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1.  Canadian Cardiovascular Society Access to Care Workshop proceedings and next steps 
On October 24, 2008, the Canadian Cardiovascular Society (CCS) Standing Committee on Access to Care invited clinical practitioners, researchers and administrators from across Canada to provide input on the CCS action plan for 2009/2010. The meeting provided an opportunity for stakeholders to identify initiatives under three CCS priority areas for action: collecting and reporting wait time data, improving systems to improve access, and establishing national networks. Building on the suggestions from this meeting, the Standing Committee drafted an action plan for 2009/2010. This plan includes a lead role for the CCS in facilitating consensus on pan-Canadian data standards and definitions, and using current resources and infrastructure. The CCS and its Standing Committee look forward to continuing to work with stakeholders to promote awareness and adoption of the benchmarks, and to undertake new initiatives that will provide insight into access to care issues along the continuum of care.
PMCID: PMC2851385  PMID: 20151051
Access to care; Cardiovascular care; Wait times data
2.  Community advocacy groups as a means to address the social environment of female sex workers: a case study in Andhra Pradesh, India 
Journal of Epidemiology and Community Health  2012;66(Suppl_2):ii87-ii94.
Background
To examine the association between the presence of community advocacy groups (CAGs) and female sex workers' (FSWs) access to social entitlements and outcomes of police advocacy.
Methods
Data were used from a cross-sectional survey conducted in 2010–2011 among 1986 FSWs and 104 NGO outreach workers from five districts of Andhra Pradesh. FSWs were recruited using a probability-based sampling from 104 primary sampling units (PSUs). A PSU is a geographical area covered by one outreach worker and is expected to have an active CAG as per community mobilisation efforts. The presence of active CAGs was defined as the presence of an active committee or advocacy group in the area (PSU). Outcome indicators included acquisition of different social entitlements and measures of police response as reported by FSWs. Multivariate linear and logistic regression analyses were used to examine the associations.
Results
Areas with active CAGs compared with their counterparts had a significantly higher mean number of FSWs linked to ration cards (12.8 vs 6.8; p<0.01), bank accounts (9.3 vs 5.9; p=0.05) and health insurance (13.1 vs 7.0; p=0.02). A significantly higher percentage of FSWs from areas with active CAGs as compared with others reported that the police treat them more fairly now than a year before (79.7% vs 70.3%; p<0.05) and the police explained the reasons for arrest when arrested the last time (95.7% vs 87%; p<0.05).
Conclusion
FSWs from areas with active CAGs were more likely to access certain social entitlements and to receive a fair response from the police, highlighting the contributions of CAGs in community mobilisation.
doi:10.1136/jech-2011-200478
PMCID: PMC3433220  PMID: 22495774
Structural interventions; sex workers; HIV prevention intervention; community advocacy; social capital; empowerment; HIV; AIDS; public health; violence; epidemiology; statistics
3.  Developing a Strategic Plan for Transitioning to Healthcare Knowledge Services Centers (HKSCs) 
Journal of hospital librarianship  2011;11(4):379-387.
Facing a negative trend in the form of downsizing, layoffs, and closures, a small committee of hospital librarians in New England was formed in 2004 to provide library advocacy. Between 2008 and 2010, 23 hospital libraries closed in New England. In 2010, the committee shifted its focus from advocacy to a platform for change. This resulted in the creation of the Healthcare Knowledge Services Center (HKSC) Template. The Template is the basis for a 3-phased, 5-year strategic plan to establish several regional pilots, transitioning traditional hospital libraries to healthcare knowledge services centers. This article focuses on Phase One of the strategic plan, Development.
doi:10.1080/15323269.2011.609076
PMCID: PMC3484838  PMID: 23125551
Advocacy; HKSC; healthcare knowledge services center; KM; knowledge management; library closures; strategic plan; template
4.  Practice-Based Teaching for Health Policy Action and Advocacy 
Public Health Reports  2008;123(Suppl 2):65-70.
