Local Outreach Research Articles

Proto-professionalism: Opportunities for student learning and service to homeless people

The concepts of professionalism including ethical practice, reflection, self-awareness, respect, teamwork and social responsibility are present in the healthcare curriculum but rarely learned in combination. The concepts can be combined when students receive practical experiences on the challenges of delivering health and social care to populations experiencing poverty and disadvantage. We report on work with homeless people in our local communities designed to align social accountability responsibilities with healthcare curricula through a student volunteering project; initially established in a medical school. Using an ethical approach we developed this learning through a staff-student-community partnership. The outcome was learning consisting of theoretical teaching, practice learning and the potential to volunteer. We report on the development phases over several years (2013-2017). The pedagogical evaluation used a sequential mixed methods approach. One hundred and ninety-five student participants scored pre- and post-questionnaires. Of these 75% completed reflective assignments and many went on to volunteer. Twenty of those who volunteered participated in one-to-one interviews. Scored data were analysed statistically and reflective written materials were analysed using content analysis. The interview data were analysed using thematic analysis. The learning was positively experience and students reported changed attitudes and understandings of homelessness. Practice-placements and volunteering further enhanced these insights and student’s perceptions of readiness for clinical practice. This can be described as proto-professionalism. The student-staff-community partnership offers an ethical platform on which to build sustainable local outreach projects. The students gained a deeper appreciation of social injustice for homeless people.

Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy.

Opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients' incarceration status at the time of BUP initiation. This is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status. Our sample included 76 patients, with 62% of patients incarcerated at BUP initiation (n = 47). Among the entire sample, 90.7% (n = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery (p = 0.02). In our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.

Conservation through Collaboration: Regional Conservation Programs of the North Carolina Zoo

In response to rapid biodiversity losses in recent decades, zoos have become more engaged in conservation issues. Solutions to conservation challenges are complex and require collaborative efforts across organizations. Zoos can be effective partners that can contribute diverse expertise and resources to protect wildlife and their habitats. While zoos often partner with international organizations to facilitate field-based conservation projects on the exotic animals they exhibit, some of the most meaningful conservation and education initiatives are conducted locally in partnership with local organizations. A core part of the mission of the North Carolina Zoo (Asheboro, NC, USA) is the conservation of wildlife and their natural habitats, both regionally and internationally. The goal of this article is to review the North Carolina Zoo’s regional conservation programs and the importance of partnerships with other local organizations in accomplishing shared goals. North Carolina Zoo plays an important role in regional conservation by protecting and managing natural lands, protecting declining amphibians through headstarting and habitat management, rehabilitating native wildlife, and working on local outreach and sustainability projects to reduce impacts on natural resources and inspire others to get involved in conservation. These programs were developed through partnerships with local and state government agencies, academic institutions, non-profit organizations, other zoos and aquariums, schools, libraries, and businesses. These collaborations have been instrumental in developing and implementing successful projects by pooling limited resources and sharing crucial expertise. They demonstrate how zoos are evolving to become leaders and partners in conservation, research, and education to protect local species and natural resources.

Street Psychiatrists Build Trust, Offer Hope to Homeless Patients With SMI

Street Psychiatrists Build Trust, Offer Hope to Homeless Patients With SMI

Evaluating Veterans Response Teams and Police Interventions on Veterans' Health Care Utilization.

This study examined the effects of veteran-specific cooperative police interventions, including a Veterans Response Team (VRT) and broad collaboration between local police departments and a Veterans Affairs (VA) medical center police department (local-VA police [LVP]), on veterans' health care utilization. Data were analyzed on 241 veterans (51 received VRT and 190 received LVP intervention) in Wilmington, Delaware. Nearly all veterans in the sample were enrolled in VA health care at the time of police intervention. Veterans who received VRT or LVP interventions showed similar increases in use of outpatient and inpatient mental health and substance abuse treatment services, rehabilitation services, ancillary care services, homeless programs, and emergency department/urgent care services after 6 months. These findings suggest the importance of relationship building among local police departments, VA Police, and Veterans Justice Outreach to create pathways to care to ensure that veterans are connected to needed VA health care services.

