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Child malnutrition is an urgent and complex issue and requires integrated approaches across agriculture, nutrition, and health. This issue has gained prominence at the global level. While national-level efforts are underway in many countries, there is little information on how to integrate at the community level. Here, we offer a community-based approach using cadres of agricultural and community health workers, drawing on qualitative work we have conducted in Tanzania. Agriculture is an important driver of nutritional and health outcomes, and improving child health will require practical solutions for integration that can add to the evidence base., (© The Author(s) 2016.)

Population aging looms over countries all over the world. The social and economic implications of this phenomenon extend beyond the individual person and the immediate family, affecting broader society and the global community in profound ways. Aging populations increase pressure on already over-burdened public health care services and expenditures. To address this impending predicament, many health care providers and countries have turned to technological solutions. The near-ubiquity of mobile devices entails that mHealth will rapidly become a key component of technologically-enabled health care delivery services. This poster presents research and engineering challenges for a sustainable ICT solution that supports information exchange for mobile geriatric care. [ABSTRACT FROM AUTHOR]

Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge.

Objective: The treatment of non-healing wounds accounts for a high proportion of wound care costs. Advanced technology treatments, such as negative pressure wound therapy (NPWT), could be cost-effective if they result in faster healing. The objective of this study is to assess the effect on healing and the cost-effectiveness of a single-use NPWT (i.e PICO by Smith & Nephew) when used on hard-to-heal wounds in a community setting., Method: This was a cohort case study in which wounds were treated with NWPT for 2 weeks. Wounds were assessed every 2-4 weeks to a healed state. The weekly cost of treatment prior to intervention, that is, the products used and nurse time, were compared with treatment costs associated with NWPT and after a return to standard treatment., Results: The study included 9 patients with leg ulcers or pressure ulcers that had been slow healing or non-healing for at least 6 weeks. While treated with NPWT, the average weekly reduction in wound size was 21%. The wound size achieved with NPWT was reached on average 10 weeks earlier than predicted. The increased healing rate continued after PICO stopped and 5 wounds healed on average 8 weeks later. Frequency of dressing changes fell from 4 times weekly at baseline to 2 times a week with NPWT and to 1.8 after NPWT stopped. Weekly cost of treatment with NPWT was, on average, 1.6 times higher than the baseline, but fell to 3 times less when NPWT stopped owing to the reduction in dressing changes. The amount of change in healing rate was considerably higher than the increase in costs associated with NPWT., Conclusion: NWPT is a cost-effective treatment for hard-to-heal wounds. Wounds decreased in size and healed more quickly under NWPT treatment than under standard treatment. Additional NPWT costs can be quickly offset by faster healing and a shortened treatment period.

Aim: The aim of the study was to examine registered nurses' (RNs) experiences of collaboration in the community health care and psychiatric inpatient care systems., Background: RNs in one area in the west of Sweden have indicated the need for collaborative routines between the community health care and psychiatric inpatient care systems., Method: Qualitative content analysis of focus group interviews., Results: RNs felt the web-based health-care communication programme was a major obstacle to the development of a collaboration plan. The poor collaboration between RNs was due to the absence of knowledge about the duties of each nursing team., Conclusion: The findings contribute to the understanding of the barriers to collaboration between RNs in community health care and psychiatric inpatient care, and highlight the need for nurse managers to ensure well-functioning routines.

Community mobilization (CM) interventions are often used to improve sexual, reproductive, and maternal health (SRMH). This systematic review provides an overview of CM indicators used in evaluation and then focuses on the use of linking constructs-those measures of the process of CM between programmatic outputs and outcomes. We identified 108 English-language articles evaluating 86 CM interventions that target SRMH. Content analysis was used to code CM indicators into five categories: qualitative descriptions of CM; participation, diffusion and community action indicators that measure tangible, programmatic outputs; and linking constructs that capture the process of moving from participation to empowerment. Fifty-five (64.0%) interventions include a CM indicator. Diffusion indicators are most common (56.4%); linking constructs are least common (20.0%). We found 23 linking constructs used in evaluations of 11 interventions, with limited information on psychometric properties available. Three evaluations report positive relationships between linking constructs and condom use, one of which was significant in multivariate analysis. To better understand how CM leads to improved outcomes, we recommend increasing the measurement of linking constructs in evaluations of CM interventions. Research should focus on developing and validating new linking construct indicators and better disseminating existing measurement tools., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.

Unlabelled: Researching the outcomes of assistive technology devices (ATDs) for older clients is important to facilitate clinical decision-making. However, to understand the outcomes associated with ATDs, one must investigate the users' experiences and acknowledge the user as an active participant in diverse social contexts., Purpose: To enhance understanding of the users' perspective regarding ATDs, this study aimed to investigate the meaning of the ATD for older individuals still living in their home environment., Methods: To provide descriptions of ATD experiences, older individuals who received a new ATD to compensate for their challenges in moving around, assist in self-care or both were recruited for the study. Participants were interviewed twice, with a few months between interviews, about their experience in using their new ATD. The interview transcripts were analyzed in a hermeneutical-phenomenological research approach., Results: The analysis revealed three recurring themes associated with the description of ATD experiences: "enabling performance and choice", "transformation from requiring assistance to assisting others", and "preparing for the future"., Conclusion: The results show that ATDs are used to enhance competence, mastery, control, self-worth, hope, and preparedness. The ATD service delivery should be client-centered and the client should be acknowledged as an active participant in producing change.

