Home Community Research Articles

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study.

Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). Planned community birth (homes and birth centers), United States. Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

Testing contingency theory to drive organizational change in community care: A case study in the Emilia Romagna Region.

The objective is to test contingency theory among "community homes" in a region in Northern Italy. Community homes constitute an emerging key setting in the Italian primary healthcare system and are emblematic of the most recent organizational solutions in primary care across countries. A case study was carried out through semi-structured interviews administered in community homes to key professionals. Results were validated in two communities of practices. Several elements of organizational and managerial variability were detected across the sample of community homes involved in the study, although they were all responding to the same regulations and normative pressures. The study provides preliminary evidence on the role of contingency theory in the primary healthcare sector, shedding light on its characteristics and providing food for thought on the extent to which organizational variability should be supported, rather than hindered.

Bionomic characterization of Anopheles mosquitoes in the Ethiopian highlands and lowlands

BackgroundThe protective effectiveness of vector control in malaria relies on how the implemented tools overlap with mosquito species-specific compositions and bionomic traits. In Ethiopia, targeted entomological data enabling strategic decision-making are lacking around high-risk migrant worker camps in the lowlands and resident communities in the highlands—resulting in suboptimal malaria control strategies for both populations. This study investigates spatial and temporal mosquito behavior, generating baseline evidence that will improve malaria control for both migrant workers in the lowlands and their home communities in the highlands.MethodsHourly Centers for Disease Control and Prevention (CDC) light trap collections were performed indoors and outdoors during the peak (October to December 2022) and minor (March to May 2023) malaria transmission seasons. These seasons coincide with the post-long rain and post-short rain seasons, respectively. Eight resident households were sampled from each of four villages in the highlands and eight households/farm structures on and near farms in four villages in the lowlands. The sampling occurred between 18:00 and 06:00. Spatiotemporal vector behaviors and hourly indoor and outdoor mosquito capture rates, used as a proxy for human biting rates, were calculated for overall catches and for individual species. Adult mosquitoes were identified using morphological keys, and a subset of samples were confirmed to species by sequencing ribosomal DNA internal transcribed spacer region 2 (ITS2) and/or mitochondrial DNA cytochrome c oxidase subunit 1 (Cox1).ResultsIn the highlands, 4697 Anopheles mosquitoes belonging to 13 morphologically identified species were collected. The predominant species of Anopheles identified in the highlands was An. gambiae sensu lato (s.l.) (n = 1970, 41.9%), followed by An. demeilloni (n = 1133, 24.1%) and An. cinereus (n = 520, 11.0%). In the lowland villages, 3220 mosquitoes belonging to 18 morphological species were collected. Anopheles gambiae s.l. (n = 1190, 36.9%), An. pretoriensis (n = 899, 27.9%), and An. demeilloni (n = 564, 17.5%) were the predominant species. A total of 20 species were identified molecularly, of which three could not be identified to species through comparison with published sequences. In highland villages, the indoor Anopheles mosquito capture rate was much greater than the outdoor rate. This trend reversed in the lowlands, where the rate of outdoor captures was greater than the indoor rate. In both highlands and lowlands, Anopheles mosquitoes showed early biting activities in the evening, which peaked between 18:00 and 21:00, for both indoor and outdoor locations.ConclusionsThe high diversity of Anopheles vectors and their variable behaviors result in a dynamic and resilient transmission system impacting both exposure to infectious bites and intervention effectiveness. This creates gaps in protection allowing malaria transmission to persist. To achieve optimal control, one-size-fits-all strategies must be abandoned, and interventions should be tailored to the diverse spatiotemporal behaviors of different mosquito populations.Graphical

The untold stories of resilience, reworking and resistance of ageing non-European migrant women

ABSTRACT Ageing non-European migrant women often do not have a space to share their stories in a manner that adds meaning to their lives. They are viewed as a group that embodies deficits. This article centres them and their stories to understand how resilience, reworking and resistance practices are embedded in their everyday lives by utilising Katz’s framework of disaggregated agency. The data consist of semi-structured interviews with 20 ageing women from non-European migrant backgrounds in Finland. The findings suggest the need to re-imagine ways of narrating the multifaceted stories of women in the margins and illuminate new pathways for social work by untangling questions on power and who gets to participate as knowers. Shedding light on their untold stories challenges the hegemonic framing of social realities, destabilising the normative understandings of social work, and unravelling the nuanced unconventional strategies of survival and well-being utilised by them in the form of cultivating home place, sisterhood, community, decolonial healing, various strengths, reworking and everyday acts of resistance against oppressive structures. The findings contest the negative perceptions in dominant narratives, which produce problematic construction of migrant women based on their vulnerability.

