Enhance Community Health Research Articles

A case study from Guyana of adapting engaged research design to promote ‘fairness in knowing’

In this paper, we have combined ideas drawn from philosophy (epistemic injustice), critical theory (epistemicide) and practical approaches (engaged research design) with Indigenous knowledge to promote ‘fairness in knowing’ in a project called DETECT (Integrated Space Technology Vector Control for Enhancing community health and resilience against escalating climatic disruptions), an early warning system to support communities in identifying mosquito breeding sites using satellite, drone and ground-sensing technologies. DETECT used engaged research design to inform pre-award planning. We document how the project team, comprising Indigenous and other researchers, re-imagined the plans in the light of the COVID-19 pandemic to allow project participants to meet safely and equitably, and reflect on some of the key challenges in engaging across borders and cultures in the context of rapidly changing conditions characterised by vulnerability, risk, complexity and uncertainty.

Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics.

Atrial fibrillation (AF) is the most frequent arrhythmia managed in clinical practice, and it is linked to an increased risk of death, stroke, and peripheral embolism. The Global Burden of Disease shows that the estimated prevalence of AF is up to 33.5 million patients. So far, successful therapeutic techniques have been implemented, with a high health-care cost burden. As a result, identifying modifiable risk factors for AF and suitable preventive measures may play a significant role in enhancing community health and lowering health-care system expenditures. Several mechanisms, including electrical and structural remodeling of atrial tissue, have been proposed to contribute to the development of AF. This review article discusses the predisposing factors in AF including the different pathogenic mechanisms, sedentary lifestyle, and dietary habits, as well as the potential genetic burden.

The impact of i-PUSH on maternal and child health care utilization, health outcomes, and financial protection: study protocol for a cluster randomized controlled trial based on financial and health diaries data

BackgroundUniversal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior, and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake.MethodsThis is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach—including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments—in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya.DiscussionPeople in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels—individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based “health wallet,” it enhances enrolment in subsidized health insurance through the mobile platform—M-TIBA—developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool—AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children.Trial registrationRegistered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571: AEARCTR-0006089; date: 29 August 2019) and The American Economic Association’s registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020).

Using Innovation to Address Adolescent and Young Adult Health Disparities in Pelvic Inflammatory Disease: Design of the Technology Enhanced Community Health Precision Nursing (TECH-PN) Trial.

New approaches to pelvic inflammatory disease (PID) care among adolescents and young adults (AYAs) that optimize self-care and personalize treatment are warranted to address age and racial-ethnic PID-related health disparities. Here we describe the 13-month preliminary feasibility and acceptability outcomes of recruitment, retention, and intervention delivery for Technology Enhanced Community Health Precision Nursing (TECH-PN) randomized controlled trial. Urban AYAs 13-25 years assigned female sex at birth with acute mild-moderate PID provided baseline and follow-up interview data and vaginal specimens for sexually transmitted infection (STI), cytokine, and microbiota assessment. All participants received medications and text-messaging support. Participants were block randomized to either control or intervention. Control participants received 1 community nursing visit with self-management for interim care per national guidelines. Intervention participants received unlimited precision care services driven by interim STI and macrolide resistance testing results by an advanced practice provider. In the first 13 months, 75.2% patients were eligible, and 76.1% of eligible patients enrolled. Of the participants, 94% completed the intervention and 96%, 91%, and 89%, respectively, completed their 14-, 30-, and 90-day visits. Baseline laboratory results revealed infection rates that were highest for Mycoplasma genitalium (45%) followed by Chlamydia trachomatis (31%). Preliminary enrollment, STI, intervention delivery, and retention data demonstrate the feasibility and acceptability of the TECH-PN intervention and support rationale for precision care for PID among urban AYAs. ClinicalTrials.gov Identifier. NCT03828994.

