Outreach Centers Research Articles

NUrse-led COntinuum of care for people with Diabetes and prediabetes (NUCOD) in Nepal: study protocol for a cluster randomized controlled trial

BackgroundThe purpose of this study will be to improve diabetes prevention, access to care and advocacy through a novel cost-effective nurse-led continuum of care approach that incorporates diabetes prevention, awareness, screening and management for low-income settings, and furthermore utilizes the endeavor to advocate for establishing a standard diabetes program in Nepal.MethodsWe will conduct a two-arm, parallel group, stratified cluster randomized controlled trial of the NUrse-led COntinuum of care for people with Diabetes (N1 = 200) and prediabetes (N2 = 1036) (NUCOD) program, with primary care centers (9 outreach centers and 17 government health posts) as a unit of randomization. The NUCOD program will be delivered through the trained diabetes nurses in the community to the intervention group and the outcomes will be compared with the usual treatment group at 6 and 12 months of the intervention. The primary outcome will be the change in glycated hemoglobin (HbA1c) level among diabetes individuals and progression to type 2 diabetes among prediabetes individuals, and implementation outcomes measured using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. Outcomes will be analyzed on an intention-to-treat basis.DiscussionThe results of this trial will provide information about the effectiveness of the NUCOD program in improving clinical outcomes for diabetes and prediabetes individuals, and implementation outcomes for the organization. The continuum of care model can be used for the prevention and management of diabetes and other noncommunicable diseases within and beyond Nepal with similar context.Trial registrationClinicalTrials.gov, NCT04131257. Registered on 18 October 2019.

Treatment Setting Influences Treatment Modality for Urinary Stone Disease

OBJECTIVETo determine whether selection of treatment modality for urinary stone disease differs between primary and outreach healthcare centers, and if patient rurality predicts treatment modality. METHODSWe retrospectively evaluated Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) procedural data from the Iowa Office of Statewide Clinical Education Programs (OSCEP) and Iowa Hospital Association (IHA) databases from 2007 to 2014. Geographical data was used to analyze travel metrics and patient proximity to sites of stone treatment. Rural-urban commuting area (RUCA) codes were used to characterize patient rurality. Chi-square tests and t tests were used to compare ESWL and URS patients, and multilevel logistic regression model was used to assess influence of treatment setting on surgical modality. RESULTSA total of 18,831 stone procedures were performed by urologists in Iowa on patients from Iowa (10,495 URS; 8336 ESWL). Around 2630 procedures occurred at outreach centers. Ureteroscopy comprised 59.7% of procedures at primary centers, but only 31.2% at outreach centers. On multilevel analysis, outreach location was associated with 2.236 OR toward ESWL (P <.001). Individual physician treatment patterns accounted for 32% of treatment variation. Patient rurality was not significantly associated with treatment modality as an independent factor (P = .879). CONCLUSIONSWide variation exists in urolithiasis treatment modality selection between outreach and primary centers. Outreach locations perform a significantly higher frequency of ESWL compared to URS, and much of the variation in treatment selection (32%) arises from individual physician practice patterns.

The Specter of Authoritarianism among Criminal Justice Majors at Outreach Centers: Do University Outreach Efforts Breed Right-Wing Authoritarianism?

While research has examined criminal justice students in traditional university settings, a predominately Black college, and a military college, no one has looked at CJ students in outreach centers. These centers allow students to pursue a four-year degree without leaving their community. Students are exposed to limited diversity because of this setting. Previous studies found that lower division male freshman CJ students were of a higher Right-Wing Authoritarian (RWA) mindset. Based on our study, we conclude that having a CJ program at an outreach center produces a broader finding. A young male CJ student at an outreach center is more prone to RWA attitudes – similar to the mindset of a military college CJ major. However, a young male CJ major does not necessarily mean lower division. We found older students tend to have lower RWA attitudes and in this setting, it is common to have older lower division students.

