Community Controls Research Articles

Dyslipidemia and cardiovascular disease among childhood cancer survivors: a St. Jude Lifetime Cohort report.

Childhood cancer survivors have increased risk of dyslipidemia and atherosclerotic cardiovascular disease (CVD). The aim of this study was to evaluate the prevalence and associated cardiovascular risks of specific lipid abnormalities among childhood cancer survivors. Comprehensive lipid panel measurements were obtained from 4115 5-year survivors, with 3406 (mean age at evaluation = 35.2 years, SD = 10.4 years) not having previous dyslipidemia diagnosis, as well as 624 age, sex, and race and ethnicity matched community controls. Previously undiagnosed dyslipidemia with abnormal low-density lipoprotein (LDL) cholesterol (>160 mg/dL), non-high density lipoprotein (HDL) cholesterol (>190 mg/dL), HDL cholesterol (<40 mg/dL for men, <50 mg/dL for women), and triglycerides (>150 mg/dL) were identified in 4%, 6%, 30%, and 17%, respectively. Survivors without previous dyslipidemia diagnosis had higher LDL cholesterol and non-HDL cholesterol and lower HDL cholesterol than community controls. Cranial radiotherapy (relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.6 to 3.0 for non-HDL cholesterol) and total body irradiation for hematopoietic cell transplantation (RR = 6.7, 95% CI = 3.5 to 13.0 for non-HDL cholesterol; RR = 9.9, 95% CI = 6.0 to 16.3 for triglycerides) were associated with greater risk of dyslipidemia. Diagnoses of low HDL cholesterol (hazard ratio [HR] = 2.9, 95% CI = 1.8 to 4.7) and elevated triglycerides (HR = 3.1, 95% CI = 1.9 to 5.1) were associated with increased risk for myocardial infarction, and diagnoses of high LDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), high non-HDL cholesterol (HR = 2.2, 95% CI = 1.3 to 3.7), low HDL cholesterol (HR = 3.9, 95% CI = 2.8 to 5.4), and elevated triglycerides (HR = 3.8, 95% CI = 2.7 to 5.5) were associated with increased risk for cardiomyopathy. Previously undiagnosed dyslipidemia among childhood cancer survivors was associated with increased risk for myocardial infarction and cardiomyopathy. Comprehensive dyslipidemia evaluation and treatment are needed to reduce cardiovascular morbidity in this population.

Prevalence and Associated Factors of Dengue Virus Circulation in the Rural Community, Handeni District in Tanga, Tanzania.

Dengue virus is among the most important re-emerging arbovirus that causes global public health attention. Dengue has historically been thought of as an urban disease that frequently occurs in rapidly urbanized settings. However, dengue has become more widespread in rural regions in recent years. Understanding the changing dengue epidemiology in different geographical settings is important for targeted intervention. In Tanzania, dengue fever is not frequently reported because of the poor surveillance infrastructure, underestimation, and a lack of consideration of dengue as a priority. Therefore, the true burden as well as the risk factors for increased transmission has not been fully ascertained, particularly in rural areas. A cross-sectional community-based study was conducted in June 2021, involving a total of 362 participants of all age groups. We investigated the prevalence of acute dengue infection, seroprevalence, and associated factors among the community in three villages of the rural Handeni district. The prevalence of acute dengue infection (based on PCR) was 2.2% (8/362). Dengue-specific IgM and IgG antibodies were detected in 3.3% (12/362) and 5.2% (19/362) of the participants, respectively. Adult participants who were having vegetation around their houses were more likely to be DENV seropositive (AOR = 2.4, CI = 1.88-4.18, p value = 0.05). Children living in houses with garbage pit around their households were less likely to be DENV seropositive (AOR = 0.13, CI = 0.03-0.56, p value <0.01). DENV continues to circulate in rural Tanzania, causes an alarming situation, and necessitates prompt public health action to enhance vector surveillance and control in rural communities.

Local carbon emission zone construction in the highly urbanized regions: Application of residential and transport CO2 emissions in Shanghai, China

Optimizing urban morphology can help city managers deploy internal carbon reduction strategies. However, due to the numerous factors that influence urban carbon emissions and the complex paths of their effects, existing research findings are diverse and difficult to compare. This study constructed the local carbon emission zone (LCEZ) which links the highly urbanization morphology profiles and CO2 emission intensity to favor summarizing the form characteristics for the low CO2 emission control in new communities. The approach involved selecting six indicators from the perspectives of urban external morphology, internal characteristics, and development intensity, and using geographically weighted regression (GWR) to identify three key factors. The selected factors were divided into low(1) medium(2) and high(3) categories and were combined with each other to construct the LCEZ. The nonparametric test and GeoDetector model were used to test the difference and similarity of LCEZs, respectively. The results showed that 1) The impacts of functional mixing entropy (FME), building height (BH) and road density (RD) on residential and transport CO2 emissions (RTCE) were relatively large and positive; 2) The low- and medium-FME areas were the major types of LCEZ; 3) The area proportions of the low FME LCEZs in different population areas of the RTCE cold spot regions were the highest (81.84%–88.25%); 4) It is recommended that the morphological feature values of compact-low rise-low network (1-1-1), mid compact-low rise-mid network (1-1-2), compact-mid rise-low network (1-2-1) and mid compact-mid rise-mid network (1-2-2) were taken as the low CO2 emission control of highly urbanized regions.

Cohort profile: recruitment and retention in a prospective cohort of Canadian healthcare workers during the COVID-19 pandemic

PurposeHealthcare workers were recruited early in 2020 to chart effects on their health as the COVID-19 pandemic evolved. The aim was to identify modifiable workplace risk factors for infection and...

Laboratory method to induce state boredom increases impulsive choice in people who use cocaine and controls

ABSTRACT Background: Impulsive choice is associated with both cocaine use and relapse. Little is known about the influence of transient states on impulsive choice in people who use cocaine (PWUC). Objective: This study investigated the direct effects of induced boredom on impulsive choice (i.e., temporal discounting) in PWUC relative to well-matched community controls. Methods: Forty-one PWUC (≥1× cocaine use in past 3 months; 7 females) and 38 demographically matched controls (5 females) underwent two experimental conditions in counterbalanced order. Temporal discounting was assessed immediately after a standardized boredom induction task (peg-turning) and a self-selected video watched for the same duration (non-boredom). Subjective mood state and perceived task characteristics were assessed at baseline, during experimental manipulations, and after the choice task. Results: PWUC and controls were well matched on sex, age, and socioeconomic status. Groups were also similar in reported use of drugs other than cocaine, except for recent cigarette and alcohol use (PWUC > controls). As expected, peg-turning increased boredom in the sample overall, with higher boredom reported during peg-turning than the video (p < .001, η2 p = .20). Participants overall exhibited greater impulsive choice after boredom than non-boredom (p = .028, η2 p = .07), with no preferential effects in PWUC (p > .05, BF01 = 2.9). Conclusion: Experimentally induced boredom increased state impulsivity irrespective of cocaine use status – in PWUC and carefully matched controls – suggesting a broad link between boredom and impulsive choice. This is the first study to show that transient boredom directly increases impulsive choice. Data support a viable laboratory method to further parse the effects of boredom on impulsive choice.

Do intercropping and mineral nitrogen fertilizer affect weed community structures in low-input maize-based cropping systems?

Weeds are a major threat to crop growth in sub-Saharan Africa (SSA), particularly in low-input cropping systems. We investigated the effect of different cropping systems and nitrogen fertilizer on weed infestation during the 2017/18 and 2018/19 cropping seasons in Goromonzi district, Zimbabwe. The objectives of this study were to (1) determine if and how weed composition and structure are affected by intercropping maize with either an improved or landrace cowpea variety compared to sole crops of maize and of improved or landrace cowpea; (2) if and how weed composition and structure are affected by nitrogen fertilization; and (3) how the subsequent changes in weed infestation affect grain yield. Weed parameters were measured at different dates during the cropping cycle, and grain yield was measured at harvest. Significant differences were observed for the density of the 21 weed species collected in two seasons; seven of these weed species had a relative density exceeding 5%. Significantly more weeds were recorded in sole maize compared to sole cowpea. Intercropping significantly reduced the density of C. benghalensis. In sole crops, application of mineral nitrogen fertilizer significantly affected weed density, diversity, richness, and groundcover. Maize grain yield was independent of weed biomass and density, in both sole crops and intercrops. However, increase in weed biomass significantly reduced cowpea yield. Our results suggest that growing sole cowpea reduces weed infestation, therefore, cowpea should be considered as one of the options for effective weed control in subsistence farming communities, where access to herbicides is lacking.

