Need For Community-based Interventions Research Articles

Social Awareness for Women’s Health: An Endline Study in Gazaria, Munshiganj, Bangladesh

Background: The “Social Awareness for Women’s Health: Gazaria Pilot” project aimed to address menstrual health awareness and distribute free sanitary napkins in the Gazaria region. This endline survey evaluates the project’s impact on menstrual health practices, knowledge, and socio-cultural barriers among women and girls. Objective: Baseline data highlighted critical challenges, including limited awareness about menstrual hygiene, widespread use of non-hygienic materials such as old cloths, and significant emotional distress associated with menstruation. Access to reliable menstrual health information was predominantly through informal channels, with cultural taboos further exacerbating the menstrual health crisis. Methodology: A mixed-methods approach was employed, combining quantitative surveys and qualitative interviews to gather data from community members participating in the Gazaria Pilot project. Surveys were conducted to assess changes in health behaviors and attitudes, while interviews provided insights into community perceptions and experiences with project interventions. Findings: Following the project’s implementation, there was a notable improvement in menstrual hygiene practices. The use of disposable sanitary napkins increased from 5.99% at baseline to 15.36% at endline, reflecting enhanced access and acceptance of sanitary products. Additionally, knowledge about the risks of unclean menstrual practices and the benefits of personal hygiene saw significant gains, with awareness rising from 55.5% to 72.66% and from 62.0% to 75.78%, respectively. Menstruation has decreased emotional reactions, promoting mental well-being, but challenges persist like reliance on old cloths, lack of medical advice, and socio-cultural taboos affecting health behaviors. Conclusion: The project emphasizes the need for community-based interventions and sustained engagement to improve menstrual health outcomes in Gazaria, highlighting the need for ongoing efforts.

The ‘FFAB’ project: Lessons learned from an early health intervention for male sports bettors

Abstract Background Sports betting is a growth area for the gambling industry with football fans becoming a key target of advertising. This demographic is also one at elevated risk from gambling harm. This paper reflects on the NIHR-funded Football Fans and Betting project (FFAB) - an innovative early health intervention with football fans (aged 18-55) who gamble regularly to reduce their betting. Methods We will present findings from interviews and observations to reflect on the delivery of our 8-week intervention delivered by 4 clubs’ Community Trust Coaches - Leicester, Preston North End, Accrington Stanley, and Blackpool. Planned as a feasibility study and pilot RCT, FFAB's feasibility learnings led to the development of a different model than originally proposed. Results Preliminary findings suggest (1) there is a clear need for an early health intervention for men looking to reduce their betting. (2) Overcoming shame and stigma are significant barriers to recruitment in a study like this. (3) Conducting independent research with football clubs, given their complex sponsorship arrangements, presents multiple challenges. (4) relatedly, while recruitment was easier in smaller more locally rooted clubs, they faced more challenges for resources which led to difficulties with retention on the programme. Conclusions FFAB is the first intervention of its kind and has lessons for interventions with underserved groups more widely. We identified the need for more focused pre-recruitment work on changing understandings of gambling through public health-focused education. We believe more recognition and visibility of a public health approach to gambling in the wider population would help to de-stigmatise language and discussion of gambling and lessen the challenges of engaging our target group. We recommend a more grassroots, localised approach to future early health interventions of this nature. In doing so, we believe that we could minimise many of the challenges we faced in delivery. Key messages • There is a clear need for community-based interventions that aim to reduce gambling harm amongst the high-risk population of male sports bettors. • Feasibility work suggests that refinements to our initial model, utilising more localised, grassroots approaches, are required to successfully engage with this target population.

