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PubMed1990

Factors enhancing and inhibiting the development of primary medical care in community health centres.

This study examined factors inhibiting and enhancing the development of primary medical care within community health centres. Nine centres with medical services, representing a range of financial administrative arrangements and a spread of locations, were selected for investigation. A modified version of the Community Health Accreditation and Standards Project (CHASP) review process was developed to look at areas of health service functioning. Effective internal management and a shared ethos were the strongest predictors of favourable outcomes overall. Salaried, as opposed to fee-for-service, financial arrangements led to better outcomes in most function areas, although salaried arrangements in themselves were not sufficient to produce good outcomes. All centres that performed well had community management structures, but the presence of such structures did not always guarantee good outcomes. The educational background and experience of the doctors had no effect. The study confirmed that primary medical care within community health centres represents a viable, alternative model of general practice in Australia and identified some factors that could strengthen it further.

Australia↗
PubMed2000

Estimating the growth potential of the soil protozoan community.

We have developed a method for determining the potential abundance of free-living protozoa in soil. The method permits enumeration of four major functional groups (flagellates, naked amoebae, testate amoebae, and ciliates) and it overcomes some limitations and problems of the usual 'direct' and 'most probable number' methods. Potential abundance is determined using light microscopy, at specific time intervals, after quantitative re-wetting of air-dried soil with rain water. No exogenous carbon substrates or mineral nutrients are employed, so the protozoan community that develops is a function of the resources and inhibitors present in the original field sample. The method was applied to 100 soil samples (25 plots x 4 seasons) from an upland grassland (Sourhope, Southern Scotland) in the UK. Median abundances for all four functional groups lie close to those derived from the literature on protozoa living in diverse soil types. Flagellates are the most abundant group in soil, followed by the naked amoebae, then the testate amoebae and ciliates. This order is inversely related to typical organism size in each group. Moreover, preliminary evidence indicates that each functional group contains roughly the same number of species. All of these observations would be consistent with soil having fractal structure across the size-scale perceived by protozoa. The method described will be useful for comparing the effects on the soil protozoan community of different soil treatments (e.g. liming and biocides).

Animals↗
PubMed2006

A community health programme in rural Tamil Nadu, India: the need for gender justice for women.

This article highlights the efforts of the Community Health and Development (CHAD) Programme of Christian Medical College to address the issues of gender discrimination and improve the status of women in the Kaniyambadi Block, Vellore, Tamil Nadu, India. The many schemes that are specifically for women and general projects for the community from which women can also benefit represent a multi-pronged approach whose aim is the improvement of women's health, education and employment in the context of community development. However, despite five decades of work with a clear bias in favour of women, the improvement in health and the empowerment of women has lagged behind that achieved by men. We believe this is because the community, with its strong male bias, utilises the health facilities and education and employment programmes more for the benefit of men and boys than women and girls. The article argues for a change of approach, in which gender and women's issues are openly discussed and debated with the community. It would appear that nothing short of social change will bring about an improvement in the health of women and a semblance of gender equality in the region.

Community Health Services↗
PubMed2002

Is a CCN degree the only way to develop children's nursing in the community?

Semi-structured interviews were carried out with convenience samples 10 CCN students completing a community children's nursing (CCN) degree programme and with five practice educators. In addition, focus group interviews were held with 28 child branch students who had undertaken community experience. The objective was to find out the perceived value of undertaking a community children's nursing degree. The overall aim of the study was to address practical questions of teachers who ran the CCN pathway within the community degree programme and inform programme development. The data confirmed ENB and UKCC views of the CCN role and supported the need for more flexible approaches to CCN education. Recommendations are made for changes, particularly in relation to the core community content of the programme which did not meet students' expectations for developing their child specialist role within a multi-agency team.

Attitude of Health Personnel↗
PubMed2001

The interaction between yeasts and bacteria in dairy environments.

The general environment from which raw dairy products originate and the microbiological quality of the products in its processed state inevitably admit yeast growth and spoilage. Only part of the primary microflora survives under the selective pressures exerted by the intrinsic and extrinsic biotic factors present, processing procedures and preservatives. Yeasts that possess the proper physiological attributes to counteract the specific ecological determinants will be favored. Eventually, a particular yeast community will develop, and if the environmental factors permit, this characteristic yeast community will result in a specific association contributing positively or negatively to the final product. The association that develops between yeasts and bacteria is governed by specific key properties selecting for a few predominant yeasts. These yeasts may either stimulate or inhibit normal bacterial growth. The extent to which interaction between yeasts and bacteria contribute to the final product is discussed.

