Promoting opioids, a story about how to influence medical science and opinions.

Key origins of the opioid crisis in the US lie in some pharmaceutical companies' substantial efforts to sell prescription painkillers. To legitimize opioids, the companies built up a body of medical science and opinions, and channels with which to communicate. Archival searches found 876 contracts that together provide information on how Mallinckrodt, an opioid manufacturer, attempted the ghost-management of medicine. These records-available because of litigation-involved contract research organizations, medical education and communication companies, publishers, professional societies, researchers, and other people who could be Mallinckrodt's agents. Together, they produced and circulated scientific messages to increase physicians' comfort with prescribing opioids. This article gives an overview of that activity, as seen in the contracts and related documents.

Feasibility and acceptability study of risk reduction approach for stroke prevention in primary care in Western India.

Objectives: Stroke is among the leading cause of morbidity and mortality and prevention is the need of the hour. Risk assessment of stroke could be done at primary care. A study was hence planned to assess if an information, education, and communication (IEC) intervention module could be used to address risk factors of stroke among attendees of primary care in Western India. Materials and Methods: Patients (>30 years) attending primary care center were enrolled (n = 215). Knowledge, attitude, and practice (KAP) questionnaire was administered at baseline and end line, and detailed diagnosis (hypertension and/diabetes, stroke, coronary artery disease, etc.) was noted from written records. A predesigned IEC module was administered about stroke, risk factors, and their prevention. Body mass index (BMI) and waist-to-hip ratio were taken before and after 16 weeks. Results: A total of 215 participants (M: F = 85:130; mean age = 51.66 ± 13.32 years) had risk factors such as hypertension (26.7%), diabetes (32.5%), history of stroke (n = 3; = 1.39%), and 7.4% (16/215) had coronary artery disease. Before and after comparison of KAP scores indicated significant difference (62.23 ± 19.73 vs. 75.32 ± 13.03); P ≤ 0.0001). Change of waist-to-hip ratio occurred from baseline 0.91-0.9 (P ≤ 0.001). Comparison of the proportion of patients taking antihypertensives before and after IEC intervention was statistically significant (P < 0.05), indicating improvement in drug compliance. BMI comparison changed marginally (26.5 ± 4.7 vs. 26.2 ± 4.5) before and after but was not significant (P ≥ 0.05). The intervention was found to be feasible and acceptable. Conclusion: IEC intervention appears to be a low-cost, feasible, and acceptable implementation model for addressing risk factors for stroke in primary care.

Inclusive partnership and community mobilization approaches to improve maternal health care access among internal migrants in nine Indian cities.

Background: Disparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants' needs. Aim: The aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities. Methods: This intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components. Findings: An increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers' prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably. Conclusions: Interventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.

Content validation of educational materials on maternal depression in Nigeria.

BACKGROUND: This study describes the content validation process of the already developed English and Yoruba (poster and leaflet) and Yoruba (song) maternal depression educational materials in Nigeria. METHODS: This study is a cross sectional study which is a part of a larger study on training and supervision of Primary health care workers. Study utilized health professionals' judgement for content validation, and maternal-child health clients' evaluation for face validation with the use of Suitability Assessment of Materials (SAM). Six bilingual professionals validated both English and Yoruba version of materials (Song has only Yoruba version) and 50 clients evaluated each Yoruba material. Validity Index was calculated by formula and inter-rater agreement using intra-class coefficient (ICC) was analyzed on Professionals' ratings. ICC, 't' test and Pearson correlation were analyzed on professionals' rating versus randomly selected six clients' rating. Descriptive statistics, and fisher exact test were used for other statistical analysis with SPSS version 25. RESULTS: The mean age of the professionals for poster was 44.3 ± 6.0 years, for leaflet 39.8 ± 7.2 years, for song 43.8 ± 8.4 years. For maternal child health clients, mean age is: 30.7 ± 5.4 years for poster; 31.3 ± 5.2 for leaflet and 29.0 ± 5.1 for song. Outcomes of bilingual professionals' validation are validity index: English {leaflet (0.94), poster (0.94)}, and Yoruba {leaflet (0.94) poster (0.94) and song (1.00)}. More than 80% clients rated the suitability of each material as superior. There is no significant relationship between clients' sociodemographic characteristics and their ratings across content, literacy demand and cultural appropriateness domains of the three materials on fisher exact test. The inter-rater agreement among the professionals is excellent on leaflet and song ICC > 0.8, but it is weak on the poster ICC < 0.6. There is no inter-rater agreement on all the three Yoruba materials, but a negative linear correlation was found on the leaflet between the professionals' ratings and the randomly selected clients' ratings. 't' test found no statistical difference in the ratings of the professionals and clients only on song material. CONCLUSION: This study shows the process of validation of the English and Yoruba versions of the educational materials. This process should be leveraged in the content validation of other maternal-child health education materials in Africa.

