in a sample of at-risk older adults and to sustain a PA program within low-income housing. Exercise and education sessions were conducted three times/week for 12 weeks. A community champion was trained to carry on the classes thereafter, with monthly inoculation visits by a nurse and exercise trainer. Outcome measures included attendance and CVD risk factor control. This ongoing community-based program, incorporating peer leadership, inoculation visits, and self-efficacy enhancement, has been sustained for over 3 years with classes one to two times per week and routine attendance of about 12-18 residents. PRAISEDD demonstrates that a community-based PA program can be maintained using within-community leadership, periodic involvement of health care experts, and social support and self-efficacy enhancement. [ABSTRACT FROM AUTHOR]

Background: Annual foot checks are recommended in patients with diabetes mellitus (DM) to identify those at risk of foot ulceration. Systematic reviews have found few studies evaluating the predictive value of tests in community-based diabetic populations.Aim: To quantify the predictive value of clinical risk factors in relation to foot ulceration in a community population.Methods: A cohort of 1192 people with diabetes receiving care in community settings was recruited and a screening procedure, covering symptoms, signs and diagnostic tests was conducted at baseline. At an average 1-year follow-up patients who developed a foot ulcer were identified by an independent blind assessor. Multivariable analysis was performed to identify clinical predictors of foot ulceration.Findings: The incidence of foot ulceration was 1.93% [95% confidence interval (CI) 1.27–2.89). Three time-independent clinical predictors with five factors were selected: previous amputation [odds ratio (OR) 14.7, 95% CI 3.1–69.5), use of insulin before 3 months with inability to distinguish between cool and cold temperatures (OR 2.97, 95% CI 1.9–4.5) and failure to obtain at least one blood pressure reading for the calculation of ankle-brachial index with the failure to feel touch with a 10-g monofilament (OR 1.7, 95% CI 1.3–2.2).Interpretation: Recommendations for annual diabetic foot check in low-risk, community-based patients should be reviewed as absolute events of ulceration are low. The accuracy of foot risk assessment tools to predict ulceration requires evaluation in randomized controlled trials with concurrent economic evaluations. [ABSTRACT FROM PUBLISHER]

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4–12-year-olds (Australia) and 13–18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan. [ABSTRACT FROM PUBLISHER]

Community-based initiatives have become a popular approach to addressing the health needs of underserved populations, in both low- and higher-income countries. This article presents findings from a study of female peer facilitators involved in a community-based maternal and newborn health intervention in urban slum areas of Mumbai. Using qualitative methods we explore their role perceptions and experiences. Our findings focus on how the facilitators understand and enact their role in the community setting, how they negotiate relationships and health issues with peer groups, and the influence of credibility. We contextualize this within broader conceptualizations of peer-led health interventions and offer recommendations for similar community-based health initiatives. [ABSTRACT FROM PUBLISHER]

The author reflects on community-based participatory research (CBPR) agenda discussed during a conference sponsored by the Office of Research on Women's Health (ORWH) of the U.S. National Institutes of Health (NIH). The author discusses the inadequacy of research in women's health and the paucity of women researchers. The author addresses the need for more research about sexual medicine. The author also mentions different issues of sexual and reproductive health.

This paper presents a randomized field experiment on community-based monitoring of public primary health care providers in Uganda. Through two rounds of village meetings, localized nongovernmental organizations encouraged communities to be more involved with the state of health service provision and strengthened their capacity to hold their local health providers to account for performance. A year after the intervention, treatment communities are more involved in monitoring the provider, and the health workers appear to exert higher effort to serve the community. We document large increases in utilization and improved health outcomes — reduced child mortality and increased child weight — that compare favorably to some of the more successful community-based intervention trials reported in the medical literature. [ABSTRACT FROM AUTHOR]

