Face Health Challenges Research Articles

Healthy Cities to Healthy People: a Grid Application to Assess the Potential of Ecosystems Services of Public Urban Green Spaces in Porto, Portugal

Abstract Introduction Contemporary cities face multiple socioenvironmental and health challenges that undermine the efforts to promote healthy environments. The 11th goal – Sustainable cities and communities – of United Nations 2030 Agenda for Sustainable Development states that the presence of nature in cities plays a vital role for its sustainability through public urban green spaces (PUGS) accessible and with quality for all. Objectives This work describes the application of a grid to evaluate the potential of the ecosystems services (ES) of PUGS. Methodology The grid was applied in 25 PUGS in the city of Porto, divided into 5 clusters of socioeconomic and environmental deprivation (SED), ranging from very high to very low), and is composed by 6 sections with 37 domains assessed: i) identification; ii) description of the activities; iii) activities that take place; iv) assessment of the environment quality; v) existence of infrastructure and facilities; and vi) security. Dimensions iii, iv, v and vi are filled in the grid by a dichotomous answer: No = 0; Yes = 1. All data calculation and statistical analyses were performed using IBM® SPSS® Statistics vs.25.0. The grid was applied in January 2019 and each PUGS visit lasted 20-25 minutes. Results The highest total score (33) corresponds to 2 parks located in a low and medium SED clusters. The lowest score (9) corresponds to 2 gardens located in a very high and high SED clusters. The most critical dimension assessed of the PUGS has to do with the activities it offers (Median = 2). On the other hand, the dimension with the highest scores relates to the PUGS environmental quality (Median = 8). Regarding results by SED clusters, it is observed that lowest scores, in all assessed domains, are from PUGS located in high and very high SED clusters. Conclusion This work presents useful information regarding the importance of promoting PUGS with quality and accessible from all, especially to socioeconomic vulnerable groups, which should be the major goal of public policies designers.

Prevalence and Associated Lifestyle Factors of Suboptimal Health Status among Chinese Children Using a Multi-Level Model.

Chinese children are facing health challenges brought by chronic non-communicable diseases, such as physical problems and psychological related health problems. Childhood represents a critical life period when the long-term dietary and lifestyle behaviors are formed. It is necessary to survey the prevalence of suboptimal health status (SHS) among Chinese children and to research the relationship between SHS and lifestyles. This study aimed to examine the prevalence of SHS among Chinese children using a large-scale population survey sample covering school students and nonstudent children, and clarified the relationships between SHS and lifestyle factors using multi-level models controlled for the cluster effect of location and the confounding effect of demographics. Multi-level generalized estimating equation models were used to examine the relationships between SHS and lifestyle factors. Prevalence ratios (PR) and 95% confidence intervals (CI) were used to assess the strength of these relationships. Of the 29,560 children, 14,393 reported one or more SHS symptoms, giving a SHS prevalence of 48.69%. The prevalence of SHS for boys (46.07%) was lower than that for girls (51.05%). After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, lifestyle factors associated with SHS were: less sleep duration, current smokers (PR = 1.085, 95%CI: 1.027–1.147), current drinkers (PR = 1.072, 95%CI: 1.016–1.131), children’ parents suffering from chronic diseases (PR = 1.294, 95%CI: 1.179–1.421), poor sleep quality (PR = 1.470, 95%CI: 1.394–1.550), stress (PR = 1.545, 95%CI: 1.398–1.707), negative life events (PR = 1.237, 95%CI: 1.088–1.406), hypertension (PR = 1.046, 95%CI: 1.009–1.084), unhealthy diet choice (PR = 1.091, 95%CI: 1.051–1.133) and irregular meal time (PR = 1.210, 95%CI: 1.163–1.259). Children who could exercise regularly (PR = 0.897, 95%CI: 0.868–0.927) and those with regular medical checkup (PR = 0.891, 95%CI: 0.854–0.929) were associated with lower prevalence probability of SHS. SHS has become a serious public health challenge for Chinese children. Unhealthy lifestyles were closely associated with SHS. Implementation of preventative strategies are needed to reduce the potential SHS burden associated with these widespread high-risk unhealthy lifestyle behaviors.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

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Health Challenges and Assets of Forest-Dependent Populations in Cameroon.

