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PubMed2006

Integrating asthma prevention and control: the roles of the coalition.

Activities addressing pediatric asthma are often fragmented. Allies coalitions promoted integration, the alignment of concurrent asthma control activities across and within sectors. Systems integration describes activities from an organizational perspective. Activities included developing a shared vision, promoting consistency in asthma education and self-management support, improving adherence to clinical guidelines, advocating jointly for policy change, and seeking funds collaboratively. Service integration describes activities focused on ensuring seamless, comprehensive services through coordination within and across organizations. Activities included use of community health workers (CHWs) and nurses for care coordination, program cross-referral, and clinical quality improvement. Integration is a sustainable role for coalitions as it requires fewer resources than service delivery and results in institutionalization of system changes. Organizations that seek integration of asthma control may benefit.

Asthma↗
PubMed2002

Integrating quantitative and qualitative methods to assess the impact of child survival programs in developing countries: the case of a program evaluation in Ceara, Northeast Brazil.

In evaluating public health programs, the tradition has been to design quantitative approaches, relying on epidemiological and statistical techniques to determine if and to what extent a program has an effect on a predetermined targeted population. More recently, however, qualitative methods such as rapid ethnographic assessments and focus groups have been implemented more frequently. This article describes an outcome evaluation of a community health workers program that integrated quantitative and qualitative methods to assess the impact of child survival interventions in reducing infant mortality and inadequate weight gain in children among municipalities in the state of Ceara, Northeast Brazil. By using multiple methods that combine quantitative and qualitative components, researchers can broaden their understanding of complex public health issues and direct use of data for decision making.

Adult↗
PubMed1982

Workers' compensation file as a potential source for community diagnosis.

In providing comprehensive care, family physicians may utilize community diagnosis to analyze the needs of their local community. Existing data bases such as Medicaid and workers' compensation can provide an inexpensive source for community diagnosis. This paper compares the data from an in-depth survey of trauma in a rural community with the medical files of the Washington State workers' compensation insurance for the same time period. Only 45 percent of those patients claiming on-the-job injury when initially treated actually appear on medical claim files of workers' compensation. However, when comparing the categorical distributions for type, mechanism, and body part of injury, the two data sets are similar. Thus, workers' compensation files may potentially be useful as a source of data for community diagnosis.

Accidents, Occupational↗
PubMed2006

Recruitment source and behavioral risk patterns of HIV-positive men who have sex with men.

To effectively target HIV prevention activities, community outreach workers need to know how to locate persons at greatest risk for acquiring or transmitting HIV. This study compared the behavioral characteristics of HIV-positive men who have sex with men recruited from different sources: AIDS service organizations, mainstream gay environments, public/private sex environments, and friend referrals. Men recruited from sex environments exhibited the riskiest behavior: more male partners, more likely to have casual sex, more likely to have had unprotected insertive sex with men of HIV-negative or unknown status, less likely to have disclosed serostatus to primary partners, less comfortable discussing serostatus with others, and less feeling of personal responsibility for disclosure. A distinctive group of men, the referral group, did not identify with the gay community and reported sex with men and women. Future efforts should continue to assess the types of people that are recruited from different sources so that program and research efforts can be appropriately targeted.

Adult↗
PubMed1985

Feasibility and efficacy of in-home water chlorination in rural North-eastern Brazil.

The purpose of this study was to assess the feasibility, acceptability and effect of an in-home water chlorination programme in a rural village. Previous studies at this site showed high levels of faecal coliforms in household water, high diarrhoea rates in children, and enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens isolated from patients. Household water came from a pond and was stored in clay pots. No homes had sanitary facilities. A blind, cross-over trial of treatment of household water with inexpensive hypochlorite by a community health worker was carried out over 18 weeks among 20 families. Water in the clay pots was sampled serially, and symptom surveillance was done by medical students. The programme was generally acceptable to the villagers and no change in water use patterns were apparent. The mean faecal coliform level in the chlorinated water was significantly less than in the placebo treated samples (70 vs 16000 organisms/dl, P less than 0.001). People living in houses receiving placebo treatment had a mean of 11.2 days of diarrhoea per year, and the highest rate of 36.7 was among children less than 2 years old. Diarrhoea rates were not significantly different among the participants while exposed to water treated with hypochlorite. We conclude that a low-cost programme of this type, which utilizes community resources, is logistically feasible, appears to be culturally acceptable in this setting, and can result in a marked reduction in water contamination. The lack of effect on diarrhoea rates suggests that improvement in water quality may affect morbidity only when other variables relating to faecal-oral agent transmission are ameliorated at the same time.