Residential Aged Care Facilities During the COVID-19 Pandemic: A Staff Survey on Impact and Resources

The current study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on staff in residential aged care facilities (RACFs). A hardcopy, voluntary, anonymous survey was circulated to local RACFs (June-July 2020), exploring challenges, staffing effects, mood within RACFs, and staff perceptions of supports. Overall, 105 staff members responded, which were mainly nursing personnel (67.6%) and owners/managers (10.5%). Seventy percent believed they were equipped to handle patients with COVID-19. One quarter reported personal protective equipment shortages. Respondents reported pressures to accept patients with COVID-19 from hospitals and/or keep residents in the RACF. One third reported staff "calling in sick" related to COVID-19/quarantine. Common compensatory strategies included increasing part-time workers' hours. Reported mood was largely positive. Most (86.4%) respondents felt supported by general practitioner and local geriatric outreach services. Opportunities to best support RACF staff require further research and dialogue. [Journal of Gerontological Nursing, 49(3), 13-17.].

Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers

BackgroundBlack individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders.MethodsFocus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations.ResultsA core theme was identified from participants’ narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities.ConclusionsKey stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.

Leipcigas un Lībencellas misijas: Hildegardes Procelas un Lilijas Otīlijas Grīviņas kalpošana

Until the 19th century, women were not considered suitable for mission work. However, when Leipzig mission started its work in India, it came to the realization that to reach Indian women with the Gospel, women missionaries were needed. Soon, other German mission societies that sent missionaries to China, Indonesia and Africa also came to the same conclusion, opening the doors for ministry for the first women from Vidzeme (Livland). Baltic-German Hildegard Prozell, from Jaunmārupe, was sent in 1896 through Leipzig to India and Lilija Otilija Grīviņa, (in German Grihwin, Griwing, Griewing) from Riga, were sent in 1913 through Liebenzell to China. Each of these societies had different theological understandings about mission. Leipzig was based on the traditional Lutheran understanding of ministry and tried to create a universal Lutheran church worldwide, including in the mission fields. Liebenzell was the German branch of China Inland Mission, which was considered a “faith” mission that was more open to co-working with others. This impacted the way the mission societies selected their candidates, prepared them (a few months for Leipzig, 3–4 years for Liebenzell with male and female candidates training together), and sent them on the missions (solid salary for Prozell, not so with Grīviņa). Both missionaries had to learn the local languages and pass language exams. They both served as teachers, did evangelism with local women, and had to be administrators and local health care specialists. Prozell was the first to establish women’s work in Mayavaram, while Grīviņa was the first to take Chinese women to a local evangelism outreach (together with other teaching staff of the Hunan Bible Institute). Prozell, being a Baltic-German, received extensive support from her home church. Since her ministry took place before World War I, there are plenty of publications about her ministry in both Latvian and German newspapers in Riga. Grīviņa came from a humble background, going with almost no support, and as her ministry in China happened during WWI, there were almost no publications about her work. Both women have been equally forgotten in Latvian church history and deserve to be remembered.

ICOPA 2022: living with parasites, collaborating globally, and breaking a glass ceiling

ICOPA 2022: living with parasites, collaborating globally, and breaking a glass ceiling

Advancing Health Equity in Health Care Coverage: A Public-Private Partnership to Engage Underserved Communities in Medicaid Expansion.

Expanding Medicaid coverage has been demonstrated to reduce health inequities by allowing people with low income to access health care at little or no cost. However, reaching eligible populations to get them enrolled can be difficult. Two private health foundations, one national and one local, worked with a late-adopting Medicaid expansion state to help accelerate enrollment through support of a broad communications campaign coupled with targeted local outreach and enrollment assistance provided by community-based organizations and data analyses to assess program impact and inform evidence-based state policy and program changes. This article presents results from a qualitative evaluation of this funding partnership and describes the culturally nuanced strategies employed by community-based grantees to raise awareness and enroll new immigrants, migrant workers, tribal communities, rural residents, and other under-enrolled groups. We also discuss how the evaluation helped inform broader state policies and replicability of the model in other late-adopting expansion states.

Informing environmental health and risk priorities through local outreach and extension

Our society is currently facing an unprecedented number of environmental and societal challenges. Stakeholder and community engagement can help identify priority issues and needs at local levels. One approach to engage stakeholders and communities in the contexts of environmental, health, and societal challenges is to leverage outreach and extension programs. Within this context, and to help identify priority issues to focus subsequent research and extension programs in North Carolina (NC), a survey was conducted with extension agents to identify priority issues as they relate to environmental health and risks and related needs. Based on responses from 66 study participants that represented half of the 100 NC counties, we found that Water pollution, Flooding, Natural resources management, and Engaging stakeholders were top priority issues across all environmental health and risk topics. Participants also identified that practices of Engaging stakeholders as well as Assessing, Managing, and Communicating risks were increasingly important. Participants indicated they needed a moderate-to-significant amount of guidance across a range of areas related to assessing, managing, communicating, and making decisions regarding environmental health and risk topics, as well as engaging with local communities. Outcomes from this work can not only help inform subsequent research and outreach efforts at local scales, but this work demonstrates a simple, low-cost approach to elicit perspectives and priorities can be leveraged in other states and regions with established stakeholder and community outreach programs more broadly.

