Use Of Community Resources Research Articles

Characteristics of children and adolescents with recurrent mental health emergency visits and clinicians' intervention tendencies.

Mental disorders affect approximately 15%-20% of childhood. However, due to various factors, these individuals do not benefit sufficiently from mental health services. Therefore, psychiatry emergency services become a key system in the need of psychiatric care for these children. This study aims to reveal the factors that predict recurrent admissions in children and adolescents admitted to the emergency department of a psychiatric hospital and the tendencies of clinicians during management. In our study, the data of patients aged 0-18 years who applied to the emergency department between 1 March 2022 and 01 March 2023 were scanned retrospectively. Participants who applied once were included in the 'single applicant' group, whereas patients who applied two or more times were included in the 'repeated applicants' group. A total of 1563 emergency applications were recorded by 785 different patients. A total of 62.2% of the patients visited the emergency department once, while 37.8% applied two or more times. Non-suicidal self-injury, delusion/hallucination, irritability and depression were significantly higher in recurrent applicants (P < 0.05). Psychotic disorder, bipolar disorder, major depression and borderline personality traits were significantly frequent in these patients (P < 0.05). Additionally, it was determined that the number of psychiatric diagnoses, referral time, need for chemical restraint, having a diagnosis of psychotic disorder or borderline personality traits increased the likelihood of recurrence. Our results indicate some special risk factors that increase the likelihood of recurrent emergency admissions in children and adolescents. Further research with larger sample sizes may elucidate the unique needs of these children in order to use of community resources beneficially.

Hydrology and trophic flexibility structure alpine stream food webs in the Teton Range, Wyoming, USA

AbstractUnderstanding biotic interactions and how they vary across habitats is important for assessing the vulnerability of communities to climate change. Receding glaciers in high mountain areas can lead to the hydrologic homogenization of streams and reduce habitat heterogeneity, which are predicted to drive declines in regional diversity and imperil endemic species. However, little is known about food web structure in alpine stream habitats, particularly among streams fed by different hydrologic sources (e.g., glaciers or snowfields). We used gut content and stable isotope analyses to characterize food web structure of alpine macroinvertebrate communities in streams fed by glaciers, subterranean ice, and seasonal snowpack in the Teton Range, Wyoming, USA. Specifically, we sought to (1) assess community resource use among streams fed by different hydrologic sources, (2) explore how variability in resource use relates to feeding strategies, and (3) identify which environmental variables influenced resource use within communities. Average taxa diet differed among all hydrologic sources, and food webs in subterranean ice‐fed streams were largely supported by the gold alga Hydrurus. This finding bolsters a hypothesis that streams fed by subterranean ice may provide key habitat for cold‐water species under climate change by maintaining a longer growing season for this high‐quality food resource. While a range of environmental variables associated with hydrologic source (e.g., stream temperature) were related to diet composition, hydrologic source categories explained the most variation in diet composition models. Less variable diets within versus among streams suggest high trophic flexibility, which was further supported by high levels of omnivory. This inherent trophic flexibility may bolster alpine stream communities against future changes in resource availability as the mountain cryosphere fades. Ultimately, our results expand understanding of the habitat requirements for imperiled alpine taxa while empowering predictions of their vulnerability under climate change.

Rural Natural Disaster Stress: A Survey of Community Resource Use and Effect

ABSTRACT Objective This study identified rural community experiences and preferences related to available resources and their effects on stress following tornadoes and floods. Methods The Rural Natural Disaster Stress and Recovery survey was distributed from December 2021 to February 2022 in rural disaster-affected communities. Within the analysis sample (N = 159) of self-selected participants representing both agricultural and non-agricultural occupations, 125 responded to the Resource Use and Effect survey component that evaluated the effects of 22 resources on post-disaster stress. Additional qualitative questions provided further data. Results The most frequently used resources post-disaster were found to be talking about the event (98.3%), friends and neighbors (97.6%) and family (97.6%). Using a derived Impact per Use score, groups from the neighboring community and personal faith activities most often reduced stress. Resources that increased stress were identified as FEMA or other government organizations; repairing, replacing, or rebuilding property; and following news or social media. Participants reported help from their community (35.8%) or things they did for themselves (31.2%) most effectively decreased disaster stress. Family, friends, faith, neighbors, and community were top choices to decrease stress in a future disaster. Conclusion Rural residents identified available resources for reducing disaster stress, but some common post-disaster activities were found to increase stress. Rural emergency management should adapt response and recovery plans and activities to leverage readily accessible people, groups, and activities to mitigate negative mental and emotional health effects.

The TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD): economic analysis

BackgroundIndigenous populations have increased risk of developing diabetes and experience poorer treatment outcomes than the general population. The FORGE AHEAD program partnered with First Nations communities across Canada to improve access to resources by developing community-driven primary healthcare models.MethodsThis was an economic assessment of FORGE AHEAD using a payer perspective. Costs of diabetes management and complications during the 18-month intervention were compared to the costs prior to intervention implementation. Cost-effectiveness of the program assessed incremental differences in cost and number of resources utilization events (pre and post). Primary outcome was all-cause hospitalizations. Secondary outcomes were specialist visits, clinic visits and community resource use. Data were obtained from a diabetes registry and published literature. Costs are expressed in 2023 Can$.ResultsStudy population was ~ 60.5 years old; 57.2% female; median duration of diabetes of 8 years; 87.5% residing in non-isolated communities; 75% residing in communities < 5000 members. Total cost of implementation was $1,221,413.60 and cost/person $27.89. There was increase in the number and cost of hospitalizations visits from 8/$68,765.85 (pre period) to 243/$2,735,612.37. Specialist visits, clinic visits and community resource use followed this trend.ConclusionConsidering the low cost of intervention and increased care access, FORGE AHEAD represents a successful community-driven partnership resulting in improved access to resources.

“I’m Doing the Best that I Can”: Mothers Lived Experience with Food Insecurity, Coping Strategies, and Mental Health Implications

BackgroundFood insecurity can have lasting physical and mental health consequences. The experience of food insecurity within a household may disproportionately impact mothers because they tend to manage the household food environment. ObjectiveThis study sought to understand the stresses faced by United States mothers experiencing food insecurity, related coping mechanisms, and the impacts of these stressors on their mental health. MethodsSemistructured interviews were conducted in May and June 2022 with a purposive sample of Virginia mothers who reported experiences of food insecurity. Participants were recruited from a related survey and university and community LISTSERVs. Interviews were transcribed and analyzed by trained coders. A thematic analysis was conducted to describe themes that emerged from the data. Virtual interviews were 20–60 min in duration. Mothers with children living in their household, having experienced food insecurity, and living in Virginia were eligible. ResultsThe following 3 themes emerged from the interviews with the mothers (n = 15): 1) food insecurity added stress to mothers’ lives in multiple ways (e.g. worry about obtaining the “right” foods and internalized or experienced stigma), 2) mothers used positive and negative coping strategies to address the impacts of these stressors (e.g. use of community resources and reduced personal food intake), and 3) the stressors and coping strategies had varying impacts on mothers’ mental health (e.g. added to existing mental health challenges or reduced their mental capacity to make changes). ConclusionsStudy findings suggest that a multilevel and tailored approach to address diverse stressors is warranted. Future research should explore emotional coping strategies that comprehensively empower mothers to manage stressors, leverage resources, and reduce social stigma associated with food insecurity and accessing nutrition and mental health assistance. This may improve their household food security and mitigate the burden of stressors on their mental health because system-level solutions to food insecurity are pursued.

