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PubMed1990

Staying well. Factors contributing to successful community adaptation.

1. Friends were rated as the most important factor in assisting former psychiatric patients to avoid rehospitalization. 2. When respondents were asked to comment on rehospitalization in their own words, the most frequent responses dealt with factors related to keeping active, developing a healthy lifestyle and positive self-image, and accepting their illness. 3. Self-help groups, community health workers, and community nurses were rated as the least beneficial in preventing rehospitalization.

Adaptation, Psychological↗
PubMedDate not supplied

[Changes in vitamin A intake following the social marketing of red palm oil among children and women in Burkina Faso].

This paper focuses on changes in vitamin A (VA) intakes as part of the evaluation of a pilot project on social marketing of red palm oil (RPO) as a VA supplement for mothers and children in central-north Burkina Faso. The objectives of the 30-month project are to demonstrate the feasibility and effectiveness of introducing RPO in non-consuming areas. RPO is collected from women in the South-West region and it is sold in project sites by village volunteers. RPO is promoted by community workers trained in persuasive communication and social marketing. The target population is free to buy and consume RPO. Evaluation design includes data collected at onset, then 12 and 24 months later, from the same sample of 210 mothers and their children randomly selected in seven project sites. Children were 1 to 3 years old at onset. Blood samples were collected at baseline from mothers and children for serum retinol determination by HPLC. VA intakes are estimated by a semi-quantitative food frequency questionnaire, using the conventional beta-carotene to retinol conversion factors and the newly revised lower factors. VA deficiency is a major public health problem in the area: 64% of mothers and 85% of children had serum retinol concentrations < 0,70 mumol/l at baseline. VA came mainly from plant foods, particularly fruits and dark green vegetables which provided more than 90% of the dietary VA at onset of the project. Mean vitamin A intakes are low. We found 138 106 mug ER for the children and 302 +/- 235 microg ER for the mothers with conventional factors and 64 +/- 58 microg ER and 133 +/- 162 microg ER, respectively, with the revised factors. One year later, one third of respondents had consumed RPO in the previous week, and it supplied around 56% of the VA intake of children and 67% of mothers (36% and 46% respectively for the whole group). VA intakes were significantly increased at 510 +/- 493 microg ER and 801 +/- 913 microg ER for the children and their mothers respectively (347 +/- 443 microg ER and 568 +/- 803 microg ER respectively, with the revised factors). Analyzing serum retinol and dietary data collected at baseline, it was found that VA intakes < 62,5% of safe level of intake were highly sensitive to low serum retinol (< 0,70 micromol/l) and using revised conversion factors to assess total VA intake slightly enhanced sensitivity. The proportion of mothers and children at risk of inadequate VA intake changed from nearly 100% at baseline to 60% one year later. The results show that promoting RPO (and other VA rich foods) was effective in improving VA intakes. This improvement will hopefully be sustained and even further enhanced during the remaining 12 months of the project, after which repeated measurement of serum retinol and VA intakes will allow the actual impact of the project to be truly assessed.

Adult↗
PubMed1988

Regional Law No. 40, 2 November 1988.

This Italian Law is designed to aid repatriated emigrants from Marche, foreign non-European Community workers, and their families. It provides subsidies for the initiation of economic activities and for residential lodging. It also makes provision for the children of emigrants to reside in Marche and for activities to maintain and protect the cultural identity of emigrants and immigrants.

Culture↗
PubMed1999

Drug therapy in HIV infection--fourth international congress. 8-12 November 1998, Glasgow, Scotland.

