Coordinated Strategies to Help the Whole Child: Examining the Contributions of Full-Service Community Schools

ERIC Educational Resources Information Center

Biag, Manuelito; Castrechini, Sebastian

2016-01-01

Full-service community schools are designed to increase students, and families' access to comprehensive and coordinated supports, services, and programs such as medical care, food aid, and enrichment activities. Despite widespread support, the research base documenting the efficacy of community schools is still emerging. Analyzing longitudinal…

Best Practices in Wireless Emergency Alerts

DTIC Science & Technology

2014-02-01

California Emergency Management Agency (Cal EMA)  Cassidian Communications  Cecil County Emergency Management Services, Maryland  City of...Jefferson County Emergency Communication Authority (JCECA), Colorado  Johnson County Emergency Management Agency, Kansas  Larimer Emergency Telephone...origination community and the challenges its members faced. Due to the infancy of the WEA service, many interviewees were not yet using WEA during the

Rural Emergency Medical Services (EMS) and Trauma

MedlinePlus

... Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning Tools Testing New Approaches Rural Health IT ... to the 2015 WWAMI Rural Health Research Center report, Prehospital Emergency Medical Services Personnel in Rural Areas: ...

"Why Are You Here? Can't You Cope at Home?" The Psychiatric Crisis of People with Intellectual Disabilities and the Community's Response

ERIC Educational Resources Information Center

Spassiani, Natasha; Abou Chacra, Megan Sarah; Lunsky, Yona

2017-01-01

Introduction: Individuals with intellectual disability (ID) are high users of emergency mental health services and can experience stigmatization in these circumstances. The purpose of the study was to examine the experiences of people with ID living in the community who interact with emergency services as a result of a psychiatric crisis, from the…

Emerging Partnerships: Safer Communities, Transformed Offenders, Shared Educational Resources.

ERIC Educational Resources Information Center

Brockett, E. Anne; Gibbons, Virginia M.

Applying the philosophy that strategic partnerships are the most effective way to share knowledge, skills, and resources, emerging community corrections adult education programs and existing community adult education service providers have begun to forge critical linkages. In Texas, the law now requires assessment of the educational level of all…

Community Services Landscape in Canada: Survey of Developmental Disability Agencies.

ERIC Educational Resources Information Center

Pedlar, Alison; Hutchison, Peggy; Arai, Susan; Dunn, Peter

2000-01-01

A survey of 801 support services for adults with developmental disabilities living in community settings in Canada found a diminution of government's role in funding and guiding service provision and the emergence of private-for-profit services. Differences between nonprofit and private sectors include a greater propensity in nonprofit agencies to…

Chemical and Biological Terrorism: Improvements to Emergency Medical Response.

ERIC Educational Resources Information Center

DeGraffenreid, Jeff Gordon

The challenge facing many emergency medical services (EMS) is the implementation of a comprehensive educational strategy to address emergency responses to terrorism. One such service, Johnson County (Kansas) Medical Action, needed a strategy that would keep paramedics safe and offer the community an effective approach to mitigation. A…

Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review

PubMed Central

Cocker, Fiona; Joss, Nerida

2016-01-01

Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD), anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10). Three included studies focused on community service workers (social workers, disability sector workers), while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4) or STS (n = 3). This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes. PMID:27338436

Alternative measures of spatial distribution and availability of health facilities for the delivery of emergency obstetric services in island communities.

PubMed

Oyerinde, Koyejo; Baravilala, Wame

2014-12-01

International guidelines and recommendations for availability and spatial distribution of emergency obstetric care services do not adequately address the challenges of providing emergency health services in island communities. The isolation and small population sizes that are typical of islands and remote populations limit the applicability of international guidelines in such communities. Universal access to emergency obstetric care services, when pregnant women encounter complications, is one of the three key strategies for reducing maternal and newborn mortality; the other two being family planning and skilled care during labor. The performance of selected lifesaving clinical interventions (signal functions) over a 3-month period is commonly used to assess and assign performance categories to health facilities but island communities might not have a large enough population to generate demand for all the signal functions over a 3-month period. Similarly, availability and spatial distribution recommendations are typically based on the size of catchment populations, but the populations of island communities tend to be sparsely distributed. With illustrations from six South Pacific Island states, we argue that the recommendation for availability of health facilities, that there should be at least five emergency obstetric care facilities (including at least one comprehensive facility) for every 500,000 population, and the recommendation for equitable distribution of health facilities, that all subnational areas meet the availability recommendation, can be substituted with a focus on access to blood transfusion and obstetric surgical care within 2 hours for all pregnant residents of islands. Island communities could replace the performance of signal functions over a 3-month period with a demonstrated capacity to perform signal functions if the need arises.

The emerging role of faith community nurses in prevention and management of chronic disease.

PubMed

McGinnis, Sandra L; Zoske, Frances M

2008-08-01

Faith community nursing, formerly known as parish nursing, is one model of care that relies heavily on older registered nurses (RNs) to provide population-based and other nonclinical services in community settings. Faith community nursing provides services not commonly available in the traditional health care system (e.g., community case management, community advocacy, community health education). With appropriate support, this model of nursing could be expanded into other settings within the community and has the potential to draw on the skills of experienced RNs to provide communities with services that address unmet health care needs.

The CHAP-EMS health promotion program: a qualitative study on participants' views of the role of paramedics.

PubMed

Brydges, Madison; Denton, Margaret; Agarwal, Gina

2016-08-24

Expanded roles for paramedics, commonly termed community paramedicine, are becoming increasingly common. Paramedics working in community paramedicine roles represent a distinct departure away from the traditional emergency paradigm of paramedic services. Despite this, little research has addressed how community paramedics are perceived by their clients. This study took an interpretivist qualitative approach to examine participants' perceptions of paramedics providing a community paramedicine program, named the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). Both participant observation and semi-structured interviews conducted with program participants were used to gain insight into the on-the-ground experiences of the program. Thematic analysis was employed to analyze all data. Three themes emerged: i) Caring and trusting relationships; ii) paramedics as health advocates; iii) the added value of EMS skills. Paramedics were perceived by residents as having dual identities: first in a novel role as health advocates and secondly in a traditional role as emergency experts despite lacking contextual features associated with emergency response. From this exploratory, qualitative study we present an emerging framework in which to conceptualize paramedic roles in community paramedicine settings. Future research should address the saliency of these roles in different contexts and how these roles relate to paramedic practice.

Acute gastrointestinal illness following a prolonged community-wide water emergency.

PubMed

Gargano, J W; Freeland, A L; Morrison, M A; Stevens, K; Zajac, L; Wolkon, A; Hightower, A; Miller, M D; Brunkard, J M

2015-10-01

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.

Using community partners to deliver low-cost and effective emergency management and business continuity services.

PubMed

Thomas, Joan; Roggiero, Jean Paul; Silva, Brian

2010-11-01

Small to medium-sized organisations enhance their business mission as well as their communities by continuing to offer services in extreme circumstances. Developing emergency preparedness and business continuity plans that are cost-effective, comprehensive and operational for small to medium-sized organisations with limited resources requires a consistent, supportive, hands-on approach over time with professionals to create appropriate and sustainable strategies. Using a unique, multi-layered and applied approach to emergency preparedness training, organisations have successfully created plans that are effective and sustainable.

Reciprocal and Scholarly Service Learning: Emergent Theoretical Understandings of the University-Community Interface in South Africa

ERIC Educational Resources Information Center

Smith-Tolken, Antoinette; Bitzer, Eli

2017-01-01

This study addresses underlying principles to interpret scholarly-based service-related teaching and learning. Such principles include addressing specific concerns of communities, transforming theoretical knowledge into lived experiences for students, making the knowledge generated within communities meaningful and forging constant growth and…

Disparities in Water and Sewer Services in North Carolina: An Analysis of the Decision-Making Process

PubMed Central

Gibson, Jacqueline MacDonald

2015-01-01

Objectives. We examined the factors that affect access to municipal water and sewer service for unincorporated communities relying on wells and septic tanks. Methods. Using a multisite case study design, we conducted in-depth, semistructured interviews with 25 key informants from 3 unincorporated communities in Hoke, New Hanover, and Transylvania counties, North Carolina, July through September 2013. Interviewees included elected officials, health officials, utility providers, and community members. We coded the interviews in ATLAS.ti to identify common themes. Results. Financing for water and sewer service emerged as the predominant factor that influenced decisions to extend these services. Improved health emerged as a minor factor, suggesting that local officials may not place a high emphasis on the health benefits of extending public water and sewer services. Awareness of failed septic systems in communities can prompt city officials to extend sewer service to these areas; however, failed systems are often underreported. Conclusions. Understanding the health costs and benefits of water and sewer extension and integrating these findings into the local decision-making process may help address disparities in access to municipal services. PMID:26270307

Police and mental health clinician partnership in response to mental health crisis: A qualitative study.

PubMed

McKenna, Brian; Furness, Trentham; Oakes, Jane; Brown, Steve

2015-10-01

Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one-to-one semistructured interviews. Themes emerged about the challenge created by a stand-alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer 'down-time', improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition. © 2015 Australian College of Mental Health Nurses Inc.

LGBT Africa: a social justice movement emerges in the era of HIV.

PubMed

Beyrer, Chris

2012-01-01

LGBT communities are emerging across Africa in 2012. Many are emerging in the context of the continents severe HIV epidemic. Homophobia is a barrier to social acceptance and to health and other social services, but African communities are showing reliance in addressing stigma and discrimination, and in organizing for rights and social tolerance.

The New Latino South and the Challenge to Public Education: Strategies for Educators and Policymakers in Emerging Immigrant Communities

ERIC Educational Resources Information Center

Wainer, Andrew

2004-01-01

The lack of resources devoted to educating Latinos in emerging immigrant communities is generating negative educational outcomes and de facto educational segregation in the South. While Latino immigrants continue to dominate employment in the meat processing, service, and construction sectors in these communities, they are underrepresented on…

Post-Project Assessment of Community-Supported Emergency Transport Systems for Health Care Services in Tanzania

ERIC Educational Resources Information Center

Ahluwalia, Indu B.; Robinson, Dorcas; Vallely, Lisa; Myeya, Juliana; Ngitoria, Lukumay; Kitambi, Victor; Kabakama, Alfreda

2012-01-01

We examined the continuation of community-organized and financed emergency transport systems implemented by the Community-Based Reproductive Health Project (CBRHP) from 1998 to 2000 in two rural districts in Tanzania. The CBRHP was a multipronged program, one component of which focused on affordable transport to health facilities from the…

The public vs private debate: separating facts from values.

PubMed

Narad, R A; Gillespie, W

1998-01-01

The choice between public and private emergency ambulance services is generally based on histological experience within the community. No empirical evidence exists that supports an argument that either public or private emergency ambulance services are better, per se. On a macro level, this debate is based on the question of the role of government and the role of the marketplace in the delivery of public services and medical care, and the comparative efficiencies of public and private organizations. On a micro or community level, these philosophical concerns are supplemented with issues relating to protection of individual jobs and investments, upholding of community tradition, and maintenance of existing relationships. Other specific values that are considered include the role of profit and equity--fairness of coverage. A rational choice would be based on consideration of efficiency and effectiveness. The effectiveness of an emergency medical services system is primarily based on its ability to provide patients with the level of care that they need within a clinically appropriate time. Efficiency is the ratio between inputs and outputs. One factor that can increase efficiency is the availability of excess production capacity that can be used to provide emergency ambulance service, with a low marginal cost of adding this to the other functions. A rational model is intended to change the level of the debate to one that is less based on values, but it is impossible for a community to select an ambulance provider in a value-free environment.

Community Service or Activism as an Identity Project for Youth

ERIC Educational Resources Information Center

Harre, Niki

2007-01-01

This article reviews the literature on community service and activism, particularly in youth, using the theoretical approach provided by an identity projects framework. This framework allows for an examination of the contextual and experiential factors that contribute to the emergence and maintenance of an identity project of service or activism.…

Building capacity in VA to provide emergency gynecology services for women.

PubMed

Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

2015-04-01

Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

Reducing Emergency Department Visits for Acute Gastrointestinal Illnesses in North Carolina (USA) by Extending Community Water Service

PubMed Central

DeFelice, Nicholas B.; Johnston, Jill E.; Gibson, Jacqueline MacDonald

2016-01-01

Background: Previous analyses have suggested that unregulated private drinking water wells carry a higher risk of exposure to microbial contamination than regulated community water systems. In North Carolina, ~35% of the state’s population relies on private wells, but the health impact associated with widespread reliance on such unregulated drinking water sources is unknown. Objectives: We estimated the total number of emergency department visits for acute gastrointestinal illness (AGI) attributable to microbial contamination in private wells in North Carolina per year, the costs of those visits, and the potential health benefits of extending regulated water service to households currently relying on private wells for their drinking water. Methods: We developed a population intervention model using 2007–2013 data from all 122 North Carolina emergency departments along with microbial contamination data for all 2,120 community water systems and for 16,138 private well water samples collected since 2008. Results: An estimated 29,400 (95% CI: 26,600, 32,200) emergency department visits per year for acute gastrointestinal illness were attributable to microbial contamination in drinking water, constituting approximately 7.3% (95% CI: 6.6, 7.9%) of all AGI-related visits. Of these attributable cases, 99% (29,200; 95% CI: 26,500, 31,900) were associated with private well contamination. The estimated statewide annual cost of emergency department visits attributable to microbiological contamination of drinking water is 40.2 million USD (95% CI: 2.58 million USD, 193 million USD), of which 39.9 million USD (95% CI: 2.56 million USD, 192 million USD) is estimated to arise from private well contamination. An estimated 2,920 (95% CI: 2,650, 3,190) annual emergency department visits could be prevented by extending community water service to 10% of the population currently relying on private wells. Conclusions: This research provides new evidence that extending regulated community water service to populations currently relying on private wells may decrease the population burden of acute gastrointestinal illness. Citation: DeFelice NB, Johnston JE, Gibson JM. 2016. Reducing emergency department visits for acute gastrointestinal illnesses in North Carolina (USA) by extending community water service. Environ Health Perspect 124:1583–1591; http://dx.doi.org/10.1289/EHP160 PMID:27203131

[Assessment of community health care services delivery during operation "Cast Lead"--a cross sectional survey].

