Sustainable Public Health Research Articles

Opportunities and Challenges for Practical Training in Public Health: Insights from Practicum Coordinators in Ontario.

Dietetic educators and practicum coordinators (PC) play critical roles in preparing students for practice. Dietitians have made significant progress in the development of educational curricula, competencies, and other resources to support knowledge and skill attainment in public health. There are identified gaps in the literature concerning practical training in sustainable food systems and public health, creating barriers in knowledge exchange and improvements in practicum programs in Canada. This paper discusses the potential opportunities and challenges associated with the number of placements for practical training in public health based on interviews with PCs in Ontario. The findings are limited to the perspectives of 7 PCs with experience in practical training and are a starting point for ongoing evaluation. Identified opportunities within traditional and "emerging settings" for practical training in public health included: the uniqueness of the experience, the potential for students to learn outside their comfort zones, and greater possibilities for dietitians in new roles and settings. Challenges included the need for significant PC engagement with nondietetic preceptors and a narrow view of dietetic practice among some dietitians. Interprofessional teams, emerging settings, and flexible learning approaches may create and support practical training opportunities in food systems and public health going forward.

Assessing the Linkages between Knowledge and Use of Veterinary Antibiotics by Pig Farmers in Rural China.

Improper use of veterinary antibiotics (VAs) has led to antibiotic resistance and food safety issues that are harmful for sustainable development and public health. In this study, farmers’ knowledge influencing their usage of veterinary antibiotics was analyzed based on a survey of 654 pig farmers in Funing County, China. A behavior probability model was constructed, and a Matlab simulation was used to evaluate the dynamic changes in farmers’ behavioral choice regarding VAs use. The survey results showed that the 654 pig farmers’ knowledge of VAs were relatively poor, along with a high occurrence of improper behavior. Specifically, 68.35% of the 654 surveyed pig farmers admitted their violation of VAs use regulations, while 55.50% among them overused and 24.31% among them misused VAs. The simulation results showed that the probability of improper VA use decreased with the increase in farmers’ knowledge about VA use specification, and when farmers’ knowledge about the hazards of VA residues increased. However, when farmers had a high level of knowledge about relevant laws and their penalties, there was still a high probability of improper VA use.

Perceptions and experiences of early-adopting registered dietitians in integrating nutrigenomics into practice

PurposeThe purpose of this paper is to explore the perceptions and experiences of early adopters of the technology.Design/methodology/approachRegistered dietitians (RDs) (n=14) were recruited from the UK, Canada, South Africa, Australia, Mexico and Israel. Six qualitative interviews and two focus groups were conducted online using a conference calling platform. Data were recorded, transcribed and thematically analyzed.FindingsEarly adopters of nutrigenomics (NGx) were experienced, self-efficacious RDs who actively sought knowledge of NGx through communication with one another and the broader scientific community. They considered NGx an extension of current practice and believed RDs had the skills to deliver it. Perceived barriers to widening the application of NGx were linked to skepticism among the wider dietetics community. Proliferation of unregulated websites offering tests and diets was considered “pseudoscience” and detrimental to dietetics fully embracing NGx. Lack of a sustainable public health model for the delivery of NGx was also perceived to hinder progress. Results are discussed with reference to “diffusion of innovation theory.”Originality/valueThe views of RDs who practice NGx have not been previously studied. These data highlight requirements for future dietetic training provision and more inclusive service delivery models. Regulation of NGx services and formal recognition by professional bodies is needed to address the research/practice translation gap. Further research is required to inquire as to the views of the wider dietetics profession.

Toward sustainable environmental quality: Identifying priority research questions for Latin America.

