社区医务人员营养培训与其干预意识及行为的关联研究

目的了解社区医务人员的膳食营养培训情况,以及培训是否与社区诊疗过程中增进的营养干预意识及行为相关联。方法选取杭州市下城区、拱墅区、西湖区的846名社区医务人员,采用问卷调查了解医务人员膳食营养技能培训情况、营养干预意识及干预行为等。应用Logistic回归分析影响技能培训的因素,采用Cochran-Mantel-Haenszel检验探索营养培训、营养干预意识、干预行为之间的关系。结果社区医务人员以女性为主,占78.49%。接受过膳食营养技能培训的医务人员占78.95%。工作时间是影响医务人员接受营养培训的主要因素。营养培训与营养咨询准备之间存在趋势性关联,随着培训的增加,营养咨询准备的自我评价越高（P〈0.05）。同时,营养培训也与增加的营养干预意识及行为相关联。随着培训种类的增加,医务人员对不健康饮食风险、接诊时常规询问患者的饮食习惯、建议患者给自己孩子树立健康饮食榜样3方面认识态度认识均有显著提高（P〈0.05）。营养培训的增加也同时增进了医务人员的营养干预行为,接受营养培训较多的医务人员,会为更多的社区就诊患者进行血压、体重、血胆固醇的测量,与患者交流平衡膳食、合理营养重要性以及给予肥胖患者减重建议（P〈0.05）。结论应进一步加强对社区医务人员的营养知识与干预技能培训,不断提升以社区为基础的慢性病综合干预措施效果。     

Training needs of staff in Romanian institutions for young children

Summary In order to make adequate provision for staffing and staff training in leagane (long-term residential care institutions for preschool age children in Romania) a postal survey was conducted in the autumn of 1991 to ascertain the demographic characteristics, job titles and educational attainment of directors and staff, staffing needs and the kinds of positions currently filled, the numbers of directors and staff exposed to continuing education programmes within the last 2 years, and the opinions of directors and staff regarding their most important continuing educational needs.
The bulk of the direct care workforce was less than 50 years old. Thirty-four per cent of the direct care staff had less than a high-school education. Sixty-seven per cent of the staff were health professionals or health care workers. There were few psychologists, physical therapists, teachers or social workers.
In the last 2 years, directors and other physicians had been mostly exposed to courses in the areas of psycho-social care/management and paediatric medical care. Nurses had attended professional development courses. Infirmiera (nursing assistants) had also attended professional development courses such as those offered by foreign non-governmental organizations on the care of institutionalized children. Educators (teaching assistants) had attended courses in child development and rehabilitation. Directors and staff expressed clear opinions regarding their needs and preferences for additional training     

A proposed intervention to improve knowledge of self-management of hypertension for Kenneth Young and C4 community mental health center staff in Cook County,Illinois

Purpose

Community mental health centers (CMHCs) provide psychiatric services and link Medicaid clients/members to both primary and specialty care within the community for people with serious mental illness (SMI), such as major depressive disorder, schizophrenia, and bipolar disorder. CMHCs help transition patients safely into the community from nursing facilities and rehabilitation centers. Patients diagnosed with an SMI have a higher incidence of cardiovascular diseases (CVDs), such as hypertension, and need management in the community to prevent further complications. CMHC staff lack knowledge to help their clients to manage medical conditions in the community, which can worsen hypertension management, potentially leading to complications for this population.

Methods

The conceptual framework used to guide this project is the health belief model. The planning model used to guide the intervention is the PRECEDE-PROCEED model. Twenty-two staff from two CMHCs participated in a one-hour educational session on hypertension management and accurate blood pressure demonstration, with pre and post session measures of hypertension knowledge and blood pressure skills checklist. Staff were re-evaluated for hypertension and blood pressure monitoring skills 8 weeks from the implementation of the intervention with a 30-min booster session, completing an additional post intervention hypertension knowledge questionnaire and blood pressure skills checklist. A hypertension management tool was developed for staff to use as a resource in the community for clients with hypertension. The tool covered accurate blood pressure measurement and documentation, red flag symptoms, medication, and physician appointment adherence.