PubMed

Savyon, Michal; Keinan-Boker, Lital; Enav, Teena; Rozentraub, Tammy; Laor, Danny; Shohat, Tamy

2010-12-01

On December 27th, 2008, the Israeli Defense Forces initiated operation "Cast Lead", aiming to strike the infrastructure of the terror organizations in the Gaza Strip. An emergency situation was declared on the home front, allowing the security forces special jurisdiction over the area. The Home Front Command's Medical Operation Center, in cooperation with the Superior National Health Authority of the Ministry of Health, coordinated the delivery of community health services. The objective of this study was to evaluate the delivery of community health services to the Israeli civilian population living in proximity to the Gaza Strip during operation "Cast Lead". A telephone household survey was initiated on the 20th day of the operation until two days after a cease-fire was declared. The sample was drawn from the Jewish population living within a radius of 40 kilometers from the Gaza Strip. Questions included the need and use of health care services, satisfaction with health care services and demographic variables. Overall, 901 interviews were conducted. Findings revealed that: 91.3%, 76.2% and 89.6% of those who needed primary physician, a specialist or a renewal of a drug prescription received these services, respectively; 87.1% of those who needed medical emergency services received them. The reported satisfaction with health care services during the combat period was very high; 91% reported high or very high satisfaction with their HMO's function during that period. The delivery of community health care services during operation "Cast Lead" efficiently addressed the needs of the population in the area. The delivery of medical emergency services and the access to medical specialists should be reassessed. It is important to plan ahead surveys such as the survey described above, and to cooperate with the HMO's and the Israel Defense Forces (IDF) in order to improve emergency preparedness.

Factors that Influence the Way Communities Respond to Proposals for Major Changes to Local Emergency Services: A Qualitative Study

PubMed Central

Barratt, Helen; Harrison, David A.; Fulop, Naomi J.; Raine, Rosalind

2015-01-01

Objective According to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions. Design Cross-sectional study involving in-depth interviews. Participants selected their priorities for emergency care, including aspects they might be prepared to have ‘less’ of (e.g. rapid access) if it meant having ‘more’ of another (e.g. consultant-delivered care). A thematic analysis was carried out, combining inductive and deductive approaches, drawing on theories about risk perception. Setting Two urban areas of England; one where changes to emergency services were under consideration (‘Greenville’), and one where they were not (‘Hilltown’). Participants 28 participants in total. Greenville interviewees included more common emergency service users - parents of young children (n=5) and older people (n=6) - plus patient representatives and individuals campaigning against service closures (n=9). Hilltown interviewees (n=8) received outpatient care for Chronic Obstructive Pulmonary Disease, an important cause of emergency admission. Results Most participants, in both areas, were not willing to accommodate the trade-offs involved in consolidating emergency services, principally because of the belief that timely access is associated with better outcomes. Participants did not consider the proposed improvements as gains worth having; interviewees believed care quality would be adversely impact, partly because increased patient numbers would place staff under greater pressure and result in longer waiting times. Conclusions Visible clinical leadership and detailed explanation of the case for change were insufficient to overcome opposition to the reconfiguration in Greenville, challenging the assumption that communities can be persuaded by evidence. Commissioners should make explicit credible plans to accommodate changes in patient flows, as well as clarifying the roles played by key staff groups. PMID:25807143

Factors that influence the way communities respond to proposals for major changes to local emergency services: a qualitative study.

PubMed

Barratt, Helen; Harrison, David A; Fulop, Naomi J; Raine, Rosalind

2015-01-01

According to policy commentators, decisions about how best to organise care involve trade-offs between factors relating to care quality, workforce, cost, and patient access. In England, proposed changes such as Emergency Department closures often face public opposition. This study examined the way communities respond to plans aimed at reorganising emergency services, including the trade-offs inherent in such decisions. Cross-sectional study involving in-depth interviews. Participants selected their priorities for emergency care, including aspects they might be prepared to have 'less' of (e.g. rapid access) if it meant having 'more' of another (e.g. consultant-delivered care). A thematic analysis was carried out, combining inductive and deductive approaches, drawing on theories about risk perception. Two urban areas of England; one where changes to emergency services were under consideration ('Greenville'), and one where they were not ('Hilltown'). 28 participants in total. Greenville interviewees included more common emergency service users - parents of young children (n=5) and older people (n=6) - plus patient representatives and individuals campaigning against service closures (n=9). Hilltown interviewees (n=8) received outpatient care for Chronic Obstructive Pulmonary Disease, an important cause of emergency admission. Most participants, in both areas, were not willing to accommodate the trade-offs involved in consolidating emergency services, principally because of the belief that timely access is associated with better outcomes. Participants did not consider the proposed improvements as gains worth having; interviewees believed care quality would be adversely impact, partly because increased patient numbers would place staff under greater pressure and result in longer waiting times. Visible clinical leadership and detailed explanation of the case for change were insufficient to overcome opposition to the reconfiguration in Greenville, challenging the assumption that communities can be persuaded by evidence. Commissioners should make explicit credible plans to accommodate changes in patient flows, as well as clarifying the roles played by key staff groups.

Promoting Science Literacy through Research Service-Learning--An Emerging Pedagogy with Significant Benefits for Students, Faculty, Universities, and Communities

ERIC Educational Resources Information Center

Reynolds, Julie A.; Ahern-Dodson, Jennifer

2010-01-01

Research service-learning (RSL) is an emerging pedagogy in which students engage in research within a service-learning context. This approach has great potential to promote science literacy because it teaches students how to use scientific knowledge and scientific ways of thinking in the service of society and helps them to better appreciate the…

'Gotta be sit down and worked out together': views of Aboriginal caregivers and service providers on ways to improve dementia care for Aboriginal Australians.

PubMed

Smith, Kate; Flicker, Leon; Shadforth, Geraldine; Carroll, Emily; Ralph, Naomi; Atkinson, David; Lindeman, Melissa; Schaper, Frank; Lautenschlager, Nicola T; LoGiudice, Dina

2011-01-01

Dementia is five-fold more prevalent among Aboriginal than non-Aboriginal Australians. Despite this, the quality of care available to people living with dementia in remote Aboriginal communities is poor. The objective of this study was to determine ways to overcome factors affecting the successful delivery of services to Aboriginal people with dementia living in remote communities, and to their families and communities. This qualitative research took place in the Kimberley Region of Western Australia. Data collection occurred in three stages: (1) interviews with service providers to identify the services available; (2) interviews with the caregivers of Aboriginal people living with dementia and community-based care workers; and (3) focus groups with community representatives and community care staff. Each stage was concluded when no new themes emerged. At each stage the transcribed information was analysed and joint interpretation identified common themes. In total, 42 service providers, 31 caregivers and community-based care workers were interviewed and 3 focus groups were conducted. Obstacles to accessing quality care were mentioned and recommendations on ways to improve care were made. The key themes that emerged were caregiver role, perspectives of dementia, community and culturally-appropriate care, workforce, education and training, issues affecting remote communities and service issues. Detailed information on how each theme affects the successful delivery of dementia care is provided. These research findings indicate that people living with dementia and their caregivers in remote Aboriginal communities are struggling to cope. They are requesting and require better community care. Implementing a culturally safe model of dementia care for remote Aboriginal communities that encompasses the recommendations made and builds on the strengths of the communities could potentially deliver the required improvements to dementia care for this population.

Community service contracting for older people in urban China: a case study in Guangdong Province.

PubMed

Lin, Wenyi

2016-01-01

Contracting of community services to non-governmental service-providing organisations - mainly social work agencies - is an emerging phenomenon and a social innovation with regard to delivering community services in urban China. Contracting of community services for the older person, which is the focus of this study, is embedded in the macro context of the development of social service contracting in China. Qualitative research techniques, including document analysis, case study, participant observation and in-depth interviews, were adopted for this study. Nine government officials, three staff working in Community Residents' Committees, 15 staff working in social work agencies and 41 older people were interviewed in an effort to understand the impact and challenges of community service contracting in urban China. The findings showed that the involvement of social work agencies in the community service provision system results in integration of community resources, expansion of service coverage and enhancement of older people's access to community services. However, several problems may impede the development of community service provision in the context of contracting in China. These include purchaser-oriented rather than user-oriented service provision, older people's negative attitude towards social work services, inappropriate performance measurement, reliance of non-government organisations on government funding and ambiguous definition of community services.

75 FR 76006 - Agency Emergency Information Collection Clearance Request for Public Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-07

... primary care services into publicly funded community mental health and other community-based behavioral... Substance Abuse and Mental Health Administration are funding an independent evaluation of the Substance Abuse and Mental Health Administration/Center for Mental Health Services' (SAMHSA/CMHS) Primary Care...

Where Children Live: Solutions for Serving Young Children and Their Families. Advances in Applied Developmental Psychology, Volume 17.

ERIC Educational Resources Information Center

Roberts, Richard N., Ed.; Magrab, Phyllis R., Ed.

The changing nature of communities necessitates a comprehensive theoretical model for effective delivery of child and family services. This edited volume provides a context for and examples of an emerging paradigm shift in human services toward one in which services for families with young children are provided in their communities. Section 1 of…

Emerging Workforce Trends and Issues Impacting the Virginia Community College System

ERIC Educational Resources Information Center

Landon, Mary Greer

2009-01-01

The mission of the Virginia Community College workforce development leaders is to expand their training and development services to new and emerging high growth occupational areas in support of Virginia's economic growth and changing workforce needs in each of their regions. This research was designed to identify: high demand occupational skill…

Trajectories of Health and Behavioral Health Services Use among Community Corrections–Involved Rural Adults

PubMed Central

Mowbray, Orion; McBeath, Bowen; Bank, Lew; Newell, Summer

2016-01-01

This article seeks to establish time-based trajectories of health and behavioral health services utilization for community corrections–involved (CCI) adults and to examine demographic and clinical correlates associated with these trajectories. To accomplish this aim, the authors applied a latent class growth analysis (LCGA) to services use data from a sample of rural CCI adults who reported their medical, mental health, and substance use treatment utilization behavior every 60 days for 1.5 years. LCGA established 1.5-year trajectories and demographic correlates of health services among rural CCI adults. For medical services, three classes emerged (stable-low users, 13%; stable-intermediate users, 40%; and stable-high users, 47%). For mental health and substance use services, three classes emerged (stable-low, 69% and 61%, respectively; low-baseline-increase, 10% and 12%, respectively; high-baseline decline, 21% and 28%, respectively). Employment, gender, medication usage, and depression severity predicted membership across all services. Results underscore the importance of social workers and other community services providers aligning health services access with the needs of the CCI population, and highlight CCI adults as being at risk of underservice in critical prevention and intervention domains. PMID:27257353

Community service provider perceptions of implementing older adult fall prevention in Ontario, Canada: a qualitative study.

PubMed

Dykeman, Catherine S; Markle-Reid, Maureen F; Boratto, Lorna J; Bowes, Chris; Gagné, Hélène; McGugan, Jennifer L; Orr-Shaw, Sarah

2018-02-01

Despite evidence for effective fall prevention interventions, measurable reductions in older adult (≥ 65 years) fall rates remain unrealized. This study aimed to describe the perceived barriers to and effective strategies for the implementation of evidence-based fall prevention practices within and across diverse community organizations. This study is unique in that it included community service providers who are not generally thought to provide fall prevention services to older adults, such as retail business, community support, volunteer services, community foundations, recreation centres, and various emergency services. Interviews and focus groups were conducted with a purposive sampling of providers (n = 84) in varied roles within diverse community-based organizations across disparate geographical settings. Community service providers experience significant multi-level barriers to fall prevention within and across organizations and settings. The overall challenge of serving dispersed populations in adverse environmental conditions was heightened in northern rural areas. Barriers across the system, within organizations and among providers themselves emerged along themes of Limited Coordination of Communication, Restrictive Organizational Mandates and Policies, Insufficient Resources, and Beliefs about Aging and Falls. Participants perceived that Educating Providers, Working Together, and Changing Policies and Legislation were strategies that have worked or would work well in implementing fall prevention. An unintentional observation was made that several participants in this extremely varied sample identified expanded roles in fall prevention for themselves during the interview process. Community service providers experience disabling contexts for implementing fall prevention on many levels: their specific geography, their service systems, their organizations and themselves. A systemic lack of fit between the older adult and fall prevention services limits access, making fall prevention inaccessible, unaccommodating, unavailable, unaffordable, and unacceptable. Educating Providers, Working Together, and Changing Policies and Legislation offers promise to create more enabling contexts for community stakeholders, including those who do not initially see their work as preventing falls.

Disaster planning for vulnerable populations: leveraging Community Human Service Organizations direct service delivery personnel.

PubMed

Levin, Karen L; Berliner, Maegan; Merdjanoff, Alexis

2014-01-01

Given the variability, complexities, and available resources for local vulnerable populations, it is clear that preparing effectively for catastrophic events cannot be accomplished with a single, simple template. Inclusion of Community Human Service Organizations' (CHSO's) direct service delivery personnel ensures that emergency disaster planning efforts for vulnerable populations are effective and responsive to unique needs and constraints. By leveraging existing local resources, it extends the preparedness system's reach to the whole community. CHSO personnel already perform community-based services and directly engage with vulnerable and special needs populations; typically they are on the front lines during an emergency event. Generally, however, the CHSOs, staff, and clients are neither adequately prepared for disasters nor well integrated into emergency systems. To address preparedness gaps identified during Hurricane Sandy, regional CHSO and local health department partners requested that the Columbia Regional Learning Center provide preparedness trainings for their agencies and staff responsible for vulnerable clients. Evaluation of this initiative was begun with a mixed-methods approach consisting of collaborative learning activities, a function-based assessment tool, and a 5 Steps to Preparedness module. Results from a survey were inclusive because of a low response rate but suggested satisfaction with the training format and content; increases in awareness of a client preparedness role; and steps toward improved personal, agency, and client preparedness. Direct service delivery personnel can leverage routine client interactions for preparedness planning and thus can contribute significantly to vulnerable population and community disaster readiness. Trainings that provide preparedness tools can help support this role. CHSO personnel are knowledgeable and have the expertise to assist clients in personal preparedness planning; yet, there are challenges around their ability and willingness to take on additional responsibilities.

