Improving the early presentation of cancer symptoms in disadvantaged communities: putting local people in control.
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ABSTRACT:
SUBMITTER: Lyon D
PROVIDER: S-EPMC2790700 | biostudies-other | 2009 Dec
REPOSITORIES: biostudies-other
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Project description:Background Physical activity has numerous health benefits, but participation is lower in disadvantaged communities. ‘parkrun’ overcomes one of the main barriers for disadvantaged communities, the cost of activities, by providing a free, regular community-based physical activity event for walkers, runners and volunteers. This study assesses equity of access (in terms of distance to the nearest parkrun) stratified by socioeconomic deprivation, and identifies the optimal location for 100 new events to increase equity of access. Methods We combined information about population location and socioeconomic deprivation, with information about the location of 403 existing parkrun events, to assess the current level of access by deprivation quintile. We then used a two-step location-allocation analysis (minimising the sum of deprivation-weighted distances) to identify optimal regions, then optimal towns within those regions, as the ideal locations for 100 new parkrun events. Results Currently, 63.1% of the Australian population lives within 5 km of an event, and the average distance to an event is 14.5 km. A socioeconomic gradient exists, with the most deprived communities having the largest average distance to an event (27.0 km), and the least deprived communities having the best access (living an average 6.6 km from an event). Access improves considerably after the introduction of new event locations with around 68% of the population residing within 5 km of an event, and the average distance to the nearest event approximately 8 km. Most importantly, the improvement in access will be greatest for the most deprived communities (now an average 11 km from an event). Conclusions There is a socioeconomic gradient in access to parkrun events. Strategic selection of new parkrun locations will improve equity of access to community physical activity events, and could contribute to enabling greater participation in physical activity by disadvantaged communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13981-5.
| S-EPMC9375319 | biostudies-literature
Project description:BACKGROUND:People live socially complex lives and have different health care needs influenced by socio-economic factors such as deprivation, unemployment, and poor housing. Lack of access to community based social care results in people seeking social support from health care services. This study explores the Life Rooms as a social prescribing model addressing the social determinants of mental health by providing support and access to resources in a local community setting. With an aim to identify key elements that contribute toward enhancing the effectiveness of the Life Rooms social prescribing approach. METHODS:Data were obtained through six semi-structured focus groups with mental health service users from two locations in the North West of the UK. Postcode data was collected to generate an Index for Multiple Deprivation (IMD) score, to understand their socio-economic background. Data were analysed using thematic analysis. RESULTS:A total of 18 participants took part in the study. The majority of participants came from disadvantaged backgrounds; 14 participants measuring 3 and below in terms of overall IMD scores and 9 participants belonged to the poorest decile (IMD score?=?1). Participants reported on different elements of the Life Rooms which they found as an effective approach to care. Four main themes emerged from the data: 1) social belonging: being able to just 'be' 2) resourceful and accessible; 3) social inclusion and connectedness; and 4) moving forward: self-development and independence. CONCLUSION:Findings support the need and benefit social prescribing to improve mental health wellbeing and reduce the burden of mental illness.
| S-EPMC6945402 | biostudies-literature
Project description:Archaeological research has by now revealed a great deal of variation in the way early complex societies, or chiefdoms, developed. This variation is widely recognized, but our understanding of the forces that produced it remains relatively undeveloped. This paper takes aim at such understanding by exploring variation in the local economies of six early chiefdoms; it considers what implications this variation had for trajectories of chiefdom development, as well as the source of that variation. Economic exchange is a primary form of local interaction in all societies. Because of distance-interaction principles, closer household spacing within local communities facilitated more frequent interaction and thus encouraged productive differentiation, economic interdependence, and the development of well-integrated local economies. Well-integrated local economies, in turn, provided ready opportunities for aspiring leaders to accumulate wealth and fund political economies, and pursuit of these opportunities led to societies with leaders whose power had a direct economic base. Wider household spacing, on the other hand, impeded interaction and the development of well-integrated local economies. In such contexts, aspiring leaders were able to turn to ritual and religion as a base of social power. Even when well-integrated local economies offered opportunities for wealth accumulation and a ready source of funding for political economies, these opportunities were not always taken advantage of. That variation in the shapes of early chiefdoms can be traced back to patterns of household spacing highlights the importance of settlement and interaction in explaining not just chiefdom development, but societal change more generally.
