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PubMed1994

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↗
PubMed1985

Myths and misconceptions in primary health care: lessons from experience.

Primary health care (PHC) is neither new nor cheap. It is a step forward in the consistent commitment of the public health movement over the past century and a half to seek out and redress the wrongs of society, paying particular attention to those most in need. PHC is not 2nd class medicine; it is not simpler but rather more complex. Selective PHC and primary medical care are significant parts of PHC but not the whole. PHC is essentially a combination of task-oriented basic health services and process-oriented community development. The former is a community-desired service, the latter less so. Community participation and community self-help in health care is more productive if based on an informed community, rather than otherwise, and is open to abuse. Health education and health legislation are the trusted tools of health advancement. Medical schools and other institutions of higher learning have a significant, if not vital, role to play in research education, evaluation, and services. They also have a coordinating role to promote PHC team effort. The selection and preparation of voluntary health workers and paid auxiliaries is at least as difficult as that for professional health workers. The preparation of their teachers is a sadly neglected aspect, without which there is little hope of any major progress in improving the image of PHC. Traditional practitioners could and should have an important role in promoting modern PHC since it is simply an update of their traditional role. Data and information systems require revision to meet the needs of local communities rather than those of central intelligence.

Community Participation↗
PubMed1999

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↗
PubMedDate not supplied

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↗
PubMed1995

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↗
PubMed1990

[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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMed1994

Public managed care: developing comprehensive community support systems in Massachusetts.

Massachusetts has harnessed taxpayer dissatisfaction with government to support change. Restructuring has permitted the Department of Mental Health to shift resources from state hospitals to comprehensive community support systems, the foundation for the Department's public managed care initiative. A commitment to psychosocial rehabilitation principles and consumer choice have produced radical change in the delivery and composition of mental health care services. While quality and utilization management programs provide the infrastructure to ensure accountability, quality, and cost effectiveness, education and the building of partnerships support planning and promote progress.

Community Mental Health Services↗
PubMed1999

Reach out to community to develop culturally sensitive patient care.

Are you meeting the needs of your minority Medicaid members? Cultural competency is becoming an issue in managed Medicaid as minority populations grow, and states require plans to meet the needs of non-English-speaking members. But researchers find that plans don't offer much help to providers. Get some expert advice on how you can better meet the needs of a multicultural population.

California↗
PubMed1991

The development of community mental health centres in the U.K.

This paper describes a survey of British Community Mental Health Centres (CMHCs). CMHCs are by far the most visible manifestation of the implementation of community mental health care policies of the 1980s. While these centres have demonstrated achievements in terms of accessibility, co-ordination and responsiveness to clients, they have also been bedevilled by ambiguity. The vast majority of CMHCs aim to serve the needs of all forms of mental illness within their catchment area, yet in practice, they have frequently failed to meet the needs of people with long term severe disorders and concentrate instead on providing assessment and counseling services for neurotic and transient situational disorders. It appears that this is a function of an early failure of multidisciplinary teams to delineate boundaries and priorities. If the British CMHC movement sharpens its focus and combines this with a determination to address the complexities involved in both rationing and enhancing choice, it could begin to improve upon rather than simply repeat the history of similar developments in America.

Community Mental Health Services↗