The Relationship between Cognitive Impairment in Psychiatric Patients and Readmission Rate to an Inpatient Facility

The primary intention of this study was to further understand the impact of assessing cognitive impairment in psychiatric patients, as a mediating factor on readmission rates. Mild cognitive dysfunction impacts a patient’s functional outcomes [1,2]. Little information exists to guide best practices in the treatment of adults with cognitive impairment who are hospitalized for acute conditions [2]. A cognitive impairment may impact patient prognosis and ability to function outside of a setting focused on stabilization. Neuropsychological testing is a valuable tool in predicting a patient’s cognitive potential. However, creating a battery of tests that must be short enough to fit the needs of patients within an inpatient setting, allowing them to demonstrate their ability, while still providing enough information for accurate diagnosis and prognosis is a challenge. Overall, this study aimed to investigate the utilization of brief cognitive screeners in identifying patients that may be more vulnerable to relapse and readmission. Cognitive impairment was assessed utilizing the Montreal Cognitive Assessment (MoCA). Readmission rate is defined by total admissions per individual patient. The use of community resources, such as medication management, case management, housing programs, and their relationship with readmission rates was examined. Archival data was taken from an inpatient facility’s HIPAA-compliant electronic medical record (EMR) database. All personal identifying information was de-identified to ensure minimal risk of breaching confidentiality. Although all objectives demonstrated significant correlations among the variables, there were no significant predictive models. This study found a positive linear relationship between admission rate and a higher MoCA score. This may partially be explained by Age (M = 69.09, SD = 8.25) having a negative relationship with inpatient readmission rate and a positive relationship with community resources. Within the inpatient setting, patients with higher cognitive functioning may be more aware of their mental health symptoms and are more likely to seek help. This may lead to more frequent admissions as they are able to seek help to address their mental health concerns. The relationship between patient demographics, community resource usage, and readmission rate was also examined. Limitations of this study included the use of archival data, a small sample size, and a lack of diversity within the sample. Future directions for research include norming the MoCA for psychiatric populations and examining deficit patterns within the cognitive domains.

Preliminary results of a feasibility study of CONFIDENCE: An intervention to reduce financial strain among Latino family caregivers

AbstractBackgroundLatino/Hispanic family caregivers to persons living with Alzheimer’s disease and related dementias (ADRD) spend 47% of their annual income on the out‐of‐pocket costs of caregiving compared to 26% of annual income spent among caregivers of any race or ethnicity.1 This presentation describes the preliminary results of the CONFIDENCE psychoeducational intervention, developed to reduce the out‐of‐pocket care costs and financial strain among ADRD Latino/Hispanic caregivers. Intervention components were designed to build caregiver resourcefulness, posited to help caregivers displace some out‐of‐pocket costs by increasing the use of community resources. CONFIDENCE consists of five, 1.5‐hour group Zoom sessions. To ensure the intervention was culturally tailored, CONFIDENCE was developed with a Community Advisory Council and informed by qualitative interviews with Latino family caregivers.MethodCONFIDENCE has been delivered at a community agency since May 2022. Data reported here are from the first 5 intervention cohorts. Participation in the study was optional. Study participants were asked to complete a self‐administered online baseline survey before the first session, followed by two surveys sent immediately and 2‐months post‐intervention. Eligible caregivers were Latino/Hispanic, cared for someone living with ADRD for at least 6 months, and were aged 50 or older. (See NCT05292248.) All sessions were delivered in English. Spanish delivery will begin in March 2023.ResultCONFIDENCE was delivered to 27 caregivers, although 55 caregivers registered to attend (49.1%). Of those who attended any of the five sessions, participants attended an average of 2.9 of 5 (SD = 1.4) sessions. Among those who attended at least one session, 56.5% expressed an interest in learning more about the research study when they registered. Of those, six caregivers were eligible to participate and enrolled into the study. Despite lower‐than‐expected participation, those who completed the intervention report high satisfaction. All study completers “Agreed” or “Strong Agreed” that they would recommend CONFIDENCE to others.ConclusionInitial findings suggest a 5‐week, Zoom‐delivered financial psychoeducational intervention may only meet the needs of a narrow portion of ADRD Latino family caregivers. To increase participation, researchers intend to explore alternative forms of delivery that require less time commitment.