Adult↗
PubMedDate not supplied

Mothers' ranking of clinical intervention strategies used to promote infant health.

PURPOSE: To support evidence-based practice for infant health promotion by determining mothers' preferences among eight clinical intervention strategies. METHOD: A sample of 138 mothers of 4-month-old infants who received care through a county health department used a card sort method to rank order intervention strategies and identified advantages and disadvantages of each method. FINDINGS: The mothers' rank ordering of the clinical intervention strategies, beginning with the most preferred, was: 1. Nurse home visitation; 2. Group session with mothers, led by a nurse; 3. Community lay worker home visitation; 4. Classes in the clinic; 5. Health diary; 6. Videotapes at home; 7. Brochures; and 8. Videotapes in the clinic. CONCLUSIONS: Intervention strategies that use interpersonal communication, including the opportunity for mothers to ask questions, were most preferred. Strategies that involve one-way messages to mothers were least preferred. Investment in strategies that do not appeal to mothers are likely be ineffective in promoting infant health and wasteful of health care dollars.

Adolescent↗
PubMed2006

Evolution of multiple disease screening in Keelung: a model for community involvement in health interventions?

OBJECTIVE: Screening for cancer and other chronic conditions tends to be conducted in independent programmes; that is, screening for one disease at a time. The Keelung community-based multiple disease screening programme, developed in Keelung city, Taiwan, is a notable exception. Here, we report on the Keelung programme's ethos and development within the community, focusing on equity of delivery of the service, and community involvement. In addition, we present some preliminary cost-effectiveness analyses of multiple disease screening. METHODS: The Keelung programme offers screening for breast, colorectal and liver cancers, cervical and oral neoplasia, all of which have an evidence base for their efficacy, and for diabetes, hypertension, osteoporosis and hyperlipidaemia, which are of unknown efficacy. We assessed variability of coverage rates of the Keelung Community-based Integrated Screening (KCIS) programme with age and socioeconomic status, availability of facilities for referral of positive screenees, and numbers of community social workers, general practitioners and local hospitals involved in the programme. We also assessed in qualitative terms how the programme interacts with non-health agencies. Finally, we simulated activities and costs for a variety of single- and multiple-disease screening situations. RESULTS: Between 1999 and 2003, coverage increased overall from 14.7 to 34.4%, and increased most dramatically in people aged 60-79 years (from around 30 to 60%) and in those of lower educational status (from around 40 to 70%). There was a significant growth in the involvement of social workers and volunteers in the programme, and an increase in the availability of local diagnostic and care facilities for those screened positive. In addition, there was substantial involvement of non-health agencies in publicizing the programme. In the health economic simulations, compared with no screening, the extra costs to gain an additional life year were estimated as 667 US dollars, 608 US dollars, 4227 and 4789 US dollars for multiple screening with 100% attendance, multiple screening with 70% attendance, single disease screening with 100% attendance and single disease screening with 30% attendance at each programme (i.e. 74% attendance for at least one out of four programmes), respectively. CONCLUSIONS: The innovative design and outreach procedures of the KCIS have led to a growth in delivery of screening services to groups sometimes overlooked (equity), community involvement in health care (participation) and the use of non-health organizations for publicity and health education (collaboration). Simulation studies indicate that multiple disease screening may be more cost-effective than single disease screening.

Adult↗
PubMedDate not supplied

Prevalence of hepatitis B infection in the general population: a rural community based study.

