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PubMed2000

Public health and the role of the nurse: the need for greater clarity.

There is evidence that public health is currently taking centre stage in the challenge to improve the population's health. This represents a change from the 1980s and 1990s where health promotion was the dominant concept among community nurses. Public health means different things to different people and while nurses have a role to play, there is a need to be more precise about their specific contribution. The creation of public health nursing posts across the UK is contribution to this confusion, as there is little emerging consensus as to what professionals in these posts should do. At present, there does not appear to be a dominant strategy or model of working. A preliminary analysis of job advertisements for public health nursing posts indicates a requirement for a 'supercharged' health visitor to work in a specific area to provide a link between the professional and lay communities. The emphasis is on community development with little on population health. Government policy on public health clearly highlights the important role of nurses in contributing to the public health agenda. The current role and function of public health nursing posts may not allow them to be classed as specialist public health nurses/nursing and to provide educational opportunities for nurses to develop the knowledge and skills which will enable them to work alongside medical and other healthcare colleagues in the pursuit of specialist public health practitioner status.

Community Health Nursing↗
PubMed2003

The development and application of a public health skills assessment tool for use in primary care organisations.

The public health skills assessment instrument described in this paper was developed to provide a key group of UK primary care practitioners (health visitors) with a personal development planning tool and researchers with a robust assessment tool for use in evaluations of innovative local public health programmes. Pilot testing with over 120 practitioners has provided evidence of its reliability and validity as a research instrument as well as yielding useful insights for public health educators, practitioners and policy-makers. Factor analysis confirms 10 core competency domains for health visitors which are remarkably consistent with those recently identified for UK public health specialists, interpreted here as grounds for optimism in the greater co-ordination between strategic and front-line approaches to public health work in primary care. However, results also confirm earlier findings indicating low levels of skill amongst health visitors in tackling health inequalities through interventions such as community development, raising questions about their capability to work effectively in new roles proposed by the Department of Health.

Community Health Nursing↗
PubMed1999

Relieving intermittent claudication: a nursing approach.

Peripheral arterial disease affects at least 10% of adults older than 70 years. Risk factors such as diabetes, hypertension, hyperlipidemia, history of smoking, and genetics increase the incidence of the disease. Intermittent claudication, experienced as calf pain or cramping, is the primary symptom in patients with lower-extremity peripheral arterial disease. Patients with claudication are unable to walk even moderate distances. As a result, they often lead lives that are profoundly restricted. Medical therapeutic options available for patients with intermittent claudication are limited to a small number of medications and walking exercise rehabilitation. Walking exercise training can significantly increase ability and decrease calf discomfort for many patients. Nurses can have a major impact on improving the quality of life of patients with claudication, not only by seeking referrals to established institutional walking exercise programs, but also by helping patients in the community develop a personalized walking program. In this article, a nursing plan of care including short-term and long-term goals is addressed. A case study will illustrate the effectiveness and improved quality of life that an individualized program of walking exercise had for one community-based client.

Activities of Daily Living↗
PubMed2005

Cultivating men's interest in family planning in rural El Salvador.

A pilot project in rural El Salvador tested the integration of family planning into a water and sanitation program as a strategy for increasing male involvement in family planning decison making and use. The organizations involved posited that integrating family planning into a resource management and community development project would facilitate male involvement by diffusing information, by referring men and women to services, and by expanding method choice to include the new Standard Days Method through networks established around issues men cared about and were already involved in. This article examines data from a community-based household survey to assess the impact of the intervention and finds significant changes in contraceptive knowledge, attitudes, and behavior from baseline to endline. Because the differences between baseline and endline are greater than the differences between participants and nonparticipants at endline, the study demonstrates the power of informal networks for spreading information.

Adult↗
PubMed1994

Nursing and empowerment: concepts and strategies.

This paper argues that although there has been an increasing use of the term 'empowerment' in the nursing literature, the word is sometimes employed uncritically and in inappropriate contexts. The origins of the expression in community development work are noted, in an effort to set the activity of empowerment in its political context and to discuss the implications of this for the relative power of health professionals and service users. A distinction is drawn between the meaning of the term at the individual and the community level and an outline strategy is discussed for nurses who may wish to think through what empowering patients or clients will entail.

Authoritarianism↗
PubMedDate not supplied

Using national news events to stimulate local awareness of public policy issues.

