Health promotion by communities and in communities: current issues for research and practice.

BACKGROUND AND AIMS: This paper explores contemporary issues around community-based health promotion in the light of international health policies reaffirming the central role of community action within broader efforts to achieve health equity. Adopting a system-level approach poses challenges for current health promotion practice and evaluation, particularly where there is a shift in emphasis from small-scale community health projects towards mainstream community programmes, capable of engaging widely across diverse populations. METHODS: Drawing on research with community members carried out by the Centre for Health Promotion Research, Leeds Metropolitan University, UK, the paper re-examines assumptions about the nature of interventions within community settings, and what participation means from a lay perspective. Key research issues for community-based health promotion are highlighted. CONCLUSIONS: The paper concludes by proposing that community-based interventions need to be reframed, if the dual challenges of citizen involvement and evidence based practice are to be met

Tailoring of the Tell-us Card communication tool for nurses to increase patient participation using Intervention Mapping

Aims and objectives: To describe the tailoring of the Tell-us Card intervention for enhanced patient participation to the Dutch hospital setting using Intervention Mapping as a systematic approach. Background: Even though patient participation is essential in any patient-to-nurse encounter, care plans often fail to take patients' preferences into account. The Tell-us Card intervention seems promising, but needs to be tailored and tested before implementation in a different setting or on large scale. Design: Description of the Intervention Mapping framework to systematically tailor the Tell-us Card intervention to the Dutch hospital setting. Methods: Intervention Mapping consists of: (i) identification of the problem through needs assessment and determination of fit, based on patients and nurses interviews and focus group interviews; (ii) developing a logic model of change and matrices, based on literature and interviews; (iii) selection of theory-based methods and practical applications; (iv) producing programme components and piloting; (v) planning for adoption, implementation and sustainability; and (vi) preparing for programme evaluation. Results: Knowledge, attitude, outcome expectations, self-efficacy and skills were identified as the main determinants influencing the use of the Tell-us Card. Linking identified determinants and performance objectives with behaviour change techniques from the literature resulted in a well-defined and tailored intervention and evaluation plan. Conclusions: The Tell-us Card intervention was adapted to fit the Dutch hospital setting and prepared for evaluation. The Medical Research Council framework was followed, and the Intervention Mapping approach was used to prepare a pilot study to confirm feasibility and relevant outcomes. Relevance to clinical practice: This article shows how Intervention Mapping is applied within the Medical Research Council framework to adapt the Tell-us Card intervention, which could serve as a guide for the tailoring of similar interventions

Combining decision trees and stochastic curtailment for assessment length reduction of test batteries used for classification.

For classification problems in psychology (e.g., clinical diagnosis), batteries of tests are often administered. However, not every test or item may be necessary for accurate classification. In the current article, a combination of classification and regression trees (CART) and stochastic curtailment (SC) is introduced to reduce assessment length of questionnaire batteries. First, the CART algorithm provides relevant subscales and cutoffs needed for accurate classification, in the form of a decision tree. Second, for every subscale and cutoff appearing in the decision tree, SC reduces the number of items needed for accurate classification. This procedure is illustrated by post hoc simulation on a data set of 3,579 patients, to whom the Mood and Anxiety Symptoms Questionnaire (MASQ) was administered. Subscales of the MASQ are used for predicting diagnoses of depression. Results show that CART-SC provided an assessment length reduction of 56%, without loss of accuracy, compared with the more traditional prediction method of performing linear discriminant analysis on subscale scores. CART-SC appears to be an efficient and accurate algorithm for shortening test batteries. © The Author(s) 2013

Female genital mutilation of a karyotypic male presenting as a female with delayed puberty

BACKGROUND: Female genital mutilation (FGM) is commonly practiced mainly in a belt reaching from East to West Africa north of the equator. The practice is known across socio-economic classes and among different ethnic, religious, and cultural groups. Few studies have been appropriately designed to measure the health effects of FGM. However, the outcome of FGM on intersex individuals has never been discussed before. CASE PRESENTATION: The patient first presented as a female with delayed puberty. Hormonal analysis revealed a normal serum prolactin level of 215 Mu/L, a low FSH of 0.5 Mu/L, and a low LH of 1.1 Mu/L. Type IV FGM (Pharaonic circumcision) had been performed during childhood. Chromosomal analysis showed a 46, XY karyotype and ultrasonography verified a soft tissue structure in the position of the prostate. CONCLUSION: FGM pose a threat to the diagnosis and management of children with abnormal genital development in the Sudan and similar societies