Reach, accessibility and acceptance of different communication channels for health promotion: a community-based analysis in Odisha, India.

INTRODUCTION: To achieve universal health coverage, improving demand generation at community is necessary. Media plays an important role by acting as a linking pin between health service providers and the community. This study intended to assess the penetration and acceptability of various forms of media for health communication in Odisha, India. METHODS: A cross-sectional mixed method study was conducted in 2016 in four districts. Following a desk review, a situational analysis was done at state, district and sub-district level. Data was collected through direct observation of study sites using a predefined checklist on knowledge awareness and practice, focussed group discussion and in-depth interviews using semi-structured questionnaire. Qualitative data was analyzed using framework approach while for quantitative data, we used SPSS 20.0. RESULTS: Major identified media houses were television (TV), radio and newspaper. Many health programs were being broadcasted in regional TV channels of the state, whereas leading public radio channel broadcasted highest number of health programs almost daily. The major source for information on disease symptoms and prevention was television (63.6%), remove hyphen (36.6%), newspaper (21.6%), health facility/service providers (17.7%), radio (9.2%), and other media like posters, pamphlets and folk dance (5.5%). Information on disease treatment or management was received mostly from television (61.2%), poster/leaflets (39.2%), remove hyphen (35.2%) and newspaper (19.7%). Only 8% of people received any health related message in mobile in past one year. Boards and hoarding provided information to 16.5% of study population. Nearly 36% respondents got information from health-wall, which are used to promote health awareness through wall paintings, graffiti etc. For immunization related information, interpersonal communication through frontline health workers was the most preferred. CONCLUSION: Interpersonal communication is believed to be most acceptable source of information on maternal and child health, immunization and neonatal care. For people with low literacy, remove hyphen campaign, folk media and interpersonal communication were found to be effective.

Influence of information, education and communication on prenatal and skilled delivery in the Tano North District, Ghana: A cross-sectional study.

Skilled birth attendance is considered an effective intervention to reduce maternal and early neonatal morbidity and mortality. Yet in Ghana, skilled birth attendance is said to be relatively low despite high antenatal attendance. In this study, we specifically assessed the influence of information, education and communication on prenatal and skilled delivery in the Tano North District of Ghana. A descriptive cross-sectional quantitative survey involving both closed and open-ended questionnaires were conducted among 393 women at three health facilities. The results showed skilled health personnel attended 94.1% of deliveries, which is higher than what has been reported in previous studies. Mothers with Senior High School Education were found to be 11.46 times more likely to be delivered by skilled birth attendant than those without formal education COR = 11.46, 95% (2.01-65.19) and this was statistically significant p = 0.006. There was also a significant association between information received by pregnant women and place of delivery (X2 = 20.85, P = 0.000 α = 0.05) in that the usefulness of information to mothers influenced their choice of health facility delivery. Marital status was also strongly correlated to being attended by skilled birth attendant (χ2 = 14.73, p = 0.005) as 0.4 times of mothers who were married were more likely to be attended by skilled birth attendants as compared to those that are single. COR = 0.005, 95% CI (0.00-0.36) and this was statistically significant p = 0.002. This study suggests the incorporation of IE&C into nursing training curriculum to orient students on the importance of IE&C so as to improve ANCs and skilled birth attendance further.

Effect of Information, Education, and Communication activity on health literacy of cardiovascular diseases among school-going adolescents in Delhi.