Social network characteristics of Black African and Caribbean people with psychosis in the UK

Poorer social networks predict more coercive pathways to care and other adverse outcomes in people with psychosis. People from Black African and Caribbean backgrounds have more negative experiences within UK mental health care systems and family relationships often breakdown. This study aimed to examine the social network characteristics of Black African and Caribbean people experiencing psychosis and associations between network characteristics and severity of psychosis, negative symptoms, and general psychopathology. Fifty-one participants completed social network mapping interviews (a gold standard approach to assessing social network composition) and the Positive and Negative Syndrome Scale. This is the first study to explicitly measure social network size amongst Black people with psychosis living within the UK and results showed that participants’ social network size (mean = 12) was comparable to that of other psychosis samples. Networks were of moderate density and comprised disproportionately more relatives than other relationship types. Poor network quality was related to more severe psychosis symptoms suggesting that social network quality may be an important factor in influencing the severity of psychosis. Findings highlight the need for community-based interventions and family therapies to mobilise sources of social support for Black people with psychosis within the UK.

Social Determinants and Prevalence of Antenatal Depression among Women in Rural Bangladesh: A Cross-Sectional Study.

The prevalence of antenatal depression in Bangladesh ranges from 18 to 33%. Antenatal depression has negative impacts on the mother and child such as suicidal ideations, low birth weight, and impaired fetal development. This cross-sectional study aims to determine the prevalence and social determinants of antenatal depression in rural Sylhet, Bangladesh. Data were collected from 235 pregnant women between March and November 2021. The validated Bangla Edinburgh Postnatal Depression Scale was used to measure antenatal depressive symptoms (ADS). Background information was collected using a structured questionnaire including the Duke Social Support and Stress Scale, pregnancy choices, and WHO Intimate Partner Violence questions. Point-prevalence of antenatal depression was 56%. Intimate partner violence (IPV) before pregnancy (adjusted odds ratio (AOR) 10.4 [95% confidence interval (CI) 2.7-39.7]) and perceived husband's male gender preference (AOR 9.9 [95% CI 1.6-59.6]) were significantly associated with increased odds of ADS among pregnant women. Increased family support was a significant protective factor for ADS (AOR 0.94 [95% CI 0.91-0.97]). Antenatal depression commonly occurs in rural Sylhet, Bangladesh, highlighting the need for improved screening and management within these settings. The findings suggest the need for community-based interventions for women with low family support and experiencing intimate partner violence, and educational programs and gender policies to tackle gender inequalities.

Assessment of Fast and Junk Food Consumption and Addiction Among Saudi Population. National Descriptive Study 2020.

Kingdome of Saudi Arabia (KSA) has undergone lifestyle changes that have resulted in unhealthy dietary patterns So this study aims to investigate the frequency, determinants, and the context of Fast Food (FF), and Junk Food (JF) consumption,, to study the effect of the Saudi Food and Drug Authority (SFDA) food related policy, and to study the use of Ministry of Health (MOH) calorie guide among Saudi population all over KSA. Through a cross-sectional study recruited 355 randomly selected Saudis stratified to represent the 20 health regions in KSA through a self-administered and validated questionnaire. Ethical approval was obtained for this work. Results; The majority had age distribution between 20-< 40 y, and 218 (61.4%) were single. The prevalence of FF, and JF consumption was 308 (86.7 %).The most frequently consumed FF in descending order were (French fries, Shawarma, Burger, then Pizza) , while the most frequently consumed JF in descending order were (all kinds of cocoa, and cakes, then Ice cream), and more than half of participants did not drink carbonated soft drinks. Dinner was the main time of consuming FF (79.2%), and soft drinks (55.6%), while sweets were consumed mainly as snack (68.8%). The consumption of FF, and JF were significantly higher among young participants. The most common causes for consuming the above mentioned foods were entertainment 173 (48.5%), eating with friends 100 (28.1%) and due to better taste 92 (25.8%). The majority 48.7% of Saudi were unaware about the SFDA food related policy. Although the use of calorie labeling policy significantly (p<0.05) affected the food choices, reduced the average weekly spending on Saudi Riyal, but not on weight loss. We concluded that FF, and JF consumption among Saudis is a prevalent, and complex problem, indicating a critical need for community-based interventions to change the attitudes and behaviors toward healthy eating.

Gendered Experiences of Parent-Child Communication on Sexual and Reproductive Health Issues: A Qualitative Study Employing Community-Based Participatory Methods among Primary Caregivers and Community Stakeholders in Rural South-Western Uganda.

