Background Nationally, immunization coverage for the DTaP/3HPV/1MMR/3HepB/3Hib/1VZV antigen series in children ages 19–35 months are near or above the Healthy People 2020 target (80%). However, children in lower socioeconomic families experience lower coverage rates. Objective Using a community-based participatory research (CBPR) approach, Community Health Improvement for Milwaukee Children (CHIMC) intervened to reduce disparities in childhood immunizations. Methods The CHIMC adopted a self-assessment to examine the effectiveness of adhering to CBPR principles. Using behavior change models, CHIMC implemented education, social marketing campaign, and theory of planned behavior interventions. Community residents and organizational representatives vetted all processes, messages, and data collection tools. Results Adherence to the principles of CBPR was consistently positive over the 8-year period. CHIMC enrolled 565 parents/caregivers with 1,533 children into educational and planned behavior change (PBC) interventions, and enrolled another 406 surveyed for the social marketing campaign. Retention rate was high (80%) with participants being predominately Black females (90%) and the unemployed (64%); children’s median age was 6.2 years. Increased knowledge about immunizations was consistently observed among parents/caregivers. Social marketing data revealed high recognition (85%) of the community-developed message (“Take Control: Protect Your Child with Immunizations”). Barriers and facilitators to immunize children revealed protective factors positively correlated with up-to-date (UTD) status (p < 0.007). Ultimately, children between the ages of 19 and 35 months whose parents/caregivers completed education sessions and benefitted from a community-wide social marketing message increased their immunization status from 45% baseline to 82% over 4 years. Conclusions Using multilayered interventions, CHIMC contributed to the elimination of immunization disparities in children. A culturally tailored CBPR approach is effective to eliminate immunization disparities.

Strategic policy has to be implemented within complex operating environments where organisations have to perform within an inter-dependent production process in a dynamic mix of competition and cooperation. This suggests that network structures need to be in place that allow for both collaboration and competition whilst mitigating against structural fragmentation. The aim of this research was to further the understanding of control and communication mechanisms and collaboration in policy implementation networks and focus upon problems of structural fragmentation in these complex policy environments. This research used a systems approach to develop a methodological framework based on Beer's Viable System Model, work by Espejo and Social Network Analysis. The research was set in a tourism 'cluster' in an English seaside context, which is that part of the Yorkshire coast covered by the Scarborough Borough Council local authority, where a more culturally focussed tourism product was being introduced.

Objective To train general medical practitioners (GPs) and nurses in providing medication review services in the primary care setting and to evaluate the reviews provided. Setting One medical practice in Scotland with five whole‐time equivalent (WTE) GP partners, two practice nurses and six community‐based nurses. Method Training for GPs was provided as a group session plus individual supported clinic sessions. Nurse training consisted of a group session only. Patients aged over 75 were invited to attend the medical practice to receive a medication review. Output measures were: number of patients with pharmaceutical care issues (PCIs) documented, changes made to repeat medicines and computer records, monitoring undertaken, number of PCIs, PCIs identifiable from notes and records but not documented (‘missed’ PCIs). A sample of GP reviews provided before training and all GP and nurse reviews during training were evaluated. Key findings In 45 case note reviews provided prior to training, GPs documented PCIs in 20% of patients; average 0.3 per patient, but missed 1.75 per patient. In 56 reviews provided during training, they documented PCIs in 98% of patients; average 3.0 per patient, missing 0.8 per patient. The proportion of patients with changes to drug therapy or monitoring carried out during training increased significantly compared to pre‐training reviews. Nurses documented PCIs in 97% of 33 patients reviewed, average 1.5 PCIs per patient, but missed 0.8. The mean number of repeat drugs prescribed reduced from 4.73 to 4.42 per patient after nurse review, but increased after GP review from 4.07 to 4.18. Conclusion After training, both GPs and nurses identified PCIs appropriate to their expertise. The sustainability of this effect in the longer term is not known. Since all patients should have repeat medication reviewed regularly, involving these professionals in providing routine reviews would allow pharmacist medication review clinics to be optimised.

As it has sought to be recognized as a developed nation with equitable human rights, the government of Panama has been an active player in international discussion of indigenous rights. The indigenous people of Panama continue to face serious challenges. Our research examines the Ngäbe Buglé because they are the largest and most politically active indigenous groups in Panama. Almost half of the indigenous people live on semiautonomous reservations (comarcas). Although some may hail Panama's creation of comarcas as a milestone for indigenous rights, norms are only partially effective in this case. The influence of key stakeholders can influence how norms are carried out. In Panama, the government alternates between attempting to constrain civil society and giving in to demands when the protests can no longer be ignored. The Panamanian government has shown little respect for indigenous rights in its battle over natural resources located on the comarcas; moreover, the indigenous do not enjoy the same rights and privileges as those Panamanians living outside of the comarcas.

Practical wisdom is essential to occupational and professional practice. However, the emphasis on technical rationality in these domains neglects the necessity of practical wisdom in doing specialized, skilled work. Microdynamic methods for analyzing social action enabled the discovery and examination of practical wisdom in two interactional episodes from community health work. Practical wisdom was found in specific acts: in adaptation to and interpretation of logical forces and interactional rules of these acts; and in deliberation among choices to reach intended outcomes. Cultivating skills in microdynamic methods for finding and analyzing practical wisdom is an essential tool for practitioners and organizations.