Diarrhoeal diseases are a global public health burden, killing 1.8 million people annually. Diarrhoea disproportionately affects children and those in poverty. Most diarrhoeal cases can be prevented through safe drinking water and basic hygiene and sanitation measures, with drinking water interventions having the most impact on reducing diarrhoeal disease. A metaevaluation of studies assessing a specific household water treatment method, the biosand water filter, was completed. Results from the meta-evaluation illustrated that biosand water filters improve drinking water quality and reduce diarrhoeal disease. However, short follow-up times and inconsistent measures are a concern. Furthermore, there is no generally accepted field method for determining biosand water filter effectiveness that is useable in low-resource communities. This study adds to understanding of biosand water filters.

Experiences of trauma and maltreatment are frequent predictors of poor physical and mental health outcomes in adulthood. Existing literature also suggests an impact of developmental adversity on criminality and aggressive behavior, though little research exists describing the effects of cumulative adversity in forensic mental health samples. In the current study of 381 forensic mental health inpatients, rates of trauma, neglect, and parental substance abuse are reported in comparison with community norms. Cumulative adversity and the occurrence of foster care placement are examined via linear and logistic regression analyses in relation to age at first arrest, first psychiatric hospitalization, and onset of aggression, as well as history of suicide attempts and non-suicidal self-injury. Results revealed that experiences of developmental adversity were more common among participants than have been reported in community samples using the ACE survey, and that there were differential effects of gender on the prevalence of traumas experienced. Cumulative adversity scores were significantly associated with all outcomes, though the addition of foster care placement to the model significantly contributed to understanding outcomes, and in some cases, removed the effect of cumulative adversity. Implications and direction for future study are discussed.

Background. This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results. Methods. There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups. Results. Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time. Conclusions. Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.

Background: Online learning has recently garnered increased attention as technology use in the classroom grows. However, most of the published approaches regarding this topic in postgraduate education centers on clinical environments. Models of partnerships between applied public health agencies and academic centers to produce mutually beneficial online learning opportunities for graduate-level public health courses have not been explored in the literature. Methods: East Tennessee State University (ETSU) and the Tennessee Department of Health (TDH) partnered to build three online, asynchronous epidemiology modules for an interdisciplinary audience of graduate students. The goals of the modules were to (1) introduce students to a public health issue, (2) provide students with hands-on learning about data and information available through TDH, and (3) allow students to connect theory to practice by having them create a product for use by TDH. TDH created topic-specific modules that would be used within the infectious disease, chronic disease, and cancer epidemiology courses, and piloted during the 2015–2016 academic term. Results: Conference calls between the two institutions occurred in the spring and the summer of 2015. Two of the three epidemiology modules were presented to ETSU staff for critique and edits at an in-person meeting during the summer. The methods of delivery for each section within a module varied from recorded webinar format to self-guided instruction. One module utilized available learning tools provided by the Centers of Disease Control and Prevention, while the other module was constructed entirely using TDH data. Both modules included various exercises and assignments to be conducted in class and as homework and concluded with the student being asked to construct a learning product as a final project. The ETSU–TDH team decided that this learning product would be provided back to TDH for possible future use. Discussion: The innovative partnership between a state government agency and an academic institution has demonstrated the need for such collaborations in public health. Understanding how applied public health practice would utilize what is learned in the classroom and preparing students for real-world application may be the missing link between theory and practice.

From 2014 to 2015, Liberia experienced the largest Ebola epidemic in world history. The impact of this disease was not only physical; it created fear, loss, and trauma throughout the country. This article will describe the process of three phases of a community-based psychosocial expressive arts program, which used theory from the fields of expressive arts therapy to build mental health capacity during and after the epidemic. This article will highlight the background of Ebola virus disease and the Ebola virus disease epidemic, provide an overview of current theory and research for expressive arts therapy and the impact of trauma, describe the process of how the program developed and was implemented, the process of partnering with the community, program components, the two pilot programs, and the large-scale community program. We performed a mixed-methods analysis of the large-scale program’s activity data to evaluate the impact. The results highlight a positive response from the participating children and facilitators. The authors discuss the findings from the results, best practices, and limitations. Additionally, the authors discuss implications and considerations for future programming.

No description available.

