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1.
Prasansa Subba Nagendra P. Luitel Brandon A. Kohrt Mark J. D. Jordans 《Conflict and health》2017,11(1):28
Background
Despite increasing efforts to expand availability of mental health services throughout the world, there continues to be limited utilization of these services by persons with mental illness and their families. Community-based detection that facilitates identification and referral of people with mental health problems has been advocated as an effective strategy to increase help-seeking and service utilization. The Community Informant Detection Tool (CIDT) was developed for the community informants to identify people with depression, psychosis, alcohol use problems, epilepsy, and child behavioral problems in community settings. The CIDT has been validated in Nepal and found to be effective in promoting treatment initiation. To facilitate replication in other settings, this paper describes the development process of CIDT and the steps to achieve comprehensibility, utility and feasibility.Methods
The CIDT was developed in four steps. First, case vignettes and illustrations were created incorporating local idioms of distress for symptoms of each disorder with an expert panel of 25 Nepali mental health professionals. Second, the utility of a draft tool was assessed through focus group discussions (n?=?19) and in-depth interviews (n?=?6). Third, a practice run was conducted assessing applicability of the tool through IDI among purposively selected community informants (n?=?8). Finally, surveys were administered to 105 community informants to assess feasibility.Results
The first through third steps led to modifications in the format and presentation of the CIDT. The pilot test found CIDT to be comprehensible and feasible for detection and referral of all conditions except child behavioral problems. Female community health volunteers were recommended as the most appropriate persons to utilize the CIDT.Conclusion
Community-based detection using the CIDT for persons in need of mental health care is perceived to be useful and feasible by key community stakeholders who would integrate the tool into their daily activities.2.
Background
The epidemiology of obesity in primary care populations has not been thoroughly explored. This study contributes to filling this gap by investigating the relationship between obesity and different sources of personal stress, mental health, exercise, and demographic characteristics.Methods
A cross-sectional survey using a convenience sample. Five hundred women who attended family planning clinics were surveyed and 274 provided completed answers to all of the questions analyzed in this study. Exercise, self-rated mental health, stress, social support, and demographic variables were included in the survey. Multiple logistic regression analysis was performed.Results
After adjusting for mental health, exercise, and demographic characteristics of subjects, analysis of the data indicated that that being having a large family and receiving no support from parents were related to obesity in this relatively young low-income primary care sample, but self-reported stress and most types of social support were not significant.Conclusion
Obesity control programs in primary care centers directed at low-income women should target women who have large families and who are not receiving support from their parents.3.
Background
Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal.Methods
This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women’s background characteristics.Results
Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR?=?1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR?=?1.44; 95% CI: 1.18-1.77) and delivery services (OR?=?1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs.Conclusions
Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women’s knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal’s health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.4.
D. M. Mijnarends Y. C. Luiking R. J. G. Halfens S. M. A. A. Evers E. L. A. Lenaerts S. Verlaan M. Wallace Jos M. G. A. Schols J. M. M. Meijers 《The journal of nutrition, health & aging》2018,22(7):766-773
Objective
To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs.Design
Cross-sectional Maastricht Sarcopenia Study (MaSS).Setting
Community-dwelling, assisted-living, residential living facility.Participants
227 adults aged 65 and older.Measurements
Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months.Results
Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs).Conclusion
Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.5.
Christina Dahl 《Pr?vention und Gesundheitsf?rderung》2018,13(2):131-137
Background
Changes in our working environment result in increased mental demands and make it necessary to consider ways to prevent negative consequences such as stress and burnout.Objectives
The aim of this paper is to discuss the preventive benefit of self-care regarding increased mental demands in current working environments.Materials and methods
Initially, current changes in the working environment and their possible consequences for health are depicted. The idea of “self-care” is presented. In order to illustrate the benefit of self-care, a study is presented that deals with the promotion of self-care in social workers.Results
The findings suggest that the practice of self-care seems to have a preventive effect. Self-care helps to prevent work-related strain and to promote mental health. The analyses revealed a reduction of perceived stress and exhaustion among social workers, after attending a self-care seminar. Varied positive changes reported by the participants concerning their self-care, their experience of stress and their well-being, strengthen the results.Conclusions
The present findings lead to a plea for more self-care. The appeal for more responsibility of the individual does not exempt employers from their responsibility to create healthy working conditions. But—when it comes to our health and well-being—primarily the individual should take care of him-/herself.6.
