2004 Sustainability Grant

The Sarov partners were awarded 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 addition, the partners were to host a best practice conference.

In February 2004, the Sarov partners hosted a conference on the above subjectives. Health administrators, OB/GYNs, dentists, and cardiologists from the three identified dissemination sites—central district hospitals in Ardatovo, Pervomaisk, and Diveevo/Nizhegorodskay Oblasts attended. The Sarov partners conducted follow up technical assistance visits to each of the sites and provided additional training and established reporting systems.

The best practice conference was held in April 2004 and was attended by over 70 health care professionals and health administrators.

Adolescent Health

• The Sarov partners hosted a three day conference on substance abuse prevention for all Russian primary health care 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. Partners who attended the conference acted as camp instructors and have continued to give presentations on healthy behaviors to children enrolled in summer camps. The presenters have specialties in venereology, drug addiction, and adolescent gynecology.
• Sarov schools continue to use the curriculum, Useful Habits and Useful Skills to teach healthy habits and resistance skills as prevention methods to address alcohol and drug use. The city event, “Let’s Stand as a Wall Against Drug Abuse” is held annually at local schools; narcologists visit with students and lecture them on drug abuse prevention. Sarov’s drug abuse problem and the project’s prevention efforts were discussed in an interview with the head of the narcology department and published in a local newspaper.
• The January 2002 issue of The Teaching Crossroad information bulletin was dedicated to school-based substance abuse activities and included articles by Sarov teachers describing the educational and volunteer programs created by the Los Alamos and Sarov partners.
• In 2002, fifteen volunteers began participating in the peer education program “Kids for Kids.” They attended 8 sessions on anatomy, physiology, contraception, female and male reproductive systems, STIs and HIV, and team building. Pre and post testing of adolescents’ knowledge was conducted.
• A narcologist presented lectures on substance abuse prevention, risk factors, and the role of the family in substance abuse prevention to 23 fathers whose children are thought to be at risk.

Dental Health

• School children, teachers, pregnant women, and parents were trained 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 an 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.
• The partners held a four-day dental training in the Sarov public schools in 2000. The audience included 1,050 students, 5 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. Over 50 children's dental professionals were trained and work in the public schools to teach dental hygiene; these same professionals train other health professionals 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:
  • Phase I – 640 mothers, with observable dental needs, were referred to the polyclinic to receive oral education. In 2001, an additional 493 patients began the program.
  • Phase II – The clinical portion of the program consisted of measuring and recording tooth pocket depths followed by appropriate dental care.
  • Phase III – When the child is 6 months old, the mother and child return to the polyclinic where the infant’s teeth are examined and proper dental practices enforced. The expectation is that the mother will bring the child into the clinic every six months for regular check-ups.
• During FY02, 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 Los Alamos partners assisted in identifying the group of patients who could receive instruction in oral care.
• The Sarov partners report a change in children’s attitudes toward dental care. School trips to dental clinics are exciting to students now whereas in the past these trips were met with dread. Children are becoming more aware of their own responsibilities towards healthy teeth and good dental care.
• Over 700 children attended dental health education events organized by the partners in the polyclinic and kindergartens in Jan- March 2004. The same quarter, 59 expectant mothers attended dental health maternal health classes.
• US partners trained Russian stomatologists in administering oral health surveys, conducting fluoride tablet and school-based brushing programs, and in clinical hygiene. Partners also met with local health administrators and physicians to discuss the oral health of children in Sarov.

Asthma

• The partners held a three-day workshop on asthma treatment and management in 2000. Eighty physicians and 30 patients attended; pre and post testing of the participants’ knowledge helped the partners to assess the success of the workshop and the quality of the materials used. Patient enrollment in the asthma project began in October 2000.
• The partners developed an asthma community needs survey for Sarov and created an asthma school where patients could learn how to control their asthma. A Sarov partner developed a master curriculum notebook for the school. Lesson plans for each class include: learning objectives, written tests, class report forms and various other education materials. The asthma patient data form was revised and translated. Additionally, partners 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 patient 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 6 months of the asthma pilot project was completed and compiled by the Los Alamos partners. An analysis of the outcomes was completed in FY03 and journal articles were published and international presentations were made on the outcomes. Analysis indicated that asthma participants:
  • have learned to recognize the signs of an impending attack and how to prevent it;
  • fear the disease less;
  • had fewer days of missed work or school;
  • had fewer emergency visits and hospitalizations; and
  • had increased their 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 and 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, Los Alamos and Sarov partners completed intensive training for the Global Youth Tobacco Survey at the Center for Disease Control. In October, the survey was administered to students ages 13-15 in selected schools throughout Sarov.
• 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 Global Youth Tobacco Survey (GYTS) was administered to 1,495 randomly selected students between 13 and 15 years of age at 20 different schools in October 2002. 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.
• The Sarov partners reported that the number of asthma patients monitoring their Peak Expiration Volume (PEV) in Jan – Feb 2004 was 210 and 215 in March 2004. Approximately 94.5% of asthma patients had PEV greater than 80% predicated which indicates the asthmas is in remission.