Community leaders in Atlanta, GA, the Detroit and Lansing, MI, areas, and San Francisco, CA, participated in a demonstration of techniques to disseminate information and increase public awareness of the recommendations from the Surgeon General's Workshop on Drunk Driving, held in December 1988. Local officials worked with the Public Health Service's Office for Substance Abuse Prevention, of the Alcohol, Drug Abuse, and Mental Health Administration, to educate and inform the public about the workshop recommendations as well as other alcohol-related concerns, and to encourage public involvement in their communities with the issue of alcohol-impaired driving and other alcohol-related concerns. With minimal assistance from Federal agencies and Washington-based health and public interest groups, the communities developed unique approaches to generating local television, radio, and newspaper coverage of an event that had originated as national news. The events demonstrated that, with minimal Federal resources and support, local groups can create media attention in conjunction with national news, and local media events can lead to successful community activism. The techniques can be applied by other community groups to gain sufficient news media attention to encourage the public to organize around issues of common concern.

Accidents, Traffic↗
PubMed1998

Evaluation of primary care futures: a faculty development program for community health center preceptors.

PURPOSE: To assess the impact of a national series of faculty development workshops for community health center preceptors. METHOD: Two hundred and twenty-three community health center preceptors from a variety of disciplines attended one of five workshops conducted in different regions of the country. The workshops emphasized active learning using role-play to provide skills in educational planning, teaching styles, evaluation, and feedback. The preceptors were evaluated before and immediately after the workshop, and again three months later. They were also asked to assess the quality of the workshop. RESULTS: The preceptors demonstrated significant increases in the use of five of seven teaching concepts while analyzing a role-play interaction. In addition, there were significant positive, immediate changes in familiarity with nine of 11 concepts, which were retained for at least three months. The preceptors also reported that they continued to use six of the effective teaching behaviors they had learned three months after the workshop. They were extremely positive in their assessments of the workshops. CONCLUSION: This preliminary study suggests that preceptors from a variety of backgrounds can improve their teaching knowledge and skills by participating in a brief faculty development program that emphasizes active learning.

Community Health Centers↗
PubMedDate not supplied

1992 Ontario Survey of Public Health Nurses: perceptions of roles and activities.

A survey of public health nurses (PHNs) who work in official public health units in Ontario was undertaken to determine whether their perceptions of their roles and activities concurred with a 1990 Canadian Public Health Association report which describes the roles and qualifications of public health nursing in Canada. The survey questionnaire was completed by 1,849 PHNs in all 42 public health units (response rate = 85%). About one tenth of the PHNs reported no activity as a caregiver/service provider. Most PHNs reported being active in the roles of educator/consultant, social marketer, and facilitator/communicator/collaborator. The community developer, policy formulator, research/evaluator, and resource manager/planner/coordinator roles were less frequently performed, however, increased activities in such roles were expected in the future. Nurses said that they needed further preparation to perform the latter roles. These results have implications for deployment of PHNs as Ontario's health system shifts to community health and health promotion.

Community-Institutional Relations↗
PubMed1994

Medical clinics in junior high school: changing the model to meet demands.

PURPOSE: To document the development of an initiative undertaken by the Columbia University School of Public Health to provide medical, mental health, and social services in inner city junior high school-based clinics. METHODS: Review of records, reports, and foundation proposals from 1984-1993. Site visits, interviews with clinic staff, school personnel, and students. RESULTS: Years of planning and community development produced four clinics in the Washington Heights area of New York City, the first school-based clinics located in junior high schools in the country. After seven years, the program has the capacity to serve over 4,000 students who present an overwhelming array of physical, psychological, social, and family problems. Almost 23,000 visits were made to the clinics this year: 49% for medical services, 38% for social services, and 13% for health education. As the demand multiplied, a form of triage was implemented that tracked the highest risk students into intensive individual and group interventions. Primary health screening, mental health services, and pregnancy prevention were identified among the critical needs in this deprived community. CONCLUSIONS: Over the years, the clinics have become integrated into the fabric of the schools. Strategies for working in urban junior high schools must be broad, encompassing medical and mental health services, group counseling, life planning and career orientation, along with enhancement of the total school and learning environment.

Adolescent↗
PubMedDate not supplied

[Factors contributing to the development of community-acquired infections in type-2 diabetics admitted to the Cayetano Heredia National Hospital].

