Bringing Global Health Home: The Case of Global to Local in King County, Washington

The article describes the experience of testing successful global health interventions in the cities of SeaTac and Tukwila, Washington—2 very diverse, underserved communities outside of Seattle that experience significant health disparities compared with surrounding areas in King County. Topics covered include an overview of the partnership that established Global to Local, the process of engaging Seattle-based global health institutions in identifying global health strategies to test, identifying communities experiencing health disparities that might benefit from global health–inspired interventions, engaging those local communities to understand the perceived drivers of poor health outcomes, tailoring global interventions to the local context, launching programs, and the successes and challenges that have emerged throughout this process. Global health strategies that were tested and are reported on in the article include the use of community health workers to support chronic disease prevention and management, partnering with and building the capacity of local organizations and institutions, linking public health and primary care by addressing the social determinants of health in a primary care and community setting, and using mobile phones to transform practices for managing type 2 diabetes. The paper concludes that based on the early learnings of this approach, there is value in looking to tested and proven global health strategies to address health disparities in underserved communities in the United States and calls for further exploration of this approach by other actors

Borderline Tumors of the Ovary: A Clinicopathological Study

Objective: To report experience with borderline ovarian tumors (BOTs) in a developing country like Pakistan with limited resources and weak database of health system. Methods: Patients with BOTs managed at Shaukat Khanum Cancer hospital, Lahore, Pakistan from 2004 to 2014 were included and reviewed retrospectively. Data was recorded on histopathological types, age, CA-125, stage of disease, treatment modalities and outcomes. Results: Eighty-six patients with BOT were included with a median age of 35 years. Forty-two (49%) patients had serous BOTs and 43 (50%) had mucinous BOTs, while one (1%) had mixed type. Using FIGO staging, 80 patients had stage I; two patients had IIA, IIB and stage III each. Median follow-up time was 31.5 months. All patients had primary surgery. Seventy (81%) patients underwent complete surgical resection of tumor. Forty-three (50%) patients had fertility preserving surgery. Seventy-three (85%) patients remained in remission. Recurrent disease was observed in 13 (15%) patients. Median time to recurrence was 22 months. On further analysis, age above forty years, late stage at diagnosis and incomplete surgery were significantly associated with invasive recurrence. Conclusion: Despite a low malignant potential, relapses may occur in patients above forty years of age, incomplete surgery and staging information and advanced stage at presentation. Fertility sparing surgery should be considered in young patients. Complete excision of tumor and prolonged follow-up are advised because recurrence and transformation to invasive carcinoma may occur

Exploring the Feasibility of Integrating Mental Health into a Family Planning Program in low-resource settings

Introduction: Mental health challenges remain a pressing issue, underscored by the glaring gap between the elevated demand and the scarce resources. Research has highlighted the effectiveness of integrating mental health services with primary care services, particularly in low-resource settings. Purpose: The objective of this research was to evaluate the perceived implications and feasibility of integrating basic mental health services into an existing community-based family planning initiative in Pakistan. By adopting a community-driven and co-produced methodology, our study not only ensured a deeper resonance with local needs but also paved the way for a sustainable and transformative uptake of mental health services in low-resource settings. This co-produced strategy, anchored in mutual collaboration and shared expertise with the community, promises a more holistic, enduring, and adaptive integration of essential health services within community frameworks.Methodology: This study utilized a qualitative research approach to obtain a comprehensive understanding of the program's feasibility and potential for expansion. Interview tools and guides, tailored to the regional language, were developed by the Research Associate to gather insights from the lady health workers involved in delivering the intervention, as well as from the clients. Overall, our team conducted 24 interviews, of which 9 were with the lady health workers and 15 with clients. The interviews were facilitated by the Research Associate and a Psychologist.Results: Utilizing the socio-ecological model, we thematically analyzed factors at individual, interpersonal, and community levels that support or hinder the integration of mental health services with existing community-based programmes. We also examined the intervention's impact on its users and the healthcare providers.Our analysis underscores the significant potential of integrating mental health services into existing community-based health programmes, such as family planning, in low-resource settings. Predominant themes highlighted women's willingness to use these services, influenced by strong relationships and trust in the lady health workers, ease of access to services, and community support. Identified barriers to integration included prevailing poverty, a preference for direct financial incentives in addition to counseling, confidentiality concerns in tight-knit communities, and the lingering stigma surrounding mental health.Conclusion: Our findings highlight the value of community collaboration in healthcare, particularly in low-resource settings. The co-production approach blends professional guidance with local insights, fostering community ownership and enhancing program sustainability. As the first to merge mental health with family planning in Pakistan, our research suggests that future health initiatives can greatly benefit from community-driven methods, leading to more sustainable and transformative health outcomes

