Search

IntroductionMany designathons, hackathons, and similar participatory events suffer from minimal training and support after the events. Responding to this need, we organized a health innovation bootcamp: an intensive, team-based apprenticeship training with research and entrepreneurial rigor among young people in Nigeria to develop HIV self-testing (HIVST) delivery strategies for Nigerian youth. The purpose of this paper was to describe an innovation bootcamp that aimed to develop HIVST delivery strategies for Nigerian youth.MethodsThe four-week, in-person innovation bootcamp, informed by youth participatory action research and comprised a series of workshops, took place in Lagos, Nigeria. The goal was to build research and entrepreneurial capacities among young people to develop and implement HIVST strategies. A qualitative content analysis informed by an adapted World Health Organization’s HIVST delivery framework explored key elements of the proposed HIVST service delivery strategies developed at the bootcamp.ResultsTwenty participants, aged 18–24 years, from five teams completed the innovation bootcamp. The five teams developed HIV service delivery strategies that included an element of repacking HIVST kits to make them more appealing to young people. Other strategies that emerged included leveraging community engagement platforms (e.g., vocational skills training and youth community events) to promote HIVST, and the use of reward-referral system to encourage HIVST uptake among young people. All strategies included ways to ensure privacy protection for recipients of the HIVST delivery package.ConclusionThis study demonstrated the feasibility and acceptability of the health innovation bootcamp model to create HIVST designed for and led by young people. This suggests a way to build capacity after participatory events to sustain youth-led research, which could have implications for post-designathon training.

IntroductionGlobal interest is growing in new value-based models of financing, delivering, and paying for health care services that could produce higher-quality and lower cost outcomes for patients and for society. However, research indicates evidence gaps in knowledge related to alternative payment models (APMs) in early experimentation phases or those contracted between private insurers and their health care provider-partners. The aim of this research was to understand and update the literature related to learning how industry experts design and implement APMs, including specific elements of their models and their choice of stakeholders to be involved in the design and contractual details.MethodsA literature review was conducted to guide the research focus and to select themes. The sample was selected using snowball sampling to identify subject matter experts (SMEs). Researchers conducted 16 semi-structured interviews with SMEs in the US, the Netherlands, and Germany in September and October 2021. Interviews were transcribed and using Braun and Clarke's six-phase approach to thematic analysis, researchers independently read, reviewed, and coded participants' responses related to APM design and implementation and subsequently reviewed each other's codes and themes for consistency.ResultsParticipants represented diverse perspectives of the payer, provider, consulting, and government areas of the health care sector. We found design considerations had five overarching themes: (1) population and scope of care and services, (2) benchmarking, metrics, data, and technology; (3) finance, APM type, risk adjustment, incentives, and influencing provider behavior, (4) provider partnerships and the role of physicians, and (5) leadership and regulatory issues.DiscussionThis study confirmed several of the core components of APM model designs and implementations found in the literature and brought insights on additional aspects not previously emphasized, particularly the role of physicians (especially in leadership) and practice transformation/care processes necessary for providers to thrive under APM models. Importantly, researchers found significant concerns relevant for policymakers about regulations relating to health data sharing, rigid price-setting, and inter-organizational data communication that greatly inhibit the ability to experiment with APMs and those models’ abilities to succeed long-term.

Abstract Background Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth. Methods The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications – Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria—an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals. Results Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention’s feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group. Conclusions Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.

Objective: The objective of this formative study was to gather women’s perspectives in the design and communication modalities of a health kiosk set within a Planned Parenthood setting to promote patient education about the Human papillomavirus (HPV) and to motivate uptake of the HPV vaccine. Methods: Twenty-four women aged 18-35 participated in in-depth one-on-one interviews at a Planned Parenthood health center, which were analyzed in code-associated categories using NVivo11 Pro. Results: Most women showed receptivity to using an on-site health kiosk, as well as QR codes linked to text messages, to receive HPV-related health information outside of the clinic setting and reminders. Participants provided suggestions for kiosk design and communication modalities. Conclusions: Among low-income women we interviewed at Planned Parenthood, increasing HPV vaccination rates necessitates engaging digital health tools which incorporate both the preferences and needs of vulnerable populations. Innovation: Designing a point-of-service health kiosk that 1) draws on user preferences early in the design phase, 2) integrates multiple communication technologies, and 3) disseminates culturally grounded HPV vaccination decisions narratives that are tailored to vaccination awareness level is a promising approach in reducing barriers to HPV vaccine education and vaccine uptake among low-income women at safety-net clinics.

