Racial Disparities in Cancer Screening Among Women with Chronic Joint Pain

Chronic pain related disorders and breast and cervical cancer are more prevalent among African-American women compared with non-Hispanic White women. However, few studies address how racial differences in the context of comorbidity may compound these disparities. This study used secondary analysis of the National Health Interview Survey (NHIS) to assess racial differences in breast and cervical cancer screening and patient education among adult women with chronic joint pain conditions. Statistical analyses included chi-square and independent samples t-tests. African-American women compared with non-Hispanic White women were less likely to receive a pap smear or mammogram within the last two years and receive patient education (p\u3c0.01). Due to competing demands, women with chronic joint pain may not receive preventive services. The results of this study can be used to formulate interventions and evaluate approaches to reduce racial disparities in outpatient service delivery in terms of continuity and scope of care

The Community-Driven Approach to Environmental Exposures: How a Community-Based Participatory Research Program Analyzing Impacts of Environmental Exposure on Lupus Led to a Toxic Site Cleanup

Community-based participatory research (CBPR) is a mechanism to improve environmental quality in communities primarily inhabited by minorities or low income families. A collaborative partnership between the University at Buffalo and the Toxic Waste Lupus Coalition was formed to investigate the high prevalence of lupus in the area and whether cases of disease were linked to chemicals found at a nearby New York State Superfund site in East Buffalo. The purpose of the study was to use CBPR practices to educate impacted residents and enable their participation in efforts to get a nearby contaminated waste site remediated. Community members were active participants in the development of the plan to clean up the toxic site. These methods can be used to better engage the community in research and involve them in actions taken to improve their neighborhood

A geographic information assessment of exposure to a toxic waste site and development of systemic lupus erythematosus (SLE): Findings from the buffalo lupus project

The Buffalo Lupus Project was a community-based participatory research partnership formed to address the relationship between an identified hazardous waste site and high rates of lupus and other autoimmune diseases in the surrounding community. Most cases identified began experiencing symptoms and were diagnosed in the periods when the site was inactive. Trends suggest that the impact of the site was more likely due to chronic exposure to waste rather than it being an acute trigger

O Controlo da Atividade de Investigação Criminal na Guarda Nacional Republicana

O presente Relatório Científico procura retratar o controlo da atividade de Investigação Criminal no seio da GNR. O controlo constitui-se como uma forma de colmatar erros que possam estar a ocorrer e simultaneamente prejudiquem o normal desenrolar de determinada tarefa, no sentido da melhoria e do aumento da proficiência para o desenvolvimento de uma atividade, neste caso em concreto, da Investigação Criminal. No final deste estudo, o principal objetivo consiste em concluir como se pode melhorar o controlo da atividade de Investigação Criminal na GNR. São três as fases essenciais que constituem esta investigação. Uma primeira, Fase exploratória, relacionada essencialmente com aspetos de cariz teórico, onde se apresentam os principais conceitos inerentes à realização deste trabalho. De seguida, numa fase mais vocacionada para o trabalho de campo, Fase analítica, são apresentados os resultados estatísticos fruto da análise dos dados obtidos. Posteriormente, na Fase conclusiva, apresentam-se as conclusões obtidas com a realização deste estudo, propondo melhorias que no futuro poderão aumentar a capacidade da instituição nesta área. A recolha de dados efetuou-se com recurso ao inquérito por questionário, sendo que posteriormente esses mesmos dados foram alvo de análise estatística. Conclui-se com este trabalho que existem algumas lacunas no que concerne a esta temática do controlo da atividade de Investigação Criminal, das quais se destaca a formação dos militares com funções nesta matéria, que segundo os resultados obtidos fica aquém do pretendido.Abstract This Scientific Report seeks to portray the control of Criminal Investigation activity within the GNR. The control it is as a manner to overcome errors that are affecting the normal path of a specific task, in order to improve and increase proficiency during the development of an activity, in this particular case, the Criminal Investigation activity. The main objective of this study seeks to demonstrate how the control of GNR Criminal Investigation could be improved. For this specific research were defined three key stages. The first, an Exploratory Phase, primarily related to aspects of theoretical nature, with the purpose to present the main concepts involved in this schoolwork. A second a phase specifically dedicated to the field research, considered as the Analytical phase, where the statistical results of data analysis are presented. And a third phase, at the conclusions of this scientific research, where were also presented some suggestions or improvements that in the future could enhance the capability of the institution in this area of knowledge. The survey questionnaires were the basis for the data gathering that was later submitted to statistical analysis. The principle conclusion of this study points to the facts that are a few shortcomings in the control of the GNR Criminal Investigation activity. The results obtained show that GNR Criminal Investigation specific training is lower than desirable

