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PubMed2002

From local concern to randomized trial: the Watcombe Housing Project.

BACKGROUND: A randomized study of the effect on people's health of improving their housing is underway in Torbay. The link between poor health, particularly respiratory health, and poor housing conditions has been recognized for a long time, but there have been few intervention studies to demonstrate that improving housing can improve health. In 1994, South and West Devon Health Authority set up a community development project in a deprived area of Torbay, in response to the concerns of local primary health-care workers. A community development worker helped local residents survey their homes for dampness and record their respiratory symptoms. The survey reported high levels of condensation/dampness and respiratory illness and the Council agreed to direct the majority of their housing improvement funds to the estate over the next 3 years. The Health Authority, University of Plymouth and Torbay Council were successful in obtaining funding to evaluate the housing improvements from the NHS R & D programme. PARTICIPANTS AND METHODS: Of 119 houses eligible for the study, 50 were chosen at random and improved in the first year. The rest were improved the following year. Questionnaires screening for health problems were sent to all 580 residents and baseline surveys of the indoor environment were also carried out. More detailed health surveys were completed by community nurses visiting residents in their homes. All adults were asked to complete SF-36 and GHQ 12 questionnaires, as well as disease-specific questionnaires if appropriate. PROGRESS: All houses in the study have now been improved, including insulation, double-glazing, re-roofing, heating, ventilation and electrical rewiring. Follow-up surveys are underway.

Community Health Planning↗
PubMedDate not supplied

A simplified guide to practising community-based/community development initiatives.

The Simplified Guide to Practising Community-Based/Community Development Initiatives is tool for professionals who are beginning to embrace the principles of community development and empowerment into their philosophy of practice. The tool can be used to prepare for the initiative, to assist with the process, or afterwards to evaluate and formulate recommendations. The role of the professional is highlighted. One retrospective descriptive case analysis is presented to demonstrate the tool as an evaluation technique and to demonstrate the role of the practitioner in community development.

Community Health Nursing↗
PubMed1996

Looking out for family caregivers.

Nurses are regularly advised to become involved in community development initiatives, but what exactly does this entail and what are the precautions that should be considered? A 10-week, government sponsored, community-development program for family caregivers allowed nurses to offer education and support to six under-serviced areas of B.C. They offer a critique of the program and recommendations for the future.

Caregivers↗
PubMedDate not supplied

Health educaton in developing countries.

Health education is of great relevance in developing communities as it is a means of improving the health level which is an integral part of the overall socioeconomic development. It must be undertaken in conjunction with health services which should involve consumer participation at an early stage. Its focus is on changing behavior in respect to healthful living both at the individual and community levels. Health education subjects in developing communities include maternal and child health (MCH), nutrition, family planning and infectious diseases. Every member in the health team must be a health educator. Personal methods, especially when used by indigenous community health workers, are best suited to induce health behavior change in developing communities. Mass media as a rule is less suited for this, although radio can inform large segments of the population.

Adult↗
PubMed1994

Potential development of community oriented HIV outreach among drug injectors in the UK.

Given the current epidemiological and behavioural risk profile of HIV infection among injecting drug users in the UK, the main strategic task continues to be to develop interventions to prevent the spread of HIV infection. Outreach to drug injectors is an important part of the wider UK HIV prevention strategy. This paper reviews critically and reassesses practically the role of outreach interventions among drug injectors in the UK. It is argued that despite the development of innovative outreach activity, the full potential of outreach has not been realized due to its theoretical orientation and in-built structural limitations. Outreach has predominantly operated with an 'individual' orientation, aiming to work with individual clients to help them to change their behaviour, gain access to services, or to become better users of services. The main thesis of this paper is that current outreach provision needs to be complemented by 'community change' models which seek to engender changes in the social etiquette of drug use within communities of drug injectors. The paper argues that the social networks through which HIV may be transmitted are the same social networks that may be coopted for HIV prevention. Future outreach services must turn to these networks as a way of targeting and encouraging changes among broad populations of drug injectors. Such models might use indigenous advocates, working within social networks, supported by community outreach facilitators.

Community Health Services↗
PubMed1985

Myths and misconceptions in primary health care: lessons from experience.

Primary health care (PHC) is neither new nor cheap. It is a step forward in the consistent commitment of the public health movement over the past century and a half to seek out and redress the wrongs of society, paying particular attention to those most in need. PHC is not 2nd class medicine; it is not simpler but rather more complex. Selective PHC and primary medical care are significant parts of PHC but not the whole. PHC is essentially a combination of task-oriented basic health services and process-oriented community development. The former is a community-desired service, the latter less so. Community participation and community self-help in health care is more productive if based on an informed community, rather than otherwise, and is open to abuse. Health education and health legislation are the trusted tools of health advancement. Medical schools and other institutions of higher learning have a significant, if not vital, role to play in research education, evaluation, and services. They also have a coordinating role to promote PHC team effort. The selection and preparation of voluntary health workers and paid auxiliaries is at least as difficult as that for professional health workers. The preparation of their teachers is a sadly neglected aspect, without which there is little hope of any major progress in improving the image of PHC. Traditional practitioners could and should have an important role in promoting modern PHC since it is simply an update of their traditional role. Data and information systems require revision to meet the needs of local communities rather than those of central intelligence.

Community Participation↗
PubMed2002

Developing appropriate community-based postgraduate training in a developing country.