Open and positive parent–child communication about sexual and reproductive health (SRH) is known to reduce negative SRH outcomes for young people. However, socio-cultural influences can inhibit meaningful SRH communication. Restrictive gender norms threaten the SRH of adolescents, as they make adolescent boys more likely to engage in risky sexual behavior and make girls more vulnerable to negative SRH outcomes. This study intended to critically understand the impact of gender norms and expectations on parent–child SRH communication in rural south-western Uganda. Methods: The study adopted a community-based participatory approach using community stakeholder engagement meetings (n = 2), in-depth interviews (n = 12), and three focus group discussions with parents (n = 18). The study considered biological parents, step-parents, grandparents, uncles and aunties, as long as they were primary caregivers of adolescents aged 10–14. Results: Participants elaborated on the socio-cultural aspects that shaped their experiences of parent–child SRH communication such as cultural gender norms, religion, and media influences. They also referred to socio-economic challenges, lack of knowledge, and the role of peers and schools. Conclusions: There is need for community-based interventions to improve parent–child SRH communication to address the deeply rooted cultural and gender contexts in rural south-western Uganda.

Scaling out a palliative compassionate community innovation: Nav-CARE.

Background:There is an urgent need for community-based interventions that can be scaled up to meet the growing demand for palliative care. The purpose of this study was to scale out a volunteer navigation intervention called Nav-CARE by replicating the program in multiple contexts and evaluating feasibility, acceptability, sustainability, and impact.Methods:This was a scale-out implementation and mixed-method evaluation study. Nav-CARE was implemented in 12 hospice and 3 nonhospice community-based organizations spanning five provinces in Canada. Volunteers visited clients in the home approximately every 2 weeks for 1 year with some modifications required by the COVID-19 public health restrictions. Qualitative evaluation data were collected from key informants (n = 26), clients/family caregivers (n = 57), and volunteers (n = 86) using semistructured interviews. Quantitative evaluation data included volunteer self-efficacy, satisfaction, and quality of life, and client engagement and quality of life.Findings:Successful implementation was influenced by organizational capacity, stable and engaged leadership, a targeted client population, and skillful messaging. Recruitment of clients was the most significant barrier to implementation. Clients reported statistically significant improvements in feeling they had someone to turn to, knowing the services available to help them in their community, being involved in things that were important to them, and having confidence in taking care of their illness. Improvements in clients’ quality of life were reported in the qualitative data, although no statistically significant gains were reported on the quality of life measure. Volunteers reported good self-efficacy and satisfaction in their role.Conclusion:The feasibility, acceptability, and sustainability of the program were largely dependent on strong intraorganizational leadership. Volunteers reported that their involvement in Nav-CARE enabled them to engage in ongoing learning and have a meaningful and relational role with clients. Clients and families described the positive impact of a volunteer on their engagement and quality of life.

Cardiovascular Disease Risk Factors and 10 Year Risk of Cardiovascular Events among Women over the Age of 40 Years in an Urban Underprivileged Area of Bangalore City.

Background:Cardiovascular disease (CVD) is one of the leading causes of death among Indian women but not a focus of current strategies to improve women's health.Objectives:To assess 10-year CVD risk and estimate the prevalence of CVD risk factors among underprivileged women.Methods:A cross-sectional study among women aged 40–79 years in an urban underprivileged area of Bangalore city, using nonlaboratory-based World Health Organization and the International Society of Hypertension risk prediction chart and INTERHEART list of CVD risk factors. Blood pressure, random blood sugar, height, weight, and waist circumference were measured. The Chi-square test was done for the association between CVD risk status and risk factors. Multiple logistic regression performed to calculate adjusted odds ratios (ORs).Results:Of 1027 women, 11% women had high risk of CVD (≥20% risk of fatal/nonfatal cardiovascular event within next 10 years). The prevalence of CVD risk factors was high with 20.2% diabetes, 53.7% hypertension, 77% overweight/obesity, and 92% central obesity. Majority were physically inactive with unhealthy diet, lacking daily fruits and vegetables, excess consumption of salty food, junk food, red meat, and excess oil. Significantly higher CVD risk found among women who were sedentary during leisure time (P = 0.028), single/separated/widowed women (OR = 1.84 [1.26–4.29] P = 0.002), and women who did not walk or cycle as a regular means of transport (OR = 1.47 [1.98–2.19] P = 0.041).Conclusion:High risk of CVD among underprivileged women reveals an urgent need for community-based interventions for prevention of CVD. Screening and management of diabetes and hypertension must include weight reduction and health education strategies. Policy-makers need to initiate efforts toward improving affordability of healthy diets for the urban underprivileged.