BACKGROUND: Available seroprevalence studies of hepatitis B in Indian population has limitations. A community based door to door epidemiological study was conducted between December 1997 and January 1988 to look for the dynamics of hepatitis B exposure in a single village of West Bengal. METHODS: In all, 960 inhabitants out of 1261 (according to 91 census) in a village of Birbhum district in West Bengal were interviewed and their blood were tested by ELISA for HBV exposure. Odds ratio was calculated to estimate the relative risks for each potential factor facilitating virus transmission. RESULTS: Participation rate in the present study was 76.1%. Over all HBsAg carrier rate was found to be 5.3%. Only 2/51 (3.9%) carriers were HBeAg positive. Injection by glass syringe (odds ratio = 3.01), age < 20 years (odds ratio = 1.41) and male sex (odds ratio = 1.57) were significant risk factor. CONCLUSION: The results of this rural, predominantly poor, agrarian worker based community data reveals a fairly large reservoir of infection (5.3%). It is mainly built-up early in life. Injection practices need to be safer in addition to HBV vaccination to fight this menace.

Adolescent↗
PubMed2001

Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy).

In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Experiences in community participation to promote nutritional education].

This paper presents several experiences obtained in the Rural Research Center of the Solís Valley in relation to community participation programs. The main objective of these projects was to improve the nutritional practices of children in the rural areas of highland Mexico. As first experience, small groups were formed with mothers, fathers, married couples and teenagers. Each of these groups started a project oriented to promote nutritional self-sufficiency. One group of mothers was successful in assuring the provision of government subsidized milk in their community. A second group of mothers started a chicken-raising farm, but the project failed because all the chicken died in an epidemic. The group of fathers started a sheep-raising project as the first step to get a milk-producing cow. The sheep-raising was successful, but when the sheep were sold each man in the group kept the revenue to himself and the group disappeared. The married couples were successful both in a home-gardening project and in a chicken-raising farm. The teenagers were also successful with their home-gardening project and acted as "injection groups" to spread the project in other communities. As a second experience in community participation, community health workers taught mothers how to use locally available food to improve their diets, preparing culturally acceptable food recipes. This intervention was successful in increasing mother's awareness of a balanced diet. A second intervention combined the presentation of a drama ("peasant's theater") in order to increase mother's participation in these projects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Children's healthful eating: from research to practice.

This paper provides a brief overview of some of the challenges facing the world community in promoting the nutrition status of schoolchildren. It begins by describing the main objectives and aims of children's nutrition promotion and then moves to consider the needs and environments of schoolchildren, the purposes of education and food and nutrition promotion, and the domains of schools and teachers. In the second part of the paper the evidence bases for food and nutrition promotion are considered, especially the gaps in current knowledge. This leads to a discussion of useful practice models as well as a case study of a school health promotion program in Australia. The final part of the paper examines some proposals for schoolchildren's food and nutrition policies, which might be implemented in local schools as well as nationally and internationally. The main theme underlying these proposals is that policies must be created and their effectiveness monitored regularly and reported back to schoolteachers, health workers, school communities, and governments.

Adolescent↗
PubMedDate not supplied

Narrowing the gap in health status of minority populations: a community-academic medical center partnership.

A major challenge in the United States is to narrow the gap in the excess morbidity and mortality rates of minority populations. This article presents a synthesis of the 15-year results of a collaborative program between the Johns Hopkins Medical Institutions and an African-American community with the highest rates of premature disease and death in Maryland. The program began with an efficacious disease prevention clinical trial with patients and ended with effective population approaches. We transferred key components to community ownership and formally trained community health workers who provided health promotion counseling, monitoring, linkage, and referral services. Results indicated significant decreases in morbidity and mortality as a result of improved control of hypertension. This program has begun to decrease the health status gap in an African-American population and has demonstrated long-term sustainability. Current joint activities are directed at several major causes of excess morbidity and mortality, including smoking, obesity, hyperlipidemia, and hypertension, and at plans for programs to control diabetes, substance abuse, and breast and cervical cancer.

Black or African American↗
PubMed1987

Community-based malaria control in Saradidi, Kenya: description of the programme and impact on parasitaemia rates and antimalarial antibodies.