7.
Background
Youth placed in out-of-home care are at significant risk of low academic achievement and poor mental health. Few studies have considered the potential effects of school-related factors, such as school placement stability and school engagement, on youth outcomes.Objective
The current study examined the potential main effects of school placement stability and engagement on academic achievement and mental health. Furthermore, we examined whether school-related factors moderated the association between home placement stability and youth outcomes.Methods
Participants included 420 youth (age 6–14 at baseline) placed in out-of-home care participating in a national longitudinal study of youth in contact with the child welfare system. Youth, caregivers, and caseworkers provided relevant information at baseline, 18, and 36 months. Hierarchical regression models were constructed to test potential main and moderating effects of school engagement and school placement stability on youth mental health and academic achievement prospectively, while accounting for relevant covariates.Results
School placement stability was an independent predictor of youth internalizing and externalizing symptoms, but was not significantly associated with academic outcomes. Furthermore, there were no main effects of school engagement or home placement stability on youth outcomes and school-related factors did not moderate the relationship between home placement stability and youth outcomes.Conclusion
For children and adolescents who do not have the benefit of a stable, safe, or caring home environment, school stability may be contribute to an environment that can foster healthy development.8.
Erika Berggren Y. Orrevall A. Ödlund Olin P. Strang R. Szulkin L. Törnkvist 《The journal of nutrition, health & aging》2016,20(4):428-438
Objective
Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.Design
Observational cohort study.Setting
10 primary health care centers in Stockholm County, Sweden.Participants
140 district nurses/registered nurses and general practitioners/physicians working with home care.Intervention
87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.Measurements
The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.Results
In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.Conclusion
The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.9.
10.
Lisanne Warmerdam Marko Barendregt Edwin de Beurs 《Zeitschrift fur Gesundheitswissenschaften》2017,25(3):311-319
Aim
A meaningful comparison of clinical outcomes of mental health care providers requires risk adjustment of case mix variables that affect treatment outcome. The first goal of the present study was to describe the risk adjustment method we applied to routine outcome monitoring data in The Netherlands. Second, the consequences of risk adjustment for the ranking of providers were investigated.Subject and methods
Using an observational study design, pre- and posttest self-report assessments of symptoms were obtained for 31,849 adults with common mental health problems, such as mood and anxiety disorders. Regression analyses were performed to predict the posttest symptom level using socio-demographics and clinical characteristics as predictors.Results
Results showed that the posttest level of symptoms was best predicted by the symptom level at baseline, followed by the baseline level of functioning, age, socioeconomic status and some diagnoses. For the majority of the providers, risk adjustment did not markedly change their ranking.Conclusion
The baseline level of symptoms is the best predictor of the posttest level. The other investigated case mix variables only have a modest influence on the performance of providers. Risk adjustment is particularly necessary when consequences are related to the performance of an individual provider. These results contribute to the limited literature on risk adjustment in mental health care by using a large national data set.11.
Background
Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model.Objective
The current study evaluates the field test of the practitioner-informed model to facilitate interdisciplinary collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices.Methods
Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project.Results
Participating practitioners’ survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration.Conclusions
Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N.12.
