In the wake of Hurricane Andrew: the development of a community-based primary care center.
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Community Health Centers↗
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Health needs of a suburban community: a nursing assessment approach.
Community health nursing can play an important role in conducting community needs assessments that provide critical data upon which programming, planning, and evaluation should be based. The community health services developed for any given community should be planned with the specific needs of the community residents in mind. A community needs survey is one method that should be periodically employed to ascertain the specific needs and concerns of community residents. Nursing conceptual models developed by CHNs are very appropriate to the assessment of all aspects of community life related to health and well-being. Comprehensive community needs surveys should include assessment of environmental, psychosocial, and physiological aspects of health as well as indicators of health-related behaviors in the population. The Omaha classification system adapted for this study provides a broad conceptual framework that facilitates the development of comprehensive programs of assessment. Public health services are in a state of crisis in many states. Traditional program offerings may no longer be the key to providing the types of services most needed by some communities. Analysis of data on problems related to personal and family well-being in one upper middle class suburban community indicate a need for health promotion and services focused on many of the psychosocial aspects of health. The stress experienced by younger community residents appears to be related to issues of parenting and balancing the dual roles required at work and home. Families of elders are also confronted by issues concerning the decreasing independence of these individuals and the need to find additional support services for them. Community health services must be designed that take these factors into account. Professional nurses can provide the leadership necessary to assess health needs and current public health practices in these communities and to recommend and implement programs appropriate to the needs of the present and the goals of the future.
Adult↗
Informing the future: 2. Developing the role of community IPCNs.
This paper is the second in a two-part series summarising the main findings and conclusions of a review of the roles and responsibilities of infection prevention and control nurses commissioned by the Department of Health. It describes the core work of IPCNs, discusses the strengths and constraints of the current role and makes suggestions for future development.
Communicable Disease Control↗
Community factors in the development of resiliency: considerations and future directions.
Researchers have questioned why some children and adolescents are more resilient than others in the face of adversity and have identified several protective factors. The present paper focuses on one of these variables, namely, support from caring adults in the community. We present a brief review of this component of the resiliency literature along with a discussion of some of the issues and challenges raised by the findings. It is suggested that the evidence is substantial enough and the possible rewards associated with exploiting these findings considerable enough to warrant mounting wide-scale community-based efforts to assist vulnerable youth.
Adaptation, Psychological↗
The development of a community-based HIV/AIDS counselling service in a rural area in Uganda.
This paper describes the evolution of a counselling service in the context of an HIV/AIDS research programme in rural Uganda. The background to AIDS counselling both in Europe/America and in Africa is outlined first, and the cultural context of the programme explained. The evolution of the counselling procedure is then described and village case studies are used to illustrate the development and the difficulties that have been faced in finding an appropriate counselling model. It is noted that the Euro-American model of person-to-person counselling needs to be adapted to the rural African setting, by placing the emphasis on support for the family. It is emphasized that the approach to counselling needs to remain flexible and sensitive to the sociocultural context in which it is developed.
Acquired Immunodeficiency Syndrome↗
A dental school's role in developing a rural, community-based, dental care delivery system for individuals with developmental disabilities.
The long-standing problem of access to dental care for persons with developmental disabilities in rural Northern California has been addressed in several communities by a unique community-based program. The goal was to create a coalition to coordinate dental school resources with those of a consortium of agencies to address problems in the local communities. This program established a community-based model demonstrating the provision of quality preventive and therapeutic dental services to these individuals. Through this program, dental care delivery systems were formed in three rural communities involving local community dentists and agency personnel. The role of the dental school was: (1) to establish and then work with a consortium of hospitals, agencies, dentists, and other dental personnel; (2) to train local dental personnel; (3) to establish and equip hospital dental facilities; (4) to conduct dental screening and triage clinics; (5) to consult with local agencies and dentists; (6) to act as a referral center for patients with complex medical situations; and (7) to develop and disseminate preventive dentistry training materials.
