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PubMed2005

Community-directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda.

The community-directed interventions (CDI) strategy achieved a desired coverage of the ultimate treatment goal (UTG) of at least 90% with ivermectin distribution for onchocerciasis control, and filled the gap between the health care services and the communities. However, it was not clear how its primary actors--the community-directed health workers (CDHW) and community-directed health supervisors (CDHS)--would perform if they were given more responsibilities for other health and development activities within their communities. A total of 429 of 636 (67.5%) of the CDHWs who were involved in other health and development activities performed better than those who were involved only in ivermectin distribution, with a drop-out rate of 2.3%. A total of 467 of 864 (54.1%) of CDHSs who were involved in other health and development activities also maintained the desired level of performance. They facilitated updating of household registers (P<0.05), trained and supervised CDHWs, and educated community members about onchocerciasis control (P<0.001). Their drop-out rate was 2.6%. The study showed that the majority of those who dropped out had not been selected by their community members. Therefore, CDI strategy promoted integration of health and development activities with a high potential for sustainability.

Community Health Services↗
PubMed2006

Improving community-based conservation near protected areas: the importance of development variables.

Community-based conservation projects implemented in conjunction with protected area management often struggle to meet expectations. This article argues that outcomes will improve if project leaders pay closer attention to four development indicators-rights, capacity, governance, and revenue-that are often taken for granted or considered beyond the scope of local conservation projects. I make the case for focusing on these variables in four steps. First, I distinguish community-based conservation linked to protected area management from community-based institutions studied by scholars of the commons. Second, I draw on the theory and practice of international development to highlight the central relevance of the variables highlighted in this article to development projects at all levels. Third, I discuss the four variables in some detail, considering problems of definition and measurement and reviewing possible interactions among them. Fourth, to illustrate the influence of the variables in particular cases, I review outcomes from community-based conservation projects implemented near protected areas in El Salvador and Zimbabwe.

Conservation of Natural Resources↗
PubMed1981

The loss from premature deaths of economically active manpower in the various populations of the RSA. Part I. Leading causes of death: health strategies for reducing mortality.

Age-adjusted mortality rates (MRs) per 100 000 for the leading causes of death were calculated for 1970 for Asians, Coloureds and Blacks and compared with the MRs of Whites for the economically active age-group of 15 - 64 years. Marked differences in mortality patterns were shown by this comparison. At the one extreme were the Whites in whom the five leading causes of death in rank order were ischaemic heart disease, motor vehicle accidents, cerebrovascular accidents (CVA), cancer of the digestive system and bronchitis and associated respiratory diseases--a mortality pattern which is characteristic of a developed Western community. At the other extreme were the Blacks in whom the five leading causes of death in rank order were "ill-defined" diseases, the pneumonias, tuberculosis, CVA and homicide and unspecified violence -- a mortality pattern commonly seen in less developed communities. Reducing mortality in the various populations will not come about by spending more money on hospital-bases curative medicine but by greater emphasis on health promotion and disease prevention. Quite different health strategies are needed to reduce mortality in the Whites and Asians on the one hand, and the Coloureds and Blacks on the other. The health strategies required for Whites and Asians involve behavioural changes in lifestyles, whereas for Coloureds and Blacks they involve elementary public health measures such as clean water, proper sanitation, better housing improved nutrition and health education.

Adolescent↗
PubMed2006

Parenting and community background and variation in women's life-history development.

For a community sample of 623 low-income women (mean age = 26.9 years), the authors use life-history theory to explore relations between parenting and community background and timing of reproductive development and sexual behaviors. Among other patterns, reported levels of paternal involvement during childhood were related to delayed menarche and ages at 1st sexual intercourse and 1st childbirth. The relation between parental investment and women's reproductive delay varied with estimates of wealth in the community in which the participants grew up. The results suggest that parents increased their investment as the level of community wealth increased, and in ways that likely facilitated women's ability to compete for social status in adulthood. Implications for future research on the relation between parenting and child outcomes are discussed.

