Adaptive Leadership in Micro Social Enterprise Teams

COVID-19 is a relatively new disease, and most victims are in low income, people-facing jobs. The most economically disadvantaged in society are less able to comply with certain non-pharmaceutical interventions (NPIs) partly due to their financial situation. Hope for the Helpless (H4H), set up as part of a micro social enterprise to cater for rough sleepers in London, UK, is at the heart of the COVID-19 response to the homeless there. A lack of financial resources or capital can constrain social entrepreneurs and restrict their ability to create social capital. However, some social entrepreneurs have been able to innovatively leverage on previous relationships to augment their resource base because engagement with stakeholders is critical. The study explores one such relationship between H4H and a local health centre. It is hoped that this study will uncover survival strategies for social entrepreneurs to succeed and thrive in a post-COVID-19 world.

PEP4LEP study protocol: integrated skin screening and SDR-PEP administration for leprosy prevention: comparing the effectiveness and feasibility of a community-based intervention to a health centre-based intervention in Ethiopia, Mozambique and Tanzania

IntroductionLeprosy, or Hansen’s disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission.Methods and analysisPEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers’ capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability.Ethics and disseminationEthical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers.Trial registration numberNL7294 (NTR7503).

EFFECT OF INBREEDING ON WEIGHT GAIN OF OFFSPRING FROM BIRTH TO 12 MONTHS AFTER BIRTH: A STUDY FROM IRAN

SummaryConsanguinity, the marriage between relatives, has been associated with adverse child health outcomes. The objective of the present study was to assess the effect of consanguinity on offspring weight gain from birth to 12 months after birth. Data were collected on 250 consecutive live-born singleton newborns referred to a local health centre in Shiraz (Fars province, southern Iran). Collected data covered socio-demographic characteristics (such as parental age at delivery and parental education), sex, birth order, weights from birth to 12 months after birth and consanguinity of marriages of parents. Considering the low prevalence of double first cousin, first cousin once removed, second cousin, and beyond second cousin marriages, only first cousin and unrelated marriages were included in the study. The study population consisted of a total of 207 newborns (57 offspring of first cousins, 150 offspring of unrelated marriages). Based on the results of repeated measurements analysis of variance, weight gain was associated with type of marriage (p=0.018), sex of offspring (p=0.001) and paternal education (p<0.001). There was no interaction between type of marriage and sex (p=0.831). Birth weight was not affected by type of marriage (p=0.46). There was significant interaction between inbreeding and time (p=0.034). Offspring of consanguineous marriages showed lower weight gain in comparison with those of unrelated marriages during 3–12 months after birth.

Seroprevalence and some correlates of Helicobacter pylori at adult ages in Gülveren Health District, Ankara, Turkey

The purpose of the study was to detect the frequency and distribution of Helicobacter pylori in the Gülveren Health Centre service area among residents aged between 25 and 64 years and to evaluate the relation of H. pylori infections with general health status, socioeconomic status, and some lifestyle habits. The study included a representative sample of Gülveren Health Centre residents, aged between 25 and 64 years. A stratified random sample of 1672 individuals was selected for study purposes out of 10569 residents, stratified by age and gender. A standardized questionnaire was completed for all study participants using a face-to-face interview and all participants were invited to the local health centre for a thorough physical examination and blood tests. The overall prevalence of H. pylori was found to be 77·5% among individuals aged between 25 and 64 years. The frequency of H. pylori was higher among individuals with low socioeconomic status; those who migrated to Ankara after the age of 20 years; members of large families (household size of 4 or above); non-alcohol drinkers; and those who regularly drink tea.

Impact of community participation on treatment outcomes and compliance of DOTS patients in Iraq

We assessed the effect of community participation on treatment outcomes for tuberculosis patients undergoing directly-observed therapy, short course [DOTS]. From February to December 2001 172 newly diagnosed patients in Baghdad were allocated into 2 treatment groups. The intervention group were visited daily at home for the 2-month initial phase by trained members of the Iraqi Women’s Federation while the control group attended the local health centre for treatment. Cure rates for patients treated at home were significantly better than controls [83.7% versus 68.6%], so too was compliance [100.0% versus 14.0%]. Smear conversion rates were significantly better in intervention cases compared with controls at all stages. Default rates were similar in both groups [11.6% versus 10.5%], as was mortality [1 patient each]

Community Case Study: Suicide Cluster in a Small Manitoba Community

Objectives: To review a cluster of suicides and suicidal ideation in a First Nations community. Method: The medical records and autopsy reports of the victims are reviewed. Collateral information obtained in the community is presented. A series of psychiatric assessments conducted at the local health centre in a 3-day period is outlined. The dilemma of developing appropriate treatment plans is discussed. Results: In the period from February 3 to May 5, 1995, an isolated northern Manitoba First Nations community had 6 suicides in a population of less than 1500. Several other suicide attempts occurred. Community resources were strained. Alcohol was a factor in 4 of the suicides. Previous sexual assault was cited in 4 of 5 female cases presenting with suicidal ideation. Conclusions: Cluster suicide is a shared psychiatric and public health problem of major concern. Dreams of beckoning are common following a suicide. Communities should have a prepared plan to deal with a suicide. Resources should be provided quickly in an effort to prevent a cluster of suicides from occurring. High-risk individuals must be identified. Substance abuse must be addressed. Resources to assess and treat victims of sexual abuse must be available.

A Prevalence Study of Age-Associated Memory Impairment

BackgroundAge-associated memory impairment (AAMI) describes a non-disease ageing-related decline in memory. Pharmacological treatment trials have been reported and DSM–IV has introduced a term for the disorder. No prevalence study with the original criteria has previously been published.MethodAn age-stratified sample was taken of 50–95-year-olds registered with a local health centre. Diagnosis of AAMI was made by questionnaire, cognitive testing, and medical and psychiatric assessment.ResultsPrevalence rates for the total population and for the over-50s were estimated to be 5.8% and 18.5%, respectively. These rates are dramatically affected by minor alterations to individual criteria.ConclusionsIt appears AAMI is less common than previous estimates suggested, although the diagnostic criteria do not satisfactorily define people with an age-related decline in memory. Complaint of memory decline is more strongly correlated with measures of affect and personality than with measures of current memory test performance or estimates of memory decline.

The Treatment of Agoraphobia in General Practice

The present paper aims to describe the work of a behaviourally oriented psychologist in the treatment of agoraphobia, the most common single problem referred in two years' work in primary care. Apart from its high frequency, agoraphobia has a particular relevance to the general practice settings as it is a problem which relates very specifically to the patient's home environment. A recent study by Mathews et al., (in press) found that a home-based treatment of agoraphobia produced at least as much improvement as clinic based treatments and required less therapist time. One might expect that a psychologist operating from the local health centre might achieve many of the advantages of such a program with a possible decrease in therapist time as travelling is reduced.