Community Intervention Program Research Articles

“Giros de Rua” - Revitalize physical and mental health in people with HIV through a psychosocial intervention program: a study protocol

IntroductionGiven the negative social representation attributed to mental illness, it is urgent to reconfigure its representation, not as an individual problem, but also as a collective. Several solutions have been indicated to improve the skills and quality of life (QoL) of these individuals. Among these, psychosocial rehabilitation programs stand out to keep individuals inserted in society reaching a level of independent functioning.ObjectivesThis study aims to: - assess the level of QoL, social support, treatment adherence, mental health status and mental health literacy of Portuguese people with HIV integrated into a community intervention program “InPulsar - Giros na Rua” program [which aims to contribute to the improvement of the socio-sanitary conditions of people who use psychoactive substances and to their social and therapeutic referral, as well as promoting risk reduction by intervening in a public space]; - improve mental health literacy levels, adherence to therapeutic regimen and QoL in individuals with HIV, after 12 months of implementation of a psychosocial rehabilitation program [biweekly sessions].MethodsWe will perform a single-group pre-experimental study with pre- and post-intervention evaluation, supported by the participatory methodology in health.ResultsThis study has received ethical approval from the local IRB. Data collection will start in November 2021 and will be completed in November 2022.ConclusionsThrough a multidisciplinary approach, this study will allow the development of health interventions articulated with psychosocial interventions based on various educational and behavioural strategies, promoting literacy and adherence to the therapeutic regimen.DisclosureNo significant relationships.

Community intervention programs prolong the onset of functional disability among older Japanese.

AimThis study examined the effects of a “community‐based center” intervention to prevent the onset of functional disability among residents in disaster‐affected areas.MethodsWe used data from a prospective cohort study conducted from 2010 to 2016 in Iwanuma City, Japan. Participants were community‐dwelling independent adults aged ≥65 years. The exposure variable was the experience of using a community‐based center. The outcome variable was functional disability onset. The average treatment effect on the treated (ATET) was estimated by adjusting for possible confounders. Additional analysis stratified by sex was conducted considering the sex differences in social participation rates.ResultsAmong 3794 participants (mean ± SD age = 72.9 ±5.3 years, 46.0% men), 196 (5.2%) used the community‐based center, and 849 (22.4%) exhibited disability onset. Of those with functional disabilities, 40 (20.4%) used the community‐based center, while 809 (22.5%) did not. The ATET for functional disability onset with community‐based center activities across all participants were not significant (ATET: 0.51 years [95% confidence interval [CI] = −0.23; 1.27]). However, the direction of the effect of community‐based center activities differed by sex (ATET: −0.14, 95% CI = −2.59; 2.31 for men [n = 18], and 0.66, 95% CI = 0.18; 1.16 for women [n = 178]). Women exhibited a 15.63% (95% CI = 3.58; 27.68) increase in the time until functional disability onset.ConclusionsThe use of community‐based centers was associated with a longer period without functional disability in women. Geriatr Gerontol Int 2022; 22: 465–470.

Systematic Review of the Effectiveness of Community Intervention and Health Promotion Programs for the Prevention of Non-Communicable Diseases in Japan and Other East and Southeast Asian Countries

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. However, current evidence regarding the efficacy and cost-effectiveness of community intervention and health promotion programs for NCDs, specifically hypertension, obesity, diabetes, and dyslipidemia, in East and Southeast Asia has not yet been systematically reviewed. We systematically reviewed the literature from East and Southeast Asian countries to answer 2 clinical questions: (1) do health promotion programs for hypertension, obesity, diabetes, and dyslipidemia reduce cardiovascular events and mortality; and (2) are these programs cost-effective?Methods and Results: Electronic literature searches were performed across Medline, Cochrane Library, and Ichushi using key words and relevant subject headings related to randomized controlled trials, comparative studies, quasi-experimental studies, or propensity score matching that met eligibility criteria that were defined for each question. In all, 3,389 records were identified, of which 12 full-text articles were reviewed. Three papers were from Japan, 7 were from China/Hong Kong Special Administrative Region, and 2 were from South Korea. None were from Southeast Asia. Four papers examined the effect of community intervention or health promotion on the incidence of cardiovascular events or mortality. Eight studies examined the cost-effectiveness of interventions.Conclusions: The literature review revealed that community intervention and health promotion programs for the control of NCDs are a cost-effective means of reducing cardiovascular events and mortality in East Asian countries.

Community intervention programmes with people affected by leprosy: Listening to the voice of professionals.