Spelling in adolescents with dyslexia: errors and modes of assessment

In this study we focused on the spelling of high-functioning students with dyslexia. We made a detailed classification of the errors in a word and sentence dictation task made by 100 students with dyslexia and 100 matched control students. All participants were in the first year of their bachelor’s studies and had Dutch as mother tongue. Three main error categories were distinguished: phonological, orthographic, and grammatical errors (on the basis of morphology and language-specific spelling rules). The results indicated that higher-education students with dyslexia made on average twice as many spelling errors as the controls, with effect sizes of d ≥ 2. When the errors were classified as phonological, orthographic, or grammatical, we found a slight dominance of phonological errors in students with dyslexia. Sentence dictation did not provide more information than word dictation in the correct classification of students with and without dyslexia

A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: There is mounting evidence of poor adherence by health service personnel to clinical guidelines for malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines. METHODS/DESIGN: A three-arm stratified cluster randomized trial is used to compare the effectiveness and cost-effectiveness of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider and community knowledge. Costs will be estimated from both a societal and provider perspective using standard economic evaluation methodologies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01350752

The emergence of international food safety standards and guidelines: understanding the current landscape through a historical approach

Following the Second World War, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) teamed up to construct an International Codex Alimentarius (or 'food code') which emerged in 1963. The Codex Committee on Food Hygiene (CCFH) was charged with the task of developing microbial hygiene standards, although it found itself embroiled in debate with the WHO over the nature these standards should take. The WHO was increasingly relying upon the input of biometricians and especially the International Commission on Microbial Specifications for Foods (ICMSF) which had developed statistical sampling plans for determining the microbial counts in the final end products. The CCFH, however, was initially more focused on a qualitative approach which looked at the entire food production system and developed codes of practice as well as more descriptive end-product specifications which the WHO argued were 'not scientifically correct'. Drawing upon historical archival material (correspondence and reports) from the WHO and FAO, this article examines this debate over microbial hygiene standards and suggests that there are many lessons from history which could shed light upon current debates and efforts in international food safety management systems and approaches

The attitudes and experiences of families with death determination in the home

The purpose of this study is to describe the attitudes and experiences of family members with respect to death determination practices for the terminally iii clients of home care agencies. A sample of family 53 members in Southeast Michigan returned survey questionnaires. The findings indicate that police and emergency medical technicians most frequently respond to the call when a person with a terminal illness has died. Fifty percent of the family members reported feeling sad, 35 percent reported feeling relieved and 18 percent of the respondents felt angry about the arrival of multiple personnel. Feelings of anger were signficantly associated with the absence of a nurse at the time of death, the use of lights and sirens, disrespectful personnel and the arrival of multiple personnel. Feelings of anger were also significantly associated with continuing thoughts of the day of death by family members. Results suggest the need to rethink state and local laws in regard to death determination and to educate those most likely to respond to families sensitively. Home care agencies and hospices should also encourage attendance by nurses at the time of death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67059/2/10.1177_104990918900600504.pd

Saliva-based colorimetric test as an index of gingival inflammation in epidemiologic studies

– There is a pressing need for a reliable, low-cost method of assessing the gingival and periodontal status of large population groups. Existing indexes, despite their value in dental public health, are still too subject to examiner variability for use by uncalibrated examiners. This study describes an evaluation of a quick, inexpensive, extraoral colorimetric test for gingival inflammation, based on a reaction between saliva and the test material. It could probably be applied by non-professional personnel. In this study, the test was applied to a population of elementary schoolchildren, denial hygiene students and faculty, and adult inmates of two correctional institutions. These populations were chosen on the assumption that they would exhibit varying intensities of gingival inflammation. Values obtained from the colorimetric test carried out by one researcher were compared with Gingival Index (GI) scores observed by a different examiner. Results suggest that the colorimetric test may be a valid, reliable means of detecting major differences in the prevalence of gingival inflammation in most adult populations, although having little, if any, useful application among children at the mixed dentition stage.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73489/1/j.1600-0528.1978.tb01169.x.pd