While there is some debate about what should be considered submissible evidence, there is no doubt that evidence-based practice has become accepted as a benchmark for service delivery in almost all areas of social work. This is not yet the case in the voluntary sector. Yet, social workers and service users rely heavily on voluntary sector services. In this paper, the effectiveness of voluntary sector services for victims of community violence is explored. Using Northern Ireland as a case in point, a time-series study was carried out with seventy-five service users who completed a research inventory (including GHQ-30, BDI-II and PDS) up to four times across a nine to twelve-month period. Additional stressful life events that occurred during this time period were considered and social validity of services was assessed. The results showed that despite detrimental effects of additional life stresses, psychological health and depression scores improved for all service users. Some community-based services (befriending) and some complementary therapies (reflexology) were significantly related to these improvements. Changes in post-traumatic stress disorder symptom severity were not significant. Social validity data were strongly in favour of voluntary sector services. [ABSTRACT FROM AUTHOR]

Purpose: The study describes Oregon state policy and supply developments for licensed long-term-care settings, particularly apartment-style assisted living facilities and more traditional residential care facilities. Design and Methods: Data came from a variety of sources, including state agency administrative records, other secondary data sources, and key informant interviews. Descriptive statistics examined public financing, Medicaid reimbursement, and licensed bed supply trends from 1986 to 2004, as well as Medicaid resident use between 1990 and 2004. Results: Residential care expansion, combined with nursing facility contraction, has transformed Oregon's supply of licensed long-term-care settings in favor of less institutional options. State financing, reimbursement, and licensing policies varied across provider type, with greater public resources supporting growth of assisted living facilities. By 2004, such settings were more likely to be Medicaid providers than residential care facilities and had a higher proportion of Medicaid residents relative to available bed supply. Implications: State financing and reimbursement policies may play a role in stimulating the supply of apartment-style assisted living available to low-income and/or rural service users. Less favorable policy conditions may have unintended consequences for the supply and use of other residential care settings. [ABSTRACT FROM PUBLISHER]

This article describes a research study which explored ways in which the inter-professional delivery of six parenting programmes from a community base succeeded in including families in high and low need. The findings suggest that working out-of-agency, with shared therapeutic purpose and from an established theoretical base, facilitated collaboration for the practitioners, although ongoing ownership of the programme by the participating agencies was not engendered by the funding arrangements. The community base promoted opportunities for a more inclusive, participative approach which was experienced as helpful by families with differing levels of need, suggesting that parenting programmes can be both preventive and restorative, at least in the short term. It is suggested that, while the new structures for the inter-agency delivery of Children's Services proposed in the 2004 Children Act, should promote opportunities for such programmes to be developed within mainstream service provision, and for closer engagement with schools, parenting programmes may not be at the core of the statutory service agenda. [ABSTRACT FROM AUTHOR]

‘Hartslag Limburg’ (Dutch for Heartbeat Limburg), a regional cardiovascular diseases (CVD) prevention program, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviors. The present paper focuses on the effects of the community intervention on fat intake and physical activity. The project was based on community organization principles and health education theories and methods. In order to implement the intervention, nine local Health Committees were set up, each organizing activities that facilitate and encourage people to adopt a healthier lifestyle. A pre-test-post-test control group design with two post-tests was used to evaluate the intervention. At baseline, representative random cohort research samples were selected in the Maastricht region and in a control region. Data on fat intake and physical activity, and on the psychosocial determinants of these behaviors, were gathered by means of mail surveys. The present study indicates that the intervention had a significant effect on fat reduction, especially among respondents aged ≤48 years (median age). Respondents in the Maastricht region were also more realistic about their fat intake at post-test as compared with the control region. Only a limited effect on intentions to increase physical activity was found. [ABSTRACT FROM AUTHOR]

Discrimination related to psychiatric disorders and people diagnosed with them is receiving increased interest and attention from researchers, policy makers, and the general public. There are diverse views about how best to alter and reduce what all parties agree are personally painful, socially wasteful, and morally inexcusable practices that surround people with psychiatric disorders. We report the results of a first step national survey of noteworthy on-the-ground efforts to reduce the negative consequences of having a psychiatric disorder and label. The sample consists of non-traditional, innovative local efforts along with well-known programs. Nominations of exemplary antistigma and antidiscrimination efforts were solicited from a national data base developed for this project. Next, an expert consensus panel selected 36 exemplary programs from among 102 nominations. A descriptive analysis and summary of the shared qualities of exemplary programs are provided. [ABSTRACT FROM PUBLISHER]