Adolescent↗
PubMed1993

The Dubai Community Psychiatric Survey: II. Development of the Socio-cultural Change Questionnaire.

The Dubai Community Psychiatric Survey was carried out to assess the effect of very rapid social change on the mental health of women in Dubai, one of the United Arab Emirates. In order to measure social change at an individual level, we developed a questionnaire covering behaviour and attitudes in a wide range of situations, the Socio-cultural Change Questionnaire (ScCQ). In this paper we give an account of the considerations that determined the form of the ScCQ, its structural characteristics, and its validity.

Adaptation, Psychological↗
PubMed1991

Community participation and attitudes of decision-makers towards community involvement in health development in Saudi Arabia.

National policies and government strategies in Saudi Arabia are adequate for the promotion of community involvement in health development (CIH). The system of government is decentralized and has ample scope for intersectorial cooperation. In Ha'il and Qasim regions active efforts are being made to realize intersectorial coordination through regional committees in which community leaders are involved; unfortunately, however, such mechanisms are lacking at the central level. Decision-makers and community leaders adequately recognized and interpreted the importance of CIH. Most of the respondents advocated community participation in planning and evaluation, while less than 50% thought that communities could participate in the implementation of health services. A survey in Ha'il and Qasim regions of 2417 residents indicated that community participation in health activities was in its infancy and that considerable effort is still needed at the central, regional, and peripheral levels to achieve meaningful community involvement in health.

Community Participation↗
PubMed2005

Development of the home and community environment (HACE) instrument.

OBJECTIVE: To develop and pilot test the Home and Community Environment instrument (HACE), a self-report measure designed to characterize factors in a person's home and community environment that may influence level of participation. DESIGN: A cross-sectional survey. SUBJECTS: Sixty-two adults recruited from community organizations and an outpatient rehabilitation center. METHODS: Six environmental domains were assessed: (i) home mobility; (ii) community mobility; (iii) basic mobility devices; (iv) communication devices; (v) transportation factors; and (vi) attitudes. Descriptive statistics, Kappa statistics and Kruskal-Wallis tests were used to ascertain whether persons were capable of assessing characteristics of their environment, could do so reliably and whether the distribution of environmental factors differed by type of living situation. RESULTS: Participants were capable of characterizing their home environment and most aspects of their community with acceptable reliability. The median percent agreement of the 6 environmental domains ranged from 75% to 100% (median Kappa values ranged from 0.47 to 1.0). Percent agreement for individual HACE items ranged from 58% to 100%. The lowest reliability values were observed in the community mobility domain. As hypothesized, individuals who lived in private homes characterized home and community mobility factors differently from those who lived in multi-unit complexes; evidence of HACE's validity. CONCLUSION: HACE is a promising self-report instrument for assessing characteristics of an individual's home and community environments. Additional research is needed to assess its utility for rehabilitation research.

Adult↗
PubMed1990

Graduate training in community medicine at Mount Sinai: the development of the Master of Science in Community Medicine.

This paper describes the philosophy, process, and outcome of the integration of independent study and classroom training with existing clinical and research experiences in The Mount Sinai Medical Center Department of Community Medicine's general preventive medicine and occupational medicine residencies leading to the creation of the Master of Science in Community Medicine.

Community Medicine↗
PubMed2004

A systems approach for the development of a sustainable community--the application of the sensitivity model (SM).

Corresponding to the concept of 'Think globally, act locally and plan regionally' of sustainable development, this paper discusses the approach of planning a sustainable community in terms of systems thinking. We apply a systems tool, the sensitivity model (SM), to build a model of the development of the community of Ping-Ding, located adjacent to the Yang-Ming-Shan National Park, Taiwan. The major issue in the development of Ping-Ding is the conflict between environmental conservation and the development of a local tourism industry. With the involvement of local residents, planners, and interest groups, a system model of 26 variables was defined to identify characteristics of Ping-Ding through pattern recognition. Two scenarios concerning the sustainable development of Ping-Ding are simulated with interlinked feedbacks from variables. The results of the analysis indicate that the development of Ping-Ding would be better served by the planning of agriculture and the tourism industry. The advantages and shortfalls of applying SM in the current planning environment of Taiwan are also discussed to conclude this paper.

