SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
The Program for Mexican Communities Abroad offices, which are located throughout the United States, represent an ideal site for outreach for both Mexican- and United States-based governmental and nongovernmental organizations interested in the well-being of Mexican migrants working in the United States. A brief overview of the PCME and the health-related programs in which it is involved is provided.
In Uganda, human onchocerciasis is controlled by annual, mass, community-directed, ivermectin-treatment programmes (CDITP) in all endemic communities where the prevalence of the disease is > or = 30%. This is a practical, long-term and cost-effective strategy. In some communities, this system succeeds in providing treatment at the desired level of coverage (i.e. 90% of the annual treatment objective, which is itself equivalent to all those individuals eligible to take ivermectin). Other communities, however, fail to reach this target. The aim of the present study was to determine the factors that were significantly associated with success or failure in achieving this target. The data analysed were answers to a questionnaire completed by 10 household heads randomly selected from each of 64 randomly selected endemic communities (of which 36 succeeded and 28 failed to reach their coverage target) in the four districts of Kabale, Moyo, Nebbi and Rukungiri. Among the programme-related factors investigated, success was associated, at a statistical level of significance (P < or = 0.05), with involvement of community members in: (1) decisions about the execution of the programme; (2) attendance at health-education sessions; (3) selection of the community-based distributors (CDB); and (4) rewarding CBD in kind. In general, the involvement of community members in the planning and execution of a CDITP (and the resultant sense of pride in community ownership) was more likely to produce successful results than when external health workers or even community leaders or local councils took responsibility.
OBJECTIVE: To pilot a community-based and owned sports massage course for Aboriginal health workers (AHWs). DESIGN: Descriptive, pilot educational intervention study. SETTING: Rural, Indigenous Australian community. SUBJECTS: AHWs working in a rural community. MAIN OUTCOME MEASURES: Cultural and logistical acceptability of the program to AHWs. RESULTS: The course was delivered within a culturally acceptable framework with applicability for the evaluation of sports massage skills and knowledge changes in a larger sample. CONCLUSION: The sports massage course demonstrated its applicability in this rural Aboriginal community and it has the potential to be adapted and adopted in other similar settings.
Reengineering of the workplace through Information Technology is an important strategic issue for today's community health care. The computer-based patient record (CPR) is one technology that has the potential to profoundly modify the work routines of the care unit. This study investigates a CPR project, Gerica aimed at allowing the health care workers in the community health care to work in a completely electronic environment. The focus of our analysis was the use of Gerica, and the health care workers interpretations of it. The rationale behind the introduction of this technology was based on its alleged capability to both enhance quality of care and control costs. This is done by better managing the flow of information within the organization. Theory of structuration is used as the conceptual vehicle to aid in widening the search to the socially constructured nature of these meaning: how people constructed their conceptions in their work setting. The present study analyzed the implementation of CPR conducted in the community health services in Trondheim, Norway. Interviews with Gerica users demonstrate that individual interpretations vary considerably, also between users of the same application. User-resistance was not the problem. This project was a good opportunity to understand better the intricate complexity of introducing technology in professional work where the usefulness of information is short lived and where it is difficult to predetermine the relevancy of information. Profound misconceptions in achieving a tighter fit (synchronization) between care processes and information processes were the main problems.
BACKGROUND: Despite a relatively recent decline in the global incidence of Chlamydia trachomatis and Neisseria gonorrhoeae it seems that some segments of the population such as street youth, sex workers, and individuals with social problems or delinquent behavior could be part of a core group for STDs. These persons may be reluctant to undergo STD diagnosis in traditional medical settings. GOALS: To determine the prevalence of C trachomatis and N gonorrhoeae infection using polymerase chain reaction on urine samples among subjects attending an anonymous HIV testing clinic and four community organizations in Quebec City, and to identify associated risk factors. STUDY DESIGN: A cross-sectional study of 626 street youth, sex workers, and women with social problems or delinquent behavior was conducted. RESULTS: The prevalences of N gonorrhoeae and C trachomatis were, respectively, 1.1% (95% CI, 0.5%--2.3%) and 5.8% (95% CI, 4.1%--7.9%). No significant difference was found between men and women, but the sexually transmitted disease (STD) prevalence was much higher in subjects younger than 20 years: 11.4% versus 3.6% (P < 0.01). In a logistic regression model, factors independently associated with STD infection were age younger than 20 years (OR, 2.6; P = 0.007), occasional sex partners (OR, 2.9; P = 0.007), and injection of drugs (OR, 2.8; P = 0.002) in the preceding 6 months. CONCLUSIONS: A moderate STD prevalence was found in the study population. The prevalence, however, can be considered high (>10%) among street youth and young sex workers. Providing community-based STD screening and treatment services appear to be an efficient method for reaching these high-risk groups.
OBJECTIVE: The aim of this study is to determine the knowledge, attitude, behaviour and practices regarding HIV/AIDS among the fishermen community in the coastal areas of Balochistan. DESIGN: A cross-sectional survey. PLACE AND DURATION OF STUDY: This study was conducted between September-October 2000 at Gidani, a coastal area of Balochistan. PATIENTS AND METHODS: About 1000 fishermen were interviewed to assess the knowledge, attitude, behaviour and practices regarding HIV/AIDS. It was a community based survey involving the key informants, interviews and focused group discussions. RESULTS: There was little awareness regarding causes and prevention of HIV/AIDS in the community. While healthcare providers believe that the prevalence of HIV/AIDS is high, the community did not consider themselves at risk. Adolescents with any sexual health problems visit hakims and quacks. The community was aware of the etiology and some of the risk factors associated with AIDS, most probably due to the recent public health campaigns against the disease. CONCLUSION: Considering the suspected high prevalence of HIV/AIDS and the relative lack of knowledge, it is imperative that a public health intervention program be initiated in these areas. This must include educating not only the community but also the health workers. The Government's initiative to train community workers in reproductive health is a step in the right direction.
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.
The primary health care approach to public health stresses recognition of economic, political, and social determinants of health. In practice, briefly trained community health workers provide people with education and health care, but they require sound supervision. Such tasks of leadership require higher education. This demands more schools of public health of independent status, as well as stronger departments of community medicine within schools of medicine. Independent schools of public health throughout the world are much stronger than preventive medicine departments in medical schools, as measured by full-time faculty, scope of teaching and research, and candidates enrolled. To train properly for leadership, such independent schools in the developing world should be multiplied by 12 times to meet the needs. Leadership requires basic preparation in the full scope of public health knowledge, along with skills of effective management.
Explore the source record for details and available documents.
The purpose of this health facility survey was to evaluate how the ARI (Acute Respiratory Infection) Program actually works in an everyday, non-research setting. We surveyed 33 clinics and aid posts, including 223 children with ARI and 104 health workers. In this primary health care setting, health workers diagnosed 37% of ARI cases as pneumonia, compared to 69% in the same children assessed independently by trained ARI surveyors using Papua New Guinea case management, which defines fast breathing as > or = 40 per minute for children 1 month to 5 years of age. Agreement between health workers and surveyors was reasonably good (kappa > or = 0.6) for the history of symptoms, but was poor (kappa < 0.3) for diagnoses, treatments and signs such as respiratory rate (RR) and chest indrawing. Health workers counted the RR in only 14% of cases in the survey. In essence, we found that health workers in Simbu are not practising ARI case management. We conclude that case management guidelines which define fast breathing as a rate of > or = 40 per minute classify too many obviously well children as pneumonia. Furthermore, we encountered difficulties in measuring RR accurately, and documented marked inter-observer variation in this setting. Consequently, we are concerned about the ARI Program's excessive reliance on RR and rigid protocols at the expense of clinical sense. Case management guidelines developed for aid post orderlies or village health workers may need to be modified, or used differently by experienced nurses at health centres, who recognize sick children better than by following a standardized protocol. Despite better overall ARI knowledge and practice by nurses, we could demonstrate an impact of the ARI Training Program only on community health workers (CHWs). In order to improve ARI clinical practice, we recommend that the ARI Program in PNG initiates regular on-site clinical supervision of nurses and CHWs at health centres.
This paper presents the major findings of an on-going monitoring and evaluation study of Primary Health Care with emphasis on child and maternal health services sponsored by UNICEF and the Government of Zambia. The objectives of this research are to evaluate and monitor the implementation of Primary Health Care in remote rural areas. Two contrasting ecological regions were selected for investigation, one in Western Province and the other in Northern Province and a core sample of 100 households from each area were selected to be monitored for 4 years. The research methodology included structured questionnaires, observation of community activities, designing and implementing community and household-based information systems, key informant interviewing, and reviewing health facility records and village registers. The findings regarding disease patterns, health service untilization, nutrition, maternal/reproductive data, health recording systems, and activities of community health workers are compared and constrasted for the two areas. Environmental and other constraints have impeded the effective provision of health services and has resulted in high morbidity, nutrition problems and inadequate child/maternal health, in both areas. An alternative model for health provision which emphasizes community-level needs is presented. Finally, the importance of community-based studies to national health policy planning is stressed.
With growing emphasis for ethical behavior of professionals in contemporary American society, those mental health specialists involved in the community must focus on their own behavior. This becomes a difficult task, since it is apparent that current ethical guidelines for community psychologists are not comprehensive enough to be adequately helpful. Nine areas of conflicting values and ethical concerns are considered in an effort to begin formulation of a blueprint for community mental health workers. These areas include community participation, continuity of services, politics, planning, autonomy versus manipulation, overism, minority groups, training, and consultation. Ethical principles generic to each area are put forth as proposed guidelines for professional activities and as propagators of discussion and debate.
In spite of planned development and expansion of health services, especially in rural areas in India, mortality due to preventable conditions has remained unacceptably high. Important reasons for failure of the health system to detect the problems early are centrally planned programmes based on inadequate data and time-bound numerical targets for achievement. This promotes a tendency for passive implementation which destroys initiative and incentive for conceptualisation of problems and strategies. For health programmes to be far more successful, the entire health team needs to be given training in epidemiology appropriate to the level of each category, so that programme planning based on epidemiologically determined local needs can be done at district level by the District Health Organisation. Participation of health workers and the community will then be more active and relevant to the needs of the community.
The categorization of leprosy into paucibacillary or multibacillary depends on the report of slit-skin smears. Unfortunately, in many control programmes the quality of slit smears is below par. Taking the example of India, the main reasons were that the work of laboratory technicians was unrewarding as compared to serving in a general health care system. There was lack of equipment and an unrealistic patient to technician ratio. Future attempts were made by experienced workers to devise a clinical system for classifying leprosy as paucibacillary or multibacillary based on counting the number of lesions. However this method did not prove cost-effective because more paucibacillary patients were classified in the multibacillary group increasing the burden of treatment. A renewed attempt to improve slit-smear performance should be made by modifying the existing methods. This can definitely improve the situation. Patients with multiple macular lesions and those with neuritic leprosy are best treated with the MB-MDT regimen. The treatment for PB leprosy is to continue up to 6 months but in MB leprosy with a high bacterial index a longer duration of MDT may be required. Following completion of MDT many cases with deformity are accumulating and their care forms are a neglected part of many control programmes. In addition to strengthening the infrastructure, simple techniques must be imparted to those with deformities and disabilities. This involves the artful and innovative cooperation of the health worker, patient and the community. The leprosy worker should be motivated to promote such activities.
A major challenge for public health services is to reach disadvantaged pregnant women with a relevant program that assists them to reduce modifiable risk factors. A community development approach was used to initiate an outreach program aimed at urban natives and other high-risk pregnant women. Community involvement in program planning, the use of native and non-native community health workers, the provision of social support and the tangible health benefits of the program contributed to its success in attracting women for service.
The objective of this study was to document the various weaning diets given by some Nigerian women and consider their implication on the oral health of their children. A cross sectional survey was conducted among 700 volunteer mothers of young children aged between 6-18 months in Ibadan, a city in south-western Nigerian. Results revealed that pap was the most frequently given food to the infants as 607 (86.7%) of them ate it. Chocolate beverages, natural fruit juice and soft drinks were the most commonly given drinks as 88.1%, 79.9% and 70.3% babies were said to be given these respectively. Over 57% of mothers sweetened pap with sugar. Forty seven percent of mothers added glucose to children's drinking water. Over two-third (64.9%) of children ate biscuits several times a day. Soft drinks, commercial fruit juices and squash were consumed by 16.1%, 9.6% and 7.7% of the infants respectively on a daily basis. Judging by the findings of this study, it is evident that many infants are being exposed to a highly cariogenic diet at an early age. In the light of the harmful effect of these foods and drinks on the body and teeth, it is important that oral health care workers initiate moves to discourage this habit via health education programmes. Nurses, community health workers at various levels, pregnant women and mothers of young children should be the targets of such intervention.
The village health worker (VHW) pilot scheme in Tonga was reviewed three months after implementation. The scheme was acceptable to the regional health workers and the communities the VHW were serving. There were demands from most for the VHW for the community to have more than one VHW, build a clinic, and to increase the emphasis on curative medicine. There was no demand for a health prevention or promotional role. The rate of recorded illnesses has increased but health seeking behaviour remained unchanged. This scheme has provided an opening for the Ministry of Health to implement equalizing strategies to merge the practice and the political rhetoric of primary health care and community participation.