Objectives: This study describes community pharmacists’ opioid analgesic and medication for opioid use disorder (MOUD) practice behaviors and behavioral intentions in the context of primary, secondary, and tertiary prevention of opioid use disorder (OUD). Methods: The study sampling frame consisted of 2302 Tennessee community-practice pharmacists who were asked to complete a mailed, paper questionnaire. Behavioral intentions were elicited by asking pharmacists to indicate the number of times (0 to 10) they engage in a behavior, given 10 patients in 3 distinct vignettes. Perceptions of evidence-based MOUD and pain management patient care practices were also elicited. Results: A response rate of 19.7% was achieved. Pharmacists reported using a brief questionnaire to evaluate risk of opioid misuse with 2.1 ± 3.7 (mean ± SD) out of 10 patients, screening 2.1 ± 3.7 patients for current opioid misuse, discussing co-dispensing of naloxone with 2.9 ± 3.4 to 3.3 ± 4 out of 10 patients at a risk of overdose, and dispensing buprenorphine/naloxone to a mean of 4.6 ± 4.2 patients when they presented a prescription. Respondents perceived 38% of pain management and 30% of MOUD prescribers in their area to practice evidenced-based care. Conclusion: Pharmacists have an opportunity to improve the outcomes for patients prescribed opioids by increasing engagement across OUD prevention levels.

Abstract available in the American Journal of Pharmaceutical Education.

Individuals in the forensic mental health system who have experienced adverse childhood experiences (ACEs) are more likely to display suicidal ideation and engage in suicidal or non-suicidal self-injurious behavior. Additionally, prior research suggests that sex offender status may be disproportionately associated with increased suicidality. The current study explores risk correlates in those at heightened risk of suicidality and self-harm due to involvement with the criminal justice system, the presence of serious mental illness, and exposure to ACEs. Initial ACEs research explored the impact of self-reported physical, sexual, and emotional abuse, emotional and physical neglect, and household dysfunction on long term adult mental and physical health outcomes. While the ACE survey is a strong determinant of possible later adulthood adversity in samples with a range of exposure to adversity, it may be less helpful in criminal justice and forensic populations who experience disproportionate exposure to ACEs. Other risk correlates above and beyond those identified in the ACE survey may influence suicidality and self-harm and are yet to be explored. Here, outcomes included history of suicide attempts, age at first suicide attempt, and if 1st psychiatric hospitalization resulted from attempting suicide. Predictors included gender, total ACE score, out of home placements, status as a violent or sexual offender, mental health diagnoses, multiple sexual perpetrators against female participants, and cause of parental incarceration. Participants were 182 forensic inpatients in a maximum and intermediate security state hospital. The majority were male (81%; n = 147), with ethnicity nearly evenly distributed between Caucasian (56%; n = 101) and African-American (40%; n = 73), with few of Hispanic (2%; n = 4) or mixed ethnic (2%; n = 4) origins. Participants were, on average, 32.5 years of age (SD = 11.6, range 10-61). Most presented with a psychotic disorder (59.90%, n = 109), while other most frequent diagnoses included intellectual disability/cognitive developmental disorders (57.70%, n =1 05), a mood disorder (45.60%, n = 83), and impulse control disorders (22.5%, n = 41). Thirty-seven participants reported an ACE score of 0 (20.6%), 36 an ACE score of 1 (20. %), 32 an ACE score of 2 (17.8%), and 17 an ACE score of 3 (9.4%). Fifty-eight patients presented with an ACE score of 4+ (33%). Mean gender differences were significant (χ2 = 25.9, df = 8, p < .001), with the modal ACE score among female participants at 7, at a rate of nearly 23%. Of note, 29 (15.9%) had previous arrests for sexual offenses, and 79 (42.7%) were arrested for non-sexual violent offenses. Those remaining had engaged in these behaviors but were not arrested. In order to evaluate the impact of our predictor variables on the relationship between ACE score and likelihood of an individual making a suicide attempt, a single predictor logistic model will be fitted to the data. History of suicide attempts included 96 participants (52.7%) having made an attempt. Because it is likely that ACE score alone will not explain the relationship between suicide attempts in a sample with such elevated ACE scores, additional predictors will be included in a multiple predictor logistic model, including status as a sexual offender. Similar analyses will examine the impact of ACEs, sex offender status, and other related variables on the likelihood that first psychiatric hospitalization resulted from suicidality. A one-way between subjects ANOVA will be conducted to compare the effect of an ACE score of four or more on the age at first suicide attempt. We will additionally examine the impact of sex offender vs. violent vs. other offense status on age at first suicide attempt.

No description available.