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Abstract Introduction Health care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities. Case description Nagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles. Discussion and Evaluation A unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor. Conclusions Programming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.

Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009-2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes., Author(s): Meghan K. Wally [sup.1] , Larissa R. Brunner Huber [sup.1] , L. Michele Issel [sup.1] , Michael E. Thompson [sup.1] Author Affiliations: (1) Department of Public Health Sciences, UNC [...]

Objectives To assess whether implementation of the Strengthen Opioid Misuse Prevention (STOP) Act was associated with an increase in the percentage of opioid prescriptions written for 7 days or fewer among patients with acute or postsurgical musculoskeletal conditions. Design An interrupted time-series study was conducted to determine the change in duration of opioid prescriptions associated with the STOP Act. Setting Data were extracted from the electronic health record of a large health care system in North Carolina. Subjects Patients presenting from 2016 to 2020 with an acute musculoskeletal injury and the clinicians treating them were included in an interrupted time-series study (n  = 12 839). Methods Trends were assessed over time, including the change in trend associated with implementation of the STOP Act, for the percentage of prescriptions written for ≤7 days. Results Among patients with acute musculoskeletal injury, less than 30% of prescriptions were written for ≤7 days in January of 2016; by December of 2020, almost 90% of prescriptions were written for ≤7 days. Prescriptions written for ≤7 days increased 17.7% after the STOP Act was implemented (P  < .001), after adjustment for the existing trend. Conclusions These results demonstrate significant potential for legislation to influence opioid prescribing behavior. [ABSTRACT FROM AUTHOR]

Objective To assess the epidemiological data on motor vehicle collisions, injuries and deaths in Kyrgyzstan to inform evidence-based policy development. Methods Data on motor vehicle collision and injury statistics covering 2003-2007 were obtained from official sources provided by the Department of Traffic Safety and the Ministry of Health's Republican Medical Information Centre. The data were analysed and compared with data derived from studies in other low- and middle-income countries. Findings Large heterogeneity between data sources was noted. Motor vehicle collisions caused by drivers increased twofold between 2003 and 2007. Reported motor vehicle collisions, deaths and injuries increased by 34%, 33% and 47%, respectively, over that period. Such increases were proportionately greater than the growth in population or in the number of registered motor vehicles. The proportion of injury attributable to motor vehicle collisions increased by 14% and the collision-related mortality rate increased by 39% in 2003-2007. Conclusion In Kyrgyzstan, the number of motor vehicle collisions is rising and so is the number of those who are injured or killed in them. Reversing this trend will call for closer collaboration among relevant agencies and for a comprehensive surveillance system, along with operational improvements in emergency medical care, new and strictly enforced passenger safety laws and improvements to the transportation infrastructure. Objectif Evaluer les donnees epidemiologiques sur les collisions de vehicules motorises, les blessures et les deces au Kirghizistan afin de contribuer au developpement d'une politique factuelle. Methodes Les donnees sur les statistiques des collisions de vehicules motorises et des blessures sur la periode 2003-2007 ont ete obtenues de sources officielles fournies par le departement de la Securite routiere et le Centre d'informations medicales republicain du ministere de la Sante. Ces donnees ont ete analysees et comparees aux donnees provenant d'etudes menees dans d'autres pays a faibles et moyens revenus. Resultats Une grande heterogeneite a ete observee entre les sources de donnees. Les collisions de vehicules motorises, causees par des conducteurs, ont double entre 2003 et 2007. Les collisions de vehicules motorises, les deces et les blessures declares ont respectivement augmente de 34%, 33% et 47% sur cette meme periode. Ces augmentations etaient proportionnellement superieures a la croissance de la population ou des vehicules motorises immatricules. La proportion des blesses imputable aux collisions de vehicules motorises a augmente de 14% et le taux de mortalite lie aux collisions a augmente de 39% entre 2003 et 2007. Conclusion Au Kirghizistan, les collisions de vehicules motorises sont en hausse, tout comme le nombre de personnes blessees ou tuees au cours de ces accidents. Renverser cette tendance exigera une collaboration plus etroite entre les agences concernees, un systeme de surveillance global, mais aussi des ameliorations operationnelles des soins medicaux d'urgence, de nouvelles lois en matiere de securite des passagers, plus rigoureusement appliquees, ainsi que des ameliorations des infrastructures des transports. Objetivo Evaluar los datos epidemiologicos sobre las colisiones de vehiculos motorizados, las lesiones y las muertes resultantes en Kirguistan para servir de apoyo al desarrollo de una politica basada en la evidencia. Metodos Los datos sobre colisiones de vehiculos motorizados y las estadisticas sobre lesiones entre 2003 y 2008 procedieron de fuentes oficiales suministradas por el Departamento de Seguridad Vial y el Centro de Informacion Medica de la Republica, perteneciente al Ministerio de Sanidad. Los datos fueron analizados y comparados con los datos procedentes de estudios realizados en otros paises de ingresos medios y bajos. Resultados Se observo una marcada heterogeneidad entre las diversas fuentes de datos. Las colisiones de vehiculos motorizados provocadas por los conductores se duplicaron en el periodo comprendido entre 2003 y 2007. Durante dicho periodo, aumento el parte de colisiones de vehiculos motorizados, las muertes y las lesiones resultantes en un 34%, 33% y 47%, respectivamente. Dichos aumentos fueron proporcionalmente mayores que el crecimiento de la poblacion o de los vehiculos motorizados registrados. La proporcion de lesiones atribuibles a las colisiones de vehiculos motorizados aumento un 14% y la tasa de mortalidad relacionada con este tipo de colisiones aumento un 39% entre 2003 y 2007. Conclusion En Kirguistan estan aumentando las colisiones de vehiculos motorizados, al igual que el numero de personas lesionadas o fallecidas por este motivo. Revertir esta tendencia implicara una colaboracion mas estrecha entre las agencias pertinentes y un sistema de vigilancia completo, ademas de mejoras operativas en la asistencia medica de urgencias, nuevas leyes de seguridad vial que se hagan cumplir de forma estricta y mejoras en la infraestructura de transportes., Introduction Motor vehicle collisions are a neglected public health problem. Approximately 45% of all hospitalized trauma patients in the world have been injured in a motor vehicle collision (1) and [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.07.026 Byline: Michael E. Thompson (a), Tsovinar L. Harutyunyan (b) Keywords: Armenia; Behavior change; Family planning; Program evaluation; Health communication Abstract: Induced abortion remains the major form of birth control among Armenian women, contributing to their excess mortality and preventable morbidity. Reliance on abortion is attributed to limited access to information concerning modern methods of contraception and to widely held misinformation among women regarding family planning and reproductive health. Based on the Steps to Behavior Change model, the Green Path Campaign for Family Health, an information-education-communication (IEC) campaign, was launched in June 2000. This multimedia campaign promoted greater awareness, knowledge, acceptance, and adoption of modern contraception through increased utilization of counseling and related services provided at underutilized family planning centers. A representative panel of 1088 married women aged 18-35 were surveyed on reproductive health/family planning knowledge, attitudes, and practices immediately prior to and immediately following the 6-month national campaign. Exposure to the campaign was associated with significant increases in factors associated with contraceptive behavior change: knowledge, favorable attitudes toward modern methods, favorable attitudes toward family planning services, and information seeking and utilization of family planning services. Women who were more educated, more affluent, and slightly older were more likely to use family planning services as well as modern contraceptive methods. New visits to family planning centers increased by 84%. Despite the usual 25% turnover among those using modern methods at the start of the study, use of modern contraceptive methods increased by 4.6%, significantly exceeding the projected 3% increase. The results document changes in underlying behavioral predictors consistent with the Steps to Behavior Change model and highlight the relatively untapped potential of media-based health promotion efforts in post-Soviet Republics. Author Affiliation: (a) University of North Carolina at Charlotte, Charlotte NC, USA (b) American University of Armenia, Yerevan, Armenia

