Establishing a community of practice of researchers, practitioners, policy-makers and communities to sustainably manage environmental health risks in Ecuador

The Sustainably Managing Environmental Health Risk in Ecuador project was launched in 2004 as a partnership linking a large Canadian university with leading Cuban and Mexican institutes to strengthen the capacities of four Ecuadorian universities for leading community-based learning and research in areas as diverse as pesticide poisoning, dengue control, water and sanitation, and disaster preparedness. By 2009, train-the-trainer project initiation involved 27 participatory action research Master’s theses in 15 communities where 1200 community learners participated in the implementation of associated interventions. This led to establishment of innovative Ecuadorian-led master’s and doctoral programs, and a Population Health Observatory on Collective Health, Environment and Society for the Andean region based at the Universidad Andina Simon Bolivar. Building on this network, numerous initiatives were begun, such as an internationally funded research project to strengthen dengue control in the coastal community of Machala, and establishment of a local community eco-health centre focusing on determinants of health near Cuenca. Alliances of academic and non-academic partners from the South and North provide a promising orientation for learning together about ways of addressing negative trends of development. Assessing the impacts and sustainability of such processes, however, requires longer term monitoring of results and related challenges.

Integrating participatory community mobilization processes to improve dengue prevention: an eco-bio-social scaling up of local success in Machala, Ecuador

This project investigates the effectiveness and feasibility of scaling-up an eco-bio-social approach for implementing an integrated community-based approach for dengue prevention in comparison with existing insecticide-based and emerging biolarvicide-based programs in an endemic setting in Machala, Ecuador.

NGOs, elite capture and community-driven development: perspectives in rural Mozambique

This article examines the problems of elite capture in community driven development (CDD). Drawing on two case studies of non-governmental organisation (NGO) intervention in rural Mozambique, the authors consider two important variables – 1) the diverse and complex contributions of local elites to CDD in different locations, and 2) the roles that non-elites play in monitoring and controlling leader activities – to argue that donors should be cautious about automatically assuming the prevalence of malevolent patrimonialism and its ill-effects in their projects. This is because the ‘checks and balances’ on elite behaviour that exist within locally-defined and historically-rooted forms of community-based governance are likely to be more effective than those introduced by the external intervener.

The potential for community groups to promote sustainable living

In recent times there has been a growing recognition amongst policy-makers of the role for community-based action in contributing to the broader aims of energy policy and climate change. In this paper, we will examine the potential for existing community groups to use their influence and elements of internal cohesion to encourage more widespread understanding and adoption of sustainable lifestyle habits; both amongst their members and within the broader communities of which they are a part. Findings are presented from recent empirical work with a range of well-established community groups for whom environmental issues are not their main priority. A central aspect of the research was to explore both the current status and potential role of groups that may have the capacity to reach and influence a broader sphere of the public than energy/environment specific initiatives of recent times have been able to achieve. Representing a diversity of interests, age groups and functionality, the results suggest that the potential for more effective ‘bottom-up’ engagement on climate change and sustainable living might be given fresh impetus by these types of established community groups and their networks. An assessment of what motivates participation and membership in the groups highlights a series of factors common to all groups and a smaller number that are significant for particular groups individually. It is argued that an appreciation of motivating factors can be useful in understanding more clearly how such groups are able to survive and maintain cohesion over time. The findings also suggest that climate change action means different things for different groups, with the diversity of the groups bringing with it the challenge of making sustainable living relevant to a range of interests and different shared values.

Identification of dementia cases in the community: A Brazilian experience

OBJECTIVES: To describe the application in Brazil of a simple, low-cost procedure, developed in India by the 10/66 Dementia Research Group, for the identification of dementia cases in the community.DESIGN: Community-based dementia case-finding method.SETTING: Piraju, São Paulo, Brazil.PARTICIPANTS: Twenty-five community health workers were trained to identify dementia cases in 2,222 people aged 65 and older in Piraju, a Brazilian town with 27,871 inhabitants.MEAUREMENTS: After the training, the health workers prepared a list of possible cases that afterward an experienced psychiatrist clinically evaluated, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and the Clinical Dementia Rating.RESULTS: of the 72 cases that were clinically assessed, 45 met the DSM-IV diagnostic criteria for dementia. Therefore, the positive predictive value of this case finding method was 62.5%; the estimated frequency of dementia was 2%. Most of the confirmed cases met clinical criteria for Alzheimer's disease and vascular dementia.CONCLUSION: This simple method was appropriate to identify cases of dementia in the general population and can possibly be extended to other developing countries with limited resources to be applied in health programs.