Results

Ordinal data were evaluated from the Likert scale to compare the percentage score from baseline to post intervention measuring hypertension knowledge. Twenty-two staff participated from both agencies, comprising 17 females and 5 males, of which 38% had their Bachelors of Science degree and 62% had their Master’s degree. The pre and post assessment of knowledge increased by 33% from baseline after the intervention. Nominal data were used to collect responses from staff based on pre and post intervention blood pressure demonstration checklist and to capture staff attendance through the sign-in sheets at the intervention training. The results showed an improvement of 133% from baseline with the blood pressure demonstration checklist after the intervention and demonstration. There was a 14% decrease of blood pressure skills checklist at the 8-week booster session compared to the post intervention results.

Implications

The recommendations based on this project include addressing content missed from the knowledge test and the blood pressure skills checklist in the booster session, and reviewing the hypertension management information resource tool. Continually monitoring the use of the resource tools and incorporating booster sessions with the agencies can address any gaps in hypertension knowledge and changing guidelines in hypertension management. Recommendations to stakeholders of the agencies will include budgeting for training resources and participation incentives, monitoring sustainability of the intervention with use of the sustainability tool, and long-term monitoring of the impact of the intervention tool on blood pressure management outcomes in clients.

     

Assessment of management training for low-level community health workers providing care for children with acute respiratory infections in four districts of Senegal

BACKGROUND: Acute respiratory infections are the leading cause of death in childhood and most child deaths in Senegal occur at home without qualified health care. Despite this situation, only qualified healthcare workers are authorized to prescribe antibiotics. A competency-based training program was developed to improve and assess management of acute respiratory infections in young children aged between 2 and 59 months by low-level educated community health workers (CHWs) in four districts of Senegal. METHODS: In accordance with the strategy developed by the World Health Organisation, educated low-level community health workers in four district of Senegal were given a three-day course on the management of acute respiratory failure. We assessed the effects of the course by comparing pre-training and post-training skills with the Students t test. RESULTS: The results showed that the educated low-level community health workers were capable of acquiring the skills needed to effectively manage children with acute respiratory failure. CONCLUSION: Further evaluation is needed to determine the mid- and long-term effects of the course and supervised post-training activities.     

Social work training of new health professionals.

The Child Health Associate program provides a model for using social workers in the training of new health professionals. Administratively, social workers have contributed to curriculum development in the behavioral sciences. They have influenced decisions regarding student selection and have developed and implemented a faculty adviser program. Because of their practical experience as primary care practitioners, social workers have been able to define effectively the skills needed by the new professionals to meet the social and emotional needs of their patients. Social workers have made use of their contacts in hospitals and communities to design and implement courses and clinics that combine in a meaningful manner theoretical material and practical experiences in patient contact. Evaluative research in the area of interviewing skills and crisis management demonstrates that the teaching methods applied by the social work profession are effective in increasing the level of students' interviewing skills in clinical practice and help prepare them to recognize familiy crises.     

A Review of Children First and Keeping Safe Training in Ireland: Implications for the Future

The aim of this paper is to report on the evaluation of two standardised training programmes provided by the statutory children and family service in the Republic of Ireland in 2012. This involved an evaluation of Children First Basic Level Training, which was delivered to all staff employed in the statutory services, and Keeping Safe, Basic Level Training, which was delivered externally to those working with children and families in voluntary and community services. The objectives of this review were: to determine the perceived need of all participants on both training programmes; to establish the relevance of the training programmes vis-à-vis the participants work practice; to evaluate whether both training programmes have met their stated aims; and to establish the necessary components of a training programme to inform future development. This retrospective review was conducted using mixed methods. The findings show that, in the main, the needs of the respondents were met by the training. Most respondents agreed that the training met its aims and was relevant. Valuable suggestions were made regarding development for the future. However, due to an unexpectedly low response rate to the research, the low sample size has meant that we cannot deduce that the mostly positive results are representative of participants in the training programmes as a whole. However, while not a reliable representation of the whole trainee population, the findings are nonetheless illustrative and instructive as a guide within this complex and important field for the development of future training. It is concluded that given the ongoing challenge of protecting children from abuse and neglect, the findings will inform a renewed commitment to ongoing development of generic training as well as the development of more advanced methods of evaluation, and increased engagement of training participants in the research process.     

