Health Efforts Research Articles

Whose kettle?

This article aims to explore how objects function in integration efforts in health and social care contexts. The article draws on boundary object theory and empirical data collected from a range of health and social care integration initiatives in Wales to illustrate the value of the focus on objects and to identify the potential implications of this approach for studies in other national contexts. Attention to objects can shed light on the dynamics of integration, its potential and limits, offering insights that conventional analysis might otherwise miss. The data drawn on in this paper are illustrative. Exploring the role of objects in integration requires more focused studies. The results suggest that integration designers and managers need to pay closer attention to the attachments that practitioners develop to objects. This is a highly original paper in view of its innovative use of boundary object theory in the context of integration, and its contribution to theory, research and practice.

Informal Occupational Safety Information Exchange Among Latino Migrant and Seasonal Farmworkers

ABSTRACT Latino farmworkers in North Carolina are a hard-to-reach population that faces diverse occupational health risks, including pesticide exposure. Health and safety education efforts often employ lay health advisor or promotor(a) de salud models in which farmworker community members are trained to provide health education. As a frequently tight-knit and isolated group, farmworkers may be well suited to serve as resident lay health advisors. This paper presents data collected from a nonrandom sample of Latino farmworkers living in North Carolina regarding the natural level of occupational safety information exchange among Latino farmworkers, specifically pesticide safety information. The data affirm that farmworkers informally exchange occupational safety information with one another, with the level of exchange increasing during the agricultural season. Consequently, if trained, the data suggest that farmworkers might be situated to provide in situ occupational health and safety education to their peers. This remains to be systematically tested and evaluated.

Griffin et al. Respond

We appreciate Silk's comments, which bring further attention to the burden of oral disease among older adults. Our findings suggest that poor oral health can further diminish the well being of persons with existing health conditions through increased mouth pain, food avoidance, self-consciousness and embarrassment, and less satisfaction with life. Moreover, disparities in the burden of oral disease also exist based on race, ethnicity, and socioeconomic status. We agree with Silk that the Smiles for Life curriculum, endorsed by both the American Dental Association and the American Association of Public Health Dentistry, is a good start for providing crucial education and awareness about the importance of oral health across the lifespan to primary care providers, including geriatricians. The National Interprofessional Initiative on Oral Health and other efforts to integrate oral health into predoctoral and residency programs are especially promising, in that it may be easier to provide oral health competencies to the next generation than to change attitudes and behaviors of established practitioners.

A Discharge Panel At Denver Health, Focused On Complex Patients, May Have Influenced Decline In Length-Of-Stay

Acute care hospitals struggle to manage complex patients who no longer require acute care services but who present medical and psychosocial challenges that make safe discharge to a lower level of care difficult. These challenges can be particularly acute at safety-net hospitals that cater predominantly to the poor and uninsured. For a person with a serious illness, such as a spinal cord injury, lack of insurance for long-term care services may add many weeks of medically unnecessary hospital days and result in higher costs. We describe safety-net system Denver Health's efforts to facilitate appropriate nonhospital care for these complex patients through the formation of a Complex Discharge Subcommittee. Successful solutions include accelerating legal guardianship approval to facilitate patient acceptance by skilled nursing facilities, as well as providing specialized equipment such as bariatric beds to nursing facilities to enable them to accommodate these patients. However, further policy interventions, such as updated reimbursement policies, are warranted.

Community-Based HIV Clinical Trials: An Integrated Approach in Underserved, Rural, Minority Communities