Obsessive-compulsive symptom dimensions in a population-based, cross-sectional sample of school-aged children

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação de polimorfismos genéticos na progressão da infecção de pacientes monoinfectados e coinfectados com os Vírus da Imunodeficiência Humana (HIV) e Vírus da Hepatite C (VHC)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Detecção do peptídeo p17 (HIV) baseado em SERS (Surface-enhanced Raman Spectrosocpy)

Pós-graduação em Química - IQ

Relationship Between Regional Brain Volumes and Cognitive Performance in the Healthy Aging: An MRI Study Using Voxel-Based Morphometry

The presence of cognitive impairment is a frequent complaint among elderly individuals in the general population. This study aimed to investigate the relationship between aging-related regional gray matter (rGM) volume changes and cognitive performance in healthy elderly adults. Morphometric magnetic resonance imaging (MRI) measures were acquired in a community-based sample of 170 cognitively-preserved subjects (66 to 75 years). This sample was drawn from the "Sao Paulo Ageing and Health" study, an epidemiological study aimed at investigating the prevalence and risk factors for Alzheimer's disease in a low income region of the city of Sao Paulo. All subjects underwent cognitive testing using a cross-culturally battery validated by the Research Group on Dementia 10/66 as well as the SKT (applied on the day of MRI scanning). Blood genotyping was performed to determine the frequency of the three apolipoprotein E allele variants (APOE epsilon 2/epsilon 3/epsilon 4) in the sample. Voxelwise linear correlation analyses between rGM volumes and cognitive test scores were performed using voxel-based morphometry, including chronological age as covariate. There were significant direct correlations between worse overall cognitive performance and rGM reductions in the right orbitofrontal cortex and parahippocampal gyrus, and also between verbal fluency scores and bilateral parahippocampal gyral volume (p < 0.05, familywise-error corrected for multiple comparisons using small volume correction). When analyses were repeated adding the presence of the APOE epsilon 4 allele as confounding covariate or excluding a minority of APOE epsilon 2 carriers, all findings retained significance. These results indicate that rGM volumes are relevant biomarkers of cognitive deficits in healthy aging individuals, most notably involving temporolimbic regions and the orbitofrontal cortex.

Differences between female and male adolescents regarding individual vulnerability to HIV

The objective of this study was to comparatively analyze male and female adolescents' vulnerability to HIV/AIDS, based on their knowledge, values and practices. This is an exploratory-descriptive study, performed using a quantitative approach. The students answered a questionnaire from which relevant questions were selected for the analysis. The participants were 207 adolescents, 43.5% male and 56.5% female. Most adolescents report having initiated sexual activities. It was observed that the participants have knowledge deficits regarding HIV transmission and safe sexual practices. Although they report knowing about condom use as a method of protection against HIV, they do not always use them. It was observed that there are values connected to the representations of gender, but it is noticed there is an evolution regarding the autonomy and power of the girls' negotiation regarding condom use.

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.

Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings

OBJECTIVE: To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. METHODS: In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. FINDINGS: Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72-19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0-18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37-0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90-0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2-19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15-0.20). CONCLUSION: The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.

An Innovative Family Preservation Program in an African American Community: Longitudinal Analysis

This paper presents a secondary analysis of data from a longitudinal evaluation of a community-based family preservation program in Portland, Oregon, designed for and by African Americans. Families served by the Family Enhancement Program (FEP) resemble chronically neglecting families in terms of numbers of children and length of contact with child protective services. Six- and twelve-month follow-ups for FEP clients were compared to data on families served by the Oregon State Office of Services to Children and Families (SOSCF). The author found that FEP families are more likely than SOSCFfamilies to show greater improvement between the pretest scores and the posttest scores for number of days in placement, number of placements, and number of founded maltreatment reports.

AIDS talk

The observations of Michel Foucault, noted Twentieth Century French philosopher, regarding modern power relations and orders of discourse, form the framework utilized to analyze and interpret the power struggles of AIDS activists and their opponents--the religious and radical right, and the administrative agencies of the 'Liberal' welfare State. Supported by the tools of sociolinguistic inquiry, the analysis highlights the success of a safer sex campaign in Houston, Texas to illustrate the dynamics of cultural and political change by means of discursive transformations initiated by the gay micro-culture. The KS/AIDS Foundation, allied with both the biomedical community and gay entertainment spheres, was successful in conveying biomedical cautions that resulted in altered personal behavior and modified public attitudes by using linguistic conventions consonant with the discourse of the Houston gay micro-culture. The transformation of discursive practices transgressed not only the Houston gay micro-culture's boundaries, but the city boundaries of Houston as well. In addition to cultural and political change, moderate and confrontational gay activists also sought to change the cognitive boundaries surrounding 'the gold standard' for clinical research trials.^ From a Foucauldian perspective, the same-sex community evolved from the subordinated Other to a position of power in a period of five years. Transformations in discursive practices and power relations are exemplified by the changing definitions employed by AIDS policy-makers, the public validation of community-based research and the establishment of parallel track drug studies. Finally, transformations in discursive practices surrounding the issues of HIV antibody testing are interpreted using Foucault's six points of power relations. The Montrose Clinic provides the case study for this investigation. The clinic turned the technical rationalities of the State against itself to achieve its own ends and those of the gay micro-culture--anonymous testing with pre and post test counseling. AIDS Talk portrays a dramatic transformation in discursive practices and power relations that transcends the historical moment to provide a model for future activists. Volume 2 contains copies of fugitive primary source materials largely unavailable elsewhere. Original documents are archived in the Harris County Medical Archives in the Houston Academy of Medicine located in the Texas Medical Center Library, Houston, Texas. ^

Symptom-based subtypes of depression and their psychosocial correlates: A person-centered approach focusing on the influence of sex

BACKGROUND: Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research. METHODS: The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics. RESULTS: Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males. LIMITATIONS:The study had a cross-sectional design, allowing for no causal inferences. CONCLUSIONS:This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.