A community-based malaria control programme initiated in Saradidi, Kenya in 1982 is described. Antimalarial treatment provided by volunteer community health workers was made available in each village. Malaria was holoendemic. Parasitaemia rates by age were high and did not change after the control programme began. Plasmodium falciparum was the most common species and was present alone or mixed in 98.2% of 8105 infections. Virtually all (98.5%) of 2040 blood samples collected in May 1981 were positive (reciprocal titre greater than or equal to 80) to P. falciparum by the indirect fluorescent antibody (IFA) test. Seropositivity rates to P. falciparum in the IFA test or the enzyme-linked immunosorbent assay (ELISA) were high in all age groups and did not change significantly in longitudinal surveys or in a cohort of children zero to nine years old followed at intervals. While the malaria control programme was successful in bringing treatment to each village, malaria prevalence was not reduced. Parasitologic and serologic studies alone were not adequate to describe the impact of the community-based malaria control programme in Saradidi. Morbidity and mortality rates caused by malaria can decline, significantly improving the health of the population, in the absence of any decrease in parasitaemia rates.

Animals↗
PubMed2004

A community-based asthma management program: effects on resource utilization and quality of life.

OBJECTIVE: The Waianae Coast Comprehensive Health Center (WCCHC) developed an integrated community-based asthma management program in an effort to reduce inappropriate medical utilization and improve quality of life in their pediatric asthma population. METHODS: Over a period of three years, eighty-eight children with asthma participated in the community-based asthma management program. During this time, an automated asthma tracking system was developed, the WCCHC established a standard system of care based on the National Asthma Education and Prevention Program Expert Panel Report Guidelines for the Diagnosis and Management of Asthma (NAEPP Asthma Guidelines) adapted for cultural sensitivity, and a coordinated team care approach was implemented in the asthma management program. RESULTS: During the pilot study, forty children participated in the program. Among these forty individuals, there was a significant decrease in both per capita expenditures and asthma related visits after community health worker (CHW) intervention. Average per capita charges decreased from dollar 735 to dollar 181, Emergency Department (ED) visits decreased from 60 to 10, and the overall asthma related visits decreased from 1.5 to 0.25 per person after the initial CHW encounter. These results were replicated during the 2000-2001 intervention period where average per capita charges decreased from dollar 310 to dollar 129 and ED encounters dropped from 32 to 10 after the first CHW encounter. In addition, the number of high utilizers-defined as those presenting to the ED two or more times for asthma-related diagnoses- sharply decreased from 176 in 1998 to only 16 in 2001. Quality of life improved, with 72% fewer nighttime and 96% fewer daytime symptoms reported after CHW intervention during the pilot study. During the year 2000, symptoms during exercise and asthma related doctor visits decreased 59% and 67% respectively after CHW intervention. CONCLUSION: The community-based asthma management program demonstrated success in improving utilization patterns and reducing asthma-related expense among program participants. Improvement was also noted in quality of life as expressed through frequency and time of asthma symptoms. Other health care institutions may also be positively impacted by developing multidisciplinary team implemented, culturally-adapted, and scientifically-based disease management programs.

Asthma↗
PubMed1997

Long-term oral supplementation with iron is not harmful for young children in a poor community of Bangladesh.

The effect of long-term oral iron supplementation on morbidity due to diarrhea, dysentery and respiratory infections in 349 children, aged 2-48 mo, living in a poor community of Bangladesh, was evaluated in this double-blind study. The treatment group received 125 mg of ferrous gluconate (15 mg elemental iron) plus multivitamins and the controls received only multivitamins, daily for 15 mo. House-to-house visits were made on alternate days by trained community health workers for recording symptoms and duration of illnesses and for monitoring medicine intake. Seventy-six percent of the children continued the syrup for over 1 y. No untoward effects were noticed in either treatment group. The attack rates for diarrhea, dysentery and acute respiratory tract infections (ARI) were 3, 3 and 5 episodes per child per year, respectively. Each episode of diarrhea lasted a mean of 3 d, and those of dysentery and ARI, 5 d. The two treatment groups did not differ in the number of episodes, mean duration of each episode, or total days of illnesses due to diarrhea, dysentery and ARI. However, a 49% greater number of episodes of dysentery was observed with iron supplementation in a subset of the study children who were less than 12 mo old (P = 0.03). The results of this study suggest that long-term oral iron supplementation is not harmful for older children in a poor community. Further studies are needed to demonstrate the safety and efficacy of iron administration in young infants.

