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PubMed1997

Developing tomorrow's integrated community health systems: a leadership challenge for public health and primary care.

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health.

Community Health Services↗
PubMed2006

Going the distance: serving the needs of older youth at scale.

Few communities have developed successful strategies for attracting large numbers of older youth to their out-of-school-time programs. In addition to meeting the unique developmental and programmatic needs of this population, communities have struggled with the challenge of creating communitywide integrated approaches to service delivery and resource development. Communities wanting to build a system of supports for older youth must do so in the context of a communitywide strategy as opposed to fragmented, individually operating programs and services. A communitywide strategy creates greater opportunity for strategic mobilization of resources, greater funding leverage, evaluation and assessment consistency, and more powerful input into creating a public voice and public will for supporting and serving older youth as they make the transition to adulthood.

Adolescent↗
PubMed1988

DNA Probe Method for the Detection of Specific Microorganisms in the Soil Bacterial Community.

We developed a protocol which yields purified bacterial DNA from the soil bacterial community. The bacteria were first dispersed and separated from soil particles in the presence of polyvinylpolypyrrolidone, which removes humic acid contaminants by adsorption to this insoluble polymer. The soil bacteria were then collected by centrifugation and lysed by using a comprehensive protocol designed to maximize disruption of the various types of bacteria present. Total bacterial DNA was purified from the cell lysate and remaining soil contaminants by using equilibrium density gradients. The isolated DNA was essentially pure as determined by UV spectral analysis, was at least 48 kilobases long, and was not subject to degradation, which indicated that there was no contaminating nuclease activity. The isolated DNA was readily digested by exogenously added restriction endonucleases and successfully analyzed by slot blot and Southern blot hybridizations. Using single-stranded, P-labeled DNA probes, we could detect and quantitate the presence of a specific microbial population in the natural soil community on the basis of the presence of a DNA sequence unique to that organism. The sensitivity of our methodology was sufficient to detect Bradyrhizobium japonicum at densities as low as 4.3 x 10 cells per g (dry weight) of soil, which corresponds to about 0.2 pg of hybridizable DNA in a 1-mug DNA sample.

Journal Article↗
PubMed2001

Nutritional support at home and in the community.

Technical developments in feeding, together with the growth of support structures in the community has lead to a steady increase in the number of children receiving home enteral tube feeding and home parenteral nutrition. In many cases the adverse nutritional consequences of disease can be ameliorated or prevented, and long term parenteral nutrition represents a life saving intervention. Careful follow up of children receiving home nutritional therapy is necessary to establish the ratio of risks to benefits. A considerable burden is sometimes placed on family or other carers who therefore require adequate training and ongoing support. The respective responsibilities of different agencies relating to funding and support tasks require more clear definition.

Child↗
PubMed1976

Sudan: national health programme and primary health care, 1977/78-1983/84.

As a follow-up to the national health programming process developed in 1975 in Sudan, a primary health care programme for the whole country was formulated with assistance from WHO. In this article the methods used in the programming and formulation are described and discussed. These methods ensured an intersectoral approach on which technical, cultural, socioeconomic, financial, and political considerations were based. Areas in the field of health and rural development requiring government and community action during the period 1977/78-1983/84 are identified. Details on the strategies for population coverage of rural and nomadic communities with primary health care are given. Fundamental to these strategies is community participation in the development of primary health care within community development as a whole.The guiding principles of these strategies are their technical, political, social and financial feasibility. The social relevance of the primary health care programme for the community and the developmental sectors is emphasized.

Health Planning↗
PubMedDate not supplied

The development of a community-based baccalaureate curriculum model in a culturally diverse health care delivery area.

In 1997, faculty at the University of Texas Health Science Center at San Antonio School of Nursing embarked on the development of a community-based care model within the existing curriculum to serve the culturally diverse populations in rural and urban areas of South Texas. A grant awarded by the Helene Fuld Health Trust in 2000 enabled faculty to develop the requisite knowledge and skills relating to community-based care and develop strategies for the delivery of community-based care in a variety of settings. This article provides an overview of the process of curriculum development and its impact on faculty, students, and a diverse community service area.

Community Health Nursing↗
PubMed2005

Pathways of influence in out-of-school time: a community-university partnership to develop ethics.

If we wish to incorporate parents and community members as full partners in building character among youth, then the activities and programs in which youth participate during their out-of-school time are potentially important venues. This chapter describes how numerous agencies in a single community partnered with a university, with the help of the cooperative extension agent, to collect local data on how adolescents used out-of-school time, what they thought about right and wrong, and how well their own behavior comported with their understandings of what was right. Results indicated that surveyed youth characterized themselves as thinking more than acting in ethical ways. For instance, nearly half acknowledged having cheated on a test at least once in the past six months, although the vast majority thought that cheating was wrong. The three pathways the community identified for reaching youth were (1) extracurricular activities at school such as sports, yearbook, and pep club; (2) organized nonschool pursuits such as music, dance, hiking, and biking; and (3) religious activities. They found that nearly 90 percent of high school-aged respondents participated in one or another of these venues.

Adolescent↗
PubMedDate not supplied

APA/HRSA National Faculty Development Scholars Program: community-based teaching track.