COVID-19 Impacts the Mental Health and Speech Function in Spinocerebellar Ataxia Type 2: Evidences from a Follow-Up Study.

Limited evidence suggests that the SARS-CoV-2 infection can accelerate the progression of neurodegenerative diseases, but this has been not verified in the spinocerebellar ataxias (SCA). The objective of this study is to assess the impact of COVID-19 on the mental health and motor features of SCA2. A follow-up study was carried out in 170 Cuban SCA2 subjects and 87 community controls between 2020 and 2021. All subjects underwent a structured questionnaire to assess the risks of exposure to COVID-19, the confirmation of COVID-19 diagnosis, and the Hospital Anxiety and Depression Scale (HADS). Moreover, 36 subjects underwent the Scale for the Assessment and Rating of ataxia (SARA). The risk of exposure to SARS-CoV-2 and the frequency of COVID-19 were similar between the ataxia cohort and the community controls. Within the ataxia group, significantly increased HADS scores existed at the 2nd visit in both groups, but this increase was more evident for the infected group regarding the depression score. Moreover, a significant within-group increase of SARA score was observed in the infected group but not the non-infected group, which was mainly mediated by the significant increase of the speech item score in the infected group. Similar results were observed within the subgroup of preclinical carriers. Our study identified no selective vulnerability nor protection to COVID-19 in SCA2, but once infected, the patients experienced a deterioration of mental health and speech function, even at preclinical disease stage. These findings set rationales for tele-health approaches that minimize the detrimental effect of COVID-19 on SCA2 progression and identify SCA2 individuals as clinical model to elucidate the link between SARS-CoV-2 infection and neurodegeneration.

Trace and Major Element Concentrations in Cadaveric Lung Tissues from World Trade Center Health Registry Decedents and Community Controls.

Studies of the health impacts of the 11 September 2001 terrorist attacks on New York City's (NYC's) World Trade Center (WTC) towers have been hindered by imprecise estimates of exposure. We sought to identify potential biomarkers of WTC exposure by measuring trace and major metal concentrations in lung tissues from WTC-exposed individuals and less exposed community controls. We also investigated associations of lung tissue metal concentrations with self-reported exposure and respiratory symptoms. The primary analyses contrasted post-mortem lung tissue concentrations obtained from autopsies in 2007-2011 of 76 WTC Health Registry (WTCHR) enrollees with those of 55 community controls. Community controls were frequency-matched to WTCHR decedents by age at death, calendar quarter of death, gender, race, ethnicity and education and resided at death in NYC zip codes less impacted by WTC dust and fumes. We found WTCHR decedents to have significantly higher iron (Fe) lung tissue concentrations than community controls. Secondary analyses among WTCHR decedents adjusted for sex and age showed the log(molybdenum (Mo)) concentration to be significantly associated with non-rescue/recovery exposure. Post hoc analyses suggested that individuals whose death certificates listed usual occupation or industry as the Sanitation or Police Departments had elevated lung tissue Fe concentrations. Among WTCHR decedents, exposure to the WTC dust cloud was significantly associated with elevated lung tissue concentrations of titanium (Ti), chromium (Cr) and cadmium (Cd) in non-parametric univariable analyses but not in multivariable analyses adjusted for age and smoking status. Logistic regression adjusted for age and smoking status among WTCHR decedents showed one or more respiratory symptoms to be positively associated with log (arsenic (As)), log(manganese (Mn)) and log(cobalt (Co)) concentrations, while new-onset wheezing and sinus problems were negatively associated with log(Fe) concentration. Fe concentrations among individuals with wheezing, nonetheless, exceeded those in community controls. In conclusion, these data suggest that further research may be warranted to explore the utility as biomarkers of WTC exposure of Fe in particular and, to a lesser extent, Mo, Ti, Cr and Cd in digestions of lung tissue.

