Advances in the prevention, management and treatment of community-acquired pneumonia

Despite the availability of powerful antibiotics, community-acquired pneumonia (CAP) remains one of the leading reasons for morbidity and mortality worldwide, and despite the availability of powerful antibiotics, there has been only little improvement in case fatality rates for many years. Consequently, it cannot be expected that novel antibiotics will substantially improve outcomes in CAP. Therefore, this review focuses on novel approaches that may reduce CAP-related mortality: the impact of immunomodulation by macrolides and fluoroquinolones and the prevention of CAP by pneumococcal vaccines.

Transnationalism and Identity: the Concept of Community in Ghanaian Literature and Contemporary Ghanaian Culture

In my thesis, I use anthropology, literature, and adinkra, an indigenous art, to study Ghanaian concepts of community from an interactive standpoint. While each of these disciplines has individually been used to study the concept of community, the three have not previously been discussed in relation to one another. I explore the major findings of each field—mainly that in anthropology, transnational informants find communities upheld; in literature, transnational characters find the opposite; and in adinkra, there are elements of both continuity and dissolution—to discuss Ghanaian constructs of community in the transnational world. Throughout time, there have always been transnational individuals and concepts, but as globalization continues, transnationalism has become an ever-more vital topic, and combined with the common anthropological discussion of tradition and modernity, its influence on developing countries, like Ghana, is significant. Therefore, in my thesis, I explore how differing conceptions of community present themselves in each discipline, and how those divergences create a new understanding of place and identity.

The sense of the body in individuals with spinal cord injury

Increasing evidence suggests that the basic foundations of the self lie in the brain systems that represent the body. Specific sensorimotor stimulation has been shown to alter the bodily self. However, little is known about how disconnection of the brain from the body affects the phenomenological sense of the body and the self. Spinal cord injury (SCI) patients who exhibit massively reduced somatomotor processes below the lesion in the absence of brain damage are suitable for testing the influence of body signals on two important components of the self-the sense of disembodiment and body ownership. We recruited 30 SCI patients and 16 healthy participants, and evaluated the following parameters: (i) depersonalization symptoms, using the Cambridge Depersonalization Scale (CDS), and (ii) measures of body ownership, as quantified by the rubber hand illusion (RHI) paradigm. We found higher CDS scores in SCI patients, which show increased detachment from their body and internal bodily sensations and decreasing global body ownership with higher lesion level. The RHI paradigm reveals no alterations in the illusory ownership of the hand between SCI patients and controls. Yet, there was no typical proprioceptive drift in SCI patients with intact tactile sensation on the hand, which might be related to cortical reorganization in these patients. These results suggest that disconnection of somatomotor inputs to the brain due to spinal cord lesions resulted in a disturbed sense of an embodied self. Furthermore, plasticity-related cortical changes might influence the dynamics of the bodily self.

Greek Life and God Attachment: the Interaction of Sorority Influence and Religiosity on Women's Body Shame

The present study investigated the relationships between sorority women’s internalization of Greek thin ideals and body image, and dimensions of sorority women’s religiosity and body image. A combined relationship among sorority women’s internalization of Greek thin ideals, body image, and religiosity was also examined. Based on previous research it was expected that women’s internalization of Greek thin ideals would be associated with worse body image (in terms of body shame, body esteem, and drive for thinness) and that women’s religiosity (in terms of secure attachment to God) would be associated with better body image. Combinations of Greek thin ideal internalization and God attachment were expected to significantly predict changes in women’s body image. Women completed a series of survey measures assessing their awareness and internalization of Greek sociocultural thin ideals and their sense of community within their particular sorority. Women also completed a series of survey measures assessing their body shame, body esteem, and drive for thinness, in addition to survey measures assessing dimensions of their religiosity. The study’s findings revealed that women’s internalization of Greek thin ideals was associated with worse body image outcomes and that anxious attachment to God was associated with worse body image outcomes, particularly in relation to body shame. Moderation analyses revealed that Greek thin ideal internalization significantly interacted with anxious God attachment to predict body shame.