Community-Based HIV Clinical Trials:An Integrated Approach in Underserved, Rural, Minority Communities Giselle Corbie-Smith, MD, MSc, Malika Roman Isler, PhD, MPH, Margaret Shandor Miles, PhD, FAAN, RN, and Bahby Banks, MPH What is the Purpose of this study/review? • To explore the perspectives of rural community leaders, service providers, and people living with HIV/AIDS about bringing HIV-related research, including clinical trials, into rural communities. What is the Problem? • Although racial and ethnic minorities have disproportionately high rates of HIV infection, these groups are underrepresented in HIV-related clinical trials. • Participants in HIV/AIDS trials still tend to be overwhelmingly White, of higher socioeconomic status, and from larger urban centers. • The literature to guide engaging rural populations in HIV/AIDS clinical trials is sparse, especially studies involving minority populations. What are the Findings? • All respondents described the need for HIV research and clinical trials to be thought of as one point on a continuum of HIV care and services. • In our analysis, effectively engaging rural minority communities in HIV clinical trials went beyond the logistics of recruitment; research teams were expected to use a comprehensive approach that addresses, in some way, all points along the continuum of HIV care. An integrated approach to research would result in building trust, sharing power, and more effectively addressing the needs and values of the community. Who Should Care Most? • People living with HIV/AIDS • Service providers • Community leaders • Rural minorities • Health organizations and agencies • HIV researchers [End Page 111] • HIV researchers should partner with other local organizations and agencies to offer comprehensive health-related services, including HIV clinical trials, as a way to conduct both HIV and non-HIV research and health outreach. • HIV researchers need to partner with existing services, organizations, and structures in the community to build trust and more effectively address the needs of a given community. • Comprehensive and deliberate attention to integrating HIV clinical trials with other HIV and non-HIV-related health efforts is thought to be important to leverage financial and nonfinancial research resources for supporting the HIV care and services continuum. • Integrating HIV clinical trials with existing services is a way to gain a more comprehensive understanding of the structure and values of a community. • Community members should be considered partners in research to engage the community in the importance and need for research. [End Page 112] Giselle Corbie-Smith Departments of Social Medicine, Medicine, and Epidemiology, The University of North Carolina at Chapel Hill Program on Health Disparities, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill North Carolina TraCS Institute - Community Engagement Core, The University of North Carolina at Chapel Hill Malika Roman Isler North Carolina TraCS Institute - Community Engagement Core, The University of North Carolina at Chapel Hill Margaret Shandor Miles School of Nursing, The University of North Carolina at Chapel Hill Bahby Banks Program on Health Disparities, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill Department of Health Behavior and Health Education, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill Copyright © 2012 The Johns Hopkins University Press

Global Mental Health: From Science to Action

This article charts the historical development of the discipline of global mental health, whose goal is to improve access to mental health care and reduce inequalities in mental health outcomes between and within nations. The article begins with an overview of the contribution of four scientific foundations toward the discipline's core agenda: to scale up services for people with mental disorders and to promote their human rights. Next, the article highlights four recent, key events that are indicative of the actions shaping the discipline: the Mental Health Gap Action Programme to synthesize evidence on what treatments are effective for a range of mental disorders; the evidence on task shifting to nonspecialist health workers to deliver these treatments; the Movement for Global Mental Health's efforts to build a common platform for professionals and civil society to advocate for their shared goal; and the Grand Challenges in Global Mental Health, which has identified the research priorities that, within the next decade, can lead to substantial improvements in the lives of people living with mental disorders. The article ends by examining the major challenges for the field, and the opportunities for addressing them in the future. (harv rev psychiatry 2012;20:6–12.)

Health-information seeking on the Internet and current smoking status: Evidence from the national health interview survey

Two research questions were addressed. First, what are the differences between internet searchers and non-searchers for health-related information among current and former smokers? Second, does searching the internet for health-related information predict current smoking status in a multivariate model that controls for variations in sociodemographic and family characteristics? Data collected from 10,929 current and former smokers who participated in the 2009 National Health Interview Survey showed significant differences in sociodemographic and family characteristics between searchers and non-searchers. Importantly, searching the internet for health-related information made an independent contribution to the prediction of current smoking status in a multinomial logistic regression model. This study is significant in that it utilized a nationally representative sample to examine the correlation between internet use and smoking behavior and supports ongoing efforts of public health advocates to continue their efforts in developing and delivering online smoking cessation programs.

Prevalence of Anemia and Risk of Adverse Bleeding Effect of Drugs: Implication for Therapy

This study aimed to evaluate the progress in reduction of prevalence of anemia in rural Australia. It also investigates the prevalence of hypoviscosity in anaemia with a view to determine the fraction of anaemic patients at risk of drug-inducible exacerbation of anemia. Archived clinical pathology data (N = 130, 354) for the period of 1999 to 2008 were utilized. The prevalence of anemia and hypoviscosity was evaluated by working out (i) the number that fell within anemia definition as a percentage of the population and (ii) the number that fell within hypoviscosity definition as a percentage of anemic patients. The prevalence in anemic diabetes and dyslipidaemia was further determined. There was progressive reduction in anemia from 6.1% to 3.2% over the ten years period. Prevalence of anemia is statistically significantly higher in males than in females (P < 0.0001), but protein level is lower in anemic females than in anemic males (P < 0.01). The results further show that up to 75% of anemic patients may benefit from NSAID or salicylates. This paper highlights differences between genders. It suggests more concerted effort in men's health and speculates a new factor to investigate in women's health.

