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PubMedDate not supplied

[Formulating a health strategy at the local level using the "Urban Health Profile" and "Urban Health Planning"].

The aim of this article was to describe the method that Croatian cities have used in the development of the City Health Profile and City Health Plan. Selected as the most appropriate and applied was the Rapid Appraisal to Assess Community Health Needs. Three sources of information were used in this research: panelist essays reflecting local community views on health, problems and potentials of their city, observations about what is diminishing and what is giving beauty of living in their city and information derived from the existing written data sources. A free-text processing program analyzed essays. During the Consensus conference, based on presented data, participants had selected (Healthy City Project) priority areas. Between 1996 and 2002 The Rapid Appraisal was applied in six Croatian cities: Pula, Metković, Rijeka, Karlovac, Varazdin and Zagreb. By applying the method of Rapid Appraisal the cities assessed their health and health needs and created the City Health Profile. They selected their (Healthy City Project) priority areas, established the working groups on priority areas, and developed the City (action) Plan for Health. The method proved that communities have the capacity to recognize and deal with their health problems.

Community Health Planning↗
PubMedDate not supplied

High rates of advance care planning in New York City's elderly population.

BACKGROUND: Previous studies have demonstrated low rates of advance care planning (ACP), particularly among nonwhite populations, raising questions about the generalizability of this decision-making process. OBJECTIVE: To explore factors that may influence patients' willingness to engage in ACP. DESIGN: Survey. SETTING: Thirty-four randomly selected New York City senior centers. PARTICIPANTS: A total of 700 African American (n = 239), Hispanic (n = 237), and white (n = 224) adults 60 years and older. INTERVENTION: Participants were administered a 51-item survey that assessed attitudes, beliefs, and practices regarding ACP. MAIN OUTCOME MEASURES: Attitudes and beliefs about physicians' trustworthiness, fatalism, beliefs about surrogate decision making, and comfort discussing end-of-life medical care; factors associated with health care proxy completion; and health care proxy completion rates. RESULTS: More than one third of the participants had completed a health care proxy. There were no significant differences in completion rates across the 3 ethnic groups. Respondents who had a primary care physician (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-3.2), were more knowledgeable about advance directives (OR, 2.0; 95% CI, 1.4-2.9), or had seen a friend or family member use a mechanical ventilator (OR, 1.5; 95% CI, 1.02-2.1) were significantly more likely to have designated a health care proxy. Respondents who were only comfortable discussing ACP if the discussion was initiated by the physician (OR, 0.6; 95% CI, 0.0-0.8) were significantly less likely to have completed a health care proxy. CONCLUSIONS: African American, Hispanic, and white community-dwelling, older adults had similarly high rates of advance directive completion. The primary predictors of advance directive completion involved modifiable factors such as established primary care physicians, personal experience with mechanical ventilation, knowledge about the process of ACP, and physicians' willingness to effectively initiate such discussions. Some of the racial/ethnic differences in desire for collective family-based decision making that were observed in this study have implications for the evolution of ACP policy that respects and operationalizes these preferences.

Advance Care Planning↗
PubMedDate not supplied

Teaching inner-city mothers about family planning and prenatal and pediatric services.

One hundred thirty-five young, black, inner-city, pregnant women assessed the usefulness of a videotape designed by community health nurses to increase the self-care practices of low-income minority women with regard to their prenatal, pediatric, and family planning health needs. Seventy percent of the women rated as very useful information on the availability of health care and the protocols of public health clinics. The women also stated that they would tell others about public health care services and intended to make use of these services themselves as a result of viewing the videotape. The viewers' responses help clarify the preferred modality, content, and length of patient education for medically and socioeconomically high-risk pregnant women who tend to underuse preventive and primary health care.

Child Health Services↗
PubMedDate not supplied

Use of the intrauterine device by inner-city women.

OBJECTIVE: To examine the use, effectiveness, acceptability, and continuation rates of the copper T 380 A intrauterine device (IUD) among women attending an inner-city family planning clinic. DESIGN: A 1-year prospective cohort study. SETTING: The family planning clinic of Grady Memorial Hospital, which serves the inner-city indigent population of Fulton and Dekalb counties in metropolitan Atlanta, Ga. PARTICIPANTS: A total of 115 women with 1 or more live births who were in a mutually monogamous relationship for the previous year had the copper T 380 A IUD inserted between December 20, 1990, and June 28, 1991. MAIN OUTCOME MEASURES: Follow-up, consisting of history and a pelvic examination, was done 2, 6, and 12 months after IUD insertion to determine the status of the IUD and to detect any complications related to its use. At the end of the study, the continuation rates, reasons for removal, and complications related to IUD use were assessed. RESULTS: Thirty-seven women were unavailable for follow-up. Eight of those were seen in other clinics at Grady Memorial Hospital, but no mention was made of their IUD status. Fifty-six of the remaining 78 women were known to continue IUD use without any complications at the end of the 12 months. Among the 22 women known to have the IUD removed, 8 women cited no problems. Pelvic pain, menometrorrhagia, desire for permanent sterilization, and expulsion of the device were mentioned as reasons for other IUD removals. Pelvic inflammatory disease was not documented in any of the patients during the year of follow-up. CONCLUSION: With proper screening and counseling, the IUD may be used successfully in selected patients in inner-city family planning clinics.

Adolescent↗