Community-based Assessment Research Articles

Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors

Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial reflect increased interest in consideration of the totality of variables affecting human health and the growing desire to develop community-based risk assessment methods. A key roadblock is the uncertainty as to how nonchemical stressors behave in relationship to chemical stressors. Physical stressors offer a reasonable starting place for measuring the effects of nonchemical stressors and their modulation of chemical effects (and vice versa), as they clearly differ from chemical stressors; and "doses" of many physical stressors are more easily quantifiable than those of psychosocial stressors. There is a commonly held belief that virtually nothing is known about the impact of nonchemical stressors on chemically mediated toxicity or the joint impact of coexposure to chemical and nonchemical stressors. Although this is generally true, there are several instances where a substantial body of evidence exists. A workshop titled "Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors" held at the 2013 Society of Toxicology Annual Meeting provided a forum for discussion of research addressing the toxicity of physical stressors and what is known about their interactions with chemical stressors, both in terms of exposure and effects. Physical stressors including sunlight, heat, radiation, infectious disease, and noise were discussed in reference to identifying pathways of interaction with chemical stressors, data gaps, and suggestions for future incorporation into cumulative risk assessments.

Participatory assessment of the health of Latino immigrant men in a community with a growing Latino population.

Latino immigrant men are an understudied population in the US, especially in areas with small yet growing Latino populations. For this community-based participatory health assessment we conducted four focus groups and 66 structured surveys with Latino immigrant men, and 10 openended interviews with service providers. We analyzed transcripts using content analysis and survey data using Pearson Chi-square tests. Overall, 53% of participating men had not completed high school. Our findings suggest that their social circumstances precluded men from behaving in a way they believe would protect their health. Loneliness, fear and lack of connections prompted stress among men, who had difficulty locating healthcare services. Newly immigrated men were significantly more likely to experience depression symptoms. Latino immigrant men face social isolation resulting in negative health consequences, which are amplified by the new growth community context. Men can benefit from interventions aimed at building their social connections.

Utilising Participatory Research Techniques for Community-Based Disaster Risk Assessment

Community-based disaster risk assessment yields the best results and most trustworthy primary data in understanding the disaster risk that communities face. Yet, most of the disaster risk assessments undertaken within South Africa exhibit very little evidence of community-based and participatory approaches. Participatory research techniques and capacity development interventions were used in a community-based disaster risk assessment project covering 22 communities in the North-West Province of South Africa. This article describes the methodology developed, as well as the resulting findings of one of these at-risk communities. The robust research approach proved to be reliable, valid, and trustworthy—and, at the same time, ensured direct community participation. A number of participatory research techniques such as transect walks, community workshops, and participatory GIS were employed. The research found that the knowledge in local communities is extremely reliable in the development of their disaster risk profile, and can mostly be unlocked through participatory methods.

Developing and Assessing a Community-based Art Project in a Control Group

To assess the impact of the community-based art initiative in the control group in a childhood obesity project targeting Mexican origin communities. Overview of the community-based art project methodology and assessment of the community impact. Focus groups and interviews were used to assess the community-based art initiative and a tracking system was established for keeping track of community participation. Community-based strategies are a useful method for developing community-art projects to engage control groups in research studies.

Asthma in Underserved Schoolchildren in Miami, Florida: Results of a School- and Community-Based Needs Assessment

Objective. Asthma is the most common chronic condition in childhood and disproportionately impacts the poorer and ethnic minorities. The objectives of the study were to estimate the prevalence of asthma in Miami–Dade County (MDC) schoolchildren to aid case-finding and linkage to care. Methods. We used the CDC Youth Risk Behavior Surveillance System (YRBSS) definition of possible asthma (“Ever told by a doctor or nurse that they had asthma and still had asthma”) and analyzed data from four sources. These included the: (1)-MDC YRBSS 2009, (2)-MDC Health Connect Asthma Survey of school nurses (>2008), (3)-parents’ survey in the five HealthConnect survey elementary schools with highest asthma prevalence, and (4)-focus group with parents of asthmatic children. Results. (1)-MDC YRBSS data showed that 21.3% of high- and 21.4% of middle-school students had been diagnosed with possible asthma. Prevalence was the highest in African-American middle-school girls (26.9%). (2)-HealthConnect survey responders reported that 4.9% of the students in 131 MDC schools had possible asthma. Asthma prevalence was higher in elementary schools (median = 7.1%) and in low-income MDC zip codes. (3)-Of the parent survey responders, 24.9% indicated that their child had possible asthma, and 19.2% reported that their children had no usual source of care. (4)-Focus group participants reported frequent loss of Medicaid coverage for their children, landlords’ indifference to the role of poorly maintained housing in asthma, and unmet needs regarding knowledge of health system navigation. Conclusions. Asthma may be common in MDC schoolchildren, particularly in poor communities. Formidable structural factors limit the caregivers’ abilities to manage childhood asthma.

Thalassemia and Hemoglobinopathies in Thua Thien Hue Province, Central Vietnam

A community-based assessment of thalassemias and hemoglobinopathies was conducted at the Thua Thien Hue Province, Central Vietnam. By cluster sampling, a total of 410 pregnant women attending the antenatal care service at 30 commune health centers were recruited consecutively from September 2011 to June 2012. Hemoglobin (Hb) analysis was performed using an automated Hb analyzer. α-Thalassemia (α-thal) genes were identified by polymerase chain reaction (PCR)-based techniques. Out of the 410 pregnant women, 2.7% carried α0-thal and 1.2% were β-thal carriers. One woman with the – –THAI deletion was also found. Among the females under survey, structural Hb variants with 3.2% Hb E [β26(B8)Glu→Lys, GAG>AAG; HBB: c.78G>C] and 3.7% Hb Constant Spring [Hb CS; α142, Term→Gln, TAA>CAA (α2); HBA2: c.427T>C] were found. Assessing the frequency of thalassemias and hemoglobinopathies by ethnicity, Kinh (Vietnamese) and ethnic minority groups, Hb CS with a high frequency of 24.0% was observed in the ethnic minority groups. These results provide basic population-based information, are useful not only for implementing measures for prevention and control of thalassemias in the region but also for studying the importance of thalassemias and hemoglobinopathies in ethnic minorities within Southeast Asia.

A Statewide, Community-Based Assessment of Alvimopan's Effect on Surgical Outcomes

Alvimopan was approved by the Food and Drug Administration in May 2008 and has been shown to accelerate gastrointestinal recovery after colectomy. Our independent study evaluated alvimopan as it is used in actual hospital practice in the state of Michigan. We hypothesized that alvimopan significantly decreases incidence of prolonged ileus and reduces length of stay (LOS) in patients who have undergone colectomy. We identified 4749 patients from the Michigan Surgical Quality Collaborative (N = 28 hospitals) database between August 2007 and December 2010 who underwent elective colectomy operations. A total of 528 patients received alvimopan both pre- and postoperatively. We first selected a control group of patients from hospitals that had never administered alvimopan (n = 1833) and used propensity matching to manage differences in patient demographics and clinical characteristics. To control for hospital and surgeon characteristics, we then performed a sensitivity analysis, using a separate group of historical control patients treated before May 2008 in hospitals that would later administer alvimopan (n = 270). The Fisher exact test was used to compare complication rates, and the Student t test was used to compare LOS. Patients who received alvimopan had significantly lower incidence of prolonged ileus (2.3% vs 7.9%; P < 0.001) and a significantly shorter LOS (4.84 ± 4.54 vs 6.40 ± 4.45 days; P < 0.001) than control patients in hospitals that had never administered alvimopan. No differences were noted in these outcomes using sensitivity analysis. This study suggests that the actual utilization of alvimopan leads to a reduction in prolonged ileus and LOS in patients who underwent colectomy. By accelerating postoperative recovery, alvimopan has the potential to benefit patients and health care systems by improving outcomes, ensuring patient comfort, and reducing cost.

Community-Based Risk Assessment of Water Contamination from High-Volume Horizontal Hydraulic Fracturing

The risk of contaminating surface and groundwater as a result of shale gas extraction using high-volume horizontal hydraulic fracturing (fracking) has not been assessed using conventional risk assessment methodologies. Baseline (pre-fracking) data on relevant water quality indicators, needed for meaningful risk assessment, are largely lacking. To fill this gap, the nonprofit Community Science Institute (CSI) partners with community volunteers who perform regular sampling of more than 50 streams in the Marcellus and Utica Shale regions of upstate New York; samples are analyzed for parameters associated with HVHHF. Similar baseline data on regional groundwater comes from CSI's testing of private drinking water wells. Analytic results for groundwater (with permission) and surface water are made publicly available in an interactive, searchable database. Baseline concentrations of potential contaminants from shale gas operations are found to be low, suggesting that early community-based monitoring is an effective foundation for assessing later contamination due to fracking.