BACKGROUND: Heart attack and stroke account for >80% of deaths due to cardio-vascular diseases (CVDs) in India. Adolescents are the most susceptible group to adopt risky behaviors causing CVDs such as use of tobacco and alcohol, sedentary lifestyle, and unhealthy diet. This study was conducted to assess the health literacy of CVDs such as heart attack and stroke among school-going adolescents and change in health literacy after different information, education, and communication (IEC) activities. MATERIALS AND METHODS: It was a school-based interventional study conducted in two schools among students of classes 6, 7, and 8. The educational interventions were done in the form of pamphlets, posters, and lectures on heart attack and stroke. The postintervention data were collected 2 weeks after the first intervention and 3 months after the last intervention. RESULTS: There were a higher proportion of students with satisfactory level of knowledge of heart attack and stroke both at 2 weeks and 3 months after the interventions in both the schools, and the results were statistically significant (P < 0.05). CONCLUSION: The health literacy regarding CVDs has improved when compared to baseline after IEC activities among school-going adolescents.

Association of information, education, and communication with enrolment in health insurance: a case of Nepal.

BACKGROUND: Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal. METHODS: We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable. RESULTS: Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41-60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17-44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09-8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61-8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34-2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI. CONCLUSION: Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.

[Using text mining to identify gap in acquired immunodeficiency syndrome related information dissemination between the official channel delivery and the needs of adolescents].

Objective: The study intends to identify gap in HIV/AIDS awareness dissemination between the official channel delivery and the needs of adolescents. Methods: We crawled all the HIV/AIDS queries from "Baidu zhidao" till June 11st, 2018. "Baidu zhidao" inquiry and information form official public service announcement (abbreviated for "official delivery" hereafter) were the data source for comparative analysis. We categorized the text data into four kinds, "prevention", "testing and treatment", "symptoms and infection" and "legalization and policies" according to official categorization. Word segmentation was used for text mining and word frequency statistics, as well word cloud was used for word frequency visualization (all based on a comparison after removing the useless words). Results: Of the official delivery, the proportion of prevention category accounted for 32.3% (n=162) (ranks 1st), and the proportion of legalization and policies category was 14.1% (n=71). While among the "Baidu zhidao" inquiry information, the proportion of testing and treatment category accounted for 51.7% (n=51 264), and the proportion of prevention category accounted for 11.4% (n=11 272). The frequencies of same terms/ repeated terms of two channels accounted for 60% (59.3%-63.9%) of each category among the official delivery, of which, the proportion of interest terms comparatively less and more diverse in "Baidu zhidao" inquiries. The proportion of the terms frequency of each category was about 45% in "prevention, testing and treatment", 34.3% (n=14 781) in "symptoms and infection" and 17.0% (n=5 744) in "legalization and policies", respectively. Conclusion: A big gap was identified between the available official source and inquiries' term, especially word frequency discrepancy between "legalization and policies" and "prevention" categories. It underscore the necessity for the official channel to address the needs and interests of adolescents in the future.

The Check and Report Ebola (CARE+) Program to Monitor Travelers for Ebola After Arrival to the United States, 2014-2016.

The 2014-2016 Ebola epidemic in West Africa influenced how public health officials considered migration and emerging infectious diseases. Responding to the public's concerns, the US government introduced enhanced entry screening and post-arrival monitoring by public health authorities to reduce the risk of importation and domestic transmission of Ebola while continuing to allow travel from West Africa. This case study describes a new initiative, the Check and Report Ebola (CARE+) program that engaged travelers arriving to the United States from countries with Ebola outbreaks. The Centers for Disease Control and Prevention employed CARE ambassadors, who quickly communicated with incoming travelers and gave them practical resources to boost their participation in monitoring for Ebola. The program aimed to increase travelers' knowledge of Ebola symptoms and how to seek medical care safely, increase travelers' awareness of monitoring requirements, reduce barriers to monitoring, and increase trust in the US public health system. This program could be adapted for use in future outbreaks that involve the potential importation of disease and require the education and active engagement of travelers to participate in post-arrival monitoring.

Knowledge and Attitude Regarding Hepatitis B and C Among Blood Donors and Nondonors in North India.

