Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe

PubMed Central

Morof, Diane; Cookson, Susan T.; Laver, Susan; Chirundu, Daniel; Desai, Sarika; Mathenge, Penninah; Shambare, Donald; Charimari, Lincoln; Midzi, Stanley; Blanton, Curtis; Handzel, Thomas

2013-01-01

In 2008–2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60% of deaths occurred at the community level. We conducted descriptive and case–control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54–14.30) and persons with larger household sizes (AOR = 1.21, 95% CI = 1.00–1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06–0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02–0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs. When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56–16.10) and receiving home-based rehydration (AOR = 0.14, 95% CI = 0.04–0.53) and being married (AOR = 0.26, 95% CI = 0.08–0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral. PMID:23400576

Rule-based exposure assessment versus case-by-case expert assessment using the same information in a community-based study.

PubMed

Peters, Susan; Glass, Deborah C; Milne, Elizabeth; Fritschi, Lin

2014-03-01

Retrospective exposure assessment in community-based studies is largely reliant on questionnaire information. Expert assessment is often used to assess lifetime occupational exposures, but these assessments generally lack transparency and are very time-consuming. We explored the agreement between a rule-based assessment approach and case-by-case expert assessment of occupational exposures in a community-based study. We used data from a case-control study of childhood acute lymphoblastic leukaemia in which parental occupational exposures were originally assigned by expert assessment. Key questions were identified from the completed parent questionnaires and, on the basis of these, rules were written to assign exposure levels to diesel exhaust, pesticides and solvents. We estimated exposure prevalence separately for fathers and mothers, and used κ statistics to assess the agreement between the two exposure assessment methods. Exposures were assigned to 5829 jobs among 1079 men and 6189 jobs among 1234 women. For both sexes, agreement was good for the two assessment methods of exposure to diesel exhaust at a job level (κ=0.70 for men and κ=0.71 for women) and at a person level (κ=0.74 and κ=0.75). The agreement was good to excellent for pesticide exposure among men (κ=0.74 for jobs and κ=0.84 at a person level) and women (κ=0.68 and κ=0.71 at a job and person level, respectively). Moderate to good agreement was observed for assessment of solvent exposure, which was better for women than men. The rule-based assessment approach appeared to be an efficient alternative for assigning occupational exposures in a community-based study for a selection of occupational exposures.

Mission-Driven Adaptability in a Changing National Training System

ERIC Educational Resources Information Center

Zoellner, Don; Stephens, Anne; Joseph, Victor; Monro, Davena

2017-01-01

This case study of an adult and community education provider based in far north Queensland describes its capacity to balance various iterations of public policy against its vision for the future of Aboriginal and Torres Straits Islanders. Community-controlled organisations wanting to contribute to economic and social development in regional/remote…

Does iodine excess lead to hypothyroidism? Evidence from a case-control study in India.

PubMed

Kotwal, Atul; Kotwal, Jyoti; Prakash, Rajat; Kotwal, Narendra

2015-08-01

Iodine deficiency disorders have been known to mankind since antiquity and various researchers elucidated the role of iodine in its causation. However, recent evidence shows that the entire control program ignored multi-causality and association of increased iodine intake with hypothyroidism. This study was conducted to assess differences of iodine intake as measured by urinary iodine excretion (UIE) between cases of hypothyroidism and healthy controls. A case-control study was conducted with three groups (cases, hospital controls and community controls) in two cities of India. Patients with overt hypothyroidism were cases (n = 150) and were compared with age, sex and socioeconomic status-matched hospital (n = 154) and community (n = 488) controls. Thyroid function tests (T3, T4, TSH) were used as diagnostic and inclusion criteria. TPOAb and UIE estimation were carried out for all study participants. Mean values of TPOAb and UIE were higher in cases as compared to hospital controls as well as community controls (p <0.05). With a cut off of 34 IU/mL for TPOAb, more cases had an anti-TPO level >34 as compared to hospital controls (p <0.001) as well as community controls (p <0.001); OR, 0.06 (95% CI, 0.03, 0.12) and 0.08 (0.05, 0.12), respectively. For UIE cut-off of 300 μg/L, more cases than hospital controls (p = 0.090) and community controls (p = 0.001) had higher levels; OR, 0.671, (0.422, 1.066) and 0.509, (0.348, 0.744), respectively. The study has clearly shown that cases of hypothyroidism are associated with excess iodine intake. Cohort studies to generate further evidence and an eco-social epidemiological approach have been suggested as the way forward. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

Structural alterations of faecal and mucosa-associated bacterial communities in irritable bowel syndrome.

PubMed

Durbán, Ana; Abellán, Juan J; Jiménez-Hernández, Nuria; Salgado, Patricia; Ponce, Marta; Ponce, Julio; Garrigues, Vicente; Latorre, Amparo; Moya, Andrés

2012-04-01

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in western countries. Previous studies on IBS, mostly based on faecal samples, suggest alterations in the intestinal microbiota. However, no consensus has been reached regarding the association between specific bacteria and IBS. We explore the alterations of intestinal bacterial communities in IBS using massive sequencing of amplified 16S rRNA genes. Mucosal biopsies of the ascending and descending colon and faeces from 16 IBS patients and 9 healthy controls were analysed. Strong inter-individual variation was observed in the composition of the bacterial communities in both patients and controls. These communities showed less diversity in IBS cases. There were larger differences in the microbiota composition between biopsies and faeces than between patients and controls. We found a few over-represented and under-represented taxa in IBS cases with respect to controls. The detected alterations varied by site, with no changes being consistent across sample types. © 2012 Society for Applied Microbiology and Blackwell Publishing Ltd.

Successful control of methicillin-resistant Staphylococcus aureus in a spinal cord injury center: a 10-year prospective study including molecular typing.

PubMed

Kappel, C; Widmer, A; Geng, V; von Arx, P; Frei, R; Koch, H-G; Knecht, H

2008-06-01

Prospective cohort study with medical record review. To evaluate the clinical utility of an infection control program in a patient cohort at high risk for methicillin-resistant Staphylococcus aureus (MRSA) infection and to identify risk factors interfering with successful decolonization of MRSA. All spinal cord injured (SCI) patients hospitalized at the Swiss Paraplegic Center (SPC) Nottwil from April 1991 to April 2001. Patients whose medical records indicated laboratory-confirmed MRSA colonization or infection were included. Incidence of MRSA colonization or infection was classified as community acquired, nosocomial or transferred based on standardized criteria. Risk factors for community-acquired MRSA colonization in SCI patients were determined. MRSA subtyping and identification of nosocomial spread was performed through pulse-field gel electrophoresis (PFGE). Of 5992 admissions, 100 episodes of MRSA (colonization 22 cases, infection 78 cases) were identified among 76 patients. Overall incidence (1991-2001) per 1000 patient days was 0.26 cases on admission compared to 0.08 at discharge (P<0.001). Community-acquired MRSA was most frequent (56%) followed by nosocomial acquisition (34%). PFGE subtyping identified two nosocomial clusters with six and three cases, respectively. Most of community-acquired MRSA isolates were genetically unrelated and also distinct from epidemic strains identified in Switzerland during the study period. Decolonization was successful in 60 of 76 (78.9%) MRSA-positive patients. In the largest European SCI center, MRSA controlling is feasible if infection control policies are vigorously applied.

Modelling of occupational respirable crystalline silica exposure for quantitative exposure assessment in community-based case-control studies.

PubMed

Peters, Susan; Vermeulen, Roel; Portengen, Lützen; Olsson, Ann; Kendzia, Benjamin; Vincent, Raymond; Savary, Barbara; Lavoué, Jérôme; Cavallo, Domenico; Cattaneo, Andrea; Mirabelli, Dario; Plato, Nils; Fevotte, Joelle; Pesch, Beate; Brüning, Thomas; Straif, Kurt; Kromhout, Hans

2011-11-01

We describe an empirical model for exposure to respirable crystalline silica (RCS) to create a quantitative job-exposure matrix (JEM) for community-based studies. Personal measurements of exposure to RCS from Europe and Canada were obtained for exposure modelling. A mixed-effects model was elaborated, with region/country and job titles as random effect terms. The fixed effect terms included year of measurement, measurement strategy (representative or worst-case), sampling duration (minutes) and a priori exposure intensity rating for each job from an independently developed JEM (none, low, high). 23,640 personal RCS exposure measurements, covering a time period from 1976 to 2009, were available for modelling. The model indicated an overall downward time trend in RCS exposure levels of -6% per year. Exposure levels were higher in the UK and Canada, and lower in Northern Europe and Germany. Worst-case sampling was associated with higher reported exposure levels and an increase in sampling duration was associated with lower reported exposure levels. Highest predicted RCS exposure levels in the reference year (1998) were for chimney bricklayers (geometric mean 0.11 mg m(-3)), monument carvers and other stone cutters and carvers (0.10 mg m(-3)). The resulting model enables us to predict time-, job-, and region/country-specific exposure levels of RCS. These predictions will be used in the SYNERGY study, an ongoing pooled multinational community-based case-control study on lung cancer.

Pilot case-control study of paediatric falls from windows.

PubMed

Johnston, Brian D; Quistberg, D Alexander; Shandro, Jamie R; Partridge, Rebecca L; Song, Hyun Rae; Ebel, Beth E

2011-12-01

Unintentional falls from windows are an important cause of paediatric morbidity. There have been no controlled studies to identify modifiable environmental risk factors for window falls in young children. The authors have piloted a case-control study to test procedures for case identification, subject enrolment, and environmental data collection. Case windows were identified when a child 0-9 years old presented for care after a fall from that window. Control windows were identified (1) from the child's home and (2) from the home of an age- and gender-matched child seeking care for an injury diagnosis not related to a window fall. Study staff visited enrolled homes to collect window measurements and conduct window screen performance tests. The authors enrolled and collected data on 18 case windows, 18 in-home controls, and 14 matched community controls. Six potential community controls were contacted for every one enrolled. Families who completed the home visit viewed study procedures positively. Case windows were more likely than community controls to be horizontal sliders (100% vs 50%), to have deeper sills (6.28 vs 4.31 inches), to be higher above the exterior surface (183 vs 82 inches), and to have screens that failed below a threshold derived from the static pressure of a 3-year-old leaning against the mesh (60.0% vs 16.7%). Case windows varied very little from in-home controls. Case-control methodology can be used to study risk factors for paediatric falls from windows. Recruitment of community controls is challenging but essential, because in-home controls tend to be over-matched on important variables. A home visit allows direct measurement of window type, height, sill depth, and screen performance. These variables should all be investigated in subsequent, larger studies covering major housing markets.

Contribution of community health workers to surveillance of vaccine-preventable diseases in the Obala health district

PubMed Central

Vouking, Marius Zambou; Binde, Thierry; Tadenfok, Carine Nouboudem; Ekani, Jean Marie Edengue; Ekra, Daniel

2017-01-01

Introduction The establishment of effective community-based surveillance is an essential objective of all disease surveillance systems. Several studies and reports have found that the situation is far from optimal in several developing countries such as Cameroon. Methods We conducted a cross-sectional descriptive study to assess the contribution of community health workers to surveillance of vaccine-preventable diseases in Obala health district. The performance of community health workers was measured using: the number of cases referred to the health center, the percentage of accomplished referrals, the percentage of cases referred by community health workers confirmed by the staff of health centers. A questionnaire containing forty-seven questions (open-ended and closed-ended) was used for interviews with community health workers. The data were analyzed using SPSS 21 and Excel 2007. Counts and percentages are reported. Results The study showed that the age ranged of community health workers was from 24 to 61 years with an average of 37.9 years ± 6.7 years. The most represented age group was between 40 and 50 with a percentage of 38.6%. The male sex was more represented than the female sex (61.4% vs 38.6%) or a sex ratio male man of 1.7. Forty-five percent of community health workers were selected at a village meeting, 93.1% of community health workers were involved in the surveillance of vaccine-preventable diseases and 87% experienced at least one preventable disease. Only 45.8% of them had the case definitions of the four diseases. Analysis of community health workers attendance at organized health committee meetings showed that 79% of community health workers attended at least one health committee meeting in 2015 and only 49% were monitored in 2015. Community health workers reported 42 suspected cases of measles, 37 of which actually went to the nearest Health Center, a baseline rate of 88%. Conclusion Community health workers play a key role in the control of vaccine-preventable diseases in the Obala health district. Community-based surveillance is the foundation of surveillance activities. It is a mechanism based on simple case definitions of priority diseases and unexpected events or unusual conditions. Our study also reaffirms the importance of mastering case definitions and home visits and early detection of vaccine-preventable diseases. PMID:29610645

Trachoma and Relative Poverty: A Case-Control Study.

PubMed

Habtamu, Esmael; Wondie, Tariku; Aweke, Sintayehu; Tadesse, Zerihun; Zerihun, Mulat; Zewdie, Zebideru; Callahan, Kelly; Emerson, Paul M; Kuper, Hannah; Bailey, Robin L; Mabey, David C W; Rajak, Saul N; Polack, Sarah; Weiss, Helen A; Burton, Matthew J

2015-11-01

Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited. Two hundred people with trachomatous trichiasis were recruited through community-based screening in Amhara Region, Ethiopia. These were individually matched by age and gender to 200 controls without trichiasis, selected randomly from the same sub-village as the case. Household economic poverty was measured through (a) A broad set of asset-based wealth indicators and relative household economic poverty determined by principal component analysis (PCA, (b) Self-rated wealth, and (c) Peer-rated wealth. Activity participation data were collected using a modified 'Stylised Activity List' developed for the World Bank's Living Standards Measurement Survey. Trichiasis cases were more likely to belong to poorer households by all measures: asset-based analysis (OR = 2.79; 95%CI: 2.06-3.78; p<0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75-7.07; p<0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59-14.72; p<0.0001). Cases had less access to latrines (57% v 76.5%, p = <0.0001) and higher person-to-room density (4.0 v 3.31; P = 0.0204) than the controls. Compared to controls, cases were significantly less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty in performing activities and more likely to receive assistance in performing productive activities. This study demonstrated a strong association between trachomatous trichiasis and relative poverty, suggesting a bidirectional causative relationship possibly may exist between poverty and trachoma. Implementation of the full SAFE strategy in the context of general improvements might lead to a virtuous cycle of improving health and wealth. Trachoma is a good proxy of inequality within communities and it could be used to target and evaluate interventions for health and poverty alleviation.

Case-control studies in cancer patients as a surveillance system of occupational exposure in the European Community. European Community Working Party.

PubMed Central

Rona, R J; Taub, N A; Rasmussen, S

1993-01-01

STUDY OBJECTIVE--The main aim was to detect known relationships between lung and blood cancers and various occupational exposures (using job titles as proxies) using a case-control design. The suitability of this system for routine surveillance could then be assessed. DESIGN--A case-control study was carried out in 1989. SETTING--Hospitals in eight European Community countries. SUBJECTS--Men aged 25 to 75 years with incident and prevalent cancer of the lung (190 cases), haematopoietic system (210 cases), or gastrointestinal tract (245 controls) were studied. MEASUREMENTS AND MAIN RESULTS--The crude estimate of the overall odds ratio exposure (OR) for relevant occupational exposure of lung cancer relative to gastrointestinal cancer was 1.20 (95% confidence interval (CI) 0.82, 1.77). In a logistic regression analysis adjusting for country, age at diagnosis, smoking, and alcohol consumption, the overall OR was not greatly changed. A significant interaction of occupational exposure and age at diagnosis showed that lung cancer patients diagnosed at a younger age had a higher OR than patients diagnosed at an older age. Thus, the overall, insignificant result may have been due to a low reliability of occupational history in older age or to a selective mechanism related to age. The overall OR for occupational exposure of cancer of the blood relative to gastrointestinal cancer was 0.88 (95% CI 0.60, 1.31). The logistic regression analysis did not alter these results. CONCLUSION--A surveillance based on a case-control design using job titles would not be sensitive enough to detect possible occupational risks. PMID:8228771

Determinants of infant nutritional status in Dabat district, North Gondar, Ethiopia: A case control study.

PubMed

Wubante, Amarech Asratie

2017-01-01

Malnutrition is the top cause of global burden of disease, disability and mortality among infants. Over two-thirds of deaths of children globally occur during the first year of life (infancy). Malnutrition among infants is substantially high in Ethiopia. Therefore, this study is aimed to assess determinants of infant nutritional status. A community based nested case-control study was conducted from February to June 2013 in Dabat district. A total of 80 cases and 320 controls (1:4 ratios) were studied. Relevant data was extracted from the community based survey data set. Anthroplus software was used to identify cases and controls. Determinants of infant nutritional status were identified using multivariate analysis. Among the total of 80 cases and 320 controls, more than half (52.5%) of the cases and the controls (53.8%) were males and females, respectively. Breast Feeding (BF) was started immediately after birth in only 43.8% of the cases. Nearly 94% of the mothers of the cases had no breast feeding information as part of Ante Natal Care (ANC) follow up. Maternal age (AOR: 0.29; 95% CI: 0.11-0.76), having radio (AOR: 0.43; 95% CI: 0.22-0.82), lack of toilet facility (AOR: 2.24; 95% CI: 1.16-4.33), deprivation of colostrum (AOR: 1.76; 95% CI: 1.01-1.06) and method of complementary feeding (AOR: 2.82; 95% CI: 1.33-5.99) were associated with wasting. This study has found that inappropriate infant feeding; nutritional information gap and lack of toilet facility as significant predictors of malnutrition. Hence, joint interventions, including counseling of mothers about benefits of colostrum feeding and use of appropriate feeding method, toilet utilization and mass media such as radio possession, are needed to address the problem in Dabat district.

Association between the 2008-09 seasonal influenza vaccine and pandemic H1N1 illness during Spring-Summer 2009: four observational studies from Canada.

PubMed

Skowronski, Danuta M; De Serres, Gaston; Crowcroft, Natasha S; Janjua, Naveed Z; Boulianne, Nicole; Hottes, Travis S; Rosella, Laura C; Dickinson, James A; Gilca, Rodica; Sethi, Pam; Ouhoummane, Najwa; Willison, Donald J; Rouleau, Isabelle; Petric, Martin; Fonseca, Kevin; Drews, Steven J; Rebbapragada, Anuradha; Charest, Hugues; Hamelin, Marie-Eve; Boivin, Guy; Gardy, Jennifer L; Li, Yan; Kwindt, Trijntje L; Patrick, David M; Brunham, Robert C

2010-04-06

In late spring 2009, concern was raised in Canada that prior vaccination with the 2008-09 trivalent inactivated influenza vaccine (TIV) was associated with increased risk of pandemic influenza A (H1N1) (pH1N1) illness. Several epidemiologic investigations were conducted through the summer to assess this putative association. (1) test-negative case-control design based on Canada's sentinel vaccine effectiveness monitoring system in British Columbia, Alberta, Ontario, and Quebec; (2) conventional case-control design using population controls in Quebec; (3) test-negative case-control design in Ontario; and (4) prospective household transmission (cohort) study in Quebec. Logistic regression was used to estimate odds ratios for TIV effect on community- or hospital-based laboratory-confirmed seasonal or pH1N1 influenza cases compared to controls with restriction, stratification, and adjustment for covariates including combinations of age, sex, comorbidity, timeliness of medical visit, prior physician visits, and/or health care worker (HCW) status. For the prospective study risk ratios were computed. Based on the sentinel study of 672 cases and 857 controls, 2008-09 TIV was associated with statistically significant protection against seasonal influenza (odds ratio 0.44, 95% CI 0.33-0.59). In contrast, estimates from the sentinel and three other observational studies, involving a total of 1,226 laboratory-confirmed pH1N1 cases and 1,505 controls, indicated that prior receipt of 2008-09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring-summer 2009, with estimated risk or odds ratios ranging from 1.4 to 2.5. Risk of pH1N1 hospitalization was not further increased among vaccinated people when comparing hospitalized to community cases. Prior receipt of 2008-09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring-summer 2009 in Canada. The occurrence of bias (selection, information) or confounding cannot be ruled out. Further experimental and epidemiological assessment is warranted. Possible biological mechanisms and immunoepidemiologic implications are considered.

Socioeconomic inequalities in risk of hospitalization for community-acquired bacteremia: a Danish population-based case-control study.

PubMed

Koch, Kristoffer; Søgaard, Mette; Nørgaard, Mette; Thomsen, Reimar Wernich; Schønheyder, Henrik Carl

2014-05-01

In a Danish population-based case-control study, we examined the association between socioeconomic status (SES) and risk of community-acquired bacteremia, as well as the contribution of chronic diseases and substance abuse to differences in bacteremia risk. Analyses were based on 4,117 patients aged 30-65 years who were hospitalized with first-time community-acquired bacteremia during 2000-2008 and 41,170 population controls matched by sex, age, and region of residence. Individual-level information on SES (education and income), chronic diseases, and substance abuse was retrieved from public and medical registries. Conditional logistic regression was used to compute odds ratios for bacteremia. Persons of low SES had a substantially higher risk of bacteremia than those of high SES (for short duration of education vs. long duration, odds ratio = 2.30 (95% confidence interval: 2.10, 2.52); for low income vs. high income, odds ratio = 2.77 (95% confidence interval: 2.54, 3.02)). A higher prevalence of chronic diseases and substance abuse in low-SES individuals versus high-SES individuals explained 43%-48% of the socioeconomic differences in bacteremia risk. In a country with a universal welfare system, differences in the burden of chronic diseases and substance abuse seem to have major importance in explaining inequalities in bacteremia risk.

Reactive community-based self-administered treatment against residual malaria transmission: study protocol for a randomized controlled trial.

PubMed

Okebe, Joseph; Ribera, Joan Muela; Balen, Julie; Jaiteh, Fatou; Masunaga, Yoriko; Nwakanma, Davis; Bradley, John; Yeung, Shunmay; Peeters Grietens, Koen; D'Alessandro, Umberto

2018-02-20

Systematic treatment of all individuals living in the same compound of a clinical malaria case may clear asymptomatic infections and possibly reduce malaria transmission, where this is focal. High and sustained coverage is extremely important and requires active community engagement. This study explores a community-based approach to treating malaria case contacts. This is a cluster-randomized trial to determine whether, in low-transmission areas, treating individuals living in the same compound of a clinical malaria case with dihydroartemisinin-piperaquine can reduce parasite carriage and thus residual malaria transmission. Treatment will be administered through the local health system with the approach of encouraging community participation designed and monitored through formative research. The trial goal is to show that this approach can reduce in intervention villages the prevalence of Plasmodium falciparum infection toward the end of the malaria transmission season. Adherence and cooperation of the local communities are critical for the success of mass treatment campaigns aimed at reducing malaria transmission. By exploring community perceptions of the changing trends in malaria burden, existing health systems, and reaction to self-administered treatment, this study will develop and adapt a model for community engagement toward malaria elimination that is cost-effective and fits within the existing health system. Clinical trials.gov, NCT02878200 . Registered on 25 August 2016.

Social Network Analysis of a Scientist-Practitioner Research Initiative Established to Facilitate Science Dissemination and Implementation within States and Communities

ERIC Educational Resources Information Center

Ginexi, Elizabeth M.; Huang, Grace; Steketee, Michael; Tsakraklides, Sophia; MacAllum, Keith; Bromberg, Julie; Huffman, Amanda; Luke, Douglas A.; Leischow, Scott J.; Okamoto, Janet M.; Rogers, Todd

2017-01-01

This article presents a case study of a scientist-practitioner research network established by the National Cancer Institute's State and Community Tobacco Control Research Initiative. While prior programs have focused on collaboration among scientists, a goal here was to encourage collaborations with non-university, practice-based partners. Two…

Increases in HIV Testing and Case Detection from NIMH Project Accept (HPTN 043) among 16–32 Year Olds: A Randomized Community-Based Intervention in Tanzania, Zimbabwe, and Thailand

PubMed Central

Sweat, Michael; Morin, Stephen; Celentano, David; Mulawa, Marta; Singh, Basant; Mbwambo, Jessie; Kawichai, Surinda; Chingono, Alfred; Khumalo-Sakutukwa, Gertrude; Gray, Glenda; Richter, Linda; Kulich, Michal; Sadowski, Andrew; Coates, Thomas

2011-01-01

SUMMARY BACKGROUND HIV counseling and testing is the gateway to treatment and care and provides important preventative and personal benefits to recipients. However, in developing countries the majority of HIV infected persons have not been tested for HIV. Combining community mobilization, mobile community-based HIV testing and counseling, and post-test support may increase HIV testing rates. METHODS We randomly assigned half of 10 rural communities in Tanzania, 8 in Zimbabwe, and 14 in Thailand to receive a multiple component community-based voluntary counseling and testing (CBVCT) intervention together with access to standard clinic-based voluntary counseling and testing (SVCT). The control communities received only SVCT. The intervention was provided for approximately 3 years. The primary study endpoint is HIV incidence and is pending completion of the post-intervention assessment. This is a descriptive interim analysis examining the percentage of the total population aged 16–32 years tested for HIV across study arms, and differences in client characteristics by study arm. FINDINGS A higher percentage of 16–32 year-olds were tested in intervention communities than in control communities (37% vs. 9% in Tanzania; 51% vs. 5% in Zimbabwe; and 69% vs. 23% in Thailand). The mean difference between the percentage of the population tested in CBVCT versus SVCT communities was 40.4% across the 3 country study arm pairs, (95% CI 15.8% – 64.7%, p-value 0.019, df=2). Despite higher prevalence of HIV among those testing at SVCT venues the intervention detected 3.6 times more HIV infected clients in the CBVCT communities than in SVCT communities (952 vs. 264, p< 0.001). Over time the rate of repeat testing grew substantially across all sites to 28% of all those testing for HIV by the end of the intervention period. INTERPRETATION This multiple component, community-level intervention is effective at both increasing HIV testing rates and detecting HIV cases in rural settings in developing countries. PMID:21546309

Infection prevention and control in home nursing: case study of four organisations in Australia.

PubMed

Felemban, Ohood; St John, Winsome; Shaban, Ramon Zenel

2015-09-01

The aim of this case study was to explore the environmental challenges nurses experience with infection control practice, and the strategies they use to overcome those challenges. An exploratory case study was conducted in four home visiting nursing organisations in southeast Queensland, Australia, using data triangulation (document review, individual interviews, and focus groups). Data were analysed using a framework approach to identify themes. Three major infection prevention and control challenges were experienced in the community context. The first challenge is the nature of the work environment, including: poor cleanliness in clients' home environments, pets or vermin, inadequate hand-washing facilities, and a lack of appropriate storage space for clinical materials. The second challenge occurs when nurses lack access to appropriate infection control equipment, including wound-management materials and sharps containers. The third challenge is dealing with clients' poor personal hygiene and health status. Participants addressed these issues by offering assistance, using clean surfaces at clients' homes, applying an alcohol-based hand rub, providing client education, and reducing the cost of purchasing equipment for clients. It is imperative that policy is developed to support nurses' decision making and practices as they address infection control challenges in the community environment. Ensuring staff are well-supported with resources, education, policy, and guidelines to address these challenges is important for the delivery of safe and high-quality care in community settings.

Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso.

PubMed

Tiono, Alfred B; Kaboré, Youssouf; Traoré, Abdoulaye; Convelbo, Nathalie; Pagnoni, Franco; Sirima, Sodiomon B

2008-10-03

Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated. A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria). The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level. The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season. A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%-22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%-71.5%), respectively in the intervention and control arms (p < 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32). The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs. 2,595), with malaria accounting for 87.4% of all disease episodes recorded in the intervention area and for 34.1% in the control area (P < 0.0001). Of all the malaria cases treated in the intervention arm, only 6.7% were treated at the health facility level. These findings suggest that implementation of HMM, by reducing the workload in health facilities, might contributes to an overall increase of the performance of the peripheral health facilities.

Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal.

PubMed

Mladovsky, Philipa; Soors, Werner; Ndiaye, Pascal; Ndiaye, Alfred; Criel, Bart

2014-01-01

CBHI has achieved low population coverage in West Africa and elsewhere. Studies which seek to explain this point to inequitable enrolment, adverse selection, lack of trust in scheme management and information and low quality of health care. Interventions to address these problems have been proposed yet enrolment rates remain low. This exploratory study proposes that an under-researched determinant of CBHI enrolment is social capital. Fieldwork comprising a household survey and qualitative interviews was conducted in Senegal in 2009. Levels of bonding and bridging social capital among 720 members and non-members of CBHI across three case study schemes are compared. The results of the logistic regression suggest that, controlling for age and gender, in all three case studies members were significantly more likely than non-members to be enrolled in another community association, to have borrowed money from sources other than friends and relatives and to report having control over all community decisions affecting daily life. In two case studies, having privileged social relationships was also positively correlated with enrolment. After controlling for additional socioeconomic and health variables, the results for borrowing money remained significant. Additionally, in two case studies, reporting having control over community decisions and believing that the community would cooperate in an emergency were significantly positively correlated with enrolment. The results suggest that CBHI members had greater bridging social capital which provided them with solidarity, risk pooling, financial protection and financial credit. Qualitative interviews with 109 individuals selected from the household survey confirm this interpretation. The results ostensibly suggest that CBHI schemes should build on bridging social capital to increase coverage, for example by enrolling households through community associations. However, this may be unadvisable from an equity perspective. It is concluded that since enrolment in CBHI was less common not only among the poor, but also among those with less social capital and less power, strategies should focus on removing social as well as financial barriers to  financial protection from the cost of ill health. Copyright © 2013 Elsevier Ltd. All rights reserved.

Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case-control study.

PubMed

Rottier, W C; van Werkhoven, C H; Bamberg, Y R P; Dorigo-Zetsma, J W; van de Garde, E M; van Hees, B C; Kluytmans, J A J W; Kuck, E M; van der Linden, P D; Prins, J M; Thijsen, S F T; Verbon, A; Vlaminckx, B J M; Ammerlaan, H S M; Bonten, M J M

2018-03-23

Current guidelines for the empirical antibiotic treatment predict the presence of third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in case of infection only poorly, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems which can better predict the presence of 3GCR-E-Bac. A retrospective nested case-control study was performed that included patients ≥18 years of age from eight Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GCR-E-Bac was matched to four control infection episodes within the same hospital, based on blood-culture date and onset location (community or hospital). Starting from 32 commonly described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GCR-E-Bac. 3GCR-E-Bac occurred in 90 of 22 506 (0.4%) community-onset infections and in 82 of 8110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes. The derived community-onset and hospital-onset scoring systems consisted of six and nine predictors, respectively. With selected score cut-offs, the models identified 3GCR-E-Bac with sensitivity equal to existing guidelines (community-onset: 54.3%; hospital-onset: 81.5%). However, they reduced the proportion of patients classified as at risk for 3GCR-E-Bac (i.e. eligible for empirical carbapenem therapy) with 40% (95%CI 21-56%) and 49% (95%CI 39-58%) in, respectively, community-onset and hospital-onset infections. These prediction scores for 3GCR-E-Bac, specifically geared towards the initiation of empirical antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988-96: a retrospective, population-based, case-control study.

PubMed

Gould, Madelyn S; Kleinman, Marjorie H; Lake, Alison M; Forman, Judith; Midle, Jennifer Bassett

2014-06-01

Public health and clinical efforts to prevent suicide clusters are seriously hampered by the unanswered question of why such outbreaks occur. We aimed to establish whether an environmental factor-newspaper reports of suicide-has a role in the emergence of suicide clusters. In this retrospective, population-based, case-control study, we identified suicide clusters in young people aged 13-20 years in the USA from 1988 to 1996 (preceding the advent of social media) using the time-space Scan statistic. For each cluster community, we selected two matched non-cluster control communities in which suicides of similarly aged youth occurred, from non-contiguous counties within the same state as the cluster. We examined newspapers within each cluster community for stories about suicide published in the days between the first and second suicides in the cluster. In non-cluster communities, we examined a matched length of time after the matched control suicide. We used a content-analysis procedure to code the characteristics of each story and compared newspaper stories about suicide published in case and control communities with mixed-effect regression analyses. We identified 53 suicide clusters, of which 48 were included in the media review. For one cluster we could identify only one appropriate control; therefore, 95 matched control communities were included. The mean number of news stories about suicidal individuals published after an index cluster suicide (7·42 [SD 10·02]) was significantly greater than the mean number of suicide stories published after a non-cluster suicide (5·14 [6.00]; p<0·0001). Several story characteristics, including front-page placement, headlines containing the word suicide or a description of the method used, and detailed descriptions of the suicidal individual and act, appeared more often in stories published after the index cluster suicides than after non-cluster suicides. Our identification of an association between newspaper reports about suicide (including specific story characteristics) and the initiation of teenage suicide clusters should provide an empirical basis to support efforts by mental health professionals, community officials, and the media to work together to identify and prevent the onset of suicide clusters. US National Institute of Mental Health and American Foundation for Suicide Prevention. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recruiting Hispanic women for a population-based study: validity of surname search and characteristics of nonparticipants.

PubMed

Sweeney, Carol; Edwards, Sandra L; Baumgartner, Kathy B; Herrick, Jennifer S; Palmer, Leslie E; Murtaugh, Maureen A; Stroup, Antoinette; Slattery, Martha L

2007-11-15

Conducting research on the health of Hispanic populations in the United States entails challenges of identifying individuals who are Hispanic and obtaining good study participation. In this report, identification of Hispanics using a surname search and ethnicity information collected by cancer registries was validated, compared with self-report, for breast cancer cases and controls in Utah and New Mexico. Factors influencing participation by Hispanics in a study interview in 2000-2005 were evaluated. The positive predictive value of identification as Hispanic by cancer registry records and surname search was 82.3% for cases and 73.2% for controls. Hispanics who were correctly classified differed from those who were misclassified, reporting lower language acculturation and educational attainment. Older age was positively associated with success in contacting Hispanic controls (p(trend) < 0.0001) but negatively associated with cooperation with the interview (p(trend) < 0.0001). Community characteristics described by US Census data, including income, education, and urban/rural residence, did not significantly influence participation by Hispanic cases or controls. The authors conclude that a surname search efficiently identifies Hispanics, although individuals identified using this method are not completely representative. Recruitment of Hispanic cases and controls does not appear to be affected by selection bias related to community characteristics.

Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya region, Ethiopia: a community based unmatched case-control study.

PubMed

Yirgu, Robel; Lemessa, Firaol; Hirpa, Selamawit; Alemayehu, Abraham; Klinkenberg, Eveline

2017-04-20

Early tuberculosis (TB) case finding and adequate chemotherapy are essential for interrupting disease transmission and preventing complications due to delayed care seeking. This study was undertaken in order to provide insights into the magnitude and determinants of patient delay. The study was conducted in rural Seru district, employing a population based unmatched case-control study design. The WHO standardized TB screening tool was used to identify presumptive TB cases among the district population ages > 15 years. Presumptive TB cases who sought care in a health facility more than 14 days after the onset of symptoms were considered cases while those who sought care within the first 14 days were classified as controls. A structured interview questionnaire was used to capture socio demographic characteristics and health care service utilization related data from the study participants. A multiple binary logistic regression model was used to identify any factor associated with patient care seeking delay. A total of 9,782 individuals were screened, of which 980 (10%, 95% CI; 9.4-10.5%) presumptive TB cases were identified. From these cases 358 (76%, 95% CI; 75.6%-76.4%) sought care within the first 14 days of the onset of symptoms with a median patient delay of 15 days, IQR (5-30 days). The most common TB suggestive symptom mentioned by the participants was night sweat 754 (76.4%) while the least common was a history of contact with a confirmed TB case in the past one year 207 (21.1%). Individuals in the 45-54 age range had lower odds of delay (AOR 0.31, 95%CI 0.15, 0.61) as compared to those 15-24 years old. First TB treatment episode (AOR16.2, 95% CI 9.94, 26.26) and limited access to either traditional or modern modes of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient care delay. Increasing community awareness about the risks of delayed care seeking and the importance of accessing health services close to the community can help decrease patient care delay.

An outbreak of hypervitaminosis D associated with the overfortification of milk from a home-delivery dairy.

PubMed Central

Blank, S; Scanlon, K S; Sinks, T H; Lett, S; Falk, H

1995-01-01

OBJECTIVES. The purpose of the study was to identify cases of hypervitaminosis D caused by the inadvertent overfortification of milk from a home-delivery dairy and to identify risk factors for this illness. METHODS. Hospital discharge, laboratory, and state health department data were used to define, identify, and describe cases of hypervitaminosis D diagnosed in the exposed communities between January 1, 1985, and June 30, 1991. To identify disease risk factors, community-based sex- and age-matched controls were used in a case-control study. RESULTS. Of the 56 case patients identified, at least 41 were hospitalized; 2 died. The study included 33 case patients and 93 control subjects. Nineteen of the 33 case patients had been customers of the implicated dairy. Risk of illness rose with increasing consumption of the dairy's milk and was also associated with vitamin D supplement use, sunburn susceptibility, and cancer history. Accounting for these factors did not alter the association between drinking the dairy's milk and developing hypervitaminosis D. CONCLUSIONS. Overfortification of milk with vitamin D can lead to hypervitaminosis D, manifested by severe illness and death. The episode highlights the need for monitoring the fortification process and enforcing the upper limit for vitamin D addition to milk. PMID:7733425

Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey.

PubMed

Djouma, Fabrice N; Ateudjieu, Jerome; Ram, Malathi; Debes, Amanda K; Sack, David A

2016-12-07

This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics. © The American Society of Tropical Medicine and Hygiene.

Strengthening malaria service delivery through supportive supervision and community mobilization in an endemic Indian setting: an evaluation of nested delivery models.

PubMed

Das, Ashis; Friedman, Jed; Kandpal, Eeshani; Ramana, Gandham N V; Gupta, Rudra Kumar Das; Pradhan, Madan M; Govindaraj, Ramesh

2014-12-08

Malaria continues to be a prominent global public health challenge. This study tested the effectiveness of two service delivery models for reducing the malaria burden, e.g. supportive supervision of community health workers (CHW) and community mobilization in promoting appropriate health-seeking behaviour for febrile illnesses in Odisha, India. The study population comprised 120 villages from two purposively chosen malaria-endemic districts, with 40 villages randomly assigned to each of the two treatment arms, one with both supportive supervision and community mobilization and one with community mobilization alone, as well as an observational control arm. Outcome measures included changes in the utilization of bed nets and timely care-seeking for fever from a trained provider compared to the control group. Analysis was by intention-to-treat. Significant improvements were observed in the reported utilization of bed nets in both intervention arms (84.5% in arm A and 82.4% in arm B versus 78.6% in the control arm; p < 0.001). While overall rates of treatment-seeking were equal across study arms, treatment-seeking from a CHW was higher in both intervention arms (28%; p = 0.005 and 27.6%; p = 0.007) than in the control arm (19.2%). Fever cases were significantly more likely to visit a CHW and receive a timely diagnosis of fever in the combined interventions arm than in the control arm (82.1% vs. 67.1%; p = 0.025). Care-seeking from trained providers also increased with a substitution away from untrained providers. Further, fever cases from the combined interventions arm (60.6%; p = 0.004) and the community mobilization arm (59.3%; p = 0.012) were more likely to have received treatment from a skilled provider within 24 hours than fever cases from the control arm (50.1%). In particular, women from the combined interventions arm were more likely to have received timely treatment from a skilled provider (61.6% vs. 47.2%; p = 0.028). A community-based intervention combining the supportive supervision of community health workers with intensive community mobilization and can be effective in improving care-seeking and preventive behaviour and may be used to strengthen the national malaria control programme.

Improved outcomes using brain SPECT-guided treatment versus treatment-as-usual in community psychiatric outpatients: a retrospective case-control study.

PubMed

Thornton, John F; Schneider, Howard; McLean, Mary K; van Lierop, Muriel J; Tarzwell, Robert

2014-01-01

Brain single-photon emission computed tomography (SPECT) scans indirectly show functional activity via measurement of regional cerebral blood flow. Thirty patients at a community-based psychiatric clinic underwent brain SPECT scans. Changes in scoring of before-treatment and after-treatment scans correlated well with changes in patient Global Assessment of Functioning (GAF) scores before treatment and after treatment. Patients were retrospectively matched with controls with similar diagnoses and pretreatment GAF scores, and those who underwent SPECT-guided treatment improved significantly more than the control patients.

Association between the 2008–09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness during Spring–Summer 2009: Four Observational Studies from Canada

PubMed Central

Skowronski, Danuta M.; De Serres, Gaston; Crowcroft, Natasha S.; Janjua, Naveed Z.; Boulianne, Nicole; Hottes, Travis S.; Rosella, Laura C.; Dickinson, James A.; Gilca, Rodica; Sethi, Pam; Ouhoummane, Najwa; Willison, Donald J.; Rouleau, Isabelle; Petric, Martin; Fonseca, Kevin; Drews, Steven J.; Rebbapragada, Anuradha; Charest, Hugues; Hamelin, Marie-Ève; Boivin, Guy; Gardy, Jennifer L.; Li, Yan; Kwindt, Trijntje L.; Patrick, David M.; Brunham, Robert C.

2010-01-01

Background In late spring 2009, concern was raised in Canada that prior vaccination with the 2008–09 trivalent inactivated influenza vaccine (TIV) was associated with increased risk of pandemic influenza A (H1N1) (pH1N1) illness. Several epidemiologic investigations were conducted through the summer to assess this putative association. Methods and Findings Studies included: (1) test-negative case-control design based on Canada's sentinel vaccine effectiveness monitoring system in British Columbia, Alberta, Ontario, and Quebec; (2) conventional case-control design using population controls in Quebec; (3) test-negative case-control design in Ontario; and (4) prospective household transmission (cohort) study in Quebec. Logistic regression was used to estimate odds ratios for TIV effect on community- or hospital-based laboratory-confirmed seasonal or pH1N1 influenza cases compared to controls with restriction, stratification, and adjustment for covariates including combinations of age, sex, comorbidity, timeliness of medical visit, prior physician visits, and/or health care worker (HCW) status. For the prospective study risk ratios were computed. Based on the sentinel study of 672 cases and 857 controls, 2008–09 TIV was associated with statistically significant protection against seasonal influenza (odds ratio 0.44, 95% CI 0.33–0.59). In contrast, estimates from the sentinel and three other observational studies, involving a total of 1,226 laboratory-confirmed pH1N1 cases and 1,505 controls, indicated that prior receipt of 2008–09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring–summer 2009, with estimated risk or odds ratios ranging from 1.4 to 2.5. Risk of pH1N1 hospitalization was not further increased among vaccinated people when comparing hospitalized to community cases. Conclusions Prior receipt of 2008–09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring–summer 2009 in Canada. The occurrence of bias (selection, information) or confounding cannot be ruled out. Further experimental and epidemiological assessment is warranted. Possible biological mechanisms and immunoepidemiologic implications are considered. Please see later in the article for the Editors' Summary PMID:20386731

Unzip the Truth: Results from the Fort Peck Men's Sexual Health Intervention and Evaluation Study

ERIC Educational Resources Information Center

Rink, Elizabeth; Ricker, Adriann; FourStar, Kris; Anastario, Michael

2016-01-01

American Indian (AI) men experience sexual and reproductive health disparities including sexually transmitted infections, unplanned pregnancy, absent fatherhood, and intimate relationship violence. Using a case-control study within a community-based participatory research framework, we investigated the effectiveness of a sexual and reproductive…

Political Barriers to Evidence-Based Tobacco Control Policy: Cronyism and Cognitive Dissonance, a Tasmanian Case Study

ERIC Educational Resources Information Center

Barnsley, Kathryn; Walters, E. Haydn; Wood-Baker, Richard

2017-01-01

Tasmania led in several areas of tobacco control legislation reform in the period 1997 to 2010. Despite this, Tasmania lagged in other crucial areas, particularly the allocation of resources for community education, mass media campaigns and cessation programmes. Key impediments were crony capitalism; the conservative ideology of "white…

Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the "palliative care trial" [ISRCTN 81117481].

PubMed

Abernethy, Amy P; Currow, David C; Shelby-James, Tania; Rowett, Debra; May, Frank; Samsa, Gregory P; Hunt, Roger; Williams, Helena; Esterman, Adrian; Phillips, Paddy A

2013-03-01

Evidence-based approaches are needed to improve the delivery of specialized palliative care. The aim of this trial was to improve on current models of service provision. This 2×2×2 factorial cluster randomized controlled trial was conducted at an Australian community-based palliative care service, allowing three simultaneous comparative effectiveness studies. Participating patients were newly referred adults, experiencing pain, and who were expected to live >48 hours. Patients enrolled with their general practitioners (GPs) and were randomized three times: 1) individualized interdisciplinary case conference including their GP vs. control, 2) educational outreach visiting for GPs about pain management vs. control, and 3) structured educational visiting for patients/caregivers about pain management vs. control. The control condition was current palliative care. Outcomes included Australia-modified Karnofsky Performance Status (AKPS) and pain from 60 days after randomization and hospitalizations. There were 461 participants: mean age 71 years, 50% male, 91% with cancer, median survival 179 days, and median baseline AKPS 60. Only 47% of individuals randomized to the case conferencing intervention received it; based on a priori-defined analyses, 32% of participants were included in final analyses. Case conferencing reduced hospitalizations by 26% (least squares means hospitalizations per patient: case conference 1.26 [SE 0.10] vs. control 1.70 [SE 0.13], P=0.0069) and better maintained performance status (AKPS case conferences 57.3 [SE 1.5] vs. control 51.7 [SE 2.3], P=0.0368). Among patients with declining function (AKPS <70), case conferencing and patient/caregiver education better maintained performance status (AKPS case conferences 55.0 [SE 2.1] vs. control 46.5 [SE 2.9], P=0.0143; patient/caregiver education 54.7 [SE 2.8] vs. control 46.8 [SE 2.1], P=0.0206). Pain was unchanged. GP education did not change outcomes. A single case conference added to current specialized community-based palliative care reduced hospitalizations and better maintained performance status. Comparatively, patient/caregiver education was less effective; GP education was not effective. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Associations of gut-flora-dependent metabolite trimethylamine-N-oxide, betaine and choline with non-alcoholic fatty liver disease in adults.

PubMed

Chen, Yu-ming; Liu, Yan; Zhou, Rui-fen; Chen, Xiao-ling; Wang, Cheng; Tan, Xu-ying; Wang, Li-jun; Zheng, Rui-dan; Zhang, Hong-wei; Ling, Wen-hua; Zhu, Hui-lian

2016-01-08

Many studies suggest that trimethylamine-N-oxide (TMAO), a gut-flora-dependent metabolite of choline, contributes to the risk of cardiovascular diseases, but little is known for non-alcoholic fatty liver disease (NAFLD). We examined the association of circulating TMAO, choline and betaine with the presence and severity of NAFLD in Chinese adults. We performed a hospital-based case-control study (CCS) and a cross-sectional study (CSS). In the CCS, we recruited 60 biopsy-proven NAFLD cases and 35 controls (18-60 years) and determined serum concentrations of TMAO, choline and betaine by HPLC-MS/MS. For the CSS, 1,628 community-based adults (40-75 years) completed the blood tests and ultrasonographic NAFLD evaluation. In the CCS, analyses of covariance showed adverse associations of ln-transformed serum levels of TMAO, choline and betaine/choline ratio with the scores of steatosis and total NAFLD activity (NAS) (all P-trend <0.05). The CSS revealed that a greater severity of NAFLD was independently correlated with higher TMAO but lower betaine and betaine/choline ratio (all P-trend <0.05). No significant choline-NAFLD association was observed. Our findings showed adverse associations between the circulating TMAO level and the presence and severity of NAFLD in hospital- and community-based Chinese adults, and a favorable betaine-NAFLD relationship in the community-based participants.

Associations of gut-flora-dependent metabolite trimethylamine-N-oxide, betaine and choline with non-alcoholic fatty liver disease in adults

PubMed Central

Chen, Yu-ming; Liu, Yan; Zhou, Rui-fen; Chen, Xiao-ling; Wang, Cheng; Tan, Xu-ying; Wang, Li-jun; Zheng, Rui-dan; Zhang, Hong-wei; Ling, Wen-hua; Zhu, Hui-lian

2016-01-01

Many studies suggest that trimethylamine-N-oxide (TMAO), a gut-flora-dependent metabolite of choline, contributes to the risk of cardiovascular diseases, but little is known for non-alcoholic fatty liver disease (NAFLD). We examined the association of circulating TMAO, choline and betaine with the presence and severity of NAFLD in Chinese adults. We performed a hospital-based case-control study (CCS) and a cross-sectional study (CSS). In the CCS, we recruited 60 biopsy-proven NAFLD cases and 35 controls (18–60 years) and determined serum concentrations of TMAO, choline and betaine by HPLC-MS/MS. For the CSS, 1,628 community-based adults (40-75 years) completed the blood tests and ultrasonographic NAFLD evaluation. In the CCS, analyses of covariance showed adverse associations of ln-transformed serum levels of TMAO, choline and betaine/choline ratio with the scores of steatosis and total NAFLD activity (NAS) (all P-trend <0.05). The CSS revealed that a greater severity of NAFLD was independently correlated with higher TMAO but lower betaine and betaine/choline ratio (all P-trend <0.05). No significant choline-NAFLD association was observed. Our findings showed adverse associations between the circulating TMAO level and the presence and severity of NAFLD in hospital- and community-based Chinese adults, and a favorable betaine-NAFLD relationship in the community-based participants. PMID:26743949

Teaching Writing for the "Real World": Community and Workplace Writing

ERIC Educational Resources Information Center

Cox, Michelle; Ortmeier-Hooper, Christina; Tirabassi, Katherine E.

2009-01-01

In this article, the authors offer an approach to teaching that can help students prepare to write for the workplace and in the community: a case study of community-based writing. In this case-study project, students work in groups to study the writing needs and practices of a community-based group or organization, such as a local public library,…

Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care

PubMed Central

Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

2013-01-01

Objectives The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventative medicine, to help promote a healthy rural community. We investigate the approaches of patient health monitoring, emergency care, and an ambulance alert alarm (AAA) under mobile cloud-based telecare or community cloud controller systems. Methods Considering permanent mobile users, an efficient health promotion method is proposed. Experiments were conducted to verify the effectiveness of the method. The performance was evaluated from September 2011 to July 2012. A total of 1,856,454 cases were transported and referred to hospital, identified with health problems, and were monitored. We selected all the peer groups and the control server N0 which controls N1, N2, and N3 proxied peer groups. The hospital cloud controller maintains the database of the patients through a JXTA network. Results Among 1,856,454 transported cases with beneficiaries of 1,712,877 cases there were 1,662,834 lives saved and 8,500 cases transported per day with 104,530 transported cases found to be registered in a JXTA network. Conclusion The registered case histories were referred from the Hospital community cloud (HCC). SMS messages were sent from node N0 to the relay peers which connected to the N1, N2, and N3 nodes, controlled by the cloud controller through a JXTA network. PMID:24298441

Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care.

PubMed

Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

2013-10-01

The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventative medicine, to help promote a healthy rural community. We investigate the approaches of patient health monitoring, emergency care, and an ambulance alert alarm (AAA) under mobile cloud-based telecare or community cloud controller systems. Considering permanent mobile users, an efficient health promotion method is proposed. Experiments were conducted to verify the effectiveness of the method. The performance was evaluated from September 2011 to July 2012. A total of 1,856,454 cases were transported and referred to hospital, identified with health problems, and were monitored. We selected all the peer groups and the control server N0 which controls N1, N2, and N3 proxied peer groups. The hospital cloud controller maintains the database of the patients through a JXTA network. Among 1,856,454 transported cases with beneficiaries of 1,712,877 cases there were 1,662,834 lives saved and 8,500 cases transported per day with 104,530 transported cases found to be registered in a JXTA network. The registered case histories were referred from the Hospital community cloud (HCC). SMS messages were sent from node N0 to the relay peers which connected to the N1, N2, and N3 nodes, controlled by the cloud controller through a JXTA network.

Teaching nutrition to medical students: a community-based problem-solving approach.

PubMed

Bhattacharji, S; Joseph, A; Abraham, S; Muliyil, J; John, K R; Ethirajan, N

1990-01-01

This paper presents a community-based problem-solving educational programme which aims at teaching medical and other health science students the importance of nutrition and its application. Through community surveys students assess the nutritional status of children under five using different anthropometric methods. They understand the cultural beliefs and customs related to food fads and the reasons for them. They also acquire the skill to educate the community using the information gathered. They use epidemiological methods such as case control study to find associations between malnutrition and other causative factors. Feedback from students has been positive and evaluation of students' knowledge before and after the programme has shown significant improvement.

Implementation of Policy, Systems, and Environmental Community-Based Interventions for Cardiovascular Health Through a National Not-for-Profit: A Multiple Case Study.

PubMed

Garney, Whitney R; Szucs, Leigh E; Primm, Kristin; King Hahn, Laura; Garcia, Kristen M; Martin, Emily; McLeroy, Kenneth

2018-05-01

In 2014, the Centers for Disease Control and Prevention funded the American Heart Association to implement policy, systems, and environment-focused strategies targeting access to healthy food and beverages, physical activity, and smoke-free environments. To understand factors affecting implementation and variations in success across sites, evaluators conducted a multiple case study. Based on past literature, community sites were categorized as capacity-building or implementation-ready, for comparison. A sample of six communities were selected using a systematic selection tool. Through site visits, evaluators conducted interviews with program staff and community partners and assessed action plans. Evaluators identified important implications for nationally coordinated community-based prevention programming. Differences in implementation varied by the communities' readiness, with the most notable differences in how they planned activities and defined success. Existing partner relationships (or lack thereof) played a significant role, regardless of the American Heart Association's existing presence within the communities, in the progression of initiatives and the differences observed among phases. Last, goals in capacity-building sites were tied to organizational goals while goals in implementation-ready sites were more incremental with increased community influence and buy-in. Using national organizations as a mechanism to carry out large-scale community-based prevention work is a viable option that provides coordinated, wide-scale implementation without sacrificing a community's priorities or input. In funding future initiatives, the presence of relationships and the time needed to cultivate such relationships should be accounted for in the planning and implementation processes, as well as both local and national expectations.

Trachoma and Relative Poverty: A Case-Control Study

PubMed Central

Habtamu, Esmael; Wondie, Tariku; Aweke, Sintayehu; Tadesse, Zerihun; Zerihun, Mulat; Zewdie, Zebideru; Callahan, Kelly; Emerson, Paul M.; Kuper, Hannah; Bailey, Robin L.; Mabey, David C. W.; Rajak, Saul N.; Polack, Sarah; Weiss, Helen A.; Burton, Matthew J.

2015-01-01

Background Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited. Methodology/Principal Findings Two hundred people with trachomatous trichiasis were recruited through community-based screening in Amhara Region, Ethiopia. These were individually matched by age and gender to 200 controls without trichiasis, selected randomly from the same sub-village as the case. Household economic poverty was measured through (a) A broad set of asset-based wealth indicators and relative household economic poverty determined by principal component analysis (PCA, (b) Self-rated wealth, and (c) Peer-rated wealth. Activity participation data were collected using a modified ‘Stylised Activity List’ developed for the World Bank’s Living Standards Measurement Survey. Trichiasis cases were more likely to belong to poorer households by all measures: asset-based analysis (OR = 2.79; 95%CI: 2.06–3.78; p<0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75–7.07; p<0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59–14.72; p<0.0001). Cases had less access to latrines (57% v 76.5%, p = <0.0001) and higher person-to-room density (4.0 v 3.31; P = 0.0204) than the controls. Compared to controls, cases were significantly less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty in performing activities and more likely to receive assistance in performing productive activities. Conclusions/Significance This study demonstrated a strong association between trachomatous trichiasis and relative poverty, suggesting a bidirectional causative relationship possibly may exist between poverty and trachoma. Implementation of the full SAFE strategy in the context of general improvements might lead to a virtuous cycle of improving health and wealth. Trachoma is a good proxy of inequality within communities and it could be used to target and evaluate interventions for health and poverty alleviation. PMID:26600211

Adult Health Learning and Transformation: A Case Study of a Canadian Community-Based Program

ERIC Educational Resources Information Center

Coady, Maureen

2013-01-01

This article describes a case study of adult learning in a Canadian multisite Community Cardiovascular Hearts in Motion program. The researcher highlights the informal learning of 40 adult participants in this 12-week community-based cardiac rehabilitation/education program in five rural Nova Scotia communities. The effects of this learning and…

Rural Governance, Community Empowerment and the New Institutionalism: A Case Study of the Isle of Wight

ERIC Educational Resources Information Center

Clark, David; Southern, Rebekah; Beer, Julian

2007-01-01

This article compares two different institutional models--state-sponsored rural partnerships and community-based development trusts--for engaging and empowering local communities in area-based regeneration, using the Isle of Wight as a case study. Following a critical review of the literature on community governance, we evaluate the effectiveness…

Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics.

PubMed

Crowley, Matthew J; Bosworth, Hayden B; Coffman, Cynthia J; Lindquist, Jennifer H; Neary, Alice M; Harris, Amy C; Datta, Santanu K; Granger, Bradi B; Pereira, Katherine; Dolor, Rowena J; Edelman, David

2013-09-01

Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both conditions have rarely been tested in community settings. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension. Tailored Case Management for Diabetes and Hypertension (TEACH-DM) is a 24-month randomized, controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control. The study recruited from nine community practices. The nurse-administered intervention targets 3 areas: 1) cultivation of healthful behaviors for diabetes and hypertension control; 2) provision of fundamentals to support attainment of healthful behaviors; and 3) identification and correction of patient-specific barriers to adopting healthful behaviors. Hemoglobin A1c and blood pressure measured at 6, 12, and 24 months are co-primary outcomes. Secondary outcomes include self-efficacy, self-reported medication adherence, exercise, and cost-effectiveness. Of 377 randomized patients, 193 were allocated to the intervention and 184 to attention control. The cohort is balanced in terms of gender, race, education level, and income. The cohort's mean baseline hemoglobin A1c and blood pressure are above goal, and mean baseline body mass index falls in the obese range. Baseline self-reported non-adherence is high for diabetes and hypertension medications. Trial results are pending. If effective, the TEACH-DM intervention's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community settings. © 2013.

Social organization and control of tuberculosis: the experience of a Brazilian town.

PubMed

Bulgarelli, Alexandre Favero; Villa, Tereza Cristina Scatena; Pinto, Ione Carvalho

2013-01-01

This study was aimed at analyzing the participation of a committee formed by representatives of the community in tuberculosis control based on a participatory management model. This is a Case Study involving a tuberculosis committee with data collected through semi-structured interviews conducted with nine individuals. The data, organized through the Association of Ideas Map technique, were analyzed based on the Social Constructionism perspective. The participation of the Tuberculosis Committee studied was shown to be effective and associated with aspects articulated according to the measures taken by the social parties involved in the committee, culminating with assistances inserted into certain parts of the town's co-management. It was concluded that the reality of this case study shows that relationships among civil society can guide the management model in the search for effective processes of tuberculosis control.

Community participation in disease control.

PubMed

Bermejo, A; Bekui, A

1993-05-01

The main determinants of community participation in disease control programmes are identified and a framework with eleven variables is developed. Attention is drawn to the political background, community characteristics, the managerial capacity of the provider and the epidemiology of the disease. The framework is designed to guide health professionals in the systematic assessment and monitoring of participation in disease control programmes. Analysis of the Ghanaian Guinea Worm Eradication Programme and the Nicaraguan Tuberculosis Control Programme are presented as case studies. They show that political support does not guarantee community participation in disease control programmes and stress the importance of other determinants such as commitment to PHC, intersectoral coordination, the project approach and human resources. The relevance of the epidemiology of the disease in determining what degree of community participation will be most effective is highlighted by the case studies.

The Place of Community-Based Learning in Higher Education: A Case Study of Interchange

ERIC Educational Resources Information Center

Hardwick, Louise

2013-01-01

This article focuses on one strand of community engagement: community-based learning for students. It considers in particular Interchange as a case study. Interchange is a registered charity based in, but independent of, a department in a Higher Education Institution. It brokers between undergraduate research/work projects and Voluntary Community…

A community-based, case-control study of childhood stroke risk associated with congenital heart disease

PubMed Central

Fox, Christine K.; Sidney, Stephen; Fullerton, Heather J.

2014-01-01

Background and Purpose A better understanding of the stroke risk factors in children with congenital heart disease (CHD) could inform stroke prevention strategies. We analyzed pediatric stroke associated with CHD in a large community-based, case-control study. Methods From 2.5 million children (< 20 years) enrolled in a Northern California integrated healthcare plan, we identified ischemic and hemorrhagic strokes and randomly selected age and facility-matched stroke-free controls (3 per case). We determined exposure to CHD (diagnosed prior to stroke) and used conditional logistic regression to analyze stroke risk. Results CHD was identified in 15/412 cases (4%) versus 7/1,236 controls (0.6%). Children (28 days – 20 years) with CHD had 19-fold (Odds Ratio [OR] 19; 95% Confidence Interval [CI] 4.2, 83) increased stroke risk compared to controls. History of CHD surgery was associated with >30-fold increased risk of stroke (OR 31; CI 4, 241 compared to controls). After excluding peri-operative strokes, a history of CHD surgery still increased childhood stroke risk (OR 13; CI 1.5, 114). The majority of children with stroke and CHD were outpatient at the time of stroke, and almost half the cases who underwent cardiac surgery had their stroke >5 years after the most recent procedure. An estimated 7% of ischemic and 2% of hemorrhagic childhood strokes in the population were attributable to CHD. Conclusions CHD is an important childhood stroke risk factor. Children who undergo CHD surgery remain at elevated risk outside of the peri-operative period, and would benefit from optimized long-term stroke prevention strategies. PMID:25516197

Breast cancer and personal environmental risk factors in Marin County - Pilot study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Erdmann, C.A.; Farren, G.; Baltzell, K.

The purpose of the Personal Environmental Risk Factor Study (PERFS) pilot project was to develop methodologies and a questionnaire for a future population-based case-control study to investigate the role of selected environmental exposures in breast cancer development. Identification of etiologically relevant exposures during a period of potential vulnerability proximate to disease onset offers the possibility of clinical disease prevention even when disease initiation may have already occurred many years earlier. Certain personal environmental agents or combinations of agents may influence disease promotion. Therefore, this pilot study focused on exposures that occurred during the ten-year period prior to diagnosis for casesmore » and the last ten years for controls, rather than more historic exposures. For this pilot study, they used a community-based research approach. In the collaborative efforts, community members participated with academic researchers in all phases of the research, including research question identification, study design, development of research tools, development of the human subjects protocol, and report writing. Community member inclusion was based upon the concept that community participation could improve the relevance of scientific studies and ultimate success of the research by encouraging an ongoing dialogue between community members and academic representatives. Early activities of this project focused on the collection of input from the community regarding the possible role of environmental factors in the incidence of breast cancer in Marin County. The intent was to inform the scientists of community concerns, enhance the research team's understanding of the community being studied, and provide interested community members with a better understanding of the strengths and weaknesses of traditional research methods through active participation in the research process.« less

Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya District, in India.

PubMed

Biggeri, Mario; Deepak, Sunil; Mauro, Vincenzo; Trani, Jean-Francois; Kumar, Jayanth; Ramasamy, Parthipan

2014-01-01

In this paper, we measure the effectiveness of Community-Based Rehabilitation (CBR) programmes in promoting the well-being of people with disabilities and removing the barriers to their participation in family and community decision-making processes. To evaluate the impact of the CBR programme, we use data from a large-scale control study in Karnataka, India. Propensity score matching is used to evaluate the impacts on disabled persons after 2, 4 and 7 years of entering the CBR. The theoretical framework for the analysis is based on the CBR guidelines, which are combined with the International Classification of Functionings (ICF), the United Nations Convention on the Rights of People with Disabilities (UN CRPD) and Amartya Sen's capability approach. CBR has a positive impact on the well-being of persons with disabilities participating in the programme and particularly on their participation within the family and the society at large. CBR programmes have a multidimensional and positive impact on individual and collective capabilities; on individual, agency and social empowerment. Implications for Rehabilitation Community-Based Rehabilitation (CBR) can make a lasting difference in the life of persons with disabilities. CBR improves participation and inclusion of persons with disabilities in the family and in the community.

"We don't want our clothes to smell smoke": changing malaria control practices and opportunities for integrated community-based management in Baringo, Kenya.

PubMed

Amadi, Jacinter A; Olago, Daniel O; Ong'amo, George O; Oriaso, Silas O; Nyamongo, Isaac K; Estambale, Benson B A

2018-05-09

The decline in global malaria cases is attributed to intensified utilization of primary vector control interventions and artemisinin-based combination therapies (ACTs). These strategies are inadequate in many rural areas, thus adopting locally appropriate integrated malaria control strategies is imperative in these heterogeneous settings. This study aimed at investigating trends and local knowledge on malaria and to develop a framework for malaria control for communities in Baringo, Kenya. Clinical malaria cases obtained from four health facilities in the riverine and lowland zones were used to analyse malaria trends for the 2005-2014 period. A mixed method approach integrating eight focus group discussions, 12 key informant interviews, 300 survey questionnaires and two stakeholders' consultative forums were used to assess local knowledge on malaria risk and develop a framework for malaria reduction. Malaria cases increased significantly during the 2005-2014 period (tau = 0.352; p < 0.001) in the riverine zone. March, April, May, June and October showed significant increases compared to other months. Misconceptions about the cause and mode of malaria transmission existed. Gender-segregated outdoor occupation such as social drinking, farm activities, herding, and circumcision events increased the risk of mosquito bites. A positive relationship occurred between education level and opinion on exposure to malaria risk after dusk (χ 2  = 2.70, p < 0.05). There was over-reliance on bed nets, yet only 68% (204/300) of respondents owned at least one net. Complementary malaria control measures were under-utilized, with 90% of respondents denying having used either sprays, repellents or burnt cow dung or plant leaves over the last one year before the study was conducted. Baraza, radios, and mobile phone messages were identified as effective media for malaria information exchange. Supplementary strategies identified included unblocking canals, clearing Prosopis bushes, and use of community volunteers and school clubs to promote social behaviour change. The knowledge gap on malaria transmission should be addressed to minimize the impacts and enhance uptake of appropriate malaria management mechanisms. Implementing community-based framework can support significant reductions in malaria prevalence by minimizing both indoor and outdoor malaria transmissions.

Obstacles to action in arthritis: a community case-control study.

PubMed

Hutton, Ingrid; Gamble, Greg; McLean, Grant; Butcher, Hugh; Gow, Peter; Dalbeth, Nicola

2009-07-01

Despite the benefits of physical activity, people with arthritis are less active than the general population. The aim of this study was to determine the motivators and obstacles to physical activity for adults with arthritis. Participants were identified from the Obstacles to Action Study, a community based study of 8163 adults, which explored barriers and motivators to physical activity. A 1:1 case-control study was designed; cases were identified as those participants who reported arthritis (n = 1106). Each case was matched with an age, sex and ethnicity-matched non-arthritis control (n = 1106). Cases were less likely to achieve recommended physical activity targets (58.8% vs. 68.1% P = 0.00001). Furthermore, fewer people with arthritis believed that physical activity would help them lead healthy lives (86.7% vs. 91.3% P = 0.006) or viewed physical activity as a priority (53.8% vs. 59.8% P = 0.005). Cases were less confident in their abilities to try a new activity (37.1% vs. 43.7% P = 0.002) or maintain a healthy weight (65.0% vs. 74.3% P = 0.00001). Cases also reported greater negative impact scores for barriers to activity, particularly arthritis, accessibility, cost and discomfort while exercising. Motivators and environmental barriers to activity were similar for cases and controls. These findings persisted after adjusting for educational level, body mass index and comorbidities. People with arthritis are less active and demonstrate different attitudes toward physical activity. Although people with arthritis identify similar environmental barriers, they have different psychosocial barriers. In order to design effective physical activity programs for people with arthritis, these barriers must be specifically addressed.

Identifying Etiological Agents Causing Diarrhea in Low Income Ecuadorian Communities

PubMed Central

Vasco, Gabriela; Trueba, Gabriel; Atherton, Richard; Calvopiña, Manuel; Cevallos, William; Andrade, Thamara; Eguiguren, Martha; Eisenberg, Joseph N. S.

2014-01-01

Continued success in decreasing diarrheal disease burden requires targeted interventions. To develop such interventions, it is crucial to understand which pathogens cause diarrhea. Using a case-control design we tested stool samples, collected in both rural and urban Ecuador, for 15 pathogenic microorganisms. Pathogens were present in 51% of case and 27% of control samples from the urban community, and 62% of case and 18% of control samples collected from the rural community. Rotavirus and Shigellae were associated with diarrhea in the urban community; co-infections were more pathogenic than single infection; Campylobacter and Entamoeba histolytica were found in large numbers in cases and controls; and non-typhi Salmonella and enteropathogenic Escherichia coli were not found in any samples. Consistent with the Global Enteric Multicenter Study, focused in south Asia and sub-Saharan Africa, we found that in Ecuador a small group of pathogens accounted for a significant amount of the diarrheal disease burden. PMID:25048373

Celiac disease: Serologic prevalence in patients with irritable bowel syndrome.

