Community Intervention Study Research Articles

Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation.

Enabling community health workers (CHWs) to treat acute malnutrition improves treatment access and coverage. However, data on the cost and cost-effectiveness of this approach is limited. We aimed to cost the treatment at scale and determine the cost-effectiveness of different levels of supervision and technical support. This economic evaluation was part of a prospective nonrandomized community intervention study in 3 districts in Mali examining the impact of different levels of CHW and health center supervision and support on treatment outcomes for children with severe acute malnutrition. Treatment admission and outcome data were extracted from the records of 120 participating health centers and 169 CHW sites. Cost data were collected from accountancy records and through key informant interviews. Results were presented as cost per child treated and cured. Modeled scenario sensitivity analyses were conducted to determine how cost-efficiency and cost-effectiveness estimates change in an equal scale scenario and/or if the supervision had been done by government staff. In the observed scenario, with an unequal number of children, the average cost per child treated was US$203.40 in Bafoulabé where a basic level of supervision and support was provided, US$279.90 in Kayes with a medium level of supervision, and US$253.9 in Kita with the highest level of supervision. Costs per child cured were US$303.90 in Bafoulabé, US$324.90 in Kayes, and US$311.80 in Kita, with overlapping uncertainty ranges. Additional supervision has the potential to be a cost-effective strategy if supervision costs are reduced without compromising the quality of supervision. Further research should aim to better adapt the supervision model and associated tools to the context and investigate where efficiencies can be made in its delivery.

Challenges and Barriers Faced by People with TB and Healthcare Workers Providing TB Care and Management - A Qualitative Study.

In tuberculosis (TB) care and management, there are practical challenges existing at the patient-provider level leading to implementation barriers at the primary care level. The objective of the study is to explore the challenges and barriers faced by people with TB and health-care workers in TB care and management. This study was done as a part of a community intervention study between November 2021 and December 2022. Twenty interviews were taken with treatment for TB (n = 7) and health-care personnel (n = 13). Health-care personnel include nursing staff, medical officers, laboratory technicians, community health workers, and medical personnel from tertiary care hospital. Participants were recruited across all levels of health-care systems. Interviews were carried out in the Hindi language, audio recorded, and translated to English. Participants were asked about their experiences of challenges and barriers faced during TB care and management. Qualitative data were coded, and thematic analysis was done manually. The challenges and barriers at the level of people with TB were issues with communication between providers and people with TB, out-of-pocket expenditure, poor adherence to medicines, lack of proper diet, gender issues, and stigma. The challenges and barriers at the level of health-care providers were a lack of infrastructure and logistics, lack of awareness, COVID-19-related issues, lack of workforce, and technical issues. Communication between providers and people with TB must be improved to improve the drug adherence and satisfaction of the end user. Proper funding must be provided for the TB programs. People with TB must be counseled properly regarding the free health care services available near their homes to prevent out-of-pocket expenditure. These will help in fast-tracking the elimination of TB.

Impact of 4% Deltamethrin-Impregnated Dog Collars on the Incidence of Human Visceral Leishmaniasis: A Community Intervention Trial in Brazil.

