Although the foreclosure crisis is considered over, some areas of the U.S. continue to suffer from high foreclosure rates. This research presents findings from in-depth interviews conducted with 18 ...service providers who worked with families to prevent their foreclosures in Cleveland, Ohio. The research focused on better understanding the landscape of the Cleveland foreclosure experience. Service providers provided insight into families’ experiences with the foreclosure process. The three main themes developed from the interviews included: (1) clients lacked knowledge about the mortgage process; (2) lenders exploited clients’ lack of knowledge, setting them up to fail with predatory mortgages and targeting specific groups; and (3) mortgage servicers were inflexible, inconsistent, incompetent, and lacked regard for clients, except for local servicers. The findings provide implications for housing research, policy, and practice.
To determine the burden of hospitalised, radiologically confirmed pneumonia (World Health Organization protocol) in Northern Territory Indigenous children.
Historical, observational study of all ...hospital admissions for any diagnosis of NT resident Indigenous children, aged between > or = 29 days and < 5 years, 1 April 1997 to 31 March 2005.
All chest radiographs taken during these admissions, regardless of diagnosis, were assessed for pneumonia in accordance with the WHO protocol.
The primary outcome was endpoint consolidation (dense fluffy consolidation alveolar infiltrate of a portion of a lobe or the entire lung) present on a chest radiograph within 3 days of hospitalisation.
We analysed data on 24,115 hospitalised episodes of care for 9492 children and 13,683 chest radiographs. The average annual cumulative incidence of endpoint consolidation was 26.6 per 1000 population per year (95% CI, 25.3-27.9); 57.5 per 1000 per year in infants aged 1-11 months, 38.3 per 1000 per year in those aged 12-23 months, and 13.3 per 1000 per year in those aged 24-59 months. In all age groups, rates of endpoint consolidation in children in the arid southern region of NT were about twice that of children in the tropical northern region.
The rates of severe pneumonia in hospitalised NT Indigenous children are among the highest reported in the world. Reducing this unacceptable burden of disease should be a national health priority.
Objective:Self-stigma is a common phenomenon among adolescents suffering from psychiatric disorders; however, this important research area has received little attention. Furthermore, there is a lack ...of clarity in the current literature on what makes individuals more or less likely to experience self-stigma. The objectives of our article are to identify the external conditions that help promote empowerment and present a model that explicates the process of those adolescents who do not self-stigmatize.
Methods:In this qualitative study, we examine the cases of three adolescents between the ages of 12–17 who were taking psychiatric medication. We gathered adolescents’ experiences and perceptions of psychiatric treatment using the TeenSEMI, coded responses, utilized Atlas.ti software to connect and hyperlink the codes, and constructed individual narratives that ultimately elicited an empowerment process among the adolescents.
Results:We identified themes that helped adolescents to buffer against self-stigma; and categorized the components of the empowerment process as: diminish, normalize and attribute.
Conclusion and implications for practice:We compare our empowerment model with an adolescent self-stigma model and identify key differences that may mitigate the effects of self-stigma. Although there are limitations to the generalizability of the study, authors recommend interventions applicable to youths with mental illness, as well as family and peers. This study indicates positive outcomes among adolescents who adhere to and are engaged in treatment.
Young people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary ...care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes.
In-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011-2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components.
Of the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs.
Across all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings.
Australian and New Zealand Clinical Trials Registry ACTRN12610000358044 . Registered 6/05/2010. Prospectively Registered.
Remote Australian Aboriginal communities have among the highest diagnosed rates of sexually transmissible infections (STIs) in the world. We did a trial to assess whether continuous improvement ...strategies related to sexual health could reduce infection rates.
In this stepped-wedge, cluster-randomised trial (STIs in remote communities: improved and enhanced primary health care STRIVE), we recruited primary health-care centres serving Aboriginal communities in remote areas of Australia. Communities were eligible to participate if they were classified as very remote, had a population predominantly of Aboriginal people, and only had one primary health-care centre serving the population. The health-care centres were grouped into clusters on the basis of geographical proximity to each other, population size, and Aboriginal cultural ties including language connections. Clusters were randomly assigned into three blocks (year 1, year 2, and year 3 clusters) using a computer-generated randomisation algorithm, with minimisation to balance geographical region, population size, and baseline STI testing level. Each year for 3 years, one block of clusters was transitioned into the intervention phase, while those not transitioned continued usual care (control clusters). The intervention phase comprised cycles of reviewing clinical data and modifying systems to support improved STI clinical practice. All investigators and participants were unmasked to the intervention. Primary endpoints were community prevalence and testing coverage in residents aged 16–34 years for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. We used Poisson regression analyses on the final dataset and compared STI prevalences and testing coverage between control and intervention clusters. All analyses were by intention to treat and models were adjusted for time as an independent covariate in overall analyses. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12610000358044.
Between April, 2010, and April, 2011, we recruited 68 primary care centres and grouped them into 24 clusters, which were randomly assigned into year 1 clusters (estimated population aged 16–34 years, n=11 286), year 2 clusters (n=10 288), or year 3 clusters (n=13 304). One primary health-care centre withdrew from the study due to restricted capacity to participate. We detected no difference in the relative prevalence of STIs between intervention and control clusters (adjusted relative risk RR 0·97, 95% CI 0·84–1·12; p=0·66). However, testing coverage was substantially higher in intervention clusters (22%) than in control clusters (16%; RR 1·38; 95% CI 1·15–1·65; p=0·0006).
Our intervention increased STI testing coverage but did not have an effect on prevalence. Additional interventions that will provide increased access to both testing and treatment are required to reduce persistently high prevalences of STIs in remote communities.
Australian National Health and Medical Research Council.
This article presents a methodology for acquisition and analysis of bright-field amplitude contrast image data in high-throughput screening (HTS) for the measurement of cell density, cell viability, ...and classification of individual cells into phenotypic classes. We present a robust image analysis pipeline, where the original data are subjected to image standardization, image enhancement, and segmentation by region growing. This work develops new imaging and analysis techniques for cell analysis in HTS and successfully addresses a particular need for direct measurement of cell density and other features without using dyes.
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