Men’s pregnancy intention is associated with a host of positive outcomes for families, yet this topic remains understudied. Because unintended pregnancies are more likely to occur at suboptimal parental health, this study aimed to examine the extent to which men improve their preconception health in the context of future fertility planning. This study used pooled data from the 2011–2019 National Survey of Family Growth for a final sample size of 10,223. Latent class analysis (LCA) was used to identify distinct classes of men’s preconception health. Eight preconception health risk factors were used to determine class membership. A classify-analyze approach was used to create the preconception health phenotype ( PhP ) exposure variable. The outcome of interest was men’s fertility intentions. Multinomial regression models were used to examine the association between the exposure and the outcome. Three unique PhPs were identified (lowest risk, substance users, and sexual risk-takers) from the LCA model. Men in the substance users’ group (22.9%) were characterized by high-risk alcohol use and drug use, while sexual risk-takers (8.1%) were characterized by having multiple sexual partners. Belonging in the phenotypes of substance users or sexual risk-takers was associated with increased odds for definite no fertility intention than definite yes intentions (adjusted odds ratio [aOR]: 1.47, 95% confidence interval [CI]: [1.18, 1.84] and aOR: 1.51, 95% CI: [1.13, 2.01], respectively). Results provide new insights on how preconception health can be measured and fills a knowledge gap on its relationship to men’s future fertility planning. Findings can be applied to preconception care intervention frameworks, and guide family planning interventions and contraceptive counseling.

Abstract Background Community-based interventions (CBIs) are interventions aimed at improving the well-being of people in a community. CBIs for HIV testing seek to increase the availability of testing services to populations that have been identified as at high risk by reaching them in homes, schools, or community centers. However, evidence for a detailed cost analysis of these community-based interventions in sub-Saharan Africa (SSA) is limited. We conducted a systematic review of the cost analysis of HIV testing interventions in SSA. Methods Keyword search was conducted on SCOPUS, CINAHL, MEDLINE, PsycINFO, Web of Science, and Global Health databases. Three categories of key terms used were cost (implementation cost OR cost-effectiveness OR cost analysis OR cost-benefit OR marginal cost), intervention (HIV testing), and region (sub-Saharan Africa OR sub-Saharan Africa OR SSA). CBI studies were included if they primarily focused on HIV testing, was implemented in SSA, and used micro-costing or ingredients approach. Results We identified 1533 citations. After screening, ten studies were included in the review: five from East Africa and five from Southern Africa. Two studies conducted cost-effectiveness analysis, and one study was a cost-utility analysis. The remainder seven studies were cost analyses. Four intervention types were identified: HIV self-testing (HIVST), home-based, mobile, and Provider Initiated Testing and Counseling. Commonly costed resources included personnel (n = 9), materials and equipment (n = 6), and training (n = 5). Cost outcomes reported included total intervention cost (n = 9), cost per HIV test (n = 9), cost per diagnosis (n = 5), and cost per linkage to care (n = 3). Overall, interventions were implemented at a higher cost than controls, with the largest cost difference with HIVST compared to facility-based testing. Conclusion To better inform policy, there is an urgent need to evaluate the costs associated with implementing CBIs in SSA. It is important for cost reports to be detailed, uniform, and informed by economic evaluation guidelines. This approach minimizes biases that may lead decision-makers to underestimate the resources required to scale up, sustain, or reproduce successful interventions in other settings. In an evolving field of implementation research, this review contributes to current resources on implementation cost studies.

