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At least 847 records · Page 47Linked to original sources
PubMed2006

Typhoid fever in children: some epidemiological considerations from Karachi, Pakistan.

BACKGROUND: The morbidity of typhoid fever is highest in Asia with 93% of global episodes occurring in this region. Southeast Asia has an estimated incidence of 110 cases/100,000 population, which is the third highest incidence rate for any region. Pakistan falls into this region. There is also a considerable seasonal variation of typhoid fever, carrying significant public health importance. Children are worst affected. Population-based data from Pakistan are scarce. METHODS: From June 1999 to December 2001 a fortnightly surveillance system was established in two squatter settlements in Karachi, Pakistan, with two study centers, each staffed by a doctor and five community health workers. Cases of continuous high-grade fever for three or more days were referred to these centers and screened clinically. Blood culture and Typhidot tests were done. RESULTS: One-third of the 4198 cases with febrile episodes of three or more days detected in the community were screened at the centers; 341 were clinically suspected of having typhoid fever. Forty-nine were positive by culture whereas 161 were positive by serology. Ten cases were multi-drug resistant. Incidence of culture-proven typhoid was estimated to be 170 (95% CI: 120, 220)/100,000 population, whereas serology-based incidence was 710 (95% CI: 620, 810)/100,000 population. Peak incidence was noted in October followed by May and June. CONCLUSION: Passive surveillance, even when augmented by household visits, misses a significant portion of suspected cases. Morbidity of typhoid is quite high in Pakistan and needs public health intervention. Hot months have higher incidence of typhoid. Healthcare behavior studies will help to develop a better surveillance system.

Adolescent↗
PubMed1987

Symptoms associated with common diseases in Saradidi, Kenya.

A community-based malaria control programme was initiated in Saradidi, Kenya. One factor determining the utilization of treatment would be the symptoms felt to be diagnostic of malaria. The 12 most common diseases and 29 most common symptoms were identified by community members. Thirty-six randomly selected women were interviewed to determine association of the common diseases and symptoms; nine women were aged 15 to 29 years, nine women were 30 to 40 years, nine were 45 to 59 years and nine were 60 years or more. Women 60 years and older recognized a higher proportion of the diseases (P less than 0.0005) when compared with the other women of other ages. More than 90% of the women associated headache, fever, vomiting, joint pain, loss of appetite, tiredness and death with malaria. Measles and influenza were distinguished from malaria by rash and mouth ulcer for measles and by 'runny nose' and 'sneezing' for influenza. Analysis by average linkage hierarchical clusters revealed that malaria, influenza and measles were distinguished readily. The results suggest that if people in Saradidi do not obtain treatment from community health workers, it is not because they do not recognize the clinical symptoms of malaria.

Adolescent↗
PubMed1999

Conditions in rural Nepal for which depot-medroxyprogesterone acetate initiation is not recommended: implications for community-based service delivery.

The presence of medical conditions that might affect the use of depot-medroxyprogesterone acetate (DMPA) as a contraceptive method was assessed in a rural district in Nepal. A general health survey was conducted in nonpregnant and noncontracepting women aged 15-44 years to determine the presence of any health problems. The survey included a general assessment interview by nonphysicians, followed by formal medical histories and physical exams by female gynecologists. Possible pregnancy (nine cases) and abnormal uterine bleeding (one case) were the only conditions identified in which DMPA should not be used, based on the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use. Five additional cases of cardiovascular problems, in which DMPA initiation is not usually recommended, were also detected. Recently developed checklists based on the WHO criteria for DMPA use would have identified all of these health conditions. This checklist would allow the safe delivery of DMPA at the community health worker level, and increase the availability and accessibility of DMPA in rural Nepal.

Adolescent↗
PubMed2000

Community care: exploring the priorities of clients, mental health professionals and community providers.

Co-ordinated joint service planning by all stakeholders is widely accepted as a valuable principle in the development of community support services for persons with severe mental illness. Even so, relatively little is known of the views and priorities of the different parties with regard to the elements that should make up the care and support system. This paper reports on a Dutch study in which clients, mental health care workers and community service professionals offered their opinions on what constitutes a support system that enables individuals with long-term mental illness to participate in the community. The results show that the respondents regarded a stable base as an essential prerequisite for the realisation of this objective. Within this general consensus, the clients stressed the importance of advocacy and sheltered meeting places; the mental health professionals emphasised the rehabilitative elements and the representatives of the generic community services felt that the key components in any such system were crisis intervention services and co-ordination at client and system level.

Community Mental Health Services↗
PubMed1997

[Current status of HIV infection in Yunnan Province of China].