Community-based first aid: a program report on the intersection of community-based participatory research and first aid education in a remote Canadian Aboriginal community.

PubMed

VanderBurgh, D; Jamieson, R; Beardy, J; Ritchie, S D; Orkin, A

2014-01-01

Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course participants and the people they help are relevant and important; (3) curriculum must be attentive to existing informal and formal emergency response systems. These lessons may be instructive for the development of other programs in similar settings.

Information Provision in Emergency Settings: The Experience of Refugee Communities in Zambia

ERIC Educational Resources Information Center

Kanyengo, Brendah Kakulwa; Kanyengo, Christine Wamunyima

2011-01-01

This article identifies information provision services in emergency settings using Zambia as a case study by identifying innovative ways of providing library and information services. The thrust of the article is to analyze information management practices of organizations that work within refugee camps and how they take specific cognizance of the…

Emergency psychiatric services for individuals with intellectual disabilities: perspectives of hospital staff.

PubMed

Lunsky, Yona; Gracey, Carolyn; Gelfand, Sara

2008-12-01

Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities, from the perspective of hospital staff. Focus groups were conducted with emergency psychiatry staff from 6 hospitals in Toronto, Canada. Hospital staff reported a lack of knowledge regarding intellectual disabilities and a shortage of available community resources. Hospital staff argued that caregivers need more community and respite support to feel better equipped to deal with the crisis before it escalates to the ER and that hospital staff feel ill prepared to provide the necessary care when the ER is the last resort. Input from hospital staff pointed to deficiencies in the system that lead caregivers to use the ER when other options have been exhausted. Both staff and caregivers need support and access to appropriate services if the system is to become more effective at serving the psychiatric needs of this complex population.

Emergency Health Services Selected Bibliography.

ERIC Educational Resources Information Center

Health Services and Mental Health Administration (DHEW), Bethesda, MD.

This annotated bibliography contains books, journal articles, visual aids, and other documents pertaining to emergency health care, which are organized according to: (1) publications dealing with day-to-day health emergencies that occur at home, work, and play, (2) documents that will help communities prepare for emergencies, including natural…

Development of Rural Emergency Medical System (REMS) with Geospatial Technology in Malaysia

NASA Astrophysics Data System (ADS)

Ooi, W. H.; Shahrizal, I. M.; Noordin, A.; Nurulain, M. I.; Norhan, M. Y.

2014-02-01

Emergency medical services are dedicated services in providing out-of-hospital transport to definitive care or patients with illnesses and injuries. In this service the response time and the preparedness of medical services is of prime importance. The application of space and geospatial technology such as satellite navigation system and Geographical Information System (GIS) was proven to improve the emergency operation in many developed countries. In collaboration with a medical service NGO, the National Space Agency (ANGKASA) has developed a prototype Rural Emergency Medical System (REMS), focusing on providing medical services to rural areas and incorporating satellite based tracking module integrated with GIS and patience database to improve the response time of the paramedic team during emergency. With the aim to benefit the grassroots community by exploiting space technology, the project was able to prove the system concept which will be addressed in this paper.

Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service.

PubMed

Fung, Russell; Hyde, Jensen Hart; Davis, Mike

2018-01-01

The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots. We found a significant improvement in ED and AIM provider satisfaction with the admission process. There was also a significant increase in admissions to the AIM service after implementation of the app. We submit that the implementation of a mobile app is a viable, cost-efficient, and effective method to streamline the admission process from the ED to AIM services at community-based hospitals.

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan.

PubMed

Imai, Hirohisa; Nakao, Hiroyuki; Nakagi, Yoshihiko; Niwata, Satoko; Sugioka, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

2006-11-01

The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction". Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

Hospital emergency on-call coverage: is there a doctor in the house?

PubMed

O'Malley, Ann S; Draper, Debra A; Felland, Laurie E

2007-11-01

The nation's community hospitals face increasing problems obtaining emergency on-call coverage from specialist physicians, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services. Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to non-hospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians stipends, and employing physicians. Nonetheless, many hospitals continue to struggle with inadequate on-call coverage, which threatens patients' timely access to high-quality emergency care and may raise health care costs.

Implementation of legislative requirements for emergency medical services in prepaid group practice organizations.

PubMed Central

Solomon, M A

1977-01-01

The Health Maintenance Organization Act of 1973, the Emergency Medical Services (EMS) Systems Act of 1973, and other laws are examined for their effects on the organization and management of emergency services in prepaid group practice plans (PPGP). The study was conducted in 1974-75 by the Group Health Association of America. The data were gathered through interviews with administrators and providers of seven PPGPs and with leaders of health planning agencies in the same communities, as well as through reviews of internal documents and a 1-month utilization survey of emergency and urgent care services in each PPGP. Effects of the laws were found to be limited, with the health maintenance legislation appearing to have the greastes effect on the design of emergency servide models. In most localities, two parallel systems may operate in offering round-the-clock emergency care and programs to educate members and the public about the appropriate use of emergency facilities. The EMS legislation has had minimal effects on the design of emergency services in the PPGPs. The emergency services component is the most transitional aspect of the PPGS nad the one most amenable to change. Revisions have come through changes in internal management policy and from demands of subscribers. A regulating inference in the operation of the PGP, in the area of emergency services as well as in the delivery of primary care services, is that the plans must compete, both in costs and benefits, with available indemnity insurance coverage. The market dictates premium levels without regard to associated benefits. Additional costs for broader coverage and administrative regulatory mechanisms must be borne by the subscriber in the form of increased premiums. As a result, the utilization of expensive emergency care must be carefully controlled, and this restraint is often accomplished by requirements specifying which health problems are appropriate for the provision of emergency care, rather than by delaying assistance until the plan's office hours. The furtherance of the PPGP concept, that the entire health care of the individual person is provided and financed by one organization, definancedby one organization, detracts from the viability of a central body charged with the coordination of the delivery of all emergency services in the community. It results not only in duplication of effort but often in the establishment of potentially antagoistic organizations. Images p308-a p311-a PMID:877204

Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

PubMed Central

Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

2015-01-01

Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

44 CFR 295.21 - Allowable compensation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Allowable compensation. 295.21 Section 295.21 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... no-cost crisis counseling services available in the community. FEMA will not reimburse for treatment...

7 CFR 1778.34 - Grant servicing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Grant servicing. 1778.34 Section 1778.34 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.34 Grant servicing. (a) Grants...

Exploring Partnership Functioning within a Community-Based Participatory Intervention to Improve Disaster Resilience

ERIC Educational Resources Information Center

Gagnon, Elizabeth; O'Sullivan, Tracey; Lane, Daniel E.; Paré, Nicole

2016-01-01

Disasters happen worldwide, and it is necessary to engage emergency management agencies, health and social services, and community-based organizations in collaborative management activities to enhance community resilience. Community-based participatory research (CBPR) has been widely accepted in public health research as an approach to develop…

Sustained Engagement with a Single Community Partner

ERIC Educational Resources Information Center

Lear, Darcy W.; Sanchez, Alejandro

2013-01-01

As scholarly work has recently turned its attention to the role of the community partner in Community Service-Learning (CSL) relationships, empirical frameworks for describing and executing community partnerships have emerged. This article applies those frameworks to one such partnership, which is presented from the perspective of both the…

Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

PubMed

Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, Michael

2018-05-04

To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed. Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed. The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%). One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Community participation to design rural primary healthcare services.

PubMed

Farmer, Jane; Nimegeer, Amy

2014-03-21

This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services. Community-based participatory action research was applied in four Scottish case study communities in 2008-10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented. Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation. Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions.

Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts.

PubMed

Formica, Scott W; Apsler, Robert; Wilkins, Lindsay; Ruiz, Sarah; Reilly, Brittni; Walley, Alexander Y

2018-04-01

Opioid overdose is a significant public health problem. Collaborative programs between local public health and public safety agencies have emerged to connect overdose survivors and their personal networks with harm reduction and addiction treatment services following a non-fatal overdose event. This study explored the prevalence of these programs in Massachusetts and the different ways they have been structured and function. We sent an online screening questionnaire to police and fire departments in all 351 communities in Massachusetts to find instances in which they collaborated with a community-based public health agency to implement a post-overdose outreach and support program. We conducted telephone interviews with communities that implemented this type of program and categorized programs based on their structure, outreach approach, and other key characteristics. Police and fire personnel from 110 of the 351 communities in Massachusetts (31% response rate) completed the screening survey. Among respondents, 21% (23/110) had implemented a collaborative, community-based, post-overdose program with a well-defined process to connect overdose survivors and their personal networks with support services or addiction treatment services. Using data from the interviews, we identified four types of programs: (1) Multi-Disciplinary Team Visit, (2) Police Visit with Referrals, (3) Clinician Outreach, and (4) Location-Based Outreach. This study represents the first attempt to systematically document an emerging approach intended to connect opioid overdose survivors and their personal networks with harm reduction and addiction treatment services soon after a non-fatal overdose event. These programs have the potential to increase engagement with the social service and addiction treatment systems by those who are at elevated risk for experiencing a fatal opioid overdose. Copyright © 2018 Elsevier B.V. All rights reserved.

Transportation and emergency preparedness checklist

DOT National Transportation Integrated Search

2006-09-01

This Transportation and Emergency Preparedness Checklist was developed by a gathering of public : and community transportation professionals who convened in April 2006 at the behest of the : National Consortium on the Coordination of Human Service Tr...

Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

PubMed Central

Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

2015-01-01

Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing. PMID:26163029

Emergency Planning Guidelines for Campus Health Services: An All-Hazards Approach

ERIC Educational Resources Information Center

Journal of American College Health, 2011

2011-01-01

This document, written collaboratively by members of ACHA's Emerging Public Health Threats and Emergency Response Coalition and Campus Safety and Violence Coalition, is designed to assist members of the college health community in planning for emergencies using an all-hazards approach. Its perspective is both macro and micro, beginning with a…

The Geriatric Emergency Department.

PubMed

Rosenberg, Mark; Rosenberg, Lynne

2016-08-01

This article presents an overview of the complex needs of older patients presenting to the emergency department for care. Discussion points for hospital communities considering emergency services to accommodate the aging population are highlighted. The essential components of a geriatric emergency department, including transition of care strategies, are reviewed. Copyright © 2016 Elsevier Inc. All rights reserved.

An assessment of priority setting process and its implication on availability of emergency obstetric care services in Malindi District, Kenya.

PubMed

Nyandieka, Lilian Nyamusi; Kombe, Yeri; Ng'ang'a, Zipporah; Byskov, Jens; Njeru, Mercy Karimi

2015-01-01

In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities.

Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission.

PubMed

Meacock, Rachel; Anselmi, Laura; Kristensen, Søren Rud; Doran, Tim; Sutton, Matt

2017-01-01

Objective Patients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends. Method Retrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends. Results Similar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010). Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054). The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths. Conclusions There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.

78 FR 57646 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2013-0002... community are available for inspection at both the online location and the respective Community Map... each community are accessible online through the FEMA Map Service Center at www.msc.fema.gov for...

77 FR 18839 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2012-0003... community are available for inspection at both the online location and the respective Community Map... each community are accessible online through the FEMA Map Service Center at www.msc.fema.gov for...

Who Is for Community Participation? Who Is Community Participation for? Exploring the Well-Being Potential for Involvement in Regeneration

ERIC Educational Resources Information Center

Evans, Melvyn

2008-01-01

Commencing from the identification of an emerging discourse in government circles expounding the benefits of community participation, this article examines critically the claims that community participation enhances involvement in decision making, builds social capital, reduces social exclusion, improves public service delivery and enhances local…

Shared patients: multiple health and social care contact.

PubMed

Keene, J; Swift, L; Bailey, S; Janacek, G

2001-07-01

The paper describes results from the 'Tracking Project', a new method for examining agency overlap, repeat service use and shared clients/patients amongst social and health care agencies in the community. This is the first project in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplinary database for one county (n = 97,162 cases), through standardised anonymisation of agency databases, using SOUNDEX, a software programme. A range of 20 community social and health care agencies were shown to have a large overlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of major overlap: 16.2% (n = 39,992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775,000) of the total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a characteristic of community agency populations (n = 39,992) revealed that increasing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients that repeatedly attend Accident and Emergency are much more likely to attend more other agencies, indicating the possibility that they share more problematic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predictors from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggested that Accident and Emergency attendance might serve as an important predictor of multiple agency attendance.

Community motivators promote use of emergency obstetric services in rural Sierra Leone. The Freetown/Makeni PMM Team.

PubMed

Kandeh, H B; Leigh, B; Kanu, M S; Kuteh, M; Bangura, J; Seisay, A L

1997-11-01

An appraisal of government health facilities documented generally poor conditions, a shortage of drugs and supplies, and inadequate skills among staff. Focus group discussions in the community revealed a lack of knowledge about obstetric complications and difficulty in reaching health facilities. Improvements were made in services at primary health units (PHUs) through May 1993. Community motivators were trained in June and provided with bicycles and raingear in September 1993. Among their duties were community education, formation of village action groups for emergency transport and facilitation of referral for women with obstetric complications. Between August 1992 and December 1995, women with major complications seen at the PHUs increased from nine to 16 per month, with fluctuations due to disruptions in services and civil strife. The proportion of women with complications who were referred by the community motivators diminished over time, dropping from 24% to 1% over the first two years (1993-1994) and then recovering somewhat to 10% in the final period of observation. The cost of this intervention was approximately US$5082, with about half coming from the project and the rest from the government (44%) and the community (8%). The project improved utilization of the PHUs by women with complications, indicating that once services are of acceptable quality, many women will use them. The contribution of the motivators was positive, though smaller than expected.

