The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance's Pilot Program

Mobile integrated health care and community paramedicine (MIH-CP) programs expand the role of traditional emergency medical services personnel to address non-emergency needs and bring outpatient primary and urgent care into patients' homes. These programs offer potential for reducing health care costs, eliminating unecessary emergency department use, and shifting service back to community-based and home settings. Between 2014 and 2015, the Massachusetts-based Commonwealth Care Alliance (CCA) piloted a community paramedicine prgoram, Acute Community Care (ACC), to serve its members in the Greater Boston area.This brief summarizes ACC's business case assessment, which showed that increasing patient volume after the pilot period would reuslt in net savings given the progam's success in averting unnecessary emergency care. By illustrating cost considerations for an expansion of MIH-CP services, this brief may inform the design and sustainability planning of other MIH-CP programs. The business case assessment was conducted by Mathematica Policy Research through support from the Center for Health Care Strategies' Complex Care Innovation Lab, a Kaiser Permanente Community Benefit-funded initiative

Protective Effects of Morin Hydrate on Acute Stress-Induced Behavioral and Biochemical Alterations in Mice

Introduction: As stress affects the brain both physiologically and chemically, researchers try to find novel anti-stress compounds with beneficial therapeutic effects. In this regard, the effect of stress and its modulation by Morin hydrate was studied using different acute models in mice.Methods: The models employed were anoxic tolerance, swimming endurance, and acute restraint test. Morin hydrate or the vehicle was administered 30 minutes prior to each stress exposure while in the acute restraint test; the animals were pretreated for 7 days with Morin hydrate, vehicle, imipramine, or diazepam before stress exposure. The measured parameters were the onset of convulsion and immobility time in the anoxic tolerance and swimming endurance test, respectively, while in the acute restraint test, the animals were assessed for stress-induced anxiety using the elevated plus maze and depression using the forced swim test. Thereafter blood was withdrawn from the retro-orbital plexus and plasma separated, the brain was also isolated, homogenized, centrifuged, and the supernatant was obtained for biochemical estimation. Results: Morin hydrate (5, 10, 20 mg/kg) produced a significant reduction in immobility time in the swimming endurance test, while significantly increased the anoxic stress tolerance time. Acute restraint stress caused a significant decrease in reduced glutathione levels (which was reversed by Morin hydrate) and increased the level of malondialdehyde, a thiobarbituric acid reactive substance which is an index of oxidative stress and nitrite. These effects were attenuated by Morin hydrate. Also, pretreatment with Morin hydrate attenuates acute restraint stress-associated anxiety and depression, reversed the hyperglycemia evoked by the stressful exposure and normalized serum cholesterol levels. Conclusion: These findings suggest that Morin hydrate exhibits anti-stress effects and may be useful in the relief of stress

Participatory Development of Demand-Driven Curriculum for Career-Ready E-Extension Services in Nigeria

This paper described and contextualized participatory development of demand-driven curriculum for career-ready e-extension services in Nigeria as introduced by the Sasakawa Africa Fund for Extension Education. The stages of participatory development were participatory need assessment, participatory stakeholders’ workshop and validation among 124 stakeholders selected as key informants in relation to agricultural extension training, delivery, end users and policy makers. The stakeholders were grouped as follows: community leaders and policy makers; extension agencies / organisations / institutions / employers; farmers; input suppliers / marketers / agro-based traders / other value actors; and potential candidate groups. Stakeholder meetings were held separately with different groups three times, and then a combined meeting took place. The aggregated major decisions/consensus were subjected to content analysis using ATLAS.ti. The validation process included reading of each agreed decision to all participants, then participants indicated their agreement or otherwise, which led to either rejection or acceptance of the decision. This paper concludes that participatory curriculum development has enhanced the stakeholders to identify areas of demand-driven training in response to community needs. The stakeholders preferred more online than face-to-face training. The major perceived advantages of e-extension were reduced risk, time and cost effectiveness while infrastructural and human challenges were the perceived challenges that could possibly hinder the smooth running of e extension