OBJECTIVES: Goals and objectives of the APA/HRSA National Faculty Development Scholars Program are described in a companion article in this supplement. Program objectives of the Community-Based Teaching Track were to 1) identify individuals with faculty development skills to serve as regional leaders, conducting local and regional workshops; 2) create a national network of leaders, thereby promoting sustainability; and 3) increase educational contributions of office-based preceptors. Participant objectives were to 1) meet expectations of the program; 2) possess knowledge, skills, and attitudes needed to recruit and retain community-based preceptors; 3) possess knowledge and skills needed to conduct faculty development workshops for practitioners; and 4) form local and national collegial networks. METHODS: Academicians and practitioners were selected to form 2 cohorts, starting in 1999 (N = 20) and 2000 (N = 22), respectively. Workshops were developed on the basis of projected needs and iterative needs assessments of the participants. Each participant was required to conduct workshops between meetings, first locally and then regionally or nationally. OUTCOMES: Forty-two participants conducted 307 workshops attended by 3815 individuals. Participants reported specific knowledge and skills gained from the program and increases in multiple areas of competence. Networks were formed, leading to collaborative regional and national presentations and formation of an APA Faculty Development Special Interest Group. Participants reported increased recruitment of training sites and preceptors, with enhanced relationships. CONCLUSION: Program and participant objectives of the Community-Based Teaching Track were met, including implementation of multiple new workshops, development of skills, and creation of a support network to enhance the sustainability of that success.

Ambulatory Care↗
PubMed1997

Better late than never? An evaluation of community nursing services for children in the UK.

The development of community nursing services for children in the UK was first suggested by Platt in 1959; until recently, however, such services have been rare and children have spent many unnecessary and potentially traumatic days in hospital. This paper considers the development of community nursing services for children in the UK. It identifies factors which have promoted the growth of these schemes, and examines the effectiveness of services from professional, managerial and economic perspectives. The viewpoint of the consumer--the child and family themselves--is also considered.

Attitude of Health Personnel↗
PubMed2002

A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

Community Health Planning↗
PubMedDate not supplied

An anthropological approach to community diagnosis in family practice.

Developing a community oriented family practice requires gathering information about the community, its health problems and resources, and organizing these data into a community diagnosis. Viewing the community from both the insider and outsider perspectives allows the clinician to use social indicator data as well as subjective data from residents in the community. This paper describes the application of anthropological concepts in the process of community diagnosis within an urban teaching family practice.

Anthropology, Cultural↗
PubMed1997

Ethical issues in the therapeutic community.

The development of ethical standards in psychiatry has been largely during the past 30 years. Psychotherapy poses particular problems of an ethical nature and the therapeutic community with its apparent lack of professional distance between patients and professionals is a situation in which unethical practices could, and sometimes do develop. Nevertheless, the very nature of the close contact between professionals and patients in the therapeutic community can be a fruitful medium for the generation of a system of values and moral behavior in patients provided the professional staff are themselves aware of the inherent dangers and build in appropriate safeguards.

Confidentiality↗
PubMed1997

Incorporating socio-economic and risk factor diversity into the development of an African-American community blood pressure control program.

OBJECTIVE: To develop culturally competent community based blood pressure control programs for inner-city African Americans. DESIGN: Cross sectional study of randomly selected households from three experimental and three control communities. SETTING: Very low, moderately low and moderate socio-economic status (SES) inner-city communities in Chicago, Illinois. PARTICIPANTS: 957 African Americans adults, aged 18 and over from target communities. MAIN OUTCOME MEASURE: Household health assessments included employment, education and other demographic information, history of hypertension, disease prevalence, health behaviors, risk factor prevalence, stress, coping/John Henryism, social support, health care utilization and standardized assessments of blood pressure, height, and weight. RESULTS: There were no significant gender differences in blood pressure levels. Men had more hypertension than women, and women in the very low SES community had significantly more hypertension than women in the moderately low SES community. There was significantly more hypertension overall in the moderately low SES community. Age, education and BMI were the only factors significantly associated with systolic and diastolic blood pressure in all three communities. The very low SES community had significantly more obesity and more uninsured persons than the other communities. CONCLUSIONS: Intraracial diversity is an important factor to be considered in the development of community blood pressure control programs for African Americans. Age, gender, educational background and SES play a major role in influencing health behaviors and access to health care.

Adolescent↗
PubMed1998

Mortality impact of the AIDS epidemic: evidence from community studies in less developed countries.

BACKGROUND: The AIDS epidemic is now more than a decade old and direct evidence of mortality impact has become measurable, as indicated by an increasing number of publications presenting empirical data from less developed countries. METHODS: This review focuses on the evidence of mortality impact among adults and children in community studies. The majority of these studies are located in Africa, particularly eastern Africa, where the AIDS epidemic is conjectured to be older than in other less developed countries. RESULTS: Community studies show a two- to threefold increase in total adult mortality with an even larger increase in mortality among young adults in communities with adult HIV prevalence levels below 10%. Mortality amongst HIV-infected adults ranges from 5 to 11% per year, and more than half of all adult deaths can be attributed to HIV. HIV-infected women die at an earlier age than men and thereby lose significantly more productive years of life. Follow-up studies of incident cases are few, but population-based data indicate that the median survival time is substantially longer than originally thought on the basis of mortality amongst HIV-infected commercial sex workers. Tuberculosis incidence is on the increase, but evidence of additional impact on mortality is hitherto limited. Infant and early child mortality among children of HIV-infected mothers is two to five times higher than among children of HIV-negative mothers in follow-up studies of maternity-based and community samples. CONCLUSION: There is now empirical evidence of the mortality impact of HIV/AIDS from several community studies. The large increase in adult mortality and moderate increase in child mortality lead to dramatic falls in life expectancy. For instance, in a rural area of Uganda, which has an HIV prevalence of 8%, life expectancy has dropped from just under 60 years to 42.5 years.

Acquired Immunodeficiency Syndrome↗