PubMed

Mehdi, Zobeiri; Sakineh, Ebrahimi; Mohammad, Farahvash; Mansour, Rezaei; Alireza, Abdollahi

2012-09-01

The prevalence of irritable bowel syndrome (IBS) in the community is 10%-20% and have symptom based diagnostic criteria. Many symptoms of celiac disease (CD) with 1% prevalence in some communities can mimic IBS. Sensitive and specific serologic tests of CD can detect asymptomatic cases. The purpose of this study was to compare the level of anti-tissue-transglutaminase (tTG) IgA in IBS patients and controls group. This case-control study was performed at a University hospital in which 107 patients with IBS who met the Rome II criteria for their diagnosis were compared with 126 healthy age and sex-matched controls. Both groups were investigated for CD by analysis of their serum tTG IgA antibody with human recombinant antigen. Titers were positive containing over 10u/ml and borderline if they were between 4 and 10 u/ml. 86 percent of IBS patients were female. The mean antibody level was 0.837 u/ml in IBS group and 0.933 u/ml in control group without any significant difference. Results of this study may intensify disagreement on the situation of CD in IBS patients.

A network function-based definition of communities in complex networks.

PubMed

Chauhan, Sanjeev; Girvan, Michelle; Ott, Edward

2012-09-01

We consider an alternate definition of community structure that is functionally motivated. We define network community structure based on the function the network system is intended to perform. In particular, as a specific example of this approach, we consider communities whose function is enhanced by the ability to synchronize and/or by resilience to node failures. Previous work has shown that, in many cases, the largest eigenvalue of the network's adjacency matrix controls the onset of both synchronization and percolation processes. Thus, for networks whose functional performance is dependent on these processes, we propose a method that divides a given network into communities based on maximizing a function of the largest eigenvalues of the adjacency matrices of the resulting communities. We also explore the differences between the partitions obtained by our method and the modularity approach (which is based solely on consideration of network structure). We do this for several different classes of networks. We find that, in many cases, modularity-based partitions do almost as well as our function-based method in finding functional communities, even though modularity does not specifically incorporate consideration of function.

Patterns of Practice: Case Studies of Early Childhood Education & Family Engagement in Community Schools

ERIC Educational Resources Information Center

Jacobson, Linda; Rollins, S. Kwesi; Brown, Janet; Naviasky, Heather

2016-01-01

This "Patterns of Practice: Case Studies of Early Childhood Education & Family Engagement in Community Schools" report updates the community school case studies through a description of ongoing developments in Cincinnati, OH; Evansville, IN; Multnomah County, OR; and Tulsa, OK and adds to that knowledge base of early learning and…

Childhood Sexual and Physical Abuse as Risk Factors for the Development of Bulimia Nervosa: A Community-Based Case Control Study.

ERIC Educational Resources Information Center

Welch, Sarah L.; Fairburn, Christopher G.

1996-01-01

Young women (n=102) with bulimia nervosa were compared with 204 control subjects without an eating disorder and with 102 subjects with other psychiatric disorders. Results suggest that sexual and physical abuse are both risk factors for psychiatric disorders in general, including bulimia nervosa, but are not specific risk factors for bulimia. (DB)

Project-Based Learning Communities in Developmental Education: A Case Study of Lessons Learned

ERIC Educational Resources Information Center

Butler, Alison; Christofili, Monica

2014-01-01

This case study tracks the application of project-based learning (PBL) during four separate college terms at Portland Community College in Portland, Oregon. Each term follows a different learning community of first-term college students enrolled in a program of developmental education (DE), reading, writing, math, and college survival and success…

Community-based outbreaks of tuberculosis.

PubMed

Raffalli, J; Sepkowitz, K A; Armstrong, D

1996-05-27

Numerous recent reports have detailed outbreaks of tuberculosis in hospitals and other congregate settings. The characteristics of such settings, including high concentrations of infectious patients and immunocompromised hosts, the potential for sustained daily contact for weeks and often months, and improper precautions taken for protection, make them well suited for tuberculosis transmission. However, community-based outbreaks, which are the source of much public concern, have not been reviewed since 1964, when 109 community outbreaks were examined. Since few of the characteristics of institutional settings are present in the community, the lessons learned may not be applicable to community-based outbreaks. Furthermore, recent studies with analysis by restriction fragment length polymorphisms have documented unexpectedly high rates of primary disease in certain urban communities, suggesting that our understanding of community-based transmission may be incomplete. We reviewed all reported community-based outbreaks of tuberculosis occurring in the last 30 years to assess the basis of our current understanding of community-based transmission. More than 70 outbreaks were identified, with schools being the most common site. In most, a delay in diagnosis, sustained contact with the index case, inadequate ventilation, or overcrowding was contributory. We conclude that community-based outbreaks of tuberculosis continue to occur and that well-established risks contribute to most outbreaks. Many outbreaks can be prevented or limited by attention to basic infection control principles.

A Value-Based Case Study to Increasing Community Mentoring in STEM for Hispanic Students

NASA Astrophysics Data System (ADS)

Moreno, Gilberto

This case study investigates the implementation of a unique community-driven mentoring pilot program (PASOS2) forging stronger community and K-12 partnerships. Focused on surfacing what matters most in engaging community mentors, this case study explores a civic organization's quest to impact, expand, and bring value via mentoring to Hispanic students' pursuit of post-secondary studies with emphasis in STEM careers. A major stumbling block faced by many underprivileged students is the lack of mentorship vital to expanding their social capital support system. This innovative mentoring approach provides students with critical access to STEM community empowerment agents supporting aspiring students' dreams. Analytical methods and principles of case study research focus on how community mentor choices impact community mentorship value. The study examines whether or not a formal mentoring system with a value-driven mentoring curriculum matters in attracting, preparing, and sustaining community mentors to advocate for STEM careers to Hispanic students. A mentor value equation is introduced correlating mentor capacity to build student relationships, demystify STEM, deliver career guidance, and fortify student readiness. A formal mentor development training program integrates a technology-based 'grit' software platform to enhance student awareness, understanding, and commitment to considering a STEM career. Through the investigation of a formal mentoring experience, the study reveals what best practices, tools, and techniques influence community mentor engagement. The findings of this case study underscore the value in preparing community mentor capacity and competency. The very nature of the PASOS2 project being civic community-based informs other communities on how their investments can fortify Hispanic student social capital in their successful pursuit of STEM careers.

Case-control vaccine effectiveness studies: Preparation, design, and enrollment of cases and controls.

PubMed

Verani, Jennifer R; Baqui, Abdullah H; Broome, Claire V; Cherian, Thomas; Cohen, Cheryl; Farrar, Jennifer L; Feikin, Daniel R; Groome, Michelle J; Hajjeh, Rana A; Johnson, Hope L; Madhi, Shabir A; Mulholland, Kim; O'Brien, Katherine L; Parashar, Umesh D; Patel, Manish M; Rodrigues, Laura C; Santosham, Mathuram; Scott, J Anthony; Smith, Peter G; Sommerfelt, Halvor; Tate, Jacqueline E; Victor, J Chris; Whitney, Cynthia G; Zaidi, Anita K; Zell, Elizabeth R

2017-06-05

Case-control studies are commonly used to evaluate effectiveness of licensed vaccines after deployment in public health programs. Such studies can provide policy-relevant data on vaccine performance under 'real world' conditions, contributing to the evidence base to support and sustain introduction of new vaccines. However, case-control studies do not measure the impact of vaccine introduction on disease at a population level, and are subject to bias and confounding, which may lead to inaccurate results that can misinform policy decisions. In 2012, a group of experts met to review recent experience with case-control studies evaluating the effectiveness of several vaccines; here we summarize the recommendations of that group regarding best practices for planning, design and enrollment of cases and controls. Rigorous planning and preparation should focus on understanding the study context including healthcare-seeking and vaccination practices. Case-control vaccine effectiveness studies are best carried out soon after vaccine introduction because high coverage creates strong potential for confounding. Endpoints specific to the vaccine target are preferable to non-specific clinical syndromes since the proportion of non-specific outcomes preventable through vaccination may vary over time and place, leading to potentially confusing results. Controls should be representative of the source population from which cases arise, and are generally recruited from the community or health facilities where cases are enrolled. Matching of controls to cases for potential confounding factors is commonly used, although should be reserved for a limited number of key variables believed to be linked to both vaccination and disease. Case-control vaccine effectiveness studies can provide information useful to guide policy decisions and vaccine development, however rigorous preparation and design is essential. Published by Elsevier Ltd.

Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries.

PubMed Central

Rice, A. L.; Sacco, L.; Hyder, A.; Black, R. E.

2000-01-01

INTRODUCTION: Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. METHODS: MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. RESULTS: The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. DISCUSSION: The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles. PMID:11100616

Expanding the chronic care framework to improve diabetes management: the REACH case study.

PubMed

Jenkins, Carolyn; Pope, Charlene; Magwood, Gayenell; Vandemark, Lisa; Thomas, Virginia; Hill, Karen; Linnen, Florene; Beck, Lorna Shelton; Zapka, Jane

2010-01-01

Reducing the burden of chronic conditions among minorities requires novel approaches to prevent and manage disease. This paper describes the expansion of the Chronic Care Model (CCM) to include a community focus for improving diabetes self-management and reducing health disparities. The literature review assesses the concept of "community" in improving outcomes as viewed by proponents of the CCM for chronic disease. The CCM was then modified and informed by experiences of a major community-based participatory action initiative to improve diabetes outcomes, the Racial and Ethnic Approaches to Community Health (REACH) Charleston and Georgetown Diabetes Coalition. Based on our experiences with community-based and health systems diabetes interventions, we present examples of improvements within both health delivery practice sites and other community systems that are essential for improving diabetes outcomes and reducing disparities. Building on the Centers for Disease Control and Prevention's (CDC) principles of community involvement, our coalition activities provide examples of working with community partners to frame this enhanced ecologically grounded Community CCM (CCCM). The resulting CCCM integrates expanded conceptual frameworks, evidence-based practice, community-based evidence and participatory actions, and highlights the possibilities and challenges for improving chronic disease outcomes and reducing disparities via community programs that foster individual, systems, community, and policy change.

Case Study of an Aboriginal Community-Controlled Health Service in Australia

PubMed Central

Baum, Fran; Lawless, Angela; Labonté, Ronald; Sanders, David; Boffa, John; Edwards, Tahnia; Javanparast, Sara

2016-01-01

Abstract Universal health coverage provides a framework to achieve health services coverage but does not articulate the model of care desired. Comprehensive primary health care includes promotive, preventive, curative, and rehabilitative interventions and health equity and health as a human right as central goals. In Australia, Aboriginal community-controlled health services have pioneered comprehensive primary health care since their inception in the early 1970s. Our five-year project on comprehensive primary health care in Australia partnered with six services, including one Aboriginal community-controlled health service, the Central Australian Aboriginal Congress. Our findings revealed more impressive outcomes in several areas—multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work, and advocacy and intersectoral collaboration on social determinants of health—at the Aboriginal community-controlled health service compared to the other participating South Australian services (state-managed and nongovernmental ones). Because of these strengths, the Central Australian Aboriginal Congress’s community-controlled model of comprehensive primary health care deserves attention as a promising form of implementation of universal health coverage by articulating a model of care based on health as a human right that pursues the goal of health equity. PMID:28559679

Risk factors for childhood burns: a case-control study of Ghanaian children.

PubMed

Forjuoh, S N; Guyer, B; Strobino, D M; Keyl, P M; Diener-West, M; Smith, G S

1995-04-01

To study risk factors for childhood burns in order to identify possible preventive strategies. Case-control design with pair matching of controls to cases in relation to age, sex, and area of residence. The cases and controls were identified by a community based, multisite survey. The effects of host and socioenvironmental variables reported by mothers were investigated in a multivariate analysis using conditional logistic regression. A developing country setting the Ashanti Region in Ghana. These comprised 610 cases aged 0-5 years who had been burned (as evidenced by a visible scar) and 610 controls with no burn history. The presence of a pre-existing impairment in a child was the strongest risk factor in this population (OR = 6.71; 95% CI 2.78, 16.16). Other significant risk factor included: sibling death from a burn (OR = 4.41; 95% CI 1.16, 16.68); history of burn in a sibling (OR = 1.79; 95% CI 1.24, 2.58); and storage of a flammable substance in the home (OR = 1.51; 95% CI 1.03; 2.21). Maternal education had a protective effect against childhood burns, although this effect was not strong (OR = 0.76; 95% CI 0.55, 1.05). Community programmes to ensure adequate child supervision and general child wellbeing, particularly for those with impairments, as well as parental education about burns are recommended, to reduce childhood burns in this region of Ghana. The public should bed advised against storing flammable substances in the home.

Fibromyalgia: epidemiology and risk factors, a population-based case-control study in Lebanon.

PubMed

Moukaddem, Afaf; Chaaya, Monique; Slim, Zeinab F N; Jaffa, Miran; Sibai, Abla Mehio; Uthman, Imad

2017-02-01

To investigate the epidemiology of fibromyalgia (FM) and assess its risk factors. Using data from the 2009 Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study conducted in Lebanon, a population-based case control study was performed. The sample included 34 FM patients, frequency matched with 136 controls free from any musculoskeletal complaints and randomly sampled from the population. The controls were frequency matched with cases by age and gender. The 34 female FM cases were prevalent cases which existed for a long period of time and all those who consulted a doctor were previously misdiagnosed. Family history of joint problems (OR = 4.93, 95% CI: 1.56-15.58) and working status (OR = 2.69, 95% CI: 1.04-6.93) were significant risk factors for FM, after adjusting for body mass index, distress level, smoking status and residence location. This was the first study to address the epidemiology of FM in Lebanon and the region. The chronic nature of FM that is characterized by frequent bouts of intense disabling pain and symptoms constitutes a significant health and economic burden. Clustering of cases in coastal areas was partially explained by other factors such as body mass index, distress level, smoking and work status. The high burden of FM found in our study calls for further investigation of potential risk factors of this condition. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Data visualisation in surveillance for injury prevention and control: conceptual bases and case studies

PubMed Central

Martinez, Ramon; Ordunez, Pedro; Soliz, Patricia N; Ballesteros, Michael F

2016-01-01

Background The complexity of current injury-related health issues demands the usage of diverse and massive data sets for comprehensive analyses, and application of novel methods to communicate data effectively to the public health community, decision-makers and the public. Recent advances in information visualisation, availability of new visual analytic methods and tools, and progress on information technology provide an opportunity for shaping the next generation of injury surveillance. Objective To introduce data visualisation conceptual bases, and propose a visual analytic and visualisation platform in public health surveillance for injury prevention and control. Methods The paper introduces data visualisation conceptual bases, describes a visual analytic and visualisation platform, and presents two real-world case studies illustrating their application in public health surveillance for injury prevention and control. Results Application of visual analytic and visualisation platform is presented as solution for improved access to heterogeneous data sources, enhance data exploration and analysis, communicate data effectively, and support decision-making. Conclusions Applications of data visualisation concepts and visual analytic platform could play a key role to shape the next generation of injury surveillance. Visual analytic and visualisation platform could improve data use, the analytic capacity, and ability to effectively communicate findings and key messages. The public health surveillance community is encouraged to identify opportunities to develop and expand its use in injury prevention and control. PMID:26728006

Professional relationships and power dynamics between urban community-based nurses and social work case managers: advocacy in action.

PubMed

Young, Staci

2009-01-01

The purpose of this study was to explore how community-based case managers interface with their clients' healthcare providers and other community organizations as a function within their advocacy efforts. Case managers previously defined advocacy as occurring at individual, organizational, and community levels. The relationships they attempt to develop and maintain are consistent with case management ideology, yet this is a complex process to ensure care for vulnerable populations with many medical and socioeconomic needs. Community-based case management settings. In-depth qualitative interviews with a total of 20 nurse and social work case managers working in public housing, university-affiliated community nursing centers, local parishes, and community ministry. The case managers in this study reflected on how they interface with their clients, other healthcare providers, and community organizations on behalf of their clients. They reflect on the importance of trust and communication to facilitate this process. The advocacy work of case managers is influenced by the setting, others' perceptions of their knowledge and expertise, and power dynamics. Their ability to effectively advocate is greatly influenced by the strength of the relationships they forge. Advocacy for vulnerable clients is influenced by the existing relationship between case managers and their clients' healthcare providers. Case managers need to be persistent in their interactions with other providers to ensure that their clients have access to valuable community resources. Clear lines of communication should be established between case managers so that there is clarity around roles and expectations in service provision. Case managers should also participate in the mentoring of future health professions students so they may learn the application of advocacy work in community settings.

Community Based Organizations as Initiators of Partnerships with Community Colleges

ERIC Educational Resources Information Center

Turner, Sharon Yael

2012-01-01

This study focused on community based organizations leading community colleges in workforce development partnerships to train unemployed and underemployed adults. These collaborations operate where community based organizations deliver case management and job search skills, while community colleges offer specific training. In order to examine…

Risk factors for childhood burns: a case-control study of Ghanaian children.

PubMed Central

Forjuoh, S N; Guyer, B; Strobino, D M; Keyl, P M; Diener-West, M; Smith, G S

1995-01-01

STUDY OBJECTIVE--To study risk factors for childhood burns in order to identify possible preventive strategies. DESIGN--Case-control design with pair matching of controls to cases in relation to age, sex, and area of residence. The cases and controls were identified by a community based, multisite survey. The effects of host and socioenvironmental variables reported by mothers were investigated in a multivariate analysis using conditional logistic regression. SETTING--A developing country setting the Ashanti Region in Ghana. PARTICIPANTS--These comprised 610 cases aged 0-5 years who had been burned (as evidenced by a visible scar) and 610 controls with no burn history. MAIN RESULTS--The presence of a pre-existing impairment in a child was the strongest risk factor in this population (OR = 6.71; 95% CI 2.78, 16.16). Other significant risk factor included: sibling death from a burn (OR = 4.41; 95% CI 1.16, 16.68); history of burn in a sibling (OR = 1.79; 95% CI 1.24, 2.58); and storage of a flammable substance in the home (OR = 1.51; 95% CI 1.03; 2.21). Maternal education had a protective effect against childhood burns, although this effect was not strong (OR = 0.76; 95% CI 0.55, 1.05). CONCLUSIONS--Community programmes to ensure adequate child supervision and general child wellbeing, particularly for those with impairments, as well as parental education about burns are recommended, to reduce childhood burns in this region of Ghana. The public should bed advised against storing flammable substances in the home. PMID:7798049

Emerging new practices in technology to support independent community access for people with intellectual and cognitive disabilities.

PubMed

Stock, Steven E; Davies, Daniel K; Wehmeyer, Michael L; Lachapelle, Yves

2011-01-01

The concept of community access is a multidimensional term, which may involve issues related to physical access, knowledge and information, power and control, relationships and communications, advocacy, participation and quality of life [21]. This paper discusses historical and emerging practices and interventions related to physical access to community and community based information for individuals with cognitive disabilities such as intellectual disability, autism or traumatic brain injury. While much societal attention has been paid to features of independent community access for populations such as individuals with hearing, vision or physical disabilities, less attention has focused on independent community access for people with intellectual and other significant cognitive disabilities. Attitudes and actions by families and professional service communities are often mixed for some individuals in this population. The somewhat limited research base in these areas is explored, including a case study review and results from several promising feasibility studies. The paper concludes with comments concerning future prospects and recommendations for improving independent community access for persons with significant cognitive disabilities.

Factors associated with poor knowledge among adults on tuberculosis in Bangladesh: results from a nationwide survey.

PubMed

Hossain, Shahed; Zaman, Khalequ; Quaiyum, Abdul; Banu, Sayera; Husain, Ashaque; Islam, Akramul; Borgdorff, Martien; van Leth, Frank

2015-05-01

In 2012, Bangladesh continues to be one of the 22 high tuberculosis (TB) burden countries in the world. Although free diagnosis and management for TB is available throughout the country, case notification rate/100,000 population for new smear positive (NSP) cases under the national TB control programme (NTP) remained at around 70/100,000 population and have not changed much since 2006. Knowledge on TB disease, treatment and its management could be an important predictor for utilization of TB services and influence case detection under the NTP. Our objective is to describe knowledge of TB among newly diagnosed TB cases and community controls to assess factors associated with poor knowledge in order to identify programmatic implications for control measures. Embedded in TB prevalence survey 2007-2009, we included 240 TB cases from the TB registers and 240 persons ≥ 15 years of age randomly selected from the households where the survey was implemented. All participants were interviewed using a structured, pre-tested questionnaire to evaluate their TB knowledge. Regression analyses were done to assess associations with poor knowledge of TB. Our survey documented that overall there was fair knowledge in all domains investigated. However, based on the number of correct answers to the questionnaires, community controls showed significantly poorer knowledge than the TB cases in the domains of TB transmission (80% vs. 88%), mode of transmission (67% vs. 82%), knowing ≥ 1 suggestive symptoms including cough (78% vs. 89%), curability of TB (90% vs. 98%) and availability of free treatment (75% vs. 95%). Community controls were more likely to have poor knowledge of TB issues compared to the TB cases even after controlling for other factors such as education and occupation in a multivariate model (OR 3.46, 95% CI: 2.00-6.09). Knowledge on various aspects of TB and TB services varies significantly between TB cases and community controls in Bangladesh. The overall higher levels of knowledge in TB cases could identify them as peer educators in ongoing communication approaches to improve care seeking behavior of the TB suspects in the community and hence case detection.

Malaria case detection using rapid diagnostic test at the community level in Ghana: consumer perception and practitioners' experiences.

PubMed

Danquah, Daniel A; Buabeng, Kwame O; Asante, Kwaku P; Mahama, Emmanuel; Bart-Plange, Constance; Owusu-Dabo, Ellis

2016-01-22

Ghana has scaled-up malaria control strategies over the past decade. Much as malaria morbidity and mortality seem to have declined with these efforts, there appears to be increased consumption of artemisinin-based combination therapy (ACT). This study explored the perception and experiences of community members and medicines outlet practitioners on malaria case detection using rapid diagnostic test (RDTs) to guide malaria therapy. This was a cross-sectional study using both quantitative and qualitative approaches for data. In-depth interviews with structured questionnaires were conducted among 197 practitioners randomly selected from community pharmacies and over-the-counter medicine sellers shops within two metropolis (Kumasi and Obuasi) in the Ashanti Region of Ghana. Two focus group discussions were also held in the two communities among female adult caregivers. Medicine outlet practitioners and community members often used raised body temperature of individuals as an index for malaria case detection. The raised body temperature was presumptively determined by touching the forehead with hands. Seventy percent of the practitioners' perceived malaria RDTs are used in hospitals and clinics but not in retail medicines outlets. Many of the practitioners and community members agreed to the need for using RDT for malaria case detection at medicine outlets. However, about 30% of the practitioners (n = 59) and some community members (n = 6) held the view that RDT negative results does not mean no malaria illness and would use ACT. Though malaria RDT use in medicines outlets was largely uncommon, both community members and medicine outlet practitioners welcomed its use. Public education is however needed to improve malaria case detection using RDTs at the community level, to inform appropriate use of ACT.

Reduction in symptomatic malaria prevalence through proactive community treatment in rural Senegal.

PubMed

Linn, Annē M; Ndiaye, Youssoupha; Hennessee, Ian; Gaye, Seynabou; Linn, Patrick; Nordstrom, Karin; McLaughlin, Matt

2015-11-01

We piloted a community-based proactive malaria case detection model in rural Senegal to evaluate whether this model can increase testing and treatment and reduce prevalence of symptomatic malaria in target communities. Home care providers conducted weekly sweeps of every household in their village throughout the transmission season to identify patients with symptoms of malaria, perform rapid diagnostic tests (RDT) on symptomatic patients and provide treatment for positive cases. The model was implemented in 15 villages from July to November 2013, the high transmission season. Fifteen comparison villages were chosen from those implementing Senegal's original, passive model of community case management of malaria. Three sweeps were conducted in the comparison villages to compare prevalence of symptomatic malaria using difference in differences analysis. At baseline, prevalence of symptomatic malaria confirmed by RDT for all symptomatic individuals found during sweeps was similar in both sets of villages (P = 0.79). At end line, prevalence was 16 times higher in the comparison villages than in the intervention villages (P = 0.003). Adjusting for potential confounders, the intervention was associated with a 30-fold reduction in odds of symptomatic malaria in the intervention villages (AOR = 0.033; 95% CI: 0.017, 0.065). Treatment seeking also increased in the intervention villages, with 57% of consultations by home care providers conducted between sweeps through routine community case management. This pilot study suggests that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care seeking behaviour. A randomised controlled trial is needed to further evaluate the impact of this model. © 2015 John Wiley & Sons Ltd.

Possible association between ocular chloramphenicol and aplastic anaemia—the absolute risk is very low

PubMed Central

Laporte, Joan-Ramon; Vidal, Xavier; Ballarín, Elena; Ibáñez, Luisa

1998-01-01

Aims To determine whether topical ocular chloramphenicol increases the risk of aplastic anaemia and to estimate the magnitude of this risk, if any. Methods Population-based prospective case-control surveillance of aplastic anaemia in a community of 4.2 million inhabitants from 1980 to 1995 (67.2 million person-years) plus case-population estimate of the risk, based on sales figures of ocular chloramphenicol in the study area during the study period. Results One hundred and forty-five patients with aplastic anaemia and 1,226 controls were included in the analysis. Three cases (2.1%) and 5 controls (0.4%) had been exposed to ocular chloramphenicol during the relevant etiological period. The adjusted odds ratio was 3.77 (95% confidence interval, 0.84–16.90). Two cases had also been exposed to other known causes of aplastic anaemia. The incidence of aplastic anaemia among users of ocular chloramphenicol was 0.36 cases per million weeks of treatment. The incidence among non users was 0.04 cases per million weeks. Conclusions An association between ocular chloramphenicol and aplastic anaemia cannot be excluded. However, the risk is less than one per million treatment courses. PMID:9723830

Formal Leadership of Department Chairpersons with a Broadening Span of Control in Restructured Community Colleges: A Multi-Case Study

ERIC Educational Resources Information Center

Fattig, Teri L.

2013-01-01

Community college department chairpersons have experienced a broadening span of control due to the restructuring tactics of community colleges and the approaches utilized in order to cope with decreased budgets and increased enrollments. Many community colleges used strategies which involved flattening the middle management section of the…

Electrocardiographic features of sudden unexpected death in epilepsy.

PubMed

Chyou, Janice Y; Friedman, Daniel; Cerrone, Marina; Slater, William; Guo, Yu; Taupin, Daniel; O'Rourke, Sean; Priori, Silvia G; Devinsky, Orrin

2016-07-01

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy-related mortality. We hypothesized that electrocardiography (ECG) features may distinguish SUDEP cases from living subjects with epilepsy. Using a matched case-control design, we compared ECG studies of 12 consecutive cases of SUDEP over 10 years and 22 epilepsy controls matched for age, sex, epilepsy type (focal, generalized, or unknown/mixed type), concomitant antiepileptic, and psychotropic drug classes. Conduction intervals and prevalence of abnormal ventricular conduction diagnosis (QRS ≥110 msec), abnormal ventricular conduction pattern (QRS <110 msec, morphology of incomplete right or left bundle branch block or intraventricular conduction delay), early repolarization, and features of inherited cardiac channelopathies were assessed. Abnormal ventricular conduction diagnosis and pattern distinguished SUDEP cases from matched controls. Abnormal ventricular conduction diagnosis was present in two cases and no controls. Abnormal ventricular conduction pattern was more common in cases than controls (58% vs. 18%, p = 0.04). Early repolarization was similarly prevalent in cases and controls, but the overall prevalence exceeded that of published community-based cohorts. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador.

PubMed

Mitchell-Foster, Kendra; Ayala, Efraín Beltrán; Breilh, Jaime; Spiegel, Jerry; Wilches, Ana Arichabala; Leon, Tania Ordóñez; Delgado, Jefferson Adrian

2015-02-01

This project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador. An integrated intervention strategy (IIS) for dengue prevention (an elementary school-based dengue education program, and clean patio and safe container program) was implemented in 10 intervention clusters from November 2012 to November 2013 using a randomized controlled cluster trial design (20 clusters: 10 intervention, 10 control; 100 households per cluster with 1986 total households). Current existing dengue prevention programs served as the control treatment in comparison clusters. Pupa per person index (PPI) is used as the main outcome measure. Particular attention was paid to social mobilization and empowerment with IIS. Overall, IIS was successful in reducing PPI levels in intervention communities versus control clusters, with intervention clusters in the six paired clusters that followed the study design experiencing a greater reduction of PPI compared to controls (2.2 OR, 95% CI: 1.2 to 4.7). Analysis of individual cases demonstrates that consideration for contexualizing programs and strategies to local neighborhoods can be very effective in reducing PPI for dengue transmission risk reduction. In the rapidly evolving political climate for dengue control in Ecuador, integration of successful social mobilization and empowerment strategies with existing and emerging biolarvicide-based government dengue prevention and control programs is promising in reducing PPI and dengue transmission risk in southern coastal communities like Machala. However, more profound analysis of social determination of health is called for to assess sustainability prospects. © The author 2015. The World Health Organization has granted Oxford University Press permission for the reproduction of this article.

Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador

PubMed Central

Mitchell-Foster, Kendra; Ayala, Efraín Beltrán; Breilh, Jaime; Spiegel, Jerry; Wilches, Ana Arichabala; Leon, Tania Ordóñez; Delgado, Jefferson Adrian

2015-01-01

Background This project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador. Methods An integrated intervention strategy (IIS) for dengue prevention (an elementary school-based dengue education program, and clean patio and safe container program) was implemented in 10 intervention clusters from November 2012 to November 2013 using a randomized controlled cluster trial design (20 clusters: 10 intervention, 10 control; 100 households per cluster with 1986 total households). Current existing dengue prevention programs served as the control treatment in comparison clusters. Pupa per person index (PPI) is used as the main outcome measure. Particular attention was paid to social mobilization and empowerment with IIS. Results Overall, IIS was successful in reducing PPI levels in intervention communities versus control clusters, with intervention clusters in the six paired clusters that followed the study design experiencing a greater reduction of PPI compared to controls (2.2 OR, 95% CI: 1.2 to 4.7). Analysis of individual cases demonstrates that consideration for contexualizing programs and strategies to local neighborhoods can be very effective in reducing PPI for dengue transmission risk reduction. Conclusions In the rapidly evolving political climate for dengue control in Ecuador, integration of successful social mobilization and empowerment strategies with existing and emerging biolarvicide-based government dengue prevention and control programs is promising in reducing PPI and dengue transmission risk in southern coastal communities like Machala. However, more profound analysis of social determination of health is called for to assess sustainability prospects. PMID:25604763

Taking a Step to Identify How to Create Professional Learning Communities--Report of a Case Study of a Korean Public High School on How to Create and Sustain a School-Based Teacher Professional Learning Community

ERIC Educational Resources Information Center

Ahn, Joonkil

2017-01-01

This study intends to identify some key factors in creating and sustaining school-based teacher professional learning communities (PLCs) through a case study of a South Korean public high school. To achieve this, the study identified some essential infrastructure, preparation, and necessary social organization for creating PLCs. The ideal unit and…

Celiac disease: Serologic prevalence in patients with irritable bowel syndrome

PubMed Central

Mehdi, Zobeiri; Sakineh, Ebrahimi; Mohammad, Farahvash; Mansour, Rezaei; Alireza, Abdollahi

2012-01-01

Background: The prevalence of irritable bowel syndrome (IBS) in the community is 10%–20% and have symptom based diagnostic criteria. Many symptoms of celiac disease (CD) with 1% prevalence in some communities can mimic IBS. Sensitive and specific serologic tests of CD can detect asymptomatic cases. The purpose of this study was to compare the level of anti-tissue-transglutaminase (tTG) IgA in IBS patients and controls group. Materials and Methods: This case-control study was performed at a University hospital in which 107 patients with IBS who met the Rome II criteria for their diagnosis were compared with 126 healthy age and sex-matched controls. Both groups were investigated for CD by analysis of their serum tTG IgA antibody with human recombinant antigen. Titers were positive containing over 10u/ml and borderline if they were between 4 and 10 u/ml. Result: 86 percent of IBS patients were female. The mean antibody level was 0.837 u/ml in IBS group and 0.933 u/ml in control group without any significant difference. Discussion and Conclusion: Results of this study may intensify disagreement on the situation of CD in IBS patients. PMID:23826010

Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis.

PubMed

Asher, Laura; Patel, Vikram; De Silva, Mary J

2017-10-30

There is consensus that the treatment of schizophrenia should combine anti-psychotic medication and psychosocial interventions in order to address complex social, economic and health needs. It is recommended that family therapy or support; community-based rehabilitation; and/or self-help and support groups should be provided for people with schizophrenia in low and middle-income countries. The effectiveness of community-based psychosocial interventions in these settings is unclear. Studies evaluating community-based psychosocial interventions for people with schizophrenia were identified through database searching up to April 2016. Randomised controlled trials were included if they compared the intervention group with a control group receiving treatment as usual including medication. Only studies set in low and middle-income countries were included. Random effects meta-analyses were performed separately for each intervention type. Eleven randomised controlled trials in five middle-income countries were identified, with a total of 1580 participants. The content of included interventions varied from single-faceted psychoeducational interventions, to multi-component rehabilitation-focused interventions, to case management interventions. A third of the included studies did not incorporate any community involvement in the intervention. The quality of evidence was often low. Amongst the seven studies that reported on symptom severity up to 18 months post intervention, the pooled standardised mean difference (SMD) across all intervention types was 0.95 (95% CI 0.28, 1.61; P 0.005; I 2  = 95%; n = 862), representing a strong effect. A strong effect on symptom severity remained after excluding two studies with a high risk of bias (SMD 0.80; 95% CI 0.07, 1.53; P 0.03; I 2  = 94%; n = 676). Community-based psychosocial interventions may also have beneficial impacts on functioning (SMD 1.12; 95% CI 0.25, 2.00; P 0.01; I 2  = 94%; n = 511) and reducing hospital readmissions (SMD 0.68; 95% CI 0.27, 1.09; P 0.001; I 2  = 33%; n = 167). The limited evidence from low and middle-income countries supports the feasibility and effectiveness of community-based psychosocial interventions for schizophrenia, even in the absence of community mobilisation. Community-based psychosocial interventions should therefore be provided in these settings as an adjuvant service in addition to facility-based care for people with schizophrenia.

Re-emerging Lassa fever outbreaks in Nigeria: Re-enforcing "One Health" community surveillance and emergency response practice.

PubMed

Tambo, Ernest; Adetunde, Oluwasegun T; Olalubi, Oluwasogo A

2018-04-28

We evaluated the impact of man-made conflict events and climate change impact in guiding evidence-based community "One Health" epidemiology and emergency response practice against re-/emerging epidemics. Increasing evidence of emerging and re-emerging zoonotic diseases including recent Lassa fever outbreaks in almost 20 states in Nigeria led to 101 deaths and 175 suspected and confirmed cases since August 2015. Of the 75 laboratory confirmed cases, 90 deaths occurred representing 120% laboratory-confirmed case fatality. The outbreak has been imported into neighbouring country such as Benin, where 23 deaths out of 68 cases has also been reported. This study assesses the current trends in re-emerging Lassa fever outbreak in understanding spatio-geographical reservoir(s), risk factors pattern and Lassa virus incidence mapping, inherent gaps and raising challenges in health systems. It is shown that Lassa fever peak endemicity incidence and prevalence overlap the dry season (within January to March) and reduced during the wet season (of May to November) annually in Sierra Leone, Senegal to Eastern Nigeria. We documented a scarcity of consistent data on rodent (reservoirs)-linked Lassa fever outbreak, weak culturally and socio-behavioural effective prevention and control measures integration, weak or limited community knowledge and awareness to inadequate preparedness capacity and access to affordable case management in affected countries. Hence, robust sub/regional leadership commitment and investment in Lassa fever is urgently needed in building integrated and effective community "One Health" surveillance and rapid response approach practice coupled with pest management and phytosanitation measures against Lassa fever epidemic. This offers new opportunities in understanding human-animal interactions in strengthening Lassa fever outbreak early detection and surveillance, warning alerts and rapid response implementation in vulnerable settings. Leveraging on Africa CDC centre, advances in cloud-sourcing and social media tools and solutions is core in developing and integrating evidence-based and timely risk communication, and reporting systems in improving contextual community-based immunization and control decision making policy to effectively defeat Lassa fever outbreak and other emerging pandemics public health emergencies in Africa and worldwide.

Using computer aided case based reasoning to support clinical reasoning in community occupational therapy.

PubMed

Taylor, Bruce; Robertson, David; Wiratunga, Nirmalie; Craw, Susan; Mitchell, Dawn; Stewart, Elaine

2007-08-01

Community occupational therapists have long been involved in the provision of environmental control systems. Diverse electronic technologies with the potential to improve the health and quality of life of selected clients have developed rapidly in recent years. Occupational therapists employ clinical reasoning in order to determine the most appropriate technology to meet the needs of individual clients. This paper describes a number of the drivers that may increase the adoption of information and communication technologies in the occupational therapy profession. It outlines case based reasoning as understood in the domains of expert systems and knowledge management and presents the preliminary results of an ongoing investigation into the potential of a prototype computer aided case based reasoning tool to support the clinical reasoning of community occupational therapists in the process of assisting clients to choose home electronic assistive or smart house technology.

The effect of community based soil conservation works on runoff and sediment loss in the Ethiopian highlands: case of Birr Watershed

USDA-ARS?s Scientific Manuscript database

Soil erosion is a serious problem in the Ethiopian highlands. Conventional erosion control approaches have generally been ineffective in halting this problem. The presented study measured precipitation, sediment yield and stream flow in 2013 and 2014 in the Ene-Chilala subwatershed of the Birr River...

Sustaining Youth Participation in a Long-Term Tobacco Control Initiative: Consideration of a Social Justice Perspective

ERIC Educational Resources Information Center

Ross, Laurie

2011-01-01

This article presents an in-depth case study of the Healthy Options for Prevention and Education Coalition's Teens Tackle Tobacco initiative, a 3-year community-based participatory research (CBPR) project about the distribution of tobacco vendors and tobacco advertising in Worcester, Massachusetts. Using two theoretical frameworks, positive youth…

Community-based youth tobacco control interventions: cost effectiveness of the Full Court Press project.

PubMed

Ross, Hana; Powell, Lisa M; Bauer, Joseph E; Levy, David T; Peck, Richard M; Lee, Hye-Ryeon

2006-01-01

We evaluated the impact of a community-based tobacco control project that was implemented in the city of Tucson, Arizona, USA, between 1996 and 2001. The project's goal was to reduce the prevalence of youth smoking through change in social norms at schools and in communities and workplaces. As is often the case, these community-based health promotion interventions were implemented in conjunction with other broader programmes, in this case implemented on the state level. Taking into account state level interventions as well as changes in sociodemographic and economic environment over the course of the project (e.g. increases in cigarette prices), we measure the net effect of the intervention in terms of the number of people who quit or did not initiate smoking and by the discounted life-years gained. To establish the value of investing into community-based intervention, we calculated the real discounted cost per quit and per life-year gained of 3789 US dollars and 3942 US dollars, respectively. These compare favourably with the real cost per quit of 4270 US dollars when implementing the 1996 US Clinical Practice Guideline for smoking cessation but exceed the real cost of 2923 US dollars per discounted life-year gained when following the guideline. A sensitivity analysis that assumed 5% programme persistence (i.e. 5% of the programme's impact would last forever in the absence of future funding for the programme), one-third would relapse and that one-third of those who quit may have quit smoking even without the programme, suggested a lower cost per discounted life-year saved of 3476 US dollars. The cost effectiveness of this project compares favourably with other tobacco control interventions. Despite its relatively small target group, this community-based intervention was cost effective.

Transient global amnesia and transient ischemic attack. Natural history, vascular risk factors, and associated conditions.

PubMed

Zorzon, M; Antonutti, L; Masè, G; Biasutti, E; Vitrani, B; Cazzato, G

1995-09-01

The purpose of the present study was to make an attempt to ascertain the etiology of transient global amnesia (TGA), which is still disputed more than 30 years after the first description of this clinical entity. In a case-control study, we compared the prevalence of vascular risk factors in 64 TGA patients with 64 first-ever transient ischemic attack (TIA) control subjects and 108 normal community-based control subjects matched for age and sex. We prospectively studied the vascular events and mortality rates of the TGA cases and of the TIA control subjects. Then we compared the outcome of the two groups using actuarial analysis based on survival curves. We did not find evidence of an increased risk of TGA associated with any vascular risk factor. In contrast to TIA control subjects, no TGA patient suffered stroke, myocardial infarction, or TIA during the follow-up period. Migraine was more common in TGA patients than in both normal and TIA control subjects. In three patients (4.5%), the TGA was eventually considered to be of epileptic origin. The results of our case-control and longitudinal studies point to the conclusion that TGA and TIA do not share the same etiology. Since half of our patients had a precipitating event in their history, it is reasonable to hypothesize that spreading depression may play a role in TGA. The significant positive association between migraine and TGA may support this hypothesis. Epilepsy may mimic TGA in a minority of cases.

Sources of heterogeneity in case-control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia.

PubMed

de Groot, Mark C H; Klungel, Olaf H; Leufkens, Hubert G M; van Dijk, Liset; Grobbee, Diederick E; van de Garde, Ewoudt M W

2014-10-01

The heterogeneity in case-control studies on the associations between community-acquired pneumonia (CAP) and ACE-inhibitors (ACEi), statins, and proton pump inhibitors (PPI) hampers translation to clinical practice. Our objective is to explore sources of this heterogeneity by applying a common protocol in different data settings. We conducted ten case-control studies using data from five different health care databases. Databases varied on type of patients (hospitalised vs. GP), level of case validity, and mode of exposure ascertainment (prescription or dispensing based). Identified CAP patients and controls were matched on age, gender, and calendar year. Conditional logistic regression was used to calculate odds ratios (OR) for the associations between the drugs of interest and CAP. Associations were adjusted by a common set of potential confounders. Data of 38,742 cases and 118,019 controls were studied. Comparable patterns of variation between case-control studies were observed for ACEi, statins and PPI use and pneumonia risk with adjusted ORs varying from 1.04 to 1.49, 0.82 to 1.50 and 1.16 to 2.71, respectively. Overall, higher ORs were found for hospitalised CAP patients matched to population controls versus GP CAP patients matched to population controls. Prevalence of drug exposure was higher in dispensing data versus prescription data. We show that case-control selection and methods of exposure ascertainment induce bias that cannot be adjusted for and to a considerable extent explain the heterogeneity in results obtained in case-control studies on statins, ACEi and PPIs and CAP. The common protocol approach helps to better understand sources of variation in observational studies.

Efficient community-based control strategies in adaptive networks

NASA Astrophysics Data System (ADS)

Yang, Hui; Tang, Ming; Zhang, Hai-Feng

2012-12-01

Most studies on adaptive networks concentrate on the properties of steady state, but neglect transient dynamics. In this study, we pay attention to the emergence of community structure in the transient process and the effects of community-based control strategies on epidemic spreading. First, by normalizing the modularity, we investigate the evolution of community structure during the transient process, and find that a strong community structure is induced by the rewiring mechanism in the early stage of epidemic dynamics, which, remarkably, delays the outbreak of disease. We then study the effects of control strategies started at different stages on the prevalence. Both immunization and quarantine strategies indicate that it is not ‘the earlier, the better’ for the implementation of control measures. And the optimal control effect is obtained if control measures can be efficiently implemented in the period of a strong community structure. For the immunization strategy, immunizing the susceptible nodes on susceptible-infected links and immunizing susceptible nodes randomly have similar control effects. However, for the quarantine strategy, quarantining the infected nodes on susceptible-infected links can yield a far better result than quarantining infected nodes randomly. More significantly, the community-based quarantine strategy performs better than the community-based immunization strategy. This study may shed new light on the forecast and the prevention of epidemics among humans.

Use of Patients With Diarrhea Who Test Negative for Rotavirus as Controls to Estimate Rotavirus Vaccine Effectiveness Through Case-Control Studies.

PubMed

Tate, Jacqueline E; Patel, Manish M; Cortese, Margaret M; Payne, Daniel C; Lopman, Benjamin A; Yen, Catherine; Parashar, Umesh D

2016-05-01

Case-control studies are often performed to estimate postlicensure vaccine effectiveness (VE), but the enrollment of controls can be challenging, time-consuming, and costly. We evaluated whether children enrolled in the same hospital-based diarrheal surveillance used to identify rotavirus cases but who test negative for rotavirus (test-negative controls) can be considered a suitable alternative to nondiarrheal hospital or community-based control groups (traditional controls). We compared calculated VE estimates as a function of varying values of true VE, attack rates of rotavirus and nonrotavirus diarrhea in the population, and sensitivity and specificity of the rotavirus enzyme immunoasssay. We also searched the literature to identify rotavirus VE studies that used traditional and test-negative control groups and compared VE estimates obtained using the different control groups. Assuming a 1% attack rate for severe rotavirus diarrhea, a 3% attack rate for severe nonrotavirus diarrhea in the population, a test sensitivity of 96%, and a specificity of 100%, the calculated VE estimates using both the traditional and test-negative control groups closely approximated the true VE for all values from 30% to 100%. As true VE decreased, the traditional case-control approach slightly overestimated the true VE and the test-negative case-control approach slightly underestimated this estimate, but the absolute difference was only ±0.2 percentage points. Field VE estimates from 10 evaluations that used both traditional and test-negative control groups were similar regardless of control group used. The use of rotavirus test-negative controls offers an efficient and cost-effective approach to estimating rotavirus VE through case-control studies. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Adapting and implementing evidence-based cancer education interventions in rural Appalachia: real world experiences and challenges

PubMed Central

Vanderpool, RC; Gainor, SJ; Conn, ME; Spencer, C; Allen, AR; Kennedy, S

2014-01-01

Introduction There is recognition among public health scholars and community practitioners that translating cancer prevention and control research into practice is challenging. This circumstance is particularly germane to medically underserved communities, such as rural Appalachia, where few evidence-based interventions originate and cancer incidence and mortality are elevated. Methods A case study approach was selected to examine the collective experience of 13 West Virginia community organizations awarded mini-grants requiring the use of an evidence-based cancer control intervention. Methods included a systematic review of grant applications and final programmatic reports, a faxed survey, and qualitative, in-depth interviews with key stakeholders. Results Appalachian grantees reported notable challenges with selecting, adapting, and implementing evidence-based cancer education interventions. Evidence-based programming was viewed as a barrier. Grantees made a range of adaptations to meet constituent needs, thereby jeopardizing intervention fidelity. However, programs were perceived as successful due to community participation and engagement, some element of behavioral change, dissemination of the health message, and establishment of collaborative partnerships. Conclusions A descriptive examination provides insights into the challenges of translating research to practice. This Appalachian cancer education grant program also highlights areas of compromise that are important for researchers and practitioners to understand. PMID:21988459

Data visualisation in surveillance for injury prevention and control: conceptual bases and case studies.

PubMed

Martinez, Ramon; Ordunez, Pedro; Soliz, Patricia N; Ballesteros, Michael F

2016-04-01

The complexity of current injury-related health issues demands the usage of diverse and massive data sets for comprehensive analyses, and application of novel methods to communicate data effectively to the public health community, decision-makers and the public. Recent advances in information visualisation, availability of new visual analytic methods and tools, and progress on information technology provide an opportunity for shaping the next generation of injury surveillance. To introduce data visualisation conceptual bases, and propose a visual analytic and visualisation platform in public health surveillance for injury prevention and control. The paper introduces data visualisation conceptual bases, describes a visual analytic and visualisation platform, and presents two real-world case studies illustrating their application in public health surveillance for injury prevention and control. Application of visual analytic and visualisation platform is presented as solution for improved access to heterogeneous data sources, enhance data exploration and analysis, communicate data effectively, and support decision-making. Applications of data visualisation concepts and visual analytic platform could play a key role to shape the next generation of injury surveillance. Visual analytic and visualisation platform could improve data use, the analytic capacity, and ability to effectively communicate findings and key messages. The public health surveillance community is encouraged to identify opportunities to develop and expand its use in injury prevention and control. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

An intervention to reduce kerosene-related burns and poisonings in low-income South African communities.

PubMed

Schwebel, David C; Swart, Dehran; Simpson, Jennifer; Hobe, Phumla; Hui, Siu-Kuen Azor

2009-07-01

Unintentional injury rates in low- and middle-income countries are up to 50 times higher than high-income nations. In South Africa, kerosene (paraffin) is a leading cause of poisoning and burns, particularly in low-income communities where it serves as a primary fuel for light, cooking, and heating. This study tested a community-based intervention to reduce kerosene-related injury risk. The intervention used a train-the-trainers model, whereby expert trainers train local paraprofessionals, who in turn deliver educational materials to community residents. The intervention was theory-driven, pragmatically motivated, and culturally sensitive. Prospective quasi-experimental intervention design with nonequivalent case versus control groups. Three primary outcome measures were considered: self-reported knowledge of kerosene safety, observed practice of safe kerosene use, and self-reported recognition of risk for kerosene-related injury. ANOVA models suggest a large and significant increase in self-reported kerosene-related knowledge in the intervention community compared to the control community. There were smaller, but statistically significant changes, in kerosene-related safety practices and recognition of kerosene injury risk in the intervention community compared to the control community. The intervention was successful. A train-the-trainers model might be an effective educational tool to reduce kerosene-related injury risk in low-income communities within low- and middle-income countries.

A modified case-control study of cryptosporidiosis (using non-Cryptosporidium-infected enteric cases as controls) in a community setting.

PubMed

Pintar, K D M; Pollari, F; Waltner-Toews, D; Charron, D F; McEwen, S A; Fazil, A; Nesbitt, A

2009-12-01

Data from the first sentinel site (Waterloo Region, Ontario) of the Canadian Integrated Enteric Disease Surveillance System (C-EnterNet) were used in a secondary-based case-control study of laboratory-confirmed Cryptosporidium infections to study the role of various exposure factors. The incidence of cryptosporidiosis in Waterloo Region was almost double both the provincial and national rates. Persons ill with one of nine other enteric infections (amoebiasis, campylobacteriosis, cyclosporiasis, giardiasis, listeriosis, salmonellosis, shigellosis, verotoxigenic E. coli infections, yersiniosis) captured by the surveillance system were used as the control group. Of 1204 cases of enteric illness in the sentinel area between April 2005 and December 2007, 36 cases and 803 controls were selected after excluding outbreak and international travel-related cases. Univariable analyses (Pearson chi2 and Fisher's exact tests) and multivariable logistic regression were performed. Results of the multivariable analysis found that cryptosporidiosis was associated with swimming in a lake or river (OR 2.9, 95% CI 1.2-7.4), drinking municipal water (a potential surrogate for urban respondents vs. rural) (OR 2.4, 95% CI 1.04-5.7), and having a family member with a diarrhoeal illness (OR 2.9, 95% CI 1.3-6.4).

Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management.

PubMed

Schmidt, Barbara; Wenitong, Mark; Esterman, Adrian; Hoy, Wendy; Segal, Leonie; Taylor, Sean; Preece, Cilla; Sticpewich, Alex; McDermott, Robyn

2012-11-21

Prevalence and incidence of diabetes and other common comorbid conditions (hypertension, coronary heart disease, renal disease and chronic lung disease) are extremely high among Indigenous Australians. Recent measures to improve quality of preventive care in Indigenous community settings, while apparently successful at increasing screening and routine check-up rates, have shown only modest or little improvements in appropriate care such as the introduction of insulin and other scaled-up drug regimens in line with evidence-based guidelines, together with support for risk factor reduction. A new strategy is required to ensure high quality integrated family-centred care is available locally, with continuity and cultural safety, by community-based care coordinators with appropriate system supports. The trial design is open parallel cluster randomised controlled trial. The objective of this pragmatic trial is to test the effectiveness of a model of health service delivery that facilitates integrated community-based, intensive chronic condition management, compared with usual care, in rural and remote Indigenous primary health care services in north Queensland. Participants are Indigenous adults (aged 18-65 years) with poorly controlled diabetes (HbA1c>=8.5) and at least one other chronic condition. The intervention is to employ an Indigenous Health Worker to case manage the care of a maximum caseload of 30 participants. The Indigenous Health Workers receive intensive clinical training initially, and throughout the study, to ensure they are competent to coordinate care for people with chronic conditions. The Indigenous Health Workers, supported by the local primary health care (PHC) team and an Indigenous Clinical Support Team, will manage care, including coordinating access to multidisciplinary team care based on best practice standards. Allocation by cluster to the intervention and control groups is by simple randomisation after participant enrolment. Participants in the control group will receive usual care, and will be wait-listed to receive a revised model of the intervention informed by the data analysis. The primary outcome is reduction in HbA1c measured at 18 months. Implementation fidelity will be monitored and a qualitative investigation (methods to be determined) will aim to identify elements of the model which may influence health outcomes for Indigenous people with chronic conditions. This pragmatic trial will test a culturally-sound family-centred model of care with supported case management by IHWs to improve outcomes for people with complex chronic care needs. This trial is now in the intervention phase. Australian New Zealand Clinical Trials Registry ACTR12610000812099.

Feasibility and implementation of community-based malaria case management with integrated vector control in the Democratic Republic of Congo.

PubMed

Swana, Edouard Kawawa; Makan, Ghislain Yav; Mukeng, Clarence Kaut; Mupumba, Henriette Ilunga; Kalaba, Gabriel Mutabusha; Luboya, Oscar Numbi; Bangs, Michael J

2016-08-15

Malaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control (indoor residual spray) and mass insecticide-treated bed net coverage. Therefore, a pilot study was implemented to attack the parasite directly and demonstrate the feasibility and acceptability of community case management of malaria (CCMm) using trained community health workers (CHWs). A 13 month prospective evaluation of CCMm was undertaken in 14 rural villages. Focus group discussions and structured interviews were conducted in pre- and post-intervention periods to assess community acceptability of CCMm. Weekly data collected by CHWs assessed program impact over time, matched with malaria school-based prevalence surveys (MSPS) in the Mulumbu Health Area (CCMm study arm) compared to a comparison (non-CCMm) arm in the Mpala Health Area approximately 25 km apart. Overall population perception of the CCMm was highly positive. 6619 community contacts were managed by CHWs from which 1433 (21.6 %) were malaria positive by rapid detection tests during the 10 month intervention. Among the malaria infected, 94.7 % (1358) were recorded as 'uncomplicated' infections with 99.7 % provided full course of treatment. CHWs referred 278 (4.2 %) patients deemed 'complicated' to a designated primary health center for advanced care. While pre-intervention MSPS data revealed significantly higher (p = 0.0135) malaria in the CCMm area compared to the non-CCMm area, at post-intervention there was no statistical difference (p = 0.562) between the two areas. Notably, for the first time, no malaria-related deaths were recorded in the 14 CCMm intervention villages during observation. Community case management of malaria was shown to be an effective and promising strategy for prompt and effective management of malaria. It was well accepted by the community and showed evidence of a reduction in malaria morbidity and mortality. Further refinement of CCMm implementation, cost implications and sustainability is advised before expanding the programme.

Community-wide interventions for tobacco control.

PubMed

Cummings, K M

1999-01-01

This article describes the rationale and evidence supporting community-wide interventions for tobacco control. Data were collected from published evaluation studies, government reports, and commentaries that describe the use of community-based approaches to tobacco control. Community-wide interventions attempt to change tobacco use in populations--not just individuals--and have increasingly begun to focus on influencing policies that promote and/or tolerate tobacco use. Examples of community-based tobacco-control activities include organizing community groups to advocate adoption of tobacco-control ordinances (e.g., smoke-free restaurants, ban on self-service tobacco displays); media advocacy to raise public awareness about illegal tobacco sales to minors; paid counter-advertising; and sponsorship of community-wide stop-smoking events such as a quit-and-win contest. Evidence in support of the effectiveness of community-based interventions to reduce smoking is found in the consistently sharper decline in tobacco consumption observed in states that have invested in comprehensive tobacco-prevention and control programs compared to those that have not. However, the results from several randomized controlled trials of community-based tobacco-control interventions have been disappointing in demonstrating large-scale changes in tobacco use. Although there appears to be a wide consensus that community-based approaches to tobacco control are an important part of a comprehensive program to reduce tobacco use, the essential elements and methods of implementation of some community-based tobacco-control efforts are less well defined. Also, given the dynamic nature of community tobacco-control interventions, the traditional randomized controlled trial model probably is not applicable for evaluation purposes. It is more likely that research models based on time-series designs will be most applicable for evaluating the impact of community-based interventions.

Factors associated with tuberculosis cases in Semarang District, Indonesia: case-control study performed in the area where case detection rate was extremely low.

PubMed

Rahayu, Sri Ratna; Katsuyama, Hironobu; Demura, Masashi; Katsuyama, Midori; Ota, Yoko; Tanii, Hideji; Higashi, Tomomi; Semadi, Ngakan Putu Djaja; Saijoh, Kiyofumi

2015-07-01

Indonesia is ranked as the 4th highest contributor to tuberculosis (TB) in the world. Semarang District in Central Java displays extremely low case detection rate (CDR), possibly contributing to the local prevalence of TB. A case-control study was performed to explore the factors that cause such low CDR. We recruited 129 TB cases and 83 controls that visited the same centers and were not diagnosed with TB. The cases had 7.5 ± 2.3 symptoms/person on average, indicating the delay in diagnosis because the controls only displayed 1.0 ± 1.7. The multiple logistic regression analysis comparing the cases/controls extracted following factors as a risk to have TB: farmer, close contact with TB patients, ignorance of whether Bacillus Calmette-Guérin (BCG) was accepted or no, smoking, low income, a lot of people living in the same room, irregular hand wash before meals, not wash hands after blow, soil floor, and no sunlight and no ventilation in the house. Neither the cases nor the controls knew the symptoms and how to avoid TB infection, which probably caused the delay in diagnosis. It is difficult to change the current living conditions. Thus, the amendment of the community-based education program of TB seems to be required.

Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains.

PubMed

Blanas, Demetri A; Ndiaye, Youssoupha; Nichols, Kim; Jensen, Andrew; Siddiqui, Ammar; Hennig, Nils

2013-03-14

Health workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs. This study evaluates communities' perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field. The study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers. Communities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage. This study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

Measles case fatality ratio in India a review of community based studies.

PubMed

Sudfeld, C R; Halsey, N A

2009-11-01

Measles remains a major cause of child mortality in India. Measles case fatality ratios (CFRs) vary substantially between countries and even within the same community over time. We present a review of Indian community-based measles CFR studies conducted from 1975 to 2008. PubMed, Cochrane Libraries, and all WHO databases were searched using a combination of terms. All community-based studies were abstracted into a database. We identified 25 studies with data on 27 communities. The median CFR was 1.63 per 100 cases (Q1= 0.00 and Q3= 5.06). Studies conducted after 1994 had significantly lower CFRs (P=0.031). Studies in rural settings had significantly higher CFRs compared to urban studies (P=0.015). No differences were found by study design or outbreak/endemic setting. This review suggests measles CFR may be declining in India. We hypothesize that increased measles vaccination coverage is the main factor contributing to the decline. Widespread vaccination increases both the average age of infection and the proportion of total measles cases previously vaccinated. Vitamin A treatment/supplementation is also likely to have contributed. In order to further reduce measles burden in India, vaccination and vitamin A treatment/supplementation coverage should be increased and a two dose vaccine strategy should be implemented in all areas.

International non-governmental organizations' provision of community-based tuberculosis care for hard-to-reach populations in Myanmar, 2013-2014.

PubMed

Soe, Kyaw Thu; Saw, Saw; van Griensven, Johan; Zhou, Shuisen; Win, Le; Chinnakali, Palanivel; Shah, Safieh; Mon, Myo Myo; Aung, Si Thu

2017-03-24

National tuberculosis (TB) programs increasingly engage with international non-governmental organizations (INGOs), especially to provide TB care in complex settings where community involvement might be required. In Myanmar, however, there is limited data on how such INGO community-based programs are organized and how effective they are. In this study, we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar, and assess their contribution to TB case detection. We conducted a descriptive study using program data from four INGOs and the National TB Program (NTP) in 2013-2014. For each INGO, we extracted information on its approach and key activities, the number of presumptive TB cases referred and undergoing TB testing, and the number of patients diagnosed with TB and their treatment outcomes. The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships. All four INGOs implemented community-based TB care in challenging contexts, targeting migrants, post-conflict areas, the urban poor, and other vulnerable populations. Two recruited community volunteers via existing community health volunteers or health structures, one via existing community leaderships, and one directly involved TB infected/affected individuals. Two INGOs compensated volunteers via performance-based financing, and two provided financial and in-kind initiatives. All relied on NTP laboratories for diagnosis and TB drugs, but provided direct observation treatment support and treatment follow-up. A total of 21 995 presumptive TB cases were referred for TB diagnosis, with 7 383 (34%) new TB cases diagnosed and almost all (98%) successfully treated. The four INGOs contributed to the detection of, on average, 36% (7 383/20 663) of the total new TB cases in their respective townships (range: 15-52%). Community-based TB care supported by INGOs successfully achieved TB case detection in hard-to-reach and vulnerable populations. This is vital to achieving the World Health Organization End TB Strategy targets. Strategies to ensure sustainability of the programs should be explored, including the need for longer-term commitment of INGOs.

Contaminated drinking water in one town manifesting as an outbreak of cryptosporidiosis in another.

PubMed

McAnulty, J M; Keene, W E; Leland, D; Hoesly, F; Hinds, B; Stevens, G; Fleming, D W

2000-08-01

In early 1992 we identified an outbreak of cryptosporidiosis in Oregon and sought to identify and control its source. We used a series of studies to identify risk factors for illness: (i) a case-control study among employees of a long-term-care facility (LTCF); (ii) a matched case-control study of the general community; (iii) a cohort study of wedding attendees; and (iv) a cross-sectional survey of the general community. Drinking Talent water was associated with illness in the LTCF (OR = 22.7, 95 % CI = 2.7-1009.0), and in the community (matched OR = 9.5, 95% CI 2.3-84.1). Drinking Talent water was associated with illness only among non-Talent residents who attended the wedding (P < 0.001) and in the community (RR = 6.5, 95 % CI 3.3-12.9). The outbreak was caused by contaminated municipal water from Talent in the absence of a discernible outbreak among Talent residents, suggesting persons exposed to contaminated water may develop immunity to cryptosporidiosis.

Birth order and risk of hepatocellular carcinoma in chronic carriers of hepatitis B virus: a case-control study in The Gambia.

PubMed

Shimakawa, Yusuke; Lemoine, Maud; Bottomley, Christian; Njai, Harr Freeya; Ndow, Gibril; Jatta, Abdoulie; Tamba, Saydiba; Bojang, Lamin; Taal, Makie; Nyan, Ousman; D'Alessandro, Umberto; Njie, Ramou; Thursz, Mark; Hall, Andrew J

2015-10-01

Early age at infection with Hepatitis B virus (HBV) increases the risk of chronic infection. Moreover, early HBV infection may further independently increase the risk of hepatocellular carcinoma (HCC) beyond its effect on chronicity. The distribution of birth order, a proxy for mode and timing of HBV transmission, was compared in The Gambia between hepatitis B surface antigen (HBsAg)-positive HCC cases recruited from hospitals (n = 72) and two HBsAg-positive control groups without HCC: population-based controls from a community HBV screening (n = 392) and hospital-based controls (n = 63). HCC risk decreased with increasing birth order in the population-based case-control analysis. Using first birth order as the reference, the odds ratios were 0.52 (95% CI: 0.20-1.36), 0.52 (0.17-1.56), 0.57 (0.16-2.05) and 0.14 (0.03-0.64) for second, third, fourth and greater than fourth birth order respectively (P = 0.01). A similar inverse association was observed in the hospital-based case-control comparison (P = 0.04). Compared to controls, HCC cases had earlier birth order, a proxy for young maternal age and maternal HBV viraemia at birth. This finding suggests that in chronic HBV carriers perinatal mother-to-infant transmission may increase HCC risk more than horizontal transmission. Providing HBV vaccine within 24 h of birth to interrupt perinatal transmission might reduce the incidence of HCC in The Gambia. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

XPAT: a toolkit to conduct cross-platform association studies with heterogeneous sequencing datasets.

PubMed

Yu, Yao; Hu, Hao; Bohlender, Ryan J; Hu, Fulan; Chen, Jiun-Sheng; Holt, Carson; Fowler, Jerry; Guthery, Stephen L; Scheet, Paul; Hildebrandt, Michelle A T; Yandell, Mark; Huff, Chad D

2018-04-06

High-throughput sequencing data are increasingly being made available to the research community for secondary analyses, providing new opportunities for large-scale association studies. However, heterogeneity in target capture and sequencing technologies often introduce strong technological stratification biases that overwhelm subtle signals of association in studies of complex traits. Here, we introduce the Cross-Platform Association Toolkit, XPAT, which provides a suite of tools designed to support and conduct large-scale association studies with heterogeneous sequencing datasets. XPAT includes tools to support cross-platform aware variant calling, quality control filtering, gene-based association testing and rare variant effect size estimation. To evaluate the performance of XPAT, we conducted case-control association studies for three diseases, including 783 breast cancer cases, 272 ovarian cancer cases, 205 Crohn disease cases and 3507 shared controls (including 1722 females) using sequencing data from multiple sources. XPAT greatly reduced Type I error inflation in the case-control analyses, while replicating many previously identified disease-gene associations. We also show that association tests conducted with XPAT using cross-platform data have comparable performance to tests using matched platform data. XPAT enables new association studies that combine existing sequencing datasets to identify genetic loci associated with common diseases and other complex traits.

Participatory Evaluation and Learning: A Case Example Involving Ripple Effects Mapping of a Tourism Assessment Program

ERIC Educational Resources Information Center

Bhattacharyya, Rani; Templin, Elizabeth; Messer, Cynthia; Chazdon, Scott

2017-01-01

Engaging communities through research-based participatory evaluation and learning methods can be rewarding for both a community and Extension. A case study of a community tourism development program evaluation shows how participatory evaluation and learning can be mutually reinforcing activities. Many communities value the opportunity to reflect…

Direct medical costs of constipation from childhood to early adulthood: a population-based birth cohort study.

PubMed

Choung, Rok Seon; Shah, Nilay D; Chitkara, Denesh; Branda, Megan E; Van Tilburg, Miranda A; Whitehead, William E; Katusic, Slavica K; Locke, G Richard; Talley, Nicholas J

2011-01-01

Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining whether longitudinal resource use is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care use associated with constipation from childhood to early adulthood. A nested case-control study was conducted to evaluate the incremental costs associated with constipation. The original sample consisted of 5718 children in a population-based birth cohort who were born during 1976 to 1982 in Rochester, MN. The cases included individuals who presented to medical facilities with constipation. The controls were matched and randomly selected among all noncases in the sample. Direct medical costs for cases and controls were collected from the time subjects were between 5 and 18 years of age or until the subject emigrated from the community. We identified 250 cases with a diagnosis of constipation in the birth cohort. Although the mean inpatient costs for cases were $9994 (95% Confidence interval [CI] 2538-37,201) compared with $2391 (95% CI 923-7452) for controls (P = 0.22) during the time period, the mean outpatient costs for cases were $13,927 (95% CI 11,325-16,525) compared with $3448 (95% CI 3771-4621) for controls (P < 0.001) during the same time period. The mean annual number of emergency department visits for cases was 0.66 (95% CI 0.62-0.70) compared with 0.34 (95% CI 0.32-0.35) for controls (P < 0.0001). Individuals with constipation have higher medical care use. Outpatient costs and emergency department use were significantly greater for individuals with constipation from childhood to early adulthood.

Community Participation, Dengue Fever Prevention and Control Practices in Swat, Pakistan.

PubMed

Zahir, Abdul; Ullah, Asad; Shah, Mussawar; Mussawar, Arsalan

2016-01-01

The aim of this study was to determine the role of community participation in prevention of dengue fever in The Swat district located in the Northern area of Khyber Pakhtunkhwa, Pakistan, which experienced a dengue fever outbreak in August, 2013. A total number of 8,963 dengue cases with 0.4% case fatality ratio were registered during the outbreak. A sample size of 354 respondents were proportionally allocated to each residential colony and then randomly selected. The association of independent variable (Community participation) and dependent variable (practices for control) were tested by using Chi Square test. Results regarding perception of practices for dengue control with community participation showed that: practices for control had significant association with organization of people to eradicate dengue mosquitoes (p=0.00), community leaders (p=0.04), community efforts (p≤0.01), use of insecticides by community people (p=0.00) and involvement of community people in awareness campaign (p=0.00). Similarly, significant associations were found between practices for control and community shared information during dengue outbreak (p=0.00), community link with health department, NGO, Other agencies (p=0.02). We conclude that the spread of dengue epidemic was aided by the ignorance, laziness of the community people and government agencies. However, the people, religious scholars, leaders and government agencies were not organized to participate in dengue prevention and eradication, hence, the chances of dengue infection increased in community. The study recommends mobilizing local communities and activating local leadership with active participation of Government and non-government organizations for initiation of preventive strategies.

Risk factors associated with the community-acquired colonization of extended-spectrum beta-lactamase (ESBL) positive Escherichia Coli. an exploratory case-control study.