Nodes and Hubs: An Exploration of Yiguandao Temples as ‘Portals of Globalization’

This paper takes a fresh look at the global spread of the Chinese–Taiwanese new religious movement Yiguandao (一貫道; the emic transcription is “I-Kuan Tao”) by directing attention to the concrete places where transnational connections and interactions actually transpire, i.e., temples, shrines, and other sites of worship. Emically known as “Buddha halls” (fotang 佛堂), these places range from large-scale temple complexes, to small niches of worship in people’s private residences. Yet, they all share the potential of becoming venues of transregional interactions through processes of migration, the circulation of personnel, and local outreach. I argued that we need to take the distinct character of these localities more seriously, in order to fully understand the global networks of Yiguandao groups. Through their specific embeddedness in both local affairs and transnational projects, these temples are not simply local chapters of the (mostly) Taiwanese headquarters, but instead they are “translocalities” or even “portals of globalization”—two concepts developed in migration and global studies to help understand the significance of place in the recent phase of so-called globalization. By exploring Yiguandao temples across the globe, this paper critically evaluated these approaches, and their usefulness for the study of global religions. Empirically, it drew on both print and online material, as well as ethnographic fieldwork conducted by the author in Taiwan, Vienna (Austria), California, South Africa, and Japan from 2016 to 2018.

P-OGC63 Care Close to Home in the Era of Centralisation

Abstract Background With increasingly centralised services for people diagnosed with OG Cancer we wanted to ensure our local service was maintained to provide the appropriate care and management by collaborating with the Specialist Sites and raising the profile of local services. Most patients remain local due to their disease stage, performance status or through choice. We wanted those patients who have tests and treatment on other sites to be able to have their care managed locally as much as possible and therefore only have to travel when absolutely necessary. We aim to facilitate and deliver a streamlined service. Methods Weekly Local MDT triages patients to Specialist MDT once appropriate information is available. Established local outreach clinic for specialist service. Ensures patients are known to specialist service from diagnosis. Patients will be diagnosed and managed locally unless input required elsewhere. Local CNS attends both Local/Specialist MDT as patient advocate and provides cross site communication and care planning. Local User Involvement- contributes to service development and feedback both locally and beyond. Local HNA at point of diagnosis to establish a bench mark. Ongoing emotional support is integral to the local service and continues wherever the patient is in their care pathway. Results Streamlined care with local and specialist team contacts. Improved communication between professionals. Identifiable contact for patients Rapid referral process - timely and appropriate discussions. Improved patient satisfaction. Direct access to specialist site from point of diagnosis. Improved patient advocacy across sites Effective use of clinic time. The right patient being seen at the right time in the right hospital with the right information. Local follow up enables integration of additional local services/teams into patient care More inclusion for local teams in wider service development. Local leadership within the network has ensured investment in local services and raised the profile. Conclusions Care is more streamlined Patients are assessed by the right person at the right time enabling more open communication Avoids unnecessary referrals Less travelling between sites Reduces patient anxiety Encourages user involvement- more personalised care. Promotes continuity of patient care Allows inclusion of local teams in decision making at specialist level Promotes collaboration and team working with flexible leadership amongst team members Improved job satisfaction by establishing a shared vision Upper GI Cancer delivery will continue to go through changes but with a motivated team who work together these changes can be implemented efficiently and effectively.