In cooperation with the Chinese Academy of Preventive Medicine and Yunnan Province Provincial Office for AIDS Control and Prevention, we studied the current status of HIV infection intravenous drug users (IVDUs) and other high risk groups in Yunnan province of China. As of the end of 1995, 1,807 HIV cases were officially reported (Positive rate was 0.6%), of which 1,278 (77.9%) were IVDUs, and 24 were their spouses. The majority of cases were found among the Dai minority male farmers near Ruili which borders on Myammar, but HIV also appears to be spreading among the Han people. HIV antibody positive rates among commercial sex workers, pregnant women and blood donors were 0.2%, 0.07% and 0.04%, respectively. A system for surveillance of HIV has been developed, but preventive strategies to cope with HIV epidemic are not sufficient. As HIV/AIDS is now a global issue, (1) the integration and coordination of such preventive strategies in cooperation with community health workers, (2) general health education for condom use promotion and (3) care of psychological vulnerable person such as IVDUs, should be developed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Pesticide-related health problems and farmworkers.

1. Migrant and seasonal farmworkers are primarily ethnic minorities who are excluded from federal laws that protect other workers. Farmworkers live and work under substandard conditions that place them at increased risk of pesticide-related illness. 2. Agriculture uses 80% of all pesticides in the U.S. Handlers who mix, load and apply pesticides as well as workers cultivating and harvesting crops sprayed with them are at risk of acute poisoning or even death from their exposures. Drift and run-off of agricultural pesticides pollute the air, soil and water, creating additional hazards to workers' families, community residents, and the environment. 3. Chronic effects, including cancer in adults and children, adverse reproductive outcomes, delayed neuropathy and neurobehavioral effects, are also associated with occupational and environmental exposure to pesticides.

Agricultural Workers' Diseases↗
PubMed2005

Women's health groups to improve perinatal care in rural Nepal.

BACKGROUND: Neonatal mortality rates are high in rural Nepal where more than 90% of deliveries are in the home. Evidence suggests that death rates can be reduced by interventions at community level. We describe an intervention which aimed to harness the power of community planning and decision making to improve maternal and newborn care in rural Nepal. METHODS: The development of 111 women's groups in a population of 86 704 in Makwanpur district, Nepal is described. The groups, facilitated by local women, were the intervention component of a randomized controlled trial to reduce perinatal and neonatal mortality rates. Through participant observation and analysis of reports, we describe the implementation of this intervention: the community entry process, the facilitation of monthly meetings through a participatory action cycle of problem identification, community planning, and implementation and evaluation of strategies to tackle the identified problems. RESULTS: In response to the needs of the group, participatory health education was added to the intervention and the women's groups developed varied strategies to tackle problems of maternal and newborn care: establishing mother and child health funds, producing clean home delivery kits and operating stretcher schemes. Close linkages with community leaders and community health workers improved strategy implementation. There were also indications of positive effects on group members and health services, and most groups remained active after 30 months. CONCLUSION: A large scale and potentially sustainable participatory intervention with women's groups, which focused on pregnancy, childbirth and the newborn period, resulted in innovative strategies identified by local communities to tackle perinatal care problems.

Journal Article↗
PubMed2004

Diabetes is a community issue: the critical elements of a successful outreach and education model on the U.S.-Mexico border.

BACKGROUND: Diabetes is reaching epidemic proportions on the U.S.-Mexico Border, and culturally competent diabetes education is not available in many communities. CONTEXT: People with diabetes often do not have access to regular medical care, cannot afford medication, and lack the community infrastructure that supports self-management practices. Self-management education and support have great potential to impact diabetes control in this environment. METHODS: To address this need, partners of the Border Health Strategic Initiative (Border Health iSI!) collaboratively developed a culturally relevant diabetes outreach and education program. The model included a five-week series of free diabetes education classes that assisted participants in gaining the knowledge and skills necessary to be physically active, control diet, monitor blood sugar, take medications, and be aware of complications. Central to the model was the use of community health workers - or promotores de salud - to conduct outreach, participate in patient education, and provide individual support. CONSEQUENCES: Program participants achieved significant improvements in self-management behaviors and HbA1c, random blood glucose, and blood pressure levels. INTERPRETATION: Quantitative and qualitative evaluation helped to identify the essential elements of a successful program, including partnership of providers, community diabetes classes, promotores outreach and support, linkage between diabetes education and clinical care, and program evaluation.

Community Health Services↗
PubMed2005

Implementation of the Integrated Management of Childhood Illness strategy in Peru and its association with health indicators: an ecological analysis.

