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PubMed1994

The development of community orientated recommendations for diabetes care in south Auckland. South Auckland Community Diabetes Planning Group.

Growing numbers and costs associated with diabetes and its tissue damage are of increasing concern. We describe the development of community orientated recommendations aimed at primary and secondary prevention of diabetes in an area with a high proportion of Maori and Pacific Islands people. Preliminary results from structured face-to-face interviews with patients (n = 555), general practitioners (n = 163) and other health professionals were discussed by a core group of elected or selected community and health professional representatives. Twelve meetings and one full day workshop were held over a 7 month period. Formal and informal consultation occurred among community and health groups between meetings. The 68 recommendations included the need to: empower communities and diabetic patients; improve coordination and standardisation of care and the importance of the general practitioner in this process; improve access to care by removing transport, cultural and language barriers to care; subsidize preventative treatment costs; improve foot and eye services; improve monitoring of those with past diabetes in pregnancy or impaired glucose tolerance; improve detection of diabetes by increased high risk screening linked to ongoing diabetes care programmes. Implementation requires quality information systems and a cooperative partnership approach between hospital, general practitioner and the community, particularly local Maori and Pacific Islands communities.

Community Health Services↗
PubMed1993

Factors controlling the spread of HIV in heterosexual communities in developing countries: patterns of mixing between different age and sexual activity classes.

The paper describes the development and analysis of a mathematical model of the spread and demographic impact of HIV in heterosexual communities in developing countries. The model extends previous work in this area by the representation of patterns of mixing between and within different age and sexual activity classes in a two sex structure. Summary parameters are derived to represent different mixing patterns, ranging from assortative via random to disassortative, as are methods to ensure that particular mixing patterns between different age and sexual classes (stratified on the basis of rates of sexual partner change) meet constraints that balance the supply and demand for sexual partners as AIDS induced mortality influences the demographic structure of a population. Analyses of model behaviour rely on numerical methods due to the complexity of the mathematical framework, and sensitivity analyses are conducted to assess the significance of different assumptions and different parameter assignments. Simulated patterns of HIV spread across the two sexes and various age classes are compared with observed patterns in Uganda. The principle conclusion of the study is that the pattern of mixing between age and sexual activity classes, combined with the assumptions made to balance supply and demand between the sexes have a very major influence on the predicted pattern of HIV spread and the demographic impact of AIDS. The paper ends with a discussion of future needs in model development and data acquisition.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Work in community health is about to change].

Changes in Ontario's political, social and economic environments have necessitated an unprecedented transformation in the health care system. The change in focus from the individual to the community now includes core units such as families, groups and communities. Visiting nurses, public health nurses and community health nurses have worked in Community Health Centres (CHCs) since 1970. However, the role of nurses working in these centres has not been clearly defined in the literature. Nor is there is a general consensus on their title. Nurse practitioners, primary care nurses or community health nurses are all used. As well, there is no existing educational program in Ontario that trains this type of nurse. This article discusses and gives examples of nurses working in community health, whose primary clinical expertise is in using community based and community development program strategies to plan health programs. These programs are specifically developed to address the health needs of the communities they serve--in this case, Toronto's francophone community. Also demonstrated are new approaches to nursing care within a community setting. From health promotion to disease prevention, from community development to research, the practice of community health nursing is complex and exciting.

Community Health Nursing↗
PubMed1989

Toward a synergism of rural development and community psychology.

It is a common experience that all social intervention programs planned and executed for social amelioration have not met with success. The major thesis of this article is that parallel growth of two subfields: rural development and community psychology, may not be coincidental, and the recent trends in Indian psychology readily lead themselves to a union between the two. The attempts to intervene in two different communities (heterogeneous and homogeneous) have proved an eye-opener for future interventions.

Community Mental Health Services↗
PubMed1979

Developing a community board for a mental health center.