Animals↗
PubMed2004

Para-veterinary professionals and the development of quality, self-sustaining community-based services.

Livestock are a major asset for rural households throughout the developing world and are increasingly regarded as a means of reducing poverty. However, many rural areas are characterised by limited or no accessibility to veterinary services. Economic theory indicates that primary level services can be provided by para-veterinary professionals working as private operators and as an outreach component of veterinary clinics and pharmacies in small urban centres. Experience from the development of community-based animal health worker (CAHW) systems indicates that these workers can have a substantial impact on livestock morbidity and mortality through the treatment or prevention of a limited range of animal health problems. Factors for success include community involvement in the design and implementation of these systems, and involvement of the private sector to supply and supervise CAHWs. Examples of privatised and veterinary supervised CAHW networks are cited to show the considerable potential of this simple model to improve primary animal health services in marginalised areas. An analysis of constraints indicates that inappropriate policies and legislation are a major concern. By referring to the section on the evaluation of Veterinary Services in the OIE (World organisation for animal health) Terrestrial Animal Health Code, the paper proposes guidelines to assist governments in improving the regulation, quality, and co-ordination of privatised, veterinary supervised CAHW systems.

Agriculture↗
PubMed2004

Public health and clinical recommendations for physical activity and physical fitness: special focus on overweight youth.

Numerous physical activity and physical fitness recommendations exist for youth. To date, however, no investigator has systematically reviewed these public health and clinical guidelines to determine whether the recommendations address overweight youth. This review examines youth-oriented physical activity and physical fitness recommendations for both the public health community and the clinical community, and assesses how overweight youth are specifically targeted by each of these two groups. Our review determined the extent to which the recommendations assessed four components of physical activity (i.e. frequency, intensity, duration and type) and four components of physical fitness (i.e. cardiorespiratory capacity, strength, flexibility and body composition). We further reviewed clinical recommendations to determine how they included two facets of the physician-patient encounter: assessment and counselling. After identifying all current physical activity and physical fitness recommendations for youth, we evaluated whether public health (n = 13) and clinical recommendations (n = 12) addressed physical activity and physical fitness for overweight youth. Findings revealed inconsistent, yet explicit, recommendations for the public health community where most organisations (12 of 13, 92%) included > or =3 physical activity components. In addition, organisations encouraged volumes of daily moderate- to vigorous-intensity physical activity for youth ranging from 30-60 or more minutes. Recommendations for the clinical community generally did not provide explicit physical activity and fitness recommendations to advise physicians on the assessment and counselling of patients and their families. Overweight youth were addressed within some recommendations (6 of 12, 50%) for the clinical community, but within few recommendations (2 of 13, 15%) for the public health community. To best inform public health and clinical communities, organisations developing future recommendations should include information fully documenting the decision-making processes used to develop the recommendations. In cases where mutual goals exist, public health and clinical communities should consider collaborating across agencies to develop joint recommendations.

Adolescent↗
PubMedDate not supplied

Some implications of a community mental health model for developing countries.

The aim of this paper is to call attention to certain problems facing many developing countries which are bound to lead to further difficulties in psychosocial adjustment. Almost all these problems are inherent in the process of socioeconomic change, urbanization, and industrialization. These changes may not only lead to an increase in the rate of mental illness, but because of their impact on the basic family structure and living conditions, will result in a reduced tolerance of deviation on the part of the community. Moreover, the spread of public education and mass media is also likely to lead to a change in the expectations and attitudes of developing nations making it no longer possible to endure psychological suffering as part of one's destiny. Even the improvement of public health services leading to reduction of infant mortality and a rise in life expectancy may lead to a gross increase in demands for mental health services by the very young and the aged sections of the population. It is the contention of this paper that a community mental health model, with certain modifications to fit the local culture, will best serve the increasing mental health needs of developing nations. Of particular relevance are such aspects of the model as population and prevention orientation, community involvement, extension of prefessional resources through consultation, utilization of non-professional manpower, continuity and comprehensiveness of care as well as an open systems conceptualization of the whole process of the organization and delivery of mental health services. The latter approach will help bring about an integration of mental health services within the wider framework of human service agencies, e.g., public health, general and adult education, family planning, and community development.

