Improving the implementation of tobacco control policies in low-and middle-income countries: a proposed framework

Although tobacco control policies have been adopted across the globe, effective implementation continues to be a major challenge, particularly in low-income and middle-income countries, where almost 80% of the world’s smokers reside. This conceptual framework illustrates the constellation of factors that have been shown to influence implementation fidelity: political commitment, institutional capacity and operational effectiveness, social climate and tobacco industry interference. Researchers and practitioners can use this framework to identify the points of leverage in the implementation process and contribute to actionable knowledge as well as theory development

Choral singing therapy following stroke or Parkinsons disease: An exploration of participants experiences

© 2015 Informa UK Ltd. Purpose: People with stroke or Parkinsons disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Method: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Results: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. Conclusions: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties.Implications for RehabilitationChoral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition.Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms.CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks

JHSPH scholar's program: strengthening the next generation of global tobacco control leaders

Background and challenges to implementation The Johns Hopkins Bloomberg School of Public Health (JHSPH) has supported a Global Tobacco Control Leadership Program and an academic Certificate Program for over a decade. These capacity building programs have reached approximately 1700 people in over 85 countries. Program evaluations and feedback from our Partners indicated a need for an advanced leadership program. In 2017, a pilot project to enhance the leadership skill set of selected JHSPH Program alumni from low- and middle-income countries was undertaken. Intervention or response Leadership and Certificate Program alumni were invited to submit a brief concept note addressing a tobacco control problem they would address as part of a project during the course of the year. Applicants were also evaluated on their statement of interest; commitment from their parent organization; their qualifications and experience; and letters of reference. Selected scholars are acquiring advanced leadership skills through a year-long curriculum focused on a systems thinking and design approach. The curriculum comprises of in-person components (lectures; group work etc.), online components (webinars), targeted mentoring by established leaders and implementation of the project. Program evaluation will include assessing of the extent to which the scholars were able to apply advanced leadership skills in the context of a systems approach in their work. Results and lessons learnt While recognizing leadership potential in individuals can be challenging from afar, in-depth queries, the strength of their organization's commitment, and the willingness of others to mentor and support an individual are expected to be indicative of the scholar's potential. A creative approach to curriculum design can help ensure that leadership value is added across a diverse scholar cohort. Conclusions and key recommendations The scholar's program provides a tailored approach to capacity building in low-and middle- income countries and provides an opportunity to advance the next generation of tobacco control leaders

Issues and options for the safe destruction and disposal of used injection materials

It has long been known that the re-use of syringes can cause the spread of infections such as HIV and hepatitis. The production of disposable syringes was undertaken as a solution to the infection problem. In developing countries, however, there has been an unwanted result: the re-use and recycling of disposable syringes. One response has been ‘auto-disable’ syringes that lock the plug and piston in place after a single use. These types of approaches, however, have resulted in greatly increased volumes of used injection materials. This is a particular problem in developing countries where contaminated medical wastes find their way into municipal garbage where people are known to scavenge and recycle. This poses obvious health risks, both in terms of direct exposure and environmental contamination. This study of issues and options for the safe destruction and disposal of used injection materials was undertaken using document analysis was to bring together and summarise approaches to the inter-related issues of ‘syringe re-use’ and ‘clinical waste disposal’. The authors suggest that holistic approaches to syringe use and clinical waste disposal need to be utilized in addressing the situation outlined. The focus is on technology and procedures that may be adaptable to rural areas in developing countries

Air nicotine levels in public places in Ahmedabad, India: Before and after implementation of the smoking ban

Aim: To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008. Materials and Methods: Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration. Results: Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m 3 Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m 3 IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m [3] at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160). Conclusion: Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban

Molecular evolution of Dmrt1 accompanies change of sex-determining mechanisms in reptilia

In reptiles, sex-determining mechanisms have evolved repeatedly and reversibly between genotypic and temperature-dependent sex determination. The gene Dmrt1 directs male determination in chicken (and presumably other birds), and regulates sex differentiation in animals as distantly related as fruit flies, nematodes and humans. Here, we show a consistent molecular difference in Dmrt1 between reptiles with genotypic and temperaturedependent sex determination. Among 34 non-avian reptiles, a convergently evolved pair of amino acids encoded by sequence within exon 2 near the DM-binding domain of Dmrt1 distinguishes species with either type of sex determination. We suggest that this amino acid shift accompanied the evolution of genotypic sex determination from an ancestral condition of temperature-dependent sex determination at least three times among reptiles, as evident in turtles, birds and squamates. This novel hypothesis describes the evolution of sex-determining mechanisms as turnover events accompanied by one or two small mutations

Choir singing and health status in people affected by cancer

Cancer survival rates have improved dramatically over recent years, however, health-related quality of life (HRQoL) for many patients, survivors and their families remains low even after successful treatment. This mixed-methods observational study explored the effects of participation in community choirs on HRQoL in individuals who have had cancer (patients) or have been affected by cancer (non-patients). This included a longitudinal analysis of choristers commencing the Tenovus Cancer Care “Sing with Us” choirs across Wales and a series of semi-structured interviews and focus groups. Participants completed the Short-form 36 and the Hospital Anxiety and Depression Scale on commencement of the choir and 3 and 6 months later. On joining the choir, several domains of the SF36 were lower, indicating worse HRQoL and greater depression in patients than non-patients (p < .05). In patients, choir participation improved vitality, overall mental health and anxiety. In non-patients, choir participation improved anxiety (p < .05). Participants experienced the choirs as both an uplifting musical activity and a supportive community group. The results support the provision of a spectrum of support options to meet the different needs and preferences of people affected by cancer