In Brazil, human visceral leishmaniasis (HVL) is caused by the protozoan parasite Leishmania infantum, primarily transmitted by the sand fly Lutzomyia longipalpis, with dogs acting as the main urban reservoir. This study aims to evaluate the effectiveness of 4% deltamethrin-impregnated dog collars (DMC) on HVL incidence. This is a community intervention study carried out from 2012 to 2015 in the municipalities of Araguaína, State of Tocantins, and Montes Claros, State of Minas Gerais, Brazil. Two areas in each were randomly allocated to either (1) culling seropositive dogs + residual insecticide spraying (control area-CA) or (2) culling seropositive dogs + residual insecticide spraying + DMC fitted to dogs every six months for two years (intervention area-IA). Cases of HVL (n = 1202) occurring from 2008 to 2020 were identified from the Brazilian Reportable Diseases Information System and georeferenced to the control and intervention areas. The HVL cases from 2008 to 2012 were considered as occurring in the "pre-intervention" period. Those cases from 2013 to 2016 and from 2017 to 2020 were regarded as occurring in the "intervention" and "post-intervention" periods, respectively. We used a mixed-effects Poisson regression model to estimate the effectiveness of the intervention, comparing the changes from the pre-intervention period to the intervention and post-intervention periods in the control and intervention areas. In Araguaína, there was a statistically significant reduction in the incidence of HVL in both the control and intervention areas, comparing both the intervention and post-intervention periods with the pre-intervention period. The intervention with DMC was significantly associated with a reduction in HVL when comparing the intervention and pre-intervention periods, yielding an effectiveness estimate of the DMC of 27% (IC95% 1-46%, p = 0.045). No differences were observed when comparing the pre- and post-intervention periods (p = 0.827). In Montes Claros, cases reduced in both the control and intervention areas from the pre-intervention period to the intervention period (p = 0.913). In the post-intervention period, the incidence increased in the control area, while cases continued to decrease in the DMC area (p = 0.188). The use of DMC was associated with a reduction of 27% in the incidence of HVL during the period of DMC delivery, indicating that DMC is effective as an additional strategy for controlling visceral leishmaniasis in Brazil. However, no significant reduction associated with DMC was detected after the intervention period, suggesting that a control program based on the large-scale deployment of DMC might have to be maintained for more extended periods without interruption.

Multidomain interventions for non-pharmacological enhancement (MINE) program in Chinese older adults with mild cognitive impairment: a multicenter randomized controlled trial protocol

BackgroundDementia is characterized by progressive neurodegeneration and therefore early intervention could have the best chance of preserving brain health. There are significant differences in health awareness, living customs, and daily behaviors among Chinese older adults compared to Europeans and Americans. Because the synergistic benefits of multidomain non-pharmacological interventions are consistent with the multifactorial pathogenicity of MCI, such interventions are more appealing, easier to adhere to, and more relevant to daily life than single-mode interventions. One of the aims of this study is to verify the effect of multidomain intervention strategies for MCI patients based on Chinese population characteristics, and the other is to establish a biobank and image database to investigate the pathogenesis and pathways of cognitive impairment.MethodsOur study was designed as a national multicenter, community-based randomized controlled trial (RCT). Twelve medical institutions in ten Chinese cities will participate in our study from 2020 to 2024, and 1080 community residents aged 50 and above will be enrolled as participants. Each sub-center will be responsible for 90 participants (30 people per community) across three communities (non-contact control group, health education group, and multidomain intervention group). The community will be the basic unit of the present study, and all participants in each community will receive the same intervention/control measure. Three working groups are set up in each sub-center to manage the three communities independently to minimize interference at the implementation level between the groups. The multidomain intervention group will receive integrated interventions including exercise, nutrition, sleep, health education and mindfulness meditation. All data generated by the research will be analyzed and processed by statistical software (such as SPSS 21.0, Python 3.0, etc.), and part of the research data will be displayed in the form of graphs and tables.DiscussionIn order to achieve a high-quality community intervention study, it is crucial to have a well-designed experimental protocol that follows rigorous scientific methodology. In addition, effective management of quality control measures and monitoring compliance throughout the study process are essential components. This study provides a detailed discussion of stakeholder compliance, research quality control, potential harm and mitigation, auditing, and future plans in order to better address research issues.Trial registration: ChiCTR2000035012 (July 27, 2020).

Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas

ObjectiveTo know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DesignQuasi-experimental study of community intervention. SiteTwo basic health zones belonging to the Elche-Crevillente health department, Spain. ParticipantsPregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. InterventionsTraining session for the IG prior to the 2019/20 flu campaign. Main measurementsAttitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. ResultsThe influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). ConclusionsJoint training strategies for professionals and community assets improve the results of vaccination coverage.