Aims and Objectives: To explore students' opinions of the learning environment during clinical placement in settings outside traditional hospital settings., Background: Clinical placement experiences may influence positively on nursing students attitudes towards the clinical setting in question. Most studies exploring the quality of clinical placements have targeted students' experience in hospital settings. The number of studies exploring students' experiences of the learning environment in healthcare settings outside of the hospital venue does not match the growing importance of such settings in the delivery of health care, nor the growing number of nurses needed in these venues., Design: A survey design was used., Method: The Clinical Learning Environment Inventory was administered to two cohorts of undergraduate nursing students (n = 184) after clinical placement in mental health care, home care and nursing home care., Results: Nursing students' overall contentment with the learning environment was quite similar across all three placement areas. Students in mental health care had significantly higher scores on the subscale individualisation, and older students had significantly higher scores on the total scale. Compared with other studies where the Clinical Learning Environment Inventory has been used, the students' total scores in this study are similar or higher than scores in studies including students from hospital settings., Conclusion: Results from this study negate the negative views on clinical placements outside the hospital setting, especially those related to placements in nursing homes and mental healthcare settings., Relevance to Clinical Practice: Students' experience of the learning environment during placements in mental health care, home care and nursing homes indicates the relevance of clinical education in settings outside the hospital setting., (© 2014 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

This study examined the healthcare experiences of Korean immigrants aged 40-64 living in the North Carolina Triangle area of the Southeastern United States. Using a mixed methods design, we collected quantitative data via a questionnaire from 125 participants and conducted a focus group with 10 interviewees from December 2010 to February 2011. The quantitative data were analysed using t-tests and chi-square tests, and a thematic analysis was used for the focus group study. Questionnaire findings showed that only 27.2% had sufficient English skills to communicate adequately. Participants with insurance were significantly more likely to be employed (P < 0.001), had higher incomes (P = 0.011) and higher education (P < 0.001), and had greater English-speaking ability (P = 0.011) than those without insurance. Participants who did not use healthcare services showed significantly less knowledge (P < 0.001) of and less satisfaction (P = 0.034) with the healthcare system than those using healthcare services. Sixty-two participants (49.6%) reported having no health insurance for one or more of the following reasons: high costs (75.8%), medical tourism (22.6%) and lack of information or knowledge (6.5%). The following themes emerged from the data collected during the focus group: (i) barriers to utilisation of healthcare services; (ii) facilitators of utilisation of healthcare services; and (iii) social support seeking for health management. Our mixed methods study findings indicate that healthcare disparities exist among Korean immigrants and that a number of factors, including health literacy, may contribute to their poor health outcomes. Continued collaboration among community members, healthcare professionals and academicians is needed to discuss the community's health concerns and to develop sustainable programmes that will ensure meaningful access to care for those with limited English proficiency and medically underserved populations., (© 2014 John Wiley & Sons Ltd.)

Objective: Providing assistive technology devices to older individuals living in their ordinary homes is an important intervention to increase and sustain independence and to enable ageing at home. However, little is known about older individuals' experiences and needs in the assistive technology device (ATD) service delivery process. The purpose of this study was to investigate older individuals' experiences during the service delivery process of ATDs., Methods: Nine older individuals were interviewed three times each throughout the ATD service delivery process. The interviews were analysed within a hermeneutical phenomenological perspective., Results: The results show that the service delivery process could be interpreted as an enigmatic journey and described using four themes: "hope and optimistic expectations", "managing after delivery or needing additional help", "having available help versus being abandoned", and "taking charge or putting up"., Conclusions: The results emphasize the need for occupational therapists to maintain an individualized approach towards older clients throughout the service delivery process. The experiences of older individuals were diverse and related to expectations that were not necessarily articulated to the occupational therapist. The situation when the ATD is delivered to the client was highlighted by the clients as an important event with the potential to facilitate a successful service delivery process.

This article presents an integrative literature review that analyses the advances and challenges in oral health care of the Brazilian primary health care system, based on a political agenda that envisages re-organising the unified health system (SistemaÚnico de Saúde - SUS). It is presumed that the actions suggested by the Alma-Ata Conference of 1978 are still up-to-date and relevant when adapted to the situation in Brazil. Several studies and policies are reviewed, including works demonstrating the importance of primary care as an organising platform in an integrated health-care network, Brazil's strategy for reorganising the primary care network known as the Family Health Strategy, and the National Oral Health Policy. This review discusses results obtained over the last twenty years, with special attention paid to changes in oral health-care practices, as well as the funding of action programmes and assistance cover. The conclusion is that oral healthcare in the Brazilian primary health care system has advanced over the past decades; however, serious obstacles have been experienced, especially with regard to the guarantee of universal access to services and funding. The continuous efforts of public managers and society should focus on the goal of achieving universal coverage for all Brazilians., (© 2013 FDI World Dental Federation.)

Creating integrated, comprehensive care practices requires access to data and informatics expertise. Information technology (IT) resources are not readily available to individual practices. One model of shared IT resources and learning is a "patient-centered medical village." We describe the OCHIN Community Health Information Network as an example of this model; community practices have come together collectively to form an organization that leverages shared IT expertise, resources, and data, providing members with the means to fully capitalize on new technologies that support improved care. This collaborative facilitates the identification of "problem sheds" through surveillance of network-wide data, enables shared learning regarding best practices, and provides a "community laboratory" for practice-based research. As an example of a community of solution, OCHIN uses health IT and data-sharing innovations to enhance partnerships between public health leaders, clinicians in community health centers, informatics experts, and policy makers. OCHIN community partners benefit from the shared IT resource (eg, a linked electronic health record, centralized data warehouse, informatics, and improvement expertise). This patient-centered medical village provides (1) the collective mechanism to build community-tailored IT solutions, (2) "neighbors" to share data and improvement strategies, and (3) infrastructure to support innovations based on electronic health records across communities, using experimental approaches.