"Access to healthcare is a human right": a constructivist study exploring the impact and potential of a hospital-community partnered COVID-19 community response team for Toronto homeless services and congregate living settings

BACKGROUND

Individuals experiencing homelessness face unique physical and mental health challenges, increased morbidity, and premature mortality. COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. In March 2020, the COVID-19 Community Response Team formed at Women's College Hospital, to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model of onsite mobile testing and infection prevention. From this, the Women's College COVID-19 vaccine program emerged, where 14 shelters were identified to co-design and support the administration of vaccine clinics within each shelter. This research seeks to evaluate the impact of this partnership model and its future potential in community-centered integrated care through three areas of inquiry: (1) vaccine program evaluation and lessons learned; (2) perceptions on hospital/community partnership; (3) opportunities to advance hospital-community partnerships.

METHODS

Constructivist grounded theory was used to explore perceptions and experiences of this partnership from the voices of shelter administrators. Semi-structured interviews were conducted with administrators from 10 shelters using maximum variation purposive sampling. A constructivist-interpretive paradigm was used to determine coding and formation of themes: initial, focused, and theoretical.

RESULTS

Data analysis revealed five main categories, 16 subcategories, and one core category. The core category "access to healthcare is a human right; understand our communities" emphasizes access to healthcare is a consistent barrier for the homeless population. The main categories revealed during a time of confusion, the hospital was seen as credible and trustworthy. However, the primary focus of many shelters lies in housing, and attention is often not placed on health resourcing, solidifying partnerships, accountability, and governance structures therein. Health advocacy, information sharing tables, formalized partnerships and educating health professionals were identified by shelter administrators as avenues to advance intersectoral relationship building.

CONCLUSION

Hospital-community programs can alleviate some of the ongoing health concerns faced by shelters - during a time of COVID-19 or not. In preparation for future pandemics, access to care and cohesion within the health system requires the continuous engagement in relationship-building between hospitals and communities to support co-creation of innovative models of care, to promote health for all.

Community perspectives on COVID-19 outbreak and public health: Inuit positive protective pathways and lessons for Indigenous public health theory

OBJECTIVES

Indigenous public health theory and the voices of Canadian Indigenous communities remain under-represented in the literature despite the Canadian Truth and Reconciliation Calls to Action, and the perspectives of Inuit are further under-represented in this literature. The goal of this paper is to explore the perspectives of Iqalungmiut (people of Iqaluit), frontline staff, and decision-makers on the management of the COVID-19 outbreak in Iqaluit in April to June 2021 and to identify lessons learned and contributions to public health policy and practice specific to Inuit populations in Canada.

METHODS

This study used the Piliriqatigiinniq Community Health Research Model which was developed by Nunavummiut to guide community-based health and well-being research. Interviews were conducted with 44 individuals: 22 community members and shelter users; 17 frontline workers; and 5 decision-makers representing municipal and territorial government. Participants were asked about their experiences during the outbreak, sources of information, and strengths and challenges during outbreak management.

RESULTS

Challenges included overcrowding, physical disconnection from family members, and mental health and trauma. Community-identified strengths included strong interagency cooperation, food hamper and COVID-19 care kit deliveries, and travel restrictions. Several Inuit positive health-protective pathways were identified including Ilaginniq; Silativut; Inuuqatigiittiarniq; Piliriqatigiinniq; Ikajurniq; and Pijitsirniq.

CONCLUSION

Outbreaks of infectious illness are not new to Nunavut communities and Inuit protective pathways have and continue to be critical avenues to adapt to and mitigate such challenges. This exploratory study provides clear direction for Inuit public health policy and practice in Canada, while contributing to the body of literature on Indigenous public health theory.

The Impact of the COVID-19 Pandemic on Depression, Anxiety, and Stress among Black Women with Depressive Symptoms at a Federally Qualified Health Center

While the COVID-19 pandemic disproportionately impacted Black American communities, there is a lack of empirical research examining mental health experiences during the COVID-19 pandemic among this population. This report examines the relationship between the COVID-19 pandemic and stress, depression, and anxiety among Black women. A cohort study with supplementary data was conducted among 45 Black American women with depressive symptoms participating in an ongoing randomized controlled trial of a mindfulness-based intervention (M-Body) at a Federally Qualified Health Center. Depressive symptoms, anxiety, and stress were measured at multiple time points before and during the COVID-19 pandemic. On average, anxiety [Pre-pandemic: 7.4 (0.5); Peri-pandemic: 7.0 (0.6); MD: -0.4 (0.5), p = 0.18] did not change substantially during the pandemic compared to pre-pandemic levels. However, depression [Pre-pandemic: 19.7 (1.4); Peri-pandemic: 24.4 (1.5); MD: 4.7 (1.0), p < 0.01] worsened while stress [Pre-pandemic: 21.7 (0.4); Peri-pandemic: 20.5 (0.5); MD: -1.2 (0.5), p = 0.01] slightly improved. Individuals caring for children exhibited modest but not statistically significant elevations in pre-pandemic stress than those who did not. These disparities more than doubled during the pandemic for stress [MD: 1.9 (0.9), p = 0.04] and depression [MD: 3.8 (2.6), p = 0.16] but increased only slightly for anxiety [MD: 1.8 (1.0), p = 0.08]. These data indicate that the COVID-19 pandemic impacted mental health among Black women with depressive symptoms, and those caring for children reported greater increases in depression, anxiety, and stress than those who did not during the pandemic. Trial Registration: ClinicalTrials.gov NCT03620721. Registered on 8 August 2018.

Partner incarceration, maternal substance use, and the mediating role of social support: A longitudinal analysis using the future of families and child wellbeing study

INTRODUCTION

The United States is responsible for the highest incarceration rate globally. This study aimed to explore the impact of partner incarceration on maternal substance use and whether social support mediates the relationship between partner incarceration and maternal substance use.

METHODS

Using data from the Future of Families and Child Wellbeing Study, a longitudinal cohort following new parents and children, this analysis quantifies the relationship between paternal incarceration and maternal substance use (N = 2823). We analyzed maternal responses in years 3 (2001-2003), 5 (2003-2006), 9 (2007-2010), and 15 (2014-2017). We explored the role of financial support and emergency social support as potential mediators. Confirmatory factor analysis (CFA) was employed to construct support-related mediators. We modeled the impact of partner incarceration and maternal substance use using generalized estimating equations (GEE) to account for repeated measures, adjusting for appropriate confounders (age of mother at child's birth, race, education, employment, and history of intimate partner violence).

RESULTS

Nearly half (44.2%, N = 1247) of participants reported partner incarceration. Among mothers who experienced partner incarceration, the odds of reporting substance use were 110% greater than those who reported no partner incarceration (adjusted Odds Ratio [aOR]: 2.10; 95% Confidence Interval (CI):1.67-2.63). Financial support at year 5 accounted for 19.5% (95% CI: 6.03-33.06%) of the association between partner incarceration at year 3 and substance use at year 9; emergency social support at year 5 accounted for 6.4% (95% CI: 0.51-12.25%) of the association between partner incarceration and substance use at year 9. Neither financial nor emergency social support at year 9 were significant mediators between partner incarceration at year 3 and substance use at year 15.

CONCLUSIONS

These findings demonstrate that partner incarceration impacts maternal substance use. Financial and emergency support may partially mediate this relationship in the short term, which has important implications for families disrupted by mass incarceration.

[Community reorientation of primary care in a health area: ROCAP project]

AIM

Evaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area.

DESIGN

During January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email.

PLACE

The scope is the 11 ZBS of a health area.

PARTICIPANTS

The study population is the ZBS and the respective teams represented by the medical and nursing coordinations.

INTERVENTIONS

Promote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives.

MAIN MEASUREMENTS

Quantitative and qualitative analysis was carried out pre and post after the first year of intervention.

RESULTS

In the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health.

CONCLUSIONS

The intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

One-year trajectories of nutritional status in perimenopausal women: a community-based multi-centered prospective study

BACKGROUND

Nutritional status is a modifiable factor associated with perimenopausal women's health and quality of life. Assessing body composition indicators helps to comprehensively understand nutritional status compared with using body mass index (BMI) only. However, few published studies measured the trends in body composition among perimenopausal women.