SYNOPSIS
The Institute of Medicine has issued numerous reports calling for the public health workforce to be adept in policy-making, communication, science translation, and other advocacy skills. Public health competencies include advocacy capabilities, but few public health graduate institutions provide systematic training for translating public health science into policy action. Specialized health-advocacy training is needed to provide future leaders with policy-making knowledge and skills in generating public support, policy-maker communications, and policy campaign operations that could lead to improvements in the outcomes of public health initiatives. Advocacy training should draw on nonprofit and government practitioners who have a range of advocacy experiences and skills. This article describes a potential model curriculum for introductory health-advocacy theory and skills based on the course, Health Advocacy, a winner of the Delta Omega Innovative Public Health Curriculum Award, at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
PMCID: PMC2431098  PMID: 18770919
5.  Nigeria's Triumph: Dracunculiasis Eradicated 
This report describes how Nigeria, a country that at one time had the highest number of cases of dracunculiasis (Guinea worm disease) in the world, reduced the number of cases from more than 653,000 in 1988 to zero in 2009, despite numerous challenges. Village-based volunteers formed the foundation of the program, which used health education, cloth filters, vector control, advocacy for safe water, voluntary isolation of patients, and monitored program interventions and cases reported monthly. Other factors in the program's success were strong governmental support, advocacy by a former head of state of Nigeria, technical and financial assistance by The Carter Center, the U.S. Centers for Disease Control and Prevention, the United Nations Children's Fund, the World Health Organization, and many other partners and donors. The estimated cost of the Nigerian program during 1988–2009 is $37.5 million, not including funding for water supply projects or salaries of Nigerian governmental workers.
doi:10.4269/ajtmh.2010.10-0140
PMCID: PMC2911162  PMID: 20682859
6.  Is there an advocate in the house? The role of health care professionals in patient advocacy 
Journal of Medical Ethics  2002;28(1):37-40.
It remains unclear what patient advocacy actually entails and what values it ought to embody. It will be useful to ascertain whether advocacy means supporting any decision the patient makes, or if the advocate can claim to represent the patient by asserting well-intentioned paternalistic claims on the patient's behalf. This is especially significant because the position of advocate brings with it certain privileges on the basis of of presumed insight into patient-perceived interests, namely, entitlement to take part in clinical decision making and increased professional standing. Three issues related to patient advocacy will be explored: are patient advocates necessary; what does advocacy entail, and who ought to represent patients in this way—arguments for and against prospective candidates will also be covered. The paper considers whether advocates are necessary since not only can they be dangerously paternalistic, but the salutary values advocacy embodies are already part of good professional health care.
doi:10.1136/jme.28.1.37
PMCID: PMC1733511  PMID: 11834758
7.  Creating a Provincial Family Council to Engage Youth and Families in Child & Youth Mental Health Systems 
Objective:
To create a mechanism in British Columbia (BC) for youth and families to directly engage with key provincial committees that develop policy and implement service delivery for child and youth mental health.
Method:
In 2009, a plan was initiated to increase the involvement and influence of youth and families in research, policy, practices and programs related to child and youth mental health. This initiative, led by a provincial family advocacy society in partnership with representatives from health services and government, resulted in the establishment of the Provincial Family Council for Child and Youth Mental Health (PFC). Formation of the PFC occurred in two phases: initially, a Working Group co-chaired by a parent and a youth was tasked with developing the Terms of Reference and framework for the PFC; phase two involved ensuring important constituencies/demographics and competencies were represented in the membership of the PFC. Result: The Provincial Family Council is officially endorsed by the provincial government and is informing key provincial committees in British Columbia.
Conclusion:
In BC, the PFC is the vehicle through which youth and families can now work in partnership with “the system” to promote and improve the mental health of BC’s children and youth.
