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A simplified guide to practising community-based/community development initiatives.

The Simplified Guide to Practising Community-Based/Community Development Initiatives is tool for professionals who are beginning to embrace the principles of community development and empowerment into their philosophy of practice. The tool can be used to prepare for the initiative, to assist with the process, or afterwards to evaluate and formulate recommendations. The role of the professional is highlighted. One retrospective descriptive case analysis is presented to demonstrate the tool as an evaluation technique and to demonstrate the role of the practitioner in community development.

Community Health Nursing↗

Looking out for family caregivers.

Nurses are regularly advised to become involved in community development initiatives, but what exactly does this entail and what are the precautions that should be considered? A 10-week, government sponsored, community-development program for family caregivers allowed nurses to offer education and support to six under-serviced areas of B.C. They offer a critique of the program and recommendations for the future.

Caregivers↗

Health educaton in developing countries.

Health education is of great relevance in developing communities as it is a means of improving the health level which is an integral part of the overall socioeconomic development. It must be undertaken in conjunction with health services which should involve consumer participation at an early stage. Its focus is on changing behavior in respect to healthful living both at the individual and community levels. Health education subjects in developing communities include maternal and child health (MCH), nutrition, family planning and infectious diseases. Every member in the health team must be a health educator. Personal methods, especially when used by indigenous community health workers, are best suited to induce health behavior change in developing communities. Mass media as a rule is less suited for this, although radio can inform large segments of the population.

Adult↗

Potential development of community oriented HIV outreach among drug injectors in the UK.

Given the current epidemiological and behavioural risk profile of HIV infection among injecting drug users in the UK, the main strategic task continues to be to develop interventions to prevent the spread of HIV infection. Outreach to drug injectors is an important part of the wider UK HIV prevention strategy. This paper reviews critically and reassesses practically the role of outreach interventions among drug injectors in the UK. It is argued that despite the development of innovative outreach activity, the full potential of outreach has not been realized due to its theoretical orientation and in-built structural limitations. Outreach has predominantly operated with an 'individual' orientation, aiming to work with individual clients to help them to change their behaviour, gain access to services, or to become better users of services. The main thesis of this paper is that current outreach provision needs to be complemented by 'community change' models which seek to engender changes in the social etiquette of drug use within communities of drug injectors. The paper argues that the social networks through which HIV may be transmitted are the same social networks that may be coopted for HIV prevention. Future outreach services must turn to these networks as a way of targeting and encouraging changes among broad populations of drug injectors. Such models might use indigenous advocates, working within social networks, supported by community outreach facilitators.

Community Health Services↗

Faculty development for community-based physicians at the University of Massachusetts and SUNY-Buffalo.

Community-based faculty development (CBFD) is becoming increasingly important as medical education moves into the ambulatory/office-based setting CBFD provides preceptors with essential knowledge, skills, and attitudes directly related to teaching while providing a sense of identity as teachers to a diverse group of practitioners in a variety of settings. This article reviews the structure and function of successful community-based faculty development, using as examples programs from the University of Massachusetts Medical School and the State University of New York at Buffalo that were supported by The Robert Wood Johnson Foundation's Generalist Physician Initiative. After reviewing the literature on successful implementation of programs dedicated to community-based precepting, the authors investigate the educational concepts, instructional designs, and operational characteristics that are the framework for providing successful faculty development to community-based preceptors. They list rationales and examples of the educational methods used and compare structural components of the programs at both institutions. Last, they explore future directions in the rapidly changing medical education environment that need to be addressed in CBFD in the areas of outcome/program evaluation, comprehensive needs assessment, and regionalization.

Education, Medical, Undergraduate↗

Castleman's disease in children: the experience of a children's hospital in Africa.

As the incidence of childhood Castleman's disease (CD) is reported to be rare in Western communities, the recent occurrence of three cases in non-HIV infected prepubertal children stimulated a 10-year (1983-1993) retrospective investigation into the conditions at a children's hospital that serves a predominantly developing community. Retrospective histologic examination revealed six cases of CD among children 3-11 years of age and another five probable cases having histological features of CD without adequate clinical and laboratory data. Three CD cases were associated with malignancy (Kaposi's sarcoma in two and a gastric B cell lymphoma in the other). Two CD cases were plasma cell type, one hyaline vascular, and three intermediate. One child with recurrent plasma cell-type features in a groin node had a Kaposi's sarcoma in the thigh. The five probable cases of CD all had intermediate histological features. Four of the 11 cases being reported came from a geographic locality that provides about 3% of the laboratory's case material and these included both cases that developed Kaposi's sarcoma. All patients who developed malignancy had the plasma cell variant. As all cases have been identified in developing communities, where the disease may often be misdiagnosed as nonspecific reactive lymphadenopathy, and there is an evident association with malignancy, it is recommended that children in these areas with the plasma cell variant of CD be closely monitored for subsequent malignancy.

Castleman Disease↗

Socio-economic aspects of animal diseases in southern Africa: research priorities in veterinary science.

During May 1995, members of organisations with a vested interest in the socio-economic aspects of animal diseases in southern Africa met for a one-day workshop. This was the first activity of a proposed three-year Forum and programme in this area under discussion. The workshop was sponsored by the Foundation for Research Development, the Agricultural Research Council and the University of Pretoria. The individuals who attended were representatives of academic and government institutions and included veterinarians, veterinary scientists, animal health officers, administrators from the region and abroad, economists, sociologists and animal welfare experts. The aims of the workshop were fourfold: 1. to define what is meant by socio-economic aspects of animal diseases in southern Africa; 2. to identify the socio-economic factors which influence occurrence and consequences of animal diseases; 3. to learn of methods which are used to assess socio-economic needs, and 4. to initiate an ongoing network and research programme in this area. Two key questions were considered and discussed by the participants, and a consensus reached for each. The first question considered the link between community development and socio-economic aspects of animal diseases. This included the role of production animals, companion animals and game in developing communities and factors influencing these roles, as well as constraints to this development. The second question concerned the gaps in our understanding of the socio-economic aspects of animal diseases in southern Africa which would lead to research opportunities. Six areas identified were were the collection of disease information, education and communication, policy, economics, community needs and technology.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa, Southern↗

[Use of public health statistics in the development of community diagnosis].

A community diagnosis which describes the health of the local population may be an important instrument in promoting health and preventing disease. Most general practitioners do not have time to carry out individual surveys in the local community. Therefore it seems relevant to look into the possibility of utilizing official health statistics as a basis for community diagnosis. We obtained and analysed demographic data, mortality data, statistics on cancer, data on causes of invalidity and risk factors for cardiovascular diseases for Askvoll municipality. This article demonstrates possibilities, obstacles and constraints in the use of such statistics. Suppliers of register data should make routine health statistics more available for use in the district health services. In this connection we recommend the development of a central health data information system.

Community Health Services↗

Crime is a public health problem.

Crime is a public health issue. It shares common causes with ill health, particularly poverty, and fear of violent crime is itself a major cause of anxiety. Community development in pre-school education, parental education, and among ethnic minorities, both reduces crime and promotes better health, for example in reducing the effects of alcohol and illicit drugs. Health workers should contribute in full to community development.

Adolescent↗

Medicare reimbursement for home infusion therapy: a contributor to the development of community acquired vancomycin-resistant enterococci?

Vancomycin is a bacteriocidal antibiotic widely used to treat gram-positive infections, including methicillin-resistant Staphylococcus aureus. During the past 5 years, there have been increasingly frequent reports of infections caused by enterococci species resistant to vancomycin. Until recently, this was a phenomenon limited almost exclusively to the hospital. Presently, there are reports of vancomycin-resistant enterococci developing in the outpatient and home care population. The intent of this article is to present one possible explanation for this trend in the hope that further research will be stimulated.

Community-Acquired Infections↗