A Community Approach to Respiratory Disease

The pulmonary retention of certain volatile compounds and particulate matter in cigarette smoke was studied in humans. A smoke-dosage apparatus delivered a standard puff which was inhaled and subsequently exhaled into cold traps. Acetaldehyde, isoprene, acetone, acetonitrile, toluene, particulate matter, and carbon monoxide were measured and compared with the amounts found in noninhaled smoke. A 86% to 99% retention was found for all compounds except carbon monoxide of which 54% was retained. These findings stress the importance of using methods which approximate actual smoking conditions when evaluating the biological effect of tobacco smoke.     

Community Outreach and Engagement to Prepare for Household Recruitment of National Children's Study Participants in a Rural Setting

Context: The National Children's Study (NCS) is a longitudinal study of environmental influences on children's health. Recruitment of a representative birth cohort that will be followed until 21 years of age requires unique approaches across the nationwide study communities. Purpose: To describe community outreach and engagement in preparation for household recruitment of women of childbearing age at a rural‐classified NCS location that includes 4 adjacent Northern Plains counties spanning 2,500 square miles. Methods: Outreach and engagement methods focused on rural community characteristics. The team established an advisory council, conducted outreach meetings with agencies and groups, participated in local events, and collaborated with stakeholders. Study awareness was raised using radio announcements, local television stories, and widespread distribution of print materials through churches, businesses, and child care centers. Impact evaluation examined the number of stakeholder events by type. Outcome evaluation examined the number of households contacted for recruitment, numbers of age‐eligible women who completed the screening, and exploration of whether women had heard about the study. Findings: Over 300 outreach events occurred, ranging from tribal council meetings to parade entries. Recruitment outcomes were as follows: (1) 80% of 14,700 non‐vacant households were reached for potential recruitment; (2) screening interviews were conducted with 89% of the 5,800 age‐eligible women identified; and (3) 53% of women who completed the screening had heard about the study. Conclusions: Outreach targeted to rural communities facilitated strong recruitment outcomes. Collaboration with the cooperative extension service was a unique rural asset that facilitated relevant activities. Participant retention is an ongoing priority.     

Connecting Our Resources: Louisiana's Approach to Community Health Network Development

ABSTRACT: Louisiana's rural community health systems are in crisis because of pressures fueled by the rising costs of health care, sustained poor health status, state budget shortfills and changes in priorities, and a sliding rural economy. The development of community health networks is providing new infrastructure and capacity for communities to reprioritize, formulate innovative partnerships, and leverage new resources. Successful elements of Louisiana's network development experience include community commitment to engage in study and action; the availability of capable and motivated technical assistance; an approach that involves open-engagement, community-driven decision-making; and data-driven problem definition, prioritization, and solutions. Louisiana's experiences illustrate the benefits of developing networks along with, or as a result of, a community health plan. When a community owns its health improvement plan, it is more likely to support the new network as a structure for implmentation. Broad-scale participation is also a principle of success. When social service agencies are included along with health agencies, more comprehensive strategies result, and they bring additional resources, resulting in more holistic solutions. The cases of 2 networks are presented as illustrations. One involves the facilitation of a community planning process for an existing network. The plan helped to expand the networks community connections and support and provided the content for a successful application for a Health Resources and Services Administration Community Access Program grant. In the second case, a new network was developed, and it leveraged federal finds from the federal Office of Rural Health Policy's Network Development Grant Program.     

An Interdisciplinary Approach to Teaching Community Oriented Primary Care and Agromedicine to Pre-Health Professions Students Planning Rural Practice

SUMMARY

Health professions students planning practice in a rural area need to learn about agromedicine. Because the curriculum during health professions training has little time for this subject area, agromedicine material was taught to undergraduate students in a one week workshop. A pre-test and post-test format was used to measure increase in knowledge about farm health and safety.     

Recruitment of Rural Health Care Providers: A Regional Recruiter Strategy

ABSTRACT: Context: Access to care in rural areas is a major problem. Despite more than 20% of the US population residing in these areas, only 9% of physicians practice there. Extensive research has documented multiple issues that affect where physicians decide to locate and maintain practices. Creative strategies have been used to influence these recruitment and retention decisions. An emerging strategy, borne out of the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), effectively uses a targeted regional approach to assist rural Communities and health care facilities in assessing health care needs and recruiting primary care providers. Purpose: This article examines the issues surrounding recruitment and retention of primary care providers to rural areas and describes the experiences of the regional recruitment strategy in several states and in particular in the Mississippi Delta region of Arkansas. Methods: A case study approach is used to examine the targeted regional recruiter strategy in the Mississippi Delta region of Arkansas. Findings: The regional recruiter strategy, which combines traditional recruitment efforts with community development activities, has been successful in recruiting health care providers to rural communities. The cost-effective strategy can be easily replicated in other rural states. Conclusions: Community factors affect provider decisions on practice locations. Addressing community factors in recruitment efforts through community development activities may increase their success.     