The Multi-Country Evaluation of Integrated Management of Childhood Illness (IMCI) Effectiveness, Cost and Impact (MCE) was launched to assess the global effectiveness of this strategy. Impact evaluations were started in five countries. The objectives of the Peru MCE were: (1) to document trends in IMCI implementation in the 24 departments of Peru from 1996 to 2000; (2) to document trends in indicators of health services coverage and impact (mortality and nutritional status) for the same period; (3) to correlate changes in these two sets of indicators, and (4) to attempt to rule out contextual factors that may affect the observed trends and correlations. An ecological analysis was performed in which the units of study were the 24 departments. By 2000, 10.2% of clinical health workers were trained in IMCI, but some districts showed considerably higher rates. There were no significant associations between clinical IMCI training coverage and indicators of outpatient utilization, vaccine coverage, mortality or malnutrition. The lack of association persisted after adjustment for several contextual factors including socioeconomic and environmental indicators and the presence of other child health projects. Community health workers were also trained in IMCI, and training coverage was not associated with any of the process or impact indicators, except for a significant positive correlation with mean height for age. According to the MCE impact model, IMCI implementation must be sufficiently strong to lead to an impact on health and nutrition. Health systems support for IMCI implementation in Peru was far from adequate. This finding, along with low training coverage level and a relatively low child mortality rate, may explain why the expected impact was not documented. Nevertheless, even districts with high levels of training coverage failed to show an impact. Further national effectiveness studies of IMCI and other child interventions are warranted as these interventions are scaled up.

Child↗
PubMed2005

Microcounseling skills training for informal helpers in Uganda.

BACKGROUND: Years of political instability, civil unrest, and disease have left scores of Ugandans in need of mental health services. However, there are few formal mental health services available in the country. Professional helpers such as clergy, teachers, and healthcare workers who have strong ties to their communities are frequently placed in formal counseling roles. AIMS: To develop, implement, and evaluate a training model for developing micro-counseling skills designed specifically for informal helpers in Uganda. METHODS: Forty-four professional helpers were provided with a one-week, 40-hour training program in microcounseling skills. RESULTS: Following the training program, trainees demonstrated proficiency in basic counseling skills and attained an increased knowledge of those skills. CONCLUSIONS: This training was readily assimilated and supported the ecological validity of the microcounseling model.

Adult↗
PubMedDate not supplied

Hobby or job? Mexican female health workers.

A critical analysis of the role and status of female health workers in the primary health care service (PHC) of the Secretary of Health in the Federal District of Mexico is presented. Women are key workers in the health service; however, since the creation of the PHC service, women appear to have been kept in low-pay, low-status jobs. Data from questionnaires and in-depth interviews with female health workers in the Federal District illustrate the situation. Female health workers' status is determined by the structure and operation of the PHC system; by family and personal needs; by the cultural context of Mexican society; and by the fact that some female health workers view their job as a hobby, placing family considerations above career enhancement.

Adult↗
PubMed2006

Does Community-Based Education come close to what it should be? A case study from the developing world: students' opinions.

CONTEXT: There has been an increase in the number of medical schools implementing community-based educational (CBE) programmes. However, there are doubts whether CBE programmes are appropriately implemented. As a case study, the CBE programme of the Medical Faculty of Diponegoro University (MFDU) in Semarang, Indonesia was evaluated. OBJECTIVES: To acquire MFDU's students' opinions on their CBE programme as part of a comprehensive evaluation of that programme, and to generate recommendations for improvement of MFDU's CBE programme. METHODS: Coles and Grant's model for curriculum evaluation was applied. This model recommends triangulation of data generated from comparison of the programme as designed "on paper", as implemented "in action" by the faculty, and "as experienced" by the students. To assess the curriculum as experienced by the students, direct participatory observation was performed and focus group discussions were conducted to collect students' opinions. RESULTS: Students specifically signalled: (1) frequent overlap of lectures given during the CBE clerkship and in the previous part of the curriculum, (2) mismatch between their activities in the community and the community's felt health needs, (3) greater benefits of the CBE programme for Primary Health Care (PHC) centres and students than for target communities, and (4) incidental defective co-operation between students and health providers or community health workers. CONCLUSION: Students' opinions yielded more in-depth information on the CBE programme evaluated and facilitated formulation of recommendations for improvement of that CBE programme.

Community Medicine↗
PubMed1976

Short-term intervention: a model of emergency services for times of crisis.