Needs assessment for the creation of a community of practice in a community health navigator cohort

BackgroundCommunity Health Navigators (CHNs) are members of a patient’s care team that aim to reduce barriers in accessing healthcare. CHNs have been described in various healthcare settings, including chronic disease management. The ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS) program of research employs CHNs, who are trained to improve access to care and community resources for patients with multiple chronic diseases. With complex and demanding roles, it is essential that CHNs communicate with each other to maintain knowledge exchange and best practices. A Community of Practice (CoP) is a model of situated learning that promotes communication, dedication, and collaboration that can facilitate this communication. The objective of this study was to engage with CHNs to determine how a CoP could be implemented to promote consistency in practices and knowledge for CHNs across primary care sites.MethodsA needs assessment for a CHN CoP was conducted using sequential steps of inquiry. A preliminary focused literature review (FLR) was done to examine the ways in which other healthcare CoPs have been implemented. Results from the FLR guided the creation of an exploratory survey and group interview with key informants to understand best approaches for CoP creation. Political, economic, social, and technological (PEST) and strengths, weaknesses, opportunities, and threats (SWOT) analyses synthesized results in a comprehensive manner for strategic recommendations.ResultsThe FLR identified different approaches and components of healthcare CoPs and guided analyses of mitigatable risk factors and leverageable assets for the intervention. The survey and group interview revealed an informal and effective CoP amongst current CHNs, with preferred methods including coffee meetings, group trainings, and seminars. A well-maintained web platform with features such as an encrypted discussion forum, community resource listing, calendar of events, and semi-annual CHN conferences were suggested methods for creating an inter-regional, formal CoP.ConclusionThe study findings recognise the presence of an informal CoP within the studied CHN cohort. Implementation of a formal CoP should complement current CoP approaches and aid in facilitating expansion to other primary care centres utilizing digital communication methods, such as a comprehensive web platform and online forum.

COMMUNITY PARTICIPATION IN PREVENTION OF COMMUNICABLE DISEASES IN RURAL AREAS OF PAKISTAN: A REVIEW OF LITERATURE

BACKGROUND: There is huge burden of both communicable and non-communicable diseases in healthcare systems. Community engagement is the diverse beneficial relationship between community stakeholders, primary healthcare system and professionals over a wide variety of tasks, their role and participation in decision making for enhancing community health. OBJECTIVES: This paper focuses to present the use of Ladder of Community Participation as a framework to integrate community health problems in Pakistan. Additional focus is on local issues and the integration of the model according to socio-politico-economic structure of Pakistan METHODS: Research articles were reviewed from PubMed, Medline, EBSCO, and CINAHL. Different key words such as “community engagement”, “community participation”, “communicable diseases”, “Ladder framework”, were used along with focus on the most recent and human based studies. After thorough review of the abstracts, selected researches were used to integrate the concept of community engagement in prevention of communicable diseases. REVIEW: Review of the literature showed that local healthcare services alone cannot make sufficient efforts to uplift the health status of the communities. Community based collaborative interventions are often cost effective, sustainable and effective in managing outbreaks and other communicable diseases. It is imperative to engage the local communities and its stakeholders for an informative, collaborative and success oriented approach. Moreover, educating the community stakeholders for on-going basis can be an asset to the public health initiatives in the community. The ladder of community participation presented in this paper guides the public health workers and community stakeholders for step-wise integration of community and its resources in different programs about communicable disease prevention. CONCLUSION: This ladder presents a continuum of different approaches, which will help in planning program management, feasibility assessment, evaluating ongoing interventions along with modification, and expanding community engagement approaches.

Importance of Community Impact as the Fourth Academic Mission: A Qualitative Study.

Most US medical schools have 3 primary missions: education, research, and clinical service. Recently there have been calls for a fourth primary mission focused on improving health in their surrounding communities. To date, few medical schools have done so. To identify factors supporting and challenges to establishing a sustainable community impact mission, the authors conducted semi-structured key informant interviews with the dean, associate deans, departments chairs, and institute and center directors at a new US medical school that established a fourth "community impact" mission at its conception. Interviewees believed that it was appropriate for a community-focused tax-supported medical school to embrace community impact as a fourth mission to enhance community health outside of its hospitals and clinics. Many also felt that community impact should be an overriding framework for activities in the 3 primary missions. Achieving community impact would require creating a "learning health community" via partnerships with community organizations and linking faculty effort and funding to specific and valid measures of community health improvement. Sustainable funding would require core school funds and a broad portfolio of extramural funding. Faculty promotions with community impact as a focus would need explicit, achievable, and unique milestones. Interviewees made specific suggestions on the support and structure needed to launch and sustain this fourth mission. Establishing a fourth mission of community impact can extend medical schools' influence beyond typical health care venues to enhance the health of their communities and their residents. Doing so requires rethinking organizational structures, support, and measures of success.

A Medical School's Community Engagement Approach to Improve Population Health.