BackgroundLife course perspectives suggest that optimizing men's health before conception is requisite to equitably improve population health, an area of increasing public health focus. Although scholarship on the social determinants of health (SDOH) suggests that men's health and health behaviors do not occur in a vacuum, preconception health studies have not explicitly examined how these factors influence men's preconception health.ObjectiveTo identify latent classes of men's preconception health and the role of the SDOHs in predicting class membership.MethodsPooled data from the 2011–2019 male file of the National Survey of Family Growth were analyzed (n = 10,223). Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight manifest variables were used to fit latent class models. A classify-analyze approach was subsequently used to create a preconception health phenotype (PhP) outcome variable. SDOHs (exposure variable) were assessed in four domains (rural/urban residence, health access, socioeconomic status, and minority/immigrant status) to predict class membership. Survey-weighted multinomial regression models were fitted to examine the association between the exposure and the outcome.ResultsThree unique PhPs were identified (lowest risk (69%), substance users (22.9%), and sexual risk-takers (8.1%) from the LCA model. Health access, socioeconomic status, and minority/immigrant status were significant predictors of class membership but not rural/urban residence. Sexual risk takers were more likely to be uninsured (aOR: 1.25, 95% CI 1.02, 1.52), college-educated (aOR: 1.94 95% CI: 1.34, 2.79), and non-Hispanic Black (aOR: 1.99 95% CI: 1.55, 2.54) while substance users were more likely to have unstable employment (aOR: 1.23 95% CI:1.04, 1.45) and have a high school degree or higher (aOR 1.48 95% CI: 1.15, 1.90) than men in the lowest risk category.ConclusionSocial determinants may impact men's preconception health in ways that are not conventionally understood. These findings raise important questions about how preconception health interventions should be created, tailored, and/or retooled. Specifically, studies that examine the sociocultural and political contexts underpinning the relationship between social class, masculinity, and men's preconception health are needed to provide nuanced insights on factors that shape these outcomes.

Chronic diseases are increasingly responsible for the burden of health outcomes across the world. However, there is also increasing recognition that patterns of chronic disease outcomes (e.g., mortality, quality of life, etc.) have inequities across race, gender, and socioeconomic groups that cannot be solely attributed to these determinants. There is a need for an organizing framework which centers fundamental causes of health disparities that may better guide future work in centering these mechanisms and moving beyond acknowledgment of health disparities. In this paper, we synthesize several concepts from health disparities literature into a conceptual framework for understanding the interplay of patients' lived experiences, the health care system and structural determinants. Our framework suggests that (1) structural factors influence the health care system, the patient, the health care provider, and the provider-patient relationship through process of subordination and (2) that structurally competent actions are critical to reducing health inequities. The addition of subordination to theoretical frameworks involving health equity and social determinants of health, along with engagement with concepts of structural competency suggest several systems level changes to improve health outcomes.

It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10–24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria.

Background: Human immunodeficiency virus risk-reduction interventions that include income-generating activities are garnering attention as effective strategies to engage adolescent girls and young women (AGYW) toward HIV risk reduction. To sustain and promote the uptake of these interventions, researchers must understand factors that may encourage or present barriers to AGYW participation in such interventions. This study explores AGYW perceived barriers and facilitators to participation in a school-based combination income-generating HIV prevention intervention in Nigeria.Methods: A convenience sample of AGYW who participated in a school-based combination income-generating HIV prevention intervention were recruited for the study. Data generated from focus group discussions (FGDs) (eight discussion groups comprising 10–12 participants) were analyzed by inductive thematic analysis.Results: A total of 93 participants with a mean age of 15.04 years (SD = 0.89) participated in the FGDs. The study participants identified several facilitators and barriers to participation in the intervention. Three main themes that emerged as facilitators were: (1) involvement of young female facilitators in the delivery of intervention components, (2) opportunity for social interaction with peers during the intervention period, and (3) support and approval from school authorities. Two main themes were also identified as barriers: (1) sexual conservatism from society and parents and (2) challenges in sustaining a microenterprise.Conclusions: Despite the perceived benefits and interest in participation in the intervention, the study participants outlined some challenges that may hinder participation in the intervention components. Addressing barriers, such as stigma associated with the discussion of sexual health-related topics, coupled with the promotion of facilitating factors, such as leveraging context-appropriate intervention delivery modalities, is important for enhancing the engagement of AGYW in HIV risk-reduction intervention. Our findings can guide future research and design of combination income-generating HIV prevention interventions for in-school AGYW in low-resource settings such as Nigeria.