California↗
Improving a community preceptorship through a clinical faculty development program.
A department of family and community medicine has successfully used annual conferences to develop the teaching skills of clinical faculty. The conferences focus on specific topics each year, faculty are required to attend, and experienced preceptors are used as facilitators. These conferences have effectively improved the preceptors' abilities as teachers of medical students. This is dramatically illustrated by the increase in measurable objectives on the negotiated learning contracts.
Community Medicine↗
Community mental-health programs and social history: an inter-American comparison.
This theoretical paper argues that the evolution of community mental health, as both a concept and a movement, is a function of social history. Furthermore cross-cultural differences in social history are seen as best explaining differences between the Americas in the relative speed and nature of the development of community mental health. Pertinent social history factors in the United states, Ontario (Canada), and Colombia (South America) are presented as providing some evidence for the validity of the paper's thesis. Finally, a universal developmental sequence model is discussed and depicted in figure form. The implications for future developments in community mental health are briefly discussed in the context of the model.
Colombia↗
Marine biofouling on fish farms and its remediation.
The fish farming industry suffers significantly from the effects of biofouling. The fouling of cages and netting, which is costly to remove, is detrimental to fish health and yield and can cause equipment failure. With rapid expansion of the aquaculture industry, coupled with the tightening of legislation on the use of antifouling biocides, the problems of fish farm biofouling are increasing. The nature of the biological communities that develop on fish farm equipment and the antifouling practices that can be employed to reduce it are described here. Particular emphasis is placed on antifouling legislature and the future needs of the industry. The biological communities that develop on fish cages and netting are distinctive, in comparison to those that foul ships. Temperate species of particular importance, because of their cosmopolitan distribution and opportunistic nature, include the blue mussel Mytilus edulis and the ascidian Ciona intestinalis. Antifouling practices include predominantly the use of copper-based antifoulant coatings, in combination with practical fish husbandry and site management practices. The antifouling solutions presently available are not ideal, and it is widely accepted that there is an urgent need for research into combatant technologies. Such alternatives include the adoption of "foul-release" technologies and "biological control" through the use of polyculture systems. However, none of these have, as yet, been proven satisfactory. In view of current legislative trends and the possible future "phasing out" of available antifouling materials, there is a need to find alternative strategies.
Animals↗
The development and evaluation of a community mental health education program for seminarians.
Because the clergy stands in an ideal position to serve the mental health needs of the community, seminaries have, for some time, included courses in pastoral counseling and related skills. While valuable, these courses tend to focus on the traditional clinical relationship excluding the broader role of community interventionist. Viewing this need, a course was developed to train seminarians in principles and practices of community mental health. The 28 students were compared to 24 controls at the beginning and end of the term. Evaluative instruments were the Community Mental Health Ideology Scale, two scales adapted from the Theological School Inventory, a self-evaluative competence scale, and a role evaluation scale. Data within a 2 X 2 X 2 design were subjected to an analysis of variance. Experimentals were found to exceed controls on the Community Mental Health Ideology Scale (p less than or equal to .001), the competence scale (p less than or equal to .01), and role evaluation scale (p less than or equal to .01).
Adult↗
Can deinstitutionalised care be provided for those at risk of violent offending?
OBJECTIVE: The aim of this article is to explain the current status of deinstitutionalisation and of community care development in the UK. DESIGN: Literature review of articles and reports on deinstitutionalisation. SETTING: Articles included in the review related either to the whole of the UK, to England and Wales, or to a specific area such as London. MAIN OUTCOME MEASURES: The review was carried out pertaining to the question of the extent to which community care can or should take over the functions of the asylum, with particular reference to those at risk of behaving violently. These functions include those that are manifest, or explicit, and those that are latent, or unintended but implicit (Bachrach, 1976). RESULTS: The example of patients at risk of violent behaviour is-one that highlights the continuing relevance of both these sets of functions, which are argued to be exerting a powerful influence on the processes of asylum closure and community care development. This influence is seen in delayed asylum closure, transinstitutionalisation (the shift of some patients from asylums to other institutions), and the institutionalisation of aspects of community care. CONCLUSIONS: Both the manifest and the latent functions of asylums must be acknowledged by those involved in planning community care; where it is felt desirable that community care does not take over certain functions, the consequences of this must be anticipated so that they can be prevented or dealt with in other ways.