This paper explores the potential of the partnership model to minimize and transform the marginalization and disadvantage experienced by an Australian rural community suffering the effects of globalization. Torrens Valley Youth Programme is a successful example of how an innovative Community Partnership model in rural South Australia was accomplished with minimal funding. This case study examines the evolution of a partnership between a community centre and a non‐government organization that responded to the needs of local young people. The paper identifies potential barriers to successful partnership and demonstrates how these might be overcome. Our evaluation offers possibilities for developing partnerships in other countries experiencing similar issues. [ABSTRACT FROM PUBLISHER]

Unintentional injury, with its broad range of injury types, possible countermeasures, and great number of agencies involved in its prevention, lends itself to community-based approaches. In this paper we examine 10 community-based injury prevention programmes that have targeted childhood injury prevention and have been evaluated using some measure of outcome. We investigate the nature of the intervention, targeting, the length of programmes and multi-agency involvement. We also consider how the programmes have been evaluated, and what outcome, impact and process measures have been used. The information on the intervention and how it was evaluated, how effective the programme was, and the strength of the evidence, is summarized in tabular form. There is increasing evidence emerging about the effectiveness of community-based approaches in injury prevention. Important elements of such approaches are long-term strategy, effective focused leadership, multi-agency collaboration, tailoring to the needs of the local community, the use of local injury surveillance, and time to coordinate existing and develop new local networks. We recommend that there is a need to develop indicators to access and monitor a culture of safety, programme sustainability and long-term community involvement. [ABSTRACT FROM AUTHOR]

This article focuses on severe mental illness (SMI) which refers to long-term and persistent disorders such as schizophrenia or major affective disorders that disrupt capacities to carry out primary aspects of daily life. Over the past 20 years, the goal of community mental health services has been to enable individuals with SMI to spend more time in the community and thus to have greater opportunities to develop personal skills necessary for coping with life tasks. Psychosocial rehabilitation can be used within the community mental health rubric to address this goal. It involves development of both specific individual skills and environmental resources to assist individuals with SMI in functioning successfully in the environments of their choice with a minimum of ongoing professional intervention. Unfortunately, community-based interventions are often conceptualized as dealing with a clientele for whom gender and socioeconomic issues are unimportant. Yet services to those with SMI must be sensitive to the individual characteristics of clients if they are to truly meet their environmental and social needs.

This article reports on a pilot study of exemplary community-based youth initiatives in the United States in which young people are active participants in solving problems, planning programs, and providing services at the community level. The article presents brief summaries of six initiatives illustrating a range of youth participation in the issues that affect their lives and their communities. These diverse initiatives exemplify a view of young people as resources and promote individual, organizational, and community development. They were selected on the basis of their commitment to youth involvement, capacity building, collaboration, cultural awareness, community-defined concerns, leadership development, continuity, and comprehensive and change-oriented practice. The initiatives provide lessons for practice and challenge social workers to build meaningful partnerships and practice approaches that challenge problem-oriented interventions and recognize young people as competent community builders. [ABSTRACT FROM AUTHOR]

This article looks at the technical, interpersonal, theoretical, and philosophical aspects of developing mental health-education partnerships in community preschool programs for disadvantaged children and their families. Economically disadvantaged children are more likely to be affected by adverse sociophysiological factors and traumatic life experiences than children of other income groups. Early childhood educators and mental health professionals must reassess, reformulate, and reconstruct the best means of providing their services to these children. The outreach model discussed in this article is designed to maximize therapeutic effectiveness by using the team approach to work with the individual child in the preschool setting. This model not only brings mental health services to a population that would not or could not seek services from a traditional mental health center, but it also creates the opportunity for two agencies with different and unique skills to work together to provide more comprehensive services than either could provide on its own.