PubMed

Leistner, Rasmus; Meyer, Elisabeth; Gastmeier, Petra; Pfeifer, Yvonne; Eller, Christoph; Dem, Petra; Schwab, Frank

2013-01-01

The number of extended-spectrum beta-lactamase (ESBL) positive (+) Escherichia coli is increasing worldwide. In contrast with many other multidrug-resistant bacteria, it is suspected that they predominantly spread within the community. The objective of this study was to assess factors associated with community-acquired colonization of ESBL (+) E. coli. We performed a matched case-control study at the Charité University Hospital Berlin between May 2011 and January 2012. Cases were defined as patients colonized with community-acquired ESBL (+) E. coli identified <72 h after hospital admission. Controls were patients that carried no ESBL-positive bacteria but an ESBL-negative E.coli identified <72 h after hospital admission. Two controls per case were chosen from potential controls according to admission date. Case and control patients completed a questionnaire assessing nutritional habits, travel habits, household situation and language most commonly spoken at home (mother tongue). An additional rectal swab was obtained together with the questionnaire to verify colonization status. Genotypes of ESBL (+) E. coli strains were determined by PCR and sequencing. Risk factors associated with ESBL (+) E. coli colonization were analyzed by a multivariable conditional logistic regression analysis. We analyzed 85 cases and 170 controls, respectively. In the multivariable analysis, speaking an Asian language most commonly at home (OR = 13.4, CI 95% 3.3-53.8; p<0.001) and frequently eating pork (≥ 3 meals per week) showed to be independently associated with ESBL colonization (OR = 3.5, CI 95% 1.8-6.6; p<0.001). The most common ESBL genotypes were CTX-M-1 with 44% (n = 37), CTX-M-15 with 28% (n = 24) and CTX-M-14 with 13% (n = 11). An Asian mother tongue and frequently consuming certain types of meat like pork can be independently associated with the colonization of ESBL-positive bacteria. We found neither frequent consumption of poultry nor previous use of antibiotics to be associated with ESBL colonization.

Physical activity and survival among Hispanic and non-Hispanic white long-term breast cancer survivors and population-based controls.

PubMed

Pinkston, Christina M; Baumgartner, Richard N; Connor, Avonne E; Boone, Stephanie D; Baumgartner, Kathy B

2015-12-01

We investigated the association of physical activity with survival for 601 Hispanic women and 682 non-Hispanic white women who participated in the population-based breast cancer case-control New Mexico Women's Health Study. We identified 240 deaths among cases diagnosed with a first primary invasive breast cancer between 1992 and 1994, and 88 deaths among controls. Follow-up extended through 2012 for cases and 2008 for controls. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression. Higher levels of total physical activity were inversely associated with all-cause mortality among Hispanic cases (Quartile (Q)4: HR = 0.55, 95% CI 0.31-0.99). A non-significant trend was observed for recreational activity in Hispanic cases also (Q4: HR = 0.50, 95% CI 0.23-1.09, p for trend = 0.08). No significant associations were noted for non-Hispanic white cases or for controls. The results suggest that increasing physical activity may be protective against mortality in Hispanic women with breast cancer, despite reporting lower levels of recreational activity than non-Hispanic white women or Hispanic controls. Public health programs in Hispanic communities should promote physical activity in women as a means of decreasing breast cancer risk and improving survival.

Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs

PubMed Central

Thomas, Melanie; Delgadillo-Duenas, Adriana T.; Leong, Karen; Najmabadi, Adriana; Harleman, Elizabeth; Rios, Christina; Quan, Judy; Soria, Catalina; Handley, Margaret A.

2016-01-01

Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18–39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420. PMID:27830157

Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs.

PubMed

Athavale, Priyanka; Thomas, Melanie; Delgadillo-Duenas, Adriana T; Leong, Karen; Najmabadi, Adriana; Harleman, Elizabeth; Rios, Christina; Quan, Judy; Soria, Catalina; Handley, Margaret A

2016-01-01

Background . Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods . STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18-39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results . Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion . The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.

Airborne bacterial assemblage in a zero carbon building: A case study.

PubMed

Leung, M H Y; Tong, X; Tong, J C K; Lee, P K H

2018-01-01

Currently, there is little information pertaining to the airborne bacterial communities of green buildings. In this case study, the air bacterial community of a zero carbon building (ZCB) in Hong Kong was characterized by targeting the bacterial 16S rRNA gene. Bacteria associated with the outdoor environment dominated the indoor airborne bacterial assemblage, with a modest contribution from bacteria associated with human skin. Differences in overall community diversity, membership, and composition associated with short (day-to-day) and long-term temporal properties were detected, which may have been driven by specific environmental genera and taxa. Furthermore, time-decay relationships in community membership (based on unweighted UniFrac distances) and composition (based on weighted UniFrac distances) differed depending on the season and sampling location. A Bayesian source-tracking approach further supported the importance of adjacent outdoor air bacterial assemblage in sourcing the ZCB indoor bioaerosol. Despite the unique building attributes, the ZCB microbial assemblage detected and its temporal characteristics were not dissimilar to that of conventional built environments investigated previously. Future controlled experiments and microbial assemblage investigations of other ZCBs will undoubtedly uncover additional knowledge related to how airborne bacteria in green buildings may be influenced by their distinctive architectural attributes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Community-Based Control of Aedes aegypti By Using Mesocyclops in Southern Vietnam

PubMed Central

Nam, Vu Sinh; Yen, Nguyen Thi; Duc, Hoang Minh; Tu, Tran Cong; Thang, Vu Trong; Le, Nguyen Hoang; San, Le Hoang; Loan, Luu Le; Huong, Vu Thi Que; Khanh, Ly Huynh Kim; Trang, Huynh Thi Thuy; Lam, Leonie Z. Y.; Kutcher, Simon C.; Aaskov, John G.; Jeffery, Jason A. L.; Ryan, Peter A.; Kay, Brian H.

2012-01-01

We previously reported a new community-based mosquito control strategy that resulted in elimination of Aedes aegypti (Linn.) in 40 of 46 communes in northern and central Vietnam, and with annual recurrent total costs (direct and indirect) of only $0.28–$0.89 international dollars per person. This control strategy was extended to four provinces in southern Vietnam in Long An and Hau Giang (2004–2007) and to Long An, Ben Tre, and Vinh Long (2005–2010). In a total of 14 communes with 124,743 residents, the mean ± SD of adult female Ae. aegypti was reduced from 0.93 ± 0.62 to 0.06 ± 0.09, and the reduction of immature Ae. aegypti averaged 98.8%. By the final survey, no adults could be collected in 6 of 14 communes, and one commune, Binh Thanh, also had no immature forms. Although the community-based programs also involved community education and clean-up campaigns, the prevalence of Mesocyclops in large water storage containers > 50 liters increased from 12.77 ± 8.39 to 75.69 ± 9.17% over periods of 15–45 months. At the conclusion of the study, no confirmed dengue cases were detected in four of the five communes for which diagnostic serologic analysis was performed. The rate of progress was faster in communes that were added in stages to the program but the reason for this finding was unclear. At the completion of the formal project, sustainability funds were set up to provide each commune with the financial means to ensure that community-based dengue control activities continued. PMID:22556087

Community Involvement: A Case Study of the Education Resource Center.

ERIC Educational Resources Information Center

Wilson, Stephen; And Others

The Education Resource Center (ERC) is a community-based teachers' resource center located in Chicago (Illinois). Its conceptual base is broader than that of a typical teachers center as ERC represents a community-based social movement with a wider orientation than teacher training. ERC's policy board reflects community organizations and the…

Concordance of occupational and environmental exposure information elicited from patients with Alzheimer's disease and surrogate respondents

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chong, J.P.; Turpie, I.; Haines, T.

Identification of risk factors for Alzheimer's disease through the use of well designed case-control studies has been described as a research priority. Increasing recognition of the neurotoxic potential of many industrial chemicals such as organic solvents raises the question of the occupational and environmental contribution to the etiology of this high-priority health problem. The intention of this study was to develop and evaluate a methodology that could be used in a large scale case-control study of the occupational and environmental risk factors for dementia or a population-based surveillance system for neurotoxic disorders. The specific objectives of this study were tomore » investigate: (1) the reliability of exposure-eliciting, interviewer-administered questionnaires given to patients with Alzheimer's disease (SDAT); (2) the reliability of exposure-eliciting interviewer-administered questionnaires given to the family of patients with SDAT and the agreement with the responses of the patient or surrogate respondents; (3) the reliability and agreement of responses of age- and sex-matched control patients and their families selected from geriatric care institutions and the community, with respect to the same exposure-eliciting and interviewer-administered questionnaire; and (4) the reliability of agent-based exposure ascertainment by a single, trained rater. The results of the study demonstrate that occupational and environmental histories from which exposure information can be derived is most reliably elicited from job descriptions of cases and control subjects rather than job titles alone or detailed probes for potential neurotoxic exposures. This will necessitate the use of standardized interviewer-administered instruments to derive this information in case-control studies of Alzheimer's disease or population-based surveillance systems for occupational and environmental neurotoxicity.« less

Organizing and delivering case management services: lessons from the National Long Term Care Channeling Demonstration.

PubMed

Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B

1988-01-01

This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.

Bringing the Community Along: A Case Study of a School District's Information Technology Rural Development Initiative

ERIC Educational Resources Information Center

Schafft, Kai A.; Alter, Theodore R.; Bridger, Jeffrey C.

2006-01-01

We draw on interactional community theory to analyze the relationship between information technology and local development through a case study of a geographically isolated and economically disadvantaged rural school district. This district has used state-of-the-art information technology infrastructure in a broad-based community and economic…

Homicide in children and adolescents: a case-control study in Recife, Brazil.

PubMed Central

Falbo, G. H.; Buzzetti, R.; Cattaneo, A.

2001-01-01

OBJECTIVE: The homicide rate for children and adolescents in Recife, Brazil, mostly caused by firearms, is one of the highest that has been reported. The present case-control study was designed to identify factors that were potentially modifiable through preventive interventions. METHODS: Cases were 255 homicide victims under 20 years of age, who had died in 1997 and been identified at the Institute of Forensic Medicine, Police Department, Recife, and whose relatives were interviewed by two community health workers when they claimed the corpse. The 255 controls were neighbours of the cases, paired by age and sex to them, and identified within one week of identification of each case, and whose relatives were interviewed by a third community health worker. FINDINGS: The overall homicide rate in Recife for under-20-year-olds in 1997 was 49 per 100,000; among males aged 15-19 years it was 324 per 100,000. Firearms were responsible for 97% of deaths. After multivariate logistic regression, history of personal police records (odds ratio (OR) = 18.65; 95% confidence interval (CI) = 1.91-182.50), use of illicit drugs (OR = 7.48; 95% CI = 1.86-30.17), tap water at home (OR = 7.30; 95% CI = 1.80-29.59), and maternal age at birth over 26 years (OR = 3.98; 95% CI = 1.79-8.84) were identified as risk factors, while higher education (OR = 0.22; 95% CI = 0.11-0.43), religious practice (OR = 0.25; 95% CI = 0.10-0.65), and presence of the father in the household (OR = 0.28; 95% CI = 0.09-0.81) were protective factors. CONCLUSION: Public health authorities should plan preventive interventions based on the findings of this study and should control the acquisition, possession and carrying of firearms. PMID:11217662

"It's like Tuskegee in reverse": a case study of ethical tensions in institutional review board review of community-based participatory research.

PubMed

Malone, Ruth E; Yerger, Valerie B; McGruder, Carol; Froelicher, Erika

2006-11-01

Community-based participatory research (CBPR) addresses the social justice dimensions of health disparities by engaging marginalized communities, building capacity for action, and encouraging more egalitarian relationships between researchers and communities. CBPR may challenge institutionalized academic practices and the understandings that inform institutional review board deliberations and, indirectly, prioritize particular kinds of research. We present our attempt to study, as part of a CBPR partnership, cigarette sales practices in an inner-city community. We use critical and communitarian perspectives to examine the implications of the refusal of the university institutional review board (in this case, the University of California, San Francisco) to approve the study. CBPR requires expanding ethical discourse beyond the procedural, principle-based approaches common in biomedical research settings. The current ethics culture of academia may sometimes serve to protect institutional power at the expense of community empowerment.

Recruitment Strategies and Costs Associated with Community-Based Research in a Mexican-Origin Population

ERIC Educational Resources Information Center

Mendez-Luck, Carolyn A.; Trejo, Laura; Miranda, Jeanne; Jimenez, Elizabeth; Quiter, Elaine S.; Mangione, Carol M.

2011-01-01

Purpose: We describe the recruitment strategies and personnel and materials costs associated with two community-based research studies in a Mexican-origin population. We also highlight the role that academic-community partnerships played in the outreach and recruitment process for our studies. We reviewed study documents using case study…

The effectiveness of the mumps component of the MMR vaccine: a case control study.

PubMed

Harling, Richard; White, Joanne M; Ramsay, Mary E; Macsween, Karen F; van den Bosch, Corry

2005-07-01

In 1998/1999, an outbreak of mumps occurred among children of a religious community in North East London. A case control study was conducted to assess the effectiveness of the mumps component of the MMR vaccine. One hundred and sixty-one cases of mumps were identified and 192 controls were selected. Fifty-one percent of cases and 77% of controls had a history at least one MMR vaccination. The observed effectiveness of any MMR vaccination adjusted for age, sex and general practice was 69% (95% CI: 41-84%). This is consistent with the results of other observational studies of mumps containing vaccines, but lower than the immunogenicity of mumps vaccines reported by clinical trials. This discrepancy is because observational studies tend to underestimate vaccine effectiveness, and because immunogenicity is not necessarily an accurate biological marker of vaccine effectiveness. Two doses of vaccine were more effective (88% (95% CI: 62-96%)) than a single dose (64% (95% CI: 40-78%)). The current two-dose vaccination programme remains the best method for controlling mumps infection in the community.

Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy-Case Management With a Health Promotion Program.

PubMed

Nyamathi, Adeline M; Shin, Sanghyuk S; Smeltzer, Jolene; Salem, Benissa E; Yadav, Kartik; Ekstrand, Maria L; Turner, Susan F; Faucette, Mark

Homeless female ex-offenders (homeless female offenders) exiting jail and prison are at a critical juncture during reentry and transitioning into the community setting. The purpose of the study was to compare the effect of a dialectical behavioral therapy-case management (DBT-CM) program with a health promotion (HP) program on achieving drug and alcohol abstinence among female parolees/probationers residing in the community. We conducted a multicenter parallel randomized controlled trial with 130 female parolees/probationers (aged 19-64 years) residing in the community randomly assigned to either DBT-CM (n = 65) or HP (n = 65). The trial was conducted in four community-based partner sites in Los Angeles and Pomona, California, from February 2015 to November 2016. Treatment assignment was carried out using a computer-based urn randomization program. The primary outcome was drug and alcohol use abstinence at 6-month follow up. Analysis was based on data from 116 participants with complete outcome data. Multivariable logistic regression revealed that the DBT-CM program remained an independent positive predictor of decrease in drug use among the DBT-CM participants at 6 months (p = .01) as compared with the HP program participants. Being non-White (p < .05) and having higher depressive symptom scores (p < .05) were associated with lower odds of drug use abstinence (i.e., increased the odds of drug use) at 6 months. DBT-CM increased drug and alcohol abstinence at 6-month follow-up, compared to an HP program.

Risk factors for measles among adults in Tianjin, China: Who should be controls in a case-control study?

PubMed

Wagner, Abram L; Boulton, Matthew L; Gillespie, Brenda W; Zhang, Ying; Ding, Yaxing; Carlson, Bradley F; Luo, Xiaoyan; Montgomery, JoLynn P; Wang, Xiexiu

2017-01-01

Control groups in previous case-control studies of vaccine-preventable diseases have included people immune to disease. This study examines risk factors for measles acquisition among adults 20 to 49 years of age in Tianjin, China, and compares findings using measles IgG antibody-negative controls to all controls, both IgG-negative and IgG-positive. Measles cases were sampled from a disease registry, and controls were enrolled from community registries in Tianjin, China, 2011-2015. Through a best subsets selection procedure, we compared which variables were selected at different model sizes when using IgG-negative controls or all controls. We entered risk factors for measles in two separate logistic regression models: one with measles IgG-negative controls and the other with all controls. The study included 384 measles cases and 1,596 community controls (194 IgG-negative). Visiting a hospital was an important risk factor. For specialty hospitals, the odds ratio (OR) was 4.53 (95% confidence interval (CI): 1.28, 16.03) using IgG-negative controls, and OR = 5.27 (95% CI: 2.73, 10.18) using all controls. Variables, such as age or length of time in Tianjin, were differentially selected depending on the control group. Individuals living in Tianjin ≤3 years had 2.87 (95% CI: 1.46, 5.66) times greater odds of measles case status compared to all controls, but this relationship was not apparent for IgG-negative controls. We recommend that case-control studies examining risk factors for infectious diseases, particularly in the context of transmission dynamics, consider antibody-negative controls as the gold standard.

Direct medical costs of constipation in children over 15 years: a population-based birth cohort

PubMed Central

Choung, Rok Seon; Shah, Nilay D.; Chitkara, Denesh; Branda, Megan E.; Van Tilburg, Miranda A.; Whitehead, William E.; Katusic, Slavica K.; Locke, G. Richard; Talley, Nicholas J.

2011-01-01

Background Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining if longitudinal resource utilization is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care utilization associated with constipation from childhood to early adulthood. Methods A nested case-control study was conducted to evaluate the incremental costs associated with constipation. The original sample consisted of 5,718 children in a population-based birth cohort who were born during 1976–1982 in Rochester, MN. The cases included individuals who presented to medical facilities with constipation. The controls were matched and randomly selected among all non-cases in the sample. Direct medical costs for cases and controls were collected from the time subjects were between 5–18 years of age or until the subject emigrated from the community. Results We identified 250 cases with a diagnosis of constipation in the birth cohort. While the mean inpatient costs for cases were $9994 (95% CI=2538, 37201) compared to $2391 (95% CI=923, 7452) for controls (p=0.22) over the time period, the mean outpatient costs for cases were $13927 (95% CI=11325, 16525) compared to $3448 (95% CI=3771, 4621) for controls (p<0.001) over the same time period. The mean annual number emergency department visits for cases were 0.66 (95% CI=0.62, 0.70) compared to 0.34 (95% CI=0.32, 0.35) for controls (p<0.0001). Conclusion Individuals with constipation have higher medical care utilization. Outpatient costs and ER utilization were significantly greater for individuals with constipation from childhood to early adulthood. PMID:20890220

Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice

PubMed Central

Rodrigues, Laura C; Viviani, Laura; Dodds, Julie P; Evans, Meirion R; Hunter, Paul R; Gray, Jim J; Letley, Louise H; Rait, Greta; Tompkins, David S; O'Brien, Sarah J

2011-01-01

Objectives To estimate, overall and by organism, the incidence of infectious intestinal disease (IID) in the community, presenting to general practice (GP) and reported to national surveillance. Design Prospective, community cohort study and prospective study of GP presentation conducted between April 2008 and August 2009. Setting Eighty-eight GPs across the UK recruited from the Medical Research Council General Practice Research Framework and the Primary Care Research Networks. Participants 6836 participants registered with the 88 participating practices in the community study; 991 patients with UK-acquired IID presenting to one of 37 practices taking part in the GP presentation study. Main outcome measures IID rates in the community, presenting to GP and reported to national surveillance, overall and by organism; annual IID cases and GP consultations by organism. Results The overall rate of IID in the community was 274 cases per 1000 person-years (95% CI 254 to 296); the rate of GP consultations was 17.7 per 1000 person-years (95% CI 14.4 to 21.8). There were 147 community cases and 10 GP consultations for every case reported to national surveillance. Norovirus was the most common organism, with incidence rates of 47 community cases per 1000 person-years and 2.1 GP consultations per 1000 person-years. Campylobacter was the most common bacterial pathogen, with a rate of 9.3 cases per 1000 person-years in the community, and 1.3 GP consultations per 1000 person-years. We estimate that there are up to 17 million sporadic, community cases of IID and 1 million GP consultations annually in the UK. Of these, norovirus accounts for 3 million cases and 130 000 GP consultations, and Campylobacter is responsible for 500 000 cases and 80 000 GP consultations. Conclusions IID poses a substantial community and healthcare burden in the UK. Control efforts must focus particularly on reducing the burden due to Campylobacter and enteric viruses. PMID:21708822

Professional Development on an International Scale: Council of Europe--Pestalozzi Programme Virtual Community of Practice

ERIC Educational Resources Information Center

Mompoint Gaillard, Pascale; Rajic, Višnja

2014-01-01

Communities of practice as organisations of learning have developed different forms as: task-based, practice-based or knowledge based communities (Barab et al., 2004). The paper presents a case study of a successful community of practice developed under the umbrella of Council of Europe Pestalozzi programme for teacher development. The programme…

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

PubMed Central

Nutbeam, D; Smith, C; Murphy, S; Catford, J

1993-01-01

STUDY OBJECTIVE--To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. DESIGN--Semistructured interviews of health promotion managers. SETTING--Wales and two reference health regions in England. PARTICIPANTS--Nine health promotion managers in Wales and 18 in England. MEASUREMENTS AND MAIN RESULTS--Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. CONCLUSION--Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended. PMID:8326270

The added value of a mobile application of Community Case Management on referral, re-consultation and hospitalization rates of children aged under 5 years in two districts in Northern Malawi: study protocol for a pragmatic, stepped-wedge cluster-randomized controlled trial.

PubMed

Hardy, Victoria; O'Connor, Yvonne; Heavin, Ciara; Mastellos, Nikolaos; Tran, Tammy; O'Donoghue, John; Fitzpatrick, Annette L; Ide, Nicole; Wu, Tsung-Shu Joseph; Chirambo, Griphin Baxter; Muula, Adamson S; Nyirenda, Moffat; Carlsson, Sven; Andersson, Bo; Thompson, Matthew

2017-10-11

There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi. This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017. This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries. ClinicalTrials.gov, ID: NCT02763345 . Registered on 3 May 2016.

[Community-based intervention to control STD/AIDS in the Amazon region, Brazil].

PubMed

Benzaken, Adele Schwartz; Galbán Garcia, Enrique; Sardinha, José Carlos Gomes; Pedrosa, Valderiza Lourenço; Paiva, Vera

2007-12-01

To describe a case study of community-based intervention, developed in a constructionist-emancipatory framework to control STD/AIDS. Descriptive study developed in the town of Manacapuru, in the state of Amazonas, from 1997 to 2004, focusing on procedures designed in collaboration with government agents, health professionals and the community. Data on the dynamics of prostitution and condom sales in this town, preventive practices and STD/AIDS care and process assessment were collected. Actions targeting STD prevention and care in the public healthcare system, a testing center, an epidemiological surveillance system and sex workers' qualification were established concomitantly. It was observed the strengthening of sex workers as peer educators and their legitimization as citizens and health agents in projects involving transvestites, homosexuals and students. There was an increase in condom sales in town, as well as in condom use among sex workers; reduction in bacterial STD; and stabilization of the incidence of HIV/AIDS infections and congenital syphilis. The sustainability of the intervention program studied, organized within the sphere of action of the Sistema Unico de Saúde (National Health System), was promoted by a political pact, which guaranteed headquarters and municipal law-regulated budget, as well as by the constant debate over the process and program results. The study strengthened the notion that effective control of STD/AIDS depends on a synergic approach that combines interventions on individual (biological-behavioral), sociocultural and programmatic levels.

Assessment of the epidemiology and burden of measles in Southern Mozambique.

PubMed

Mandomando, Inácio; Naniche, Denise; Pasetti, Marcela F; Cuberos, Lilian; Sanz, Sergi; Vallès, Xavier; Sigauque, Betuel; Macete, Eusébio; Nhalungo, Delino; Kotloff, Karen L; Levine, Myron M; Alonso, Pedro L

2011-07-01

Measles has been a major killer among vaccine-preventable diseases in children < 5 years of age in developing countries. Despite progress in global efforts to reduce mortality, measles remains a public health problem. Hospital-based measles surveillance was conducted in Manhica, Mozambique (July 2001-September 2004). Suspected cases and community-based controls were enrolled, and blood was collected for immunoglobulin M (IgM) confirmation. Two hundred fifty-three suspected cases and 477 controls were enrolled, with 85% (216 of 253) cases reported during a measles outbreak. Measles-IgM confirmation was 30% among suspected cases and 5% in controls. Fifty-eight percent (14 of 24) of laboratory-confirmed cases had records indicating previous measles vaccination. Mortality was 3% (8 of 246) among cases and 1% among controls (6 of 426). Forty-five percent (33 of 74) of cases were < 24 months of age and 22% occurred in infants < 9 months of age and were associated with a high case-fatality rate (25%). Our data suggest that improved diagnostics, new tools to protect infants < 9 months of age, and a supplemental dose of measles vaccine could assist measles control.

Leadership to Build a Democratic Community within School: A Case Study of Two Korean High Schools

ERIC Educational Resources Information Center

Kang, Young Taek; Printy, Susan

2009-01-01

This article aims to explore how democratic community is manifest in schools in Korea. It also tries to examine how leadership, specifically transformational leadership, functions in shaping a democratic community within a school. Toward this aim, we have conducted a case study of two religious high schools in Korea. Based on the findings from the…

High-density livestock operations, crop field application of manure, and risk of community-associated methicillin-resistant Staphylococcus aureus infection, Pennsylvania, USA

PubMed Central

Casey, Joan A.; Curriero, Frank C.; Cosgrove, Sara E.; Nachman, Keeve E.; Schwartz, Brian S.

2015-01-01

Context Nearly 80% of antibiotics in the United States are sold for use in livestock feeds. The manure produced by these livestock contains antibiotic-resistant bacteria, resistance genes, and antibiotics, and is subsequently applied to crop fields where it may put community members at risk for antibiotic-resistant infections. Objective To assess the association between individual exposure to swine and dairy/veal industrial agriculture and risk of methicillin-resistant Staphylococcus aureus (MRSA) infection. Design, Setting, and Participants A population-based, nested case-control study of Geisinger primary care patients in Pennsylvania from 2005–2010. Incident MRSA cases were identified using electronic health records, classified as community-associated or healthcare-associated, and frequency-matched to randomly selected controls and patients with skin and soft tissue infection. Nutrient management plans were used to create two exposure variables: seasonal crop field manure application and number of livestock at the operation. In a sub-study we collected 200 isolates from patients stratified by location of diagnosis and proximity to livestock operations. Main outcome measures Community-associated MRSA, healthcare associated-MRSA, and skin and soft tissue infection status (with no history of MRSA) compared to controls. Results From 446,480 patients, 1539 community-associated MRSA, 1335 healthcare-associated MRSA, 2895 skin and soft tissue infection cases, and 2914 controls were included. After adjustment for MRSA risk factors, the highest quartile of swine crop field exposure was significantly associated with community-associated MRSA, healthcare-associated MRSA, and skin and soft tissue infection case status (adjusted odds ratio, 1.38 [95% CI, 1.13–1.69], 1.30 [95% CI, 1.05–1.61], and 1.37 [95% CI, 1.18–1.60], respectively); and there was a trend of increasing odds across quartiles for each outcome (all P for trend ≤0.01). There were similar but weaker associations of swine operations with community-associated MRSA and skin and soft tissue infection. Molecular testing of 200 isolates identified 31 unique spa types, none of which corresponded to CC398, but some have been previously found in swine. Conclusion Proximity to swine manure application to crop fields and livestock operations each was associated with MRSA and skin and soft tissue infection. These findings contribute to the growing concern about the potential public health impacts of high-density livestock production. PMID:24043228

Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis

PubMed Central

Zhang, HaiYang; Ehiri, John; Yang, Huan; Tang, Shenglan; Li, Ying

2016-01-01

Background Poor adherence to tuberculosis (TB) treatment can lead to prolonged infectivity and poor treatment outcomes. Directly observed treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medication. Although community-based DOT (CB-DOT) programs have been widely studied and promoted, their effectiveness has been inconsistent. The aim of this study was to critical appraise and summarize evidence of the effects of CB-DOT on TB treatment outcomes. Methods Studies published up to the end of February 2015 were identified from three major international literature databases: Medline/PubMed, EBSCO, and EMBASE. Unpublished data from the grey literature were identified through Google and Google Scholar searches. Results Seventeen studies involving 12,839 pulmonary TB patients (PTB) in eight randomized controlled trials (RCTs) and nine cohort studies from 12 countries met the criteria for inclusion in this review and 14 studies were included in meta-analysis. Compared with clinic-based DOT, pooled results of RCTs for all PTB cases (including smear-negative or -positive, new or retreated TB cases) and smear-positive PTB cases indicated that CB-DOT promoted successful treatment [pooled RRs (95%CIs): 1.11 (1.02–1.19) for all PTB cases and 1.11 (1.02–1.19) for smear-positive PTB cases], and completed treatment [pooled RRs (95%CIs): 1.74(1.05, 2.90) for all PTB cases and 2.22(1.16, 4.23) for smear-positive PTB cases], reduced death [pooled RRs (95%CIs): 0.44 (0.26–0.72) for all PTB cases and 0.39 (0.23–0.66) for smear-positive PTB cases], and transfer out [pooled RRs (95%CIs): 0.37 (0.23–0.61) for all PTB cases and 0.42 (0.25–0.70) for smear-positive PTB cases]. Pooled results of all studies (RCTs and cohort studies) with all PTB cases demonstrated that CB-DOT promoted successful treatment [pooled RR (95%CI): 1.13 (1.03–1.24)] and curative treatment [pooled RR (95%CI): 1.24 (1.04–1.48)] compared with self-administered treatment. Conclusions CB-DOT did improved TB treatment outcomes according to the pooled results of included studies in this review. Studies on strategies for implementation of patient-centered and community-centered CB-DOT deserve further attention. PMID:26849656

Community owned solutions for fire management in tropical ecosystems: case studies from Indigenous communities of South America

PubMed Central

2016-01-01

Fire plays an increasingly significant role in tropical forest and savanna ecosystems, contributing to greenhouse gas emissions and impacting on biodiversity. Emerging research shows the potential role of Indigenous land-use practices for controlling deforestation and reducing CO2 emissions. Analysis of satellite imagery suggests that Indigenous lands have the lowest incidence of wildfires, significantly contributing to maintaining carbon stocks and enhancing biodiversity. Yet acknowledgement of Indigenous peoples' role in fire management and control is limited, and in many cases dismissed, especially in policy-making circles. In this paper, we review existing data on Indigenous fire management and impact, focusing on examples from tropical forest and savanna ecosystems in Venezuela, Brazil and Guyana. We highlight how the complexities of community owned solutions for fire management are being lost as well as undermined by continued efforts on fire suppression and firefighting, and emerging approaches to incorporate Indigenous fire management into market- and incentive-based mechanisms for climate change mitigation. Our aim is to build a case for supporting Indigenous fire practices within all scales of decision-making by strengthening Indigenous knowledge systems to ensure more effective and sustainable fire management. This article is part of the themed issue ‘The interaction of fire and mankind’. PMID:27216507

Community owned solutions for fire management in tropical ecosystems: case studies from Indigenous communities of South America.

PubMed

Mistry, Jayalaxshmi; Bilbao, Bibiana A; Berardi, Andrea

2016-06-05

Fire plays an increasingly significant role in tropical forest and savanna ecosystems, contributing to greenhouse gas emissions and impacting on biodiversity. Emerging research shows the potential role of Indigenous land-use practices for controlling deforestation and reducing CO2 emissions. Analysis of satellite imagery suggests that Indigenous lands have the lowest incidence of wildfires, significantly contributing to maintaining carbon stocks and enhancing biodiversity. Yet acknowledgement of Indigenous peoples' role in fire management and control is limited, and in many cases dismissed, especially in policy-making circles. In this paper, we review existing data on Indigenous fire management and impact, focusing on examples from tropical forest and savanna ecosystems in Venezuela, Brazil and Guyana. We highlight how the complexities of community owned solutions for fire management are being lost as well as undermined by continued efforts on fire suppression and firefighting, and emerging approaches to incorporate Indigenous fire management into market- and incentive-based mechanisms for climate change mitigation. Our aim is to build a case for supporting Indigenous fire practices within all scales of decision-making by strengthening Indigenous knowledge systems to ensure more effective and sustainable fire management.This article is part of the themed issue 'The interaction of fire and mankind'. © 2016 The Author(s).

Risk factors associated with asbestos-related diseases: a community-based case-control study.

PubMed

Rosell-Murphy, Magdalena-Isabel; Abós-Herràndiz, Rafael; Olivella, Josep Tarrés; Alberti-Casas, Constança; Allas, Isabel García; Artés, Xavier Martinez; Günther, Ilona Krier; Malet, Isidre Grimau; Martínez, Ramon Orriols; Canela-Soler, Jaume

2013-08-06

Asbestos is a first level carcinogen. However, few epidemiological studies analyse the risk and protective factors associated with asbestos-related diseases and follow up these conditions in the general population. Pleural mesothelioma, caused by inhalation of asbestos fibres at work, at home or in the environment, is the most representative asbestos-related disease.The objectives of this study are to analyse the risk and protective factors associated with asbestos-related diseases and to investigate the incidence of new clinical manifestations in patients already diagnosed with some form of ARD. We have designed a matched case-control study with follow up of both cohorts from a population of a health district of the Barcelona province that has been exposed to asbestos for a period of 90 years. A better understanding of asbestos-related diseases should improve i) the clinical and epidemiological follow up of patients with this condition; ii) the design of new treatment strategies; iii) and the development of preventive activities. At the end of the study, the two cohorts created in this study (affected cases and healthy controls) will constitute the basis for future research.

Are community-based forest enterprises in the tropics financially viable? Case studies from the Brazilian Amazon

Treesearch

Shoana Humphries; Thomas P. Holmes; Karen Kainer; Carlos Gabriel Goncalves Koury; Edson Cruz; Rosana de Miranda Rocha

2012-01-01

Community-based forest management is an integral component of sustainable forest management and conservation in the Brazilian Amazon, where it has been heavily subsidized for the last ten years. Yet knowledge of the financial viability and impact of community-based forest enterprises (CFEs) is lacking. This study evaluates the profitability of three CFEs in the...

Community-Based Inquiry in Allied Health Biochemistry Promotes Equity by Improving Critical Thinking for Women and Showing Promise for Increasing Content Gains for Ethnic Minority Students

ERIC Educational Resources Information Center

Goeden, Terrah J.; Kurtz, Martha J.; Quitadamo, Ian J.; Thomas, Carin

2015-01-01

In the Community-Based Inquiry (CBI) instructional method, cooperative student groups complete case study activities based on scientific literature and conduct their own laboratory investigations that address authentic community needs. This study compared critical thinking and content knowledge outcomes between traditional Introduction to…

More money more motivation? Master Settlement Agreement and tobacco control funding in communities of color.

PubMed

Themba-Nixon, Makani; Sutton, Charyn D; Shorty, Lawrence; Lew, Rod; Baezconde-Garbanati, Lourdes

2004-07-01

This article examines state Master Settlement Agreement (MSA) funding of tobacco control in communities of color. The primary research question was whether MSA monies resulted in dedicated funding for communities of color at the state level. This article also explores some of the historical factors that shape the relationship of communities of color to MSA funding as well as some of the institutional barriers to implementing comprehensive tobacco control programs in these communities. Three model approaches to funding parity in tobacco control programs were examined as case studies. Because of the limited amount of research available in this area, the data on tobacco control funding for communities of color was collected in interviews with state tobacco control agencies during October 2003. Findings supported our hypothesis that there were few dedicated resources at the state level for tobacco control and prevention in communities of color.

Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013.

PubMed

Germinario, Cinzia; Caprioli, Alfredo; Giordano, Mario; Chironna, Maria; Gallone, Maria Serena; Tafuri, Silvio; Minelli, Fabio; Maugliani, Antonella; Michelacci, Valeria; Santangelo, Luisa; Mongelli, Onofrio; Montagna, Cosimo; Scavia, Gaia

2016-09-22

In summer 2013, an excess of paediatric cases of haemolytic uraemic syndrome (HUS) in a southern region of Italy prompted the investigation of a community-wide outbreak of Shiga toxin 2-producing Escherichia coli (STEC) O26:H11 infections. Case finding was based on testing patients with HUS or bloody diarrhoea for STEC infection by microbiological and serological methods. A case-control study was conducted to identify the source of the outbreak. STEC O26 infection was identified in 20 children (median age 17 months) with HUS, two of whom reported severe neurological sequelae. No cases in adults were detected. Molecular typing showed that two distinct STEC O26:H11 strains were involved. The case-control study showed an association between STEC O26 infection and consumption of dairy products from two local plants, but not with specific ready-to-eat products. E.coli O26:H11 strains lacking the stx genes were isolated from bulk milk and curd samples, but their PFGE profiles did not match those of the outbreak isolates. This outbreak supports the view that infections with Stx2-producing E. coli O26 in children have a high probability of progressing to HUS and represent an emerging public health problem in Europe. This article is copyright of The Authors, 2016.

How has the economic downturn affected communities and implementation of science-based prevention in the randomized trial of communities that care?

PubMed

Kuklinski, Margaret R; Hawkins, J David; Plotnick, Robert D; Abbott, Robert D; Reid, Carolina K

2013-06-01

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods.

How Has the Economic Downturn Affected Communities and Implementation of Science-Based Prevention in the Randomized Trial of Communities That Care?

PubMed Central

Kuklinski, Margaret R.; Hawkins, J. David; Plotnick, Robert D.; Abbott, Robert D.; Reid, Carolina K.

2013-01-01

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods. PMID:23054169

International travel is a risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae acquisition in children: A case-case-control study in an urban U.S. hospital.

PubMed

Strysko, Jonathan P; Mony, Vidya; Cleveland, Jeremiah; Siddiqui, Hanna; Homel, Peter; Gagliardo, Christina

Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) infections are increasing in both adults and children. The aim of this study was to describe the epidemiology of children with ESBL in an ethnically-diverse population, to determine what proportion of these infections were community-onset, and to identify risk factors predisposing children to ESBL acquisition. A case-case-control study of children aged 0-18 years was conducted from 2012 to 2014. Patients with ESBL (detected via VITEK2) were matched 1:1:5 (based on age, sex, specimen source, and healthcare setting) with non-ESBL and uninfected controls. Data on prior antibiotic and healthcare exposure, international travel, prior urinary tract infection (UTI), comorbid gastrointestinal (GI), genitourinary (GU), neurologic, and immunocompromising conditions were collected and compared. Seventy-six patients were identified with 85 ESBL infections, of which 77 (91%) were E. coli. ESBL was isolated most frequently from urine (n = 72, 85%). Most infections were community-onset (n = 76, 89%) and were managed in the ambulatory setting (n = 47, 62%). On multivariate analysis, international travel (p < 0.001, OR 8.93; CI 2.92-27.78), comorbid GI condition (p = 0.002, OR 2.65, CI 1.36-5.15), Asian race (p = 0.005, OR 2.56, CI 1.34-4.89) and prior UTI (p < 0.001, OR 8.06, CI 3.47-18.87) were significant risk factors for ESBL. Most ESBL infections in this study were community-onset. To our knowledge, this is the first description of international travel as a risk factor for ESBL acquisition in children in the United States. Copyright © 2016 Elsevier Ltd. All rights reserved.

Driving following Kava Use and Road Traffic Injuries: A Population-Based Case-Control Study in Fiji (TRIP 14).

PubMed

Wainiqolo, Iris; Kafoa, Berlin; Kool, Bridget; Robinson, Elizabeth; Herman, Josephine; McCaig, Eddie; Ameratunga, Shanthi

2016-01-01

To investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available. Data for this population-based case-control study were collected from drivers of 'case' vehicles involved in serious injury-involved crashes (where at least one road user was killed or admitted to hospital for 12 hours or more) and 'control' vehicles representative of 'driving time' in the study base. Structured interviewer administered questionnaires collected self-reported participant data on demographic characteristics and a range of risk factors including kava use and potential confounders. Unconditional logistic regression models estimated odds ratios relating to the association between kava use and injury-involved crash risk. Overall, 23% and 4% of drivers of case and control vehicles, respectively, reported consuming kava in the 12 hours prior to the crash or road survey. After controlling for assessed confounders, driving following kava use was associated with a four-fold increase in the odds of crash involvement (Odds ratio: 4.70; 95% CI: 1.90-11.63). The related population attributable risk was 18.37% (95% CI: 13.77-22.72). Acknowledging limited statistical power, we did not find a significant interaction in this association with concurrent alcohol use. In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common.

An integrated pest control strategy against the Asian tiger mosquito in northern Italy: a case study.

PubMed

Baldacchino, Frédéric; Bussola, Francesca; Arnoldi, Daniele; Marcantonio, Matteo; Montarsi, Fabrizio; Capelli, Gioia; Rosà, Roberto; Rizzoli, Annapaola

2017-01-01

In Europe, Aedes albopictus is an invasive mosquito species known to be a major nuisance as well as a vector of a range of arboviruses. A number of studies have indicated that community participation programmes are an effective pest control tool to reduce mosquito populations. However, few studies have evaluated the effectiveness of a community-based approach in Europe. In this study, we examined two Ae. albopictus control strategies that implemented a community-based approach in northern Italy: one was a partial intervention that included a public education campaign and the larviciding of public spaces, and the other was a full intervention that additionally included a door-to-door campaign. This latter consisted of going door to door actively to educate residents about control measures and deliver larvicide tablets for treating catch basins at home. A site where no intervention measures were carried out was used as a control. In the site where a full intervention was carried out, Ae. albopictus egg density was 1.6 times less than at the site that received partial intervention, and 1.9 times less than at the non-intervention site. No significant reduction in egg density was achieved in the partial intervention site. In our study, Ae. albopictus populations were most effectively reduced by larviciding both public and private catch basins. Door-to-door education was effective in convincing residents to apply control measures on their property; however, this method was labour intensive and costly. It may be possible to reduce personnel costs by involving volunteers or using a 'hot spot' approach. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Quality Audit in the Fastener Industry

NASA Technical Reports Server (NTRS)

Reagan, John R.

1995-01-01

Both the financial and quality communities rely on audits to verify customers records. The financial community is highly structured around three categories of risk, INHERENT RISK, CONTROL RISK, and DETECTION RISK. Combined, the product of these three categories constitute the AUDIT RISK. The financial community establishes CONTROL RISK based in large part on a systems level understanding of the process flow. This system level understanding is best expressed in a flowchart. The quality community may be able to adopt this structure and thereby reduce cost while maintaining and enhancing quality. The quality community should attempt to flowchart the systems level quality process before beginning substantive testing. This theory needs to be applied in several trial cases to prove or disprove this hypothesis

Quality audit in the fastener industry

NASA Astrophysics Data System (ADS)

Reagan, John R.

1995-09-01

Both the financial and quality communities rely on audits to verify customers records. The financial community is highly structured around three categories of risk, INHERENT RISK, CONTROL RISK, and DETECTION RISK. Combined, the product of these three categories constitute the AUDIT RISK. The financial community establishes CONTROL RISK based in large part on a systems level understanding of the process flow. This system level understanding is best expressed in a flowchart. The quality community may be able to adopt this structure and thereby reduce cost while maintaining and enhancing quality. The quality community should attempt to flowchart the systems level quality process before beginning substantive testing. This theory needs to be applied in several trial cases to prove or disprove this hypothesis

Using Case-Based Pedagogy in the Philippines: A Narrative Inquiry

NASA Astrophysics Data System (ADS)

Arellano, Elvira L.; Barcenal, Tessie L.; Bilbao, Purita P.; Castellano, Merilin A.; Nichols, Sharon E.; Tippins, Deborah J.

2001-04-01

This study features use of case-based pedagogy as a context for exploring science teacher education reform. A central premise of the study is that science teacher education reform is a complex process characterised by the individual and collective narrative histories of teachers. The study was conducted at West Visayas State University in the Philippines as a collaborative research endeavour involving two US and four Filipino science teacher educators. The centrepiece of this study was a case experience prompted by reflection on prospective and practicing elementary teachers' written cases. Results of the study are presented here as a layered narrative. An initial layer explores how a case, written by a prospective teacher, was interwoven with her past and future life history. A second layer looks at sociocultural and professional tensions that mediated the participants' case experience. A third layer represents how the case experience provided a community that supported critical reflection among the research team members. Implications from the study emphasise that case-based pedagogy can serve as a basis for critical reflection to inform community-based approaches to science teacher education pedagogical and research reform.

Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

PubMed Central

2012-01-01

Background Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes. Methods We searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented. Results Ten RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above. Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes. PMID:23151143

Smoke-free workplace ballot campaigns: case studies from Missouri and lessons for policy and media advocacy.

PubMed

Bach, Laura E; Shelton, Sarah C; Moreland-Russell, Sarah; Israel, Kendre

2013-01-01

To assess the key components of smoke-free campaigns that may have influenced voting outcomes in three communities. Community case studies with content analysis of tobacco-related newspaper articles. Three semiurban Missouri communities. One hundred eighty-one articles referencing tobacco published during the campaigns and five key informant interviews. Articles were coded for type, community referenced, tobacco control position, source of quotations, use of evidence, and frame. Semistructured interviews with key informants collected additional information. Descriptive statistics were utilized to examine media coverage in each community. Key themes and events for each campaign were identified from qualitative interviews. The only community that failed to pass its initiative had the highest proportion of letters to the editor (81.1%), anti-tobacco control articles (34.2%), use of a rights frame (28.8%), no evidence used (36.9%), no neighboring communities with policies, strong Tea Party presence, and no support from the chamber of commerce. Across all communities, more articles incorporating health frames were pro-tobacco control (70.7%) and more articles with a rights frame were anti-tobacco control (62.0%), compared to other positions. Several factors can influence the policy process. Tobacco control policy advocates facing strong opposition should consider the many factors (demographics, proximity to other adopting localities, politics) driving the debate and use media as an avenue to influence the discussion, connect with the public and policymakers, and mobilize proponents.

Using an intervention mapping approach for planning, implementing and assessing a community-led project towards malaria elimination in the Eastern Province of Rwanda.

PubMed

Ingabire, Chantal Marie; Hakizimana, Emmanuel; Kateera, Fredrick; Rulisa, Alexis; Van Den Borne, Bart; Nieuwold, Ingmar; Muvunyi, Claude; Koenraadt, Constantianus J M; Van Vugt, Michele; Mutesa, Leon; Alaii, Jane

2016-12-16

Active community participation in malaria control is key to achieving malaria pre-elimination in Rwanda. This paper describes development, implementation and evaluation of a community-based malaria elimination project in Ruhuha sector, Bugesera district, Eastern province of Rwanda. Guided by an intervention mapping approach, a needs assessment was conducted using household and entomological surveys and focus group interviews. Data related to behavioural, epidemiological, entomological and economical aspects were collected. Desired behavioural and environmental outcomes were identified concurrently with behavioural and environmental determinants. Theoretical methods and their practical applications were enumerated to guide programme development and implementation. An operational plan including the scope and sequence as well as programme materials was developed. Two project components were subsequently implemented following community trainings: (1) community malaria action teams (CMATs) were initiated in mid-2014 as platforms to deliver malaria preventive messages at village level, and (2) a mosquito larval source control programme using biological substances was deployed for a duration of 6 months, implemented from January to July 2015. Process and outcome evaluation has been conducted for both programme components to inform future scale up. The project highlighted malaria patterns in the area and underpinned behavioural and environmental factors contributing to malaria transmission. Active involvement of the community in collaboration with CMATs contributed to health literacy, particularly increasing ability to make knowledgeable decisions in regards to malaria prevention and control. A follow up survey conducted six months following the establishment of CMATs reported a reduction of presumed malaria cases at the end of 2014. The changes were related to an increase in the acceptance and use of available preventive measures, such as indoor residual spraying and increase in community-based health insurance membership, also considered as a predictor of prompt and adequate care. The innovative larval source control intervention contributed to reduction in mosquito density and nuisance bites, increased knowledge and skills for malaria control as well as programme ownership. This community-based programme demonstrated the feasibility and effectiveness of active community participation in malaria control activities, which largely contributed to community empowerment and reduction of presumed malaria in the area. Further studies should explore how gains may be sustained to achieve the goal of malaria pre-elimination.

A community-based health education analysis of an infectous disease control program in Nigeria.

PubMed

Adeyanju, O M

1987-01-01

This descriptive study utilized the strategy of primary health care in program development-especially a community-based health education intervention approach-in the control of guinea-worm in rural communities of Nigeria. Two closely related rural communities in two states served as target groups. Committee system approach, nominal group process, interview methods, audio-visual aids, and health care volunteer trainingship were the educational strategies employed in a control and experimental set up. The PRECEDE model was applied in the analysis. Results show a significant control action on guinea-worm infestation in the experimental community and a tremendous achievement in preventive health education interventions through organized community participation/involvement and ultimate self-reliance and individual responsibility. A positive increase in health knowledge and attitude examined through interview method, and observable changes in health behavior were noticed. Wells were provided, drinking water treated, while personal and community health promotion strategies were encouraged by all. The study has shown the effectiveness/efficacy of a community-based effort facilitated by a health educator.

Risk Factors for Acute Unintentional Poisoning among Children Aged 1–5 Years in the Rural Community of Sri Lanka

PubMed Central

Jayamanne, Shaluka F.; Jayasinghe, Chamilka Y.

2017-01-01

Background Acute poisoning in children is a major preventable cause of morbidity and mortality in both developed and developing countries. However, there is a wide variation in patterns of poisoning and related risk factors across different geographic regions globally. This hospital based case-control study identifies the risk factors of acute unintentional poisoning among children aged 1−5 years of the rural community in a developing Asian country. Methods This hospital based case-control study included 600 children. Each group comprised three hundred children and all children were recruited at Anuradhapura Teaching Hospital, Sri Lanka, over two years (from February 2012 to January 2014). The two groups were compared to identify the effect of 23 proposed risk factors for unintentional poisoning using multivariate analysis in a binary logistic regression model. Results Multivariate analysis identified eight risk factors which were significantly associated with unintentional poisoning. The strongest risk factors were inadequate supervision (95% CI: 15.4–52.6), employed mother (95% CI: 2.9–17.5), parental concern of lack of family support (95% CI: 3.65–83.3), and unsafe storage of household poisons (95% CI: 1.5–4.9). Conclusions Since inadequate supervision, unsafe storage, and unsafe environment are the strongest risk factors for childhood unintentional poisoning, the effect of community education to enhance vigilance, safe storage, and assurance of safe environment should be evaluated. PMID:28932247

Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010-2012.

PubMed

Ferdinands, Jill M; Olsho, Lauren E W; Agan, Anna A; Bhat, Niranjan; Sullivan, Ryan M; Hall, Mark; Mourani, Peter M; Thompson, Mark; Randolph, Adrienne G

2014-09-01

No studies have examined the effectiveness of influenza vaccine against intensive care unit (ICU) admission associated with influenza virus infection among children. In 2010-2011 and 2011-2012, children aged 6 months to 17 years admitted to 21 US pediatric intensive care units (PICUs) with acute severe respiratory illness and testing positive for influenza were enrolled as cases; children who tested negative were PICU controls. Community controls were children without an influenza-related hospitalization, matched to cases by comorbidities and geographic region. Vaccine effectiveness was estimated with logistic regression models. We analyzed data from 44 cases, 172 PICU controls, and 93 community controls. Eighteen percent of cases, 31% of PICU controls, and 51% of community controls were fully vaccinated. Compared to unvaccinated children, children who were fully vaccinated were 74% (95% CI, 19% to 91%) or 82% (95% CI, 23% to 96%) less likely to be admitted to a PICU for influenza compared to PICU controls or community controls, respectively. Receipt of 1 dose of vaccine among children for whom 2 doses were recommended was not protective. During the 2010-2011 and 2011-2012 US influenza seasons, influenza vaccination was associated with a three-quarters reduction in the risk of life-threatening influenza illness in children. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Breast feeding, but not use of oral contraceptives, is associated with a reduced risk of rheumatoid arthritis.

PubMed

Pikwer, M; Bergström, U; Nilsson, J-A; Jacobsson, L; Berglund, G; Turesson, C

2009-04-01

To determine whether breast feeding or the use of oral contraceptives (OCs) affects the future risk of rheumatoid arthritis (RA) in a community-based prospective cohort. A community-based health survey (18 326 women) was linked to regional and national registers, and incident cases of RA were identified. All women with a diagnosis of RA after inclusion in the health survey (n = 136) and four female controls for every case, who were alive and free from RA when the index person was given a diagnosis of RA, were included in a case-control study. Data on lifestyle factors at baseline were derived from a self-administered questionnaire. Potential predictors were examined in logistic regression models. 136 women with incident RA were compared with 544 age-matched controls. A longer history of breast feeding was associated with a reduced risk of RA (OR 0.46 (95% CI 0.24 to 0.91) for women who had breast fed for >/=13 months and OR 0.74 (95% CI 0.45 to 1.20) for those who had breast fed for 1-12 months, compared with those who had never breast fed). The protective effect of longer breast feeding remained significant after adjustment for smoking and level of education in multivariate models, and point estimates were protective also when the analyses were restricted to parous women. Neither parity nor OC use had any significant effect on the risk of RA. In this study, long-term breast feeding, but not OC use, was associated with a significant reduction in the risk of RA.

An academic practice's transition to the business of medicine in the community. A case study.

PubMed

Griffin, S L; Schryver, D L

2000-01-01

This case study highlights the problems confronting a clinical practice corporation affiliated with a major medical school, and the business realizations it made in the acquisition of a community-based clinic. Launching a financially viable enterprise requires careful planning, determination of formal goals and expectations, an appropriate mix of physicians and services, a specific marketing campaign and community support.

Risk Factors for SARS among Persons without Known Contact with SARS Patients, Beijing, China

PubMed Central

Wu, Jiang; Xu, Fujie; Zhou, Weigong; Feikin, Daniel R.; Lin, Chang-Ying; He, Xiong; Zhu, Zonghan; Liang, Wannian; Chin, Daniel P.

2004-01-01

Most cases of severe acute respiratory syndrome (SARS) have occurred in close contacts of SARS patients. However, in Beijing, a large proportion of SARS cases occurred in persons without such contact. We conducted a case-control study in Beijing that compared exposures of 94 unlinked, probable SARS patients with those of 281 community-based controls matched for age group and sex. Case-patients were more likely than controls to have chronic medical conditions or to have visited fever clinics (clinics at which possible SARS patients were separated from other patients), eaten outside the home, or taken taxis frequently. The use of masks was strongly protective. Among 31 case-patients for whom convalescent-phase (>21 days) sera were available, 26% had immunoglobulin G to SARS-associated coronavirus. Our finding that clinical SARS was associated with visits to fever clinics supports Beijing’s strategy of closing clinics with poor infection-control measures. Our finding that mask use lowered the risk for disease supports the community’s use of this strategy. PMID:15030685

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case–control studies

PubMed Central

March, Sebastià; Ripoll, Joana; Jordan Martin, Matilde; Zabaleta-del-Olmo, Edurne; Benedé Azagra, Carmen Belén; Elizalde Soto, Lázaro; Vidal, Mª Clara; Bauzà Amengual, María de Lluc; Planas Juan, Trinidad; Pérez Mariano, Damiana Maria; Llull Sarralde, Micaela; Ruiz-Giménez, Juan Luís; Bajo Viñas, Rosa; Solano Villarubia, Carmen; Rodriguez Bajo, Maria; Cordoba Victoria, Manuela; Badia Capdevila, Marta; Serrano Ferrandez, Elena; Bosom Diumenjo, Maria; Montaner-Gomis, Isabel; Bolibar-Ribas, Buenaventura; Antoñanzas Lombarte, Angel; Bregel Cotaina, Samantha; Calvo Tocado, Ana; Olivan Blázquez, Barbara; Magallon Botaya, Rosa; Marín Palacios, Pilar; Echauri Ozcoidi, Margarita; Perez - arauta, María Jose; Llobera, Joan; Ramos, Maria

2017-01-01

Objective Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. Design Two case–control studies. Setting Performed in primary care of five Spanish regions. Subjects In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. Main outcome measures Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. Results The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). Conclusions Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs. PMID:28993380

A Review of Economic Evaluations of Tobacco Control Programs

PubMed Central

Kahende, Jennifer W.; Loomis, Brett R.; Adhikari, Bishwa; Marshall, LaTisha

2009-01-01

Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually. In an effort to reduce this burden, many states, the federal government, and several national organizations fund tobacco control programs and policies. For this report we reviewed existing literature on economic evaluations of tobacco control interventions. We found that smoking cessation therapies, including nicotine replacement therapy (NRT) and self-help are most commonly studied. There are far fewer studies on other important interventions, such as price and tax increases, media campaigns, smoke free air laws and workplace smoking interventions, quitlines, youth access enforcement, school-based programs, and community-based programs. Although there are obvious gaps in the literature, the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective. PMID:19440269

Effectiveness of Varicella Vaccination Program in Preventing Laboratory-Confirmed Cases in Children in Seoul, Korea.

PubMed

Lee, Young Hwa; Choe, Young June; Cho, Sung Il; Kang, Cho Ryok; Bang, Ji Hwan; Oh, Myoung Don; Lee, Jong Koo

2016-12-01

A universal one-dose varicella vaccination program was introduced in 2005 in Republic of Korea. However, the incidence of varicella in Korea has tripled over the last decade. We conducted a community based 1:1 matched case-control study to assess the effectiveness of one MAV strain-based vaccine and three Oka strain-based vaccines licensed for use in Korea. All cases were children in Seoul, Korea with varicella who were reported to the National Notifiable Disease Surveillance System in Seoul during 2013. The controls were age-matched children with mumps or scarlet fever but no history of varicella. We included 537 cases and 537 controls. The overall effectiveness of one dose of varicella vaccination was 13% (95% confidence interval [CI], -17.3-35.6). Of the four licensed varicella vaccines, only one was highly effective (88.9%; 95% CI, 52.1-97.4). The vaccine effectiveness for the other vaccines were 71.4% (95% CI, -37.5-94.1), -5% (95% CI, -61.9-31.9), and -100% (95% CI, -700-50.0). The overall effectiveness of vaccination was 75.8% (95% CI, 22.8-92.4) in the first year after vaccination and decreased thereafter; the effectiveness became -7.2% (95% CI, -130.9-59.2) in the fourth year after vaccination. Further studies are warranted to investigate reduced effectiveness of varicella vaccines in Korea.

Finding a Balance: A Case Study Using Framing and Sensemaking Theory to Analyze the Implementation of Campus Carry Law at Four South Texas Community Colleges

ERIC Educational Resources Information Center

Ortega-Feerick, Diana

2017-01-01

The issue of guns and gun control is very complex especially since the passage of Campus Carry Law in the state of Texas. The purpose of this qualitative case study is to explore how decision-making administrators at four nonresidential community colleges in South Texas implemented Campus Carry Law. This study further seeks to examine how 10…

Teaching and Learning Technology and New Media in a Community-Based Program: Adult Educators and Older Learners' Experiences

ERIC Educational Resources Information Center

Hernandez, Regina

2016-01-01

This qualitative case study documented the experiences of two adult educators and four older learners' teaching and learning technology and new media in a community-based program in Texas. The research questions guiding this study included: (1) What can we learn from looking at the educational efforts of a community-based programs offering…

Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design.

PubMed

McLaughlin, John M; Jiang, Qin; Isturiz, Raul E; Sings, Heather L; Swerdlow, David L; Gessner, Bradford D; Carrico, Ruth M; Peyrani, Paula; Wiemken, Timothy L; Mattingly, William A; Ramirez, Julio A; Jodar, Luis

2018-05-21

Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P = .02) and overweight or obese (41.2% vs 58.6%, P = .01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%-91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%-73.3%). Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.

Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines: study methods and challenges.

PubMed

Blyth, Christopher C; Ford, Rebecca; Sapura, Joycelyn; Kumani, Tonny; Masiria, Geraldine; Kave, John; Yuasi, Lapule; Greenhill, Andrew; Hwaihwanje, Ilomo; Lang, Amanda; Lehmann, Deborah; Pomat, William

2017-01-01

Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment. A prospective case-control study was undertaken, enrolling children <5 years of age to determine the contemporary etiology of clinically defined moderate or severe pneumonia or suspected meningitis. Cases were identified following presentation for inpatient or outpatient care in Goroka town, the major population centre in the Eastern Highlands Province. Following enrolment, routine diagnostic specimens including blood, nasopharyngeal swabs, urine and (if required) cerebrospinal fluid, were obtained. Cases residing within one hour's drive of Goroka were followed up, and recruitment of healthy contemporaneous controls was undertaken in the cases' communities. 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9-14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2-36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p  < 0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%. Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.

Community-Based Field Experiences in Teacher Education: Possibilities for a Pedagogical Third Space

ERIC Educational Resources Information Center

Hallman, Heidi L.

2012-01-01

The present article discusses the importance of community-based field experiences as a feature of teacher education programs. Through a qualitative case study, prospective teachers' work with homeless youth in an after-school initiative is presented. Framing community-based field experiences in teacher education through "third space" theory, the…

Childhood acute respiratory infections and household environment in an Eastern Indonesian urban setting.

PubMed

Shibata, Tomoyuki; Wilson, James L; Watson, Lindsey M; LeDuc, Alyse; Meng, Can; Ansariadi; La Ane, Ruslan; Manyullei, Syamsuar; Maidin, Alimin

2014-11-25

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children's respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM2.5 and PM10) was measured in living rooms, kitchens, children's bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother's education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM2.5 and PM10 ranged from 0.5 to 35.7 µg/m3 and 7.7 to 575.7 µg/m3, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children.

Childhood Acute Respiratory Infections and Household Environment in an Eastern Indonesian Urban Setting

PubMed Central

Shibata, Tomoyuki; Wilson, James L.; Watson, Lindsey M.; LeDuc, Alyse; Meng, Can; Ansariadi; La Ane, Ruslan; Manyullei, Syamsuar; Maidin, Alimin

2014-01-01

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children’s respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM2.5 and PM10) was measured in living rooms, kitchens, children’s bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother’s education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM2.5 and PM10 ranged from 0.5 to 35.7 µg/m3 and 7.7 to 575.7 µg/m3, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children. PMID:25429685

Roles of Urban Indigenous Community Members in Collaborative Field-Based Teacher Preparation

ERIC Educational Resources Information Center

Lees, Anna

2016-01-01

This qualitative case study explored a community-university partnership for teacher preparation with an urban Indigenous community organization. The study examined the roles of Indigenous community partners as co-teacher educators working to better prepare teachers for the needs of urban Indigenous children and communities. The author collected…

Promoting Environmental Justice through Community-Based Participatory Research: The Role of Community and Partnership Capacity

ERIC Educational Resources Information Center

Minkler, Meredith; Vasquez, Victoria Breckwich; Tajik, Mansoureh; Petersen, Dana

2008-01-01

Community-based participatory research (CBPR) increasingly is being used to study and address environmental justice. This article presents the results of a cross-site case study of four CBPR partnerships in the United States that researched environmental health problems and worked to educate legislators and promote relevant public policy. The…

Incidental Becomes Visible: A Comparison of School- and Community-Based Field Experience Narratives

ERIC Educational Resources Information Center

Holder, K. C.; Downey, Jayne A.

2008-01-01

The purpose of this study was to describe and compare student learning documented using written field experience summary narratives and occurring in community-based or school-based locations. Utilizing a hybrid portraiture--instrumental case study design, two researchers selected participants from undergraduate educational psychology courses using…

Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey.

PubMed

Selton-Suty, Christine; Célard, Marie; Le Moing, Vincent; Doco-Lecompte, Thanh; Chirouze, Catherine; Iung, Bernard; Strady, Christophe; Revest, Matthieu; Vandenesch, François; Bouvet, Anne; Delahaye, François; Alla, François; Duval, Xavier; Hoen, Bruno

2012-05-01

Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE. A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death. The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]). S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.

Jiangsu Four Cancers Study: a large case-control study of lung, liver, stomach, and esophageal cancers in Jiangsu Province, China.

PubMed

Zhao, Jin-Kou; Wu, Ming; Kim, Claire H; Jin, Zi-Yi; Zhou, Jin-Yi; Han, Ren-Qiang; Yang, Jie; Zhang, Xiao-Feng; Wang, Xu-Shan; Liu, Ai-Ming; Gu, Xiaoping; Su, Ming; Hu, Xu; Sun, Zheng; Li, Gang; Li, Liming; Mu, Lina; Zhang, Zuo-Feng

2017-07-01

Cancer is a major public health burden both globally and in China. The most common cancer-related deaths in China are attributable to cancers of the lung, liver, stomach, and esophagus. Previous epidemiologic studies on cancer in China have often been limited by small sample sizes, inconsistent measurements, and lack of precise and accurate data. The Jiangsu Four Cancers (JFC) Study is a population-based case-control study carried out in an effort to obtain consistent and high-quality data to investigate the life style, behavioral, environmental, and genetic factors associated with the four major cancers in China. The aim of this paper is to describe the overall design of the JFC Study and report selected findings on the major risk factors for cancers. Epidemiologic data were collected from 2003 to 2010 through in-person interviews using a structured questionnaire and blood samples were drawn. Unconditional logistic regression was used to estimate the associations of putative risk factors with risks of cancers of the lung, liver, stomach, and esophagus. The study included 2871 lung cancer cases, 2018 liver cancer cases, 2969 esophageal cancer cases, 2216 stomach cancer cases, and 8019 community controls. Low educational level, low income level, tobacco smoking, alcohol drinking, and family history of cancer were confirmed as risk factors for these major cancers. The JFC Study is one of the largest case-control studies of cancers in the Chinese population and will serve as a rich resource for future research on the four major cancers in China.

Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

PubMed

Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Naa-Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-07-05

Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.

Home-based intermediate care program vs hospitalization: Cost comparison study.

PubMed

Armstrong, Catherine Deri; Hogg, William E; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S; Saginur, Raphael

2008-01-01

To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. Single-arm study with historical controls. Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.

Outpatient Medication Use in Chinese Geriatric Patients Admitted for Falls: A Case-Control Study at an Acute Hospital in Hong Kong.

PubMed

Lee, Vivian W Y; Leung, Teresa P Y; Lee, Vincent W H

The study objective was to investigate the association of polypharmacy and medications with patient falls resulting in hip fractures among community-living geriatric patients. A case-control study was conducted at an acute public hospital in Hong Kong. The study population was community-living Chinese patients aged 65 years and above who were admitted for falls resulting in hip fractures during an 18-month study period. Each of these patients was matched to a control patient with the same age and sex, but without falls and fractures. Data were collected from electronic patient record. Data of 170 cases and 170 controls were eventually collected. The following variables associated with increased risk of falls resulting in hip fractures remained statistically significant after multivariate logistic regression, including benign prostatic hyperplasia [odds ratio (OR) = 2.654; 95% confidence interval (CI), 1.105-6.378; P = 0.029], first-generation antihistamines (OR = 3.176; 95% CI, 1.044-9.664; P = 0.042), antiparkinson medications (OR = 3.754; 95% CI, 1.158-12.169; P = 0.027), osteoporosis (OR = 3.159; 95% CI, 1.167-8.552; P = 0.024), and use of walking aids (OR = 2.543; 95% CI, 1.544-4.188; P < 0.001). In conclusion, this study identified various medications and comorbidities, rather than polypharmacy based on the number of medications, as predictors associated with increased risk of falls resulting in hip fractures for local geriatric patients. The findings provided insights into the potential medication-related fall prevention strategies, including clinical medication review, adverse drug event monitoring, and drug optimization.

Should Controls With Respiratory Symptoms Be Excluded From Case-Control Studies of Pneumonia Etiology? Reflections From the PERCH Study

PubMed Central

Hammitt, Laura L.; Deloria Knoll, Maria; Baggett, Henry C.; Brooks, W. Abdullah; Howie, Stephen R. C.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; Murdoch, David R.; Scott, J. Anthony G.; Thea, Donald M.; Driscoll, Amanda J.; Karron, Ruth A.; Park, Daniel E.; Prosperi, Christine; Zeger, Scott L.; O’Brien, Katherine L.; Feikin, Daniel R.; O’Brien, Katherine L.; Levine, Orin S.; Knoll, Maria Deloria; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Fu, Wei; Hammitt, Laura L.; Higdon, Melissa M.; Kagucia, E. Wangeci; Karron, Ruth A.; Li, Mengying; Park, Daniel E.; Prosperi, Christine; Wu, Zhenke; Zeger, Scott L.; Watson, Nora L.; Crawley, Jane; Murdoch, David R.; Brooks, W. Abdullah; Endtz, Hubert P.; Zaman, Khalequ; Goswami, Doli; Hossain, Lokman; Jahan, Yasmin; Ashraf, Hasan; Howie, Stephen R. C.; Ebruke, Bernard E.; Antonio, Martin; McLellan, Jessica; Machuka, Eunice; Shamsul, Arifin; Zaman, Syed M.A.; Mackenzie, Grant; Scott, J. Anthony G.; Awori, Juliet O.; Morpeth, Susan C.; Kamau, Alice; Kazungu, Sidi; Kotloff, Karen L.; Tapia, Milagritos D.; Sow, Samba O.; Sylla, Mamadou; Tamboura, Boubou; Onwuchekwa, Uma; Kourouma, Nana; Toure, Aliou; Madhi, Shabir A.; Moore, David P.; Adrian, Peter V.; Baillie, Vicky L.; Kuwanda, Locadiah; Mudau, Azwifarwi; Groome, Michelle J.; Baggett, Henry C.; Thamthitiwat, Somsak; Maloney, Susan A.; Bunthi, Charatdao; Rhodes, Julia; Sawatwong, Pongpun; Akarasewi, Pasakorn; Thea, Donald M.; Mwananyanda, Lawrence; Chipeta, James; Seidenberg, Phil; Mwansa, James; wa Somwe, Somwe; Kwenda, Geoffrey

2017-01-01

Abstract Many pneumonia etiology case-control studies exclude controls with respiratory illness from enrollment or analyses. Herein we argue that selecting controls regardless of respiratory symptoms provides the least biased estimates of pneumonia etiology. We review 3 reasons investigators may choose to exclude controls with respiratory symptoms in light of epidemiologic principles of control selection and present data from the Pneumonia Etiology Research for Child Health (PERCH) study where relevant to assess their validity. We conclude that exclusion of controls with respiratory symptoms will result in biased estimates of etiology. Randomly selected community controls, with or without respiratory symptoms, as long as they do not meet the criteria for case-defining pneumonia, are most representative of the general population from which cases arose and the least subject to selection bias. PMID:28575354

Effectiveness of Different Models of Case Management for Substance-Abusing Populations

PubMed Central

Vanderplasschen, Wouter; Wolf, Judith; Rapp, Richard C.; Broekaert, Eric

2007-01-01

Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes. PMID:17523588

Child Maltreatment as a Risk Factor for Opioid Dependence: Comparison of Family Characteristics and Type and Severity of Child Maltreatment with a Matched Control Group

ERIC Educational Resources Information Center

Conroy, Elizabeth; Degenhardt, Louisa; Mattick, Richard P.; Nelson, Elliot C.