BackgroundCommunity participation and implementing interventions based on the community are key strategies to eliminate leprosy. Health professionals have an essential role as they are a necessary source of information because of their knowledge and experience, as well as their comprehensive perspective of contexts included in the programmes. This study has the aim of analysing the perceptions on the development of programmes with people affected by leprosy from the perspective of professionals that work at different organisations in endemic contexts.MethodologyA qualitative study was carried out with the written response to an open question questionnaire which was sent by email. The script content was related to positive aspects and difficulties in daily work, participation from the community in activities, contribution to gender equality and programme sustainability. 27 health professionals were interviewed, 14 women and 13 men, all of which belonged to 16 organisations in India and Brazil. Once the content of the interviews was analysed, two main topics emerged: barriers perceived by professionals and proposals to improve the sustainability of the programmes.Principal findingProfessionals identify barriers related to social stigma, inequalities, gender inequalities, difficulty managing the disease, limited services, lack of resources and lack of community participation. Furthermore, some necessary recommendations were taken into account to improve programme development related to: Eliminating stigma, reaching gender equality, developing adequate and effective services, guaranteeing adequate and quality resources and achieving compassion among professionals.ConclusionsAlthough introducing community programmes with people affected by leprosy has a long history in countries such as India and Brazil, there are still several barriers that can hinder their development. Based on the specific needs of the contexts, recommendations are suggested that, with the involvement of all parties and with sensitive approaches towards human rights and gender, they could help to guarantee universal health coverage and the sustainability of said programmes.

Loneliness and psychological well-being among community-dwelling elderly people: the mediating role of death anxiety

Purpose The present study aims to investigate the relationship between loneliness and psychological well-being and examine whether death anxiety mediates the association between loneliness and psychological well-being among community-dwelling elderly people in the Kerala state of India. Design/methodology/approach A total of 209 participants (125 males and 84 females) were selected for this study through the convenience sampling method. SPSS (version 22) was used to estimate descriptive and correlational indices. Mediation analysis was conducted using Hayes Process macro-Version 3.5 and 5,000 bootstrapped sample-based analysis. Findings Results indicate the significant indirect effect of loneliness on psychological well-being through the influence of death anxiety. It was thus concluded that lonely feelings among elderly people lower psychological well-being and death anxiety partially mediates the relationship of loneliness and psychological well-being. Research limitations/implications The cross-sectional study with the use of questionnaires might not be adequate to establish causal links. All the participants were from community-dwelling. So it reduces the possibility of generalizing the findings to institutional settings. The study recommends the need and importance of mental health support for elderly people through community intervention programs to reduce their feeling of loneliness. Originality/value The present study contributes to the existing body of knowledge by substantiating the mediating role of death anxiety in the relationship between loneliness and the psychological well-being of elderly people staying at home.

Client Perspectives Regarding the Effects of a Community-centred Programme Aimed at Reducing Poverty and Social Exclusion

Abstract People struggling with poverty and social exclusion constitute the principal population targeted by social services around the world. To deal with this social problem, many intervention plans have been developed. In Israel, the ‘Otzma’ Centre programme was adopted in 2007 by the Ministry of Welfare and Social Affairs. The programme’s goals are reducing clients’ economic distress and social exclusion through various social work methods, with the core principle being the population’s participation. The current qualitative study focused on a community programme for reducing poverty and exclusion. It was based on semi-structured in-depth interviews with thirteen women and two men aged thirty-five to fifty-eight years who participated in the programme. The study had two central goals: (i) understanding clients’ experience of living in poverty and (ii) understanding clients’ perceptions of the contribution of a community programme to their lives. Research findings included participants’ most salient perceptions: namely, the multidimensional experience of dealing with poverty, becoming knowledgeable about their rights and the change process in terms of economic, personal and family issues. A finding that stood out in its absence concerned partnership and participation. The study enriches the literature regarding community intervention programmes, which aim to reduce poverty and exclusion. Practical and theoretical considerations are discussed.