An important challenge for those conducting health promotion research is to reconcile the competing demands of scientific rigor and community participation. To develop further the theoretical and empirical basis for health promotion, research needs to be scientifically rigorous in every aspect of conceptualization, design, implementation, analysis and interpretation. Another widely held perspective in health promotion research is that it should be based on widespread community participation in various stages of the process. These two compelling forces are competing to the extent that they create questions about control of the research questions, methods used and relevance. The nature of this dilemma is discussed in this paper, along with an example of how one community-based research unit is dealing with these issues [ABSTRACT FROM PUBLISHER]

Longitudinal relations between depressive symptoms and alcohol problems have been examined infrequently in community-based studies, and gender-specific findings to date appear to be inconclusive. Study hypotheses were that depressive symptoms predicted subsequent alcohol problems for females, whereas alcohol problems predicted subsequent depressive symptoms for males. The authors examined these relations in a random sample of household adults (aged 19 years or more) from Erie County, New York, assessed in 1986, 1989, and 1993 (n = 1,306). Measures of alcohol problems (in the previous year) incorporated an alcohol abuse/dependence diagnosis and a heavy alcohol use index. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms over a 1-month time frame. Comprehensive logistic regression models incorporated prior depressive symptoms, prior alcohol problems, and sociodemo graphic variables (age, race, education, marital status, employment, total family income, and number of children living at home). For females, depressive symptoms predicted subsequent alcohol problems over 3 years (odds ratio = 3.04, 95% confidence interval 1.35–6.80, p <0.01) and 4 years (odds ratio = 2.42, 95% confidence interval 1.14–5.12, p <0.05), but not for 7 years. There was no evidence to support the hypothesis for males. This study clarifies and extends prior investigations of relations between these two prevalent mental health problems in a community-based sample. [ABSTRACT FROM AUTHOR]

Background: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel.Methods: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements.Results: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers' knowledge and training about malaria and other tropical diseases.Conclusion: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health. [ABSTRACT FROM AUTHOR]

The author comments on the study by Salazar and colleagues about community-based programs for the management of hypertension. He recommends the use of mobile technology and social media in the delivery of hypertension programs. He stresses that evidence has demonstrated the effectiveness of community programs in reducing blood pressure and improving cardiovascular health.

The article focuses on the community-based monitoring system established by research student Jonathan Stone of the University of East Anglia on the Caribbean island of Montserrat to involve local residents in monitoring the volcano.

As Afghanistan rebuilds its health system, it faces key challenges in financing health services. To reduce dependence on donor funds, it is important to develop sustainable local financing mechanisms. A second challenge is to reduce high levels of out-of-pocket payments. Community-based health insurance (CBHI) schemes offer the possibility of raising revenues from communities and at the same time providing financial protection. This paper describes the performance of one type of CBHI scheme, the Community Health Fund (CHF), which was piloted for the first time in five provinces of Afghanistan between June 2005 and October 2006. The performance of the CHF programme demonstrates that complex community-based health financing schemes can be implemented in post-conflict settings like Afghanistan, except in areas of high insecurity. The funds raised from the community, via premiums and user fees, enabled the pilot facilities to overcome temporary shortages of drugs and supplies, and to conduct outreach services via mobile clinics. However, enrolment and cost-recovery were modest. The median enrolment rate for premium-paying households was 6% of eligible households in the catchment areas of the clinics. Cost recovery rates ranged up to 16% of total operating costs and 32% of non-salary operating costs. No evidence of reduced out-of-pocket health expenditures was observed at the community level, though CHF members had markedly higher utilization of health services. The main reasons among non-members for not enrolling were being unaware of the programme; high premiums; and perceived low quality of services at the CHF clinics. The performance of Afghanistans CHF was similar to other CHF-type programmes operating at the primary care level internationally. The solution to building local capacity to finance health services lies in a combination of financing sources rather than any single mechanism. In this context, it is critical that international assistance for Afghanistans health sector continues. [ABSTRACT FROM AUTHOR]