The Roles of Emerging and Conventional Technologies in Serving Children and Adolescents with Special Needs in Rural and Northern Communities

ERIC Educational Resources Information Center

Roberts, Judy; O'Sullivan, Julia; Howard, Joan

2005-01-01

More than a century of Canadian and international experience and research in open and distance learning indicates that traditional and emerging technologies can be used effectively, alone or in combination, to provide access to services and education for adults and children living in rural and northern communities. However, although there is an…

"You get what you get": unexpected findings about low-income parents' negative experiences with community resources.

PubMed

Silverstein, Michael; Lamberto, Jacqueline; DePeau, Kristina; Grossman, David C

2008-12-01

Community-based resources are considered a critical part of the American health care system. However, studies evaluating the effectiveness of such resources have not been accompanied by rigorous explorations of the perceptions or experiences of those who use them. We aimed to understand and classify types of negative perceptions that low-income parents have of community resources. This objective originated from a series of unexpected findings that emerged during the analysis of qualitative data that were initially collected for other purposes. We conducted in-depth qualitative interviews with urban low-income parents. Themes emerged through a grounded theory analysis of coded interview transcripts. Interviews took place in 2 different cities as part of 2 studies with distinct objectives. We completed 41 interviews. Informants often perceived their interactions with people and organizations as a series of trade-offs, and often perceived important choices as decisions between 2 suboptimal options. Seeking help from community resources was seen in that context. The following specific themes emerged: (1) engaging with services sometimes meant subjecting oneself to requirements perceived as unnecessary and, in the extreme, having to adopt the value systems of others; (2) accepting services was sometimes perceived as a loss of control over one's surroundings, which, in turn, was associated with feelings of sadness, helplessness, or stress; (3) individuals staffing community agencies were sometimes seen as judgmental or intrusive, and when many services were accessed concurrently, information sometimes became overbearing or a source of additional stress; and (4) some services or advice received as part of such services were perceived as unhelpful because they were too generic or formulaic. Our data suggest that definable patterns of negative perceptions of community resources may exist among low-income parents. Quantifying these perceptions may help improve the client-centeredness of such organizations and may ultimately help reduce barriers to engagement.

Community participation to design rural primary healthcare services

PubMed Central

2014-01-01

Background This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services. Methods Community-based participatory action research was applied in four Scottish case study communities in 2008–10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented. Results Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation. Conclusions Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions. PMID:24649834

Digital Library Collaboration: A Service-Oriented Perspective

ERIC Educational Resources Information Center

Buchanan, Steven; Gibb, Forbes; Simmons, Susan; McMenemy, David

2012-01-01

Collaboration in the digital domain offers an opportunity to provide enhanced digital services and extended reach to the community. This article adopts a service-oriented perspective through which it considers environmental drivers for digital library collaboration; discusses emergent collaborative partnerships across UK educational institutions,…

40 CFR 305.5 - Filing, service, and form of pleadings and documents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... SUPERFUND General § 305.5 Filing, service, and form of pleadings and documents. (a) Filing of pleadings and...

40 CFR 305.5 - Filing, service, and form of pleadings and documents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... SUPERFUND General § 305.5 Filing, service, and form of pleadings and documents. (a) Filing of pleadings and...

40 CFR 305.5 - Filing, service, and form of pleadings and documents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... SUPERFUND General § 305.5 Filing, service, and form of pleadings and documents. (a) Filing of pleadings and...

Community outreach library services in the UK: a case study of Wirral Hospital NHS Trust (WHNT).

PubMed

Dowse, Frances Maria; Sen, Barbara

2007-09-01

The study evaluates the Community Outreach Library Service at Wirral Hospital National Health Service Trust (WHNT). It considers the information seeking behaviour and information needs of primary care staff, and service effectiveness in meeting those needs. A literature review established the current context and areas of best practice. The investigative case study used postal questionnaires to 250 primary care staff and an interview with the Community Outreach Librarian. Themes emerged from the literature regarding information seeking behaviour, information needs, and meeting user needs through effective service delivery. Outreach services have value in terms of improving information skills and providing services at point of need. Time is a major constraint for both users and service providers. Investment is needed from appropriate funding sources to support the provision and marketing of outreach library services. Librarians benefit from sharing best practice. The continued evaluation of outreach library services is recommended.

What Motivates the Community College Rogue Trustee?

ERIC Educational Resources Information Center

O'Banion, Terry

2009-01-01

Approximately 6500 elected or appointed trustees govern local community colleges in 36 states. The great majority of these trustees are extraordinary citizens motivated by the opportunity to provide service to their communities and to their colleges. On occasion, a trustee emerges whose motivations do not support the common good; some of these…

Opportunities and challenges for public libraries to enhance community resilience.

PubMed

Veil, Shari R; Bishop, Bradley Wade

2014-04-01

This study bridges a gap between public library and emergency management policy versus practice by examining the role of public libraries in the community resource network for disaster recovery. Specifically, this study identifies the opportunities and challenges for public libraries to fulfill their role as a FEMA-designated essential community organization and enhance community resilience. The results indicate there are several opportunities for libraries to enhance community resilience by offering technology resources and assistance; providing office, meeting, and community living room space; serving as the last redundant communication channel and a repository for community information and disaster narratives; and adapting or expanding services already offered to meet the changing needs of the community. However, libraries also face challenges in enhancing community resilience, including the temptation to overcommit library capacity and staff capability beyond the library mission and a lack of long-term disaster plans and collaboration with emergency managers and government officials. Implications for library and emergency management practice and crisis research are discussed. © 2013 Society for Risk Analysis.

EMS workforce for the 21st century : a national assessment

DOT National Transportation Integrated Search

2008-06-01

Emergency medical technicians (EMTs) and paramedics are a critical component of any communitys Emergency Medical Services (EMS) system. Assuring the continued viability of the prehospital EMS workforce is a key concern for many local, State, Feder...

Effectiveness of Asynchronous Reference Services for Distance Learning Students within Florida's Community College System

ERIC Educational Resources Information Center

Profeta, Patricia C.

2007-01-01

The provision of equitable library services to distance learning students emerged as a critical area during the 1990s. Library services available to distance learning students included digital reference and instructional services, remote access to online research tools, database and research tutorials, interlibrary loan, and document delivery.…

Are you ready to invest in business development?

PubMed

Mack, Ken E

2002-10-01

A hospital's strategy to increase market share should focus on physicians and the hospital's community. Organization managers should actively seek to enhance relations with physicians. The hospital should seek opportunities to collaborate with physicians. Promotional budgets should focus on informing consumers about service areas that interest them most, such as emergency and obstetrics services. A sales strategy should focus on acquainting community physicians with the hospital's specialists.

Try to Be a Hero: Community Service Learning as a Pedagogy for Moral-Political Education and Leadership Development in the Chinese University

ERIC Educational Resources Information Center

Waite, Paul Daniel

2009-01-01

Based on ten months of ethnographic fieldwork, including more than 65 in-depth interviews with Chinese university students and higher education administrators, this study examines the roots of an emerging community service learning movement in mainland China. The dissertation focuses on a case study of a pioneering Chinese Party State-sponsored…

Look Who's Under the Same Roof Now

ERIC Educational Resources Information Center

Green, Alan C.

1973-01-01

Discusses emerging steps toward integration and coordination of public services including using excess school and college space for community purposes; building extra space in order to provide room for other services; providing for education and social services through cooperative building ventures; joining schools and housing or commercial…

42 CFR 136a.10 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Service from public or private medical or hospital facilities other than those of the Service or those funded by the Service. Emergency means any medical condition for which immediate medical attention is... Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or...

Analysis of the Community Benefit Standard in Texas Hospitals.

PubMed

Worthy, James Corbett; Anderson, Cheryl L

2016-01-01

The federal government provides special tax-exemption status, known as the community benefit standard, to some nonprofit hospitals. It is not known if hospitals that claim the community benefit standard provide more or different services from those provided by hospitals that do not claim the community benefit status. Guided by the socioecological model, this quantitative study investigated 95 hospitals serving 52 counties in South Texas--43 that claimed a community benefit and 52 that did not. The independent variables were hospitals that claimed the community benefit standard versus hospitals that did not. The dependent variables were the three essential criteria and the 13 reported services used to meet the community benefit standard. The study results show that all hospitals that claimed the community benefit standard met two of the three required criteria. However, only 22 of 43 hospitals had a full-time emergency department (ED), the third criterion. Χ² analysis showed statistically significant differences for only two of the five common services: having an ED and community education for community benefit hospitals versus noncommunity benefit hospitals. On average, hospitals that claimed the community benefit spent 100 times more money on community services than hospitals that did not claim the community benefit. Further investigation is needed to determine the reasons for the gap in services pertaining to EDs, trauma care, neonatal intensive care, free-standing clinics, collaborative efforts, other medical services, education of patients, community health education, and other education services.

24 CFR 576.65 - Recordkeeping.

Code of Federal Regulations, 2011 CFR

2011-04-01

... ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SHELTER GRANTS PROGRAM: STEWART B. McKINNEY HOMELESS ASSISTANCE ACT Grant... confidentiality of records pertaining to the provision of family violence prevention or treatment services with...

24 CFR 576.56 - Homeless assistance and participation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... treatment, mental health treatment, counseling, supervision, and other services essential for achieving... Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SHELTER GRANTS PROGRAM: STEWART B. McKINNEY...

An initiative to provide emergency healthcare for older people in the community: the impact on carers.

PubMed

Knowles, E; Mason, S; Colwell, B

2011-04-01

The increase in the size and age of the UK older population has had a major effect on emergency services. Many older people will visit the emergency department but not necessarily require significant clinical intervention. The Paramedic Practitioner in Older People's Support (PPOPS) scheme was set up to provide community-based clinical assessment of older patients contacting the emergency services with minor acute conditions as an alternative approach to emergency department transfer. Patient carers were followed-up to evaluate the impact of this scheme when compared with standard transfer to the emergency department. Postal questionnaires, including items on the level of care provided, satisfaction with care received and carer impact, were administered to 561 carers. The overall response rate was 71.5% (401/561). The carers were predominantly female, approximately 60 years of age and family members, with more than three-quarters providing some form of physical care before the patient episode. Overall, carers did report an increase in the level of care provided before episode, significantly more so in the emergency department group (p=0.003). These increases related to more input needed in supporting physical activities. The carers in the PPOPS group were more likely to report greater satisfaction with their impression of care and staff attitude and would prefer treatment at home for the patient than those in the emergency department group (p<0.001). A minor health event does impact on the life of a carer. However, community-based schemes, such as PPOPS, do not increase the burden on carers and have high levels of satisfaction among this important group of the community.

Emergency medical care in developing countries: is it worthwhile?

PubMed Central

Razzak, Junaid A.; Kellermann, Arthur L.

2002-01-01

Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations. PMID:12481213

Exploring home visits in a faith community as a service-learning opportunity.

PubMed

du Plessis, Emmerentia; Koen, Magdalene P; Bester, Petra

2013-08-01

Within South Africa the Psychiatric Nursing Science curriculum in undergraduate Baccalaureate nursing education utilizes home visits as a service-learning opportunity. In this context faith communities are currently unexplored with regards to service-learning opportunities. With limited literature available on this topic, the question was raised as to what are these students' and family members' experience of home visits within a faith community. To explore and describe nursing students' and family members' experiences of home visits within a faith community. A qualitative approach was used that was phenomenological, explorative and descriptive and contextual in nature. The research was conducted within a faith community as service learning opportunity for Baccalaureate degree nursing students. This community was situated in a semi-urban area in the North-West Province, South Africa. Eighteen (n=18) final year nursing students from different cultural representations, grouped into seven groups conducted home visits at seven (n=7) families. Comprehensive reflective reporting after the visits, namely that the students participated in a World Café data collection technique and interviews were conducted with family members. Three main themes emerged: students' initial experiences of feeling overwhelmed but later felt more competent; students' awareness of religious and cultural factors; and students' perception of their role. Two main themes from the family members emerged: experiencing caring and growth. There is mutual benefit for nursing students and family members. Students' experiences progress during home visits from feeling overwhelmed and incompetent towards a trusting relationship. Home visits in a faith community seems to be a valuable service learning opportunity, and the emotional competence, as well as spiritual and cultural awareness of nursing students should be facilitated in preparation for such home visits. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effectiveness of mitigation interventions on occupational violence against emergency service workers: a mixed methods systematic review protocol.

PubMed

Drew, Peter; Tippett, Vivienne; Devenish, Scott

2018-05-01

The objective of this review is to develop an aggregated synthesis of qualitative and quantitative data on occupational violence (OV) mitigation interventions for Emergency Service Workers (ESW), to cultivate useful conclusions and recommendations for paramedic occupational safety and policy development. Emergency Service Worker is a broad term encompassing all elements of community-based emergency support and includes paramedics, firefighters, and police.The objective of the quantitative component of this review is to quantify the effectiveness of OV mitigation interventions for ESW.The objective of the qualitative component of this review is to explore the perceptions and experiences of ESW on the effectiveness of OV mitigation interventions.This review seeks to address the following questions.

[Factors related to the use of pediatric emergency services: results from the Spanish National Health Survey].

PubMed

Expósito-Ruiz, Manuela; Sánchez-López, Juan; Ruiz-Bailén, Manuel; Rodríguez-Del Águila, María Del Mar

2017-01-01

To determine the frequency of use of Spanish pediatric emergency services, and to describe user profiles and geographic variations. Descriptive study based on data from the Spanish National Health Survey. We calculated descriptive statistics and analyzed crude and adjusted odds ratios (ORs). Thirty-five percent of the 5495 respondents had come to an emergency department in the past year, and 88.1% of them had used the services of a Spanish national health service hospital. Factors associated with higher use of emergency services were male sex of the patient, (OR, 1.202; 95% CI, 1.047-1.381), a higher educational level of parents (OR, 1.255; 95% CI, 0.983-1.603), and younger age of the child (OR, 0.909; 95% CI, 0.894-0.924). Emergency department use varied widely from one Spanish community to another. There was a positive correlation between use and the presence of a foreign-born population (ρ=0.495, P=.031). The rate of emergency department use is high in Spain. Variability between geographic areas is considerable, and some variation is explained by population characteristics.