Marfatia Award Abstracts

Background:Treatment gap, conceptualized as a proportion of eligible persons not having access to treatment, is a key indicator of adequacy of mental health services of a state, driving policies and financial allocation for the sector. Impact of public health interventions on the gap is not studied howeverMethods:We examined the impact of two community intervention programs (for persons with schizophrenia) running in two taluks of Karnataka, India (Thirthahalli and Turuvekere) on the reduction of treatment gap. Prevalence (target population) was measured by adding up the already existing cases with the ones identified by way of house-to-house survey, conducted by Accredited Social Health Activists (ASHAs) who were trained in a simple screening tool. Screen positives were further scrutinized by research social workers and psychiatrists to confirm the diagnosis. Gap was calculated by noting the difference between the target population and the ones who had not contacted the service even onceResults:In Thirthahalli, out of 364 patients, 14 had not contacted the services even once, pegging the gap at 3.84%. In Turuvekere, out of 236 cases, 29 had not contacted the services, pegging the gap at 12.28%. 7.16% was the gap in both taluks put-together.Conclusion:Meaningful reduction of gap for schizophrenia is a feasible target to achieve. Policies commensurate with this aim should be considered. Principal worker: Naveen Kumar C, MD, DPM. Professor & Head, Community Psychiatry Unit Department of Psychiatry.National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru –560029, India. Email: cnkumar1974@gmail.com Ph: 9448504903

Pregnancy and Infant Development (PRIDE)\u2014a preliminary observational study of maternal adversity and infant development

BackgroundChildren from socioeconomically disadvantaged families have a markedly elevated risk for impaired cognitive and social-emotional development. Children in poverty experience have a high risk for developmental delays. Poverty engenders disproportionate exposure to psychological adversity which may contribute to impaired offspring development; however the effect may be mitigated by social support and other aspects of resilience. Our objective was to determine the association between maternal stress, adversity and social support and early infant neurobehavior and child behavior at two and three years.MethodsWe conducted a longitudinal mother-infant cohort study nested within a regional home visiting program in Cincinnati, Ohio. Four home study visits were completed to collect measures of maternal stress, adversity and social support and infant and child behavior. A measure of infant neurobehavior (‘high-arousal’ infant) was derived from the NICU Network Neurobehavioral Scale (NNNS) at 1 month and externalizing and internalizing symptoms were measured by the Child Behavior Checklist (CBCL) at 24 and 36 months. Linear and logistic regression identified associations between maternal risk/protective factors and infant and child behavioral measures. We used stratification and multiplicative interaction terms to examine potential interactions.ResultsWe enrolled n = 55 pregnant mothers and follow 53 mother–offspring dyads at 1 month, 40 dyads at 24 months and 27 dyads at 36 months. Maternal adversity and protective factors were not associated with neurobehavior at one month. However, maternal depression and measures of distress in pregnancy were significantly associated with internalizing and externalizing symptoms at 24 and 36 months.ConclusionsThis pilot study established the feasibility of conducting longitudinal research within a community intervention program. In addition, although there were no statistically significant associations between maternal psychosocial factors in pregnancy and infant neurobehavior, there were several associations at 24 months, primarily internalizing symptoms, which persisted through 36 months. Future work will replicate findings within a larger study as well as explore mediators and modifiers of these associations.

Amma Unavagam: mitigating food insecurity through state sponsored food subsidisation programme

Learning outcomes The following are the learning objectives of the case study: to address the problem of urban food insecurity. To facilitate the generation of more employment opportunities and women empowerment through self-help groups (SHGs). To understand the transition from the founder to new leadership provided by Ms J Jayalalithaa. To understand consumer perception and preferences for “Amma canteens”. To appreciate how the case study has added to the historical role of soup kitchens. To address the challenges faced by the government on the sustainability and viability of “Amma canteens” post the death of its founder Ms Jayalalithaa. Case overview/synopsis “Amma Unavagam” is a food subsidisation programme operated by the State Government of Tamil Nadu in India. Under the scheme, municipal corporations of the state are required to run canteens that serve subsidised food. The canteens were first launched by the then Chief Minister of the state Ms Jayalalithaa, who was widely acknowledged as “Amma”. These low-cost canteens will be announced as part of government schemes aimed to support economically disadvantaged sections of society. The scheme had been able to generate employment for thousands of women. However, the success of the scheme lies in the low prices and the cooperative management of all the outlets by the SHGs. The SHGs have been able to run the canteens based on self-governing norms, mutual reciprocity and shared responsibilities. This case study evaluates the role of state-sponsored mechanisms to ensure food security, alleviate food inflation and empower more women in the workforce. Yet, several concerns continue to remain unaddressed. Considering the huge amount of subsidy provided by the state government, the sustainability and economic viability of the scheme are uncertain. Complexity academic level This case study can be used for management students studying the basics of management such as teamwork, motivation, leadership and good governance. They may also study government policies and community intervention programmes for the benefit of society. The present case study will help the students to analyse the concept of women empowerment and social inclusion. The students, before discussing the case, may study and read the socio-economic theory of “community engagement and participation”, the “self-help model” and the related “theory of reasoned action/planned behaviour”. Supplementary materials Teaching notes are available for educators only. Subject code CSS 6: Human resource management.