Federally funded community mental health centers are required to have governing boards made up of community residents to ensure that services are meeting the community's needs. Sound View-Throgs Neck Community Mental Health Center in Bronx, New York, met that requirement by developing three local advisory boards, one for each subcatchment area served by an outpatient clinic. Later a central community board with 12 members, four from each of the local advisory boards, was formed. The central board has several standing committees that parallel the organization of the center, including community, hospital, and rehabilitation services; research and development; and administration. Board members and center staff meet regularly. They have found that they must act as partners and learn to share power, privileges, and knowledge.

Catchment Area, Health↗
PubMedDate not supplied

A framework for the development of community health agency partnerships.

The purpose of the study reported in this paper was to generate substantive theory regarding the development of effective partnerships among community agencies working with vulnerable populations. Ethnographic interviews were conducted and analyzed by applying the constant comparative method of qualitative analysis. This information was supplemented with data from the participants in two workshops, three manuscript reviewers, and relevant literature. Analysis of the data resulted in the emergence of a framework that outlines elements of partnerships. This framework furnishes the foundation for discussions of partnership configuration and partnership development. The results of this study provide basic guidelines for the formation of effective partnerships, and show that there is no single way to develop and structure such collaborative initiatives. Further studies are required in other substantive areas to advance the emergence of a formal theory of partnerships.

Adult↗
PubMed1996

Initial community site development for first--and second-year medical students.

BACKGROUND: Many medical schools are planning community-based experiences for preclinical students. As part of a generalist physician initiative, the University of Texas Medical Branch in Galveston placed all 200 first-year medical students in generalists' offices in a new course, called the "Community Continuity Experience." METHODS: Driven by significant time, class size, and geographic constraints, a process managed by the local Area Health Education Center was formulated for identifying and developing potential sites. The final process included identification of candidate generalist sites, departmental participation, and a detailed site assessment. The individual office nurses were the focus of site development activities. RESULTS: Feedback indicated that having office nurses serve as site facilitators was effective, and a key enabling strategy was having a nurse site coordinator serve as a single point of contact for all the sites. The students expressed positive views of the site experience and an interest in assignment, rather than student choice, for site allocation. CONCLUSIONS: Important components of site development for such a new course are development of an accurate database of available generalist community faculty, a methodical site selection process, an early orientation for all involved, and consideration of nonphysician site facilitators during the start-up phase.

Ambulatory Care↗
PubMed1997

[Participatory action-research in the development of health policies for Izumo City, Japan].

The method of participatory action-research has been introduced in planning and implementing health and welfare projects for the elderly in Izumo City since 1993. Public health researchers have participated in the projects with other related administrative sectors, citizen and non-profit organizations. This study analyzes the establishment and implementation of health policies of Izumo from the following five aspects: policy-making, priority, education, intersectoral cooperation and community development. The participatory action-research method was useful for developing the ability of health-staff to work with citizens; for integrating community care and community development; for using community resources effectively for primary health care; and for developing community-based education of citizens, medical students and health staff. This method can be and should be adopted for strengthening the policy-making ability of public health researchers who learn through cooperation with citizens and non-profit organizations.

Community Participation↗
PubMedDate not supplied

Cysticercosis in an urban black South African community: prevalence and risk factors.

Cysticercosis still represents a significant health problem in developing communities, despite supposed improvements in sanitation and personal hygiene. An ELISA for Cysticercosis antibodies was performed on serum from 230 random adult admissions to Baragwanath Hospital. Seventeen patients were seropositive giving a prevalence of 7.39% for this group of urban black South Africans. Twenty-one patients with documented cerebral cysticercosis were selected in order to evaluate risk factors for cysticercosis. Of the risk factors considered only a history of tapeworm infestation appeared to be significant. Even urbanisation has not resulted in n reduction in the prevalence of Cysticercosis and it appears that the disease continues to be endemic in this developing community.

Black or African American↗
PubMed1989

Nosocomial infections in black South African children.