The crisis in United States hospital emergency services.

PubMed

Harrison, Jeffrey P; Ferguson, Emily D

2011-01-01

Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

Extreme Heat and Health: Perspectives from Health Service Providers in Rural and Remote Communities in South Australia

PubMed Central

Williams, Susan; Bi, Peng; Newbury, Jonathan; Robinson, Guy; Pisaniello, Dino; Saniotis, Arthur; Hansen, Alana

2013-01-01

Among the challenges for rural communities and health services in Australia, climate change and increasing extreme heat are emerging as additional stressors. Effective public health responses to extreme heat require an understanding of the impact on health and well-being, and the risk or protective factors within communities. This study draws on lived experiences to explore these issues in eleven rural and remote communities across South Australia, framing these within a socio-ecological model. Semi-structured interviews with health service providers (n = 13), and a thematic analysis of these data, has identified particular challenges for rural communities and their health services during extreme heat. The findings draw attention to the social impacts of extreme heat in rural communities, the protective factors (independence, social support, education, community safety), and challenges for adaptation (vulnerabilities, infrastructure, community demographics, housing and local industries). With temperatures increasing across South Australia, there is a need for local planning and low-cost strategies to address heat-exacerbating factors in rural communities, to minimise the impact of extreme heat in the future. PMID:24173140

Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania

PubMed Central

Jenkins, Marion W.; Cumming, Oliver; Cairncross, Sandy

2015-01-01

Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM) services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, attitudes, behavior, trends and rates of safe/unsafe emptying, and measure demand for a new hygienic latrine emptying service in unplanned communities in Dar Es Salaam (Dar), Tanzania, using data from a cross-sectional survey at 662 residential properties in 35 unplanned sub-wards across Dar, where 97% had pit latrines. A picture emerges of expensive and poor FSM service options for latrine owners, resulting in widespread fecal sludge exposure that is likely to increase unless addressed. Households delay emptying as long as possible, use full pits beyond what is safe, face high costs even for unhygienic emptying, and resort to unsafe practices like ‘flooding out’. We measured strong interest in and willingness to pay (WTP) for the new pit emptying service at 96% of residences; 57% were WTP ≥U.S. $17 to remove ≥200 L of sludge. Emerging policy recommendations for safe FSM in unplanned urban communities in Dar and elsewhere are discussed. PMID:25734790

Handicapped Children and Youth: Current-Future International Perspectives and Challenges.

ERIC Educational Resources Information Center

Menolascino, Frank J.

1979-01-01

Current and emerging trends that impact upon special education worldwide are reviewed. These trends focus on prevention and research, normalization, community-based service systems, parental rights, consumer advocacy, home training, curative approaches, and cost/service benefits. (PHR)

Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives.

PubMed

Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

2015-07-10

To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October-November 2012 and April 2013); interviews with CPs (February-April 2013); follow-up interviews with patients (April-May 2013); interactive feedback sessions with general practice teams (October-November 2013). 22 community pharmacies and 6 general practices in Northwest England. 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were 'loaned' in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

7 CFR 1942.17 - Community facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... economic purposes a single community having a contiguous boundary. (2) Project selection process. The... efficient management and economical service; and/or enlarge, extend, or otherwise modify existing facilities... account for items such as geographic distribution of funds and emergency conditions caused by economic...

7 CFR 1942.17 - Community facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... economic purposes a single community having a contiguous boundary. (2) Project selection process. The... efficient management and economical service; and/or enlarge, extend, or otherwise modify existing facilities... account for items such as geographic distribution of funds and emergency conditions caused by economic...

7 CFR 1942.17 - Community facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... economic purposes a single community having a contiguous boundary. (2) Project selection process. The... efficient management and economical service; and/or enlarge, extend, or otherwise modify existing facilities... account for items such as geographic distribution of funds and emergency conditions caused by economic...

7 CFR 1942.17 - Community facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... economic purposes a single community having a contiguous boundary. (2) Project selection process. The... efficient management and economical service; and/or enlarge, extend, or otherwise modify existing facilities... account for items such as geographic distribution of funds and emergency conditions caused by economic...

Community-Based Learning. Adding Value to Programs Involving Service Agencies and Schools.

ERIC Educational Resources Information Center

Cumming, Jim

Community-based learning (CBL) is a structured approach to learning and teaching that connects meaningful community experience with intellectual development, personal growth, and active citizenship. Enthusiasm for CBL is emerging in Australia and elsewhere because it is seen as the following: strategy for whole-school reform, especially in…

Rights and Responsibilities of Participants in Networked Communities.

ERIC Educational Resources Information Center

Denning, Dorothy E., Ed.; Lin, Herbert S., Ed.

This report is based on a November 1992 workshop and a February 1993 public forum which discussed some of the social issues raised by the emergence of electronic communities. The workshop examined user, provider, and other perspectives on different types of networked communities, including those on the Internet, commercial information services,…

Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care

PubMed Central

Snooks, Helen; Anthony, Rebecca; Chatters, Robin; Cheung, Wai-Yee; Dale, Jeremy; Donohoe, Rachael; Gaze, Sarah; Halter, Mary; Koniotou, Marina; Logan, Phillippa; Lyons, Ronan; Mason, Suzanne; Nicholl, Jon; Phillips, Ceri; Phillips, Judith; Russell, Ian; Siriwardena, A Niroshan; Wani, Mushtaq; Watkins, Alan; Whitfield, Richard; Wilson, Lynsey

2012-01-01

Introduction Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. Design Pragmatic cluster randomised trial. Methods and analysis We randomly allocated 25 participating ambulance stations (clusters) in three services to intervention or control group. Intervention paramedics received training and clinical protocols for assessing and referring older people who have fallen to community-based falls services when appropriate, while control paramedics deliver care as usual. Patients are eligible for the trial if they are aged 65 or over; resident in a participating falls service catchment area; and attended by a trial paramedic following an emergency call coded as a fall without priority symptoms. The principal outcome is the rate of further emergency contacts (or death), for any cause and for falls. Secondary outcomes include further falls, health-related quality of life, ‘fear of falling’, patient satisfaction reported by participants through postal questionnaires at 1 and 6 months, and quality and pathways of care at the index incident. We shall compare National Health Service (NHS) and patient/carer costs between intervention and control groups and estimate quality-adjusted life years (QALYs) gained from the intervention and thus incremental cost per QALY. We shall estimate wider system effects on key-performance indicators. We shall interview 60 intervention patients, and conduct focus groups with contributing NHS staff to explore their experiences of the assessment and referral service. We shall analyse quantitative trial data by ‘treatment allocated’; and qualitative data using content analysis. Ethics and dissemination The Research Ethics Committee for Wales gave ethical approval and each participating centre gave NHS Research and Development approval. We shall disseminate study findings through peer-reviewed publications and conference presentations. Trial Registration: ISRCTN 60481756 PMID:23148348

Service Learning: A Vehicle for Building Health Equity and Eliminating Health Disparities

PubMed Central

Sabo, Samantha; de Zapien, Jill; Teufel-Shone, Nicolette; Rosales, Cecilia; Bergsma, Lynda

2015-01-01

Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health. We describe the elements and impact of five distinct week-long intensive SL courses focused on the context of urban, rural, border, and indigenous health contexts. Students involved in these SL courses demonstrated a commitment to community-engaged scholarship and practice in both their student and professional lives. SL is directly in line with the core public health value of social justice and serves as a venue to strengthen community–campus partnerships in addressing health disparities through sustained collaboration and action in vulnerable communities. PMID:25706014

Helpful advice and hidden expertize: pharmacy users' experiences of community pharmacy accessibility.

PubMed

Lindsey, Laura; Husband, Andy; Steed, Liz; Walton, Robert; Todd, Adam

2017-09-01

In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access. In-depth semi-structured interviews were used to explore the perceptions and experiences' of people using community pharmacies. A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment. The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.

PubMed

Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip

2017-03-01

There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

Public health initiatives in South Africa in the 1940s and 1950s: lessons for a post-apartheid era.

PubMed

Yach, D; Tollman, S M

1993-07-01

Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought.

Metabolic and Demographic Feedbacks Shape the Emergent Spatial Structure and Function of Microbial Communities

PubMed Central

Estrela, Sylvie; Brown, Sam P.

2013-01-01

Microbes are predominantly found in surface-attached and spatially structured polymicrobial communities. Within these communities, microbial cells excrete a wide range of metabolites, setting the stage for interspecific metabolic interactions. The links, however, between metabolic and ecological interactions (functional relationships), and species spatial organization (structural relationships) are still poorly understood. Here, we use an individual-based modelling framework to simulate the growth of a two-species surface-attached community where food (resource) is traded for detoxification (service) and investigate how metabolic constraints of individual species shape the emergent structural and functional relationships of the community. We show that strong metabolic interdependence drives the emergence of mutualism, robust interspecific mixing, and increased community productivity. Specifically, we observed a striking and highly stable emergent lineage branching pattern, generating a persistent lineage mixing that was absent when the metabolic exchange was removed. These emergent community properties are driven by demographic feedbacks, such that aid from neighbouring cells directly enhances focal cell growth, which in turn feeds back to neighbour fecundity. In contrast, weak metabolic interdependence drives conflict (exploitation or competition), and in turn greater interspecific segregation. Together, these results support the idea that species structural and functional relationships represent the net balance of metabolic interdependencies. PMID:24385891

When a LIC came to town: the impact of longitudinal integrated clerkships on a rural community of healthcare practice.

PubMed

Hudson, Judith N; Thomson, Brett; Weston, Kathryn M; Knight-Billington, Patricia J

2015-01-01

Two small rural towns in Australia, where medical practitioners provide primary care to the population, including emergency, anaesthetic and obstetric services, were early adopters of an innovative year-long integrated clerkship (clinical placement) designed to foster medical student skill attainment and a commitment to underserved rural communities. Primary care vocational trainees had previously trained in the region. Engaging with the university to participate in the clerkship initiative for undergraduate medical education offered the local healthcare service an opportunity to really integrate education with service. This study sought perspectives from a multidisciplinary group of stakeholders on the impact of the longitudinal integrated clerkship (LIC) on the healthcare community. Three analysts independently analysed the transcripts arising from semi-structured interviews with a range of health care clinicians and managers (N=23). Themes were identified using inductive content analysis methodology. Four major themes emerged from the perspectives of a multi-professional group of participants from both towns: transforming a community of practice, realising the potential of the health service, investment in rural return, and sustainability. There was significant clinical exposure, skill and teaching capacity in these previously unrecognised rural placements but realising the potential of the health service needs careful management to sustain this resource. Early engagement and initial enthusiasm have produced many positive outcomes for the healthcare community, but this alone is not sufficient to sustain an increasing role for rural primary care in medical education. The study identified issues that need addressing for sustainability, namely validation, time and costs. Strategies to address these are key to continuation of LICs in small rural communities.

Infrastructural challenges to better health in maternity facilities in rural Kenya: community and healthworker perceptions.

PubMed

Essendi, Hildah; Johnson, Fiifi Amoako; Madise, Nyovani; Matthews, Zoe; Falkingham, Jane; Bahaj, Abubakr S; James, Patrick; Blunden, Luke

2015-11-09

The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas. This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities. The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations. The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

Building community resilience through mental health infrastructure and training in post-Katrina New Orleans.

PubMed

Springgate, Benjamin F; Wennerstrom, Ashley; Meyers, Diana; Allen, Charles E; Vannoy, Steven D; Bentham, Wayne; Wells, Kenneth B

2011-01-01

To describe a disaster recovery model focused on developing mental health services and capacity-building within a disparities-focused, community-academic participatory partnership framework. Community-based participatory, partnered training and services delivery intervention in a post-disaster setting. Post-Katrina Greater New Orleans community. More than 400 community providers from more than 70 health and social services agencies participated in the trainings. Partnered development of a training and services delivery program involving physicians, therapists, community health workers, and other clinical and non-clinical personnel to improve access and quality of care for mental health services in a post-disaster setting. Services delivery (outreach, education, screening, referral, direct treatment); training delivery; satisfaction and feedback related to training; partnered development of training products. Clinical services in the form of outreach, education, screening, referral and treatment were provided in excess of 110,000 service units. More than 400 trainees participated in training, and provided feedback that led to evolution of training curricula and training products, to meet evolving community needs over time. Participant satisfaction with training generally scored very highly. This paper describes a participatory, health-focused model of community recovery that began with addressing emerging, unmet mental health needs using a disparities-conscious partnership framework as one of the principle mechanisms for intervention. Population mental health needs were addressed by investment in infrastructure and services capacity among small and medium sized non-profit organizations working in disaster-impacted, low resource settings.

Community Satisfaction: Implications for Army Communities

DTIC Science & Technology

1990-08-01

1954) hierarchical theory of motivation, hypothesize that a hierarchy of community services exists, such that basic human needs must be provided for...help in an emergency (Ahlbrandt, 1984). Neighbors 13 may provide socioemotional support, which is positively associated with neighborhood satisfaction...Saroson & B. R. Sarason (Eds.), Social .support: Theory , research and applications. Boston: Martinus Nijhoff. Baldassare, M. (1979). Residential crowding

A University-Assisted, Place-Based Model for Enhancing Students' Peer, Family, and Community Ecologies

ERIC Educational Resources Information Center

Lawson, Michael A.; Alameda-Lawson, Tania; Richards, K. Andrew R.

2016-01-01

Community schools have recently (re)emerged in the United States as a vital, comprehensive strategy for addressing poverty-related barriers to children's school learning. However, not all low-income school communities are endowed with the resources needed to launch a comprehensive array of school-based/linked services and programs. In this…

Grid Technology as a Cyberinfrastructure for Delivering High-End Services to the Earth and Space Science Community

NASA Technical Reports Server (NTRS)

Hinke, Thomas H.