Prevalence and risk factors of Taenia hydatigena in dogs, pigs, and cattle in the Central Highlands of Vietnam.

Taenia hydatigena is a globally distributed canine tapeworm. The canine tapeworm results in economic impacts for farmers owing to organ condemnation. T. hydatigena utilizes dogs and other carnivores as definitive hosts while swine and ruminants serve as intermediate hosts. T. hydatigena is endemic in Vietnam; however, information on the prevalence and risk factors associated with infection is scarce. This cross-sectional study aims to identify the prevalence of T. hydatigena taeniasis in dogs and T. hydatigena cysticercosis in pigs and cattle. The risk factors associated with taeniasis in dogs were identified using a fixed effects logistic regression model and quantified using population attributable fractions. The prevalence of T. hydatigena taeniasis in dogs and T. hydatigena cysticercosis in pigs and cattle was 10.31% (95% CI 8.21 to 12.84%), 7.60% (95% CI 6.34 to 9.08%), and 11.11% (95% CI 7.63 to 11.81%), respectively; these levels were lower than those reported in other regions of Vietnam. The population attributable fraction of risk factors associated with T. hydatigena taeniasis in dogs for dogs living in proximity of an abattoir, those having access to raw pork or beef viscera, and those living in multi-dog households were 80%, 19%, and 7%, respectively. This current study identified and quantified the risk factors for taeniasis in dogs thus advocating for targeted community intervention programs to break the lifecycle of T. hydatigena in Dak Lak province.

DEPRESSION AND EFFECTIVENESS OF COMMUNITY-BASED DEPRESSION INTERVENTION PROGRAMME FOR ELDERLY IN QUANG NGAI CITY

Introduction: With the growing elderly population in Vietnam and the increasing impact of mental health problems, the prevention of these disorders should be emphasized and support programs in the community are needed. Objectives: 1. To determine the prevalence of depression using the GDS-30 scale; 2. To evaluate the effectiveness of community intervention in preventing depression. Methods: A quasi-experimental survey with pretest/posttest design was adopted. A cross-sectional survey of 1572 elderly people to determine the prevalence and factors related to depression. The next step was to implement a community intervention program on 402 people (intervention group) and 384 people (control group). Results: The prevalence of depression in the elderly population was 18.8% (mild: 12.1%, moderate: 6.5%; and severe: 0.2%). Finding from posttest of intervention, the prevalence of depression in intervention group and control group was 12.4% (mild 7.7%, moderate 4.7%), 19.5% (mild 13.8%; moderate 5.5%), respectively. The effectiveness of the intervention program was reported to reduce the prevalence of depression compared to baseline by 34.0% and to control group by 31.3%. Conclusion: the finding indicates that depression among elderly people is prevalent in the community, accounting for 18.8%. The community intervention program to reduce the risk of depression has proven to be effective and it is necessary to recommend the health department to disseminate this model locally. " Key words: Effective; community intervention; Depression of the elderly; Quang Ngai city

Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review.

Children and adolescents with heterogeneous psychiatric disorders, of whom over 50% have a second psychiatric comorbidity, have low rates of physical activity and experience unique challenges to engaging in community-based exercise programming, school-based physical education programming, and targeted physical activity interventions. This contributes to elevated rates of gross and fine motor delays, lower mood and self-regulation, and increased risk of chronic diseases such as obesity and type 2 diabetes. Perform a systematic scoping review of the literature to assess known barriers to and facilitators of engaging in physical activity programming among children and adolescents with heterogeneous and/or comorbid psychiatric disorders, in order to improve engagement among this population in real world intervention settings. Systematic Boolean diagnostic and physical activity search terms were entered into PubMed, MEDLINE, PsycINFO and Web of Science for English-language studies published between 2005 and 2020, examining barriers and facilitators for common psychiatric diagnoses and general psychiatric population's engagement in physical activity, physical education, sports, or exercise interventions. Two reviewers independently reviewed titles, abstracts and full articles to determine inclusion. A total of 5,198 articles were returned; 39 relating to children and adolescents were qualified for full-text review. After review, 24 studies were included addressing barriers and facilitators across multiple diagnoses; 7 studies were quantitative, 10 were qualitative, and 7 were mixed methods. Major barriers included low motivation, low self-efficacy, depleted parental reserve capacity, social isolation, lack of staff training, and safety concerns. Major facilitators included peer support/engagement, exergames, supportive parental behaviors, and inclusive/adaptive programming. Numerous barriers and facilitators to physical activity have been identified which should inform community, school, clinical, and research intervention program design. Further research is needed to develop effective strategies that address the challenges to inclusion that children and adolescents with heterogeneous and/or comorbid psychiatric disorders face.