Stakeholders’ Perceptions of Science-Day Programs at University-Based Science Outreach Centers

University-based science youth centers offer science-day activities for students that include lectures and sometimes a laboratory experience. This phenomenological study explores stakeholders’ views of science-day programs at 3 different university-based science outreach centers. The study describes the characteristics, the goals, the pedagogy, and the challenges of science days as voiced by the different informants. We found that the main goal was exposing students to science and “showing STEM is fun." Some teachers sought added value of learning in out-of-school environments and pointed to the importance of hands-on activities. The centers’ staff did not address pedagogy and viewed teachers’ role as being chaperons. Teachers felt patronized by the young guides who did not acknowledge their experience and expertise. Some differences in approaches of junior and senior teachers are discussed. In conclusion, we recommend mutual discussion of goals, and finding ways for teachers and centers' staff to collaborate in planning and enactment of science days.

Soiled Instrument Handling in Outpatient Clinics; Our process to compliance

BACKGROUND: The outpatient clinic system of about 35 centers, including 4 ambulatory surgery centers (ASCs) with central sterilization (CS) services, was incorrectly handling and transporting soiled instruments. Non-ASC instruments were hand-carried through hallways to collection bins on countertops in clerical areas. Bins did not meet standards. Bins from outreach centers were left in mailrooms for courier collection, and were mixed with clean items. Some bins still contained a portion of the water/enzymatic soak solution. METHODS: A task force was formed to improve the process at the clinic site with the largest ASC first. The other clinic sites with ASCs and then the remaining outreach centers followed suite. New instrument bins were purchased and a new instrument spray replaced soaking. Soiled utility rooms were constructed where there were none. A policy, procedure, checklist, algorithm and training video were made and placed in an online toolkit. Couriers were given turn-by-turn directions to all the soiled utility rooms and were educated on maintaining separation of clean and dirty within the transport vans. RESULTS: With support starting at the executive level, safe soiled instrument handling and transportation resulted system-wide after seven months. Joint Commission accreditation was achieved. I, along with my coworkers, continue to educate staff as necessary to make this process their “new normal” for soiled instrument handling. CONCLUSIONS: Process change across a large healthcare system requires commitment at the executive level including funding and educational tools.

Community-based self-collected human papillomavirus screening in rural Zimbabwe

BackgroundIn low- and middle-income countries (LMIC), women have limited access to and uptake of cervical cancer screening. Delayed diagnosis leads to poorer outcomes and early mortality, and continues to impede cancer control disproportionately in LMIC. Integrating self-collected, community-based screening for High Risk-Human Papilloma Virus (HR-HPV) into existent HIV programs is a potential screening method to identify women at high risk for developing high-risk cervical lesions.MethodsWe implemented community-based cross-sectional study on self-collection HR-HPV screening in conjunction with existing community outreach models for the distribution of antiretroviral therapy (ART) and the World Health Organization Expanded Program on Immunization (EPI) outreach in villages in rural Zimbabwe from January 2017 through May 2017.ResultsOverall, there was an 82% response rate: 70% of respondents participated in self-collection and 12% were ineligible for the study (inclusion criteria: age 30–65, not pregnant, with an intact uterus). Women recruited in the first 2–3 months of the study had more opportunities to participate and therefore significantly higher participation: 81% participation (additional 11% ineligible), while those with fewer opportunities also had lower participation: 63% (additional 13% ineligible) (p < 0.001). Some village outreach centers (N = 5/12) had greater than 89% participation.ConclusionsIntegration of HR-HPV screening into existing community outreach models for HIV and immunizations could facilitate population-based screening to scale cancer control and prevention programs in sub-Saharan Africa. Community/village health workers (CHW/VHW) and village outreach programs offer a potential option for cervical cancer screening programs to move towards improving access of sexual and reproductive health resources for women at highest risk.

