Adolescent Health

Sarov partners hosted a three-day conference on substance abuse prevention for all Russian primary healthcare partnerships in 2000. The conference was co-sponsored by the US Substance Abuse and Mental Health Services Administration (SAMHSA) and the US Department of Energy. That summer, approximately 4,500 children attended a camp focused on substance abuse prevention.

Sarov schools implemented the curriculum, “Useful Habits and Useful Skills,” to teach healthy habits and resistance skills as prevention methods to address alcohol and drug use among youth.

The January 2002 issue of The Teaching Crossroad, a Russian publication, was dedicated to school-based substance abuse activities and included articles by Sarov teachers describing the educational and volunteer programs created by partners.

In 2002, 15 volunteers began participating in the peer education program “Kids for Kids.” Partners conducted pre- and post-testing of adolescent knowledge, attitudes, and behaviors.

A narcologist working with the partnership routinely presents lectures on substance abuse prevention, risk factors, and the role of the family in substance abuse prevention to parents whose children are thought to be at risk.

Dental Health

Partners trained school children, teachers, pregnant women, and parents on proper dental techniques and hygiene. The Los Alamos partners trained Sarov stomatologists in the administration of oral health surveys, fluoride tablet programs, examination of dental caries and proper documentation, and clinical hygiene.

During exchanges to Los Alamos, the Sarov partners learned scaling and polishing techniques at private dental clinics and at the School of Dental Hygiene at the University of New Mexico. Dentists now routinely give exams and lectures to students at school and at the dental polyclinic each quarter.

Partners held a four-day dental training in Sarov public schools in 2000. The audience included 1,050 students, five pediatricians, 50 parents, 80 teachers, and 40 nurses. Dental professionals now work in the public schools to teach dental hygiene as well as train other health professionals and teachers about oral health prevention. More than 50 children's dental professionals were trained and now work in the public schools to teach dental hygiene; these same professionals train other healthcare providers and teachers about oral health prevention.

In addition to school children, the partners also focused on a prenatal preventive dental program that began in March 2000. The program consisted of three phases of work and provided oral health education to more than 1,130 new mothers in 2002-2001; follow up care as needed; and examination and reinforcement of proper oral hygiene when the infants reach six months of age. The expectation was that the mother will bring the child into the clinic every six months for regular check-ups.

In 2002, the partners decided to combine the goals of the diabetes and dental projects in order to provide dental care to diabetics who might not receive the proper treatment.

The Sarov partners reported a change in children’s attitudes toward dental care. School trips to dental clinics became exciting to students whereas in the past these trips were met with dread. Children became more aware of their own responsibilities towards healthy teeth and good dental care.

More than 700 children attended dental health education events organized by the partners in the polyclinic and kindergartens between July and September of 2004. Approximately 700 children have attended such events each quarter since 2002.

Expectant mothers attend dental health maternal health classes established by the partners.

Three dentistry programs were established in nearby city clinics as a result of the sustainability grant. The Sarov partners provide consultation and training.

US partners trained Russian stomatologists in administering oral health surveys, conducting fluoride tablet and school-based brushing programs, and in clinical hygiene.

Asthma

Partners held a three-day workshop on asthma treatment and management in 2000, which was attended by 80 physicians and 30 patients. Pre- and post-testing of participant knowledge helped the partners to assess the success of the workshop and the quality of the materials used. Patient enrollment in the asthma control project began in October 2000.

Partners developed an asthma community needs survey for Sarov and created an asthma school where patients could learn how to control their condition. A Sarov partner developed a master curriculum notebook for the school that included lesson plans for classes along with learning objectives, written tests, class report forms, and various other educational materials.

Partners revised and translated an asthma patient data form and developed an output form to record asthma statistics.

Computers for the asthma team were installed in Sarov and all team members completed a computer training course.

All patients completed initial registration, underwent a baseline examination as defined in the project protocol, and received educational training from members of the asthma team. The goals of patient education supported the concept of self-care and included teaching the patients to recognize signs and symptoms of their condition and prevent emergencies; monitor disease status with peak flow metering; take medicines properly; know the difference between medications for acute and chronic care; and avoid asthma-triggers.