2009-01-01

Objective: To examine the prevalence, characteristics and risk factors for child maltreatment among opioid-dependent persons compared to a community sample of similar social disadvantage. Method: The study employed a case-control design. Cases had a history of opioid pharmacotherapy. Controls were frequency matched to cases with regard to age, sex…

Rapid Population Growth and Rural Community Change: A Focus on Land Use Issues.

ERIC Educational Resources Information Center

Garkovich, Lorraine

Land use controls are often a major point of conflict between recent migrants and long-term residents of rapidly growing communities. Such conflict was noted in a case study of a rural community undergoing rapid population growth. The revision of a comprehensive land use plan for the community provided the opportunity to evaluate citizen…

Engaging the Community Cultural Wealth of Latino Immigrant Families in a Community-Based Program

ERIC Educational Resources Information Center

Gil, Elizabeth

2017-01-01

The purpose of this qualitative case study utilizing ethnographic methods was to understand how family members' participation in Digital Home, a community-based technology program in an urban mid-sized Midwestern city, built on and fostered Latino immigrant families' community cultural wealth (Yosso, 2005) in order to increase their abilities to…

The relation between amyotrophic lateral sclerosis and inorganic selenium in drinking water: a population-based case-control study

PubMed Central

2010-01-01

Background A community in northern Italy was previously reported to have an excess incidence of amyotrophic lateral sclerosis among residents exposed to high levels of inorganic selenium in their drinking water. Methods To assess the extent to which such association persisted in the decade following its initial observation, we conducted a population-based case-control study encompassing forty-one newly-diagnosed cases of amyotrophic lateral sclerosis and eighty-two age- and sex-matched controls. We measured long-term intake of inorganic selenium along with other potentially neurotoxic trace elements. Results We found that consumption of drinking water containing ≥ 1 μg/l of inorganic selenium was associated with a relative risk for amyotrophic lateral sclerosis of 5.4 (95% confidence interval 1.1-26) after adjustment for confounding factors. Greater amounts of cumulative inorganic selenium intake were associated with progressively increasing effects, with a relative risk of 2.1 (95% confidence interval 0.5-9.1) for intermediate levels of cumulative intake and 6.4 (95% confidence interval 1.3-31) for high intake. Conclusion Based on these results, coupled with other epidemiologic data and with findings from animal studies that show specific toxicity of the trace element on motor neurons, we hypothesize that dietary intake of inorganic selenium through drinking water increases the risk for amyotrophic lateral sclerosis. PMID:21134276

Assessment of the Epidemiology and Burden of Measles in Southern Mozambique

PubMed Central

Mandomando, Inácio; Naniche, Denise; Pasetti, Marcela F.; Cuberos, Lilian; Sanz, Sergi; Vallès, Xavier; Sigauque, Betuel; Macete, Eusébio; Nhalungo, Delino; Kotloff, Karen L.; Levine, Myron M.; Alonso, Pedro L.

2011-01-01

Measles has been a major killer among vaccine-preventable diseases in children < 5 years of age in developing countries. Despite progress in global efforts to reduce mortality, measles remains a public health problem. Hospital-based measles surveillance was conducted in Manhica, Mozambique (July 2001–September 2004). Suspected cases and community-based controls were enrolled, and blood was collected for immunoglobulin M (IgM) confirmation. Two hundred fifty-three suspected cases and 477 controls were enrolled, with 85% (216 of 253) cases reported during a measles outbreak. Measles-IgM confirmation was 30% among suspected cases and 5% in controls. Fifty-eight percent (14 of 24) of laboratory-confirmed cases had records indicating previous measles vaccination. Mortality was 3% (8 of 246) among cases and 1% among controls (6 of 426). Forty-five percent (33 of 74) of cases were < 24 months of age and 22% occurred in infants < 9 months of age and were associated with a high case-fatality rate (25%). Our data suggest that improved diagnostics, new tools to protect infants < 9 months of age, and a supplemental dose of measles vaccine could assist measles control. PMID:21734140

Sudden cardiac arrest in people with epilepsy in the community

PubMed Central

Lamberts, Robert J.; Blom, Marieke T.; Wassenaar, Merel; Bardai, Abdennasser; Leijten, Frans S.; de Haan, Gerrit-Jan; Sander, Josemir W.; Thijs, Roland D.

2015-01-01

Objective: To ascertain whether characteristics of ventricular tachycardia/fibrillation (VT/VF) differed between people with epilepsy and those without and which individuals with epilepsy were at highest risk. Methods: We ascertained 18 people with active epilepsy identified in a community-based registry of sudden cardiac arrest (SCA) with ECG-confirmed VT/VF (cases). We compared them with 470 individuals with VT/VF without epilepsy (VT/VF controls) and 54 individuals with epilepsy without VT/VF (epilepsy controls). Data on comorbidity, epilepsy severity, and medication use were collected and entered into (conditional) logistic regression models to identify determinants of VT/VF in epilepsy. Results: In most cases, there was an obvious (10/18) or presumed cardiovascular cause (5/18) in view of preexisting heart disease. In 2 of the 3 remaining events, near–sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation. Cases had a higher prevalence of congenital/inherited heart disease (17% vs 1%, p = 0.002), and experienced VT/VF at younger age (57 vs 64 years, p = 0.023) than VT/VF controls. VT/VF in cases occurred more frequently at/near home (89% vs 58%, p = 0.009), and was less frequently witnessed (72% vs 89%, p = 0.048) than in VT/VF controls. Cases more frequently had clinically relevant heart disease (50% vs 15%, p = 0.005) and intellectual disability (28% vs 1%, p < 0.001) than epilepsy controls. Conclusion: Cardiovascular disease rather than epilepsy characteristics is the main determinant of VT/VF in people with epilepsy in the community. SCA and SUDEP are partially overlapping disease entities. PMID:26092917

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes.

PubMed

Golden, Sherita Hill; Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia

2017-07-01

The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.

A Case Study Examination of Best Practices of Professional Learning Communities

ERIC Educational Resources Information Center

Akopoff, Tanya M.

2010-01-01

A current trend in education is that small teacher groups, called professional learning communities (PLC), are being advocated as a tool to help teachers reach struggling students. Educators planning to use PLC as an intervention strategy can benefit from research-based information about PLC best practices. This multiple case study addressed the…

Answering the Call for Accountability: An Activity and Cost Analysis Case Study

ERIC Educational Resources Information Center

Carducci, Rozana; Kisker, Carrie B.; Chang, June; Schirmer, James

2007-01-01

This article summarizes the findings of a case study on the creation and application of an activity-based cost accounting model that links community college salary expenditures to mission-critical practices within academic divisions of a southern California community college. Although initially applied as a financial management tool in private…

The validity of proxy-based data on loneliness in suicide research: a case-control psychological autopsy study in rural China.

PubMed

Niu, Lu; Jia, Cunxian; Ma, Zhenyu; Wang, Guojun; Yu, Zhenjun; Zhou, Liang

2018-05-01

There is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants' reports on loneliness is not well established. This study aimed to investigate the validity of proxy respondent reports on loneliness, and the reliability and validity of the University of California Los Angeles Loneliness Scale-6 (ULS-6) as used in psychological autopsy method with rural elderly people in China. Two hundred forty-two suicide cases and 242 normal community controls were selected, and the psychological autopsy method was utilized to collect information. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards). Subject-proxy concordance for ULS-6 was fair (ICC = 0.447) in the living controls. The suicide cases were more likely to have a higher score of ULS-6 than the living controls. Additionally, our data supported that ULS-6 had adequate psychometric properties in both suicide and control groups: factor analyses yielded one-factor component solution; Cronbach's alpha (both > 0.90) demonstrated excellent internal consistency; the Spearman correlation analysis indicated that the ULS-6 score was positively correlated with depression; and negatively correlated with QOL and social support. Results support proxy-based data on loneliness in research of suicide in older adults in rural China, and the ULS-6 is a psychometrically sound instrument for measuring loneliness in psychological autopsy studies.

Association of the homeobox transcription factor gene ENGRAILED 2 with autistic disorder in Chinese children.

PubMed

Yang, Pinchen; Lung, For-Wey; Jong, Yuh-Jyh; Hsieh, Hsin-Yi; Liang, Chung-Ling; Juo, Suh-Hang Hank

2008-01-01

Autism is a neurodevelopmental disorder with a strong genetic component. Previous studies have mapped the disease to chromosome 7q, where the homeobox transcription factor ENGRAILED 2 (EN2) gene is located. EN2 is specifically involved in patterning the region that gives rise to the cerebellum. In the present work, we carried out a case-control study to determine whether 2 intronic single-nucleotide polymorphisms (SNPs) of EN2 are a susceptibility to autism in a Han Chinese population. We enrolled 184 cases of DSM-IV-TR diagnosed autistic disorder, 225 controls of unrelated healthy volunteers and 409 randomly selected controls from the community who lives in the adjacent geographical regions for this study. Two SNPs (rs1861972, rs1861973) at the EN2 gene that have been reported to be associated with autism underwent analysis among our studied cohorts. Both the UNPHASE and PHASE statistical programs were utilized for evaluating the association of EN2 SNPs with autism based on allelic and genotypic frequencies and haplotype compositions accompanied with the goodness-of-fit method of the chi(2) test. The gender difference was also investigated by using 2-side Fisher's exact test treated as a covariate in logistic regression analysis. Both the allelic and genotypic distributions of the 2 polymorphisms were concordant with Hardy-Weinberg equilibrium. Significant differences were found for cases versus community and overall controls. By using the UNPHASE and PHASE programs, the 2-marker haplotype A-C of EN2 was identified to have a protective effect for autism, indicating that the ethnic difference might confound the EN2 association with autism. Therefore, more EN2 gene association studies of Han Chinese populations are warranted to confirm this finding. 2008 S. Karger AG, Basel.

Post-stroke bacteriuria among stroke patients attending a physiotherapy clinic in Ghana: a cross-sectional study

PubMed Central

Donkor, Eric S; Akumwena, Amos; Amoo, Philip K; Owolabi, Mayowa O; Aspelund, Thor; Gudnason, Vilmundur

2016-01-01

Background Infections are known to be a major complication of stroke patients. In this study, we evaluated the risk of community-acquired bacteriuria among stroke patients, the associated factors, and the causative organisms. Methods This was a cross-sectional study involving 70 stroke patients and 83 age- and sex-matched, apparently healthy controls. Urine specimens were collected from all the study subjects and were analyzed by standard microbiological methods. Demographic and clinical information was also collected from the study subjects. For stroke patients, the information collected also included stroke parameters, such as stroke duration, frequency, and subtype. Results Bacteriuria was significantly higher among stroke patients (24.3%, n=17) than among the control group (7.2%, n=6), with a relative risk of 3.36 (confidence interval [CI], 1.40–8.01, P=0.006). Among the control group, all six bacteriuria cases were asymptomatic, whereas the 17 stroke bacteriuria cases comprised 15 cases of asymptomatic bacteriuria and two cases of symptomatic bacteriuria. Female sex (OR, 3.40; CI, 1.12–10.30; P=0.03) and presence of stroke (OR, 0.24; CI, 0.08–0.70; P=0.009) were significantly associated with bacteriuria. The etiology of bacteriuria was similar in both study groups, and coagulase-negative Staphylococcus spp. were the most predominant organisms isolated from both stroke patients (12.9%) and the control group (2.4%). Conclusion Stroke patients in the study region have a significantly higher risk of community-acquired bacteriuria, which in most cases is asymptomatic. Community-acquired bacteriuria in stroke patients appears to have little or no relationship with clinical parameters of stroke such as stroke subtype, duration and frequency. PMID:27051289

COMMUNITY-BASED WATERSHED MANAGEMENT: CREATING A TOOL FOR PROGRAM EVALUATION AND DESIGN

EPA Science Inventory

The criteria will be assembled into a manual to be used by community organizers, academics, managers, or policy makers in evaluating community-based watershed management initiatives and in designing new watershed management programs. The case study will also be added to the b...

Lessons Learned From Community-Based Approaches to Sodium Reduction

PubMed Central

Kane, Heather; Strazza, Karen; Losby PhD, Jan L.; Lane, Rashon; Mugavero, Kristy; Anater, Andrea S.; Frost, Corey; Margolis, Marjorie; Hersey, James

2017-01-01

Purpose This article describes lessons from a Centers for Disease Control and Prevention initiative encompassing sodium reduction interventions in six communities. Design A multiple case study design was used. Setting This evaluation examined data from programs implemented in six communities located in New York (Broome County, Schenectady County, and New York City); California (Los Angeles County and Shasta County); and Kansas (Shawnee County). Subjects Participants (n = 80) included program staff, program directors, state-level staff, and partners. Measures Measures for this evaluation included challenges, facilitators, and lessons learned from implementing sodium reduction strategies. Analysis The project team conducted a document review of program materials and semi structured interviews 12 to 14 months after implementation. The team coded and analyzed data deductively and inductively. Results Five lessons for implementing community-based sodium reduction approaches emerged: (1) build relationships with partners to understand their concerns, (2) involve individuals knowledgeable about specific venues early, (3) incorporate sodium reduction efforts and messaging into broader nutrition efforts, (4) design the program to reduce sodium gradually to take into account consumer preferences and taste transitions, and (5) identify ways to address the cost of lower-sodium products. Conclusion The experiences of the six communities may assist practitioners in planning community-based sodium reduction interventions. Addressing sodium reduction using a community-based approach can foster meaningful change in dietary sodium consumption. PMID:24575726

Stochasticity, succession, and environmental perturbations in a fluidic ecosystem.

PubMed

Zhou, Jizhong; Deng, Ye; Zhang, Ping; Xue, Kai; Liang, Yuting; Van Nostrand, Joy D; Yang, Yunfeng; He, Zhili; Wu, Liyou; Stahl, David A; Hazen, Terry C; Tiedje, James M; Arkin, Adam P

2014-03-04

Unraveling the drivers of community structure and succession in response to environmental change is a central goal in ecology. Although the mechanisms shaping community structure have been intensively examined, those controlling ecological succession remain elusive. To understand the relative importance of stochastic and deterministic processes in mediating microbial community succession, a unique framework composed of four different cases was developed for fluidic and nonfluidic ecosystems. The framework was then tested for one fluidic ecosystem: a groundwater system perturbed by adding emulsified vegetable oil (EVO) for uranium immobilization. Our results revealed that groundwater microbial community diverged substantially away from the initial community after EVO amendment and eventually converged to a new community state, which was closely clustered with its initial state. However, their composition and structure were significantly different from each other. Null model analysis indicated that both deterministic and stochastic processes played important roles in controlling the assembly and succession of the groundwater microbial community, but their relative importance was time dependent. Additionally, consistent with the proposed conceptual framework but contradictory to conventional wisdom, the community succession responding to EVO amendment was primarily controlled by stochastic rather than deterministic processes. During the middle phase of the succession, the roles of stochastic processes in controlling community composition increased substantially, ranging from 81.3% to 92.0%. Finally, there are limited successional studies available to support different cases in the conceptual framework, but further well-replicated explicit time-series experiments are needed to understand the relative importance of deterministic and stochastic processes in controlling community succession.

Shared Values as Anchors of a Learning Community: A Case Study in Information Systems Design

ERIC Educational Resources Information Center

Giordano, Daniela

2004-01-01

This paper examines the role in both individual and organizational learning of the system of values sustained by a community undertaking a design task. The discussion is based on the results of a longitudinal study of a community of novice information system designers supported by a Web-based shared design memory which allows reuse of design…

Age-Related Differences in Influenza B Infection by Lineage in a Community-Based Sentinel System, 2010-2011 to 2015-2016, Canada.

PubMed

Skowronski, Danuta M; Chambers, Catharine; De Serres, Gaston; Sabaiduc, Suzana; Winter, Anne-Luise; Dickinson, James A; Gubbay, Jonathan B; Fonseca, Kevin; Drews, Steven J; Charest, Hugues; Martineau, Christine; Krajden, Mel; Petric, Martin; Bastien, Nathalie; Li, Yan

2017-09-15

Age-related differences in influenza B lineage detection were explored in the community-based Canadian Sentinel Practitioner Surveillance Network (SPSN) from 2010-2011 to 2015-2016. Whereas >80% of B(Victoria) cases were <40 years old, B(Yamagata) cases showed a bimodal age distribution with 27% who were <20 years old and 61% who were 30-64 years old, but with a notable gap in cases between 20 and 29 years old (4%). Overall, the median age was 20 years lower for B(Victoria) vs B(Yamagata) cases (20 vs 40 years; P < .01). Additional phylodynamic and immuno-epidemiological research is needed to understand age-related variation in influenza B risk by lineage, with potential implications for prevention and control across the lifespan. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Health issues in the Arab American community. Male infertility in Lebanon: a case-controlled study.

PubMed

Kobeissi, Loulou; Inhorn, Marcia C

2007-01-01

The impact of risk factors, such as consanguinity and familial clustering, reproductive infections, traumas, and diseases, lifestyle factors and occupational and war exposures on male infertility, was investigated in a case-controlled study conducted in Lebanon. One-hundred-twenty males and 100 controls of Lebanese, Syrian or Lebanese-Palestinian descents were selected from two in-vitro fertilization (IVF) clinics located in Beirut, Lebanon. All cases suffered from impaired sperm count and function, according to World Health Organization guidelines for semen analysis. Controls were the fertile husbands of infertile women. Data were collected using a semi-structured interview, laboratory blood testing and the results of the most recent semen analysis. Univariate, bivariate and multivariate logistic regression analyses were used for data analysis, along with checks for effect modification and control of confounders. Consanguinity and the familial clustering of male infertility cases, as well as reproductive illnesses and war exposures were independently significant risk factors for male infertility. The odds of having infertility problems in the immediate family were 2.6 times higher in cases than controls. The odds of reproductive illness were 2 times higher in cases than controls. The odds of war exposures were 1.57 times higher in cases than controls. Occupational exposures, such as smoking and caffeine intake, were not shown to be important risk factors. This case-controlled study highlights the importance of investigating the etiology of male infertility in Middle Eastern communities. It suggests the need to expand research on male reproductive health in the Middle East in order to improve the prevention and management of male infertility and other male reproductive health problems.

Enteric fever burden in North Jakarta, Indonesia: a prospective, community-based study.

PubMed

Punjabi, Narain H; Agtini, Magdarina D; Ochiai, R Leon; Simanjuntak, Cyrus H; Lesmana, Murad; Subekti, Decy; Oyofo, Buhari A; von Seidlein, Lorenz; Deen, Jacqueline; Shin, Seonghye; Acosta, Camilo; Wangsasaputra, Ferry; Pulungsih, Sri P; Saroso, Santoso; Suyeti, Suyeti; R, Suharno; Sudarmono, Pratiwi; Syarurachman, Agus; Suwandono, Agus; Arjoso, Sumarjati; Beecham, H James; Corwin, Andrew L; Clemens, John D

2013-11-15

We undertook a prospective community-based study in North Jakarta, Indonesia, to determine the incidence, clinical characteristics, seasonality, etiologic agent, and antimicrobial susceptibility pattern of enteric fever. Following a census, treatment centre-based surveillance for febrile illness was conducted for two-years. Clinical data and a blood culture were obtained from each patient. In a population of 160,261, we detected 296 laboratory-confirmed enteric fever cases during the surveillance period, of which 221 (75%) were typhoid fever and 75 (25%)  were paratyphoid fever.  The overall incidence of typhoid and paratyphoid cases was 1.4, and 0.5 per thousand populations per year, respectively. Although the incidence of febrile episodes evaluated was highest among children under 5 years of age at 92.6 per thousand persons per year, we found that the burden of typhoid fever was greatest among children between 5 and 20 years of age. Paratyphoid fever occurred most commonly in children and was infrequent in adults. Enteric fever is a public health problem in North Jakarta with a substantial proportion due to paratyphoid fever. The results highlight the need for control strategies against enteric fever.

A Mixed-Method Study to Determine the Benefits of Periconceptional Folic Acid Supplementation and Effects of Folic Acid Deficiency in Mothers on Birth Outcomes.

PubMed

Murthy, Gudlavalleti Venkata S; Kolli, Sunanda Reddy; Neogi, Sutapa B; Singh, Samiksha; Allagh, Komal Preet; John, Neena; N, Srinivas; Ramani, Sudha; Shamanna, B R; Doyle, Pat; Kinra, Sanjay; Ness, Andy; Pallepogula, Dinesh Raj; Pant, Hira B; Babbar, Smiksha; Reddy, Raghunath; Singh, Rachna

2016-06-23

Evidence from high income countries shows mothers who are supplemented with folic acid in their periconceptional period and early pregnancy have significantly reduced adverse outcomes like birth defects. However, in India there is a paucity of data on association of birth defects and folic acid supplementation. We identified a few important questions to be answered using separate scientific methods and then planned to triangulate the information. In this paper, we describe the protocol of our study that aims to determine the association of folic acid and pregnancy outcomes like neural tube defects (NTDs) and orofacial clefts (OFCs). We decided to fill the gaps in knowledge from India to determine public health consequences of folic acid deficiency and factors influencing dietary and periconceptional consumption of folic acid. The proposed study will be carried out in five stages and will examine the questions related to folic acid deficiency across selected locations in South and North India. The study will be carried out over a period of 4 years through the hierarchical evidence-based approach. At first a systematic review was conducted to pool the current birth prevalence of NTDs and orofacial clefts OFCs in India. To investigate the population prevalence, we plan to use the key informant method to determine prevalence of NTDs and OFCs. To determine the normal serum estimates of folic acid, iron, and vitamin B12 among Indian women (15-35 years), we will conduct a population-based, cross-sectional study. We will further strengthen the evidence of association between OFCs and folic acid by conducting a hospital-based, case-control study across three locations of India. Lastly, using qualitative methods we will understand community and health workers perspective on factors that decide the intake of folic acid supplements. This study will provide evidence on the community prevalence of birth defects and prevalence folic acid and vitamin B12 deficiency in the community. The case-control study will help understand the association of folic acid deficiency with OFCs. The results from this study are intended to strengthen the evidence base in childhood disability for planning and policy initiatives.

Links between real and virtual networks: a comparative study of online communities in Japan and Korea.

PubMed

Ishii, Kenichi; Ogasahara, Morihiro

2007-04-01

The present study explores how online communities affect real-world personal relations based on a cross-cultural survey conducted in Japan and Korea. Findings indicate that the gratifications of online communities moderate the effects of online communities on social participation. Online communities are categorized into a real-group-based community and a virtual-network-based community. The membership of real-group-based online community is positively correlated with social bonding gratification and negatively correlated with information- seeking gratification. Japanese users prefer more virtual-network-based online communities, while their Korean counterparts prefer real-group-based online communities. Korean users are more active in online communities and seek a higher level of socializing gratifications, such as social bonding and making new friends, when compared with their Japanese counterparts. These results indicate that in Korea, personal relations via the online community are closely associated with the real-world personal relations, but this is not the case in Japan. This study suggests that the effects of the Internet are culture-specific and that the online community can serve a different function in different cultural environments.

Training in the Community-Collaborative Context: A Case Study

ERIC Educational Resources Information Center

Yamada, Racquel-María

2014-01-01

Emerging community-based methodologies call for collaboration with speech community members. Although motivated, community members may lack the tools or training to contribute actively. In response, many linguists deliver training workshops in documentation or preservation, while others train community members to record data. Although workshops…

Pathways to Program Success: A Qualitative Comparative Analysis (QCA) of Communities Putting Prevention to Work Case Study Programs

PubMed Central

Kane, Heather; Hinnant, Laurie; Day, Kristine; Council, Mary; Tzeng, Janice; Soler, Robin; Chambard, Megan; Roussel, Amy; Heirendt, Wendy

2016-01-01

Objective To examine the elements of capacity, a measure of organizational resources supporting program implementation that result in successful completion of public health program objectives in a public health initiative serving 50 communities. Design We used crisp set Qualitative Comparative Analysis (QCA) to analyze case study and quantitative data collected during the evaluation of the Communities Putting Prevention to Work (CPPW) program. Setting CPPW awardee program staff and partners implemented evidence-based public health improvements in counties, cities, and organizations (eg, worksites, schools). Participants Data came from case studies of 22 CPPW awardee programs that implemented evidence-based, community-and organizational-level public health improvements. Intervention Program staff implemented a range of evidence-based public health improvements related to tobacco control and obesity prevention. Main Outcome Measure The outcome measure was completion of approximately 60% of work plan objectives. Results Analysis of the capacity conditions revealed 2 combinations for completing most work plan objectives: (1) having experience implementing public health improvements in combination with having a history of collaboration with partners; and (2) not having experience implementing public health improvements in combination with having leadership support. Conclusion Awardees have varying levels of capacity. The combinations identified in this analysis provide important insights into how awardees with different combinations of elements of capacity achieved most of their work plan objectives. Even when awardees lack some elements of capacity, they can build it through strategies such as hiring staff and engaging new partners with expertise. In some instances, lacking 1 or more elements of capacity did not prevent an awardee from successfully completing objectives. Implications for Policy & Practice These findings can help funders and practitioners recognize and assemble different aspects of capacity to achieve more successful programs; awardees can draw on extant organizational strengths to compensate when other aspects of capacity are absent. PMID:27598714

Should Controls With Respiratory Symptoms Be Excluded From Case-Control Studies of Pneumonia Etiology? Reflections From the PERCH Study.

PubMed

Higdon, Melissa M; Hammitt, Laura L; Deloria Knoll, Maria; Baggett, Henry C; Brooks, W Abdullah; Howie, Stephen R C; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; Scott, J Anthony G; Thea, Donald M; Driscoll, Amanda J; Karron, Ruth A; Park, Daniel E; Prosperi, Christine; Zeger, Scott L; O'Brien, Katherine L; Feikin, Daniel R

2017-06-15

Many pneumonia etiology case-control studies exclude controls with respiratory illness from enrollment or analyses. Herein we argue that selecting controls regardless of respiratory symptoms provides the least biased estimates of pneumonia etiology. We review 3 reasons investigators may choose to exclude controls with respiratory symptoms in light of epidemiologic principles of control selection and present data from the Pneumonia Etiology Research for Child Health (PERCH) study where relevant to assess their validity. We conclude that exclusion of controls with respiratory symptoms will result in biased estimates of etiology. Randomly selected community controls, with or without respiratory symptoms, as long as they do not meet the criteria for case-defining pneumonia, are most representative of the general population from which cases arose and the least subject to selection bias. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Disease management: a leap of faith to lower-cost, higher-quality health care.

PubMed

Short, Ashley; Mays, Glen; Mittler, Jessica

2003-10-01

With managed care's promise to reduce costs and improve quality waning, employers and health plans are exploring more targeted ways to control rapidly rising health costs. Disease management programs, which focus on patients with chronic conditions such as asthma and diabetes, are growing in popularity, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. In addition to condition-based disease management programs, some health plans and employers are using intensive case management services to coordinate care for high-risk patients with potentially costly and complex medical conditions. Despite high expectations, evidence of both disease management and case management programs' success in controlling costs and improving quality remains limited.

Systemic Lupus Erythematosus is Associated with Uranium Exposure in a Community Living Near a Uranium Processing Plant: A Nested Case-Control Study

PubMed Central

Lu-Fritts, Pai-Yue; Kottyan, Leah C.; James, Judith A.; Xie, Changchung; Buckholz, Jeanette M.; Pinney, Susan M.; Harley, John B.

2014-01-01

Objective Explore the hypothesis that cases of SLE will be found more frequently in community members with high prior uranium exposure in the Fernald Community Cohort (FCC). Methods A nested case control study was performed. The FCC is a volunteer population that lived near a uranium ore processing plant in Fernald, Ohio, USA during plant operation and members were monitored for 18 years. Uranium plant workers were excluded. SLE cases were identified using American College of Rheumatology classification criteria, laboratory testing, and medical record review. Each case was matched to four age-, race-, and sex-matched controls. Sera from potential cases and controls were screened for autoantibodies. Cumulative uranium particulate exposure was calculated using a dosimetry model. Logistic regression with covariates was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Results The FCC includes 4,187 individuals with background uranium exposure, 1,273 with moderate exposure, and 2,756 with higher exposure. SLE was confirmed in 23 of 31 individuals with a lupus ICD9 code, and in 2 of 43 other individuals prescribed hydroxychloroquine. The female:male ratio was 5.25:1. Of the 25 SLE cases, 12 were in the higher exposure group. SLE was associated with higher uranium exposure (OR 3.92, 95% CI 1.131-13.588, p = 0.031). Conclusion High uranium exposure is associated with SLE relative to matched controls in this sample of uranium exposed individuals. Potential explanations for this relationship include possible autoimmune or estrogen effects of uranium, somatic mutation, epigenetic effects, or effects of some other unidentified accompanying exposure. PMID:25103365

A Case Study of Teacher Reflection: Examining Teacher Participation in a Video-Based Professional Learning Community

ERIC Educational Resources Information Center

Steeg, Susanna M.

2016-01-01

Professional learning communities (PLCs) constitute worthwhile spaces in which to study teacher participation in the reflective practices that have potential to shift their teaching. This qualitative case study details the interactions between dual-language and ELL teachers in a grade-level PLC as they met together to confer over video-clips of…

The assessment of risk factors for the Central/East African Genotype of chikungunya virus infections in the state of Kelantan: a case control study in Malaysia.

PubMed

Yusoff, Ahmad Faudzi; Mustafa, Amal Nasir; Husaain, Hani Mat; Hamzah, Wan Mansor; Yusof, Apandi Mohd; Harun, Rozilawati; Abdullah, Faezah Noor

2013-05-08

The aims of the study were to assess the risk factors in relation to cross border activities, exposure to mosquito bite and preventive measures taken.An outbreak of chikungunya virus (CHIKV) infection in Malaysia has been reported in Klang, Selangor (1998) and Bagan Panchor, Perak (2006). In 2009, CHIKV infection re-emerged in some states in Malaysia. It raises the possibilities that re-emergence is part of the epidemics in neighbouring countries or the disease is endemic in Malaysia. For this reason, A community-based case control study was carried out in the state of Kelantan. Prospective case finding was performed from June to December 2009. Those who presented with signs and symptoms of CHIKV infection were investigated. We designed a case control study to assess the risk factors. Assessment consisted of answering questions, undergoing a medical examination, and being tested for the presence of IgM antibodies to CHIKV. Descriptive epidemiological studies were conducted by reviewing both the national surveillance and laboratory data. Multivariable logistic regression analysis was performed to determine risk factors contributing to the illness. Cases were determined by positive to RT-PCR or serological for antibodies by IgM. CHIKV specificity was confirmed by DNA sequencing. There were 129 suspected cases and 176 controls. Among suspected cases, 54.4% were diagnosed to have CHIKV infection. Among the controls, 30.1% were found to be positive to serology for antibodies [IgM, 14.2% and IgG, 15.9%]. For analytic study and based on laboratory case definition, 95 were considered as cases and 123 as controls. Those who were positive to IgG were excluded. CHIKV infection affected all ages and mostly between 50-59 years old. Staying together in the same house with infected patients and working as rubber tappers were at a higher risk of infection. The usage of Mosquito coil insecticide had shown to be a significant protective factor. Most cases were treated as outpatient, only 7.5% needed hospitalization. The CHIKV infection was attributable to central/east African genotype CHIKV. In this study, cross border activity was not a significant risk factor although Thailand and Malaysia shared the same CHIKV genotype during the episode of infections.

The assessment of risk factors for the Central/East African Genotype of chikungunya virus infections in the state of Kelantan: a case control study in Malaysia

PubMed Central

2013-01-01

Background The aims of the study were to assess the risk factors in relation to cross border activities, exposure to mosquito bite and preventive measures taken. An outbreak of chikungunya virus (CHIKV) infection in Malaysia has been reported in Klang, Selangor (1998) and Bagan Panchor, Perak (2006). In 2009, CHIKV infection re-emerged in some states in Malaysia. It raises the possibilities that re-emergence is part of the epidemics in neighbouring countries or the disease is endemic in Malaysia. For this reason, A community-based case control study was carried out in the state of Kelantan. Methods Prospective case finding was performed from June to December 2009. Those who presented with signs and symptoms of CHIKV infection were investigated. We designed a case control study to assess the risk factors. Assessment consisted of answering questions, undergoing a medical examination, and being tested for the presence of IgM antibodies to CHIKV. Descriptive epidemiological studies were conducted by reviewing both the national surveillance and laboratory data. Multivariable logistic regression analysis was performed to determine risk factors contributing to the illness. Cases were determined by positive to RT-PCR or serological for antibodies by IgM. CHIKV specificity was confirmed by DNA sequencing. Results There were 129 suspected cases and 176 controls. Among suspected cases, 54.4% were diagnosed to have CHIKV infection. Among the controls, 30.1% were found to be positive to serology for antibodies [IgM, 14.2% and IgG, 15.9%]. For analytic study and based on laboratory case definition, 95 were considered as cases and 123 as controls. Those who were positive to IgG were excluded. CHIKV infection affected all ages and mostly between 50–59 years old. Staying together in the same house with infected patients and working as rubber tappers were at a higher risk of infection. The usage of Mosquito coil insecticide had shown to be a significant protective factor. Most cases were treated as outpatient, only 7.5% needed hospitalization. The CHIKV infection was attributable to central/east African genotype CHIKV. Conclusions In this study, cross border activity was not a significant risk factor although Thailand and Malaysia shared the same CHIKV genotype during the episode of infections. PMID:23656634

Community Interventions to Improve Glycemic Control in African Americans With Type 2 Diabetes: A Systemic Review

PubMed Central

Smalls, Brittany L.; Walker, Rebekah J.; Bonilha, Heather S.; Campbell, Jennifer A.; Egede, Leonard E.

2015-01-01

Purpose: The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. Methods: Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. Results: Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. Conclusion: In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches. PMID:26156923

A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda.

PubMed

Kwesiga, Benon; Pande, Gerald; Ario, Alex Riolexus; Tumwesigye, Nazarius Mbona; Matovu, Joseph K B; Zhu, Bao-Ping

2017-07-18

In May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. We conducted an investigation to identify the mode of transmission to guide control measures. We defined a suspected case as onset of acute watery diarrhoea from 1 February 2015 onwards in a Kasese resident. A confirmed case was a suspected case with Vibrio cholerae O1 El Tor, serotype Inaba cultured from a stool sample. We reviewed medical records to find cases. We conducted a case-control study to compare exposures among confirmed case-persons and asymptomatic controls, matched by village and age-group. We conducted environmental assessments. We tested water samples from the most affected area for total coliforms using the Most Probable Number (MPN) method. We identified 183 suspected cases including 61 confirmed cases of Vibrio cholerae 01; serotype Inaba, with onset between February and July 2015. 2 case-persons died of cholera. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in the 5-14 year age group (4.1/10,000). The outbreak started in Bwera Sub-County bordering the Democratic Republic of Congo and spread eastward through sustained community transmission. The first case-persons were involved in cross-border trading. The case-control study, which involved 49 confirmed cases and 201 controls, showed that 94% (46/49) of case-persons compared with 79% (160/201) of control-persons drank water without boiling or treatment (OR M-H =4.8, 95% CI: 1.3-18). Water collected from the two main sources, i.e., public pipes (consumed by 39% of case-persons and 38% of control-persons) or streams (consumed by 29% of case-persons and 24% control-persons) had high coliform counts, a marker of faecal contamination. Environmental assessment revealed evidence of open defecation along the streams. No food items were significantly associated with illness. This prolonged, community-wide cholera outbreak was associated with drinking water contaminated by faecal matter and cross-border trading. We recommended rigorous disposal of patients' faeces, chlorination of piped water, and boiling or treatment of drinking water. The outbreak stopped 6 weeks after these recommendations were implemented.

Prevention Service System Transformation Using "Communities That Care"

ERIC Educational Resources Information Center

Brown, Eric C.; Hawkins, J. David; Arthur, Michael W.; Briney, John S.; Fagan, Abigail A.

2011-01-01

This study examines prevention system transformation as part of a community-randomized controlled trial of Communities That Care (CTC). Using data from surveys of community leaders, we examine differences between CTC and control communities 4.5 years after CTC implementation. Significantly higher levels of adopting a science-based approach to…

Performance factors of mobile rich media job aids for community health workers

PubMed Central

Florez-Arango, Jose F; Dunn, Kim; Zhang, Jiajie

2011-01-01

Objective To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms. Design A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject). Measurements Error rate per case and task, protocol compliance. Results A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p=0.001) and increases protocol compliance 30.18% (p<0.001). Limitations Medical cases were presented on human patient simulators in a laboratory setting, not on real patients. Conclusion These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries. PMID:21292702

Performance factors of mobile rich media job aids for community health workers.

PubMed

Florez-Arango, Jose F; Iyengar, M Sriram; Dunn, Kim; Zhang, Jiajie

2011-01-01

To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms. A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject). Error rate per case and task, protocol compliance. A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p = 0.001) and increases protocol compliance 30.18% (p < 0.001). Limitations Medical cases were presented on human patient simulators in a laboratory setting, not on real patients. These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries.

Effects of a Community-Based, Post-Rehabilitation Exercise Program in COPD: Protocol for a Randomized Controlled Trial With Embedded Process Evaluation.

PubMed

Desveaux, Laura; Beauchamp, Marla K; Lee, Annemarie; Ivers, Noah; Goldstein, Roger; Brooks, Dina

2016-05-11

This manuscript (1) outlines the intervention, (2) describes how its effectiveness is being evaluated in a pragmatic randomized controlled trial, and (3) summarizes the embedded process evaluation aiming to understand key barriers and facilitators for implementation in new environments. Participating centers refer eligible individuals with COPD following discharge from their local PR program. Consenting patients are assigned to a year-long community exercise program or usual care using block randomization and stratifying for supplemental oxygen use. Patients in the intervention arm are asked to attend an exercise session at least twice per week at their local community facility where their progress is supervised by a case manager. Each exercise session includes a component of aerobic exercise, and activities designed to optimize balance, flexibility, and strength. All study participants will have access to routine follow-up appointments with their respiratory physician, and additional health care providers as part of their usual care. Assessments will be completed at baseline (post-PR), 6, and 12 months, and include measures of functional exercise capacity, quality of life, self-efficacy, and health care usage. Intervention effectiveness will be assessed by comparing functional exercise capacity between intervention and control groups. A mixed-methods process evaluation will be conducted to better understand intervention implementation, guided by Normalization Process Theory and the Consolidated Framework for Implementation Research. Based on results from our pilot work, we anticipate a maintenance of exercise capacity and improved health-related quality of life in the intervention group, compared with a decline in exercise capacity in the usual care group. Findings from this study will improve our understanding of the effectiveness of community-based exercise programs for maintaining benefits following PR in patients with COPD and provide information on how best to implement them. If effective, the intervention represents an opportunity to transition patients from institutionally-based rehabilitative management to community-based care. The results of the process evaluation will contribute to the science of translating evidence-based programs into regular practice.

Head or brain injuries and Alzheimer's disease: A nested case-control register study.

PubMed

Tolppanen, Anna-Maija; Taipale, Heidi; Hartikainen, Sirpa

2017-12-01

Many previous studies have been limited by self- or proxy-reported injury or short follow-up. We investigated whether head or brain injuries are associated with Alzheimer's disease (AD), possible modifying factors and dose-response relationship. Nested register-based case-control study of all community dwellers who received clinically verified AD diagnosis in Finland in 2005 to 2011 (n = 70,719) and one to four matched controls for each case (n of controls = 282,862). The magnitude of association between hospital-treated head and/or brain injuries was strongly dependent on the lag time between exposure and outcome. With a 5-year lag time, head injury (adjusted odds ratio; 95% confidence interval 1.19; 1.15-1.23) or brain injury (1.23; 1.18-1.29) was associated with higher risk of AD. Dose-response relationship with number and severity of injuries was observed. Associations were stronger in those with earlier onset of AD. Stronger associations with shorter lag times indicate that head and/or brain injuries may also reflect the ongoing AD disease process. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Consulting, Mediating, Conducting, and Supporting: How Community-Based Organizations Engage with Research to Influence Policy

ERIC Educational Resources Information Center

Winton, Sue; Evans, Michael P.

2016-01-01

Grounded in critical policy theories and democratic conceptions of research, case studies of three community-based organizations, one in Canada and two in the U.S., were analyzed to determine if and how the groups engaged with research in their efforts to influence education policy. The findings demonstrate that the community-based organizations…

Disadvantaged persons' participation in health promotion projects: some structural dimensions.

PubMed

Boyce, W F

2001-05-01

A structural perspective was used in studying community participation of disadvantaged groups (poor women, street youth, and disabled persons) in health promotion projects. Five community projects in the Canadian Health Promotion Contribution Program were examined in a comparative case study utilizing in-depth interviews, documents, and secondary sources. Analysis revealed relatively low numbers and restricted range of participants, difficulties in recruiting and maintaining participants, declining rates of active participation over time, and limited target group influence and power. This paper reports on the relationship between various dimensions of structure (social-cultural, organizational, political-legal-economic) and the community participation process. Participation was influenced by structural factors such as bureaucratic rules and regulators, perceived minority group rights and relations, agency reputations and responsibilities, available resources, and organizational roles. Control of projects by target group members, rather than by service agencies, was an important overall organizational structural factor which allowed community members to achieve influence in projects. The study concludes that a conceptual model based on structural factors is useful in explaining how key factors from federal and local levels can restrict or facilitate the community participation process.

A case study in the use of evidence in a changing political context: an Aboriginal and Torres Strait Islander health service re-examines practice models, governance and financing.

PubMed

Gajjar, Deepa; Zwi, Anthony B; Hill, Peter S; Shannon, Cindy

2014-09-01

This paper examines the response of a regional body, the Institute for Urban Indigenous Health (IUIH), coordinating Aboriginal community controlled health organisations (ACCHOs) in south-east Queensland, to research evidence as they prioritise and plan services in response to internal economic and organisational factors, as well as external policy change. An event-based analysis of a quarterly management meeting of the IUIH allowed an exploration of how the IUIH uses a range of evidence to respond to the challenges faced within the Aboriginal community controlled health sector. The study identified three distinct but interconnected processes: (1) identifying evidence for change; (2) exploring and reframing this evidence; and (3) the application of this evidence at different levels of policy and practice. These processes were evident in each of the three major agendas addressed during the meeting, namely navigating current political change, reforming the ACCHO business model and reframing the available evidence for advocacy. The result has been the emergence of a new service delivery model, in which evidence supports accountability, change management, self-sufficiency and attempts to redefine community control.

Cohorts and community: a case study of community engagement in the establishment of a health and demographic surveillance site in Malaysia

PubMed Central

Allotey, Pascale; Reidpath, Daniel D.; Devarajan, Nirmala; Rajagobal, Kanason; Yasin, Shajahan; Arunachalam, Dharmalingam; Imelda, Johanna Debora; Soyiri, Ireneous; Davey, Tamzyn; Jahan, Nowrozy

2014-01-01

Background Community engagement is an increasingly important requirement of public health research and plays an important role in the informed consent and recruitment process. However, there is very little guidance about how it should be done, the indicators for assessing effectiveness of the community engagement process and the impact it has on recruitment, retention, and ultimately on the quality of the data collected as part of longitudinal cohort studies. Methods An instrumental case study approach, with data from field notes, policy documents, unstructured interviews, and focus group discussions with key community stakeholders and informants, was used to explore systematically the implementation and outcomes of the community engagement strategy for recruitment of an entire community into a demographic and health surveillance site in Malaysia. Results For a dynamic cohort, community engagement needs to be an ongoing process. The community engagement process has likely helped to facilitate the current response rate of 85% in the research communities. The case study highlights the importance of systematic documentation of the community engagement process to ensure an understanding of the effects of the research on recruitment and the community. Conclusions A critical lesson from the case study data is the importance of relationships in the recruitment process for large population-based studies, and the need for ongoing documentation and analysis of the impact of cumulative interactions between research and community engagement. PMID:24804983

The Keys to Governance and Stakeholder Engagement: The Southeast Michigan Beacon Community Case Study

PubMed Central

Des Jardins, Terrisca R.

2014-01-01

Community-based health information exchanges (HIEs) and efforts to consolidate and house data are growing, given the advent of Accountable Care Organizations (ACOs) under the Affordable Care Act and other similar population health focused initiatives. The Southeast Michigan Beacon Community (SEMBC) can be looked to as one case study that offers lessons learned, insights on challenges faced and accompanying workarounds related to governance and stakeholder engagement. The SEMBC case study employs an established Data Warehouse Governance Framework to identify and explain the necessary governance and stakeholder engagement components, particularly as they relate to community-wide data sharing and data warehouses or repositories. Perhaps the biggest lesson learned through the SEMBC experience is that community-based work is hard. It requires a great deal of community leadership, collaboration and resources. SEMBC found that organizational structure and guiding principles needed to be continually revisited and nurtured in order to build the relationships and trust needed among stakeholder organizations. SEMBC also found that risks and risk mitigation tactics presented challenges and opportunities at the outset and through the duration of the three year pilot period. Other communities across the country embarking on similar efforts need to consider realistic expectations about community data sharing infrastructures and the accompanying and necessary governance and stakeholder engagement fundamentals. PMID:25848612

Secondhand Smoke Exposure and Low Blood Lead Levels in Association With Attention-Deficit Hyperactivity Disorder and Its Symptom Domain in Children: A Community-Based Case-Control Study.

PubMed

Joo, Hyunjoo; Lim, Myung-Ho; Ha, Mina; Kwon, Ho-Jang; Yoo, Seung Jin; Choi, Kyung-Hwa; Paik, Ki-Chung

2017-01-01

Secondhand smoke (SHS) is a major indoor pollutant. We examined the possible association between exposure to both SHS and low levels of lead and attention-deficit-hyperactivity disorder (ADHD) and its symptom domain in children. This case-control study was based on the results of a community survey using the ADHD rating scale conducted in 49 elementary schools. Both cases and control subjects were confirmed by a child psychiatrist. Each case was matched with one control subject according to gender, school, and grade in school. Using a multivariate conditional logistic regression model, we analyzed 214 case-control pairs of children who ranged in age from 6 to 10 years. Urine and blood levels of cotinine and of lead were determined, and information pertaining to SHS exposure was obtained by means of a questionnaire. Exposure to low levels of lead (geometric mean = 1.65 µg/dL) was related to ADHD, particularly inattention (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.07-2.59), whereas SHS exposure was associated mainly with hyperactivity/impulsivity (OR = 3.85, 95% CI = 1.55-9.56). In the pathway from blood lead to hyperactivity/impulsivity, children's SHS exposure mediated and indirectly accounted for about 73% of this relationship. The combined exposure to lead and SHS synergistically increased the risk of ADHD, evident as both inattention and hyperactivity/impulsivity. SHS, which is associated with hyperactivity/impulsivity in particular, combined with exposure to low blood levels of lead synergistically increased the risk of ADHD. Therefore, the exposure of children to both SHS and lead needs to be reduced. Although exposure to low levels of lead has been shown to be associated with ADHD, there is little evidence of symptom domain specificity. In our study, low blood lead levels were related to inattention. In addition, prenatal or postnatal exposure to SHS increased the risk of ADHD, particularly hyperactivity/impulsivity. Combined exposure to lead and SHS synergistically increased the risk for both these ADHD symptom domains. To protect children from environmental risk factors related to ADHD, it is necessary to further reduce children's exposure to SHS and lead, even in those with low blood lead levels. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

Abnormal folate metabolism as a risk factor for first-trimester spontaneous abortion.

PubMed

Hoffman, Michael L; Scoccia, Bert; Kurczynski, Thaddeus W; Shulman, Lee P; Gao, Weihua

2008-03-01

To assess the potential role of folic acid in early pregnancy loss by measuring homocysteine (hcy) levels in healthy, pregnant women who present with a current first-trimester miscarriage. This was a cross-sectional analysis comprising 13 patients aged 18-31 years old who had a scheduled dilatation and curettage for a first-trimester miscarriage. The controls were 15 patients of similar maternal age presenting for a first-trimester prenatal care visit. Following completion of a 21-item, structured questionnaire, patients were excluded from the study if they had any known risk factors for a first-trimester miscarriage. The remaining patients provided blood samples for measurement of homocysteine and red blood cell folate. Cases and controls were compared using a standard 2-sample t test. In order to detect a clinically relevant 2.3 micromol/L difference in homocysteine levels, 11 cases and 8 controls were needed. The mean hcy level in cases (5.8 umolmol/L) vs. controls (5.7 micromol/L) was not significantly different (p = 0.83), and all individual values fell within the normal range expected in pregnant women. Red blood cell folate levels (cases=586 ng/mL, controls=611 ng/mL) were also not significantly different (p = 0.72), and no cases of folate deficiency were detected. Maternal age (cases=26, controls=25) and gestational age (cases = 8.8 weeks, controls = 8.4 weeks) were similar between the 2 groups. In this community-based pilot study, abnormal folate metabolism was not an apparent risk factor for spontaneous first-trimester pregnancy loss.

Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest: rationale and outline of the AmsteRdam Resuscitation Studies (ARREST) registry.

PubMed

Blom, M T; van Hoeijen, D A; Bardai, A; Berdowski, J; Souverein, P C; De Bruin, M L; Koster, R W; de Boer, A; Tan, H L

2014-01-01

Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA. We set up a large-scale prospective community-based registry (AmsteRdam Resuscitation Studies, ARREST) in which we prospectively include all resuscitation attempts from OHCA in a large study region in the Netherlands in collaboration with Emergency Medical Services. Of all OHCA victims since June 2005, we prospectively collect medical history (through hospital and general practitioner), and current and previous medication use (through community pharmacy). In addition, we include DNA samples from OHCA victims with documented ventricular tachycardia/fibrillation during the resuscitation attempt since July 2007. Various study designs are employed to analyse the data of the ARREST registry, including case-control, cohort, case only and case-cross over designs. We describe the rationale, outline and potential results of the ARREST registry. The design allows for a stable and reliable collection of multiple determinants of OHCA, while assuring that the patient, lay-caregiver or medical professional is not hindered in any way. Such comprehensive data collection is required to unravel the complex basis of OHCA. Results will be published in peer-reviewed journals and presented at relevant scientific symposia.

Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management.

PubMed

Prendergast, Michael; Cartier, Jerome J

2008-01-01

In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.

Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province.

PubMed Central

May, P A; Brooke, L; Gossage, J P; Croxford, J; Adnams, C; Jones, K L; Robinson, L; Viljoen, D

2000-01-01

OBJECTIVES: This study determined the characteristics of fetal alcohol syndrome in a South African community, and methodology was designed for the multidisciplinary study of fetal alcohol syndrome in developing societies. METHODS: An active case ascertainment, 2-tier methodology was used among 992 first-grade pupils. A case-control design, using measures of growth, development, dysmorphology, and maternal risk, delineated characteristics of children with fetal alcohol syndrome. RESULTS: A high rate of fetal alcohol syndrome was found in the schools--40.5 to 46.4 per 1000 children aged 5 to 9 years--and age-specific community rates (ages 6-7) were 39.2 to 42.9. These rates are 18 to 141 times greater than in the United States. Rural residents had significantly more fetal alcohol syndrome. After control for ethnic variation, children with fetal alcohol syndrome had traits similar to those elsewhere: poor growth and development, congruent dysmorphology, and lower intellectual functioning. CONCLUSIONS: This study documented the highest fetal alcohol syndrome rate to date in an overall community population. Fetal alcohol syndrome initiatives that incorporate innovative sampling and active case ascertainment methods can be used to obtain timely and accurate data among developing populations. PMID:11111264

A Community-Based Activities Survey: Systematically Determining the Impact on and of Faculty

ERIC Educational Resources Information Center

Perry, Lane; Farmer, Betty; Onder, David; Tanner, Benjamin; Burton, Carol

2015-01-01

As a descriptive case study from Western Carolina University (WCU), this article describes the development of a measuring, monitoring, and tracking system (the WCU Community-based Activities Survey) for faculty engagement in, adoption of, and impact through community engagement practices both internal and external to their courses. This paper will…

International Community-Based Service Learning: Two Comparative Case Studies of Benefits and Tensions

ERIC Educational Resources Information Center

Akhurst, Jacqueline

2016-01-01

The drives to internationalise the UK curriculum and psychology students' desires to work in communities are brought together in this paper. International community-based learning (ICBL) links with many psychology students' motivations to make contributions to others; with the potential to enhance students' learning and cultural sensitivities. The…

Systems Thinking Tools as Applied to Community-Based Participatory Research: A Case Study

ERIC Educational Resources Information Center

BeLue, Rhonda; Carmack, Chakema; Myers, Kyle R.; Weinreb-Welch, Laurie; Lengerich, Eugene J.

2012-01-01

Community-based participatory research (CBPR) is being used increasingly to address health disparities and complex health issues. The authors propose that CBPR can benefit from a systems science framework to represent the complex and dynamic characteristics of a community and identify intervention points and potential "tipping points."…

Differences in child versus parent reports of the child's health-related quality of life in children with epilepsy and healthy siblings.

PubMed

Baca, Christine Bower; Vickrey, Barbara G; Hays, Ron D; Vassar, Stefanie D; Berg, Anne T

2010-01-01

Self versus proxy perspectives may produce different results that are important for clinical decision-making and for assessing outcomes in research studies. We examined differences in child versus parent report of the child's health-related quality of life (HRQOL) in a large prospective, community-based study of newly diagnosed childhood epilepsy that included children with epilepsy (case) and sibling controls. HRQOL was assessed 8 to 9 years after initial diagnosis of epilepsy in a subset of 143 case-control matched pairs using the Child Health Questionnaire (CHQ), a generic HRQOL measure with child (CHQ-CF87), and parent (CHQ-PF50) versions. There were no significant differences between self-reported case and sibling control HRQOL scores on 9 of 11 scales or 2 global items. Nevertheless, parent ratings were significantly better (higher HRQOL) for sibling controls compared with epilepsy cases on 10 of 12 scales, global behavior and general health items, and the physical and psychosocial summary scores (P≤0.05). Parent-child agreement was low for cases and controls (kappa 0.27-0.33) for three single-item questions with the same wording on parent and child versions. Parent ratings of the case's HRQOL were often significantly associated with 5-year remission status and current antiepileptic drug use, but the case's self-reported HRQOL scores were not. In contrast, current pharmacoresistance was often associated with the child and parent ratings of the child's HRQOL. Children with epilepsy report HRQOL that is comparable to that of sibling controls, while parents rate children with epilepsy as having lower HRQOL than sibling controls. Measuring outcomes in studies of this population should incorporate both perspectives. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Risk factors for moderate and severe microbial keratitis in daily wear contact lens users.

PubMed

Stapleton, Fiona; Edwards, Katie; Keay, Lisa; Naduvilath, Thomas; Dart, John K G; Brian, Garry; Holden, Brien

2012-08-01

To establish risk factors for moderate and severe microbial keratitis among daily contact lens (CL) wearers in Australia. A prospective, 12-month, population-based, case-control study. New cases of moderate and severe microbial keratitis in daily wear CL users presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners. Case detection was augmented by record audits at major ophthalmic centers. Controls were users of daily wear CLs in the community identified using a national telephone survey. Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Multiple binary logistic regression was used to determine independent risk factors and univariate population attributable risk percentage (PAR%) was estimated for each risk factor. Independent risk factors, relative risk (with 95% confidence intervals [CIs]), and PAR%. There were 90 eligible moderate and severe cases related to daily wear of CLs reported during the study period. We identified 1090 community controls using daily wear CLs. Independent risk factors for moderate and severe keratitis while adjusting for age, gender, and lens material type included poor storage case hygiene 6.4× (95% CI, 1.9-21.8; PAR, 49%), infrequent storage case replacement 5.4× (95% CI, 1.5-18.9; PAR, 27%), solution type 7.2× (95% CI, 2.3-22.5; PAR, 35%), occasional overnight lens use (<1 night per week) 6.5× (95% CI, 1.3-31.7; PAR, 23%), high socioeconomic status 4.1× (95% CI, 1.2-14.4; PAR, 31%), and smoking 3.7× (95% CI, 1.1-12.8; PAR, 31%). Moderate and severe microbial keratitis associated with daily use of CLs was independently associated with factors likely to cause contamination of CL storage cases (frequency of storage case replacement, hygiene, and solution type). Other factors included occasional overnight use of CLs, smoking, and socioeconomic class. Disease load may be considerably reduced by attention to modifiable risk factors related to CL storage case practice. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015.

PubMed

Bwire, Godfrey; Munier, Aline; Ouedraogo, Issaka; Heyerdahl, Leonard; Komakech, Henry; Kagirita, Atek; Wood, Richard; Mhlanga, Raymond; Njanpop-Lafourcade, Berthe; Malimbo, Mugagga; Makumbi, Issa; Wandawa, Jennifer; Gessner, Bradford D; Orach, Christopher Garimoi; Mengel, Martin A

2017-03-01

The communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities. We conducted a prospective study between 2011-15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5-10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5-9 years had increased risk. Cholera was endemic in some villages with well-defined "hotspots". Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty. Cholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities.

Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015

PubMed Central

Ouedraogo, Issaka; Heyerdahl, Leonard; Komakech, Henry; Kagirita, Atek; Wood, Richard; Mhlanga, Raymond; Njanpop-Lafourcade, Berthe; Malimbo, Mugagga; Makumbi, Issa; Wandawa, Jennifer; Gessner, Bradford D.; Orach, Christopher Garimoi; Mengel, Martin A.

2017-01-01

Background The communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities. Methodology/Principal findings We conducted a prospective study between 2011–15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5–10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5–9 years had increased risk. Cholera was endemic in some villages with well-defined “hotspots”. Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty. Conclusions/Significance Cholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities. PMID:28288154

Factors that are associated with the risk of acquiring Plasmodium knowlesi malaria in Sabah, Malaysia: a case-control study protocol

PubMed Central

Grigg, M J; William, T; Drakeley, C J; Jelip, J; von Seidlein, L; Barber, B E; Fornace, K M; Anstey, N M; Yeo, T W; Cox, J

2014-01-01

Introduction Plasmodium knowlesi has long been present in Malaysia, and is now an emerging cause of zoonotic human malaria. Cases have been confirmed throughout South-East Asia where the ranges of its natural macaque hosts and Anopheles leucosphyrus group vectors overlap. The majority of cases are from Eastern Malaysia, with increasing total public health notifications despite a concurrent reduction in Plasmodium falciparum and P. vivax malaria. The public health implications are concerning given P. knowlesi has the highest risk of severe and fatal disease of all Plasmodium spp in Malaysia. Current patterns of risk and disease vary based on vector type and competence, with individual exposure risks related to forest and forest-edge activities still poorly defined. Clustering of cases has not yet been systematically evaluated despite reports of peri-domestic transmission and known vector competence for human-to-human transmission. Methods and analysis A population-based case–control study will be conducted over a 2-year period at two adjacent districts in north-west Sabah, Malaysia. Confirmed malaria cases presenting to the district hospital sites meeting relevant inclusion criteria will be requested to enrol. Three community controls matched to the same village as the case will be selected randomly. Study procedures will include blood sampling and administration of household and individual questionnaires to evaluate potential exposure risks associated with acquisition of P. knowlesi malaria. Secondary outcomes will include differences in exposure variables between P. knowlesi and other Plasmodium spp, risk of severe P. knowlesi malaria, and evaluation of P. knowlesi case clustering. Primary analysis will be per protocol, with adjusted ORs for exposure risks between cases and controls calculated using conditional multiple logistic regression models. Ethics This study has been approved by the human research ethics committees of Malaysia, the Menzies School of Health Research, Australia, and the London School of Hygiene and Tropical Medicine, UK. PMID:25149186

Aggressive active case detection: a malaria control strategy based on the Brazilian model.

PubMed

Macauley, Cameron

2005-02-01

Since 1996, the Brazilian Ministry of Health has adopted a malaria control strategy known as aggressive active case detection (AACD) in which most or all members of every community are tested and treated for malaria on a monthly basis. The strategy attempts to identify and treat cases of asymptomatic malaria, which, if untreated, continue to transmit the infection. Malaria remains uncontrolled because almost all health care systems in the world rely on passive case detection: the treatment of only symptomatic cases of malaria. Research has shown conclusively that asymptomatic cases exist in any population where malaria transmission is stable and incidence is high: therefore passive case detection simply will not succeed in breaking the cycle of transmission. Numerous case studies show that malaria has been successfully controlled on a regional or national level by mass blood surveys. AACD is an effective malaria control strategy if used in conjunction with other methods, especially when (1) an effective treatment exists, (2) influx of potential carriers of the infection can be monitored, and (3) people are inclined to cooperate with monthly blood testing. AACD requires access to rapid diagnostic tests (RDTs), microscopy supplies, extensive human resources, and prompt, affordable, and effective treatment. AACD is compared to PCD in terms of clinical efficacy and cost effectiveness in a case study of malaria in the Brazilian Yanomami Indians. Where it is feasible, AACD could drastically reduce the incidence of malaria and should be an integral part of the World Health Organization's Roll Back Malaria strategy.

Pre-Service Elementary Teachers' Experience in a Community of Practice through a Place-Based Inquiry

ERIC Educational Resources Information Center

Cook, Kristin; Buck, Gayle

2014-01-01

With this case study, we explored efforts to connect pre-service elementary teachers (PSTs) and campus scientists through place-based inquiry instruction. Using the framework of Community of Practice (CoP), the research question guiding this study was: what features of our place-based inquiry course intervention (involving PSTs and scientists)…

"We make the path by walking it": building an academic community partnership with Boston Chinatown.

PubMed

Rubin, Carolyn Leung; Allukian, Nathan; Wang, Xingyue; Ghosh, Sujata; Huang, Chien-Chi; Wang, Jacy; Brugge, Doug; Wong, John B; Mark, Shirley; Dong, Sherry; Koch-Weser, Susan; Parsons, Susan K; Leslie, Laurel K; Freund, Karen M

2014-01-01

The potential for academic community partnerships are challenged in places where there is a history of conflict and mistrust. Addressing Disparities in Asian Populations through Translational Research (ADAPT) represents an academic community partnership between researchers and clinicians from Tufts Medical Center and Tufts University and community partners from Boston Chinatown. Based in principles of community-based participatory research and partnership research, this partnership is seeking to build a trusting relationship between Tufts and Boston Chinatown. This case study aims to provides a narrative story of the development and formation of ADAPT as well as discuss challenges to its future viability. Using case study research tools, this study draws upon a variety of data sources including interviews, program evaluation data and documents. Several contextual factors laid the foundation for ADAPT. Weaving these factors together helped to create synergy and led to ADAPT's formation. In its first year, ADAPT has conducted formative research, piloted an educational program for community partners and held stakeholder forums to build a broad base of support. ADAPT recognizes that long term sustainability requires bringing multiple stakeholders to the table even before a funding opportunity is released and attempting to build a diversified funding base.

Risk of congenital anomalies around a municipal solid waste incinerator: a GIS-based case-control study

PubMed Central

Vinceti, Marco; Malagoli, Carlotta; Fabbi, Sara; Teggi, Sergio; Rodolfi, Rossella; Garavelli, Livia; Astolfi, Gianni; Rivieri, Francesca

2009-01-01

Background Waste incineration releases into the environment toxic substances having a teratogenic potential, but little epidemiologic evidence is available on this topic. We aimed at examining the relation between exposure to the emissions from a municipal solid waste incinerator and risk of birth defects in a northern Italy community, using Geographical Information System (GIS) data to estimate exposure and a population-based case-control study design. By modelling the incinerator emissions, we defined in the GIS three areas of increasing exposure according to predicted dioxins concentrations. We mapped the 228 births and induced abortions with diagnosis of congenital anomalies observed during the 1998–2006 period, together with a corresponding series of control births matched for year and hospital of birth/abortion as well as maternal age, using maternal address in the first three months of pregnancy to geocode cases and controls. Results Among women residing in the areas with medium and high exposure, prevalence of anomalies in the offspring was substantially comparable to that observed in the control population, nor dose-response relations for any of the major categories of birth defects emerged. Furthermore, odds ratio for congenital anomalies did not decrease during a prolonged shut-down period of the plant. Conclusion Overall, these findings do not lend support to the hypothesis that the environmental contamination occurring around an incineration plant such as that examined in this study may induce major teratogenic effects. PMID:19208225

Community Participation in Chagas Disease Vector Surveillance: Systematic Review

PubMed Central

Abad-Franch, Fernando; Vega, M. Celeste; Rolón, Miriam S.; Santos, Walter S.; Rojas de Arias, Antonieta

2011-01-01

Background Vector control has substantially reduced Chagas disease (ChD) incidence. However, transmission by household-reinfesting triatomines persists, suggesting that entomological surveillance should play a crucial role in the long-term interruption of transmission. Yet, infestation foci become smaller and harder to detect as vector control proceeds, and highly sensitive surveillance methods are needed. Community participation (CP) and vector-detection devices (VDDs) are both thought to enhance surveillance, but this remains to be thoroughly assessed. Methodology/Principal Findings We searched Medline, Web of Knowledge, Scopus, LILACS, SciELO, the bibliographies of retrieved studies, and our own records. Data from studies describing vector control and/or surveillance interventions were extracted by two reviewers. Outcomes of primary interest included changes in infestation rates and the detection of infestation/reinfestation foci. Most results likely depended on study- and site-specific conditions, precluding meta-analysis, but we re-analysed data from studies comparing vector control and detection methods whenever possible. Results confirm that professional, insecticide-based vector control is highly effective, but also show that reinfestation by native triatomines is common and widespread across Latin America. Bug notification by householders (the simplest CP-based strategy) significantly boosts vector detection probabilities; in comparison, both active searches and VDDs perform poorly, although they might in some cases complement each other. Conclusions/Significance CP should become a strategic component of ChD surveillance, but only professional insecticide spraying seems consistently effective at eliminating infestation foci. Involvement of stakeholders at all process stages, from planning to evaluation, would probably enhance such CP-based strategies. PMID:21713022

Association of type 1 diabetes and concentrations of drinking water components in Newfoundland and Labrador, Canada.

PubMed

Chafe, Roger; Aslanov, Rana; Sarkar, Atanu; Gregory, Peter; Comeau, Alex; Newhook, Leigh Anne

2018-01-01

To determine the association between drinking water quality and rates of type 1 diabetes in the Newfoundland and Labrador (NL) population, which has one of the highest incidences of type 1 diabetes reported globally. The study used a community-based, case-control design. We first calculated incidence rates of type 1 diabetes at the provincial, regional and community levels. The connection between incidence rates and components in public water supplies were then analyzed in three ways: to evaluate differences in water quality between communities with and without incident cases of type 1 diabetes, and to analyze the relationship between water quality and incidence rates of type 1 diabetes at both the community and regional levels. The provincial incidence of type 1 diabetes was 51.7/100 000 (0-14 year age group) for the period studied. In the community-based analysis, there were significant associations found between higher concentrations of arsenic (β=0.268, P=0.013) and fluoride (β=0.202, P=0.005) in drinking water and higher incidence of type 1 diabetes. In the regional analysis, barium (β=-0.478, P=0.009) and nickel (β=-0.354, P=0.050) concentrations were negatively associated with incidence of type 1 diabetes. We confirmed the high incidence of type 1 diabetes in NL. We also found that concentrations of some components in drinking water were associated with higher incidence of type 1 diabetes, but no component was found to have a significant association across the three different levels of analysis performed.