BACKGROUND: The selection of a low-risk blood donor involves a dialogue between the trained medical staff and the volunteer blood donor, and this is where the knowledge of the prospective blood donor with regard to the risk factors for acquiring hepatitis B and C and the mode of spread through a blood transfusion is of utmost importance. Therefore, the study was conducted to assess the knowledge and attitude on hepatitis B and C with regard to blood donation, in the existing and the potential donor base. MATERIALS AND METHODS: This is a cross-sectional study conducted on 4000 participants, including 2000 blood donors and 2000 nondonors. The study tool was a pilot-tested, self-administered questionnaire, content and construct validated using Delphi methodology. RESULTS: The mean age of the study participants was 25.12 ± 8.43 years ranging from 18 to 60 years; 24.64 ± 8.31 years in donors and 25.61 ± 8.55 years in non-donors. The study included 69.8% males and 30.2% females, with 87.5% males and 12.6% females in donors and 52.1% males and 47.9% females in non-donors. Overall knowledge score was 51.02%, being 51.21% in donors and 50.84% in non-donors. Overall attitude score was 47.93%, being 47.09% in donors and 48.77% in non-donors. There was a low degree of significant linear correlation between knowledge and attitude in the study participants. CONCLUSION: Based on the results obtained in the study, it is evident that neither the existing level of knowledge nor the attitude of both donors and nondonors towards hepatitis B and C is adequate for being able to select a low-risk blood donor.

"Our girls need to see a path to the future" --perspectives on sexual and reproductive health information among adolescent girls, guardians, and initiation counselors in Mulanje district, Malawi.

BACKGROUND: Malawi has one of the highest adolescent pregnancy rates worldwide; at 141 births/1000 girls it is 3-fold higher than the global average. Adolescent pregnancy contributes to poor maternal and neonatal outcomes, school dropout, and poverty. In preparation for an information, education, and communication (IEC) intervention to reduce unintended pregnancy among adolescent girls, formative research was conducted to understand how and what sexual and reproductive health (SRH) information is shared with girls in southern, rural Malawi, and perceptions of such information among key informants. METHODS: Forty semi-structured interviews were conducted with three participant groups: adolescent girls (n = 18), mothers/female guardians (M/FGs) of adolescent girls (n = 12), and leaders of initiation rites (n = 10). Interviews were conducted in 15 villages. Data were analyzed and coded using Dedoose 7.5. RESULTS: Participants widely acknowledged both the health risks and the general social unacceptability of early childbearing, yet adolescent pregnancy is common in the region. Respondents also acknowledged the importance of female school completion and the norm that pregnancy usually marks the end of a girl's education. Unprotected transactional sex was reported to be common and driven by poverty. Initiation rites were described as prevalent and often encourage girls to practice sex at puberty. Contraceptives, and even condoms, were reportedly discouraged for adolescents due to concerns about inappropriateness for nulliparous and young girls and misconceptions about side effects. Adolescent respondents also noted barriers to accessing condoms and contraceptives. M/FGs were described as gatekeepers to SRH information and services, and many parents reported delaying SRH discussions until after sexual debut due to concerns about encouraging sexual activity. Adolescent and M/FG participants expressed a desire for role models or "outside experts" to provide SRH education and to promote an alternate vision to adolescent motherhood. CONCLUSION: To improve SRH outcomes for adolescent girls, it is critical to engage key stakeholders and create an enabling environment so that girls can effectively act on the IEC they receive. Initiation counselors remain entrenched information sources; efforts to provide them with training on accurate SRH messaging could leverage an existing channel. Engaging parents, especially mothers, is crucial to encourage earlier SRH education and to gain their acceptance of adolescent access to SRH services. Also important is mobilizing the broader community of influencers in support of girls' SRH and vision for a healthier future. Sensitization messages focusing on the health, educational and economic benefits of preventing early pregnancy may overcome misconceptions about and barriers to contraceptive use. Finally, fostering girls' aspirations for school completion and jobs and other income generating opportunities via role models can encourage an alternative to adolescent motherhood. Ultimately, poverty and gender inequity reduction is critical for long-lasting impact on the SRH of adolescent girls in the region.

Immunization coverage among under-five children living along a school student through child-to-child and child-to-parent information, education and communication strategy.