PMCID: PMC2938749  PMID: 20842271
early intervention; parenting; partnerships; family engagement; intervention précoce; rôle des parents; partenariat; engagement de la famille
8.  Are there any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis? 
Background
This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident.
Methods
Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee.
Results
Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels higher than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3rd dose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009.
Conclusion
While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact.
doi:10.1186/1752-1505-5-9
PMCID: PMC3135519  PMID: 21708044
9.  Who knew? Awareness of being recommended for influenza vaccination among U.S. adults 
Background
Starting with the 2010–2011 influenza season, the Advisory Committee on Immunization Practices at the U.S. Centers for Disease Control and Prevention recommends annual influenza vaccination to all people aged 6 months and older unless contraindicated.
Objectives
To measure perceived influenza vaccination recommendation status among U.S. adults (n=2,122) and its association with socio-demographic characteristics and recommendation status during the 2009–2010 pandemic influenza season.
Methods
We analyze nationally representative data from longitudinal Internet surveys of U.S. adults conducted in November/December 2009 and September/October 2010.
Results
46.2 percent (95%-CI: 43.3%–49.1%) of U.S. adults correctly reported to be covered by a government recommendation for influenza vaccination during the 2010–2011 vaccination season. Awareness of being covered by a government influenza vaccination recommendation was statistically significantly higher among non-working adults and adults who had been recommended for seasonal vaccination or both seasonal and H1N1 vaccination during the 2009–2010 pandemic influenza vaccination season.
Conclusion
Our results highlight that a majority of U.S. adults does not know that they are recommended for annual influenza vaccination by the government. The fraction of adults who are unaware of their recommendation status is especially large among newly recommended healthy young adults. The universal vaccination recommendations will only be successful if they reach both patients and physicians and lead to changing vaccination practices. The universal nature of the new recommendation simplifies vaccination-related outreach and compliance with government vaccination guidelines considerably, since it does not require any identification of specific recommendation groups based on complex personal or health risk factors.
doi:10.1111/j.1750-2659.2011.00305.x
PMCID: PMC3292703  PMID: 22118416
Influenza; Influenza vaccination; ACIP recommendations; Patient knowledge
10.  Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus 
Diabetes Care  2011;34(6):e61-e99.
BACKGROUND
Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially.
APPROACH
An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association.
CONTENT
In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (HbA1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed.
SUMMARY
The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
doi:10.2337/dc11-9998
PMCID: PMC3114322  PMID: 21617108
11.  The care of the mentally abnormal offender and the protection of the public 
Journal of Medical Ethics  1976;2(4):157-160.
When a serious crime—say a murder—is committed by someone who has been discharged or has absconded from prison the public reaction is extreme. And public anger is not appeased by psychiatrists and sociologists who argue in the media the case either for all mental disorders being capable of treatment leading at least to partial cure or that all crime springs from unfortunate social circumstances. In the two papers which follow the situation is described how psychopathic and other mentally abnormal offenders are dealt with at the present time, and how the Aarvold and Butler Committees were set up. The Aarvold Committee (Chairman, Mr Justice Aarvold) was to be concerned with tightening the provisions of the law as it now stands whereas the Butler Committee (Chairman, Lord Butler) was asked to look into and recommend changes in the law relating to these offenders. The Aarvold Committee reported swiftly and the Butler Committee made its final report in 1975. (An interim report was produced in 1974.) It is with the Butler Report that Dr Rollin and Dr Norton are principally concerned here. The fundamental aim of both committees was to maintain a balance between `what is best for those guilty of dangerous offences and the right of the public to be protected'. Both writers describe the various forms of detention for psychopathic offenders in operation and proposed, and both conclude that the Butler Report offers wise and realistic guidance but fear that continuing official inertia will preclude the recommendations ever being implemented. Dr Norton deals particularly with the concept of `dangerousness', and the controversial issue of the Butler `reviewable sentences' for mentally abnormal offenders.