FOXO3 variants are beneficial for longevity in Southern Chinese living in the Red River Basin: A case-control study and meta-analysis

PubMed Central

Sun, Liang; Hu, Caiyou; Zheng, Chenguang; Qian, Yu; Liang, Qinghua; Lv, Zeping; Huang, Zezhi; Qi, KeYan; Gong, Huan; Zhang, Zheng; Huang, Jin; Zhou, Qin; Yang, Ze

2015-01-01

Forkhead box class O (FOXO) transcription factors play a crucial role in longevity across species. Several polymorphisms in FOXO3 were previously reported to be associated with human longevity. However, only one Chinese replication study has been performed so far. To verify the role of FOXO3 in southern Chinese in the Red River Basin, a community-based case-control study was conducted, and seven polymorphisms were genotyped in 1336 participants, followed by a meta-analysis of eight case-control studies that included 5327 longevity cases and 4608 controls. In our case-control study, we found rs2802288*A and rs2802292*G were beneficial to longevity after Bonferroni correction (pallele = 0.005, OR = 1.266; pallele = 0.026, OR = 1.207). In addition, in the longevity group, carriers with rs2802288*A and rs2802292*G presented reduced HbA1c (p = 0.001), and homozygotes of rs2802292*GG presented improved HOMA–IR (p = 0.014). The meta-analysis further revealed the overall contribution of rs2802288*A and rs2802292*G to longevity. However, our stratified analysis revealed that rs2802292*G might act more strongly in Asians than Europeans, for enhancement of longevity. In conclusion, our study provides convincing evidence for a significant association between the rs2802288*A and rs2802292*G gene variants in FOXO3 and human longevity, and adds the Southern Chinese in the Red River Basin to the growing number of human replication populations. PMID:25913413

FOXO3 variants are beneficial for longevity in Southern Chinese living in the Red River Basin: A case-control study and meta-analysis.

PubMed

Sun, Liang; Hu, Caiyou; Zheng, Chenguang; Qian, Yu; Liang, Qinghua; Lv, Zeping; Huang, Zezhi; Qi, KeYan; Gong, Huan; Zhang, Zheng; Huang, Jin; Zhou, Qin; Yang, Ze

2015-04-27

Forkhead box class O (FOXO) transcription factors play a crucial role in longevity across species. Several polymorphisms in FOXO3 were previously reported to be associated with human longevity. However, only one Chinese replication study has been performed so far. To verify the role of FOXO3 in southern Chinese in the Red River Basin, a community-based case-control study was conducted, and seven polymorphisms were genotyped in 1336 participants, followed by a meta-analysis of eight case-control studies that included 5327 longevity cases and 4608 controls. In our case-control study, we found rs2802288*A and rs2802292*G were beneficial to longevity after Bonferroni correction (pallele = 0.005, OR = 1.266; pallele = 0.026, OR = 1.207). In addition, in the longevity group, carriers with rs2802288*A and rs2802292*G presented reduced HbA1c (p = 0.001), and homozygotes of rs2802292*GG presented improved HOMA-IR (p = 0.014). The meta-analysis further revealed the overall contribution of rs2802288*A and rs2802292*G to longevity. However, our stratified analysis revealed that rs2802292*G might act more strongly in Asians than Europeans, for enhancement of longevity. In conclusion, our study provides convincing evidence for a significant association between the rs2802288*A and rs2802292*G gene variants in FOXO3 and human longevity, and adds the Southern Chinese in the Red River Basin to the growing number of human replication populations.

Acute respiratory infection case definitions for young children: a systematic review of community-based epidemiologic studies in South Asia.

PubMed

Roth, Daniel E; Gaffey, Michelle F; Smith-Romero, Evelyn; Fitzpatrick, Tiffany; Morris, Shaun K

2015-12-01

To explore the variability in childhood acute respiratory infection case definitions for research in low-income settings where there is limited access to laboratory or radiologic investigations. We conducted a systematic review of community-based, longitudinal studies in South Asia published from January 1990 to August 2013, in which childhood acute respiratory infection outcomes were reported. Case definitions were classified by their label (e.g. pneumonia, acute lower respiratory infection) and clinical content 'signatures' (array of clinical features that would be always present, conditionally present or always absent among cases). Case definition heterogeneity was primarily assessed by the number of unique case definitions overall and by label. We also compared case definition-specific acute respiratory infection incidence rates for studies reporting incidence rates for multiple case definitions. In 56 eligible studies, we found 124 acute respiratory infection case definitions. Of 90 case definitions for which clinical content was explicitly defined, 66 (73%) were unique. There was a high degree of content heterogeneity among case definitions with the same label, and some content signatures were assigned multiple labels. Within studies for which incidence rates were reported for multiple case definitions, variation in content was always associated with a change in incidence rate, even when the content differed by a single clinical feature. There has been a wide variability in case definition label and content combinations to define acute upper and lower respiratory infections in children in community-based studies in South Asia over the past two decades. These inconsistencies have important implications for the synthesis and translation of knowledge regarding the prevention and treatment of childhood acute respiratory infection. © 2015 John Wiley & Sons Ltd.

A Case Study of Peer Educators in a Community-Based Program to Reduce Teen Pregnancy: Selected Characteristics Prior to Training, Perceptions of Training and Work, and Perceptions of How Participation in the Program Has Affected Them

ERIC Educational Resources Information Center

Beshers, Sarah C.

2007-01-01

This investigation is a case study of peer educators in a community-based teen pregnancy prevention program. Research questions focused on identifying ways in which peer educators differed from other teens and exploring the perceptions of the peer educators about their experience in the program and the ways in which it has affected them. Data were…

Evaluation of Abdominal Ultrasonography Mass Screening for Hepatocellular Carcinoma in Taiwan

PubMed Central

Yeh, Yen-Po; Hu, Tsung-Hui; Cho, Po-Yuan; Chen, Hsiu-Hsi; Yen, Amy Ming-Fang; Chen, Sam Li-Sheng; Chiu, Sherry Yueh-Hsia; Fann, Jean Ching-Yuan; Su, Wei-Wen; Fang, Yi-Jen; Chen, Shih-Tien; San, Hsiao-Ching; Chen, Hung-Pin; Liao, Chao-Sheng

2014-01-01

Mass screening with abdominal ultrasonography (AUS) has been suggested as a tool to control adult hepatocellular carcinoma (HCC) in individuals, but its efficacy in reducing HCC mortality has never been demonstrated. This study aimed to assess the effectiveness of reducing HCC mortality by mass AUS screening for HCC based on a program designed and implemented in the Changhua Community-based Integrated Screening (CHCIS) program with an efficient invitation scheme guided by the risk score. We invited 11,114 (27.0%) of 41,219 eligible Taiwanese subjects between 45 and 69 years of age who resided in an HCC high-incidence area to attend a risk score-guided mass AUS screening between 2008 and 2010. The efficacy of reducing HCC mortality was estimated. Of the 8,962 AUS screening attendees (with an 80.6% attendance rate), a total of 16 confirmed HCC cases were identified through community-based ultrasonography screening. Among the 16 screen-detected HCC cases, only two died from HCC, indicating a favorable survival. The cumulative mortality due to HCC (per 100,000) was considerably lower in the invited AUS group (17.26) compared with the uninvited AUS group (42.87) and the historical control group (47.51), yielding age- and gender-adjusted relative mortality rates of 0.69 (95% confidence interval [CI]: 0.56-0.84) and 0.63 (95% CI: 0.52-0.77), respectively. Conclusion: The residents invited to community-based AUS screening for HCC, compared with those who were not invited, showed a reduction in HCC mortality by ∼31% among subjects aged 45-69 years who had not been included in the nationwide vaccination program against hepatitis B virus infection. (Hepatology 2014;59:1840–1849) PMID:24002724

Community-based shared values as a 'Heart-ware' driver for integrated watershed management: Japan-Malaysia policy learning perspective

NASA Astrophysics Data System (ADS)

Mohamad, Zeeda Fatimah; Nasaruddin, Affan; Abd Kadir, Siti Norasiah; Musa, Mohd Noor; Ong, Benjamin; Sakai, Nobumitsu

2015-11-01

This paper explores the case for using ;community-based shared values; as a potential driver for the ;Heartware; aspects of governance in Integrated Watershed Management (IWM) - from a Japan-Malaysia policy learning perspective. This policy approach was originally inspired by the Japanese experience, and the paper investigates whether a similar strategy can be adapted in the Malaysian context-based on a qualitative exploratory case study of a local downstream watershed community. The community-based shared values are categorized into six functional values that can be placed on a watershed: industry, ecosystem, lifestyle, landscape, water resource and spirituality. The study confirmed the availability of a range of community-based shared values in each category that are promising to drive the heartware for integrated watershed management in the local Malaysian context. However, most of these shared values are either declining in its appreciation or nostalgic in nature. The paper ends with findings on key differences and similarities between the Malaysian and Japanese contexts, and concludes with lessons for international transfer of IWM heartware policy strategies between the two countries.

The Legacy Project: A Case Study of Civic Capacity Building and Transformative Educational Leadership in a Community-Based Academic Enrichment Program

ERIC Educational Resources Information Center

Didlick-Davis, Celeste R.

2016-01-01

This study examines how a grassroots educational enrichment program in a small urban economically depressed area builds and uses civic capacity. Using qualitative data collected through a case study of the Legacy Academic Enrichment program in Middletown, Ohio, I identify factors that make Legacy sustainable and successful in a community that has…

Anticholinergic Exposure and Risk of Pneumonia in Persons with Alzheimer's Disease: A Nested Case-Control Study.

PubMed

Lampela, Pasi; Tolppanen, Anna-Maija; Tanskanen, Antti; Tiihonen, Jari; Hartikainen, Sirpa; Taipale, Heidi

2017-01-01

Risk of pneumonia is increased in persons with Alzheimer's disease (AD). In some studies, anticholinergic drugs (AC) have been associated with an increased pneumonia risk. We analyzed the risk of pneumonia associated with ACs in persons with AD. We performed a nested case-control study using register-based data from a Finnish nationwide MEDALZ cohort including all community-dwelling persons diagnosed with AD during 2005-2011. Cases were identified based on pneumonia diagnoses (n = 12,442) from hospital discharge and causes of death registers. Up to two controls without pneumonia were matched based on time since AD diagnoses, age, and gender for each case; AC use was measured using Anticholinergic Drug Scale. Use of AC was associated with an increased risk of pneumonia (adjusted odds ratio (OR) 1.36, 95% confidence interval (CI) 1.29-1.43). However, there was no increased pneumonia risk in persons using level 3 ACs. Incident use was associated with higher risk of pneumonia (OR 2.68, 95% CI 2.15-3.34) than prevalent use (OR 1.48, 95% CI 1.40-1.57). Among persons using cholinesterase inhibitors (AChEIs), risk of pneumonia was increased in persons using also ACs (OR 1.53, 95% CI 1.41-1.66). ACs were associated with an increased risk of pneumonia in persons with AD, especially at the time of initiation of these drugs. AC use was associated with increased pneumonia risk also in persons using AChEIs. This risk should be carefully considered when treating AD patients.

Stochasticity, succession, and environmental perturbations in a fluidic ecosystem

PubMed Central

Zhou, Jizhong; Deng, Ye; Zhang, Ping; Xue, Kai; Liang, Yuting; Van Nostrand, Joy D.; Yang, Yunfeng; He, Zhili; Wu, Liyou; Stahl, David A.; Hazen, Terry C.; Tiedje, James M.; Arkin, Adam P.

2014-01-01

Unraveling the drivers of community structure and succession in response to environmental change is a central goal in ecology. Although the mechanisms shaping community structure have been intensively examined, those controlling ecological succession remain elusive. To understand the relative importance of stochastic and deterministic processes in mediating microbial community succession, a unique framework composed of four different cases was developed for fluidic and nonfluidic ecosystems. The framework was then tested for one fluidic ecosystem: a groundwater system perturbed by adding emulsified vegetable oil (EVO) for uranium immobilization. Our results revealed that groundwater microbial community diverged substantially away from the initial community after EVO amendment and eventually converged to a new community state, which was closely clustered with its initial state. However, their composition and structure were significantly different from each other. Null model analysis indicated that both deterministic and stochastic processes played important roles in controlling the assembly and succession of the groundwater microbial community, but their relative importance was time dependent. Additionally, consistent with the proposed conceptual framework but contradictory to conventional wisdom, the community succession responding to EVO amendment was primarily controlled by stochastic rather than deterministic processes. During the middle phase of the succession, the roles of stochastic processes in controlling community composition increased substantially, ranging from 81.3% to 92.0%. Finally, there are limited successional studies available to support different cases in the conceptual framework, but further well-replicated explicit time-series experiments are needed to understand the relative importance of deterministic and stochastic processes in controlling community succession. PMID:24550501

Probing community nurses' professional basis: a situational case study in diabetic foot ulcer treatment.

PubMed

Schaarup, Clara; Pape-Haugaard, Louise; Jensen, Merete Hartun; Laursen, Anders Christian; Bermark, Susan; Hejlesen, Ole Kristian

2017-03-01

Complicated and long-lasting wound care of diabetic foot ulcers are moving from specialists in wound care at hospitals towards community nurses without specialist diabetic foot ulcer wound care knowledge. The aim of the study is to elucidate community nurses' professional basis for treating diabetic foot ulcers. A situational case study design was adopted in an archetypical Danish community nursing setting. Experience is a crucial component in the community nurses' professional basis for treating diabetic foot ulcers. Peer-to-peer training is the prevailing way to learn about diabetic foot ulcer, however, this contributes to the risk of low evidence-based practice. Finally, a frequent behaviour among the community nurses is to consult colleagues before treating the diabetic foot ulcers.

The Effect of Curanderismo on Chronic Non-malignant Pain: A Case Report.

PubMed

Kennedy, Laura; Gonzales, Erin; Corbin, Lisa

2016-01-01

This case study describes the effects of the use of curanderismo, an indigenous healing modality combining techniques in massage, sound, and aromatherapy, on a patient with chronic pain. Despite being a commonly used health practice in certain populations, little is reported in the medical literature about the use of curanderismo. Case report as part of a larger randomized trial of curanderismo for chronic pain. Setting was a community-based hospital affiliated primary care clinic. An adult patient with chronic, opioid dependent back pain following an injury, and subsequent spinal fusion was treated. Intervention was the patient received 33 curanderismo treatment sessions over 10 months in addition to ongoing conventional treatment at a community-based chronic pain management clinic. Main outcomes measures were self-reported assessments of pain, functional ability, mood, insomnia, and narcotic usage. Secondary outcome measure was qualitative interview. Although there was no change in quantitative self-reported pain measures, the patient reported improved function, mood, and sleep as well as decreased narcotic usage. Curanderismo, in addition to conventional pain management, improved patient reported symptoms and functional ability, led to healthy lifestyle changes, and decreased narcotic usage. Controlled studies are needed to confirm the benefit of curanderismo as safe, non-interventional, and cost-effective adjunct for chronic pain management. Copyright © 2016 Elsevier Inc. All rights reserved.

Community-based screening for obstetric fistula in Nigeria: a novel approach

PubMed Central

2014-01-01

Background Obstetric fistula continues to have devastating effects on the physical, social, and economic lives of thousands of women in many low-resource settings. Governments require credible estimates of the backlog of existing cases requiring care to effectively plan for the treatment of fistula cases. Our study aims to quantify the backlog of obstetric fistula cases within two states via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module. Methods The screening sites, all lower level health facilities, were selected based on their geographic coverage, prior relationships with the communities and availability of fistula surgery facilities in the state. This cross-sectional study included women who presented for fistula screenings at study facilities based on their perceived fistula-like symptoms. Research assistants administered the pre-screening questionnaire. Nurse-midwives then conducted a medical exam. Univariate and bivariate analyses are presented. Results A total of 268 women attended the screenings. Based on the pre-screening interview, the backlog of fistula cases reported was 75 (28% of women screened). The backlog identified after the medical exam was 26 fistula cases (29.5% of women screened) in Kebbi State sites and 12 cases in Cross River State sites (6.7%). Verification assessment showed that the DHS questionnaire had 92% sensitivity, 83% specificity with 47% positive predictive value and 98% negative predictive value for identifying women afflicted by fistula among women who came for the screenings. Conclusions This methodology, involving effective, locally appropriate messaging and community outreach followed up with medical examination by nurse-midwives at lower level facilities, is challenging, but represents a promising approach to identify the backlog of women needing surgery and to link them with surgical facilities. PMID:24456506

Job coach factors associated with community-based employment service programme outcome measures for people with disabilities--a Taiwan case study.

PubMed

Yun-Tung, Wang

2010-01-01

The aim of this study is to explore whether/which job coach factors were significantly associated with the community-based employment service (CBES) programme outcome measures in Taiwan. This study used the 2003-2005 CBES programme for People with Disabilities Database in Taipei City in Taiwan (n = 3924) to do a secondary data analysis using hierarchical multiple linear regression. This study found that 'occurrences of the services provided by the job coaches' variable was definitely the dominant predictor and explained additional 19.6% and 27.8% of the variances of annual salary and annual working month outcome measures, respectively. In addition, among six composition variables of 'occurrences of the services provided by the job coaches', 'occurrences of follow-up guidance', 'occurrences of intensive guidance', and 'occurrences of consultation before interviews with employer/director of human resources' were more powerful than the other three in predicting outcomes. Job coach factors in this study were significantly correlated with CBES programme outcome measures for people with disabilities in Taiwan after controlling for the socio-demographic variables. It indicates that the more inputs in the people with disabilities made by job coaches equates to better outcomes in this Taiwan case study.

Determinants of skilled attendance for delivery in Northwest Ethiopia: a community based nested case control study.

PubMed

Mengesha, Zelalem Birhanu; Biks, Gashaw Andargie; Ayele, Tadesse Awoke; Tessema, Gizachew Assefa; Koye, Digsu Negesse

2013-02-12

The fifth Millennium Development Goal calls for a reduction of maternal mortality ratio by 75% between 1990 and 2015. A key indicator to measure this goal is the proportion of births attended by skilled health personnel. The maternal mortality ratio of Ethiopia is 676 deaths per 100,000 live births. Skilled birth attendance is correlated with lower maternal mortality rates globally and in Sub-Saharan Africa. However, the proportion of births with a skilled attendant is only 10% in Ethiopia. Therefore identifying the determinants of skilled attendance for delivery is a priority area to give policy recommendations. A community based nested case control study was conducted from October 2009 - August 2011 at the University of Gondar health and demographic surveillance systems site located at Dabat district, Northwest Ethiopia. Data were obtained from the infant mortality prospective follow up study conducted to identify the determinants of infant survival. A pretested and structured questionnaire via interview was used to collect data on the different variables. Logistic regression analysis was used to identify the determinants of skilled birth attendance. Strength of the association was assessed using odds ratio with 95% CI. A total of 1065 mothers (213 cases and 852 controls) were included in the analysis. Among the cases, 166 (77.9%) were from urban areas. More than half (54%) of the cases have secondary and above level of education. Secondary and above level of education [AOR (95%CI) = 2.8 (1.29, 3.68)] and urban residence [AOR (95%CI) = 8.8 (5.32, 14.46)] were associated with skilled attendance for delivery. Similarly, women who had ANC during their pregnancy four or more times [AOR (95%CI) = 2.8 (1.56, 4.98)] and who own TV [AOR (95%CI) = 2.5 (1.32, 4.76)] were more likely to deliver with the assistance of a skilled attendant. Women's education, place of residence, frequency of antenatal care visit and ever use of family planning were found to be determinants of skilled birth attendance. Encouraging women to complete at least secondary education and to have antenatal care frequently are important to increase skilled attendance during delivery.

Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study

PubMed Central

O'Loughlin, Rosalyn E; Kightlinger, Lon; Werpy, Matthew C; Brown, Ellen; Stevens, Valerie; Hepper, Clark; Keane, Tim; Benson, Robert F; Fields, Barry S; Moore, Matthew R

2007-01-01

Background From June to November 2005, 18 cases of community-acquired Legionnaires' disease (LD) were reported in Rapid City South Dakota. We conducted epidemiologic and environmental investigations to identify the source of the outbreak. Methods We conducted a case-control study that included the first 13 cases and 52 controls randomly selected from emergency department records and matched on underlying illness. We collected information about activities of case-patients and controls during the 14 days before symptom onset. Environmental samples (n = 291) were cultured for Legionella. Clinical and environmental isolates were compared using monoclonal antibody subtyping and sequence based typing (SBT). Results Case-patients were significantly more likely than controls to have passed through several city areas that contained or were adjacent to areas with cooling towers positive for Legionella. Six of 11 case-patients (matched odds ratio (mOR) 32.7, 95% CI 4.7-∞) reported eating in Restaurant A versus 0 controls. Legionella pneumophila serogroup 1 was isolated from four clinical specimens: 3 were Benidorm type strains and 1 was a Denver type strain. Legionella were identified from several environmental sites including 24 (56%) of 43 cooling towers tested, but only one site, a small decorative fountain in Restaurant A, contained Benidorm, the outbreak strain. Clinical and environmental Benidorm isolates had identical SBT patterns. Conclusion This is the first time that small fountain without obvious aerosol-generating capability has been implicated as the source of a LD outbreak. Removal of the fountain halted transmission. PMID:17688692

Building research infrastructure in community health centers: a Community Health Applied Research Network (CHARN) report.

PubMed

Likumahuwa, Sonja; Song, Hui; Singal, Robbie; Weir, Rosy Chang; Crane, Heidi; Muench, John; Sim, Shao-Chee; DeVoe, Jennifer E

2013-01-01

This article introduces the Community Health Applied Research Network (CHARN), a practice-based research network of community health centers (CHCs). Established by the Health Resources and Services Administration in 2010, CHARN is a network of 4 community research nodes, each with multiple affiliated CHCs and an academic center. The four nodes (18 individual CHCs and 4 academic partners in 9 states) are supported by a data coordinating center. Here we provide case studies detailing how CHARN is building research infrastructure and capacity in CHCs, with a particular focus on how community practice-academic partnerships were facilitated by the CHARN structure. The examples provided by the CHARN nodes include many of the building blocks of research capacity: communication capacity and "matchmaking" between providers and researchers; technology transfer; research methods tailored to community practice settings; and community institutional review board infrastructure to enable community oversight. We draw lessons learned from these case studies that we hope will serve as examples for other networks, with special relevance for community-based networks seeking to build research infrastructure in primary care settings.

Building Research Infrastructure in Community Health Centers: A Community Health Applied Research Network (CHARN) Report

PubMed Central

Likumahuwa, Sonja; Song, Hui; Singal, Robbie; Weir, Rosy Chang; Crane, Heidi; Muench, John; Sim, Shao-Chee; DeVoe, Jennifer E.

2015-01-01

This article introduces the Community Health Applied Research Network (CHARN), a practice-based research network of community health centers (CHCs). Established by the Health Resources and Services Administration in 2010, CHARN is a network of 4 community research nodes, each with multiple affiliated CHCs and an academic center. The four nodes (18 individual CHCs and 4 academic partners in 9 states) are supported by a data coordinating center. Here we provide case studies detailing how CHARN is building research infrastructure and capacity in CHCs, with a particular focus on how community practice-academic partnerships were facilitated by the CHARN structure. The examples provided by the CHARN nodes include many of the building blocks of research capacity: communication capacity and “matchmaking” between providers and researchers; technology transfer; research methods tailored to community practice settings; and community institutional review board infrastructure to enable community oversight. We draw lessons learned from these case studies that we hope will serve as examples for other networks, with special relevance for community-based networks seeking to build research infrastructure in primary care settings. PMID:24004710

Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme

PubMed Central

Marks, Michael; Taotao-Wini, Betty; Satorara, Lorraine; Engelman, Daniel; Nasi, Titus; Mabey, David C.; Steer, Andrew C.

2015-01-01

Introduction Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections. Methods We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo. Results Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less. Discussion We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts. PMID:26624616

Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme.

PubMed

Marks, Michael; Taotao-Wini, Betty; Satorara, Lorraine; Engelman, Daniel; Nasi, Titus; Mabey, David C; Steer, Andrew C

2015-12-01

Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections. We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo. Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less. We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts.

The brain injury case management taxonomy (BICM-T); a classification of community-based case management interventions for a common language.

PubMed

Lukersmith, Sue; Fernandez, Ana; Millington, Michael; Salvador-Carulla, Luis

2016-04-01

Case management is a complex intervention. Complexity arises from the interaction of different components: the model (theoretical basis), implementation context (service), population and health condition, focus for the intervention (client and/or their family), case manager's actions (interventions) and the target of case management (integrated care and support, client's community participation). There is a lack of understanding and a common language. To our knowledge there is no classification (taxonomy) for community-based case management. To develop a community-based case management in brain injury taxonomy (BICM-T), as a common language and understanding of case management for use in quality analysis, policy, planning and practice. The mixed qualitative methods used multiple sources of knowledge including scoping, framing and a nominal group technique to iteratively develop the Beta version (draft) of the taxonomy. A two part developmental evaluation involving case studies and mapping to international frameworks assessed the applicability and acceptability (feasibility) before finalization of the BICM-T. The BICM-T includes a definition of community-based case management, taxonomy trees, tables and a glossary. The interventions domain tree has 9 main actions (parent category): engagement, holistic assessment, planning, education, training and skills development, emotional and motivational support, advising, coordination, monitoring; 17 linked actions (children category); 8 related actions; 63 relevant terms defined in the glossary. The BICM-T provides a knowledge map with the definitions and relationships between the core actions (interventions domain). Use of the taxonomy as a common language will benefit practice, quality analysis, evaluation, policy, planning and resource allocation. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

A Legal Discourse Community: Text Centered and Interdisciplinary in Social and Political Context.

ERIC Educational Resources Information Center

Griggs, Karen

1996-01-01

Reviews recent studies of legal discourse and nonacademic writing and presents the results of a historical case study on an environmental public policy. Finds that a dynamic discourse community changed writing roles among government employees, lay members of the audience, and water pollution control board members. States that controversial…

Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study

PubMed Central

Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

2015-01-01

Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging. PMID:26489096

Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

PubMed

Spoorenberg, Sophie L W; Wynia, Klaske; Fokkens, Andrea S; Slotman, Karin; Kremer, Hubertus P H; Reijneveld, Sijmen A

2015-01-01

Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

Political will, traditional leaders and the fight against HIV/AIDS: a South African case study.

PubMed

Campbell, Catherine

2010-01-01

"Political will" and leadership are increasingly considered key contextual influences on the outcomes of HIV/AIDS programmes in sub-Saharan Africa. Such debates tend to focus on the role of national leadership in shaping responses to the epidemic, with little attention to local leaders. Yet many of the settings in which HIV/AIDS flourishes are geographically distant from the reach of national leadership and policies. Furthermore, local leaders often play a key role in shaping how national policies and decisions are interpreted and implemented in local areas. Against this background, we present a case study of the impact of the leadership style of a traditional Chief on a community-based AIDS programme in a South African rural community, which sought to build community-level "AIDS competence", using the "empowerment via participation" approach. The case study involved 134 interviews and 57 focus groups conducted over three years. Thematic content analysis revealed a number of direct and indirect ways in which his leadership style impacted on project outcomes. Despite his strong support for the programme, the Chief's "traditional" attitudes towards women and youth, his celebration of polygamy, and his authoritarian governance style undermined the project's "empowerment via participation" agenda - especially the programme's attempts to reduce AIDS stigma, to build female and youth capacity to control their sexual health, and to encourage men to take responsibility for their role in tackling AIDS.

Association of Phosphodiesterase 4D with ischemic stroke: a population-based case-control study.

PubMed

Woo, Daniel; Kaushal, Ritesh; Kissela, Brett; Sekar, Padmini; Wolujewicz, Michael; Pal, Prodipto; Alwell, Kathleen; Haverbusch, Mary; Ewing, Irene; Miller, Rosie; Kleindorfer, Dawn; Flaherty, Matthew; Chakraborty, Ranajit; Deka, Ranjan; Broderick, Joseph

2006-02-01

The Phosphodiesterase 4D (PDE4D) gene was reported recently to be associated with ischemic stroke in an Icelandic population. The association was found predominately with large vessel and cardioembolic stroke. However, 2 recent reports were unable to confirm this association, although a trend toward association with cardioembolic stroke was reported. None of the reports included significant proportions of blacks. We tested for genotype and haplotype association of polymorphisms of the PDE4D gene with ischemic stroke in a population-based, biracial, case-control study. A total of 357 cases of ischemic stroke and 482 stroke-free controls from the same community were examined. Single nucleotide polymorphisms (SNPs) were chosen based on significant associations reported previously. Linkage disequilibrium (LD), SNP, and haplotype association analysis was performed using PHASE 2.0 and Haploview 3.2. Although several univariate associations were identified, only 1 SNP (rs2910829) was found to be significantly associated with cardioembolic stroke among both whites and blacks. The rs152312 SNP was associated with cardioembolic stroke among whites after multiple comparison corrections. The same SNP was not associated with cardioembolic stroke among blacks. However, significant haplotype association was identified for both whites and blacks for all ischemic stroke, cardioembolic stroke, and stroke of unknown origin. Haplotype association was identified for small vessel stroke among whites. PDE4D is a risk factor for ischemic stroke and, in particular, for cardioembolic stroke, among whites and blacks. Further study of this gene is warranted.

Competition from below for light and nutrients shifts productivity among tropical species.

PubMed

Ewel, John J; Mazzarino, María Julia

2008-12-02

Chance events such as seed dispersal determine the potential composition of plant communities, but the eventual assemblage is determined in large part by subsequent interactions among species. Postcolonization sorting also affects the ultimate composition of communities assembled by people for restoration, horticulture, or conservation. Thus, knowledge of the mechanisms controlling interspecific interactions in plant communities is important for explaining patterns observed in nature and predicting success or failure of utilitarian combinations. Relationships among species, especially those from studies of biological diversity and ecosystem functioning, are largely based on studies of short-lived, temperate-zone plants. Extrapolation to perennial plants in the humid tropics is risky because functional relationships among large-stature species change with time. Shifts in competitive relationships among 3 life forms--trees, palms, and perennial herbs--occurred during 13 yr in experimental tropical ecosystems. In 2 cases the novel competitive mechanism responsible for the shift was reduction in crown volume, and therefore light-capturing capability, of overtopping deciduous trees by intrusive growth from below a palm. In a third case, complementary resource use developed between 2 evergreen life forms (overstory tree and palm), probably because of differential nutrient acquisition. Species-level traits and adequate time for shifts in interspecific relationships to emerge are crucial for predicting community trajectories.

Unit costs for house spraying and bednet impregnation with residual insecticides in Colombia: a management tool for the control of vector-borne disease.

PubMed

Kroeger, A; Ayala, C; Medina Lara, A

2002-06-01

A study of unit costs and cost components of two malaria-control strategies (house spraying and bednet impregnation with residual insecticides) was undertaken in 11 malaria-endemic states (departamentos) of Colombia, using data provided by control staff on self-administered questionnaires. The accuracy of the data was verified by personal visits, telephone conversations and complementary information from 10 other states. Allthe financial-cost components of the malaria-control operations carried out in the previous 6 months and the results of the control operations themselves (including the numbers of houses sprayed and numbers of bednets impregnated/day) were recorded. The information was stratified according to whether the target communities were 'near' or 'far away' from an operational base, the far-away communities being those that needed overnight stays by the control staff. The main variables analysed were unit costs/house treated, and annual cost/person protected. The results show that house spraying was generally more expensive for the health services than bednet impregnation. This is particularly the case in 'nearby' communities, where most of those at-risk live. In such communities, spraying one house was 7.2 times more expensive than impregnating one bednet. Even if only those sleeping under an impregnated net were assumed to be protected, the unit costs/person protected in a 'nearby' community were twice as high for house spraying than for bednet impregnation. In 'nearby' communities, where technicians could return to the operational base each evening, insecticides made up 80% of the total spraying costs and 42% of the costs of bednet impregnation. In 'far-away' communities, however, salaries and 'per diems' were the most important cost components, representing, respectively, 23% and 22% of the costs of spraying, and 34% plus 27% of the costs of impregnation. Insecticide wastage and non-use of discounts on insecticide prices (available through the national Ministry of Health) increased the overall costs considerably. The multiple uses of these cost calculations for district health managers are presented.

Which sexual abuse victims receive a forensic medical examination? The impact of Children's Advocacy Centers.

PubMed

Walsh, Wendy A; Cross, Theodore P; Jones, Lisa M; Simone, Monique; Kolko, David J

2007-10-01

This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on forensic medical exams in 1,220 child sexual abuse cases through review of case records. Suspected sexual abuse victims at CACs were two times more likely to have forensic medical examinations than those seen at comparison communities, controlling for other variables. Girls, children with reported penetration, victims who were physically injured while being abused, White victims, and younger children were more likely to have exams, controlling for other variables. Non-penetration cases at CACs were four times more likely to receive exams as compared to those in comparison communities. About half of exams were conducted the same day as the reported abuse in both CAC and comparison communities. The majority of caregivers were very satisfied with the medical professional. Receipt of a medical exam was not associated with offenders being charged. Results of this study suggest that CACs are an effective tool for furthering access to forensic medical examinations for child sexual abuse victims.

Personality as a risk factor in large bowel cancer: data from the Melbourne Colorectal Cancer Study.

PubMed

Kune, G A; Kune, S; Watson, L F; Bahnson, C B

1991-02-01

In a case control study which formed one arm of a large, population-based investigation of colorectal cancer incidence, aetiology and survival. 'The Melbourne Colorectal Cancer Study', among others, 22 psychosocially orientated questions were asked by personal interview of 637 histologically confirmed new cases of colorectal cancer and 714 age/sex frequency matched community controls, from Melbourne (population 2.81 million). Self-reported childhood or adult life 'unhappiness' was statistically significantly more common among the cancer cases, while 'unhappiness with retirement' was similarly distributed among cases and controls. Questions which were formulated to test a particular personality profile as a cancer risk, and which included the elements of denial and repression of anger and of other negative emotions, a commitment to prevailing social norms resulting in the external appearance of a 'nice' or 'good' person, a suppression of reactions which may offend others and the avoidance of conflict, showed a statistically significant discrimination between cases and controls. The risk of colorectal cancer with respect to this model was independent of the previously found risk factors of diet, beer intake, and family history of colorectal cancer, and was also independent of other potential confounding factors of socioeconomic level, marital status, religion and country of birth. Although the results must be interpreted with caution, the data are consistent with the hypothesis that this personality type may play a role in the clinical expression of colorectal cancer and merits further study.

Community-Based Services and Depression from Person-Environment Fit Perspective: Focusing on Functional Impairments and Living Alone.

PubMed

Kim, BoRin; Park, Sojung; Bishop-Saucier, Jennifer; Amorim, Carrie

2017-01-01

Guided by the Person-Environment Fit perspective, we investigated the extent to which personal and environmental factors influence depression among community-dwelling adults. The data came from the special section about community-based service utilization in the 2012 Health and Retirement Study (N=1,710). Although community-based service was not significantly associated with depression after controlling for covariates, respondents with functional limitations and living alone were less likely to be depressed when using community-based services. This study demonstrates the different associations between community-based services and depression depending on personal needs. It discusses the importance of community-based services for aging-in-place policy, particularly among vulnerable populations.

Faculty and Community Collaboration in Sustained Community-University Engagement Partnerships

ERIC Educational Resources Information Center

Allen, Angela Danyell

2009-01-01

This dissertation is a qualitative case study of the factors of collaboration between faculty and community partners in sustained community-university engagement partnerships at a public research university in the Midwest. Based on secondary data from an annual, online, mixed-method survey of faculty-reported engagement activity, parallel yet…

Antenatal depression case-finding by community health workers in South Africa: feasibility of a mobile phone application

PubMed Central

Tsai, Alexander C.; Tomlinson, Mark; Dewing, Sarah; le Roux, Ingrid M.; Harwood, Jessica M.; Chopra, Mickey; Rotheram-Borus, Mary Jane

2014-01-01

Purpose Randomised controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultra-short screening instruments programmed into mobile phones. Methods Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N=1,144 and N=361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subjects research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of 4 short and ultra-short versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥13. Results The prevalence of probable depression (475/1144 [42%] and 165/361 [46%]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach’s α ranged from 0.55-0.58). All 4 subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91-0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. Conclusions The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression. PMID:24682529

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application.

PubMed

Tsai, Alexander C; Tomlinson, Mark; Dewing, Sarah; le Roux, Ingrid M; Harwood, Jessica M; Chopra, Mickey; Rotheram-Borus, Mary Jane

2014-10-01

Randomized controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones. Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N = 1,144 and N = 361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subject research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of four short and ultrashort versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥ 13. The prevalence of probable depression (475/1144 [42 %] and 165/361 [46 %]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach's α ranged from 0.55 to 0.58). All four subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91 to 0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression.

AAC and community partnerships: the participation path to community inclusion.

PubMed

Batorowicz, Beata; McDougall, Stacy; Shepherd, Tracy A

2006-09-01

The Life Needs Model (LNM) of service delivery emphasizes the importance of community participation in children's development and quality of life. This article is a case illustration of two community partnership programs based on the LNM. StoryTime and Dress Up and Drama provide participation opportunities in the community for children who use Augmentative and Alternative Communication (AAC). The authors describe the development and implementation of both programs. Regardless of level of functioning, each child who participated in the programs did so by communicating, interacting socially, and controlling the environment. Multiple benefits for children, parents/caregivers, community partners, and AAC clinicians are highlighted. The authors hope that this article will assist others in developing partnerships and implementing inclusive practices within their communities.

Active Trachoma Cases in the Solomon Islands Have Varied Polymicrobial Community Structures but Do Not Associate with Individual Non-Chlamydial Pathogens of the Eye.

PubMed

Butcher, Robert M R; Sokana, Oliver; Jack, Kelvin; Kalae, Eric; Sui, Leslie; Russell, Charles; Houghton, Joanna; Palmer, Christine; Holland, Martin J; Le Mesurier, Richard T; Solomon, Anthony W; Mabey, David C W; Roberts, Chrissy H

2017-01-01

Several non-chlamydial microbial pathogens are associated with clinical signs of active trachoma in trachoma-endemic communities with a low prevalence of ocular Chlamydia trachomatis ( Ct ) infection. In the Solomon Islands, the prevalence of Ct among children is low despite the prevalence of active trachoma being moderate. Therefore, we set out to investigate whether active trachoma was associated with a common non-chlamydial infection or with a dominant polymicrobial community dysbiosis in the Solomon Islands. We studied DNA from conjunctival swabs collected from 257 Solomon Islanders with active trachoma and matched controls. Droplet digital PCR was used to test for pathogens suspected to be able to induce follicular conjunctivitis. Polymicrobial community diversity and composition were studied by sequencing of hypervariable regions of the 16S ribosomal ribonucleic acid gene in a subset of 54 cases and 53 controls. Although Ct was associated with active trachoma, the number of infections was low (cases, 3.9%; controls, 0.4%). Estimated prevalence (cases and controls, respectively) of each non-chlamydial infection was as follows: Staphylococcus aureus : 1.9 and 1.9%, Adenoviridae: 1.2 and 1.2%, coagulase-negative Staphylococcus : 5.8 and 4.3%, Haemophilus influenzae : 7.4 and 11.7%, Moraxella catarrhalis : 2.3 and 4.7%, and Streptococcus pneumoniae : 7.0 and 6.2%. There was no statistically significant association between the clinical signs of trachoma and the presence or load of any of the non- Ct infections that were assayed. Interindividual variations in the conjunctival microbiome were characterized by differences in the levels of Corynebacterium, Propionibacterium, Helicobacter , and Paracoccus , but diversity and relative abundance of these specific genera did not differ significantly between cases and controls. It is unlikely that the prevalent trachoma-like follicular conjunctivitis in this region of the Solomon Islands has a dominant bacterial etiology. Before implementing community-wide azithromycin distribution for trachoma, policy makers should consider that clinical signs of trachoma can be observed in the absence of any detectable azithromycin-susceptible organism.

Gut microbiota in early pediatric multiple sclerosis: a case-control study.

PubMed

Tremlett, Helen; Fadrosh, Douglas W; Faruqi, Ali A; Zhu, Feng; Hart, Janace; Roalstad, Shelly; Graves, Jennifer; Lynch, Susan; Waubant, Emmanuelle

2016-08-01

Alterations in the gut microbial community composition may be influential in neurological disease. Microbial community profiles were compared between early onset pediatric multiple sclerosis (MS) and control children similar for age and sex. Children ≤18 years old within 2 years of MS onset or controls without autoimmune disorders attending a University of California, San Francisco, USA, pediatric clinic were examined for fecal bacterial community composition and predicted function by 16S ribosomal RNA sequencing and phylogenetic reconstruction of unobserved states (PICRUSt) analysis. Associations between subject characteristics and the microbiota, including beta diversity and taxa abundance, were identified using non-parametric tests, permutational multivariate analysis of variance and negative binomial regression. Eighteen relapsing-remitting MS cases and 17 controls (mean age 13 years; range 4-18) were studied. Cases had a short disease duration (mean 11 months; range 2-24) and half were immunomodulatory drug (IMD) naïve. Whilst overall gut bacterial beta diversity was not significantly related to MS status, IMD exposure was (Canberra, P < 0.02). However, relative to controls, MS cases had a significant enrichment in relative abundance for members of the Desulfovibrionaceae (Bilophila, Desulfovibrio and Christensenellaceae) and depletion in Lachnospiraceae and Ruminococcaceae (all P and q < 0.000005). Microbial genes predicted as enriched in MS versus controls included those involved in glutathione metabolism (Mann-Whitney, P = 0.017), findings that were consistent regardless of IMD exposure. In recent onset pediatric MS, perturbations in the gut microbiome composition were observed, in parallel with predicted enrichment of metabolic pathways associated with neurodegeneration. Findings were suggestive of a pro-inflammatory milieu. © 2016 EAN.

Case managers and the use of Medicare, Part D.

PubMed

Hensley, Melissa Anne

2011-01-01

The purpose of this study was to examine the experiences and opinions of community-based mental health case managers with the Medicare prescription drug benefit. A qualitative approach, consisting of analysis of data from 3 case manager focus groups, was used to achieve an understanding of the role that case managers played in beneficiaries' access to and use of prescription medicines. Two urban nonprofit community-based mental health agencies. Adults who are disabled by mental illness depend on case managers for information about their prescription drug insurance, help with formulary and plan switching information, and assistance with tasks related to medication adherence in the community. Common themes in the case managers' discussion were managing beneficiary problems, stress for beneficiaries, information and paperwork issues, and cynicism regarding health care reform. The critical role of case managers in the use of Medicare Part D is not well understood or appreciated. Case managers need to be informed about Medicare Part D and ready to advocate for their clients in the community. In addition, it is important for case managers to understand how Medicare Part D affects not only older adults, but also adults living with serious and persistent mental illness.

Teaching community diagnosis to medical students: evaluation of a case study approach.

PubMed

Bair, C W

1980-01-01

A unique case study approach to training medical students in community diagnosis techniques was initiated at the Medical College of Ohio at Toledo. This paper describes the five elements of this teaching method: preliminary specification of target community and data base; group problem-solving requirement; specification of desired output; defined performance objectives; and regularly scheduled time for analysis. Experience with the case study method over two years was evaluated to identify specific strengths and weaknesses. The identified strengths include use of limited educational time to introduce community health problems, development of experience in a collegial team work setting, and specific awareness of the types of data useful to the analysis of community health service problems. Negative evaluations suggested that the method was not conducive to the development of skills in three areas: ability to establish the relative importance of health problems in communities; ability to identify an appropriate health system response to a community health problem from feasible alternatives; and ability to anticipate the community impact of health program modifications or improvements. Potential explanations for these deficiencies include: need for increased didactic support in the classroom for particular skill areas; need to establish a direct field experience in community diagnosis; inappropriateness of the data base used for evaluation of particular skills; and the probability that quantitative analysis, as used in this evaluation, may not be sufficient in and of itself to measure the outcome of a community diagnosis experience.

The impact of changing dental needs on cost savings from fluoridation.

PubMed

Campain, A C; Mariño, R J; Wright, F A C; Harrison, D; Bailey, D L; Morgan, M V

2010-03-01

Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia. Net costs were estimated as Costs((programme)) minus Costs((averted caries).) Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6-20, 21-45, 46-65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized. With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal. Community water fluoridation remains a cost-effective preventive measure in Australia.

A systematic review of community-based interventions for emerging zoonotic infectious diseases in Southeast Asia

PubMed Central

Halton, Kate; Sarna, Mohinder; Barnett, Adrian; Leonardo, Lydia; Graves, Nicholas

2013-01-01

Executive Summary Background Southeast Asia has been at the epicentre of recent epidemics of emerging and re-emerging zoonotic diseases. Community-based surveillance and control interventions have been heavily promoted but the most effective interventions have not been identified. Objectives This review evaluated evidence for the effectiveness of community-based surveillance interventions at monitoring and identifying emerging infectious disease; the effectiveness of community-based control interventions at reducing rates of emerging infectious disease; and contextual factors that influence intervention effectiveness. Inclusion criteria Participants Communities in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. Types of intervention(s) Non-pharmaceutical, non-vaccine, and community-based surveillance or prevention and control interventions targeting rabies, Nipah virus, dengue, SARS or avian influenza. Types of outcomes Primary outcomes: measures: of infection or disease; secondary outcomes: measures of intervention function. Types of studies Original quantitative studies published in English. Search strategy Databases searched (1980 to 2011): PubMed, CINAHL, ProQuest, EBSCOhost, Web of Science, Science Direct, Cochrane database of systematic reviews, WHOLIS, British Development Library, LILACS, World Bank (East Asia), Asian Development Bank. Methodological quality Two independent reviewers critically appraised studies using standard Joanna Briggs Institute instruments. Disagreements were resolved through discussion. Data extraction A customised tool was used to extract quantitative data on intervention(s), populations, study methods, and primary and secondary outcomes; and qualitative contextual information or narrative evidence about interventions. Data synthesis Data was synthesised in a narrative summary with the aid of tables. Meta-analysis was used to statistically pool quantitative results. Results Fifty-seven studies were included. Vector control interventions using copepods, environmental cleanup and education are effective and sustainable at reducing dengue in rural and urban communities, whilst insecticide spraying is effective in urban outbreak situations. Community-based surveillance interventions can effectively identify avian influenza in backyard flocks, but have not been broadly applied. Outbreak control interventions for Nipah virus and SARS are effective but may not be suitable for ongoing control. Canine vaccination and education is more acceptable than culling, but still fails to reach coverage levels required to effectively control rabies. Contextual factors were identified that influence community engagement with, and ultimately effectiveness of, interventions. Conclusion Despite investment in community-based disease control and surveillance in Southeast Asia, published evidence evaluating interventions is limited in quantity and quality. Nonetheless this review identified a number of effective interventions, and several contextual factors influencing effectiveness. Identification of the best programs will require comparative evidence of effectiveness acceptability, cost-effectiveness and sustainability. Implications for practice Interventions are more effective if there are high levels of community ownership and engagement. Linkages between veterinary and public health surveillance systems are essential. Interventions are not well accepted when they fail to acknowledge the importance of animals for economic activity in communities. Implications for research Evidence is needed on functioning and outcomes of current surveillance systems and novel low-cost methods of surveillance. Evaluations of control interventions should control for confounding and report measures of disease, cost and sustainability. Translational research is needed to assess generalisability and evaluate roll-out of effective interventions as regional or national programs.

Comparisons between the State Share of Community College Operating Budgets and State Centralization of Control in Eleven State Community College Systems.

ERIC Educational Resources Information Center

Tollefson, Terrence A.

This paper describes studies by Fonte (1993), Garrett (1992-93), and Ingram and Tollefson (1996) regarding state funding and control of community colleges. This article compares each of the three studies and contrasts the results. All research was based on questionnaires returned by 44 state directors of community colleges. Garrett concluded that…

Malaria epidemiology in low-endemicity areas of the northern coast of Ecuador: high prevalence of asymptomatic infections.

PubMed

Sáenz, Fabián E; Arévalo-Cortés, Andrea; Valenzuela, Gabriela; Vallejo, Andrés F; Castellanos, Angélica; Poveda-Loayza, Andrea C; Gutierrez, Juan B; Alvarez, Alvaro; Yan, Yi Heng; Benavides, Yoldy; Castro, Luis Enrique; Arévalo-Herrera, Myriam; Herrera, Sócrates

2017-07-26

The recent scale-up in malaria control measures in Latin America has resulted in a significant decrease in the number of reported cases in several countries including Ecuador, where it presented a low malaria incidence in recent years (558 reported cases in 2015) with occasional outbreaks of both Plasmodium falciparum and Plasmodium vivax in the coastal and Amazonian regions. This success in malaria control in recent years has led Ecuador to transition its malaria policy from control to elimination. This study evaluated the general knowledge, attitude and practices (KAP) about malaria, as well as its prevalence in four communities of an endemic area in northwest Ecuador. A total of 258 interviews to assess KAP in the community indicated that most people in the study area have a basic knowledge about the disease but did not use to contribute to its control. Six hundred and forty-eight blood samples were collected and analysed by thick blood smear and real-time PCR. In addition, the distribution of the infections was mapped in the study communities. Although, no parasites were found by microscopy, by PCR the total malaria prevalence was 7.5% (6.9% P. vivax and 0.6% P. falciparum), much higher than expected and comparable to that reported in endemic areas of neighbouring countries with higher malaria transmission. Serology using ELISA and immunofluorescence indicated 27% respondents for P. vivax and 22% respondents for P. falciparum. Results suggest that despite a great malaria reduction in Ecuador, transition from control to elimination would demand further improvement in malaria diagnostics, including active case detection to identify and treat parasite asymptomatic carriers, as well as community participation in its elimination.

Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility.

PubMed

Greenwood, Eleni A; Cedars, Marcelle I; Santoro, Nanette; Eisenberg, Esther; Kao, Chia-Ning; Haisenleder, Daniel J; Diamond, Michael P; Huddleston, Heather G

2017-12-01

To test the hypothesis that women with unexplained infertility demonstrate evidence of diminished ovarian reserve when compared with a population of community controls. Cross-sectional study. Multicenter university-based clinical practices. Study participants included 277 healthy, normo-ovulatory female partners with rigorously defined unexplained infertility randomly selected from a multicenter trial (Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation). Controls included 226 healthy, normo-ovulatory women not seeking treatment for fertility from a community-based cohort (Ovarian Aging study). Serum antimüllerian hormone (AMH) assay at a central laboratory, FSH, fasting serum metabolic testing, transvaginal ultrasonography for antral follicle counts (AFCs), anthropometric measurements. Average AMH, AFC, and AMH/AFC were compared between infertile and control women by age. Analyses of covariance compared these outcomes while controlling for confounders, including age, race, body mass index, smoking history, and study site. In our models, AMH, AFC, and AMH/AFC ovarian reserve indices did not differ between infertile women and community-based controls, after controlling for age, race, body mass index, smoking history, and study site. Currently utilized predictors of ovarian reserve do not discriminate women with rigorously defined unexplained infertility from healthy community-based women of similar demographic characteristics. Contrary to our hypothesis, among women with FSH in the normal range (≤12 IU/L), women with unexplained infertility did not show evidence of decreased ovarian reserve as measured by AMH and AFC. Ovarian reserve markers in isolation may not serve as predictors of future fertility. Copyright © 2017 American Society for Reproductive Medicine. All rights reserved.

Keeping children safe at home: protocol for three matched case–control studies of modifiable risk factors for falls

PubMed Central

Kendrick, Denise; Stewart, Jane; Clacy, Rose; Coffey, Frank; Cooper, Nicola; Coupland, Carol; Hayes, Mike; McColl, Elaine; Reading, Richard; Sutton, Alex; M L Towner, Elizabeth; Craig Watson, Michael

2012-01-01

Background Childhood falls result in considerable morbidity, mortality and health service use. Despite this, little evidence exists on protective factors or effective falls prevention interventions in young children. Objectives To estimate ORs for three types of medically attended fall injuries in young children in relation to safety equipment, safety behaviours and hazard reduction and explore differential effects by child and family factors and injury severity. Design Three multicentre case–control studies in UK hospitals with validation of parental reported exposures using home observations. Cases are aged 0–4 years with a medically attended fall injury occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression to adjust for potential confounding variables. Unmatched analyses will use unconditional logistic regression, adjusted for age, sex, deprivation and distance from hospital in addition to other confounders. Each study requires 496 cases and 1984 controls to detect an OR of 0.7, with 80% power, 5% significance level, a correlation between cases and controls of 0.1 and a range of exposure prevalences. Main outcome measures Falls on stairs, on one level and from furniture. Discussion As the largest in the field to date, these case control studies will adjust for potential confounders, validate measures of exposure and investigate modifiable risk factors for specific falls injury mechanisms. Findings should enhance the evidence base for falls prevention for young children. PMID:22628151

Assessing the role of case mix in cesarean delivery rates.

PubMed

Lieberman, E; Lang, J M; Heffner, L J; Cohen, A

1998-07-01

Implicit in comparisons of unadjusted cesarean rates for hospitals and providers is the assumption that differences result from management practices rather than differences in case mix. This study proposes a method for comparison of cesarean rates that takes the effect of case mix into account. All women delivered of infants at our institution from December 1, 1994, through July 31, 1995, were classified according to whether they received care from community-based practitioners (N=3913) or from the hospital-based practice that serves a higher-risk population (N=1556). Women were categorized according to both obstetric history (nulliparas, multiparas without a previous cesarean, multiparas with a previous cesarean) and the presence of obstetric conditions influencing the risk of cesarean delivery (multiple birth, breech presentation or transverse lie, preterm, no trial of labor for a medical indication). We determined the percent of women in each parity-obstetric condition subgroup and calculated a standardized cesarean rate for the hospital-based practice using the case mix of the community-based practitioners as the standard. The crude cesarean rate was higher for the hospital-based practice (24.4%) than for the community-based practitioners (21.5%), a rate difference of 2.9% (95% confidence interval=0.4%, 5.4%; P=.02). However, the proportion of women falling into categories conferring a high risk of cesarean delivery (multiple pregnancy, breech presentation or transverse lie, preterm, no trial of labor permitted) was twice as high for the hospital-based practice (24.4% hospital, 12.1% community). The standardization indicates that if the hospital-based practitioners had the same case mix as community-based practitioners, their overall cesarean rate would be 20.1%, similar to the 21.5% rate of community providers (rate difference=-1.4%, 95% confidence interval =-3.1%, 0.3%; P=.11). Standardization for case mix provides a mechanism for distinguishing differences in cesarean rates resulting from case mix from those relating to differences in practice. The methodology is not complex and could be applied to facilitate fairer comparisons of rates among providers and across institutions.

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

PubMed Central

Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia

2017-01-01

Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies. PMID:28567711

Outbreak of Neisseria meningitidis C in workers at a large food-processing plant in Brazil: challenges of controlling disease spread to the larger community.

PubMed

Iser, B P M; Lima, H C A V; de Moraes, C; de Almeida, R P A; Watanabe, L T; Alves, S L A; Lemos, A P S; Gorla, M C O; Gonçalves, M G; Dos Santos, D A; Sobel, J

2012-05-01

SUMMARYAn outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3-207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11-43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.

Community pharmacy-based point-of-care testing: A case study of pharmacist-physician collaborative working relationships.

PubMed

Bacci, Jennifer L; Klepser, Donald; Tilley, Heather; Smith, Jaclyn K; Klepser, Michael E

2018-01-01

Building collaborative working relationships (CWRs) with physicians or other prescribers is an important step for community pharmacists in establishing a collaborative practice agreement (CPA). This case study describes the individual, context, and exchange factors that drive pharmacist-physician CWR development for community pharmacy-based point-of-care (POC) testing. Two physicians who had entered in a CPA with community pharmacists to provide POC testing were surveyed and interviewed. High scores on the pharmacist-physician collaborative index indicated a high level of collaboration between the physicians and the pharmacist who initiated the relationship. Trust was established through the physicians' personal relationships with the pharmacist or due to the community pharmacy organization's strong reputation. The physicians' individual perceptions of community pharmacy-based POC testing affected their CWRs and willingness to establish a CPA. These findings suggest that exchange characteristics remain significant factors in CWR development. Individual factors may also contribute to physicians' willingness to advance their CWR to include a CPA for POC testing. Copyright © 2017 Elsevier Inc. All rights reserved.

Involving lay community researchers in epidemiological research: experiences from a seroprevalence study among sub-Saharan African migrants.

PubMed

Nöstlinger, Christiana; Loos, Jasna

2016-01-01

Community-based participatory research (CBPR) has received considerable attention during past decades as a method to increase community ownership in research and prevention. We discuss its application to epidemiological research using the case of second-generation surveillance conducted among sub-Saharan African (SSA) migrants in Antwerp city. To inform evidence-based prevention planning for this target group, this HIV-prevalence study used two-stage time-location sampling preceded by formative research. Extensive collaborative partnerships were built with community organizations, a Community Advisory Board provided input throughout the project, and community researchers were trained to participate in all phases of the seroprevalence study. Valid oral fluid samples for HIV testing were collected among 717 SSA migrants and linked to behavioural data assessed through an anonymous survey between December 2013 and August 2014. A qualitative content analysis of various data sources (extensive field notes, minutes of intervision, and training protocols) collected at 77 data collection visits in 51 settings was carried out to describe experiences with challenges and opportunities inherent to the CBPR approach at three crucial stages of the research process: building collaborative partnerships; implementing the study; dissemination of findings including prevention planning. The results show that CBPR is feasible in conducting scientifically sound epidemiological research, but certain requirements need to be in place. These include among others sufficient resources to train, coordinate, and supervise community researchers; continuity in the implementation; transparency about decision-taking and administrative procedures, and willingness to share power and control over the full research process. CBPR contributed to empowering community researchers on a personal level, and to create greater HIV prevention demand in the SSA communities.

The Transformation of a Florida Community College into a State College: A Case Study of the Impact on Institutional Culture, Mission, & Identity

ERIC Educational Resources Information Center

Hagen, Lisa J.

2012-01-01

A case-study was designed to assess the extent of change at a selected Florida community college that transformed into a state college. The purpose of the investigation was to explore how the transformation influenced institutional culture, mission, and identity based on the perceptions of faculty members and administrators. Data collection…

Community Organizations' Programming and the Development of Community Science Teachers

ERIC Educational Resources Information Center

Varelas, Maria; Morales-Doyle, Daniel; Raza, Syeda; Segura, David; Canales, Karen; Mitchener, Carole

2018-01-01

In this study, we explored how science teacher candidates construct ideas about science teaching and learning in the context of partnerships with urban community-based organizations. We used a case study design focusing on a group of 10 preservice teachers' participation in educational programming that focused on environmental racism and connected…

Service-Learning and Emergent Communities of Practice: A Teacher Education Case Study

ERIC Educational Resources Information Center

Kaschak, Jennifer Cutsforth; Letwinsky, Karim Medico

2015-01-01

This study investigates the unexpected emergence of a community of practice in a middle level mathematics and science methods course. The authors describe how preservice teacher participation in a collaborative, project-based service-learning experience resulted in the formation of a community of practice characterized by teamwork, meaningful…

Risk factors for extended-spectrum β-lactamase-producing Escherichia coli urinary tract infection in the community in Denmark: a case-control study.

PubMed

Søgaard, M; Heide-Jørgensen, U; Vandenbroucke, J P; Schønheyder, H C; Vandenbroucke-Grauls, C M J E

2017-12-01

To verify the role of proton pump inhibitors (PPI) and nitrofurantoin, which have appeared as novel risk factors for carriage of extended-spectrum β-lactamase (ESBL) -producing Escherichia coli, as risk factors for ESBL E. coli urinary tract infection (UTI). We included known risk factors to ascertain whether our findings are comparable with those of previous studies. Population-based case-control study including 339 cases with community-onset ESBL E. coli UTI in 2007-2012, 3390 non-ESBL E. coli UTI controls and 3390 population controls. We investigated potential risk factors by estimating ORs and 95% CIs adjusting for sex, age and co-morbidity. Comparing cases with non-ESBL E. coli UTI, PPI use yielded an OR of 1.6 (95% CI 1.2-2.0) and antibiotic exposure gave an OR of 1.4 (95% CI 1.1-1.8); these were driven by nitrofurantoin (OR 1.8; 95% CI 1.3-2.6) and macrolides (OR 1.7; 95% CI 1.2-2.3). Other risk factors included previous hospitalization with one or two and more than two hospitalizations versus none yielding ORs of 1.9 (95% CI 1.4-2.5) and 4.6 (95% CI 3.2-6.8), recent surgery (OR 2.0; 95% CI 1.5-2.8), renal disease (OR 2.2; 95% CI 1.4-3.4), chronic pulmonary disease (OR 1.4; 95% CI 1.0-2.0) and cancer (OR 1.5; 95% CI 1.1-2.1). Comparing cases with population controls, we found that most risk factors were also risk factors for non-ESBL UTI. ESBL E. coli UTI were associated with previous hospitalization and surgery. Nitrofurantoin and macrolides augmented the risk. PPIs had a moderate effect but may be important facilitators of ESBL carriage due to their widespread use. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Using the critical incident technique in community-based participatory research: a case study.

PubMed

Belkora, Jeffrey; Stupar, Lauren; O'Donnell, Sara

2011-01-01

Successful community-based participatory research involves the community partner in every step of the research process. The primary study for this paper took place in rural, Northern California. Collaborative partners included an academic researcher and two community based resource centers that provide supportive services to people diagnosed with cancer. This paper describes our use of the Critical Incident Technique (CIT) to conduct Community-based Participatory Research. We ask: Did the CIT facilitate or impede the active engagement of the community in all steps of the study process? We identified factors about the Critical Incident Technique that were either barriers or facilitators to involving the community partner in every step of the research process. Facilitators included the CIT's ability to accommodate involvement from a large spectrum of the community, its flexible design, and its personal approach. Barriers to community engagement included training required to conduct interviews, depth of interview probes, and time required. Overall, our academic-community partners felt that our use of the CIT facilitated community involvement in our Community-Based Participatory Research Project, where we used it to formally document the forces promoting and inhibiting successful achievement of community aims.

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

PubMed

Schneider, Helen; Nxumalo, Nonhlanhla

2017-09-15

National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.

Preventing Truancy and Dropout among Urban Middle School Youth: Understanding Community-Based Action from the Student's Perspective

ERIC Educational Resources Information Center

Rodriguez, Louie F.; Conchas, Gilberto Q.

2009-01-01

This case study explores how a community-based truancy prevention program mediates against absenteeism, truancy, and dropping out and positively transforms the lives of Black and Latina/Latino middle school youth. Findings suggest that community-school partnerships are critical in the quest to combat truancy and the alarming dropout rate among…

Improving knowledge and behaviours related to the cause, transmission and prevention of Tuberculosis and early case detection: a descriptive study of community led Tuberculosis program in Flores, Indonesia.

PubMed

Dewi, Christa; Barclay, Lesley; Passey, Megan; Wilson, Shawn

2016-08-08

The community's awareness of Tuberculosis (TB) and delays in health care seeking remain important issues in Indonesia despite the extensive efforts of community-based TB programs delivered by a non-government organisation (NGO). This study explored the knowledge and behaviours in relation to TB and early diagnosis before and after an asset-based intervention designed to improve these issues. Six villages in Flores, Indonesia were purposively selected to participate in this study. Three villages served as intervention villages and the other three villages provided a comparison group. Data collection included interviews, group discussions, observations, field notes and audit of records. In total, 50 participants across six villages were interviewed and three group discussions were conducted in the intervention villages supplemented by 1 - 5 h of observation during monthly visits. Overall, participants in all villages had limited knowledge regarding the cause and transmission of TB before the intervention. The delay in health seeking behaviour was mainly influenced by ignorance of TB symptoms. Health care providers also contributed to delayed diagnosis by ignoring the symptoms of TB suspects at the first visit and failing to examine TB suspects with sputum tests. Stigmatisation of TB patients by the community was reported, although this did not seem to be common. Early case detection was less than 50 % in four of the six villages before the asset-based intervention. Knowledge of TB improved after the intervention in the intervention villages alongside improved education activities. Early case detection also increased in the intervention villages following this intervention. The behaviour changes related to prevention of TB were also obvious in the intervention villages but not the comparison group. This small project demonstrated that an asset-based intervention can result in positive changes in community's knowledge and behaviour in relation to TB and early case detection. A continuing education process is like to be required to maintain this outcome and to reach a wider community. Promoting community involvement and local initiatives and engaging health care providers were important elements in the community-based TB program implemented.

School-based participatory health education for malaria control in Ghana: engaging children as health messengers.

PubMed

Ayi, Irene; Nonaka, Daisuke; Adjovu, Josiah K; Hanafusa, Shigeki; Jimba, Masamine; Bosompem, Kwabena M; Mizoue, Tetsuya; Takeuchi, Tsutomu; Boakye, Daniel A; Kobayashi, Jun

2010-04-18

School children have been increasingly recognized as health messengers for malaria control. However, little evidence is available. The objective of this study was to determine the impact of school-based malaria education intervention on school children and community adults. This study was conducted in the Dangme-East district of the Greater Accra Region, Ghana, between 2007 and 2008. Trained schoolteachers designed participatory health education activities and led school children to disseminate messages related to malaria control to their communities. Three schools and their respective communities were chosen for the study and assigned to an intervention group (one school) and a control group (two schools). Questionnaire-based interviews and parasitological surveys were conducted before and after the intervention, with the intervention group (105 children, 250 community adults) and the control group (81 children, 133 community adults). Chi-square and Fisher's Exact tests were used to analyse differences in knowledge, practices, and parasite prevalence between pre- and post-intervention. After the intervention, the misperception that malaria has multiple causes was significantly improved, both among children and community adults. Moreover, the community adults who treated a bed net with insecticide in the past six months, increased from 21.5% to 50.0% (p < 0.001). Parasite prevalence in school children decreased from 30.9% to 10.3% (p = 0.003). These positive changes were observed only in the intervention group. This study suggests that the participatory health education intervention contributed to the decreased malaria prevalence among children. It had a positive impact not only on school children, but also on community adults, through the improvement of knowledge and practices. This strategy can be applied as a complementary approach to existing malaria control strategies in West African countries where school health management systems have been strengthened.

“We Make the Path by Walking It”: Building an Academic Community Partnership With Boston Chinatown

PubMed Central

Rubin, Carolyn Leung; Allukian, Nathan; Wang, Xingyue; Ghosh, Sujata; Huang, Chien-Chi; Wang, Jacy; Brugge, Doug; Wong, John B.; Mark, Shirley; Dong, Sherry; Koch-Weser, Susan; Parsons, Susan K.; Leslie, Laurel K.; Freund, Karen M.

2015-01-01

Background The potential for academic community partnerships are challenged in places where there is a history of conflict and mistrust. Addressing Disparities in Asian Populations through Translational Research (ADAPT) represents an academic community partnership between researchers and clinicians from Tufts Medical Center and Tufts University and community partners from Boston Chinatown. Based in principles of community-based participatory research and partnership research, this partnership is seeking to build a trusting relationship between Tufts and Boston Chinatown. Objectives This case study aims to provides a narrative story of the development and formation of ADAPT as well as discuss challenges to its future viability. Methods Using case study research tools, this study draws upon a variety of data sources including interviews, program evaluation data and documents. Results Several contextual factors laid the foundation for ADAPT. Weaving these factors together helped to create synergy and led to ADAPT’s formation. In its first year, ADAPT has conducted formative research, piloted an educational program for community partners and held stakeholder forums to build a broad base of support. Conclusions ADAPT recognizes that long term sustainability requires bringing multiple stakeholders to the table even before a funding opportunity is released and attempting to build a diversified funding base. PMID:25435562

Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013

PubMed Central

Germinario, Cinzia; Caprioli, Alfredo; Giordano, Mario; Chironna, Maria; Gallone, Maria Serena; Tafuri, Silvio; Minelli, Fabio; Maugliani, Antonella; Michelacci, Valeria; Santangelo, Luisa; Mongelli, Onofrio; Montagna, Cosimo; Scavia, Gaia

2016-01-01

In summer 2013, an excess of paediatric cases of haemolytic uraemic syndrome (HUS) in a southern region of Italy prompted the investigation of a community-wide outbreak of Shiga toxin 2-producing Escherichia coli (STEC) O26:H11 infections. Case finding was based on testing patients with HUS or bloody diarrhoea for STEC infection by microbiological and serological methods. A case–control study was conducted to identify the source of the outbreak. STEC O26 infection was identified in 20 children (median age 17 months) with HUS, two of whom reported severe neurological sequelae. No cases in adults were detected. Molecular typing showed that two distinct STEC O26:H11 strains were involved. The case–control study showed an association between STEC O26 infection and consumption of dairy products from two local plants, but not with specific ready-to-eat products. E.coli O26:H11 strains lacking the stx genes were isolated from bulk milk and curd samples, but their PFGE profiles did not match those of the outbreak isolates. This outbreak supports the view that infections with Stx2-producing E. coli O26 in children have a high probability of progressing to HUS and represent an emerging public health problem in Europe. PMID:27684204

Driving following Kava Use and Road Traffic Injuries: A Population-Based Case-Control Study in Fiji (TRIP 14)

PubMed Central

Wainiqolo, Iris; Kafoa, Berlin; Kool, Bridget; Robinson, Elizabeth; Herman, Josephine; McCaig, Eddie; Ameratunga, Shanthi

2016-01-01

Objective To investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available. Methods Data for this population-based case-control study were collected from drivers of ‘case’ vehicles involved in serious injury-involved crashes (where at least one road user was killed or admitted to hospital for 12 hours or more) and ‘control’ vehicles representative of ‘driving time’ in the study base. Structured interviewer administered questionnaires collected self-reported participant data on demographic characteristics and a range of risk factors including kava use and potential confounders. Unconditional logistic regression models estimated odds ratios relating to the association between kava use and injury-involved crash risk. Findings Overall, 23% and 4% of drivers of case and control vehicles, respectively, reported consuming kava in the 12 hours prior to the crash or road survey. After controlling for assessed confounders, driving following kava use was associated with a four-fold increase in the odds of crash involvement (Odds ratio: 4.70; 95% CI: 1.90–11.63). The related population attributable risk was 18.37% (95% CI: 13.77–22.72). Acknowledging limited statistical power, we did not find a significant interaction in this association with concurrent alcohol use. Conclusion In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common. PMID:26930404

Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

PubMed

Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

2014-01-01

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

Health information system model for monitoring treatment and surveillance for leprosy patients in indonesia (case study in Pekalongan District, Central Java, Indonesia).