Measles vaccination coverage among children aged (12-23) months in Marawi locality - Northern state, Sudan - 2016

Background: Worldwide measles remains the fifth cause of mortality among children under 5 years. Immunization coverage is the proportion of individuals in the target population who are vaccinated. It is a key measure of immunization system performance. Coverage for measles in Eastern Mediterranean region in 2015 for MCV1 was 85%, and MCV2 was 61%.Methods: A total sample size of 462 mothers was determined according to WHO guidelines regarding coverage survey in (February - July 2016). Data were collected using a prepared and pretested questionnaire, reviewing cards of children, and interview with EPI personnel. Data were analyzed using SPSS version 20, p≤0.05 was considered significant.Results: The majority of the children (96.1%) were vaccinated against MCV1, and (77.4%) were vaccinated against MCV2. Small group of mothers (5.7%) had a negative attitude towards immunization. Most mothers (94.3%) were satisfied with measles immunization services. More than half of mothers (55.7%) wait for &lt;15 minutes to immunize their children. Most of the mothers (62.3%) went to the immunization centers by public transports. The main factors affecting vaccination coverage were: weakness of incentives, lack of means of transport for staff, poor working environment like: shortage of water, furniture and technological materials.Conclusions: The coverage with MCV1 was reaching the WHO elimination standards while the coverage of MCV2 was not; due to many factors that affected the vaccination coverage. The study recommends health education covering all aspects of immunization, improvement of the working environment, and availing outreach centers.

A Protocol for a Feasibility and Acceptability Study of a Participatory, Multi-Level, Dynamic Intervention in Urban Outreach Centers to Improve the Oral Health of Low-Income Chinese Americans.

While the US health care system has the capability to provide amazing treatment of a wide array of conditions, this care is not uniformly available to all population groups. Oral health care is one of the dimensions of the US health care delivery system in which striking disparities exist. More than half of the population does not visit a dentist each year. Improving access to oral health care is a critical and necessary first step to improving oral health outcomes and reducing disparities. Fluoride has contributed profoundly to the improved dental health of populations worldwide and is needed regularly throughout the life course to protect teeth against dental caries. To ensure additional gains in oral health, fluoride toothpaste should be used routinely at all ages. Evidence-based guidelines for annual dental visits and brushing teeth with fluoride toothpaste form the basis of this implementation science project that is intended to bridge the care gap for underserved Asian American populations by improving access to quality oral health care and enhancing effective oral health promotion strategies. The ultimate goal of this study is to provide information for the design and implementation of a randomized controlled trial of a participatory, multi-level, partnered (i.e., with community stakeholders) intervention to improve the oral and general health of low-income Chinese American adults. This study will evaluate the feasibility and acceptability of implementing a partnered intervention using remote data entry into an electronic health record (EHR) to improve access to oral health care and promote oral health. The research staff will survey a sample of Chinese American patients (planned n = 90) screened at three outreach centers about their satisfaction with the partnered intervention. Providers (dentists and community health workers), research staff, administrators, site directors, and community advisory board members will participate in structured interviews about the partnered intervention. The remote EHR evaluation will include group adaptation sessions and workflow analyses via multiple recorded sessions with research staff, administrators, outreach site directors, and providers. The study will also model knowledge held by non-patient participants to evaluate and enhance the partnered intervention for use in future implementations.

Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers

ABSTRACTThere is limited data regarding women who inject drugs, and how harm-reduction services can be made more women-centered. This study explored experiences of Kenyan women who inject drugs, with regard to access to HIV, harm reduction and sexual and reproductive health (SRH) services. A total of 45 women who inject drugs and 5 key stakeholders participated in-depth interviews and focus group discussions. Thematic analysis of the data revealed that stigma, long distances, lack of confidentiality, user fees, multiple appointments, drug users’ unfamiliarity with health facilities, disconnect in communication with healthcare providers, and healthcare providers’ lack of understanding of women’s needs were factors that impede women’s access to health services. Community-based services, comprising of outreach and drop-in centers mitigate these barriers by building trust, educating women on their health and rights, linking women to health facilities, sensitizing health providers on the needs of women who inject drugs, and integrating women’s SRH services into community-based harm-reduction outreach. Inclusion of SRH services into community-based harm-reduction activities increased women’s interest and access to harm-reduction interventions. These findings underscore the need to strengthen community-based programming for women who inject drugs, and to integrate SRH services into needle and syringe exchange programs.