OBJECTIVES

To assess the one-year trajectory of the nutritional status of perimenopausal women and to explore its influential factors.

METHODS

A community-based observational study with 3-wave repeated measurements at 6-month intervals was carried out. The nutritional status indicators include weight, body mass index (BMI), and body composition variables. Bioelectrical impedance analysis was used to assess body composition. Repeated measures ANOVA and Chi-square test were used to calculate the changes in nutritional status and generalized estimating equations were performed to explore their influential factors.

RESULTS

2760 participants completed the study. Increasing trajectories in weight (from 56.05 ± 7.55 to 57.02 ± 7.60), fat mass (from 17.99 ± 4.80 to 20.49 ± 4.90), and waist-hip ratio (from 0.86 ± 0.04 to 0.91 ± 0.15) were found (P < 0.001). Decreasing trajectories in skeletal muscle (from 20.30 ± 2.38 to 19.19 ± 2.46), protein level (from 7.39 ± 0.79 to 7.06 ± 0.81), and total body water (from 27.87 ± 2.92 to 27.00 ± 3.01) were found (P < 0.001). Being married/unmarried with a partner and without negative life events were associated with higher total body water, skeletal muscle, and protein level, while negatively associated with fat mass and waist-hip ratio. Age was positively associated with fat mass (P < 0.001). Participants with junior high school education were prone to increased fat mass (P = 0.018) compared with those holding primary school education and below. A per capita monthly income of 1500 to 3000 Yuan was associated with higher total body water, skeletal muscle, and protein level (P < 0.001) compared with a per capita monthly income of less than 1500 Yuan.

CONCLUSION

Worsening nutritional status exists in perimenopausal women, which is characterized by increased weight, fat mass, and waist-hip ratio, and decreased skeletal muscle, total body water, and protein level. For greater efficiency, precision nutritional interventions are needed, and recipients should be classified into different risk levels based on their sociodemographic background.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Examining Patient- and Community-Level Factors Associated with Pediatric Mental Healthcare Access Within a Patient Navigation Program

In 2021, national leaders in the United States declared a "national youth mental health crisis." Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children's referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS' inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β = .053, SE = .010, p < .001). Children with greater number of referral needs are more likely to connect with mental health services (β = .034, SE = .011, p = .002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β = .016, SE = .008, p = .040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings.

Community-based surveillance programme evaluation using the platform Nyss implemented by the Somali Red Crescent Society-a mixed methods approach

BACKGROUND

Somali Red Crescent Society (SRCS), supported by Norwegian Red Cross, has implemented community-based surveillance (CBS) in Somaliland. This methodology aims to reduce the high risk of epidemics by strengthening early warning and response from and at community level, particularly where there is a weak public health surveillance system. CBS is implemented through SRCS community volunteers, who report signals from the community via SMS to the software platform Nyss. This paper presents key findings from the CBS programme evaluation.

METHODS

A retrospective observational mixed-methods approach to evaluate the CBS programme was conducted, using routine CBS data from 2021 for Awdal and Togdheer regions and qualitative interviews with stakeholders' representatives.

RESULTS

The usefulness of the CBS programme in preventing, detecting, and responding to disease outbreaks was acknowledged by the stakeholders' representatives. 83% of the signals in Awdal region matched a Community Case Definition (CCD) and were escalated to the Ministry of Health and Development (MoHD)). For Togdheer region, 97% were escalated. Verification of signals by supervisors and escalation to the authorities was done timely.Alert outcome and response action was not well recorded, therefore there is limited evidence on sensitivity. The programme was shown to be simple and can be flexibly adjusted for new diseases and changing CCDs.Stakeholders appreciated being engaged, the good collaboration, their participation throughout the implementation and expressed high acceptance of the programme.

CONCLUSION

CBS can support early warning and response for a variety of public health risks. Improved documentation for alert outcomes could help to better evaluate the sensitivity of CBS. A participatory approach is vital to achieve successful community volunteer engagement. Software tools, such as the Nyss platform, can be useful to support effective and efficient CBS implementation.

Self-administered at-home lung ultrasound with remote guidance in patients without clinical training

BACKGROUND

Access to timely and accurate diagnostic imaging is essential for high-quality healthcare. Point-of-care ultrasound has been shown to be accessible and effective in many aspects of healthcare, including assessing changes in lung pathology. However, few studies have examined self-administered at-home lung ultrasound (SAAH-LUS), in particular performed by non-clinical patients (NCPs).

RESEARCH QUESTION

Are NCPs able to perform SAAH-LUS using remote teleguidance and produce interpretable images?

STUDY DESIGN

Patients were enrolled to the study in a mix of in-person and virtual recruitment, and shipped a smartphone as well as a point of care ultrasound device. Tele-guidance was provided by a remote physician using software integrated with the point of care ultrasound device, allowing real-time remote visualization and guidance of a patient scanning their own chest. A post-intervention survey was conducted to assess patient satisfaction, feasibility, and acceptability of SAAH-LUS. Two POCUS expert reviewers reviewed the scans for interpretability, and inter-rater agreement between the two reviewers was also computed.

RESULTS

Eighteen patients successfully underwent 7-14 days of daily telemedicine in parallel to daily SAAH-LUS. Across 1339 scans obtained from ten different lung zones, the average proportion of interpretability was 96% with a chance-corrected agreement, or Cohen's kappa, reported as κ = 0.67 (significant agreement). 100% of NCPs surveyed found SAAH-LUS to be a positive experience, particularly for its ease of operation and ability to increase access to healthcare services.

INTERPRETATION

This study demonstrates that NCPs can obtain interpretable LUS images at home, highlighting the potential for SAAH-LUS to increase diagnostic capacity, particularly for rural and remote regions where complex imaging and healthcare providers are difficult to obtain. Trial registration The clinical trials has been registered (clinicaltrials.gov).

REGISTRATION NUMBER

NCT04967729.

The impact of a health promotion program on toddlers' socio-emotional development: a cluster randomized study

BACKGROUND

The first 3 years of life are a critical period for the development of socio-emotional skills, highlighting the importance of socio-emotional development in early childhood. This study aimed to evaluate the effectiveness of a health promotion intervention program on the socio-emotional development of children aged 12 to 42 months during the COVID-19 pandemic.

METHODS

A total of 344 children from 15 childcare centers participated in this study, with six centers in the intervention group and nine in the control group. Childcare teachers in the intervention group received a 6-month training program aimed at promoting healthy lifestyles, including topics such as diet, sleep, physical activity, and sedentary behavior. Sociodemographic and anthropometric measures were assessed at baseline, and socio-emotional development was assessed using the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) at baseline and post-intervention.

RESULTS

After the intervention, a significant difference in socio-emotional development was observed between children with mothers of varying education levels. Specifically, children whose mothers had lower education levels demonstrated significantly greater socio-emotional development (B = 19.000, p = 0.028) compared to the control group. In contrast, there was no significant difference in socio-emotional development among children with mothers from higher education levels.

CONCLUSION

These findings suggest that intervention programs for childcare teachers can effectively promote healthy socio-emotional development in children from socioeconomically disadvantaged backgrounds. Future intervention programs should consider tailoring their approaches to target disadvantaged populations.

TRIAL REGISTRATION

This cluster randomized controlled trial was registered in the Clinical Trials database/platform on 09/09/2019 (number NCT04082247).

Delivering COVID-19 Vaccine via Trusted Social Services: Program Evaluation Results from the Chicagoland CEAL Program

To describe the reach, implementation, and sustainability of COVID-19 vaccination programs delivered by social service community organizations. Five academic institutions in the Chicagoland CEAL (Community Engagement Alliance) program partnered with 17 community organizations from September 2021-April 2022. Interviews, community organizations program implementation tracking documents, and health department vaccination data were used to conduct the evaluation. A total of 269 events were held and 5,432 COVID-19 vaccines delivered from May 2021-April 2022. Strategies that worked best included offering vaccinations in community settings with flexible and reliable hours; pairing vaccinations with ongoing social services; giving community organizations flexibility to adjust programs; offering incentives; and vaccinating staff first. These strategies and partnership structures supported vaccine uptake, community organization alignment with their missions and communities' needs, and trust. Community organizations delivering social services are local community experts and trusted messengers. Pairing social service delivery with COVID-19 vaccination built individual and community agency. Giving COs creative control over program implementation enhanced trust and vaccine delivery. When given appropriate resources and control, community organizations can quickly deliver urgently needed health services in a public health crisis.