PubMed

Rachmani, Enny; Kurniadi, Arif; Hsu, Chien Yeh

2013-01-01

After India and Brazil, Indonesia has the third highest incidence/prevalence of leprosy in the world. Every year thousands of new cases and case with grade-2 disability are reported and, while the recovery rate lingers only 80-90 %. Therefore, more than 10 % of leprosy patients drop out of treatment and can be a source of new infections in the community. Our research was aimed at determining apparent difficulties in the leprosy control program as well as how a health information system (HIS) could assist the Indonesian leprosy control program. We used qualitative method with deep interview and observation of document. One of the difficulties which the Indonesian leprosy control program faces is discontinuity of patient's data due to rotating staff as well as the treatment monitoring and queries patients which should be monitored after treatment has ceased. Technology implementation is feasible through short message service (sms) reminders and web base applications. The leprosy control program urgently needs to implement continuous monitoring and recording of patients because of the particular characteristics of this contagious disease.

Innovating for Transformation in First Nations Health Using Community-Based Participatory Research.

PubMed

Kyoon-Achan, Grace; Lavoie, Josée; Avery Kinew, Kathi; Phillips-Beck, Wanda; Ibrahim, Naser; Sinclair, Stephanie; Katz, Alan

2018-06-01

Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the conceptualization of the study, data collection, analysis, and knowledge translation. It was accomplished through a variety of methods, including qualitative interviews, administrative health data analyses, surveys, and case studies. Research relationships built on strong ethics and protocols to enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening community health care priorities. We further discuss how partnerships were forged to own and sustain innovations. This article contributes a blueprint for respectful CBPR. The outcome is a community-owned, widely recognized process that is sustainable while fulfilling researcher and funding obligations.

Is bisphosphonate therapy for benign bone disease associated with impaired dental healing? A case-controlled study

PubMed Central

2011-01-01

Background Bisphosphonates are common first line medications used for the management of benign bone disease. One of the most devastating complications associated with bisphosphonate use is osteonecrosis of the jaws which may be related to duration of exposure and hence cumulative dose, dental interventions, medical co-morbidities or in some circumstances with no identifiable aggravating factor. While jaw osteonecrosis is a devastating outcome which is currently difficult to manage, various forms of delayed dental healing may be a less dramatic and, therefore, poorly-recognised complications of bisphosphonate use for the treatment of osteoporosis. It is hypothesised that long-term (more than 1 year's duration) bisphosphonate use for the treatment of post-menopausal osteoporosis or other benign bone disease is associated with impaired dental healing. Methods/Design A case-control study has been chosen to test the hypothesis as the outcome event rate is likely to be very low. A total of 54 cases will be recruited into the study following review of all dental files from oral and maxillofacial surgeons and special needs dentists in Victoria where potential cases of delayed dental healing will be identified. Potential cases will be presented to an independent case adjudication panel to determine if they are definitive delayed dental healing cases. Two hundred and fifteen controls (1:4 cases:controls), matched for age and visit window period, will be selected from those who have attended local community based referring dental practices. The primary outcome will be the incidence of delayed dental healing that occurs either spontaneously or following dental treatment such as extractions, implant placement, or denture use. Discussion This study is the largest case-controlled study assessing the link between bisphosphonate use and delayed dental healing in Australia. It will provide invaluable data on the potential link between bisphosphonate use and osteonecrosis of the jaws. PMID:21477374

Beacon communities' public health initiatives: a case study analysis.

PubMed

Massoudi, Barbara L; Marcial, Laura H; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

2014-01-01

The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach to evaluation at the beginning of implementation made the work more effective. Supporting evaluation to inform future implementations is important.

Nationwide implementation of integrated community case management of childhood illness in Rwanda

PubMed Central

Mugeni, Catherine; Levine, Adam C; Munyaneza, Richard M; Mulindahabi, Epiphanie; Cockrell, Hannah C; Glavis-Bloom, Justin; Nutt, Cameron T; Wagner, Claire M; Gaju, Erick; Rukundo, Alphonse; Habimana, Jean Pierre; Karema, Corine; Ngabo, Fidele; Binagwaho, Agnes

2014-01-01

ABSTRACT Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries. PMID:25276592

A rapid assessment and response approach to review and enhance Advocacy, Communication and Social Mobilisation for Tuberculosis control in Odisha state, India

PubMed Central

2011-01-01

Background Tuberculosis remains a major public health problem in India with the country accounting for 1 in 5 of all TB cases reported globally. An advocacy, communication and social mobilisation project for Tuberculosis control was implemented and evaluated in Odisha state of India. The purpose of the study was to identify the impact of project interventions including the use of 'Interface NGOs' and involvement of community groups such as women's self-help groups, local government bodies, village health sanitation committees, and general health staff in promoting TB control efforts. Methods The study utilized a rapid assessment and response (RAR) methodology. The approach combined both qualitative field work approaches, including semi-structured interviews and focus group discussions with empirical data collection and desk research. Results Results revealed that a combination of factors including the involvement of Interface NGOs, coupled with increased training and engagement of front line health workers and community groups, and dissemination of community based resources, contributed to improved awareness and knowledge about TB in the targeted districts. Project activities also contributed towards improving health worker and community effectiveness to raise the TB agenda, and improved TB literacy and treatment adherence. Engagement of successfully treated patients also assisted in reducing community stigma and discrimination. Conclusion The expanded use of advocacy, communication and social mobilisation activities in TB control has resulted in a number of benefits. These include bridging pre-existing gaps between the health system and the community through support and coordination of general health services stakeholders, NGOs and the community. The strategic use of 'tailored messages' to address specific TB problems in low performing areas also led to more positive behavioural outcomes and improved efficiencies in service delivery. Implications for future studies are that a comprehensive and well planned range of ACSM activities can enhance TB knowledge, attitudes and behaviours while also mobilising specific community groups to build community efficacy to combat TB. The use of rapid assessments combined with other complementary evaluation approaches can be effective when reviewing the impact of TB advocacy, communication and social mobilisation activities. PMID:21663623

A rapid assessment and response approach to review and enhance advocacy, communication and social mobilisation for tuberculosis control in Odisha state, India.

PubMed

Kamineni, Vishnu Vardhan; Turk, Tahir; Wilson, Nevin; Satyanarayana, Srinath; Chauhan, Lakbir Singh

2011-06-10

Tuberculosis remains a major public health problem in India with the country accounting for 1 in 5 of all TB cases reported globally. An advocacy, communication and social mobilisation project for Tuberculosis control was implemented and evaluated in Odisha state of India. The purpose of the study was to identify the impact of project interventions including the use of 'Interface NGOs' and involvement of community groups such as women's self-help groups, local government bodies, village health sanitation committees, and general health staff in promoting TB control efforts. The study utilized a rapid assessment and response (RAR) methodology. The approach combined both qualitative field work approaches, including semi-structured interviews and focus group discussions with empirical data collection and desk research. Results revealed that a combination of factors including the involvement of Interface NGOs, coupled with increased training and engagement of front line health workers and community groups, and dissemination of community based resources, contributed to improved awareness and knowledge about TB in the targeted districts. Project activities also contributed towards improving health worker and community effectiveness to raise the TB agenda, and improved TB literacy and treatment adherence. Engagement of successfully treated patients also assisted in reducing community stigma and discrimination. The expanded use of advocacy, communication and social mobilisation activities in TB control has resulted in a number of benefits. These include bridging pre-existing gaps between the health system and the community through support and coordination of general health services stakeholders, NGOs and the community. The strategic use of 'tailored messages' to address specific TB problems in low performing areas also led to more positive behavioural outcomes and improved efficiencies in service delivery. Implications for future studies are that a comprehensive and well planned range of ACSM activities can enhance TB knowledge, attitudes and behaviours while also mobilising specific community groups to build community efficacy to combat TB. The use of rapid assessments combined with other complementary evaluation approaches can be effective when reviewing the impact of TB advocacy, communication and social mobilisation activities.

Teaching Community-Based Learning Course in Retailing Management

ERIC Educational Resources Information Center

Rhee, Eddie

2018-01-01

This study outlines the use of a community-based learning (CBL) applied to a Retailing Management course conducted in a 16-week semester in a private institution in the East Coast. The study addresses the case method of teaching and its potential weaknesses, and discusses experiential learning for a real-world application. It further addresses CBL…

A Community-Based Research Approach to Develop an Educational Web Portal

ERIC Educational Resources Information Center

Preiser-Houy, Lara; Navarrete, Carlos J.

2011-01-01

Service-learning projects are becoming more prevalent in Information Systems education. This study explores the use of community-based research, a special kind of a service-learning strategy, in an Information Systems web development course. The paper presents a case study of a service-learning project to develop an educational web portal for a…

Evaluation of Viewpoints of Health Care Professionals on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas Based on Practice Environment.

PubMed

Marcus, Brian S; Carlson, Jestin N; Hegde, Gajanan G; Shang, Jennifer; Venkat, Arvind

2016-03-01

We sought to evaluate whether health care professionals' viewpoints differed on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas based on practice location. We conducted a survey study from December 21, 2013 to March 15, 2014 of health care professionals at six hospitals (one tertiary care academic medical center, three large community hospitals and two small community hospitals). The survey consisted of eight clinical ethics cases followed by statements on whether there was a role for the ethics committee or hospital in their resolution, what that role might be and case specific queries. Respondents used a 5-point Likert scale to express their degree of agreement with the premises posed. We used the ANOVA test to evaluate whether respondent views significantly varied based on practice location. 240 health care professionals (108-tertiary care center, 92-large community hospitals, 40-small community hospitals) completed the survey (response rate: 63.6 %). Only three individual queries of 32 showed any significant response variations across practice locations. Overall, viewpoints did not vary across practice locations within question categories on whether the ethics committee or hospital had a role in case resolution, what that role might be and case specific queries. In this multicenter survey study, the viewpoints of health care professionals on the role of ethics committees or hospitals in the resolution of clinical ethics cases varied little based on practice location.

Suicide by people in a community justice pathway: population-based nested case–control study

PubMed Central

King, Carlene; Senior, Jane; Webb, Roger T.; Millar, Tim; Piper, Mary; Pearsall, Alison; Humber, Naomi; Appleby, Louis; Shaw, Jenny

2015-01-01

The elevated risk of suicide in prison and after release is a well-recognised and serious problem. Despite this, evidence concerning community-based offenders' suicide risk is sparse. We conducted a population-based nested case–control study of all people in a community justice pathway in England and Wales. Our data show 13% of general population suicides were in community justice pathways before death. Suicide risks were highest among individuals receiving police cautions, and those having recent, or impending prosecution for sexual offences. Findings have implications for the training and practice of clinicians identifying and assessing suicidality, and offering support to those at elevated risk. PMID:26159602

Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project.

PubMed

Chao, Shin Margaret; Donatoni, Giannina; Bemis, Cathleen; Donovan, Kevin; Harding, Cynthia; Davenport, Deborah; Gilbert, Carol; Kasehagen, Laurin; Peck, Magda G

2010-11-01

This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the LAMB case-control study (279 controls, 87 cases) identified additional factors associated with LBW births: high blood pressure before and during pregnancy, pregnancy weight gain falling outside of the recommended range, smoking during pregnancy, and feeling unhappy during pregnancy. PT birth was significantly associated with having a previous LBW/PT birth, not taking multivitamins before pregnancy, and feeling unhappy during pregnancy. In response to these findings, community stakeholders gathered to develop strategic actions for targeted prevention to address infant mortality. Subsequently, key funders infused resources into the community, resulting in expanded case management of high-risk women, increased family planning services and local resources, better training for nurses, and public health initiatives to increase awareness of infant safety. Community readiness, mobilization, and alignment in addressing a public health concern in Los Angeles County enabled the integration of PPOR analytic methods into the established IMR structure and [the design and implementation of a population-based l study (LAMB)] to monitor the factors associated with adverse birth outcomes. PPOR proved an effective approach for identifying risk and social factors of greatest concern, the magnitude of the problem, and mobilizing community action to improve infant mortality in the Antelope Valley.

Increased stroke risk and lipoprotein(a) in a multiethnic community: the Northern Manhattan Stroke Study.

PubMed

Boden-Albala, Bernadette; Kargman, Douglas E; Lin, I-Feng; Paik, Myunghee C; Sacco, Ralph L; Berglund, Lars

2010-08-01

Elevated lipoprotein(a) [Lp(a)] is associated with ischemic stroke (IS) among Whites, but data is sparse for non-White populations. Using a population-based case-control study design with subjects from the Northern Manhattan Stroke Study, we assessed whether Lp(a) levels were independently associated with IS risk among Whites, Blacks and Hispanics. Lp(a) levels were measured in 317 IS cases (mean age 69 +/- 13 years; 56% women; 16% Whites, 31% Blacks and 52% Hispanics) and 413 community-based controls, matched by age, race/ethnicity and gender. In-person assessments included demographics, socioeconomic status, presence of vascular risk factors and fasting lipid levels. Logistic regression was used to determine the independent association of Lp(a) and IS. Stratified analyses investigated gender and race/ethnic differences. Mean Lp(a) levels were greater among cases than controls (46.3 +/- 41.0 vs. 38.9 +/- 38.2 mg/dl; p < 0.01). After adjusting for stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, cigarette smoking), lipid levels, and socioeconomic status, Lp(a) levels > or =30 mg/dl were independently associated with an increased stroke risk in the overall cohort (adjusted odds ratio, OR, 1.8, 95% confidence interval, CI, 1.20-2.6; p = 0.004). There was a significant linear dose-response relationship between Lp(a) levels and IS risk. The association between IS risk and Lp(a) > or =30 mg/dl was more pronounced among men (adjusted OR 2.0, 95% CI 1.1-3.5; p = 0.02) and among Blacks (adjusted OR 2.7, 95% CI 1.2-6.2; p = 0.02). Elevated Lp(a) levels were significantly and independently associated with increased stroke risk, suggesting that Lp(a) is a risk factor for IS across White, Black and Hispanic race/ethnic groups. Copyright 2010 S. Karger AG, Basel.

Pathways To Scaling-Up in Community Based Rehabilitation Agencies.

ERIC Educational Resources Information Center

Boyce, W.; Johnston, C.; Thomas, M.; Enns, H.; Naidu, D. M.; Tjandrakusuma, H.

1997-01-01

Scaling-up (the expansion or development of organizational activities of nongovernmental agencies to achieve greater impact) in community-based rehabilitation is described by using case study materials from industrialized and less-developed countries (India, Canada, and Indonesia) and focusing on differences in structural characteristics of…

Using Analysis of Governance to Unpack Community-Based Conservation: A Case Study from Tanzania.

PubMed

Robinson, Lance W; Makupa, Enock

2015-11-01

Community-based conservation policies and programs are often hollow with little real devolution. But to pass a judgment of community-based or not community-based on such initiatives and programs obscures what is actually a suite of attributes. In this paper, we analyze governance around a specific case of what is nominally community-based conservation-Ikona Wildlife Management Area (WMA) in Tanzania-using two complementary sets of criteria. The first relates to governance "powers": planning powers, regulatory powers, spending powers, revenue-generating powers, and the power to enter into agreements. The second set of criteria derive from the understanding of governance as a set of social functions: social coordination, shaping power, setting direction, and building community. The analysis helps to detail ways in which the Tanzanian state through policy and regulations has constrained the potential for Ikona WMA to empower communities and community actors. Although it has some features of community-based conservation, community input into how the governance social functions would be carried out in the WMA was constrained from the start and is now largely out of community hands. The two governance powers that have any significant community-based flavor-spending powers and revenue-generating powers-relate to the WMA's tourism activities, but even here the picture is equivocal at best. The unpacking of governance that we have done, however, reveals that community empowerment through the processes associated with creating and recognizing indigenous and community-conserved areas is something that can be pursued through multiple channels, some of which might be more strategic than others.

Association of type 1 diabetes and concentrations of drinking water components in Newfoundland and Labrador, Canada

PubMed Central

Chafe, Roger; Aslanov, Rana; Sarkar, Atanu; Gregory, Peter; Comeau, Alex; Newhook, Leigh Anne

2018-01-01

Objective To determine the association between drinking water quality and rates of type 1 diabetes in the Newfoundland and Labrador (NL) population, which has one of the highest incidences of type 1 diabetes reported globally. Research design and methods The study used a community-based, case-control design. We first calculated incidence rates of type 1 diabetes at the provincial, regional and community levels. The connection between incidence rates and components in public water supplies were then analyzed in three ways: to evaluate differences in water quality between communities with and without incident cases of type 1 diabetes, and to analyze the relationship between water quality and incidence rates of type 1 diabetes at both the community and regional levels. Results The provincial incidence of type 1 diabetes was 51.7/100 000 (0-14 year age group) for the period studied. In the community-based analysis, there were significant associations found between higher concentrations of arsenic (β=0.268, P=0.013) and fluoride (β=0.202, P=0.005) in drinking water and higher incidence of type 1 diabetes. In the regional analysis, barium (β=−0.478, P=0.009) and nickel (β=−0.354, P=0.050) concentrations were negatively associated with incidence of type 1 diabetes. Conclusions We confirmed the high incidence of type 1 diabetes in NL. We also found that concentrations of some components in drinking water were associated with higher incidence of type 1 diabetes, but no component was found to have a significant association across the three different levels of analysis performed. PMID:29527309

Environmental exposure to BDE47 is associated with increased diabetes prevalence: Evidence from community-based case-control studies and an animal experiment

NASA Astrophysics Data System (ADS)

Zhang, Zhan; Li, Shushu; Liu, Lu; Wang, Li; Xiao, Xue; Sun, Zhenzhen; Wang, Xichen; Wang, Chao; Wang, Meilin; Li, Lei; Xu, Qiujin; Gao, Weimin; Wang, Shou-Lin

2016-06-01

Brominated flame retardants exposure has been associated with increasing trends of diabetes and metabolic disease. Thus, the purpose of this study was to provide evidence of polybrominated diphenyl ethers (PBDEs) exposure in relation to diabetes prevalence and to reveal the potential underlying mechanism in epidemiological and animal studies. All the participants received a questionnaire, health examination, and the detection of 7 PBDE congeners in serum in two independent community-based studies from 2011 to 2012 in China. Male rats were exposed to 2,2’4,4’-tetrabromodiphenyl ether (BDE47) for 8 weeks to explore its effects on glucose homeostasis and potential mechanisms using high-throughput genomic analysis. Among the 7 congeners, BDE47 showed significant high detection rate and concentration in cases in Study I and Study II. Every tertile of BDE47 exposure significantly increased the risk of diabetes prevalence in Study I (Ptrend = 0.001) and Study II (Ptrend < 0.001). Additionally, BDE47 treatments induced hyperglycemia in rats. Furthermore, gene microarray analysis showed that diabetes pathway and three gene ontology terms involved in glucose transport were enriched. The results indicated that environmental exposure to BDE47 was associated with increased diabetes prevalence. However, further prospective and mechanistic studies are needed to the causation of diabetes in relation to BDE47.

Challenges in Recruiting Aging Women Holocaust Survivors to a Case Control Study of Breast Cancer.

PubMed

Vin-Raviv, Neomi; Dekel, Rachel; Barchana, Micha; Linn, Shai; Keinan-Boker, Lital

2015-01-01

Older adults are underrepresented in medical research for many reasons, including recruitment difficulties. Recruitment of older adults for research studies is often a time-consuming process and can be more challenging when the study involves older adults with unique exposures to traumatic events and from minority groups. The current article provides a brief overview of (a) challenges encountered while recruiting aging women Holocaust survivors for a case control study and (b) strategies used for meeting those challenges. The case group comprised women Holocaust survivors who were recently diagnosed with breast cancer and the control group comprised healthy women from a Holocaust-survivor community in Israel. Copyright 2015, SLACK Incorporated.

Costs of Illness Due to Endemic Cholera

PubMed Central

Poulos, C.; Riewpaiboon, A.; Stewart, J.F.; Clemens, J.; Guh, S.; Agtini, M.; Sur, D.; Islam, Z.; Lucas, M.; Whittington, D.

2013-01-01

Summary Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were USD 32 and 47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between USD 28 and USD 206, depending on hospitalization. Patient costs of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective. PMID:21554781

Using Community Health Workers in Community-Based Growth Promotion: What Stakeholders Think

ERIC Educational Resources Information Center

Afulani, Patience A.; Awoonor-Williams, John K.; Opoku, Ernest C.; Asunka, Joseph

2012-01-01

The Nutrition and Malaria Control for Child Survival Project is a community-based growth promotion project that utilizes Community Health Workers (CHWs), referred to as Community Child Growth Promoters (CCGPs), as the principal change agents. The purpose of this study was to identify perceptions of key stakeholders about the project and the role…

The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls.

PubMed

White, K P; Speechley, M; Harth, M; Ostbye, T

1999-07-01

To identify demographic and clinical features that distinguish fibromyalgia (FM) from other chronic widespread pain. We identified 100 confirmed FM cases, 76 widespread pain controls, and 135 general controls in a random community survey of 3395 noninstitutionalized adults living in London, Ontario. FM cases were distinguished from pain controls using the 1990 American College of Rheumatology (ACR) classification criteria for FM. The mean age of FM cases was 47.8 years (range 19 to 86), the same as for pain controls; 86% of FM cases were female versus 67.1% of pain controls (p < 0.01). FM cases were less educated than general controls (p = 0.03). Male and female FM cases were similar, except females were older and reported more major symptoms (both p = 0.02). FM cases reported more severe pain and fatigue, more symptoms, more major symptoms, and worse overall health than pain controls or general controls. The most commonly reported major symptoms among FM cases were musculoskeletal pain (77.3%), fatigue (77.3%), severe fatigue lasting 24 h after minimal activity (77.0%), nonrestorative sleep (65.7%), and insomnia (56.0%). Subjects with 11-14 tender points were more similar to those with 15-18 tender points than to those with 7-10 points in 11 of 14 clinical variables. On multivariate analysis, 4 symptoms distinguished FM cases from pain controls: pain severity (p = 0.004), severe fatigue lasting 24 h after minimal activity (p = 0.006), weakness (p = 0.008), and self-reported swelling of neck glands (p = 0.01). In the general population, adults who meet the ACR definition of FM appear to have distinct features compared to those with chronic widespread pain who do not meet criteria.

The impact of hotspot-targeted interventions on malaria transmission: study protocol for a cluster-randomized controlled trial

PubMed Central

2013-01-01

Background Malaria transmission is highly heterogeneous in most settings, resulting in the formation of recognizable malaria hotspots. Targeting these hotspots might represent a highly efficacious way of controlling or eliminating malaria if the hotspots fuel malaria transmission to the wider community. Methods/design Hotspots of malaria will be determined based on spatial patterns in age-adjusted prevalence and density of antibodies against malaria antigens apical membrane antigen-1 and merozoite surface protein-1. The community effect of interventions targeted at these hotspots will be determined. The intervention will comprise larviciding, focal screening and treatment of the human population, distribution of long-lasting insecticide-treated nets and indoor residual spraying. The impact of the intervention will be determined inside and up to 500 m outside the targeted hotspots by PCR-based parasite prevalence in cross-sectional surveys, malaria morbidity by passive case detection in selected facilities and entomological monitoring of larval and adult Anopheles populations. Discussion This study aims to provide direct evidence for a community effect of hotspot-targeted interventions. The trial is powered to detect large effects on malaria transmission in the context of ongoing malaria interventions. Follow-up studies will be needed to determine the effect of individual components of the interventions and the cost-effectiveness of a hotspot-targeted approach, where savings made by reducing the number of compounds that need to receive interventions should outweigh the costs of hotspot-detection. Trial registration NCT01575613. The protocol was registered online on 20 March 2012; the first community was randomized on 26 March 2012. PMID:23374910

Constant Communities in Complex Networks

NASA Astrophysics Data System (ADS)

Chakraborty, Tanmoy; Srinivasan, Sriram; Ganguly, Niloy; Bhowmick, Sanjukta; Mukherjee, Animesh

2013-05-01

Identifying community structure is a fundamental problem in network analysis. Most community detection algorithms are based on optimizing a combinatorial parameter, for example modularity. This optimization is generally NP-hard, thus merely changing the vertex order can alter their assignments to the community. However, there has been less study on how vertex ordering influences the results of the community detection algorithms. Here we identify and study the properties of invariant groups of vertices (constant communities) whose assignment to communities are, quite remarkably, not affected by vertex ordering. The percentage of constant communities can vary across different applications and based on empirical results we propose metrics to evaluate these communities. Using constant communities as a pre-processing step, one can significantly reduce the variation of the results. Finally, we present a case study on phoneme network and illustrate that constant communities, quite strikingly, form the core functional units of the larger communities.

Implementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa

PubMed Central

Amoussouhoui, Arnaud Setondji; Wadagni, Anita Carolle; Johnson, Roch Christian; Aoulou, Paulin; Agbo, Inès Elvire; Houezo, Jean-Gabin; Boyer, Micah; Nichter, Mark

2018-01-01

Background Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU), is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In Benin, BU patient care is being integrated into the government health system. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin’s most endemic districts previously served by centralized hospital-based care. Methodology/Principal findings We conducted intervention-oriented research implemented in four steps: baseline study, training of health district clinical staff, outreach education, outcome and impact assessments. Study results demonstrated that early BU lesions (71% of all detected cases) could be treated in the community following outreach education, and that most of the afflicted were willing to accept decentralized treatment. Ninety-three percent were successfully treated with antibiotics alone. The impact evaluation found that community confidence in decentralized BU care was greatly enhanced by clinic staff who came to be seen as having expertise in the care of most chronic wounds. Conclusions/Significance This study documents a successful BU outreach and decentralized care program reaching early BU cases not previously treated by a proactive centralized BU program. The pilot program further demonstrates the added value of integrated wound management for NTD control. PMID:29529087

Implementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa.

PubMed

Amoussouhoui, Arnaud Setondji; Sopoh, Ghislain Emmanuel; Wadagni, Anita Carolle; Johnson, Roch Christian; Aoulou, Paulin; Agbo, Inès Elvire; Houezo, Jean-Gabin; Boyer, Micah; Nichter, Mark

2018-03-01

Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU), is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In Benin, BU patient care is being integrated into the government health system. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin's most endemic districts previously served by centralized hospital-based care. We conducted intervention-oriented research implemented in four steps: baseline study, training of health district clinical staff, outreach education, outcome and impact assessments. Study results demonstrated that early BU lesions (71% of all detected cases) could be treated in the community following outreach education, and that most of the afflicted were willing to accept decentralized treatment. Ninety-three percent were successfully treated with antibiotics alone. The impact evaluation found that community confidence in decentralized BU care was greatly enhanced by clinic staff who came to be seen as having expertise in the care of most chronic wounds. This study documents a successful BU outreach and decentralized care program reaching early BU cases not previously treated by a proactive centralized BU program. The pilot program further demonstrates the added value of integrated wound management for NTD control.

Competency-Based Training and Worker Turnover in Community Supports for People with IDD: Results from a Group Randomized Controlled Study

ERIC Educational Resources Information Center

Bogenschutz, Matthew; Nord, Derek; Hewitt, Amy

2015-01-01

Turnover among direct support professionals (DSPs) in community support settings for individuals with intellectual and developmental disabilities (IDD) has been regarded as a challenge since tracking of this workforce began in the 1980s. This study utilized a group randomized controlled design to test the effects of a competency-based training…

Spatial distribution and deployment of community-based distributors implementing integrated community case management (iCCM): Geographic information system (GIS) mapping study in three South Sudan states.

PubMed

Pratt, Abigail; Dale, Martin; Olivi, Elena; Miller, Jane

2014-12-01

In late 2012 and in conjunction with South Sudan's Ministry of Health - National Malaria Control Program, PSI (Population Services International) conducted a comprehensive mapping exercise to assess geographical coverage of its integrated community case management (iCCM) program and consider scope for expansion. The operational research was designed to provide evidence and support for low-cost mapping and monitoring systems, demonstrating the use of technology to enhance the quality of programming and to allow for the improved allocation of resources through appropriate and need-based deployment of community-based distributors (CBDs). The survey took place over the course of three months and program staff gathered GPS (global positioning system) data, along with demographic data, for over 1200 CBDs and 111 CBD supervisors operating in six counties in South Sudan. Data was collated, cleaned and quality assured, input into an Excel database, and subsequently uploaded to geographic information system (GIS) for spatial analysis and map production. The mapping results showed that over three-quarters of CBDs were deployed within a five kilometer radius of a health facility or another CBD, contrary to program planning and design. Other characteristics of the CBD and CBD supervisor profiles (age, gender, literacy) were more closely matched with other regional programs. The results of this mapping exercise provided a valuable insight into the contradictions found between a program "deployment plan" and the realities observed during field implementation. It also highlighted an important need for program implementers and national-level strategy makers to consider the natural and community-driven diffusion of CBDs, and take into consideration the strength of the local health facilities when developing a deployment plan.

Success Factors for Community-Based Natural Resource Management (CBNRM): Lessons from Kenya and Australia

NASA Astrophysics Data System (ADS)

Measham, Thomas G.; Lumbasi, Jared A.

2013-09-01

Recent concerns over a crisis of identity and legitimacy in community-based natural resource management (CBNRM) have emerged following several decades of documented failure. A substantial literature has developed on the reasons for failure in CBNRM. In this paper, we complement this literature by considering these factors in relation to two successful CBNRM case studies. These cases have distinct differences, one focusing on the conservation of hirola in Kenya on community-held trust land and the other focusing on remnant vegetation conservation from grazing pressure on privately held farm land in Australia. What these cases have in common is that both CBNRM projects were initiated by local communities with strong attachments to their local environments. The projects both represent genuine community initiatives, closely aligned to the original aims of CBNRM. The intrinsically high level of "ownership" held by local residents has proven effective in surviving many challenges which have affected other CBNRM projects: from impacts on local livelihoods to complex governance arrangements involving non-government organizations and research organizations. The cases provide some signs of hope among broader signs of crisis in CBNRM practice.

The Connotations of "Botho Philosophy" and Its Potential Contribution towards Environmental Conservation: The Case of Tlokoeng Community in Lesotho

ERIC Educational Resources Information Center

Mokuku, Tšepo

2017-01-01

This paper explores innovative environmental education strategies to conserve biodiversity in a rural-based context, in Lesotho. A case study approach was employed to investigate the community's conception of botho philosophy and how it might promote nature conservation. Focus Group Interviews were conducted with 105 participants. The responses…

C-reactive protein levels and risk of disabling dementia with and without stroke in Japanese: the Circulatory Risk in Communities Study (CIRCS).

PubMed

Chei, Choy-Lye; Yamagishi, Kazumasa; Ikeda, Ai; Noda, Hiroyuki; Maruyama, Minako; Cui, Renzhe; Imano, Hironori; Kiyama, Masahiko; Kitamura, Akihiko; Asada, Takashi; Iso, Hiroyasu

2014-10-01

Studies have shown that elevated high-sensitivity C-reactive protein (hs-CRP) predicts stroke, which is a risk factor for dementia. It remains, however, unclear whether hs-CRP increases risk of dementia. A prospective nested case-control study of Japanese 40-69 years of age was conducted using frozen serum samples collected from approximately 7531men and women who participated in cardiovascular risk surveys from 1984 to 1994 in one community and 1989-1995 in another community under the Circulatory Risk in Communities Study (CIRCS). Two control subjects per case were matched by sex, age, community, and year of serum storage. The hs-CRP was measured using a latex particle-enhanced immunonephelometric assay. Between 1999 and 2013, we identified 275 disabling dementia cases (96 cases with history of stroke and 179 without it). There was a positive association between hs-CRP levels and risk of dementia with history of stroke. No significant association was observed between hs-CRP levels and risk of dementia without history of stroke. After adjustment for hypertension, diabetes and other confounding variables, the positive association remained statistically significant. The multivariable odds ratios associated with 1-SD increment of log hs-CRP were 1.02 (0.87-1.20) for total dementia, 1.35 (1.02-1.79) for dementia with history of stroke, and 0.89 (0.72-1.10) for dementia without history of stroke. Elevated hs-CRP levels were associated with increased risk of disabling dementia in individuals with history of stroke but not in those without it. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Factors that are associated with the risk of acquiring Plasmodium knowlesi malaria in Sabah, Malaysia: a case-control study protocol.

PubMed

Grigg, M J; William, T; Drakeley, C J; Jelip, J; von Seidlein, L; Barber, B E; Fornace, K M; Anstey, N M; Yeo, T W; Cox, J

2014-08-22

Plasmodium knowlesi has long been present in Malaysia, and is now an emerging cause of zoonotic human malaria. Cases have been confirmed throughout South-East Asia where the ranges of its natural macaque hosts and Anopheles leucosphyrus group vectors overlap. The majority of cases are from Eastern Malaysia, with increasing total public health notifications despite a concurrent reduction in Plasmodium falciparum and P. vivax malaria. The public health implications are concerning given P. knowlesi has the highest risk of severe and fatal disease of all Plasmodium spp in Malaysia. Current patterns of risk and disease vary based on vector type and competence, with individual exposure risks related to forest and forest-edge activities still poorly defined. Clustering of cases has not yet been systematically evaluated despite reports of peri-domestic transmission and known vector competence for human-to-human transmission. A population-based case-control study will be conducted over a 2-year period at two adjacent districts in north-west Sabah, Malaysia. Confirmed malaria cases presenting to the district hospital sites meeting relevant inclusion criteria will be requested to enrol. Three community controls matched to the same village as the case will be selected randomly. Study procedures will include blood sampling and administration of household and individual questionnaires to evaluate potential exposure risks associated with acquisition of P. knowlesi malaria. Secondary outcomes will include differences in exposure variables between P. knowlesi and other Plasmodium spp, risk of severe P. knowlesi malaria, and evaluation of P. knowlesi case clustering. Primary analysis will be per protocol, with adjusted ORs for exposure risks between cases and controls calculated using conditional multiple logistic regression models. This study has been approved by the human research ethics committees of Malaysia, the Menzies School of Health Research, Australia, and the London School of Hygiene and Tropical Medicine, UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Camino Verde (The Green Way): evidence-based community mobilisation for dengue control in Nicaragua and Mexico: feasibility study and study protocol for a randomised controlled trial.

PubMed

Andersson, Neil; Arostegui, Jorge; Nava-Aguilera, Elizabeth; Harris, Eva; Ledogar, Robert J

2017-05-30

Since the Aedes aegypti mosquitoes that transmit dengue virus can breed in clean water, WHO-endorsed vector control strategies place sachets of organophosphate pesticide, temephos (Abate), in household water storage containers. These and other pesticide-dependent approaches have failed to curb the spread of dengue and multiple dengue virus serotypes continue to spread throughout tropical and subtropical regions worldwide. A feasibility study in Managua, Nicaragua, generated instruments, intervention protocols, training schedules and impact assessment tools for a cluster randomised controlled trial of community-based approaches to vector control comprising an alternative strategy for dengue prevention and control in Nicaragua and Mexico. The Camino Verde (Green Way) is a pragmatic parallel group trial of pesticide-free dengue vector control, adding effectiveness to the standard government dengue control. A random sample from the most recent census in three coastal regions of Guerrero state in Mexico will generate 90 study clusters and the equivalent sampling frame in Managua, Nicaragua will generate 60 clusters, making a total of 150 clusters each of 137-140 households. After a baseline study, computer-driven randomisation will allocate to intervention one half of the sites, stratified by country, evidence of recent dengue virus infection in children aged 3-9 years and, in Nicaragua, level of community organisation. Following a common evidence-based education protocol, each cluster will develop and implement its own collective interventions including house-to-house visits, school-based programmes and inter-community visits. After 18 months, a follow-up study will compare dengue history, serological evidence of recent dengue virus infection (via measurement of anti-dengue virus antibodies in saliva samples) and entomological indices between intervention and control sites. Our hypothesis is that informed community mobilisation adds effectiveness in controlling dengue. ISRCTN27581154 .

Hot food and beverage consumption and the risk of esophageal squamous cell carcinoma: A case-control study in a northwest area in China.

PubMed

Tai, Wei-Ping; Nie, Guo-Ji; Chen, Meng-Jie; Yaz, Tajigul Yiminni; Guli, Arzi; Wuxur, Arzigul; Huang, Qing-Qing; Lin, Zhi-Gang; Wu, Jing

2017-12-01

This study was trying to investigate the association of hot food and beverage consumption and the risk of esophageal squamous cell carcinoma in Hotan, a northwest area of China with high risk of esophageal squmous cell carcinoma. A population-based case-control study was designed. For the study, 167 patients diagnosed with esophageal squamous cell carcinoma were selected from Hotan during 2014 to 2015, and 167 community-based controls were selected from the same area, matched with age and sex. Information involved of temperature of food and beverage intake was obtained by face-to-face interview. Logistic regression analyses were performed to investigate the association between temperature of food and beverage intake and the risk of esophageal squamous cell carcinoma. The temperature of the food and beverage consumed by the esophageal squamous cell carcinoma patients was significantly higher than the controls. High temperature of tea, water, and food intake significantly increased the risk of esophageal squamous cell carcinoma by more than 2-fold, with adjusted odds ratio 2.23 (1.45-2.90), 2.13 (1.53-2.66), and 2.98 (1.89-4.12). Intake of food and beverage with high temperature was positively associated with the incidence of esophageal squamous cell carcinoma in Northwestern China. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Indigenous cultural contexts for STEM experiences: snow snakes' impact on students and the community

NASA Astrophysics Data System (ADS)

Miller, Brant G.; Roehrig, Gillian

2018-03-01

Opportunities for American Indian youth to meaningfully engage in school-based science, technology, engineering, and mathematics (STEM) experiences have historically been inadequate. As a consequence, American Indian students perform lower on standardized assessments of science education than their peers. In this article we describe the emergence of meaning for students—as well as their community—resulting from Indigenous culturally-based STEM curriculum that used an American Indian tradition as a focal context. Specifically, the game of snow snakes ( Gooneginebig in Ojibwe) afforded an opportunity for STEM and culturally-based resources to work in unison. A case study research design was used with the bounded case represented by the community associated with the snow snake project. The research question guiding this study was: What forms of culturally relevant meaning do students and the community form as a result of the snow snake game? Results indicate evidence of increased student and community engagement through culturally-based STEM experiences in the form of active participation and the rejuvenation of a traditional game. Implications are discussed for using culturally-based contexts for STEM learning.

Creating Economic Lift: Jobs, Training, and Business Opportunities in Public and Indian Housing.

ERIC Educational Resources Information Center

Watkins, Dan

This document contains 10 case studies that examine community-based efforts to improve the economies and provide jobs in public and Indian housing communities. The innovative approaches described in the studies indicate the potential of local communities to address their most serious problems. The models have several common threads: creative and…

Utilizing Benchmarking to Study the Effectiveness of Parent-Child Interaction Therapy Implemented in a Community Setting

ERIC Educational Resources Information Center

Self-Brown, Shannon; Valente, Jessica R.; Wild, Robert C.; Whitaker, Daniel J.; Galanter, Rachel; Dorsey, Shannon; Stanley, Jenelle

2012-01-01

Benchmarking is a program evaluation approach that can be used to study whether the outcomes of parents/children who participate in an evidence-based program in the community approximate the outcomes found in randomized trials. This paper presents a case illustration using benchmarking methodology to examine a community implementation of…

School Leadership and Professional Learning Community: Case Study of Two Senior High Schools in Northeast China

ERIC Educational Resources Information Center

Wang, Ting

2016-01-01

This article presents findings of a qualitative study on school leadership and professional learning community in two high achieving senior high schools in Northeast China. The findings show that teachers participated in school-based communities of professional learning, such as Teaching and Research Groups, Lesson Preparation Groups, and Grade…

Transgressing the norm: Transformative agency in community-based learning for sustainability in southern African contexts

NASA Astrophysics Data System (ADS)

Lotz-Sisitka, Heila; Mukute, Mutizwa; Chikunda, Charles; Baloi, Aristides; Pesanayi, Tichaona

2017-12-01

Environment and sustainability education processes are often oriented to change and transformation, and frequently involve the emergence of new forms of human activity. However, not much is known about how such change emerges from the learning process, or how it contributes to the development of transformative agency in community contexts. The authors of this article present four cross-case perspectives of expansive learning and transformative agency development in community-based education in southern Africa, studying communities pursuing new activities that are more socially just and sustainable. The four cases of community learning and transformative agency focus on the following activities: (1) sustainable agriculture in Lesotho; (2) seed saving and rainwater harvesting in Zimbabwe; (3) community-based irrigation scheme management in Mozambique; and (4) biodiversity conservation co-management in South Africa. The case studies all draw on cultural-historical activity theory to guide learning and change processes, especially third-generation cultural-historical activity theory (CHAT), which emphasises expansive learning in collectives across interacting activity systems. CHAT researchers, such as the authors of this article, argue that expansive learning can lead to the emergence of transformative agency. The authors extend their transformative agency analysis to probe if and how expansive learning might also facilitate instances of transgressing norms - viewed here as embedded practices which need to be reframed and changed in order for sustainability to emerge.

Analysing a Web-Based E-Commerce Learning Community: A Case Study in Brazil.

ERIC Educational Resources Information Center

Joia, Luiz Antonio

2002-01-01

Demonstrates the use of a Web-based participative virtual learning environment for graduate students in Brazil enrolled in an electronic commerce course in a Masters in Business Administration program. Discusses learning communities; computer-supported collaborative work and collaborative learning; influences on student participation; the role of…

The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon.

PubMed

Vouking, Marius Zambou; Takougang, Innocent; Mbam, Léonard Mbam; Mbuagbaw, Lawrence; Tadenfok, Carine Nouboudem; Tamo, Claire Violette

2013-01-01

Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. It is the third most common mycobacterial infection after tuberculosis and leprosy. Community Health Workers (CHWs) hold the potential to support patients and their families at the community level. We conducted a cross-sectional descriptive study to assess the participation of CHWs in the early diagnosis and treatment of BU in Ngoantet, Cameroon. The CHWs performance was measured using: the number of cases referred to the Ngoantet Health Centre, the percentage of accomplished referrals, the percentage of cases referred by CHWs confirmed by the staff of Ngoantet Health Centre. Data was analyzed using Epi-info version 3.4.1. and Microsoft Office Excel 2003. The study focused on 51 CHWs in the Ngoantet health area. The referral rate was 95.0%. Most of the suspicious cases (91.5%) referred were confirmed by health workers. Most CHWs (78.4%) declared that they had identified at least one presumptive case of BU infection. We conclude that the CHWs can play a key role in scaling up BU control activities using a referral system. This study confirms the role of home visits and inspections in the early detection and treatment of BU.

Tumor-based case-control studies of infection and cancer: muddling the when and where of molecular epidemiology.

PubMed

Engels, Eric A; Wacholder, Sholom; Katki, Hormuzd A; Chaturvedi, Anil K

2014-10-01

We describe the "tumor-based case-control" study as a type of epidemiologic study used to evaluate associations between infectious agents and cancer. These studies assess exposure using diseased tissues from affected individuals (i.e., evaluating tumor tissue for cancer cases), but they must utilize nondiseased tissues to assess control subjects, who do not have the disease of interest. This approach can lead to exposure misclassification in two ways. First, concerning the "when" of exposure assessment, retrospective assessment of tissues may not accurately measure exposure at the key earlier time point (i.e., during the etiologic window). Second, concerning the "where" of exposure assessment, use of different tissues in cases and controls can have different accuracy for detecting the exposure (i.e., differential exposure misclassification). We present an example concerning the association of human papillomavirus with various cancers, where tumor-based case-control studies likely overestimate risk associated with infection. In another example, we illustrate how tumor-based case-control studies of Helicobacter pylori and gastric cancer underestimate risk. Tumor-based case-control studies can demonstrate infection within tumor cells, providing qualitative information about disease etiology. However, measures of association calculated in tumor-based case-control studies are prone to over- or underestimating the relationship between infections and subsequent cancer risk. ©2014 American Association for Cancer Research.

Developing a Deeper Understanding of Community-Based Pedagogies with Teachers: Learning with and from Teachers in Colombia

ERIC Educational Resources Information Center

Sharkey, Judy; Clavijo Olarte, Amparo; Ramírez, Luz Maribel

2016-01-01

Here we share findings from a 9-month qualitative case study involving a school-university professional development inquiry into how teachers develop, implement, and interpret community-based pedagogies (CBPs), an asset-based approach to curriculum that acknowledges mandated standards but begins with recognizing and valuing local knowledge. After…

The Intersection of Community-Based Writing and Computer-Based Writing: A Cyberliteracy Case Study.

ERIC Educational Resources Information Center

Gabor, Catherine

The learning goals that inform service learning as a whole can contribute to the computers and writing field significantly. This paper demonstrates how two lines of inquiry can be furthered, community-based writing and computers and writing, through new data and critical reflection on learning goals and communication tools. The paper presents a…

Characterizing heterogeneity in children with and without ADHD based on reward system connectivity

PubMed Central

Costa Dias, Taciana G.; Iyer, Swathi P.; Carpenter, Samuel D.; Cary, Robert P.; Wilson, Vanessa B.; Mitchell, Suzanne H.; Nigg, Joel T.; Fair, Damien A.

2015-01-01

One potential obstacle limiting our ability to clarify ADHD etiology is the heterogeneity within the disorder, as well as in typical samples. In this study, we utilized a community detection approach on 106 children with and without ADHD (aged 7–12 years), in order to identify potential subgroups of participants based on the connectivity of the reward system. Children with ADHD were compared to typically developing children within each identified community, aiming to find the community-specific ADHD characteristics. Furthermore, to assess how the organization in subgroups relates to behavior, we evaluated delay-discounting gradient and impulsivity-related temperament traits within each community. We found that discrete subgroups were identified that characterized distinct connectivity profiles in the reward system. Importantly, which connections were atypical in ADHD relative to the control children were specific to the community membership. Our findings showed that children with ADHD and typically developing children could be classified into distinct subgroups according to brain functional connectivity. Results also suggested that the differentiation in “functional” subgroups is related to specific behavioral characteristics, in this case impulsivity. Thus, combining neuroimaging data and community detection might be a valuable approach to elucidate heterogeneity in ADHD etiology and examine ADHD neurobiology. PMID:25660033

Estimating the influenza vaccine effectiveness against medically attended influenza in clinical settings: a hospital-based case-control study with a rapid diagnostic test in Japan.

PubMed

Suzuki, Motoi; Yoshimine, Hiroyuki; Harada, Yoshitaka; Tsuchiya, Naho; Shimada, Ikumi; Ariyoshi, Koya; Inoue, Kenichiro

2013-01-01

Influenza vaccine effectiveness (VE) studies are usually conducted by specialized agencies and require time and resources. The objective of this study was to estimate the influenza VE against medically attended influenza using a test-negative case-control design with rapid influenza diagnostic tests (RIDT) in a clinical setting. A prospective study was conducted at a community hospital in Nagasaki, western Japan during the 2010/11 influenza season. All outpatients aged 15 years and older with influenza-like illnesses (ILI) who had undergone RIDT were enrolled. A test-negative case-control design was applied to estimate the VEs: the cases were ILI patients with positive RIDT results and the controls were ILI patients with negative RIDT results. Information on patient characteristics, including vaccination histories, was collected using questionnaires and medical records. Between December 2010 and April 2011, 526 ILI patients were tested with RIDT, and 476 were eligible for the analysis. The overall VE estimate against medically attended influenza was 47.6%, after adjusting for the patients' age groups, presence of chronic conditions, month of visit, and smoking and alcohol use. The seasonal influenza vaccine reduced the risk of medically attended influenza by 60.9% for patients less than 50 years of age, but a significant reduction was not observed for patients 50 years of age and older. A sensitivity analysis provided similar figures. The test-negative case-control study using RIDT provided moderate influenza VE consistent with other reports. Utilizing the commonly used RIDT to estimate VE provides rapid assessment of VE; however, it may require validation with more specific endpoint.

Trends in Segregation of Hispanic Students in Major School Districts Having Large Hispanic Enrollment. Ethnographic Case Studies, Volume II. Final Report.

ERIC Educational Resources Information Center

Aspira, Inc., New York, NY.

School desegregation did not lead to greater understanding of the Hispanic community by white educational personnel in two school districts analyzed to document the desegregation process and the impact of school desegregation on the Hispanic community. Each district was in a white-controlled, tri-ethnic community in its second year of successful…

Community-Based Participatory Research and Policy Advocacy to Reduce Diesel Exposure in West Oakland, California

PubMed Central

Gonzalez, Priscilla A.; Garcia, Analilia P.; Gordon, Margaret; Garzón, Catalina; Palaniappan, Meena; Prakash, Swati; Beveridge, Brian

2011-01-01

We conducted a multimethod case study analysis of a community-based participatory research partnership in West Oakland, California, and its efforts to study and address the neighborhood's disproportionate exposure to diesel air pollution. We employed 10 interviews with partners and policymakers, participant observation, and a review of documents. Results of the partnership's truck count and truck idling studies suggested substantial exposure to diesel pollution and were used by the partners and their allies to make the case for a truck route ordinance. Despite weak enforcement, the partnership's increased political visibility helped change the policy environment, with the community partner now heavily engaged in environmental decision-making on the local and regional levels. Finally, we discussed implications for research, policy, and practice. PMID:21551381

Impact of Web-based Case Conferencing on Cancer Genetics Training Outcomes for Community-based Clinicians

PubMed Central

Blazer, Kathleen R.; Christie, Christina; Uman, Gwen; Weitzel, Jeffrey N.

2013-01-01

Introduction Technology and market forces are driving the demand for cancer risk assessment services in the community setting, where few clinicians are trained to order and interpret predictive genetic tests. City of Hope conducts a three-phase course in genetic cancer risk assessment (GCRA) for community-based clinicians, comprised of distance didactics, face-to-face workshops and 12 months of professional development. As designed, the course cannot meet increasing demands for GCRA training. Action research identified face-to-face workshops as a barrier to increasing course capacity. This study compared the learning effectiveness of Web-based case conferencing to face-to-face training. Methods A quasi-experimental design compared pre-post knowledge, skills and professional self-efficacy outcomes from 2009-2010 course cohorts (n=96). The intervention group (n=52) engaged in Web-based case conferences during distance learning; the comparison group (n=44) participated in the course as originally designed. Results Both groups and all practice disciplines demonstrated significant pre-to-post increases on all measures. Knowledge increases were higher for the intervention group (p < .015); skills and self-efficacy increases were comparable between groups (p < .33 and p < .30, respectively). Discussion Findings support the learning utility of Web-based case conferencing. Further studies may inform the development of tools to assess the impact of Web-based case conferencing on practice change and patient outcomes, in alignment with the highest standards of continuing professional development. PMID:22328115

Pharmaceutical industry research and cost savings in community-acquired pneumonia.

PubMed

Kessler, Lori A; Waterer, Grant W; Barca, Robin; Wunderink, Richard G

2002-09-01

To provide financial justification for continuing pharmaceutical research in an environment that has met with increasing resistance from insurance carriers to paying for the care of patients enrolled in research studies. Matched case-control study of patients enrolled into inpatient community-acquired pneumonia (CAP) pharmaceutical research protocols. Case patients were enrolled into a CAP pharmaceutical research trial. Control patients were obtained from a prospective cohort study of CAP. Cases were matched to controls on the basis of age, sex, pneumonia severity index (PSI) grade, and comorbid illnesses as measured by the PSI and Acute Physiologic and Chronic Health Evaluation II (APACHE II) scoring systems. Financial data were obtained from hospital billing records. Twenty-five cases were identified and matched to appropriate controls. There was no statistically significant difference in mean PSI and APACHE II scores between cases and controls. There was a significant reduction in the total charges for hospital care of patients enrolled into a pharmaceutical industry trial ($6267 vs $9979; P = .03). As expected, the most dramatic reduction was in pharmacy charges ($642 vs $1797; P = .002), but there were trends toward lower charges in all cost subgroups. Interestingly, there was also a strong trend toward reduced length of hospital stay associated with enrollment in a pharmaceutical trial (4.5 vs 6.0 days; P = .06). Enrollment in a pharmaceutical research protocol results in significant cost savings in patients admitted to the hospital with CAP and may lead to earlier hospital discharge.

The pathway of obstructed labour as perceived by communities in south-western Uganda: a grounded theory study

PubMed Central

Kabakyenga, Jerome K.; Östergren, Per-Olof; Emmelin, Maria; Kyomuhendo, Phionah; Odberg Pettersson, Karen

2011-01-01

Background Obstructed labour is still a major cause of maternal and perinatal morbidity and mortality in Uganda, where many women give birth at home alone or assisted by non-skilled birth attendants. Little is known of how the community view obstructed labour, and what actions they take in cases where this complication occurs. Objective The objective of the study was to explore community members’ understanding of and actions taken in cases of obstructed labour in south-western Uganda. Design Grounded theory (GT) was used to analyse data from 20 focus group discussions (FGDs), 10 with women and 10 with men, which were conducted in eight rural and two urban communities. Results A conceptual model based on the community members’ understanding of obstructed labour and actions taken in response is presented as a pathway initiated by women's desire to ‘protecting own integrity’ (core category). The pathway consisted of six other categories closely linked to the core category, namely: (1) ‘taking control of own birth process’; (2) ‘reaching the limit – failing to give birth’ (individual level); (3) ‘exhausting traditional options’; (4) ‘partner taking charge’; (5) ‘facing challenging referral conditions’ (community level); and finally (6) ‘enduring a non-responsive healthcare system’ (healthcare system level). Conclusions There is a need to understand and acknowledge women's reluctance to involve others during childbirth. However, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community's ability to seek timely care as a response to obstructed labour. Easy access to mobile phones may improve referral systems. Upgrading of infrastructure in the region requires a multi-sectoral approach. Testing of the conceptual model through a quantitative questionnaire is recommended. PMID:22216018

Improving childhood malaria treatment and referral practices by training patent medicine vendors in rural south-east Nigeria

PubMed Central

2009-01-01

Background Malaria remains a major cause of morbidity and mortality among children under five years of age in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with anti-malarials bought over-the-counter (OTC) from untrained drug vendors. Self-medication through drug vendors can be ineffective, with increased risks of drug toxicity and development of drug resistance. Global malaria control initiatives highlights the potential role of drug vendors to improve access to early effective malaria treatment, which underscores the need for interventions to improve treatment obtained from these outlets. This study aimed to determine the feasibility and impact of training rural drug vendors on community-based malaria treatment and advice with referral of severe cases to a health facility. Methods A drug vendor-training programme was carried out between 2003 and 2005 in Ugwuogo-Nike, a rural community in south-east Nigeria. A total of 16 drug vendors were trained and monitored for eight months. The programme was evaluated to measure changes in drug vendor practice and knowledge using exit interviews. In addition, home visits were conducted to measure compliance with referral. Results The intervention achieved major improvements in drug selling and referral practices and knowledge. Exit interviews confirmed significant increases in appropriate anti-malarial drug dispensing, correct history questions asked and advice given. Improvements in malaria knowledge was established and 80% compliance with referred cases was observed during the study period, Conclusion The remarkable change in knowledge and practices observed indicates that training of drug vendors, as a means of communication in the community, is feasible and strongly supports their inclusion in control strategies aimed at improving prompt effective treatment of malaria with referral of severe cases. PMID:19930561

Improving childhood malaria treatment and referral practices by training patent medicine vendors in rural south-east Nigeria.

PubMed

Okeke, Theodora A; Uzochukwu, Benjamin S C

2009-11-20

Malaria remains a major cause of morbidity and mortality among children under five years of age in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with anti-malarials bought over-the-counter (OTC) from untrained drug vendors. Self-medication through drug vendors can be ineffective, with increased risks of drug toxicity and development of drug resistance. Global malaria control initiatives highlights the potential role of drug vendors to improve access to early effective malaria treatment, which underscores the need for interventions to improve treatment obtained from these outlets. This study aimed to determine the feasibility and impact of training rural drug vendors on community-based malaria treatment and advice with referral of severe cases to a health facility. A drug vendor-training programme was carried out between 2003 and 2005 in Ugwuogo-Nike, a rural community in south-east Nigeria. A total of 16 drug vendors were trained and monitored for eight months. The programme was evaluated to measure changes in drug vendor practice and knowledge using exit interviews. In addition, home visits were conducted to measure compliance with referral. The intervention achieved major improvements in drug selling and referral practices and knowledge. Exit interviews confirmed significant increases in appropriate anti-malarial drug dispensing, correct history questions asked and advice given. Improvements in malaria knowledge was established and 80% compliance with referred cases was observed during the study period, The remarkable change in knowledge and practices observed indicates that training of drug vendors, as a means of communication in the community, is feasible and strongly supports their inclusion in control strategies aimed at improving prompt effective treatment of malaria with referral of severe cases.

Early warnings for suicide attempt among Chinese rural population.

PubMed

Lyu, Juncheng; Wang, Yingying; Shi, Hong; Zhang, Jie

2018-06-05

This study was to explore the main influencing factors of attempted suicide and establish an early warning model, so as to put forward prevention strategies for attempted suicide. Data came from a large-scale case-control epidemiological survey. A sample of 659 serious suicide attempters was randomly recruited from 13 rural counties in China. Each case was matched by a community control for gender, age, and residence location. Face to face interviews were conducted for all the cases and controls with the same structured questionnaire. Univariate logistic regression was applied to screen the factors and multivariate logistic regression was used to excavate the predictors. There were no statistical differences between suicide attempters and the community controls in gender, age, and residence location. The Cronbach`s coefficients for all the scales used were above 0.675. The multivariate logistic regressions have revealed 12 statistically significant variables predicting attempted suicide, including less education, family history of suicide, poor health, mental problem, aspiration strain, hopelessness, impulsivity, depression, negative life events. On the other hand, social support, coping skills, and healthy community protected the rural residents from suicide attempt. The excavated warning predictors are significant clinical meaning for the clinical psychiatrist. Crisis intervention strategies in rural China should be informed by the findings from this research. Education, social support, healthy community, and strain reduction are all measures to decrease the likelihood of crises. Copyright © 2018. Published by Elsevier B.V.

Community responses to government defunding of watershed projects: a comparative study in India and the USA.

PubMed

Koontz, Tomas M; Sen, Sucharita

2013-03-01

When central governments decentralize natural resource management (NRM), they often retain an interest in the local efforts and provide funding for them. Such outside investments can serve an important role in moving community-based efforts forward. At the same time, they can represent risks to the community if government resources are not stable over time. Our focus in this article is on the effects of withdrawal of government resources from community-based NRM. A critical question is how to build institutional capacity to carry on when the government funding runs out. This study compares institutional survival and coping strategies used by community-based project organizations in two different contexts, India and the United States. Despite higher links to livelihoods, community participation, and private benefits, efforts in the Indian cases exhibited lower survival rates than did those in the U.S. cases. Successful coping strategies in the U.S. context often involved tapping into existing institutions and resources. In the Indian context, successful coping strategies often involved building broad community support for the projects and creatively finding additional funding sources. On the other hand, the lack of local community interest, due to the top-down development approach and sometimes narrow benefit distribution, often challenged organizational survival and project maintenance.

Community Responses to Government Defunding of Watershed Projects: A Comparative Study in India and the USA

NASA Astrophysics Data System (ADS)

Koontz, Tomas M.; Sen, Sucharita

2013-03-01

When central governments decentralize natural resource management (NRM), they often retain an interest in the local efforts and provide funding for them. Such outside investments can serve an important role in moving community-based efforts forward. At the same time, they can represent risks to the community if government resources are not stable over time. Our focus in this article is on the effects of withdrawal of government resources from community-based NRM. A critical question is how to build institutional capacity to carry on when the government funding runs out. This study compares institutional survival and coping strategies used by community-based project organizations in two different contexts, India and the United States. Despite higher links to livelihoods, community participation, and private benefits, efforts in the Indian cases exhibited lower survival rates than did those in the U.S. cases. Successful coping strategies in the U.S. context often involved tapping into existing institutions and resources. In the Indian context, successful coping strategies often involved building broad community support for the projects and creatively finding additional funding sources. On the other hand, the lack of local community interest, due to the top-down development approach and sometimes narrow benefit distribution, often challenged organizational survival and project maintenance.

Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey

PubMed Central

Tripathy, Jaya Prasad; Jeet, Gursimer; Chawla, Sohan; Jain, Sanjay

2017-01-01

Objectives The study was primarily aimed at estimating the prevalence of hypertension and pre-hypertension and the risk factors of hypertension in the North Indian state of Punjab. It also aimed at assessing the magnitude of undiagnosed cases of hypertension in the community and ascertaining the blood pressure control status of those on treatment. Methods A non-communicable disease risk factor survey (based on WHO-STEPS approach) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS-questionnaire and also underwent anthropometric and blood pressure measurements. Results Overall prevalence of HTN among the study participants was found out to be 40.1% (95% CI: 38.8–41.5%) whereas prevalence of pre-hypertension, isolated diastolic and isolated systolic hypertension were 40.8% (39.5–42.2%), 9.2% (8.4–10.0%) and 6.5% (5.9–7.2%) respectively. Age group (45–69 years), male gender, social group, marital status, alcohol use, obesity and salt intake (> = 5 gms/day) were the risk factors significantly associated with HTN. Among all persons with HTN, only 30.1% were known case of HTN or on treatment, among whom nearly 61% had controlled blood pressure. Patients with uncontrolled BP were more frequently male, obese patients, with sedentary lifestyle and patients with diabetes. Conclusions The study reported alarmingly high prevalence of hypertension, especially of undiagnosed or untreated cases amongst the adult population, a significant proportion of whom have uncontrolled blood pressure levels. This indicates the need for systematic screening and awareness program to identify the undiagnosed cases in the community and offer early treatment and regular follow up. PMID:29267338

A capacity building approach to increase sports participation in disadvantaged urban communities: a multilevel analysis.

PubMed

Marlier, Mathieu; Cardon, Greet; De Bourdeaudhuij, Ilse; Willem, Annick

2014-12-01

Recent evidence showed that community capacity building is one of the key methods to reach health improvements within disadvantaged communities. Physical activity and sports participation are important means to reach health improvements. This study investigates a capacity building method which aims at increasing sports participation in the community, especially for individuals at higher risk of sports deprivation. The main aims of the present study, are the following: (1) to examine differences in sports participation between individuals living in communities implementing a sports-based capacity building program and individuals living in communities without such capacity building program and (2) to investigate if the community sports program reaches the individuals known to experience higher barriers to engage in sports. In Flanders, Belgium, five disadvantaged urban communities implementing the community capacity building program (program communities) and four without (control communities) were selected based on similarity of sociodemographic and environmental characteristics. Two hundred adults (aged 18-56 years) per community were randomly selected and visited at home to fill out a questionnaire on sociodemographics, sports participation, and the community sports program. A sample of 414 adults participated in the study. Results showed that adults from program communities reported on average 96 min/week more participation in sports than their counterparts living in control communities. Furthermore, 61.3% of the individuals of program communities indicated to engage in sports, whereas in control communities, this was only 42.4%. Respondents at higher risk of sports deprivation also engaged in significantly more sports participation in program communities than those in control communities. This difference was also noted for groups that are not related with sports deprivation. These results are promising and plead for a community capacity building approach to increase sports participation in disadvantaged communities.

"For Some Reason, I'm Just Tired": Women Domestic Workers Persisting in Community-Based Programmes

ERIC Educational Resources Information Center

Cuban, Sondra

2007-01-01

A study of women migrant domestic workers in the USA and their reasons for participating and persisting in community-based literacy and ESOL programmes is presented. Case studies and themes were developed about the women's experiences of work life and how it connected to their programme participation. The findings revealed that the women had…

Fostering Teacher Learning Communities: A Case Study of a School-Based Leadership Team's Action Research

ERIC Educational Resources Information Center

Fischer, Kenneth Brian

2013-01-01

The purpose of this study is to examine how a school-based leadership team identifies and alters school conditions to foster the development of TLCs. Many educators, school leaders, and politicians have embraced teacher learning communities (TLCs) as a vehicle for school reform. Despite the considerable documentation of the capability for TLCs to…

The Fundamental Lifestyle of a University Community: A Case Study of Higher Education in a Malaysian Institution

ERIC Educational Resources Information Center

Abdullah, Melissa Ng Lee Yen; Mey, See Ching

2012-01-01

This study identified the fundamental lifestyles adopted by a university community in Malaysia. Rapid growth and expansion of higher education in Malaysia is inevitable as the country moves from a production-based economy to one that is innovative and knowledge-based, requiring the development of a highly skilled and knowledgeable workforce.…

Community socioeconomic context and its influence on intermediary determinants of child health: evidence from Colombia.

PubMed

Osorio, Ana María; Bolancé, Catalina; Madise, Nyovani

2015-01-01

Intermediary determinants are the most immediate mechanisms through which socioeconomic position shapes health inequities. This study examines the effect of community socioeconomic context on different indicators representing intermediary determinants of child health. In the context of Colombia, a developing country with a clear economic expansion, but one of the most unequal countries in the world, two categories of intermediary determinants, namely behavioural and psychosocial factors and the health system, are analysed. Using data from the 2010 Colombian Demographic and Health Survey (DHS), the results suggest that whilst the community context can exert a greater influence on factors linked directly to health, in the case of psychosocial factors and parent's behaviours, the family context can be more important. In addition, the results from multilevel analysis indicate that a significant percentage of the variability in the overall index of intermediary determinants of child health is explained by the community context, even after controlling for individual, family and community characteristics. These findings underline the importance of distinguishing between community and family intervention programmes in order to reduce place-based health inequities in Colombia.

The business case for provider participation in clinical trials research: an application to the National Cancer Institute's community clinical oncology program.

PubMed

Song, Paula H; Reiter, Kristin L; Weiner, Bryan J; Minasian, Lori; McAlearney, Ann Scheck

2013-01-01

Provider-based research networks (PBRNs) make clinical trials available in community-based practice settings, where most people receive their care, but provider participation requires both financial and in-kind contributions. The aim of this study was to explore whether providers believe there is a business case for participating in PBRNs and what factors contribute to the business case. We use a multiple case study methodology approach to examine the National Cancer Institute's community clinical oncology program, a long-standing federally funded PBRN. Interviews with 41 key informants across five sites, selected on the basis of organizational maturity, were conducted using a semistructured interview guide. We analyzed interview transcripts using an iterative, deductive process to identify themes and subthemes in the data. We found that a business case for provider participation in PBRNs may exist if both direct and indirect financial benefits are identified and included in the analysis and if the time horizon is long enough to allow those benefits to be realized. We identified specific direct and indirect financial benefits that were perceived as important contributors to the business case and the perceived length of time required for a positive return to accrue. As the lack of a business case may result in provider reluctance to participate in PBRNs, knowledge of the benefits we identified may be crucial to encouraging and sustaining participation, thereby preserving patient access to innovative community-based treatments. The results are also relevant to federally funded PBRNs outside of oncology or to providers considering participation in any clinical trials research.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

PubMed Central

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Cancer and construction: what occupational histories in a Canadian community reveal.

PubMed

Brophy, James T; Keith, Margaret M; Gorey, Kevin M; Laukkanen, Ethan; Luginaah, Isaac; Abu-Zahra, Hakam; Watterson, Andrew E; Hellyer, Deborah J; Reinhartz, Abraham; Park, Robert M

2007-01-01

From 2000 to 2002, male patients at a Canadian cancer treatment center with new-incident head-and-neck or esophageal cancers were invited to participate in a population-based study. The study population included 87 cases and 172 controls. A lifetime-history questionnaire was administered. Odds ratios (ORs) were calculated for occupational groups with a minimum of five cases, adjusted for duration of employment, age, smoking, alcohol, education, and income. A significantly increased risk was shown for construction workers (OR = 2.20; 95% CI 1.25-3.91). This investigation of a set of rare cancers over a limited time period demonstrates the feasibility of this research approach. The increased risk among construction workers supports the need for more comprehensive study of exposures in this occupational group.

Pragmatism and Community Inquiry: A Case Study of Community-Based Learning

ERIC Educational Resources Information Center

Bruce, Bertram C.; Bloch, Naomi

2013-01-01

This paper develops a philosophical basis for the concept of community inquiry. Community inquiry derives from pragmatist theory as articulated by Dewey, Peirce, Addams, and others. Following Brendel, we discuss pragmatism in terms of its emphasis on the practical dimensions of inquiry, the pluralistic nature of the tools that are used to study…

How Do Communities Act? Unique Events and Purposeful Strategies in the Formation of an Industrial Base in Rivertown. [Revised].