The NHS, the private sector and the future

The times are troubling for the future of the National Health Service (NHS), in the sense of a reasonably comprehensive, effective, equitable and integrated service, free at the point of use, which coordinates the efforts of public health, primary care and hospital-based services for the good of the

Research agenda for black prostate health: issues, challenges and future directions

Background A disproportionate burden of prostate cancer among Black men continues to be observed worldwide. Between 1975 and 2007 the age adjusted incidence of prostate cancer in African-American men was 235 per 100,000 compared to White men (149 per 100,000). Similarly a racial disparity in mortality rates is observed in the United States (White men: 29.97 per 100,000 vs. Black men: 66.49 per 100,000). Globally, prostate cancer incidence and mortality rates also vary geographically. According to the World Health Organization, higher incidence and mortality rates are observed in more developed regions compared to less developed regions of the world. Prostate cancer continues to be a major public health issue and efforts to address the global prostate cancer disparities in Black males are met with many challenges, specifically in developing nations. Methods During a Lunch “N” Dialogue at the Global Prostate Cancer conference held in August 27-29, 2010, challenges and future directions for the Research Agenda for Black Prostate Health were addressed. Results Some of the challenges identified were competitive funding opportunities, limited funding available to nonprofit community-based organizations, limited resources for research and limited career development and mentorship opportunities. In developing regions, such as Africa and the Caribbean, low screening rates prohibit the estimation of baseline levels of prostate cancer incidence. Furthermore, there is little known about the level of knowledge and attitudes among practitioners with regard to prostate cancer screening. An engaging discussion yielded suggestions of the future directions that might help to address some of these challenges. There was a clear expression of a need for the translation of research to the community by increasing the educational messages to the community and increasing educational interventions at the community level through the utilization of culturally-specific research methodologies for the Black population. Conclusion

A new narrative of young people's health and well-being

Young people's health is continuing to improve in line with historic trends. Death rates are low and falling, and most young people say they are healthy, happy and enjoying life. For most, social conditions and opportunities have got better. Health efforts need to focus on the minorities whose well-being is lagging behind, especially the disadvantaged and marginalised. This is the widely accepted story of young people's health. There is another very different story. It suggests young people's health may be declining – in contrast to historic trends. Mortality rates understate the importance of non-fatal, chronic ill-health, and self-reported health and happiness do not give an accurate picture of well-being. Mental illness and obesity-related health problems and risks have increased. The trends are not confined to the disadvantaged. The causes stem from fundamental social and cultural changes of the past several decades. Which story is the more accurate matters. Stories inform and define how governments and society as a whole address youth health issues. The usual narrative says interventions should target the minorities at risk. The new narrative argues that broader efforts to improve social conditions are also needed.

Perry et al. Respond

We agree with Faulx et al. that the recognition and prevention of adverse childhood experiences (ACEs) should be part of public health efforts to prevent mental illness and chronic disease. The Centers for Disease Control and Prevention (CDC), in collaboration with Kaiser Permanente, has been studying the relationship between ACEs and adverse health outcomes in adulthood for more than a decade. These findings helped establish a strong evidence base supporting the association between ACEs and many chronic diseases and risk behaviors.1,2 The CDC's work on exploring the health impacts of ACEs incorporates both clinical and population-based assessments through surveillance in selected states.3 Addressing ACEs in the public health sector was beyond the scope of our editorial,4 the purpose of which was to encourage incorporation of mental illness prevention and mental health promotion into overall health promotion efforts. Evidence-based programs, such as the Nurse Family Partnership, the Early Start5 program, and the Triple P−Positive Parenting Program system,6 can be effective in preventing child abuse. Further trauma-focused cognitive behavioral therapy has also proven to be an effective clinical treatment to alleviate distress associated with ACEs.7 These approaches could potentially serve as models for public health interventions to prevent ACEs and thereby help prevent later adverse health outcomes, including mental illness. Although the CDC and Kaiser Permanente findings provided strong evidence of the negative effects of ACEs on adult health,1,2 population-wide data supporting this association are lacking. To identify the burden of ACEs in the general population, 12 states administered the ACE optional module on the Behavioral Risk Factor Surveillance System between 2008 and 2010. Initial results from the five states reporting data in 2009 confirm that ACEs are common and interrelated across all demographic groups, with 59% of respondents reporting at least one ACE and 8.7% reporting five or more.3 Such information can help states develop public health interventions to prevent and help reduce ACEs and their adverse health effects. Moving public health efforts in mental health and mental illness forward will require strategies that integrate both mental health promotion and mental illness prevention with broader chronic disease prevention efforts; these strategies include but are not limited to ACEs. This integrated approach will help to elucidate and address ACEs, mental health, and chronic diseases in the general population. Because it is estimated that by 2020 mental illness will be the second-leading contributor to the global disease burden, behind cardiovascular disease,8 public health entities must address mental health promotion and mental illness prevention. Therefore, we join the call for action to protect and promote the nation's mental health.