Review and statistical analysis of the data from the first six months of the asthma pilot project was completed and compiled by the Los Alamos partners. An analysis of the outcomes was completed in 2003, journal articles were published, and international presentations were made on the outcomes. Positive outcomes included improved patient recognition of signs of an impending attack and how to prevent it; reduced fear of the disease; fewer days of missed work or school; fewer emergency visits and hospitalizations; and increased participation in sports.

Plans and modified guidelines to treat patients with “difficult” asthma were finalized. The persistent use of rescue inhalers by patients who had normal pulmonary functioning was addressed through the development of a special “refresher” class given by the asthma school.

The municipal Duma agreed to provide the asthma medication fluticosone to both children and adults free of charge; the Duma continues to provide funding for high potency glucocorticoids for adult and pediatric asthma patients.

Three members of the Sarov asthma team attended the Russian National Pulmonary Conference in the fall of 2001. One partner presented a manuscript describing the results of the asthma project at the epidemiology section of the conference.

In July 2001, a Los Alamos partner presented a paper summarizing the model developed by the asthma team to the 3rd Triennial World Asthma Meeting in Chicago, Illinois. The Russian Chief Pulmonologist
attended the conference, as well.

In May 2002 the Los Alamos and Sarov partners completed intensive training for the Global Youth Tobacco Survey at the Center for Disease Control. In October, they administered the survey to 1,495
randomly selected students aged 13-15 in selected schools throughout Sarov.

A modified Global School Personnel Survey (GSPS) Tobacco Survey was given to 900 school employees at 20 schools. Both surveys were forwarded to the Centers for Disease Control and Prevention for review and analysis.

A poster summarizing the asthma pilot project was on exhibit at the American Thoracic Society’s Annual Scientific Meeting in Georgia in May 2002 and was presented at the AIHA annual conference.

The Los Alamos partnership coordinator participated in the Annual Meeting of the European Respiratory Society in September 2002 where he presented an abstract and poster detailing the asthma project.

The Sarov partners reported that the number of asthma patients monitoring their Peak Expiration Volume (PEV) between January and February 2004 was 210; it was 215 in March. Approximately 94.5 percent of asthma patients had PEV greater than 80 percent, which indicated the asthma was in remission. Similar
numbers were reported each quarter.

Diabetes

Partners created a diabetes school similar in structure to the asthma school. They developed and revised documents to aid in monitoring diabetic patients and now use the diabetes school curriculum, medical visit protocol, food and activity record, patient diary, written treatment plan template, an output report form, pre- and post-tests, personal insulin plan form, and the diabetes school master list to treat patients. Project data is measured in several ways, including office visits, weight, blood pressure, hemoglobin, cholesterol, and written and skills tests. The diabetes team members also completed a basic computer skills course.

Four Sarov team members participated in a training exchange at the International Center for Diabetes in Minneapolis, Minnesota in August 2001. They were trained in the concept of staged diabetic care, particularly related to patients with Type II diabetes.

In October 2002, the Sarov partners reported that the pharmaceutical company Roche donated an instrument to measure patients’ cholesterol and sugar levels to the diabetes team. Patients involved in the project continue to see their physicians on a monthly basis and the municipal government of Sarov agreed to provide test strips for patients free of charge until 2005.

The Los Alamos partnership coordinator presented a poster abstract on the partnership’s diabetes project at the International Diabetes Federation Meeting in Paris in 2003.

Hypertension

Partners assembled a coordinating team for the hypertension project in 2002. The team accomplished several tasks in the first quarter of the project, including the development of objectives, guidelines, and a protocol for the project that included 150 hypertensive patients from the nuclear facility who have no target organ damage. They also completed a community needs survey and continued development of a patient education curriculum, data collection instruments, and a patient database.

Servier Pharmaceuticals agreed to provide discounted medication and support for further training and supplies and the City Administration agreed to provide funds for some asthma equipment in 2002.

Hypertension patients received their own blood pressure cuffs free of charge thanks to funding from the nuclear city administration and the USAID-supported partnership.