BACKGROUND: In spite of being a principal producer and exporter of vaccines and billions spent over decades, India is home to one-third of the world's under-five children (U5C) with no immunization. OBJECTIVES: The objective of this study was to find the outcome of child-to-child and child-to-parent Information, Education and Communication (IEC) strategy on the current percentage of immunization coverage (IC). METHODS: A mixed design research with multilevel concurrent sampling was conducted in Pune. Based on school students' households, 44 clusters having U5C were divided randomly into 11 experimental/control groups each. IEC strategy to students was independent variable and IC among U5C was dependent variable. Data were collected from 1092 students and 2352 U5C parents over 6 years. Vaccination card and Bacillus Calmette-Guérin mark were considered as evidence to conclude on full, partial and no IC. Change in knowledge quotient (KQ) among students/parents and U5C IC before and after IEC strategy assessed. RESULTS: Rural/urban age-appropriate full IC of U5C was 51% and 67% before and 88% and 85% in post-IEC, respectively. The mean KQ change score of 8-12/20 in students is likely to increase full IC by 37% and 18%, decrease partial coverage at 14% and 12%, and improve none coverage at 23% and 16%, from its existing level positively in experimental groups. Numerous factors discouraged parents to pursue their U5C immunization. CONCLUSIONS: Advocacy through school students can be an economically viable alternative marketing strategy for inadequate U5C IC than billions spent on treating vaccine-preventable diseases and impractical options.

Que no tengan miedo de nosotros:el Chagas según los propios protagonistas / Não tenham medo de nós: a doença de Chagas segundo os protagonistas / Do not be afraid of us: Chagas disease as explained by people affected by it

El artículo da cuenta de un estudio internacional realizado entre octubre de 2011 y enero de 2012, como fundamento para el diseño y elaboración de un material audiovisual (spot) con el objeto de sensibilizar y visibilizar la problemática del Chagas. La investigación, de carácter cualitativo, recogió los datos de 38 encuestas, respondidas por personas afectadas y especialistas en la temática. La información para cada grupo se ordenó según aspectos que las personas asociaban con la palabra Chagas, y dificultades, retos, desafíos y logros vinculados. Para cada punto se presenta un análisis de las respuestas, relatos y anécdotas relacionadas. Las conclusiones refuerzan la necesidad de conocer y dar a conocer las dificultades que viven las personas afectadas por el Chagas, considerando que se trata de una realidad que tiene diversas manifestaciones dependiendo del contexto...

O artigo apresenta um estudo internacional realizado entre outubro de 2011 e janeiro de 2012, no qual se baseou o desenho e elaboração de um vídeo (spot) que tinha como objetivo a sensibilização e promoção da visibilidade da problemática vinculada à doença de Chagas. A pesquisa, de caráter qualitativo, analisou a informação recolhida por meio de 38 questionários respondidos por pessoas afetadas e especialistas sobre a doença. A informação, para cada um dos dois grupos, foi classificada de acordo com os aspectos que as pessoas associavam com a palavra Chagas, e as dificuldades, adversidades, desafios e conquistas vinculadas com a doença. Para cada um dos referidos aspectos, apresenta-se uma análise das respostas, relatos e anedotas. As conclusões reforçam a necessidade de se conhecer e divulgar as dificuldades vividas pelas pessoas afetadas pela doença de Chagas, tendo em mente que se trata de uma realidade que se manifesta de forma diversa dependendo do contexto...

This paper presents an international study that was conducted between October 2011 and January 2012, in which a video (spot) to boost awareness and raise the profile of Chagas disease issues was designed and developed. This study was of qualitative nature and analyzed information that was gathered from 38 questionnaires that had been answered by individuals affected by the disease and by specialists on this disease. The information from each group was classified according to factors that they associated with the word Chagas, along with the difficulties, adversities, challenges, objectives and achievements relating to the disease. The responses, reports and anecdotes relating to each of these factors were analyzed. The conclusions emphasize the need to know and make known the difficulties that people affected by Chagas disease experience, bearing in mind that the realities are manifested differently depending on the context...

