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PubMed1999

The impact of water supplies and sanitation on growth in Chinese children.

In many developing countries, improvement in water supplies has not been supplemented by improvement in sanitation facilities. Moreover, health education is rarely included in environmental hygiene programmes. Community health workers need to know if water supplies and sanitation have independent or complementary effects on health. This study analysed the weight data of 1,045 Chinese children aged 60 months or below. Regression models with interaction terms were tested against a model with main effects only. There was no evidence of interaction between water supplies and sanitation measures. The results show that water supplies and toilet facilities had independent associations with growth. Improved water source (P = 0.01) and flush-toilet (P = 0.06) were found positively associated with the children's weight. Presence of excreta in the home had a negative, but not statistically significant, association with weight.

Body Weight↗
PubMed2006

A lay health advisor program to promote community capacity and change among change agents.

The Charlotte REACH 2010 project focuses on cardiovascular disease and diabetes among African Americans in a geographically defined community. The goal of the project is to create changes in individual behaviors, community capacity, change agents, and systemic policies and actions that will result in the reduction of health disparities related to cardiovascular disease and diabetes. The project consists of three main components: lay health advisors as change agents, targeted interventions (exercise, nutrition, smoking cessation, primary care), and environmental and systemic interventions. The purpose of this article is to describe the lay health advisor intervention using qualitative methodologies that were developed to document changes in community capacity and change among change agents. Lay health advisors report that they have internalized their role as a community advocate and have made positive changes in their own personal health behavior. Their understanding of the underlying causes of poor health has expanded to include social and institutional factors and they have begun to shift their emphasis toward advocacy for social and institutional change.

Black or African American↗
PubMed2004

Children aged 6 to 60 months in Nepal may require a vitamin A supplement regardless of dietary intake from plant an animal food sources.

The purpose of this survey was to explore the relationship between the prevalence of the health indicators of malnutrition, diarrhea, and acute respiratory infection and the consumption of vitamin A-rich food and the supplementation status of three groups of children in Nepal (supplemented, supplemented only once, and never supplemented). A trained female community health worker interviewed mothers about vitamin A-rich food feeding practices to children aged 6 to 60 months using a standardized questionnaire and then estimated the nutritional status of the children using mid-upper-arm circumference measurements and recording the incidence of diarrhea and acute respiratory infection from mothers' interviews. Regardless of the amount of vitamin A-rich foods consumed, children who were regularly supplemented with high doses of vitamin A were protected against malnutrition, diarrhea, and acute respiratory infection at a higher rate than children who were supplemented only once or were never supplemented. Regularly providing a high-dose (200,000 IU) capsule of vitamin A to children aged 6 to 60 months, including those who eat vitamin A-rich foods, may be effective in decreasing the prevalence of morbidity from malnutrition, diarrhea, and acute respiratory infection.

Anthropometry↗
PubMedDate not supplied

Community-based survey of maquiladora workers in Tijuana and Tecate, Mexico.

Responses to a survey of 177 maquiladora workers by specially trained peers suggest that transnational corporations operating the plants are ignoring Mexican regulations regarding hazard communication, training, health and safety committees, and uncontrolled hazards in the workplace. The "global standard" for workplace health and safety, often claimed by transnationals, should be made a reality.

Adult↗
PubMed2006

Cardiovascular risk factors among Chamorros.

BACKGROUND: Little is known regarding the cardiovascular disease risk factors among Chamorros residing in the United States. METHODS: The Chamorro Directory International and the CDC's Behavioral Risk Factor Surveillance System Questionnaire (BRFSS) were used to assess the health related practices and needs of a random sample of 228 Chamorros. RESULTS: Inactivity, hypertension, elevated cholesterol and diabetes mellitus were more prevalent in this Chamorro sample compared to the US average. Participants who were 50-and-older or unemployed were more likely to report hypertension, diabetes and inactivity, but they were also more likely to consume more fruits and vegetables than their younger and employed counterparts. Women were more likely to report hypertension and diabetes, whereas men were more likely to have elevated BMI and to have never had their blood cholesterol checked. CONCLUSION: The study provides data that will help healthcare providers, public health workers and community leaders identify where to focus their health improvement efforts for Chamorros and create culturally competent programs to promote health in this community.