Objectives: This study aims to evaluate the impact of Microburst Insulin Infusion (MII) treatment on Type 1 and 2 diabetic patients' HbA1c, lipids, peripheral neuropathy, and patient-reported health status.Methods: We reviewed clinical charts, including lab results, for more than 80 diabetic and pre-diabetic patients treated at one U.S. outpatient clinic in St. Louis, Missouri between February 2017 and December 2019. Data included patient demographics, treatment data, lab and neuropathy tests, and self-reported patient health status questions.The explanatory variable was number of months of MII treatment. Treatments are 3–4 h in length, with two intensive infusions the first week and one treatment each week thereafter, usually for 12 weeks total. Lab tests were at 12-week intervals.Generalized linear modeling and t-tests assessed the significance of differences between patients' baseline lab values, neuropathy measures, and health status before treatment vs. after final treatment.Results: Number of MII treatments per patient ranged from 1 to 262, over 1–24 months. Time in MII treatment was significantly associated with reductions in HbA1c by nearly 0.04 points per month, and triglycerides declined 3 points per month. Neuropathy measures of large toe vibratory sensation (clanging tuning fork) improved significantly, as did patient-reported health and feelings of improvement since beginning treatment.Discussion: The MII therapy appears to be efficacious in treating diabetic patients, particularly those with complications like neuropathy. Our findings affirmed several other studies. We uniquely incorporated patient health questionnaires, and empirically studied MII treatment efficacy for diabetes in a population large enough to permit statistically valid inferences. With multiple waves of data for over 80 patients, this is one of the most extensive quantitative studies of microburst insulin infusion therapy conducted to date, with protocols more uniformly implemented and survey instruments more consistently administered by the same clinical team. Given the advances in insulin infusion therapy brought by MII, and early indications of its efficacy, the time is right for more in-depth studies of the outcomes patients can achieve, the physiological mechanisms by which they occur, MII's comparative effectiveness vis-à-vis traditional treatments, and cost-effectiveness.

Background: It is known that patients with noncommunicable diseases utilize traditional healers (THs) regardless of their ability to access biomedical treatment facilities. However, information regarding the practices of THs and how they treat in Sub-Saharan African (SSA) is limited. This study examines the sociodemographic characteristics of Senegalese THs, how they treat diabetes, and how they interact with both patients and the larger health-care system. Materials and Methods: THs were identified in M'bour, Senegal, who practice alongside a government hospital and several health outposts. Twenty THs agreed to participate in recorded interviews. A standardized questionnaire was used to investigate general practices and management of diabetes. Results: Eighteen of the THs were male, ages 22–70 years. Thirteen were trained through family members, while five never received training, citing that they were born with or received their gift in a dream. All THs treated physical illnesses, including diabetes. Plants were used by all THs and were usually dispensed in the form of powder. Nine THs stated that they could lower blood sugar levels, while five said they were able to cure diabetes completely. Many THs cited referring patients to biomedical treatment centers if unable to manage their conditions either initially or after treatments were unsuccessful. Conclusions: This study provides insight into the practice of THs in rural Senegal. Findings suggest the need for collaboration among THs, health professionals, and patients, given the increasing burden of diabetes in SSA.

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.

Background Young people in low- and middle-income countries are often neglected in designing youth-friendly health services, especially HIV testing and preventive services. Designathons, which are time-bounded co-creation events where individuals gather in teams to develop solutions to a problem, could promote youth participation and ownership of health services. Objective The purpose of this study is to examine youth participation in a designathon to create youth-friendly health services in Nigeria. Methods Our designathon was based on crowdsourcing principles and informed by a human-centered design approach. The designathon included an open call for Nigerian youths between 14 and 24 years to share ideas on how to promote uptake of HIV self-testing services and a three-day sprint event that brought together diverse teams to develop strategies enhancing linkage to care. Teams pitched their solutions to a panel of five independent experts who scored ideas based on the desirability, feasibility, potential impact, and teamwork. We used descriptive statistics to summarize participants’ demographics and conducted a content analysis to synthesize themes from youth proposals. Results Nine hundred seventy-six youth across Nigeria applied to join the designathon. Forty-eight youth in 13 teams participated in the designathon with a median age of 20 years (IQR: 17–22]. Boys and young men were 48.5% (446/919) of the total applicants, 62.5% (30/48) of the designathon participants, and 63.6% (7/11) of the finalists. Students, from all educational levels, represented 91.2% (841/922) of the total applicants, 88.4% (38/43) of the designathon participants, and 90.0% (9/10) of the finalists. About twenty-three percent (3/13) of the final proposals were top ranked. The three finalist approaches to optimize youth-friendly health services centered on decentralizing service delivery to young people through mobile health technologies, use of mobile tents, or peer support services. Conclusions Our open call engaged diverse groups of Nigerian youth, including young women and students. Our data suggest that designathons may be useful for developing tailored youth-friendly health services. Further research is needed to understand the designathon process and the effectiveness of the finalist submissions.

The ability to analyze data to identify best practices is key to improving quality of care for community-based health care organizations (CBOs). Leading commercial statistical software remains too costly for many CBOs operating in underserved communities. The St Louis Integrated Health Network (IHN) collaborates with CBOs to increase access to health care. IHN and a local university developed the Community Analytics Academy (CAA), a training collaborative designed to meet the need for data-informed decision making among CBOs. Establishing analytics training collaboratives for CBOs empowers organizations to respond to the ever-growing amounts of health care data and the need for data-driven decision making.

Background: While many researchers document the immediate and localized health effects of armed conflicts on combatants are well documented in the literature, less is known about the effects of armed conflict on individuals who have subsequently migrated elsewhere. Objective: This study aims to estimate associations between pre-migration armed conflict in Central America and post-migration health in the United States. Methods: We created a new dataset that combines information on armed conflicts in Central America and immigrant health in the United States. We used ordered probit regressions to estimate age-adjusted associations between pre-migration armed conflict and post-migration health. Findings: The study sample of Central American immigrants included 15,563 females and 16,236 males between the ages 15 and 69. The mean age was 37.2 years (standard deviation, 11.6 years) for females and 35.5 years (standard deviation, 11.2 years) for males. After adjusting for age, pre-migration armed conflict was associated with a 8.6 percentage point decrease in excellent health for females (95% confidence interval, 6.0 to 11.1), and a 7.3 percentage point decrease for males (95% confidence interval, 4.0 to 10.7). Each decade of pre-migration armed conflict was associated a 2.9-percentage point decrease in excellent health for females (95% confidence interval, 2.0 to 3.8) and a 1.6-percentage point decrease for males (95% confidence interval, 0.6 to 2.6). For those individuals exposed to armed conflict, each decade since the most recent armed conflict was associated with a 1.5 percentage point increase in excellent health for females (95% confidence interval, 0.4 to 2.5). For males, the average marginal effect of decades since last conflict was not statistically significant (95% confidence interval, –0.001 to 0.002). Conclusions: Pre-migration armed conflict in Central America is associated with decreases in excellent post-migration health in the United States. The effects of armed conflict are cumulative and fade over time for females.

Abstract Background Hospitalized older persons with Alzheimer’s disease and related dementias are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, lack of family involvement and limited staff knowledge of dementia care. We have developed a theory-based intervention, Family centered Function-focused Care, that incorporates an educational empowerment model for family caregivers (FCGs) provided within a social-ecological framework to promote specialized care to patients with dementia during hospitalization and the 60-day post-acute period. Primary aims are to test the efficacy of the intervention in improving physical and cognitive recovery in hospitalized persons living with Alzheimer’s disease and related dementias (ADRD) and improving FCG preparedness and experiences. Method We will implement Family centered Function-focused Care in a cluster-randomized trial of 438 patient/FCG dyads in six hospital units randomized within three hospitals. We hypothesize that patients who receive the intervention will demonstrate better physical function, less delirium occurrence and severity, neuropsychiatric symptoms, and depression compared to those in the control condition (Education-only). We also hypothesize that FCGs enrolled in Family centered Function-focused Care will experience increased preparedness for caregiving, and less strain, burden, and desire to institutionalize, as compared to FCGs the control group. We will also examine the costs and relative cost savings associated with the intervention and will evaluate the cultural appropriateness of Family centered Function-focused Care for families from diverse backgrounds. Discussion Our theory-based intervention makes use of real-world applicable approaches in a novel and innovative way to change the paradigm of how we currently look at acute care and post-acute transitions in persons with ADRD. Trial registration ClinicalTrials.gov, ID: NCT03046121. Registered on 8 February 2017.