Abstract Introduction Self-rated health is a widely used health outcome measure that strongly correlates with physical and mental health status and predicts mortality. This study identified the set of predictors of fair/poor self-rated health in adult female and male populations of Armenia during a period of long-lasting socio-economic transition to a market economy. Methods Differences in self-rated health were analyzed along three dimensions: socioeconomic, behavioral/attitudinal, and psychosocial. The study utilized data from a 2006 nationwide household health survey that used a multi-stage probability proportional to size cluster sampling with a combination of interviewer-administered and self-administered surveys. Both female and male representatives of a household aged 18 and over completed the self-administered survey. Multivariate odds ratios (OR) for fair/poor self-rated health were calculated for different sets of variables and logistic regression models fitted separately for women and men to identify the determinants of fair/poor self-rated health. Results Overall, 2310 women and 462 men participated in the survey. The rate of fair/poor self-rated health was 61.8% among women and 59.7% among men. For women, the set of independent predictors of fair/poor self-rated health included age, unemployment, poverty, low affordability of healthcare, depression, and weak social support. For men, the set included age, lower education, depression, weak social support, and drinking alcohol less than once a week. For both genders, depression and weak social support demonstrated the strongest independent association with fair/poor self-rated health. Conclusions The prevalence of fair/poor self-rated health was similar among men and women in this study, but the sets of independent predictors of perceived health differed somewhat, possibly, reflecting lifestyle differences between men and women in Armenia. Nevertheless, psychosocial variables were the strongest predictors of fair/poor self-rated health for both genders, indicating the importance of improving the country’s psychosocial environment through social reforms and poverty reduction.