The Sarov partners reported that 160 patients with hypertension had monitored their blood pressure January through March of 2004. The number of patients who controlled their blood pressure below 140/90 mmHG varied from 147 to 153 of the 180 patients enrolled in the program — roughly 94 percent.

In the spring of 2004, the Sarov newspaper published an interview with the hypertension team featuring the partnership hypertension project.

The hypertension guideline and program has been established at three dissemination clinics as a result of a sustainability grant. The Sarov City team provides ongoing consultation and training.

Women’s Health

Partners opened a WWC in March 2002. The opening ceremony was attended by approximately 40 community and healthcare leaders. The center’s staff includes four physicians and seven midwives and it serves a population of 24,000 women and 4,000 adolescent girls. Key priorities for the center were adolescent and maternal health, breastfeeding, and screening for STIs.

Unexpected financial support from the government of Sarov was used to purchase mammography and ultrasound equipment in 2002.
Partnership funds were used for renovating the WWC facility and purchasing patient education materials such as posters, leaflets, models, and mannequins.

The WWC staff implemented “Project Aurora,” an initiative to encourage adolescents to be responsible for their health, specifically with regard to prevention of HIV/AIDS and STIs. A questionnaire was created to test girls’ knowledge on hygiene, contraception, and STI prevention and to evaluate the effectiveness of the lectures.

Curricula for classes given at the WWC were developed based upon the results of the questionnaire.

A group of 15 adolescents taught to be peer educators conducted a number of education activities to 14-16 year old school students in Sarov.

Funding for a fetal heart monitor was obtained through the Los Alamos-Sarov Children’s Fund and forwarded to the Sarov partners.

The Sarov WWC conducted 336 health promotion activities in 2003, which were attended by 1,491 people.

Breast Feeding

Pregnant women and new mothers continuously attend lectures on breastfeeding offered at the WWC and children’s polyclinic. The Los Alamos partners provided several breast pumps for use at the center.

After compiling nine months of data on the breastfeeding objective, partners found that the number of women who breastfeed had increased substantially. Some 80.6 percent of infants younger than three months, 56 percent of infants younger than 6 months, and 32.5 percent of infants younger than one year were breastfed at that time.

Community Mobilization

Much of the work done in the first year of the partnership focused on organizational management methods, community-based strategic planning, media relations, and sustainability strategies. The Los
Alamos and Sarov partners were both trained on these topics together. In September 2000, partners met with the mayor and officials from the Sarov Municipal Government; partners attribute the strategic planning and training for persuading the government to provide matching funds to support a Health Education and Women’s Wellness Center. Officials also agreed to include specific partnership workplan objectives and goals in the Sarov municipal plan.

Sixteen community stakeholders participated in a community development workshop conducted by the partners. Participants developed plans for new programs and/or changed business practices as part of the workshop. Within the year, a multidisciplinary team including representatives from the educational, social, and medical committees of the city administration, the police, and NGOs was formed. With participation from the Los Alamos partners, a project on prevention of drug abuse among adolescents was implemented. The model, Resolving Public Health Problems through Community Involvement, was later replicated by AIHA at several other partnership sites. 

Partners created community-specific action plans for smoking cessation that were implemented through the CMU-50 hospital.
Partners drafted an article titled, “Pursuing Community-Oriented Primary Care in a Russian Closed Scientific City: The Sarov/Los Alamos Community Health Partnership,” which was accepted for publication in the November 2002 issue of the American Journal of Public Health.

A total of 124 health promotion activities were held at Medical Sanitary Unit No. 50 in 2003 and attended by 5,045 people; 146 activities were conducted in 2004 and attended by 4,937 people.

Sustainability Activities

USAID awarded the Sarov partners a sustainability grant in November 2004 to work with three communities to replicate and disseminate their successful models on chronic disease management for hypertension, dental health and reduction of carries, and women’s health.

In April 2004, partners hosted a conference on the above subjects attended by some 70 healthcare professionals. Health administrators, ob/gyns, dentists, and cardiologists from the three dissemination sites — central district hospitals in Ardatovo, Pervomaisk, and Diveevo/Nizhegorodskay Oblasts — attended the event.

Sarov partners conducted follow up technical assistance visits to each of the sites, providing additional training and assisting with the establishment of reporting systems.