ERIC Educational Resources Information Center

Brown, Ralph B.

Effective rural education depends on active community involvement. This ethnographic case study examines three models of community organization as an explanation of how community action occurs. The three models are: (1) individuals interacting in formal and informal groups; (2) networks of "weak ties" effective for diffusing information and…

Why STEM Learning Communities Work: The Development of Psychosocial Learning Factors through Social Interaction

ERIC Educational Resources Information Center

Carrino, Stephanie Sedberry; Gerace, William J.

2016-01-01

STEM learning communities facilitate student academic success and persistence in science disciplines. This prompted us to explore the underlying factors that make learning communities successful. In this paper, we report findings from an illustrative case study of a 2-year STEM-based learning community designed to identify and describe these…

Community of Communities: An Electronic Link to Integrating Cultural Diversity in Nursing Curriculum.

ERIC Educational Resources Information Center

Ryan, Marilyn; Ali, Nagia; Carlton, Kay Hodson

2002-01-01

The Community of Communities (COC) website contains information and case studies based on cultural assessment. Online nursing courses are linked to a cultural module in the COC. Evaluation results from 63 students showed that the COC increased awareness of the role of culture in health care and knowledge of international health practices.…

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults.

PubMed

Agmon, Maayan; Belza, Basia; Nguyen, Huong Q; Logsdon, Rebecca G; Kelly, Valerie E

2014-01-01

Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control) have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk. THE AIMS OF THIS SYSTEMATIC REVIEW ARE: 1) to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2) to identify the key elements of those interventions. Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science. Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected. All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted. Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions. The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome measures. Dual-task postural control can be modified by specific training. There was little evidence that single-task training transferred to dual-task postural control performance. Further investigation of dual-task training using standardized outcome measurements is needed.

THE EMPACT COLLECTION

EPA Science Inventory

The TTSD of the USEPA's ORD/NRMRL has completed a series of technology transfer and risk communication handbooks, case studies, and summary reports for community-based environmental monitoring projects under EPA's Environmental Monitoring for Public Access and Community Tracking ...

Controlling the last known cluster of Ebola virus disease - Liberia, January-February 2015.

PubMed

Nyenswah, Tolbert; Fallah, Mosoka; Sieh, Sonpon; Kollie, Karsor; Badio, Moses; Gray, Alvin; Dilah, Priscilla; Shannon, Marnijina; Duwor, Stanley; Ihekweazu, Chikwe; Cordier-Lassalle, Thierry; Cordier-Lasalle, Thierry; Shinde, Shivam A; Hamblion, Esther; Davies-Wayne, Gloria; Ratnesh, Murugan; Dye, Christopher; Yoder, Jonathan S; McElroy, Peter; Hoots, Brooke; Christie, Athalia; Vertefeuille, John; Olsen, Sonja J; Laney, A Scott; Neal, Joyce J; Yaemsiri, Sirin; Navin, Thomas R; Coulter, Stewart; Pordell, Paran; Lo, Terrence; Kinkade, Carl; Mahoney, Frank

2015-05-15

As one of the three West African countries highly affected by the 2014-2015 Ebola virus disease (Ebola) epidemic, Liberia reported approximately 10,000 cases. The Ebola epidemic in Liberia was marked by intense urban transmission, multiple community outbreaks with source cases occurring in patients coming from the urban areas, and outbreaks in health care facilities (HCFs). This report, based on data from routine case investigations and contact tracing, describes efforts to stop the last known chain of Ebola transmission in Liberia. The index patient became ill on December 29, 2014, and the last of 21 associated cases was in a patient admitted into an Ebola treatment unit (ETU) on February 18, 2015. The chain of transmission was stopped because of early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the health care system; and rapid isolation of symptomatic contacts. In addition, a "sector" approach, which divided Montserrado County into geographic units, facilitated the ability of response teams to rapidly respond to community needs. In the final stages of the outbreak, intensive coordination among partners and engagement of community leaders were needed to stop transmission in densely populated Montserrado County. A companion report describes the efforts to enhance infection prevention and control efforts in HCFs. After February 19, no additional clusters of Ebola cases have been detected in Liberia. On May 9, the World Health Organization declared the end of the Ebola outbreak in Liberia.

Comparative assessment of the prevalence of periodontal disease in subjects with and without systemic autoimmune diseases: A case-control study.

PubMed

Ramesh Kumar, S G; Aswath Narayanan, M B; Jayanthi, D

2016-01-01

Immune mechanism shares a common pathway both for systemic autoimmune diseases and periodontal diseases. Scientific exploration of literature revealed limited studies on the association between systemic autoimmune diseases and periodontal diseases in India. The aim of the study is to find whether the presence of systemic autoimmune diseases in an individual is a risk factor for the development of periodontal disease. This was a hospital-based case-control study. A sample of 253 patients with systemic autoimmune diseases, attending the Rheumatology Department of Government General Hospital, Chennai-3, and 262 patients without systemic autoimmune diseases, attending the outpatient department of the Tamil Nadu Government Dental College and Hospital, Chennai-3, constituted the case and control groups, respectively. Age, gender, and oral hygiene status matching was done. Oral hygiene status was assessed using oral hygiene index (OHI) and periodontal status was assessed using community periodontal index (CPI) and loss of attachment (LOA) index. Statistical analysis was done using SPSS version 15 (SPSS Inc, 2006, Chicago). Results showed 99.2% and 73.9% prevalence of gingivitis and periodontitis, respectively, in the case group as compared to 85.5% and 14.9%, respectively, in the control group. There is no linear relationship between OHI scores and prevalence of periodontitis (CPI and LOA scores) in the case group. Patients suffering from systemic autoimmune diseases showed more prevalence of periodontal diseases irrespective of oral hygiene scores. It is postulated that the presence of systemic autoimmune diseases may pose a risk for the development of periodontal diseases.

Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali.

PubMed

Rogers, Eleanor; Martínez, Karen; Morán, Jose Luis Alvarez; Alé, Franck G B; Charle, Pilar; Guerrero, Saul; Puett, Chloe

2018-02-20

The Malian Nutrition Division of the Ministry of Health and Action Against Hunger tested the feasibility of integrating treatment of severe acute malnutrition (SAM) into the existing Integrated Community Case Management package delivered by community health workers (CHWs). This study assessed costs and cost-effectiveness of CHW-delivered care compared to outpatient facility-based care. Activity-based costing methods were used, and a societal perspective employed to include all relevant costs incurred by institutions, beneficiaries and communities. The intervention and control arm enrolled different numbers of children so a modelled scenario sensitivity analysis was conducted to assess the cost-effectiveness of the two arms, assuming equal numbers of children enrolled. In the base case, with unequal numbers of children in each arm, for CHW-delivered care, the cost per child treated was 244 USD and cost per child recovered was 259 USD. Outpatient facility-based care was less cost-effective at 442 USD per child and 501 USD per child recovered. The conclusions of the analysis changed in the modelled scenario sensitivity analysis, with outpatient facility-based care being marginally more cost-effective (cost per child treated is 188 USD, cost per child recovered is 214 USD), compared to CHW-delivered care. This suggests that achieving good coverage is a key factor influencing cost-effectiveness of CHWs delivering treatment for SAM in this setting. Per week of treatment, households receiving CHW-delivered care spent half of the time receiving treatment and three times less money compared with those receiving treatment from the outpatient facility. This study supports existing evidence that the delivery of treatment by CHWs is a cost-effective intervention, provided that good coverage is achieved. A major benefit of this strategy was the lower cost incurred by the beneficiary household when treatment is available in the community. Further research is needed on the implementation costs that would be incurred by the government to increase the operability of these results.

Evaluating the social and economic impact of community-based prenatal care.

PubMed

Cramer, Mary E; Chen, Li-Wu; Roberts, Sara; Clute, Dorothea

2007-01-01

This article describes the evaluation and findings of a community-based prenatal care program, Omaha Healthy Start (OHS), designed to reduce local racial disparities in birth outcomes. This evaluative study used a comparative descriptive design, and Targeting Outcomes of Programs was the conceptual framework for evaluation. The evaluation followed 3 groups for 2 years: OHS birth mothers (N=79; N=157); non-OHS participant birth mothers (N=746; N=774); and Douglas County birth mothers (N=7,962; N=7,987). OHS provided case management, home visits, screening, referral, transportation, and health education to participants. Program outcome measures included low birth weight, infant mortality, adequacy of care, trimester of care, and costs of care. OHS birth outcomes improved during year 2, and there was a 31% cost saving in the average hospital expenditure compared with the nonparticipant groups. Preliminary evaluative analysis indicates that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings. Further prospective study is needed to document trends over a longer period of time regarding the relationship between community-based case management programs for minority populations, birth outcomes, and costs of care.

Dialogical action: moving from community-based to community-driven participatory research.

PubMed

Montoya, Michael J; Kent, Erin E

2011-07-01

Proponents of community-based research advocate for the active involvement and engagement of community members, citing improved construct validity, intervention efficacy, and accountability. However, to create the conditions in which expertise is mutually constructed and in which no one is the object of research, a reconsideration of the fundamental ethos of community involvement and engagement is required. In this article, we seek to accomplish two goals: (a) to briefly assess the definitions of community health, focus groups, and dissemination that are often used in community-based research; and (b) to introduce an application of dialogical action that goes beyond traditional focus group methodology to promote the creation of an evolving and dynamic dialogue among campus and community stakeholders. An urban case study is presented.

Determinant of Implanon Discontinuation among Women Who Ever Used Implanon in Diguna Fango District, Wolayita Zone, Southern Ethiopia: A Community Based Case Control Study

PubMed Central

Kondale, Mekides; Boti, Negussie; Oumer, Bilcha

2017-01-01

Background A significant number of women make Implanon their first choice of contraception. However, they discontinue their Implanon before its expiry date was high, but factors that contribute to discontinuing their Implanon were poorly described in Ethiopia. Methods A community based unmatched case control study was conducted. Then simple random sampling technique was used to select 340 women. Data was collected by nurses using face to face interview. Epi-Info version 7 and SPSS 20 software were used. Bivariate and multiple logistic regressions were performed with COR and AOR with 95% CI. Findings Having preinsertion counseling (AOR: 0.36, 95% CI: 0.20–0.64), having follow-up appointment (AOR: 0.35, 95% CI: 0.2–0.62), age at insertion <20 years (AOR: 3, 95% CI: 1.16–7.8), women who had no formal education (AOR: 2.8, 95% CI: 1.31–6.11), women who had ≤4 children (AOR: 1.8, 95% CI: 1.01–3.21), and women who had previous abortion history (AOR: 2.3, 95% CI: 1.10–4.63) were determinants of Implanon discontinuation. Conclusions Policy makers and concerned bodies should take into account future intervention and also great emphasis should be given to follow-up appointment and counseling services, especially counseling on side effects, and informed choice for clients after Implanon insertion. PMID:29234726

Collaborating with the Community: Lessons from a Rural School District

ERIC Educational Resources Information Center

Walker, Anne

2012-01-01

This article, based on case study research, highlights how a rural school district in the midwestern United States collaborated with local community organizations to meet the needs of English language learners after the district and community experienced rapid ethnic diversification. In particular, the district EL coordinator spearheaded the…

Sustaining Professional Learning Communities: Case Studies

ERIC Educational Resources Information Center

Hipp, Kristine; Huffman, Jane; Pankake, Anita; Olivier, Dianne

2008-01-01

The purpose is to document the ongoing development of two schools in becoming professional learning communities and the effects of meaningful collaboration on teacher learning. The question that guides this research is: How does a school become a sustainable professional learning community? The theoretical framework is based on the work of Senge,…

Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population.

PubMed

McLean, Kendra; Day, Lesley; Dalton, Andrew

2015-03-26

Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population. A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP). The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even. The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.

Headache in a nonclinical population in Dar es Salaam, Tanzania. A community-based study.

PubMed

Matuja, W B; Mteza, I B; Rwiza, H T

1995-05-01

Headache is a common symptom that constitutes a major health problem to all countries in the world with a variable prevalence from about 20.2% in the African population to about 80% in populations of the civilized world. Community-based studies in African populations are still scanty, and the impact on health facility utilization and sickness absence from work is unknown. After a simple random selection, 1540 urban workers and students of higher education completed a standardized self-administered questionnaire on headache. A total of 815 (52%), (620 (51%) men, 195 (60%) women) admitted to having suffered a headache requiring medication or medical consultation in the last year. Of these, 366 (23.7%) had recurrent headache not attributable to systemic disease. Of the total with recurrent headache, there was a significant preponderance of women over men with sex prevalence of 28.9% and 22.4%, respectively (X2 P = 0.0001). Combined vascular-muscular-type of headache exceeded all types of headache, accounting for 35.8% of cases, followed by migraine accounting for 30.8% of cases. Organic disease was rare, accounting for 8.5% of cases, and psychogenic causes of headache were even rarer at less than 1.2% of cases. Within 2 months of onset of recurrent headaches, over 32% of sufferers had utilized the health facility at their place of work or study. A significant number of cases (175) had an average of 11.3 lost work days per year in comparison to a control group of 154 persons with an average of 5.7 lost work days per year for reasons other than headache (X2 P = 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Community-Engagement Strategies of the Developmental Disabilities Practice-Based Research Network (DD-PBRN)

PubMed Central

Tyler, Carl; Werner, James J.

2016-01-01

There is often a rich but untold history of events that occurred and relationships that formed prior to the launching of a practice-based research network (PBRN.) This is particularly the case in PBRNs that are community-based and comprised of partnerships outside of the health care system. In this article we summarize an organizational "prenatal history" prior to the birth of a PBRN devoted to persons with developmental disabilities. Using a case study approach, this article describes the historical events that preceded and fostered the evolution of this PBRN and contrasts how the processes leading to the creation of this multi-stakeholder community-based PBRN differ from those of typical academic-clinical practice PBRNs. We propose potential advantages and complexities inherent to this newest iteration of PBRNs. PMID:25381081

Dental Caries in American Indian Toddlers after a Community-Based Beverage Intervention

PubMed Central

Maupomé, Gerardo; Karanja, Njeri; Ritenbaugh, Cheryl; Lutz, Tam; Aickin, Mikel; Becker, Thomas

2014-01-01

Objective/Setting The Toddler Overweight and Tooth decay prevention Study (TOTS) was an overweight and early childhood caries (ECC) project in the Pacific Northwest USA. It targeted American Indian (AI) toddlers from birth, to effect changes in breastfeeding and sweetened beverage consumption. Design/Intervention/Participants The intervention cohort was children born in three communities during 12 months; expectant mothers were identified through prenatal visits, and recruited by tribal coordinators. The local comparison cohorts were children in those communities who were 18–30 months at study start. A control longitudinal cohort consisted of annual samples of children aged 18–30 months in a fourth community, supplying secular trends. Outcome measures d1–2mfs was used to identify incident caries in intervention, comparison, and control cohorts after 18-to-30 months of follow-up in 2006. Results No missing or filled teeth were found. For d1t, all three intervention cohorts showed statistically significant downward intervention effects, decreases of between 0.300 and 0.631 in terms of the fraction of affected mouths. The results for d2t were similar but of smaller magnitudes, decreases of between 0.342 and 0.449; these results met the 0.05 level for significance in two of three cases. In light of an estimated secular increase in dental caries in the control site, all three intervention cohorts showed improvements in both d1t and d2t. Conclusions Simple interventions targeting sweetened beverage availability (in combination with related measures) reduced high tooth decay trends, and were both feasible and acceptable to the AI communities we studied. PMID:21305835

77 FR 12598 - Notice Correction; A Multi-Center International Hospital-Based Case-Control Study of Lymphoma in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Notice Correction; A Multi-Center International Hospital-Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI) The Federal... project titled, ``A multi-center international hospital-based case-control study of lymphoma in Asia (Asia...

Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine.

PubMed

Bondy, Susan J; Russell, Margaret L; Laflèche, Julie Ml; Rea, Elizabeth

2009-12-24

Community quarantine is controversial, and the decision to use and prepare for it should be informed by specific quantitative evidence of benefit. Case-study reports on 2002-2004 SARS outbreaks have discussed the role of quarantine in the community in transmission. However, this literature has not yielded quantitative estimates of the reduction in secondary cases attributable to quarantine as would be seen in other areas of health policy and cost-effectiveness analysis. Using data from the 2003 Ontario, Canada, SARS outbreak, two novel expressions for the impact of quarantine are presented. Secondary Case Count Difference (SCCD) reflects reduction in the average number of transmissions arising from a SARS case in quarantine, relative to not in quarantine, at onset of symptoms. SCCD was estimated using Poisson and negative binomial regression models (with identity link function) comparing the number of secondary cases to each index case for quarantine relative to non-quarantined index cases. The inverse of this statistic is proposed as the number needed to quarantine (NNQ) to prevent one additional secondary transmission. Our estimated SCCD was 0.133 fewer secondary cases per quarantined versus non-quarantined index case; and a NNQ of 7.5 exposed individuals to be placed in community quarantine to prevent one additional case of transmission in the community. This analysis suggests quarantine can be an effective preventive measure, although these estimates lack statistical precision. Relative to other health policy areas, literature on quarantine tends to lack in quantitative expressions of effectiveness, or agreement on how best to report differences in outcomes attributable to control measure. We hope to further this discussion through presentation of means to calculate and express the impact of population control measures. The study of quarantine effectiveness presents several methodological and statistical challenges. Further research and discussion are needed to understand the costs and benefits of enacting quarantine, and this includes a discussion of how quantitative benefit should be communicated to decision-makers and the public, and evaluated.

Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine

PubMed Central

2009-01-01

Background Community quarantine is controversial, and the decision to use and prepare for it should be informed by specific quantitative evidence of benefit. Case-study reports on 2002-2004 SARS outbreaks have discussed the role of quarantine in the community in transmission. However, this literature has not yielded quantitative estimates of the reduction in secondary cases attributable to quarantine as would be seen in other areas of health policy and cost-effectiveness analysis. Methods Using data from the 2003 Ontario, Canada, SARS outbreak, two novel expressions for the impact of quarantine are presented. Secondary Case Count Difference (SCCD) reflects reduction in the average number of transmissions arising from a SARS case in quarantine, relative to not in quarantine, at onset of symptoms. SCCD was estimated using Poisson and negative binomial regression models (with identity link function) comparing the number of secondary cases to each index case for quarantine relative to non-quarantined index cases. The inverse of this statistic is proposed as the number needed to quarantine (NNQ) to prevent one additional secondary transmission. Results Our estimated SCCD was 0.133 fewer secondary cases per quarantined versus non-quarantined index case; and a NNQ of 7.5 exposed individuals to be placed in community quarantine to prevent one additional case of transmission in the community. This analysis suggests quarantine can be an effective preventive measure, although these estimates lack statistical precision. Conclusions Relative to other health policy areas, literature on quarantine tends to lack in quantitative expressions of effectiveness, or agreement on how best to report differences in outcomes attributable to control measure. We hope to further this discussion through presentation of means to calculate and express the impact of population control measures. The study of quarantine effectiveness presents several methodological and statistical challenges. Further research and discussion are needed to understand the costs and benefits of enacting quarantine, and this includes a discussion of how quantitative benefit should be communicated to decision-makers and the public, and evaluated. PMID:20034405

Investigation of a cluster of pituitary adenomas in workers in the aluminum industry.

PubMed

Cullen, M R; Checkoway, H; Alexander, B H

1996-11-01

Four cases of pituitary adenoma among employees at a primary aluminum production factory were identified over a five year period by a community physician. The objective of this investigation was to determine whether there has been a comparable high incidence in other aluminum factories, and if particular jobs, departments, or activities in the industry are associated with higher rates of the disease. Pituitary adenoma in employees at all United States factories of the company for the years 1989-94 was assessed by a search of a health data information bank and an insurance data base covering present and past employees of the corporation. The incidence in the aluminum workers was estimated and compared with the workers in the index plant. A nested case control study was conducted to compare employment histories of identified cases with those of age and sex matched controls selected from the health information data base. 25 cases, including the index cases, were identified which had been diagnosed during the period 1989-94. The resulting rate of 10.4/100,000 person-years was much lower than that at the index plant. Case-control analysis showed no coherent pattern of location, department, or job significantly associated with risk. In particular, jobs and departments associated with exposures common to aluminum smelting-such as coal tar pitch volatiles and fluorides-were shown to be uncommon among cases compared with age and sex matched controls. Overall, despite the unprecedented cluster at a single plant, no strong evidence was found that the rate of pituitary adenoma is increased in aluminum workers generally. We found no association with any work activity or location in the industry to suggest a work related or exposure related cause for the disease.

Knowledge of human social and behavioral factors essential for the success of community malaria control intervention programs: The case of Lomahasha in Swaziland.

PubMed

Dlamini, Sabelo V; Liao, Chien-Wei; Dlamini, Zandile H; Siphepho, Jameson S; Cheng, Po-Ching; Chuang, Ting-Wu; Fan, Chia-Kwung

2017-04-01

Although malaria control programs have made rapid progress recently, they neglect important social and behavioral factors associated with the disease. Social, political, and cultural factors are involved in malaria control, and individuals in a community may be comfortable in behaving in ways that, to an outsider, may seem contrary to commonly held perceptions. Malaria control efforts can no longer afford to overlook the multidimensional human contexts that create and support varying notions of malaria and its prevention, treatment, and control. This study aimed to assess the knowledge and perceptions of malaria issues in the community, and to identify practices that support or hinder the progress of malaria control programs. A triangulation study involving individual interviews, focus group discussions, and observatory analysis between 2003 and 2010 at Lomahasha, a malarious community on the eastern border of Swaziland and Mozambique, was conducted. Results indicated that a high knowledge level and good perception of the disease were observed in the age group of < 40 years, contrary to those in higher age groups, among the Lomahasha community members. However, behavior of certain community groups includes practices that are not supportive of the national control program's aspirations, such as delay in seeking medical attention, staying outdoors until late, maintaining stagnant water in roadside excavations, and seeking medical assistance from wrong sources. Malpractices are more commonly observed among men, boys, and those who drink alcohol. This study suggests a thorough community diagnosis before all intervention programs for malaria control are instituted. Copyright © 2015. Published by Elsevier B.V.

Consideration of the influence of place on access to employment for persons with serious mental illness in northeastern Ontario.

PubMed

Rebeiro Gruhl, K L; Kauppi, C; Montgomery, P; James, S

2012-01-01

Despite increasing attention to employment within the mental health sector, reports indicate that people with serious mental illness (SMI) continue to experience limited employment success in the province of Ontario, Canada. Research specifies that people with SMI who live in rural places are less likely than those living in urban centers to have access to satisfactory employment services or to become gainfully employed. The objective of this study was to examine access to employment from the perspectives of people with SMI, mental health and vocational service providers, and decision-makers, and to explore whether place influenced their access to work in northeastern Ontario. A qualitative case study using community-based participatory research methods was chosen to examine the experience of access to competitive employment in two northeastern Ontario communities. The cases selected for study were two geographic areas in northeastern Ontario which provided best-practice, mental health services to persons with SMI. Community-based site partners advertised and recruited participants, and a consumer advisory provided input on key stakeholders, questions, findings and the study action plan. The study findings were informed by individual and group interviews conducted with 46 individuals who resided in both rural and urban settings in the case communities, and feedback from 49 participants who attended town hall forums for presentation of study findings and development of an action plan. The qualitative data was supported by a secondary data source reporting on the employment outcomes of 4112 people with SMI who received disability income support and who resided in the case communities. Qualitative data were analyzed inductively, and categories and themes were developed. Findings were member checked with all informants and town hall participants in each case community. This article draws on the findings of a larger study and reports on the influence of place to the low employment success experienced by people with SMI who reside in the case communities; 91.3% of those receiving disability income support are unemployed, and rural residents experience higher levels of unemployment than those in urban places. Place was found to influence access to employment in five ways: by limited access to employment support services in rural places, and to recommended ratios in urban places; by the use of different models and practices that were inconsistent with best practices for people with SMI; by the lack of a plan for the implementation of employment services in the case communities; by limited use of the available, dedicated vocational resources for employment purposes; and by inadequate supports provided to persons with SMI who wish to enter the workforce. The results also underscore how people with SMI continue to be perceived negatively regarding their capacity for employment. Such stereotypical attitudes additionally contributed to employment marginalization of people with SMI from the workforce, especially in rural communities. The study highlights the influence of geography and human resources to the implementation of best practice employment services and supports for persons with SMI. Important policy implications include the need to consider place when implementing evidence-based practices in places where geography, distance and human health resources limit the communities' capacity to successfully do so. The study also underscores the need to build community capacity for supported employment, especially in rural places, in order to improve the participation of people with SMI in employment, and subsequently, to help shift the communities' thinking about their capacity for work.

Comparison of outpatient medically attended and community-level influenza-like illness-New York City, 2013-2015.

PubMed

Russell, Kate E; Fowlkes, Ashley; Stockwell, Melissa S; Vargas, Celibell Y; Saiman, Lisa; Larson, Elaine L; LaRussa, Philip; Di Lonardo, Steve; Popowich, Michael; St George, Kirsten; Steffens, Andrea; Reed, Carrie

2018-05-01

Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.

Differences in fungi present in induced sputum samples from asthma patients and non-atopic controls: a community based case control study

PubMed Central

2013-01-01

Background There is emerging evidence for the presence of an extensive microbiota in human lungs. It is not known whether variations in the prevalence of species of microbiota in the lungs may have aetiological significance in respiratory conditions such as asthma. The aim of the study was to undertake semi-quantitative analysis of the differences in fungal species in pooled sputum samples from asthma patients and controls. Methods Induced sputum samples were collected in a case control study of asthma patients and control subjects drawn from the community in Wandsworth, London. Samples from both groups were pooled and then tested for eukaryotes. DNA was amplified using standard PCR techniques, followed by pyrosequencing and comparison of reads to databases of known sequences to determine in a semi-quantitative way the percentage of DNA from known species in each of the two pooled samples. Results A total of 136 fungal species were identified in the induced sputum samples, with 90 species more common in asthma patients and 46 species more common in control subjects. Psathyrella candolleana, Malassezia pachydermatis, Termitomyces clypeatus and Grifola sordulenta showed a higher percentage of reads in the sputum of asthma patients and Eremothecium sinecaudum, Systenostrema alba, Cladosporium cladosporioides and Vanderwaltozyma polyspora showed a higher percentage of reads in the sputum of control subjects. A statistically significant difference in the pattern of fungi that were present in the respective samples was demonstrated using the Phylogenetic (P) test (P < 0.0001). Conclusion This study is novel in providing evidence for the widespread nature of fungi in the sputum of healthy and asthmatic individuals. Differences in the pattern of fungi present in asthma patients and controls merit further investigation. Of particular interest was the presence of Malassezia pachydermatis, which is known to be associated with atopic dermatitis. PMID:23384395

Differences in fungi present in induced sputum samples from asthma patients and non-atopic controls: a community based case control study.

PubMed

van Woerden, Hugo Cornelis; Gregory, Clive; Brown, Richard; Marchesi, Julian Roberto; Hoogendoorn, Bastiaan; Matthews, Ian Price

2013-02-05

There is emerging evidence for the presence of an extensive microbiota in human lungs. It is not known whether variations in the prevalence of species of microbiota in the lungs may have aetiological significance in respiratory conditions such as asthma. The aim of the study was to undertake semi-quantitative analysis of the differences in fungal species in pooled sputum samples from asthma patients and controls. Induced sputum samples were collected in a case control study of asthma patients and control subjects drawn from the community in Wandsworth, London. Samples from both groups were pooled and then tested for eukaryotes. DNA was amplified using standard PCR techniques, followed by pyrosequencing and comparison of reads to databases of known sequences to determine in a semi-quantitative way the percentage of DNA from known species in each of the two pooled samples. A total of 136 fungal species were identified in the induced sputum samples, with 90 species more common in asthma patients and 46 species more common in control subjects. Psathyrella candolleana, Malassezia pachydermatis, Termitomyces clypeatus and Grifola sordulenta showed a higher percentage of reads in the sputum of asthma patients and Eremothecium sinecaudum, Systenostrema alba, Cladosporium cladosporioides and Vanderwaltozyma polyspora showed a higher percentage of reads in the sputum of control subjects. A statistically significant difference in the pattern of fungi that were present in the respective samples was demonstrated using the Phylogenetic (P) test (P < 0.0001). This study is novel in providing evidence for the widespread nature of fungi in the sputum of healthy and asthmatic individuals. Differences in the pattern of fungi present in asthma patients and controls merit further investigation. Of particular interest was the presence of Malassezia pachydermatis, which is known to be associated with atopic dermatitis.

Controlling congenital and paediatric chagas disease through a community health approach with active surveillance and promotion of paediatric awareness.

PubMed

Soriano-Arandes, Antoni; Basile, Luca; Ouaarab, Hakima; Clavería, Isabel; Gómez i Prat, Jordi; Cabezos, Juan; Ciruela, Pilar; Albajar-Viñas, Pedro; Jané, Mireia

2014-11-21

Chagas disease (CD) is endemic in countries of continental Latin America. Congenital transmission is a major concern worldwide. In 2010, the Public Health Agency of Catalonia (ASPCAT) launched a screening protocol for Trypanosoma cruzi infection in pregnant women and their newborns. In 2012, ASPCAT detected appropriate follow-up of pregnant women but incomplete information about their offspring. The PROSICS community health team carried out active surveillance and community health action in target populations. These activities included active case searches, group awareness workshops and visualization campaigns as well as investigation of all lost children born from pregnant women with CD and their families. Overall, 42/179 (23.5%) cases were included in the study: 35/42 (83.3%) children were born in Hospitalet de Llobregat (Catalonia, Spain); 4/42 (16.7%) were born in Latin America; two were miscarried and one was stillborn. The mean age of pregnant women was 31.3 years (SD 5.52; range: 21-44): 90.5% were Bolivian, of whom 74% were diagnosed with CD during pregnancy. Of the 35 newborns, 31 were recovered by community health action; 12/31 were correctly controlled at Hospitalet de Llobregat and 19/31 were controlled at a primary health centre. Of these 19 (73.7%) cases, 14 were not tested for CD by family paediatricians and were recovered by the PROSICS community health team. Finally, two (6.9%) of the 29 newborns tested with serology were positive. It is essential to implement active surveillance, education and information activities at paediatric primary care and community levels to avoid the loss of CD-infected mothers and their newborns. Training sessions addressed to paediatricians and other involved health professionals would consolidate surveillance and care reference circuits, improving the control of congenital CD.

SOMWeb: a semantic web-based system for supporting collaboration of distributed medical communities of practice.

PubMed

Falkman, Göran; Gustafsson, Marie; Jontell, Mats; Torgersson, Olof

2008-08-26

Information technology (IT) support for remote collaboration of geographically distributed communities of practice (CoP) in health care must deal with a number of sociotechnical aspects of communication within the community. In the mid-1990s, participants of the Swedish Oral Medicine Network (SOMNet) began discussing patient cases in telephone conferences. The cases were distributed prior to the conferences using PowerPoint and email. For the technical support of online CoP, Semantic Web technologies can potentially fulfill needs of knowledge reuse, data exchange, and reasoning based on ontologies. However, more research is needed on the use of Semantic Web technologies in practice. The objectives of this research were to (1) study the communication of distributed health care professionals in oral medicine; (2) apply Semantic Web technologies to describe community data and oral medicine knowledge; (3) develop an online CoP, Swedish Oral Medicine Web (SOMWeb), centered on user-contributed case descriptions and meetings; and (4) evaluate SOMWeb and study how work practices change with IT support. Based on Java, and using the Web Ontology Language and Resource Description Framework for handling community data and oral medicine knowledge, SOMWeb was developed using a user-centered and iterative approach. For studying the work practices and evaluating the system, a mixed-method approach of interviews, observations, and a questionnaire was used. By May 2008, there were 90 registered users of SOMWeb, 93 cases had been added, and 18 meetings had utilized the system. The introduction of SOMWeb has improved the structure of meetings and their discussions, and a tenfold increase in the number of participants has been observed. Users submit cases to seek advice on diagnosis or treatment, to show an unusual case, or to create discussion. Identified barriers to submitting cases are lack of time, concern about whether the case is interesting enough, and showing gaps in one's own knowledge. Three levels of member participation are discernable: a core group that contributes most cases and most meeting feedback; an active group that participates often but only sometimes contribute cases and feedback; and a large peripheral group that seldom or never contribute cases or feedback. SOMWeb is beneficial for individual clinicians as well as for the SOMNet community. The system provides an opportunity for its members to share both high quality clinical practice knowledge and external evidence related to complex oral medicine cases. The foundation in Semantic Web technologies enables formalization and structuring of case data that can be used for further reasoning and research. Main success factors are the long history of collaboration between different disciplines, the user-centered development approach, the existence of a "champion" within the field, and nontechnical community aspects already being in place.

SOMWeb: A Semantic Web-Based System for Supporting Collaboration of Distributed Medical Communities of Practice

PubMed Central

Gustafsson, Marie; Jontell, Mats; Torgersson, Olof

2008-01-01

Background Information technology (IT) support for remote collaboration of geographically distributed communities of practice (CoP) in health care must deal with a number of sociotechnical aspects of communication within the community. In the mid-1990s, participants of the Swedish Oral Medicine Network (SOMNet) began discussing patient cases in telephone conferences. The cases were distributed prior to the conferences using PowerPoint and email. For the technical support of online CoP, Semantic Web technologies can potentially fulfill needs of knowledge reuse, data exchange, and reasoning based on ontologies. However, more research is needed on the use of Semantic Web technologies in practice. Objectives The objectives of this research were to (1) study the communication of distributed health care professionals in oral medicine; (2) apply Semantic Web technologies to describe community data and oral medicine knowledge; (3) develop an online CoP, Swedish Oral Medicine Web (SOMWeb), centered on user-contributed case descriptions and meetings; and (4) evaluate SOMWeb and study how work practices change with IT support. Methods Based on Java, and using the Web Ontology Language and Resource Description Framework for handling community data and oral medicine knowledge, SOMWeb was developed using a user-centered and iterative approach. For studying the work practices and evaluating the system, a mixed-method approach of interviews, observations, and a questionnaire was used. Results By May 2008, there were 90 registered users of SOMWeb, 93 cases had been added, and 18 meetings had utilized the system. The introduction of SOMWeb has improved the structure of meetings and their discussions, and a tenfold increase in the number of participants has been observed. Users submit cases to seek advice on diagnosis or treatment, to show an unusual case, or to create discussion. Identified barriers to submitting cases are lack of time, concern about whether the case is interesting enough, and showing gaps in one’s own knowledge. Three levels of member participation are discernable: a core group that contributes most cases and most meeting feedback; an active group that participates often but only sometimes contribute cases and feedback; and a large peripheral group that seldom or never contribute cases or feedback. Conclusions SOMWeb is beneficial for individual clinicians as well as for the SOMNet community. The system provides an opportunity for its members to share both high quality clinical practice knowledge and external evidence related to complex oral medicine cases. The foundation in Semantic Web technologies enables formalization and structuring of case data that can be used for further reasoning and research. Main success factors are the long history of collaboration between different disciplines, the user-centered development approach, the existence of a “champion” within the field, and nontechnical community aspects already being in place. PMID:18725355

Professions and Working Conditions Associated With Community-Acquired Pneumonia.

PubMed

Almirall, Jordi; Serra-Prat, Mateu; Bolíbar, Ignasi; Palomera, Elisabet; Roig, Jordi; Boixeda, Ramon; Bartolomé, Maria; de la Torre, Mari; Parra, Olga; Torres, Antoni

2015-12-01

Community-acquired pneumonia (CAP) is not considered a professional disease, and the effect of different occupations and working conditions on susceptibility to CAP is unknown. The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP. Over a 1-year period, all radiologically confirmed cases of CAP (n=1,336) and age- and sex-matched controls (n=1,326) were enrolled in a population-based case-control study. A questionnaire on CAP risk factors, including work-related questions, was administered to all participants during an in-person interview. The bivariate analysis showed that office work is a protective factor against CAP, while building work, contact with dust and sudden changes of temperature in the workplace were risk factors for CAP. The occupational factor disappeared when the multivariate analysis was adjusted for working conditions. Contact with dust (previous month) and sudden changes of temperature (previous 3 months) were risk factors for CAP, irrespective of the number of years spent working in these conditions, suggesting reversibility. Some recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP. Both factors are reversible and preventable. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Community-level Moderators of a School-Based Childhood Sexual Assault Prevention Program

PubMed Central

Morris, Matthew C.; Kouros, Chrystyna D.; Janecek, Kim; Freeman, Rachel; Mielock, Alyssa; Garber, Judy

2016-01-01

Childhood sexual abuse (CSA) is highly prevalent and associated with a wide variety of negative mental and physical health outcomes. School-based CSA education and prevention programs have shown promise, but it is unclear to what extent community-level characteristics are related to their effectiveness. The present cluster randomized controlled trial evaluated community-level moderators of the Safe@Last program compared to a waitlist control condition. Knowledge gains from pre- to post-intervention were assessed in 5 domains: safe versus unsafe people; safe choices; problem-solving; clear disclosure; and assertiveness. Participants were 1,177 students (46% White, 26% African American, 15% Hispanic, 4% Asian American, 6% Other) in grades 1 through 6 from 14 public schools in Tennessee. Multilevel models accounting for the nesting of children within schools revealed large effect sizes for the intervention versus control across all knowledge domains (d’s ranged from 1.56 to 2.13). The effectiveness of the program was moderated by mean per capita income and rates of substantiated cases of child abuse and neglect in the community. Intervention effects were stronger for youth living in lower as compared to higher income counties, and for youth attending schools in counties with lower as compared to higher abuse/neglect rates. Child characteristics (sex, race) did not moderate intervention effects. This research identified two community-level factors that predicted the effectiveness of a CSA education and prevention program designed to improve children’s knowledge of personal safety skills. School-based CSA prevention programs may require modification for communities with higher rates of child abuse and neglect. PMID:27890344

An outbreak of multi-drug resistant Escherichia coli urinary tract infection in an elderly population: a case-control study of risk factors.

PubMed

Ikram, Rosemary; Psutka, Rebecca; Carter, Alison; Priest, Patricia

2015-06-09

Prevention of infection due to multi-drug resistant organisms is particularly challenging because of the spread of resistant bacteria beyond hospitals into the community, including nursing homes. This study aimed to identify risk factors for the acquisition of a multidrug resistant (MDR) Escherichia coli in a local outbreak. Study participants were all aged over 65 years. Cases had the MDR E. coli isolated from a routine urine sample, and controls had a urine sample submitted to the laboratory in the same time period but the MDR E. coli was not isolated. Information from clinical records was used to identify risk factors both in the hospital and the community setting for acquisition of the MDR E. coli. 76 cases and 156 controls were identified and included in the study. In a multivariate analysis, risk factors statistically significantly associated with acquisition of the MDR E. coli were female gender (adjusted OR 3.2; 95 % confidence interval 1.5-6.9), level of care (high dependency OR 7.5; 2.2-25.7) compared with living independently), and in hospital prescription of antimicrobials to which the MDR E. coli was resistant (OR 5.6; 2.5-12.9). The major risk factors for the acquisition of a MDR E. coli were found to be residence in a nursing home and in-hospital prescription of antimicrobials to which the MDR E. coli was resistant. This emphasises that prevention of transmission of MDROs within a community needs to involve both hospitals and also other healthcare organizations, in this case nursing homes.

Global estimate of the incidence of clinical pneumonia among children under five years of age.

PubMed Central

Rudan, Igor; Tomaskovic, Lana; Boschi-Pinto, Cynthia; Campbell, Harry

2004-01-01

OBJECTIVE: Clinical pneumonia (defined as respiratory infections associated with clinical signs of pneumonia, principally pneumonia and bronchiolitis) in children under five years of age is still the leading cause of childhood mortality in the world. In this paper we aim to estimate the worldwide incidence of clinical pneumonia in young children. METHODS: Our estimate for the developing world is based on an analysis of published data on the incidence of clinical pneumonia from community based longitudinal studies. Among more than 2000 studies published since 1961, we identified 46 studies that reported the incidence of clinical pneumonia, and 28 of these met pre-defined quality criteria. FINDINGS: The estimate of the median incidence from those studies was 0.28 episodes per child-year (e/cy). The 25-75% interquartile range was 0.21-0.71. We assessed the plausibility of this estimate using estimates of global mortality from acute respiratory infections and reported case fatality rates for all episodes of clinical pneumonia reported in community-based studies or the case-fatality rate reported only for severe cases and estimates of the proportion of severe cases occurring in a defined population or community. CONCLUSION: The overlap between the ranges of the estimates implies that a plausible incidence estimate of clinical pneumonia for developing countries is 0.29 e/cy. This equates to an annual incidence of 150.7 million new cases, 11-20 million (7-13%) of which are severe enough to require hospital admission. In the developed world no comparable data are available. However, large population-based studies report that the incidence of community-acquired pneumonia among children less than five years old is approximately 0.026 e/cy, suggesting that more than 95% of all episodes of clinical pneumonia in young children worldwide occur in developing countries. PMID:15654403

Community-Based Rehabilitation to Improve Stroke Survivors' Rehabilitation Participation and Functional Recovery.

PubMed

Ru, Xiaojuan; Dai, Hong; Jiang, Bin; Li, Ninghua; Zhao, Xingquan; Hong, Zhen; He, Li; Wang, Wenzhi

2017-07-01

The aim of this study was to evaluate the effectiveness of a community-based rehabilitation appropriate technique (CRAT) intervention program in increasing rehabilitation participation and improving functional recovery of stroke survivors. This study followed a quasi-experimental design. In each of 5 centers servicing approximately 50,000 individuals, 2 communities were designated as either the intervention or control community. A CRAT intervention program, including 2-year rehabilitation education and 3-month CRAT treatment, was regularly implemented in the intervention communities, whereas there was no special intervention in the control community. Two sampling surveys, at baseline and after intervention, were administered to evaluate the rehabilitation activity undertaken. In intervention communities, stroke survivor's motor function, daily activity, and social activity were evaluated pretreatment and posttreatment, using the Fugl-Meyer Motor Function Assessment, Barthel index, and Social Functional Activities Questionnaire. The proportion of individuals participating in rehabilitation-related activity was increased significantly (P < 0.05) in intervention communities, as compared with control communities. In intervention communities, the patients' Fugl-Meyer Motor Function Assessment, Barthel index, and Social Functional Activities Questionnaire scores were significantly improved after rehabilitation (P < 0.05) across all ages and disease courses, except for the FAQ scores in patients younger than 50 years (P > 0.05). Community-based rehabilitation appropriate technique increases rehabilitation participation rates and enhances motor function, daily activity, and social activity of stroke survivors.

A study protocol: a community pharmacy-based intervention for improving the management of sleep disorders in the community settings

PubMed Central

2014-01-01

Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are– (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders, (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders and (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12612000825853 PMID:24533916

Cluster Randomized Test-Negative Design (CR-TND) Trials: A Novel and Efficient Method to Assess the Efficacy of Community Level Dengue Interventions.

PubMed

Anders, Katherine L; Cutcher, Zoe; Kleinschmidt, Immo; Donnelly, Christl A; Ferguson, Neil M; Indriani, Citra; O'Neill, Scott L; Jewell, Nicholas P; Simmons, Cameron P

2018-05-07

Cluster randomized trials are the gold standard for assessing efficacy of community-level interventions, such as vector control strategies against dengue. We describe a novel cluster randomized trial methodology with a test-negative design, which offers advantages over traditional approaches. It utilizes outcome-based sampling of patients presenting with a syndrome consistent with the disease of interest, who are subsequently classified as test-positive cases or test-negative controls on the basis of diagnostic testing. We use simulations of a cluster trial to demonstrate validity of efficacy estimates under the test-negative approach. This demonstrates that, provided study arms are balanced for both test-negative and test-positive illness at baseline and that other test-negative design assumptions are met, the efficacy estimates closely match true efficacy. We also briefly discuss analytical considerations for an odds ratio-based effect estimate arising from clustered data, and outline potential approaches to analysis. We conclude that application of the test-negative design to certain cluster randomized trials could increase their efficiency and ease of implementation.

Tangled paths: Three experienced teachers' growth in understanding during an extended science community of practice professional development effort

NASA Astrophysics Data System (ADS)

Brown, Nancy Melamed

This qualitative investigation extends the study of teacher learning within a reform-based community of practice model of professional development. This long-term, multiple case study examined three experienced teachers' transformations in thinking about science instruction. Data were collected during the three years of the Guided Inquiry supporting Multiple Literacies research project, designed to develop instructional practices informed by a socio-cultural, inquiry-based orientation. Data sources included: transcripts of semi-structured interviews collected at strategic points, the teacher's journals, initial application information, and teachers' written case studies. Using an interpretive case study approach, tenets of the teachers' orientations were identified through a recursive process. Results are organized to reflect two principles that were integral to the design of the professional development community. The first principle describes changes in teachers' orientations about the goals and characteristics of science instruction in the elementary grades. The second describes changes about teachers' knowledge about themselves as learners and the influence of this knowledge on their thinking about science instruction and student learning. Illustrative findings indicate that: (a) it is possible for teachers' language regarding conceptions of their practice to change with only superficial change in their orientations, (b) teachers can hold dualistic ways of thinking about their practice, (c) in some cases, teachers use a significant amount of autobiography about their own learning to explain their practice; over time, this was replaced with warrants using the language that developed within the professional development community, and (d) long-term case studies revealed differences in orientations that emerged and were refined over time. These findings provide strong support for communities of practice as a model of professional development and hold implications for advancing teacher learning.

Improving Problem-Based Learning in Creative Communities through Effective Group Evaluation

ERIC Educational Resources Information Center

West, Richard E.; Williams, Greg; Williams, David

2013-01-01

In this case study, we researched one cohort from the Center for Animation, a higher education teaching environment that has successfully fostered group creativity and learning outcomes through problem-based learning. Through live and videotaped observations of the interactions of this community over 18 months, in addition to focused interviews…

Case Studies of Student Mentoring in Three New York City Community-Based Organizations

ERIC Educational Resources Information Center

Truitt, Brett J.

2012-01-01

This researcher examined three selected New York City community-based organizations' roles in student mentoring and the building of social capital. The methodology included focus group interviews, individual interviews, shadowing, and the collection of archival materials. The data were analyzed through pattern, theme and discrepancy analysis to…

Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease

PubMed Central

Corrales-Medina, Vicente F.; Alvarez, Karina N.; Weissfeld, Lisa A.; Angus, Derek C.; Chirinos, Julio A.; Chang, Chung-Chou H.; Newman, Anne; Loehr, Laura; Folsom, Aaron R.; Elkind, Mitchell S.; Lyles, Mary F.; Kronmal, Richard A.; Yende, Sachin

2015-01-01

IMPORTANCE The risk of cardiovascular disease (CVD) after infection is poorly understood. OBJECTIVE To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD. DESIGN, SETTINGS, AND PARTICIPANTS We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989–1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15 792; enrollment age, 45-64 years; enrollment period, 1987–1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status. EXPOSURES Hospitalization for pneumonia. MAIN OUTCOMES AND MEASURES Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease). RESULTS Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. Compared with controls, CVD risk among pneumonia cases was highest during the first year after hospitalization and remained significantly higher than among controls through 10 years. In ARIC, of 680 pneumonia cases, 112 had CVD events over 10 years after hospitalization. After the second year, CVD risk among pneumonia cases was not significantly higher than among controls. Pneumonia Cases Controls HR (95% CI) CHS No. of participants 591 1182 CVD events  0-30 d 54 6 4.07 (2.86-5.27)  31-90 d 11 9 2.94 (2.18-3.70)  91 d-1 y 22 55 2.10 (1.59-2.60)  9-10 y 4 12 1.86 (1.18-2.55) ARIC No. of participants 680 1360 CVD events  0-30 d 4 3 2.38 (1.12-3.63)  31-90 d 4 0 2.40 (1.23-3.47)  91 d-1 y 11 8 2.19 (1.20-3.19)  1-2 y 8 7 1.88 (1.10-2.66) CONCLUSIONS AND RELEVANCE Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD. PMID:25602997

Biogenic reefs affect multiple components of intertidal soft-bottom benthic assemblages: the Lanice conchilega case study

NASA Astrophysics Data System (ADS)

De Smet, Bart; D'Hondt, An-Sofie; Verhelst, Pieterjan; Fournier, Jérôme; Godet, Laurent; Desroy, Nicolas; Rabaut, Marijn; Vincx, Magda; Vanaverbeke, Jan

2015-01-01

Biogenic reefs composed of the tube-building polychaete Lanice conchilega are important from a conservation point of view because they noticeably increase the biodiversity in otherwise species poor environments. However, up to now, little or no attention has been paid to the intertidal epi- and hyperbenthic communities associated with the reefs. Therefore, this is the first study which focuses on the effect of L. conchilega reefs on the entire bentho-pelagic community at two different locations. Environmental variables were measured and macro-, epi- and hyperbenthic communities were sampled within a L. conchilega reef and a control area at two locations in France: the bay of the Mont Saint-Michel (BMSM) and Boulogne-sur-Mer (Boulogne). The effect of the reef presence on the benthic community was studied with a 3-factor (Reef, Location and Period) Permanova. In addition, the relationship between the benthic community and the environmental variables was investigated using Distance-based linear models (DistLM). Most collected organisms were sampled in the reef area (macrobenthos: 91%, epibenthos: 81% and hyperbenthos: 78.5%) indicating that, independent of the location, the L. conchilega reefs positively affect all three associated benthic communities. However, the extent of the effect seems to be most pronounced for the macrobenthos and less distinct in case of the hyperbenthos. The macro-, and epibenthos are mainly structured by biotic variables (L. conchilega density and macrobenthic food availability respectively), while the hyperbenthos is rather structured by environmental variables. In general, L. conchilega reefs do not only affect abundances and diversity but they substantially steer the structure of the intertidal benthic sandy beach ecosystem.

Population-based study of invasive disease due to beta-hemolytic streptococci of groups other than A and B.

PubMed

Broyles, Laura N; Van Beneden, Chris; Beall, Bernard; Facklam, Richard; Shewmaker, P Lynn; Malpiedi, Paul; Daily, Pamala; Reingold, Arthur; Farley, Monica M

2009-03-15

Beta-hemolytic streptococci of groups other than A and B (NABS) are increasingly recognized as causes of clinically significant disease, but precise information about this heterogeneous group is lacking. We report the incidence of NABS infection and describe the epidemiologic and clinical characteristics. Active, population-based surveillance for invasive NABS was performed over a 2-year period in the 8-county metropolitan Atlanta, Georgia, area and the 3-county San Francisco Bay, California, area. Clinical records were reviewed, and available isolates were sent to the Centers for Disease Control and Prevention (Atlanta) for additional microbiologic characterization. Incidences were calculated using year-appropriate US Census Bureau data. A total of 489 cases of invasive NABS infection were identified (3.2 cases per 100,000 population). The median age of patients was 55 years; 64% of patients were males, and 87% had underlying diseases. The incidence was higher among black persons than white persons (4.0 vs. 2.5 cases per 100,000 population; P < .01) and increased with age among all races. Infections were community acquired in 416 cases (85%). Among the 450 patients (94%) with NABS infection who were hospitalized, 55 (12%) died. Of 266 isolates (54%) speciated at the Centers for Disease Control and Prevention, 212 (80%) were Streptococcus dysgalactiae subspecies equisimilis; 46 (17%) were members of the Streptococcus anginosus group. S. dysgalactiae subspecies equisimilis primarily presented as skin and soft-tissue infection in older patients, whereas individuals with invasive S. anginosus group infections were more likely to be younger patients with intra-abdominal infections. NABS comprise multiple distinct species that cause a significant number of community-acquired invasive infections. Clinical manifestations differ by species. Thus, speciation of invasive NABS may be warranted in clinical settings.

Methodology Series Module 2: Case-control Studies.

PubMed

Setia, Maninder Singh

2016-01-01

Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same 'study base' as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive - particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases - selection bias and recall bias.

The outing of Philip Morris: advertising tobacco to gay men.

PubMed

Smith, Elizabeth A; Malone, Ruth E

2003-06-01

This case study describes the events surrounding the first time a major tobacco company advertised in gay media. We analyzed internal tobacco company documents, mainstream newspapers, and the gay press. Philip Morris was unprepared for the attention its entry into the gay market received. The company's reaction to this incident demonstrates that its approach to the gay community both parallels and diverges from industry strategies toward other marginalized communities. The tobacco industry's relationship to the gay community is relatively undeveloped, a fact that may provide tobacco control advocates an opportunity for early intervention. The gay community's particular vulnerabilities to the industry make development of gay tobacco control programs crucial to reducing gay smoking prevalence and industry presence in the community.

Combining In-School and Community-Based Media Efforts: Reducing Marijuana and Alcohol Uptake among Younger Adolescents

ERIC Educational Resources Information Center

Slater, Michael D.; Kelly, Kathleen J.; Edwards, Ruth W.; Thurman, Pamela J.; Plested, Barbara A.; Keefe, Thomas J.; Lawrence, Frank R.; Henry, Kimberly L.

2006-01-01

This study tests the impact of an in-school mediated communication campaign based on social marketing principles, in combination with a participatory, community-based media effort, on marijuana, alcohol and tobacco uptake among middle-school students. Eight media treatment and eight control communities throughout the US were randomly assigned to…

The dynamic evolution of social ties and user-generated content: a case study on a Douban group

NASA Astrophysics Data System (ADS)

Shan, Siqing; Ren, Jie; Li, Cangyan

2017-11-01

As platforms based on user-generated content (UGC), social media platforms emphasise the social ties between users and user participation, which promote the communication and propagation of ideas and help to build and maintain relationships. However, many researchers have studied only predefined social networks, such as academic social networks. We believe that there are certain characteristics associated with the network's UGC worth evaluating. We conducted research in communities in which content attracts discussion and new members and examined the evolution patterns of social and content networks in a topic-oriented Douban group. Datasets of user and content information in communities of interest were collected through web crawler software. Networks based on social and content ties were constructed and analysed. We chose scale, density, centrality, average path length and cluster coefficient as measures for exploring the evolution and correlation of both types of networks. These findings are valuable for social media marketing and helpful in directing and controlling public opinion.

Home-based intermediate care program vs hospitalization

PubMed Central

Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

2008-01-01

OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

A case study in the use of community-based participatory research in public health nursing.

PubMed

Savage, Christine L; Xu, Yin; Lee, Rebecca; Rose, Barbara L; Kappesser, Mary; Anthony, Jean Spann

2006-01-01

There is growing demand for research using a community-based participatory (CBPR) approach. CBPR requires that the academic research team actively partner with community members and stakeholders in the entire research process. The community members are full partners with the researchers in relation to the development and implementation of the study, analysis of the data, and dissemination of the findings. The purpose of this article is to review four basic principles of CBPR and provide an example of how these CBPR principles were used in an ethnographic study related to the culture of African American infant health. In the pilot study, CBPR provided the framework for recruitment and retention of participants, ongoing data analysis, and dissemination of findings. Using CBPR provided the researchers an introduction into the selected community. Community members served as key informants about the culture of the community and provided access to potential participants. The community partners contributed to analysis of emerging themes and in the dissemination of findings to the community, stakeholders, and the scientific community. CBPR provides opportunities for community health nurse researchers to conduct research with vulnerable populations and sets the stage for implementing evidenced-based nursing interventions in the community.

Deployment and use of mobile phone technology for real-time reporting of fever cases and malaria treatment failure in areas of declining malaria transmission in Muheza district north-eastern Tanzania.

PubMed

Francis, Filbert; Ishengoma, Deus S; Mmbando, Bruno P; Rutta, Acleus S M; Malecela, Mwelecele N; Mayala, Benjamin; Lemnge, Martha M; Michael, Edwin

2017-08-01

Early detection of febrile illnesses at community level is essential for improved malaria case management and control. Currently, mobile phone-based technology has been commonly used to collect and transfer health information and services in different settings. This study assessed the applicability of mobile phone-based technology in real-time reporting of fever cases and management of malaria by village health workers (VHWs) in north-eastern Tanzania. The community mobile phone-based disease surveillance and treatment for malaria (ComDSTM) platform, combined with mobile phones and web applications, was developed and implemented in three villages and one dispensary in Muheza district from November 2013 to October 2014. A baseline census was conducted in May 2013. The data were uploaded on a web-based database and updated during follow-up home visits by VHWs. Active and passive case detection (ACD, PCD) of febrile cases were done by VHWs and cases found positive by malaria rapid diagnostic test (RDT) were given the first dose of artemether-lumefantrine (AL) at the dispensary. Each patient was visited at home by VHWs daily for the first 3 days to supervise intake of anti-malarial and on day 7 to monitor the recovery process. The data were captured and transmitted to the database using mobile phones. The baseline population in the three villages was 2934 in 678 households. A total of 1907 febrile cases were recorded by VHWs and 1828 (95.9%) were captured using mobile phones. At the dispensary, 1778 (93.2%) febrile cases were registered and of these, 84.2% were captured through PCD. Positivity rates were 48.2 and 45.8% by RDT and microscopy, respectively. Nine cases had treatment failure reported on day 7 post-treatment and adherence to treatment was 98%. One patient with severe febrile illness was referred to Muheza district hospital. The study showed that mobile phone-based technology can be successfully used by VHWs in surveillance and timely reporting of fever episodes and monitoring of treatment failure in remote areas. Further optimization and scaling-up will be required to utilize the tools for improved malaria case management and drug resistance surveillance.

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

PubMed Central

Agmon, Maayan; Belza, Basia; Nguyen, Huong Q; Logsdon, Rebecca G; Kelly, Valerie E

2014-01-01

Background Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control) have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk. Purpose The aims of this systematic review are: 1) to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2) to identify the key elements of those interventions. Data sources Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science. Study selection Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected. Data extraction All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted. Data synthesis Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions. Limitations The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome measures. Conclusion Dual-task postural control can be modified by specific training. There was little evidence that single-task training transferred to dual-task postural control performance. Further investigation of dual-task training using standardized outcome measurements is needed. PMID:24741296

Legal Rights, Local Wrongs: When Community Control Collides with Educational Equity. SUNY Series, Restructuring and School Change.

ERIC Educational Resources Information Center

Welner, Kevin G.

This book challenges fundamental assumptions about the opportunities for equity-minded educational reform, using data from case studies of districts nationwide and their experiences with court-ordered detracking. The case studies show how white, upper middle class parents exercised a disproportionate amount of power in local school policy making…

Control of a community outbreak of hepatitis A in an area of low endemicity, Wales, 2016.

PubMed

Vaz, J; Floyd, C; Mason, B; Shankar, A G; Lewis, H

2017-10-03

Incidence of hepatitis A in Wales is low (average of 0.48/100,000 inhabitants from 2004-2015). We describe a community outbreak of hepatitis A involving 3 schools (primary and secondary) in South Wales between March and June 2016 and reflect on the adequacy of the control measures used. Anyone in South Wales epidemiologically linked to a serological and/or RNA positive confirmed case of hepatitis A during the 15-50 d before onset of symptoms (diarrhea, vomiting, fever, nausea, AND jaundice, or jaundice-associated symptom) was defined as a case. Case identification was based on laboratory or GP suspicion notification, changing to active surveillance toward the end. As per national guidance, household contacts were identified and offered immunisation while in schools vaccination followed evidence of transmission. We went beyond guidance by vaccinating street play mates and in secondary schools. Mass vaccination uptake was calculated. There were 17 cases, mostly in children under 16 y of age. All cases had an epidemiological link to either a school or a household case (except primary) and no travel history. Street playing was the only epidemiological link between 2 cases in different schools. A total of 139 household contacts were identified. All schools, including secondary one, had a transmission event preceding mass vaccination (overall uptake 85%, reaching 1,574 individuals) and no tertiary cases emerged after the campaigns. We recommend extending guidance to include actions taken that helped curb this outbreak: 1) vaccinating in secondary school and 2) broadening the household contact definition. Based on our learning we further suggest 3) vaccinating upon identification of a single case who attended school while infectious regardless of source and 4) active case finding by serologically testing contacts.

The use of insecticide-treated nets for reducing malaria morbidity among children aged 6-59 months, in an area of high malaria transmission in central Côte d'Ivoire

PubMed Central

2010-01-01

Background Long-lasting insecticidal nets (LLINs) are an important tool for controlling malaria. Much attention has been devoted to determine both the effect of LLINs on the reduction of Plasmodium infection rate and on clinically-confirmed malaria cases in sub-Saharan Africa. We carried out an epidemiological study to investigate whether LLINs impact on Plasmodium prevalence rate and the proportion of clinically-confirmed malaria cases, in five villages in the district of Toumodi, central Côte d'Ivoire. Methods From April 2007 to November 2008, a community-based malaria control programme was implemented in the study villages, which involved large-scale distribution of LLINs, and training and sensitization activities within the community. We determined the effect of this programme on Plasmodium prevalence rate, clinically-confirmed malaria cases and proportion of high parasitaemia rates in children aged 6-59 months through a series of cross-sectional surveys starting in April 2007 and repeated once every 6 months. Results We observed a significant decrease in the mean P. falciparum prevalence rate from April 2007 to April 2008 (p = 0.029). An opposite trend was observed from November 2007 to November 2008 when P. falciparum prevalence rate increased significantly (p = 0.003). Highly significant decreases in the proportions of clinical malaria cases were observed between April 2007 and April 2008 (p < 0.001), and between November 2007 and November 2008 (p = 0.001). Conclusions Large-scale distribution of LLINs, accompanied by training and sensitization activities, significantly reduced Plasmodium prevalence rates among young children in the first year of the project, whereas overall clinical malaria rates dropped over the entire 18-month project period. A decrease in community motivation to sleep under bed nets, perhaps along with changing patterns of malaria transmission, might explain the observed increase in the Plasmodium prevalence rate between November 2007 and November 2008. PMID:20860829

Study designs may influence results: the problems with questionnaire-based case-control studies on the epidemiology of glioma.

PubMed

Johansen, Christoffer; Schüz, Joachim; Andreasen, Anne-Marie Serena; Dalton, Susanne Oksbjerg

2017-03-28

Glioma is a rare brain tumour with a very poor prognosis and the search for modifiable factors is intense. We reviewed the literature concerning risk factors for glioma obtained in case-control designed epidemiological studies in order to discuss the influence of this methodology on the observed results. When reviewing the association between three exposures, medical radiation, exogenous hormone use and allergy, we critically appraised the evidence from both case-control and cohort studies. For medical radiation and hormone replacement therapy (HRT), questionnaire-based case-control studies appeared to show an inverse association, whereas nested case-control and cohort studies showed no association. For allergies, the inverse association was observed irrespective of study design. We recommend that the questionnaire-based case-control design be placed lower in the hierarchy of studies for establishing cause-and-effect for diseases such as glioma. We suggest that a state-of-the-art case-control study should, as a minimum, be accompanied by extensive validation of the exposure assessment methods and the representativeness of the study sample with regard to the exposures of interest. Otherwise, such studies cannot be regarded as 'hypothesis testing' but only 'hypothesis generating'. We consider that this holds true for all questionnaire-based case-control studies on cancer and other chronic diseases, although perhaps not to the same extent for each exposure-outcome combination.

Reduced plasma concentrations of vitamin B6 and increased plasma concentrations of the neurotoxin 3-hydroxykynurenine are associated with nodding syndrome: a case control study in Gulu and Amuru districts, Northern Uganda.

PubMed

Obol, James Henry; Arony, Denis Anywar; Wanyama, Ronald; Moi, Kenneth Luryama; Bodo, Bongomin; Odong, Patrick Olwedo; Odida, Michael

2016-01-01

Nodding syndrome was first reported in Uganda in 2003 among internally displaced populations. Risk factors for the syndrome remain unknown. We therefore explored vitamin B6 deficiency and resulting high 3-hydroxykynurenine (3-HK) levels as risk factor for nodding syndrome in Northern Uganda. Case-control study conducted in Gulu and Amuru districts. Cases were children/young adults with nodding syndrome. Healthy children/young adults were recruited as controls from same community as cases. Data on socio-demographic and other risk factors was collected using questionnaires. Whole blood was collected in EDTA tubes for assay of 3-HK and vitamin B6 using sandwich ELISA. Conditional logistic regression model was used to assess associations. 66 cases and 73 controls were studied. Factors associated with nodding syndrome were being positive for 3-HK (AOR=4.50, p=0.013), vitamin B6 concentration below mean (AOR=7.22, P=0.001), child being taken care of by mother only (AOR=5.43, p=0.011), child being taken care of by guardian (AOR=5.90, p=0.019) and child consuming relief food at weaning (AOR=4.05, p=0.021). Having low vitamin B6 concentration which leads to a build up of 3-hydroxykynurenine concentration in cases as a main risk factor. Therefore, cases should be treated with vitamin B6 and community members should be sensitise to ensure adequate dietary intake of vitamin B6 so that the risk of nodding syndrome among children is averted. We encourage future prospective intervention study to be conducted to assess the effect of low vitamin B6 on the development of nodding syndrome via raised 3-HK concentration.

Purposes and Approaches of Selected Mentors in School-Based Mentoring: A Collective Case Study

ERIC Educational Resources Information Center

Frels, Rebecca K.; Onwuegbuzie, Anthony J.; Bustamante, Rebecca M.; Garza, Yvonne; Nelson, Judith A.; Nichter, Mary; Leggett, Elsa Soto

2013-01-01

Over the last decade, community leaders have connected with students through school-based mentoring (SBM) programs (e.g., adults who mentor at-risk students). However, research in the area of SBM is only on the cusp of understanding relationship elements for impacting youth. In this collective case study, we examined the perceptions and…

Models of community care for severe mental illness: a review of research on case management.

PubMed

Mueser, K T; Bond, G R; Drake, R E; Resnick, S G

1998-01-01

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

Dietary polyphenols and colorectal cancer risk: The Fukuoka colorectal cancer study

PubMed Central

Wang, Zhen-Jie; Ohnaka, Keizo; Morita, Makiko; Toyomura, Kengo; Kono, Suminori; Ueki, Takashi; Tanaka, Masao; Kakeji, Yoshihiro; Maehara, Yoshihiko; Okamura, Takeshi; Ikejiri, Koji; Futami, Kitaroh; Maekawa, Takafumi; Yasunami, Yohichi; Takenaka, Kenji; Ichimiya, Hitoshi; Terasaka, Reiji

2013-01-01

AIM: To investigate the associations between dietary intake of polyphenols and colorectal cancer. METHODS: The study subjects were derived from the Fukuoka colorectal cancer study, a community-based case-control study. The study subjects were 816 cases of colorectal cancer and 815 community-based controls. The consumption of 148 food items was assessed by a computer-assisted interview. We used the consumption of 97 food items to estimate dietary intakes of total, tea and coffee polyphenols. The Phenol-Explorer database was used for 92 food items. Of the 5 foods which were not listed in the Phenol-Explorer Database, polyphenol contents of 3 foods (sweet potatoes, satoimo and daikon) were based on a Japanese study and 2 foods (soybeans and fried potatoes) were estimated by ORAC-based polyphenol contents in the United States Department of Agriculture Database. Odds ratios (OR) and 95%CI of colorectal cancer risk according to quintile categories of intake were obtained by using logistic regression models with adjustment for age, sex, residential area, parental history of colorectal cancer, smoking, alcohol consumption, body mass index 10 years before, type of job, leisure-time physical activity and dietary intakes of calcium and n-3 polyunsaturated fatty acids. RESULTS: There was no measurable difference in total or tea polyphenol intake between cases and controls, but intake of coffee polyphenols was lower in cases than in controls. The multivariate-adjusted OR of colorectal cancer according to quintile categories of coffee polyphenols (from the first to top quintile) were 1.00 (referent), 0.81 (95%CI: 0.60-1.10), 0.65 (95%CI: 0.47-0.89), 0.65 (95%CI: 0.46-0.89) and 0.82 (95%CI: 0.60-1.10), respectively (Ptrend = 0.07). Similar, but less pronounced, decreases in the OR were also noted for the third and fourth quintiles of total polyphenol intake. Tea polyphenols and non-coffee polyphenols showed no association with colorectal cancer risk. The site-specific analysis, based on 463 colon cancer cases and 340 rectal cancer cases, showed an inverse association between coffee polyphenols and colon cancer. The multivariate-adjusted OR of colon cancer for the first to top quintiles of coffee polyphenols were 1.00 (referent), 0.92 (95%CI: 0.64-1.31), 0.75 (95%CI: 0.52-1.08), 0.69 (95%CI: 0.47-1.01), and 0.68 (95%CI: 0.46-1.00), respectively (Ptrend = 0.02). Distal colon cancer showed a more evident inverse association with coffee polyphenols than proximal colon cancer. The association between coffee polyphenols and rectal cancer risk was U-shaped, with significant decreases in the OR at the second to fourth quintile categories. There was also a tendency that the OR of colon and rectal cancer decreased in the intermediate categories of total polyphenols. The decrease in the OR in the intermediate categories of total polyphenols was most pronounced for distal colon cancer. Intake of tea polyphenols was not associated with either colon or rectal cancer. The associations of coffee consumption with colorectal, colon and rectal cancers were almost the same as observed for coffee polyphenols. The trend of the association between coffee consumption and colorectal cancer was statistically significant. CONCLUSION: The present findings suggest a decreased risk of colorectal cancer associated with coffee consumption. PMID:23674876

Twenty-one days of isolation: A prospective observational cohort study of an Ebola-exposed hot zone community in Liberia.

