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PubMedDate not supplied

Case management: a source of support and stability for the client and the healthcare system.

This article is updated from a series written to introduce a Japanese audience to case management after the enactment of Japan's Long Term Care Insurance Acted in 2000. This act includes a provision for care management, and its anticipation resulted in the creation of a new professional called 'care manager' or 'kaigo shien senmon in.' The series was published last summer in Quality Nursing: The Japanese Journal of Research and Scholarship. The article presents the role of the case manager in the United States including background, definition, and functions of assessment planning, implementation, coordination, monitoring, and evaluation. Benefits of case management to the consumer, providers, payors, and the system are discussed. New directions for case management discussed include working with Community Health Workers to reach culturally diverse populations, population health management case management for long-term care populations, and direct contracting. The article is accompanied by a sidebar, which discusses case management as a linchpin, or central cohesive element that enhances the work of other health system components.

Case Management↗
PubMed2005

Use of multiple opportunities for improving feeding practices in under-twos within child health programmes.

OBJECTIVES: In a community randomized trial, we aimed to promote exclusive breastfeeding and appropriate complementary feeding practices in under-twos to ascertain the feasibility of using available channels for nutrition counselling, their relative performance and the relationship between intensity of counselling and behaviour change. We also assessed whether using multiple opportunities to impart nutrition education adversely affected routine activities. METHODS: We conducted a community randomized, controlled effectiveness trial in rural Haryana, India, with four intervention and four control communities. We trained health and nutrition workers in the intervention communities to counsel mothers at multiple contacts on breastfeeding exclusively for 6 months and on appropriate complementary feeding practices thereafter. The intervention was not just training health and nutrition workers in counselling but included community and health worker mobilization. FINDINGS: In the intervention group, about 32% of caregivers were counselled by traditional birth attendants at birth. The most frequent sources of counselling from birth to 3 months were immunization sessions (45.1%) and home visits (32.1%), followed closely by weighing sessions (25.5%); from 7 to 12 months, home visits (42.6%) became more important than the other two. An increase in the number of channels through which caregivers were counselled was positively associated with exclusive breastfeeding prevalence at 3 months (p = 0.002), consumption of milk/cereal gruel or mix use at 9 months (p = 0.004) and 18 months (p = 0.003), undiluted milk at 9 months (p<0.0001) and 24 hour non-breast-milk energy intakes at 18 months (p = 0.023), after controlling for potential confounding factors. Intervention areas, compared with the control, had higher coverage for vitamin A (45% vs. 11.5%) and iron folic acid (45% vs. 0.4%) supplementation. CONCLUSIONS: Using multiple available opportunities and workers for counselling caregivers was feasible, resulted in high coverage and impact, and instead of disrupting ongoing services, resulted in their improvement.

Breast Feeding↗
PubMed2004

Injection practices in Burkina Faso in 2000.

BACKGROUND: Unsafe delivery and overuse of injections can result in the spread of hepatitis B virus, hepatitis C virus, and HIV. The aim of the present survey was to estimate the frequency of safe injection practices in Burkina Faso. METHOD: Using the new standardized World Health Organization tool to assess injection practices, we selected 80 primary health facilities with a two-stage cluster sampling method, collected information using structured observations and provider interviews, and analyzed the data using Epi-Info software. RESULTS: We observed 116 injections in 52 facilities. In 50 facilities [96%; 95% confidence interval (CI) 85-99%] injections were given with a new, single-use syringe and needle. In 29 facilities (56%; 95% CI 36-74%), staff recapped needles using two hands. All 80 facilities visited had a stock in the community to provide new, single-use syringes and needles. In 61% (95% CI 54-79%) of facilities, staff reported needlestick injuries in the last 12 months. Used needles were discarded in open containers in 66 facilities (83%; 95% CI 55-96%) and observed in the surroundings of 46 facilities (57%; 95% CI 32-80%). CONCLUSIONS: In 2000, most of the health facilities in Burkina Faso were using sterile injection equipment. However, practices were still observed that could expose patients, health care workers, and communities to risks, and that required specific interventions.