Cognitive and behavioural processes in adolescents with social anxiety disorder

BackgroundA better understanding of the processes that maintain social anxiety disorder (SAD) in adolescents could improve treatment outcomes. This study aimed to establish whether cognitive and behavioural processes known to be important in the maintenance of adult SAD are observed in adolescent populations and whether they are specific to SAD. MethodsWe recruited three groups of adolescents (12-18y): (1) 90 adolescents with a SAD diagnosis, (2) 58 adolescents with an anxiety disorder that was not SAD, and (3) 45 community-based adolescents. Participants completed measures of negative social cognitions, social attitudes, safety behaviours, self-focused attention, and social anxiety, anxiety, and depression symptoms. ResultsThe clinical SAD sample endorsed higher levels of negative social cognitions, attitudes, and safety behaviours compared to both control groups. Self-focused attention was higher in the clinical SAD sample compared to the anxiety clinical control group but not compared to the community control group. ConclusionsThis study provided evidence of SAD-specific mechanisms including negative social cognitions, attitudes and safety behaviours in adolescents. The study did not provide evidence of disorder-specific mechanisms of self-focused attention but this may have been due to methodological limitations. These findings indicate avenues for further research and point to the potential value of Cognitive Therapy for the treatment of adolescent SAD.

Adapting E-cigarette prevention programming to reach the latinx community

PurposeE-cigarettes are the most commonly used tobacco product among youth in the United States. Yet evidence-based prevention programming is limited due to the rapid onset of this threat. Community-based efforts to address vaping largely target youth in school settings. Although parents can play an important role in youth tobacco control efforts, messages about the dangers of vaping, use among adolescents, and strategies for intervening have not reached many Spanish-speaking parents in low-income Latinx communities. Our community-academic team developed e-cigarette prevention programming for use by promotor/as de salud to address this unmet need.MethodsDuring the 1-year project, the team worked closely with a Project Advisory Committee to: review existing evidence-informed materials; conduct focus groups with parents, youth and promotor/as to guide program development; develop a curriculum to prepare promotor/as to educate low-literacy, Spanish-speaking parents about vaping; craft Spanish language resources for promotor/as to use in community education sessions; train 61 promotor/as to deliver the program; and support program delivery to 657 community members.ResultsFocus groups with promotor/as and community members, key-informant interviews, and brief surveys informed program development and assessment. Community member feedback was essential to development of appropriate materials. Promotor/as demonstrated significant pre- to post- training increases in e-cigarette knowledge and confidence in delivering vaping prevention education. Community members demonstrated a mastery of basic e-cigarette concepts and expressed intention to discuss vaping with their children.ConclusionsPromotor/a-led programming for parents represents a promising approach to vaping prevention and control in the Latinx community.

B - 75 Recall Versus Recognition? A Systematic Review and Meta-Analysis of Recall Versus Recognition Testing to Differentiate Diagnostic Groups.

A systematic review and meta-analysis to evaluate the clinical utility of separate recall and recognition testing in the identification of anterograde memory impairment. Articles published from 2010 onwards that reported outcomes for both recall and recognition testing in patients with a diagnosed memory disorder compared to community controls were eligible for inclusion. A search of PsycINFO, Medline, and EMBASE databases in June 2020 led to a total of 63 articles. Standardized mean differences between patients and controls were calculated for recall and recognition outcomes. Study quality was assessed using a modified QUADAS-2 form. Multivariate meta-analyses revealed that overall, patients performed significantly worse than controls on both recall (Hedges' g = 2.37, 95%CI: 1.88 to 2.87) and recognition tests (Hedges' g = 1.62, 95%CI: 1.26 to 1.99). A comparison of effect sizes between recall and recognition outcomes using multivariate meta-analysis showed that recall tests were significantly more impaired in patients versus controls (g = 0.76, 95%CI: 0.54 to 0.98) across all test categories and all diagnostic categories, except temporal lobe epilepsy, likely due to the small sample size for this group. The results were not influenced by test material (i.e., verbal or visual), the age or education of patients, or studies considered to have a high risk of bias. The results show that recall test scores provide a more effective method to identify anterograde memory impairment compared to recognition test scores, regardless of the underlying cause of memory impairment. In no diagnostic group examined did recognition testing confer any advantage.