ABSTRACTThe Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab‐to‐field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical questions will support development of long‐term strategic research efforts to advance more sustainable environmental quality and protect public health and the environment in LA. Integr Environ Assess Manag 2018;14:344–357. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC)

Effective translation of a type-2 diabetes primary prevention programme into routine primary care: The PreDE cluster randomised clinical trial

AimsWe assessed the effectiveness of a Type 2 diabetes mellitus (T2D) prevention programme in routine primary health care (PHC) in high-risk patients. MethodsPhase IV cluster clinical trial involving 14 PHC centres in the Basque Health Service were randomised to the DE-PLAN educational healthy lifestyle promotion programme or standard care. All non-diabetic 45- to 70-year-old PHC attendees considered at high risk of T2D (FINDRISC ≥ 14 points) were eligible. The primary outcome was the 24-month cumulative incidence of T2D confirmed by oral glucose tolerance testing. Secondary outcomes were self-reported physical activity and dietary changes at 12 months in a subsample. ResultsOf the 4170 patients screened, 2128 (51%) were considered high risk, but 355 (33%) and 459 (43.6%) refused to participate in the control and intervention groups, respectively. Of all eligible non-diabetic patients, 634 and 454 were included in the control and intervention arms, 545 (85.9%) and 411 (90.5%) completed the follow-up. Intention-to-treat cumulative incidences of T2D were 12.1% (77/634) in the control group and 8.4% (38/454) in intervention group, with an absolute difference of 3.8% (95% CI: 0.18%–7.4%, p = 0.045) and a relative risk reduction of 32% (0.68; 95% CI: 0.47–0.99, p = 0.048) in favour of the intervention. Intervention patients were 1.83-fold more likely to meet recommended physical activity levels at 12 months (95% CI: 1.06–3.17, p = 0.03). ConclusionsThe DE-PLAN programme was effective in reducing T2D incidence in PHC high-risk patients. Research on implementation strategies to improve its feasible and sustainable adoption, reach and public health impact is warranted.

Hypertension control activities in Latin America and the Caribbean: opportunities for late-stage (T4) translation research.

ABSTRACTThis work had two objectives: (1) to identify the extent of the problem and gaps pertaining to hypertension control in Latin America and the Caribbean (LAC) and (2) to identify the potential role for late-stage (T4) translation research to tackle the current and future hypertension burden in that region. We explored the extent of the problem and the potential opportunities to use late-stage (T4) translation research to address it. We analyzed calls to action and policies implemented within several LAC countries and also at the regional level. Some LAC countries are currently developing comprehensive plans for controlling noncommunicable diseases. Additionally, the Pan American Health Organization (PAHO) is working on implementing a comprehensive plan of action within the PAHO Strategy for the Prevention and Control of Noncommunicable Diseases. These endeavors underscore the need for and the relevance of implementing effective, evidence-based, affordable interventions for treating and controlling hypertension. In these efforts, late-stage (T4) translation research can help to determine the best strategies for delivery of hypertension control. This late-stage (T4) translation research should involve all relevant stakeholders and partners in order to best enhance and scale up appropriate, affordable, and sustainable public health interventions.

Ionic Liquids As Tunable Toxicity Storage Media for Sustainable Chemical Waste Management

Storage and handling of toxic wastes is a top-priority challenge for sustainable development and public health. In recent years, the risk of irreversible environmental pollution has been increasing gradually, necessitating the development of new concepts in this highly demanding area. Here, we report a flexible approach to address the problem using tunable ionic liquids as a carrier and storage medium for chemicals. Encapsulation in microscale tunable media surrounded by an inert ionic liquid facilitates the efficient capture of chemicals. The adaptive character of the designed microscale compartments opens new possibilities for the waste management of chemicals of a diverse nature. Real-time field-emission scanning electron microscopy was used to visualize the formation of microscale compartments upon the sequestration of chemicals in ionic liquids. Ionic liquids captured the chemicals better than traditional organic solvents or water; moreover, the chemicals subsequently could be effectively extracted f...

A Ball Skills Intervention in Preschoolers: The CHAMP Randomized Controlled Trial.