A new modality of colorectal cancer screening based on chronic disease management

BackgroundTo develop a new modality of colorectal cancer screening based on chronic disease management (CDM) to improve the participation rate of screening, and maximize the benefits of limited resources.MethodsPatients under CDM were assigned to screening intervention group (SI) and screening control group1 (SC1), residents from natural community were assigned to screening control group2 (SC2). A parallel controlled community intervention study was performed. Only SI would achieve “one-to-one” intervention services. Meanwhile, 200 subjects were selected from each of the three groups for the Knowledge-Attitude-Practice (KAP) questionnaire before and after intervention, named questionnaire intervention group(QI), questionnaire control group1(QC1) and questionnaire control group2(QC2). The outcome of the intervention was evaluated using the difference-in-differences method and multiple regression analysis.ResultsThe preliminary screening participation rate was 43.63%(473/1084) in SI, 14.32%(132/922) in SCI, and 5.87%(105/1789) in SC2. The baseline questionnaire showed low knowledge scores in the three questionnaire groups with no statistically significant differences, while attitude scores in QI and QC1 were significantly higher than QC2. The differences between baseline and terminal showed QI increased larger in knowledge and attitude scores than QC1 and QC2, while no difference was detected between QC1 and QC2.ConclusionThe colorectal cancer screening model based on chronic disease management effectively improved the screening participation rate, and the “one-to-one” intervention and the inherent characteristics of the patient population under CDM were the core elements of the new modality.

Auxiliary delivered school based oral health promotion among 12-14-year-old children from a low resource setting-A cluster randomized trial.

This community intervention study compared the changes in oral health knowledge, attitude, practices (KAP), and oral health indicators among 12-14-year-old children who received a school based oral health promotion delivered by auxiliaries in a rural setting in India. The interventions in this school based cluster randomized trial were delivered using schoolteachers and school health nurses. Oral health education (once in 3months), weekly classroom based sodium fluoride mouth rinsing and biannual oral health screening/ referral were provided for 1 year. The control arm did not receive these interventions. Oral health indicators and self-administered KAP questionnaire were evaluated at baseline and 1-year follow-up. Oral health indicators included oral hygiene index simplified, DMFT/DMFS net caries increments, prevented fraction, number of sites with gingival bleeding, changes in care index, restorative index, treatment index, and dental attendance. The improvement in total KAP score, oral hygiene, and gingival bleeding from baseline to follow up was higher in the intervention arm (p < 0.05). The prevented fraction for net caries increment were 23.33% and 20.51% for DMFT and DMFS, respectively. Students in the intervention group had a higher dental attendance (OR 2.92, p < 0.001). The change in treatment index, restorative index, and care index were significantly higher in the intervention arm (p < 0.001). Inclusion of available primary care auxiliaries like school health nurses and teachers in oral health promotion is a novel, effective, and sustainable strategy to improve oral health indicators and utilization in rural areas in low resource settings.

Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review.

Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.

Effect of a repeated educational intervention versus an initial intervention on blood pressure control in hypertensive patients

Introduction and objectivesHypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients. MethodsExperimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension. Results980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). ConclusionA continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.

Effects of Integration of Social Marketing and Health Belief Model for Preventing Cholangiocarcinoma in High-Risk Areas of Thailand: A Community Intervention Study.

Introduction/Objective:To examine the effects of applying social marketing and Health Belief Model (HBM) in preventing cholangiocarcinoma (CCA) in high-risk areas of Thailand.Methods:About 2 randomized high-risk areas of CCA from multiple-stage sampling were assigned as study areas. The 150 participants were allocated to the experimental group, which received a 12-week health education program that applied social marketing and HBM. The comparison group received the usual services. Data were collected by a questionnaire created by the researchers. We employed descriptive, inferential statistics (paired t-test and independent t-test) for normal distribution, while Analysis of Covariance (ANCOVA) was used for mean scores differing before the experiment.Results:After the experiment, the mean scores of the perceived risk of CCA, perceived severity of CCA, perceived benefits of CCA prevention, perceived barriers to CCA prevention, and correct behaviors of CCA prevention in the experimental group were significantly higher than those before the experiment the .05 level. They were also considerably higher than those of the comparison group at the .05 level.Conclusion:This is the first study to integrate social marketing and HBM for CCA prevention. Therefore, formulating policies or measures to prevent disease through public communication will form a model to avoid CCA and create a channel for distributing useful information to the general public.

Achievements and Challenges of Social Epidemiology Research Aiming to Reduce Health Inequality: A Revised English Version of Japanese in the Journal of the Japan Medical Association 2020;149(9):1626-30.