Functional and temporal facets of predation by marsh frogs across the aquatic–terrestrial ecotone of ponds and implications in the context of biological invasions

Abstract Freshwater vertebrate predators can exert trophic control over aquatic and littoral communities. Among these predators, post‐metamorphic anurans exhibit a biphasic trophic spectrum by foraging in both terrestrial and aquatic habitats. Many studies have described their diet through the classical taxonomic classification of prey. However, these singular diet habits imply a complex, time‐dependent, realised trophic niche in which predation pressure occurs over many consumers that fill diverse functional roles throughout the aquatic and terrestrial interface of ponds. Among anurans, marsh frogs (Pelophylax ridibundus) have been introduced outside their range in many countries and are now invading nationwide areas, particularly in western Europe. Focusing on their foraging specificities will therefore further the understanding of the trophic role of these alien taxa in pond environments that are highly colonised. We collected stomach contents from 761 marsh frogs from introduced populations in 19 ponds in southern France once a month over 4 months of their active period in the spring. The populations of marsh frogs were studied in a geographic area that was devoid of native water frogs and their origin tracks back as far as south‐eastern Europe (i.e., more than 1,000 km from the studied sites, as evidenced previously by genetic analyses). Marsh frogs exhibited generalist and opportunistic feeding strategies. The trophic niche was strongly asymmetrical and broader in the terrestrial environment than in the aquatic environment. However, predation occurred in communities of large freshwater macroinvertebrates and amphibians. Whereas the composition of the terrestrial diet exhibited strong seasonal variations, predation pressure was continuously exerted on the same aquatic organisms over time. Primary consumers and consumers at higher trophic levels frequenting aquatic benthic, vegetated, pelagic, and surface microhabitats were preyed upon, underlying the multidimensional extent of the predation spectrum. The diversified feeding strategies of alien marsh frogs highlight the extent of potential ecological control by predation on pond communities. Because of their wide trophic niche, they exert predation pressure on most pond organisms, triggering possible top‐down control of the overall aquatic communities. Our results show that the integration of the functional traits and microhabitats of consumed prey may aid in a better understanding of how predation by anurans may target specific components of pond communities. More particularly, this study raises concerns about the predatory role of introduced anurans in the context of biological invasions.

Nutrients patterns and attention deficit hyperactivity disorder among Egyptian children: a sibling and community matched case-control study

BackgroundAttention Deficit Hyperactive Disorder (ADHD) diagnosis has been growing among children, with great public health concern. The relationship between nutrient intake pattern and ADHD remains unclear.AimTo identify the nutrient intake patterns and its association with ADHD in children.Subjects and methodsThe study involved 146 children with ADHD, 141 control sibling, and 146 community controls. ADHD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria following the assessment by the long-form Conner’s Scale. Dietary intakes were assessed using a semi-quantitative food frequency questionnaire. Nutrients patterns were identified using the principal component analysis (PCA).ResultsADHD children have significantly higher mean total energy intake than community controls and siblings (8867.9, 4481.9 and 7308.2 KJ, respectively, p < 0.001). Four nutrient patterns extracted by the PCA explained 75.9% of the total variance. Lower tertiles of “predominantly calcium-phosphorus; pattern 1” and “predominantly-vitamins; pattern 3” were significantly associated with increasing odds of ADHD, compared to community controls (p for trend: 0.002 and 0.005, respectively), while the same associations were noted in “predominantly-vitamins” and “predominantly Zinc-Iron; pattern 2” when compared to siblings (p for trend: <0.001 and <0.001, respectively). However, Higher tertiles of macronutrients; pattern 4” were associated with increased ADHD odds, compared to either community controls or siblings (p for trend: 0.017 and <0.001, respectively).ConclusionLower intakes of nutrients patterns of minerals and vitamins, and higher intakes of macronutrients were associated with increased likelihood of ADHD in children.