This study aims to identify factors contributing to the development of community-acquired infections in hospitalized type-2 diabetics, using an unmatched case-control design. A total of 105 pairs of diabetic patients with community-acquired infections as compared to non-infectious diseases, respectively, were chosen randomly from the discharge registry of the clinical wards of a teaching hospital from 1991 to 1998. Bivariate and multivariate analysis was conducted with estimation of the adjusted odds ratio. According to stratified analysis controlling for age and sex, autonomic neuropathy proved to be a contributing factor to development of urinary tract infections (OR = 4.07). In the multivariate model, peripheral vasculopathy was isolated (R2: 0.24) as a contributing factor in the development of soft-tissue infections (OR = 6.79). Confidence intervals were significant at 0.05. In conclusion, peripheral vasculopathy and neurogenic bladder contribute to the development of community-acquired infections in hospitalized type-2 diabetics.

Adult↗
PubMed2005

A community-based integrated nutrition research programme to alleviate poverty: baseline survey.

BACKGROUND: The United Nation's Children Fund (UNICEF) has indicated that urban poverty is primarily found in squatter settlements. At present, 13.5% of all South African households live in informal settlements. The main hypothesis for this empirical study was that micromechanisms would not negatively influence food, nutrition and health of residents in an informal settlement in the Vaal Triangle, South Africa. This hypothesis was tested empirically against the UNICEF framework of the immediate, underlying and basic causes of malnutrition. The purpose of this study was to establish a situation analysis of children and women before designing any intervention. OBJECTIVES: The objectives covered in this paper include Phases I and II of the project, namely planning of the project and determining the demographic and health profile of the sample as part of a situation analysis. STUDY DESIGN: This is a community participatory project. After a strategic participatory planning workshop with stakeholders, a plan of operation document, guiding all field undertakings, was drawn up (Phase 1), followed by a cross-sectional baseline survey (Phase II), situation analysis (Phase III), and implementation of community-based intervention studies (Phase IV). Impact measurement will follow in Phase V. METHODS: After the planning meeting and obtaining consent, a pretested, structured demographic and health questionnaire was used to obtain data from 357 randomly selected households in an informal settlement. Data were statistically analysed for means and standard deviations. RESULTS: The findings of the workshop evaluation indicated that 100% of the participants (n = 34) agreed that a need existed for this project, 74% (n = 24) understood the relevance, and 64% (n = 22) realized the importance for sustainable community development. In the baseline survey, 89% of the respondents lived in zinc shacks with two rooms or less (32.2%), three or four rooms (41.5%) or four rooms or more (26.3%). The household size was six people or more (33%), five people (18.5%), four people (21.3%) and three people or less (27.2%). The unemployment rate was 94.2% for respondents and 80.1% for their partners. The majority of households (42.6%) had a monthly income of <R500 (71 US dollars). The major health problems observed were chronic coughing (42%) and headaches (50.4%). Death of a child under 5 years of age was reported by 27.7% of respondents, of which 34.8% were stillborn, over the previous 5 years. CONCLUSIONS: These findings confirmed that poverty and household food insecurity were major problems. As such, these results form the basis for planning and implementing sustainable community-based intervention projects to promote public health nutrition in the Vaal Triangle, South Africa. It is, however, important to ensure community participation during all phases of the project to ensure sustainability.

Community Health Services↗
PubMed2002

Oxidic nanotubes and nanorods--anisotropic modules for a future nanotechnology.

The discovery of carbon nanotubes in 1991 is a milestone in nanomaterials research. Since then, more and more anisotropic nanoparticles have been detected and characterized. The development of nanodevices might benefit from the distinct morphology and high aspect ratio of nanorods and nanotubes as these can be functionalized in unique ways such as incorporation of nanorods in nanotubes. Downscaling a broad range of materials to 1D nanoscopic structures is currently the focus of a rapidly growing scientific community. Developing general pathways to this goal would transfer a wide variety of properties to the nanoscale-a spectrum of phenomena so diverse that it would cover not only inorganic systems but all of materials science. Synthesis of real functional materials, however, always involves considerable synthetic ingenuity, interdisciplinary collaboration, as well as technological and economical realism. The major topic of this review is to provide a survey of recent progress in the synthesis of oxidic nanotubes and nanorods-with their non-oxidic counterparts briefly highlighted-and to outline the major synthetic routes leading to them. With the challenges of synthesizing bulk oxidic materials in mind, the establishment of trustworthy and uncomplicated ways of providing them as anisotropic nano-modules on an industrial scale appears to be more or less serendipity. Of the methods utilized in nanotube and nanorod synthesis solvothermal processes have emerged as powerful tools for generalizing and systematizing controlled syntheses of nano-morphologies. The flexibility and reliability of this synthetic approach is demonstrated here for the transformation of transition-metal oxides into high-quality anisotropic nanomaterials.