Burkina Faso↗
PubMed1999

Community care. Flexible friends.

A scheme that trains students to become part-time community support workers to people with mental health problems has proved popular with clients. A third of the carers had felt unsafe on at least one occasion and the service requires a high level of supervision. Professionals considered the service particularly useful for clients who felt isolated, and those at risk of self-neglect.

Community Mental Health Services↗
PubMed1996

Methodological issues for eliciting local signs/symptoms/illness terms associated with acute respiratory illnesses.

Acute respiratory infections (ARI) are among the principal causes of mortality of children under 5 years of age. Most deaths are due to pneumonia, which, when timely identified and properly treated, could be avoided. An effective case management scheme, based on early recognition of pneumonia and prompt antibiotic treatment, relies on early recognition of alarm signs by mothers and community health workers. For mothers to understand and act on advice from health workers, language and concepts commonly used by mothers should be utilized. The present study was carried out to compare the relative effectiveness of two different methods to elicit local terms used by mothers to refer to ARI symptoms/signs/treatments. A comparison was made among the terms elicited by a free listing of common terms mentioned by mothers in relation to ARI, and the terms they recognized when looking at a video that showed children with different ARI signs. The video was shown in a community and a clinical setting, in order to identify strengths and weaknesses of showing it in these settings. The video elicited more signs dealing with serious illness, respiratory distress and general malaise, but missed non-visual signs, such as fever, lack of appetite or pain. Also, mothers tended to be distracted by trivial signs, such as skin color. Free listing was easier to administer and elicited more non-life-threatening symptoms/signs, but mothers were more prone to drift away and mention terms not related to respiratory illness. Showing the video in the clinic elicited more medical-related terms, and was easier to show than in the community. In conclusion, choice of either of the two methods depends on the researcher's purpose. Using both methods produced a larger list of terms associated with ARI.

Academies and Institutes↗
PubMed2006

A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods.

BACKGROUND: Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 2000-2004 and the effects and possible interactions between the public health interventions in use. METHODS: This study employed cross-sectional survey to collect data from households, community and health facilities on coverage and usage of Insecticide-Treated Nets (ITNs), Indoor Residual Spraying (IRS), larvicidal activities and malaria case management. Comparative data was obtained from a similar survey carried out in 2001. Data from the Health Management Information System (HMIS) and reports of the annual assessments by the National Malaria Control Programme was used to assess impact. Time series model (ARIMA) was used to assess association. RESULTS: In the period 2000-2004, approximately 874,000 ITNs were distributed and 13,109 health workers and community health agents were trained on malaria case management. In 2004, approximately 81% households owned at least one net, of which 73% were ITNs and 58.6% of children 0-5 years slept under a net. The proportion of malaria cases managed by community health agents rose from 50% in 1999 to 78% in 2004. IRS coverage increased with the combined amount of DDT and Malathion used rising from 6,444 kg, in 2000 to 43,491 kg, in 2004, increasing the population protected from 117,017 to 259,420. Drug resistance necessitated regimen change to chloroquine plus sulfadoxine-pyrimethamine. During the period, there was a steep decline in malaria morbidity and case fatality by 84% and 40% respectively. Malaria morbidity was strongly correlated to the numbers of ITNs distributed (beta = -0.125, p < 0.005) and the amount (kg) of DDT and Malathion used for IRS (beta = -2.352, p < 0.05). The correlation between malaria case fatality and ITNs, IRS, population protected and annual rainfall was not statistically significant. CONCLUSION: Eritrea has within 5 years attained key Roll Back Malaria targets. ITNs and IRS contributed most to reducing malaria morbidity.

Adult↗
PubMed1976

The use 0f two-way TV in bringing mental health services to the inner city.