Participants’ and caregivers’ experiences of a multidisciplinary programme for healthy lifestyle change in Aotearoa/New Zealand: a qualitative, focus group study

ObjectiveChild and adolescent obesity continues to be a major health issue internationally. This study aims to understand the views and experiences of caregivers and participants in a child and adolescent...

Mindfulness-Based Stress Reduction (MBSR) and Self Compassion (SC) Training for Parents of Children with Autism Spectrum Disorders: A Pilot Trial in Community Services in Spain.

This study aims to develop a clinical trial to test the efficacy of a mindfulness-based stress reduction (MBSR) and self-compassion (SC) program on self-reported values of anxiety, depression, and stress in parents of children with autism spectrum disorder (ASD) in primary school, in order to assess their integration into the framework of community intervention programs in Spain. Methods: A brief 8-week training program using mindfulness-based intervention (MBSR) and self-compassion (SC) has been applied to twelve Valencian ASD parents, ten of whom completed the program. Participants were assigned to two groups; both groups received the same treatment but at two different measurement moments. Depression, anxiety, stress, satisfaction with life and mindful attention awareness measurements were performed, in all participants, in three testing stages. Results: Analysis of variance results suggested that MBSR and SC training reduces stress and anxiety and increases mindful attention awareness. No significant changes were found in life satisfaction measurements. Conclusions: The small number of participants prevents us from generalizing the results found. More MBSR and SC clinical trials are needed in parents of ASD with results on anxiety, depression and stress in order to demonstrate the relevance of the inclusion of these programs in community-based early intervention services.

Diseño de un programa comunitario en una empresa de transportes de San Juan de Pasto

La interacción social no solo da cuenta de los comportamientos y actitudes que muestran los seres humanos para comunicarse, sino que además permite proponer marcos explicativos y de análisis sobre los procesos relacionales que caracterizan a las organizaciones. En este sentido, el artículo tiene como objetivo presentar el diseño de un programa de intervención comunitaria en una empresa de transportes de la Ciudad de San Juan de Pasto, Colombia. El estudio se realizó desde el paradigma cualitativo, con enfoque crítico social y tipo de estudio investigación acción. Para la recolección de información se utilizaron como técnicas la revisión de la literatura, la entrevista semiestructurada, grupo focal y observación participante. Los resultados evidencian la necesidad de implementar un programa enfocado en la autogestión, las habilidades sociales y el civismo en los colaboradores y los usuarios de la organización, lo cual contribuye no solo a su bienestar integral sino también al mejoramiento de los procesos organizacionales. Cabe aclarar que el presente artículo describe la fase de diseño de programa de intervención, la cual se seguirá desarrollando.

Gender perspective in leprosy programs: A critical literature review

Objective: To analyze the gender perspective in articles on community participation programs carried out with people affected by leprosy. Methodology: A critical literature review was carried out with an ad-hoc guide based on three documents related to the analysis of the gender perspective in scientific publications. Different variables related to the theoretical framework, methodology, results and discussion were analyzed in addition to two transversal variables related to gender biases and the use of terms related to sex/gender. Results: Thirty articles related to community intervention programs and leprosy were analyzed, identified in a prior scoping review. The results showed that, in general, a gender perspective was not taken into account in the majority of the sections analyzed. Although there was a tendency to disaggregate data based on sex, subgroups of men and women were not analyzed, nor was there discussion of the differences between the two. In all of the articles, there was evidence of the presence of gender biases, and in the majority there was a proper use of the terms sex and gender. Conclusions: Results show that in the case of the studies we analyzed, a gender perspective was not taken into account in the approach to community intervention programs related to leprosy. It is necessary to develop strategies to incorporate a gender approach in research related to leprosy in order to address the gap in inequalities between men and women affected by the disease.

Implementation of a medication adherence program in senior public housing facilities utilizing pharmacists and health educators.