Health inequalities are defined as “gaps in health status between groups, which are created by differences in community or socioeconomic status.” In response to the General Assembly Resolution (2009) of the World Health Organization, the World Medical Association issued a statement in the same year, and the Japanese health policy “Health Japan 21 (second term)” indicated a “reduction of health inequalities” as the basic direction. In 2000, we described the presence of health inequalities in Japan, which was regarded as a relatively egalitarian country. This was the starting point of the Japan Gerontological Evaluation Study. It was developed into large longitudinal studies that reveal the significance of “social determinants of health” that cause health inequalities. We verified the feasibility and effects of healthy aging policies by fostering social capital through community intervention studies. These findings and knowledge have been translated into municipal and central government policies. Here we review what has been achieved and the remaining challenges in more than 20 years of social epidemiological research.

Are Community Coalitions a Better Mechanism to Advance Health Equity? A Narrative Review

Background/Objective: Despite increasing emphasis on health equity in policy, leadership, and program development, meaningful advancement in health equity remains a challenge. A comprehensive review of community health coalition efforts to improve health equity has not been conducted. In this narrative review, we examine what evidence exists that community health coalitions can advance health equity, and whether coalitions are a preferred approach to address health equity.&#x0D; Methods: PubMed, CINAHL, PsycINFO, and Web of Science were searched for peer-reviewed, English articles with no date restrictions. In total, 1256 records were screened, of which 1163 were excluded for duplicate publications, no coalition or coalition-based intervention, no relevant outcomes, no emphasis on health equity or disparities, not primary literature, or unavailable full text. The remaining 93 articles are presented as a table of interventions based on outcomes. Further, evaluations of coalition effectiveness with controls are reviewed.&#x0D; Results: Populations of interest were racial and ethnic minorities, women and girls, low socioeconomic status communities, rural and urban areas, older adults, and LGBTQ groups. The most commonly reported results were changes in health outcomes or behaviors and community or organizational policy. Few studies were randomized, double-blinded, or controlled trials. This is not unexpected given the difficult nature of evaluating community interventions. Very few studies evaluated the effectiveness of a coalition-based intervention as compared to organizational interventions.&#x0D; Conclusion, Impact, &amp; Implications: Available literature suggests that health coalitions influence health outcomes, policies, and important social determinants of health in populations affected by health inequity. However, community intervention studies pose a unique challenge for high quality evaluation. While health coalitions have a positive influence on health equity, more research is needed to determine the advantages of health coalition interventions versus organizational interventions.

Community intervention study of viscera massage in overweight/obese type 2 diabetes high-risk population

Background:Prediabetes is an intermediate metabolic state between normoglycemia and diabetes. Without intervention, prediabetes often progresses to diabetes and prediabetes is associated with increased risk of cardiovascular disease, cancer, renal disease, and dementia. Lifestyle modification play a major role in controlling prediabetes. But lifestyle interventions are often with poor compliance and side effects of drugs are often be dislike by people. As a non-invasive therapy with no side effects, abdominal massage (AM), also called viscera massage in China, has been used to treat prediabetes and obesity-associated diseases. The gut microbiota has been recognized as an important factor in the development of metabolic diseases. Individuals with prediabetes have aberrant intestinal microbiota character. Colonic transport time and stool consistency are strongly associated with gut microbiota. Viscera massage can ease constipation by reducing colonic transport time and promoting intestinal motility. We can infer that viscera massage can modulate composition of gut microbiota affects human metabolism. So, in this trial, we will explore the mechanism of viscera massage on prediabetes from the perspective of intestinal microbiota.Methods and design:Eighty prediabetes individuals will be recruited for this study. Eighty prediabetes individuals will be divided into lifestyle intervention group and viscera massage + lifestyle intervention group by a simple random method. Each group will have 40 individuals. The manipulation of the viscera massage + lifestyle intervention group will be mainly carried out through rubbing the abdomen, kneading abdomen, vibrating abdomen, and pressing the abdomen, 30 minutes per time, once a day, with 2 days off every 5 days. Lifestyle interventions will be performed by combining pushing healthy lifestyle guidance information through Wechat application and giving face-to-face advice together daily. The lifestyle intervention group will receive healthy lifestyle intervention only. All the intervention will be conducted for 4 weeks. Weight, body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio will be measured at the last day of every week. Triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood-glucose, 2-hour post-meal blood glucose (2hPG) and glycosylated hemoglobin, fasting insulin and insulin resistance index will be tested at the first day and last day of the intervention course. The fecal samples of subjects will be gathered at the first day and last day of the intervention course and will be performed 16S rRNA gene sequencing and metagenomic detection. Finally, the effect and potential mechanism of viscera massage on prediabetes will be discussed in combination with all the results.Discussion:The results of this study will be used to verify the effect of AM on prediabetes and explore the mechanism of AM on prediabetes from the perspective of gut microbiota.

