According to the National Psoriasis Foundation (1976), psoriasis is a little known and poorly understood skin disease afflicting an estimated eight million victims in the United States. About fifteen thousand new cases of psoriasis are diagnosed each year. It affects men and women in equal numbers at any age, most often between the ages of fifteen and thirty-five.

During and following the Deepwater Horizon (DWH) accident in 2010, concerns about air and seafood quality were paramount. Though individual perceptions varied, many people in coastal communities in southeast Louisiana felt they had been exposed to oil- and dispersant-related compounds. We hypothesized that implementation of a Community-based Participatory Research (CBPR) project would promote a more transparent and mutually beneficial relationship between researchers and the community. We conducted both in-home and community-based assessments (n=198) in culturally diverse populations most impacted by the DWH event, including the Vietnamese in New Orleans East and the residents of the Bayou communities. Levels of volatile organic compounds (VOCs) in paired indoor/outdoor air samples and polycyclic aromatic hydrocarbons (PAHs) in seafood samples were determined with chemical analysis. Data were collected from multiple self-administered surveys regarding environmental awareness and impact of the DWH event, access to, and trusted sources of, information, perceptions about safety, and selected behavioral and socio-demographic variables. In an effort to enhance public understanding of the interconnectedness of their health with the Gulf ecosystem, we disseminated the information directly to the participants as well as the larger communities at risk. Through post-dissemination follow-up surveys, we explored the effectiveness of our environmental CBPR research strategy with our primary goals being to improve risk communication and promote informed decision-making among our coastal populations. / Jessi Howard

The history of the care of the mentally ill in Britain, which has been broadly reflected in Western Australia since 1826, can be conveniently, if simplistically divided into a number of epochs. Each epoch is characterised by a particular focus or paradigm of clinical management, which prevails over a period of time but is then followed by a comparatively short period of rapid change to a new paradigm. Such changes are shaped by a number of forces, but three categories can be readily identified. These are: concepts of mental illness; reactions of administrative systems and the attitudes of medical practitioners. As the concept of the nature of mental illness has changed, succeeding epochs have evolved to a more humane and enlightened approach to the mentally ill. Nevertheless, each management paradigm has failed to deliver the expected 'cures' and the consequent reduction in the burden of illness. Each has been replaced by a new and radically different paradigm, often at enormous cost, but there has been no progressive evolution towards a system that incorporates measures that have proven value. In recent years 'Community Care', has failed in such a manner that there have been strong arguments that it should be abandoned. At the same time there is evidence that a new paradigm 'Primary Care Psychiatry' is emerging as government policy. The challenge is to preserve the best elements of community care and integrate Primary Care Psychiatry into the broader framework. The best chance of achieving this is to develop a gradual, evolutionary process, built on consensus between psychiatrists, general practitioners and administrators. / The purposes of the present research are threefold: to develop a conceptual model for an optimal community based mental health service. Then by examining the views of general practitioners, psychiatrists and administrators, determine the degree of congruence of these views. This is achieved by a qualitative study comprising extended interviews with 24 GPs, 15 psychiatrists and 11 administrators. This approach is chosen over a more broadly based, structured questionnaire approach for two reasons. Firstly, the views expressed in informal face to face interviews are more likely to be true expressions of opinion, especially when these are critical. Secondly, by using a comparatively unstructured approach, the stakeholders are able to express views on issues that they consider important. Finally, the areas of consensus and disagreement are analysed and recommendations made on strategies to develop a plan for a practical, viable service in a local area.