Depression and its associated factors among the older adults in rural, Tamilnadu, India

BackgroundDepression is a significant public health concern, especially among older adults due to its distressing morbidity and mortality rate. This study aimed to assess the prevalence of depression and the associated risk factors among older adults (age ≥ 60 years) in Tamilnadu, India. Materials and methodsA community-based cross-sectional study was carried out from July 2016 to May 2018 among the older adults in the rural area of three districts of Tamil Nadu, India. Geriatric Depression Scale item 15 (GDS-15) was used to assess depression with face to face interviews from 7200 participants. Descriptive statistics and multivariable logistic regression analysis were employed. Adjusted odds ratio (OR) with a 95% confidence interval was used to calculate the significance. ResultsPrevalence of depression among older adults were found to be 67.5% (95% CI-0.66–0.68). The multivariable logistic regression model revealed that older adults above 80 years (OR = 1.91; CI = 0.885–1.344), female sex (OR = 0.88; 95% CI = 0.803–0.982), widow (OR = 0.88; 95% CI = 0.77–1.00), living with children (OR = 0.86, 95% CI = 0.77–0.97), lack of family support (OR = 1.48; CI = 1.321–1.638), and physically dependent (OR = 1.01; CI = 0.88–1.15) were associated with depression among older adults. Additional to this, people with diabetes (OR = 1.15; CI = 1.007–1.33), and with the history of fall (OR = 1.28; CI = 1.017–1.620) also associated with the depression. ConclusionPrevalence of depression among the elderly population is reported to be high in this study. Screening the elderly for depression at the primary care level helps in early detection of depression. This suggests the need for community-based interventions for effective management of older adults with chronic diseases.

Covid-19 and inequality: developing an age-friendly strategy for recovery in low income communities

Purpose This paper aims to explore the social impact of the COVID-19 pandemic, focusing on issues facing older people living in urban areas characterised by multiple deprivation. Design/methodology/approach The paper first reviews the role of place and neighbourhood in later life; second, it examines the relationship between neighbourhood deprivation and the impact of COVID-19; and, third, it outlines the basis for an “age-friendly” recovery strategy. Findings The paper argues that COVID-19 is having a disproportionate impact on low-income communities, which have already been affected by cuts to public services, the loss of social infrastructure and pressures on the voluntary sector. It highlights the need for community-based interventions to be developed as an essential part of future policies designed to tackle the effects of COVID-19. Originality/value The paper contributes to debates about developing COVID-19 recovery strategies in the context of growing inequalities affecting urban neighbourhoods.

Prevalence and factors associated with depression, anxiety, and stress symptoms among older adults: A cross‐sectional population‐based study

Despite population aging and the increase in mental health problems, studies on the mental health of older people in developing countries are lacking. This population-based cross-sectional study estimated the prevalence and associated factors for depression, anxiety and stress symptoms among older adults in Nepal. Community-dwelling older adults (N = 794) were interviewed using a questionnaire which consisted of the 21-item Depression Anxiety Stress Scales; and a wide range of sociodemographic, health-related, and lifestyle characteristics; functional ability, social support, participation in social activities, and adverse life events. The prevalence of symptoms was 15.4% for depression, 18.1% for anxiety, and 12.1% for stress. Risk factors for symptoms included female gender, working in agriculture, lower household wealth, perceived poor health, smoking, chronic conditions, migration of adult children, and exposure to adverse life events. Receiving an allowance, physical exercise, functional ability, social support, and participation in social activities were found to have protective effects. The findings indicate the need for community-based interventions, including appropriate diagnosis and treatment of mental health conditions, and mental health promotion programs targeting the risk and protective factors.