2004-01-01

Grid technology consists of middleware that permits distributed computations, data and sensors to be seamlessly integrated into a secure, single-sign-on processing environment. In &is environment, a user has to identify and authenticate himself once to the grid middleware, and then can utilize any of the distributed resources to which he has been,panted access. Grid technology allows resources that exist in enterprises that are under different administrative control to be securely integrated into a single processing environment The grid community has adopted commercial web services technology as a means for implementing persistent, re-usable grid services that sit on top of the basic distributed processing environment that grids provide. These grid services can then form building blocks for even more complex grid services. Each grid service is characterized using the Web Service Description Language, which provides a description of the interface and how other applications can access it. The emerging Semantic grid work seeks to associates sufficient semantic information with each grid service such that applications wii1 he able to automatically select, compose and if necessary substitute available equivalent services in order to assemble collections of services that are most appropriate for a particular application. Grid technology has been used to provide limited support to various Earth and space science applications. Looking to the future, this emerging grid service technology can provide a cyberinfrastructures for both the Earth and space science communities. Groups within these communities could transform those applications that have community-wide applicability into persistent grid services that are made widely available to their respective communities. In concert with grid-enabled data archives, users could easily create complex workflows that extract desired data from one or more archives and process it though an appropriate set of widely distributed grid services discovered using semantic grid technology. As required, high-end computational resources could be drawn from available grid resource pools. Using grid technology, this confluence of data, services and computational resources could easily be harnessed to transform data from many different sources into a desired product that is delivered to a user's workstation or to a web portal though which it could be accessed by its intended audience.

Rethinking Twenty-First Century Acquisition: Emerging Trends for Efficiency Ends

DTIC Science & Technology

1997-01-01

improve the quality of their services. However, dispari- ties in current accounting methods and rules between the two sectors make evalu- ating costs ...are facilitated by the grow- ing use of ABC methods in the account - ing community. These methods tie the to- tal costs of production or services more...Acquisition program man- agers can learn by studying recent devel- opments in the private sector accounting community. Knowledge of relevant total costs and

42 CFR 136.21 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the expense of the Indian Health Service from public or private medical or hospital facilities other than those of the Service. (f) Emergency means any medical condition for which immediate medical... tribe means any Indian tribe, band, nation, group, Pueblo, or community, including any Alaska Native...

77 FR 18842 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2012-0003... are available for inspection at both the online location and the respective Community Map Repository... community are accessible online through the FEMA Map Service Center at www.msc.fema.gov for comparison. You...

78 FR 36220 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2013-0002... are available for inspection at both the online location and the respective Community Map Repository... community are accessible online through the FEMA Map Service Center at www.msc.fema.gov for comparison. You...

78 FR 21143 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-09

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2013-0002... are available for inspection at both the online location and the respective Community Map Repository... community are accessible online through the FEMA Map Service Center at www.msc.fema.gov for comparison. You...

Developing rural palliative care: validating a conceptual model.

PubMed

Kelley, Mary Lou; Williams, Allison; DeMiglio, Lily; Mettam, Hilary

2011-01-01

The purpose of this research was to validate a conceptual model for developing palliative care in rural communities. This model articulates how local rural healthcare providers develop palliative care services according to four sequential phases. The model has roots in concepts of community capacity development, evolves from collaborative, generalist rural practice, and utilizes existing health services infrastructure. It addresses how rural providers manage challenges, specifically those related to: lack of resources, minimal community understanding of palliative care, health professionals' resistance, the bureaucracy of the health system, and the obstacles of providing services in rural environments. Seven semi-structured focus groups were conducted with interdisciplinary health providers in 7 rural communities in two Canadian provinces. Using a constant comparative analysis approach, focus group data were analyzed by examining participants' statements in relation to the model and comparing emerging themes in the development of rural palliative care to the elements of the model. The data validated the conceptual model as the model was able to theoretically predict and explain the experiences of the 7 rural communities that participated in the study. New emerging themes from the data elaborated existing elements in the model and informed the requirement for minor revisions. The model was validated and slightly revised, as suggested by the data. The model was confirmed as being a useful theoretical tool for conceptualizing the development of rural palliative care that is applicable in diverse rural communities.

Comparison of emergency medical services systems across Pan-Asian countries: a Web-based survey.

PubMed

Shin, Sang Do; Ong, Marcus Eng Hock; Tanaka, Hideharu; Ma, Matthew Huei-Ming; Nishiuchi, Tatsuya; Alsakaf, Omer; Karim, Sarah Abdul; Khunkhlai, Nalinas; Lin, Chih-Hao; Song, Kyoung Jun; Ryoo, Hyun Wook; Ryu, Hyun Ho; Tham, Lai Peng; Cone, David C

2012-01-01

There are great variations in out-of-hospital cardiac arrest (OHCA) survival outcomes among different countries and different emergency medical services (EMS) systems. The impact of different systems and their contribution to enhanced survival are poorly understood. This paper compares the EMS systems of several Asian sites making up the Pan-Asian Resuscitation Outcomes Study (PAROS) network. Some preliminary cardiac arrest outcomes are also reported. This is a cross-sectional descriptive survey study addressing population demographics, service levels, provider characteristics, system operations, budget and finance, medical direction (leadership), and oversight. Most of the systems are single-tiered. Fire-based EMS systems are predominant. Bangkok and Kuala Lumpur have hospital-based systems. Service level is relatively low, from basic to intermediate in most of the communities. Korea, Japan, Singapore, and Bangkok have intermediate emergency medical technician (EMT) service levels, while Taiwan and Dubai have paramedic service levels. Medical direction and oversight have not been systemically established, except in some communities. Systems are mostly dependent on public funding. We found variations in available resources in terms of ambulances and providers. The number of ambulances is 0.3 to 3.2 per 100,000 population, and most ambulances are basic life support (BLS) vehicles. The number of human resources ranges from 4.0 per 100,000 population in Singapore to 55.7 per 100,000 population in Taipei. Average response times vary between 5.1 minutes (Tainan) and 22.5 minutes (Kuala Lumpur). We found substantial variation in 11 communities across the PAROS EMS systems. This study will provide the foundation for understanding subsequent studies arising from the PAROS effort.

School Emergency Planning Guide. [Revised.

ERIC Educational Resources Information Center

Pennsylvania State Emergency Management Agency, Harrisburg.

Guidelines to help school districts in Pennsylvania recognize potential hazards and develop a plan of community action are presented in this guidebook. The 1988 Emergency Management Services Code requires that every publicly funded state school have a disaster response plan that is exercised annually. Further, all publicly funded educational…

Insurance Exchange Marketplace: Implications for Emergency Medicine Practice

PubMed Central

Rankey, David S.

2012-01-01

The Patient Protection and Affordable Care Act of 2010 requires states to establish healthcare insurance exchanges by 2014 to facilitate the purchase of qualified health plans. States are required to establish exchanges for small businesses and individuals. A federally operated exchange will be established, and states failing to participate in any other exchanges will be mandated to join the federal exchange. Policymakers and health economists believe that exchanges will improve healthcare at lower cost by promoting competition among insurers and by reducing burdensome transaction costs. Consumers will no longer be isolated from monthly insurance premium costs. Exchanges will increase the number of patients insured with more cost-conscious managed care and high-deductible plans. These insurance plan models have historically undervalued emergency medical services, while also underinsuring patients and limiting their healthcare system access to the emergency department. This paradoxically increases demand for emergency services while decreasing supply. The continual devaluation of emergency medical services by insurance payers will result in inadequate distribution of resources to emergency care, resulting in further emergency department closures, increases in emergency department crowding, and the demise of acute care services provided to families and communities. PMID:22900107

[Consideration of national policies to support the development of medical services for dementia].

PubMed

Awata, Shuichi

2014-01-01

To consider national policies to support the development of medical services for dementia, we conducted three studies. Study 1: We evaluated the dementia management capacity of clinics using a questionnaire on medical services for dementia 1) Clinics that employed doctors who had attended a lecture on dementia management had a superior capacity to provide primary care services, make diagnoses, manage behavioral and psychological symptoms of dementia (BPSD), provide home healthcare for dementia, and promote community integration compared to clinics that did not employ such doctors. 2)Clinics that employed"dementia support doctors"had a superior capacity to provide such dementia management as mentioned above compared to clinics employing doctors who had attended a lecture on dementia management. However, 3) the questionnaire data suggested that only some clinics that employed "dementia support doctors" could provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in their regular clinical practice. Study 2: We evaluated the current activities of Medical Centers for Dementia (MCDs). 1) MCDs had more efficient activities in general compared to Dementia Centers for the Elderly (DCEs) established in 1989 and suspended in 2007. However, there was a large disparity among the facilities in terms of their activities. 2) Many MCDs thought that they could not provide adequate services due to the size of their catchment area. 3) Emergency services for dementia patients with concurrent medical conditions were supported by staff of many MCDs located in general hospitals without the designation of a special MCD for providing emergency services. 4) Inpatient stays tended to be longer in psychiatric hospitals where MCDs were located. Study 3: We conducted a preliminary investigation on activities in possible "dementia support clinics". These clinics had an inferior capacity to provide inpatient services but a similar capacity to make diagnoses, provide management of BPSD, and promote community integration compared to MCDs. From these findings, we made recommendations as follows: (1) It is necessary to not only increase the number of "dementia support doctors", but also to develop adequate numbers of "dementia support clinics" that provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in cooperation with community general support centers in regular clinical practice. (2) It is necessary to monitor the level of activities and develop adequate numbers of MCDs based on the size of the area and population. MCDs should take part in establishing community-based, integrated care systems in cooperation with the local government. Equipping "dementia support teams" might be indispensable in general hospitals that provide emergency medical services for dementia patients. (3) It would be significant to arrange "dementia support clinics" as a medical resource to make diagnoses, provide management of BPSD, and promote community integration for dementia in local dementia planning by a municipality.

Building a bioinformatics community of practice through library education programs.

PubMed

Moore, Margaret E; Vaughan, K T L; Hayes, Barrie E

2004-01-01

This paper addresses the following questions:What makes the community of practice concept an intriguing framework for developing library services for bioinformatics? What is the campus context and setting? What has been the Health Sciences Library's role in bioinformatics at the University of North Carolina (UNC) Chapel Hill? What are the Health Sciences Library's goals? What services are currently offered? How will these services be evaluated and developed? How can libraries demonstrate their value? Providing library services for an emerging community such as bioinformatics and computational biology presents special challenges for libraries including understanding needs, defining and communicating the library's role, building relationships within the community, preparing staff, and securing funding. Like many academic health sciences libraries, the University of North Carolina (UNC) at Chapel Hill Health Sciences Library is addressing these challenges in the context of its overall mission and goals.

78 FR 78993 - Proposed Flood Elevation Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2013-0002... Insurance Study (FIS) report for each community are available for inspection at both the online location and... effective FIRM and FIS report for each community are accessible online through the FEMA Map Service Center...

24 CFR 576.56 - Homeless assistance and participation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SHELTER GRANTS PROGRAM: STEWART B. McKINNEY... violence prevention or treatment services with assistance under this part are set forth in 42 U.S.C. 11375...

Transport of pregnant women and obstetric emergencies in India: an analysis of the '108' ambulance service system data.

PubMed

Singh, Samiksha; Doyle, Pat; Campbell, Oona M R; Rao, G V R; Murthy, G V S

2016-10-21

The transport of pregnant women to an appropriate health facility plays a pivotal role in preventing maternal deaths. In India, state-run call-centre based ambulance systems ('108' and '102'), along with district-level Janani Express and local community-based innovations, provide transport services for pregnant women. We studied the role of '108' ambulance services in transporting pregnant women routinely and obstetric emergencies in India. This study was an analysis of '108' ambulance call-centre data from six states for the year 2013-14. We estimated the number of expected pregnancies and obstetric complications for each state and calculated the proportions of these transported using '108'. The characteristics of the pregnant women transported, their obstetric complications, and the distance and travel-time for journeys made, are described for each state. The estimated proportion of pregnant women transported by '108' ambulance services ranged from 9.0 % in Chhattisgarh to 20.5 % in Himachal Pradesh. The '108' service transported an estimated 12.7 % of obstetric emergencies in Himachal Pradesh, 7.2 % in Gujarat and less than 3.5 % in other states. Women who used the service were more likely to be from rural backgrounds and from lower socio-economic strata of the population. Across states, the ambulance journeys traversed less than 10-11 km to reach 50 % of obstetric emergencies and less than 10-21 km to reach hospitals from the pick-up site. The overall time from the call to reaching the hospital was less than 2 h for 89 % to 98 % of obstetric emergencies in 5 states, although this percentage was 61 % in Himachal Pradesh. Inter-facility transfers ranged between 2.4 % -11.3 % of all '108' transports. A small proportion of pregnant women and obstetric emergencies made use of '108' services. Community-based studies are required to study knowledge and preferences, and to assess the potential for increasing or rationalising the use of '108' services.

Cumbersome yet Worthwhile: Service Learning in Postdisaster Rehabilitation and Recovery Efforts in the Philippines

ERIC Educational Resources Information Center

Adarlo, Genejane; Marquez, Norman Dennis

2017-01-01

Service learning holds the potential to educate for citizenship, preparing students as individuals who can respond not only to the daily challenges of an interconnected yet fragmented world but also to the emerging calls to rebuild disaster-stricken communities. Although seen by some as a cumbersome pedagogical approach, service learning can offer…

The Role of Libraries in eHealth Service Delivery in Australia

ERIC Educational Resources Information Center

Rao, Sarada

2009-01-01

eHealth is an emerging service sector which has great potential to improve health care delivery to rural and remote communities, facilitate health surveillance, and promote health education and research. Despite the critical need for eHealth services in Australia based on the challenges of distance and human resources, its utility has yet to be…

United States Geological Survey (USGS) Natural Hazards Response

USGS Publications Warehouse

Lamb, Rynn M.; Jones, Brenda K.

2012-01-01

The primary goal of U.S. Geological Survey (USGS) Natural Hazards Response is to ensure that the disaster response community has access to timely, accurate, and relevant geospatial products, imagery, and services during and after an emergency event. To accomplish this goal, products and services provided by the National Geospatial Program (NGP) and Land Remote Sensing (LRS) Program serve as a geospatial framework for mapping activities of the emergency response community. Post-event imagery and analysis can provide important and timely information about the extent and severity of an event. USGS Natural Hazards Response will also support the coordination of remotely sensed data acquisitions, image distribution, and authoritative geospatial information production as required for use in disaster preparedness, response, and recovery operations.

Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods.

PubMed

Farmer, Jane; Carlisle, Karen; Dickson-Swift, Virginia; Teasdale, Simon; Kenny, Amanda; Taylor, Judy; Croker, Felicity; Marini, Karen; Gussy, Mark

2018-01-31

Citizen participation in health service co-production is increasingly enacted. A reason for engaging community members is to co-design services that are locally-appropriate and harness local assets. To date, much literature examines processes of involving participants, with little consideration of innovative services are designed, how innovations emerge, develop and whether they sustain or diffuse. This paper addresses this gap by examining co-designed initiatives through the lens of social innovation - a conceptualisation more attuned to analysing grassroots innovation than common health services research approaches considering top-down, technical innovations. This paper considers whether social innovation is a useful frame for examining co-designed services. Eighty-eight volunteer community-based participants from six rural Australian communities were engaged using the same, tested co-design framework for a 12-month design and then 12-month implementation phase, in 24 workshops (2014-16). Mixed, qualitative data were collected and used to formulate five case studies of community co-designed innovations. A social innovation theory, derived from literature, was applied as an analytical frame to examine co-design cases at 3 stages: innovation growth, development and sustainability/diffusion. Social innovation theory was found relevant in examining and understanding what occurred at each stage of innovation development. Innovations themselves were all adaptations of existing ideas. They emerged due to local participants combining knowledge from local context, own experiences and exemplars. External facilitation brought resources together. The project provided a protective niche in which pilot innovations developed, but they needed support from managers and/or policymakers to be implemented; and to be compatible with existing health system practices. For innovations to move to sustainability/diffusion required political relationships. Challenging existing practice without these was problematical. Social innovation provides a useful lens to understand the grassroots innovation process implied in community participation in service co-design. It helps to show problems in co-design processes and highlights the need for strong partnerships and advocacy beyond the immediate community for new ideas to thrive. Regional commissioning organisations are intended to diffuse useful, co-designed service innovations. Efforts are required to develop an innovation system to realise the potential of community involvement in co-design.

Burnout and work environments of public health nurses involved in mental health care.

PubMed

Imai, H; Nakao, H; Tsuchiya, M; Kuroda, Y; Katoh, T

2004-09-01

(1) To examine whether prevalence of burnout is higher among community psychiatric nurses working under recently introduced job specific work systems than among public health nurses (PHNs) engaged in other public health services. (2) To identify work environment factors potentially contributing to burnout. Two groups were examined. The psychiatric group comprised 525 PHNs primarily engaged in public mental health services at public health centres (PHCs) that had adopted the job specific work system. The control group comprised 525 PHNs primarily engaged in other health services. Pines' Burnout Scale was used to measure burnout. Respondents were classified by burnout score into three groups: A (mentally stable, no burnout); B (positive signs, risk of burnout); and C (burnout present, action required). Groups B and C were considered representative of "burnout". A questionnaire was also prepared to investigate systems for supporting PHNs working at PHCs and to define emergency mental health service factors contributing to burnout. Final respondents comprised 785 PHNs. Prevalence of burnout was significantly higher in the psychiatric group (59.2%) than in the control group (51.5%). Responses indicating lack of job control and increased annual frequency of emergency overtime services were significantly correlated with prevalence of burnout in the psychiatric group, but not in the control group. Prevalence of burnout is significantly higher for community psychiatric nurses than for PHNs engaged in other services. Overwork in emergency services and lack of job control appear to represent work environment factors contributing to burnout.

Partnering with women collectives for delivering essential women's nutrition interventions in tribal areas of eastern India: a scoping study.

PubMed

Sethi, Vani; Bhanot, Arti; Bhalla, Surbhi; Bhattacharjee, Sourav; Daniel, Abner; Sharma, Deepika Mehrish; Gope, Rajkumar; Mebrahtu, Saba

2017-05-22

We examined the feasibility of engaging women collectives in delivering a package of women's nutrition messages/services as a funded stakeholder in three tribal-dominated districts of Odisha, Jharkhand and Chhattisgarh States, in eastern India. These districts have high prevalence of child stunting and poor government service outreach. Conducted between July 2014 and March 2015, an exploratory mix-methods design was adopted (review of coverage data and government reports, field interviews and focus group discussion with multiple stakeholders and intended communities) to assess coverage of women's nutrition services. A capacity assessment tool was developed to map all types of community collectives and assess their awareness, institutional and programme capacity as a funded stakeholder for delivering women's nutrition services/behaviour promotion. Limited targeting of pre-pregnancy period, delays in first trimester registration of pregnant women, and low micronutrient supplementation supply and awareness issues emerged as key bottlenecks in improving women's nutrition in these districts. Amongst the 18 different types of community collectives mapped, Self Help Groups (SHGs) and their federations (tier 2 and tier 3), with total membership of over 650,000, emerged as the most promising community collective due to their vast network, governance structure, bank linkage, and regular interface. Nearly 400,000 (or 20% of women) in these districts can be reached through the mapped 31,919 SHGs. SHGs with organisational readiness for receiving and managing grants for income generation and community development activities varied from 41 to 94% across study districts. Stakeholders perceived that SHGs federations managing grants from government and be engaged for nutrition promotion and service delivery and SHG weekly meetings can serve as community interface for discussing/resolving local issues impeding access to services. Women SHGs (with tier 2 and tier 3) can become direct grantees for strengthening coverage of women's nutrition interventions in these tribal districts/pockets, provided they are capacitated, supervised and given safe guards against exploitation and violence.

78 FR 23775 - Agency Information Collection Activities; Proposed Collection; Comment Request: Community...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-22

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID: FEMA-2013-0014... Preparedness and Participation Survey used to identify progress and gaps in citizen and community preparedness... direction in Executive Order 13254 to study and track the progress of public service programs. Citizen Corps...

Assistive Technology in Medicaid Home- and Community-Based Waiver Programs

ERIC Educational Resources Information Center

Kitchener, Martin; Ng, Terence; Lee, Hyang Yuol; Harrington, Charlene

2008-01-01

Purpose: As consensus emerges concerning the need to extend publicly funded home- and community-based services that support the independence of seniors, studies have reported the efficacy and cost effectiveness of assistive technology (AT). This article presents the latest available national AT expenditure and participation trends (1999-2002) for…

Realities of Rural School Reform.

ERIC Educational Resources Information Center

Seal, Kenna R.; Harmon, Hobart L.

1995-01-01

Schools in isolated rural areas like Braxton County, West Virginia, can emerge as learning communities and telecommuting villages. Future school mergers will be less common than consolidation of programs and services to improve access for students, their families, and the community. Technology will link schools with a global information network.…

Role of academic institutions in community disaster response since september 11, 2001.

PubMed

Dunlop, Anne L; Logue, Kristi M; Beltran, Gerald; Isakov, Alexander P

2011-10-01

To describe the role of academic institutions in the community response to Federal Emergency Management Agency-declared disasters from September 11, 2001, to February 1, 2009. We conducted a review of the published literature and Internet reports to identify academic institutions that participated in the community response to disaster events between September 11, 2001, to February 1, 2009, inclusive. From retrieved reports, we abstracted the identity of the academic institutions and the resources and services each provided. We characterized the resources and services in terms of their contribution to established constructs of community disaster resilience and disaster preparedness and response. Between September 11, 2001, and February 1, 2009, there were 98 published or Internet-accessible reports describing 106 instances in which academic institutions participated in the community response to 11 Federal Emergency Management Agency-declared disaster events that occurred between September 11, 2001, and February 1, 2009. Academic institutions included academic health centers and community teaching hospitals; schools of medicine, nursing, and public health; schools with graduate programs such as engineering and psychology; and 4-year programs. The services and resources provided by the academic institutions as part of the community disaster response could be categorized as contributing to community disaster resilience by reducing the consequences or likelihood of an event or to specific dimensions of public health preparedness and response, or both. The most common dimensions addressed by academic institutions (in order of occurrence) were resource management, enabling and sustaining a public health response, information capacity management, and performance evaluation. Since September 11, 2001, the participation of academic institutions in community disaster response has contributed to community resilience and the achievement of specific dimensions of disaster preparedness and response.

USEPA’s Ecological Exposure Modeling Science: Frameworks, Components and the Emerging Community of Practice for Reuse

EPA Science Inventory

The Ecosystem Services Research Program of the EPA Office of Research and Development envisions a comprehensive theory and practice for characterizing, quantifying and valuing ecosystem services and their relationship to human well-being. This vision of future environmental deci...

Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial).

PubMed

Pasha, Omrana; Goldenberg, Robert L; McClure, Elizabeth M; Saleem, Sarah; Goudar, Shivaprasad S; Althabe, Fernando; Patel, Archana; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Mazariegos, Manolo; Kodkany, Bhala; Belizan, Jose M; Derman, Richard J; Hibberd, Patricia L; Carlo, Waldemar A; Liechty, Edward A; Hambidge, K Michael; Buekens, Pierre; Wallace, Dennis; Howard-Grabman, Lisa; Stalls, Suzanne; Koso-Thomas, Marion; Jobe, Alan H; Wright, Linda L

2010-12-14

Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries. ClinicalTrials.gov NCT01073488.

Applying the lessons of maternal mortality reduction to global emergency health

PubMed Central

Skog, Alexander P; Tenner, Andrea G; Wallis, Lee A

2015-01-01

Abstract Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions. PMID:26240463

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

PubMed

Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

Factors associated with emergency services use in Taiwanese advanced cancer patients receiving palliative home care services during out-of-hours periods: a retrospective medical record study.

PubMed

Kao, Yee-Hsin; Liu, Yao-Ting; Koo, Malcolm; Chiang, Jui-Kun

2018-03-12

For patients receiving palliative home care, the need to visit the emergency department is considered to be an indicator of poor quality care. The situation can be particularly distressing when it occurs outside of normal hours of palliative home care service. The aim of this study was to investigate the factors for emergency department use during out-of-hours periods of palliative home care service among advanced cancer patients in Taiwan. This case-control study was based on a retrospective medical chart review (January 2010 to December 2012) of advanced cancer patients who were receiving palliative home care in a community hospital in south Taiwan. The use of emergency medical services by these patients was dichotomized into either normal hours (8 a.m. to midnight, Monday to Friday, excluding public holidays) of palliative home care or outside normal hours. Logistic regression analyses were performed to evaluate factors associated with emergency services use during out-of-hours period of palliative home care. Of the 94 patients receiving palliative home care, 65 had used emergency services at least once during the 3-year study period. Of these 65 patients, 40% used emergency services during out-of-hours of palliative home care. Patients with distressing conditions (defined as the occurrence of any two conditions of dyspnea, change of consciousness, or gastrointestinal bleeding) were significantly more likely to use emergency services during out-of-hours of palliative home care. Patients at risk of developing dyspnea, change of consciousness, or gastrointestinal bleeding should be provided with relevant information regarding these symptoms and signs.

Stroke awareness in Brazil: alarming results in a community-based study.

PubMed

Pontes-Neto, Octávio Marques; Silva, Gisele Sampaio; Feitosa, Marley Ribeiro; de Figueiredo, Nathalie Lôbo; Fiorot, José Antonio; Rocha, Talitha Nery; Massaro, Ayrton Roberto; Leite, João Pereira

2008-02-01

Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil. The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home. Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (P=0.038, OR=1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (P<0.05, OR=2.0, 95% CI: 1.2 to 3.2) more often than those with lower education. Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies.

Implementation of oral health initiatives by Australian rural communities: Factors for success.

PubMed

Taylor, Judy; Carlisle, Karen; Farmer, Jane; Larkins, Sarah; Dickson-Swift, Virginia; Kenny, Amanda

2018-01-01

In this paper, we consider factors significant in the success of community participation in the implementation of new oral health services. Our analysis draws on data from the Rural Engaging Communities in Oral Health (Rural ECOH) study (2014-2016). We aimed to assess the Australian relevance of a Scottish community participation framework for health service development; Remote Service Futures. Internationally, community participation in planning of health initiatives is common, but less common in new service implementation. Health managers query the legitimacy of "lay" community members, whether they will persist, and whether they can act as change agents. Our data provide evidence that helps answer these queries. Six communities, located within regions covered by two large rural primary healthcare organisations (Medicare Locals), were selected in two Australian states. Two university-based facilitators worked with a group of local residents (for each community) to monitor implementation of new oral health initiatives designed through participatory processes. Data about implementation were collected through interviews with 28 key stakeholders at the beginning of implementation and 12 months later. Data were coded, themed and analysed abductively. Five themes emerged; the inter-relationship between community motivation to participate with the fortunes of the oral health initiatives, having the "right" people involved, continuing involvement of sponsors and/or significant people, trusting working relationships between participants and perceiving benefits from participation. Findings provide evidence of a role for community participation in implementing new community services if solid partnerships with relevant providers can be negotiated and services are seen to be relevant and useful to the community. © 2017 John Wiley & Sons Ltd.

Disparities in access to emergency general surgery care in the United States.

PubMed

Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

Perceived Service Need After Hurricane Sandy in a Representative Sample of Survivors: The Roles of Community-Level Damage and Individual-Level Stressors.

PubMed

Sampson, Laura; Lowe, Sarah R; Gruebner, Oliver; Cohen, Gregory H; Galea, Sandro

2016-06-01

We aimed to explore how individually experienced disaster-related stressors and collectively experienced community-level damage influenced perceived need for mental health services in the aftermath of Hurricane Sandy. In a cross-sectional study we analyzed 418 adults who lived in the most affected areas of New York City at the time of the storm. Participants indicated whether they perceived a need for mental health services since the storm and reported on their exposure to disaster-related stressors (eg, displacement, property damage). We located participants in communities (n=293 census tracts) and gathered community-level demographic data through the US Census and data on the number of damaged buildings in each community from the Federal Emergency Management Agency Modeling Task Force. A total of 7.9% of participants reported mental health service need since the hurricane. Through multilevel binomial logistic regression analysis, we found a cross-level interaction (P=0.04) between individual-level exposure to disaster-related stressors and community-level building damage. Individual-level stressors were significantly predictive of individual service needs in communities with building damage (adjusted odds ratio: 2.56; 95% confidence interval: 1.58-4.16) and not in communities without damage. Individuals who experienced individual stressors and who lived in more damaged communities were more likely to report need for services than were other persons after Hurricane Sandy. (Disaster Med Public Health Preparedness. 2016;10:428-435).