Indigenous populations often have poorer health outcomes than the general population. Marginalization, colonization, and migration from traditional lands have all affected traditional medicine usage, health access, and indigenous health equity. An in-depth understanding of health for specific populations is essential to develop actionable insights into contributing factors to poor indigenous health. To develop a more complete, nuanced understanding of indigenous health status, we conducted first-person interviews with both the indigenous Baka and neighboring Bantu villagers (the reference population in the region), as well as local clinicians in Southern Cameroon. These interviews elucidated perspectives on the most pressing challenges to health and assets to health for both groups, including access to health services, causes of illness, the uses and values of traditional versus modern medicine, and community resilience during severe health events. Baka interviewees, in particular, reported facing health challenges due to affordability and discrimination in public health centers, health effects due to migration from their traditional lands, and a lack of culturally appropriate public health services.

The Situated Influence of Chronic Pain Perception on Chinese Older Adults' Self-Management in Home Care.

Background and objective: Worldwide, 26 million older adults die from chronic disease, and chronic pain is typically a part of the experience of chronic disease. This study explores the perception of chronic pain for home-dwelling Chinese older adults and its influence on (1) self-management ability and (2) management and reduction of chronic pain. Methods: Adopting a qualitative study design, we conducted in-depth interviews with 10 Chinese community-dwelling older adults who experience chronic pain. Half of our informants perceive chronic pain, whereas the other half, diagnosed with Alzheimer’s disease, do not report that they perceive chronic pain. Data were analyzed with inductive thematic analysis. Results: Chronic pain perception plays important roles in (1) defining the challenge of self-management, (2) connecting previous caretaking experience, (3) adjusting the identity of self-management, (4) acquiring support from important others and (5) re-planning self-management arrangements. Conclusion: Pain perception helps to motivate Chinese older adults to face health challenges and regain self-management capacity through adjustments in self-identity and care experience with the support of important others. Pain perception can consolidate the situation of independent living of older adults. It helps to motivate Chinese older adults to face health challenges and regain self-management capacity.

The Role of Sex, Gender, Health Factors, and Job Context in Workplace Accommodation Use Among Men and Women with Arthritis.

BackgroundWith the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men.ObjectivesThis study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs.MethodsA cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health benefits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses.ResultsThere was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met.ConclusionsThe findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed.

Life Skills at a Tribal College: A Culturally Relevant Educational Intervention

American Indians, Alaska Natives, and Native Hawaiians (AI/AN/NH) experience the lowest rates of college retention and significant barriers to graduation. In addition, AI/AN/NH individuals face health challenges that include higher rates of obesity, overweight, and type 2 diabetes. We designed a culturally relevant life skills curriculum based on family and consumer science standards to promote educational achievement, self-efficacy, and healthful food choices among tribal college students. The Life Skills at a Tribal College course was delivered by tribal college Extension professionals in a family meal–style environment and involved culturally appropriate, traditional ways of learning to promote positive educational and health outcomes.

‘Once there is life, there is hope’ Ebola survivors' experiences, behaviours and attitudes in Sierra Leone, 2015

BackgroundIn Sierra Leone, over 4000 individuals survived Ebola since the outbreak began in 2014. Because Ebola survivorship was largely unprecedented prior to this outbreak, little is known about survivor experiences...

The Transformative Power of Authentic Conversations About Cancer

ABSTRACTEntertainment-education (E-E) assumes that actors performing content should be ethnically and culturally homogeneous with targeted audiences. The present study challenges this basic E-E assumption. Findings are presented from audience members who viewed When Cancer Calls… This theatrical production was constructed from verbatim transcriptions of naturally occurring telephone conversations between White family members as they communicated about and through their cancer journey. Non-White audience members were significantly more likely than White audience members to (a) regard the performance as authentic, (b) find it would influence “people like me,” and (c) recommend the production to others. These findings suggest that all people must rely on communication when facing health challenges together. Such interactions that are fundamental to family membership are thus primal for the human social condition, regardless of differences in race and ethnicity. These findings also suggest innovative approaches to E-E health interventions that may contradict traditional market segmentation theories based on cultural differences and the principle of homophily.

ASSESSMENT OF BENZOPHENANTHRIDINE AND PROTOPINE ALKALOIDS IN BROILER CHALLENGED AND NOT BY SALMONELLA HEIDELBERG

Salmonellosis is a globally important zoonosis, and Salmonella Heidelberg is one of the most prevalent serovars in poultry production worldwide, as well as in food poisoning cases. Antimicrobial drugs were previously widely used to face health challenges in animal production; however, since their ban as performance enhancers, many alternative strategies have been proposed. One of these strategies is the use of plant extracts, such as those containing the alkaloids benzophenanthridine and protopine. These compounds have antimicrobial, anti-inflammatory, immunomodulation, and nutritional effects. The objective of the present study was to evaluate the effects of the supply of a product containing benzophenanthridine and protopine (Sangrovit(r)WS 100 g/1000 L of drinking water) to broilers during different rearing periods 1-21, 1-6 and 6-21 days of age challenged or not with Salmonella Heidelberg at six days of age. There was no effect of the product on the performance, jejunal morphometry, cecal goblet cell counts, or control of Salmonella spp. in broilers challenged or not with Salmonella Heidelberg. However, the group receiving the alkaloids from 1 to 21 days of age, compared with the control group, presented a numerical difference of 28 points in productive efficiency index, which directly impacts live production cost of live broiler, representing savings of R$ 0.11/kg of meat produced.

Experiences in Conducting Participatory Communication Research for HIV Prevention Globally: Translating Critical Dialog into Action through Action Media.

Developing communication to support health and well-being of vulnerable communities requires a multifaceted understanding of local perspectives of contextual challenges and potentials for change. While participatory research enhances understanding, robust methodologies are necessary to translate emerging concepts into viable communication approaches. Communicators and change agents need to clarify pathways for change, barriers and enablers for change, as well as the role, orientation, and content of communication to support change. While various approaches to participatory action research with vulnerable communities have been developed, there is a dearth of methodologies that address the formulation of communication concepts that can be applied at scale. The Action Media methodology has been refined over a period of two decades, being applied to addressing HIV, related aspects such as gender-based violence, as well as broader issues, such as maternal and child health, sanitation, and malaria in Africa, The Caribbean, and Asia. The approach employs a sequence of interactive sessions involving communicator researchers and participants from one or more communities that face social or health challenges. Sessions focus on understanding audiences through their engagement with these challenges and leading to shaping of relevant communication concepts that can be linked to mobilization for change. The Action Media methodology contributes to processes of shared learning linked to addressing social and health challenges. This includes determining priorities, identifying barriers and facilitators for change, understanding processes of mobilizing knowledge in relation to context, determining appropriate communication approaches, and integrating indigenous language and cultural perspectives into communication concepts. Emerging communication strategies include support to systematic action and long-term mobilization. Communication to address public health concerns is typically developed through expert-led didactic approaches that, at best, engage audiences at the end of the development cycle through pretesting of communication concepts. Action Media provides an alternative approach that can be utilized to inform communication by integrating community perspectives at the outset. Notwithstanding the focused engagement with small group representative of health-vulnerable subpopulations, Action Media findings have informed large-scale communication interventions. The approach is directly linked to enabling ownership, critical thinking, and mobilization of knowledge for change.

Diagnosis for Imported Cases of Emerging and Reemerging Infectious Diseases in Korea

Despite recent advances in the development of diagnostics, therapeutics, and vaccines, the ease of international travel and increasing global interdependence have brought about particular challenges for the control of infectious diseases, highlighting concerns for the worldwide spread of emerging and reemerging infectious diseases. Korea is also facing public health challenges for controlling imported cases of infectious diseases; dengue virus, which is the most commonly reported case of imported infectious diseases; the largest outbreak of Middle East respiratory syndrome coronavirus infections outside the Arabian Peninsula in 2015; and the Zika virus infection, which was declared by the WHO as a "Public Health Emergency of International Concern." Although national and global partnerships are critical to controlling imported infectious disease threats, the role of local hospitals, public health sectors, and laboratory capacity remains the cornerstone for initial disease recognition and response. The current status of laboratory diagnosis for imported infectious diseases is reviewed.

