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PubMed1994

Hunger in California: what interventions are needed?

OBJECTIVE: Although research exists on the nutritional status of individuals and families who seek emergency food, there is little guidance on what to do about it. Our purpose was to develop effective nutrition interventions to assist individuals and families seeking emergency food. DESIGN AND SUBJECTS: Two survey instruments were used to collect data on 697 emergency food providers and 3,365 emergency food clients in 20 California counties between 1986 and 1990. STATISTICAL ANALYSES PERFORMED: Data were analyzed using the Statistical Package for the Social Sciences. RESULTS: Information from the food providers who staff the emergency food sites revealed insufficient food to meet the growing demand, client difficulties in using the donated food, and the need for information to improve the safety and nutritional quality of the donated food. Information from the emergency food clients documented that 70.4% of them were families with children, 84% had incomes below the poverty level, and 20% reported no income at all. In addition, most clients (70%) were not enrolled in the food stamp program. APPLICATIONS/CONCLUSIONS: In response to the surveys, counties initiated a variety of interventions, including public awareness campaigns, community development activities, and nutrition education programs. Important strategies are to teach recipients ways to optimize food resources, encourage eligible individuals to enroll in federal nutrition programs, and link individuals with agencies that offer assistance.

California↗
PubMed2006

PRISM (Program of Resources, Information and Support for Mothers): a community-randomised trial to reduce depression and improve women's physical health six months after birth [ISRCTN03464021].

BACKGROUND: In the year after birth one in six women has a depressive illness, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support, more negative life events, and poorer physical health and see factors contributing to depression as lack of support, isolation, exhaustion and physical health problems. Fewer than one in three seek help in primary care despite frequent health care contacts. METHODS: Primary care and community-based strategies embedded in existing services were implemented in a cluster-randomised trial involving 16 rural and metropolitan communities, pair-matched, within the State of Victoria, Australia. Intervention areas were also provided with a community development officer for two years. The primary aim was to reduce the relative risk of depression by 20% in mothers six months after birth and to improve their physical health. Primary outcomes were obtained by postal questionnaires. The analysis was by intention-to-treat, unmatched, adjusting for the correlated nature of the data. RESULTS: 6,248 of 10,144 women (61.6%) in the intervention arm and 5057/ 8,411 (60.1%) in the comparison arm responded at six months, and there was no imbalance in major covariates between the two arms. Women's mental health scores were not significantly different in the intervention arm and the comparison arm (MCS mean score 45.98 and 46.30, mean EPDS score 6.91 and 6.82, EPDS > or = 13 ('probable depression') 15.7% vs. 14.9%, Odds ratio(adj) 1.06 (95% CI 0.91-1.24). Women's physical health scores were not significantly different in intervention and comparison arms (PCS mean scores 52.86 and 52.88). CONCLUSION: The combined community and primary care interventions were not effective in reducing depression, or in improving the physical health of mothers six months after birth.

Adult↗
PubMed1992

Nosocomial colonisation and infection in a paediatric respiratory intensive care unit.

A study of the prevalence of nosocomial colonisation and nosocomial infection (NI) was conducted in the paediatric respiratory intensive care unit of a large teaching hospital serving a developing community. Surveillance specimens were collected regularly from 63 consecutive patients admitted over 4 months, and also from professional staff, boarder mothers, cleaners and the unit environment. The incidence among patients of colonisation (40%) and of NI (43%) was high. The risk of dying in children with NI was appreciably increased (relative risk 2,241, confidence interval 0,591-8,503). This did not reach statistical significance, probably because so few children escaped acquiring hospital organisms. The significant risk factor for acquiring colonisation (P = 0.008) and NI (P < 0.0001) was a ward stay of more than 10 days. In addition, for acquiring NI an age of under 6 months was also predictive (P = 0.0298). The nature of the primary illness dictated the time spent in the ward; an important proportion of patients had preventable diseases, such as measles, pneumonia and tetanus, which required prolonged treatment. All children with endotracheal intubation had hospital-acquired organisms in tracheal aspirates. Eighty-two per cent of children developed positive gastric aspirates, 17% a positive urine culture and 11% a positive blood culture. Colonisation occurred rapidly; organisms initially appeared in gastric aspirates (mean 2 days), then in tracheal aspirates (mean 5 days) and urine cultures (mean 10 days). The acquired organisms, many of which were antibiotic-resistant, were almost exclusively enteric Gram-negative bacilli (GNB) and Staphylococcus aureus.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗
PubMed1987

Primary prevention of psychiatric disorders.