Transmigrant identities and attitudes: the case of a Pangasinan-American family

Abstract Identity plays a crucial role in determining whether diasporic minority communities either integrate into the host country or resist acculturation and assimilation. Since identity is performed and negotiated through discourse, the study of connections between identity and language practices of migrant groups is crucial in understanding how language is used to express their multilayered identities. Using sociolinguistic interviews as the primary data source, this research analyzes how three generations of a Pangasinan-American family negotiate their complex identities and express their attitudes towards English, Filipino, and Pangasinan. Findings show that their Pangasinan-American identity is performed through translingual practices, which enable the portrayal of their membership to their home community and their integration into the host society. Each participant situates their Pangasinan identity in relation to their other identities – Filipino and American – which emerge in the diasporic context. This study contributes to the research on the role of language in the development of community membership and allegiances of bi-/multilingual transmigrants.

Gender and Environmental Management: Exploring Spousal Roles Decision-Making Patterns in Owner-Occupied Homes in Mahuta and Mando Communities, Kaduna State, Nigeria

Gender and Environmental Management: Exploring Spousal Roles Decision-Making Patterns in Owner-Occupied Homes in Mahuta and Mando Communities, Kaduna State, Nigeria

Remembering Girmitiyas: tracing the past of indentured migrants in their homeland

ABSTRACT This paper looks at the reminiscence of the family members of girmitiyas from north Indian villages who, in post-slavery circumstances, were transported under an indenture contract to overseas plantation colonies during the late nineteenth and early twentieth centuries. While the memories and experiences of the departed migrants are extensively chronicled in history writing, historians have rarely looked into the memories of the family members who were left behind. This essay tries to address this gap in historical literature, by examining the memories documented in the colonial reports, as well as songs and narratives of the families of indentured Indians in their home communities. The paper makes the argument that the acute sense of loss and pain of family members recorded during the nineteenth century, no longer persists in the form of ‘communicative’ memory, but has instead become ‘cultural’ memory as time passed, and that the descendants now view this past differently.

Mapswipe for SDGs 3 & 13: take urgent cartographic action to combat heat vulnerability of manufactured and mobile home communities

ABSTRACT Our research has established the extent to which extreme heat disproportionately impacts manufactured and mobile home communities (MMHC), posing challenges in achieving both targets of Sustainable Development Goal (SDG) 3 of ‘good health and wellbeing’ and SDG 13 of ‘urgent action to combat climate change impacts’. In Maricopa County, Arizona, USA, an alarming statistic of annually 30–40% indoor heat-related mortality occurs within a mere 5% of local housing stock dedicated to MMHC. Effectively addressing the multifaceted nexus of heat vulnerability and housing precarity necessitates the availability of geospatial microdata. Yet, given the idiosyncratic nature of ownership tenure within MMHC communities, sufficient microdata at the household unit level remain notably elusive through conventional tax records or other publicly available sources. In this paper, we assess how employing MapSwipe, a crowdsourcing application affiliated with the Missing Maps initiative, improves the completeness and precision of existing MMHC cartographic data inventory. Our approach harnesses MapSwipe’s micro-tasking methodology to identify absent MMHC locations within the state of Arizona. The contribution of this research is to present a viable methodology that organizes geospatial microdata around SDG initiatives and web-based volunteer mapping to effectively target the resources required to address the heat vulnerability of MMHC.