The U.S. spends trillions annually on health care that affects only 16% of health outcomes, with 84% driven by social factors, behaviors, and the physical environment. Medical schools are focusing more on these social determinants of health. We describe an academic community engagement unit with unique methods for partnering with the surrounding community to improve its members' health. Annually, a Call for Ideas asked community members to identify important health problems and propose solutions. A panel of community members and academic researchers reviewed submitted ideas and selects those addressing significant issues, that are also feasible, can be accomplished in a year, and are potentially scalable. Financial, project development, and evaluation support is provided where needed. Three Calls for Ideas generated 268 ideas from 249 individuals: 35% focused on social and behavioral factors, 33% on health behaviors, 16% on health care, and 6% on the physical environment. Half were submitted by individuals and half by community service organizations. Twenty-four (9%) were selected for implementation; 19 have been successfully implemented while 5 are under development. People with lived experience can identify barriers to health in their communities and effective mitigating interventions. By seeking community leadership and mutual benefit, academicians can gain community members' trust and meet both community and academic needs by establishing true partnerships, recognizing power dynamics and structural biases, and using language and approaches that respect the importance and power of lived experiences in identifying approaches to enhancing community health.

The MindLab Project. Local Museums Supporting Community Wellbeing Before and After UK Lockdown

Catalyst is a science discovery centre and independent museum based in Widnes, United Kingdom. Since 2018, it has collaborated with mental health charity Mind Halton on The MindLab project; a science inspired wellbeing programme for residents local to the museum in an area where access to mental health support is low. As museums in the twenty-first century are being increasingly regarded as community resources capable of producing valuable social impact, this article considers the role of museums in harnessing this potential to enhance community health and wellbeing during the COVID-19 pandemic. It reflects on the challenges encountered during this unprecedented period of lockdown, as well as the emerging opportunities through the perspectives of those delivering The MindLab project.

Attitude towards shared learning activities and Interprofessional education among dental students in South India.

Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are being introduced in healthcare institutions gradually to enable comprehensive learning and its application to enhance community health outcomes. To assess the attitude of dental students towards Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) To assess whether Readiness for Interprofessional Learning Scale (RIPLS) is a suitable instrument to measure the attitude of under graduate dental students towards IPE. To assess how the study year and gender affect the attitude of under graduate dental students towards IPE. The research design was a cross-sectional survey. The dental students of first to fifth year based on availability of students and the existing academic calendar were participated in the study. A total number of 417 validated RIPLS questionnaire were distributed to dental students studying in two dental institutions at Manipal in South India in the year 2017 with the collected response rate of 81.53%. Principal component analysis of the responses was applied to the data along with Varimax rotation and Cronbach alpha to confirm the internal consistency of the questionnaire. Independent sample t test and ANOVA were used to assess the differences between the groups. Seventy five percent of the respondents were females, and the mean age was 21.26years (SD=1.34). The mean scores in RIPLS and all its subscales were high. The mean scores were also higher as the year of study increased and with female students. Senior and female dental students had more encouraging attitudes towards shared learning. The RIPLS can be utilised to determine the different subscales of learning namely learning behaviour, attitudes, teamwork and collaboration, professional identity perspectives, and roles and responsibilities towards interprofessional education of dental students. The dental students with an Indian outlook, perspective and training had a favourable attitude towards interprofessional learning.

Culturally Responsive Health Promotion to Address Health Disparities in African American Men: A Program Impact Evaluation.

African American (AA) men continue to experience worse health outcomes compared to men of other races/ethnicities. Community-based interventions are known to be effective in health promotion and disease prevention. The program objectives were to (a) increase knowledge and risk awareness of targeted conditions, (b) change health-care-seeking attitudes toward regular primary care among AA men, and (c) improve their lifestyle-related health behaviors by leveraging the influence of women in their lives. The community-engaged educational intervention targeted both men and women and included eight 90-min sessions per cohort. Topics included prostate cancer, cardiovascular disease, diabetes, mental health, health-care access, and healthy lifestyle. Sessions were both didactic and interactive. A pre-/post-intervention questionnaire assessed knowledge. Interviews were conducted with male participants and a focus group discussion (FGD) with women to assess program impact. Interview and FGD transcripts were analyzed for themes and recommendations. Major themes were—increased knowledge/awareness of risk associated with chronic conditions, change in health-care-seeking attitudes, increased self-efficacy to engage the health-care system, and lifestyle changes. Other impacts reported were building community/social support, a safe and enabling learning environment, and enhanced community health status overall. Recommendations included having extended, more in-depth sessions, targeting the younger generation, smaller cohort sizes, and more community-based health programming. Community-engaged health promotion using a cohort model as well as including women can be effective in increasing knowledge, enhancing self-efficacy, and providing the much-needed social support. These can influence health-related behaviors and thus contribute to improving health outcomes for AA men.