Journal Article↗
PubMed2003

Reducing acute poisoning in developing countries--options for restricting the availability of pesticides.

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts.

Acute Disease↗
PubMed2006

Dental health of 5-year-olds following community-based oral health promotion in Glasgow, UK.

AIM: A community development oral health promotion programme based on the principles of the Ottawa Charter was conducted in an attempt to improve the dental health of children under 5 years of age in two severely socioeconomically challenged pilot districts in Glasgow, UK. Later phased extension involved all of the area's most deprived communities. The aim of the present study was to assess dental health outcomes by secondary analysis of routine caries datasets for Glasgow 5-year-olds over the interval from 1997-1998 to 2003-2004. DESIGN: Wilcoxon tests assessed change in d3mft scores and logistic regression was used to analyse binomial scores (e.g. % d3mft = 0). RESULTS: After adjusting for age and deprivation (DepCat) in pilot districts 1 and 2, significant redistributions of the relative frequency of d3mft scores were observed (P = 0.012 and P < 0.001, respectively), mean d3mft decreased from 5.5 to 3.6 and from 6.0 to 3.6, respectively, and the proportions with d3mft = 0 increased from 11% to 29% and from 10% to 32%, respectively [P = 0.010, odds ratio (OR) = 0.25, and P = 0.006, OR = 0.30, respectively, for d3mft > 0]. Following extension of the programme into all of Glasgow's socioeconomically challenged areas, the mean d3mft values of 5-year-olds reduced in all DepCat 7 communities, and across Glasgow as a whole from 4.9 to 4.1 and from 3.5 to 3.1, respectively, while the proportion with d3mft = 0 increased from 20% to 32% (P < 0.001) and from 34% to 42% (P < 0.001), respectively. CONCLUSION: Dental health improvements were observed in pilot districts and across all DepCat 7 communities following the roll-out of the programme. This change was of sufficient magnitude to impact upon area-wide statistics for Glasgow.

Age Factors↗
PubMed1991

Psychologists' role in family-centered approach to practice, training, and research with young children.

Family-centered, community-based, coordinated care for children with special needs is presented as the best practice model for providing services to children and families. Psychologists must learn to play an active role in this frame-work that both integrates psychology with other health and education disciplines and uses the broad spectrum of psychological knowledge about families, development, community organization, and intervention strategies. Key principles of family-centered child psychology affect practice research and training. The psychologist becomes part of a team created to support families as the primary care-givers of their children. Training programs must reorganize the types of experiences both in the classroom and the field to train new psychologists within this model. As mandates for family-centered care affect policies at the state and federal levels, research will remain a critical factor in understanding the effects of these policy shifts on child and family functioning and the delivery of services.

Child↗
PubMedDate not supplied

[Study of diversity of the animal population in zonal climatic gradients using the transect method].

Zonal trends of changes in animal population diversity on land are studied with the models of individual taxa and multispecies communities. Development of the transect method and use of different scale topoecological gradients make it possible to follow the succession of the species composition and topical preferences of individual species, as well as changes in their absolute and relative abundance, which lead to changes in the structure and pattern of functioning of the community as a whole. Modern methodological approaches concerning organization of complex studies on megatransects crossing several natural zones are analyzed. Methods of estimation of inter- and intrazonal changes in the animal population structure and diversity are discussed.

Animals↗
PubMed1979

A simple systems model for community programs.

A simple model for general application to the planning and evaluation of community programs is presented. It is based on a systems approach and consists of seven procedural steps: overview, need assessment, goal-setting, resource organization, action, reviews, and outcome statements. Feedback information is used to correct and improve system performance. Two examples of the model in use are given to illustrate both its application and its generality. These concern the management of individual patients in a community-oriented psychiatric ward program and the organization of a comprehensive community development project. The feature common to these applications is the ability of the model to reduce complex endeavors to a few manageable steps, with no loss of comprehensiveness.

Adult↗