The prevalence and burden of primary headache disorders among adults in rural villages of Bangalore District, South India: A community-based study

The prevalence of primary headache disorders (PHDs) and their burden has been seldom studied in the rural community setting of a developing country. To study the prevalence of primary headache disorders and their burden in the rural community A door to door survey was done in seven rural villages under Mugalur sub centre area, Sarjapura Primary Health Centre and Anekal taluk, Bangalore district, Karnataka State, south India, for finding the prevalence and burden of PHDs. During the study period of three months, a total of 1255 people were screened in the seven villages. 13.1% (165/1255) of people suffered from PHDs. The population prevalence of migraine without aura was 8.84% (111/1255), tension type headache was 2.86% (36/1255) and chronic migraine was 1.43%(18/1255). The mean number of headache days for all the PHDs was 4.26 (±1.64) days. 66.1% of persons with headache reported minimal or infrequent impact of headache. Among various demographic variables, headache was significantly associated with the female gender and marital status. PHDs are prevalent in the rural communities of developing countries and need urgent attention of primary care physicians, community health departments, governmental agencies and policy makers.

Implementation evaluation of a collective impact initiative to promote adolescent health in Oklahoma County, USA

Background The teenage birth rate in the USA has considerably decreased in recent decades; however, more innovative, collaborative approaches are needed to promote adolescent health and prevent teenage pregnancy at the community level. Despite literature on the promising results of the collective impact (CI) model for health promotion, there is limited literature on the model’s ability to reduce teenage pregnancies in a community. The Central Oklahoma Teen Pregnancy Prevention Collaboration is applying the CI model to foster collaboration among multiple stakeholders with the goal of increasing community and organizational capacity to improve adolescent health outcomes. This paper reports the findings from the initiative’s implementation evaluation, which sought to understand whether the CI model improved collaboration among organizations and understand barriers and facilitators that affected program delivery. Methods Program implementers and evaluators jointly developed research questions to guide the intervention and evaluation design. The Consolidated Framework for Implementation Research (CFIR) was used to assess program components including the intervention characteristics, organization setting, community setting, facilitator characteristics, and the process of implementation. Primary sources of data included performance measures, meeting observations (n = 11), and semi-structured interviews (n = 10). The data was thematically analyzed using CFIR constructs, community capacity domains, and the five constructs of CI. Results Key findings include the need for shortened meeting times for meaningful engagement, opportunities for organizations to take on more active roles in the Collaboration, and enhanced community context expertise (i.e., those with lived experience) in all Collaboration initiatives. We identified additional elements to the core constructs of CI that are necessary for successful implementation: distinct role identification for partner organizations and incorporation of equity and inclusivity into collaboration processes and procedures. Conclusions Results from this implementation evaluation provide valuable insights into implementation fidelity, participant experience, and implementation reach of an innovative, systems-level program. Findings demonstrate the context and requirements needed to successfully implement this innovative program approach and CI overall. Additional core elements for CI are identified and contribute to the growing body of literature on successful CI initiatives.

A Qualitative Analysis to Understand Perception about Medication-Related Problems among Older Minority Adults in a Historically Black Community

Older adults taking multiple chronic medications experience an increased risk of adverse drug events and other medication-related problems (MRP). Most current literature on medication management involves researcher-driven intervention, yet few studies investigate patients’ understanding of MRP in a diverse community setting. This report investigates patients’ perception of MRP and patient-centered strategies among a cohort of the older adult group in a historically Black urban community. The study design is qualitative using structured open-ended questions in a multidisciplinary patient-centered focus group. Patients (age 65 years or older) taking seven or more medications were recruited. The group comprises patients, caregivers, pharmacists, health educators, a physician, and a nurse. Recordings of the group discussion are transcribed verbatim and analyzed using thematic content analysis and categorized by codes developed from the social-ecological model. The group reports patient-provider relationships, previous experience, fear of side effects played important roles in medication adherence. There is an unmet need for medication management education and tools to organize complex medication lists from multiple providers. This study provides important insights into MRP experienced by minority older adults and provided researchers with potential strategies for future interventions.