Abstract Background Poor water quality, one of the leading causes of diarrhea, is an issue for most developing countries. Although the health burden of poor-quality water has been studied extensively, there is a paucity of research regarding the impact of household water treatment (HWT) on children’s nutritional status using data from large-scale surveys. In this research, we study the effect of HWT on the nutritional status of primary-aged children in India using a secondary data set consisting of 20,315 children between the ages of 6 and 14 (10,523 males and 9,792 females) in 12,839 households from the second wave of the India Human Development Survey (IHDS-II). Methods The IHDS-II is a nationally representative, household-based, comprehensive, and face-to-face survey. Households were selected using stratified random sampling, and a team consisting of one male and one female interviewer visited each household between November 2011 and October 2012. A knowledgeable member, typically the male head of household, was interviewed about the socioeconomic condition of the household. An ever-married woman between the ages of 15 and 49, typically the wife of the male head of household, answered questions related to education and health. The height and weight of all eligible household members were measured by interviewers. Correlation between HWT and nutritional status was computed first, and the estimation of a generalized simultaneous equation model, in which a binary indicator of HWT and other covariates was included, was carried out afterward. Results Bivariate analysis shows a negative association between the nutritional status of children and HWT. Additionally, findings from the generalized simultaneous equation model demonstrate that HWT increases the probability of producing normal-weighted primary-aged children by 1.7 %, while it decreases the probability of primary-aged children being thin by 2.5% and being severely thin by 1.7% in India. Conclusions This study indicates that HWT has the potential to advance the nutritional status of primary school-aged children in India.

Introduction: Emergency medicine is a relatively new specialty in Africa, with the first emergency medicine training programme only started in South Africa in 2004. Continued emergency centre development and preparedness relies on a better understanding of the quantity and category of emergency centre encounters within the various African regions. Methods: This study was conducted over four, consecutive months in 2014 using a retrospective chart review, aimed to examine the types of visits made to one emergency centre at the Grande Mbour Hospital in Mbour, Senegal. The New York University Emergency Department Algorithm was used to classify emergency centre encounters. Each diagnosis included in this study was classified per the algorithm as non-emergent; emergent but primary care treatable; emergent with emergency centre care needed but avoidable/preventable; and emergent with emergency centre care needed and not avoidable/preventable. The algorithm also categorised diagnoses of injury, mental health problems, alcohol, or substance abuse. Results: This study included 1268 diagnoses from the emergency centre. The most common presentations in Mbour, Senegal were injuries, with 302 cases (33%), and from the category: emergent but primary care treatable, with 303 cases (33%). In total, 174 cases (19%) were classified as: non-emergent. While only 93 cases (10%) were considered: emergency care needed/preventable or avoidable, a substantial number (n = 218, 24%) were categorised as: emergent with emergency centre care needed and not avoidable/preventable. Conclusion: This study provides the first description of patients presenting for care in the emergency centre of Mbour’s hospital and demonstrates the wide range of illnesses and types of trauma that the emergency centre must accommodate while contending with the limited resources available in the area. Understanding the burden of disease will help prioritise resources appropriately.