Computer Simulation↗
PubMed2007

Community factors in the development of antibiotic resistance.

The global impact of antibiotic resistance is potentially devastating, threatening to set back progress against certain infectious diseases to the pre-antibiotic era. Although most antibiotic-resistant bacteria originally emerged in hospitals, drug-resistant strains are becoming more common in the community. Factors that facilitate the development of resistance within the community can be categorized as behavioral or environmental/policy. Behavioral factors include inappropriate use of antibiotics and ineffective infection control and hygiene practices. Environmental/policy factors include the continued use of antibiotics in agriculture and the lack of new drug development. A multifaceted approach that includes behavioral strategies in the community and the political will to make difficult regulatory decisions will help to minimize the problem of antimicrobial resistance globally.

Agrochemicals↗
PubMedDate not supplied

Collaborative HIV Prevention Research in Minority Communities Program: a model for developing investigators of color.

The Collaborative HIV Prevention Research in Minority Communities Program was developed to address the simultaneous overrepresentation of communities of color among those with HIV and under-representation of researchers of color at the National Institutes of Health. The program is designed to help scientists develop their programs of research and obtain significant research funding. The 27-month program has the following elements: small grant funding, a structured summer program, individualized long-term research collaboration, access to behavioral science expertise, and internal peer review of all products. To date, the 19 program participants, eight of whom have not completed the program, have received almost $11,000,000 in research funding and have conducted culturally specific research with communities of color. In addition, a network of HIV prevention investigators of color has been created. Institutes throughout the National Institutes of Health (NIH) and other entities could use this model to develop investigators of color, improve the quality of research with communities of color, and begin to address health disparities.

Attitude to Health↗
PubMed2004

Social cognition as a mediator of the influence of family and community violence on adolescent development: implications for intervention.

Several studies have shown that exposure to family and community violence during childhood and adolescence is associated with an increased risk for development of externalizing behavior problems, but less is known about specific mechanisms that mediate this relation. Variations in social cognition serve as one possible mechanism by which these environmental experiences influence aggressive behavior during adolescence. Children who have been maltreated tend to display negatively biased social-cognitive processing styles, which may in turn increase their likelihood of reacting aggressively in ambiguous social situations. Similarly, witnessing community violence is associated with aspects of social cognition, including beliefs that support aggressive responses to threat. Recent studies also suggest that exposure to extreme forms of stress and violence can produce changes in children's neurobiology that may increase their hypersensitivity and reactivity to interpersonal threat. Some of the strongest evidence of the role of social cognition as a mechanism in this association comes from intervention studies which reduced aggressive behavior by targeting negatively biased social-cognitive processing styles.

Adolescent↗
PubMed2006

Development and factor structure of a brief instrument to assess the impact of community programs on positive youth development: The Rochester Evaluation of Asset Development for Youth (READY) tool.

PURPOSE: Positive youth development is increasingly recognized as important to the health and well-being of adolescents. We describe the development of a brief, standardized instrument for measuring outcomes and indicators important for youth development evaluation. Additionally, we describe the psychometric properties of these constructs. METHODS: A coalition of representatives from 12 community organizations, funders, and researchers identified four core outcomes associated with positive youth development likely able to be affected by community-based youth-serving agencies. Items were piloted and field tested to test feasibility and establish face validity with experts and with adolescents. Furthermore, we tested construct reliability using factor analysis to determine how well the items reflected underlying constructs. RESULTS: Items representing four empirical constructs were used to survey 389 adolescents. Those who participated in the pilot took an average of 11 minutes to complete the survey. Overall, 24 items loaded on to six discrete factors representing the outcomes of basic social skills, caring adult relationships, and decision-making. When participants under age 13 years were eliminated from the analysis, items were more cohesive, resulting in a five-factor solution with all items loading at .40 or higher. CONCLUSIONS: The four youth development outcomes identified by community-based youth-serving organizations factor into reliable constructs with acceptable alpha coefficients for adolescents over age 13. A major strength of this youth development outcome measurement is that it has an easy-to-administer format, which allows community-based programs to receive feedback for program improvement, and to track the effectiveness of their programs for funders.