Yoga and Tai Chi: a mind-body approach in managing respiratory symptoms in obstructive lung diseases.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation because of airway and/or alveolar abnormalities. Symptoms include dyspnea, cough, chronic sputum production. As the third-ranked cause of death as well as disability-adjusted life years (DALYs), it poses a significant burden on patients, families, healthcare system and society. Regular physical activity is linked to decrease in morbidity and mortality associated with COPD, but implementation remains challenging. There is a need for community-based interventions that promote physical activity. Yoga and Tai Chi are widely available in the community and have been shown to be beneficial in patients with COPD as well as many of the co-morbid conditions associated with COPD. Yoga and Tai Chi have been found to be more effective than usual care in COPD with clinically meaningful improvements in 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1), and health-related quality of life (HRQoL). They have also been found to be comparable to pulmonary rehabilitation interventions. Yoga and Tai Chi provide community-based options for patients with COPD to improve their physical activity, quality of life, and pulmonary function.

Tobacco outlet density, neighbourhood stressors and smoking prevalence in Toronto, Canada.

A growing body of research has shown that neighbourhood-level factors, such as the density of retail outlets selling tobacco and neighbourhood socioeconomic disadvantage affect smoking prevalence, with high levels of outlet density and neighbourhood disadvantage related to higher smoking prevalence. However, few studies have considered the role of other neighbourhood processes like stressors including perceived neighbourhood disorder in these effects. The present study examined the effects of tobacco outlet density, neighbourhood income and perceived neighbourhood disorder on smoking prevalence among a representative sample of 2,412 adult neighbourhood residents in a large urban centre in Canada. Tobacco outlet density and perceived neighbourhood disorder were significantly associated with smoking in an unadjusted multilevel model, but only perceived neighbourhood disorder remained significant in a model adjusting for other confounders. Findings suggest the need for community-based interventions to address the relationship between neighbourhood disorder and smoking, as well as more research on the combined role of tobacco availability and neighbourhood stressors, beyond neighbourhood socioeconomic disadvantage, on smoking behaviour.

Application of the Social Vulnerability Index for Identifying Teen Pregnancy Intervention Need in the United States.

Objectives Originally developed to assess emergency preparedness, evidence suggests the Social Vulnerability Index (SVI) may also be useful to investigate multilevel environmental and social influences on health risk behaviors and outcomes. This ecological study explores the application of the SVI as a predictor of teen pregnancy rates across counties in the United States (U.S.) and identifies areas with greatest need for community-based interventions. Methods County-level SVI and teen birth rate data were obtained from the Centers for Disease Control and Prevention. Regression analysis was conducted to examine associations between teen birth rates and social vulnerability, geographic region, and the four themes which compromise the index: socioeconomic status, household composition, minority status, and housing. Dot maps of teen birth rates and SVI by quartiles were used to examine spatial distribution across counties. Results Each increase in SVI quartile was associated with an additional 11.5 births per 1000 females ages 15-19. Higher social vulnerability was significantly associated with higher teen birth rates to varying degrees across the U.S., with largest effect sizes observed in East South Central (β = 62.56; SE = 6.28; p < 0.001) and West South Central (β = 66.75; SE = 5.33; p < 0.001) Census divisions. Among index themes, socioeconomic status (β = 25.56; SE = 1.16; p < 0.001), household composition (β = 23.49; SE = 1.00; p < 0.001), and minority/language status (β = 10.99; SE = 0.83; p < 0.001) were positively associated with teen birth. No association was observed with housing/transportation. Conclusions The SVI offers a novel tool for identifying at-risk populations most in need of resources and guiding community-based teen pregnancy interventions across the U.S.