Advancing diabetes primary care education and knowledge in Nepal: A scoping review and case study discussion

AIMS

Diabetes mellitus (DM) is a chronic disorder of insulin and glucose metabolism. It affects more than 463 million people worldwide and is expected to reach 700 million by 2045. In the Southeast Asian region, the prevalence of DM has tripled to 115 million due to rapid urbanization, unhealthy diet, sedentary lifestyles, and genetic factors. In Nepal, a developing country, DM affects 8.5% of adults, with an alarming increase in recent years. Lack of diabetes education and limited populational adoption of behavioural changes further hamper care.

METHODS

In the present study, we performed a scoping review to determine the status of awareness, attitudes, and knowledge about diabetes in the Nepalese population with a focus on the educational initiatives that have been implemented. We also conducted a two-week international case study discussion among medical students to brainstorm viable intervention strategies.

RESULTS

Our findings indicate that limited data is available on the level of education or initiatives to improve knowledge and practice among healthcare professionals and community members. Targeted studies of people with diabetes also present heterogeneous results due to differences in the sample population, geographic location, education, age, and gender. Accordingly, we propose five interrelated education-based strategies that leverage existing networks to expand community outreach and engagement, improve system resilience, and improve health outcomes.

CONCLUSIONS

Effective education for healthcare professionals, community, and patients with diabetes is vital in improving diabetes outcomes in Nepal and South Asia. Collaboration, funding, and evaluation are key areas needing reform.

Community Resilience and Cultural Responses in Crisis: Lessons Learned from Pacific Islander Responses to the COVID-19 Pandemic in the USA

Pacific Islander communities in the USA experienced some of the most severe effects of the COVID-19 pandemic. This qualitative synthesis examines the literature on Pacific Islander community responses and lessons learned from COVID-19, using a systematic search that identified 28 articles with this focus. Thematic analysis was subsequently used to classify both documented efforts by Pacific Islander communities to respond to the pandemic, as well as lessons learned and best practices from research in this area. Results revealed multiple efforts to address the pandemic, including Pacific Islander grassroots approaches, government responses, inter-sector collaboration, and research. Results further emphasized the importance of culturally and linguistically responsive outreach and messaging; partnership, engagement, and capacity building; and changes in research and policy approaches to promote health equity. Future efforts to address public health crises should make the most of Pacific Islander cultural approaches to disaster response. To achieve this, government and other organizations that work with PI communities need to support the development of the PI leadership, healthcare and research workforces, and work with Pacific Islander communities to build long-term, sustainable, and trustworthy partnerships.

Evaluating COVID-19 Risk to Essential Workers by Occupational Group: A Case Study in Massachusetts

Occupational exposure to SARS-CoV-2 varies by profession, but "essential workers" are often considered in aggregate in COVID-19 models. This aggregation complicates efforts to understand risks to specific types of workers or industries and target interventions, specifically towards non-healthcare workers. We used census tract-resolution American Community Survey data to develop novel essential worker categories among the occupations designated as COVID-19 Essential Services in Massachusetts. Census tract-resolution COVID-19 cases and deaths were provided by the Massachusetts Department of Public Health. We evaluated the association between essential worker categories and cases and deaths over two phases of the pandemic from March 2020 to February 2021 using adjusted mixed-effects negative binomial regression, controlling for other sociodemographic risk factors. We observed elevated COVID-19 case incidence in census tracts in the highest tertile of workers in construction/transportation/buildings maintenance (Phase 1: IRR 1.32 [95% CI 1.22, 1.42]; Phase 2: IRR: 1.19 [1.13, 1.25]), production (Phase 1: IRR: 1.23 [1.15, 1.33]; Phase 2: 1.18 [1.12, 1.24]), and public-facing sales and services occupations (Phase 1: IRR: 1.14 [1.07, 1.21]; Phase 2: IRR: 1.10 [1.06, 1.15]). We found reduced case incidence associated with greater percentage of essential workers able to work from home (Phase 1: IRR: 0.85 [0.78, 0.94]; Phase 2: IRR: 0.83 [0.77, 0.88]). Similar trends exist in the associations between essential worker categories and deaths, though attenuated. Estimating industry-specific risk for essential workers is important in targeting interventions for COVID-19 and other diseases and our categories provide a reproducible and straightforward way to support such efforts.

Ebola Virus Disease Sensitization: Community-Driven Efforts in Sierra Leone

The 2014-2016 West Africa Ebola outbreak was the largest in history, resulting in approximately 11,000 deaths. Despite the outbreak's eventual end, national and international health sensitization and containment efforts were subject to criticism. This study investigates disease-related knowledge and beliefs, as well as trusted sources of health information among EVD-survivors and their family members, highlighting the importance of community-informed public health responses. Participants (n = 134) were adults who were either EVD-infected, affected families/caregivers, or community leaders. In-depth interviews and focus groups explored EVD-related experiences, including health effects, stigma, and community relationships. Using a grounded theory and thematic content analysis approach, transcripts were coded for evidence of health sensitization, as well as compliance with mitigation measures and trusted sources of information. Participants displayed a high level of knowledge around EVD and reported compliance with mandated and personal prevention measures. Levels of health sensitization and subsequent reintegration of survivors were reported to be largely the products of community-based efforts, rather than the top-down, national public health response. Primary sources of trusted information included EVD survivors acting as peer educators; local leaders; and EVD sensitization by community health workers. This study highlights the importance of a community-based response for increasing the effectiveness of public health campaigns. Participants expressed that relying on the experiences of trusted cultural insiders led to a deeper understanding of Ebola compared to top-down public health campaigns, and helped infected and affected community members reintegrate. Future public health efforts should incorporate community-based participatory approaches to address infectious disease outbreaks.

[How to improve community engagement in health: Analysis of proposed actions following the implementation of a community engagement assessment tool]

OBJECTIVE

To analyse the lines of action identified in the health promotion projects participating in the EvaluA GPS research, and their relationship with the scores assigned in EvalGuia, a tool for evaluating evidence-based community participation.

DESIGN

Qualitative-quantitative multicentre study.

SETTING

Primary care or intersectoral network of primary care and municipalities in five autonomous communities in Spain.

PARTICIPANTS

Participants of 10 health promotion projects, selected with convenience sampling, following inclusion criteria (projects with a minimum of community engagement and centred on community health).

METHOD

Data were collected through questionnaires (EvalGuía tool) and participatory workshops. Quantitative data were analysed with descriptive statistics, qualitative data were analysed using matrix analysis.

RESULTS

After implementing the EvalGuide tool, the lowest scores were assigned in outcome evaluation, knowledge of policies related to community participation, diversity in the core working group, inclusivity policies, financial resources and diffusion of results. The lines of action proposed were heterogeneous and did not always match with those prioritised as lower score. The prioritised lines revolved around project organisation and communication.

CONCLUSIONS

The EvalGuide tool can be helpful to design action plans in Health Promotion projects. The implementation of measures in 12 months to increase the diversity of the core working group, to incorporate work-life balance measures or to improve evaluation is difficult. More time is needed to implement such measures.

Effectiveness of peer-led intervention in control of non-communicable diseases in rural areas of Khordha district: study protocol for a cluster randomized controlled trial

BACKGROUND

The main contributors to death and disability from chronic illnesses in developing nations are elevated blood pressure (hypertension), blood sugar (diabetes mellitus), and blood cholesterol (dyslipidaemia). Even though there are affordable treatments, the treatment gap for these conditions is still significant. Few pilot studies from industrialized nations discuss the value of peer-led interventions for achieving community-level management of blood pressure and blood sugar. This study aims to evaluate the effectiveness of peer-led intervention compared to standard care in achieving control of selected non-communicable diseases (NCDs) in Indian context at 1 year of intervention among people of 30-60 years with hypertension and/or diabetes mellitus and/or dyslipidaemia.