Integrated management of childhood illness: a summary of first experiences.

The strategy of Integrated Management of Childhood Illness (IMCI) aims to reduce child mortality and morbidity in developing countries by combining improved management of common childhood illnesses with proper nutrition and immunization. The strategy includes interventions to improve the skills of health workers, the health system, and family and community practices. This article describes the experience of the first countries to adopt and implement the IMCI interventions, the clinical guidelines dealing with the major causes of morbidity and mortality in children, and the training package on these guidelines for health workers in first-level health facilities. The most relevant lessons learned and how these lessons have served as a basis for developing a broader IMCI strategy are described.     

Nutrition project in a remote Australian aboriginal community.

Much of the ill health of Australian indigenous populations can be attributed to diet-related diseases. This community nutrition project is part of a wider renal screening and prevention program based in the Umoona aboriginal community in Coober Pedy in South Australia's far north. The nutrition project facilitates the capacity of the Umoona aboriginal community to identify and redress nutrition-related issues considered important in improving their overall health status. Project nutritionists developed and implemented a specialized nutrition training program with the Umoona aboriginal health workers. The nutritionists were responsive to requests from community groups to provide nutrition expertise and support in program development. Individual nutrition counseling for adults and children taking part in renal health screening was also provided. The aboriginal health workers reported increased nutritional knowledge and confidence in addressing nutrition-related issues within the community after nutrition training. Individual consultations and partnerships formed with community groups have increased awareness and prompted action to address the importance of nutrition in renal disease and overall health in the Umoona community.     

探索社区卫生服务人员院前急救知识和技能的培训对策

目的通过社区医护人员的院前急救演练,探索社区卫生服务人员院前急救技能的培训对策。方法采取社区卫生服务中心医护人员现场进行演练,由专家现场点评、提问以及评分。结果医护人员院前急救基本知识和技能掌握不够、医护整体配合欠佳、操作手法生硬和急救设备差等。结论社区卫生服务人员院前急救知识和技能水平直接影响着发生紧急情况时所做出的判断和行为选择,建立社区卫生服务人员院前急救知识和技能培训体系,可以有效地降低居民的病死率和致残率。     

Motivating health workers through nutrition training: an example from Egypt

Inappropriate training of primary health care staff and underuseof health facilities are two widely recognized problems in Egypt.Collaboration between the regional health services, a universitynutrition department and external technical assistance enableda successful programme of nutrition training to be set up inthe governorate of Alexandria. Locally adapted training materialswere produced. The training improved teamwork in the healthcentre and increased levels of nutrition activities within motherand child health (MCH) care. This, together with wide publicityof the aims of the programme, increased activity, continuityof care and established mothers' groups, resulted in greateruptake of services, and better infant feeding practices. Regular supervision of staff, using field staff as trainers,and constructive feedback were identified as factors which increasedthe motivation and morale of health centre personnel. The integrationof the project with local health management structures ensuredthat the lessons learnt were well disseminated and incorporatedinto future planning. Recommendations are made in this paperon community consultation, supervision by health care managers,and on local analysis and relevance of the health information.     

Scaling up integrated management of childhood illness to the national level: achievements and challenges in Peru

This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.     

A people-centered approach to primary health care implementation in Mvumi, Tanzania

The Mvumi community-based health care programme in Dodoma Region has been attempting to involve communities in promoting their health. It established a dialogue using communication and adult training skills and assisted communities only in those activities which they themselves planned and which they were ready to finance. Such activities included training of community resource persons such as traditional midwives and village health promoters/workers. Within only 4 years substantial output and outcome results could be demonstrated. Many village communities, for example, have assumed responsibility for the village-based nutrition rehabilitation of their severely malnourished children.     