| S-EPMC8158874 | biostudies-literature
Project description:BackgroundAn evaluation of progress with participatory approaches for improvement of health knowledge and health experiences of disadvantaged people in eight Districts of Eastern Nepal has been undertaken.MethodsA random selection of Village Development Committees and households, within the eight Districts where participation and a Rights-based Approach had been promoted specifically by local NGOs were compared with similar villages and households in eight Districts where this approach had not been promoted. Information was sought by structured interview and observation by experienced enumerators from both groups of householders. Health knowledge and experiences were compared between the two sets of households. Adjustments were made for demographic confounders.ResultsComplete data sets were available for 628 of the 640 households. Health knowledge and experiences were low for both sets of households. However, health knowledge and experiences were greater in the participatory households compared with the non-participatory households. These differences remained after adjustment for confounders.ConclusionsThe study was designed to evaluate progress with participatory processes delivered by non-governmental organisations over a five year period. Improvements in health knowledge and experiences of disadvantaged people were demonstrated in a consistent and robust manner where interventions had taken place.
| S-EPMC3489826 | biostudies-literature
Project description:Efforts have been made to understand the processes that lead to the introduction of exotic species into local pharmacopoeias. Among those efforts, the diversification hypothesis predicts that exotic plants are introduced in local medical systems to amplify the repertoire of knowledge related to the treatment of diseases, filling blanks that were not occupied by native species. Based on such hypothesis, this study aimed to contribute to this discussion using the context of local Brazilian populations. We performed a systematic review of Brazilian studies up to 2011 involving medicinal plants, excluding those studies that presented a high risk of bias (because of sampling or plant identification problems). An analysis of similarities (ANOSIM) was conducted in different scales to test for differences in the repertoire of therapeutic indications treated using native and exotic species. We have found that although there is some overlap between native and exotic plants regarding their therapeutic indications and the body systems (BSs) that they treat, there are clear gaps present, that is, there are therapeutic indications and BSs treated that are exclusive to exotic species. This scenario enables the postulation of two alternative unfoldings of the diversification hypothesis, namely, (1) exotic species are initially introduced to fill gaps and undergo subsequent expansion of their use for medical purposes already addressed using native species and (2) exotic species are initially introduced to address problems already addressed using native species to diversify the repertoire of medicinal plants and to increase the resilience of medical systems. The reasons why exotic species may have a competitive advantage over the native ones, the implications of the introduction of exotic species for the resilience of medical systems, and the contexts in which autochthonous plants can gain strength to remain in pharmacopoeias are also discussed.
| S-EPMC5617200 | biostudies-literature
Project description:BackgroundResidents of socioeconomically disadvantaged locations are more likely to have poor health than residents of socioeconomically advantaged locations and this has been comprehensively mapped in Australian cities. These inequalities present a challenge for the public health workers based in or responsible for improving the health of people living in disadvantaged localities. The purpose of this study was to develop a generic workforce needs assessment tool and to use it to identify the competencies needed by the public health workforce to work effectively in disadvantaged communities.MethodsA two-step mixed method process was used to identify the workforce needs. In step 1 a generic workforce needs assessment tool was developed and applied in three NSW Area Health Services using focus groups, key stakeholder interviews and a staff survey. In step 2 the findings of this needs assessment process were mapped against the existing National Health Training Package (HLT07) competencies, gaps were identified, additional competencies described and modules of training developed to fill identified gaps.ResultsThere was a high level of agreement among the AHS staff on the nature of the problems to be addressed but less confidence indentifying the work to be done. Processes for needs assessments, community consultations and adapting mainstream programs to local needs were frequently mentioned as points of intervention. Recruiting and retaining experienced staff to work in these communities and ensuring their safety were major concerns. Workforce skill development needs were seen in two ways: higher order planning/epidemiological skills and more effective working relationships with communities and other sectors. Organisational barriers to effective practice were high levels of annual compulsory training, balancing state and national priorities with local needs and giving equal attention to the population groups that are easy to reach and to those that are difficult to engage. A number of additional competency areas were identified and three training modules developed.ConclusionThe generic workforce needs assessment tool was easy to use and interpret. It appears that the public health workforce involved in this study has a high level of understanding of the relationship between the social determinants and health. However there is a skill gap in identifying and undertaking effective intervention.