Affective Symptoms↗
PubMed1994

Beyond rhetoric: building and achieving community consensus in planning and developing an innovative public health nurse-midwifery education program.

Program planners collaborated with communities to achieve the goal of increasing the number of public health-educated nurse-midwives, and thus improve women's access to health services. By developing an innovative master's degree in public health nurse-midwifery education program. Boston University School of Public Health revitalized a model first developed at Johns Hopkins University School of Hygiene and Public Health. The dearth of nurse-midwifery education programs in the Northeast, coupled with the critical deficit of obstetric providers, had contributed to an alarmingly is an exciting alternative for meeting the health care needs of mothers and children and achieving the year 2000 objectives for the nation. Such a program, coupled with a foundation in public health education, synthesizes the best in nursing, nurse-midwifery, and public health Graduate nurse-midwives will have an enhanced understanding of the health care delivery system, the causal factors that contribute to disease, and the environmental, legal, and management dimensions surrounding the delivery of care.

Boston↗
PubMed2003

Obesity in American-Indian children: prevalence, consequences, and prevention.

BACKGROUND: American Indians of all ages and both sexes have a high prevalence of obesity. The health risks associated with obesity are numerous and include Type 2 diabetes mellitus, hypertension, dyslipidemia, and respiratory problems. Obesity has become a major health problem in American Indians only in the past few generations and it is believed to be associated with the relative abundance of high-fat, high-calorie foods and the rapid change from active to sedentary lifestyles. METHODS: The authors reviewed selected literature on prevalence of obesity in American-Indian children, and health consequences of obesity. RESULTS: Obesity is now one of the most serious public health problems facing American-Indian children, and it has grave implications for the immediate and long-term health of American-Indian youth. Unless this pattern is reversed, American-Indian populations will be burdened by an increased incidence of chronic diseases. Intervention studies are urgently needed in American-Indian communities to develop and test effective strategies for obesity prevention and treatment. CONCLUSIONS: To be effective, educational and environmental interventions must be developed with full participation of the American-Indian communities.

Adult↗
PubMed1988

What do we really know about community support programs? Strategies for better monitoring.

Studies have shown that community support programs are more effective in treating the chronic mentally ill than traditional forms of aftercare. Yet an analysis of 33 controlled studies of community support programs reveals that almost no systematic empirical knowledge exists about their actual implementation, including the kinds of treatment they deliver, how they can be replicated, or what ingredients account for their success. As a result, dissemination of the community support program model has been slower than expected. Developing effective community support programs requires making a commitment to evaluating programs as they are implemented, identifying program variables to monitor, devising methods for monitoring the variables chosen, and drawing from and building on existing literature about program evaluation. Strategies and models for monitoring implementation of community support programs are described.

Aftercare↗
PubMed2006

Preliminary results for the PAR-PRO: a measure of home and community participation.

OBJECTIVE: To develop a measure of home and community participation related to the World Health Organization's International Classification of Functioning, Disability and Health. DESIGN: Cross-sectional analysis of survey data. SETTING: Nine medical inpatient rehabilitation facilities from 6 states. PARTICIPANTS: A total of 594 patients of mixed impairment type admitted for inpatient rehabilitation in 2002. Mean age was 74.0 years and 61.4% were women. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reliability and validity of the participation instrument. RESULTS: A 20-item instrument of home and community participation was developed (PAR-PRO). The instrument showed good internal consistency and good Rasch person and item fit statistics. Four subfactors were identified beyond the unidimensional construct of participation including domestic management, socialization, physical vigor, and generative activities. The PAR-PRO total participation score correlated inversely with age (r=-.31, P<.001) but did not differ by sex. CONCLUSIONS: The 20-item PAR-PRO instrument of home and community participation displayed good psychometric characteristics. The instrument shows promise as a broad measure of home and community involvement for persons with disabilities. Further work is needed to support its application for people without disability.

Activities of Daily Living↗
PubMed2001

Pharmaceutical care program for patients with reactive airways disease.