Adolescent↗
PubMed2005

The costs of reducing loss to follow-up in South African cervical cancer screening.

BACKGROUND: This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. METHODS: Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW) time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s), and those who never returned despite attempted contact(s) were determined. The number of CHW visits per woman was also estimated. RESULTS: 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5%) occurred without CHW contact, 918 (24.8%) occurred after contact(s), and 472 (12.7%) did not occur despite contact(s). Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand) for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. CONCLUSION: CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.

Journal Article↗
PubMed1991

Role of general practitioners in care of long-term mentally ill patients.

"OBJECTIVE--To assess general practitioners' involvement with long term mentally ill patients and attitudes towards their care. DESIGN--Postal questionnaire survey. SETTING--General practices in South West Thames region. SUBJECTS--507 general practitioners, 369 (73%) of whom returned the questionnaire. MAIN OUTCOME MEASURES--The number of adult long term mentally ill patients whom general practitioners estimate they have on their lists and general practitioners' willingness to take responsibility for them. RESULTS--110 respondents had noticed an effect of the discharge of adult long term mentally ill patients on their practices. Most (225) respondents estimated that they had 10 or fewer such patients each on their lists. Having higher numbers was significantly associated with practising in Greater London or within three miles of a large mental hospital and having contact with a psychiatrist visiting the practice. 333 general practitioners would agree to share the care of long term mentally ill patients with the psychiatrist by taking responsibility for the patients' physical problems. Only 59 would agree to act as a key worker, 308 preferring the community psychiatric nurse to do it. Only nine had specific practice policies for looking after long term mentally ill patients and 287 agreed that such patients often come to their general practitioner's attention only when there is a crisis. CONCLUSIONS--The uneven distribution of long term mentally ill patients suggests that community psychiatric resources might be better targeted at those practices with higher numbers of such patients. Most general practitioners seem to be receptive to a shared care plan where the consultant takes responsibility for monitoring psychiatric health with the community nurse as key worker. The lack of practice policies for reviewing the care of long term mentally ill patients must limit general practitioners' ability to prevent crises developing in their care."

Attitude of Health Personnel↗
PubMed1982

Contracting state mental hospital systems.

The predominant approach to contracting state mental hospital systems has been to close individual hospitals. Such a policy creates conflict between state government and the affected workers and communities. Closing of hospitals has been motivated by an implicit assumption on the part of state policy-makers that there are increasing returns to scale in mental hospitals. The bulk of empirical evidence suggests that returns to scale are constant. Thus, in many cases one may forego the political conflict inherent in closing hospitals by shrinking them with no loss in economic efficiency.

Bed Occupancy↗
PubMed2000

Distance education for health centre staff in rural Japan.

We have evaluated a course delivered by videoconferencing to rural health centre staff in Hokkaido. The course focused on the planning and evaluation of community health interventions. It included four 90 min sessions and two follow-up sessions. Fourteen professional staff members (public health nurses, nutritionists and dental assistants) attended each class. Knowledge of community health-care planning and evaluation was higher at post-education testing than pre-education testing. Ratings for 'using a computer', 'using some computer software', 'using the Internet' and 'interest in telehealth' increased significantly in post-education testing compared with pre-education testing. The course had an additional benefit in increasing the collaboration between community health workers and university staff.

Adult↗
PubMed2002

Starlink corn: a risk analysis.