Effect evaluation of reproductive health program with IEC method among junior middle school students in Shanghai / 上海预防医学

[ Objective ] To evaluate the feasibility and effectiveness of a reproductive health program with information, education and communication ( IEC ) method among junior middle school students. [ Methods] Investigation was performed by the stratified cluster sampling method.Self-report questionnaires were given to junior middle school students who were randomly included from 16 classes of 8 middle schools in Shanghai.A 3-month intervention with IEC method was conducted, which included activities as issuing intervention material, hand-copying paper competition, debating discussion, knowledge contest, scene plays and so on.Participant teachers had been trained for organization of these activities. After that, a second investigation by questionnaire was made both in intervention and control groups and then effect evaluation was done on the basis of the results of the two investigations before and after intervention. [ Results] Compared with control group, knowledge scores of intervention group were improved significantly after the intervention.The general knowledge scores were increased from 42.3 to 61.3 (P<0.01), which was apparently higher than that in control group.At posttest, the intervention group students'premarital sex attitude was more conservative compared with the control group, with the scores being increased from 66.7 to 73.9 (P<0.01).The intervention group students'scores of having premarital sex and safe sex intention were increased from 77.7, 68.7 to 89.9, 87.3 (P all<0.01).There were about four fifths students who expressed that they were satisfied with the intervention content, format, time schedule, and benefited from it. [ Conclusion ] The school-based IEC method can change the premarital sexual behavior intention in some students and some others tend to have safe sex.Short-term effect of intervention is apparent, but the long-term impact of the intervention on the students still needs to be further investigated and confirmed.

Diagnóstico participativo para la prevención y control del Aedes aegypti en una zona de riesgo.: Municipio Sancti Spíritus, 2007 / Participation diagnosis for intervention and control of Aedes aegypti in a risk area:: Sancti Spíritus municipality, 2007

Se realizó una investigación de desarrollo tecnológico consistente en una estrategia educativa con participación comunitaria en una zona de riesgo del Consejo Popular Colón, municipio Sancti Spíritus en el 2007. El estudio comprendió 2 fases: la primera, la elaboración de la estrategia donde se identificaron los factores ambientales y sociales que influyen en la aparición de criaderos de Aedes aegypti; la segunda fase, validación de la estrategia a partir del criterio de expertos. El universo de estudio incluyó los líderes comunitarios de la zona de riesgo que pertenecen a los consultorios médicos de la familia números 7, 13 y 25, del área de salud Sur. La muestra estuvo conformada por 12 participantes: médicos y enfermeras de la familia, trabajadores de la "campaña", representantes del gobierno local, de los Comité de Defensa de la Revolución y la Federación de Mujeres Cubanas, presidente del Consejo de Defensa y educador para la salud del área. Como resultado se diseñó una estrategia educativa de información, educación y comunicación con participación comunitaria, sobre la base de los principales problemas sociales y ambientales identificados, tomando en consideración las necesidades de aprendizaje detectadas en la exploración de conocimientos y prácticas de la población estudiada. La totalidad de los expertos coincidieron en que la estrategia diseñada tiene amplias posibilidades y probabilidades de éxito en su aplicación y consideraron que el enfoque educativo propuesto permitirá que la comunidad potencialice la responsabilidad individual, familiar y comunitaria con su salud.

A technological development research consisting in an educational strategy with community involvement in a risk area of the Consejo Popular Colón, Sancti Spíritus municipality in 2007 was carried out. Study included two phases: First, the design of a strategy to identify the environmental and social factors influencing on the appearance of Aedes aegypty breeding places; the second one the validation of strategy from the expert criteria. Study group included the health area community leaders of risk area from the number 7, 13 and 25 family physician consulting room of the southern health area. Sample included 12 participants: family physicians and nurses. "campaign" workers, local government representatives, Defence Committee of the Revolution and the Cuban Women Federation, the Defence Council Chief and the health area teacher. As result, information, education and communication strategy was designed with community involvement, on the base of the main social and environmental problems identified, taking into account the learning needs detected in knowledge exploration and practice of study population. The total of experts agreed that designed strategy has wide possibilities and probabilities of success in its application and considered that the proposed educational approach will allows that community strengthen individual, family and community responsibility in relation to health.

Of sophists and spin-doctors: industry-sponsored ghostwriting and the crisis of academic medicine.

Ghostwriting for medical journals has become a major, but largely invisible, factor contributing to the problem of credibility in academic medicine. In this paper I argue that the pharmaceutical marketing objectives and use of medical communication firms in the production of ghostwritten articles constitute a new form of sophistry. After identifying three distinct types of medical ghostwriting, I survey the known cases of ghostwriting in the literature and explain the harm done to academic medicine and to patients. Finally, I outline steps to address the problem and restore the integrity of the medical literature.