深圳市龙岗区社康中心人力资源现状与人员稳定性分析

目的对深圳市社康中心卫生人力资源配置现状、人员工作满意度和离职意向进行分析,为提高社区卫生服务质量、促进社区卫生服务可持续发展提供参考依据。方法随机抽取59家社康中心,对目标机构及在职职工进行自填式问卷调查。采用氈2检验与 Logistic 回归分析模型进行数据处理。结果深圳市社康中心人力资源结构配置不合理,年龄分布以35岁以下为主;卫生人员数量不足,业务素质偏低;员工对工作报酬、福利待遇以及政府对机构的资助方面满意度低,10.70%的被调查者存在离职倾向,学历与收入水平是主要的人口学影响因素（P〈0.05）;同时,对所从事职务、福利待遇与培训机会的满意度情况也影响着人员的稳定性。结论应采取措施加强社区卫生服务工作人员培训;加大社区卫生人员经费投入,改善职工待遇;加强人力资源管理,确保资源合理高效利用。     

Research capacity development and training

The HSRC was awarded a large core grant specifically for research capacity development and training, with the aim of facilitating future high quality HSR in the UK. This was used to pursue three main areas of activity. First, the provision of small grants to facilitate the development of new work, help create new, multidisciplinary groupings and support junior researchers. Of the various schemes discussed, the research initiation grants (max pound6000) and workshop awards (max pound3000) appear to have been particularly valuable. Second, appoint cohorts of PhD students to pursue four-year training programmes (rather than the traditional three years), during which they received individualized research training and development opportunities with an emphasis on both multidisciplinary HSR training and generic skills training, as well as pursuing their own research projects. Third, improving research training opportunities by developing networks for research staff at various stages in their careers and organizing workshops and courses in specialist HSR subjects, and for generic skills training. The premature closure of the HSRC prevented us from fully evaluating these initiatives and, arguably, their real value will not be apparent for some years. However, we believe that the programme was successful and that it went some way to helping us break out from the traditional, entrenched approaches to research training, and to helping us think of research capacity development as being as important as doing the research itself. But much more remains to be done.     

Why does teaching research skills to family medicine trainees make sense?

There are only a few countries in Europe that have incorporated research skills training in specialty training programmes. In the eyes of most practising family physicians, research traditionally is a field reserved for colleagues with academic ambitions; an activity that often is not associated with the clinical practice of family medicine. However, residents became aware that research is essential to improving healthcare provision. Research in family medicine has a long tradition. Performing or taking part in research projects opens new horizons to present and future family physicians and provides support to increase their self-esteem. Consequently, this could foster future family medicine development. The authors urge the whole family physician community to raise the awareness every single family physician towards teaching and learning research skills in specialty training and basic medical education as a generic subject.     

Reliability of anthropometric measurements performed by community nutrition workers in a community-based pediatric growth-monitoring program in rural Rwanda

BackgroundIn Rwanda, the community-based growth-monitoring program is implemented via volunteer community nutrition workers. These volunteers are recruited from within their communities, and receive basic training prior to providing services. Utilizing local volunteers improves access to basic nutrition services, and allows the local health jurisdictions to use qualified health care staff more efficiently. In addition to concerns raised in regards to the accountability of unpaid workers, some question the relevance of the data that is collected. We carried out a nutritional survey in the catchment area of Ruli District Hospital to evaluate the reliability of the community nutrition workers’ measurements of anthropometric standards collected within the growth-monitoring framework.MethodsA nutritional survey was recently organized in the catchment area of the hospital in December 2006. The prevalence rates of malnutrition from the survey were compared with those from the existing community-based growth-monitoring program. Z-test was used to compare the prevalence rate of underweight from the survey with the prevalence rate determined by data collected from community nutrition workers. The concordance of children classified with moderate and severe underweight in each data set was determined by the coefficient Kappa of Cohen.ResultsOur findings show that the recent survey reported an overall underweight prevalence rate of 27.2%. Community data calculated a prevalence rate of 28.8% for the same population. The difference is not statistically significant (P = 0.294). Of 724 children evaluated, the survey and the community were in agreement in regards to 454 children classified in the category of good nutritional status, 143 children classified in moderate underweight and 11 children classified in the severe underweight category. The Kappa of Cohen coefficient of 0.636 indicates strong concordance between data sets.ConclusionAnthropometric measurements provided by the community are reliable. Information gathered from the community can be used for epidemiologic monitoring of malnutrition. To ensure continued reliability, health centers must provide sufficient and permanent training to community nutrition workers. In addition, continued access to essential materials used for measuring nutritional status and maintenance of these materials will be crucial to the program's ongoing success.     

Why healthcare workers give prelacteal feeds

OBJECTIVE: Because prelacteal feeds can adversely affect breastfeeding, UNICEF/WHO discourage their use unless medically indicated. The study was carried out to determine the proportion of healthcare workers who routinely give prelacteal feeds, and their reasons for doing so; further, to determine whether any differences exist between medically and non-medically trained healthcare workers in their administration of prelacteal feeds. DESIGN: Survey. SETTING: Primary, secondary and tertiary health facilities in Kaduna township Nigeria. SUBJECTS: Of 1100 healthcare workers sampled, 747 (68%) responded. Of these 80% had received medical training, 20% had not. METHODS: Use of a pretested validated questionnaire. RESULTS: Large proportions of both medical and non-medically trained healthcare workers stated they routinely give prelacteal feeds (doctors, 68.2%; nurses, 70.2%; and non-medical, 73.6%). However their reasons for doing so differed significantly (P=0.00001). Nurses gave mainly for perceived breast milk insufficiency, doctors for prevention of dehydration, hypoglycaemia and neonatal jaundice and non-medical staff to prepare the gastrointestinal tract for digestion and to quench thirst. CONCLUSIONS: Most healthcare workers (medical and non-medical) routinely and unnecessarily give prelacteal feeds. Therefore training and retraining programmes in lactation management are necessary and must include non-medical staff. These programmes, while emphasizing the danger of giving prelacteal feeds, must deal with the misconceptions of each group. Deliberate efforts have to be made to incorporate clinical training in breastfeeding in curricula of Schools of Medicine and Nursing.     

Guidelines for School Health Programs to Promote Lifelong Healthy Eating

ABSTRACT: Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart disease, cancer, and stroke. School health programs can help children and adolescents attain full educational potential and good health by providing them with the skills, social support, and environmental reinforcement they need to adopt long-term, healthy eating behaviors. This report summarizes strategies most likely to be effective in promoting healthy eating among school-age youths and provides nutrition education guidelines for a comprehensive school health program. These guidelines are based on a review of research, theory, and current practice, and they were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies. The guidelines include recommendations on seven aspects of a school-based program to promote healthy eating: school policy on nutrition, a sequential, coordinated curriculum, appropriate instruction for students, integration of school food service and nutrition education, staff training, family and community involvement, and program evaluation.     

社区卫生服务培训需求调查

目的：分析成都、沈阳两项目市(城市社区卫生与贫困医疗救助)社区卫生服务的培训需求，为项目设计培训计划提供参考。方法：社区卫生服务机构与人员的问卷调查、卫生人员专题小组讨论、机构领导深入访谈。结果：卫生人员的背景和所具知识、技能尚不能完全胜任社区卫生服务，卫生人员本身和领导都表示了培训的需求，并对培训内容、方式、对象、费用等提出了具体看法和希望。结论：加强两项目市杜区卫生人员的培训有必要也有可能。注意周密、完善培训计划；社区卫生管理人员和技术人员的培训齐抓并管；岗位任务分析；因地制宜；多种形式结合，注重社区实践。     

Strengthening public health nutrition research and training capacities in West Africa: Report of a planning workshop convened in Dakar, Senegal, 26-28 March 2009

A three-day workshop was convened in Dakar, Senegal, to provide participants from West African and international academic and research institutions, public health agencies, and donor organisations an opportunity to review current public health nutrition research and training capabilities in West Africa, assess needs for strengthening the regional institutional and workforce capacities, and discuss appropriate steps required to advance this agenda. The workshop included presentations of background papers, experiences of regional and international training programmes and small group discussions. Participants concluded that there is an urgent need to: (1) increase the throughput of public health nutrition training programmes, including undergraduate education, pre-service and in-service professional training, and higher education in public health nutrition and related research skills; and (2) enhance applied research capacity, to provide the evidence base necessary for nutrition program planning and evaluation. A Task Team was appointed to inform the regional Assembly of Health Ministers of the workshop conclusions and to develop political and financial support for a regional nutrition initiative to: (1) conduct advocacy and nutrition stewardship; (2) survey existing training programmes and assist with curriculum development; and (3) develop a plan for a regional applied research institute in Public Health Nutrition.