Modern biotechnology has dramatically increased our ability to alter the agronomic traits of plants. Among the novel traits that biotechnology has made available, an important group includes Bacillus thuringiensis-derived insect resistance. This technology has been applied to potatoes, cotton, and corn. Benefits of Bt crops, and biotechnology generally, can be realized only if risks are assessed and managed properly. The case of Starlink corn, a plant modified with a gene that encodes the Bt protein Cry9c, was a severe test of U.S. regulatory agencies. The U.S. Environmental Protection Agency had restricted its use to animal feed due to concern about the potential for allergenicity. However, Starlink corn was later found throughout the human food supply, resulting in food recalls by the Food and Drug Administration and significant disruption of the food supply. Here we examine the regulatory history of Starlink, the assessment framework employed by the U.S. government, assumptions and information gaps, and the key elements of government efforts to manage the product. We explore the impacts on regulations, science, and society and conclude that only significant advances in our understanding of food allergies and improvements in monitoring and enforcement will avoid similar events in the future. Specifically, we need to develop a stronger fundamental basis for predicting allergic sensitization and reactions if novel proteins are to be introduced in this fashion. Mechanisms are needed to assure that worker and community aeroallergen risks are considered. Requirements are needed for the development of valid assays so that enforcement and post market surveillance activities can be conducted.

Bacillus thuringiensis↗
PubMed1994

African American women and AIDS: a public health/social work challenge.

AIDS is a global problem affecting people regardless of economic status, ethnicity, age, occupation, or gender. Although, initially perceived as a gay men's disease, the fastest growing population in the AIDS epidemic is women. African American women represent over half the reported cases of AIDS among women in the United States. An epidemiological analysis is presented about AIDS among African American women. Utilizing feminist empowerment strategies and multidimensional prevention/intervention strategies to engage the African American community, social workers, and health professionals is suggested.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study.

The impact of specialist psychosocial treatment on health service use costs by patients with personality disorder is not yet sufficiently documented. In this prospective study we compare patterns of health service costs by three groups of people with personality disorder treated in a hospital-based program (IPP), a step down program (SDP), and a general psychiatric program (GPP). Total service use costs at follow up, compared with intake costs, showed that significantly higher savings were achieved by SDP and IIP compared with GPP. Cost reductions in SDP were significantly greater than in IPP. Significant cost reductions were found between treatment programs in social worker and community psychiatric nursing and psychotherapy. The cost-effectiveness of the two specialist treatment programs was indicated by the significant association between total cost reduction and clinical outcome in GPP and IPP, but not in GPP. The effect of Major Depression and Borderline Personality Disorder on health service use alone and in combination was also investigated. The finding that Major Depression was found to be more significantly associated with higher health service use costs than Borderline Personality Disorder is discussed.

Adult↗
PubMed1975

Attitudes toward alcohol and alcoholism among professionals and nonprofessionals.

Analysis of the responses of graduate students, professional social service agency workers and community residents to scales measuring attitudes and beliefs about alcohol and alcoholism suggests that the professionals tend to reflect the opinions and biases of the community within which they work. The results are discussed in terms of the usefulness of the multidimensional model of attitude structure for comparing attitudes among various groups and the implications for professional and community education programs.

Adult↗
PubMed2006

[Child health in poor areas of North and Northeast Brazil: a comparison of areas covered by the Children's Mission and control areas].

Community surveys are essential to estimate health indicators, evaluate health programs, and define health interventions. In 2002, a cross-sectional survey of children under five was conducted in 18 areas of the poorest counties in North and Northeast Brazil. Nine areas were visited by volunteer community health workers (CHW) under the Children's Mission, and the others were not visited. Using a standard questionnaire, trained interviewers collected information at the household level for 1,528 children, 782 of whom were visited monthly by CHWs and 772 were not. All the children and their families were living below the poverty line; 40.0% of the parents were illiterate, per capita daily income was about US$0.30, and household conditions were substandard. However, most were living less than 1km from a public health service and almost all children who were referred to these services received medical care. Prenatal care was also poor in terms of number of medical visits and laboratory tests. Children visited by CHWs from the Children's Mission received better care in terms of growth monitoring, number of medical check-ups, and prenatal iron supplementation.

Brazil↗
PubMed2006

[Intervention levels for abdominal obesity: prevalence and associated factors].