Nosocomial infections in infants and children were prospectively studied in the general wards of a hospital serving a developing community. Of 1350 admissions in 5 months, 193 (14.3%) developed 302 infections (22.4/100 admissions). The major risk factors were malnutrition, age less than 2 years and prolonged hospitalization. The most common sites of infection were the lower respiratory and gastrointestinal tracts. The most frequently isolated organisms were Staphylococcus aureus and Klebsiella species and the site of most frequent isolation was the lower respiratory tract for which the method most commonly used was endotracheal aspiration. Seventy percent of isolates were resistant in vitro to conventional antibiotics. Thirty-one percent of infections developed while the patient was awaiting a diagnostic procedure or waiting to be sent home. During the study period 60 patients (4.4% of admissions) were admitted with a nosocomial infection acquired elsewhere (31 at this hospital and 29 from other hospitals). Measles and its complications accounted for 28 of these cases and 7 deaths. This study provides information on nosocomial infections in children from a developing community.

Black or African American↗
PubMed1988

Development of a community health programme.

This formulation of the steps necessary to develop a community health programme is based on Ms Johnston's considerable experience in the "Dana Sehat" programme in Central Java, Indonesia. "Dana Sehat" means health funds and the programme is based on the concept of a community development programme, built upon a health insurance scheme. Further details on the Dana Sehat programme were given in CONTACT 31 "Community Health Care in Rural Java" and in an article by Dr Gunawan Nugroho in the WHO book "Health by the People", 1975. The following outline was first printed in CONTACT 43, February 1976.

Community Health Services↗
PubMed1989

Evaluation of public health impact of schistosomiasis.

Present knowledge on the "importance"/"impact" of schistosomiasis is reviewed. Due to different methological approaches and outcome measures used as well as the substantial inter- and intra-setting variation of the epidemiology, the public health importance of schistosomiasis appears quite inconclusive for any schistosome species and cannot be generalised. In most studies "importance" is mainly understood as the amount of schistosome-related morbidity and mortality. The consequence of these morbidity patterns are however hardly specified in terms of impact on (i) the physical and socioeconomic development of an affected family/household and on (ii) the economic and social consequences for community development. It follows that impact studies mainly considered individuals as unit of analysis and hardly focused on the family/household-level. Consequently, microeconomic studies were so far not undertaken within the concept of household production models and did not distinguish between market and non-market productivity. Standardized ranking of measured schistosome-related morbidity combined with perception patterns of disease, signs, symptoms and of additional health and community development issues could lead to new approaches on how epidemiological data on the transmission and morbidity of schistosomiasis could be linked with information on health and development priorities of a community in order to estimate the relative impact of the disease.

Animals↗
PubMed1986

Rural development and primary health care in less developed countries.

The traditional approach has been to regard health activities as a small component of rural development programmes. Under the Primary Health Care approach health is seen as the lever for rural development. But there are tendencies in the implementation of Primary Health Care in less developed countries towards limiting the range of activities to preventive and curative personal health services and of denuding it of its community development orientation. This paper highlights some of the issues that seem to militate against the establishment of Primary Health Care with its full complement of rural development activities. These activities together with the preventive and curative personal health services undertaken in the framework of community development promise to lead to the achievement of the hitherto elusive goal of improving the socioeconomic and health status of the rural population of less developed countries.

Allied Health Personnel↗
PubMed1989

Community organization and development for health promotion within an urban black community: a conceptual model.

The community organization and development process is not new and has its roots in social action ideology from the 1960s. The difference between the 1960s and the 1990s is in bringing together of target community consumers with representatives of private and public sector resources (with consumers in the majority), to form a community coalition board. This community coalition board must make policy decisions. Combining these community organizers and development techniques with the mission of health promotion is a viable methodology for addressing the needs of medically underserved and unserved communities. The approach is a multifactorial one, as illustrated in Figure 1. The Health Promotion Resource Center at Morehouse School of Medicine seeks to combine the ideology of community organization and development with culturally sensitive and linguistically appropriate health promotion curriculum materials and intervention strategies. Within the HPRC lies the Statewide Coordinating Center for Georgia which has been funded by the Henry J. Kaiser Family Foundation. Its mandate is to assist minority and poor communities in Georgia in developing community-based health promotion initiatives which address the areas of cancer, cardiovascular disease, adolescent pregnancy, substance abuse, and violence and unintentional injury. Our strategy in carrying out this mandate is the community organization and development model described in this article.

Black or African American↗