A pharmaceutical care program for patients with reactive airways disease (RAD) is described. A pharmaceutical care program for patients with RAD was developed and implemented at 36 CVS pharmacies. The impact on patient outcomes, pharmacist job satisfaction, and other variables is currently being evaluated in a controlled trial with more than 1100 patient enrollees. Guiding the program are the beliefs that pharmacists must have clinically relevant, patient-specific data to provide appropriate care; that pharmacists must have adequate training to provide pharmaceutical care; that the program must be sensitive to organizational barriers, particularly time demands; and that there must be ongoing support for the program. The program has five components: (1) computer display of patient-specific data for patients enrolled in the study, (2) distribution of tailored patient education materials, (3) use of a resource guide to facilitate the implementation of pharmaceutical care, (4) strategies to reinforce and facilitate the program, and (5) pharmacist training. While developed for community pharmacies, the program is applicable to most ambulatory care pharmacy practices. A pharmaceutical care program for patients with RAD was developed for use in community pharmacies.

Community Pharmacy Services↗
PubMed2003

Occupational safety and health in The Gambia. Developing concern for worker health.

It is important for the occupational health nursing community to develop an international interest in worker health in countries with limited resources. The collaboration between The Gambia and the University of Iowa discussed in this article can be replicated in other settings and need not be limited to academic institutions. Corporate sponsorship and inclusion of workplace safety criteria in business contracts provide incentives for fostering change in developing countries.

Gambia↗
PubMed2003

Single-dose versus multi-dose vaccine vials for immunization programmes in developing countries.

Excessive vaccine wastage and safety concerns have prompted the international health community to develop and supply vaccines in formats other than the standard multi-dose vial. This article presents a programmatic and economic comparison of the major differences between the multi-dose vials and single-dose formats used for immunization services in developing countries. Multi-dose vials, in general, sell at a lower per-dose price and occupy less cold-chain capacity than single-dose formats. However, higher wastage rates may offset these benefits, especially for more expensive vaccines. Single-dose formats offer several important programmatic benefits, such as increased vaccination opportunities and improved vaccine safety. One single-dose format, the prefilled auto-disable (AD) device, provides additional injection safety and convenience features because it physically combines the vaccine and AD syringe. Selecting the appropriate vaccine presentation will depend on many factors. However, multi-dose vials are likely to be most appropriate for cheaper vaccines and in settings where cold-chain storage capacity is restricted. Single-dose formats will be most appropriate for more expensive vaccines and where there are problems with unsafe injection practices. Prefilled AD injection devices will be particularly useful in expanding outreach services while eliminating the possibility of needle reuse.

Developing Countries↗
PubMed2003

A public health response to a cluster of suicidal behaviors: clinical psychiatry, prevention, and community health.

OBJECTIVE: To develop and implement a community public health response to a suicidal behavior cluster, including collection of risk factor data in order to prevent further behaviors. METHODS: A three-phase response, including school-wide educational debriefings, individual screening for referrals, and on-site crisis management, was implemented. Incidence of suicidal behaviors and their association with hypothesized risk factors were measured. RESULTS: Thirty-three percent of students were screened. Depression and poor social functioning were associated with an increased risk of suicidal ideation. Poor social functioning and school adjustment were associated with an increased risk of suicide attempts. CONCLUSIONS: Development and implementation of a timely public health response, including elucidation of critical risk factors, might prevent further suicidal behaviors.

Journal Article↗
PubMed1996

Building community participation in health care: a model and example from South Africa.

A conceptual model was developed for a community-based intervention study in a Black township in South Africa. The model shows a useful way to structure the complex role public health nurses play as they meet community health needs using a community's priorities and building toward community involvement in health and self-care. The model was applied over a 2-year period in an under-developed community of 100,00 people where the unemployment rate was over 50%, fewer than 10% of the homes had electricity, and only one-third had access to the sewage removal system. Over half of older adults interviewed were illiterate. The residents, in collaboration with the nurse researcher, gathered data, prioritized needs, and chose projects to produce solutions. The model guided activities for community empowerment through a deliberate transfer of information and expertise from the nurse to members of the community. Conceptual models or paradigms are useful to focus nursing strategies, to guide professional nursing practice, and to support interdisciplinary goals for cooperative efforts. The principles are also applicable in the United States and other developed countries as more effective ways to achieve health goals are sought.

Black or African American↗