Adapted Helping Babies Breathe approach to neonatal resuscitation in Haiti: a retrospective cohort study

Background Helping Babies Breathe (HBB) is an American Academy of Pediatrics neonatal resuscitation program designed to reduce neonatal mortality in low resource settings. The 2017 neonatal mortality rate in Haiti was 28 per 1000 live births and an estimated 85 % of Haitian women deliver at home. Given this, the Community Health Initiative implemented an adapted HBB (aHBB) in Haiti to evaluate neonatal mortality. Methods Community Health Workers taught an aHBB program to laypeople, which didn’t include bag-valve-mask ventilation. Follow-up after delivery assessed for maternal and neonatal mortality and health. Results Analysis included 536 births of which 84.3 % (n=452) were attended by someone trained in aHBB. The odds of neonatal mortality was not significantly different among the two groups (aOR=0.48 [0.16-1.44]). Composite outcome of neonatal health as reported by the mother (subjective morbidity and mortality) was significantly lower in aHBB attended births (aOR=0.31 [0.14-0.70]). Conclusion This analysis of the aHBB program indicates that community training to laypersons in low resource settings may reduce neonatal ill-health but not neonatal mortality. This study is likely underpowered to find a difference in neonatal mortality. Further work is needed to evaluate which components of the aHBB program are instrumental in improving neonatal health.

Leveraging genomic diversity for discovery in an EHR-linked biobank: the UCLA ATLAS Community Health Initiative

Large medical centers located in urban areas such as Los Angeles care for a diverse patient population and offer the potential to study the interplay between genomic ancestry and social determinants of health within a single medical system. Here, we introduce the UCLA ATLAS Community Health Initiative-- a biobank of genomic data linked with de-identified electronic health records (EHRs) of UCLA Health patients. We leverage the unique genomic diversity of the patient population in ATLAS to explore the interplay between self-reported race/ethnicity and genetic ancestry within a disease context using phenotypes extracted from the EHR. First, we identify an extensive amount of continental and subcontinental genomic diversity within the ATLAS data that is consistent with the global diversity of Los Angeles; this includes clusters of ATLAS individuals corresponding to individuals with Korean, Japanese, Filipino, and Middle Eastern genomic ancestries. Most importantly, we find that common diseases and traits stratify across genomic ancestry clusters, thus suggesting their utility in understanding disease biology across diverse individuals. Next, we showcase the power of genetic data linked with EHR to perform ancestry-specific genome and phenome-wide scans to identify genetic factors for a variety of EHR-derived phenotypes (phecodes). For example, we find ancestry-specific associations for liver disease, and link the genetic variants with neurological and neoplastic phenotypes primarily within individuals of admixed ancestries. Overall, our results underscore the utility of studying the genomes of diverse individuals through biobank-scale genotyping efforts linked with EHR-based phenotyping.

An evaluation of PlayStreets in the South Side neighborhood of Columbus, Ohio

Outdoor play, physical activity, and social cohesion are crucial indicators of community health. PlayStreets, a street play initiative to engage local children and families in outdoor play, physical activity, and social interactions, were implemented in a low-income neighborhood in Columbus, Ohio throughout the summer of 2019. This article aims to describe the implementation of a hospital-sponsored PlayStreets model executed through support from a community health initiative and to assess neighborhood impact through parent and child surveys. Approximately 350 children attended the events and 69 surveys were collected. Descriptive statistics were used to analyze survey data. The mean age of children was 7 years, and the majority of children who attended were male. If not for PlayStreets, 55% of caregivers reported that their children would be inside. Event satisfaction levels were high, and 54% of caregivers said that they had more contact with their neighbors because of the events. Hospital buy-in and community support were crucial to the success of the event. We found that this model can successfully engage the local community while increasing opportunity for childhood outdoor play, physical activity, and neighborhood social interaction.