Alcohol policy compliance among retailers in Bhutan: a multisite community intervention study

BackgroundAlcohol use is a major public health problem in Bhutan. Compliance with regulations at the point of sale is an important strategy in alcohol control. Retail outlets were briefed on sale regulations and provided notification of rules, which they were directed to display on the premises. The extent to which licensed alcohol outlets responded to possible alcohol purchases was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults. A total of 854 visits (pre versus post visits) were made across four district towns. Two towns (Damphu town in Tsirang district and Pema Gatshel town in Pema Gatshel district) received pre- and post-intervention purchase surveys, while the other two neighbouring towns (Khuruthang town in Punakha and Bajo town in Wangdue) were administered only baseline surveys.MethodWe used a pre- and post-test community intervention design covering all alcohol retailers both on premise (bar, hotel, restaurant, karaoke bars) and off premise (grocery shops). Compliance with alcohol regulations at the point of sale was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults.ResultsRetailers rarely checked the age and/or identification (ID) of the proxy-purchasers before the intervention. There was a 22.7% (8.6, 37) percent increase in compliance with laws after the intervention. While some strategies are suggested, the strongest and most effective measure to prevent under-age drinking and service to intoxicated individuals is more rigorous enforcement of existing liquor laws.ConclusionAlcohol control requires ongoing government enforcements, supplemented by public awareness and knowledge.

THE EFFECTIVENESS OF MICRONUTRIENT SUPPLEMENTATION ON ZINC DEFICIENCY, VITAMIN A DEFICIENCY AMONG ADOLESCENT GIRLS IN MOUNTAINOUS HIGH SCHOOL IN THANH HOA PROVINCE IN 2019 - 2020

A community intervention study with a placebo group, double-blind, evaluating the effect of using multi-micronutrient tablets on zinc deficiency, vitamin A deficiency among adolescent girls in mountainous high school in Thanh Hoa province in 2019 - 2020, using WHO and IZiNCG classifications. A double-blind randomized controlled trial was conducted among 322 school girls randomly divided into 2 groups. The multi-micronutrient supplements consist of 23 vitamins and minerals, including zinc (10.8 mg), vitamin A (550mcg), while the placebo group took a placebo tablet, once a week for 9 months. All of the children were dewormed by Albendazole 400 mg at baseline. Results showed that after 9 months of intervention, the mean serum zinc concentration of the intervention group (11.35 ± 2.88 µmol/l) was significantly improved and significantly higher than that of the Control group (10.51 ± 2.08 µmol/l) with p&lt;0.05. The retinol concentration did not show significant difference between the two groups, but there was a significant improvement compared to the baseline time the intervention group with an increase level of 0.07 ± 0.30 mol. /l. After the intervention, the rate of zinc deficiency, sub-clinical vitamin A deficiency was not statistically significant between the two groups.

Effectiveness of Educational Communication in Knowledge, Attitude, and Practice to Hand-Foot-Mouth Disease Prevention of Mother Having Children Under 5 Years Old