The School of Medical Sciences, KNUST, established in 1975, indicated its educational orientation to a community-based and community-oriented system using the problem-based learning approach. Falling victim to the phenomenon of brain-drain, the School developed a postgraduate medical curriculum which takes into account the needs and demands of national governments and communities for quality specialist care and equitable distribution of existing health facilities. There is an innovative community-based fourth year for obstetrics and gynaecology, ophthalmology, otorhinolaryngology, paediatrics, surgery and medicine. After attainment of the Part I Examination, residents are sent to Ulm, Maastricht, Britain and the United States for clinical attachments for a period of 3 to 6 months before returning to sit for their Final Part II for the Fellowship of the West African College of Surgeons or Physicians (FWACS, FWACP). By ensuring that the Final Examinations take place after the elective attachment, none of the new breed of specialists so far produced has been lost to the Western world. The strengths and weaknesses of the programme are discussed.

Journal Article↗
PubMed1999

Faculty development for community-based physicians at the University of Massachusetts and SUNY-Buffalo.

Community-based faculty development (CBFD) is becoming increasingly important as medical education moves into the ambulatory/office-based setting CBFD provides preceptors with essential knowledge, skills, and attitudes directly related to teaching while providing a sense of identity as teachers to a diverse group of practitioners in a variety of settings. This article reviews the structure and function of successful community-based faculty development, using as examples programs from the University of Massachusetts Medical School and the State University of New York at Buffalo that were supported by The Robert Wood Johnson Foundation's Generalist Physician Initiative. After reviewing the literature on successful implementation of programs dedicated to community-based precepting, the authors investigate the educational concepts, instructional designs, and operational characteristics that are the framework for providing successful faculty development to community-based preceptors. They list rationales and examples of the educational methods used and compare structural components of the programs at both institutions. Last, they explore future directions in the rapidly changing medical education environment that need to be addressed in CBFD in the areas of outcome/program evaluation, comprehensive needs assessment, and regionalization.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Castleman's disease in children: the experience of a children's hospital in Africa.

As the incidence of childhood Castleman's disease (CD) is reported to be rare in Western communities, the recent occurrence of three cases in non-HIV infected prepubertal children stimulated a 10-year (1983-1993) retrospective investigation into the conditions at a children's hospital that serves a predominantly developing community. Retrospective histologic examination revealed six cases of CD among children 3-11 years of age and another five probable cases having histological features of CD without adequate clinical and laboratory data. Three CD cases were associated with malignancy (Kaposi's sarcoma in two and a gastric B cell lymphoma in the other). Two CD cases were plasma cell type, one hyaline vascular, and three intermediate. One child with recurrent plasma cell-type features in a groin node had a Kaposi's sarcoma in the thigh. The five probable cases of CD all had intermediate histological features. Four of the 11 cases being reported came from a geographic locality that provides about 3% of the laboratory's case material and these included both cases that developed Kaposi's sarcoma. All patients who developed malignancy had the plasma cell variant. As all cases have been identified in developing communities, where the disease may often be misdiagnosed as nonspecific reactive lymphadenopathy, and there is an evident association with malignancy, it is recommended that children in these areas with the plasma cell variant of CD be closely monitored for subsequent malignancy.

Castleman Disease↗
PubMed2005

Quality of research on community partnerships: developing the evidence base.

Recent years have witnessed broad public health transformations. Central to these changes is that partnership work is increasingly mandated and employed as a vehicle for health education and promotion and disease prevention. Such efforts involve partnerships that span National Health Service bodies, local authorities and health and social care organizations, with stakeholders from the public, private, voluntary and community sectors. However, a more adequate evidence base is required to guide policy and action. The aims of this paper are to draw attention to some of the issues that have hampered the quality of partnership research and to discuss ways in which this research can be improved, in an effort to encourage the development of a more valuable evidence base for researchers, practitioners and policy makers. Multimethod approaches to research on partnership context, functioning and outcomes are advocated, and policy recommendations are made.

Community Networks↗
PubMed1995

Socio-economic aspects of animal diseases in southern Africa: research priorities in veterinary science.

During May 1995, members of organisations with a vested interest in the socio-economic aspects of animal diseases in southern Africa met for a one-day workshop. This was the first activity of a proposed three-year Forum and programme in this area under discussion. The workshop was sponsored by the Foundation for Research Development, the Agricultural Research Council and the University of Pretoria. The individuals who attended were representatives of academic and government institutions and included veterinarians, veterinary scientists, animal health officers, administrators from the region and abroad, economists, sociologists and animal welfare experts. The aims of the workshop were fourfold: 1. to define what is meant by socio-economic aspects of animal diseases in southern Africa; 2. to identify the socio-economic factors which influence occurrence and consequences of animal diseases; 3. to learn of methods which are used to assess socio-economic needs, and 4. to initiate an ongoing network and research programme in this area. Two key questions were considered and discussed by the participants, and a consensus reached for each. The first question considered the link between community development and socio-economic aspects of animal diseases. This included the role of production animals, companion animals and game in developing communities and factors influencing these roles, as well as constraints to this development. The second question concerned the gaps in our understanding of the socio-economic aspects of animal diseases in southern Africa which would lead to research opportunities. Six areas identified were were the collection of disease information, education and communication, policy, economics, community needs and technology.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa, Southern↗
PubMed1990

[Use of public health statistics in the development of community diagnosis].

A community diagnosis which describes the health of the local population may be an important instrument in promoting health and preventing disease. Most general practitioners do not have time to carry out individual surveys in the local community. Therefore it seems relevant to look into the possibility of utilizing official health statistics as a basis for community diagnosis. We obtained and analysed demographic data, mortality data, statistics on cancer, data on causes of invalidity and risk factors for cardiovascular diseases for Askvoll municipality. This article demonstrates possibilities, obstacles and constraints in the use of such statistics. Suppliers of register data should make routine health statistics more available for use in the district health services. In this connection we recommend the development of a central health data information system.

Community Health Services↗