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PubMed2000

Integration of health care delivery in the Eastern Mediterranean Region of the World Health Organization.

This paper reviews developments in the integration of health care delivery in the Eastern Mediterranean Region. It describes the integrated intersectoral support of socioeconomic community development (district health systems and basic development needs), the functional intrasectoral integration of health services and interventions, and health resources integration.

Delivery of Health Care, Integrated↗
PubMed1999

A Qualitative Study of Community Kitchens as a Response to Income-Related Food Insecurity.

A variety of self-help and community development strategies have recently emerged to address problems of hunger and food insecurity at a local level. One such strategy is community kitchens. Loosely defined as community-based cooking programs, "kitchens" are groups of people who regularly come together to prepare food for themselves and their families. This study employed grounded theory methods to examine the potential of community kitchens to enhance food security among those with constrained resources. Insights gained from participant observations of ten kitchens in progress were augmented by in-depth interviewing of a sample of participants and facilitators. Study findings suggest that, in some cases, community kitchen participation may enhance coping skills and provide valuable social support. However, the programs have limited potential to resolve food security issues rooted in severe and chronic poverty because they do not alter households' economic circumstances in any substantial way.

Journal Article↗
PubMed2002

Communication among oral bacteria.

Human oral bacteria interact with their environment by attaching to surfaces and establishing mixed-species communities. As each bacterial cell attaches, it forms a new surface to which other cells can adhere. Adherence and community development are spatiotemporal; such order requires communication. The discovery of soluble signals, such as autoinducer-2, that may be exchanged within multispecies communities to convey information between organisms has emerged as a new research direction. Direct-contact signals, such as adhesins and receptors, that elicit changes in gene expression after cell-cell contact and biofilm growth are also an active research area. Considering that the majority of oral bacteria are organized in dense three-dimensional biofilms on teeth, confocal microscopy and fluorescently labeled probes provide valuable approaches for investigating the architecture of these organized communities in situ. Oral biofilms are readily accessible to microbiologists and are excellent model systems for studies of microbial communication. One attractive model system is a saliva-coated flowcell with oral bacterial biofilms growing on saliva as the sole nutrient source; an intergeneric mutualism is discussed. Several oral bacterial species are amenable to genetic manipulation for molecular characterization of communication both among bacteria and between bacteria and the host. A successful search for genes critical for mixed-species community organization will be accomplished only when it is conducted with mixed-species communities.

Amino Acid Sequence↗
PubMed1986

Dental benefits of limited exposure to fluoridated water in childhood.

The effect of limited exposure to fluoridated water in childhood is of potential importance in highly-mobile modern society, but the subject has not been well-studied. This longitudinal study assessed caries experience and S. mutans proportions from fissure plaque in school-children who lived for at least the three years of the study in a non-fluoridated community (0.2 mg/L). Residence histories permitted division of the cohort into those who had lived all their lives in non-fluoridated communities, and those who had lived for some time previously in a fluoridated community. The children were aged 6-7 years at the beginning of the three-year study. Children with previous residence in the fluoridated communities developed 26.8% less caries in their permanent teeth during the study than did the children who had lived in non-fluoridated communities all their lives (p = 0.04), and had 29.8% less caries after three years (p = 0.02). Differences between the groups in S. mutans proportions from fissure plaque, sampled at six-monthly intervals throughout the study, could not be demonstrated. The dental benefits observed could not be attributed to socio-economic differences between the groups. Despite evidence that the benefits of limited ingestion of fluoridated water are topical in nature, the fact that many of the affected teeth in this study were unerupted at the time of the fluoride exposure means that pre-eruptive benefits cannot be ruled out.

Child↗
PubMedDate not supplied

Utilisation differentials in a rural Nigerian health centre.

The Ala-Idowa health centre was established in 1980 to serve the two contiguous communities of Ala and Idowa with population of 3960 and 6580 respectively. Situated reasonably between the two communities, there is adequate physical accessibility to the health centre from both sides. The population structure of the combined community was determined through a household survey involving 125 households selected systematically from the total of 2500 households. A comparison is presented between this structure and that of the population of attendees at the outpatient department of the Ala/Idowa health centre as recorded in the outpatient register with a view to discerning differentials in utilisation among different age groups. The data showed that those under the age of 15 years made more use of the health centre services than any other age group. Also, of the total of 958 patients for whom a diagnosis was recorded, 565 (56%) presented with an infection or infestation alone while another 4% presented with an infection together with another condition. Malaria accounted for 358 (63.4%) of all reported cases of infection/infestation. It is hoped that the findings of this study can be used to further target health centre services at the appropriate groups within the community as well as directed to those conditions, particularly communicable and preventable, that continue to exert great morbidity on the populations of developing communities.

Adolescent↗
PubMed1995

The role and functions of the psychiatric-mental health nurse in the care and comfort of individuals, families, and communities subjected to violence.

Individuals, families, and communities subjected to violence experience mental health needs and mental health problems that are obstacles in their everyday living. The psychiatric-mental health nurse, as an integral part of the health delivery system, has a facilitative role in assisting individuals, families, and communities to mobilize resources in the promotion, maintenance, and restoration of their mental health. The functions of the psychiatric-mental health nurse thus include coordinator of community development, psychotherapist, mental health educator, and monitor of the use of psychotropic medications.

Community Health Nursing↗
PubMed1990

Primary prevention of type 2 (non-insulin-dependent) diabetes mellitus.

Type 2 (non-insulin-dependent) diabetes mellitus is the major form of the disease in all societies. Its public health impact appears to be increasing and the greatest genetic predisposition to the disease is encountered in developing communities. The reduction or elimination of disease in whole populations is a fundamental goal in public health. Whilst several factors are associated with the development of Type 2 diabetes, it is not clear how they cause the disease, if indeed they do, nor whether they act in the same way in all populations. Risk factors may be true determinants of a disease but alternatively they may be associated with its occurrence only by virtue of an innocent relationship with the true causes. Furthermore, known risk factors usually explain only a small proportion of any chronic disease. The role of risk factors in disease causation is therefore of fundamental importance in considering disease prevention. Two alternative strategies for prevention of disease in populations have been proposed. The population strategy seeks to remove the causes of disease in communities as a whole, whilst the high-risk strategy aims to identify subjects at increased risk, and to intervene selectively. The population approach should be tried and carefully evaluated in selected communities at above-average risk of several noncommunicable diseases. However, certain epidemiological features of Type 2 diabetes, including the distributional characteristics of glycaemia and the complications of hyperglycaemia, the clustering of cardiovascular risk factors in the diabetic subpopulation, as well as uncertainties over the causal nature of known risk factors, suggest that a high-risk approach to prevention is also appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 2↗
PubMed2006

Dissolved organic matter concentration and quality influences upon structure and function of freshwater microbial communities.

Past studies have suggested that the concentration and quality of dissolved organic matter (DOM) may influence microbial community structure. In this study, we cross-inoculated the bacterial communities from two streams and a dystrophic lake that varied in DOM concentration and chemistry, to yield nine fully crossed treatments. We measured dissolved organic carbon (DOC) concentration and heterotrophic microbial community productivity throughout a 72-h incubation period, characterized DOM quality by molecular weight, and determined microbial community structure at the initial and final time points. Our results indicate that all bacterial inoculate sources had similar effects upon DOC concentration and DOM quality, regardless of the DOM source. These effects included an overall decrease in DOM M (W) and an initial period of DOC concentration variability between 0-24h. In contrast, microbial communities and their metabolic rates converged to profiles that reflected the DOM source upon which they were growing, regardless of the initial bacterial inoculation. The one exception was that the bacterial community from the low-concentration and low-molecular-weight DOM source exhibited a greater denaturing gradient gel electrophoresis (DGGE) band richness when grown in its own DOM source than when grown in the highest concentration and molecular weight DOM source. This treatment also exhibited a higher rate of productivity. In general, our data suggest that microbial communities are selected by the DOM sources to which they are exposed. A microbial community will utilize the low-molecular-weight (or labile) DOM sources as well as parts of the high-molecular-weight (refractory) DOM, until a community develops that can efficiently metabolize the more abundant high-molecular-weight source. This experiment examines some of the complex interactions between microbial community selection and the combined factors of DOM quality and concentration. Our data suggest that the roles of aerobic aquatic heterotrophic bacteria in carbon cycling, as well as the importance of high-molecular-weight DOM as a carbon source, may be more complex than is conventionally recognized.

Bacteria↗
PubMed2005

Specialist public health capacity in England: working in the new primary care organizations.

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.

England↗
PubMed1999

An oral health promotion module for the primary health care nursing course in Acornhoek, South Africa.

The severe personnel shortage in the health professions in most developing communities is well documented. This dearth of health workers and the widespread adoption of the primary health care approach (PHCA), requires that health professionals be trained to understand and effectively utilize the skills offered by other disciplines in the health care field. Nurses are expected to play active roles in the promotion of health including oral health, particularly in the rural under-served communities. There is a paucity of oral health education in nursing curricula. This article describes a 4-day module on oral health promotion developed and delivered to 36 nurses as part of a 12-month primary health care nursing (PHCN) training course. The module utilized a variety of educational methods and materials to facilitate and encourage both individual and group learning. The module was evaluated using both student academic attainment and perceptions as outcome measures. The evaluation and the experience of facilitating this module show that an oral health promotion module of short duration can sensitize nurses to the importance of oral health and increase oral health knowledge and skills.

Curriculum↗
PubMed2001

Nutrition education training of health workers and other field staff to support chronically deprived communities.

This paper focuses on the provision of adequate training in nutrition education to health and other community development workers for their improved performance and achievement. The difficulties encountered and special care needed when dealing with low-income, chronically deprived communities are raised. A brief analysis of past and present trends in nutrition education is presented to show the progress made from restricted, authoritative and not very successful proposals to more comprehensive and participatory approaches. The need to train and update regional and field-level personnel on the new approaches, theories and models offered by nutrition education is highlighted, but the scant availability of resources for training activities may be a great limitation for this undertaking. The contribution of educational, social, psychological and communication sciences, as well as marketing, in improving and broadening the performance of health and nutrition education is recognised. Some successful nutrition education projects, implemented in different regions, using various approaches, have managed to improve the nutrition situation of low-income groups and could be used as good examples to be followed. Recommendations for implementing nutrition education projects or activities need to consider some prerequisites, such as good knowledge and analysis of the nutrition situation, careful selection of the strategies and methods, careful planning and implementation, and clear definition of the procedures and instruments for follow-up and evaluation.

Adult↗
PubMedDate not supplied

The UK, health and peace-building: the mysterious disappearance of Health as a Bridge for Peace.

The problem of how to build peace in post-conflict societies continues to loom large for governments and development agencies worldwide. This article examines the involvement of the UK development community in the creation of the World Health Organization's 'Health as a Bridge for Peace' (HBP) programme. It argues that the new development policy context brought in by the United Kingdom Labour administration in 1997 appeared to provide fertile ground for health-sector initiatives such as these to become an important part of the UK's peace-building strategy, but that HBP in fact failed to take root. The role of individuals, the changing departmental focus of the Department for International Development (DFID), its relationship with WHO, and the absence of persuasive evidence for the efficacy of HBP are highlighted as being crucial in explaining the policy's mysterious disappearance.

Global Health↗
PubMed2001

A critical examination of community-based responses to household food insecurity in Canada.

Over the past two decades, household food insecurity has emerged as a significant social problem and serious public health concern in the "First World." In Canada, communities initially responded by establishing ad hoc charitable food assistance programs, but the programs have become institutionalized. In the quest for more appropriate and effective responses, a variety of community development programs have recently been initiated. Some are designed to foster personal empowerment through self-help and mutual support; others promote community-level strategies to strengthen local control over food production. The capacity of current initiatives to improve household food security appears limited by their inability to overcome or alter the poverty that under-pins this problem. This may relate to the continued focus on food-based responses, the ad hoc and community-based nature of the initiatives, and their origins in publicly funded health and social service sectors.

Canada↗
PubMed1997

School-as-community activity selection at continuation high schools.

This paper describes two studies which together provide an example of an empirically based "school-as-community" development process used in a large-scale school-based drug prevention trial among youth at continuation high schools in California. First, we generated a list of schools' current community involvement from 96 school personnel and 144 students from 20 continuation high schools. Second, we reduced the number of activities indicated, with some discussion, to a list of 12 populars. Then, we administered this list to a total of 388 students from six continuation high schools who provided perceived quality ratings. We generated six categories of activities from the results of these two studies. These studies reveal a means to determine activities likely to be completed by this school system and a means to limit the variability of activities which could be manipulated in an experimental trial involving a school-as-community component.

Adolescent↗
PubMed2006

Chronic kidney disease management--what can we learn from South African and Australian efforts?

BACKGROUND: The prevalence of chronic kidney disease is on the rise. Our objective is to describe two programs to improve the awareness and management of hypertension, renal disease, and diabetes in remote Australian Aboriginal and urban and periurban South African communities. We focus on how the Australian Aboriginal and South African Chronic Disease Outreach Programs have worked together. METHODS: The establishment of prevention programs in developing countries is a challenge. The paper evaluates these challenges, including accessing international aid. The programs advocate that regular integrated checks for chronic disease and their risk factors are essential elements of regular adult health care. Programs should be run by primary health workers, following algorithms for testing and treatment, and a backup provided by nurse coordinators. Constant evaluation is essential to develop community health profiles and adapt program structure. RESULTS: Both programs are discussed, including how they are organized to deliver preventative and treatment strategies. The challenges and adaptations required are outlined. CONCLUSIONS: It is the aim of the international kidney community to prevent chronic kidney disease. The South African and Australian groups highlight the need for a systematic and sustained approach to the management of chronic diseases to achieve this goal.

Australia↗
PubMed1984

The drug problem in The Netherlands.

In the Netherlands, the drug problem among adolescents developed as a new phenomenon in the mid 1960s. Without remarkable success, methadone maintenance programs were introduced in 1968. Drug free treatment in therapeutic communities, developed since 1972, was successful after the first experimental years. This success provoked the illusion that drug related problems could be solved by treatment; low threshold programs, putting few demands on participants, were established to dispense methadone. The illusion was that addicts can be motivated into further treatment if they are brought into contact with professionals. As the addict population kept growing and their street crimes increased in number, Dutch drug policies changed in 1978, using methadone as a means to decrease criminal activities rather than to treat addicts. This also turned out to be an illusion. Currently, there is strong political pressure to distribute heroin to addicts to diminish the negative side effects of drug abuse. Dutch drug policies are characterized by the opinion that drug problems cannot be solved and have to be accepted.

Day Care, Medical↗
PubMed1995

Towards AIDS prevention and education at the University of Malawi.

It is important to develop community orientated approaches to health promotion. Malawi has one of the highest rates of AIDS/HIV infection and one of the lowest percentages of students in tertiary education, in the world. We surveyed the opinions of 175 undergraduate university students on developing prevention and education regarding HIV/AIDS. Descriptive statistics, analysis of variance and factor analysis revealed several important findings: there were no consequential differences between the responses of male and female students; information on self protection was rated as most important for AIDS/HIV education; the primary factor for AIDS/HIV prevention also related to protection, but this was in conjunction with a desire for "sex-perpetuation". These findings should contribute to the development of health promotion initiatives, directed at AIDS/HIV, which reflect the values and concerns of the university student community. Such an approach acknowledges the role of students as a major 'stakeholder' in the university community, rather than dissempowering them as simply the recipients of 'appropriate AIDS/HIV prevention/education'.

Acquired Immunodeficiency Syndrome↗