INTRODUCTION: This study analyzed the trends of trauma cases that presented to the Emergency Department (ED) in the Grand M'Bour Hospital. We examined demographics of patients, mechanisms of trauma and types of injuries that result and times from injury to arrival. METHODS: this was a descriptive study using prospective ED trauma cases. Patients were selected for the study if their chief complaint was related to a traumatic injury. A trauma flow sheet was developed to obtain information. Data was collected from 6/22/16-7/13/16, with 105 cases recorded. Abstracted data included date, time of arrival, time of injury, age, gender, mechanism of injury, injury sustained and disposition. RESULTS: patients presented to the ED for 13 different trauma-related reasons. 71% of the patients encountered had a mechanism of injury related to falls or motor vehicle accidents. The majority of patients who suffered from a fall-or motor vehicle-related injury were children, with ages 0-10 representing 31% and ages 11-20 representing 14% of the total patients. While 29% of patients were seen within 1 hour of the time of their injury, 10% of the patients were not seen until days after their injury. CONCLUSION: we report that traumatic injuries are most commonly a result of fall-related and vehicle-related accidents. Children under the age of 20 years old are a vulnerable population for traumatic injuries. We observed that many patients were unable to seek care within a day of their injury. This was concerning that proper emergency transportation was not available, leading to potential complications or improper healing of injuries. Knowing these trends, an ED can be better prepared to treat these patients.

Current South African health policy for chronic disease management proposes integration of chronic services for better outcomes for chronic conditions; that is based on the Integrated Chronic Disease Model (ICDM). However, scant data exist on how patients with chronic multimorbidities currently experience the (re)-organisation of health services and what their perceived needs are in order to enhance the management of their conditions.A qualitative study was conducted in a community health centre treating both HIV and diabetes patients in Cape Town. The study was grounded in the Shippee's Cumulative Complexity Model (CCM) and explored "patient workload" and "patient capacity" to manage chronic conditions. Individual interviews were conducted with 10 adult patient-participants with HIV and type two diabetes (T2D) multimorbidity and 6 healthcare workers who provided health services to these patient-participants.Patient-participants in this study experienced clinic-related workload such as: two separate clinics for HIV and T2D and perceived and experienced power mismatch between patients and healthcare workers. Self-care related workloads were largely around nutritional requirements, pill burden, and stigma. Burden of these demands varied in difficulty among patient-participants due to capacity factors such as: positive attitudes, optimal health literacy, social support and availability of economic resources. Strategies mentioned by participants for improved continuity of care and self-management of multi-morbidities included integration of chronic services, consolidated guidelines for healthcare workers, educational materials for patients, improved information systems and income for patients.Using the CCM to explore multimorbidity captured most of the themes around "patient workload" and "patient capacity", and was thus a suitable framework to explore multimorbidity in this high HIV/T2D burden setting. Integration of chronic services and addressing social determinants of health may be the first steps towards alleviating patient burden and improving their access and utilisation of these services. Further studies are necessary to explore multimorbidity beyond the context of HIV/T2D.

n/a

Background: Uninsured patients with diabetes are at increased risk for poor outcomes and often have limited access to health and prescription services necessary to manage diabetes. Hamilton Health Center, a federally qualified community health center, with support from the Highmark Foundation, implemented a Diabetes Healthy Outcomes Program (DHOP) for uninsured patients. Purpose: To evaluate the effectiveness of DHOP that is designed to provide health care and supportive services for uninsured diabetic patients at a federally qualified community health center. Methods: Mixed quantitative and qualitative analyses of participant outcomes and satisfaction were used to assess program effectiveness. Results: A total of 189 participants enrolled in DHOP over 2 years. Thirty-four (18%) participants had adequate glycemic control with hemoglobin A1c (HbA1c) ≤7%. Overall, 105 participants received prescription drugs, 101 participants received eye care services, 23 participants received dental services, 45 received podiatry services, 37 received nutrition services, and 28 patients engaged in an exercise program. More participants (38%, 34) had controlled diabetes mellitus at study start than at the end (28%, 25). However, 30% versus 17% of participants with 2 HbA1c measurements achieved or maintained HbA1c ≤7% by the end of the program compared with the start. Participants who accessed more services were more likely to achieve glycemic control as measured by HbA1c ( P > .01). Conclusion: Although 30% of participants improved or maintained glycemic control over 2 years, more were uncontrolled at the end than at study start. Participants who accessed more primary and specialty care services were more likely to achieve glycemic control. Multidisciplinary care may improve diabetes control in low-income patients.