After a general discussion of factors involved in primary prevention of mental disorders, a case is described where community intervention aiming at reversing a process of social disintegration seemed to reduce the prevalence of anxiety and depression. Further experience with community development as an activity integrated into the functioning of a mental health centre is described. It was possible to encourage the growth of social networks that in turn led to several sustained organizations for self help and mutual aid. Even if this is promising from a preventive point of view, the effect upon mental health is not known. Repeated epidemiological studies in the area show a very stable prevalence level over time with high degree of chronicity and few new cases. This means that change in prevalence over a limited period of time only to a very small degree can be caused by primary prevention.

Adaptation, Psychological↗
PubMed2001

A review of annual growth screening in Aboriginal schoolchildren in Australia.

OBJECTIVES: To determine if growth screening in school-age Aboriginal children detects new, treatable growth problems. METHODOLOGY: A retrospective review of health centre records of children identified as stunted or wasted from school screening from 11 remote Aboriginal communities in the Top End of the Northern Territory. The age of onset of growth faltering, the occurrence of new growth problems in school-age children and initiation of treatment in response to the school screening results were determined. RESULTS: Weight faltering had occurred in all children by 18 months. The average age of onset of weight faltering was 6.6 months (range 3.5-12 months) for stunted children and 8.9 months (range 7.5-18 months) for wasted children. Height faltering in stunted children commenced in all children with documented height measurements by 3 years. Staff did not report any new interventions for poor growth as a result of screening school-age children in 1993 although many children had previously been assessed by the local doctor or visiting paediatrician and were being monitored. CONCLUSIONS: All children that were found to be stunted or wasted were already known to have poor growth prior to school entry. A change in focus is needed from repeatedly weighing and measuring school-age children to developing community- based interventions to improve the nutritional status of all children. Annual measurement of weight and height beyond 5 years of age is not recommended unless it is used to help evaluate interventions aimed at improving nutritional status and educational achievement.

Adolescent↗
PubMed1999

[Cataract surgery: or why are there some patients excluded].

Cataracts are the main cause of blindness in the world, although they can be treated with relatively simple and inexpensive surgery. This study was carried out in 1997 and 1998 in five cities in the state of São Paulo, Brazil, to identify the reasons for persons not having cataract surgery. The population studied were patients seen at a community project for the rehabilitation of cataract-caused blindness, Projeto Zona Livre de Catarata (the Cataract-free-Zone Project). A questionnaire was used to interview 776 individuals with cataracts who sought assistance at the project and who had a visual acuity of 20/100 or less in the better eye. Six hundred and eighty-three patients had previously sought ophthalmic care, most frequently (27%) at public health services. The main reasons for subjects not having had cataract surgery were financial (69% of respondents) and the feeling of "still having good eyesight" (69% of respondents). Among patients who said they were afraid of surgery, the main reason was concern about being left blind. All the subjects whom the project deemed suitable for surgery agreed to undergo the procedure. Apparently, there is a gap between searching for ophthalmic services and the surgical resolution of cataracts. The predominant reasons for not having surgery were financial and logistical. There is a need to facilitate access to cataract surgery by decentralizing social services and by developing community projects to prevent cataract-caused blindness.

Blindness↗
PubMed2004

Clearing the air and breathing freely: the health politics of air pollution and asthma.