Demand for community-based Case Management in Austria - a qualitative analysis

Background The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. Methods A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. Results The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. Conclusions Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.

HIV Vulnerability Among Survival Sex Workers Through Sexual Violence and Drug Taking in a Qualitative Study From Victoria, Canada, With Additional Implications for Pre-exposure Prophylaxis for Sex Workers

Objective: This qualitative study investigates how social and structural forces mediate vulnerability to HIV infection and transmission among survival sex workers, their clients, and their non-commercial, intimate partners—with especial focus on sexual violence and drug taking.Method: I employed an adapted grounded theory approach to conducting and analyzing (n = 9) open-ended, in-depth interviews with a convenience sample of currently working (and recently exited) survival sex workers from a community setting in Victoria, Canada.Findings: Participants revealed important contexts and conditions under which they were vulnerable to HIV infection. At the behavioural level, participants were aware of how HIV could be transmitted (condomless sex and sharing drug equipment), yet participants voiced strongly how structural and systemic features (for instance, client violence, the need for drugs, and “bad date” referrals) could squeeze and constrain their agency to take up safer practices, mediating their optimal HIV health and safety. Some participants reported strained relationships with police because of previous drug involvement.Conclusion: Survival sex workers constitute a health population vulnerable to HIV infection, and ensuring there could be a supportive (outreach) community replete with HIV resources is paramount. The availability of safer sex and drug equipment play important roles in HIV behavioural prevention efforts. However, uptake of pre-exposure prophylaxis (PrEP) at no cost in the Canadian province of British Columbia could be an important and beneficial structural intervention for non-injection drug taking cis-female sex workers in this study who are presently ineligible for no cost PrEP.

ATOPIC DERMATITIS: IMPROVING EARLY DETECTION AND PREVENTION MEASURES IN THE COMMUNITY SETTING

Atopic dermatitis is a chronic inflammation of the skin characterized by disruption of the skin barrier and aberrations in the immune response. In general, atopic dermatitis can be affected by various complex interactions including genetics, diet, and stress. The lack of public attention to atopic dermatitis which often affects children is one of the factors for the increasing prevalence of atopic dermatitis. The purpose of this community service is to help the community understand the importance of early detection and allergy prevention efforts. Community service is carried out by holding online seminars that can be followed by the general public as well as direct consultations and discussions with pediatricians for allergy patients at the Department of Pediatrics at Dr. RSUD Dr. Saiful Anwar Malang. The total Immunoglobulin E level of the respondents was measured using the enzyme-linked immunosorbent assay method. The severity of the respondents was determined by calculating the SCORAD index. The results of early detection showed that 100% of respondents had intrinsic atopic dermatitis, 90% with mild severity and 10% with moderate severity. After being checked for allergies, the respondents received the appropriate supplements. Conclusion: By holding this community service activity, ordinary people become more aware of the importance of treating allergic diseases as early as possible because the incidence of atopic dermatitis can be reduced and the quality of life of patients can be improved. This outreach activity must be carried out continuously in the following years.

The Effectiveness of Minor Procedure as the Management of Onychocryptosis in Community Podiatry Setting: A Retrospective Study