Community Health Planning↗
Community genetics: a new discipline and its application in Brazil.
Community genetics is a new discipline which aims to provide genetic services to the community as a whole. As a science, community genetics encompasses all research needed to develop and evaluate its application. There is no question that the development of community genetics is necessary in Brazil. The implementation of such programs in our country, especially for hemoglobinopathies, has been recommended by the World Health Organization and other international organizations. Apart from the need for and appeal of community genetics programs, some aspects require serious review. This article discusses various cultural, social, psychological, and economic factors that can make genetic screening an invasion of individual privacy.
Brazil↗
Methodological development: structured outcome assessment and community risk monitoring (SORM).
This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.
Forensic Psychiatry↗
Capacity for methane oxidation in landfill cover soils measured in laboratory-scale soil microcosms.
Laboratory-scale soil microcosms containing different soils were permeated with CH(inf4) for up to 6 months to investigate their capacity to develop a methanotrophic community. Methane emissions were monitored continuously until steady states were established. The porous, coarse sand soil developed the greatest methanotrophic capacity (10.4 mol of CH(inf4) (middot) m(sup-2) (middot) day(sup-1)), the greatest yet reported in the literature. Vertical profiles of O(inf2), CH(inf4), and methanotrophic potential in the soils were determined at steady state. Methane oxidation potentials were greatest where the vertical profiles of O(inf2) and CH(inf4) overlapped. A significant increase in the organic matter content of the soil, presumably derived from methanotroph biomass, occurred where CH(inf4) oxidation was greatest. Methane oxidation kinetics showed that a soil community with a low methanotrophic capacity (V(infmax) of 258 nmol (middot) g of soil(sup-1) (middot) h(sup-1)) but relatively high affinity (k(infapp) of 1.6 (mu)M) remained in N(inf2)-purged control microcosms, even after 6 months without CH(inf4). We attribute this to a facultative, possibly mixotrophic, methanotrophic microbial community. When purged with CH(inf4), a different methanotrophic community developed which had a lower affinity (k(infapp) of 31.7 (mu)M) for CH(inf4) but a greater capacity (V(infmax) of 998 nmol (middot) g of soil(sup-1) (middot) h(sup-1)) for CH(inf4) oxidation, reflecting the enrichment of an active high-capacity methanotrophic community. Compared with the unamended control soil, amendment of the coarse sand with sewage sludge enhanced CH(inf4) oxidation capacity by 26%; K(inf2)HPO(inf4) amendment had no significant effect, while amendment with NH(inf4)NO(inf3) reduced the CH(inf4) oxidation capacity by 64%. In vitro experiments suggested that NH(inf4)NO(inf3) additions (10 and 71 (mu)mol (middot) g of soil(sup-1)) inhibited CH(inf4) oxidation by a nonspecific ionic effect rather than by specific inhibition by NH(inf4)(sup+).
Journal Article↗
Programs of safety surveillance and control of fishery products.
In the United States, fishery product safety at the federal level falls primarily under the authority of the Food and Drug Administration. However, other federal agencies play an important role. The Environmental Protection Agency is responsible for setting and recommending pesticide limits in seafood, and the National Marine Fisheries Service operates a voluntary inspection program. The Centers for Disease Control is responsible for the collection and evaluation of data characterizing the source of seafood-borne illness. Individual states also play a dominant role in the control of seafood-borne risk because of the important differences in consumption and contaminant levels across regions of the country. State public health, environmental protection, and resource management agencies have developed programs designed to mitigate that risk. Because of the complication and variability of the fishery industry, an effective safety system can be developed based on partnership among federal and state agencies, in which state governments retain the dominant role and the federal government develops and updates guidance programs and provides oversight. The international community has developed practices and protocols impacting the regulation of seafood safety in the United States. In view of developing trade agreements, the international community should address the criteria of setting equivalent contaminant levels and consider the option of establishing import contract criteria for fishery products.