Bangladesh: Extension, Gender and Nutrition Landscape Analysis

This landscape study documents several initiatives that have been implemented by the Government of Bangladesh, agricultural universities, research institutes, development, and non-governmental organizations. The gender, nutrition, and extension related activities four agricultural universities, almost all agricultural research and training organizations, and a good number of non-governmental and development organizations were reviewed. Activities of DAE are also documented thoroughly, as the department is implementing several projects that have deep connections with gender, nutrition and extension. These include the ANGel project as well as the Nutrition and Food Security through Integrated Agricultural Development and the Agriculture Growth and Employment program. These projects train male and female farmers and their office staffs to enhance their working capacity and create gender and nutrition awareness. Agricultural research institutes only do sporadic research on gender and nutrition issues. However, research on bio-fortification is contributing to enrich nutrients in agricultural produce. Research organizations’ extension activities are not significant but they do collaborate with DAE. Government run research and training centers, particularly RDA, has distinctly focused gender components in their research and training activities. At present, agricultural universities do not offer distinct course related to gender and nutrition at undergraduate level but there are some courses at the Masters level. Universities have research centers that manage research projects but there is no mandate for carrying out gender and nutrition related research. Bangladesh Agricultural University and Bangabahdu Sheik Mujibur Rahman Agricultural universities have extension and outreach centers, but others do not. Non-governmental and development organizations are a bit ahead in addressing gender and nutrition issues. However, they are mostly project based and lack upscaling strategies, which would be crucial to generating greater impact. As an outcome of an interactive workshop with four different stakeholder groups, seventeen key points were identified for evaluating a project whether it can be considered as good practice or not. Accordingly, a couple of projects have been presented as good practices in this report. Every participant recognized the importance of collaboration for effective project implementation. Workshop participants reported that collaboration is must among education, research and development organizations but this may take time. Collaboration may begin with gaining an understanding of each other, which this landscape study is intended to help with, and it may require spending time at the organization level. The benefit of getting to know the organizations are equally valuable in terms of optimizing action design. Innovative approaches through collaborative efforts are necessary for organizational growth, for addressing technical challenges and institutional adaptation. The landscape study revealed that agricultural extension in Bangladesh has untapped potential for integrating gender and nutrition as part of a holistic development strategy. Insight were drawn from several initiatives working on gender and nutrition integration throughout Bangladesh. It is evident that more multidisciplinary action research is needed to fulfill existing development gaps in gender incorporation in agriculture. At organizational level, there should be a clear organizational mandate in mainstreaming gender and nutrition within agriculture and advisory services. Some agriculture interventions are explicitly found to be demand driven, gender responsive, nutrition sensitive, climate smart, etc. The key challenge is disconnection among the service providers and the subsequent programs. There seems to be competition over resources instead of collaboration. The lack of common understanding also deprives getting benefit from joint action planning. The supportive policy alignment among extension service providers supporting collaboration will also create a favorable environment to scale up agriculture intervention. To do so, it is important to create a supportive environment through a strong consensus and commitment on integrating gender and nutrition within agricultural extension enriched with effective interventions for development. Coordination and implementation actions will work in synergies towards gender equity and nutritional security within the broader scope of agriculture. It is important to mainstream gender and nutrition into the curriculum of educational institutions, make them a research priority and anchor them as organizational mandates. Attempts are needed in bridging the gap in combining gender and nutrition policies, programs and projects within agriculture. Gender mainstreaming in nutrition within agriculture thus can act as a key tool in strengthening gender nutrition linkage and the enlightenment process through recognizing women contribution in agriculture and household nutritional security.