Neurocognitive impairment associated with chronic morbidity in long-term survivors of Hodgkin Lymphoma

AbstractThoracic radiation is associated with significant cardiopulmonary morbidities in survivors of long-term Hodgkin lymphoma and may affect neurocognitive outcomes. Survivors (N = 204; 52.5% female; mean [standard deviation] age, 36.6 [8.01] years) treated with thoracic radiation and age-, sex-, and race/ethnicity-matched community controls (N = 205; 51.7% female; age, 36.7 [9.17] years) completed standardized neurocognitive testing, echocardiography, pulmonary function tests, and vascular studies during the same visit. Treatments were abstracted from medical records. Cardiac (ie, left ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), vascular (ie, large and small artery elasticity [SAE]), pulmonary (ie, diffusing capacity of the lungs for carbon monoxide [DLCO] and forced expiratory volume [FEV1]), and chronic health conditions were evaluated for associations with age-adjusted neurocognitive performance using multivariable linear regression. Compared with controls, survivors had lower performance (P < 0.05) in visuomotor (0.11 vs 0.41), visual processing speed (0.25 vs 0.64), short-term recall (−0.24 vs 0.12), and flexibility (−0.04 vs 0.28). Survivors had lower pulmonary (FEV1, DLCOcorr), cardiac (LVEF, GLS), and vascular function (SAE) than controls (all P < 0.001). FEV1 was associated with visuomotor (P = .008) and visual processing speed (P = .05), and flexibility (P = .05). GLS was associated with short-term recall (P = .03). SAE was associated with flexibility (P = .007). Neurocognitive outcomes were also associated with moderate-to-severe neurologic chronic conditions (P < .05). Findings suggest a link between subclinical cardiopulmonary and vascular findings, neurologic morbidity, and neurocognitive impairments. Prevention of health morbidity may benefit neurocognitive outcomes.

Fortify the Truth: How to Defend Human Rights in an Age of Deepfakes and Generative AI

Abstract Audiovisual digital media and tools are critical elements in contemporary human rights documentation and advocacy. Generative AI, deepfakes and synthetic media compound questions of what to trust in an existing situation of government suppression, difficulty proving witness accounts and broader societal challenges to trust. There is a need to ‘fortify the truth’ by fostering resilient witnessing practices that can ensure trustworthy videos and strengthen narratives of vulnerable communities. The author identifies and speculates on actions at tactical, strategic, tools, technology, and policy levels, drawing upon human rights organization WITNESS’s work on proactive preparation for emerging technologies and technical infrastructures. Practical steps occur across a trajectory of using images and video in human rights advocacy and activism including filming, storytelling, watching, analysing, sharing, advocacy, and preservation. Guidance on filming must evolve to address deepfakes and opportunities and challenges in ‘authenticity infrastructure’. Narrative video advocacy and formal legal and policy processes must adapt to new technologies including text-to-image and text-to-video, new disinformation threats such as ‘floods of falsehood’ and new presentation opportunities. The evolution of watching, scrutinizing, and sharing videos accountability amid increasing volume and normalized image manipulation includes positive dimensions of the ‘media forensic turn’, including collaborative ‘open-source intelligence’ verification, and negative aspects involving excessive scrutiny. Finally, preserving audiovisual media is critical, and emerging socio-technical infrastructure should be shaped for community control. Underlying principles for ‘fortifying the truth’ include taking a proactive approach, centring voices and needs of people facing human rights abuses, and working with and challenging technologists and technology companies.