Animals↗
Community health equipment loans: developing a clinical prioritization system.
This project aimed to develop an objective method for making equipment loans to home-based patients using a prioritisation system based on clinical need. An action research approach was selected as the most appropriate method because of the collaborative nature of the project. It involved working mainly with community nurses using questionnaires, focus groups, telephone and direct interviews. An important part of the process was a workshop with all stakeholders to involve them in decision-making. The resulting unique clinical referral form was implemented successfully. The research also highlighted existing attitudes and perceptions of the equipment loans service among health professionals. The new clinical referral form has improved service provision, is more equitable and now allows decisions to be made using agreed clinical criteria. The results of the research have been disseminated locally in the process of integration of NHS and social services equipment loans. This is a unique example of collaboration between community nursing practitioners, primary care trust managers and researchers producing a measurable difference to patient care.
Community Health Nursing↗
A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development.
BACKGROUND: Deficiencies of iron and zinc are associated with delayed development, growth faltering, and increased infectious-disease morbidity during infancy and childhood. Combined iron and zinc supplementation may therefore be a logical preventive strategy. OBJECTIVE: The objective of the study was to compare the effects of combined iron and zinc supplementation in infancy with the effects of iron and zinc as single micronutrients on growth, psychomotor development, and incidence of infectious disease. DESIGN: Indonesian infants (n = 680) were randomly assigned to daily supplementation with 10 mg Fe (Fe group), 10 mg Zn (Zn group), 10 mg Fe and 10 mg Zn (Fe+Zn group), or placebo from 6 to 12 mo of age. Anthropometric indexes, developmental indexes (Bayley Scales of Infant Development; BSID), and morbidity were recorded. RESULTS: At 12 mo, two-factor analysis of variance showed a significant interaction between iron and zinc for weight-for-age z score, knee-heel length, and BSID psychomotor development. Weight-for-age z score was higher in the Zn group than in the placebo and Fe+Zn groups, knee-heel length was higher in the Zn and Fe groups than in the placebo group, and the BSID psychomotor development index was higher in the Fe group than in the placebo group. No significant effect on morbidity was found. CONCLUSIONS: Single supplementation with zinc significantly improved growth, and single supplementation with iron significantly improved growth and psychomotor development, but combined supplementation with iron and zinc had no significant effect on growth or development. Combined, simultaneous supplementation with iron and zinc to infants cannot be routinely recommended at the iron-to-zinc ratio used in this study.
Anemia, Iron-Deficiency↗
Community life and the development of avoidance reaction in the laboratory rat.
The development of learning of active avoidance reaction in laboratory rats was studied in the course of the juvenile period, sexual maturation and in adulthood. The ability of acquiring and extinguishing an active avoidance reaction during the juvenile period is determined by the way of life: life in a community, at least during the suckling, weaning, or juvenile period positively influenced the ability of the animals to extinguish the reaction while the rate of acquisition slowed down. During learning a balance was thus reached between the rate of acquisition and extinction. In the young reared exclusively in presence of their mother and siblings, the rate of acquisition of this reaction was higher, and the ability of extinguishing was both qualitatively and quantitatively worsened. Thus the relation between the process of excitation and inhibition became unbalanced. In the period of sexual maturation and in adulthood community life had no effect on acquisition and extinction. It had, however, a late effect in those animals which were reared until weaning in a community: in the adulthood a positive correlation was detected between their rate of acquisition and extinction. In contrast, in adult animals reared until weaning in the presence of their mother and siblings, the correlation was found to be negative.
Age Factors↗