Background: Onychocryptosis is a common and debilitating condition that often require surgical management. Despite this minor procedure being the most common and effective method in managing this condition, as well as being one of the essential services provided by Health Care Professional Council (HCPC) registered podiatrists, there is limited evidence around the effectiveness of this procedure in the community setting. The aim of this study was to evaluate the effectiveness of a non-invasive minor procedure for the management of onychocryptosis. Methods: A retrospective study was undertaken within the community podiatry department. All patients who underwent minor procedure for the management of onychocryptosis between June 2018 and December 2019 were included in this study. The data were collected from the electronic patient records using a comprehensive data collection tool. Recurrence rate and infection rate were calculated to determine the effectiveness of the minor procedure. Results: 354 minor procedures were performed on 272 patients presenting with onychocryptosis. The recurrence rate of nail regrowth following intervention was 5.6% (N=20). Patients <40 years old were more likely to experience a recurrence of nail regrowth following an intervention (N=16). The postoperative infection rate was 8.8% (N=31). Patients who had a partial nail avulsion procedure were more likely to experience postoperative infection compared to total nail avulsion.Conclusions: Although the management of onychocryptosis with this minor procedure is effective within the community podiatry department, incorporation of evaluation of patient satisfaction following this procedure is suggested within the recommendations. The limitations of this study have been highlighted and a mixed method research project is recommended to explore this area of specialty to improve patient outcome.

Remote Covid Assessment in Primary Care (RECAP) risk prediction tool: derivation and real-world validation studies.

Background Accurate assessment of COVID-19 severity in the community is essential for best patient care and efficient use of services and requires a risk prediction score that is COVID-19 specific and adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms and risk factors, we sought to develop and validate two COVID-19-specific risk prediction scores RECAP-GP (without peripheral oxygen saturation (SpO2)) and RECAP-O2 (with SpO2). Methods Prospective cohort study using multivariable logistic regression for model development. Data on signs and symptoms (model predictors) were collected on community-based patients with suspected COVID-19 via primary care electronic health records systems and linked with secondary data on hospital admission (primary outcome) within 28 days of symptom onset. Data sources: RECAP-GP: Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC) primary care practices (development), Northwest London (NWL) primary care practices, NHS COVID-19 Clinical Assessment Service (CCAS) (validation). RECAP-O2: Doctaly Assist platform (development, and validation in subsequent sample). Estimated sample size was 2,880 per model. Findings Data were available from 8,311 individuals. Observations, such SpO2, were mostly missing in NWL, RSC, and CCAS data; however, SpO2 was available for around 70% of Doctaly patients. In the final predictive models, RECAP-GP included sex, age, degree of breathlessness, temperature symptoms, and presence of hypertension (Area Under the Curve (AUC): 0.802, Validation Negative Predictive Value (NPV) of low risk 98.8%. RECAP-O2 included age, degree of breathlessness, fatigue, and SpO2 at rest (AUC: 0.843), Validation NPV of low risk 99.4%. Interpretation Both RECAP models are a valid tool in the assessment of COVID-19 patients in the community. RECAP-GP can be used initially, without need for observations, to identify patients who require monitoring. If the patient is monitored at home and SpO2 is available, RECAP-O2 is useful to assess the need for further treatment escalation.

Leveraging data and digital health technologies to assess and impact social determinants of health (SDoH)

Objective: Identify how novel datasets and digital health technology, including analytics- and artificial intelligence (AI)-based tools, can be used to assess non-clinical, social determinants of health (SDoH) for population health improvement. Methods: A targeted review with systematic methods was performed on three databases and the grey literature to identify recently published articles (2013-2018) for evidence-based qualitative synthesis. Following single review of titles and abstracts, two independent reviewers assessed eligibility of full-texts using predefined criteria and extracted data into predefined templates. Results: The search yielded 2,714 unique database records of which 65 met inclusion criteria. Most studies were conducted retrospectively in a United States community setting. Identity, behavioral, and economic factors were frequently identified social determinants, due to reliance on administrative data. Three main themes were identified: 1) improve access to data and technology with policy – advance the standardization and interoperability of data, and expand consumer access to digital health technologies; 2) leverage data aggregation – enrich SDoH insights using multiple data sources, and use analytics- and AI-based methods to aggregate data; and 3) use analytics and AI-based methods to assess and address SDoH – retrieve SDoH in unstructured and structured data, and provide contextual care management sights and community-level interventions. Conclusions: If multiple datasets and advanced analytical technologies can be effectively integrated, and consumers have access to and literacy of technology, more SDoH insights can be identified and targeted to improve public health.