Peer Reviewed: Community Health Status Indicators Project: The Development of a National Approach to Community Health

The Community Health Status Indicators Project (CHSI) 2008 provides 16-page reports for the 3141 counties in the United States, each of which includes more than 300 county-specific data items related to chronic and infectious diseases, birth characteristics or outcomes, causes of death, environmental health, availability of health services, behavioral risk factors, health-related quality of life, vulnerable populations, summary measures of health, and health disparities. The CHSI, originally initiated in 2000, provides county-level health profiles for all U.S. counties so that programs addressing community health can readily access community health indicators. Each county report also permits comparisons of a county''s health status with similar "peer counties," with all counties, and with national Healthy People 2010 objectives. Under the leadership of a public–private partnership, the CHSI Steering Committee updated each county report and added new information and features to create CHSI 2008. This new CHSI version includes data for 1994 through 2006 from multiple surveillance systems. New features include an enhanced Web site, an Internet mapping application, and a downloadable database of the indicators for all counties.     

A Multidisciplinary Approach to Treating Obesity in a Community Health Centre

Objectives

The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme.

Methods

The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months.

Results

346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction.

Conclusions

The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.     

Community Organizing Network for Environmental Health: Using a Community Health Development Approach to Increase Community Capacity around Reduction of Environmental Triggers

The Community Organizing Network for Environmental Health (CONEH), a project of Community Action Against Asthma, used a community health development approach to improve children’s asthma-related health through increasing the community’s capacity to reduce physical and social environmental triggers for asthma. Three community organizers were hired to work with community groups and residents in neighborhoods in Detroit on the priority areas of air quality, housing, and citizen involvement in the environmental project and policy decision-making. As part of the evaluation of the CONEH project, 20 one-on-one semi-structured, in-depth interviews were conducted between August and November 2005 involving steering committee members, staff members, and key community organization staff and/or community members. Using data from the evaluation of the CONEH project, this article identifies the dimensions of community capacity that were enhanced as part of a CBPR community health development approach to reducing physical and social environmental triggers associated with childhood asthma and the factors that facilitated or inhibited the enhancement of community capacity.     

A Model-Driven Approach to Qualitatively Assessing the Added Value of Community Coalitions

Community-based coalitions are commonly formed to plan and to carry out public health interventions. The literature includes evaluations of coalition structure, composition, and functioning; evaluations of community-level changes achieved through coalition activities; and the association between coalition characteristics and various indicators of success. Little information is available on the comparative advantage or “added value” of conducting public health interventions through coalitions as opposed to less structured collaborative mechanisms. This paper describes a qualitative, iterative process carried out with site representatives of the Controlling Asthma in American Cities Project (CAACP) to identify outcomes directly attributable to coalitions. The process yielded 2 complementary sets of results. The first were criteria that articulated and limited the concept of “added value of coalitions”. The criteria included consensus definitions, an organizing figure, a logic model, and inclusion/exclusion criteria. The second set of results identified site-specific activities that met the definitional criteria and were, by agreement, examples of CAACP coalitions’ added value. Beyond the specific findings relevant to the added value of coalitions in this project, the use of a social ecological model to identify the components of added value and the placement of those components within a logic model specific to coalitions should provide useful tools for those planning and assessing coalition-based projects.     

A Typological Approach to the Study of Rural HIV Service Delivery Networks

Despite the rapid growth of AIDS cases in nonmetropolitan areas, little is known about the characteristics and needs of HIV-positive rural residents or how rural areas are responding to the epidemic. This paper proposes a typology for distinguishing among rural environments and examining variations in HIV service networks. The typology identifies three dimensions that have a major effect on the development of rural HIV service networks: degree of rurality, the prevalence of AIDS, and the epidemiological and demographic characteristics of the infected populations. Data from four case studies are used to illustrate how variations in rural environments can affect the organization and delivery of HIV/AIDS care. The typology contributes to public policy discussions by identifying key attributes of rural environments that influence program planning and implementation and the transferability of service delivery models.     

Peer Reviewed: Community Health: A Critical Approach to Addressing Chronic Diseases

Many public health solutions to chronic diseases involve individual lifestyle choices: eating more healthfully, increasing physical activity, and quitting smoking. This approach neglects barriers in the community environment that make modifying unhealthy behaviors challenging. Addressing environmental barriers is an essential strategy to supporting behavioral changes. Changing community environments that contribute to unhealthy behaviors can improve community health.

Community indicator reports can be used to strengthen community environments for optimum health. The reports are comprehensive evaluations of community well-being that reflect community factors that influence health. Prevention Institute studied community indicator reports for The California Endowment and produced Good Health Counts: A 21st Century Approach to Health and Community for California. This commentary on that document highlights recommendations for the use of community indicator reports.

     

农村社区卫生服务可持续发展对策研究

发展农村社区卫生服务有利于减轻县级医院的负担、控制农村医疗费用、合理配置农村卫生资源及推进农村公共卫生计划。然而,由于农村社区卫生服务发展的观念滞后、农村社区卫生资源缺乏且服务水平低下和农村社区卫生服务中基本医疗项目纳入新型农村合作医疗保障的比例偏低,以及农村社区卫生服务相关的制度建设滞后,我国农村社区卫生服务发展缓慢。为了实现农村社区卫生服务的可持续发展,要创新农村社区卫生服务观念、建立合理的农村社区卫生服务筹资机制、加强农村社区卫生服务人力资源队伍建设和提高农村社区卫生服务质量。