People with diabetes mellitus are more likely to die from cardiovascular causes than those without diabetes, and modifiable risk factors, such as hyperglycaemia, dyslipidaemia and hypertension can be targeted in intervention programs to decrease this risk. In addition to tertiary care for patients with diabetes, there is a need for simple programs to be implemented in the community that allow the benefits of improved metabolic and blood pressure control to be realised more widely. Pharmaceutical care comprises the detection, prevention and solution of drug-related problems in a quantifiable form, so that outcomes of care can be easily reviewed and monitored. Previous studies of pharmaceutical care programs in patients with diabetes do not provide conclusive evidence of the benefit of pharmaceutical care. The aim of this research was to evaluate the impact of the provision of pharmaceutical care to patients with diabetes mellitus in an Australian context. In order to develop a pharmaceutical care program, the characteristics of an Australian cohort of patients with diabetes were reviewed. The Fremantle Diabetes Study (FDS), was a community-based prospective observational study of diabetes care, control and complications in a postcode-defined region of 120 097 people surrounding the port city of Fremantle in Western Australia. It was intended that the FDS annual reviews would provide important local information in order to design and implement a prospective pharmaceutical care program. A pilot pharmaceutical care program was subsequently developed for use in a diabetes outpatient clinic. This program was then modified for use in a community-based sample of type 2 diabetes mellitus patients, drawn from the FDS cohort. / Demographic parameters, including ethnicity and treatment details, were reviewed at study entry for the full FDS cohort and then over time for a subset of patients that returned for four subsequent annual assessments. Insulin use was more common in patients of Southern European origin compared with the Anglo-Celt group irrespective of the level of glycaemia, at baseline. This difference persisted during subsequent follow-up but was not associated with improved glycaemic control. These findings demonstrated that there are important ethnic differences in the management of patients with type 2 diabetes mellitus. The pilot pharmaceutical care program was carried out in high-risk diabetes mellitus patients attending a hospital outpatient clinic. The patients had poor glycaemic control, dyslipidaemia, hypertension and/or were on three or more prescription medications. In the pharmaceutical care arm, a clinical pharmacist reviewed and monitored all aspects of the patients' drug therapy in collaboration with other health care professionals at six weekly intervals for six months. The control patients received usual outpatient care. Seventy-three patients were recruited into the study, of whom 48 (66%) were randomised to receive pharmaceutical care. One in six patients was taking complementary medicines. The pharmaceutical care program provided patients with important medication information that resulted in changes to drug therapy. However, the six-month program did not lead to an improvement in glycaemic control. The next phase of the study adapted the pilot hospital-based pharmaceutical care program to a community-based setting. / Two hundred and two type 2 diabetes mellitus FDS patients were recruited, of whom 101 (50%) were randomised to the pharmaceutical care program, and all were followed for 12-months. There were significant reductions in risk factors associated with coronary heart disease in the case but not the control group over time, specifically glycaemic control, lipid levels, and blood pressure. Glycosylated haemoglobin fell from 7.5% to 7.0% (P<0.0001), total cholesterol fell from 5 mmol/L to 4.6 mmol/L (P<0.0001), systolic blood pressure fell from 158 mmHg to 143 mmHg (P<0.0001) and diastolic blood pressure fell from 77mmHg to 71mmHg (P<0.0001). Multiple linear regression analysis confirmed that pharmaceutical care program involvement was an independent predictor of benefit after adjustment for key variables. The 10-year coronary heart disease risk for patients without a previous coronary event was reduced by 4.6% over the 12-month study period in the pharmaceutical care group (P<0.0001), while there was no change in the controls (P=0.23). This phase of the study showed that medium-term individualised pharmaceutical care reduced vascular risk factors in a community-based cohort of patients with diabetes and that provision of a multifactorial intervention can improve health outcomes in type 2 diabetes mellitus. As part of the pharmaceutical care program, a high level of complementary medicine use was found. As a result, a study of complementary medicine use was undertaken in 351 patients from the FDS. A convenience sample of FDS patients was interviewed regarding their use of complementary medicines. A literature search was conducted to assess the potential impact of these medicines on diabetes, concomitant medications or diabetes-related co-morbidities. / Eighty-three of 351 (23.6%) patients with diabetes had consumed at least one complementary medicine in the previous year and 42% (77/183) of the products potentially necessitated additional patient monitoring or could be considered potentially inappropriate for a diabetic patient. The data indicated the need for patient disclosure of complementary medicine use and adequate monitoring for complementary medicine-related adverse events, as part of the pharmaceutical care process. The pharmaceutical care model was established to provide a framework by which drug use could be improved to enhance patients' clinical and health-related quality of life outcomes. For the present study, a straightforward pharmaceutical care program was adapted from a hospital setting to a community setting, where the principal requirement was a clinical pharmacist who had completed a self-directed diabetes-training program. In this context, clinically relevant parameters improved over the course of the study period. Pharmaceutical care programs such as this can begin the process of translating the findings of large and expensive clinical trials into standard clinical practice.