PMCID: PMC1154513  PMID: 1003431
12.  Human papillomavirus vaccine uptake, knowledge and attitude among 10th grade students in Berlin, Germany, 2010 
Purpose:
Since March 2007, the Standing Committee on Vaccination (STIKO) recommends HPV vaccination for all 12–17 y-old females in Germany. In the absence of an immunization register, we aimed at assessing HPV-vaccination coverage and knowledge among students in Berlin, the largest city in Germany, to identify factors influencing HPV-vaccine uptake.
Results:
Between September and December 2010, 442 students completed the questionnaire (mean age 15.1; range 14–19). In total 281/442 (63.6%) students specified HPV correctly as a sexually transmitted infection. Of 238 participating girls, 161 (67.6%) provided their vaccination records. Among these, 66 (41.0%) had received the recommended three HPV-vaccine doses. Reasons for being HPV-unvaccinated were reported by 65 girls: Dissuasion from parents (40.2%), dissuasion from their physician (18.5%), and concerns about side-effects (30.8%) (multiple choices possible). The odds of being vaccinated increased with age (Odds Ratio (OR) 2.19, 95% Confidence Interval (CI) 1.16, 4.15) and decreased with negative attitude toward vaccinations (OR = 0.33, 95%CI 0.13, 0.84).
Methods:
Self-administered questionnaires were distributed to 10th grade school students in 14 participating schools in Berlin to assess socio-demographic characteristics, knowledge, and statements on vaccinations. Vaccination records were reviewed. Multivariable statistical methods were applied to identify independent predictors for HPV-vaccine uptake among female participants.
Conclusions:
HPV-vaccine uptake was low among school girls in Berlin. Both, physicians and parents were influential regarding their HPV-vaccination decision even though personal perceptions played an important role as well. School programs could be beneficial to improve knowledge related to HPV and vaccines, and to offer low-barrier access to HPV vaccination.
doi:10.4161/hv.22192
PMCID: PMC3667949  PMID: 22995838
human papillomavirus; vaccination status; knowledge; school students; Germany
13.  A rapid assessment and response approach to review and enhance Advocacy, Communication and Social Mobilisation for Tuberculosis control in Odisha state, India 
BMC Public Health  2011;11:463.
Background
Tuberculosis remains a major public health problem in India with the country accounting for 1 in 5 of all TB cases reported globally. An advocacy, communication and social mobilisation project for Tuberculosis control was implemented and evaluated in Odisha state of India. The purpose of the study was to identify the impact of project interventions including the use of 'Interface NGOs' and involvement of community groups such as women's self-help groups, local government bodies, village health sanitation committees, and general health staff in promoting TB control efforts.
Methods
The study utilized a rapid assessment and response (RAR) methodology. The approach combined both qualitative field work approaches, including semi-structured interviews and focus group discussions with empirical data collection and desk research.
Results
Results revealed that a combination of factors including the involvement of Interface NGOs, coupled with increased training and engagement of front line health workers and community groups, and dissemination of community based resources, contributed to improved awareness and knowledge about TB in the targeted districts. Project activities also contributed towards improving health worker and community effectiveness to raise the TB agenda, and improved TB literacy and treatment adherence. Engagement of successfully treated patients also assisted in reducing community stigma and discrimination.
Conclusion
The expanded use of advocacy, communication and social mobilisation activities in TB control has resulted in a number of benefits. These include bridging pre-existing gaps between the health system and the community through support and coordination of general health services stakeholders, NGOs and the community. The strategic use of 'tailored messages' to address specific TB problems in low performing areas also led to more positive behavioural outcomes and improved efficiencies in service delivery. Implications for future studies are that a comprehensive and well planned range of ACSM activities can enhance TB knowledge, attitudes and behaviours while also mobilising specific community groups to build community efficacy to combat TB. The use of rapid assessments combined with other complementary evaluation approaches can be effective when reviewing the impact of TB advocacy, communication and social mobilisation activities.