The authors describe a cable TV link between a medical school and a child health station in East Harlem. Nurse associates and community health workers trained through television conferences with a child psychiatrist have the primary responsibility for patient care at the clinic. Patients and their mothers are evaluated by the child psychiatrist in TV consultations at which nurse associates, health workers, medical students, and child psychiatric fellows are present. Patients and mothers respond positively to the system, and a high percentage of the psychiatrist's treatment recommendations are accepted. The authors suggest that such TV links can increase mental health services to underserved inner-city children.

Allied Health Personnel↗
PubMed1991

Tuberculosis, poverty, and "compliance": lessons from rural Haiti.

Tuberculosis (TB) is the leading cause of death among rural Haitian adults, and TB control in Haiti is widely acknowledged to be a failure. The causes of both the endemicity of TB and the failure of attempts to address it are briefly reviewed before data from a study conducted in rural, central Haiti are presented. Members of one group of patients with active TB were given free medical care; members of a second group were given free care as well as financial aid, incentives to attend a monthly clinic, and aggressive home follow-up by trained village health workers. Comparing the two groups shows significant differences in mortality, sputum positivity after 6 months of treatment, persistent pulmonary symptoms after 1 year of treatment, average amount of weight gained, ability to return to work, and cure rate. The roles of human immunodeficiency virus and cultural factors are also examined. When adequate nutrition and access to free care were assured, drug-dependent and patient-dependent factors were shown to be of secondary importance in determining treatment outcome. Based on these data from a small, community-based TB-control project, the authors conclude that high cure rates can be achieved if the primacy of economic causes of TB is acknowledged and addressed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Ecological theory in practice: illustrations from a community-based intervention to promote the health of recent mothers.

We present a qualitative case study where we used four principles of ecological theory from community psychology as a template to assess the dynamics about how a preventive community intervention was transacted in eight communities in Victoria, Australia. The principles were cycling of resources, interdependence, adaptation, and succession. Ecological thinking focuses on key resources in communities. That is, the people, events, and settings that are the foundations of thinking about communities as systems. The data set consists of field diaries kept by and serial interviews with nine community development workers over a 2-year period. We found that the analysis highlighted a process-oriented way of representing the intervention, one that sees beyond the intervention's technical components (or packaged elements) to the complexities of the cultural and political change processes occurring beneath. The value of this is the attention focussed on likely project sustainability.

Community Networks↗
PubMedDate not supplied

Translational research principles of an effectiveness trial for diabetes care in an urban African American population.

PURPOSE: Large-scale effectiveness trials designed to translate evidence-based diabetes care to community settings are few. Studies describing these methods among high-risk minority populations are particularly limited. METHODS: The authors describe Project Sugar, a randomized controlled trial conducted in 2 phases: Project Sugar 1 (1994-1999), which piloted a 4-arm clinic and home-based intervention using nurse case management and community health workers in 186 urban African Americans with type 2 diabetes, and Project Sugar 2 (2000-2005), which examined effectiveness of this intervention among 542 diabetic, urban African Americans. Results and Conclusions Project Sugar had success with regard to recruitment and retention, both in phase 1 (80% rate at 24 months) and phase 2 (>90% at 24 months). Using the RE-AIM framework, planning and research design for Project Sugar 2 is described in detail for elements that contributed to the reach, effectiveness, adoption, implementation, and maintenance of this study within a minority community setting. In addition to successful strategies, challenges to conducting effectiveness trials in an inner-city African American community are identified.

Black People↗
PubMed1980

Village-based distribution of oral rehydration therapy packets in Bangladesh.

The distribution of sucrose-electrolyte oral therapy packets (1 liter) by community-based workers in a rural Bangladesh population of 157,000 was evaluated. A similar population of 134,000 served as a comparison group. The locally-produced packets showed satisfactory chemical composition with a shelf-life of up to 3 months and a cost of U.S. $0.05. After 4 months the workers were distributing an average of 70 packets/1,000 population per month. Most patients used one packet for each episode of diarrhea; 13% of children used two packets, and 15% and 8% of adults used, respectively, two and three packets. The electrolyte composition of the oral fluids prepared by field workers and mothers showed substantial variation, but no hyperconcentrated solutions were noted. A comparison of the hospitalization rate from the two study areas suggested a 29% reduction in hospitalization for diarrhea during the 4 months of distribution.