The aim of this study was to evaluate the effect of participation in the Otago Exercise Programme (OEP) on strength and balance. The change in a number of balance and strength measures were compared between a group of community dwelling women over the age of 80 years participating in the OEP and a control group matched by gender and age.Study design: A cohort study of two independent groups.Participants: Nineteen women over the age of 80 years who were community dwelling and participating in the OEP and 18 age matched community dwelling women who continued with their normal activities of daily living.Main outcome measures: Participants' strength and balance was measured using the timed up and go test, the step test, the 30 second chair stand test and gait velocity. Participants' fear of falling was measured with the Modified Falls Efficacy Scale and falls were monitored using a falls diary.Results: There were no statistically significant improvements in strength and balance in the OEP group and no statistically significant differences between the OEP and control group, after participating in the OEP for 6 months. The only statistically significant change in the OEP group was a slowing of gait velocity, all other outcome measures remained unchanged for both the OEP group and the control group.Conclusions: There were no statistically significant improvements in strength and balance after participating in the OEP. These results are consistent with those of the original Otago trial and the subsequent meta-analysis of all the Otago trials. The results from this study need to be interpreted with caution, as due to the small sample size the study was underpowered. The critical components of the OEP remain unknown.

<p>Tanzania has exceptional wildlife, environment and natural resources. The traditional way of conserving nature and wildlife has been through parks and reserves. In the 1980’s community based conservation emerged as a resource management paradigm. Its premise was that giving local people a stake in wildlife would increase their incentive to conserve it. This would make wildlife an important engine of local economic development. The core elements in community based conservation projects concern development, conservation and sustainable land use. Its ambition both to improve conditions for the local communities and conserve wildlife seems like a win-win situation, but has this really been working that well when applied in the field? This study aims to review the Community Based Wildlife Management in Tanzania, exemplified by a case study in the Wildlife Management Area in Burunge, located in a migration corridor between two national parks. There has been much controversy surrounding community-based management projects. While gains for the local communities have not always been clear, gains for wildlife seem more evident. Both species numbers and individuals have increased, but at the same time there has also been increasing conflicts between locals and wildlife. This is a sign that the WMAs are only halfway to towards reaching their goal of improving conditions for both communities and wildlife. CBC stills seems like the way forwards, maybe in a modified form which allows more government control, but where local people’s rights are still respected.</p>

Tanzania has exceptional wildlife, environment and natural resources. The traditional way of conserving nature and wildlife has been through parks and reserves. In the 1980’s community based conservation emerged as a resource management paradigm. Its premise was that giving local people a stake in wildlife would increase their incentive to conserve it. This would make wildlife an important engine of local economic development. The core elements in community based conservation projects concern development, conservation and sustainable land use. Its ambition both to improve conditions for the local communities and conserve wildlife seems like a win-win situation, but has this really been working that well when applied in the field? This study aims to review the Community Based Wildlife Management in Tanzania, exemplified by a case study in the Wildlife Management Area in Burunge, located in a migration corridor between two national parks. There has been much controversy surrounding community-based management projects. While gains for the local communities have not always been clear, gains for wildlife seem more evident. Both species numbers and individuals have increased, but at the same time there has also been increasing conflicts between locals and wildlife. This is a sign that the WMAs are only halfway to towards reaching their goal of improving conditions for both communities and wildlife. CBC stills seems like the way forwards, maybe in a modified form which allows more government control, but where local people’s rights are still respected.