정신장애인 자립생활의 개념 및 구성요소에 관한 델파이 기법 연구

The purpose of this study is to elicit the concepts and components of independent living for people with psychiatric disabilities through the Delphi technique. The expert panel consisted of social workers (N=20) with at least five years of experience practicing independent living support services to people with mental disabilities on the front lines of the community and conducted three Delphi technique surveys. All delphi technique survey was performed by e-mail. as a Result, the concept of independent living for people with psychiatric disabilities were 6 domains, which were health of body, mental health, daily living skill, residence and economic activities, the use of community resources and leisure use, protection of rights and interests. Also, the component of Independent living for people with psychiatric disabilities were 44 items. All items of the concept and component were average, construct validity ratio, consensus and convergence for validity verification were proper. Finally, practical and policy implications and recommendations for independent living for people with mental disabilities are discussed based on the results of this study.

Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial

PurposeAdolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. MethodsBetween July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine “socially sensitive” chief complaints) using logistic regression. ResultsA total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DiscussionSocial needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.

Parental support for physical activity and children’s physical activities: a cross-sectional study

BackgroundPhysical activity (PA) in school-aged children is imperative for physical and mental development. However, there has been reduced PA among children in recent years owing to environmental changes, resulting in declining physical strength and athletic ability. Although parents’ and children’s PA has been found to be correlated, the specific parental caregiving attitudes associated with children’s actual levels of PA during school-age years remain unknown. Therefore, this study aimed to examine the relationship between parental support for PA and children’s levels of PA.MethodsIn 2017, a self-reported questionnaire survey was administered to 1,515 third-grade students (8–9 years old) and their caregivers in Nagoya, Aichi, a major metropolitan area in Japan. The main items surveyed included the attitudes of children and parents towards PA and the children’s actual PA level. Multiple regression analysis was conducted with parental involvement related to PA as the explanatory variable and children’s PA as the objective variable.ResultsIn total, 717 children with valid responses were included in the analysis. The mean age of the children was 9.08 ± 0.33 years; 366 (51.0%) were boys, and 351 (49.0%) were girls. For moderate-to-vigorous and vigorous PA, PA levels tended to be significantly higher in children whose parents provided logistic support such as enrolling their children in a sports club. However, for moderate PA and walking, PA levels tended to be significantly higher in children whose parents used community resources. Modeling and limiting sedentary activities were not associated with children’s PA.ConclusionsThe results of this study suggest that direct parental assistance for PA such as logistic support encourages children to engage in moderate-to-vigorous PA; in addition, parental use of community resources may encourage children to engage in moderate and light PA such as walking. Conversely, indirect and negative involvement such as modeling and limiting sedentary activities were not associated with children’s PA. Therefore, logistic support may need to be strengthened to encourage moderate-to-vigorous and vigorous PA, which is important for children’s health.

Use of community resources as health assets for rehabilitation of people with Long COVID in northeastern Spain two years after the outbreak of the COVID-19 pandemic: qualitative study

IntroductionThe epidemiology of Post COVID Condition is not yet known. There are different treatment options, but they are not recommended or suitable for all those affected. For this reason and due to the lack of health treatment, many of these patients have tried to carry out their own rehabilitation through the use of community resources.ObjectiveThe objective of this study is to deepen into the understanding about the use of community resources as assets for health and rehabilitation by people with Long COVID and their utility.MethodologyA qualitative design was carried out with the participation of 35 Long COVID patients, of which 17 subjects were interviewed individually and 18 of them were part of two focus groups. The participating patients were recruited in November and December 2021 from the Primary Health Care centers and through the Association of Long COVID patients of Aragon. The research topics were the use of community resources, before and after their infection by COVID-19, rehabilitation through their use, as well as barriers and strengths for their employment. All analyses were performed iteratively using NVivo software.ResultsLong COVID patients who have used community resources for rehabilitation have seen an improvement in their physical and mental health. Most of them, specifically those affected, have used green spaces, public facilities, physical or cultural activities and associations. The main barriers identified have been the symptoms themselves and the fear of reinfection, with the main advantage of these activities being the perceived health benefits.ConclusionThe use of community resources seems to be beneficial in the recovery process of Long COVID patients, so it is necessary to continue delving into this topic and promote the formal use of the Recommendation of Health Assets from Primary healthcare.