An Active Learning Approach to Teaching Social Determinants of Health

This active learning exercise is designed to deconstruct the impact of social determinants through the assumption of randomly selected personas. As an active learning exercise, it provides opportunities for discussion, problem solving, writing, and synthesis, while incorporating multiple learning style preferences. Part 1 involves assessing the individual social determinants at work. Part 2 involves exploring ways said determinants can enhance community health through collaboration. Assumption of personas unlike one’s own facilitates an open discussion of social position and ranges of factors influential to health without potentially evoking a sense of defensiveness associated with personal privilege (or the lack thereof).

The pharmacological and biological roles of eriodictyol

Eriodictyol is a flavonoid in the flavanones subclass. It is abundantly present in a wide range of medicinal plants, citrus fruits, and vegetables that are considered to have potential health importance. Having the considerable medicinal properties, eriodictyol has been predicted to clarify the mode of action in various cellular and molecular pathways. Evidence for the existing therapeutic roles of eriodictyol includes antioxidant, anti-inflammatory, anti-cancer, neuroprotective, cardioprotective, anti-diabetic, anti-obesity, hepatoprotective, and miscellaneous. Therefore, this review aims to present the recent evidence regarding the mechanisms of action of eriodictyol in different signaling pathways in a specific disease condition. In view of the immense therapeutic effects, eriodictyol may serve as a potential drug source to enhance community health standards.

Community organizations’ perspectives on the impact of a nursing student-led academic-community partnership program

Academic-community partnerships can have a direct positive impact on community partners and university students. Community Champions, a student-led program, promotes local outreach and engagement with a variety of community initiatives. The purpose of this study was to assess community partners’ perceptions of the Community Champions program to better support the goals of the community and to complement prior research evaluating the impact of the Community Champions program on university students. The study used a 27-item survey, consisting of 20 Likert-scale items and seven open-ended questions. Eighteen community partners were invited via email to complete the online survey. Quantitative responses were analyzed using descriptive statistics, and qualitative responses were reviewed for themes to generate future recommendations. Fourteen of the eighteen community organizations responded to the survey (78% response rate). Assessment of community partners’ perspectives were synthesized across four themes: motivations, benefits, challenges, and general satisfaction. Community partners indicated that sharing labor and resources to enhance community health goals were key factors in creating mutually beneficial partnerships. Building effective academic-community partnerships is essential to increasing student engagement, while also addressing priorities of community organizations. Academic student programs that engage the community can positively impact both the community partners and university students.

Enhancing community health through patient navigation, advocacy, and social support: A community health navigator pilot study