METHODS

A cluster-randomized controlled trial will be conducted in villages of two rural blocks of the Khordha district of Odisha from August 2023 to December 2024. A total of 720 eligible participants (360 in the intervention group and 360 in the control group) will be recruited and randomized into two study arms. The participants in the intervention arm will receive a peer-led intervention model for 6 months in addition to standard care. The sessions will be based on the six domains of NCDs - self-care, follow-up care, medication, physical activity, diet, limiting substance use, mental health and co-morbidities. The mean reduction in blood pressure, HbA1C, and blood cholesterol in the intervention arm compared to the standard care arm will be the main outcome.

DISCUSSION

The increasing burden of NCDs demands for newer strategies for management. Peer-led interventions have proven to be useful at the international level. Incorporating it in India will have remarkable results in controlling NCDs.

TRIAL REGISTRATION

Clinical Trial Registry of India (CTRI) CTRI/2023/02/050022. Registered on 23 February 2023.

A comparison between antibiotic utilisation in public and private community healthcare in Malaysia

BACKGROUND

There are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018-2021.

METHODS

This study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors.

RESULTS

The overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and 'Not Recommended' antibiotics increased slightly over the years.

CONCLUSION

Antibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.

Determining priority areas for health promotion amongst Australian professional sporting organisations

OBJECTIVES

Professional sporting organisations (PSOs) are well-positioned to promote health through their reach and standing within communities. However, the health promotion (HP) priority areas of interest of PSOs are unknown. The objectives of this study were to: identify HP priority areas amongst Australian PSOs and explore the development, implementation, and evaluation of HP programming within the identified priority areas.

DESIGN

Delphi procedure with qualitative interviews.

METHODS

Participants were community-focussed employees from PSOs across Australia. To identify HP priory areas, three rounds of surveys were used in a Delphi procedure. Participants were then invited to participate in semi-structured interviews focussed on the development, implementation, and evaluation of HP programmes.

RESULTS

Of the 103 community employees invited to participate in the Delphi, 28 participated in at least one round and 16 completed all rounds. Overall, HP priorities fell under five main areas: access/participation in sport; general HP; physical activity promotion; community, culture, and inclusion; and support for HP initiatives. Eleven interviews were conducted, and central themes included needing support with programme design and evaluation, and the need to build employee capacity and greater inter-organisational collaboration.

CONCLUSIONS

This study determined HP priority areas amongst PSOs using a consensus-generating approach. Interview findings demonstrated that community-focussed employees are committed to delivering HP programmes, but encounter difficulty with funding, employee capacity, and programme design and evaluation expertise. The findings from these interviews reveal potential avenues of collaboration between organisations that can provide expertise in design and evaluation and sporting organisations for HP programming.

Culturally and contextually adaptive indicators of organizational success: Nunavik, Quebec

OBJECTIVE

This study aimed to develop a preliminary guide to culturally and contextually relevant indicators to assess community resources in the 14 communities of the Inuit territory of Nunavik, Quebec.

METHODS

As part of the Community Component of Qanuilirpitaa? of the 2017 Nunavik Health Survey, data were collected from 354 organizations located across Nunavik. Data were collected via short structured interviews with representatives of the organization. An inductive qualitative analysis was conducted to identify emerging themes describing the contexts that influence organizations, how key informants conceptualized what is a successful resource, and the facilitators and needs to achieving these indicators of success. Inuit partners were involved throughout the project to offer insight and to ascertain its pertinence and validity.

RESULTS

Interviews revealed structural and community realities that influenced organizations. Three main indicators were used to describe successes: (1) team efficiency and dynamics; (2) accessibility of the resource; and (3) ability to impact clients and the community. The third indicator was by far the most discussed indicator of success. Participants and leaders offer suggestions as to how to achieve these indicators and advocate for the conditions necessary for organizational sustainability.

CONCLUSION

This data-driven framework suggests that the measures of success that are frequently used by funding agencies (e.g., number of people reached, number of activities) may not fully represent the potential of local services in a given community. Indeed, services may be creating job opportunities for Inuit, instilling pride, offering cultural opportunities, and increasing capital (human, economic, health) within the community, all of which are equally important indicators of success that may more adequately further improve the social determinants of health among communities.

Eviction as a community health exposure

Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.

The Qanuilirpitaa? 2017 Nunavik Health Survey: design, methods, and lessons learned

OBJECTIVE

To depict the design, methods, sociodemographic characteristics of the population, and lessons learned during the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, the third major health survey to be conducted among youth and adults residing in Nunavik (Northern Quebec, Canada).

METHODS

Qanuilirpitaa? 2017 is a cross-sectional survey that served to update information regarding various aspects of physical health, mental health, and general well-being of Nunavimmiut. The survey was guided by the ethics principles of Ownership, Control, Access, and Possession (OCAP®) ( https://fnigc.ca/ocap ). Questionnaires and clinical tests were administered to residents from the 14 coastal communities onboard the Canadian Coast Guard Ship Amundsen during late summer and early fall 2017. As part of the community component of the survey, qualitative interviews were performed with key respondents, and services and resources supporting health and well-being in the 14 communities were inventoried and characterized.

RESULTS

A total of 1326 Nunavimmiut aged 16 and over participated in the survey. Despite difficulties encountered with the recruitment of participants, co-interpretation sessions with Inuit partners revealed that the survey had succeeded in capturing cultural, socio-economic, and lifestyle characteristics of Nunavimmiut. In all, 20 thematic reports have been published covering various aspects of health and well-being of Nunavimmiut. Regional and local reports pertaining to the community component were produced. More in-depth analyses have ensued, and results are presented in articles published in this CJPH supplement issue.

CONCLUSION

Information from this survey is being used to update health services and programs in the region and for the development of health policies and public health interventions to tackle key health-related issues faced by Nunavimmiut. Drawing lessons from challenges and successes encountered in Qanuilirpitaa? 2017, this survey paved the way to the upcoming Inuit-led Qanuippitaa? National Inuit Health Survey to be conducted every 5 years throughout Inuit Nunangat.

Vulnerability and Colorectal screening during the pandemic

Objective

Disparities in colorectal cancer (CRC) screening prevalence across United States neighborhoods may reflect social inequities that create barriers to accessing and completing preventive health services. Our objective was to identify whether neighborhood social vulnerability was associated with a change in CRC screening prevalence in Boston neighborhoods during the COVID-19 pandemic.

Methods

Adults ages 50-74 years due for CRC screening who received primary care at one of 35 primary care practices affiliated with Massachusetts General Hospital or Brigham and Women's Hospital (Boston, MA), 3/1/2020 to 3/1/2022. The Social Vulnerability Index (SVI) is an aggregate measure of neighborhood social factors often used by public health authorities to examine neighborhood susceptibility to many health outcomes.

Results

In 2020, 74.9 % of eligible individuals were up to date with CRC screening and this fell to 67.4 % in 2022 (p < 0.001). In 2020, 36.2 % of eligible patients lived in a neighborhood above the 80th percentile of SVI, consistent with high social vulnerability, while the same value was 35.1 % in 2022. There was no association between the change in screening prevalence and SVI: a decrease of 5.5 % screened in neighborhoods with SVI ≤ 80 compared to a decrease of 3.6 % in neighborhoods with SVI > 80 (p = 0.79).

Conclusions

The COVID-19 pandemic equalized the prevalence of CRC screening across Boston-area neighborhoods despite pre-existing geographic disparities in screening prevalence and SVI. Strategies to ensure equitable participation in CRC screening to promote health equity should be considered to promote equitable pandemic recovery.

Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program

Approximately 1-in-5 children have a diagnosed mental, behavioral, and/or developmental disorder or delay by age 8 in the United States. Children with such conditions often require complex, complicated diagnostic and specialty care, making them susceptible to repeated referrals and ongoing unmet healthcare needs. Patient navigation programs (PNPs) are designed to integrate care from primary care providers to community-based services, using trained navigators to help patients and their families manage referrals and connect with referred services. This study examines factors associated with repeated referrals to an active PNP to inform ongoing referral patterns and adaptations to standard navigation support within a large healthcare system in South Carolina (SC). Data is sourced from the inception of the PNP in 2017 through 2022, including 15,702 referrals. Overall, 71.07% had no repeated referrals. Children who are older, diagnosed with attention deficit disorder(s), behavioral concerns, depression, multiple referral needs, and insured by Medicaid were found to be most susceptible to repeated referrals. Conversely, children who are non-Hispanic Black, were referred at a well-child visit, and are primarily insured by private insurance or Tricare were least likely to have repeated referrals. Children who are insured by Medicaid are more likely to be younger, identify as non-Hispanic Black, Hispanic, or another race/ethnicity, and have multiple needs at time of initial referral, identifying a potentially compounded risk for those who hold multiple risk factors to experiencing repeated referrals. Findings may inform adaptations to this PNP model to adjust navigator protocol for at-risk populations and equitably optimize referral-to-service connection.