Ethical Standards for Transnational Mental Health and Psychosocial Support (MHPSS): Do No Harm, Preventing Cross-Cultural Errors and Inviting Pushback

Important components of bioethics are routinely underappreciated in cross-cultural and transnational mental health and psychosocial support (MHPSS) efforts. This article provides case examples of cultural errors and/or harm by outsiders delivering MHPSS on different continents. The errors illustrate violations of informed consent (principle of autonomy) and avoiding harm (nonmaleficence). Ethical cultural adaptation standards are presented in order to avert such errors. Given the real risk of outsiders applying culturally erroneous and/or harmful practices in the process of delivering aid, the ability to discern pushback (resistance and redirection by intended beneficiaries) can yield ethically significant data. Actively inviting pushback is proposed as an additional methodology for ethical cultural adaptation with the purpose of at least gaining informed consent and, at best, shaping the most beneficent MHPSS.

Recent epidemiologic trends in the incidence of myocardial infarction: what have we learned?

Substantial improvements in the primary and secondary prevention of myocardial infarction (MI) have occurred over the previous 20 years, based on results from a number of landmark clinical trials [1–9]. However, over the same period the US population has become less physically active, more obese, more often diabetic and older [10–12]. Understanding the net effect of these disparate trends on the incidence of MI is of critical importance. At the most f undamental level, whether MIs are increasing or decreasing in incidence is the ultimate m easure of the s uccess or failure of the efforts of the public health, primary care and cardiology c ommunities to prevent heart disease.

Abstract B2: Educational intervention to reduce breast cancer disparities: The Dallas Cancer Disparities Community Research Coalition

Abstract Purpose: South Dallas experiences significant disparities in breast cancer mortality, with a high proportion of stage III and IV diagnoses. In an effort to address these rates, the Dallas Cancer Disparities Community Research Coalition created an educational intervention in 2009 to promote breast health and early detection efforts. The goals of the intervention were to increase: (1) knowledge regarding the chief contributing factors for breast cancer and steps to reduce breast cancer risk; (2) awareness of the importance of screening for early detection; and (3) the proportion of women who have engaged in appropriate breast cancer screening practices. The innovation of the project lies in the community-based participatory research (CBPR) approach, which brings together scientists and community representatives. Methods: This study was approved by the UNT Health Science Center IRB. Women residing in South Dallas were recruited for the intervention, and West Dallas was chosen as the control group. In addition to residence in one of these two communities, eligibility criteria included age 40 and older, English-speaking, and no personal history of cancer. Participants were recruited through community partnerships, posting flyers throughout the community in high-traffic areas, and door-to-door visits in the targeted areas. Participants in the control group received only written breast health educational materials. Intervention participants attended 8 weekly sessions that included written educational materials, cooking demonstrations and discussions with clinicians from the Dallas/Fort Worth area. All study participants completed a one-hour survey at baseline and 4 months later to assess the outcome variables as well as a variety of possible intervening variables. Results: A total of 59 women were enrolled in the intervention and 60 in the control group. Retention for the 8-week intervention was 71 %. After controlling for baseline mammography status, women in the intervention group were 10.4 times more likely (95% CI: 2.9-36.4) to report having had a screening mammogram in the last year compared to the control group. Intervention participants demonstrated statistically significantly higher rates of breast self examination (OR: 3.0,95% CI: 1.0-8.6) and breast cancer knowledge (p=.003). Conclusion: Lessons learned from this study can be used to create sustainable cancer disparity reduction models that can be replicated in similar communities across the United States. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B2.

Prevalence and risk factors of low birth weight in Jos

This study examines the Prevalence and factors associated with low birthweight (LBW) in Jos.208 babies delivered by 208 women in Jos University Teaching Hospital, (JUTH) were studied over an eight week ( 12th February to 11th April 2003. A cross-sectional study was done and the sample gotten by systematic sampling of all the babies delivered. Mean birth weight of the infants was 3.08±1.319 (range 0.904 to 4.005) kg. The prevalence of LBW was found to be 12.7 %. LBW has bivariate associations with mother's educational status, height, and health problems during pregnancy, use of antenatal care facilities, and gestational age. No association was found between LBW and mother's occupation. Although antenatal care provision is absolutely necessary, intervention approaches that go beyond clinical or primary care settings are also warranted for better nutrition of women. Concerted efforts in health and non-health sectors are necessary for improvement in health and social status of women in order to reduce low birthweight.