Social Experiences, Social Support and Residence as Determinants of Sedentary Behaviour Among Indigenous Adults in Saskatchewan

Centuries of ongoing colonization, assimilation and historic trauma have changed social structures, roles and responsibilities among Indigenous Peoples: First Nations, Métis and Inuit. Social factors and experiences can influence sedentary behaviour; however, relationships between social determinants and sedentary behaviour among Indigenous Peoples in Saskatchewan are unclear. Objective: The purpose of this study is to examine historic trauma, social support and residence as determinants of sedentary behaviour for Indigenous Peoples in Saskatchewan. Design: Historic trauma, social support, discriminatory experiences, residence type and sedentary behaviour were evaluated through questionnaires by 111 Indigenous adults from the University of Saskatchewan in 2018-2019. Results: Regression associated community, family and positive perceptions of social support, as well as rural/urban home communities, northern/southern home communities and age with continuous sitting among Métis (N=38, R=0.88, p<0.001). Among First Nations (N=69), regression associated age and friend support (R=0.40, p=0.01) with screen time, and community support (R=0.27, p=0.04) with continuous sitting. Regression among Indigenous participants (N=111) associated discrimination, on- and off-reserve home communities, and age (R=0.40, p=0.001) with sedentary behaviour, and discrimination and positive perceptions of support (R=0.33, p=0.01) with continuous sitting. Conclusion: Social supports, home communities and discrimination experiences are important determinants of sedentary behaviour, screen time and continuous sitting for First Nations and Métis, with experiences specific to each identity.

Research on the Evaluation System of Community Daycare Center Planning and Implementation from the Perspective of Subject-Object Relationships

Through literature review, we found that evaluations of urban planning implementation often focus narrowly on either the subject (stakeholders) or the object (projects), while micro-level aspects such as site selection and construction are primarily considered within the context of planning implementation. There is insufficient research on the evaluation of implementation. Community daycare centers play a crucial role in the community home care model, yet there is relatively little research on their usage efficiency, satisfaction levels, and spatial evaluation of planning implementation. Based on the theoretical understanding of the human environment, including the subject, object, and their interactions, an evaluation system for the planning and implementation of community day care centers was constructed, incorporating subjective evaluation, objective evaluation, and comparative analysis.

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives.

To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs). Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires. A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist. Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach. The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life. Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person. The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care. Registered nurses working in community home care participated in data collection.

The growth and development of a novel distance accelerated bachelor of science in nursing program

Severe nursing shortages threaten the sustainability of US health systems. Rural and underserved communities are disproportionately affected by staffing crises and associated facility closures, as well as health disparities. A major factor contributing to geographic gaps in care is the absence of nursing schools, nursing faculty, and locations for clinical rotations in many rural and underserved areas. Emory School of Nursing is helping to solve for these issues through the Distance Accelerated Bachelor of Science in Nursing (DABSN) program. The DABSN is establishing accelerated pipelines of nursing students into practice in locations where nursing education has historically been difficult or impossible to access. This innovative nursing education model allows students to enroll in a top-ranked nursing school while remaining in their home communities. Students complete synchronous didactic coursework with peers in every US time zone while performing clinical rotations in local healthcare facilities. This paper details the growth and development of the DABSN. It describes the challenges and opportunities we have navigated in implementing the program, along with information about its pedagogy, clinical placement practices, and student/faculty characteristics. We share program outcomes and conclude with recommendations for the future.

'No health without mental health': where are we now?

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.

:South Central Dreams: Finding Home and Building Community in South L.A.

:<i>South Central Dreams: Finding Home and Building Community in South L.A.</i>

Plant diversity and its use in Javanese urban home garden: An ethnobotanical study in Central Java, Indonesia