Reciprocal Neighborhood Dynamics in Gun Violence Exposure, Community Health, and Concentrated Disadvantage in One Hundred US Cities

Gun violence imparts a tremendous human and financial toll on local communities. Researchers have documented extensive mental and physical health consequences of generalized violence exposure but few studies have analyzed the particular impacts of gun violence on community well-being using nationally comprehensive data. We leverage a unique database of almost 16,000 neighborhoods in 100 US cities (2014-2019) to examine how year-over-year rates of gun violence correspond to overall neighborhood well-being and three aspects of community health: (1) health behaviors, (2) physical and mental health status, and (3) health prevention efforts. We simultaneously consider the reciprocal influence of neighborhood well-being on subsequent gun violence while accounting for concentrated disadvantage in communities. The results demonstrate that gun violence is associated with poorer community health in subsequent years, particularly health behaviors and mental/physical health status. Furthermore, we find substantial reciprocal effects for both gun violence and community health in their relationship to neighborhood concentrated disadvantage. These findings highlight the consequential role of gun violence in perpetuating cycles of harm in local communities.

Beliefs, mental health, healthy lifestyle behaviors and coping strategies of college faculty and staff during the COVID-19 pandemic

Objective: To assess faculty and staff beliefs about returning to campus as well as their mental health and healthy lifestyle behaviors. Participants: Faculty and staff at a large Mid-west public land-grant university. Methods: A survey was emailed to a random sample of faculty and staff (N = 6,000 faculty; N = 6,000 staff). Results: Response rate was 35.6% for faculty (n = 2,138) and 37.8% (n = 2,226) for staff. Participants who were working from home (>60%) had less confidence about returning to campus safely than those who had been working on campus. Eighteen to 27% of faculty and 25%-31% of staff met the cutoff for clinical anxiety and the rates of depression were 4.4%-8.3% and 9.7%-10.0% respectively. Conclusion: Institutions of higher education must build wellness cultures and accelerate access to mental health services, which should be evidence-based and include a focus on promoting and maintaining overall wellness.

The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample

Within the United States (US), 2.4 million individuals are living with chronic hepatitis B, but less than 20% are diagnosed. Isolated anti-hepatitis B core (iAHBc) antibodies indicate serology in an individual that is positive for anti-HBc antibodies, while negative for surface antigen (HBsAg) and surface antibodies (anti-HBs). A result of iAHBc could indicate a chronic occult bloodstream infection, necessitating further testing. This study assesses the prevalence and risk factors associated with anti-HBc and iAHBc within community high-risk screening in Greater Philadelphia. Participants (n = 177) were screened for HBsAg, anti-HBs, and anti-HBc during community screening events in 2022. Chi-square tables and Firth logistic regression were used to describe the data and to assess the odds of iAHBc. The findings indicate that there was an iAHBc prevalence of 7.3% (n = 13) within our study. The odds of anti-HBc were increased for immigrants from the Western Pacific (4.5%) and Africa (11.9%). Individuals born in Africa had 7.93 greater odds for iAHBc than those born in the Americas, and these odds are multiplied by 1.01 for every 1-year increase in age. Our data show a high burden of iAHBc within high-risk and often hard-to-reach communities. Triple panel screening should be incorporated into all HBV screening programs, in accordance with current Centers for Disease Control and Prevention (CDC) universal screening recommendations, to ensure a comprehensive picture of the disease burden and reduce the risk of missing people with occult hepatitis B and those at risk for viral reactivation or liver complications.

The Bite of HOPE Small Food Business Development Program: a clinic-based culinary medicine program targeting local business owners

Culinary medicine is a popular approach to health promotion, but most programs focus on patient or provider-facing education. While laudable, these efforts do not represent the full potential for culinary medicine to impact community health. We describe a novel approach to culinary medicine at a federally qualified health center (FQHC), the HOPE Clinic: Bite of HOPE Small Food Business Development (SFBD) program. Describe the design and implementation of the Bite of HOPE SFBD program and examine initial response to the program through interviews and focus groups with past participants. The SFBD program aims to create healthy food outlets by supporting local small businesses with education, resources, and mentorship support. Former participants in the SFBD program were invited to participate in focus groups and interviews exploring their experience and perceived program impact. Three focus groups (n = 10) and nine in-depth interviews were conducted. Most participants were Black or Hispanic and all operated their businesses in the community surrounding HOPE Clinic. Five themes emerged from the data including perceived program purpose, program discovery, motivating factors to participation, perceived program impact, and suggestions for improvement. Participants expressed high satisfaction with the program and positive changes in both business development and personal eating habits. There is an opportunity to leverage the culinary medicine model to support local small food business and improve community health. The Bite of HOPE SFBD program offers an example of how clinic-based resources can expand into the surrounding environment.

The challenges of the Iranian nursing system in addressing community care needs

BACKGROUND

The nursing system is one of the major and important fields of health and medicine in every country, responsible for providing nursing care and addressing medical and health-related community care needs. The aim of this study was to explain the challenges of the Iranian nursing system in addressing community care needs.

MATERIALS AND METHODS

A conventional content analysis method was performed in this exploratory qualitative study, and 27 participants were selected through a purposive sampling method based on the inclusion criteria. In-depth semi-structured interviews were conducted with the subjects, and data saturation was achieved in the 27th interview. The main interviews with the participants were individual, in person, and face-to-face, conducted at different times (morning and evening) in a peaceful environment and at the convenience of the participants. The interviews were recorded by the researcher with the participants' consent. The duration of the interviews ranged from 50 to 70 minutes, given the participants' energy and time. Data analyses were done using Graneheim and Lundman approach.

RESULTS

After conducting the interviews and the simultaneous analysis, three themes were extracted, including the challenging structure in the internal environment, the operating environment, and the social environment, with seven main categories and 26 subcategories. An inadequate number of nurses given the real needs of society, the unbalanced proportion of employed clinical nurses to the real needs of society, poor presence of nurses in community-based nursing services, insufficient attention to the optimization of the work environment, the gap between education and clinical practice in the nursing system, poor mutual accountability of the community, and policies in the health system were seven main categories in this study.

CONCLUSION

In general, the results showed that the Iranian nursing system faces many micro, meso, and macroscale challenges. It is necessary to plan properly to enhance the accountability of the nursing system to the current community care needs by improving the situation.

Neighborhood environment and quality of life among community-living older adults in Nigeria: The moderating effect of physical activity

Understanding how neighborhood environments are related to older adults' quality of life (QoL) and physical activity (PA) is important for public health actions on healthy ageing in sub-Saharan Africa. We examined associations of perceived neighborhood environment attributes with QoL among older adults in Nigeria and investigated the moderating effects of PA on these associations. We conducted a cross-sectional study of 353 older adults (mean age = 68.9 ± 9.1 years) selected from 5 high- and low-income communities in Maiduguri, Nigeria. QoL, attributes of the neighborhood environments and PA were self-reported using validated questionnaires. Multi-level models were used to examine the direct associations between neighborhood environment attributes and each of the four domains of QoL (physical health, psychological health, social relationships, and environmental health), as well as the moderating effects of leisure-time and total PA. Seven of nine neighborhood environment features were positively associated with multiple domains of QoL. Residential density, land-use diversity, land-use mix-access, walking infrastructure, traffic safety and 'overall walkability' were positively related to both or either physical health and environmental health QoL among those who are physically active. In contrast, walking infrastructure, traffic safety, and 'overall walkability' were negatively related to psychological health QoL among those not physically active. Our findings suggest being physically active moderates the association of neighborhood environments with QoL among Nigerian older adults. We suggest that designing age-friendly communities and simultaneously promoting PA may be needed to improve QoL and help prepare the Nigerian society for the predicted increase in the older adult population.