doi:10.1186/1471-2458-11-463
PMCID: PMC3141449  PMID: 21663623
tuberculosis; advocacy; communication; social mobilisation; rapid assessment and review
14.  Political activity for physical activity: health advocacy for active transport 
Effective health advocacy is a priority for efforts to increase population participation in physical activity. Local councils are an important audience for this advocacy. The aim of the current study was to describe features of advocacy for active transport via submissions to city council annual plans in New Zealand, and the impact of an information sheet to encourage the health sector to be involved in this process. Written submissions to city council's annual consultation process were requested for 16 city councils over the period of three years (2007/08, 2008/09, and 2009/10). Submissions were reviewed and categories of responses were created. An advocacy information sheet encouraging health sector participation and summarising some of the evidence-base related to physical activity, active transport and health was released just prior to the 2009/10 submission time. Over the period of the study, city councils received 47,392 submissions, 17% of which were related to active transport. Most submissions came from city residents, with a small proportion (2%) from the health sector. The largest category of submissions was in support of pedestrian and cycling infrastructure, design and maintenance of facilities and additional features to support use of these transport modes. Health arguments featured prominently in justifications for active transport initiatives, including concerns about injury risk, obesity, physical inactivity, personal safety and facilities for people with disabilities. There was evidence that the information sheet was utilised by some health sector submitters (12.5%), providing tentative support for initiatives of this nature. In conclusion, the study provides novel information about the current nature of health advocacy for active transport and informs future advocacy efforts about areas for emphasis, such as health benefits of active transport, and potential alliances with other sectors such as environmental sustainability, transport and urban planning and local communities.
doi:10.1186/1479-5868-8-52
PMCID: PMC3124408  PMID: 21619697
15.  Health advocacy training in urology: a Canadian survey on attitudes and experience in residency 
Introduction
Health advocacy is a well-defined core competency recognized by medical education and regulatory bodies. Advocacy is stressed as a critical component of a physician's function within his or her community and also of performance evaluation during residency training. We sought to assess urology residents' perceptions and attitudes toward health advocacy in residency training and practice.
Methods
We administered an anonymous, cross-sectional, self-report questionnaire to all final-year urology residents in Canadian training programs. The survey was closed-ended and employed a 5-point Likert scale. It was designed to assess familiarity with the concept of health advocacy and with its application and importance to training and practice. We used descriptive and correlative statistics to analyze the responses, such as the availability of formal training and resident participation in activities involving health advocacy.
Results
There was a 93% response rate among the chief residents. Most residents were well aware of the role of the health advocate in urology, and a majority (68%) believed it is important in residency training and in the urologist's role in practice. This is in stark contrast to acknowledged participation and formal training in health advocacy. A minority (7%–25%) agreed that formal training or mentorship in health advocacy was available at their institution, and only 21%–39% felt that they had used its principles in the clinic or community. Only 4%–7% of residents surveyed were aware of or had participated in local urological health advocacy groups.
Conclusion
Despite knowledge about and acceptance of the importance of the health advocate role, there is a perceived lack of formal training and a dearth of participation during urological residency training.
PMCID: PMC2422986  PMID: 18542818
16.  Physician at Risk Committees Re-evaluated 
Canadian Family Physician  1986;32:345-347.
Physician at risk committees have existed in some provinces for close to a decade. The major concern originally was that addicted physicians denied they suffered from an addictive illness, and so failed to seek treatment. Many provinces, including Manitoba, chose to develop an at risk committee so that an advocacy program was separate from the traditional disciplinary bodies. The rationale for the existence of such advocacy programs and the terms of reference of the physician at risk committees are reexamined in the light of eight years' experience.
PMCID: PMC2328118  PMID: 21267267
Physicians; addiction; advocacy programs
17.  Strong advocacy led to successful implementation of smokefree Mexico City 
Tobacco control  2010;20(1):64-72.