Understanding Research Fatigue in the Context of Community-University Relations

Community research fatigue has been understudied within the context of community-university relationships and knowledge production. Community-based research (CBR), often occurring within a limited geography and population, increases the possibility that community members feel exhausted or over-whelmed by university research —particularly when they do not see tangible results from research activities. Prompted by informal stories of research fatigue from community members, a small graduate student team sought to understand the extent to which community members experienced research fatigue, and what factors contributed to or relieved feelings of research fatigue. In order to explore these dimensions of research fatigue, semi-structured, face-to-face interviews were conducted with 21 participants, including community members (n = 9), staff and faculty (n = 10), and students (n = 2). The objective of the research was to identify university practices that contribute to research fatigue and how to address the issue at the university level. Qualitative data analysis revealed several important actionable findings: the structure and conduct of community-based research, structured reciprocity and impact, and the role of trust in research. This study’s findings are used to assess the quality of Clark University’s research relationship with its adjacent community. Recommendations are offered; such as to improve partnerships, the impact of CBR, and to develop clear principles of practice.

Rural water system sustainability : a case study of community-managed water systems in Saramaka communities

Worldwide, rural populations are far less likely to have access to clean drinking water than are urban ones. In many developing countries, the current approach to rural water supply uses a model of demand-driven, community-managed water systems. In Suriname, South America rural populations have limited access to improved water supplies; community-managed water supply systems have been installed in several rural communities by nongovernmental organizations as part of the solution. To date, there has been no review of the performance of these water supply systems. This report presents the results of an investigation of three rural water supply systems constructed in Saramaka villages in the interior of Suriname. The investigation used a combination of qualitative and quantitative methods, coupled with ethnographic information, to construct a comprehensive overview of these water systems. This overview includes the water use of the communities, the current status of the water supply systems, histories and sustainability of the water supply projects, technical reviews, and community perceptions. From this overview, factors important to the sustainability of these water systems were identified. Community water supply systems are engineered solutions that operate through social cooperation. The results from this investigation show that technical adequacy is the first and most critical factor for long-term sustainability of a water system. It also shows that technical adequacy is dependent on the appropriateness of the engineering design for the social, cultural, and natural setting in which it takes place. The complex relationships between technical adequacy, community support, and the involvement of women play important roles in the success of water supply projects. Addressing these factors during the project process and taking advantage of alternative water resources may increase the supply of improved drinking water to rural communities.

The self-administered 24-item geriatric pain measure (GPM-24-SA): psychometric properties in three European populations of community-dwelling older adults

OBJECTIVE: To explore the feasibility and psychometric properties of a self-administered version of the 24-item Geriatric Pain Measure (GPM-24-SA). DESIGN: Secondary analysis of baseline data from the Prevention in Older People-Assessment in Generalists' practices trial, an international multi-center study of a health-risk appraisal system. PARTICIPANTS: One thousand seventy-two community dwelling nondisabled older adults self-reporting pain from London, UK; Hamburg, Germany; and Solothurn, Switzerland. OUTCOME MEASURES: GPM-24-SA as part of a multidimensional Health Risk Appraisal Questionnaire including self-reported demographic and health-related information. RESULTS: Among the 1,072 subjects, 655 had complete GPM-24-SA data, 404 had 30% missing GPM-24-SA data. In psychometric analyses across the three European populations with complete GPM-24-SA data, the measure exhibited stable internal consistency, good convergent, divergent and discriminant validity, and produced stable pain measurements. However, factor analysis indicated differences in the GPM-24-SA across sites with discrepancies mainly related to items of a single subscale that failed to load appropriately. Analyses including imputation for subjects with of pain in community dwelling older adults. However, because of incomplete response and uncertainty in factor structure, further refinement and psychometric evaluation of the GPM-24-SA is needed before it could be recommended for widespread use.

[Active and healthy living in old age--results from a representative survey of community-dwelling senior citizens in Hamburg]

BACKGROUND: The majority of community-dwelling people 60 years and older are independent and live actively. However, there is little information about elderly persons' views on aging, health and health promotion. METHODS: Therefore, an anonymous, written questionnaire survey was performed in a representative sample of inhabitants from a section of the city of Hamburg, 60 years and older; 5 year intervals, 14 subsamples according to 7 age groups of females and males. RESULTS: Questionnaires from 950 participants (29% response) could be evaluated: mean age 71.5 years, 58% women, 34% living alone, 5% with professional healthcare needs as indicated by status according to German nursing care insurance. Senior citizens' positive attitudes towards aging and health were predominant: 69% of respondents felt young, 85% worried about loss of autonomy in old age. CONCLUSIONS: The results provide evidence indicating potential for improving health-promoting lifestyles in parts of the older population by evaluating and strengthening older persons' competencies and by considering their concerns seriously. These results provide valuable information for future plans in the public-health sector in the city of Hamburg where particular health-promoting actions for elderly persons will be considered.