Background: Hand-foot-mouth disease (HFMD) is an infectious disease that mainly occurs in children under five years old. Vietnam is a developing country with high prevalence of the disease outbreak every year. Can Tho City, Co Do District had the highest incidence of children under five years old acquired HFMD. Objective: 1) To determine the factors correlating with knowledge, attitude, and practice in HFMD prevention of mothers having children under five years old, and 2) to evaluate the alteration in knowledge, attitude, and practice in prevention HFMD of mothers having children under five years old after intervention with health educational communication. Materials and Methods: Community intervention study was done in 420 subjects. At first, all the participants would do the questionnaire and practicing assessment. Then, the participants were divided into two groups, the intervened group for educational communication, and the control group with no intervention. The intervention included three steps, 1) training knowledge and skills for medical staffs and collaborators, 2) providing information about HFMD for the mothers, 3) broadcasting information leaflets to the subjects’ house every month. The assessment in awareness, attitude, and practice would be performed again after one month. The present study staff achieved approval from the Science and Educating Council of Can Tho University of Medicine and Pharmacy. In addition, the present study also received the agreement from The People’s Committee of Co Do District. Results: The present study results shows that 23.3% of mothers had the right knowledge, 50.5% of mothers had the right attitude, and 17.4% of mothers with children under five years of age had the right disease prevention practice. There was an association between education level of mothers with children under five years of age with knowledge, attitude, and practice in disease prevention. After intervention, knowledge of the mothers in the intervened group improved more than 2.79 times, right attitude more than 2.84 times, and practice improvement more than 1.83 times in compared with the control group. Conclusion: Educational communication plays an important role in HFMD disease prevention through increasing the awareness, opinion, and disease prevention of the mothers who directly take care of the under five years old children. Keywords: Hand-foot-mouth disease; Knowledge; Attitudes; Practices; Effective intervention

Efecto de una intervención educativa repetida frente a una intervención inicial sobre el control de la presión arterial en pacientes hipertensos

Introduction and objectivesHypertension is one of the main cardiovascular risk factors. An educational intervention, aimed at increasing or reinforcing the patient's knowledge, can contribute to better control of their blood pressure. Our goal was to evaluate the efficacy of a continuing therapeutic education versus an initial intervention in hypertensive patients. MethodsExperimental study of multicenter community intervention, through the application of a therapeutic education program in hypertension. Results980 patients on antihypertensive treatment were included, 490 in each group, with a mean age of 65 years, and 50% women, baseline mean SBP in both groups was136 mmHg. Regarding knowledge about hypertension, although a similar initial improvement was observed in both groups, at the end of the study, in the continuous intervention group (CIG) an average of 23.06 correct answers was observed, while in the Initial intervention group (IIG) the mean was 20.91, being the difference statistically significant (p < 0.001). At the end of the study, the mean SBP was 127.5 mmHg in the CIG and 136.57 mmHg in the IIG group. Likewise, a lower percentage of patients with a BMI ≥25 was observed in the CIG (78.2%) than in the IIG 82.6%, this difference being statistically significant (p < 0.001). This same effect was observed on the abdominal perimeter, observing an increased abdominal perimeter in 46.3% of the CIG compared to 68.8% in the IIG (p < 0.001). ConclusiónA continuous educational intervention increases the degree of knowledge about hypertension compared to an initial intervention. Likewise, this intervention is associated with an improvement in blood pressure, weight, body mass index and abdominal girth figures.

Tình hình tái nhiễm và các yếu tố liên quan đến tái nhiễm giun truyền qua đất ở học sinh tiểu học tỉnh Hậu Giang sau can thiệp bằng mebendazole 500mg năm 2019-2020

* Background: Soil-transmitted helminthiasis is a fairly common disease, the estimated 24% of the world's population infected with soil-transmitted helminth (STH), of which over 43% are in preschool and school-aged students. The study was conducted to provide information on the situation of re-infection, factors related to STH reinfection. The study was carried out from June 2019 to October 2020 on primary school students in Hau Giang province. * Methods: Community intervention study on 206 primary school students infected with STH by Mebendazole 500mg single dose. Data processing on SPSS 18.0 software, using descriptive statistical calculations and analyzing the relationship between worm reinfection with related factors by squared (χ²) test with p &lt; 0.05. * Results: The general SHT reinfection rate of the pupils after 12 months of intervention was 11.2%. The re-infection rate at 3 months was 1.5%, at 6 months it was 2.0%, at 9 months it was 3.5% and at 12 months it was 4.7%. The study observed the relationship between reinfection with STH and the habit of walking barefoot, not wearing shoes in the house and garden, eating raw vegetables, playing with sandy soil, dogs and cats, and the structure of the floor of the school is the ground, the student's family has livestock and poultry running around in the house and the student has unclean hands (p&lt;0.05). * Conclusion: The rate of the general reinfection of the SHT in elementary school students after 12 months of intervention was 11.2%. It is necessary to strengthen propaganda and advocacy to change students' behavior, to clean the house and the school and to guide them to prevent the STH infection. Keywords: soil-transmitted helminth reinfection, soil-transmitted helminthiasis.