Administration, Oral↗
PubMed1998

Montserrat. Managing health care in a volcanic crisis.

The volcano on Montserrat, after being dormant for over 400 years, has been active for the past two years, last erupting on 27 June, 1997. With the capital, Plymouth, in the unsafe zone, major dislocation of people, facilities and services has occurred. The Health Department is splintered over five sites across an eight mile span and the temporary 30 bed hospital, sited at a primary school, is separated from its Casualty and Out-patient Department and Operating Theatre by 0.25 mile. In order to maintain continuity of care for communities, efforts have been made to keep evacuated clients and their community health workers as close together as possible. The mass emigration has depleted the health services, creating severe stress for those remaining. Elderly relatives have frequently been left behind, necessitating the establishment of special geriatric care facilities to cater to their needs. Increased and continuous health surveillance and mass media education have been integral to the prevention of major disease outbreak--particularly with added challenges to food safety, and management of liquid and solid waste disposal. Cooperation from neighbouring states, particularly Antigua, Barbados and Guadeloupe, as well as from the United Kingdom, has been critical in the management of the continuing crisis.

Aged↗
PubMed1998

[Chagas disease in the central region of Honduras: knowledge, beliefs, and practices].

From November to December 1991 and in March 1993 a survey was conducted in 17 rural communities located in Central Honduras. The communities belonged to two areas where Chagas' disease is endemic. In one of them, disease control activities had been conducted. A total of 849 adults, one in each of an equal number of households, was interviewed. The objective of the survey was to investigate and compare in both locations knowledge about Chagas' disease and its routes of transmission, measures aimed at avoiding the presence of triatomines within households, beliefs surrounding the vector and its control, and the population's sources of information about the disease. A 23-item questionnaire was tested and precoded. Almost 100% of the subjects who were surveyed were able to identify the vector and to describe its habits, but only 30.1% knew that Triatoma is the vector for the disease and only about 6% associated it with a chronic heart condition. Around 47.9% of survey subjects indicated that eliminating triatomines from households is a personal responsibility, although 78% identified as the control measure the institutional application of insecticides. Personal contact between a health worker and community members was the chief source of information for those who mentioned having heard of Chagas' disease (41.0%). These results suggest that health education should be included as a component in the planification of control programs. The role played by triatomines in disease transmission should be emphasized, as well as the importance of carrying out household improvements, with community participation, as an effective and sustainable measure. To achieve greater impact, this component should be developed through interpersonal communication channels.

Adult↗
PubMed2003

Upper airway irritation, odor perception and health risk due to airborne chemicals.

Chemosensory irritation associated with the manufacture and use of volatile materials has been a public and employee health concern for many years. Because odor properties can often be detected at much lower concentrations than those capable of eliciting upper respiratory tract irritation, confusion between odor and irritation coupled with variability in odor sensitivity and response can produce significant obstacles for evaluating the potential for adverse effects or annoyance from worker and community exposures. Although rigorous research methods have been developed to accurately quantify chemosensory irritation in human evaluations, several important considerations should be included in the design and interpretation of such studies. Specifically, research studies evaluating chemosensory irritation from volatile materials should be capable of (1) distinguishing between the annoyance or concern elicited by odor sensation and that elicited by true sensory irritation, (2) evaluating exposure-related factors that affect odor or irritancy responses, and (3) separating true adverse health effects from those mediated via psychosocial factors. Objective measures of upper respiratory tract irritation onset obtained in conjunction with subjective reports can lend valuable input to the decision process for determining occupational exposure limits. Subjective reports of irritation at low levels that cannot be reconciled with objective measures should prompt a careful investigation into the other factors (e.g. cognitive or emotional) that may be modulating the sensory response. Distinguishing between the exposure that elicits local effects of sensory irritation in the upper respiratory tract and the exposure that elicits self-reports of irritation is a key component in establishing occupational exposure limits that are protective of exposed workers.

Air Pollutants↗