Fundamental motor skills (FMS) contribute to positive health trajectories. A high level of competence in ball skills (a subset of FMS) is a predictor for time spent in moderate- to vigorous-intensity physical activity during adolescence. This study examined the effects of a ball skills intervention on ball skill competence among preschool-aged boys and girls. This is a two-armed randomized controlled trial. A total of 124 preschoolers (Mage ± SD = 48.14 ± 6.62 months) were randomly assigned to one of two groups, the Children's Health Activity Motor Program (CHAMP; n = 81) or control (n = 43). FMS were measured before, after (9 wk), and at retention (18 wk) using the object control subscale of the Test of Gross Motor Development, Second Edition. Changes in ball skill scores were calculated (pretest-posttest, pretest-retention, posttest-retention) and were compared using one-way ANOVAs with post hoc Scheffe analysis. Findings support that groups demonstrated significantly different rates of change from pretest to posttest (F3,117 = 179.45, P < 0.001), pretest to retention (F3,113 = 95.8, P < 0.001), and posttest to retention (F3,113 = 189.89, P < 0.001). Compared with their control group peers, CHAMP boys and girls had greater positive rates of change from pretest to posttest and pretest to retention as well as greater negative rates of change from posttest to retention. CHAMP was effective in improving and maintaining ball skills in preschool-age boys and girls. Findings support that providing a high-quality motor skill program in early childhood settings could potentially be a sustainable public health approach to promoting FMS and positive developmental trajectories for health.

A community approach as a lever for integrated health &amp; social care

As a worldwide trend in health care and social care, new organizational arrangements and care perspectives focus more on a socio-ecological perspective towards integrated forms of health and social care (1,2,3). Based upon principles of social equity, sustainability and collective responsibility, a community-oriented Integrated Care Model is developed within health and social care (IC-model). This framework is acknowledged in both scientific papers (4) and international policy documents, including WHO-declarations (5). The community-oriented Integrated Care Model is developed as an alternative for the actual highly fragmented care delivery, the recently growing interplay between social care and health care and the access problem to health care and social care for the most socially vulnerable citizens (6,7). This framework is characterized by a community orientation, where integrated primary health care and social care can contribute to more positive health outcomes and social equity (8). In this exploratory study, an interdisciplinary research team (i.e. welfare and health academics) examine how a community (health) approach can be a lever for integrated health care and social care, and which roles community (health) workers can play in this approach. In this study the community-oriented (health) approach is scrutinized in the context of primary health care in Flanders (Belgium). Based on ethnographic research methodology, namely a combination of literature review, fieldwork (participant observation and document analyses) and interviews with (health and welfare) professionals, patients and informal caregivers (n=40), this research question is studied in three particular community health centres in Ghent (Flanders). The results will be available at the conference 2017. References : 1- Bentley M. An ecological public health approach to understanding the relationships between sustainable urban environments, public health and social equity. Health Promotion International, 2014;29(3): 528–37. 2- Conill EM. The socio-ecological and primary care approach to the creation of universal health systems in the work of Hernan san Martin. Cienc. saude coletiva. 2016;21(1):173-178. 3- De Maeseneer J, et al., Together we change. Eerstelijnsgezondheidszorg: nu meer dan ooit! Brussel. 2014 4- Lloyd J. and Wait S. Integrated Care: A guide for policymakers. London: Alliance for Health and the Future. 2005 5- World Health Organization (WHO). The World Health Report 2008: Primary Health Care – Now More Than Ever. 2008, Geneva. 6- Enthoven AC. Integrated delivery systems: the cure for fragmentation. Am J Manag Care. 2009;15(10):284-90. 7- Xyrichis A., & Lowton K. What fosters or prevents interprofessional teamworking in primary and community care? A literature review. International Journal of Nursing Studies, 2008;45: 140-153. 8- Shi L, The Impact of Primary Care: A Focused Review. Scientifica, 2012: 22.

Community Coalitions’ Gender-Aware Policy and Systems Changes to Improve the Health of Women and Girls

BackgroundAddressing environmental barriers and community conditions through policy and systems change provides the foundation for creating sustainable public health change at the population level. In an effort to influence population-level change that is gender aware, the United States Department of Health and Human Services Office on Women's Health funded the Coalition for a Healthier Community initiative supporting 10 grantees in the implementation of gender-based, public health systems approaches to improve women and girls' health. MethodsA national evaluation assessed the extent to which these gender-aware public health systems approaches result in programs and policies that are sustainable and cost effective in addressing health disparities in women and girls. For this paper, a review of policies reported on in grantees' quarterly progress reports was conducted, and policies were categorized based on each policy's status, level, sector affected, and whether it was gender aware. ResultsThe review revealed 77 policies at varying stages of development or implementation intended to facilitate systems-level change at the coalition, school, organizational, local, or state level. Fifty-one percent of these policies were identified as being gender aware, because they were intended to reduce barriers to or increase facilitators of gender equity. ConclusionsCommunity coalitions, like the Coalition for a Healthier Community coalitions, can be valuable channels for promoting policy change, as demonstrated by the many policies developed and/or supported by the Coalition for a Healthier Community grantees in their attempt to meet the needs of women and girls.