Impact of rurality on maternal and infant health indicators and outcomes in Maine

Rural residents may face health challenges related to geographic barriers to care, physician shortages, poverty, lower educational attainment, and other demographic factors. In maternal and child health, these disparities may be evidenced by the health risks and behaviors of new mothers, the health of infants born to these mothers, and the care received by both mothers and infants. To determine the impact of rurality on maternal and child health in Maine, USA, 11 years of data (2000-2010) for the state of Maine from the Pregnancy Risk Assessment Monitoring System (PRAMS) project were analyzed. PRAMS is a national public health surveillance system that uses questionnaires to survey women who had delivered live infants in the previous 2-4 months. Using a geographic information system, each questionnaire response was assigned a rurality tier (urban, suburban, large rural town, or isolated rural community) based on the rural-urban commuting area code of the town of residence of the mother. Results from the four rurality tiers were compared using the survey procedures in Statistical Analysis Software to adjust for the complex sampling strategy of the PRAMS dataset. Means (for continuous variables) and percentages (for categorical variables) were calculated for each rurality tier, along with 95% confidence intervals. Significant differences between rurality tiers were tested for using F-tests or χ2 tests. If significant differences between rurality tiers existed (p<0.05), specific tiers were judged to be different from each other if their 95% confidence intervals did not overlap. A total of 12 600 mothers responded to the PRAMS questionnaire during the study period. Compared to mothers from more urban areas, rural mothers were younger (10.5% of mothers from isolated rural areas were teenagers compared to 6.2% of mothers from urban areas), less well educated, less likely to be married, and more likely to live in lower income households (39.6% of isolated rural mothers had household incomes ≤US$20 000/year vs 28.8% of urban mothers). Rural mothers had higher pre-pregnancy body mass indexes (BMIs; average BMI 26.1 for isolated rural women vs 25.3 for urban women) and were more likely to smoke but less likely to drink alcohol (both before and during pregnancy). Compared to mothers from more urban areas, rural mothers were not sure they were pregnant until a later gestational age but received prenatal care just as early and were just as likely to receive prenatal care as early as they wished. There were no differences among rurality tiers in Caesarean section rates, rates of premature births (<37 weeks gestation), or rates of underweight births (<2500 g). However infants born to rural mothers were less likely to be breastfed (52.9% of isolated rural vs 60.9% of urban infants breast fed for ≥8 weeks). These results show that, while rural women face significant demographic and behavior challenges, their access to prenatal care, the care they receive while pregnant, and the outcomes of their pregnancies are similar to those of urban women. These results highlight areas where focused pre-pregnancy and prenatal education may improve maternal and child health in rural Maine.

From integrated care towards DIY Health – Combining person-centered health care delivery, mobile technology and entrepreneurship

Conference Abstract. Introduction and objectives: To achieve the level of impact necessary to reverse current trends of rising incidence and costs of multimorbidity and enabling healthy ageing will require new health care policy and practices. Notwithstanding integrated care receiving worldwide attention in improving healthcare delivery, the value of data driven and mobile technology for integration of health and care services remains unclear. Nevertheless, person-centered and data driven mobile health (mHealth) has the potential to evolve integrated care from business process re-design towards a new digital health ecosystem that is truly centered around a person facing health challenges. The objective of our study was to identify the opportunities and barriers of mHealth to do this. Highlights: MHealth applications attack the underlying causes of the multimorbidity and ageing challenge in various ways. First, mHealth lifestyle apps promise to help in the prevention of chronic disease and multimorbidity by attacking high risk conditions such as obesity and diabetes. Secondly, personalised care promised by participative mHealth apps will reduce reliance on expensive, institutionalised care by augmenting the effectiveness of treatments. Finally, mHealth apps could empower patients by facilitating remote care, self-medication, independent living and more. One of the major developments in mHealth for integrated care is that (new) entrants in the mHealth market focus more on patients and consumers than on medical professionals. This development has several benefits: First the emphasis on intuitive user interfaces, usability and immediate feedback by these parties seems more effective in nudging people to change towards desired behaviors than traditional (preventive) healthcare interventions. Furthermore, mHealth applications encourage self-monitoring and self-diagnosis, potentially reducing the number of hospital visits for purposes of monitoring and simple diagnoses. However, we see certain challenges. First and foremost, attention should be paid to manage sensitivity of health information by allowing more control over data-driven solutions by end-users and other stakeholders. Secure and dedicated data platforms for the health sector should govern the secure interconnection of health data components. Secondly, to create an effective learning ecosystem, new cross-disciplinary and collaborative research and innovation approaches are needed. These will help tackle technological, behavioral and institutional challenges. Finally, to stimulate the emergence and participation of mHealth entrepreneurs, any health data exchange initiative will need to prioritize access by startups and SMEs to fast track the required fundamental innovations in a traditional health sector. Conclusions: Our analysis shows that new, consumer-focused entrants have a high potential to stimulate person-centered coordinated care. Nevertheless, research and policy should find solutions for potential ‘showstoppers’, such as challenges in privacy, accountability and security. A learning ecosystem, which has to include new research and innovation models, may facilitate this. Another important aspect is to find ways to grant new entrants, in particular start-ups and SMEs, access to core health infrastructure and key data-sets.