Intracluster correlation estimates from a World Health Organisation STEPwise approach to surveillance (STEPS) survey for cardiovascular risk factors in Vellore, Tamil Nadu, India

ObjectivesMost World Health Organisation (WHO) STEPS surveys use cluster sampling to assess the prevalence of risk factors for non-communicable diseases (NCDs) for which design effects need to be estimated using intracluster correlation (ICCs) coefficients, for sample size calculation. Although there are many reports of risk factor surveys reported from developing countries, there are very few reports of ICCs for risk factors for NCDs, which can inform planning the appropriate sample size needed for such surveys. This study reports the ICCs for NCD risk factors, obtained from a WHO STEPS survey conducted in Vellore district, in the state of Tamil Nadu, South India. Study designCross-sectional study. MethodsA cross-sectional study was carried out in 48 urban clusters (wards) and nine rural clusters (villages) between 2011 and 2012, using the WHO STEPS methodology for assessing behavioural, anthropometric, physical and biochemical risk factors. The ICC estimates for various risk factors were obtained using loneway and xtmelogit commands using STATA to study clustering of risk factors. ResultsThe number of respondents was 6196 adults aged 30–64 years. The median ICC of cardiovascular risk factors in the urban area was 0.046, while it was 0.064 in the rural area. Clustering was higher for behavioural risk factors such as physical activity (ICC: 0.179 rural, 0.049 urban) and fruit and vegetable intake (ICC: 0.105 rural, 0.091 urban) as compared with physical risk factors (ICCs for hypertension: 0.044 rural, 0.006 urban; body mass index: 0.046 rural, 0.041 urban) and biochemical outcomes such as fasting plasma glucose (ICC: 0.017 rural, 0.027 urban). ConclusionsThis study provides estimates of ICCs for cardiovascular risk factors from Vellore, South India, as such data have not been reported from WHO STEPS surveys in India or neighbouring countries. Such estimates of ICCs if reported from various WHO STEPS being carried out across the country can contribute to better planning of epidemiological surveys. Clustering of behavioural risk factors at village/ward level as seen in this study points to the need for community-based interventions for health promotion, as spatial clustering influences behaviour, which in turn affects chronic disease outcomes.

Prevalence and Risk Factors for Hearing Loss in Chilean Shellfish Divers.

Background:Diving within artisanal fishing is a profession carried out by many men in coastal communities of southern Chile. These shellfish divers use surface supplied air for breathing. Among potential health threats are occupational accidents, decompression sickness and barotrauma. Repeated middle and inner ear barotrauma and decompression sickness of the ear may result in hearing loss.Objective:To determine the prevalence of hearing loss and related risk factors in artisanal shellfish divers.Methods:A cross–sectional study including 125 male shellfish divers was carried out in a coastal village in southern Chile. Participants were interviewed using a standard Spanish questionnaire adapted for this population. Hearing loss was assessed through audiometry. Any hearing loss, sensorineural hearing loss and other types of hearing loss (conduction, unilateral and mixed) were used as the outcomes. Bivariate and multiple logistic regression models were carried out to identify risk factors for hearing loss.Findings:Median duration on the job was 25 years (range 1–52), 64% of divers had a low level of schooling and 52% reported not knowing how to use decompression tables. Most (86%) of the divers dove deeper than 30 meters exceeding the 20 meters permitted by law. The majority (80%) reported having experienced several episodes of type II decompression sickness during their working life. The prevalence of any type of hearing loss was 54.4%: 29.0% presented sensorineural hearing loss and 25.6% presented other types of hearing impairment. After adjustment for age and other potential risk factors, diving more than 25 years was the main predictor for all kinds of hearing loss under study.Conclusions:Hearing loss is frequent in artisanal shellfish divers and safety measures are limited. Although based on small numbers and lacking an unexposed comparison group, our results suggest the need for community-based interventions.

Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon.

IntroductionUrinary schistosomiasis (US) is endemic in Cameroon. Knowledge, attitudes and practices (KAP) are important aspects for control of the disease. However, data on these remain scanty. We aimed at evaluating knowledge, attitudes and practices regarding urinary schistosomiasis among adults in households in the Ekombe Bonji health area.MethodsA community-based, cross-sectional study was carried out at Ekombe Bonji health area from February to March, 2017, involving all 12 communities. A pre-tested questionnaire was used to assess knowledge, attitudes and practices regarding urinary schistosomiasis among 198 adults and to record their socio-demographic, environmental and clinical variables. Data were stored in Excel version 2013 and analysed using Stata version 14.2.ResultsOf the 198 adults interviewed, only 35.4% had prior knowledge about urinary schistosomiasis. Among these, 94.3%, 74.3%, 57.7% knew the signs and symptoms, modes of transmission and preventive measures respectively. Only 14.3% knew the cause and treatment. 81.2% considered urinary schistosomiasis a serious disease and 77.1% believed it could be prevented, albeit, their practices to prevent infection were inadequate.ConclusionKnowledge, attitudes and practices regarding urinary schistosomiasis among adults are inadequate, since most of them are not aware of the disease. Therefore, there is need for community-based interventions especially health education to effectively reduce the disease burden.

Early psychosis in central Vietnam: A longitudinal study of short-term functional outcomes and their predictors.

Few longitudinal studies have investigated the functional outcomes of individuals with recent-onset psychotic illness in low- and middle-income countries. To investigate short-term functional remission and its predictors in a central Vietnamese sample. A naturalistic 6-month prospective cohort study recruited 79 patients of public health facilities who had experienced a first episode of schizophrenia or related illness in the past 18 months. Individuals and their family members were interviewed using standardised assessments of community functioning, symptoms, treatment, demographics and various psychosocial variables. Rates of functional remission (i.e. no or minimal impairment) were calculated based on rigorous, culturally appropriate criteria. Generalised estimating equations were used to explore predictors of remission. Rates of global functional remission were 28% at baseline and 53% at follow-up. In individual functional domains, remission was least common for occupational activities, intermediate for relationships and relatively common for daily living activities. Global functional remission was significantly associated with absence of negative and cognitive symptoms, average or better household economic status and unimpaired premorbid functioning. Remission rates appeared similar to those seen in many international intervention studies. However, individuals from poor households had markedly unfavourable outcomes, suggesting the need for community-based interventions targeting low-socioeconomic status (SES) groups.

What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China.

Regular maintenance of non-communicable chronic diseases can constrain disease progression in diabetic and hypertensive patients. To identify the individual and social factors that are associated with positive health-seeking behaviors and regular maintenance of chronic diseases, we have conducted a follow up study in 2015 on diabetic and hypertensive patients in Hubei Province. We used binary logistic regression models to determine specific factors associated with diabetic and hypertensive patients that sought healthcare services for their conditions in accordance with current Chinese Centers for Disease Prevention and Control (CDC) guidelines. Our findings show that 42.16% of 510 people living with chronic conditions (PLCDs) sought health services in line with existing guidelines. Findings also show a higher probability (8.418 times) for PLCDs seeking healthcare services at higher-tiered hospitals (secondary and tertiary hospitals) than for PLCDs seeking care at primary hospitals (odds ratio (OR) = 8.418, 95% confidence interval (CI) = 4.82, 14.27, p < 0.001). These analyses underscore the importance of having patient advocates who can provide support, where necessary, and encourage positive health-seeking behavior. The study also shows a negative impact on regular maintenance for PLCDs in households with high financial constraints. In contrast, the study shows positive impacts for increased household income, age, and residency in rural locations. In sum, this study underscores the importance of primary hospitals as key points of care and critical players in care coordination for PLCDs. The study provides more evidence for Chinese policymakers seeking to contain costs and improve population health. The findings also underscore the need for community-based interventions, specifically interventions that link local primary hospitals, friends/family members, and PLCDs.

Population attributable risk estimates for factors associated with non-use of postnatal care services among women in Nigeria

ObjectivesTo determine population attributable risks (PARs) estimates for factors associated with non-use of postnatal care (PNC) in Nigeria.Design, setting and participantsThe most recent Nigeria Demographic and Health Survey (NDHS, 2013)...