Background: The healthcare system is complex and difficult to navigate, particularly for patients with multiple chronic conditions and complex care plans. Patient adherence to care plans and patient health outcomes can be negatively impacted by language, financial, and other social barriers. Community Health Navigators (CHNs) are community members that are hired and trained to navigate the healthcare system, who work with patients to overcome barriers to care and support patient self-management by providing services tailored to needs. While these types of interventions can improve access to care in other settings, they are not well studied in Canada nor in Canadian primary care settings.
 Objective: For this pilot study, we aimed to determine the feasibility of a CHN intervention for patients with multiple chronic conditions. Our secondary objective was to assess the potential impact of a CHN intervention on patient-reported outcome measures.
 Methods: We used an observational single arm pre-post study design. Using interviewer-administered patient surveys, we assessed patient-reported outcomes at baseline (pre-enrolment), and 6-months and 12-months post-enrolment. The survey included instruments to assess quality of life (EQ-5D-5L), patient chronic disease care experience (PACIC), social support (mMOS-SS), and cost-related adherence to care (i.e. financial security to pay for care-related costs). Descriptive analysis was performed on survey data, and the sample was restricted to participants who completed both follow-up surveys (6- and 12-month). 
 Results: Of the 21 participants enrolled in our pilot study, the mean age was 61.3 years, 56% had an annual household income below $30,000, and 68% were born outside of Canada. The three most common conditions reported were hypertension (77%), diabetes (59%), and back problems (55%). The mean number of conditions a patient reported was 5.4 (SD 2.3, range 3-11).
 Of the sample enrolled, 14 (67%) patients completed both follow-up surveys. Mean social support (scale: 0-100), was 56, 68, and 75 at baseline, 6, and 12 months, respectively—indicating a potential increase in social support after the intervention. Mean self-ranked health (scale: 0-100) did not change over time. Mean patient experience with chronic disease care (scale: 1-3) was 2.01 at baseline; 2.24 at 6 months, and 1.89 at 12 months. The proportion of patients who reported no difficulty paying for medical expenses increased from 36% at baseline to 79% at 6 months and 86% at 12 months. In other words, fewer patients reported difficulty paying for medical expenses at 6 months and at 12 months. Results presented here are preliminary; further analysis is underway which will include analysis of health outcomes using administrative data, statistical tests of survey data (where appropriate), and qualitative analysis of interview data.
 Conclusions: CHNs may improve patients’ social and financial support and satisfaction with care. Our pilot study demonstrates that a CHN intervention is feasible to implement in primary care for patients with multiple chronic conditions. These findings informed a large ongoing cluster-randomized pragmatic trial.

Examining the Usefulness of Patient Documentation Forms as a Tool for Community Health Navigators

Introduction | Effective documentation of patient encounters may influence Community Health Navigators’ (CHNs) success in providing support to patients as well as provide a data source to examine CHN practices. The ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS) study, based in partnership between the University of Calgary and the Mosaic Primary Care Network (MPCN) is evaluating a CHN program to determine whether CHNs improve outcomes for patients with multiple chronic conditions. CHNs support their patients by helping them navigate the health system, connect to community resources, and access culturally appropriate support. The purpose of this study was to examine the quality and usefulness of CHN-patient documentation forms used in the ENCOMPASS pilot study (i.e., Initial Action Planning Form, Follow-up Action Planning Form, Patient Encounter Form, all implemented on the REDCap platform) and revise the documentation process using co-design with the end user.
 Methods | An iterative co-design quality improvement process was employed across three phases. First, content analyses were conducted on the Patient Encounter Form notes to examine how CHNs were using the forms and how they were documenting their activities. Second, a survey was distributed to CHNs to gather their perspectives about their experiences with the REDCap platform and the three forms. Third, a working group, consisting of four CHNs, met twice with research team members to discuss barriers to use and opportunities for improvement.
 Results | The REDCap platform and the three CHN-patient encounter forms did not adequately meet the needs of the CHNs. Content analysis revealed significant variation in how the Patient Encounter Form was utilized and various form sections were not completed as intended. In the survey, CHNs reported that the documentation experience was not satisfactory and the training that they had received to date was insufficient. The CHN working group suggested changes to the interface with the REDCap platform and form structure. Revisions were made based on these suggestions, and approved by the working group.
 Conclusions | The approved changes to REDCap and the three forms will be implemented and introduced to the CHN team. The research team will develop a patient encounter documentation guidelines document and will provide all members of the CHN team with the opportunity to receive re-training. These changes will be reviewed with the CHNs to continue the iterative quality improvement process. Prior to final implementation, consultation with the Clinical Research Unit administrators on the feasibility of the revisions made to the forms and interface with the REDCap platform will be held. The results of this study have the potential to provide a better overall experience for CHNs in the ENCOMPASS program and enhance their work with patients.

HEALTH CENTER NEEDS MANAGER WITH GRADUATE OF PROFESSION OF PUBLIC HEALTH GENERALIST IN INDONESIA

An additional cost of health insurance paid by the government has increased every year. Theoretically, this is due to curative services have been more and more dominant. The one problem might be due to different views between 2 organizations concerning public health. The objective of this paper is offering innovative thought to create the same view between the 2 organizations to strengthen preventive and promotional health services through health centers. One organization has conducted competency examination to Bachelor of Public Health Specialist; if he/she passes the examination, they are granted a Letter of Registration. However, another organization disagrees, because someone will obtain a Letter of Registration if he/she has already passed as a Profession of Public Health. Concerning with the different view, the writers offer an Innovative Thoughts that necessary Profession in Public Health Generalist appointed to be Manager in Health Center, for which Profession of Public Health Generalist Education Program established, where students receive theory in class and practice in the Field Laboratory of Public Health based on Integration of Public Health Scientific Disciplines. The government should also provide the Profession of Public Health Specialist working in the functional position in the Ministry of Health and Provincial/District Health Department. The writers formulate several conclusions to strengthen preventive and promotional health services enhancing community health status as the one factor to develop human resources namely Presidents Joko Widodo’s Vision in the Second Working Cabinet 2019-2024.