Knowledge, attitude, and awareness regarding dental implants among patients visiting a university hospital and its teaching districts

Introduction: Dental implants are considered one of the best treatment options for completely or partially edentulous patients. But due to lack of knowledge and education many patients especially in the region of underdeveloped or developing countries do not opt for this. In current study the knowledge, attitude and awareness about dental implants was studied in a referral center and its outreach centers in Nepal. Purpose: To determine the status of knowledge, attitude and awareness about dental implants in a tertiary care hospital and its outreach centers. Materials and Methods: 192 patients were asked about dental implants using a standard questionnaire. Their response were recorded and analyzed statistically. Results: Among the respondents 52.6% were aware of implant therapy, however in specific knowledge only 24.5% could attribute the jaw as site for implant placement. It was also found that rather than dental professionals (17.7%), friends and acquaintances (30.2%) play a role in awareness. Conclusion: Within the limitations of this study limited knowledge and awareness about dental implants was noticed and role of dentists for the information is lacking in our part of world.

Comparative Study of Lifestyle-related Risk Factors of Periodontal Disease among Urban and Rural Population of India

ABSTRACTAimTo compare participants’ lifestyle-related risk factors for periodontal disease between urban and rural population.Materials and methodsA cross-sectional study consisting of a structured questionnaire on health practice index (HPI), oral health-related behavior, and personal habits as well as sociodemographic variables was conducted on 800 subjects aged 20 to 50 years attending dental outreach centers of Manipal College of Dental Sciences in urban and rural areas of Udupi District. Clinical examination for periodontal status was done by using community periodontal index, simplified oral hygiene index, and gingival index. Statistical analysis of the data was done using chi-square.ResultsIt was found that except the number of hours of work/day (p = 0.02) urban participants had significantly better occupations, higher education, more income, better oral health care behaviors like dental visits, device of cleaning, frequency of cleaning, method of cleaning, healthier personal habits like tobacco chewing, pan chewing (&lt; 0.001 respectively), physical exercise, mental stress levels and healthier overall lifestyles (p &lt; 0.001 respectively) than the rural participants. It was also found that more number of urban participants had better oral hygiene status (p &lt; 0.001), gingival status (p &lt; 0.001), and healthier periodontium (p = 0.002) than the rural counterparts.ConclusionThese findings suggest that rural participants had more lifestyle-related risk factors for periodontitis as well as less healthy periodontium than the urban participants. Patient's involvement in self-care by promoting healthy lifestyles is needed especially in rural areas where adequate treatment facilities are lacking.How to cite this articleSingla R, Acharya S, Singla N. Comparative Study of Lifestyle-related Risk Factors of Periodontal Disease among Urban and Rural Population of India. World J Dent 2016;7(3):129-134.

Letter From the Editor

Letter From the Editor

A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area

Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma.