Volunteer Youth Leaders for Health - Philippines: Providing a Mechanism for Youth Empowerment towards Advocacy for Birth Defects Prevention and Care

The Volunteer Youth Leaders for Health - Philippines (VYLHPhilippines) is a national youth network established in 2009 as a model of how to organize young women and men into a national force that promotes self-learning, independence, personal growth and sustained positive public health change from the grassroots level and up. Formed under the aegis of the University of the Philippines Manila and the Department of Health, the VYLH-Philippines has focused its activities in the past eight years on helping reduce mortality and disability from congenital disorders through awareness programs and support for policy development. This paper describes in detail the organization and extraordinary accomplishments of the VYLHPhilippines to date.

An outline of anemia among adolescent girls in Bangladesh: findings from a cross-sectional study

BackgroundAnemia is a significant wide spread public health threat especially among the adolescent girls who are more vulnerable towards low level of hemoglobin particularly of low and middle income countries (LMICs). We investigated the prevalence of anemia among the adolescent girls (10–19 years) in Bangladesh and its socio-demographics distribution.MethodsWe collected data digitally in ODK platform from a sub-sample of a nationwide cross-sectional survey of 1314 adolescent girls in 2015. Capillary blood hemoglobin level was estimated using HemoCue®; anthropometric measurements through standardized procedure and details socio-demographic information were captured and analyzed. Malnutrition was defined as BMI-for-age Z-score below -2SD (BAZ < −2SD), measured in WHO-AnthroPlus. Univariate analysis followed by multiple logistic regression were performed to examine the association between socio-demographic variables and anemia, while controlling the effect of potential confounding variables.ResultsOverall, 51.6% girls were suffering from any form of anemia (non-pregnant-Hb < 12 g/dl; pregnant-Hb < 11 g/dl) while 46% were mildly (non-pregnant-Hb: 10–11.9 g/dl; pregnant-Hb: 10–10.9 g/dl) and 5.4% were moderately (Hb: 7–9.9 g/dl) anemic while only 0.2% were severely anemic. After controlling for relevant covariates in multiple logistic regression model, malnutrition (AOR: 1.42, 95% CI = 1.0–2.10, p-value = 0.083), non-pregnancy (AOR: 6.10, 95% CI = 2.70–13.78, p-value < 0.001), and households with bottom wealth quintile (AOR: 1.54, 95% CI = 1.03–2.30, p-value = 0.037) were identified as significant risk factors of anemia among adolescent girls of Bangladesh.ConclusionsHigher number of adolescent girls are still suffering from anemia in Bangladesh and non-pregnant adolescent girls contributed the most. Immediate, long term and sustainable public health intervention would require to combat the situation.

Experimental study of tuberculosis: From animal models to complex cell systems and organoids.

Tuberculosis (TB) is a devastating disease to mankind that has killed more people than any other infectious disease. Despite many efforts and successes from the scientific and health communities, the prospect of TB elimination remains distant. On the one hand, sustainable public health programs with affordable and broad implementation of anti-TB measures are needed. On the other hand, achieving TB elimination requires critical advances in three areas: vaccination, diagnosis, and treatment. It is also well accepted that succeeding in advancing these areas requires a deeper knowledge of host—pathogen interactions during infection, and for that, better experimental models are needed. Here, we review the potential and limitations of different experimental approaches used in TB research, focusing on animal and human-based cell culture models. We highlight the most recent advances in developing in vitro 3D models and introduce the potential of lung organoids as a new tool to study Mycobacterium tuberculosis infection.

Hypertension and Cardiovascular Risk Profile in a Middle-Income Setting: The HELISUR Study.