Utilization of Smartphones to Access Health-related Information: A Descriptive Analysis (2010-2012)

Thesis (Master's)--University of Washington, 2013Objective: To examine the extent to which smartphone utilization to access the internet and health-related information increased from 2010 to 2012, and how this utilization varies by demographics and type of chronic disease. Methods: Analysis was done on publicly available de-identified survey data obtained from the Pew Research Center. Three outcome variables were assessed by demographics and chronic disease: a) Cellphone use to access internet b) Cellphone use to look up health-related information and c) Cellphone with downloadable "apps" to help manage health. Results: Smartphone utilization to access the internet increased by 17.3% from 2010 to 2012 and smartphone utilization to access health-related information increased by 13.6%. Utilization of health management "apps" increased by 1.3%. Conclusions: Smartphone adoption and utilization for accessing health-related information seems to be increasing steadily; however, this increase is primarily happening in individuals from higher income brackets, those that are younger, and those living in urban/suburban areas. Without finding strategies to specifically target low-income, urban/rural, and elderly populations whilst facilitating increased health literacy, mHealth technology solutions run the risk of becoming an amenity available for the privileged few

Use of the Health Belief Model for the Assessment of Public Knowledge and Household Preventive Practices in Karachi, Pakistan, a Dengue-Endemic City.

Prevention is most effective in reducing dengue infection risk, especially in endemic countries like Pakistan. Evaluation of public awareness and health beliefs regarding dengue fever (DF) is important for devising disease control strategies. This study assessed dengue knowledge, health beliefs, and preventive practices against DF in different socioeconomic groups of Karachi, Pakistan.In this community-based cross-sectional study, 6 randomly selected towns were visited, 2 persons (man and woman) per household were interviewed using a structured questionnaire, and household practices were observed. Information regarding DF was shared through a printed pamphlet. Multivariate logistic regression analysis of variables associated with dengue knowledge and practices was conducted.We interviewed 608 Karachi residents (mean age: 33.2 ± 13.35 years); 7.7%, 71.9%, and 20.4% had a high, middle, and low socioeconomic status, respectively. The mean knowledge score was 6.4 ± 2.10 out of 14. The mean preventive practices score was 9 ± 1.8 out of 17. Predictors of dengue knowledge were perceived threat (odds ratio [OR] = 1.802; 95% confidence interval [CI] = 1.19-2.71; p = 0.005), self-efficacy (OR = 2.910; 95% CI = 1.77-4.76; p = 0.000), and television as an information source (OR = 3.202; 95% CI = 1.97-5.17; p = 0.000). Predictors of dengue preventive practices were perceived threat (OR = 1.502; 95% CI = 1.02-2.19; p = 0.036), self-efficacy (OR = 1.982; 95% CI = 1.34-2.91; p = 0.000), and dengue knowledge (OR = 1.581; 95% CI = 1.05-2.37; p = 0.028).Public knowledge about DF is low in Karachi. Knowledge, threat perception, and self-efficacy are significant predictors of adequate dengue preventive practices. Prevention and control strategies should focus on raising awareness about dengue contraction risk and severity through television. Health messages should be designed to increase individual self-efficacy

Exploring the Feasibility of Integrating Mental Health into a Family Planning Program in low-resource settings

Introduction: Mental health challenges remain a pressing issue, underscored by the glaring gap between the elevated demand and the scarce resources. Research has highlighted the effectiveness of integrating mental health services with primary care services, particularly in low-resource settings

Multivariate Logistic Regression Analysis of Variables Associated with Dengue Preventive Practices.

<p>Multivariate Logistic Regression Analysis of Variables Associated with Dengue Preventive Practices.</p

Willingness to Support the Government Campaign and Its Association with Demographics, Dengue Knowledge, Practices, and Health Beliefs.

<p>Bars represent the willingness to support the government campaign for dengue prevention according to demographic characteristics, perceived threat of dengue, self-efficacy, and preventive practices. P-values shown in bold indicate a significant association.</p

Univariate Analysis of the Association of Dengue Preventive Practices with Demographic and Other Determinants (N = 608).

<p>Univariate Analysis of the Association of Dengue Preventive Practices with Demographic and Other Determinants (N = 608).</p