Feasibility and validity of self-reported walking capacity in patients with intermittent claudication

The primary aim of this study was to assess if self-reported measures of walking limitation correlate better with a community-based assessment of maximum walking distance (MWD) than they do with laboratory-based tests in patients with intermittent claudication. A secondary aim was to examine the effect of prior objective testing on these correlations. Thirty-one patients completed three self-report tools (self-reported MWD; Walking Impairment Questionnaire [WIQ]; Estimation of Ambulatory Capacity by History-Questionnaire [EACH-Q]) immediately before and approximately 1 week after a series of objective tests (incremental treadmill walking test, 6-minute walk test, 1-hour global positioning system [GPS] recording of a community walk). We analyzed the feasibility of the self-report tools in terms of number of errors and their correlation (r) with objective measures. The correlations of self-report tests to GPS-MWD (range, .579-.808) were consistently higher than with the treadmill test (range, .310-.584) and 6-minute walk test (range, .414-.613). The WIQ had the highest proportion of errors, both at first and second completion (58% and 42%, respectively), compared with self-reported MWD (23% and 13%, respectively) and the EACH-Q (6.5% and 13%, respectively). Correlations were improved with the second set of self-report tests (range, .310-.595 to .414-.808). The fact that all self-report tools correlated better with a community-based measure of MWD using GPS than with laboratory results confirms that they measure what they aim to: community-based MWD. In addition, prescription of a community walk might help patients to better estimate their walking limitation.

Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training

This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs. This prospective study included 4187 births at >28 weeks' gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using χ(2) and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding. Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37-0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80-1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007). HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.

A large-scale evaluation of computational protein function prediction

Automated annotation of protein function is challenging. As the number of sequenced genomes rapidly grows, the overwhelming majority of protein products can only be annotated computationally. If computational predictions are to be relied upon, it is crucial that the accuracy of these methods be high. Here we report the results from the first large-scale community-based critical assessment of protein function annotation (CAFA) experiment. Fifty-four methods representing the state of the art for protein function prediction were evaluated on a target set of 866 proteins from 11 organisms. Two findings stand out: (i) today's best protein function prediction algorithms substantially outperform widely used first-generation methods, with large gains on all types of targets; and (ii) although the top methods perform well enough to guide experiments, there is considerable need for improvement of currently available tools.

The Analysis of Community-Based Identification, Assessment and Allocation System for Early Psychosis

조현병을 비롯한 정신병적 장애는 청소년 및 청년기에 발 병하여 삶 전반에 걸쳐 영향을 미칠 만큼 질병의 부담이 높고 손상이 큰 질병으로 알려져 있다. 그러나 정신증의 미치료기 간(duration of untreated psychosis : DUP)이 짧을수록 예 후에 긍정적인 영향을 미친다는 연구결과들로 인해 조기정 신증에 대해 낙관적인 관점이 생겨나고 있다. 국내의 경우 임혜 선 등이 입원한 초발 조현병 환자를 대상으로 연구한 결과 미 치료기간이 길수록 첫 입원기간, 총 입원기간, 총 입원 횟수, 평 균 입원기간이 모두 길어지는 것으로 보고하였다. 정재철 등 이 첫 삽화 조현병 스펙트럼 환자를 5년간 추적한 연구에서는 회복군이 비회복군에 비해 미치료기간이 유의미하게 짧았다 고 보고하였다. 따라서 정신증의 조기발견 및 조기개입은 사 회 및 개인의 질병의 부담을 최소화할 수 있을 것이라는 기 대를 모으고 있으며 세계 여러 나라에서 국가차원의 미치료 기간 조사를 통한 지표생성 및 정신증 조기발견 및 조기개입 을 위한 서비스 개발에 나서고 있다. 호주의 PACE Clinic은 16~30세를 대상으로 스트레스에 취약한 상태의 젊은이에 대 해 정신질환의 평가 및 개입을 실시하고 있으며 정신질환의 발병 위험도를 감소시킨다는 관점에서 알코올 및 약물남용, 스트레스, 적응 및 발달 문제, 위기, 가족과의 문제 등을 다루 고 있다. 홍콩의 EASY (Early Assessment Service for Young People with Psychosis) program는 정신증에 대한 인식개 선과, 정신증 의심군에 대한 평가, 진단군에 대한 조기개입서 Received: April 7, 2013 / Revised: April 17, 2013 Accepted: April 19, 2013 Address for correspondence: Myung-Soo Lee, Seoul Mental Health Center, Yongin Mental Hospital, ilyang B/D 5F, 6 Bongeunsa-ro 21-gil, Gangnam-gu, Seoul 135-010, Korea Tel: 02-3444-9934, Fax: 02-3444-9961 E-mail: mslee1010@hanmail.net 지역사회 기반의 조기정신증 발견, 평가 및 배치 시스템 분석