Hypertension is the leading risk factor responsible for premature death worldwide, but its burden has shifted to low- and middle-income countries. Therefore, we studied hypertension and cardiovascular risk in the population of Suriname, a middle-income country with a predominantly urban population of African and Asian ancestry. A random sample of 1,800 noninstitutionalized men and women aged 18-70 years was selected to be interviewed at home and examined at the local hospital for cardiovascular risk factors, asymptomatic organ damage, and cardiovascular disease. The 1,157 participants examined (37% men) were mainly of self-defined Asian (43%) or African (39%) ancestry, mean age 43 years (SD 14). The majority of the population (71%) had hypertension or prehypertension, respectively, 40% and 31%. Furthermore, 72% was obese or overweight, while 63% had diabetes or prediabetes. Only 1% of the adult population had an optimal cardiovascular risk profile. Hypertension awareness, treatment, and control were respectively 68%, 56%, and 20%. In line with this, 22% of the adult population had asymptomatic organ damage, including increased arterial stiffness, left ventricular hypertrophy, microalbuminuria, or asymptomatic chronic kidney disease. In this first extensive cardiovascular assessment in the general population of this middle-income Caribbean country, high prevalence of hypertension with inadequate levels of treatment and control was predominant. The findings emphasize the need for collaborative effort from national and international bodies to prioritize the implementation of affordable and sustainable public health programs that combat the escalating hypertension and cardiovascular risk factor burden.

Analysis of temperature data over semi-arid Botswana: trends and break points

Climate change is a global challenge which impacts negatively on sustainable rural livelihoods, public health and economic development, more especially for communities in Southern Africa. Assessment of indices that signify climate change can inform formulation of relevant adaptation strategies and policies for the communities. Diurnal temperature range (DTR) is acknowledged as an expedient measure of the scourge as it is sensitive to variations in radiative energy balance. In this study, a long-term (1961–2010) daily temperature data obtained from nine (9) synoptic stations in Botswana were analyzed for monotonic trends and epochal changes in annual maximum (T max), minimum (T min) temperatures and DTR time series. Most of the considered stations were along the Kalahari Transect, a region which is at high risk of extensive environmental change due to climate change. Mann–Kendall trend and Lepage tests were applied for trend and change point analysis, respectively. The statistical analysis shows that stations in the southern part of the country experienced significant negative trends in annual DTR at the rate of −0.09 to −0.30 °C per decade due to steeper warming rates in annual T min than annual T max trends. On the contrary, stations in the northern part of the country experienced positive trends in annual DTR brought about by either a decreasing annual T min trend which outstripped annual T max or annual T max which outpaced annual T min. The increasing trends in DTR varied from 0.25 to 0.67 °C per decade. For most of the stations, the most significant annual DTR trends change point was in 1982 which coincided with the reversal of atmospheric circulation patterns.

Effects of Sectoral Diversity on Community Coalition Processes and Outcomes.

Collaboration with diverse partners is challenging but essential for the implementation of prevention programs and policies. Increased communication with partners from diverse sectors may help community coalitions overcome the challenges that diversity presents. We examined these issues empirically in a study of 17 substance use prevention coalitions in Mexico. Building on coalition and workgroup literatures, we hypothesized that sectoral diversity would improve outcomes but undermine coalition processes. Conversely, we expected uniformly positive effects from higher levels of intersectoral communication. Data are from a 2015 survey of 211 members within the 17 community coalitions. Regression models used sectoral diversity and intersectoral communication to predict coalition processes (cohesion, leader-member communication, efficiency) and outcomes (community support, community improvement, sustainability planning). Sectoral diversity was negatively associated with coalition processes and was not associated with coalition outcomes. Intersectoral communication was positively associated with two of the three measures of coalition outcomes but not associated with coalition processes. Our findings concur with those from prior research indicating that sectoral diversity may undermine coalition processes. However, more communication between sectors may facilitate the coalition outcomes of community support and sustainability planning. Skilled team leaders and participatory decision making may also help coalitions promote intersectoral communication, thereby engaging diverse community sectors to implement preventive interventions and actualize sustained public health impact.