The current state of diabetes mellitus in India.

Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease. 1,2 In 2000, India (31.7 million) topped the world with the highest number of people with diabetes mellitus followed by China (20.8 million) with the United States (17.7 million) in second and third place respectively. According to Wild et al. 3 the prevalence of diabetes is predicted to double globally from 171 million in 2000 to 366 million in 2030 with a maximum increase in India. It is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India, while China (42.3 million) and the United States (30.3 million) will also see significant increases in those affected by the disease. 3,4 India currently faces an uncertain future in relation to the potential burden that diabetes may impose upon the country. Many influences affect the prevalence of disease throughout a country, and identification of those factors is necessary to facilitate change when facing health challenges. So what are the factors currently affecting diabetes in India that are making this problem so extreme?

Mortality among children and youth in high-percentage First Nations identity areas, 2000-2002 and 2005-2007

Many First Nations children live in communities that face diverse social and health challenges compared with their non-Aboriginal peers, including some of the most socio-economically challenging situations in Canada. These differences can be seen in broad indicators of the social determinants of health. Studies of mortality in Aboriginal populations across Canada are often restricted by the lack of Aboriginal identifiers on national death records. While some studies have utilised a record-linkage approach, this is often not possible for the entire country or for recent data. Some researchers have adopted a geographic approach and examined mortality and morbidity in areas that have a high percentage of Aboriginal identity residents, and have uniformly reported elevated rates of mortality and morbidity compared with other areas. The purpose of this article was to examine child and youth mortality (aged 1 to 19 years) in areas where a high percentage of the population identified as First Nations in comparison with areas where there is a low percentage of Aboriginal identity residents. Using a geographic threshold table approach, areas with a high percentage of Aboriginal identity peoples were classified as either First Nations, Métis, or Inuit communities based on the predominant identity group. The upper one-third of the total Aboriginal population distribution was used as a cut-off for high percentage First Nations areas, where 97.7% of the population aged 1-19 were of First Nations identity in 2006 (N=140 779). Mortality rates were then calculated for high-percentage First Nations identity areas and compared with low-percentage Aboriginal identity areas, excluding high-percentage Métis or Inuit identity areas. Deaths were aggregated for the 3 years surrounding the 2001 and 2006 census periods, and a total of 473 deaths were recorded for 2000-2002 and 493 deaths for 2005-2007. Analysis was facilitated via the correspondence of six-digit residential postal codes on vital statistics records to census geographical areas using automated geo-coding software (Statistics Canada; PCCF+). Age-standardized mortality rates for children and youth in high-percentage First Nations identity areas were significantly higher than in low-percentage Aboriginal identity areas. The rate ratio for all-cause mortality for boys was 3.2 (CI: 2.9-3.6) for 2005-2007 and 3.6 (CI: 3.2-4.2) for girls. Mortality rates for injuries had the largest difference, with rate ratios of 4.7 (CI: 4.0-5.5) and 5.3 (CI:4.5-6.3) for boys in 2000-2002 and 2005-2007 and 5.5 (CI: 4.4-6.8) and 8.3 (CI: 6.8-10.1) for girls in the same period. A strength of this study is that it is the first to use national-level vital statistics registration data across two time periods to report mortality by cause for children and youth living in high-percentage First Nations areas. Vital events were geographically coded to high-percentage First Nations identity areas and compared with low-percentage Aboriginal identity areas at the Dissemination Areas level. This area-based methodology allows for mortality to be calculated for children and youth by sex and by detailed cause of death for multiple time periods. The results provide key evidence for the persistent differences in the causes of death for children and youth living in high-percentage First Nations identity areas.