Abstract Introduction Health care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities. Case description Nagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles. Discussion and Evaluation A unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor. Conclusions Programming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.

Abstract Introduction The University of North Carolina at Charlotte, a doctoral/research-intensive university, is the largest institution of higher education in the Charlotte region. The university currently offers 18 doctoral, 62 master's and 90 baccalaureate programmes. Fall 2008 enrolment exceeded 23 300 students, including more than 4900 graduate students. The university's Department of Health Behavior and Administration was established on 1 July 2002 as part of a transformed College of Health & Human Services. Case description In 2003, the Department initiated a series of stakeholder activities as part of its strategic planning and programmatic realignment efforts. The Department followed an empirically derived top-down/bottom-up strategic planning process that fostered community engagement and coordination of efforts across institutional levels. This process culminated in a vision to transform the unit into a Council on Education for Public Health accredited programme in public health and, eventually, an accredited school of public health. To date, the Department has revised its Master of Science in health promotion into an Master of Science in Public Health programme, renamed itself the Department of Public Health Sciences, launched a Bachelor of Science in Public Health major, laid plans for a doctoral programme, and received accreditation from the Council on Education for Public Health as a public health programme. Furthermore, the campus has endorsed the programme's growth into a school of public health as one of its priorities. Discussion and Evaluation It is only through this rigorous and cyclical process of determining what society needs, designing a curriculum specifically to prepare graduates to meet those needs, ensuring that those graduates meet those needs, and reassessing society's needs that we can continue to advance the profession and ensure the public's health. Community stakeholders should be active contributors to programme innovation. Lessons learnt from this process include: being connected to your community and knowing its needs, being responsive to your community, remembering that process is as important as product, and preparing for success. Conclusion The efforts reported here can be informative to other institutions by exemplifying an integrated top-down/bottom-up process of strategic planning that ensures that a department's degree programmes meet current needs and that students graduate with the competences to address those needs.

Abstract Background The former soviet Republic of Armenia entered a turbulent and long-lasting economic transition when it declared its independence in 1991. This analysis sought to identify the determinants of poor self-rated health as an indirect measure of health status and mortality prognosis in an adult female population during a period of socio-economic transition in Armenia. Methods Differences in self-rated health in women respondents were analyzed along three main dimensions: social, behavioral/attitudinal, and psychological. The data used were generated from cross-sectional household health surveys conducted in Armavir marz in 2001 and 2004. The surveys utilized the same instruments and study design (probability proportional to size, multistage cluster sampling with a combination of interviewer-administered and self-administered surveys) and generated two independent samples of households representative of Armavir marz. Binary logistic regression models with self-rated health as the outcome were fitted to the 2001 and 2004 datasets and a combined 2001/2004 dataset. Results Overall, 2 038 women aged 18 and over participated in the two surveys (1 019 in each). The rate of perceived "poor" health was relatively high in both surveys: 38.1% in 2001 and 27.0% in 2004. The sets of independent predictors of poor self-rated health were similar in all three models and included severe and moderate material deprivation, probable and possible depression, low level of education, and having ever smoked. These predictors mediated the effect of women's economic activity (including unemployment), ethnicity, low access to/utilization of healthcare services, and living alone on self-rated health. Conclusion Material deprivation was the most influential predictor of self-rated health. Thus, social reforms to decrease the gap between the rich and poor are recommended as a powerful tool for reducing health inequalities and improving the health status of the population.

Background: Few prognostic tools are currently available to predict hospital mortality in patients with acute type A aortic dissection. The aim of this study was to validate the performance of two existing risk-assessment tools, the original and the adjusted Leipzig-Halifax scorecards, to predict hospital mortality among Armenian patients with acute type A aortic dissection. Methods: This retrospective cohort study included all consecutive patients with acute type A aortic dissection who were admitted to two tertiary cardiac centers in Armenia and underwent surgery from January 2008 to April 2018. We evaluated the predictive power of the original and adjusted Leipzig-Halifax scorecards using logistic regression analysis. Results: Overall, 211 patients (76% males, mean age 57 ± 9 years) were included in the study, of whom 37 (17.5%) died during hospitalization. The adjusted Leipzig-Halifax score, but not the original Leipzig-Halifax score, was a significant predictor of hospital mortality. Patients with medium and high adjusted Leipzig-Halifax scores had a significantly higher odds of death compared to patients with low scores (odds ratio = 3.0 vs. 3.9, 95% confidence interval: 1.3–6.9 vs. 1.0–14.9, respectively). The areas under the receiver operating characteristic curves were 0.58 and 0.63, respectively, p > 0.05. Conclusion: The adjusted Leipzig-Halifax score performed slightly better than the original Leipzig-Halifax score in the Armenian acute type A aortic dissection population. The adjusted Leipzig-Halifax score should now be applied prospectively to generate more data for further validation and potential improvement. [ABSTRACT FROM AUTHOR]