| S-EPMC2684114 | biostudies-literature
Project description:BackgroundLow socio-economic status can lead to poor patient outcomes, exacerbated by lack of integration between health and social care and there is a demand for developing new models of working.AimTo improve connections between patients, local services and their communities to reduce unscheduled admissions.Design and settingA primary care cluster with areas of high deprivation, consisting of 11 general practices serving over 74,000 people.MethodA multi-disciplinary team with representatives from healthcare, local council and the third sector was formed to provide support for people with complex or social needs. A discharge liaison hub contacted patients following hospital discharge offering support, while cluster pharmacists led medicine reviews. Wellbeing Connectors were commissioned to act as a link to local wellbeing and social resources. Advance Care Planning was implemented to support personalised decision making.ResultsUnscheduled admissions in the over 75 age group decreased following the changes, equating to over 800 avoided monthly referrals to assessment units for the cluster. Over 2,500 patients have been reviewed by the MDT since its inception with referrals to social prescribing groups, physiotherapy and mental health teams; these patients are 20% less likely to contact their GP after their case is discussed. An improved sense of wellbeing was reported by 80% of patients supported by wellbeing connectors. Staff feel better able to meet patient needs and reported an increased joy in working.ConclusionImproved integration between health, social care and third sector has led to a reduction in admissions, improved patient wellbeing and has improved job satisfaction amongst staff.
| S-EPMC11330060 | biostudies-literature
Project description:This study bridges gaps in air pollution research by examining exposure dynamics in disadvantaged communities. Using cutting-edge machine learning and massive data processing, we produced high-resolution (100 meters) daily air pollution maps for nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone (O3) across California for 2012-2019. Our findings revealed opposite spatial patterns of NO2 and PM2.5 to that of O3. We also identified consistent, higher pollutant exposure for disadvantaged communities from 2012 to 2019, although the most disadvantaged communities saw the largest NO2 and PM2.5 reductions and the advantaged neighborhoods experienced greatest rising O3 concentrations. Further, day-to-day exposure variations decreased for NO2 and O3. The disparity in NO2 exposure decreased, while it persisted for O3. In addition, PM2.5 showed increased day-to-day variations across all communities due to the increase in wildfire frequency and intensity, particularly affecting advantaged suburban and rural communities.
| S-EPMC11305374 | biostudies-literature
Project description:BackgroundWalking aids are issued to older adults to prevent falls, however, paradoxically their use has been identified as a risk factor for falling. To prevent falls, walking aids must be used in a stable manner, but it remains unknown to what extent associated clinical guidance is adhered to at home, and whether following guidance facilitates a stable walking pattern. It was the aim of this study to investigate adherence to guidance on walking frame use, and to quantify user stability whilst using walking frames. Additionally, we explored the views of users and healthcare professionals on walking aid use, and regarding the instrumented walking frames ('Smart Walkers') utilized in this study.MethodsThis observational study used Smart Walkers and pressure-sensing insoles to investigate usage patterns of 17 older people in their home environment; corresponding video captured contextual information. Additionally, stability when following, or not, clinical guidance was quantified for a subset of users during walking in an Activities of Daily Living Flat and in a gait laboratory. Two focus groups (users, healthcare professionals) shared their experiences with walking aids and provided feedback on the Smart Walkers.ResultsIncorrect use was observed for 16% of single support periods and for 29% of dual support periods, and was associated with environmental constraints and a specific frame design feature. Incorrect use was associated with reduced stability. Participants and healthcare professionals perceived the Smart Walker technology positively.ConclusionsClinical guidance cannot easily be adhered to and self-selected strategies reduce stability, hence are placing the user at risk. Current guidance needs to be improved to address environmental constraints whilst facilitating stable walking. The research is highly relevant considering the rising number of walking aid users, their increased falls-risk, and the costs of falls.
| S-EPMC7057469 | biostudies-literature
Project description:Rural cancer inequalities are evident internationally, with rural cancer patients 5% less likely to survive than their urban counterparts. There is evidence to suggest that diagnostic delays prior to entry into secondary care may be contributing to these poorer rural cancer outcomes. This study explores the symptom appraisal and help-seeking decision-making of people experiencing symptoms of colorectal cancer in rural areas of England. Patients were randomly invited from 4 rural practices, serving diverse communities. Semi-structured interviews were undertaken with 40 people who had experienced symptoms of colorectal cancer in the preceding 8 weeks. Four key themes were identified as influential in participants' willingness and timeliness of consultation: a desire to rule out cancer (facilitator of help-seeking); stoicism and self-reliance (barrier to help-seeking); time scarcity (barrier to help-seeking); and GP/patient relationship (barrier or facilitator, depending on perceived strength of the relationship). Self-employed, and "native" rural residents most commonly reported experiencing time scarcity and poor GP/patient relationships as a barrier to (re-)consultation. Targeted, active safety-netting approaches, and increased continuity of care, may be particularly beneficial to expedite timely diagnoses and minimise cancer inequalities for rural populations.
| S-EPMC9818976 | biostudies-literature