School principals’ perceptions of autonomy and control in low-SES communities - navigating local school administration on the front line

ABSTRACT In the decentralized Swedish school system, the local education authority (LEA) level has an important position when it comes to school governance. This article takes a micro-level perspective on principals’ perceptions of autonomy and control as they navigate local school administration in their front-line work in low – socio-economic status (SES) communities. The point of departure is taken in a multidimensional understanding of principal autonomy and street level bureaucracy. Empirical data consist of group conversations among principals, all of them working in a highly segregated Swedish city. The analysis shows that the principals perceive local school administration to be dominated by uniformity expressed through digitalization and specialization lacking contextual adaption. This orientation gives the principals a sense of local school administration being controlling and non-supportive. In addition, lack of adaption to the specific conditions of the low-SES community context tend to increase the principals’ workload and further restrict their autonomy. To cope with the situation and still deliver the education the students are entitled to, the principals act pragmatically in an innovative way. Based on contextual awareness they delay demands, deviate from routines and come up with alternative solutions, hence expanding their autonomy and intensifying their professional judgement.

Knowledge, attitudes and practices regarding malaria prevention and control in communities in the Eastern Region, Ghana, 2020.

In sub-Saharan Africa countries including Ghana, the malaria burden remains unacceptably high and still a serious health challenge. Evaluating a community's level of knowledge, attitude, and practice (KAP) regarding malaria is essential to enabling appropriate preventive and control measures. This study aimed to evaluate knowledge of malaria, attitudes toward the disease, and adoption of control and prevention practices in some communities across the Eastern Region of Ghana. A cross‑sectional based study was carried out in 13 communities across 8 districts from January -June, 2020. Complete data on socio-demographic characteristics and KAP were obtained from 316 randomly selected household respondents by a structured pre-tested questionnaire. Associations between KAP scores and socio-demographic profiles were tested by Chi-square and binary logistic regression. Data analysis was done with SPSS version 26.0. Most respondents (85.4%) had good knowledge score about malaria. Preferred choice of treatment seeking place (50.6%) was the health center/clinic. All respondents indicated they would seek treatment within 24 hours. Mosquito coils were the preferred choice (58.9%) against mosquito bites. Majority of households (58.5%) had no bed nets and bed net usage was poor (10.1%). Nearly half of the respondents (49.4%) had a positive attitude toward malaria and 40.5% showed good practices. Chi-square analysis showed significant associations for gender and attitude scores (p = 0.033), and educational status and practice scores (p = 0.023). Binary logistic regression analysis showed that 51-60 year-olds were less likely to have good knowledge (OR = 0.20, p = 0.04) than 15-20 year-olds. Respondents with complete basic schooling were less likely to have good knowledge (OR = 0.33, p = 0.04) than those with no formal schooling. A positive attitude was less likely in men (OR = 0.61, p = 0.04). Good malaria prevention practice was lower (OR = 0.30, p = 0.01) in participants with incomplete basic school education compared to those with no formal schooling. Overall scores for respondents' knowledge, though good, was not reflected in attitudes and levels of practice regarding malaria control and prevention. Behavioral change communication, preferably on radio, should be aimed at attitudes and practice toward the disease.

The Use of Graphic Facilitation to Support Adherence to OCAP® Principles in Research With Indigenous Communities

Graphic facilitation is a creative, robust visual communication process and tool that can be used by researchers for several benefits including improving data integrity; mitigating barriers between researchers and participants; promoting participants’ ownership of data, decision-making, and creativity; and, co-creating knowledge, which is of particular interest among certain cultures and in some contexts. For Indigenous Peoples who traditionally use visual, oral, and narrative modalities as primary forms of communication, graphic facilitation is a methodology that aligns well with these modes of communicating. In this article, we describe our use of graphic facilitation in a community-led project exploring Indigenous parents’ perceptions of community strengths, needs and priorities related to healthy early childhood development and optimal parenting. In collaboration with the Indigenous Friendship Centre in Hamilton, Canada, we held a Community Gathering that was facilitated by a graphic artist experienced in working with the Indigenous community; the findings resulting from the Gathering are presented. We discuss how researchers can use graphic facilitation as a tool to ensure adherence to the OCAP® principles of data ownership, control, access, and possession for the Indigenous community and describe the potential for mitigating power imbalances. Finally, considerations for researchers contemplating using graphic facilitation as a tool for research projects with Indigenous people and communities are presented.