Changes in Leisure Self-Efficacy and Fall Risk: One-Year Results of N’Balance, a Fall Prevention Intervention Program

Fear of falling can prevent people from engaging in valued leisure activities. Yet few studies have examined the role of leisure self-efficacy in fall prevention (Datillo, Martire, Proctor, 2012). The purpose of this study was to assess how participation in a fall prevention program affected worrying about falls, self-reported falls, and leisure self-efficacy in older adults over a 1-year fall prevention intervention. N ’Balance is an 8-week community-based multi-modal fall prevention program. This community intervention study included a treatment (N=50) and control group (N=42). Data were collected in four waves: 1) pre-program physical assessment and survey, 2) post-program physical assessment and survey, 3) six month follow-up survey, and 4) 12 month follow-up survey. Measures included the Activities-Specific Balance Confidence Scale (Powell, Myers 1995), self-reported worry about falling and the leisure self-efficacy scale. Analysis of covariance was used to assess the group x time effects of N ‘Balance on worry about falling, leisure self-efficacy and the number of falls in the last 12 months, while controlling for age and subjective health. From baseline to six months post intervention, fall worry decreased significantly for the treatment group and increased for the control group (p< .05). However, there was no significant change over time in the number of self-reported falls by either group. Leisure self-efficacy was higher at baseline for the treatment group and decreased significantly from 6 to 12-months post N Balance participation, whereas the control group had lower leisure self-efficacy at baseline and increased significantly over the 1-year study period (p<.05).

Effectiveness of insecticide-impregnated collars for the control of canine visceral leishmaniasis

Visceral leishmaniasis is a neglected tropical disease widely distributed worldwide. In Brazil, the control measures adopted in the last decades have not been able to prevent the spread of the disease. This study aimed to evaluate the effectiveness of a population-based intervention using 4% deltamethrin-impregnated dog collars on the incidence of canine visceral leishmaniasis.A community intervention study was carried out in two areas of the city of Montes Claros, State of Minas Gerais, Brazil. In the control area, the preventive measures recommended by the Brazilian Program for Surveillance and Control of Visceral Leishmaniasis were implemented (culling of infected dogs and vector control with residual insecticides). In the intervention area, deltamethrin-impregnated collars were fit to domiciled dogs, in addition to the above mentioned preventive measures. At the beginning of the study, a census survey was carried out among domiciled dogs to detect the prevalence of L. infantum infection. Dogs found seronegative at recruitment were longitudinally followed-up to evaluate the incidence of infection. Monitoring of canine infection (control and intervention areas) and replacement of collars (intervention area) occurred through sequential surveys at 12, 18, and 24 months after the initial survey. At each survey, dogs were tested, and the owner answered a questionnaire about the general characteristics of the animal. Multilevel logistic regression models were used to test the effect of collars on the risk of canine infection, with households considered as aggregation units. Associations were expressed as odds ratios (OR) and respective 95% confidence intervals (95%CI).The prevalence of infection in the initial survey was 9.7% and 9.9% in the intervention and control areas, respectively (p = 0.732). Among a total of 20,477 dogs participating in the study, 9,770 were seronegative at recruitment. The cumulative incidence of infection was 4.1% in the intervention area and 7.9% in the control area (p < 0.001). In the multivariable analysis, the risk of infection was 52% lower in the intervention area as compared to the control area (OR = 0.48, 95%CI:0.39-0.59), after adjusting for the number of dogs in the house, period of recruitment, time of dog ownership, and age, sex, length of fur and breed.The use of 4% deltamethrin-impregnated dog collars was effective in reducing the incidence of canine leishmaniasis. Cost-effectiveness studies are recommended before the incorporation of collars in the arsenal of control measures of the Brazilian Program for Surveillance and Control of Visceral Leishmaniasis.