Surviving violent conflicts and climate variability: An intersectional analysis of differentiated access to diversification resources among smallholder farmers in Kuka

Kuka, a sub-district in Shendam Local Government Area of Plateau State-Nigeria has been experiencing violent conflicts since 2001 amidst damning ecological stressors. Between 2001 to date, Shendam Local Government, to which Kuka belongs, has experienced 28 different violent conflicts which were fought largely along ethnic and religious lines. This has intersected with climate variability to generate various risk factors for smallholder farmers in Kuka prompting varied diversification processes. While issues of diversification among smallholder farmers have been well documented in critical literature on adaptation, the extent to which social and relational factors inform differentiated access to diversification resources among smallholder farmers in the specific region of Kuka, to the best knowledge of the researcher, has been least investigated. This study contributes to critical debate on farmers' adaptation strategies by arguing that social and relational factors of sex, age, gender, social capital, economic status, religion and ethnicity intersect to inform differentiated access to diversification resources prompting differentiated vulnerabilities to social and ecological stressors among smallholder farmers in Kuka. This was arrived at by integrating an explanatory sequential design of the mixed methods approach with the Theory of Access to develop questionnaires and interview guides which enabled the collection of field data from 330 participants. It was therefore, recommended that: (1) the relational and social mechanisms of access should be checked to reduce the alienation of smallholder farmers from access and use of community resources, (2) the traditional authorities should work with the various religious leaders to address discriminatory cultural and social practices that inform differentiated access to diversification resources among smallholder farmers, and (3) the people of kuka should engage in collective projects that would provide avenues for cross-cultural and inter-religious interactions bringing about an integration of all social groups and the consequent elimination of discriminatory social practices that inform differentiated treatment of community members.

Community-Based Response to Pandemic: Case Study of Home Isolation Center using Flexible Surge Capacity

Introduction:The SARS-CoV-2 virus 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the Flexible Surge Capacity concept in relieving hospitals by focusing on the community resources to develop “Home Isolation Centers” in Bangkok, Thailand.Method:This is a qualitative study consisting of observational and semi-structured interview data. The development and activities of Home Isolation Centers were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analyzed and categorized based on the practical elements necessary in disaster and emergency management.Results:The obtained data could be categorized into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: 1) coordination and collaboration, 2) staff engagement, 3) responsibility clarification, and 4) sustainability. Safety presented two subcategories: 1) patients’ information privacy and treatment, and 2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment, and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organization guidelines and hospital operations. Several supplies and patient-related challenges were identified and managed during center development.Conclusion:The use of community resources, based on the flexible surge capacity concept, was feasible under restricted circumstances and enabled the relief of hospitals during the pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of the emergencies’ etiology.

Incorporation of community resources in teaching social studies in junior high schools: A case in the adentan district of the greater accra region of Ghana

Social studies education constitutes a diverse aspect of the human ecosystem that needs external resources to enable effective tuition and learning in the classroom. Using external resources has been a significant challenge for Ghana’s junior high school teachers. Given this, the study explored the integration of community resources in teaching social studies in a selected junior high school in the Adentan District in the Greater Accra Region of Ghana. It investigated the factors that militate against using community resources and assessed how these problems could be resolved. The study made use of the random sampling technique, with a sample size of forty (n = 40) students, a teacher (n = 1) and a principal (n = 1). The researchers employed questionnaires and interviews as instruments for gathering data. The expressive survey research design was used as the methodology for the reading. It was revealed that community resources were not efficiently utilised to teach social studies, although the respondents reported its enormous benefits in the teaching-learning procedure. Again, the study identified some factors that impede the use of community resources in teaching social studies; over-reliance on textbooks, lack of means of transport, inflexible timetable, and lack of support and cooperation from parents and other stakeholders. Despite the challenges, we recommend that social studies teachers prioritise integrating community resources in coaching social studies to make it more pragmatic, relevant, and effective.