Objective
To describe the approval process and implementation of the 100% smokefree law in Mexico City and a competing federal law between 2007 and 2010.
Methods
Reviewed smokefree legislation, published newspaper articles and interviewed key informants.
Results
Strong efforts by tobacco control advocacy groups and key policymakers in Mexico City in 2008 prompted the approval of a 100% smokefree law following the WHO FCTC. As elsewhere, the tobacco industry utilised the hospitality sector to block smokefree legislation, challenged the City law before the Supreme Court and promoted the passage of a federal law that required designated smoking areas. These tactics disrupted implementation of the City law by causing confusion over which law applied in Mexico City. Despite interference, the City law increased public support for 100% smokefree policies and decreased the social acceptability of smoking. In September 2009, the Supreme Court ruled in favour of the City law, giving it the authority to go beyond the federal law to protect the fundamental right of health for all citizens.
Conclusions
Early education and enforcement efforts by tobacco control advocates promoted the City law in 2008 but advocates should still anticipate continuing opposition from the tobacco industry, which will require continued pressure on the government. Advocates should utilise the Supreme Court’s ruling to promote 100% smokefree policies outside Mexico City. Strong advocacy for the City law could be used as a model of success throughout Mexico and other Latin American countries.
doi:10.1136/tc.2010.037010
PMCID: PMC3089444  PMID: 21059606
18.  Patient advocacy groups: Need and opportunity in India 
With an increasing number of corporate hospitals, healthcare related issues, research trials and undue attention by media in India, there is a need to focus more on patient’s rights and protection. In India, multiple agencies like regulatory bodies, scientific review committees, ethics committees, NGOs, etc. work toward patient rights and protection. However, these agencies are inadequate to cater to the general issues related to patient’s rights. There’s a need to have a separate group of people who provide advocacy to the patient, or simply, a patient advocacy group which will work explicitly in these areas to increase transparency and credibility of healthcare system in India. This group will provide special attention to patient care and protection of rights from the planning stage rather than at the troubleshooting stage.
doi:10.4103/2229-3485.76283
PMCID: PMC3088956  PMID: 21584175
Healthcare providers; government; media; patient advocacy; research
19.  The Mental Health Leadership and Advocacy Program (mhLAP): a pioneering response to the neglect of mental health in Anglophone West Africa 
Developing countries in Africa and other regions share a similar profile of insufficient human resources for mental health, poor funding, a high unmet need for services and a low official prioritisation of mental health. This situation is worsened by misconceptions about the causes of mental disorders, stigma and discrimination that frequently result in harmful practices against persons with mental illness. Previous explorations of the required response to these challenges have identified the need for strong leadership and consistent advocacy as potential drivers of the desired change. The Mental Health Leadership and Advocacy Program (mhLAP) is a project that aims to provide and enhance the acquisition of skills in mental health leadership, service development, advocacy and policy planning and to build partnerships for action. Launched in 2010 to serve the Anglophone countries of The Gambia, Ghana, Liberia, Nigeria, Sierra Leone, this paper describes the components of the program, the experience gained since its initiation, and the achievements made during the three years of its implementation. These achievements include: 1) the annual training in mental health leadership and advocacy which has graduated 96 participants from 9 different African countries and 2) the establishment of a broad coalition of service user groups, non-governmental organizations, media practitioners and mental health professionals in each participating country to implement concerted mental health advocacy efforts that are focused on country-specific priorities
doi:10.1186/1752-4458-8-5
PMCID: PMC3931322  PMID: 24467884
Mental health; advocacy; West Africa; Service users; Stakeholders; Stigma; LAMIC
20.  To assess the effects of nutritional intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz 
Background:
The present study was carried out to assess the effects of community nutrition intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz, Iran.