This study examines the growing debate around environmental causes of asthma in the context of federal regulatory disputes, scientific controversy, and environmental justice activism. A multifaceted form of social discovery of the effect of air pollution on asthma has resulted from multipartner and multiorganizational approaches and from intersectoral policy that deals with social inequality and environmental justice. Scientists, activists, health voluntary organizations, and some government agencies and officials have identified various elements of the asthma and air pollution connection. To tackle these issues, they have worked through a variety of collaborations and across different sectors of environmental regulation, public health, health services, housing, transportation, and community development. The authors examine the role of activist groups in discovering the increased rates of asthma and framing it as a social and environmental issue; give an overview of the current knowledge base on air pollution and asthma, and the controversies within science; and situate that science in the regulatory debate, discussing the many challenges to the air quality researchers. They then examine the implications of the scientific and regulatory controversies over linking air pollution to increases in asthma. The article concludes with a discussion of how alliances between activists and scientists lead to new research strategies and innovations.

Air Pollution↗
PubMed2001

Comparative measurements of microbial activity in drinking water biofilters.

Tetrazolium reduction assays, phospholipid analysis, and 16S rRNA (rDNA) sequence analysis were applied to assess the distribution, composition and activity of microbial communities developing in biofilters treating non-ozonated and ozonated drinking water. The response of media-attached biomass to both operating temperature (3 degrees C vs. > 12 degrees C) and ozone application point was assessed. As judged by 2-(p-iodo-phenyl)-3-(p-nitrophenyl)-s-phenyl tetrazolium chloride (INT) reduction, the dehydrogenase activity in biofilter systems that were operated with non-ozonated water was 55% lower than in identical filters operating with ozonated water. There was no significant difference between the microbiological activity measured in a biofilter series treating ozonated water and an identical series where ozonated water was introduced at an intermediate point. The biomass levels in biofilter systems that were operated with ozonated water were 47% higher on average than identical systems operated with non-ozonated water. Operating temperature had no significant impact on total biomass levels; however, specific dehydrogenase activity was 70% higher in systems operated at ambient temperatures (> 12 degrees C) than in systems held at 3 degrees C. Phospholipid and rDNA analysis suggests that there was a community structure response to ozone application and operating temperature, but no response to different ozone application points.

Biomass↗
PubMed1989

Aetiological factors of infantile diarrhoea: a community-based study.

A community-based study was undertaken to compare the organisms responsible for diarrhoea in children living in formal housing with indoor water supply and sanitation with those from a deprived environment. The role of "home remedies" was also assessed. Among 373 children with diarrhoea, rotavirus was detected in 15% (in 371 symptom-free controls, 9%), and proved to be the single most common causative agent. Bacterial pathogens were found in 20% of patients, with enteropathogenic Escherichia coli (EPEC) being isolated most frequently (9%; controls 3%), followed by Shigella species (4%; controls 1%), Campylobacter jejuni (4%; controls 1%), Salmonella species (2%; controls 1%) and enterotoxigenic E. coli (ETEC) (2%; controls 1%). Giardia lamblia and cryptosporidium were detected in 6% (controls 6%) and 3% (controls 1%) of patients, respectively; 7% (controls 1%) harboured more than one enteropathogen and no pathogens were detected in 58% (controls 78%). The vast majority (greater than 90%) of both patients and controls received some form of "home remedy" which included disinfectants and traditional herbs. The findings of this study therefore confirm the extremely complex nature of diarrhoea in developing communities and indicate that environmental factors are compounded by other issues.

Child, Preschool↗
PubMed2005

Cardiorespiratory fitness, all-cause mortality, and risk of cardiovascular disease in Trinidadian men--the St James survey.

BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.

Adult↗
PubMed2002

'Lifelong investment in health': the discursive construction of 'problems' in Hong Kong health policy.

This paper reflects on the contemporary health policy debate in Hong Kong, and the shape assigned to particular 'problems'. Health reform discourses are identified to reveal the tensions that exist between the dominant biomedical discourse that focuses on individual responsibility, lifestyle change and health education while articulating a community development approach to health care reform. A critical review of the Consultation Document on Health Care Reform in Hong Kong, entitled Lifelong Investment in Health, will reveal a rhetorical commitment to health care reform alongside proposals that suggest little understanding of the changes required to implement such reform. In fact, the document proposes a model of health care that not only remains within the biomedical paradigm, but which if enacted may extend the influence of medicine into the psychosocial sphere. Edelman has defined policy as 'a set of shifting, diverse, and contradictory responses to a spectrum of political interests'. The starting point from this perspective is the identification of the discursive construction of policy problems and the associated 'spectrum of political interests'. It is an attempt to reveal the operation of power in places in which administrative, political and professional discourses tend to obscure it.