Effect of pregnancy tests on demand for family planning: evidence from a randomized controlled trial in Uganda

BackgroundUnmet need for family planning and unintended pregnancies are high in developing countries. Home pregnancy tests help women determine their pregnancy status earlier and the confirmation of a negative pregnancy status can facilitate the adoption of family planning. This study provides the first experimental evidence of the effect of access to pregnancy tests on women’s demand for modern family planning.MethodsA randomized controlled trial was conducted among 810 women of reproductive age in northern Uganda. During a baseline survey, women were randomly allocated to either: (1) an offer to take a hCG urine pregnancy test during the survey (on-the-spot pregnancy test) (N = 170), (2) an offer of a home pregnancy test kit to be used at any time in the future (future-use pregnancy test) (N = 163), (3) offers of both on-the-spot and future-use pregnancy tests (N = 153), or (4) a control group (N = 324). Future-use pregnancy tests were offered either for free, or randomly assigned prices. Approximately 4 weeks after the baseline survey, a follow-up survey was conducted; modern contraception methods were made available at no charge at local community outreach centers.ResultsWhen offered a free, on-the-spot pregnancy test, 62 percent of women accepted (N = 200). Almost all, 97 percent (N = 69), of women offered a free future-use pregnancy test strip, accepted it. Purchases of future-use pregnancy tests declined with price. The offer of either on-the-spot, future-use tests, or both, have no overall large or statistically significant effects on the take-up of modern family planning.ConclusionDemand for pregnancy tests is high and access to pregnancy tests has the potential to facilitate the demand for family planning. At the same time, more research is needed to understand underlying beliefs about pregnancy status and risk that guide behaviors ultimately important for maternal and neonatal health.Trial registration The study was pre-registered in July 2018 for AEA RCT registry (AEARCTR-0003187) and clinicaltrials.gov (NCT03975933). Registered 05 June 2019, https://clinicaltrials.gov/ct2/show/record/NCT03975933

“Someday we will all learn anew through hands that love us”: Protecting a key insular population of the Sulawesi Fruit Bat Acerodon celebensis

“Someday we will all learn anew through hands that love us”: Protecting a key insular population of the Sulawesi Fruit Bat <i>Acerodon celebensis</i>

Nursing student community engagement barriers, facilitators and satisfaction: Perceptions of community champions

Nursing students could benefit professionally by participating in community engagement, but barriers to student involvement in community engagement exist. Community Champions, a nursing student-led, faculty-mentored service-learning group, promotes local outreach and engagement with a variety of community initiatives for nursing students. The purpose of this study was to examine former and current Community Champions perceptions of the barriers and facilitators to participating in community engagement initiatives, as well as their satisfaction with the community engagement initiatives. The study used a 14-item survey, consisting of both Likert-scale items and open-ended questions. Of the 130 Community Champions invited to complete the survey, 40 Community Champions responded (30.8% response rate). Quantitative responses were analyzed using descriptive statistics, and qualitative responses were reviewed for themes to generate future recommendations for program improvement. Respondents rated Community Champions highly and reported personal and professional benefits to community engagement. Reasons for program satisfaction were synthesized into “opportunities for interactions with diverse community members”, “stress relief”, and “professional development”; reasons for program dissatisfaction were summarized as “disorganization of community sites”, “competing academic priorities”, and “lack of information”. Academic student programs that engage the community can positively impact both the community partners and university students.

Global Health Curricula in Ophthalmology Residency Programs in the United States

Abstract Objective The aim of the study is to investigate the design, content, and administration of global health curricula within ophthalmology residency programs in the United States (U.S.) and share the curriculum utilized in the Department of Ophthalmology at Boston University School of Medicine (BUSM). Design A survey designed through the Association of University Professors in Ophthalmology platform was emailed to residency program directors at 106 accredited ophthalmology residency programs. Setting BUSM Department of Ophthalmology, Boston, MA. Tertiary clinical care. Participants Twenty-eight ophthalmology residency program directors responded, which represent 26% of the total number of residency programs in the United States. Twenty-seven programs fully completed the survey, and one program partially completed the survey. Results Of the respondents, three programs do not include global health curricula. The most common curricular elements included are: lectures (n = 15, 60%); wet laboratories (n = 10, 40%); and journal clubs (n = 9, 36%). In terms of annual frequency, global health activities occur: twice a year (n = 12, 46%); less than once a year (n = 10, 39%); or every few months (n = 4, 15%). Fewer than half of programs (n = 10, 42%) incorporate local outreach at least once a year into their program. Twelve programs (48%) do not incorporate ethics-related topics, while the 13 remaining programs (52%) incorporate them at least once annually. The most common curricular topic is surgical techniques, with manual small incision cataract surgery (MSICS) being the most frequently emphasized (n = 17, 68%). Conclusion A robust global health curricula combined with a hands-on international component can contribute to a well-rounded training experience. Many ophthalmology residency programs value the importance of incorporating global health into their residents' training. The most common elements of global health curricula in U.S. ophthalmology residency programs included are teaching of surgical techniques for resource-limited settings and international electives. Further investigation into the impact of different components of a global health curriculum on both resident experience and international partnerships is warranted.