English

There are major concerns worldwide regarding sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis as a major cause of morbidity as they result in significant health and economic consequences, particularly in developing countries. This study was intended to obtain information about the prevalence of these pathologies in women considered to be at low risk using both traditional and&nbsp;in-house&nbsp;NAAT methods. Cervical and vaginal samples were collected all volunteers signed an informed consent form and completed a survey. BV, trichomoniasis, candidiasis, genital mycoplasmas colonization and&nbsp;Chlamydia trachomatis&nbsp;or&nbsp;Neisseria gonorrhoeae&nbsp;cervicitis were diagnosed. Candidiasis and abnormal vaginal flora associated with BV were very frequent. The high colonization with micoplasmas was detected.&nbsp;C. trachomatis&nbsp;cervicitis was found in 10.67% from which a third of the cases were of asymptomatic woman. No cases of gonorrhoea or trichomoniasis were diagnosed.&nbsp;In house&nbsp;NAAT&rsquo;s used seems to viable tools for the cheap and reliable test for the diagnosis of gonorrhoea and chlamydial infections. Increased awareness of the importance of protected sexual intercourse is imperative to prevent the transmission of sexually transmitted. Further studies for a comprehensive understanding of the rates of these infections in Mexican women are necessary and should be an impulse for make community-based assessment of STI and RTI. &nbsp; Key words:&nbsp;Bacterial vaginosis, candidosis, STI, cervicitis, gonorrhoea.

Taking a learning approach to community-based strategic environmental assessment: results from a Costa Rican case study

This paper describes an innovative approach to environmental assessment that built local capacity enabling a more sustainable management of natural resources. It presents learning outcomes from a community-based strategic environmental assessment (CBSEA) involving communities from two Costa Rican watersheds who assessed the Instituto Costarricense de Electricidad's (ICE) proposed agro-conservation programme. Participants were engaged throughout the CBSEA process, from planning to the implementation of four highly interactive workshops representing steps in a strategic environmental assessment. Instrumental learning results included: learning about CBSEA and its role in programme planning; developing problem-solving skills related to assessing impacts and creating mitigation strategies; effective group-working strategies; and technical information. Communicative learning outcomes included becoming more self-aware, and appreciating environmental conservation and collaboration. ICE learnt a participatory methodology and reconsidered communities' role in programme planning. Findings contribute to understanding the process of adult learning in cross-cultural contexts and the link between individual learning and social action.

Comparison of the vicorder and SphygmoCor devices in routine, community-based blood pressure assessment

Comparison of the vicorder and SphygmoCor devices in routine, community-based blood pressure assessment

Capacity development for participatory disaster risk assessment

In this paper a large-scale community-based disaster risk-assessment project, undertaken in the Dr Kenneth Kaunda District Municipality in the North-West Province of South Africa, is evaluated. In contrast to other disaster risk management consultancy projects in South Africa, this project included a significant skills transfer component to the at-risk communities and local government officials. In this evaluation, the authors draw on their own experiences in implementing this and similar projects, a review of the project management documents is undertaken, and a focus group interview with facilitators involved in the project is used as a primary source. The discussion is further contextualised in terms of community-based disaster risk assessment theory and the existing literature on disaster risk assessment in South Africa. Logistical and data quality issues as well as staff turnover were found to be concerns during the project. From the findings, it is argued that the common practice of outsourcing disaster risk-management projects is not conducive to effective disaster risk management. Local government entities should take responsibility for disaster risk assessment as a continual activity. This is in contrast to the view currently manifesting in South Africa as a set of bureaucratic actions undertaken by consultants to achieve ‘legislative compliance’ for municipalities.

Requirements for Independent Community-Based Quality Assessment and Accountability Practices in Humanitarian Assistance and Disaster Relief Activities

During responses to disasters, the credibility of humanitarian agencies can be threatened by perceptions of poor quality of the responses. Many initiatives have been introduced over the last two decades to help address these issues and enhance the overall quality of humanitarian response, often with limited success. There remain important gaps and deficiencies in quality assurance efforts, including potential conflicts of interest. While many definitions for quality exist, a common component is that meeting the needs of the "beneficiary" or "client" is the ultimate determinant of quality. This paper examines the current status of assessment and accountability practices in the humanitarian response community, identifies gaps, and recommends timely, concise, and population-based assessments to elicit the perspective of quality performance and accountability to the affected populations. Direct and independent surveys of the disaster-affected population will help to redirect ongoing aid efforts, and generate more effective and comparable methods for assessing the quality of humanitarian practices and assistance activities.