Diet quality and Parkinson’s disease: Potential strategies for non-motor symptom management

IntroductionParkinson’s disease (PD) is now considered a systemic disease, and some phenotypes may be modifiable by diet. We will compare the diet quality and intake of specific nutrients and food groups of PD patients with household and community controls to examine how diet may influence PD clinical features. MethodsWe conducted a case-control study of 98 PD patients and 83 controls (household = 53; community = 30) in central California, assessing dietary habits over the past month and calculating the Healthy Eating Index (HEI)-2015. We employed multivariate logistic and linear regression analyses to assess associations between diet and PD status, PD symptom profiles, and medication, adjusting for relevant confounders. ResultsPD patients had a lower HEI score than controls, with an OR of 0.65 (95% CI: 0.45, 0.94) per 10-points increase in HEI. Lower-quality diet was characterized by higher intakes of carbohydrates, total and added sugars, and trans fats and lower intakes of fiber, folate, unsaturated fatty acids, protein, and fat. PD patients with chronic constipation had a 4.84 point lower HEI score than those without (β per 10-point in HEI: −0.48; 95% CI: −0.97, −0.00). Furthermore, patients on high dopamine agonist doses consumed more sugar than those on lower doses. ConclusionPD patients consume a lower-quality diet compared to household and community controls. Dietary modifications may alleviate non-motor symptoms like constipation, and promoting a healthy diet should become a part of routine care and disease management for PD patients, with special attention on agonist-treated and hyposmic patients.

Mobile Health School Screening and Telemedicine Referral to Improve Access to Specialty Care in Rural Alaska: Integrating Mixed Methods Data to Contextualize Trial Outcomes.

To understand factors associated with outcomes in a cluster-randomized controlled trial that evaluated a telemedicine specialty referral intervention for school hearing screenings in 15 rural Alaskan communities. Hearing Norton Sound was a mixed methods cluster-randomized controlled trial that compared a telemedicine specialty referral pathway (intervention) to a standard primary care referral pathway (control) for school hearing screenings. As a mixed methods trial, both quantitative and qualitative data were collected, analyzed, and integrated. Main trial results are published elsewhere, but integration of community-specific quantitative outcomes and qualitative results have not yet been reported. The constant comparative method was used to analyze qualitative data from semistructured interviews with six stakeholder groups across all 15 communities. Descriptive statistics were used to describe community-specific proportions of follow-up in both trial years. Qualitative and quantitative results were integrated to reveal relationships between contextual factors and follow-up outcomes across communities. The Hearing Norton Sound trial enrolled 1481 children from October 2017 to March 2019, with a total of 790 children requiring referral. Of the children who referred in the telemedicine specialty referral pathway communities (intervention), 68.5% received follow-up (268/391), compared to 32.1% (128/399) in primary care referral communities (control)(previously reported). When broken down by community, the mean proportion receiving follow-up was 75.26% (SD 22.5) and 37.9% (SD 11.4) for the telemedicine specialty referral communities and primary care referral communities, respectively. For qualitative data collection, semistructured interviews were conducted with 101 individuals between December 2018 and August 2019. Six stakeholder groups participated: elders (n = 14), parents (n = 25), children (n = 11), teachers/school staff (n = 18), principals (n = 6), and healthcare providers/clinic staff (n = 27). Six overall factors related to the outcomes of the telemedicine specialty referral pathway emerged during analysis: clinic capacity, personnel ownership and engagement, scheduling, telemedicine equipment/processes, communication, and awareness of the need for follow-up. We integrated these factors with the community-specific follow-up percentages and found associations for four of the six qualitative factors: clinic capacity, personnel ownership and engagement, communication, and awareness. An association was not seen for scheduling and telemedicine equipment/processes, which had variable relationships with the follow-up outcome. The Hearing Norton Sound trial demonstrated that a telemedicine specialty referral pathway can close the gap on children lost to follow up after school hearing screening. As a whole, the intervention profoundly increased the proportion of children receiving follow-up, but there was variability in outcomes within and between communities. To understand this variability, we analyzed community-specific intervention outcomes alongside community member feedback on factors related to the intervention. We identified four key factors that contributed to the success of the intervention. Attention to these factors will be essential to successful adaptation and implementation of this telemedicine specialty referral intervention and other similar interventions in future work in rural Alaska and beyond.