Materials and Methods:
This case-control nutritional intervention has been done between 2008 and 2009 on 2897 primary and secondary school boys and girls (7-13 years old) based on advocacy approach in Shiraz, Iran. The project provided nutritious snacks in public schools over a 2-year period along with advocacy oriented actions in order to implement and promote nutritional intervention. For evaluation of effectiveness of the intervention growth monitoring indices of pre- and post-intervention were statistically compared.
Results:
The frequency of subjects with body mass index lower than 5% decreased significantly after intervention among girls (P = 0.02). However, there were no significant changes among boys or total population. The mean of all anthropometric indices changed significantly after intervention both among girls and boys as well as in total population. The pre- and post-test education assessment in both groups showed that the student's average knowledge score has been significantly increased from 12.5 ± 3.2 to 16.8 ± 4.3 (P < 0.0001).
Conclusion:
This study demonstrates the potential success and scalability of school feeding programs in Iran. Community nutrition intervention based on the advocacy process model is effective on reducing the prevalence of underweight specifically among female school aged children.
PMCID: PMC3872579  PMID: 24381614
Malnutrition; public health advocacy; school age children
21.  Intimate partner violence towards women 
Clinical Evidence  2010;2010:1013.
Introduction
Between 10% and 70% of women may have been physically or sexually assaulted by a partner at some stage, with assault rates against men reported at about one quarter of the rate against women. In at least half of people studied, the problem lasts for 5 years or more. Women reporting intimate partner violence (IPV) are more likely than other women to complain of poor physical or mental health, and of disability.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions initiated by healthcare professionals aimed at female victims of intimate partner violence? We searched: Medline, Embase, The Cochrane Library, and other relevant databases up to September 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review).
Results
We found 26 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: advocacy; career counselling plus critical consciousness awareness; cognitive behavioural counselling; cognitive trauma therapy; counselling; nurse support and guidance; peer support groups; safety planning; and shelters.
Key Points
Between 10% and 70% of women may have been physically or sexually assaulted by a partner at some stage, with reported assault rates against men about one quarter of the rate against women. In at least half of people studied, the problem lasts for 5 years or more. Intimate partner violence (IPV) has been associated with socioeconomic and personality factors, marital discord, exposure to violence in family of origin, and partner's drug or alcohol abuse.Women reporting IPV are more likely than other women to complain of poor physical or mental health, and of disability.
Advocacy may reduce revictimisation rates compared with no treatment, but it may have low levels of acceptability.
Cognitive trauma therapy may reduce post-traumatic stress disorder and depression compared with no treatment.
Cognitive behavioural counselling may reduce minor physical or sexual IPV, both minor and severe psychological IPV and depression compared with no counselling.
Career counselling plus critical consciousness awareness may increase a woman's confidence and awareness of the impact of IPV on her life compared with career counselling alone.
We don't know whether other types of counselling are effective compared with no counselling. Although empowerment counselling seems to reduce trait anxiety, it does not seem to reduce current anxiety or depression or to improve self-esteem.
We don't know how different types of counselling compare with each other.
Peer support groups may improve psychological distress and decrease use of healthcare services compared with no intervention.
Nurse support and guidance is probably unlikely to be beneficial in IPV
Safety planning may reduce the rate of subsequent abuse in the short term, but longer-term benefit is unknown.
We don't know whether the use of shelters reduces revictimisation, as we found little research.
PMCID: PMC2907621  PMID: 21733197
22.  Addressing the Future Burden of Cancer and Its Impact on the Oncology Workforce: Where Is Cancer Prevention and Control? 
Journal of Cancer Education  2012;27(Suppl 2):118-127.
The need for cancer professionals has never been more urgent than it is today. Reports project serious shortages by 2020 of oncology health care providers. Although many plans have been proposed, no role for prevention has been described. In response, a 2-day symposium was held in 2009 at The University of Texas MD Anderson Cancer Center to capture the current status of the cancer prevention workforce and begin to identify gaps in the workforce. Five working groups were organized around the following topic areas: (a) health policy and advocacy; (b) translation to the community; (c) integrating cancer prevention into clinical practice; (d) health services infrastructure and economics; and (e) discovery, research, and technology. Along with specific recommendations on these topics, the working groups identified two additional major themes: the difficulty of defining areas within the field (including barriers to communication) and lack of sufficient funding. These interdependent issues synergistically impede progress in preventing cancer; they are explored in detail in this synthesis, and recommendations for actions to address them are presented. Progress in cancer prevention should be a major national and international goal. To achieve this goal, ensuring the health of the workforce in cancer prevention and control is imperative.
doi:10.1007/s13187-012-0342-3
PMCID: PMC3316776  PMID: 22367593
Training; Education; Preparation; Evaluation
23.  "A powerful intervention: general practitioners'; use of sickness certification in depression" 
BMC Family Practice  2012;13:82.
Background
Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression.
This study aimed to explore GPs views of sickness certification in relation to depression.
Methods
A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009.
Results
A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work.
Conclusions
GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry.
doi:10.1186/1471-2296-13-82
PMCID: PMC3441202  PMID: 22877237
Depression; Mood disorder; Primary care; Occupational; Environmental medicine; Doctor-patient relationship; Mental health
24.  Identification of technical item flaws leads to improvement of the quality of single best Multiple Choice Questions 
Objective: The purpose of the study was to identify technical item flaws in the multiple choice questions submitted for the final exams for the years 2009, 2010 and 2011.
Methods: This descriptive analytical study was carried out in Islamic International Medical College (IIMC). The Data was collected from the MCQ’s submitted by the faculty for the final exams for the year 2009, 2010 and 2011. The data was compiled and evaluated by a three member assessment committee. The data was analyzed for frequency and percentages the categorical data was analyzed by chi-square test.
Results: Overall percentage of flawed item was 67% for the year 2009 of which 21% were for testwiseness and 40% were for irrelevant difficulty. In year 2010 the total item flaws were 36% and 11% testwiseness and 22% were for irrelevant difficulty. The year 2011 data showed decreased overall flaws of 21%. The flaws of testwisness were 7%, irrelevant difficulty were 11%.
Conclusion: Technical item flaws are frequently encountered during MCQ construction, and the identification of flaws leads to improved quality of the single best MCQ’s.
PMCID: PMC3809311  PMID: 24353614
Frequency; Item writing flaws; Testwiseness
25.  NON-INVASIVE FALL RISK ASSESSMENT IN COMMUNITY DWELLING ELDERLY WITH WIRELESS INERTIAL MEASUREMENT UNITS 
Falls are among the most serious accidents among the elderly leading to increased injuries, reduced functioning and mortality. In 2009, about 2.2 million nonfatal fall injuries were reported among the elderly population (CDC, 2010). In this study, eleven community dwelling elderly (aged 65-84 years) participated in fall risk assessment camp at sterling senior center organized by Northern Virginia Fall Prevention Coalition (NVFPC). Three custom made wireless inertial measurement units (IMUs) were attached on trunk and both shanks. All participants performed postural and locomotor tasks such as sit-to-stand (STS) and timed up and go (TUG). Temporal and kinematic parameters were obtained. Raw signals obtained were denoised using ensemble empirical mode decomposition and savistzky-golay filtering. The mean and standard deviation of TUG time and STS completion time for participants were found to be 11.3±6.6 sec and 3.58±2.07 sec respectively. The high variation in the result may be due to the use of assistive devices (i.e., cane and walker) by two participants. The objective of this study is to classify fall prone community dwelling individuals using non-invasive system. Four participants were classified as fall prone, three without fall risk and four were at potential risk based on their objective assessment and task performance. This system provides a platform for identifying fall prone individuals and may be used for early fall interventions among the elderly.
PMCID: PMC3716278  PMID: 22846292
Inertial measurement units; Timed up and go; Ensemble empirical mode decomposition; Fall; community dwelling elderly

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