Administration, Oral↗
PubMed2006

Using participatory research to build an effective type 2 diabetes intervention: the process of advocacy among female Hispanic farmworkers and their families in Southeast Idaho.

The Formando Nuestro Futuro/Shaping our Future project (herewith, Formando) is a community-based participative research (CBPR) focused on type 2 diabetes. It was conceptualized and designed by a team of university-based researchers and community health workers (promotores). This article describes the process of establishing a CBPR project such as Formando and the most current results from that project. The Formando project is an example of health-focused advocacy with the Mexican agricultural workers in Southeast (SE) Idaho. To date, 172 qualitative interviews on participants' knowledge about type 2 diabetes have been carried out with farmworker women and their families. Biometric data (heights, weights, blood pressures and fasting blood glucoses) were obtained from participants. Fieldnotes, focus group discussions and key informants were used to triangulate findings. Significant quantitative findings include that age was significantly associated with Body Mass Index (BMI) (p < 0.001, Spearman Correlation < 0.001) and with elevated fasting blood glucose (p < 0.001, Spearman Correlation < 0.001). The qualitative interviews were thematically analyzed. Key themes associated with type 2 diabetes in this community were the connection between thinness and vanity, dieting and starvation and the onset of diabetes as a result of, what social scientists call, structural violence within the immigrants' daily lives. We conclude that long-term commitment to using the CBPR approach in these Mexican agricultural communities is an effective way to engage in health research and to establish real and meaningful dialogue with community members.

Adult↗
PubMed2003

[Severe acute respiratory syndrome in Guangdong Province of China: epidemiology and control measures].

OBJECTIVE: To explore epidemiological features and risk factors of severe acute respiratory syndrome (SARS) in Guangdong Province of China, so as to work out effective strategies for its better control. METHODS: A total of 1 511 clinically confirmed SARS cases in Guangdong Province of China from November 16, 2002 to Jun 15, 2003 were retrospectively analyzed. RESULTS: The first SARS case was identified in Foshan municipality on November 16, 2002, followed by 1 511 clinically confirmed cases (including 58 deaths) up to May 15, 2003. Of all cases, health care workers and community family cluster cases accounted for 19.38% and 12.04%. 65.86% SARS patients aged 20 - 49 years, and increased incidence was positively related to their ages. 95.97% cases lived in the following five cities around Pearl Delta Area: Foshan, Guangzhou, Shenzhen, Zhongshan, and Jiangmen. Eleven early reported cases in the communities took animal-related positions. Face-to-face contacts with infected droplets were the main transmission route. An epidemic peak occurred during January 28 to February 26, and those cases accounted for 50.69% of total. Incidence, mortality, and case fatality of SARS were 1.77/100,000, 0.07/100,000, and 3.84% respectively. The mean incubation period was 4.5 days. CONCLUSION: The most effective way to control SARS is to break the chain of transmission from infected to healthy persons-early identification, prompt and effective isolation, and vigorous close contact tracing. Hospital infections among health care workers is critical. Several observations support the hypothesis of an animal origin for the disease.

Adolescent↗
PubMed1996

Widespread HIV counseling and testing linked to a community-based tuberculosis control program in a high-risk population.

The aim of the work reported here was to evaluate community-wide screening for HIV infection that was linked to a tuberculosis control program in a population at high risk for both infections. Between May 1990 and August 1992, adults in Cité Soleil, Haiti, were recruited by community health workers at their homes and in clinics for individual, clinic-based counseling and testing for HIV and tuberculosis. All of the screened subjects were offered post-test HIV counseling. Those with active tuberculosis received treatment, while those with latent tuberculosis and HIV infection were offered an opportunity to participate in a trial of antituberculosis chemoprophylaxis. The 10,611 individuals screened for HIV represented 10.0% of the adult population in Cité Soleil. HIV infection was detected in 1,629 (15.4%) and active tuberculosis in 242 (2.3%). Latent M. tuberculosis infection was found in 4,800 (67.5%) of 7,309 community residents who completed tuberculosis screening, 781 (16.3%) of whom were coinfected with HIV. The high prevalence of HIV infection found in this screened population, as compared to other groups undergoing HIV screening in the same community, suggests that people at high risk for HIV infection selectively sought or accepted tuberculosis clinic screening. Also, many people with active tuberculosis were identified earlier in the course of their disease than they would have been in the absence of a screening program. Overall, the results indicate that community-based screening for HIV infection within a tuberculosis control program can result in effective targeting of screening for both infections.