This paper approaches 'crisis' in system terms. The analysis is applied broadly to organization and community systems, as well as to personality and small-group systems. Based primarily on current developments in Israel, it is written from the viewpoint of a community social worker. Using public health theory, the author develops a model of three distinct types of social service systems: Restorative (traditional), Curative (crisis-intervention in the literature of therapy), and Preventive. He goes on to elaborate both the general characteristics of these service systems and the particular emergency-oriented contribution each can make in times of community-wide crisis.

Adaptation, Psychological↗
PubMed2003

The attitudes of forensic nurses to substance using service users.

There is now a body of research that has shown that the attitudes of nurses towards substance misuse in the mentally ill are generally suboptimal and this has an impact on the quality of nursing care provided. Despite this, to date there have been no published studies that have examined the attitudes of forensic nurses towards substance misusing forensic service users. Sixty-three multiethnic registered forensic psychiatric nurses based on an inpatient unit in outer London were surveyed using the Substance Abuse Attitude Survey (SAAS). This has five subscores: Treatment Intervention, Treatment Optimism, Permissiveness, Non-Moralism and Non-Stereotypes. Only Permissiveness scores were at an optimum level and equivalent to other community mental health workers. The Treatment Intervention and Treatment Optimism subscores were well below those of a multidisciplinary group of community mental health workers. Three other findings were of note. Firstly, women had higher Non-Moralism scores than men. Secondly, staff nurses had higher Non-Stereotypes scores than other grades. Finally, Black nurses had higher Treatment Optimism scores than non-Black colleagues. In conclusion, the attitudes of forensic nurses towards substance misuse in forensic clients are more suboptimal than other groups of community mental health workers. Our findings also indicate that gender, staff grading and ethnicity are associated with suboptimal scores.

Adult↗
PubMed1978

Sexual adjustment of spinal cord injured veterans living in the community.

Data were gathered from interviews conducted by the investigators with 145 spinal cord injured outpatients from the Veterans Administration Hospital, Bronx, NY. The index of Sexual Adjustment was developed based on factors such as adaptation to sexual limitations, partner satisfaction, sexual self-concept, and regularity of sexual contact. The index was correlated with 21 variables permitting a description of significant factors which are related to successful rehabilitation. Higher scores on the index were significantly and positively associated with better physical function, higher level of income, the roles of worker and community participant, higher morale, injury at an earlier age, younger current age, positive attitudes of self-acceptance and independence. Abstinence from sexual relations as a form of adjustment is also considered. Results of this study support the hypothesis that sexual adjustment is related to psychologic, social and physical factors that are relevant for successful rehabilitation. These findings suggest that sexuality is an integral part of the disabled person's personality and behavior and that adjustment to disability includes a sexual dimension.

Adaptation, Physiological↗
PubMedDate not supplied

Primary school teacher as a primary health care worker.

School children (1608) were examined for three items (nails, scalp hairs and teeth) relating to personal hygiene and relevant infective conditions from two sets of villages i.e. one set where primary school teacher was working as primary health care worker (Group I) and the other set where Community Health Volunteer (CHV) was delivering primary health care (Group II). The objective was to evaluate the efficiency of school teachers' role vis-a-vis CHVs' in imparting health education to school children. Out of 1608 school children, 801 belonged to Group I villages and the remaining 807 to Group II villages. From the results, it was evident that children of Group I villages were better with respect to all the items related to personal hygiene and infective conditions excepting scalp infections, where difference was not statistically significant, indicating teachers' superiority over the CHVs' in imparting health education to school children.

Child↗
PubMed1997

Mental health. Sending in the paras.

Community support workers have become a common feature of mental health services. They work mainly with people with severe mental illness and offer intense support. Their need for training should be considered.

Allied Health Personnel↗
PubMed2002

Research capacity in general practice. Opinions from the field.

BACKGROUND: The Primary Health Care Research Evaluation and Development (PHCRED) Strategy includes funding for universities to build research capacity. As part of its implementation, the University of NSW consulted widely with Divisions of General Practice, GPs and representatives from Community Health Services to determine current research capacity. OBJECTIVE: We summarise the results of this consultation, and outline implications for the PHCRED Strategy. DISCUSSION: Divisions reported low research capacity, and welcomed the opportunity to develop it further. GPs with an interest in research were particularly focused on clinical areas, and saw their role in providing patients and collecting data, rather than initiating and developing ideas. Workers in Community Health Services were keen to be involved. There was considerable support and enthusiasm for the concept of capacity building and the activities proposed, despite perceived low levels of research skills. The overall aim of the PHC-RED Strategy may need to be clarified to successfully build on this enthusiasm.

Attitude of Health Personnel↗