PubMed

Williams, George Sie; Naiene, Jeremias; Gayflor, Joseph; Malibiche, Theophil; Zoogley, Bentoe; Frank, Wimot G; Nayeri, Fariba

2015-08-01

As West Africa continues to suffer from a deadly Ebola epidemic, the national health sectors struggle to minimize the damages and stop the spread of disease. A cohort of inhabitants of a small village and an Ebola hot zone in Sinoe County of Liberia was followed on a day-by-day basis to search for new cases and to minimize the spread of Ebola to the other community members or to other regions. Technical, clinical, and humanistic aspects of the response are discussed in this report. Of the 22 confirmed Ebola cases in Sinoe County since the beginning of outbreak (June 16, 2014), 7 cases were inhabitants of Polay Town, a small village 5.5 miles east of Greenville, the Sinoe County capital. After the last wave of outbreak at the beginning of December, enhanced response activity provided essential coordination and mobilized the resources to stop the epidemic. Despite unprotected contacts in crowded houses, no new cases were detected among the contact families, or in the surrounding houses or communities. Strong national mobilization in a decentralized but harmonized system at the community level has been of great value in controlling the epidemic in Liberia. The major interventions include epidemiological surveillance, public information dissemination, effective communication, case management, and infection control. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Validation of English and Spanish-language versions of a screening questionnaire for rheumatoid arthritis in an underserved community.

PubMed

Potter, Jeffrey; Odutola, Jennifer; Gonzales, Christian Amurrio; Ward, Michael M

2008-08-01

Questionnaires to screen for rheumatoid arthritis (RA) have been tested in groups that were primarily well educated and Caucasian. We sought to validate the RA questions of the Connective Tissue Disease Screening Questionnaire (CSQ) in ethnic minorities in an underserved community, and to test a Spanish-language version. The Spanish-language version was developed by 2 native speakers. Consecutive English-speaking or Spanish-speaking patients in a community-based rheumatology practice completed the questionnaire. Diagnoses were confirmed by medical record review. Sensitivity and specificity of the questionnaire for a diagnosis of RA were computed for each language version, using 2 groups as controls: patients with noninflammatory conditions, and participants recruited from the community. The English-language version was tested in 53 patients with RA (79% ethnic minorities; mean education level 11.3 yrs), 85 rheumatology controls with noninflammatory conditions, and 82 community controls. Using 3 positive responses as indicating a positive screening test, the sensitivity of the questionnaire was 0.77, the specificity based on rheumatology controls was 0.45, and the specificity based on community controls was 0.94. The Spanish-language version was tested in 55 patients with RA (mean education level 7.8 yrs), 149 rheumatology controls, and 88 community controls. The sensitivity of the Spanish-language version was 0.87, with specificities of 0.60 and 0.97 using the rheumatology controls and community controls, respectively. The sensitivity of the English-language version of the RA questions of the CSQ was lower in this study than in other cohorts, reflecting differences in the performance of the questions in different ethnic or socioeconomic groups. The Spanish-language version demonstrated good sensitivity, and both had excellent specificity when tested in community controls.

Engaging homeless youth in community-based participatory research: a case study from Skid Row, Los Angeles.

PubMed

Garcia, Analilia P; Minkler, Meredith; Cardenas, Zelenne; Grills, Cheryl; Porter, Charles

2014-01-01

Growing evidence highlights the benefits to youth of involvement in community-based participatory research. Less attention has been paid, however, to the contributions youth can make to helping change health-promoting policy through such work. We describe a multi-method case study of a policy-focused community-based participatory research project in the Skid Row area of downtown Los Angeles, California, where a small group of homeless youth worked with adult mentors to develop and conduct a survey of 96 homeless youth and used the findings to help secure health-promoting policy change. We review the partnership's work at each stage of the policy-making process; its successes in changing policy regarding recreation, juvenile justice, and education; and the challenges encountered, especially with policy enforcement. We share lessons learned, including the importance of strong adult mentors and of policy environments conducive to sustainable, health-promoting change for marginalized youth.

Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study.

PubMed

Coutinho, Evandro S F; Fletcher, Astrid; Bloch, Katia V; Rodrigues, Laura C

2008-08-26

Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

Reshaping the Boundaries of Community Engagement in Design Education: Global and Local Explorations

ERIC Educational Resources Information Center

Hicks, Travis L.; Radtke, Rebekah Ison

2015-01-01

Community-driven design is a current movement in the forefront of many designers' practices and on university campuses in design programs. The authors examine work from their respective public state universities' design programs as examples of best practices. In these case studies, the authors share experiences using community-based design…

Creating New Learning Communities: Towards Effective E-Learning Production.

ERIC Educational Resources Information Center

Russell, David; Calvey, David; Banks, Mark

2003-01-01

Case study research and a literature review suggest that formation of new learning communities is a strategy being used to meet demand for electronic learning products such as CD-ROMs and web-based learning tools. Companies, external experts, clients, and learners are the constituents of the learning community that must converge to create…

Conjoint Analysis for New Service Development on Electricity Distribution in Indonesia

NASA Astrophysics Data System (ADS)

Widaningrum, D. L.; Chynthia; Astuti, L. D.; Seran, M. A. B.

2017-07-01

Many cases of illegal use of electricity in Indonesia is still rampant, especially for activities where the power source is not available, such as in the location of street vendors. It is not only detrimental to the state, but also harm the perpetrators of theft of electricity and the surrounding communities. The purpose of this study is to create New Service Development (NSD) to provide a new electricity source for street vendors' activity based on their preferences. The methods applied in NSD is Conjoint Analysis, Cluster Analysis, Quality Function Deployment (QFD), Service Blueprint, Process Flow Diagrams and Quality Control Plan. The results of this study are the attributes and their importance in the new electricity’s service based on street vendors’ preferences as customers, customer segmentation, service design for new service, designing technical response, designing operational procedures, the quality control plan of any existing operational procedures.

Novel genes identified in a high-density genome wide association study for nicotine dependence.

PubMed

Bierut, Laura Jean; Madden, Pamela A F; Breslau, Naomi; Johnson, Eric O; Hatsukami, Dorothy; Pomerleau, Ovide F; Swan, Gary E; Rutter, Joni; Bertelsen, Sarah; Fox, Louis; Fugman, Douglas; Goate, Alison M; Hinrichs, Anthony L; Konvicka, Karel; Martin, Nicholas G; Montgomery, Grant W; Saccone, Nancy L; Saccone, Scott F; Wang, Jen C; Chase, Gary A; Rice, John P; Ballinger, Dennis G

2007-01-01

Tobacco use is a leading contributor to disability and death worldwide, and genetic factors contribute in part to the development of nicotine dependence. To identify novel genes for which natural variation contributes to the development of nicotine dependence, we performed a comprehensive genome wide association study using nicotine dependent smokers as cases and non-dependent smokers as controls. To allow the efficient, rapid, and cost effective screen of the genome, the study was carried out using a two-stage design. In the first stage, genotyping of over 2.4 million single nucleotide polymorphisms (SNPs) was completed in case and control pools. In the second stage, we selected SNPs for individual genotyping based on the most significant allele frequency differences between cases and controls from the pooled results. Individual genotyping was performed in 1050 cases and 879 controls using 31 960 selected SNPs. The primary analysis, a logistic regression model with covariates of age, gender, genotype and gender by genotype interaction, identified 35 SNPs with P-values less than 10(-4) (minimum P-value 1.53 x 10(-6)). Although none of the individual findings is statistically significant after correcting for multiple tests, additional statistical analyses support the existence of true findings in this group. Our study nominates several novel genes, such as Neurexin 1 (NRXN1), in the development of nicotine dependence while also identifying a known candidate gene, the beta3 nicotinic cholinergic receptor. This work anticipates the future directions of large-scale genome wide association studies with state-of-the-art methodological approaches and sharing of data with the scientific community.

Open Crowdsourcing: Leveraging Community Software Developers for IT Projects

ERIC Educational Resources Information Center

Phair, Derek

2012-01-01

This qualitative exploratory single-case study was designed to examine and understand the use of volunteer community participants as software developers and other project related roles, such as testers, in completing a web-based application project by a non-profit organization. This study analyzed the strategic decision to engage crowd…

A community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol

PubMed Central

2011-01-01

Background The WHO recognises pesticide poisoning to be the single most important means of suicide globally. Pesticide self-poisoning is a major public health and clinical problem in rural Asia, where it has led to case fatality ratios 20-30 times higher than self-poisoning in the developed world. One approach to reducing access to pesticides is for households to store pesticides in lockable "safe-storage" containers. However, before this approach can be promoted, evidence is required on its effectiveness and safety. Methods/Design A community-based cluster randomised controlled trial has been set up in 44,000 households in the North Central Province, Sri Lanka. A census is being performed, collecting baseline demographic data, socio-economic status, pesticide usage, self-harm and alcohol. Participating villages are then randomised and eligible households in the intervention arm given a lockable safe storage container for agrochemicals. The primary outcome will be incidence of pesticide self-poisoning over three years amongst individuals aged 14 years and over. 217,944 person years of follow-up are required in each arm to detect a 33% reduction in pesticide self-poisoning with 80% power at the 5% significance level. Secondary outcomes will include the incidence of all pesticide poisoning and total self-harm. Discussion This paper describes a large effectiveness study of a community intervention to reduce the burden of intentional poisoning in rural Sri Lanka. The study builds on a strong partnership between provincial health services, local and international researchers, and local communities. We discuss issues in relation to randomisation and contamination, engaging control villages, the intervention, and strategies to improve adherence. Trial Registritation The trial is registered on ClinicalTrials.gov ref: NCT1146496 (http://clinicaltrialsfeeds.org/clinical-trials/show/NCT01146496). PMID:22104027

The Business Case for Provider Participation in Clinical Trials Research: An Application to the National Cancer Institute's Community Clinical Oncology Program

PubMed Central

Song, Paula H.; Reiter, Kristin L.; Weiner, Bryan J.; Minasian, Lori; McAlearney, Ann Scheck

2012-01-01

Background Provider-based research networks (PBRNs) make clinical trials available in community-based practice settings, where most people receive their care, but provider participation requires both financial and in-kind contributions. Purpose This study explores whether providers believe there is a business case for participating in PBRNs and what factors contribute to the business case. Methodology/Approach We use a multiple case study methodology approach to examine the National Cancer Institute's Community Clinical Oncology Program, a longstanding federally funded PBRN. Interviews with 41 key informants across five sites, selected on the basis of organizational maturity, were conducted using a semi-structured interview guide. We analyzed interview transcripts using an iterative, deductive process to identify themes and subthemes in the data. Findings We found that a business case for provider participation in PBRNs may exist if both direct and indirect financial benefits are identified and included in the analysis, and if the time horizon is long enough to allow those benefits to be realized. We identified specific direct and indirect financial benefits that were perceived as important contributors to the business case and the perceived length of time required for a positive return to accrue. Practice Implications As the lack of a business case may result in provider reluctance to participate in PBRNs, knowledge of the benefits we identified may be crucial to encouraging and sustaining participation, thereby preserving patient access to innovative community-based treatments. The results are also relevant to federally-funded PBRNs outside of oncology or to providers considering participation in any clinical trials research. PMID:23044836

Effect of interventions on children's blood lead levels.

PubMed Central

Hilts, S R; Bock, S E; Oke, T L; Yates, C L; Copes, R A

1998-01-01

Trail, Canada, has been the site of an active lead/zinc smelter for nearly a century. Since 1991, the Trail Community Lead Task Force has carried out blood lead screening, case management, education programs targeted at early childhood groups and the general community, community dust abatement, exposure pathways studies, and remedial trials. From 1989 through 1996, average blood lead levels of children tested for the first time declined at an average rate of 0.6 microg/dl/year, while blood lead levels in Canadian children not living near point sources appeared to be leveling off following the phase-out of leaded gasoline. Since there was no concurrent improvement in local environmental conditions during this time, it is possible that the continuing decline in Trail blood lead levels has been at least partly due to community-wide intervention programs. One year follow-up of children whose families received in-home educational visits, as well as assistance with home-based dust control measures, found that these specific interventions produced average blood lead changes of +0.5- -4.0 microg/dl, with statistically significant declines in 3 years out of 5. Education and dust control, particularly actions targeted toward higher risk children, appear to have served as effective and appropriate interim remedial measures while major source control measures have been implemented at the smelter site. Images Figure 1 Figure 2 PMID:9435149

Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

PubMed Central

Griffiths, Karolina; Banjara, Megha Raj; O'Dempsey, T.; Munslow, B.; Kroeger, Axel

2013-01-01

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. PMID:23690789

Assessment of a Leishmaniasis Reporting System in Tropical Bolivia Using the Capture-Recapture Method.

PubMed

Eid, Daniel; Guzman-Rivero, Miguel; Rojas, Ernesto; Goicolea, Isabel; Hurtig, Anna-Karin; Illanes, Daniel; San Sebastian, Miguel

2018-01-01

This study evaluates the level of underreporting of the National Program of Leishmaniasis Control (NPLC) in two communities of Cochabamba, Bolivia during the period 2013-2014. Montenegro skin test-confirmed cases of cutaneous leishmaniasis (CL) were identified through active surveillance during medical campaigns. These cases were compared with those registered in the NPLC by passive surveillance. After matching and cleaning data from the two sources, the total number of cases and the level of underreporting of the National Program were calculated using the capture-recapture analysis. This estimated that 86 cases of CL (95% confidence interval [CI]: 62.1-110.8) occurred in the study period in both communities. The level of underreporting of the NPLC in these communities was very high: 73.4% (95% CI: 63.1-81.5%). These results can be explained by the inaccessibility of health services and centralization of the NPLC activities. This information is important to establish priorities among policy-makers and funding organizations as well as implementing adequate intervention plans.

Adoption and sustained use of cleaner cooking fuels in rural India: a case control study protocol to understand household, network, and organizational drivers.

PubMed

Kumar, Praveen; Dhand, Amar; Tabak, Rachel G; Brownson, Ross C; Yadama, Gautam N

2017-01-01

Implementing efficient stoves and clean fuels in low and middle-income countries are critical for improving health of poor women and children and improve the environment. Cleaner biomass stoves, however, perform poorly against the World Health Organization's indoor air quality guidelines. This has shifted the focus to systematic dissemination and implementation of cleaner cooking systems such as liquefied petroleum gas (LPG) among poor communities. Even when there is some uptake of LPG by poor communities, its sustained use has been low. Concurrent use of LPG with traditional biomass cookstoves compromises reductions in household air pollution and limits health and environmental dividends. Therefore understanding key drivers of adoption and sustained implementation of clean fuels among the poor is critical. There is a significant gap, however, in the research to understand determinants and sustained exclusive use of clean fuels in rural poor communities. Using a case control study design, this study will explore the impact of affordability, accessibility, and awareness on adoption and sustained use of LPG among rural poor communities of India. The study uses a multistage random sampling to collect primary data from 510 households. Case group or LPG adopters constitute 255 households while control group or non-LPG adopters constitute the remaining 255 households. The study will deploy sophisticated stove use monitoring sensors in each of the stoves in 100 case group households to monitor stove use and stacking behavior (using clean and traditional systems of cooking) of participants for 12 months. Moreover, this will be the first study to explore the impact of personal social networks striated by gender on LPG adoption. This study is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) implementation science evaluation framework. Lessons from this study will feed into a larger discussion on developing a pro-poor strategy to foster uptake and sustained use of cleaner cooking systems such as LPG. Understanding the determinants of adoption and sustained use of cleaner cooking systems through the RE-AIM framework will expand our insights on implementation of cleaner cooking systems among poor communities and will advance implementation science in the clean cooking sector. A thorough study of such implementation strategies is crucial to realize multiple UN Sustainable Development Goals on global health, climate change, and energy security.

Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery.

PubMed

Nguyen, Dao M; Bancroft, Elizabeth; Mascola, Laurene; Guevara, Ramon; Yasuda, Lori

2007-04-01

To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery. Case-control studies. A well-infant nursery in a nonteaching, community hospital. Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis. Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak 1, case infants (n=6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P=.01). In outbreak 2, case infants (n=5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114). Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.

Identification and selection of cases and controls in the Pneumonia Etiology Research for Child Health project.

PubMed

Deloria-Knoll, Maria; Feikin, Daniel R; Scott, J Anthony G; O'Brien, Katherine L; DeLuca, Andrea N; Driscoll, Amanda J; Levine, Orin S

2012-04-01

Methods for the identification and selection of patients (cases) with severe or very severe pneumonia and controls for the Pneumonia Etiology Research for Child Health (PERCH) project were needed. Issues considered include eligibility criteria and sampling strategies, whether to enroll hospital or community controls, whether to exclude controls with upper respiratory tract infection (URTI) or nonsevere pneumonia, and matching criteria, among others. PERCH ultimately decided to enroll community controls and an additional human immunodeficiency virus (HIV)-infected control group at high HIV-prevalence sites matched on age and enrollment date of cases; controls with symptoms of URTI or nonsevere pneumonia will not be excluded. Systematic sampling of cases (when necessary) and random sampling of controls will be implemented. For each issue, we present the options that were considered, the advantages and disadvantages of each, the rationale for the methods selected for PERCH, and remaining implications and limitations.

Retention of female volunteer community health workers in Dhaka urban slums: a case-control study.

PubMed

Alam, Khurshid; Tasneem, Sakiba; Oliveras, Elizabeth

2012-09-01

Volunteer community health workers (CHWs) are one approach to addressing the health workforce shortage in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in using female volunteer CHWs as core workers in its successful health programmes. After 25 years of implementing the CHW model in rural areas, BRAC is now using CHWs in urban slums of Dhaka through Manoshi, a community-based maternal and child health project. However, high dropout rates among CHWs in the slums suggested a need to better understand factors associated with their retention, and consequently recommend strategies for increasing their retention. This mixed-method study included a case-control design to assess factors relating to the retention of volunteer CHWs, and focus group discussions (FGDs) to explore solutions to problems. In total, 542 current and 146 dropout CHWs participated in the survey. Six FGDs were held with groups of current and groups of dropout CHWs. Financial incentives were the main factor linked to CHW retention. CHWs who joined with the expectation of income were almost twice as likely to remain as CHWs. This finding was reinforced by the inverse association between wealth quintile of the CHWs and retention; the poorest CHWs were significantly more likely to stay in the programme than the richest. However, social prestige, community approval and household responsibilities were important non-financial factors associated with CHW retention. Restructuring and expansion of existing financial incentives to better compensate CHWs were recommended by CHWs to improve their retention. Factors found to be important in this study are similar to those from earlier studies in rural areas. While the data indicate that financial incentives are the most commonly discussed factor regarding CHW retention in urban slums, the results also suggest other avenues that could be strengthened to improve their retention.

Combined effects of 19 common variations on type 2 diabetes in Chinese: results from two community-based studies.

PubMed

Xu, Min; Bi, Yufang; Xu, Yu; Yu, Bing; Huang, Yun; Gu, Lina; Wu, Yaohua; Zhu, Xiaolin; Li, Mian; Wang, Tiange; Song, Aiyun; Hou, Jianing; Li, Xiaoying; Ning, Guang

2010-11-17

Many susceptible loci for type 2 diabetes mellitus (T2DM) have recently been identified from Caucasians through genome wide association studies (GWAS). We aimed to determine the association of 11 known loci with T2DM and impaired glucose regulation (IGR), individually and in combination, in Chinese. Subjects were enrolled in: (1) a case-control study including 1825 subjects with T2DM, 1487 with IGR and 2200 with normal glucose regulation; and (2) a prospective cohort with 734 non-diabetic subjects at baseline. The latter was followed up for 3.5 years, in which 67 subjects developed T2DM. Nineteen single nucleotide polymorphisms (SNPs) were selected to replicate in both studies. We found that CDKAL1 (rs7756992), SLC30A8 (rs13266634, rs2466293), CDKN2A/2B (rs10811661) and KCNQ1 (rs2237892) were associated with T2DM with odds ratio from 1.21 to 1.35. In the prospective study, the fourth quartile of risk scores based on the combined effects of the risk alleles had 3.05 folds (95% CI, 1.31-7.12) higher risk for incident T2DM as compared with the first quartile, after adjustment for age, gender, body mass index and diabetes family history. This combined effect was confirmed in the case-control study after the same adjustments. The addition of the risk scores to the model of clinical risk factors modestly improved discrimination for T2DM by 1.6% in the case-control study and 2.9% in the prospective study. Our study provided further evidence for these GWAS derived SNPs as the genetic susceptible loci for T2DM in Chinese and extended this association to IGR.

Risk factors for syphilis infection among pregnant women: results of a case‐control study in Shenzhen, China

PubMed Central

Zhou, Hua; Chen, Xiang‐Sheng; Hong, Fu‐Chang; Pan, Peng; Yang, Fan; Cai, Yu‐Mao; Yin, Yue‐Ping; Peeling, Rosanna W; Mabey, David

2007-01-01

Background China has been experiencing a rapidly growing syphilis epidemic since the early 1990s, with the reported incidence of congenital syphilis increasing from 0.01 cases per 100 000 live births in 1991 to 19.7 cases per 100 000 live births in 2005. Detailed studies of risk factors for syphilis in pregnant women are needed to inform new preventive interventions. Objective To investigate factors associated with recent syphilis infection among pregnant women and recommend strategies for improved preventive interventions in the community. Methods A case–control study was conducted among women attending antenatal clinics in Shenzhen City, South China. Cases were antenatal clinic women testing positive for early syphilis, based on laboratory results, with those testing negative being controls. All participants completed the same anonymous questionnaire covering demographics, lifestyle, sexual behaviour, and sexual partnerships. Results 129 cases and 345 controls were recruited. Syphilis was significantly associated with unmarried status, less education, multiple sex partners, travel of sex partner in the past 12 months, a history of induced abortion, and previous sexually transmitted infections. Overall, there were no differences between syphilis‐positive and negative women in household registration status (hukou), living district and duration in Shenzhen, monthly income, and age at first sex. Conclusions Many demographic and behavioural risk factors are associated with syphilis among pregnant women. In the government congenital syphilis control programme, comprehensive preventive interventions should be provided in all clinical settings in addition to the current procedures for syphilis screening among antenatal women. PMID:17675391

Comparative Study on the Characteristics of Community-Based Tourism between Pentingsari and Nglanggeran Tourism Village, Special Region Yogyakarta

NASA Astrophysics Data System (ADS)

Purbasari, Novia; Manaf, Asnawi

2018-02-01

Community-based tourism is one of the tourism development models that effectively used as a tool to alleviate poverty through empowerment strategy of the local community. Nevertheless, many people do not have adequate understanding on the characteristics of community-based tourism, which are used as a determinant in the tourism development. This article describes the comparison on characteristics of community-based tourism between Pentingsari and Nglanggeran. These villages were chosen because Pentingsari was a tourism village that able to apply the principles ethical codes of world tourism, shown by an award from the World Committee on Tourism Ethics Code and Nglanggeran was awarded as Best Tourism Village award in Indonesia from ASEAN Community Based Tourism Award 2017.The objectives of this study is to explore the characteristics of community-based tourism applied in the Pentingsari and Nglanggeran, and to identify any indicators that could be used to indicate those characteristics. The research achieves through in-depth interviews, observation, and review of documents. There were 17 persons as informants. Further, the observation was reached by directly observing in the both study cases. In addition, the data obtained through the review of secondary data from the local manager of tourism village. Generally, Pentingsari has characteristics as a community-based rural tourism, while Nglanggeran has characteristics as community-based ecotourism.

Combining matched and unmatched control groups in case-control studies.

PubMed

le Cessie, Saskia; Nagelkerke, Nico; Rosendaal, Frits R; van Stralen, Karlijn J; Pomp, Elisabeth R; van Houwelingen, Hans C

2008-11-15

Multiple control groups in case-control studies are used to control for different sources of confounding. For example, cases can be contrasted with matched controls to adjust for multiple genetic or unknown lifestyle factors and simultaneously contrasted with an unmatched population-based control group. Inclusion of different control groups for a single exposure analysis yields several estimates of the odds ratio, all using only part of the data. Here the authors introduce an easy way to combine odds ratios from several case-control analyses with the same cases. The approach is based upon methods used for meta-analysis but takes into account the fact that the same cases are used and that the estimated odds ratios are therefore correlated. Two ways of estimating this correlation are discussed: sandwich methodology and the bootstrap. Confidence intervals for the pooled estimates and a test for checking whether the odds ratios in the separate case-control studies differ significantly are derived. The performance of the method is studied by simulation and by applying the methods to a large study on risk factors for thrombosis, the MEGA Study (1999-2004), wherein cases with first venous thrombosis were included with a matched control group of partners and an unmatched population-based control group.

Developing Tools for Community-Based Environmental Education for Migrant Children and Youth in Ghana

ERIC Educational Resources Information Center

Lawson, Elaine T.; Gordon, Christopher; Mensah, Adelina; Atipoe, Esinam

2015-01-01

This case study presents a detailed description of how community-based environmental education can be used to increase environment awareness and knowledge among migrant children and youth. Data was collected primarily from interviews and learning activities with 454 participants aged 11 to 19 years. The results show that children and youth are…

Dispersed or clustered housing for adults with intellectual disability: a systematic review.

PubMed

Mansell, Jim; Beadle-Brown, Julie

2009-12-01

The purpose of this review was to evaluate the available research on the quality and costs of dispersed community-based housing when compared with clustered housing. Searches against specified criteria yielded 19 papers based on 10 studies presenting data comparing dispersed housing with some kind of clustered housing (village communities, residential campuses, or clusters of houses). The studies reported the experience of nearly 2,500 people from four different countries. In five of eight quality of life domains there were no studies reporting benefits of clustered settings. In respect of interpersonal relations, emotional, and physical well-being, clustered settings had some advantages. However, in many of these cases the better results refer only to village communities and not to campus housing or clustered housing. In terms of costs, clustered housing was usually less expensive because of lower staffing levels. In two of the three studies that examined costs controlling for user characteristics, there was no statistically significant difference. Dispersed housing appears to be superior to clustered housing on the majority of quality indicators studied. The only exception to this is that village communities for people with less severe disabilities have some benefits; this is not, however, a model which can be feasibly provided for everyone. Clustered housing is usually less expensive than dispersed housing but this is because it provides fewer staff hours per person. There is no evidence that clustered housing can deliver the same quality of life as dispersed housing at a lower cost.

Cultivating nature-based solutions: The governance of communal urban gardens in the European Union.

PubMed

van der Jagt, Alexander P N; Szaraz, Luca R; Delshammar, Tim; Cvejić, Rozalija; Santos, Artur; Goodness, Julie; Buijs, Arjen

2017-11-01

In many countries in the European Union (EU), the popularity of communal urban gardening (CUG) on allotments and community gardens is on the rise. Given the role of this practice in increasing urban resilience, most notably social resilience, municipalities in the Global North are promoting CUG as a nature-based solution (NbS). However, the mechanisms by which institutional actors can best support and facilitate CUG are understudied, which could create a gap between aspiration and reality. The aim of this study is therefore to identify what governance arrangements contribute to CUG delivering social resilience. Through the EU GREEN SURGE project, we studied six CUG initiatives from five EU-countries, representing different planning regimes and traditions. We selected cases taking a locally unique or innovative approach to dealing with urban challenges. A variety of actors associated with each of the cases were interviewed to achieve as complete a picture as possible regarding important governance arrangements. A cross-case comparison revealed a range of success factors, varying from clearly formulated objectives and regulations, municipal support, financial resources and social capital through to the availability of local food champions and facilitators engaging in community building. Municipalities can support CUG initiatives by moving beyond a rigid focus on top-down control, while involved citizens can increase the impact of CUG by pursuing political, in addition to hands-on, activities. We conclude that CUG has clear potential to act as a nature-based solution if managed with sensitivity to local dynamics and context. Copyright © 2017 Elsevier Inc. All rights reserved.

Look Local: The Value of Cancer Surveillance and Reporting by American Indian Clinics

PubMed Central

Creswell, Paul D.; Stephenson, Laura; Pierce-Hudson, Kimmine; Matloub, Jacqueline; Waukau, Jerry; Adams, Alexandra; Kaur, Judith; Remington, Patrick L.

2013-01-01

Introduction Cancer incidence and mortality rates for American Indians in the Northern Plains region of the United States are among the highest in the nation. Reliable cancer surveillance data are essential to help reduce this burden; however, racial data in state cancer registries are often misclassified, and cases are often underreported. Methods We used a community-based participatory research approach to conduct a retrospective ascertainment of cancer cases in clinic medical records over a 9-year period (1995–2003) and compared the results with the state cancer registry to evaluate missing or racially misclassified cases. Six tribal and/or urban Indian clinics participated in the study. The project team consisted of participating clinics, a state cancer registry, a comprehensive cancer center, an American Indian/Alaska Native Leadership Initiative on Cancer, and a set of diverse organizational partners. Clinic personnel were trained by project staff to accurately identify cancer cases in clinic records. These records were then matched with the state cancer registry to assess misclassification and underreporting. Results Forty American Indian cases were identified that were either missing or misclassified in the state registry. Adding these cases to the registry increased the number of American Indian cases by 21.3% during the study period (P = .05). Conclusions Our results indicate that direct reporting of cancer cases by tribal and urban Indian health clinics to a state cancer registry improved the quality of the data available for cancer surveillance. Higher-quality data can advance the efforts of cancer prevention and control stakeholders to address disparities in Native communities. PMID:24286271

Look local: the value of cancer surveillance and reporting by American Indian clinics.

PubMed

Creswell, Paul D; Strickland, Rick; Stephenson, Laura; Pierce-Hudson, Kimmine; Matloub, Jacqueline; Waukau, Jerry; Adams, Alexandra; Kaur, Judith; Remington, Patrick L

2013-11-27

Cancer incidence and mortality rates for American Indians in the Northern Plains region of the United States are among the highest in the nation. Reliable cancer surveillance data are essential to help reduce this burden; however, racial data in state cancer registries are often misclassified, and cases are often underreported. We used a community-based participatory research approach to conduct a retrospective ascertainment of cancer cases in clinic medical records over a 9-year period (1995-2003) and compared the results with the state cancer registry to evaluate missing or racially misclassified cases. Six tribal and/or urban Indian clinics participated in the study. The project team consisted of participating clinics, a state cancer registry, a comprehensive cancer center, an American Indian/Alaska Native Leadership Initiative on Cancer, and a set of diverse organizational partners. Clinic personnel were trained by project staff to accurately identify cancer cases in clinic records. These records were then matched with the state cancer registry to assess misclassification and underreporting. Forty American Indian cases were identified that were either missing or misclassified in the state registry. Adding these cases to the registry increased the number of American Indian cases by 21.3% during the study period (P = .05). Our results indicate that direct reporting of cancer cases by tribal and urban Indian health clinics to a state cancer registry improved the quality of the data available for cancer surveillance. Higher-quality data can advance the efforts of cancer prevention and control stakeholders to address disparities in Native communities.

Rethinking sources of representative controls for the conduct of case–control studies in minority populations

PubMed Central

2013-01-01

Background Recruitment of controls remains a challenge in case–control studies and particularly in studies involving minority populations. Methods We compared characteristics of controls recruited through random digit dialing (RDD) to those of community controls enrolled through churches, health events and other outreach sources among women of African ancestry (AA) participating in the Women’s Circle of Health Study, a case–control study of breast cancer. Odds ratios and 95% confidence intervals were also computed using unconditional logistic regression to evaluate the impact of including the community controls for selected variables relevant to breast cancer and for which there were significant differences in distribution between the two control groups. Results Compared to community controls (n=347), RDD controls (n=207) had more years of education and higher income, lower body mass index, were more likely to have private insurance, and less likely to be single. While the percentage of nulliparous women in the two groups was similar, community controls tended to have more children, have their first child at a younger age, and were less likely to breastfeed their children. Dietary intake was similar in the two groups. Compared to census data, the combination of RDD and community controls seems to be more representative of the general population than RDD controls alone. Furthermore, the inclusion of the community group had little impact on the magnitude of risk estimates for most variables, while enhancing statistical power. Conclusions Community-based recruitment was found to be an efficient and feasible method to recruit AA controls. PMID:23721229

Computers and the internet: tools for youth empowerment.

PubMed

Valaitis, Ruta K

2005-10-04

Youth are often disenfranchised in their communities and may feel they have little voice. Since computers are an important aspect of youth culture, they may offer solutions to increasing youth participation in communities. This qualitative case study investigated the perceptions of 19 (predominantly female) inner-city school youth about their use of computers and the Internet in a school-based community development project. Youth working with public health nurses in a school-based community development project communicated with local community members using computer-mediated communication, surveyed peers online, built websites, searched for information online, and prepared project materials using computers and the Internet. Participant observation, semistructured interviews, analysis of online messages, and online- and paper-based surveys were used to gather data about youth's and adults' perceptions and use of the technologies. Constant comparison method and between-method triangulation were used in the analysis to satisfy the existence of themes. Not all youth were interested in working with computers. Some electronic messages from adults were perceived to be critical, and writing to adults was intimidating for some youth. In addition, technical problems were experienced. Despite these barriers, most youth perceived that using computers and the Internet reduced their anxiety concerning communication with adults, increased their control when dealing with adults, raised their perception of their social status, increased participation within the community, supported reflective thought, increased efficiency, and improved their access to resources. Overall, youth perceived computers and the Internet to be empowering tools, and they should be encouraged to use such technology to support them in community initiatives.

Computers and the Internet: Tools for Youth Empowerment

PubMed Central

2005-01-01

Background Youth are often disenfranchised in their communities and may feel they have little voice. Since computers are an important aspect of youth culture, they may offer solutions to increasing youth participation in communities. Objective This qualitative case study investigated the perceptions of 19 (predominantly female) inner-city school youth about their use of computers and the Internet in a school-based community development project. Methods Youth working with public health nurses in a school-based community development project communicated with local community members using computer-mediated communication, surveyed peers online, built websites, searched for information online, and prepared project materials using computers and the Internet. Participant observation, semistructured interviews, analysis of online messages, and online- and paper-based surveys were used to gather data about youth’s and adults’ perceptions and use of the technologies. Constant comparison method and between-method triangulation were used in the analysis to satisfy the existence of themes. Results Not all youth were interested in working with computers. Some electronic messages from adults were perceived to be critical, and writing to adults was intimidating for some youth. In addition, technical problems were experienced. Despite these barriers, most youth perceived that using computers and the Internet reduced their anxiety concerning communication with adults, increased their control when dealing with adults, raised their perception of their social status, increased participation within the community, supported reflective thought, increased efficiency, and improved their access to resources. Conclusions Overall, youth perceived computers and the Internet to be empowering tools, and they should be encouraged to use such technology to support them in community initiatives. PMID:16403715

Albendazole and ivermectin for the control of soil-transmitted helminths in an area with high prevalence of Strongyloides stercoralis and hookworm in northwestern Argentina: A community-based pragmatic study.

PubMed

Echazú, Adriana; Juarez, Marisa; Vargas, Paola A; Cajal, Silvana P; Cimino, Ruben O; Heredia, Viviana; Caropresi, Silvia; Paredes, Gladys; Arias, Luis M; Abril, Marcelo; Gold, Silvia; Lammie, Patrick; Krolewiecki, Alejandro J

2017-10-01

Recommendations for soil-transmitted helminth (STH) control give a key role to deworming of school and pre-school age children with albendazole or mebendazole; which might be insufficient to achieve adequate control, particularly against Strongyloides stercoralis. The impact of preventive chemotherapy (PC) against STH morbidity is still incompletely understood. The aim of this study was to assess the effectiveness of a community-based program with albendazole and ivermectin in a high transmission setting for S. stercoralis and hookworm. Community-based pragmatic trial conducted in Tartagal, Argentina; from 2012 to 2015. Six communities (5070 people) were enrolled for community-based PC with albendazole and ivermectin. Two communities (2721 people) were re-treated for second and third rounds. STH prevalence, anemia and malnutrition were explored through consecutive surveys. Anthropometric assessment of children, stool analysis, complete blood count and NIE-ELISA serology for S. stercoralis were performed. STH infection was associated with anemia and stunting in the baseline survey that included all communities and showed a STH prevalence of 47.6% (almost exclusively hookworm and S. stercoralis). Among communities with multiple interventions, STH prevalence decreased from 62% to 23% (p<0.001) after the first PC; anemia also diminished from 52% to 12% (p<0.001). After two interventions S. stercoralis seroprevalence declined, from 51% to 14% (p<0.001) and stunting prevalence decreased, from 19% to 12% (p = 0.009). Hookworm' infections are associated with anemia in the general population and nutritional impairment in children. S. stercoralis is also associated with anemia. Community-based deworming with albendazole and ivermectin is effective for the reduction of STH prevalence and morbidity in communities with high prevalence of hookworm and S. stercoralis.

Systematic Review of Community-Based Childhood Obesity Prevention Studies

PubMed Central

Segal, Jodi; Wu, Yang; Wilson, Renee; Wang, Youfa

2013-01-01

OBJECTIVE: This study systematically reviewed community-based childhood obesity prevention programs in the United States and high-income countries. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library for relevant English-language studies. Studies were eligible if the intervention was primarily implemented in the community setting; had at least 1 year of follow-up after baseline; and compared results from an intervention to a comparison group. Two independent reviewers conducted title scans and abstract reviews and reviewed the full articles to assess eligibility. Each article received a double review for data abstraction. The second reviewer confirmed the first reviewer’s data abstraction for completeness and accuracy. RESULTS: Nine community-based studies were included; 5 randomized controlled trials and 4 non–randomized controlled trials. One study was conducted only in the community setting, 3 were conducted in the community and school setting, and 5 were conducted in the community setting in combination with at least 1 other setting such as the home. Desirable changes in BMI or BMI z-score were found in 4 of the 9 studies. Two studies reported significant improvements in behavioral outcomes (1 in physical activity and 1 in vegetable intake). CONCLUSIONS: The strength of evidence is moderate that a combined diet and physical activity intervention conducted in the community with a school component is more effective at preventing obesity or overweight. More research and consistent methods are needed to understand the comparative effectiveness of childhood obesity prevention programs in the community setting. PMID:23753099

Active local control of propeller-aircraft run-up noise.

PubMed

Hodgson, Murray; Guo, Jingnan; Germain, Pierre

2003-12-01

Engine run-ups are part of the regular maintenance schedule at Vancouver International Airport. The noise generated by the run-ups propagates into neighboring communities, disturbing the residents. Active noise control is a potentially cost-effective alternative to passive methods, such as enclosures. Propeller aircraft generate low-frequency tonal noise that is highly compatible with active control. This paper presents a preliminary investigation of the feasibility and effectiveness of controlling run-up noise from propeller aircraft using local active control. Computer simulations for different configurations of multi-channel active-noise-control systems, aimed at reducing run-up noise in adjacent residential areas using a local-control strategy, were performed. These were based on an optimal configuration of a single-channel control system studied previously. The variations of the attenuation and amplification zones with the number of control channels, and with source/control-system geometry, were studied. Here, the aircraft was modeled using one or two sources, with monopole or multipole radiation patterns. Both free-field and half-space conditions were considered: for the configurations studied, results were similar in the two cases. In both cases, large triangular quiet zones, with local attenuations of 10 dB or more, were obtained when nine or more control channels were used. Increases of noise were predicted outside of these areas, but these were minimized as more control channels were employed. By combining predicted attenuations with measured noise spectra, noise levels after implementation of an active control system were estimated.

The business case for payer support of a community-based health information exchange: a humana pilot evaluating its effectiveness in cost control for plan members seeking emergency department care.

PubMed

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R

2011-07-01

As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.

Platelet aggregation inhibitors, vitamin K antagonists and risk of subarachnoid hemorrhage.

PubMed

Risselada, R; Straatman, H; van Kooten, F; Dippel, D W J; van der Lugt, A; Niessen, W J; Firouzian, A; Herings, R M C; Sturkenboom, M C J M

2011-03-01

Use of platelet aggregation inhibitors and vitamin K antagonists has been associated with an increased risk of intracranial hemorrhage (ICH). Whether the use of these antithrombotic drugs is associated with an increased risk of subarachnoid hemorrhage (SAH) remains unclear, especially as confounding by indication might play a role. The aim of the present study was to investigate whether use of platelet aggregation inhibitors or vitamin K antagonists increase the risk of SAH. We applied population-based case-control, case-crossover and case-time-control designs to estimate the risk of SAH while addressing issues both of confounding by indication and time varying exposure within the PHARMO Record Linkage System database. This system includes drug dispensing records from community pharmacies and hospital discharge records of more than 3 million community-dwelling inhabitants in the Netherlands. Patients were considered a case if they were hospitalized for a first SAH (ICD-9-CM code 430) in the period between 1st January 1998 and 31st December 2006. Controls were selected from the source population, matched on age, gender and date of hospitalization. Conditional logistic regression was used to estimate multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of SAH during use of platelet aggregation inhibitors or vitamin K antagonists. In the case-crossover and case-time-control designs we selected 11 control periods preceding the index date in successive steps of 1 month in the past. In all, 1004 cases of SAH were identified. In the case-control analysis the adjusted OR for the risk of SAH in current use of platelet aggregation inhibitors was 1.32 (95% CI: 1.02-1.70) and in current use of vitamin K antagonists 1.29 (95% CI: 0.89-1.87) compared with no use. In the case-crossover analysis the ORs for the risk of SAH in current use of platelet aggregation inhibitors and vitamin K antagonists were 1.04 (95% CI: 0.56-1.94) and 2.46 (95% CI: 1.04-5.82), respectively. In the case-time-control analysis the OR for platelet aggregation inhibitors was 0.50 (95% CI: 0.26-0.98) and for vitamin K antagonists 1.98 (95% CI: 0.82-4.76). The use of platelet aggregation inhibitors was not associated with an increased SAH risk; the modest increase observed in the case-control analysis could be as a result of confounding. The use of vitamin K antagonists seemed to be associated with an increased risk of SAH. The increase was most pronounced in the case-crossover analysis and therefore cannot be explained by unmeasured confounding. © 2011 International Society on Thrombosis and Haemostasis.

Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers.

PubMed

Rodrigo, Shelly; Sinclair, Martha; Cunliffe, David; Leder, Karin

2009-07-16

Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies.

Measuring local depletion of terrestrial game vertebrates by central-place hunters in rural Amazonia.

PubMed

Abrahams, Mark I; Peres, Carlos A; Costa, Hugo C M

2017-01-01

The degree to which terrestrial vertebrate populations are depleted in tropical forests occupied by human communities has been the subject of an intense polarising debate that has important conservation implications. Conservation ecologists and practitioners are divided over the extent to which community-based subsistence offtake is compatible with ecologically functional populations of tropical forest game species. To quantify depletion envelopes of forest vertebrates around human communities, we deployed a total of 383 camera trap stations and 78 quantitative interviews to survey the peri-community areas controlled by 60 semi-subsistence communities over a combined area of over 3.2 million hectares in the Médio Juruá and Uatumã regions of Central-Western Brazilian Amazonia. Our results largely conform with prior evidence that hunting large-bodied vertebrates reduces wildlife populations near settlements, such that they are only found at a distance to settlements where they are hunted less frequently. Camera trap data suggest that a select few harvest-sensitive species, including lowland tapir, are either repelled or depleted by human communities. Nocturnal and cathemeral species were detected relatively more frequently in disturbed areas close to communities, but individual species did not necessarily shift their activity patterns. Group biomass of all species was depressed in the wider neighbourhood of urban areas rather than communities. Interview data suggest that species traits, especially group size and body mass, mediate these relationships. Large-bodied, large-group-living species are detected farther from communities as reported by experienced informants. Long-established communities in our study regions have not "emptied" the surrounding forest. Low human population density and low hunting offtake due to abundant sources of alternative aquatic protein, suggest that these communities represent a best-case scenario for sustainable hunting of wildlife for food, thereby providing a conservative assessment of game depletion. Given this 'best-case' camera trap and interview-based evidence for hunting depletion, regions with higher human population densities, external trade in wildlife and limited access to alternative protein will likely exhibit more severe depletion.

[Knowledge, attitudes and community practice during an outbreak of dengue in a town in Colombia, 2010].

PubMed

Castañeda, Oneida; Segura, Omar; Ramírez, Alba N

2011-06-01

17 cases of dengue were reported from the town of El Playón (7°28'15"-N/73°12'00"-W/altitude 510 masl) during epidemiological study weeks 5-6 and 12-13/2010. The Santander Department's Health Secretariat sought outbreak investigation and community knowledge-attitudes-practice (KAP) assessment on 16-4-2010 concerning a dengue fever outbreak in the town after an epidemiological surveillance committee had met; this was to strengthen local action regarding Aedes aegypti vector promotion-prevention-control. This was a descriptive outbreak investigation study using an active search for cases having clinical manifestations of dengue according to protocol definitions, an entomological survey and a KAP survey of 47 people selected by simple-random-sampling. Data was systematised and analysed using Epi-INFO (3.5.1) with measures of central tendency-male ratio, in-house Aegypti (IA), water-storage (WI) and Breatau (BI) indexes. 4,774 clinical records were examined. There were 67 records compatible with dengue, 24 cases were notified (75 % town-25 % department), 15 (63 %) being women and 9 (38 %) men. 20 (83 %) cases occurred in the urban area and 4 (17 %) in rural areas. Attack rate/cumulated incidence: initial=0.3 % (17/6 303), final=0.4 % (24/6 303), male ratio=1.5. 47 houses and 142 water-storage items proved positive: low water-stores=8.7 %(4/46), rubber tyres=8.3 %(1/12), others=4.4 %(2/45), plants=2.9 %(1/34). IA=5 %, WI=6%, BI=17%, taxonomy confirmed=15 %(7/47). 47 KAP, 36 (77 %) women, 11 (23 %) men; knowledge on disease, symptoms and signs 44 (94 %), eliminating larvae deposits 32(68 %), asked about dengue 3(6 %), informed about responsibilities related to control 25(53 %). The local community knows about risk factors and is aware of its responsibility regarding vector control. Community participation should be promoted using the ecosystem as a strategy for mosquito and dengue transmission control.

Vector control programs in Saint Johns County, Florida and Guayas, Ecuador: successes and barriers to integrated vector management.

PubMed

Naranjo, Diana P; Qualls, Whitney A; Jurado, Hugo; Perez, Juan C; Xue, Rui-De; Gomez, Eduardo; Beier, John C

2014-07-02

Vector-borne diseases (VBDs) and mosquito control programs (MCPs) diverge in settings and countries, and lead control specialists need to be aware of the most effective control strategies. Integrated Vector Management (IVM) strategies, once implemented in MCPs, aim to reduce cost and optimize protection of the populations against VBDs. This study presents a strengths, weaknesses, opportunities, and threats (SWOT) analysis to compare IVM strategies used by MCPs in Saint Johns County, Florida and Guayas, Ecuador. This research evaluates MCPs strategies to improve vector control activities. Methods included descriptive findings of the MCP operations. Information was obtained from vector control specialists, directors, and residents through field trips, surveys, and questionnaires. Evaluations of the strategies and assets of the control programs where obtained through SWOT analysis and within an IVM approach. Organizationally, the Floridian MCP is a tax-based District able to make decisions independently from county government officials, with the oversight of an elected board of commissioners. The Guayas program is directed by the country government and assessed by non-governmental organizations like the World health Organization. Operationally, the Floridian MCP conducts entomological surveillance and the Ecuadorian MCP focuses on epidemiological monitoring of human disease cases. Strengths of both MCPs were their community participation and educational programs. Weaknesses for both MCPs included limitations in budgets and technical capabilities. Opportunities, for both MCPs, are additional funding and partnerships with private, non-governmental, and governmental organizations. Threats experienced by both MCPs included political constraints and changes in the social and ecological environment that affect mosquito densities and control efforts. IVM pillars for policy making were used to compare the information among the programs. Differences included how the Ecuadorian MCP relies heavily on the community for vector control while the American MCP relies on technologies and research. IVM based recommendations direct health policy leaders toward improving surveillance systems both entomologically and epidemiologically, improving community risk perceptions by integrating components of community participation, maximizing resources though the use of applied research, and protecting the environment by selecting low-risk pesticides. Outcomes of the research revealed that inter-sectorial and multidisciplinary interventions are critical to improve public health.

The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention.

PubMed

McKay, Virginia R; Margaret Dolcini, M; Hoffer, Lee D

2017-12-01

Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.

The Global Enteric Multicenter Study (GEMS) of Diarrheal Disease in Infants and Young Children in Developing Countries: Epidemiologic and Clinical Methods of the Case/Control Study

PubMed Central

Kotloff, Karen L.; Blackwelder, William C.; Nasrin, Dilruba; Nataro, James P.; Farag, Tamer H.; van Eijk, Annemieke; Adegbola, Richard A.; Alonso, Pedro L.; Breiman, Robert F.; Golam Faruque, Abu Syed; Saha, Debasish; Sow, Samba O.; Sur, Dipika; Zaidi, Anita K. M.; Biswas, Kousick; Panchalingam, Sandra; Clemens, John D.; Cohen, Dani; Glass, Roger I.; Mintz, Eric D.; Sommerfelt, Halvor; Levine, Myron M.

2012-01-01

Background. Diarrhea is a leading cause of illness and death among children aged <5 years in developing countries. This paper describes the clinical and epidemiological methods used to conduct the Global Enteric Multicenter Study (GEMS), a 3-year, prospective, age-stratified, case/control study to estimate the population-based burden, microbiologic etiology, and adverse clinical consequences of acute moderate-to-severe diarrhea (MSD) among a censused population of children aged 0–59 months seeking care at health centers in sub-Saharan Africa and South Asia. Methods. GEMS was conducted at 7 field sites, each serving a population whose demography and healthcare utilization practices for childhood diarrhea were documented. We aimed to enroll 220 MSD cases per year from selected health centers serving each site in each of 3 age strata (0–11, 12–23, and 24–59 months), along with 1–3 matched community controls. Cases and controls supplied clinical, epidemiologic, and anthropometric data at enrollment and again approximately 60 days later, and provided enrollment stool specimens for identification and characterization of potential diarrheal pathogens. Verbal autopsy was performed if a child died. Analytic strategies will calculate the fraction of MSD attributable to each pathogen and the incidence, financial costs, nutritional consequences, and case fatality overall and by pathogen. Conclusions. When completed, GEMS will provide estimates of the incidence, etiology, and outcomes of MSD among infants and young children in sub-Saharan Africa and South Asia. This information can guide development and implementation of public health interventions to diminish morbidity and mortality from diarrheal diseases. PMID:23169936

Metabolomic Analysis in Severe Childhood Pneumonia in The Gambia, West Africa: Findings from a Pilot Study

PubMed Central

Laiakis, Evagelia C.; Morris, Gerard A. J.; Fornace, Albert J.; Howie, Stephen R. C.

2010-01-01

Background Pneumonia remains the leading cause of death in young children globally and improved diagnostics are needed to better identify cases and reduce case fatality. Metabolomics, a rapidly evolving field aimed at characterizing metabolites in biofluids, has the potential to improve diagnostics in a range of diseases. The objective of this pilot study is to apply metabolomic analysis to childhood pneumonia to explore its potential to improve pneumonia diagnosis in a high-burden setting. Methodology/Principal Findings Eleven children with World Health Organization (WHO)-defined severe pneumonia of non-homogeneous aetiology were selected in The Gambia, West Africa, along with community controls. Metabolomic analysis of matched plasma and urine samples was undertaken using Ultra Performance Liquid Chromatography (UPLC) coupled to Time-of-Flight Mass Spectrometry (TOFMS). Biomarker extraction was done using SIMCA-P+ and Random Forests (RF). ‘Unsupervised’ (blinded) data were analyzed by Principal Component Analysis (PCA), while ‘supervised’ (unblinded) analysis was by Partial Least Squares-Discriminant Analysis (PLS-DA) and Orthogonal Projection to Latent Structures (OPLS). Potential markers were extracted from S-plots constructed following analysis with OPLS, and markers were chosen based on their contribution to the variation and correlation within the data set. The dataset was additionally analyzed with the machine-learning algorithm RF in order to address issues of model overfitting and markers were selected based on their variable importance ranking. Unsupervised PCA analysis revealed good separation of pneumonia and control groups, with even clearer separation of the groups with PLS-DA and OPLS analysis. Statistically significant differences (p<0.05) between groups were seen with the following metabolites: uric acid, hypoxanthine and glutamic acid were higher in plasma from cases, while L-tryptophan and adenosine-5′-diphosphate (ADP) were lower; uric acid and L-histidine were lower in urine from cases. The key limitation of this study is its small size. Conclusions/Significance Metabolomic analysis clearly distinguished severe pneumonia patients from community controls. The metabolites identified are important for the host response to infection through antioxidant, inflammatory and antimicrobial pathways, and energy metabolism. Larger studies are needed to determine whether these findings are pneumonia-specific and to distinguish organism-specific responses. Metabolomics has considerable potential to improve diagnostics for childhood pneumonia. PMID:20844590

Metabolomic analysis in severe childhood pneumonia in the Gambia, West Africa: findings from a pilot study.

PubMed

Laiakis, Evagelia C; Morris, Gerard A J; Fornace, Albert J; Howie, Stephen R C

2010-09-09

Pneumonia remains the leading cause of death in young children globally and improved diagnostics are needed to better identify cases and reduce case fatality. Metabolomics, a rapidly evolving field aimed at characterizing metabolites in biofluids, has the potential to improve diagnostics in a range of diseases. The objective of this pilot study is to apply metabolomic analysis to childhood pneumonia to explore its potential to improve pneumonia diagnosis in a high-burden setting. Eleven children with World Health Organization (WHO)-defined severe pneumonia of non-homogeneous aetiology were selected in The Gambia, West Africa, along with community controls. Metabolomic analysis of matched plasma and urine samples was undertaken using Ultra Performance Liquid Chromatography (UPLC) coupled to Time-of-Flight Mass Spectrometry (TOFMS). Biomarker extraction was done using SIMCA-P+ and Random Forests (RF). 'Unsupervised' (blinded) data were analyzed by Principal Component Analysis (PCA), while 'supervised' (unblinded) analysis was by Partial Least Squares-Discriminant Analysis (PLS-DA) and Orthogonal Projection to Latent Structures (OPLS). Potential markers were extracted from S-plots constructed following analysis with OPLS, and markers were chosen based on their contribution to the variation and correlation within the data set. The dataset was additionally analyzed with the machine-learning algorithm RF in order to address issues of model overfitting and markers were selected based on their variable importance ranking. Unsupervised PCA analysis revealed good separation of pneumonia and control groups, with even clearer separation of the groups with PLS-DA and OPLS analysis. Statistically significant differences (p<0.05) between groups were seen with the following metabolites: uric acid, hypoxanthine and glutamic acid were higher in plasma from cases, while L-tryptophan and adenosine-5'-diphosphate (ADP) were lower; uric acid and L-histidine were lower in urine from cases. The key limitation of this study is its small size. Metabolomic analysis clearly distinguished severe pneumonia patients from community controls. The metabolites identified are important for the host response to infection through antioxidant, inflammatory and antimicrobial pathways, and energy metabolism. Larger studies are needed to determine whether these findings are pneumonia-specific and to distinguish organism-specific responses. Metabolomics has considerable potential to improve diagnostics for childhood pneumonia.

Reach and Effectiveness of an Integrated Community-Based Intervention on Physical Activity and Healthy Eating of Older Adults in a Socioeconomically Disadvantaged Community

ERIC Educational Resources Information Center

Luten, Karla A.; Reijneveld, Sijmen A.; Dijkstra, Arie; de Winter, Andrea F.

2016-01-01

The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre-post quasi-experimental design, with 430…

Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers.

PubMed

Levinson, Arnold H; Valverde, Patricia; Garrett, Kathleen; Kimminau, Michele; Burns, Emily K; Albright, Karen; Flynn, Debra

2015-07-09

A majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates. A national research initiative seeks effective new strategies for increasing successful smoking cessation outcomes among SED populations. There is evidence that chronic and acute stressors may interfere with SED smokers who try to quit on their own. Patient navigators have been effectively used to improve adherence to chronic disease treatment. We designed and have pilot-tested an innovative, non-clinical community-based intervention--smoking cessation treatment navigators--to determine feasibility (acceptance, adherence, and uncontrolled results) for evaluation by randomized controlled trial (RCT). The intervention was developed for smokers among parents and other household members of inner city pre-school for low-income children. Smoking cessation treatment navigators were trained and deployed to help participants choose and adhere to evidence-based cessation treatment (EBCT). Navigators provided empathy, resource-linking, problem-solving, and motivational reinforcement. Measures included rates of study follow-up completion, EBCT utilization, navigation participation, perceived intervention quality, 7-day point abstinence and longest abstinence at three months. Both complete-case and intent-to-treat analyses were performed. Eighty-five percent of study participants (n = 40) completed final data collection. More than half (53%) enrolled in a telephone quitline and nearly three-fourths (71%) initiated nicotine replacement therapy. Participants completed a mean 3.4 navigation sessions (mean 30 min duration) and gave the intervention very high quality and satisfaction ratings. Self-reported abstinence was comparable to rates for evidence-based cessation strategies (21% among study completers, 18% using intent-to-treat analysis; median 21 days abstinent among relapsers). The pilot results suggest that smoking cessation treatment navigators are feasible to study in community settings and are well-accepted for increasing use of EBCT among low-income smokers. Randomized controlled trial for efficacy is warranted.

Epidemiology of rheumatic diseases in Mixtec and Chontal indigenous communities in Mexico: a cross-sectional community-based study.

PubMed

Julián-Santiago, Flor; García-García, Conrado; García-Olivera, Imelda; Goycochea-Robles, María Victoria; Pelaez-Ballestas, Ingris

2016-07-01

This study aimed to estimate the prevalence of musculoskeletal (MSK) disorders and rheumatic diseases in the Chontal and Mixtec indigenous communities in the state of Oaxaca, Mexico, using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology. After cross-culturally validating the COPCORD questionnaire for these communities, we conducted a cross-sectional, analytical, community-based census study using a house-to-house method. Positive cases of MSK disorders were assessed by primary care physicians and rheumatologists. The study population included participants aged ≥18 years from the indigenous communities of San Antonio Huitepec and San Carlos Yautepec. A total of 1061 persons participated in the study. Mean age was 46.9 years (standard deviation 19.9; age range 18-97 years); 642 (60.5 %) were women; 483 participants (45.5; 42.4-48.5 %) had MSK pain in the previous 7 days. Diagnoses were back pain 170 (16.0 %; 95 % confidence interval [CI] 13.8-18.3); osteoarthritis 157 (14.7 %; 95 % CI 12.7-17.0); rheumatic regional pain syndrome 53 (4.9 %; 95 % CI 3.7-6.4); rheumatoid arthritis 4 (0.3 %; 95 % CI 0.1-0.9); dermatomyositis 1 (0.09 %; 95 % CI 0.0-0.5); ankylosing spondylitis 1 (0.09 %; 95 % CI 0.0-0.5); systemic lupus erythematosus 1 (0.09 %; 95 % CI 0.02-0.5); and gout 1 (0.09 %; 95 % CI 0.0-0.5). 53.2 % had not received medical treatment for their disease. The prevalence of MSK disorders in indigenous communities in the Mixtec and Chontal regions is very high. The most common rheumatic diseases found were back pain and osteoarthritis. A high percentage of participants had not received medical care.

Epidemiological trends and the effect of airport fever screening on prevention of domestic dengue fever outbreaks in Taiwan, 1998-2007.

PubMed

Kuan, Mei-Mei; Lin, Ting; Chuang, Jen-Hsiang; Wu, Ho-Sheng

2010-08-01

This study aimed to examine the epidemiological trends in dengue infection and the impact of imported cases and airport fever screening on community transmission in Taiwan, a dengue non-endemic island. All of the dengue case data were obtained from the surveillance system of the Taiwan Center for Disease Control and were analyzed by Pearson correlations, linear regression, and geographical information system (GIS)-based mapping. The impact of implementing airport fever screening was evaluated using the Student's t-test and two-way analysis of variance. A total of 10 351 dengue cases, including 7.1% of imported cases were investigated between 1998 and 2007. The majority of indigenous dengue cases (98.5%) were significantly clustered in southern Taiwan; 62.9% occurred in the metropolitan areas. The seasonality of dengue cases showed a peak from September to November. Airport fever screening was successful in identifying 45% (244/542 ; 95% confidence interval 33.1-57.8%) of imported dengue cases with fever. However, no statistical difference was found regarding the impact on community transmission when comparing the presence and absence of airport fever screening. Our results show that airport fever screening had a positive effect on partially blocking the local transmission of imported dengue cases, while those undetected cases due to latent or asymptomatic infection would be the source of new dengue outbreaks each year. Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.

PubMed

Williams, Abimbola Onigbanjo; Makinde, Olusesan Ayodeji; Ojo, Mojisola

2016-01-01

Multidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR-TB patients in the 27 MDR-TB High burden countries (HBC). We searched PubMed, Cochrane, Lancet, Web of Science, International Journal of Tuberculosis and Lung Disease, and Centre for Reviews and Dissemination (CRD) for studies on community-based treatment and traditional hospitalization and MDR-TB and XDR-TB from the 27 MDR-TB HBC. Data on treatment success and failure rates were extracted from retrospective and prospective cohort studies, and a case control study. Sensitivity analysis, subgroup analyses, and meta-regression analysis were used to explore bias and potential sources of heterogeneity. The final sample included 16 studies involving 3344 patients from nine countries; Bangladesh, China, Ethiopia, Kenya, India, South Africa, Philippines, Russia, and Uzbekistan. Based on a random-effects model, we observed a higher treatment success rate in community-based treatment (Point estimate = 0.68, 95 % CI: 0.59 to 0.76, p  < 0.01) compared to traditional hospitalization (Point estimate = 0.57, 95 % CI: 0.44 to 0.69, p  < 0.01). A lower treatment failure rate was observed in community-based treatment 7 % (Point estimate = 0.07, 95 % CI: 0.03 to 0.10; p  < 0.01) compared to traditional hospitalization (Point estimate = 0.188, 95 % CI: 0.10 to 0.28; p  < 0.01). In the subgroup analysis, studies without HIV co-infected patients, directly observed therapy short course-plus (DOTS-Plus) implemented throughout therapy, treatment duration > 18 months, and regimen with drugs >5 reported higher treatment success rate. In the meta-regression model, age of patients, adverse events, treatment duration, and lost to follow up explains some of the heterogeneity of treatment effects between studies. Community-based management improved treatment outcomes. A mix of interventions with DOTS-Plus throughout therapy and treatment duration > 18 months as well as strategies in place for lost to follow up and adverse events should be considered in MDR-TB and XDR-TB interventions, as they influenced positively, treatment success.

Professional Learning Communities' Impact on Science Teacher Classroom Practice in a Midwestern Urban School District

ERIC Educational Resources Information Center

Carpenter, Dan

2012-01-01

The purpose of this reputation-based, multiple-site case study was to explore professional learning communities' impact on teacher classroom practice. The goal of this research was to describe the administrator and teachers' perceptions with respect to professional learning communities as it related to teacher practice in their school. Educators…

Developing a Culture of Assessment through a Faculty Learning Community: A Case Study

ERIC Educational Resources Information Center

Schlitz, Stephanie A.; O'Connor, Margaret; Pang, Yanhui; Stryker, Deborah; Markell, Stephen; Krupp, Ethan; Byers, Celina; Jones, Sheila Dove; Redfern, Alicia King

2009-01-01

This article describes how a diverse, interdisciplinary team of faculty formed a topic-based faculty learning community. Following an introduction to faculty learning communities and a brief discussion of their benefit to faculty engaged in the process of adopting new technology, we explain how our team, through a competitive mini-grant…

A Leap of Trust: Qualitative Research in a Musical Community of Practice

ERIC Educational Resources Information Center

Godwin, Louise

2014-01-01

This article explores the process of determining an approach to the analysis of qualitative data collected as part of a case study research project involving children and teenagers from a community of musical practice--an all ages community-based fiddle group in central Scotland. The researcher's overarching goal is to find ways to increase…

Traditions and Customs in Community Development: The Case of Nkanu West and Nkanu East Local Government Areas of Enugu State, Nigeria

ERIC Educational Resources Information Center

Adekola, G.; Egbo, Nwoye Charles

2016-01-01

This study examined the influence of traditions and customs on community development in Nkanu West and Nkanu East Local Government Areas of Enugu State. The study was carried out with three objectives and three null hypotheses. The research adopted descriptive survey design with a population of 2,125 members of community Based Organizations in the…

Ecology of the aging human brain.

PubMed

Sonnen, Joshua A; Santa Cruz, Karen; Hemmy, Laura S; Woltjer, Randall; Leverenz, James B; Montine, Kathleen S; Jack, Clifford R; Kaye, Jeffrey; Lim, Kelvin; Larson, Eric B; White, Lon; Montine, Thomas J

2011-08-01

Alzheimer disease, cerebral vascular brain injury, and isocortical Lewy body disease (LBD) are the major contributors to dementia in community- and population-based studies. To estimate the prevalence of clinically silent forms of these diseases in cognitively normal (CN) adults. Autopsy study. Community- and population based. A total of 1672 brain autopsies from the Adult Changes in Thought study, Honolulu-Asia Aging Study, Nun Study, and Oregon Brain Aging Study, of which 424 met the criteria for CN. Of these, 336 cases had a comprehensive neuropathologic examination of neuritic plaque density, Braak stage for neurofibrillary tangles, LB distribution, and number of cerebral microinfarcts. Forty-seven percent of CN cases had moderate or frequent neuritic plaque density; of these, 6% also had Braak stage V or VI for neurofibrillary tangles. Fifteen percent of CN cases had medullary LBD; 8% also had nigral and 4% isocortical LBD. The presence of any cerebral microinfarcts was identified in 33% and of high-level cerebral microinfarcts in 10% of CN individuals. Overall, the burden of lesions in each individual and their comorbidity varied widely within each study but were similar across studies. These data show an individually varying complex convergence of subclinical diseases in the brain of older CN adults. Appreciating this ecology should help guide future biomarker and neuroimaging studies and clinical trials that focus on community- and population-based cohorts.

Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.

PubMed

Markle-Reid, Maureen; Dykeman, Cathy; Ploeg, Jenny; Kelly Stradiotto, Caralyn; Andrews, Angela; Bonomo, Susan; Orr-Shaw, Sarah; Salker, Niyati

2017-02-16

Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact. Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers. The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted. To align stakeholders working towards fall prevention for community-dwelling older adults and establish a foundation for collective impact, public health professionals employed practices that reflected a collaborative leadership style. Looking ahead, public health professionals will want to shift their focus to evaluating the effectiveness of their group work within communities. They will also need to assess outcomes and evaluate whether the anticipated reductions in fall rates among community-dwelling older adults is being achieved.

Conducting Research With Community Groups.

PubMed

Doornbos, Mary Molewyk; Ayoola, Adejoke; Topp, Robert; Zandee, Gail Landheer

2015-10-01

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments. © The Author(s) 2015.

Conducting Research with Community Groups

PubMed Central

Doornbos, Mary Molewyk; Ayoola, Adejoke; Topp, Robert; Zandee, Gail Landheer

2016-01-01

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. While several barriers to conducting research with community groups exist, community based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This manuscript presents case studies that demonstrate how CBPR principles guided the development of: (a) a healthy body weight program for urban, underserved African-American women, (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women, and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research intensive academic environments. PMID:25724557

Team-based care and improved blood pressure control: a community guide systematic review.

PubMed

Proia, Krista K; Thota, Anilkrishna B; Njie, Gibril J; Finnie, Ramona K C; Hopkins, David P; Mukhtar, Qaiser; Pronk, Nicolaas P; Zeigler, Donald; Kottke, Thomas E; Rask, Kimberly J; Lackland, Daniel T; Brooks, Joy F; Braun, Lynne T; Cooksey, Tonya

2014-07-01

Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes. An existing systematic review (search period, January 1980-July 2003) assessing team-based care for BP control was supplemented with a Community Guide update (January 2003-May 2012). For the Community Guide update, two reviewers independently abstracted data and assessed quality of eligible studies. Twenty-eight studies in the prior review (1980-2003) and an additional 52 studies from the Community Guide update (2003-2012) qualified for inclusion. Results from both bodies of evidence suggest that team-based care is effective in improving BP outcomes. From the update, the proportion of patients with controlled BP improved (median increase=12 percentage points); systolic BP decreased (median reduction=5.4 mmHg); and diastolic BP also decreased (median reduction=1.8 mmHg). Team-based care increased the proportion of people with controlled BP and reduced both systolic and diastolic BP, especially when pharmacists and nurses were part of the team. Findings are applicable to a range of U.S. settings and population groups. Implementation of this multidisciplinary approach will require health system-level organizational changes and could be an important element of the medical home. Published by Elsevier Inc.

From front yards to street corners: revitalizing neighborhoods through community-based land stewardship

Treesearch

Colleen Murphy-Dunning

2009-01-01

One of 18 articles inspired by the Meristem 2007 Forum, "Restorative Commons for Community Health." The articles include interviews, case studies, thought pieces, and interdisciplinary theoretical works that explore the relationship between human health and the urban...