A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria

<p>Abstract</p> <p>Background</p> <p>In Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect. The treatment regimen of ACT is however more complicated than that of CQ. There is thus a need to determine the feasibility of using ACT at the home level and determine community perception on its use.</p> <p>Methods</p> <p>A before and after qualitative study using key informant interviews (KII) and focus group discussions (FGDs) was conducted in selected villages in Ona-Ara local government area. At baseline, 14 FGDs and 14 KIIs were conducted. Thereafter, community medicine distributors (CMDs) were trained in each village to dispense artemeter-lumenfantrine (AL) to febrile children aged 6–59 months presumed to have uncomplicated malaria. After one year of drug distribution, nine KIIs and 10 FGDs were conducted. Participants and key informants were mothers and fathers with children under five years, traditional heads of communities, opinion leaders and health workers.</p> <p>Results</p> <p>None of the participants have heard of AL prior to study. Participants were favourably disposed to introduction of AL into the community. Mothers/caregivers were said to have used AL in place of the orthodox drugs and herbs reported commonly used prior to study after commencement of AL distribution. The use of CMDs for drug distribution was acceptable to the participants and they were judged to be efficient as they were readily available, distributed correct dose of AL and mobilised the community effectively. AL was perceived to be very effective and no significant adverse event was reported. Major concerns to the sustainability of the program were the negative attitudes of health workers towards discharge of their duties, support to the CMDs and the need to provide CMDs incentives. In addition regular supply of drugs and adequate supervision of CMDs were advised.</p> <p>Conclusion</p> <p>Our findings showed that the use of AL at home and community level is feasible with adequate training of community medicine distributors and caregivers. Community members perceived AL to be effective thus fostering acceptability. The negative attitudes of the health workers and issue of incentives to CMDs need to be addressed for successful scaling-up of ACT use at community level.</p

High-Value Care for Marginalized Communities: Aligning the Healthcare Ecosystem

This is a crucible moment for health care in the US. Trust at an all-time low Health care workers in crisis Life expectancy declining Disparities stubbornly persist Health care spending as a % of GDP continues to rise We are running out of time, money, and moral standing. We must begin to do things differently

Analysis of the Dimensions and Determinants of Household Food Security Status among Maize Farming Households in Lagos State, Nigeria

The study focused on analysis of the dimensions and determinants of household food security status among maize farming households in Lagos State, Nigeria. The specific objectives of the study were to describe the socio-economic characteristics of the respondents, examine the dimensions of food security status of the households, determine their food security status and examine the factors influencing food security among the maize farming households in the study area. Primary data for the study were obtained from 155 maize farming household heads with the aid of structured questionnaire. Descriptive statistics, food security index assessment and logit regression model were used to analyse the data. The results showed that majority (91.6%) of the households were headed by males who were aged 59 years, on the average, married (91.6%) and their level of literacy was very high as all of the respondents had a form of formal education. The mean household size of the study area was 7 members. The household heads had farming experience of 32 years, a mean farm size of 2.14 hectares for maize farming and an average of 1.24 hectares for farming other crops. The results further showed that 77.4% of the household heads perceived food to be moderately available for consumption throughout the year, 81.3% had three square meals each day and 81.2% perceived their food quality consumed to be high all year round. Consequently, majority (97%) of them were food secure. Significant determinants of food security status among the households were farm size, household size and access to credit facilities. Farm size and access to credit facilities influenced food security positively while household size affected it negatively. It was recommended that government should create enabling environment for the farmers to have easy access to more arable land and credit facilities to help them expand their production in order to improve food security for both the farmers and the citizens at large. Keywords: food security, household, socio-economics DOI: 10.7176/JESD/12-20-04 Publication date:October 31st 202

