The Effect of Distance to Formal Health Facility on Childhood Mortality in Rural Tanzania, 2005-2007.

Major improvements are required in the coverage and quality of essential childhood interventions to achieve Millennium Development Goal Four (MDG 4). Long distance to health facilities is one of the known barriers to access. We investigated the effect of networked and Euclidean distances from home to formal health facilities on childhood mortality in rural Tanzania between 2005 and 2007. A secondary analysis of data from a cohort of 28,823 children younger than age 5 between 2005 and 2007 from Ifakara Health and Demographic Surveillance System was carried out. Both Euclidean and networked distances from the household to the nearest health facility were calculated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on child mortality. Children who lived in homes with networked distance>5 km experienced approximately 17% increased mortality risk (HR=1.17; 95% CI 1.02-1.38) compared to those who lived <5 km networked distance to the nearest health facility. Death of a mother (HR=5.87; 95% CI 4.11-8.40), death of preceding sibling (HR=1.9; 95% CI 1.37-2.65), and twin birth (HR=2.9; 95% CI 2.27-3.74) were the strongest independent predictors of child mortality. Physical access to health facilities is a determinant of child mortality in rural Tanzania. Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania

A social-cognitive model of trait and state levels of gratitude.

Three studies tested a new model of gratitude, which specified the generative mechanisms linking individual differences (trait gratitude) and objective situations with the amount of gratitude people experience after receiving aid (state gratitude). In Study 1, all participants (N = 253) read identical vignettes describing a situation in which they received help. People higher in trait gratitude made more positive beneficial appraisals (seeing the help as more valuable, more costly to provide, and more altruistically intended), which fully mediated the relationship between trait and state levels of gratitude. Study 2 (N = 113) replicated the findings using a daily process study in which participants reported on real events each day for up to14 days. In Study 3, participants (N = 200) read vignettes experimentally manipulating objective situations to be either high or low in benefit. Benefit appraisals were shown to have a causal effect on state gratitude and to mediate the relationship between different prosocial situations and state gratitude. The 3 studies demonstrate the critical role of benefit appraisals in linking state gratitude with trait gratitude and the objective situation

Research-based assessment affordances and constraints: Perceptions of physics faculty

To help faculty use research-based materials in a more significant way, we learn about their perceived needs and desires and use this information to suggest ways for the Physics Education Research community to address these needs. When research-based resources are well aligned with the perceived needs of faculty, faculty members will more readily take them up. We used phenomenographic interviews of ordinary physics faculty and department chairs to identify four families of issues that faculty have around research-based assessments (RBA). First, many faculty are interested in using RBAs but have practical needs around how to do so: how to find them, which ones there are, and how to administer them. They want help addressing these needs. Second, at the same time, many faculty think that RBAs are limited and don't measure many of the things they care about, or aren't applicable in their classes. They want assessments to measure skills, perceptions, and specific concepts. Third, many faculty want to turn to communities of other faculty and experts to help them interpret their assessment results and suggest other ways to do assessment. They want to norm their assessment results by comparing to others and interacting with faculty from other schools to learn about how they do assessment. Fourth, many faculty consider their courses in the broader contexts of accountability and their departments. They want help with assessment in these broader contexts. We also discuss how faculty members role in their department and type of institution influence their perceived wants and needs around assessment.Comment: submitted to Physical Review Special Topics - Physics Education Researc

General health and residential proximity to the coast in Belgium : results from a cross-sectional health survey

The health risks of coastal areas have long been researched, but the potential benefits for health are only recently being explored. The present study compared the general health of Belgian citizens a) according to the EU's definition of coastal ( 50 km), and b) between eight more refined categories of residential proximity to the coast ( 250 km). Data was drawn from the Belgian Health Interview Survey (n = 60,939) and investigated using linear regression models and mediation analyses on several hypothesized mechanisms. Results indicated that populations living 50-100 km. Four commonly hypothesized mechanisms were considered but no indirect associations were found: scores for mental health, physical activity levels and social contacts were not higher at 0-5 km from the coast, and air pollution (PM ic , concentrations) was lower at 0-5 km from the coast but not statistically associated with better health. Results are controlled for typical variables such as age, sex, income, neighbourhood levels of green and freshwater blue space, etc. The spatial urban-rural-nature mosaic at the Belgian coast and alternative explanations are discussed. The positive associations between the ocean and human health observed in this study encourage policy makers to manage coastal areas sustainably to maintain associated public health benefits into the future

Assessing the impact of malaria interventions on morbidity through a community-based surveillance system

Background The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment in rural Tanzania with a set of integrated interventions targeting both users and providers. The aim of this article is to evaluate the programme's impact on the community and health facility burden of malaria and to investigate the value of community-based reporting for routine malaria control programme monitoring. Methods This work was implemented within the Ifakara Demographic Surveillance System (DSS) between 2004 and 2008. At community level the DSS staff routinely collected data on reported history of fever and severe malaria (convulsions) based on a 2-week recall. In parallel, we collected in-patient and out-patient fever and malaria diagnoses data from the 15 health facilities in the area. Treatment-seeking surveys conducted in the study area and nationally representative data were used to validate our measure of community fever. Results Between 2005 and 2008, community-reported fever incidence rates in children under the age of 5 years declined by 34%, from 4.9 to 3.2 average cases per child per year, whereas convulsions, a marker of severe malaria morbidity in children, decreased by 46%, from 4263 to 2320 cases for every 100 000 children per year. The decrease in the community rates was paralleled by a decrease in the health facility fever rates, although the number of fever cases seen in health facilities did not change because of population growth. Our data showed very good internal and external consistency with independent local and national surveys. Conclusions There is an evidence of a substantial decline in the community burden of malaria morbidity between 2005 and 2008 in the Kilombero and Ulanga DSS areas in Tanzania, most likely as a result of malaria control efforts. The good internal and external consistency of the data shows that history of fever in the previous 2 weeks in children under the age of 5 years can be used as a morbidity monitoring too

Stigma as a fundamental hindrance to the United States opioid overdose crisis response.

Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis