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  Citation statistics : Table of Contents
   2016| October-December  | Volume 1 | Issue 3  
    Online since January 18, 2017

 
 
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ORIGINAL ARTICLES
Co-occurring mental health and addiction disorders: The elusive path to integrated care
Avra Selick, Mary Wiktorowicz
October-December 2016, 1(3):97-104
DOI:10.4103/2468-8827.198576  
Background: Co-occurrence of mental health and addictions disorders occurs at a high rate, posing significant costs to affected individuals and society if left untreated. Although decades of research and policy reports have argued the necessity of integrated mental health and addiction services to effectively treat this population, it appears as though relatively little integration has been achieved. Methods: This exploratory study used key informant interviews to investigate the current state of integrated treatment in Ontario, Canada, potential models for integrated treatment and barriers to their implementation. Interview transcripts were analyzed inductively, and thematic analysis used to identify emerging themes. Results: Five domains were identified: organizational barriers, system barriers, historical barriers, barriers related to stigma and discrimination, and knowledge barriers. A key challenge is the absence of provincial direction and limited evidence on the relative effectiveness of the different integrated treatment models. Discussion and Conclusion: Insights from interviews with research, policy and provider experts clarify the relevant factors affecting the implementation of integrated treatment in Ontario. In identifying potential models of integration and the barriers to their implementation, further research is required to assess the relative effectiveness of the different integration models and to identify the critical organizational and system factors needed for successful implementation of integrated care. Avenues that merit further exploration are the fields of implementation science and complex adaptive systems.
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PUBLIC HEALTH INNOVATION
Advancing personal health and health care by e-Health technology and health coaching
Harvey Skinner
October-December 2016, 1(3):134-136
DOI:10.4103/2468-8827.198587  
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REVIEW ARTICLE
Noncommunicable disease research
Luke Allen
October-December 2016, 1(3):131-133
DOI:10.4103/2468-8827.198586  
Research is an essential component of the fight against noncommunicable disease (NCD) as it provides the evidence for effective prevention and control interventions. While the biological causes and manifestations of NCDs have been studied in depth, we are still trying to understand the best ways of implementing effective control policies. Exploring which interventions work in different settings is fundamental to the attainment of international targets set out in the Global Action Plan and the Sustainable Development Goals. The vast majority of NCD research comes from high-income countries and interventions that work in these settings are not necessarily effective in the Global South. Translational research is needed alongside wider engagement with social scientists: the most significant drivers of NCD epidemics are political, social, economic, and behavioral. Collaborative research spanning these domains is required for the development of effective, evidence-based NCD prevention, and control policies. This short article provides an overview of the role research has to play in the global NCD response and highlights areas in need of investment.
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EDITORIAL
Mainstreaming cancer control in non-communicable disease agenda
Rakesh Kapoor
October-December 2016, 1(3):95-96
DOI:10.4103/2468-8827.198574  
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ORIGINAL ARTICLES
Effect of community health worker-provided targeted education with regular follow-up of hypertensive patients on blood pressure control: 24-month results of a longitudinal study in Bangladesh
Muhammad Ashique Haider Chowdhury, Ali Tanweer Siddiquee, Shyfuddin Ahmed, Dewan Shamsul Alam
October-December 2016, 1(3):105-115
DOI:10.4103/2468-8827.198580  
Context: Sustainability of blood pressure (BP) control by trained community health workers (CHWs) in a low awareness setting is yet to be explored. Aim: The aim of this study is to assess the effect of CHW-provided targeted education with regular follow-up of hypertensive patients on BP control. Materials and Methods: We conducted a longitudinal study on hypertension in a semi-urban and a rural district in Bangladesh. Adult hypertensive individuals (n = 287) were identified. Trained CHWs regularly followed up and provided specific health messages on BP control through quarterly group meetings and individual counseling. We assessed mean BP changes and control status (systolic BP [SBP] <140 mmHg and diastolic BP [DBP] <90 mmHg) at around every 6 months for 24 months. A subgroup of hypertensive patients (n = 118) age >40 years was compared with an unmatched comparison group (n = 226) under usual care. Results: Both SBP and DBP of hypertensive patients under intervention were significantly reduced compared to baseline. The intervention subgroup had a significant lower SBP (149.1 ± 17.7 mmHg vs. 141.3 ± 20.34 mmHg; P = 0.004) and DBP (86.7 ± 13.32 mmHg vs. 91.31 ± 13.54 mmHg; P = 0.003) compared to comparison group. Proportion achieved BP control was higher (44.1% vs. 26.7%, P = 0.001) in the intervention subgroup. Patients who visited qualified providers within a year were 2 times more likely to be under better BP control. Conclusion: Targeted education with regular follow-up of hypertensive patients by trained CHWs has the potential to reduce BP and enhance BP control in settings with low awareness.
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How effective is tobacco control enforcement to protect minors: Results from subnational surveys across four districts in India
Sonu Goel, Ravinder Kumar, Pranay Lal, Rana J Singh
October-December 2016, 1(3):116-121
DOI:10.4103/2468-8827.198583  
Context: On analogy with the WHO's Framework Convention on Tobacco Control, Indian tobacco control legislation, namely, Cigarette and Other Tobacco Products Act (COTPA), prohibits the sale of tobacco products to minors and near an educational institution. Aims: The objectives are to measure the compliance to the provisions of COTPA which bans the tobacco sale to and by the minors, prohibits sale within 100 yards distance of an educational institution, and an overall compliance to guidelines of "Tobacco-free educational institutions." Methods: Using a pretested observational checklist, a cross-sectional survey was conducted between January and March 2013 across 1227 point-of-sale and 1408 educational institutions in four districts in India in 2013. Requisite ethical and administrative approvals were taken. Results: The study found moderate to low compliance to the provisions of COTPA regarding the ban on sale of tobacco products, to and by the minors, and around educational institutions. Tobacco products were easily accessible to minors in 57.7% of tobacco shops. The mandatory signages under Section-6 (b) of COTPA were not displayed in less than half of the educational institutions. In nearly one-fifth, tobacco products were being sold in and around 100 yards of institute's boundary. More violations pertaining to Section-6 (a) and 6 (b) were reported in district Jhunjhunu (representing Western India) and district Dhar (representing Central India), respectively, as compared to other jurisdictions under study. The tobacco-free institution guidelines were being followed by most educational institutions of Ernakulam district (representing South India). Conclusions: The present study observed a low compliance with enforcement of Indian tobacco control legislation. Thus, monitoring for compliance of policies and advocacy with policymakers is important for ensuring proper enforcement and preventing youth from initiating into tobacco use.
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Effectiveness of district health promotion model (Hoshiarpur Ambala model): An implementation experience from two districts from Northern part of India
JS Thakur, Nidhi Jaswal, Ashoo Grover, Rupinder Kaur, Gurismer Jeet, Bhavneet Bharti, Manmeet Kaur
October-December 2016, 1(3):122-130
DOI:10.4103/2468-8827.198584  
Introduction: In India, implementation of Health Promotion activities follows a vertical approach at district level. A Health Promotion project was therefore implemented for 3 years in Hoshiarpur and Ambala districts of Northern India, with objectives to develop, implement, and assess the effectiveness of integrated health promotion model. Materials and Methods: Situation analysis in two districts was followed by a state level stakeholders workshop in which detailed layout of model and a health promotion manual (Hindi, English, and Punjabi) was developed for capacity building of workforce. The effectiveness of model was assessed using mix of quantitative as well as qualitative methods. Results: The key features of model included integration and convergence within National Health Programs, multitasking, multisectoral involvement, and community empowerment, using digital media and advocacy tools. The facility assessment survey revealed improvements in implementation of activities as per annual activity calendar of IEC/BCC activities, better display of IEC material, with improved reporting, monitoring, and supervision. At community level, the awareness levels of the community members regarding communicable/noncommunicable diseases and key Reproductive and Child Health issues improved significantly (P < 0.05). Similarly, the client exit survey showed that dissemination of health information by MO/ANM increased in 3 years from 8% to 80% and 7.3% to 75% in districts Hoshiarpur and Ambala, respectively (P < 0.05). In-depth interview with key stakeholders and focused group discussion with Village Health and Sanitation Committee/Village Level Core Committee has shown their active involvement and improvements in their functioning. Based on indicative costing, per capita costs of National Health Mission for IEC/BCC/Health promotion activities need to be increased from INR 0.7 (USD 0.01) to INR 4 (USD 0.06), which requires increase in budget allocation from 1% to minimum of 4%. Conclusion: Model was found to be effective and feasible on pilot implementation. District level human and financial resources, however, must be augmented to implement health promotion activities effectively.
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