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PubMed1997

Developing healthy local communities at local government level: lessons from the past decade.

There have been many approaches by the health sector to developing healthy communities based on local government areas in Australia in the past decade. Each has struggled with the need to establish realistic goals and to find ways of working more effectively with local government. This paper outlines four of these approaches--Healthy Cities, the Healthy Localities project, municipal health plans, and programs to address specific health problems or issues. Although the picture is one of huge diversity in the ways in which the issue is defined and action taken, a number of dimensions to a healthy community are emerging. However, if we are to be able to monitor change within and between the health of communities over time, indicators need to be developed and goals set. This will require a shift away from defining goals and targets in terms of populations (people), towards goals based on changes in organisations and systems. Engaging local government in this process will be vital and will require the health sector to develop a better understanding of the ways in which local government defines its role in creating healthy communities. It will also involve learning from local government the strategies that they have found most effective in dealing with complex problems that require action at many levels.

Australia↗
PubMed2005

Role of community risk factors and resources on breast carcinoma stage at diagnosis.

BACKGROUND: The current study investigated the individual and community determinants of breast carcinoma stage at diagnosis (BCSAD) using multiple data sources merged with cancer registry data. The literature review yielded 5 studies that analyzed cancer registry data merged with community-level variables (1995-2004). METHODS: Community variables constructed for the current study reflected social and economic risk factors, physician supply, and health maintenance organization penetration. Multivariate logistic regression was used to identify the significant predictors of increasingly progressive BCSAD. RESULTS: Disparities remained for black and Hispanic females in California, who were least likely to be diagnosed early compared with their white counterparts. Younger (< 40 years) and middle-aged (40-64 years) females were less likely to be diagnosed with early BCSAD, compared with older females (> or = 65 years). Utilizing services at hospitals serving a lower volume of patients with breast carcinoma was associated with later BCSAD. After controlling for individual-level factors, community-level variables constructed at the census block group and county level were tested. If a woman resided in a neighborhood with greater percentages of female-headed households, persons living below the poverty level, less educated people, and more recent immigrants, then her chances of being diagnosed at an earlier stage were diminished. If, conversely, she resided in a neighborhood with greater percentages of females > or = 65 years (a proxy for Medicare coverage), her access to medical care and the probability of earlier BCSAD increased. County-level insurance rates and residing in counties where greater percentages of women ever had a mammogram were associated with in situ and early-stage diagnosis. Similarly, the supply of primary care physicians and radiologists was associated positively with earlier BCSAD. CONCLUSIONS: Results confirmed community-level predictors of socioeconomic and delivery system context matter, although the individual-level predictors showed a stronger effect. Nevertheless, analysis of community variables is promising for guiding and evaluating the effects of health policy and developing community and delivery system interventions for earlier detection and treatment of breast carcinoma.

Adult↗
PubMedDate not supplied

Community mobile treatment. What it is and how it works.

In 1984, Paul Hanki of Prince George, British Columbia, Canada, developed community mobile treatment, an innovative approach to substance abuse treatment in Native communities. The feature that distinguishes community mobile treatment from most other forms of treatment is the strong emphasis on community involvement. Before an actual treatment program is implemented, the community must acknowledge that a substance abuse problem exists and be committed and involved in addressing the problem. Once a community is mobilized, a 21 to 28 day intensive alcohol and drug treatment program for substance abusers and their families is brought into the community. Since its inception in 1984, community mobile treatment has been implemented in approximately 17 Canadian communities. The few evaluations that have been conducted suggest that this approach holds much promise in reducing alcohol and drug-related problems. This article reviews the existing documentation and provides a comprehensive description of this unique approach.

Aftercare↗
PubMed2003

A marine biological underwater depuration system (MUDS) to process waste waters.

An underwater device, able to favour the sea auto-cleaning capacities, is herein described. This system, called MUDS (marine underwater depuration system), consists of a percolating filter and is placed at sea over an urban sewage outflow of a submarine pipeline. Due to the density difference, the water effluent flows through the percolating filter: this favours the mixing and a prompt recycling of organic matter, activating a marine trophic web. Rich microbenthic communities develop on the MUDS, both interstitially, inside the filter, and on the structure. The community mainly consists of ciliates, nematodes, harpacticoid copepods and polychaetes, all of which being organisms that increase the depuration efficiency by consumption of organic matter. This structure acts also as a deterrent for the illegal trawling activity in the area, and attracts large numbers of several finfish species, thus working as a fish aggregating device (FAD). It is possible to utilise this underwater device for medium littoral towns with strong differences in effluent discharges during the year, where the use of land-built effluent treatment plants is too expensive.