Translating research into practice

Dear Friends Wish you all a very happy new year!!! Hope this year brings you all success and prosperity. In the inaugural issue of this year, I once again salute the illustrious past editors of the Indian Journal of Ophthalmology (IJO) - Dr. SN Cooper, Dr. SRK Malik, Dr. Madan Mohan, Dr. Tony Fernandez, Dr. Tony Ittyerah, Dr. GN Rao, Dr. TP Das, and Dr. BK Nayak. Without their foresight and hard work, IJO would not have been able to reach its Diamond Jubilee year. Research when transformed and inculcated into practice turns paper work into innovation. Zora Neale Hurston rightly said, “Research is a formalized curiosity. It is poking and prying with a purpose”. The best purpose is its application into practice. The gap between research and practice can be bridged by “Translating Research Into Practice (TRIP)” - the theme of this Diamond Jubilee issue. TRIP embodies the progression of science and research from the scientist's bench to the clinician's office. Knowledge is transferred from basic to clinical research and thence to practice settings aimed at improving public health.[1,2] An innovation or discovery in biomedical research will remain meaningful only if it serves clinical good. This issue highlights important scientific achievements from our country, which echo this principle. The technology of telemedicine to provide clinical care, where the information is transmitted between individuals who are far from each other, is not new to the medical field. It has been widely used in the field of radiology and pathology where imaging modalities are vital.[3] A report by Vinekar et al.[4] elaborates on a novel platform of telemedicine to screen and treat infants with retinopathy of prematurity (ROP) in outreach centers. The program is named Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) where non-physician graders traveling to peripheral neonatal units in rural and semi-urban underserved regions of the state are trained to image ROP. Although similar programs have been shown to be effective in the Western world, this is the first study where technicians have not only been trained to capture images but also report them at the rural periphery along with a robust tele-ROP platform for remote expert validation. Interestingly, an excellent agreement was observed between technicians and retina specialists in detecting ROP. Albeit the fact that the cost-effectiveness was not assessed, promising results of this study, which is the largest pragmatic program of its kind to be reported worldwide, mandates its inclusion in routine clinical practice in those regions with a similar demographic profile. Another article by Shanmugam[5] talks about the paradigm shift in the use of anti-VEGF antibodies such as bevacizumab, pegaptanib, and ranibizumab in the management of various vasoproliferative and degenerative disorders of the eye in the Indian population. Monoclonal antibodies have revolutionized treatment strategies of age-related macular degeneration, diabetic retinopathy, retinal venous occlusions, and choroidal neovascular membranes. A recent Cochrane systematic review[6] has concluded that these antiangiogenic agents have a definite but small effect size as compared with the conventional grid laser photocoagulation in diabetic macular edema. In addition their efficacy has also been proved in the treatment of age-related macular degeneration.[7] Before their availability, the only treatment option for this sub-group of patients was photodynamic therapy using verteporfin. Although, cost-effective studies have not been published especially in the Indian population, bevacizumab seems to be affordable and comparable to photodynamic treatment.[8] Shanmugham in this article has provided a systematic review of all the original studies of anti-VEGF used in the Indian context. He reports that bevacizumab is the most commonly used drug, albeit “off-label”, with multiple use of a single vial. Gulani[9] in this issue elaborates on a unique and a novel procedure called Corneoplastique TM, which is a boon to patients with corneal scars, corneal transplants, radial keratotomy, and previous cataract surgery and LASIK complications. This minimally invasive and aesthetic technique aims at achieving a visual acuity of 20/20 for patients with all types of refractive errors. Additionally, he describes the various modalities of corneal rehabilitation. We hope that this TRIP issue will ignite the spark for enhancing research in India and promote the untapped research acumen in our clinicians.

Snapshot From Superstorm Sandy: American Red Cross Mental Health Risk Surveillance in Lower New York State

Disasters often cause psychological injury, as well as dramatic physical damage. Epidemiologic research has identified a set of disaster experiences and predisposing characteristics that place survivors at risk for post traumatic stress disorder (PTSD), depression, and anxiety. Rapid triage of at-risk survivors could have benefits for individual and population-level outcomes. We examine American Red Cross mental health risk surveillance data collected from October 29 to November 20, 2012, immediately after Hurricane Sandy in 8 lower New York State counties to evaluate the feasibility and utility of collecting these data. PsySTART, an evidence-based disaster mental health triage tool, was used to record survivor-reported risk factors after each survivor contact. Red Cross disaster mental health volunteers interfaced with survivors at disaster operation sites, including shelters, emergency aid stations, and mobile feeding and community outreach centers. Riskdata were called into the operations center each day and reported by county. PsySTART risk surveillance data for 18,823 disaster mental health contacts are presented for adults and children. A total of 17,979 risk factors were reported. Overall levels of risk per contact were statistically different (χ(2)(1,N=6,045)=248.1; P<.001) across the 8 counties. Survivors with high levels of risk were found in locations apartfrom the areas with the greatest physical damage. Aggregated PsySTART data in Superstorm Sandy indicate substantial population-level impact suggestive of risk for disorders that may persist chronically without treatment. Mental health triage has the potential to improve care of individual disaster survivors, as well as inform disaster management, local health providers, and public health officials.