Community Resources in Social Studies Education: The Case of Tamale College of Education, Northern Region of Ghana

The study sought the level of use of community resources in Senior High School (SHS) within Tamale Metropolis of the Northern Region of Ghana. The explanatory survey research method was adopted to assess the phenomenon of community resource use during Social Studies lessons from the perspectives of SHS Social Studies teachers within the metropolis. The study adopted quantitative methodology in which a sample of 40 Social Studies teachers was selected for the study using purposive sampling technique. Community Resource Use (CRU) questionnaires comprising closed-ended items, were used in generating data from the respondents. The quantitative data obtained were analyzed using frequencies and percentages. Findings of the study showed that even though SHS Social Studies teachers within the Tamale Metropolis perceive the importance of community resources for effective teaching of the subject, the usage of the resources was relatively low. Hence the study recommended that effort should be made by all the stakeholders especially Ghana Education Service (GES) and teachers involved in the Social Studies curriculum implementation to promote the regular use of community resources for effective teaching and learning of Social Studies in SHS within the Metropolis.

Exploration of Cardiology Patient Hospital Presentations, Health Care Utilisation and Cardiovascular Risk Factors During the COVID-19 Pandemic.

COVID-19 and the lockdowns have affected health care provision internationally, including medical procedures and methods of consultation. We aimed to assess the impact of COVID-19 at two Australian hospitals, focussing on cardiovascular hospital admissions, the use of community resources and cardiovascular risk factor control through a mixed methods approach. Admissions data from the quaternary referral hospital were analysed, and 299 patients were interviewed from July 2020 to December 2021. With the admissions data, the number, complexity and mortality of cardiology hospital admissions, prior to the first COVID-19 lockdown (T0=February 2018-July 2019) were compared to after the introduction of COVID-19 lockdowns (T1=February 2020-July 2021). During interviews, we asked patients about hospital and community health resource use, and their control of cardiovascular risk factors from the first lockdown. Admission data showed a reduction in hospital presentations (T0=138,099 vs T1=128,030) and cardiology admissions after the lockdown period began (T0=4,951 vs T1=4,390). After the COVID-19-related lockdowns began, there was an increased complexity of cardiology admissions (T0=18.7%, 95% CI 17.7%-19.9% vs T1=20.3%, 95% CI 19.1%-21.5%, chi-square test: 4,158.658, p<0.001) and in-hospital mortality (T0=2.3% of total cardiology admissions 95% CI 1.9%-2.8% vs T1=2.8%, 95% CI 2.3%-3.3%, chi-square test: 4,060.217, p<0.001). In addition, 27% of patients delayed presentation due to fears of COVID-19 while several patients reported reducing their general practitioner or pathology/imaging appointments (27% and 11% respectively). Overall, 19% reported more difficulty accessing medical care during the lockdown periods. Patients described changes in their cardiovascular risk factors, including 25% reporting reductions in physical activity. We found a decrease in hospital presentations but with increased complexity after the introduction of COVID-19 lockdowns. Patients reported being fearful about presenting to hospital and experiencing difficulty in accessing community health services.

Psychosocial factors and caregiver burden among primary family caregivers of frail older adults with multimorbidity

BackgroundProvision of care for frail older adults with multiple chronic diseases (multimorbidity) poses increasing challenge for family caregivers. Our study aims to evaluate to what extent caregiving competence, social support and positive aspects of caregiving can mitigate the effect of burden experienced by family caregivers of frail older adults with multimorbidity.MethodsA descriptive cross-sectional study was conducted in 2 primary care clinics. Family caregivers of older adults aged 65 years and above were invited to complete interviewer-administered questionnaires. Descriptive statistics were used to describe sociodemographic and clinical data. Caregiver’s burden was measured using the Zarit Burden Interview (ZBI). Mann–Whitney U test was used to compare differences in Caregiving Competence Scale (CCS), short Positive Aspects of Caregiving (S-PAC) and modified Medical Outcome Study Social support (mMOS-SS). Multivariable logistic regression was used to analyse factors associating with caregiver burden.ResultsA total of 188 participants were recruited. 71.8% reported caregiver burden (ZBI score ≥ 10). Caregivers who perceived burden had significantly lower CCS, S-PAC and mMOS-SS scores than those who did not (10.0 vs 11.6; 26.8 vs 29.8; 24.8 vs 31.4, p < 0.001 respectively). Factors significantly associated with higher odds of perceived burden were presence of alternative caregivers (OR 3.3, 95% CI 1.09, 10.19, p = 0.04), use of community resources (OR 4.4, 95% CI 1.15, 16.83, p = 0.03) and time spent caregiving per week (OR 1.1, 95% CI 1.02, 1.10, p = 0.003).Discussion and conclusionThis study found that caregivers had high perception of burden as demand in caregiving may increase. Anticipating caregiver burden and social support needs may be important part of managing these frail older adults.