The effects of COVID-19 on African American communities in Baltimore's health enterprise zones: a mixed-methods examination

BACKGROUND

The CoVID-19 pandemic underscored effects of community resources on the built environment, health and health outcomes. The purpose of this study was to conduct community-engaged research and examine aspects of health, and access to healthcare from the voices of community members, as a foundation for improving health equity through the built environment.

METHODS

This study utilized a convergent mixed methods design that included surveys and semi-structured interviews conducted from July 2021 to August 2022 to examine the impact of limited community resources, such as community health clinics on participants during the CoVID-19 pandemic. A convenient sample of 345 male and female African American participants represented five zip codes (21215, 21216, 21217, 21223, and 21229) in with the highest impact from CoVID 19, in Baltimore, Maryland. Quantitative and qualitative data were integrated to describe how the two types supported one another in health, healthcare and healthcare access.

RESULTS

More than half of all participants reported satisfaction with overall health, quality of healthcare provided and access to health care services. However, results indicated extreme differences in factors related to health and wellness after, as comparted to before the onset of the pandemic, Semi-structured interviews, expanded on overall community health, highlighting that overall satisfaction with health does not equal satisfaction with health-related resources and suggested participants felt frustrated and left out of much-needed community health resources to improve health and mental health services for all ages, nutrition services and community activities that make communities thrive. Data integration provided a more realistic view of what participants really experience, due to the expanded analysis of semi-structured interviews, and indicated quantitative and qualitative data did not always support each other.

CONCLUSIONS

Future research to improve the built environment, and to address historic health inequities, will require ongoing community engagement to better understand community needs. This study results encourage ongoing research to expand resources for community-engaged research and interventions. Researchers must remain cognoscente of changing needs, and persistent disparities that can only be addressed if policies, supported by these results, are introduced to make equitable investments to forge an environment where healthy communities thrive.

Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review

OBJECTIVE

To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA).

DATA SOURCES

The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022.

STUDY SELECTION

To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting.

DATA EXTRACTION

The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer.

DATA SYNTHESIS

Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported.

CONCLUSION

The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.

A pharmacist-led community-based survey study: Determining the impact of the Covid-19 pandemic on actionable factors associated with worse cancer outcomes and cancer health disparities

Purpose

The goals of this cross-sectional community-based survey study were to assess the impact of the Covid-19 pandemic on actionable factors which are known to contribute to worse cancer outcomes, and to determine whether race and ethnicity-based differences exist.

Methods

A survey study which captured demographic information and changes in cancer outcomes-related factors since the start of the Covid-19 pandemic, was conducted at a public Covid-19 vaccination clinic over a period of 10 days during March 2021. Surveys were administered in multiple languages. Chi-square tests and ANOVA followed by post-hoc Dunnett testing assessed for race and ethnicity-based differences.

Results

A total of 949 people participated (61.6% participation rate). Ninety-three surveys were removed based on inclusion criteria giving a final participant number of 856. Many participants reported postponing cancer screenings (17.8%) and cancellation of medical appointments (22.8% and 25.8% reported cancelled appointments by providers or themselves, respectively) due to the pandemic. Participants also reported decreased physical activity (44.7%) and increased tobacco and/or marijuana usage (7.0%). Conversely, participants reported consuming more fruits and vegetables (21.4%) and decreasing alcohol consumption (21.4%). Several race-related differences but no ethnicity-related differences were observed.

Conclusion

Our data can be used to help guide pharmacist-led targeted outreach in our community which will help mitigate Covid-19 pandemic-driven changes in behaviors associated with worse cancer outcomes and exacerbation of cancer health disparities. To our knowledge, this is the first cancer outcomes-related study to be conducted at a public Covid-19 vaccination site and is the first pharmacist-led study in this area.

'Our hands are bound': Pathways to community health labour in Kenya

An ideal model of Community Health Worker (CHW) selection has existed since long before Alma Ata catalysed the community health approach, dating to late colonial times. In this model, a willing, trusted, relatively well-educated and secure member of the community with proven aptitude is openly elected by their leadership, peers or relevant committee. Their participation is entirely voluntary and that voluntarism is symbolic of their community's participation as a whole. While this imagery is long-embedded in CHW storytelling, such practice is rare. While elements of this 'model pathway' exist, a myriad of structural and agential factors shape who becomes a CHW, how and why. Through life history interviews over twelve months 2022-2023 with 68 CHWs in Isiolo, northern Kenya (known as CHVs), we explore predominant pathways to community health labour as told through stories. We articulate five such pathways: model, handpicked, shadow, outsider and, most importantly, dispossession. Through telling five CHVs' stories, we present each 'ideal type' but also explore how each pathway is not singular, rather overlapping in complex, context-specific ways. These pathways confound Western-centric, Western-promoted notions of voluntarism and indeed community health, which cannot explain why such labour endures. We conclude that our findings provide a timely commentary on how voluntary labour within health continues to tax structural poverty and frustrated life chances in lieu of concrete and expansive investments in human resources for health by governments and health agencies both North and South. In understanding voluntary labour as a form of structural violence, we can better elucidate the historical dependency on this work in impoverished regions and how the undervaluing of such work persists over time.

Community features' varying insight into emergency department use for different childhood injuries

BACKGROUND

Community-level factors, including poverty level, minority population, and rurality are predictive of child injury rates. Community-based interventions targeting high-risk communities have been suggested for prevention and are reliant on understanding details of the community and prevalent types of injuries. The present study assessed injury rates based on characteristics of the community and for different types of injuries.

METHOD

A retrospective review of emergency department visits identified zip-code and injury type data for children 0-19. Injuries related to bicycles, falls, motor-vehicle traffic (MTV), and violence were examined. Poverty level, minority population, rural classification, and insured population were obtained at the zip-code level. Regression models examined the association between community features and injury rates for the four categories of injuries.

RESULTS

The results showed that the relationship between community features and injury rates was dependent on injury type. Rurality was associated with a lower rate for bicycle and falls, but a higher rate of MVT; higher insured population was associated with higher MVT and violence rates; higher minority population was associated with lower rates for falls and MTV; and higher population in poverty was associated with lower rate for MTV.

CONCLUSIONS

The findings indicate that injury rates not only cluster among community-level characteristics, but also the type of injury. Variation in community features and injury types offer insight into a holistic approach to child health.

PRACTICAL APPLICATIONS

In addition to other factors related to risk for injuries, health providers' knowledge of features of the local community and prevalent injuries in the environment may be helpful additions to programming geared toward lessening the burden of injuries on children and healthcare systems.

The impact of a meditative movement practice intervention on short- and long-term changes in physical activity among breast cancer survivors

PURPOSE

Tai Chi Easy (TCE) is a low-impact, meditative movement practice that is feasible for breast cancer survivors, even in the face of post-treatment symptoms, and may even serve as a gateway into developing an active lifestyle and improving overall physical activity (PA). In the context of a randomized controlled trial testing effects of an 8-week TCE intervention on breast cancer survivors' symptoms, we examined the short- (8-week) and long-term (9-month) impact on total PA compared to an educational control group.

METHODS

Participants were recruited from two hospital systems, local community organizations, and different media platforms. Eligible participants were predominant non-Hispanic White (82%), college educated (92%), and middle- to high-income (65%), and most commonly reported stage 1 (40%) or 2 breast cancer (38%). After baseline assessments, participants were randomized to the 8-week TCE intervention (N=51) or education control (N=53). Weekly intervention TCE classes were led by a trained instructor. Weekly educational control classes focused on a series of readings and group discussions. Total PA and steps were objectively measured via accelerometry, and the international physical activity questionnaire was used to measure self-reported total PA.

RESULTS

Multilevel mixed-effects linear regression models revealed no significant short- or long-term changes in objectively measured total PA or steps in either group; however, participants in the intervention reported short- and long-term changes in self-reported total PA.

CONCLUSIONS

TCE is an appropriate PA strategy for survivors that may lead to modest improvements in PA; however, more research is needed to examine the long-term impact on PA as well as other physical and psychological outcomes (i.e., flexibility, mobility, stress).

IMPLICATIONS FOR CANCER SURVIVORS

Low-impact, low-intensity activities like meditative movement practices are needed to assist survivors in overcoming post-treatment physical and psychological limitations to initiate a more active lifestyle.

