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PubMed2001

[The community pharmacist and the problem of excessive drinkers].

On a daily basis, the community pharmacist is just as concerned with alcohol (when detecting the interactions between alcohol and medication, or the use of alcohol as an excipient or active ingredient), as with alcoholism (when filling prescriptions, providing advice and guidance to patients, or undertaking other health education actions). In order to define the pharmacist's perception of the problem of alcoholism, an opinion poll was conducted by direct interrogation using a standardised questionnaire. The poll surveyed the owners of 101 randomly selected pharmacies in Puy de Dome. All of the pharmacists questioned are sensitive to and aware of the problem of interactions resulting from mixing alcohol and medication at the time of filling prescriptions. On the other hand, their perception of alcoholism and their behavior towards alcoholic patients vary. They frequently stressed the difficulty of establishing a dialogue. In spite of receiving information and training on alcoholism, perceived as insufficient, pharmacists claim to be really concerned by this problem. As field workers, community pharmacists think that they have a major role to play in carrying out health education campaigns and alcoholism prevention. In fact, the pharmacy is a privileged setting for facilitating encounters and discussions, where alcoholism, like all public health problems, can be addressed.

Adult↗

PubMed1997

The contribution of interagency collaboration to the promotion of young people's sexual health.

This paper employs a case study approach in order to examine the contribution of interagency working to the delivery of education and services in the difficult field of young people's sexual health. It reports on a collaborative UK initiative involving teachers, community health practitioners, health promotion staff, and youth and community workers. The provision included school-based sex education, drop-in advice and information facilities, 'detached' street work, and a young person's clinic. A qualitative study was completed involving detailed interviews with 25 staff from the different agencies involved. The findings suggest that interagency collaboration can enhance the work of each organization, and can achieve a comprehensive response to young people's sexual health needs by making positive use of the distinctive roles, skills, knowledge and approaches of the different agencies. The potential that such a collaboration will have a significant impact on young people's sexual health is discussed.

Adolescent↗

PubMed1981

Problems facing aboriginal health workers in a community health service.

The length of service and reason for resignation of Aboriginal health workers recruited from 1976 to 1978 are discussed. Resignation rates in the first and second years of employment were 46% and 22.4%, respectively. Resignation was often the final outcome of intolerable personal conflicts with family, community and workmates, compounded by confusion and diversity of opinion over job roles.

Australia↗

PubMed2001

Increasing research capacity and changing the culture of primary care towards reflective inquiring practice: the experience of the West London Research Network (WeLReN).

A number of primary care research networks were set up throughout England in 1998 in order to (1) improve the quality of primary care research (2) increase the research capacity of primary care, and (3) change the culture of primary care towards reflective inquiring practice (NHSE, 2000b). It is not clear how best to operate a network to achieve these diverse aims. This paper describes the first 30 months of a network that adopted a whole system approach in the belief that this would offer the best chance of simultaneously achieving the three aims. A cycle of activity was designed to facilitate the formation of multidisciplinary coalitions of interest for research with complementary 'top down' and 'bottom up' programmes of work co-existing. At least 330 people participated in the generation of research questions of whom one third (33%) were general practitioners, 16% community nurses, 6% practice managers and other primary care practitioners. Over two fifths (43%) were 'key allies'--academics, health authority staff, community workers and project workers. One fifth (110) of all practices (500) in the WeLReN area have collaborated in at least one research project. The ratio of doctor:nurse participation in the 24 research project teams was markedly different in the supported coalitions (2:1) compared to projects devised and led by more experienced researchers (6:1). The evidence suggests that it is possible to operate a primary care research network in a way that develops coalitions of interest from different parts of the health care system as well as both 'top down' and 'bottom up' led projects. It is too early to tell if the approach will be able to achieve its aims in the long-term but the activity data are encouraging. There is a need for more research on the theoretical basis of network operation.

Community Networks↗

PubMed1996

Rapid HbA1c testing in a community setting.