A Randomized Controlled Trial of a Research-Tested Mobile Produce Market Model Designed to Improve Diet in Under-Resourced Communities: Rationale and Design for the Veggie Van Study

Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets

Community Engagement in Academic Health Centers: A Model for Capturing and Advancing Our Successes

Academic health centers (AHCs) are under increased pressure to demonstrate the effectiveness of their community-engaged activities, but there are no common metrics for evaluating community engagement in AHCs. Eight AHCs piloted the Institutional Community Engagement Self-Assessment (ICESA), a two-phase project to assess community-engagement efforts. The first phase uses a framework developed by the University of Rochester Medical Center, which utilizes structure, process, and outcome criteria to map CE activities. The second phase uses the Community-Campus Partnerships for Health (CCPH) Self-Assessment to identify institutional resources for community engagement, and potential gaps, to inform community engagement goal-setting. The authors conducted a structured, directed content analysis to determine the effectiveness of using the two-phase process at the participating AHCs. The findings suggest that the ICESA project assisted AHCs in three key areas, and may provide a strategy for assessing community engagement in AHCs

'It is fun, fitness and football really': a process evaluation of a football-based health intervention for men

Concerns about gender inequalities in longevity, particularly premature male mortality, have prompted a range of innovative approaches to health promotion work dating back to the 1980s. In developing such work, sport, and football in particular, has emerged as a gendered cultural field that has utility for engaging men in community health initiatives. Evaluations of such work have shown that health initiatives using football settings, football interventions or even club branding can have positive impact on various health measures in the short and longer term. However, little work to date has looked at the underlying mechanisms that generate success in such projects. This paper presents secondary analysis of data collected during the evaluation of the Premier League Health (PLH) programme specifically focusing on these underlying mechanisms and how/where gender (masculinities) appears in these processes. We draw on interview data with 16 staff who had been involved in the delivery of the PLH initiative and 58 men who took part. Thematic analysis highlighted two overarching (and underpinning) themes: 'Trust', what processes it was key to and how it was developed and sustained; and 'Change', including what it was facilitated by and what impact it had. The paper adds to our understanding of how active listening, flexibility and sustained engagement are key to community-based sports projects' success. Furthermore, it demonstrates how the physicality and sociability of involvement, rather than any direct focus on 'health', are important in acting as a springboard for facilitating reflection and aiding lifestyle changes for men. © 2013 Taylor & Francis

CHOICE: Choosing Health Options In Chronic Care Emergencies

Background Over 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation. Objectives The aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs). Design A three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team. Setting Primary care. Manchester and London. Participants People aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff. Results Evidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling. Limitations The findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD. Conclusions Prior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness. Future work The potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention

Community-Based Participatory Research: Defining Community Stakeholders

Community-based participatory research requires the participation of community stakeholders to inform the process. The West Side Community Asthma Project, a community-based participatory research program to study the effects of the environment on asthma conducted in Buffalo, N. Y, identified a stakeholders group of community leaders and activists. Creative strategies have been implemented to reach out to other community residents to invite them to participate in the participatory process