Organizational Use of a Media Campaign Booklet to Encourage Parent–Child Communication about Waiting to Have Sex

Promoting parent—child communication through the use of print materials may be an important health communication approach for preventing teen sexual activity in the United States. Although prior work has suggested successful methods of disseminating print materials, research has not examined dissemination approaches across organization types. Understanding the use and dissemination of print materials among different organizations is crucial to guiding materials development in a way that maximizes uptake and effectiveness among consumers. Accordingly, this study examined the use of a booklet for parents that encouraged parent–child communication about waiting to have sex as collateral material for a national media campaign. We interviewed staff at 9 community organizations, 9 health care facilities, 5 school-based organizations, and 3 campaign outreach centers. Results suggested variability within and across organization types regarding use of the booklet. Community and outreach center staff tended to walk through the booklet content with parents; health care facilities and education-oriented organizations usually reported both direct and indirect distribution approaches. Staff identified useful elements of the booklet and made suggestions for dissemination in line with prior research. A better understanding of how print materials are utilized to supplement media campaigns can improve their usefulness and potential influence on health behaviors.

Living in the Buckle: Promoting LGBT Outreach Services in Conservative Urban/Rural Centers

LGBT Outreach Center (LOC) faces the difficult task of marketing outreach services to lesbian, gay, bisexual, and transgender (LGBT) individuals in a conservative rural/urban center. Creating internal messages that support the LGBT identity is critical to organizational member support. However, presenting external messages to a community-at-large that tends to be unsupportive of LGBT individuals is daunting. Focus groups identified obstacles to outreach and fundraising. Recommendations are provided for LGBT outreach centers in conservative areas.

Pain among Veterans Returning from Deployment in Iraq and Afghanistan: Update on the Veterans Health Administration Pain Research Program

In November 1998, the former Undersecretary for Health for the Department of Veterans Affairs (VA), Dr. Kenneth Kizer, launched the Veterans Health Administration (VHA) National Pain Management Strategy establishing pain management as a national priority. The overall objective of the national strategy is to develop a comprehensive, multicultural, integrated, system-wide approach to pain management that reduces pain and suffering and improves quality of life for veterans experiencing acute and chronic pain associated with a wide range of injuries and illnesses, including terminal illness. Among the key elements of the strategy, a need to “expand basic and applied research on management of acute and chronic pain, emphasizing conditions that are most prevalent among Veterans,” was articulated. The importance of this initiative cannot be overemphasized. There are over 23 million U.S. Military Veterans, and in 2008, approximately 5.8 million veterans received care in any of the VHA's 154 medical centers, 765 community-based outpatient clinics, and/or 230 veteran outreach centers. Of those receiving primary care in VHA facilities, as many as 50% of male veterans and as many as 75% of female veterans report the presence of pain [1,2]). Similarly, high rates of pain are documented among veterans returning from deployment in the recent wars in Iraq and Afghanistan, and painful musculoskeletal conditions are by far the most common diagnosed medical problems among these veterans, far surpassing the prevalence of other medical and mental health disorders [3]. Among veterans who have experienced polytrauma, defined as injury to two or more body parts or systems that results in cognitive, physical, psychological, or other psychosocial impairments, rates of pain may be even higher [4,5]. The presence of pain is known to be associated with a high prevalence of other mental health conditions, including post-traumatic stress disorder (PTSD) and depression [4]. Beyond the …

Experiences of stigma and discrimination endured by people suffering from schizophrenia.

Objective:It is important to understand stigma in India, given its varied culture and mixture of rural and urban populations. Information from western literature cannot be applied without considering the sociocultural differences.Aims:The research aimed to study the subjective experiences of stigma and discrimination undergone by people suffering from schizophrenia in rural and urban environments in India.Settings and Design:Patients were selected from the outpatient services of six adult psychiatric units of the National Institute of Mental Health and Neurosciences (NIMHANS), India, and from the six outreach centers located in rural areas.Materials and Method:Two hundred patients diagnosed with schizophrenia were selected from rural and urban areas. The experiences of stigma and discrimination were assessed using a semi-structured instrument.Statistical Techniques:Both quantitative and qualitative analyses were done.Results:Significant differences were seen between rural and urban respondents. Urban respondents felt the need to hide their illness and avoided illness histories in job applications, whereas rural respondents experienced more ridicule, shame, and discrimination. The narratives provide direct views of patients, supporting the key findings.Conclusion:Mental health programs and policies need to be sensitive to the consumers’ needs and to organize services and to effectively decrease stigma and discrimination.