SUD treatment needs and barriers among vets returning to the inner city

Operation Enduring Freedom/Operation Iraqi Freedom veterans reintegrating into civilian life have been facing mental health challenges, especially post-traumatic stress disorder, traumatic brain injury, depression and substance use disorders. This paper examines the treatment need, unmet need and self-reported barriers to treatment among those returning to New York's inner city. Using respondent driven sampling, this analysis provides some of the first unbiased estimates for this vulnerable population of predominately African American veterans living in low-income communities.

The benefits and potential impacts of household cooking fuel substitution with bio-ethanol produced from cassava feedstock in Nigeria

The major cooking fuels in Nigeria, which are fuel wood and kerosene, face supply difficulties, price instabilities, safety, health and environmental challenges. In response to these challenges, the Federal Government of Nigeria recently announced the partial replacement of these cooking fuels with bio-ethanol produced from cassava in a project called ‘cassakero’. The project involves the installation of 10,000micro-scale bio-refineries across the country with a combined capacity of 4millionliters per day. The project includes the establishment of a 400,000ha cassava farm to supply cassava feedstock to the ethanol refineries. Though the detailed design of the project is not yet available, the aim of this paper is to appraise the project with the aim of highlighting the benefits of the project for enhancement while emphasizing the potential negative impacts for mitigation. The results of the appraisal revealed that the project will be beneficial in terms of job creation, boost rural agriculture, conserve forest from fuel wood exploitation, alleviate poverty and prevent indoor pollution. The impact of the project on greenhouse gas emission is ambiguous. While the shift to ethanol cooking fuel will release less CO2 comparatively, the conversion of 400,000ha of forest to cassava farm, the use of fossil fuel for processing cassava tubers to ethanol, fermentation of cassava starch and the use of agro-chemicals will release CO2 as well. Other potential negative impacts of the project include large input of water and energy and the production of large volume of waste stream, which need to be handled. There is a potential food versus fuel conflict, especially if the current production of cassava is not scaled up to meet the several emerging projects in Nigeria requiring cassava feedstock.

Survivorship care plans for colorectal cancer survivors: What do primary care providers want and need?

9131 Background: Colorectal cancer (CRC) survivors face health challenges and poor coordination of care. The Institute of Medicine (IOM) proposed that after treatment completion, oncologists should provide patients with personalized treatment summaries and plans of care to share with their primary care providers (PCPs) to inform ongoing care. We aimed to determine the optimal content of these survivorship care plans by assessing what information PCPs need to care for CRC survivors. Methods: All physicians and mid-level clinicians in two Practice-Based Research Networks in MN and PA were invited to participate in an internet survey between August and December 2010. The survey assessed the need for information about the care of CRC survivors. The IOM‘s proposed survivorship care plan includes 45 topics of information. For each topic, PCPs rated whether they typically receive enough information. Results: 108 (44%) of PCPs responded to the invitation; 87 PCPs were eligible and completed the survey. For 24 (53%) of the topics, at least half of respondents felt they typically had too little information. Most PCPs felt they had too little information about whether there were problems with chemotherapy (70%) and whether the oncologist intended to monitor for other cancers (68%). There was widespread agreement that PCPs do not receive enough information about increased risk of second cancers, other cancers, and other diseases (78%); long-term effects of chemotherapy (72%); long-term effects of radiation (64%); and genetic counseling and testing to identify high-risk individuals (76%). Conclusions: PCPs typically lack information to provide optimal care for their patients who have had CRC. PCPs often need information both about their individual patients and about general survivorship issues. Survivorship care plans which address the treatment history and recommended care for CRC survivors may fill important gaps in PCPs’ knowledge by communicating details of patients’ cancer history and providing general survivorship information. Further, specifying which providers are responsible for different aspects of ongoing care could promote care coordination as survivors navigate between cancer treatment and primary care.