OBJECTIVE: To determine whether the DCA 2000 analyzer provides valid and reliable HbA1c results when used under field conditions and operated by nonmedical personnel. This study was part of a community diabetes education program, the Native American Diabetes Project, in which HbA1c was measured as an indicator of average glycemic control. RESEARCH DESIGN AND METHODS: Two study samples were taken, the first in the spring of 1994 and the second in the spring of 1995. Seven community members in 1994 and six new community members in 1995 were trained over 2 days, using standard protocol, to operate the DCA 2000 HbA1c analyzer and to collect two capillary blood samples from participants in the Native American Diabetes Project. Duplicate DCA 2000 HbA1c measurements performed by the community workers were compared with measurements from a high-performance liquid chromatography (HPLC) system. Validity and reliability measures were calculated. RESULTS: Of the participants, 43 were studied in 1994 and 14 in 1995. Comparison of the mean DCA 2000 results with those of HPLC showed high validity, with the absolute relative difference between the mean DCA 2000 and the external reference of HPLC (magnitude of mean DCA 2000-HPLC magnitude of /HPLC) as 4.0 and 2.0% for 1994 and 1995, respectively. The Pearson correlation coefficients (r) between these two measures were 0.968 and 0.996 for 1994 and 1995, respectively. While the 1994 data appeared to have less validity for values > 10%, they included only one value with a 60-min warm-up of the DCA analyzer. The 1995 data, all collected after a 60-min warm-up, had good correlation throughout the range of values. The within-run reliability was excellent, with an intraclass correlation coefficient of reliability of 0.959 and 0.975 for paired samples, for 1994 and 1995 respectively. The mean coefficient of variation for these paired measures was 3.0% in 1994 and 2.8% in 1995. Both validity and reliability were improved by changing the warm-up period of the DCA 2000 analyzer from 5 to 60 min. All correlation coefficients were statistically significant (P < 0.0001). CONCLUSIONS: The DCA 2000 gave valid and reliable HbA1c results when operated in a community setting by nonmedical personnel. Extending the warm-up period of the device to 60 min slightly improved the validity and reliability of the test.

Blood Chemical Analysis↗

PubMed2002

Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative.

OBJECTIVE: To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. A total of 256 randomly selected individuals with type 2 diabetes between 35 and 70 years of age, diagnosed with type 2 diabetes after 35 years of age, and accompanied by a family member or friend were included. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Outcomes included indicators of metabolic control (HbA(1c) and fasting blood glucose), diabetes knowledge, and diabetes-related health beliefs. RESULTS: Experimental groups showed significantly lower levels of HbA(1c) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA(1c) of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (>10%). CONCLUSIONS: This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA(1c) levels >10%.

Adult↗

PubMed2001

Health needs assessment and the ecology of care: a research note.

A Health Needs Assessment project was undertaken in 1999 for The Royal New Zealand Plunket Society (Inc.), a voluntary community organisation that provides child and family health promotion to 50,000 new babies each year nationwide. Specially qualified registered nurses, community workers and volunteers deliver the service that includes home visiting as part of universal health care. The aims were to verify and refine criteria for health needs assessment by nurses for the ongoing development of practice. Methods used enabled participatory action by child and family health nurses (Plunket nurses). The context was health promotion for apparently well children and their families as part of the Ministry of Health universal Well-Child Tamariki Ora program. The results included identification of a series of health needs assessment criteria, and direction to further develop practice. As a result of the project, it was possible to incorporate the four major concepts in the 2000 revision of the Plunket Health Record. The challenge for child and family health promotion in New Zealand is to assess health need at a family level with the focus on improving child health outcomes. Nurses who use standard data collection items to assess health needs are also likely to identify subsequent interventions more explicitly. Therefore the main benefit of the project is the potential to improve clinical practice.

Child Health Services↗

PubMed2000

Diagnosis and management of asbestosis.