Community Health Planning↗
PubMed2004

Knowledge of oral cancer risk factors among african americans: do nurses have a role?

PURPOSE/OBJECTIVES: To assess the knowledge of oral cancer risk factors among African Americans. DESIGN: Descriptive; guided by the Patient/Provider/System Theoretical Model for cancer screening. SETTING: Community-based primary care center in a southern state. SAMPLE: 141 African Americans. The majority was female, had a 12th grade education, and had an income less than 10,000 dollars; 25% were smokers. METHODS: Participants were asked to identify whether each of 15 factors (i.e., seven risk factors and eight nonrisk factors) increased risk for oral cancer. One point was added for each correct response; therefore, scores could range from 0-15 points. Demographic data were collected. MAIN RESEARCH VARIABLES: Knowledge of and misconceptions about oral cancer. FINDINGS: Only six participants correctly identified all of the risk factors. The majority recognized tobacco but was not as aware of the effects of the sun, alcohol, and diet. Many erroneously identified factors such as hot beverages, poor oral hygiene, spicy foods, dentures, and mouthwash as risk factors. Those with higher incomes and those who visited their dentists in the prior year had more knowledge of risk factors. No differences were found in knowledge based on age, gender, education, or smoking status. CONCLUSIONS: Some patients are less likely to routinely visit a dentist and are less knowledgeable about the risk factors for oral cancer. Many of these risk factors are modifiable; therefore, patients need to be aware of the risks and have access to effective strategies to reduce risk. IMPLICATIONS FOR NURSING: Assess risk factors, teach risk reduction, and correct misinformation. Refer patients to dental professionals. Develop community outreach to African American men at barbershops and fraternal organizations.

Adolescent↗
PubMed2003

The effect of container-biofilm on the microbiological quality of water used from plastic household containers.

Studies in Southern Africa have shown that even when microbiologically safe water is supplied to developing communities at communal standpipes, contamination by high numbers of pathogenic microorganisms may occur during the processes of fetching water from the supply source and storage during use at home, rendering such waters unsafe for human consumption. This study investigated the occurrence of biofilm in PVC storage containers as one possible reason for this deterioration, using heterotrophic bacteria and total coliform counts as well as turbidity as indicators. A second objective was to determine whether biofilm in water-storage containers could contribute to hazardous microbiological contamination indicated by Escherichia coli and Clostridium perfringens. Results indicated that increased microbiological contamination is associated with biofilm. The biofilm harbours heterotrophic bacteria, total coliforms and C. perfringens. E. coli could not be associated directly with the levels of biofilm in containers but rather appears to be introduced intermittently from the ambient domestic environment. When dislodged with the biofilm, these bacteria contributed substantially to the deterioration of the microbiological quality of supplied water stored in plastic containers.

Biofilms↗
PubMed1996

Bacterial vaginosis and associated infections in pregnancy.