Colorectal cancer is the third most diagnosed cancer and second leading cause of cancer related deaths in Canada. As Ontario has the largest population in Canada, it also has great disparities in colorectal cancer incidence. The region of Timiskaming has the highest incidence for colorectal cancer, while the region of Peel has the lowest incidence for colorectal cancer in Ontario. The purpose of this study is to identify the dominant non-nutritional modifiable environmental risk factors in the region of Timiskaming compared to the region of Peel that may be associated with diverging colorectal cancer incidence rates. The three objectives of the study included performing a systematic review on available published literature, creating an assessment questionnaire tool regarding environmental exposures, and utilizing the questionnaire assessment tool within a pilot study group while expanding it into the communities of interest. Findings indicate that there are dominant non-nutritional modifiable environmental risk factors in the regions of Timiskaming and Peel that may be associated with colorectal cancer. The dominant factors identified are tobacco/smoking, alcohol use, pesticides/organochlorines, and metal toxins. Following this study, it is imperative that recommendations are directed at a community level and relate to the assessment of potential non-nutritional modifiable environmental risk factors. Future research should accompany a larger sample size, multiple participant communities, and catering of the questionnaire tool towards the communities of interest. / UOIT

Reducing health disparities requires intervention on the social determinants of health, as well as a means to monitor and evaluate these actions. Indicators are powerful evaluation tools that can support these efforts, but they are often developed without the input of those being measured and invariably reflect the value judgments of those who create them. This is particularly evident in the measurement of subjective social constructs such as gender equity, and the participation and collaboration of the intended beneficiaries are critical to the creation of relevant and useful indicators. These issues are examined in the context of a study to develop indicators to measure gender equity in the Nicaraguan Fair Trade coffee cooperative PROCOCER. Recent studies report that Fair Trade cooperatives are not adequately addressing the needs of its women members. Indicators can provide cooperatives with a consistent means to plan, implement, and sustain actions to improve gender equity. This study used participatory and feminist research methods to develop indicators based on focus groups and interviews with women members of PROCOCER, the cooperative staff, and external experts. The findings suggest that the cooperative has a role in promoting gender equity not only at the organizational level, but in the member families as well. Moreover, gender equity requires the empowerment of women in four broad dimensions of measurement: economic, political, sociocultural, and wellbeing. The indicator set proposes 22 objective and subjective indicators for immediate use by the cooperative and 7 indicators for future integration, mirroring its evolving gender strategy. The results also highlight salient lessons from the participatory process of indicator development, where the selected indicators were inherently shaped by the organizational context, the emerging research partnership, and the unique study constraints. These findings speak to the need for continued efforts to develop a critical awareness and organizational response to gender inequities, as well as the importance of providing spaces for women to define their own tools of evaluation.

In the past few years, natural disasters have been taking more lives and, especially more in the lesser-developed countries. There have been debates in the scientific world on what could be the best ways to mitigate disasters and reduce their impacts. In addition, there is a growing concern about finding the best way of restoring normal lives in the disaster affected communities. Traditional top-down approaches practiced by local governments, aid-agencies, and NGOs have now been replaced by community-based disaster management approaches. International aid-agencies such as the World Bank, UNDP, CIDA, USAID etc., emphasize on the involvement of the community for development purposes and long term sustainability. However, experiences from catastrophic disasters such as the Indian Ocean Tsunami of 2004 or the Hurricane Katrina of 2005 revealed post-disaster scenario to be chaotic and at times insensitive to local cultures and needs of victims. Literature review of past theories indicated the widening gap in disaster management approaches for establishing effective models to deal with recurrent mega-disasters. To address some of the gaps and issues related to disaster management strategies and approaches, an ongoing reconstruction process of the Indian Ocean Tsunami of 2004 was evaluated in the coastal regions of Tamil Nadu, India. Four underlying objectives were set. The first was to review the evolving disaster paradigm and related theories and concepts in literature and to build connections with planning models and community based planning. Gaps in the literature were identified and a ‘common framework’ to study both the domains of environmental planning and disaster management was designed. The ‘framework’ was designed using other interdisciplinary planning frameworks, and suffices the second objective of this dissertation. The third objective was to assess an ongoing reconstruction process using an appropriate methodology and suitable indicators. Environmental issues and disaster related problems have risen over the last decade with its effects worsening in the developing countries. Despite technological advancements, it seems almost impossible to make disaster related losses negligible. However, losses can be minimised with proper interventions and community preparedness. Case studies were carried out within disaster affected fishing communities in the coastal areas of Tamil Nadu, India.