Asbestos-related illness usually arises at least 10 to 20 years after initial exposure. In many instances, patients may be unaware of the source of exposure. Although community-based exposures are unusual, recent events indicate that both communities and workers may have had significant exposure to asbestos contained within vermiculite. Physicians should obtain a medical history as outlined above when examining workers or community members who believe they have been significantly exposed to vermiculite. In addition, pulmonary function testing and chest radiographs should be obtained. If these are normal and there is no ongoing exposure, it is likely that no further evaluation is required. Physicians should have a radiologist familiar with occupational lung diseases read films. Patients may ask that a "B" reader, a physician who is certified by the National Institute for Occupational Safety and Health to read x-rays for changes related to the pneumoconioses, review their films. Facilitating smoking cessation and providing routine immunizations are important secondary preventive measures. Workers exposed to asbestos should receive ongoing screening as specified by the Occupational Safety and Health Administration. Over the last several decades, numerous epidemiologic studies have evaluated the efficacy of lung cancer screening. Period chest radiographs and sputum cytology have not been shown to increase lung cancer survival rates. Recent studies have demonstrated the potential benefit of scanning in the early detection of lung cancer. Although encouraging, these studies do not yet support the use of imaging for the routine screening of high-risk populations as required by the Occupational Safety and Health Administration.

Asbestosis↗

PubMed1988

Growth monitoring--inappropriate promotion of an appropriate technology.

Growth monitoring has been identified as an important component of the 'Child Survival and Development Revolution'--an initiative advocated by UNICEF and supported by several other development agencies. In this initiative, improvements in the survival of children are attained through the widespread promotion, distribution and utilisation of selected health maintaining technologies by family members. Health workers, community institutions and welfare services help the family by providing encouragement, support and assistance. Growth monitoring has been identified as one of the key technologies--not only because it helps to promote the satisfactory nutrition of children, but also because it provides an opportunity for uniting other low-cost child health interventions. This paper re-examines the importance of widespread growth monitoring as a part of child care in developing countries. In the early sections, reasons for monitoring the growth of children are examined and the role of growth monitoring in primary health care is considered. The rationale for including growth monitoring in the child survival revolution is explored and the potential benefits of growth monitoring are reviewed. The authors then examine the results that have been achieved, to date, in a variety of programmes where child growth is being monitored. They conclude with a re-assessment of the importance of growth monitoring in child care. If the widespread promotion of growth monitoring is being considered as a means to improve the health of a community's children, three key questions must be answered. What are the risks associated with growth faltering or weight loss? To what extent can different health, educational or welfare interventions reduce these risks?(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1991

A comparison of efficacy of the key informant and community survey methods in the identification of childhood disability in Jamaica.

A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of childhood disability. Approximately 130 key informants were exposed to a 2-day workshop giving information on signs of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded 6 months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen in the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability.

Child↗

PubMed1996

Lung (agricultural/rural).

Industrialization of farming, animal raising, and forestry has added chemical and mechanical hazards that need to be recognized and prevented. Lung disease among farmworkers can result from a wide variety of hazardous exposures, which include organic dusts, allergens, chemicals, toxic gases, and infectious agents. In addition to nonspecific symptoms of mucous membrane irritation, farmworkers can experience occupational asthma or bronchitis, organic dust toxic syndrome, hypersensitivity pneumonitis, silo filler's disease (toxic hemorrhagic pulmonary edema), and neuromuscular respiratory failure. At risk are farmworkers and those involved in the processing, stocking, transportation, handling, and inspection of unprocessed agricultural, animal, and forestry products; veterinarians; gardeners; game, river, and forest keepers; persons involved in building, supplying, or servicing farm operations; and residents of rural communities. Worker education on the risks of environmental exposures, adherence to safety regulations, and increased knowledge of the cause and prevention of environmental diseases will reduce their prevalence and their adverse human and animal health and socioeconomic effects.

Agriculture↗

PubMedDate not supplied

[Changes in the hiring of health personnel: the family health program in Brazil].

This article analyzes the procedures involved in the hiring of health personnel in the Family Program in Brazil. We examine the values, problems and relative outcomes of each of the processes used in hiring doctors, nurses and health community workers. Before analyzing hiring procedures, the author briefly describes the importance and role of the Family Health Program of the Brazilian health care system. Based on these factors, this article aims to demonstrate the characteristics and effects of this key program, considered a pivotal reform in the Brazilian health system, on the development of human resources.Finally, after presenting and analyzing the data available on the hiring models and the various salaries of physicians and nurses in several Brazilian states and municipalities, the author highlights the new social context in which the government, at different levels, flouts the labor regulations, which are their responsibility to enforce. This fact alone reinforces the hypothesis that a new phase of reforms has already begun.

Brazil↗

PubMed2000

The female condom and STDs: design of a community intervention trial.

OBJECTIVES: The main purpose of this study is to compare sexually transmitted disease (STD) prevalence in cohorts of women with and without access to female condoms. METHODS: Six matched pairs of communities were identified from Kenya tea, coffee and flower plantations. One community within each pair was randomly selected to receive the female condom intervention. Approximately 160 eligible women were enrolled at each site. Female condom communities underwent an education program on use of female and male condoms and STDs, comprising group meetings, puppetry and other folk media, and training of clinic service providers and community outreach workers. Control communities received similar information on use of male condoms (freely available at all sites). At baseline, participants were tested for cervical gonorrhea and chlamydia and vaginal trichomoniasis, to be repeated at 6 and 12 months. The study has 80% power to detect a 10% prevalence difference, assuming an aggregate STD prevalence of 20% with 25% loss to follow-up and intracluster correlation of 0.03. RESULTS: Among 1929 women at baseline, the mean age was 33.1 years; 78% had never used a male condom. The prevalences of gonorrhea, chlamydia and trichomoniasis were 2.6%, 3. 2% and 20.4%, respectively (23.9% overall). The intracluster correlation based on these data was near zero. CONCLUSIONS: Comparable pairs of study sites have been selected. STD prevalence is sufficiently high, and the variation between sites is acceptably low. The study is feasible as designed.

Adolescent↗

PubMed2004

Tuberculosis as a major global health problem in the 21st century: a WHO perspective.

The World Health Organization, the Global Partnership to Stop TB, and the Millenium Development Project have all adopted the following 2005 targets for tuberculosis control: to detect at least 70% of all estimated sputum smear-positive cases and to treat successfully at least 85% of them. Although implementation of the DOTS strategy is the foundation for proper tuberculosis control, basic DOTS implementation may not be enough to reach these targets. Instead, evidence from several countries indicates that, although cure rates are approaching the global target, the case detection target may not be met, even with 100% DOTS implementation in designated public facilities. Thus, tuberculosis control must be critically examined to foster higher performance. In the context of an expanded framework for tuberculosis control, we present four strategic interventions through which cure and case detection rates may be significantly improved: (1) wider involvement of community workers, (2) engagement of private practitioners, (3) proper management of drug-resistant tuberculosis, and (4) efforts focused on controlling tuberculosis and human immunodeficiency virus. We conclude that, although country-based estimates need further refinement to ascertain the impact of each intervention, a fundamental shift in the approach to tuberculosis control is required if the global targets are to be reached rapidly.

Journal Article↗

PubMed2005

Weight management in primary care: how can it be made more effective?

Obesity is often difficult to tackle in primary care. Pressure of time in the consultation, a lack of appropriately-trained primary care staff, a shortage of community dietitians or nutritionists, the potentially enormous caseload, language or cultural barriers and the sheer intractability of patients' eating habits, exercise behaviour and their clinical condition, all conspire to make general practitioners, other team members and often the patients themselves lose heart and stop even trying. However, there are ways of overcoming these difficulties. Examples of changes that evidence suggests are able to support and enhance basic one-to-one interventions in general practice include: improved clinical guidelines; better training of primary care staff; at-risk patient registers; smarter database search tools; new quality incentives; closer working with dietitians, counsellors and pharmacists; more hospital outreach clinics; designated general practitioner specialists and practice clustering; expanded exercise referral schemes and links with leisure providers; subsidised referral to commercial slimming groups; better use of patient groups and voluntary and community workers. The present paper describes a proposed 'triple-tier' pathway for weight management incorporating most of the elements mentioned earlier. With a more joined-up and creative approach to the development and organisation of primary care, more comprehensive training and workforce planning, and better integration with social care, voluntary groups and the commercial sector, weight management in general practice has the potential to be much more effective.

Combined Modality Therapy↗

PubMedDate not supplied

Young women's health concerns: revealing paradox.

Because of the numerous physical, psychological, and social changes that take place for adolescents, the risk of engaging in life-threatening behavior is greater than at any other time in their life-span. Community workers identified the invisibility of adolescent women (ages 16-24) in their health-related programs and sought to rectify this. To discover the unmet health concerns of adolescent women, eight focus groups were held with a diverse group of adolescent women. Forty-two adolescent women, including adolescent mothers, women of color, attendees at a drop-in youth center, high school and university students, and employed persons participated. While most women attended one focus group, some participants attended two. Using Spradley's ethnographic method, we identified two overarching themes shared by the adolescent women. These themes included feeling invisible and struggling with independence. Our findings underscore the invisibility of adolescent women's lived experiences and concerns within most research agendas.

Adolescent↗

PubMed2006

Sources of AIDS awareness among women in India.

Sources of AIDS awareness among rural and urban Indian women were analysed using data from the National Family and Health Survey (1998-2000). Two measures were developed to study the impact each source had on knowledge. 'Effectiveness' was defined as the proportion of women who had heard of AIDS from only one source, from among women who had heard of AIDS from that particular source and other sources. 'Independent effect' was the proportion who had heard of AIDS from only one source in relation to all women who had heard of AIDS. Television was the most effective medium, and also had the highest independent effect. Radio and print had very low effectiveness and independent effect. Although television and print audiences are growing in India, it is likely a sub-group of women will continue to lack media access. There is an urgent need to disseminate AIDS awareness to this 'media underclass'. Since the media will not reach this group, other sources including health workers, community level activities such as adult education programmes, and networks of friends and relatives need to be explored.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Attitudes to sex and sexual behaviour in rural Matabeleland, Zimbabwe.

Though HIV prevention campaigns in Zimbabwe have increased public awareness of HIV, they have not meaningfully changed sexual behaviour. Possibly these campaigns are based on wrong assumptions about sexual behaviour. By means of 111 structured interviews with hospital patients, secondary school students and teachers, and 11 focus group discussions with traditional healers, midwives, village community workers, secondary school students and teachers, and commercial sex workers in a rural district of Matabeleland in Zimbabwe, this low-budget study explores attitudes towards sex and sexual behaviour in order to define more appropriate health education messages. Results indicate that traditional sex education no longer takes place and that communication between sexual partners is limited. The almost ubiquitous expectation of women to get rewards for sex outside marriage motivates mostly single women out of economic necessity to meet the male demand for sexual partners, which is created by large scale migrant labour and men's professed 'biological' need for multiple partners. Types of sexual behaviour other than penetrative vaginal sex are uncommon and considered deviant. Safe sex messages from the West therefore are inappropriate in the Zimbabwean context. Recommendations are given to restore traditional communication about sexual matters across generations and to urge sexual partners to discuss sex. Women who, for economic reasons, engage in casual sex should at least learn to negotiate the use of condoms. Men seriously need to reconsider their attitudes to sex and sexual practices in view of the high HIV sero-prevalence. Faithfulness, rather than multiple sexual contacts, should become a reason to boast.

Adolescent↗