Adolescent↗
PubMed1999

Utilization of substrates by bacterial communities (biofilm) as they develop on stored chicken meat samples.

Understanding and controlling the metabolic processes of microorganisms associated with chicken meat can lead to safer poultry products with a longer shelf life. The objective of the present study was threefold: 1) to determine the feasibility of using 96-well Biolog GN microtiter plates to assess substrate utilization profiles of bacterial communities (biofilm) as they develop on poultry products, 2) to identify substrates metabolized by microbial populations associated with stored chicken meat, and 3) to compare the substrate utilization profiles of biofilm communities as they develop on meat stored at 4 C (refrigeration temperature) for up to 5 d or at 13 C (a temperature common in poultry processing areas) for 2 d. The protocol used herein for preparing inocula for microplates was acceptable for the collection of optical density values (590 nm) in microplate wells as an indicator of microbial substrate utilization over time. Data from treatment of chicken meat samples using this protocol indicate that most of the 95 substrates tested were metabolized by microbial communities present as early as 1 d after storage at 4 or at 13 C. However, the rapidity (incubation time required for initial substrate utilization) and frequency (percentage of plates positive for transformation of an individual substrate) of metabolism of the substrates by the biofilm communities varied from 4 to 164 h of plate incubation and from 17 to 100% of microplates, respectively. At 13 C, polymers were the most rapidly metabolized substrate group, followed by carbohydrates, carboxylic acids, miscellaneous or amino acids, and amides or amines. Initial utilization of these substrate groups at 4 C occurred within a consistently shorter period (24 h of plate incubation). The frequency of metabolism of each individual substrate group varied only 3 to 16% between samples stored at 4 and 13 C. However, a greater difference in frequency of utilization of some individual substrates was noted. Such divergences may be useful in characterizing biofilm communities implicated in pathogenicity or affecting food quality of poultry products.

Animals↗
PubMed1991

Disciplines within general practice.

The disciplines within general practice derive partly from its community setting, and partly from the nature of professional expertise. The maladies range from a high prevalence of low risk, self-limited illness to a low prevalence of high risk, persistent disease. Each set calls on different knowledge and skills. The setting offers the substrate for studying social and behavioural sciences and community health development in action. Choosing a few particular fields, and developing those with rigour, could strengthen general practice as a discipline with special insights and skills to offer all branches of clinical practice. Four fields of activity have been identified. In each, general practice has a clear responsibility and opportunity. I have suggested some knowledge and skill areas for their success--clinical 'working' knowledge, decision making and judgment, predictive knowledge, planning knowledge, calibration of investigators, intuitive knowledge, local knowledge, leadership skills and people management, measurement of burden of illness, calculation of cost-benefit trade-offs, building of local databases, re-learning fine discrimination in clinical perception, and understanding of community development. These subjects have not been part of formal medical education, or of much academic study in family practice. Despite their being central to the success of daily practice, the curriculum is silent about the study of these areas of practical knowledge, reasoning, judgment and skill. Worse, we do not have a common language to express clearly what we are talking about. Experience and skill lie within the practitioner, and are used in practical, concrete situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Practice↗
PubMed1997

Diabetes management: improving care in HMO and community settings.

Developing an effective, quality-driven disease management program for the treatment of patients with diabetes has become essential for MCOs, which cover the majority of American individuals suffering from this condition. At Cedars-Sinai Medical Center in Los Angeles, the Diabetes Managed Care Program was developed and implemented in an effort to provide a model for similar diabetes management initiatives in both managed health care plans and community settings.

California↗