Adolescent↗
PubMed1991

Assessment of knowledge and skills about growth monitoring amongst multipurpose workers in an ICDS project.

Knowledge and skills amongst 34 multipurpose workers working in an ICDS project about growth monitoring was assessed using interview technique. All workers had correct knowledge about rationale of growth monitoring. A total of 73.5% and 94.1% had knowledge that flattened growth curve indicates no weight gain and descending growth indicates decrease in weight, respectively.

Body Weight↗
PubMed2006

Caseworkers' perceptions of the mental health information needs of persons living with HIV/AIDS.

This qualitative study was the first phase in designing a computer system that provides interactive tailored interventions for management of depressive symptoms in HIV-infected individuals (HIV TIDES). The purposes of the study were to explore caseworkers' perceptions of the mental health information needs of persons living with HIV/AIDS (PLWHA), barriers of accessing mental health information, and possible solutions to fulfilling PLWHA's mental health information needs. A focus group methodology was used to gather perceptions from six experienced community-based workers who provided direct case management services for PLWHA in East Harlem, New York. Data were classified into four main categories: mental health information needs, information sources for mental health concerns, barriers to accessing mental health information, and need for mental health interventions. The results of this study were used to inform the design of HIV TIDES.

Allied Health Personnel↗
PubMed2006

Reducing the risk of sexual abuse for people who use augmentative and alternative communication.

To date little attention has been focused on the sexual abuse experiences of people who use augmentative and alternative communication (AAC) and on addressing ways to reduce their risk for this type of abuse. This paper describes the results of a 3-year project that aimed to: (a) learn about the sexual abuse experiences of people who use AAC; (b) provide educational forums and resources on topics relating to sexual abuse for adults who use AAC; (c) define implications in risk reduction for various community service workers who support people who use AAC (e.g., attendant service providers, abuse counselors, sexual health educators, police, victim assistance services, legal professionals, and health care professionals); and (d) make recommendations to parents, educators, service providers, and consumer advocacy organizations about their roles in reducing the risk of abuse for youth and adults who use AAC. The findings suggest that the majority of participants in this project have experienced a range of abuses including sexual abuse, lack information about healthy and abusive relationships, have no way of communicating about sexuality and abuse, and lack supports in their personal lives and from within the community-at-large that are necessary to cope with relationship difficulties and specifically problems associated with abuse and justice system services. These findings and implications are shared with the intent of highlighting the need for more research and attention to the issue of abuse prevention for people who use AAC.

Adult↗
PubMed1983

Effects of grain dust exposure and smoking on respiratory symptoms and lung function.

In four groups of individually-matched subjects (nonsmoking grain workers, smoking grain workers, nonsmoking community controls, and smoking community controls) we measured pulmonary function variables from the spirogram, from the maximal expiratory flow-volume curve breathing air and helium, and from the single breath nitrogen test as well as symptom prevalences from a questionnaire in order to assess the relative effects of smoking and occupational exposure to grain dust in Saskatchewan country grain elevators. There were similar increased prevalences of respiratory symptoms and reductions in pulmonary function associated with either grain dust exposure or smoking, but the effects of smoking were slightly more pronounced. The combined effects of grain dust and smoking on lung function appeared to be additive except in the least exposed workers (five years or less) where a synergistic effect was observed in tests of peripheral airways dysfunction.

Adolescent↗