Anna Myers Samira Sami Monica Adhiambo Onyango Hari Karki Rosilawati Anggraini Sandra Krause 《Conflict and health》2018,12(1):35
Background
Following the Nepal earthquake in April 2015, UNFPA estimated that 1.4 million women of reproductive age were affected, with approximately 93,000 pregnant and 28,000 at risk of sexual violence. A set of priority reproductive health (RH) actions, the Minimum Initial Services Package (MISP), was initiated by government, international and local actors. The purpose of this study was to identify the facilitators and barriers affecting the implementation of priority RH services in two districts.Methods
In September 2015, a mixed methods study design was used in Kathmandu and Sindhupalchowk districts to assess the implementation of the priority RH services five months post-earthquake. Data collection activities included 32 focus group discussions with male and female participants aged 18–49; 26 key informant interviews with RH, gender-based violence (GBV), and human immunodeficiency virus (HIV) experts; and 17 health facility assessments.Results
The implementation of priority RH services was achieved in both districts. In Kathmandu implementation of emergency RH services started within days of the earthquake. Facilitating factors for successful implementation included disaster preparedness; leadership and commitment among national, international, and district level actors; resource mobilization; strong national level coordination; existing reproductive and child health services and community outreach programs; and supply chain management. Barriers included inadequate MISP training for RH coordinators and managers; weak communication between national and district level stakeholders; inadequate staffing; under-resourced and fewer facilities in rural areas; limited attention given to local GBV and HIV organizations; low availability of clinical management of rape services; and low awareness of GBV services and benefits of timely care.Conclusion
Ensuring RH is included in emergency preparedness and immediate response efforts and is continued through the transition to comprehensive care is critical for national governments and humanitarian response agencies. The MISP for RH remains a critical component of response efforts, and the humanitarian community should consider these learnings in future emergency response.13.
Aim
The main aim of this study was to assess the psychological consequences that displacement brings into the lives of India’s tribal populations, specifically, in the form of mental illness.Subject and methods
Literature review.Results
The impact of forced displacement on the mental state of tribal populations is significant and multi-faceted. In spite of sufficient evidence indicating the extent of mental health challenges, the Governmental response in India has been completely missing. Some of the challenges in the path of Indian health providers are poor diagnostic facilities, lack of psychiatric epidemiological data for tribal populations, and culturally inappropriate instruments. Scientists and practitioners can play an important role in bridging the knowledge gap in the field.Conclusion
It is necessary to perceive the mental health status of displaced tribal populations within the larger framework of social justice. A strictly biomedical approach is insufficient when the individuals seeking help are under constant stress. Thus, a mental health program is needed for tribal people that offers a perspective broad enough to address the needs of individuals and the local worlds in which they live.14.
Background
Intermittent treatment of acute lower acuity situations has come to be defined as urgent rather than emergent care. The location of urgent care delivery has been shifting from exclusively hospital or office settings to other community locales.Aims
To review the concept of urgent care and the new models of health care delivery in the niche between hospitals and primary care. To highlight the roles of urgent care in Israel and compare these roles with those in other countries.Method
Narrative review of the literature.Main findings
The new models of community based urgent care include 1) the urgent care center; 2) the retail or convenience clinic, 3) the free standing emergency center, and 4) the walk-in clinic. These models fall on a continuum of comprehensiveness. They offer care at a lower cost than hospital-based emergency departments and greater temporal convenience than primary care physicians. However, their impact on emergency department utilization and overcrowding or primary care physician overload is unclear.Israel has integrated its urgent care centers into its national health system by encouraging the use of urgent care centers and by requiring all health insurance funds to reimburse patients who use these centers. This integration is similar to the approach in England; however, the type of service is different in that the service in England is provided by nurses. It is different from most other countries where urgent care facilities are primarily private ventures.Conclusions
Community-based acute care facilities are becoming a part of the medical landscape in a number of countries. Still, they remain primarily on the fringe of organized medicine. Despite the important role of community-based acute care facilities in Israel, no nationwide study has been done in two decades. Health policy planning in Israel necessitates further study of urgent care use and its clinical outcomes.15.
Background
Given the challenges to ensuring facility-based care in conflict settings, the Women’s Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization’s Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings.Methods
A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age.Results
Qualitative feedback contributed to an understanding of the model’s feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment.Conclusions
Data speak to the promising “feasibility” of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not accessible for women and girls that need it most.16.
