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Background In 2013, a cohort of public health students participated in a ‘flipped’ Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach. Methods Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions. Results Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1–5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years’ overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field). Conclusion Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.

Background Although the prevalence of depression in Vietnam is on par with global rates, services for depression are limited. The government of Vietnam has prioritized enhancing depression care through primary healthcare (PHC) and efforts are currently underway to test and scale-up psychosocial interventions throughout the country. With these initiatives in progress, it is important to understand implementation factors that might influence the successful integration of depression services into PHC. As the implementers of these new interventions, primary care providers (PHPs) are well placed to provide important insight into implementation factors affecting the integration of depression services into PHC. This mixed-methods study examines factors at the individual, organizational and structural levels that may act as barriers and facilitators to the integration of depression services into PHC in Vietnam from the perspective of PHPs. Methods Data collection took place in Hanoi, Vietnam in 2014. We conducted semi-structured interviews with PHPs ( n  = 30) at commune health centres and outpatient clinics in one rural and one urban district of Hanoi. Theoretical thematic analysis was used to analyse interview data. We administered an online survey to PHPs at n  = 150 randomly selected communes across Hanoi. N  = 226 PHPs responded to the survey. We used descriptive statistics to describe the study variables acting as barriers and facilitators and used a chi-square test of independence to indicate statistically significant ( p  < .05) associations between study variables and the profession, location and gender of PHPs. Results Individual-level barriers include low level of knowledge and familiarity with depression among PHPs. Organizational barriers include low resource availability in PHC and low managerial discretion. Barriers at the structural level include limited mental health training among all PHPs and the existing programmatic structure of PHC in Vietnam, which sets mental health apart from general services. Facilitators at the individual level include positive attitudes among PHPs towards people with depression and interest in undergoing enhanced training in depression service delivery. Conclusions While facilitating factors at the individual level are encouraging, considerable barriers at the structural level must be addressed to ensure the successful integration of depression services into PHC in Vietnam.

Aboriginal peoples are among the most food insecure groups in Canada, yet their perspectives and knowledge are often sidelined in mainstream food security debates. In order to create food security for all, Aboriginal perspectives must be included in food security research and discourse. This project demonstrates a process in which Aboriginal and non-Aboriginal partners engaged in a culturally appropriate and respectful collaboration, assessing the challenges and barriers to traditional foods access in the urban environment of Vancouver, BC, Canada. The findings highlight local, national, and international actions required to increase access to traditional foods as a means of achieving food security for all people. The paper underscores the interconnectedness of local and global food security issues and highlights challenges as well as solutions with potential to improve food security of both Aboriginal and non-Aboriginal peoples alike.

Background The presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia. Methods The research question is addressed using a geographic information system (GIS) and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest. Results This study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar. Conclusions The uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty levels. Considering these results we discuss broader implications for global health and development and make several recommendations relevant for development and health practice and research.

The focus is on modelling how different behaviours and social structures affect disease spread, thereby resulting in epidemics, disease containment, stuttering transmission, or burnout.6 An important finding is that contact networks are characterised by community structure--ie, a tendency for formation of high-connectivity clusters, which can amplify or reduce population transmission.6 Social networks can transmit information that increases community cohesion and ability to prevent infection, and also foster social mobilisation and culture change. [...]the social sciences are crucial in creation of appropriate public health responses to risk and emergence of epidemics.

This article addresses anthropology's engagement with the emerging discipline of global health. We develop a definition for global health and then present four principal contributions of anthropology to global health: (a) ethnographic studies of health inequities in political and economic contexts; (b) analysis of the impact on local worlds of the assemblages of science and technology that circulate globally; (c) interrogation, analysis, and critique of international health programs and policies; and (d) analysis of the health consequences of the reconfiguration of the social relations of international health development.

Depression is an important and growing contributor to the burden of disease around the world and evidence suggests the experience of depression varies cross-culturally. Efforts to improve the integration of services for depression in primary care are increasing globally, meaning that culturally valid measures that are acceptable for use in primary care settings are needed. We conducted a scoping review of 27 studies that validated or used 10 measures of depression in Vietnamese populations. We reviewed the validity of the instruments as reported in the studies and qualitatively assessed cultural validity and acceptability for use in primary care. We found much variation in the methods used to validate the measures, with an emphasis on criterion validity and reliability. Enhanced evaluation of content and construct validity is needed to ensure validity within diverse cultural contexts such as Vietnam. For effective use in primary care, measures must be further evaluated for their brevity and ease of use. To identify appropriate measures for use in primary care in diverse populations, assessment must balance standard validity testing with enhanced testing for appropriateness in terms of culture, language, and gender and for acceptability for use in primary care.

Among low- and middle-income countries, there is evidence that populations experiencing rapid political and economic transition have particularly high burdens of disease and disability from mental health conditions. This paper undertakes a political economy analysis of mental health in Vietnam to enhance knowledge translation, notably how both explicit and tacit knowledge can be used to promote evidence-based policy making. It argues that Vietnam's experience illustrates the need to better understand, not only how transition transforms societies, but how it impacts on the mental health needs and care of populations. The political economy of transition in Vietnam has so far given highest priority to economic growth through integration with the world economy and public sector reform. There is a need to recognise that transition in Vietnam poses both a potential threat to the care of people with mental health needs, and an opportunity to develop mental health services appropriate to local contexts.

OBJECTIVE: To decrease unnecessary antibiotic use for acute respiratory tract infections in adults in a point‐of‐service health care setting. DESIGN: Prospective, nonrandomized controlled trial. SETTING: An urban urgent care clinic associated with the major indigent care hospital in Denver, Colorado between October 2000 and April 2001. PATIENTS/PARTICIPANTS: Adults diagnosed with acute respiratory tract infections (bronchitis, sinusitis, pharyngitis, and nonspecific upper respiratory infection). A total of 554 adults were included in the baseline period (October to December 2000) and 964 adults were included in the study period (January to April 2001). INTERVENTIONS: A provider educational session on recommendations for appropriate antibiotic use recently published by the Centers for Disease Control and Prevention, and placement of examination room posters were performed during the last week of December 2000. Study period patients who completed a brief, interactive computerized education (ICE) module were classified as being exposed to the full intervention, whereas study period patients who did not complete the ICE module were classified as being exposed to the limited intervention. MEASUREMENTS AND MAIN RESULTS: The proportion of patients diagnosed with acute bronchitis who received antibiotics decreased from 58% during the baseline period to 30% and 24% among patients exposed to the limited and full intervention, respectively (P < .001 for intervention groups vs baseline). Antibiotic prescriptions for nonspecific upper respiratory tract infections decreased from 14% to 3% and 1% in the limited‐ and full‐intervention groups, respectively (P < .001 for intervention groups vs baseline). CONCLUSION: Antibiotic use for adults diagnosed with acute respiratory tract infections can be reduced in a point‐of‐service health care setting using a combination of patient and provider educational interventions.

Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul's Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain-Health-directed activity: -0.13, 95% CI -0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI -0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI -0.22 to 0.29, P=.77; Self-monitoring and insight: -0.14, 95% CI -0.33 to 0.05, P=.15; Constructive attitudes and approaches: -0.10, 95% CI -0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI -0.18 to 0.27, P=.69; Social integration and support: -0.12, 95% CI -0.34 to 0.10, P=.27; and Health services navigation: -0.05, 95% CI -0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference -0.36, 95% CI -0.66 to -0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919. RR2-10.2196/resprot.6968.