Biofilms↗
PubMed2002

Prevention and control of anemia: Thailand experiences.

Thailand has addressed nutrition in national development policy since the mid-1970s, including efforts to reduce iron deficiency anemia. Nutritional improvement has been implemented as an integral part of primary health care and community development extending beyond government services to include community participation. Utilization of village health volunteers has been a crucial feature of the program. Available data indicate that anemia rates have declined among pregnant women and preschool children, although there has been no formal evaluation of the program effect. Universal iron supplementation has been the major strategy for pregnant women, using village health volunteers to encourage continuation of the antenatal care schedule and encouraging a preventive approach by health service providers. Program obstacles have included lack of access to iron tablets by some populations and lack of understanding of the importance of anemia. Women's compliance was complicated by fear of having a large fetus, forgetfulness and side effects. Weekly iron supplementation of school children was piloted in 2000, and is now being extended. Other strategies utilized to address iron deficiency include food fortification, dietary improvement and complementary public health measures. Program monitoring and evaluation require strengthening to assess the effectiveness of intervention strategies and provide proper data for decision-making.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

From chaos to a structured therapeutic community: treatment programme on Emiliehoeve, a farm for young addicts.

Within two years a centre for young addicts emerged; from a chaotic situation where drug use was frequent a drug-free therapeutic community developed with a solid structure; encounter group techniques were the major therapeutic tool. The community is located on a farm providing a great variety of work situations. The evolution in this direction is described, pointing out the failings of several approaches attempted during the different phases of the programme.

Adult↗
PubMed1994

Moving from community coalitions to regional collaboration.

The author discusses a coalition between two East Texas cities which are forging a lasting relationship grounded in a common goal of community development, stimulated by funding from the Pew Foundation. The strategies--open-space technology, community navigators, leadership training and issues forums--used to build regional networks are discussed.

Community Participation↗
PubMedDate not supplied

[Community participation patterns in health programs].

The study of some Latin American experiences of participation of the community in health programs allows us to consider the following as minimum requirements to establish interrelationships between local health organisms and the community: a) To have a local health system. b) To have a participating health them. c) To show respect for the community. d) To have contact with community organizations. e) To have contact with private and government organizations at a local level. The models for participation of the community in health are manifold and the experiences have been countless. For teaching purpose and based on Latin American experiences, some considerations are made regarding: 1) Community health volunteers. 2) Local health councils. 3) Local councils for community development. 4) Health brigades. Finally, it is concluded that the active participation of the community organized in health activities is the best guarantee of success in implementing integral health programs.

Child Care↗
PubMedDate not supplied

Developing comprehensive health care for an underserved population.

An especially vulnerable population is the disadvantaged and underserved older adult population residing in urban communities. This article describes a hospital-sponsored program in an urban community developed to improve access to health promotion and chronic disease control services for older adults. As part of the newly designed service, the hospital also sought to change its image from simply that of a "hospital" to that of a "community setting" dedicated to serving the comprehensive needs of older adults.

Aged↗
PubMed2006

Measuring youth development outcomes for community program evaluation and quality improvement: findings from Dissemination of the Rochester Evaluation of Asset Development for Youth (READY) tool.

PURPOSE: The Rochester Evaluation of Asset Development for Youth (READY) is a brief program-controlled evaluation and quality improvement tool used for assessment of four developmental assets for youth: caring adult relationships, basic social skills, decision making, and constructive use of leisure time. This article reports on the early implementation and combined benchmark data generated from the use of the READY tool by community-based youth-serving agencies in Rochester, New York. METHODS: Nine youth-serving agencies used the 40-item READY tool in 2002-2003. In addition to individual program evaluation and quality improvement, a combined dataset was developed and analyzed to establish community benchmarks. Program leaders' qualitative feedback on their experience with the READY tool is also reviewed. RESULTS: 1,070 youth participated. Those youth who reported feeling more connected to the programs in which they participated and having more active and frequent participation had consistently higher scores on measured outcomes. Overall, most agencies required some technical assistance to first field READY. Most agencies successfully used their own data to address program quality improvement, and reported being happy with their ability to do so. DISCUSSION: READY is a promising tool for measuring community-based program-attributable positive developmental outcomes for youth.

Adolescent↗
PubMed1987

An interactive contextual model of migration in Ilocos Norte, the Philippines.

This paper develops and estimates an interactive contextual model of migration in Ilocos Norte, the Philippines. It focuses on how contextual features alter the effects of family class status and community development level on the family's migration decisions. The model estimates show a curvilinear relation between class status and migration, but the pattern differs in accordance with the prevalence of migration from the community in the past. In addition, the effects of socioeconomic development and agricultural commercialization patterns vary with context. These results demonstrate the importance of using interactive models for analyzing the contextual influences on migration.

Agriculture↗
PubMed1996

Obstacles to community health promotion.

The health transition ushered into the world in this century calls for a reorientation of traditional health services to manage the new causes of morbidity and mortality, renewing interest in disease prevention and health promotion. Community-based health promotion emphasizes prevention and community participation with people's empowerment to overturn current inequities and increase control over their health. Encouraged worldwide by the World Health Organization for the last two decades, some community health promotion programs have been implemented and lessons learned. However, the shift in focus required means nothing less than a paradigm change demanding not only a reorientation of professional training, but also a reorganization of social structures in communities. This article discusses nine of the interrelated obstacles that must be overcome to further develop community health promotion.

Community Health Services↗
PubMed2006

Developing internet-based eHealth promotion programs: the Spiral Technology Action Research (STAR) model.

Health education and health promotion have a tradition of using information and communication technology (ICT). In recent years, the rapid growth of the Internet has created innovative opportunities for Web-based health education and behavior change applications-termed eHealth promotion. However, many eHealth promotion applications are developed without an explicit model to guide the design, evaluation, and ongoing improvement of the program. The spiral technology action research (STAR) model was developed to address this need. The model comprises five cycles (listen, plan, do, study, act) that weave together technological development, community involvement, and continuous improvement. The model is illustrated by a case study describing the development of the Smoking Zine (www.SmokingZine.org), a youth smoking prevention and cessation Web site.

Adolescent↗
PubMedDate not supplied

Strengthening black and minority community coalitions for health policy action.

African Americans and other racial/ethnic minorities suffer greater disparities in health and quality of life than do nonminorities. Health professionals are challenged to improve the health of minority communities by mobilizing minority people to participate in the public policy process through coalition building. The purpose of this article is to examine the role of the nurse in community development and the policy making process. A case study analyzing one nurse's role in community activism for child care policy is presented. Recommendations are provided for strengthening the involvement of minority community coalitions in influencing policy initiatives.

Black or African American↗
PubMed1997

Managed behavioral health care: a key component of integrated regional delivery systems.

Managed behavioral health care is a key component of integrated regional delivery systems. Mental health and chemical dependency services are of growing importance in developing insurance programs and establishing health systems. Primary features include full involvement of the medical community, development of a free-standing organization, joint ventures with existing entities, and effective contract negotiations.

Academic Medical Centers↗
PubMed2003

The Dental Hygiene Program in Portugal.

The Dental Hygiene Program is a fairly recent addition in the field of the health professions in Portugal. In the past 19 years, the programme has developed community activities alongside with clinical work. This programme provides an education that is responsive, scientific and professional, in a learning environment that is dynamic, student-centred and that encourages collaboration between students and faculty. The community activities play a major role in the curricula of the programme and allow the students to develop skills in working with a wide range of population groups and to attend to their specific needs. Dental hygienists are integrated in health teams and work under the supervision of a physician or a dentist. Among other responsibilities, the following functions are part of the scope of the profession: to participate in health education programmes and sensitise the population to the prevention of dental diseases, to participate in the planning, implementation, and evaluation of the public health programmes and to perform clinical treatment for prevention and control of gingivitis, periodontitis, and dental caries. An overview of the activities developed in the year 2002 and future perspectives are presented in this article.

Clinical Competence↗
PubMed1996

From feedback to reciprocity. Developing a student-centered approach to course evaluation.

Reforms to medical education have refocused curricula on the need to produce primary care physicians through a problem-based, student-centered, community-oriented, and integrated approach to instruction. Course evaluations, originally designed for traditional lecture-based, teacher-centered curricula, provide inadequate input from students to support curriculum planning and change and to determine appropriate mixes of educational methods. At the University of Toronto Faculty of Medicine, a unique community-centered course, called "Health, Illness and the Community," developed a student-centered course evaluation to provide adequate student input to support curriculum planning and change. A 35-item evaluation was developed to obtain data to identify student concerns, student learning styles, and preferred community agency utilization. The results suggest that student-centered course evaluation can play a role in managing and identifying key relationships in integrated and systematic courses as well as establishing a method for continual improvement.

Curriculum↗