Learning in a crisis moment: a randomized controlled trial in emergency bystander intervention

BACKGROUND

Opioid overdose is the leading cause of injury-related death in the United States. Individuals who overdose outside of clinical settings have more positive clinical outcomes when they receive naloxone, an opioid antagonist, from a bystander as an early intervention before emergency personnel arrive. However, there is a gap in knowledge about successful instantaneous learning and intervention in a real-life stressful environment. The objective of this study is to explore the efficacy of different instructional delivery methods for bystanders in a stressful environment. We aim to evaluate which methods are most effective for instantaneous learning, successful intervention, and improved clinical outcomes.

METHODS

To explore instantaneous learning in a stressful environment, we conducted a quantitative randomized controlled trial to measure how accurately individuals responded to memory-based survey questions guided by different instructional methods. Students from a large university in the Midwest (n = 157) were recruited in a public space on campus and accessed the six-question survey on their mobile devices. The intervention group competed the survey immediately while the research team created a distracting environment. The control group was asked to complete the survey later in a quiet environment.

RESULTS

The intervention group correctly answered 0.72 questions fewer than the control group (p = .000, CI [0.337, 1.103]). Questions Q1 and Q5 contained direct instructions with a verbal component and showed the greatest accuracy with over 90% correct for both stressful and controlled environments.

CONCLUSIONS

The variability in the responses suggests that there are environmental factors as well as instructional design features which influence instantaneous learning. The findings of this study begin to address the gap in knowledge about the effects of stress on instantaneous learning and the most effective types of instruction for untrained bystanders in emergency situations.

The effect of training medical students in the community area in the midst of the Covid-19 pandemic in China: a community-based study

BACKGROUND

Community practice training is an important part of education in medicine, public health, social medicine, and other disciplines. The objective of this study is to explore the effect and importance of the community practice of Master of Public Health graduates on community residents' health during the Coronavirus Disease 2019 pandemic.

METHODS

This study used a pretest-posttest design. A total of 152 participants with age ≥ 60 years were selected using a multistage sampling method from Hangzhou in China. Baseline and endline data were collected using structured questionnaires by face-to-face interviews. All psychological and behavioral measurements were performed using standardized instruments and showed good reliability and validity. A total of 147 participants were included in the analysis. The chi-square and rank sum tests were used to compare the difference between baseline and endline for categorical variables. Binary logistic regression analysis was used to evaluate the association between community practice training and changes in psychology and behavior.

RESULTS

The result of chi-square test revealed a statistically significant difference in participants' eating habits from baseline to endline. Participants reported that the self-perceived health status was different between endline and baseline by the rank sum test. The results of logistic regression analysis showed that community practice training was significantly associated with increased self-efficacy scores, cognitive function and eating habits, with odd ratios of 1.08, 0.90 and 1.93, respectively.

CONCLUSIONS

Community practice training was associated with changes in health behavior and psychology of community residents. Our results suggested enhanced community practice training for students under the Master of Public Health program.

Recruitment strategies to increase racial and ethnic diversity in anorexia nervosa clinical research

OBJECTIVE

Inclusion of underrepresented racial and ethnic groups in eating disorder (ED) research is a critical unmet need, but evidence-based recruitment strategies are lacking. We sought to determine whether methods we had implemented to increase recruitment of underrepresented racial and ethnic groups were successful in improving racial and ethnic diversity in a clinical trial in women with anorexia nervosa.

METHOD

We implemented new strategies for recruitment of underrepresented racial and ethnic groups in a clinical trial on bone health in women with anorexia nervosa, including leveraging social media, liberalizing language on advertisements to be more inclusive of women who are as yet undiagnosed with the disorder or feel stigmatized by its name, translating advertisements to Spanish, and engaging community health centers. We compared participants' race and ethnicity in this clinical trial versus two similar prior clinical trials.

RESULTS

The percent of non-White and Hispanic participants who have signed a consent form in our ongoing clinical trial (2021-2023) is higher versus two previous clinical trials on bone health in women with anorexia nervosa (2011-2019) with similar inclusion/exclusion criteria and endpoints [non-White: 11/38 (28.9%) vs. 11/188 (5.9%), Hispanic: 6/38 (15.8%) vs. 5/188 (2.7%), p ≤ 0.006]. There was no change in the percent of Black participants [0/38 (0%) vs. 1/188 (0.5%), p = 1.0].

DISCUSSION

Viewing clinical research recruitment through a diversity, equity, and inclusion lens can improve racial and ethnic diversity in ED research. Further research recruitment strategies are needed to be more inclusive of Black populations.

Community-based organization perspectives on participating in state-wide community canvassing program aimed to reduce COVID-19 vaccine disparities in California

BACKGROUND

Inequities in COVID-19 vaccine accessibility and reliable COVID-related information disproportionately affected marginalized racial and ethnic communities in the U.S. The Get Out the Vaccine (GOTVax) program, an innovative statewide government-funded COVID-19 vaccine canvassing program in California, aimed to reduce structural barriers to COVID-19 vaccination in high-risk communities with low vaccination rates. GOTVax consisted of a community-academic-government partnership with 34 local trusted community-based organizations' (CBOs) to conduct COVID-19 vaccine outreach, education, and vaccine registration. The purpose of this qualitative evaluation study was to explore the barriers and facilitators of using local CBOs to deploy a geographically, racially, and ethnically diverse state-wide COVID-19 vaccine outreach program.

METHODS

Semi-structured online interviews were conducted with participating GOTVax CBO leaders from November 2021 to January 2022. Transcripts were analyzed using reflexive thematic analysis.

RESULTS

Thirty-one of 34 CBOs participated (91% response rate). Identified themes encompassed both facilitators and barriers to program participation. Key facilitators included leveraging trust through recognized entities; promoting empathetic, tailored outreach; and flexibility of milestone-based CBO funding contracts for rapid program implementation. Barriers included navigating community sociopolitical, geographic, and cultural factors; managing canvassers' safety; desiring metrics for self-evaluation of outreach success; mitigating canvassing technology challenges; and concerns of program infrastructure initially limiting outreach. CBOs problem-solved barriers with academic and government partners.

CONCLUSIONS

Between May and December 2021, the GOTVax program reached over 2 million California residents and registered over 60,000 residents for COVID-19 vaccination. Public health campaigns may improve benefits from leveraging the expertise of community-trusted CBOs and universities by providing flexible infrastructure and funding, allowing CBOs to seamlessly tailor outreach most applicable to local minoritized communities.

A cross-sectional study of the impact of the COVID-19 pandemic on an ophthalmology consult service in four Michigan community hospitals

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time.

Methods

A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances.

Results

Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1).

Conclusion

This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.

Spatial distribution of selenium and other potentially toxic elements surrounding mountaintop coal mines in the Elk Valley, British Columbia, Canada

Despite the extensive use of mountaintop coal mining in the Elk Valley, British Columbia, Canada's largest metallurgical coal-producing region, little is known about the transport and deposition of fugitive dust emissions within its mountain landscape. This study aimed to assess the extent and spatial distribution of selenium and other potentially toxic elements (PTEs) near the town of Sparwood originating from fugitive dust emitted from two mountaintop coal mines. To achieve these objectives concentrations of 47 elements within moss tissues of Hylocomium splendens, Pleurozium schreberi, and Ptilium crista-castrensis were analyzed from 19 locations between May 29 to June 1, 2022. Contamination factors were then calculated to identify areas of contamination, along with generalized additive models to assess the relationship between selenium and the mines. Finally, Pearson correlation coefficients were calculated between selenium and other PTEs to determine which exhibited similar behaviour. This study found that selenium concentrations are a function of proximity to mountaintop mines, and the region's topographic features and prevailing wind patterns play a role in the transport and deposition of fugitive dust. Contamination is highest immediately surrounding mines and decreases at increasing distances, with the region's steep mountain ridges shielding the deposition of some fugitive dust when acting as a geographic barrier between adjacent valleys. Furthermore, silver, germanium, nickel, uranium, vanadium, and zirconium were identified as other PTEs of concern. The implications of this study are significant as it demonstrated the extent and spatial distribution of contaminants originating from fugitive dust emissions surrounding mountaintop mines and some of the controls to its distribution in mountain regions. As Canada and other mining jurisdictions look to expand critical mineral development, it will be important for proper risk assessment and mitigation in mountain regions to limit community and environmental exposure to contaminants within fugitive dust.