During 1999 and 2000, a population-based cross-sectional study was conducted in Pelotas, southern Brazil, to describe the population distribution of abdominal adiposity according to "action level points" and to identify risk factors. The study included a sample of 1,935 adults (20-69 years) residing in urban areas. Abdominal obesity was classified as action level I for waist circumference (WCLI) 80-88 cm in women and 94-102 cm in men; and as action level II (WCLII) for > 88 cm in women and > 102 cm in men. Abdominal obesity was present in 62% of women and 37% of men. Some 23% and 19% of men and women were classified as WCLI, respectively; 39% of women and 19% of men were classified as WCLII. After adjustment for confounding variables, age and being married or in a stable relationship were strongly associated with WCLII. Schooling was a risk factor in men only, and family income in women. In women, income was inversely associated with abdominal obesity. Use of a simple measurement such as waist circumference, which allows identification of levels of intervention, should be incorporated into health promotion measures, especially to help community health workers monitor the population needs.

Adiposity↗
PubMed2000

Epidemiology of malaria in the Amazon basin of Ecuador.

Malaria is reemerging in most endemic countries of South America. In Ecuador, malaria is endemic on the Pacific coast, in the inter-Andean valleys, and in the Amazon River basin. In the Lower-Napo region of northeastern Ecuador, malaria was considered eliminated in the 1970s, but the disease has reemerged in recent years. Three organizations are involved in malaria-related work in the area, but they are not coordinating their efforts. This study was designed to describe the epidemiology of malaria incidence in the Lower-Napo region for the period of January 1992 through December 1995, and to determine the extent of seasonality in transmission in the area. To determine malaria incidence, data were collected for that 4-year period from the records of the three malaria-related organizations: the office of the National Center for Malaria Eradication (NCME) in the town of Coca, the district hospital in Nuevo Rocafuerte (DHNR), and an association of community health workers called Sandi Yura. Data on climatic conditions for the same period were collected from the Ecuadorian Air Force and civil aviation authorities. During the 1992-1995 period, NCME diagnosed a total of 773 malaria cases, DHNR diagnosed 485, and Sandi Yura clinically diagnosed 859. For the 4-year period, an annual parasite index of 40.4 was found with the DHNR data, 35.8 with the Sandi Yura data, and 6.2 with the NCME data. The predominant parasite in the area was Plasmodium vivax (92% of all the cases). Twenty-eight percent of the infected persons were under 10 years old. No discernible differences between the genders were found. There was also no seasonal variation among the cases. Further research is needed in order to confirm these findings and better understand malaria transmission in the region. The study highlights the need for a closer coordination among the area's malaria-control organizations so as to have an improved understanding of malaria epidemiology and to design and implement effective control strategies.

Adolescent↗
PubMed2006

[Preventing deaths from dengue: a space and challenge for primary health care].

Dengue is an arthropod-borne viral disease whose frequency has increased steadily in the Americas over the past 25 years. The type of dengue that carries the highest mortality is the clinical variant known as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Even though no vaccine or drug against the disease is available, successful management consists of preventing serious illness through patient follow-up and monitoring danger signals so as to be able to initiate aggressive intravenous rehydration and prevent shock or treat it early and successfully. These measures are also useful in preventing other complications, such as massive hemorrhage, disseminated intravascular coagulation, multiple organ failure, and respiratory failure due to non-cardiogenic pulmonary edema. Primary health care (PHC) settings and the community are ideal spaces for this type of preventive management based on health education and active case detection. It involves training all medical and nursing staff, students, and community health workers, as well as reorganizing health care in PHC units and hospitals and redistributing available resources during a dengue epidemic.

Americas↗
PubMed1976

Application of social science theories to family planning health education in the People's Republic of China.

The transformation of the Chinese society was political and economic by revolution; it was also social and cultural through mass education. Group decisions have been used to induce social change in the Chinese society and applied extensively to the family planning program. The methods which Kurt Lewin developed to change food habits, have been perfected on a grand scale of myriad ways by the Chinese.

Adult↗