Results of Community Deliberation About Social Impacts of Ecological Restoration: Comparing Public Input of Self-Selected Versus Actively Engaged Community Members

Participatory processes for obtaining residents' input about community impacts of proposed environmental management actions have long raised concerns about who participates in public involvement efforts and whose interests they represent. This study explored methods of broad-based involvement and the role of deliberation in social impact assessment. Interactive community forums were conducted in 27 communities to solicit public input on proposed alternatives for recovering wild salmon in the Pacific Northwest US. Individuals identified by fellow residents as most active and involved in community affairs ("AE residents") were invited to participate in deliberations about likely social impacts of proposed engineering and ecological actions such as dam removal. Judgments of these AE participants about community impacts were compared with the judgments of residents motivated to attend a forum out of personal interest, who were designated as self-selected ("SS") participants. While the magnitude of impacts rated by SS participants across all communities differed significantly from AE participants' ratings, in-depth analysis of results from two community case studies found that both AE and SS participants identified a large and diverse set of unique impacts, as well as many of the same kinds of impacts. Thus, inclusion of both kinds of residents resulted in a greater range of impacts for consideration in the environmental impact study. The case study results also found that the extent to which similar kinds of impacts are specified by AE and SS group members can differ by type of community. Study results caution against simplistic conclusions drawn from this approach to community-wide public participation. Nonetheless, the results affirm that deliberative methods for community-based impact assessment involving both AE and SS residents can provide a more complete picture of perceived impacts of proposed restoration activities.

Focused Community-based Research for Eliminating CVD Risk Disparities in a Rural Underserved Population

Background Cardiovascular disease (CVD) is the leading cause of death and chronic illness in the U.S. In parts of the rural south disparities in both health care access and CVD health outcomes are pervasive. Descriptive analyses of community-based CVD risk factors are valuable to begin to unfold the complex nature of CVD mortality in specific rural, underserved populations. Objective To evaluate the prevalence of cardiovascular disease (CVD) risk factors among patients age 25 and over at a primary rural healthcare setting in a specific rural, medically underserved population to guide the development of community-based CVD treatment and prevention strategies. Methods This study used a descriptive retrospective explorative design. Data were collected through chart audits from a random sample of 197 patients at a rural health center in northwest Alabama, U.S. Cardiovascular risk factors were identified using health data, anthropometric measures and ICD-9 codes. Prevalence was evaluated and descriptive statistics were used to describe cardiovascular risk factors as well as socio-demographics variables. Findings In this rural medically underserved cohort (n= 197), the prevalence of selected cardiovascular risk factors was: smoking: 39.1%; hypertension: 58.4%; dyslipidemia: 15.1%; diabetes mellitus: 27.9%; and obesity: 44.5%. Smoking, hypertension and diabetes were noted to be higher in men, while women had higher rates of dyslipidemia and obesity. Rates of hypertension and diabetes increased with age as seen in similar studies. More than 48% of the study population ages 41-55 years were noted to have dyslipidemia. Conclusions This community-based CVD risk factor assessment can be used to guide future community-based research and interventions. The high prevalence and inadequate control of CVD risk factors seen in this population coupled with an existing shortage of physicians is an opportunity for nursing interventions. The use of advanced practice nurses for CVD assessment and interventions may be one practical strategy for this rural, medically underserved population. Key Words Prevalence, Cardiovascular Disease, Risk Factors, Disparities, Community-based research, Rural, Underserved, Appalachian

Community-based vulnerability assessment of Tuktoyaktuk, NWT, Canada to environmental and socio-economic changes

Environmental change in the Canadian Arctic has implications for livelihoods, food systems, infrastructure and Inuit culture. Although Inuit communities are located in industrialized countries, their integral connections with the natural environments contribute to significant exposures and sensitivities to changing conditions. This paper characterizes the vulnerability of Tuktoyaktuk in the western Canadian Arctic to climate change in the context of ongoing socio-economic and environmental changes. Existing stresses in the community influence infrastructure, livelihoods and wellbeing. Strategies for adapting to adverse conditions have largely been tactical and short term, rather than planned actions in anticipation of changes in climate. In light of projected intensification of climate change and a proposed natural gas pipeline in the Tuktoyaktuk area, the community is expected to experience new stresses in the future. Future adaptation planning and policy needs to enable community involvement in the protection of important community attributes.