Background:Hypertension and diabetes disproportionately impact people of color when compared to majority populations. Medication adherence among seniors with chronic diseases has been suboptimal with the estimation that only half of those taking antihypertensives are adherent. Therefore, the purpose of The Managing Your Medications (MY Rx) program was to evaluate the effectiveness of evidence-based practices used to improve rates of medication adherence through information dissemination among diabetic and hypertensive African American, Asian American, and Hispanic residents housed in senior public housing facilities in the Greater Houston Area. The program comprised an 8-week intervention with individual and group components with small incentives provided throughout the program. Individual components included one home visit and telephone consultations conducted by pharmacists. Health educators provided two group education sessions on lifestyle modifications.Result:Qualitative analysis of focus group discussions revealed participant satisfaction with the MY Rx program and willingness to change after participation in the program.Conclusion:The Rx program showed the potential effectiveness of an innovative strategy in medication counseling using interdisciplinary pharmacists and health educators to promote health. It demonstrated the importance of using the patient-centered care framework in designing a community intervention program.

Correlación entre medidas antropométricas, hipertensión arterial y glucosa en ayunas, en una población rural de Paraguay

Antecedentes: el sobrepeso y la obesidad son importantes factores de riesgo de hipertensión y diabetes tipo 2. Además, imponen una carga significativa sobre el sistema nacional de salud. Objetivo: evaluar la correlación entre el índice de masa corporal (IMC) y la circunferencia de la cintura (CC) con la glucemia de glucosa en ayunas por presión arterial en residentes de la fracción Norma Luisa del municipio de Minga Guazú, Paraguay en 2013. Métodos: Estudio transversal que incluyó a 280 participantes entre 18 y 64 años, de la comunidad Norma Luisa del municipio de Minga Guazú, Paraguay, entre septiembre de 2012 y mayo de 2013. Resultados: en las cuatro categorías de IMC y WC, las diferencias entre los valores medios para la presión arterial sistólica y diastólica y la glucosa en ayunas fueron estadísticamente significativas (p <0.01). Hubo una correlación estadísticamente significativa entre los indicadores de IMC y WC con la presión arterial sistólica, diastólica y glucosa en ayunas. Además, hubo una correlación significativa entre el IMC y el WC. Conclusiones: Los resultados obtenidos mostraron que el IMC y el WC son predictores de hipertensión y aumento de la glucosa en ayunas. Estos estimadores pueden ayudar a establecer predicciones de morbilidad y mortalidad, tanto con fines clínicos como en el diseño de programas de intervención comunitaria para cambiar los hábitos de estilo de vida en la población local.

Folate Status and Serum Folate Forms in a Population Without Fortification

Abstract Objectives To evaluate the presence and amounts of folate forms by strata of total folate in a population without fortification or supplementation. Methods The Chinese Families and Children Cohort feasibility study evaluated the potential for follow-up of mothers and offspring who participated in the Community Intervention Program, a folate intervention program conducted in China during 1993–1996. The feasibility study was carried out during 2012. Subjects completed an 8-day protocol that included multiple questionnaires (on diet, physical activity, ultraviolet radiation exposure and other factors) and provided fasting blood samples that were processed in local hospitals. The samples were then shipped frozen to the US. CDC's Nutritional Biomarkers Branch laboratory, which analyzed the 183 serum samples by LC-MS/MS for 6 folate forms; total folate was the sum of 5 biologically active folate forms (excluding MeFox). Results Median total folate concentration (nmol/L) in the 183 Chinese subjects (15.3 nmol/L) was comparable to US data prior to folic acid fortification (NHANES 1988–1994 = 18.4, NHANES 2005–2010 = 40.7). The mean total folate in the lowest quintile was 6.5 nmol/L suggesting folate insufficiency among those individuals with levels below 7 nmol/L. Forty-two of the 183 subjects had detectable levels of unmetabolized folic acid (UMFA) with the measurements of the remaining samples being below the detection limit (0.28 nmol/L). While most of the samples with detectable UMFA were in the top 2 quintiles of total folate (>18.6 nmol/L), all samples measured had fairly low UMFA concentrations (0.28–0.78 nmol/L). Of the 42 subjects with detectable UMFA, 36 lived in an urban center near Shanghai and may have had access to imported foods fortified with folic acid. None of the participants reported dietary supplement usage that contained folic acid. All folate forms also showed lower concentrations than the levels in the US post-fortification, with the distributions generally matching the lower half of the US distributions. Conclusions These data suggest that low levels of UMFA are likely not a marker of excessive folic acid intakes and more likely a marker of limited dihydrofolate reductase enzyme activity. Funding Sources Division of Cancer Control and Population Studies and the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH.

Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia

BackgroundHospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory...