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PubMed1987

Community-based distribution of family planning services in Saradidi, Kenya.

Community-based distribution (CBD) of family planning services was initiated in 1980 in Saradidi, Kenya, as part of a community development effort. Family planning information and services in each village were provided by volunteer health helpers (VHH's) chosen and supported by the people in each village. The initial examination and supply of commodities was provided at a community clinic. Less than 1% of women 15 to 49 years of age used a family planning method before CBD was initiated. In 1983, 31 (17.3%) of 179 randomly selected currently married women and 26 (52.0%) of 50 currently married VHH's reported having used a family planning method; 38 (66.7%) were still using a method at the time of the survey. Family planning use increased with age and education. Women who used family planning had higher parity, were less likely to want more children and had had a longer time since the last delivery. From 1980 to 1983, 732 persons (including 121 men) were seen at the Saradidi clinic requesting family planning services; 17.2% were referred from the VHH's. About one-third of clients referred from VHH's to the clinic for examination and commodities actually came. Allowing VHH's to carry out the initial examination and provide the first supply of commodities to the acceptors might have significantly increased the rate of family planning use. The findings demonstrate an increased use of family planning services in Saradidi following the inception of CBD.

Adolescent↗
PubMed1992

A food fair to promote dietary change in the Stockholm cancer prevention programme.

Involving organizations is crucial when developing community intervention strategies aimed at dietary change. This case study describes the use of a food fair as a change agent. The aim of the food fair was to obtain commitment and build up a network in the community comprised of professionals in the fields of food production, food distribution and information. The fair was organized in 1989 and intended to disseminate knowledge and information about healthy foods and encourage food industries, test kitchens and also publishing companies to develop and present products in accordance with the dietary objectives of the Stockholm Cancer Prevention Programme (ie a simultaneous reduction of fat and an increase in fibre intake). The food fair consisted of exhibitions and conferences/seminars. Policy makers, journalists, people in the educational and health professions and those working with food were invited to participate. Nearly 60 companies and organizations made presentations at the exhibition and 1,000 professionals attended the conferences and seminars. In all, 6,400 people visited the fair. Seventy-eight trade journals and newspapers and three radio stations reported on the fair. The food fair was so well received that a second fair was arranged in 1991.

Community Participation↗
PubMed2005

UML as a cell and biochemistry modeling language.

The systems biology community is building increasingly complex models and simulations of cells and other biological entities, and are beginning to look at alternatives to traditional representations such as those provided by ordinary differential equations (ODE). The lessons learned over the years by the software development community in designing and building increasingly complex telecommunication and other commercial real-time reactive systems, can be advantageously applied to the problems of modeling in the biology domain. Making use of the object-oriented (OO) paradigm, the unified modeling language (UML) and Real-Time Object-Oriented Modeling (ROOM) visual formalisms, and the Rational Rose RealTime (RRT) visual modeling tool, we describe a multi-step process we have used to construct top-down models of cells and cell aggregates. The simple example model described in this paper includes membranes with lipid bilayers, multiple compartments including a variable number of mitochondria, substrate molecules, enzymes with reaction rules, and metabolic pathways. We demonstrate the relevance of abstraction, reuse, objects, classes, component and inheritance hierarchies, multiplicity, visual modeling, and other current software development best practices. We show how it is possible to start with a direct diagrammatic representation of a biological structure such as a cell, using terminology familiar to biologists, and by following a process of gradually adding more and more detail, arrive at a system with structure and behavior of arbitrary complexity that can run and be observed on a computer. We discuss our CellAK (Cell Assembly Kit) approach in terms of features found in SBML, CellML, E-CELL, Gepasi, Jarnac, StochSim, Virtual Cell, and membrane computing systems.

Algorithms↗
PubMed2001

Culturability as an indicator of succession in microbial communities.

Successional theory predicts that opportunistic species with high investment of energy in reproduction and wide niche width will be replaced by equilibrium species with relatively higher investment of energy in maintenance and narrower niche width as communities develop. Since the ability to rapidly grow into a detectable colony on nonselective agar medium could be considered as characteristic of opportunistic types of bacteria, the percentage of culturable cells may be an indicator of successional state in microbial communities. The ratios of culturable cells (colony forming units on R2A agar) to total cells (acridine orange direct microscopic counts) and culturable cells to active cells (reduction of 5-cyano-2,3-ditolyl tetrazolium chloride) were measured over time in two types of laboratory microcosms (the rhizosphere of hydroponically grown wheat and aerobic, continuously stirred tank reactors containing plant biomass) to determine the effectiveness of culturabilty as an index of successional state. The culturable cell:total cell ratio in the rhizosphere decreased from approximately 0.25 to less than 0.05 during the first 30-50 days of plant growth, and from 0.65 to 0.14 during the first 7 days of operation of the bioreactor. The culturable cell:active cell ratio followed similar trends, but the values were consistently greater than the culturable cell:total cell ratio, and even exceeded I in early samples. Follow-up studies used a cultivation-independent method, terminal restriction fragment length polymorphisms (TRFLP) from whole community DNA, to assess community structure. The number of TRFLP peaks increased with time, while the number of culturable types did not, indicating that the general decrease in culturability is associated with a shift in community structure. The ratio of respired to assimilated C-14-labeled amino acids increased with the age of rhizosphere communities, supporting the hypothesis that a shift in resource allocation from growth to maintenance occurs with time. Results from this work indicate that the percentage of culturable cells may be a useful method for assessing the successional state of microbial communities.

Amino Acids↗
PubMed1994

Community as client: a challenge for nursing education.

The mandate of public health departments has been, and continues to be, to provide and deliver a variety of health programs and services pertinent to local circumstances and needs. Public health nurses are the largest group of health care professionals who deliver these services. The objectives of this paper are to identify what policy makers expect of public health nurses related to community development for health, and to describe the educational components necessary for baccalaureate nursing curricula if these expectations are to be met.

Community Participation↗
PubMed1976

[Public hypertension screening and problems of individual long term control].

Four months after public screening for hypertension during the Swiss Trade Fair 1974, a random sample of 302 hypertensives referred to private practitioners were interviewed to determine the impact of the screening on longterm control through private practice. 201 hypertensives went for further blood pressure control: the previously aware did so more frequently than the previously unaware (p less than 0.01). 112 of 201 were confirmed as hypertensives by private practitioners: this occurred in 80% of aware but in only 36% of unaware patients. 94 were started on therapy. 76 of 112 (2/3) received further appointments. Another 101 hypertensives did not seek care. Main determinants were insufficient knowledge about hypertensive disease and a shorter period of formal education; half of them claimed "they felt perfectly well". In summary one third did not seek care, another third were not confirmed as hypertensive or were lost to follow-up, and only one third (50% of the aware and 10% of the unaware) were still under regular care. While community-wide screening provided an opportunity for educational compaigns and positively affected the behaviour of hypertensives who were already aware, the yield in terms of newly identified hypertensives still under control 4 months later was extremely low. Before further developing community screening programs, feasibility studies must define mechanism for improved longterm control.

Follow-Up Studies↗
PubMedDate not supplied

Designing and building new local public health agencies in Nebraska.

Prior to 2001, the local public health system in Nebraska was weak, fragmented, and severely under funded. Local public health departments covered only 22 of the state's 93 counties. The Turning Point project provided the impetus for change by allowing a diverse group of public health stakeholders to develop a strategic plan for strengthening and transforming the public health system. The plan acted as a catalyst to use some of the Nebraska Tobacco Settlement Funds to provide dedicated state funding to build the local public health system. By June 2002, 16 new local public health departments had been organized, ultimately covering all of the 93 counties in the state. Some of the keys to long-term sustainability are creating a network of community health partners that support collaborative decision making, continually seeking input from the community, developing and implementing an education and training plan for public health professionals and local board of health members, and demonstrating accountability by documenting results and communicating them to policy makers and the general public.

Community Health Planning↗
PubMedDate not supplied

The Limerick Leg-Ulcer Project: early results.

Nurse led clinics in joint hospital and community settings are now being advocated as the most effective and economic way of dealing with leg ulcers. However, little information exists on the profile and outcome of patients with venous ulcers treated either in the community or in the hospital setting. Over a 2 yr period we assessed 134 patients with leg ulcers of whom 122 were deemed suitable for compression bandaging therapy. Thirty-four patients (28 per cent) were treated by the newly developed community service and 88 (72 per cent) were treated at the hospital clinic. Our overall healing rate for venous ulcers was 50 per cent @ 40 weeks. This probably reflects the long duration (48 per cent > 2 yr) and large size (0.5-600 cm2) of ulcer prior to treatment. There were no differences in outcome between hospital (50 per cent @ 40 weeks) and community (35 per cent @ 40 weeks) based treatment (p > 0.05). We conclude that most venous ulcers can be effectively treated in the community and resources should be provided to achieve this goal.

Adult↗
PubMed2005

The eHealth agenda for developing countries.

Delivering eHealth in developing countries faces different health and socio-economic challenges to the developed one. But, if a global health infrastructure is to evolve, then developing countries need to play their part. So, whilst the context may differ, the localization-globalization of content issues needs to be jointly addressed. In providing robust and affordable connectivity, particularly to rural areas, developing countries can fully exploit the potential of handheld computers and wireless connectivity. Over such an infrastructure new ways of building capacity, both locally and globally, can be supported. Finally, an eHealth infrastructure can support the delivery of healthcare in communities, thereby supporting individuals and community development.

Developing Countries↗
PubMedDate not supplied

Key informants' perceptions of health care for elders at the U.S.-Mexico border.

OBJECTIVE: This study was part of a systematic assessment to gain an understanding of aging in a rural community along the U.S.-Mexico border in Arizona. DESIGN: It used a participatory action research design. Interviews were conducted among key informants (n = 29), including health and social services providers and community leaders. Content analysis focused on identifying common themes and concerns related to elders. RESULTS: Major themes identified were (1) social infrastructure issues, (2) community awareness of health problems, (3) socioeconomic problems, (4) cultural influences on health beliefs, practice, and use of services, (5) image of aging, (6) border issues, and (7) educational needs for service providers. CONCLUSION: Elders living at the border are a particularly vulnerable population with strong cultural affiliations and health disparities. Although the population of elders has been growing at the border, the traditional focus on the health care needs of youth and children has contributed to the neglect of issues facing elders. This study provided community key informants' perspective of aging to community members, policy makers, service agencies, and health care providers for community development. A conceptual framework was developed for educational programs and research projects for health professionals who care for elders at the border.

Aged↗
PubMed2006

Community participation in organising rural general practice: is it sustainable?

OBJECTIVE: We analysed community participation in organising rural general medical practice in order to suggest ways to extend and sustain it. DESIGN: A multisite, embedded case-study design collecting data through semistructured interviews, non-participation observation and a document analysis. SETTING: One remote and two rural communities in Australia. PARTICIPANTS: Community members, GPs, health professionals, government officers and rural medical workforce consultants. RESULTS: High levels of community participation in recruiting and retaining GPs, organising the business model, and contributing to practice infrastructure were evident. Community participation in designing health care was uncommon. Participation was primarily to ensure viable general practice services necessary to strengthen the social and economic fabric of the community. There were factors about the decision-making and partnership processes in each of the communities that threatened the viability of community participation. CONCLUSIONS: We recommend that a concept of community development and explicit facilitation of the processes involved is necessary to strengthen participation, create effective partnerships and ensure inclusive decision-making.

Community Health Planning↗
PubMed1997

The challenge to meet the mental health and biopsychosocial needs of the poor: expanded roles for hospital social workers in a changing healthcare environment.

Despite the absence of coordinated federal health care reform, social workers in hospital settings have opportunities to identify, develop, advocate for, and facilitate access to innovative health care services, resulting in improved capacity to meet the mental health and biopsychosocial needs of the poor and, potentially, reduced hospital costs over time. There are opportunities for expanded roles for social workers in forging better linkages between hospital services and the community, developing an integrated biopsychosocial healthcare delivery system within hospitals and primary care settings, utilizing information systems as tools in an integrated system, and advocating for a client-centered approach to mental health services.

Community Mental Health Services↗
PubMed2005

The evolution of sexual health nursing in Australia: a literature review.

BACKGROUND: The purpose of this paper is to describe and encapsulate the elements of the sexual health nurse's role in Australia. In Australia, sexual health nursing is a fast evolving speciality operating within a climate of diverse role expectations, settings and population groups. Today's health care climate demands that nurses' roles and their impact on patient care be held up to scrutiny. METHODS: A literature review was conducted that used descriptive analysis to elicit the recurrent themes appearing in the Australian sexual health nursing literature that would describe the role. RESULTS: A model of sexual health nursing was evident with the two primary themes of professional responsibility and patient care. The professional role included a philosophy of sharing nursing experiences, collaboration, employment in multiple settings, and the development of the role into advanced practice, appropriate academic and clinical preparation and a commitment to research. The patient care role included the provision of individual and holistic patient care, ability to access specific at-risk groups, clinical effectiveness, patient education and community development roles. CONCLUSION: Australian sexual health nurses make a specific and measurable contribution to the health care system. They are likely to continue to advance their role supported by appropriate research that validates their models of practice, continues their philosophy of sharing their experiences and that documents the impact they have on the health outcomes of individuals and populations.

Australia↗
PubMed1996

Professional development support for community nurses.

This article presents the outline of a programme developed to support quality nursing care and provide professional development for staff nurses in a grade mixed, community nursing team. The initiative has been a joint venture between First Community Health NHS Trust and the University of Wolverhampton, School of Health Sciences, and shows the value of working together to establish a sound underpinning for practice.

Community Health Nursing↗
PubMed1995

Health information networks.

Health information networks could link health care providers throughout the community. Development activities in the United States are varied and numerous. Collaboration is key to the ultimate "network of networks" and is actively fostered.

Community Networks↗
PubMed1992

The causal model approach to nutritional problems: an effective tool for research and action at the local level.

Reported are the results of a case study from Kirotshe rural health district, Northern Kivu, Zaire, where a workshop on the causal model approach to nutrition was organized in 1987. The model has since been used in the field for research design, training of health professionals, nutrition intervention, and community development. The rationale behind this approach is reviewed, the experience accumulated from Kirotshe district is described, and the ways in which the causal model contributes to comprehensive health and nutrition care are discussed. The broad range of possible policy implications of this approach underlines its usefulness for future action.

Child, Preschool↗
PubMed1991

Community care for patients with schizophrenia one year after hospital discharge.

OBJECTIVES: To document the circumstances and care of patients with schizophrenia who had recently been discharged from local psychiatric inpatient services, and to establish the extent to which misgivings about community care might be justified. DESIGN: Cross sectional surveys with review of case notes. Follow up interviews with questionnaires administered one year after discharge. SETTING: Two inner London districts (West Lambeth and Lewisham) with high levels of social deprivation and at different stages of developing community services. PATIENTS: 90 and 50 patients in the two services respectively, aged 18 to 65, who satisfied the Research Diagnostic Criteria for schizophrenia and who were discharged from inpatient services. MAIN OUTCOME MEASURES: Diagnosis elicited by present state examination, global social disability rating, use of services during the three months before interview. RESULTS: 89 of the 140 patients (64%) had been ill for five or more years, yet few were former long stay inpatients. 55% (50/91; 95% confidence interval 45% to 65%) of those interviewed had current psychotic mental states and 22% (27/124; 16% to 31%) were functioning socially at very poor or severely maladjusted levels. 86% (107/124) were unemployed. The majority of patients had seen a mental health or social service professional, yet only 16% (20/124) were in specialised accomodation (excluding hospitals) and only 23% (17/73) of those eligible had used day care. Small numbers of people had experienced homelessness (two) or imprisonment (four over six months). CONCLUSIONS: Many schizophrenic patients leaving local psychiatric inpatient care have active symptomatology and profound social disabilities. Community care was characterised by high rates of contact with service professionals but little supported accommodation or day activity. This group of clients may require dedicated provision, which would actively encourage them to use services protected from the demands of those with less severe illness.

Adolescent↗
PubMedDate not supplied

Charitable care and the nonprofit paradigm.

Nonprofit hospitals have begun to focus once again on serving the health needs of their communities. Governmental needs for additional revenue and for-profit hospitals' contention that tax exemptions give nonprofit hospitals an unfair competitive advantage have resulted in changes in laws and regulations and have caused a change in the role of nonprofit hospitals. As local governments become more responsive to the health needs of their communities, they are requiring nonprofit hospitals to become more responsive as well. Laws, regulations, and court decisions have begun to require nonprofit hospitals to provide charity care and services at levels equal to the amount of their exempt taxes. In response, nonprofit hospitals are developing community benefit programs and public health services.

Community-Institutional Relations↗