OBJECTIVE: To assess the role of bacterial vaginosis (BV) on pregnancy complications in a developing community where mixed cervico-vaginal infections are common. SETTING: The antenatal clinic at King Edward VIII Hospital (KEH), Durban, South Africa, which is a large urban tertiary hospital serving mainly a Black underprivileged population of KwaZulu/Natal. METHODS: Asymptomatic pregnant women < or = 30 weeks gestation were recruited at their first antenatal visit. Clinical data including the sexual history were recorded. Swab specimens were collected from the vagina and endocervix for diagnosing BV, trichomoniasis, candidiasis, gonorrhea and chlamydial infection. Venous blood specimens were tested for antibody to syphilis and human immunodeficiency virus (HIV). All women continued standard antenatal care and hospital records were reviewed following delivery to evaluate pregnancy outcome. RESULTS: BV was found in 52% of the women studied and was the commonest infection diagnosed. Mixed vaginal infections of BV and trichomoniasis were diagnosed in 14%. Only 29% of asymptomatic women did not have any microbiological evidence of a lower genital tract infection. A total of 46% of women studied had poor pregnancy outcome as measured by obstetrical complications, pregnancy loss and/or neonatal morbidity. There was a significant difference in outcome in women with BV (55 of 88) compared to those having infections other than BV (13 of 31), or no infection (5 of 9)-P = 0.005. This difference was for obstetrical complications of preterm delivery, premature rupture of membranes and intrauterine infection, but not for pregnancy losses and neonatal morbidity. CONCLUSIONS: The high prevalence of BV and concomitant lower genital tract infections among asymptomatic pregnant women and the resultant adverse pregnancy outcome associated with BV, confirms reports from developed countries of the need for screening for BV at the initial antenatal clinic visit. Whether pregnancy outcome was worse in the presence of BV and other infections than BV alone could not be determined. Future studies with appropriate interventions are needed to evaluate the unique problems of developing countries.

Adolescent↗
PubMed2002

Surveying and screening preschool language development in community-focused intervention programmes: a review of instruments.

Preschool language intervention has come increasingly to the fore with the development of community-focused interventions including Sure Start in the UK. Successful intervention methods may well be incorporated into mainstream service delivery, especially in areas of disadvantage. The question of whether such interventions will work and of their impact on children's language development has focused attention on measures of language. This paper distinguishes two reasons for measuring language development: (1) surveying language; and (2) screening language. It goes on to suggest a set of criteria for selecting instruments for these applications. The review includes a wide range of language assessment instruments for preschool children and examines those most likely to be suitable. It suggests a role for paraprofessionals in survey and screening and argues that this may be advantageous in terms of reaching families and thereby achieving high levels of coverage of a population group. Finally, there is a discussion of the implications of such measures in community-focused preschool interventions.

Child, Preschool↗
PubMed2001

A review of state legislation related to immunization registries.

BACKGROUND: Since the early 1990s, a concerted effort has been made to develop community- and state-based immunization registries. A 1995 survey showed that nine states had laws specifically authorizing immunization registries. This survey was conducted to describe the current status of legislation and policies addressing immunization registries and the sharing of immunization information. METHODS: A telephone survey was administered from September 1997 to February 1998 to immunization program managers and/or their designees within the state health department of each of the 50 states and the District of Columbia. Some of the survey items were later updated through follow-up interviews and informal communications. Copies of legislation, administrative rules and regulations, and immunization registry policies were collected for review. RESULTS: As of October 2000, 24 of 51 states (47%) had laws (21) or rules (3) specifically authorizing an immunization registry. Nine additional states (18%) have laws specifically addressing the sharing of immunization information. CONCLUSIONS: Over half of the states have enacted legislation or rules addressing registries or the sharing of immunization information. Further research should be conducted to assess the impact of this legislation on immunization registries.

Adolescent↗
PubMed2006

REACH-Meharry community-campus partnership: developing culturally competent health care providers.

An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry's pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers' familiarity with the processes involved in community-based participatory research.

Black or African American↗
PubMed2002

Therapies in development for community-acquired pneumonia.

The current use of antimicrobials has become more complex due to the extensive emergence of antibiotic resistance. The single most important approach in resistance control is probably the judicious use of chemotherapeutic agents. New agents that may be of use in the treatment of community-acquired pneumonia are currently in development. Antimicrobials can be grouped according to their mechanism of action. These include protein synthesis inhibitors (ketolides, oxazolidinones, streptogramins and glycylcyclines), nucleic acid synthesis inhibitors (fluoroquinolones), peptidoglycan synthesis inhibitors (beta-lactams and glycopeptides) and agents interfering with membrane function (cationic peptides and lipopeptides). Among those agents under development, only the oxazolidinones, the cationic peptides and the lipopeptide antibiotics can be truly regarded as structurally novel inhibitors as the other agents are analogues of existing compounds which have been in clinical use for many years.

Anti-Bacterial Agents↗