An exploratory study of condom sabotage and sexual health risk indicators in college students

Condom sabotage is a form of sexual assault that violates bodily autonomy, increasing the risk of unintended pregnancy and sexually transmitted infections (STI). The current study explored associations between reports of condom sabotage and sexual risk indicators among college students. College students (N = 466) completed a web-based cross-sectional survey. Students who reported experiencing condom sabotage were significantly more likely to describe themselves as single in comparison to students who described themselves as partnered (p = .002). After adjusting for relationship status, condom sabotage was significantly associated with reporting having multiple sexual partners (adjusted OR [aOR], 2.27; 95% CI, 2.22-42.28; p = .003), and being treated in the past 12 months for an STI (adjusted OR [aOR], 1,84; 95% CI, 1.82-21.98; p = . 004). The manuscript offers practical recommendations to develop health communication campaigns and public health interventions to prevent sexual assault, including condom sabotage, among college students.

Analysis of COVID-19 vaccine uptake among people with underlying chronic conditions in 2022: A cross-sectional study

Background

COVID-19 has been a global burden and vaccinations have proven to be the most effective measure to fight this pandemic. Since the approval and distribution of the vaccines, approximately 75% of District of Columbia residents have been fully vaccinated leaving a quarter of the population at risk. With the availability and approval of the booster doses to people with high-risk chronic conditions, it is important to understand the attitude of people towards vaccinations.

Objective

The objective of this research study is to analyze the COVID-19 vaccination uptake among people with underlying chronic conditions residing in District of Columbia residents and to determine the reason for the hesitancy to perform targeted outreach to unvaccinated populations.

Study design/methods

In 2022, we conducted a cross sectional study via a short online survey that was distributed to the target populations via email and social media. Multivariable Regression Analyses were conducted to determine the factors associated with the acceptance of the vaccination across various demographics.

Results

The findings of the study demonstrate that the acceptance of COVID-19 vaccination was low among people with chronic conditions compared to those with no underlying chronic conditions, and vaccination rates strongly differ based on social determinants like education, employment, and area of residence across District of Columbia.

Conclusion

The public health significance of this study is to understand the reason behind the vaccine hesitancy so that we can work towards building trust, extending outreach, creating targeted health education, and increasing access to vaccination to all communities across District of Columbia.

Symptom severity in an outbreak of SARS-CoV-2 at a university student gala in the Omicron era, Chicago, Illinois, April 2022

Objective: In April 2022, the University of Illinois Chicago (UIC) COVID-19 Contact Tracing & Epidemiology Program identified an outbreak associated with an indoor student gala. This study's aims were to characterize COVID-19 transmission dynamics and measure symptom severity among cases.Participants: The study population included UIC-affiliated gala attendees. Outbreak-associated cases tested positive for COVID-19 between April 2 and April 11, 2022. Attendees who did not test positive or develop symptoms within ten days of the event were classified as contacts.Methods: We ascertained cases through phone-based contact tracing and a survey and evaluated symptom severity using a novel classification system.Results: Among 307 UIC students registered to attend the gala, the minimum attack rate was 14.0%. Approximately 56% of cases were mildly symptomatic, and 38.9% reported severe symptoms.Conclusions: Our findings align with prior research documenting heightened transmissibility of Omicron-variant-related strains and highlight the need for nuanced symptom assessment methodologies.

Community Health Teams: a qualitative study about the factors influencing the decision-making process

BACKGROUND

The purpose of this study was to explore the factors influencing how individual Community Health Teams (CHTs) make decisions about what services to offer and how to allocate their resources.

METHODS

We conducted thirteen semi-structured interviews with all 13 CHTs program managers between January and March, 2021. We analyzed interviewees descriptions of their service offerings, resources allocation, and decision-making process to identify themes.

RESULTS

Four major themes emerged from the interview data as factors influencing community health team program managers' decision-making process: commitment to offering high-quality care coordination, Blueprint's stable and flexible structure, use of data in priority setting, and leveraging community partnerships and local resources.

CONCLUSIONS

Community-based CHTs with flexible funding allowed programs to tailor service offerings in response to community needs. It is important for teams to have access to community-level data. Teams are cultivating and leveraging community partners to increase their care coordination capacity, which is focus of their work. CHTs are a model for leveraging community partnerships to increase service capacity and pubic engagement in health services for other states to replicate.

Enhancing the utilization of healthy living interventions among cancer survivors in historically underserved populations and communities

PURPOSE

This study aimed to describe the clinical characteristics and wellness programming preferences of cancer survivors from Acres Homes, a historically Black neighborhood in Houston, Texas, with areas of persistent poverty. The goal of this study was to identify opportunities to increase cancer survivor utilization of healthy eating and active living interventions aligned to cancer center community outreach and engagement efforts.

METHODS

This multiple methods study included a retrospective review of electronic health record data (n = 413) and qualitative interviews with cancer survivors (n = 31) immediately preceding initiation of healthy eating, active living programming in Acres Homes.

RESULTS

This study found Acres Homes survivors have high rates of co-occurrent cardiometabolic disease including obesity (45.0%), diabetes (30.8%), and other related risk factors as well as treatment-related symptoms. Four major concepts emerged from interviews: (1) Factors that influence survivors' ability to eat well and exercise, (2) Current usage of community resources, (3) Interest in relevant programming, and (4) Specific programming preferences. Opportunities for current and future health promotion programming for cancer survivors were explored.

CONCLUSION

Strategically tailoring community resources for cancer survivors can provide a more robust network of support to promote healthy eating and active living in this population. This work informed community implementation of evidence-based health interventions in Acres Homes and may support future projects aiming to enhance community-led cancer prevention efforts in historically underserved communities.

Uncovering the gray zone: mapping the global landscape of direct-to-consumer businesses offering interventions based on secretomes, extracellular vesicles, and exosomes

BACKGROUND

The last decade has seen a significant increase in media attention, industrial growth, and patient interest in stem cell-based interventions. This led to a rise in direct-to-consumer businesses offering stem cell "therapies" for multiple indications with little evidence of safety and efficacy. In parallel, the use of stem cell secretomes as a substitute for stem cell transplantation has become an increasing trend in regenerative medicine with multiple clinical trials currently assessing their efficacy and safety profile. As a result, multiple businesses and private clinics have now started to exploit this situation and are offering secretome-based interventions despite the lack of supporting data. This poses significant risks for the patients and could lead to a credibility crisis in the field.

METHODS

Internet searches were used to locate clinics marketing and selling interventions based on stem cell secretomes, exosomes, or extracellular vesicles. Data were extracted from websites with a particular focus on the global distribution of the businesses, the cellular source of the secretome, the indication spectrum, and the pricing of the provided services. Lastly, the types of evidence used on the websites of the businesses to market their services were extracted.

RESULTS

Overall, 114 companies market secretome-based therapies in 28 countries. The vast majority of the interventions are based on allogenic stem cells from undisclosed cellular sources and skin care is the most marketed indication. The price range is USD99-20,000 depending on the indication.

CONCLUSIONS

The direct-to-consumer industry for secretome-based therapies appears to be primed for growth in the absence of appropriate regulatory frameworks and guidelines. We conclude that such business activity requires tight regulations and monitoring by the respective national regulatory bodies to prevent patients from being conned and more importantly from being put at risk.

Under-representation of low-income countries in the literature - targeting the bummock of neglected tropical diseases

More than 50% of the world's youth and many economies with the greatest growth rates are in tropical and subtropical regions of Africa, Asia, and Latin America. Many prevailing diseases in these areas comprise neglected tropical diseases (NTDs) - the 13 bacterial and parasitic infections that predominantly affect the poorest one-sixth of the world's population. The lack of published data, heightened by the disregard of researchers of developed countries, amounts to the 'missing piece' when attempting to draw a global picture of such diseases using systematic reviews or meta-analyses because of the imbalance in distribution. Defining and measuring the problem, evaluating the effectiveness and cost of interventions, and assessing cost-effectiveness are all necessary steps in determining health priorities for eradicating these NTDs.