 
Diabetes

• The partners created a diabetes school similar in structure to the asthma school. They developed and revised documents to aid them 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. The team members 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; the municipal government of Sarov has agreed to provide test strips for patients until 2005.
• Partners began work on a collaborative hypertension-diabetes project and discussed whether classes should be offered through the diabetes or hypertension school. Discussions included whether or not patients should attend all six hypertension classes and if the project should offer joint presentations during classes on hypertension and diabetes. The hypertension school is expected to continue its work after the initial pilot period is over. The diabetes-dental collaborative project continues to progress. Leaders for the project were identified and protocol and documents for the project were finalized by the dental team in August 2002.

Hypertension

• The partners assembled a coordinating team for the hypertension project in 2002. The team developed objectives and guidelines; developed a protocol for the project to include 150 hypertensive patients from the nuclear facility who have no target organ damage; completed a community needs survey; continued the 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; the City Administration agreed to provide funds for some asthma equipment in 2002.
• Hypertension patients purchase their own blood pressure cuffs at a subsidized price provided by the partnership.
• The Sarov partners reported that 160 patients with hypertension had monitored their blood pressure in Jan – March 2004. The number of patients who controlled their blood pressure below 140/90 mmHG varied from 147 – 153 of the 180 total patients (94%).

Breastfeeding

• Pregnant women and new mothers continuously attend lectures on breastfeeding offered at the WWC. The Los Alamos partners provided several breast pumps for use at the WWC.
• After compiling nine months of data on the breastfeeding objective, partners found that the number of women who breastfeed had increased substantially: 80.6% of infants younger than three months, 56% of infants younger than 6 months, and 32.5% of infants younger than one year are breastfed.

Women's Health

• The WWC opening ceremony was held in March 2002 and was attended by approximately 40 community and health leaders. The staff includes four physicians and seven midwives and serves a population of approximately 24,000 women and 4,000 female adolescents. The center’s efforts focus primarily on adolescent and pregnant women’s health, breastfeeding, and screening for STIs. The center also serves as a health education center for diabetes and asthma education.
• Unexpected financial support from the government of Sarov was used to purchase mammography and ultrasound equipment in 2002.
• The WWC staff implemented “Project Aurora,” an initiative to encourage female adolescents to be responsible for their health, specifically with regard to prevention of HIV/AIDS and STIs. Physicians, counselors, school teachers, and parents educate adolescents about healthy lifestyles and behaviors within this context. A questionnaire was created to test girls’ knowledge on hygiene, contraception, and STI prevention and to evaluate the effectiveness of the lectures given by the adolescent gynecologist. Curricula for classes given at the WWC were developed based upon the results of the questionnaire.
• Funding for a fetal heart monitor was obtained through the Los Alamos-Sarov Children’s Fund and forwarded to the Sarov partners.
• WWC staff attended numerous AIHA sponsored workshops and trainings, including a contraceptive technology workshop in Moscow in October 2001, WWC dissemination conference in Kiev in December 2001, a Domestic Violence Conference in Samara in September 2001, and a management training workshop in St. Petersburg in 2002.

 
Community Mobilization

• Much of the work done in the first year of the partnership focused on organizational management methods, community-based strategic planning, medial 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 pursuading 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 the AIHA sponsored four-day community development workshop, Resolving Public Health Problems Through Community Involvement, in September 2000. 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.
• In September 2002, five Sarov partners attended a smoking cessation conference in Moscow. They were introduced to a systematic approach to tobacco cessation through the instruction and practice of intervention techniques. Partners created community-specific action plans for smoking cessation that would be implemented through the CMU-50 hospital. It gave the partners the opportunity to work in small groups and brainstorm ideas for how to tackle smoking in Sarov. Examples were presented for effective population based treatments, including clinical and community treatments.
• An article entitled Pursuing Community-Oriented Primary Care (COPC) in a Russian Closed Scientific City: The Sarov-Los Alamos Community Health Partnership was accepted for publication in the November 2002 issue of the American Journal of Public Health. It was written by the Los Alamos partners and describes the work done by the partnership.