Satellite images and machine learning can identify remote communities to facilitate access to health services.

Community health systems operating in remote areas require accurate information about where people live to efficiently provide services across large regions. We sought to determine whether a machine learning analyses of satellite imagery can be used to map remote communities to facilitate service delivery and planning. We developed a method for mapping communities using a deep learning approach that excels at detecting objects within images. We trained an algorithm to detect individual buildings, then examined building clusters to identify groupings suggestive of communities. The approach was validated in southeastern Liberia, by comparing algorithmically generated results with community location data collected manually by enumerators and community health workers. The deep learning approach achieved 86.47% positive predictive value and 79.49% sensitivity with respect to individual building detection. The approach identified 75.67% (n = 451) of communities registered through the community enumeration process, and identified an additional 167 potential communities not previously registered. Several instances of false positives and false negatives were identified. Analysis of satellite images is a promising solution for mapping remote communities rapidly, and with relatively low costs. Further research is needed to determine whether the communities identified algorithmically, but not registered in the manual enumeration process, are currently inhabited. To our knowledge, this study represents the first effort to apply image recognition algorithms to rural healthcare delivery. Results suggest that these methods have the potential to enhance community health worker scale-up efforts in underserved remote communities.

Partner Notification, Treatment, and Subsequent Condom Use After Pelvic Inflammatory Disease: Implications for Dyadic Intervention With Urban Youth.

Research suggests that youth in urban communities often remain in the same sexual relationships after a pelvic inflammatory disease (PID) diagnosis. Utilizing data from the Technology Enhanced Community Health Nursing (TECH-N) study, we explored partner notification, treatment, and condom use after PID diagnosis. Outreach interviews assessed adherence to self-care behaviors, followed by interviews 3 months after diagnosis. Descriptive statistics and multivariable logistic regressions evaluated baseline condom use versus 3 months after diagnosis as it relates to group and relationship status. Ninety-one percent reported partner notification, and of those notified, 90% reported partner treatment. Reports of condom use increased in both groups compared with baseline use. TECH-N participants were more likely to report condom use at last sex at 3 months compared with baseline. Given the open communication with partners about PID and partner-associated effects on condom use, exploring dyadic intervention to promote consistent, condom use after PID for youth in high STI (sexually transmitted infection) prevalence communities is required.

Prevalence of HTN in Iran: Meta-analysis of Published Studies in 2004-2018.

Introduction:Prevalence of hypertension (HTN) is increasing in the developing countries like Iran. Various stud-ies have reported different rates of HTN in Iran. The purpose of this study was to estimate an overall prevalence of HTN in Iran.Methodology:Using the English and Persian key derived from Mesh, the databases including MagIran, Iran Medex, SID, Web of Sciences, PubMed, Science Direct and Google Scholar as a searching engine were reviewed: from 2004 to 2018. The overall prevalence of MA was estimated using Random effect model. The I2 test was used to assess the heterogeneity of the studies. Additionally, the quality of studies was evaluated using a standard tool. Publication bias was conducted with the Egger test. Meta-regression and analysis of subgroups were analyzed based on variables such as age, marital status, region and tools. Data were analyzed using STATA 12 software.Results:Analysis of 58 primary articles with a sample size of 902580 showed that the prevalence of HTN in Iran was 25% (with 95% CI of 22-28). The highest prevalence of HTN was related to elderly (42%). The prevalence of HTN was 25% (95% CI: 19-31) in women and 24% (95% CI: 20-28) in men with no significant difference (p = 0.758). The results also in-dicated that the prevalence of HTN was not related to the year of studies (p = 0.708) or sample size (p = 769).Conclusion:Despite the advancements in science and technology, along with health and prevention of diseases, the overall prevalence of HTN raised in Iran. Since HTN is a silent disease with significant health consequences and economic burden, programs designed to better HTN control seem vital to enhance community health.