Towards Sustainable Public Health Surveillance in India: Using Routinely Collected Electronic Emergency Medical Service Data for Early Warning of Infectious Diseases

Infectious disease surveillance, timely detection and early warning of outbreaks present a complex challenge to health authorities in India. Approaches based on the use of unexplored data sources, like emergency medical services (EMS) data, can contribute to the further advancement of public health surveillance capacities in India and support and strengthen the Integrated Disease Surveillance Programme (IDSP) strategy. This research followed a mixed method approach including a series of semi-structured interviews and fever data analysis of the EMS operating dispatch system in Andra Pradesh, India. In this paper, we explore whether routinely collected EMS health data can improve sustainable infectious disease surveillance and early warning capacity. The result highlights the need for improved surveillance systems for early warning of infectious diseases in India. The data availability at the EMS dispatch centre includes patient data and spatial information and can be used for near real-time analysis. Routine data relevant for health surveillance can be extracted to provide timely health information that supplements and enhances more traditional surveillance mechanisms and thus provides a cost-efficient, near real-time early warning system for the operating states. The designed intervention is sustainable and can improve infectious disease surveillance to potentially help the government officials to appropriately prioritize timely interventions to prevent infectious disease spread.

Tracing Africa\u2019s progress towards implementing the Non-Communicable Diseases Global action plan 2013\u20132020: a synthesis of WHO country profile reports

BackgroundHalf of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013–2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa’s progress towards WHO policy recommendations for reducing the NCD burden.MethodsData from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports.ResultsMore than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive.ConclusionOur findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa.

A globally networked hybrid approach to public health capacity training for maternal health professionals in low and middle income countries

BackgroundMundoComm is a current NIH-funded project for sustainable public health capacity building in community engagement and technological advances aimed at improving maternal health issues. Two to four teams are selected annually, each consisting of three healthcare professionals and one technical person from specific low and middle income countries (LMICs) including Costa Rica, Dominican Republic, Honduras, and other LMICs. MundoComm is a course with three parts: in-person workshops, online modules, and mentored community engagement development. Two annual 1-week on-site “short courses” convened in Costa Rica are supplemented with six monthly online training modules using the Moodle® online platform for e-learning, and mentored project development. The year-long course comprises over 20 topics divided into the six modules - each module further segmented into 4 week-long assignments, with readings and assigned tasks covering different aspects of community-engaged interventions. The content is peer reviewed by experts in the respective fields from University of Rochester, UCIMED in Costa Rica, and faculty from Costa Rica and the Dominican Republic who maintain regular contact with the trainees to mentor learning and project progress. The purpose of this paper is to report the first year results of the MundoComm project.MethodsBoth quantitative and qualitative feedback (using online data capturing forms) assess baseline and post-training knowledge and skills in public health project strategies.ResultsThe course currently has one team each in Costa Rica, the Dominican Republic, and Honduras for a total of 12 trainees. The course and modules include best practices in information and communication technologies (ICTs), ethical reviews, community engagement, evidence-based community interventions, and e-Health strategies. To maximize successful and culturally appropriate training approaches, the multi-media didactic presentations, flexible distance learning strategies, and the use of tablets for offline data collection are offered to trainees, and then feedback from trainees and other lessons learned aid in the refinement of subsequent curricular improvements.ConclusionsThrough remark and discussion, the authors report on 1) the feasibility of using a globally networked learning environment (GNLE) plus workshop approach to public health capacity training and 2) the capacity of LMIC teams to complete the MundoComm trainings and produce ICT-based interventions to address a maternal health issue in their respective regions.

Sustainable public health systems for rare diseases.

In the framework of the Joint Action for Rare Diseases (RD-ACTION), a specific task was defined to identify mechanisms influencing sustainability, equity and resilience of health systems for rare diseases (RDs). Literature narrative review on health systems sustainability and resilience for RDs. Years: 2000-2015. Databases: PubMed, Scopus, EBSCOHost, EMBAL, PASCAL, EMBASE, STN International and GoogleScholar. interpretive synthesis concept and thematic analysis (Dixon-Wood, et al.). 97 papers and 4 grey literature publications were identified. Two main topics stand out: economic evaluation and networks. The first topic did not identify widely accepted criterion to assign more weight to individuals with greater health needs. Healthcare network are identified as increasingly important for sustainability and resilience, in all of their aspects: professional "expertise", "experience" networks of users and carers; policy, learning, and interest networks. Possible mechanisms for ensuring sustainability can be identified in networking, patients' empowerment and reorienting healthcare towards integrated community and home care.