Perspectives of National Coordinators and Partners on the Work of the Global Trachoma Mapping Project.

PURPOSE: Neglected tropical diseases (NTDs) affect people living in the poorest regions of the world and their debilitating effects perpetuate the poverty cycle. Understanding the distribution of NTDs is crucial for effective intervention delivery. In 2012, the Global Trachoma Mapping Project (GTMP) was initiated to map >1800 suspected trachoma endemic districts by March 2015. This research was carried out to better understand the implementation experience and identify lessons which might inform the GTMP and similar initiatives. METHODS: Using grounded theory methodology, semi-structured interviews were conducted with key informants from six countries with 63% of the global mapping backlog (Ethiopia, Malawi, Mozambique, Nigeria, Solomon Islands, and Yemen). Interviews were transcribed, coded, and findings separated into categories. RESULTS: Three themes were identified during the research; planning and operations, technical implementation, and governance. The project was felt to be most successful in countries where the Ministry of Health was actively engaged in setting standards, ensuring capacity building for government staff, and guiding the training, data collection, analysis, and interpretation of data. Standardized tools, training platforms, and the use of electronic data capture increased confidence in the reliability of the survey data, informed quality improvement efforts within survey implementation, and the immediate release of results empowered end-user decision-makers. Regional collaboration between endemic countries bolstered program manager competence and confidence, while reinforcing partnerships essential to the success of the GTMP. CONCLUSIONS: We depict how innovative characteristics of the GTMP, and lessons learned from its implementation, can strengthen similar initiatives to map disease prevalence and risk factors

Multiple psychological senses of community and community influences on personal recovery processes from substance use problems in later life: a collaborative and deductive reflexive thematic analysis

Purpose: There is a pressing need for substance use services to know more about how to promote recovery from substance use problems, particularly in later life. Psychological sense of community (PSOC) is an important recovery dimension. This study aims to clarify in what ways PSOC and communities influence later life recovery processes. Method: A collaborative and deductive reflexive thematic approach was used to analyse 23 interviews with older adults in recovery from different substance use problems. Results: The findings suggest that PSOC and recovery in later life include multiple commu nities (relational, geographical, substance use-related, ideal and service-related) and affective states (PSOC and NPSOC). Older adults’ recovery, moreover, can be described as personal and heterogenic (with respect to community relationships, individual needs, type of substance use problem, age of onset and meaningful activities). Conclusions: The findings confirm age of onset, type of substance use problem and com munity memberships as essential to later life recovery. They also supplement prior evidence on community resources and challenges to later life recovery. Importantly, the new findings extend and nuance current understandings of later life recovery. Taken together, the article illustrates MPSOC as a useful concept, with central practical and theoretical implications for later life recovery.publishedVersio

In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?

Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.publishedVersio

Defining Seropositivity Thresholds for Use in Trachoma Elimination Studies.

BACKGROUND: Efforts are underway to eliminate trachoma as a public health problem by 2020. Programmatic guidelines are based on clinical signs that correlate poorly with Chlamydia trachomatis (Ct) infection in post-treatment and low-endemicity settings. Age-specific seroprevalence of anti Ct Pgp3 antibodies has been proposed as an alternative indicator of the need for intervention. To standardise the use of these tools, it is necessary to develop an analytical approach that performs reproducibly both within and between studies. METHODOLOGY: Dried blood spots were collected in 2014 from children aged 1-9 years in Laos (n = 952) and Uganda (n = 2700) and from people aged 1-90 years in The Gambia (n = 1868). Anti-Pgp3 antibodies were detected by ELISA. A number of visual and statistical analytical approaches for defining serological status were compared. PRINCIPAL FINDINGS: Seroprevalence was estimated at 11.3% (Laos), 13.4% (Uganda) and 29.3% (The Gambia) by visual inspection of the inflection point. The expectation-maximisation algorithm estimated seroprevalence at 10.4% (Laos), 24.3% (Uganda) and 29.3% (The Gambia). Finite mixture model estimates were 15.6% (Laos), 17.1% (Uganda) and 26.2% (The Gambia). Receiver operating characteristic (ROC) curve analysis using a threshold calibrated against external reference specimens estimated the seroprevalence at 6.7% (Laos), 6.8% (Uganda) and 20.9% (The Gambia) when the threshold was set to optimise Youden's J index. The ROC curve analysis was found to estimate seroprevalence at lower levels than estimates based on thresholds established using internal reference data. Thresholds defined using internal reference threshold methods did not vary substantially between population samples. CONCLUSIONS: Internally calibrated approaches to threshold specification are reproducible and consistent and thus have advantages over methods that require external calibrators. We propose that future serological analyses in trachoma use a finite mixture model or expectation-maximisation algorithm as a means of setting the threshold for ELISA data. This will facilitate standardisation and harmonisation between studies and eliminate the need to establish and maintain a global calibration standard

Curious Curiosity – Reflections on How Early Childhood Lecturers Perceive Children’s Curiosity

Curiosity and wonder are considered fundamental for children’s development. However, no precise defnition of curiosity exists, and there is little research on the nature of curiosity. There is also a lack of knowledge and ideas about how pedagogy can sustain and stimulate curiosity. Drawing upon empirical material from semi-structured interviews with seven Early Childhood Teacher Education (ECTE) lecturers from the disciplines of mathematics, arts, literature, drama, pedagogy, science and physical education about their view of children’s curiosity, the authors aim to explore the lecturers’ understanding of children’s curiosity and how this understanding varies between disciplines. Children enact their curiosity in a cultural-historical context. The cultural-historical tradition of outdoor play is a part of the institution’s practices infuencing the children, while the children may use curiosity to infuence the content of these practices. Although the lecturers are from different disciplines, their understanding of curiosity were consistent, particularly with regards to their focus on bodily expressions of curiosity. Expanding the concept of curiosity, we suggest the term bodily curiosity to recognise and operationalise a sensory, active and embodied search for answers. Similarly, we suggest the term bodily wonder about a kind of embodied philosophising

Patient Assessments of the Factors Facilitating and Impeding User Involvement During the First Phase of Substance Abuse Treatment

User involvement in the first phase of treatment is essential for treatment satisfaction among patients with substance use disorders (SUDs). This study explores how patients perceive the first phase of specialized SUD treatment and identifies what promotes and inhibits user involvement. We used a qualitative approach, and semi-structured interviews were conducted with 14 informants admitted to a substance abuse treatment unit in central Norway. The analysis was inspired by a phenomenographical analysis approach, and 4 categories were identified as the core experiences of user involvement during the first phase of SUD treatment: (a) a new hold on life, (b) missing information, (c) the importance of a sense of community, and (d) ambivalence about the usefulness of the treatment. Overlapping elements with Aaron Antonovsky’s theoretical framework of salutogenesis were used to support the main findings. The study indicates that activating personal resources (eg, the ability to envision a different life), conveying information in a matter sensitive to patients’ current cognitive state, a sense of community, and therapeutic alliance are essential factors to promote user involvement in the first phase of specialized SUD treatment. Based on the findings, we suggest a salutogenesis approach to promote user involvement and provide several ways to employ this approach in the crucial first phase of specialized SUD treatment

Children as eco-citizens?

Education for sustainability in early childhood tends to focus on practices and advocacy, rather than on the aims of this education. We suggest that the aim should be to consider children as being and becoming eco-citizens. This suggestion is built on an exploration of children as eco-citizens. With theories concerning child-sized citizenship we suggest a description of children and adults as being and becoming eco-citizen. We explore this through the fields of nature connection and science and children’s curiosity. We find that environmentally friendly practices as gardening and harvesting wild food show how children’s eco-citizenship is realizable. We support this additionally by references to how children’s literature, seeing how children depicted as eco-citizens can support the notion of children as eco-citizens. Through these analyses, we conclude that children should be viewed as being and becoming eco-citizens.publishedVersio

Mapping, assessing and promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems

Aim: The recent nationally implemented clinical pathways for the treatment of substance use problems in Norway require mapping and assessing of patients’ needs, challenges, and resources. However, there is a lack of tools for systematically mapping and assessing patients’ social situations and social networks as part of the national guidelines. The aim of this article is to present a tool developed to map and assess the patient’s social situation, and to propose approaches for promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems. Methods: The proposed tool and approaches are developed based on findings in a previous in-depth collaborative study of MPSOC and recovery among people with substance use problems who received help and services from Norwegian municipalities. Findings: The findings suggest that multiple communities (geographical, relational and ideal) and senses of communities (within and outside treatment) simultaneously can influence individual recovery processes from problematic substance use in both positive as well as negative ways. As such, these community dimensions are of central importance to include in mapping and assessing of patients’ social situations, as well as in the promotion of MPSOC through clinical pathways. Conclusions: The suggested tool and approaches can increase the likelihood of achieving key aims of the national clinical pathways. Most important, mapping, assessing and promoting MPSOC through clinical pathways may promote long-term recovery processes and positive recovery capital for persons with substance use problems