This meeting was one of a series which is held in Glasgow on a biannual basis. The major themes of the conference were the use of combination therapy to reduce viral replication in HIV infected individuals and the successes and failures of various treatment regimens; the issue of viral sequestration in sanctuary sites over long periods in the context of non-susceptibility to antiviral therapy due to viral latency and other considerations; drug resistance to antiviral therapy and how to prevent this problem from occurring; immune-based therapeutic approaches in the treatment of HIV disease; and, the development of treatment strategies for individuals who have failed on their initial antiviral regimens. The majority of delegates at this conference were HIV clinicians involved in direct patient contact. The meeting also included the participation of HIV community workers, representatives of the pharmaceutical industry, as well as research scientists concerned with basic mechanisms of HIV pathogenesis, drug resistance and other issues. Most of the presentations were from academic physicians involved in a variety of HIV clinical trials, although pharmaceutical scientists, who specialize in the development of techniques to monitor drug resistance, also featured prominently in the program. Both oral papers and poster sessions were featured.

Journal Article↗
PubMed1981

[Educational activity and psychosocial prevention : a model of intervention.].

The authors describe the socio-economic conditions of the retired in 1980 (poverty, poor health, lack of adequate services, etc.) and explain how these conditions are related to capitalist social organization. Their analysis leads them to set down the principal goal of the community workers in regard to the elderly population as follows : contribute to the organization and to the development of conditions favorable to the mobilization of the retired and elderly workers who, as a group, have the greatest potential for changing their conditions. To attain this long-term objective, the pre-retirement clientele possess the most favorable potential, and this is why the retirement preparation intervention is defined in an educationel orientation of psycho-social prevention. Seconding to the authors, the apprenticeships showed permit the elderly to assume both personal and collective control - thereby making it possible to transform the existing conditions.

English Abstract↗
PubMedDate not supplied

Health Management Information System in Leprosy Control Programme.

Health Management Information System was introduced methodically and enforced with ruthless punctuality in Maharashtra State from April 1981. It has paid excellent dividends so far as the implementation of the National Leprosy Control Programme is concerned. Key indicators have been fixed for new case detection, bacteriological examination, regularity of treatment and screening of old patients for activity status. Monitoring of these activities is done regularly and a feed back is provided. Marks are assigned for each kidney indicator and ranking is done based on the achievement of targets by each district, Municipal Corporation, Health Circle etc., every month. The same procedure is adopted at Primary Health Centre and even lower level. This has introduced a spirit of competition and generated a desire to better one's own performance by identifying and removing deficiencies. Maximum assistance is being derived from the Primary Health Care and use is being made of Multi Purpose Workers, Community Health Volunteers and other anciliary agencies in case finding and case holding programmes. The improvement in performance in respect of all key indicators during 1981-82 has been between 40 and 60 percent over the performance during 1980-81.

Bacteriological Techniques↗
PubMed1982

Domestic care dependency in the aged: a total community survey in Israel.

Two hundred and sixty elderly residents of 10 rural Israeli communities were screened for the presence of a variety of domestic disabilities using the Domestic Care Dependency Index. The Index measures ability to function without help in shopping, cooking, laundering, housekeeping, reaching a source of primary medical care and identifying doctor-prescribed medication. Sixty-four per cent of the population screened showed dependency in at least one category. Dependency increased with age and was much more common in men (94.7 per cent) than women (33.3 per cent). We emphasize the importance of identifying domestic needs in the elderly, both real and potential, so that family members or community workers can provide help where it is needed and the necessity for prolonged professional or institutional care can be avoided or postponed.

Activities of Daily Living↗
PubMed1994

Validity of the ten questions screened for childhood disability: results from population-based studies in Bangladesh, Jamaica, and Pakistan.

An international study to validate the Ten Questions screen for serious childhood disability was undertaken in communities in Bangladesh, Jamaica, and Pakistan, where community workers screened more than 22,000 children ages 2-9 years. All children who screened positive, as well as random samples of those who screened negative, were referred for clinical evaluations. Applying comparable diagnostic criteria, the sensitivity of the screen for serious cognitive, motor, and seizure disabilities is acceptable (80-100%) in all three populations, whereas the positive predictive values range from 3 to 15%. These results confirm the usefulness of the Ten Questions as a low-cost and rapid screen for these disabilities, although not for vision and hearing disabilities, in populations where few affected children have previously been identified and treated. They also show that the value of the Ten Questions for identifying disability in underserved populations is limited to that of a screen; more thorough evaluations of children screened positive are necessary to distinguish true- from false-positive results and to identify the nature of the disability if present.

Bangladesh↗
PubMedDate not supplied

[The dilemma of the midwife--Part 2].

The author outlines the similarities and dissimilarities between nursing and midwifery and comes to the conclusion that the method of training midwives as part of the general nursing curriculum has advantages and disadvantages; advantages such as time, cost and manpower savings; disadvantages such as integrated course content, and lack of sufficient practical experience before graduating. Simulations can help with the latter, but do not provide sufficient skills to handle real situations. The author proposes post-basic midwifery internship; improved training; and broadening the functions of the midwife to include training and supervision of voluntary community workers and traditional birth attendants.

Clinical Competence↗
PubMed1993

Evaluating the best interests of the child--a model of multidisciplinary teamwork.

This article describes the rationale, goals and procedure of a working model of multidisciplinary teamwork in conducting clinical evaluations of children and families and preparing expert testimony. Over the past five years, the team has evaluated over 60 cases involving child abuse and neglect, and questions of parental ability. Teamwork can reduce the distorting effects of personal biases, beliefs and countertransference issues. The contribution of integrating different theoretical viewpoints (theories of development, object relations, family systems, etc) is discussed. Recommendations include: (a) separation of roles of expert witness and therapist: (b) utilization of different diagnostic tools (psychodiagnostic tests, observations of interaction, joint clinical interviews, etc); (c) value of examining the feasibility of the recommendations with parents, care givers and community workers; and (d) strategies of dispute resolution and attainment of parental consent, utilizing the effects of potential judicial power and focusing on the best interests of the child.

Child↗
PubMed1993

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 1: Screening.

This paper reviews and summarises the requirements and criteria for the screening of childhood disabilities. It reviews recent advances in research carried out in Jamaica and outlines available techniques for the screening of cognitive, motor, speech, hearing and visual disabilities and fits. The availability of validated, simple, low-cost techniques that can be used by community workers facilitates the conduct of surveys for the planning of programmes and the identification of cases for rehabilitation.

Child, Preschool↗
PubMedDate not supplied

Perinatal care in Pakistan: a situational analysis.

Pakistan, one of the most populous countries in the world, has an estimated perinatal mortality rate of 60 to 90 per thousand births, of which almost half are stillbirths. Although infant mortality rates have declined in recent years, nearly 60% of all deaths occur in the neonatal period and have shown comparatively little change over several decades. This is attributed mainly to inadequate attention to programs of maternal and newborn care. The recently implemented Social Action and Health Care Programs of the Government of Pakistan promises to provide domiciliary maternal and newborn care services through the use of trained birth attendants and community workers. The primary health care services network is also being revamped in an effort to improve timely recognition of high-risk pregnancies and to facilitate prompt referral. The importance of the newborn period is also being emphasized in pediatric undergraduate and postgraduate training programs, as well as through continuing medical education. However, the most important long-term solution would be improvement in the educational and social status of women, as well as a greater political support for diversion of limited resources to appropriate primary and secondary health care.

Delivery of Health Care↗
PubMedDate not supplied

Health promotion and early detection of cancer in older adults: assessing knowledge about cancer.

PURPOSE/OBJECTIVES: To identify the knowledge level concerning cancer in older Canadian adults. DESIGN: Descriptive. SETTING: Urban community in Canada. SAMPLE: Convenience sample of 513 adults over the age of 55 (72% female; 68% born in countries other than Canada). METHODS: A self-report questionnaire, the Cancer Knowledge Survey for Elders, was administered to participants in their native language (eight different language groups). Distribution was through community workers and public healthy nurses who worked with older adults. MAIN RESEARCH VARIABLES: Knowledge about cancer, language group, length of time living in the country. FINDINGS: The highest number of correct responses (87%) was for the item "Can some cancers be cured if they are discovered early?" The highest number of wrong answers (67%) was for the item "Can a bump or bruise to the body cause cancer?" Sixty-six percent did not consider age as a risk factor. For all but three items, the proportion of English language to non-English language individuals with correct answers was significantly different individuals whose native language was not English were less knowledgeable about cancer. IMPLICATIONS FOR NURSING PRACTICE: This study offers a basis for a large multicultural survey. Should the observations be confirmed in a larger sample, implications exist for public education about the risk factors and signs and symptoms of cancer, especially with individuals for whom English is not a native language. CONCLUSIONS: In this sample, specific areas were identified in which knowledge about cancer was lacking. In particular, the increased risk of cancer with advancing age was not recognized by a significant portion of study participants.

Aged↗
PubMed1998

Recommendations for prevention and control of tuberculosis among foreign-born persons. Report of the Working Group on Tuberculosis among Foreign-Born Persons. Centers for Disease Control and Prevention.

During 1986-1997, the number of tuberculosis (TB) cases among foreign-born persons in the United States increased by 56%, from 4,925 cases (22% of the national total) to 7,702 cases (39% of the national total). As the percentage of reported TB cases among foreign-born persons continues to increase, the elimination of TB in the United States will depend increasingly on the elimination of TB among foreign-born persons. On May 16-17, 1997, CDC convened a working group of state and city TB-control program staff, as well as representatives from CDC's Division of TB Elimination and Division of Quarantine, to outline problems and propose solutions for addressing TB among foreign-born persons. The Working Group on Tuberculosis Among Foreign-Born Persons considered a) epidemiologic profiles of TB cases among foreign-born persons, b) case finding, screening, and preventive therapy for the foreign born, c) TB diagnosis and management for the foreign born, d) opportunities for collaborations with community-based organizations (CBOs) to address TB among the foreign born, and e) TB-related training needs. The Working Group's deliberations and the resulting recommendations for action by federal agencies, state and local TB-control programs, CBOs, and private health-care providers form the basis of this report. For each of the five topics of discussion, the group identified key issues, problems, and constraints and suggested solutions in the form of recommendations, which are detailed in this report. The Working Group made the following recommendations: * The epidemiology of TB among foreign-born populations differs considerably from area to area. To tailor TB-control efforts to local needs, TB-control programs should develop epidemiologic profiles to identify groups of foreign-born persons in their jurisdictions who are at high risk for TB. * The priorities of TB control among the foreign born should be the same as those for control of TB among other U.S. populations - completion of treatment by persons infected with active TB, contact tracing, and screening and provision of preventive therapy for groups at high risk. Screening and preventive therapy should be limited to areas where completion of therapy rates and contact-tracing activities are currently adequate. * Based on local epidemiologic profiles, selective screening should be conducted among populations identified as being at high risk for TB. Screening should target groups of persons who are at the highest risk for TB infection and disease, accessible for screening, and likely to complete preventive therapy. The decision to screen for infection, disease, or both should be based on the person's age and time in the United States, prior screening, and locally available resources for the provision of preventive therapy. * TB-control programs should direct efforts towards identifying impediments to TB diagnosis and care among local foreign-born populations, devising strategies to address these barriers, and maximizing activities to ensure completion of treatment. * Providing TB preventive therapy and other TB-related services for foreign-born persons is often impeded by linguistic, cultural, and health-services barriers. TB-control programs can help overcome these barriers by establishing partnerships with CBOs and by strengthening training and education efforts. Collaborations with health-service CBOs should center on developing more complementary roles, more effective coordination of services, and better use of existing resources for serving the foreign born. TB-related training should be linked to overall TB-control strategies for the foreign born. Training and education should be targeted to providers, patients, and community workers.

Communicable Disease Control↗
PubMedDate not supplied

Evaluation of a community-based outreach worker program for children with asthma.

OBJECTIVE: An asthma outreach worker (AOW) can provide home-based education about asthma management and methods to minimize home environmental asthma triggers. A theory-based AOW program was implemented by a community partnership and its effectiveness was evaluated. DESIGN: Baseline and follow-up surveys were used to evaluate the effectiveness of the AOW. SAMPLE: The convenience sample consisted of 60 caregivers whose children received AOW services. MEASURES: Quality of life, use of asthma management plans, medication use, health care utilization, home environmental behavior changes to reduce triggers, and satisfaction with AOW services were self-reported by caregivers. RESULTS: Caregivers reported significantly higher quality of life at follow-up than at baseline. At follow-up, 93% of the children had asthma management plans as compared with 31% at baseline. Self-reported hospitalizations were significantly reduced. All of the families made changes to minimize household asthma triggers. Caregivers reported high satisfaction with the AOW and 90% of them felt that the home environmental assessment conducted by the AOW helped improve their child's asthma. CONCLUSION: Short-term community-based AOW services for children can be effective in enhancing self-management capabilities, improving the quality of life, increasing the use of asthma management plans, and helping families reduce asthma triggers in the home environment.

Adolescent↗
PubMed1999

The attitudes of community based rehabilitation workers towards people with disabilities in south India.

This study explored the attitudes of south Indian Community Based Rehabilitation (CBR) workers towards people with disabilities. The research presents a demographic profile of the CBR worker, provides a measure of their attitudes towards people with disabilities, and investigates the factors that influence the formation of these attitudes, in particular the role of CBR education programmes. A questionnaire and an attitude measurement instrument, specifically developed for the Indian context, provided descriptive data. Interviews provided background information on south Indian culture and CBR educational programmes. Analysis of the data revealed that CBR workers in south India tend to be young, female and lacking in work experience. They have positive attitudes towards people with disabilities, which are influenced by their amount of education. CBR educational programmes appeared to have little effect on workers' attitudes, perhaps reflecting a lack of educational strategies directed specifically at attitude development.

Adolescent↗
PubMed2006

Collaboration and referral practices of general practitioners and community mental health workers in rural and remote Australia.

OBJECTIVE: To assess an important part of Australia's National Mental Health Strategy by examining the collaboration and referral practices between general practitioners and community mental health workers in rural and remote areas. DESIGN: Semistructured interviews. SETTING: Rural and remote health service region in Australia. PARTICIPANTS: In total, 31 general practitioners and 14 mental health workers. RESULTS: Meaningful collaboration and referral practices between general practitioners and mental health workers are prevented by contradictory and ambiguous definitions involving professional roles and mental health. A pattern of negative collaboration was further magnified by the rural and remote context. CONCLUSION: The implementation of Australia's National Mental Health Strategy faces serious problems in rural and remote area due to the negative collaboration and referral practices between general practitioners and mental health workers.

Attitude of Health Personnel↗
PubMed2005

Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease.

BACKGROUND: Black subjects with a family history of premature coronary heart disease (CHD) have a marked excess risk, yet barriers prevent effective risk reduction. We tested a community-based multiple risk factor intervention (community-based care [CBC]) and compared it with "enhanced" primary care (EPC) to reduce CHD risk in high-risk black families. METHODS AND RESULTS: Black 30- to 59-year-old siblings of a proband with CHD aged <60 years were randomized for care of BP > or =140/90 mm Hg, LDL cholesterol > or =3.37 mmol/L, or current smoking to EPC (n=168) or CBC (n=196) and monitored for 1 year. EPC and CBC were designed to eliminate barriers to care. The CBC group received care by a nurse practitioner and a community health worker in a community setting. The CBC group was 2 times more likely to achieve goal levels of LDL cholesterol and blood pressure compared with the EPC group (95% CI, 1.11 to 4.20 and 1.39 to 3.88, respectively) with adjustment for baseline levels of age, sex, education, and baseline use of medications. The CBC group demonstrated a significant reduction in global CHD risk, whereas no reduction was seen in the EPC group (P<0.0001). CONCLUSIONS: Eliminating known barriers may not be sufficient to reduce CHD risk in primary care settings. An alternative community care model that addresses barriers may be a more effective way to ameliorate CHD risk in high-risk black families.

Adult↗