A Community Health Initiative: Health to the Power of You

In April 2020, the COVID-19 pandemic impacted the number of visits to ambulatory care practices and was reported to have declined by nearly 60%. The extent of this decline is alarming as outpatient visits help manage chronic diseases in patients, such as diabetes, high blood pressure, and high cholesterol. This trend sparked an interest in pharmacist and student pharmacist, Dr. Cynthia Koh-Knox Sharp and Stephanie Hendricks, respectively, as it offered an opportunity to help serve the Greater Lafayette community. We created Health to the Power of You (HealthYou), which targets two of Lafayette’s neglected populations: community members experiencing homelessness, and members that are 62 years and older living in section 8 housing. Our community health initiative is currently in two facilities, Fairington Apartments of Lafayette and Lafayette Transitional Housing Center, and funded by the Purdue Student Service-Learning Program for Community Service Grant. Student pharmacists conduct weekly home visits and document trends in blood pressure, blood sugars, and blood oxygen levels, as well as facilitate a tobacco cessation program. Additionally, residents are provided health education from a list of 15 health topics, where they select up to three topics to learn over the course of nine weeks. These include, but are not limited to, education on their medications and disease states, vaccines, nutrition, prescription medication insurance, and current events such as COVID-19. Since inception, the program has offered student pharmacists the chance to bridge gaps in transitions of care, assist in the decline of outpatient visits, practice patient-friendly terminology, and motivate patients to take responsibility of their own health. Through this community health initiative, we are mentoring student pharmacists and empowering members of the community to become their biggest healthcare advocates through patient-care services and education.

Using retrospective process analysis to identify lessons learned from a community health initiative

As the WHO-Health-in-all-Policies-concept suggests many of the health-related aspects of the social, physical and economic environments can be modified within the community setting. In reality, developing and implementing population-based health initiatives is often challenging for both communities and researchers. To guide future efforts of community health initiatives, we systematically analyzed challenges we encountered and the lessons learned. We systematically reviewed daily logbooks, meeting minutes and press releases about the initiative to identify successes, unexpected challenges and barriers in its implementation. Comments from two reflective workshops held in the partner community identified additional areas of knowledge. Retrospective content analysis of these sources uncovered emerging process-related themes. Success was evident in a high degree of citizen participation in initiative-related forums. Challenges included a greater need to a) develop a common vision before starting initiative activities, b) establish an effective collaboration between community residents and our team, c) create more transparent lines of communication, foster trust and better manage community expectations. Establishing a project office in the community for regular updates, trust building and partnering with a professional communication agency were key steps that helped turn some challenges into successes. Barriers identified were missing resources both within the community and our team, a limited time period and limited possibilities of reach into all systems within the community (e.g. kindergartens). The use of the method of retrospective process analysis helped to uncover detailed insights into the operational implementation process of a community health initiative. These insights serve as a transfer of practical knowledge, which intends to enable researchers and practioneers within communities to plan and conduct their community health initiatives to large success. Key messages Analyzing the process of health initiatives retrospectively uncovers detailed insights into implementation processes and helps to understand successes, challenges and barriers of the initiative. Insights into the implementation process of health initiatives function as guidance to other researchers and practioneers to support future efforts in the field of community health.

Patient Engagement in Type 2 Diabetes: A Collaborative Community Health Initiative

Purpose The purpose of this study was to describe the effects of an innovative rural community-based, diabetes self-management education and support (DSMES) program on patient behaviors and outcomes. Methods A 12-month pre-post study design with physiological data collection at program initiation, 16 weeks, and 6 and 12 months postenrollment was used for program assessment. The program consisted of an American Diabetes Association–accredited curriculum provided by the hospital and interfaced with a YMCA curriculum promoting lifestyle change. The 28-session program was delivered over a 1-year period. Results The sample size was 115. Participants were primarily white and female, with a mean age of 57 years. Mean body mass index (BMI) at program initiation was 37; mean A1C was 8.5 (69.4 mmol/mol). Significant reductions were obtained in weight, BMI (at 16 weeks), and A1C (at 6 months); these reductions were sustained at 12 months. Medication intake was significantly reduced, and diabetes-related emergency department visits were below national averages. Conclusions Results support the positive impact of a year-long, community-based, healthy behavior, DSMES program on health outcomes and overall costs of care delivery in the rural setting.