Punishing Pregnant Drug-Using Women: Defying Law, Medicine, and Common Sense

ABSTRACT The arrests, detentions, prosecutions, and other legal actions taken against drug-dependent pregnant women distract attention from significant social problems, such as our lack of universal health care, the dearth of policies to support pregnant and parenting women, the absence of social supports for children, and the overall failure of the drug war. The attempts to “protect the fetus” undertaken through the criminal justice system (as well as in family and drug courts) actually undermine maternal and fetal health and discourage efforts to identify and implement effective strategies for addressing the needs of pregnant drug users and their families. In this article, the authors seek to expose some of the flawed premises on which the arrests, detentions, and prosecutions are based. The authors highlight the inherent unfairness of a system that expects low-income and drug-dependent pregnant women to provide their fetuses with the health care and safety that these women themselves are not provided and have not been guaranteed.

Género y niveles de adherencia al tratamiento antihipertensivo en el personal de la Universidad Estatal a Distancia de Costa Rica

La hipertensión arterial es una de las enfermedades crónicas que ocupa los primeros lugares de mortalidad a nivel mundial. Hasta ahora, las acciones de salud se han enfocado en la disminución de esta patología; sin embargo los tratamientos han sido poco efectivos y los costos elevados, y la hipertensión continua siendo una de las enfermedades con menos control. Diversos estudios han determinado que la adherencia al tratamiento en enfermedades crónicas define el éxito terapéutico. La adherencia a su vez, depende de varios factores tanto del paciente como de su entorno, siendo clave la relación con el médico. En este contexto, el género (femenino o masculino) es un factor importante. Para este estudio se entrevistaron 39 mujeres y 41 hombres hipertensos que visitaron el consultorio médico de la Universidad Estatal a Distancia entre el 14 de enero de 2002 y el 15 de diciembre de 2008, para buscar diferencias por género en los pacientes, su relación con el personal médico y su adherencia al tratamiento. El análisis estadístico indicó que no hay diferencias de importancia debidas al género en las características físicas y personales de los pacientes, ni en su ambiente. Las diferencias de género en cuanto a la relación con el médico son mínimas y en general tanto la relación como la adherencia son buenas en toda esta población.

Progress Towards the Millennium Development Goals: A Long Trek for Reproductive Health

With only six years remaining to achieve the Millennium Development Goals in 2015, issues pertaining to universal access to reproductive health deserve more emphasis as part of current efforts in international health. The maternal health goal is the Millennium Development Goal with the most disappointing progress. Whereas much has been achieved globally for the utilization of family planning services, there are some geographical areas and subpopulations where progress is lacking. Health systems should be strengthened whilst addressing disparities. The rights and gender aspects of reproductive health have been fully documented, but equitable access and economic aspects should be considered in policy formulation and program implementation. Advocacy is needed for key players to leverage support, whereas efforts for accelerating progress should be sustainable in the long term.

Racial and ethnic differences in willingness to participate in psychiatric genetic research

The National Institute of Mental Health's effort to rectify the underrepresentation of American Blacks in the genetic studies of psychiatric disorders has met with mixed success. This study was designed to understand some of the barriers to recruitment. Men and women, who were of Black, White or Hispanic race/ethnicity, aged 18-79 years (N= 353), were recruited from clinical and community settings in New York City. Participants responded to a survey that was designed to measure willingness to participate and attitudes toward genetic research. Principal components analyses generated eight factors including perceived benefits, concerns about, and drawbacks of genetic research, and beliefs about genetic or environmental contributions to psychopathology. Analysis of variance assessed within-ethnic group differences on factor scores, as they related to willingness to participate in genetic research. Ethnic groups did not differ significantly in stated willingness to participate in genetic research; more than 70% in each group were willing to participate. Among Blacks and Hispanics, mistrust and wariness, and stigma were significantly increased in those unwilling to participate; for Whites, perceived benefit to society and perceived importance for knowledge/education were associated with willingness to participate. For Blacks and Hispanics, youth (aged 18-29 years) and college education reduced, but did not eliminate the association between wariness and mistrust and willingness to participate. Findings suggest that recruitment efforts aimed at increasing the representation of Blacks should be aware of the barriers among those who are less educated, and involve interactive community collaborations, to fully address the mistrust in this population.