Problems Affecting the Accessibility of Physically-Challenged Individuals to Intermediate Public Transport Services in Oyo State, Nigeria

The greatest challenge of physically-challenged individuals is mobility, thereby making access to public transportation essential to independent living for these individuals. The study was conducted in Oyo State. Multistage sampling method comprising purposive and simple random sampling was used to select a sample size of 226 students from three special education centres in the state. Findings revealed that factors such as operators’ impatience/discrimination, waiting time and lack of assistance were major problems that affects accessibility to IPTs. Furthermore, results showed that difficulties experienced by the physically-challenged individuals differ significantly by the nature of disability as evidenced by a chi-square value of 37.218, p<0.05. It was therefore recommended that government should listen more to these transport disadvantaged people living with disabilities and integrate their concerns/suggestions in the design, implementation and monitoring of transport infrastructure and services as well as providing sustainable transport means to their transport challenges

Influence of COVID-19 on the Psychological Wellbeing of Tertiary Institution Students in Nigeria

The outbreak of COVID-19 has led to a global lockdown, pending the time medical researchers find a vaccine for the coronavirus. This study examined if loneliness, depression and stress are influences of COVID-19 on the psychological wellbeing of tertiary institutions students in Nigeria. A descriptive research design of survey type was employed for this study. The population comprised all students of tertiary institutions in Nigeria totaling about 4,406,000. One hundred and thirty-seven (137) respondents were sampled for the study. A validated researcher developed questionnaire tested for reliability was used for the study. The data collected were analyzed using descriptive statistics. Chi-square was used to test the hypotheses. All the hypotheses were tested at 0.05 level of significance. The results revealed that loneliness, depression and stress are significant influences of COVID-19 on the psychological wellbeing (Cal χ2 val ˃ Tab χ2 val) @ 0.05 alpha level). The study concluded that loneliness, depression and stress are influences of COVID-19 on the psychological wellbeing of the students. Therefore, it was recommended that more social programmes should be organized on television as long as lockdown is active to help students out of loneliness to support the mental health and well-being of students to save them for depression. Keywords: COVID-19; psychological wellbeing; depression; loneliness; stress; tertiar

Protective Effects of Morin Hydrate on Acute Stress-Induced Behavioral and Biochemical Alterations in Mice

Introduction: As stress affects the brain both physiologically and chemically, researchers try to find novel anti-stress compounds with beneficial therapeutic effects. In this regard, the effect of stress and its modulation by Morin hydrate was studied using different acute models in mice. Methods: The models employed were anoxic tolerance, swimming endurance, and acute restraint test. Morin hydrate or the vehicle was administered 30 minutes prior to each stress exposure while in the acute restraint test; the animals were pretreated for 7 days with Morin hydrate, vehicle, imipramine, or diazepam before stress exposure. The measured parameters were the onset of convulsion and immobility time in the anoxic tolerance and swimming endurance test, respectively, while in the acute restraint test, the animals were assessed for stress-induced anxiety using the elevated plus maze and depression using the forced swim test. Thereafter blood was withdrawn from the retro-orbital plexus and plasma separated, the brain was also isolated, homogenized, centrifuged, and the supernatant was obtained for biochemical estimation. Results: Morin hydrate (5, 10, 20 mg/kg) produced a significant reduction in immobility time in the swimming endurance test, while significantly increased the anoxic stress tolerance time. Acute restraint stress caused a significant decrease in reduced glutathione levels (which was reversed by Morin hydrate) and increased the level of malondialdehyde, a thiobarbituric acid reactive substance which is an index of oxidative stress and nitrite. These effects were attenuated by Morin hydrate. Also, pretreatment with Morin hydrate attenuates acute restraint stress-associated anxiety and depression, reversed the hyperglycemia evoked by the stressful exposure and normalized serum cholesterol levels. Conclusion: These findings suggest that Morin hydrate exhibits anti-stress effects and may be useful in the relief of stress