Abstract. Darmastuti SA, Nazar IA, Setyawan AD. 2024. Plant diversity and its use in Javanese urban home garden: An ethnobotanical study in Central Java, Indonesia. Asian J Ethnobiol 7: 32-42. Urbanization makes the spread of botanical knowledge increasingly widespread. Ethnobotanical knowledge brought by village communities can be applied in urban areas. The implementation of Proklim (Climate Village Program) by the Indonesian Government strengthens the development of environmentally friendly cities that are able to adapt and overcome climate change and are sustainable by paying attention to the balance of social, economic, and environmental aspects. Currently, communities and home gardens have responded to various driving factors, such as the environmental movement and urban sustainability, and are more focused on providing healthy local food and community development. The objectives of this study were to find out the medicinal and food plants found in the home gardens and community gardens of ProKlim RW 16 Banjarsari Village, Banjarsari Sub-district, Surakarta City, Central Java, Indonesia and the influence felt by the community and knowing the existence of ProKlim RW 16 to support the 13th Sustainable Development Goals (SDGs), climate action. The method used is descriptive quantitative, which is conducted through observation, interviews, and questionnaires. Data from observations and interviews were calculated using the formula of Use Value, Relative Frequency of Citation, Informant Consensus Factor, and Fidelity Level. Meanwhile, questionnaire data is calculated using the Likert Scale calculations. The research results show 56 species that residents often use for medicinal and food plants. The most widely used medicinal plant is lemongrass (Cymbopogon citratus (DC.) Stapf), and the most widely used food plant is chili (Capsicum frutescens L.). Based on Likert Scale calculations, the adaptation indicator states that 90.25% of respondents agree that food plants grown by themselves are fresher and healthier. Meanwhile, on the mitigation indicator, 93.39% of respondents agreed that the more plants planted could reduce air pollution and lower the earth's temperature.

Quality in care homes: How wearable devices and social network analysis might help.

Social network analysis can support quality improvement in care homes but traditional approaches to social network analysis are not always feasible in care homes. Recalling contacts and movements in a home is difficult for residents and staff and documentary and other sources of individual contacts can be unreliable. Bluetooth enabled wearable devices are a potential means of generating reliable, trustworthy, social network data in care home communities. In this paper, we explore the empirical, theoretical and real-world potential and difficulties in using Bluetooth enabled wearables with residents and staff in care homes for quality improvement. We demonstrate, for the first time, that a relatively simple system built around the Internet of Things, Bluetooth enabled wearables for residents and staff and passive location devices (the CONTACT intervention) can capture social networks and data in homes, enabling social network analysis, measures, statistics and visualisations. Unexpected variations in social network measures and patterns are surfaced, alongside "uncomfortable" information concerning staff time spent with residents. We show how technology might also help identify those most in need of social contact in a home. The possibilities of technology-enabled social network analysis must be balanced against the implementation-related challenges associated with introducing innovations in complex social systems such as care homes. Behavioural challenges notwithstanding, we argue that armed with social network information, care home staff could better tailor, plan and evaluate the effects of quality improvement with the sub-communities that make up a care home community.

Implementation of a clinical breast exam and referral program in a rural district of Pakistan

BackgroundThe role of clinical breast examination (CBE) for early detection of breast cancer is extremely important in lower-middle-income countries (LMICs) where access to breast imaging is limited. Our study aimed to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan.MethodsEight health care workers (HCW) and a gynecologist were educated on basic breast cancer knowledge and trained to create breast cancer awareness and conduct CBE in the community. They were then deployed in the Dadu district of Pakistan where they carried out home visits to perform CBE in the community. Breast cancer awareness was assessed in the community using a standardized questionnaire and standard educational intervention was performed. Clinically detectable breast lesions were identified during home CBE and women were referred to the study gynecologist to confirm the presence of clinical abnormalities. Those confirmed to have clinical abnormalities were referred for imaging. Follow-up home visits were carried out to assess reasons for non-compliance in patients who did not follow-through with the gynecologist appointment or prescribed imaging and re-enforce the need for follow-up.ResultsBasic breast cancer knowledge of HCWs and study gynecologist improved post-intervention. HCWs conducted home CBE in 8757 women. Of these, 149 were warranted a CBE by a physician (to avoid missing an abnormality), while 20 were found to have a definitive lump by HCWs, all were referred to the study gynecologist (CBE checkpoint). Only 50% (10/20) of those with a suspected lump complied with the referral to the gynecologist, where 90% concordance was found between their CBEs. Follow-up home visits were conducted in 119/169 non-compliant patients. Major reasons for non-compliance were a lack of understanding of the risks and financial constraints. A significant improvement was observed in the community’s breast cancer knowledge at the follow-up visits using the standardized post-test.ConclusionsBasic and focused education of HCWs can increase their knowledge and dispel myths. Hand-on structured training can enable HCWs to perform CBE. Community awareness is essential for patient compliance and for early-detection, diagnosis, and treatment.

Mothers in stress: Hair cortisol of mothers living in marginalised Roma communities and the role of socioeconomic disadvantage

Roma living in marginalised communities are among the most disadvantaged groups in Slovakia. Socioeconomic disadvantage is associated with higher hair cortisol concentrations (HCC), including in parents. The aim of this study is therefore to assess differences in HCC, reflecting the levels of stress, between mothers living in MRCs and from the majority population, to assess the association of socioeconomic disadvantage with HCC, and whether disadvantage mediates the MRC/majority differences in HCC. Participants were mothers of children aged 15–18 months old living in MRCs (N=61) and from the Slovak majority population (N=90). During preventive paediatric visits, visits at community centres and home visits, hair samples and data by questionnaire were collected. HCC differed significantly between mothers living in MRCs and mothers from the majority population, with the mean HCC value being twice as high in mothers living in MRCs (22.98 (95% confidence interval, CI, 15.70–30.30) vs. 11.76 (8.34–15.20), p<0.05). HCC was significantly associated with education, household equipment and household overcrowding, but not with billing, socioeconomic stress and social support. The difference in HCC between mothers living in MRCs and mothers from the majority population was partially mediated by poor house equipment, such as no access to running water, no flushing toilet or no bathroom (the indirect effect of B=7.63 (95% CI: 2.12–13.92)). Practitioners and policymakers should be aware of high stress levels among mothers living in MRCs and aim at enhancing their living and housing conditions.

The Impact of Tanjung Karang Tourism Village on Local Labor Absorption: A Case Study on Loang Baloq Tourism, Mataram City

This study aims to analyze the impact of the existence of Tanjung Karang tourism village on local employment in Tanjung Karang, Mataram City. The business units in this study are Grocery Micro Small Medium Enterprises, Souvenir Micro Small Medium Enterprises, Fish Culinary Center Micro Small Medium Enterprises, and Homestays. This research uses a qualitative method with a descriptive approach. Data were obtained through observation, interviews, and documentation. Informants were selected using purposive sampling technique. Data analysis used the Miles and Huberman model, namely reducing data, displaying data, and drawing conclusions. The results found that the impact of the existence of the Tanjung Karang tourism village with the Loang Baloq Park tourist attraction on the absorption of local labor in Tanjung Karang is still relatively low. It can be seen from the number of workers who work as owners of Micro, Small and Medium Enterprises that are more often not selling and have not even been seen selling again for a long time, preferring to work elsewhere and there are also some who are unemployed. Homestay owners also experience obstacles such as a lack of interest from tourists to stay overnight due to the unattractive form of community housing and a community culture that is prone to social unrest due to the presence of tourist lodging in community homes. These conditions make employment in Tanjung Karang tourism village relatively low.

Social reproduction, migration and labour control regimes: understanding Filipino crew experiences in the UK fishing fleet

The notion of a labour control regime provides a conceptual framework for understanding the web of actors, institutions and norms that shape disciplinary mechanisms in the labour process. While labour regime approaches have drawn in multiple scales and diverse processes, this paper argues that international migration, and social reproduction in migrant source areas, must also be understood as part of the regime. Focusing on the case of Filipino migrants in the UK fishing industry, we use qualitative interviews conducted in the port of Fraserburgh, Scotland, and a migrant sending community in the province of Cebu, Philippines. We argue that the reproductive processes of workers’ lives in their home communities are an important underpinning of the labour regime they participate in when working on contracts overseas. We identify three sets of reproductive processes in particular: the trajectories of household poverty and debt that propel labour migration; the socialisation and social networks, as well as zones of recuperation, provided by home communities; and, the long-term temporalities of previous investments in fishery migration, as well as future aspirations for financial stability and intergenerational social mobility. While reproductive spaces and processes are not controlling mechanisms in themselves, they do represent an important part of the labour regime and they begin to explain migrant fishers’ forbearance in the face of a disciplinary labour regime.