Cervical screening in assertive outreach team patients

AimsTo assess the uptake of cervical screening in patients under Birmingham and Solihull Assertive Outreach Teams; this included a re-audit of patients under the Central Birmingham Assertive Outreach Team.BackgroundPatients with severe and enduring mental illness are known to have poorer physical health outcomes. In Birmingham and Solihull there are 6 Assertive Outreach Teams. These teams manage patients with a diagnosis of psychosis who have complex needs requiring intensive multidisciplinary input and often struggle to engage with health services. The national cervical screening programme aims to prevent cervical cancer by detecting and treating cervical abnormalities. Acceptable coverage is defined as screening at least 80% of people aged 25–49 years within the last 3.5 years and 80% of people aged 50–64 years within the last 5.5 years. In 2018 71.4% of women in England and 70.9% in the West Midlands were screened adequately. An audit of 15 patients under the Central Birmingham Assertive Outreach Team in 2014 showed 46.2% had taken up screening, measured in the last 5 years for those aged 50–64 years and the last 3 years for those aged 25–49 years.MethodA list was obtained of all female patients under the Assertive Outreach Teams with patients excluded if they were under 25 years or over 64 years or if they were known to have undergone a total hysterectomy. All GP practices with eligible patients registered to them were written to requesting the date of the patient's most recent smear test. Cervical screening was classed as in date if carried out in the last 3.5 years for patients aged 25–49 years or 5.5 years for patients aged 50–64 years.ResultOut of 127 eligible patients, 110 had correct GP details on their record. Responses were received regarding 101 patients, 48 of whom had in date cervical screening (47.5%). Of 58 patients aged 25–49 years, 26 had in date cervical screening (44.8%). Of 43 patients aged 50–64 years, 22 had in date cervical screening (51.2%).Conclusion13.4% patients did not have a known GP practice, increasing the risk of multiple poor physical health outcomes. The rates of cervical screening among Assertive Outreach Team patients are similar to the original audit in 2014 and fall significantly below the national standards and averages. These findings, along with the importance of working together to address the need for physical health monitoring in this population, will be communicated with the local Assertive Outreach Teams and GP practices.

How societal expectations, new digital tools, andthe COVID crisis are driving a step-change in human centric remediation.

How societal expectations, new digital tools, andthe COVID crisis are driving a step-change in human centric remediation.

Reducing the prevalence of chemical UV filters from sunscreen in aquatic environments: Regulatory, public awareness, and other considerations.

Given increasing concerns about the persistence and toxic effects of some sunscreen ingredients in aquatic ecosystems, several states, territories, and nations have banned the sale and/or possession of sunscreens containing chemicals of concern. Little is known, however, about the outcomes or effectiveness of these efforts to reduce the prevalence of toxic chemicals in coastal waters. This article reviews the state of knowledge relating to regulatory and other efforts to reduce the impact of chemical ingredients in sunscreens on aquatic ecosystems, focusing on the following questions: To what extent will local legislative restrictions on ingredients actually reduce the concentrations of chemicals in coastal waters and protect aquatic health? Do these legislative measures effectively decrease overall public use of sunscreens containing potentially harmful ingredients, or would other measures, such as local outreach programs, consumer education, or broad-scale ingredient regulation, be more effective? How might restrictions on chemical UV filtersimpact human health? Although it is still early to assess the outcomes of recent ingredient bans, their effectiveness is limited by the fact that legislation generally applies only to sunscreens sold within the legislating jurisdiction. Public awareness campaigns can be locally effective, but they are hindered by the absence of clear environmental labeling standards for sunscreen. Although retail and industry groups, and many dermatologists, cite concerns that sunscreen ingredient bans might lead to increased incidences of skin cancer, consumer preferences are influenced by a wide range of factors and no studies clearly document whether restrictions on chemical ingredients will cause people to use sun protection less frequently or less effectively. Until more information is available, many consider it prudent to take a precautionary approach to sunscreen regulation supported by broad-scale, consistent regulatory policies and labeling standards that limit chemical ingredients to those considered safe for human use and ecosystem health. Integr Environ Assess Manag 2021;17:982-988. © 2021 SETAC.