Anita L. Hansen G. Ambroziak D. Thornton L. Dahl B. Grung 《The journal of nutrition, health & aging》2018,22(4):513-518
Objectives
To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.Design
A randomized controlled trial.Setting
A forensic facility.Participants
Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.Intervention
Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.Measurement
Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.Results
Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.Conclusion
Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.17.
Objectives
Health effects associated with air pollution at exposure levels below toxicity may not be directly related to level of exposure, but rather mediated by perception of the air pollution and by top-down processing (e.g., beliefs that the exposure is hazardous). The aim of the study was to test a model that describes interrelations between odorous air pollution at non-toxic exposure levels, perceived pollution, health risk perception, annoyance and health symptoms.Methods
A population-based questionnaire study was conducted in a Swedish community of residents living near a biofuel facility that emitted odorous substances. Individuals aged 18–75 years were selected at random for participation (n = 1,118); 722 (65 %) agreed to participate. Path analyses were performed to test the validity of the model.Results
The data support a model proposing that exposure level does not directly influence annoyance and symptoms, and that these relations instead are mediated by perceived pollution and health risk perception.Conclusions
Perceived pollution and health risk perception play important roles in understanding and predicting environmentally induced annoyance and health symptoms in odorous environments at non-toxic levels of exposure.18.
Emmanuel Janagan Johnson Cheryl-Ann Sarita Boodram 《Zeitschrift fur Gesundheitswissenschaften》2017,25(1):69-74
Aims
The study sought to investigate the lived experiences regarding the health, well-being and quality of life of persons experiencing displacement due to an industrial disaster in Trinidad.Study and methods
The study used qualitative design using focus group discussions and semi-structured interviews. The study explored the experiences of two tiers of participants: first, participants were drawn from people who experienced the disaster themselves and second from the health care providers who provided intervention for persons affected by the disaster. Purposive sampling was used to select a list of participants from these two groups of participants, and data were collected over a 3-week period following the oil spill.Results
Residents experienced the disaster as a life-threatening tragedy. The immediate effects of the disaster were felt as many people complained of respiratory problems. Diets were also affected since people were not allowed to use gas and electric stoves or flammable materials. The groups most vulnerable to sickness were the elderly and children. The medical officers revealed that they were unprepared for dealing with a disaster such as was caused by the environmental pollution.Conclusions
The authors suggest that community-level health workers in industrial disaster situations should focus on building community social capital and train first respondents and health workers to become alert to possible health challenges such as delayed or postponed health routines and the emergence of psychological and mental health issues.19.
Background
African American youth residing in urban poverty have been shown to be at increased risk for exposure to violence and for psychological symptoms, but there has been little investigation of mediating processes that might explain this association.Objectives
This study tested the quality of parent–adolescent relationships and adolescent nondisclosure to adults as mediating mechanisms through which exposure to community violence may lead to psychological symptoms.Methods
The current study surveyed a sample of 152 low-income urban African American early adolescents (aged 12–14). Participants completed self-report questionnaires assessing exposure to community violence, nondisclosure, parent–adolescent relationship, and psychological symptoms (i.e., internalizing and externalizing symptoms).Results
Path analyses revealed that parent–adolescent relationship quality and nondisclosure both functioned as mediators of the relation between exposure to community violence and both internalizing and externalizing symptoms, though significant direct effects for violence exposure on externalizing symptoms remained. Decomposition of effects revealed that nondisclosure was a stronger mediator than parent–adolescent relationship quality. Results also indicated that exposure to violence can lead to externalizing (but not internalizing) symptoms first by way of parent–adolescent relationship quality and then nondisclosure.Conclusions
Combined, these findings suggest that the development of preventive interventions designed to assist adults and parents improve communication and strengthen relationships with adolescents might reduce the negative effects of exposure to community violence on adolescent mental health.20.