Neighbourhood characteristics, lifestyle factors, and child development: Secondary analysis of the All our families cohort study.

Neighbourhood characteristics have been found to influence child development, but little is known about lifestyle factors that may moderate this relationship, which can provide modifiable targets for policies and programing. This study investigated the association between neighbourhood characteristics (e.g., deprivation, disorder) during pregnancy and child development at age 5 in relation to various lifestyle factors (e.g., physical activity, parent-child reading, community resource use) during early childhood. A secondary analysis was conducted using multilevel modeling of data from the All Our Families cohort, recruited in Canada from 2008 to 2010. Participants self-reported on demographics during pregnancy, lifestyle factors at 3 years, and child development at 5 years using the Ages and Stages Questionnaire (ASQ-3). Neighbourhood deprivation was evaluated using the Vancouver Area Deprivation Index (VANDIX), while disorder was measured using police services' community crime reports. Geocoded information was available for 2,444 participants. After adjusting for covariates, multilevel modeling indicated a significant negative association between neighbourhood deprivation and overall child development (b = -.726, 95% CI: -1.344, -.120). Parent-child reading was found to be a significant moderator of the effect of neighbourhood disorder (b = .005, 95% CI: .001, .009). There were no statistically significant moderation effects for physical activity or community resource use. Neighbourhood deprivation during pregnancy is associated with early child development. Parent-child reading may function as a protective factor in the presence of higher neighbourhood disorder. Overall, neighbourhood-level effects should be considered in policies and community programs that promote family and child well-being.

Effective resources management in the territorial communities as the key to their development

Some aspects of the use of community resources were studied. It was determined that it is impractical to be limited exclusively to financial or land resources, it is necessary to cover the entire resource complex of the community within the framework of the study. It was established that community resources require identification, description, analysis, classification, evaluation and planning of their rational use. Community resources are classified with a basic division into land, natural and other community resources. The need to develop a Program for the rational use and protection of land, natural and other community resources as an effective tool for identification, descriptions, analysis, classification, evaluation and use planning of community resources is substantiated. It was established that as a result of the assessment of the community's resources, it is possible to adjust the measures provided by the territorial community's development strategy, because the management of land-resource (land-property) complexes at any level has a strategic nature and must be tied to the territorial community's development strategy. It was found that an effective means to achieve this is the use of an automated system of accounting and management of land-resource (land-property) complexes of territorial communities, the creation of which should take into account the peculiarities and needs of communities. It is noted that in the framework of the development of an inclusive economy, it is necessary to involve the residents of the community in public goods, in particular, in the use of resources and their management, because the effective use of resources is achieved in the cooperation of local residents and local self-government bodies, and one of the tools is the involvement of residents in the use of resources or their management , is conducting surveys of community residents with the aim of forming strategic goals and measures for community development.

Human papillomavirus vaccination: news and perspectives

Cervical cancer occupies the second place, after breast cancer, regarding the types of cancer that affect women of fertile age (15-44 years old) in Romania. The resumption of the vac­ci­na­tion program in Romania is a success, but the vac­ci­na­tion rate is so low that Romania does not even ap­pear in international statistics. The example of Rwanda, which makes excellent use of community resources, offers us a new approach and, on the other hand, evidence emer­ging in recent years has shown that the one-dose vac­ci­na­tion sche­dule also offers a high degree of protection similar to established schedules. A more coherent and sustained in­volve­ment of all partners in the vaccination process is necessary to recover the lost start, and to be among the top countries in the finish line of the global strategy for the elimination of cervical cancer in 2030.