Evaluating perceptions of the effectiveness of the community advisory panel model for enhancing service delivery to marginalized populations.

PubMed

Ramsay, Jason T; Smith, Peter; Thompson, Alison; O'Campo, Patricia; Nisenbaum, Rosane; Watson, Priya; Park-Wylie, Laura; Bryant, Toba; Tandon, Reena; Farah, Mohammed

2012-01-01

The objective of this study was to evaluate perceptions of the effectiveness of the community advisory panels (CAPs) at St. Michael's Hospital, in Toronto, Canada. A qualitative design was employed. Participants included hospital staff, patients, Community Advisory Panel chairs, and key informants from community services in the St. Michael's Hospital catchment area. An online survey about awareness of the CAPs and CAP accomplishments; (2) Key informants interviews; and (3) Review of memos and meeting minutes of the CAPs to assess their impact in the hospital and the community. St. Michael's Hospital was the setting of the study. Descriptive statistics were generated for the survey data. Qualitative interview data were coded for major themes. Participants included hospital staff, patients, CAP chairs, and key informants from community services in the St. Michael's Hospital catchment area. Although the CAPs initiated and implemented an array of programs and services at St. Michael's Hospital, the visibility of the CAPs and their service to the hospital and community were very low. Themes that emerged from the semistructured interviews involved the visibility, effectiveness, and role of the CAPs in the hospital. Although the CAPs at St. Michael's Hospital appear to be an effective model for community responsiveness, the visibility of their work in the hospital and community was very low. © 2012 Wiley Periodicals, Inc.

Consumer-operated service organizations: organizational characteristics, community relationships, and the potential for citizenship.

PubMed

Tanenbaum, Sandra J

2012-08-01

Consumer-operated service organizations (COSOs) are independent organizations whose administrative and financial control resides with consumers. Based on a 2008 mail survey and followup interviews conducted in 2009, this study depicts the internal characteristics and external relationships, as well as some relationships between the two, of COSOs in one state. Profiles include on the one hand, governance structures, services provided, sources and levels of funding, etc. and on the other, relationships between COSOs and other actors in the mental health system and the local community. COSOs emerge as more self-governing and community-based than required by certification requirements and as developing internally and externally in tandem. COSOs are not only adjunct or alternative service providers, but also civic associations and loci for the expression of citizenship by mentally ill people.

Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

ERIC Educational Resources Information Center

Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

2003-01-01

Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

Organizational models of emergency psychiatric intervention: state of the art.

PubMed

Barra, A; Daini, S; Tonioni, F; Bria, P

2007-01-01

Authors outline the differences between medical and psychiatric definition of emergency and analyze different organizational models of psychiatric intervention in Emergency Room. The historical evolution changed these models, and the relation with services for acute and subacute patients in hospital and community services. The Italian reform model is compared with the slow deinstitutionalization of psychiatry in other countries. Critical points in Italian emergency organization after the Psychiatric Reform are pointed out: low number of beds for acute patients, difficulties and delays in transfer from Emergency Room to GHPW (General Hospital Psychiatric Ward), waiting lists for voluntary treatments. To overcome some of these problems, the Authors propose that even in hospitals without psychiatric ward, a small unit of short psychiatric observation be implemented, for voluntary treatments, before transfer to other institutions.

Characterizing local EMS systems.

DOT National Transportation Integrated Search

2013-08-01

Emergency medical services (EMS) systems are configured differently depending on several factors, including the size, demographics, geography, and politics of the local communities they serve. Although some information exists about the organization, ...

More effective and less expensive: lessons from five studies examining community approaches to care.

PubMed

Browne, G; Roberts, J; Gafni, A; Weir, R; Watt, S; Byrne, C

1995-11-01

Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.

Enhancing Self-Efficacy in Elementary Science Teaching with Professional Learning Communities

ERIC Educational Resources Information Center

Mintzes, Joel J.; Marcum, Bev; Messerschmidt-Yates, Christl; Mark, Andrew

2013-01-01

Emerging from Bandura's Social Learning Theory, this study of in-service elementary school teachers examined the effects of sustained Professional Learning Communities (PLCs) on self-efficacy in science teaching. Based on mixed research methods, and a non-equivalent control group experimental design, the investigation explored changes in…

Blogging the Field: An Emergent Continuum for Urban Teacher Development

ERIC Educational Resources Information Center

Domine, Vanessa

2012-01-01

Preparing teachers to work in urban settings poses unique challenges, as urban communities are complex and require systemic understanding of students and their families, culture, and community. Pre-service teachers often harbor misconceptions about what it means to work in urban settings and many bring to their teacher education program minimal…

Greening Community Colleges: An Environmental Path to Improving Educational Outcomes

ERIC Educational Resources Information Center

Rogers, Kimberly R.; Pleasants, Rachel

2011-01-01

The emerging and expanding green economy has the potential to create not just jobs, but career opportunities across the United States as green manufacturing, green products, and green services fuel demand for workers at all skill levels. Community colleges are leading the way in defining and addressing these opportunities. They are: developing…

Improved Maternal and Child Health Care Access in a Rural Community.

ERIC Educational Resources Information Center

Carcillo, Joseph A.; And Others

1995-01-01

Describes an underserved rural community in which health care initiatives increased access to comprehensive care. Over a 3-year period, increased accessibility to maternal and child health care also increased use of preventive services, thus decreasing emergency room visits and hospitalizations as well as low birth weight, risk of congenital…

Maui Community College Campus Safety and Security.

ERIC Educational Resources Information Center

Hawaii Univ., Kahului. Maui Community Coll.

This document discusses campus safety at Maui Community College (MCC) (Hawaii). MCC is situated on 75 acres of land; the campus population is approximately 2,700 day and night students, with a faculty and staff of approximately 175. The report presents information on campus security services, procedures for reporting crimes and emergencies,…

In the Wake of Hurricane Katrina: Delivering Crisis Mental Health Services to Host Communities

ERIC Educational Resources Information Center

Marbley, Aretha Faye

2007-01-01

Throughout the country and especially in Texas, local communities opened their arms to hurricane Katrina evacuees. Like the federal government, emergency health and mental health entities were unprepared for the massive numbers of people needing assistance. Mental health professionals, though armed with a wealth of crisis intervention information,…

Funding for change: New Zealand pharmacists' views on, and experiences of, the community pharmacy services agreement.

PubMed

Kinsey, Hannah; Scahill, Shane; Bye, Lynne; Harrison, Jeff

2016-12-01

To explore pharmacist's views on the shift in ethos, funding and service delivery model introduced through the New Zealand's Community Pharmacy Services Agreement (CPSA). A purposive sampling approach drew pharmacists from a matrix who were then contacted via telephone and invited to be interviewed. Semistructured interviews were conducted face-to-face with community pharmacists (n = 17) across urban and rural New Zealand. An interview schedule exploring 12 subject areas was used to facilitate discussion and determine pharmacist's views and understanding of the CPSA. The interviews were recorded and transcribed verbatim and a general inductive approach was taken to identifying emergent themes. Key themes that emerged were: pharmacists supported the philosophy behind the CPSA, pharmacists understanding of the CPSA, implementing CPSA-related services, perceived impact on patient outcomes and future sustainability of the CPSA. Overall, pharmacists supported the alignment of funding with patient-centred services, but pharmacy owners reported difficulty understanding the funding model, resulting in uncertainty over income. Several pharmacists believed the quality of care offered had not changed, while others found their attitudes towards care had evolved. All pharmacists communicated an increase in their workload and many perceived the sustainability of the CPSA to be linked to its ability to financially sustain community pharmacies. The majority of pharmacists believed in the philosophy of the CPSA, but expressed concerns over funding, workload and benefits for patients. Future research is required to determine generalisability of these findings, investigate patient perspectives and assess the effect of the CPSA on patient outcomes. © 2016 Royal Pharmaceutical Society.

A partial test of a hospital behavioral model.

PubMed

Hornbrook, M C; Goldfarb, M G

1983-01-01

The influence of hospital and community characteristics on the behavior of five dimensions of hospital output is examined in this article. These dimensions are the level of emergency stand-by capacity, total admissions, the diagnosis-mix of admissions and the hospital's 'style of practice' with regard to ancillary services and length of stay. A simultaneous equations model is estimated with data from a sample of 63 New England short-term general hospitals for 1970. The findings suggest that various types of short-term general hospitals have distinctive preferences for emergency capacity, volume, case mix and style of practice, and that style of practice may be more appropriately viewed as a rate of resource use per day. Specific findings of interest include the positive interdependence between protection against running out of emergency beds and length of stay, and between length of stay and ancillary service use. Hospitals that admit greater numbers of patients tend to treat more severely ill patients, and sicker patients tend to go to larger hospitals. Hospitals that provide more ancillary services tend to attract the more acutely ill patients. Relationships among other elements of the hospital's utility function represent trade-offs, i.e. substitution, in a constrained world. Among the exogenous factors, patient preferences and ability to pay have strong associations with the types of care provided by hospitals. Highly educated, high income communities, for example, tend to prefer risk averse, service intensive hospital output. Teaching hospitals are shown to prefer higher protection levels, service-intensive patterns of care, and higher admissions levels. Self-paying patients tend to be admitted for more discretionary types of diagnoses and to receive longer diagnosis-specific lengths of stay. A relatively greater supply of physician specialists in the market area is associated with increased use of ancillary services in the hospital. If replicated, these results have significant policy implications for reimbursing teaching hospitals; for defining accessibility of hospital care for the uninsured; for identifying the practice of 'skimming' by proprietary hospitals; and for specifying the role of community preferences in determining hospital performance, especially with respect to quality of care and level of emergency stand-by capacity.

Perspectives on leadership in organizations providing services to people with disabilities: an exploratory study.

PubMed

Brady, Laura Thompson; Fong, Lisa; Waninger, Kendra N; Eidelman, Steven

2009-10-01

As leaders from the Baby Boomer generation prepare for retirement over the next decade, emerging leaders must be identified and supported in anticipation of a major organizational transition. Authentic leadership is a construct that informs the development of values-driven leaders who will bring organizations into the future, just as the previous generation of leaders oversaw the movement of services away from state institutions and into networks of community-based service delivery organizations. The purpose of this exploratory study was to examine executive and emerging leaders' opinions about the unique leadership values, skills, and challenges in organizations that serve individuals with intellectual and developmental disabilities. Themes of defining, developing, and sustaining leaders emerged from the data and are explored through an authentic leadership framework.

Web Service Execution and Monitoring in Integrated Applications in Support of Business Communities

NASA Astrophysics Data System (ADS)

Chiriacescu, Rares M.; SzóKe, Alexandru; Portase, Sorin; Florea, Monica

Emerging technology is one of the key factors that drive the business world to faster adaptation, reaction and shorter communication path. Building upon such technologies, business communities emerge, geared toward high flexibility in their offerings and collaboration: business-to-customer and business-to-business collaborations. Adapting to the market requirements, companies must address several technical challenges that arise from the main requirements of the system they have to introduce: a high degree of flexibility, heterogeneous system collaboration and security of the transferred data.

Assessment of Emergency Medical Services in the Ashanti Region of Ghana.

PubMed

Mould-Millman, N K; Oteng, R; Zakariah, A; Osei-Ampofo, M; Oduro, G; Barsan, W; Donkor, P; Kowalenko, T

2015-09-01

We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting - pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. This was an observational study using qualitative and quantitative assessment techniques. The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.

Understanding the Dynamic System of Terrorist-Government Interaction

DTIC Science & Technology

2003-03-01

organizations out of support or for services rendered (Department of State, 2002:65; Wallace, 2003:2). However, financial support does not have to be in...America’s critical infrastructure encompasses a large number of sectors[:]” agriculture, food, water, public health, emergency services , government...military, international law enforcement community, or the U.S. or international intelligence services (Department of State, 2002:vii-xiii). In fact

Sentinel monitoring of general community health during the 1998 World Football Cup.

PubMed

Hanslik, T; Espinoza, P; Boelle, P Y; Cantin-Bertaux, D; Gallichon, B; Quendez, S; Aïm, J L; Retel, O; Ballereau, M; Gorodetzky, N; Flahault, A

2001-04-01

Present knowledge of the consequences of mass gatherings for the health of the community is scant. Our objective was to determine the impact of the 1998 World Football Cup on general community health. We set up an electronic sentinel disease surveillance, before, during and after the World Football Cup tournament held in France from June 10 to July 12, 1998. Medical activity, and the daily number of cases of communicable, environmental, and societal diseases relating to mass gatherings were surveyed. The incidence of the pathologies surveyed in real time during and after the World Cup versus the pre-Cup reference period was the main outcome measure. Five sentinel networks participated, comprising 553 general practitioners, 60 hospital adult emergency departments, 19 private emergency community services, 4 community health centres, and the medical centre of the Paris airports. Throughout the 66-day study period, physicians reported 558,829 medical encounters via 21,532 connections to the computer. Compared to the reference period, the level of medical activity reflected by the pathological items surveyed remained stable during the study period. The 1998 World Football Cup had no epidemiological impact on general community health, as observed by sentinel networks located downstream of the specific health services provided by the French authorities to ensure high standards of safety.

Research in Service Learning: Publishing Opportunities Resource List

ERIC Educational Resources Information Center

Homana, Gary, Comp.

2007-01-01

This resource list was developed as part of the Emerging Scholars in K-12 Service-Learning Research Seminar, held at the University of Maryland on June 14-16, 2007 and hosted by The Center for Information & Research on Civic Learning & Engagement (CIRCLE), University of Maryland; the Center for Youth and Communities, Brandeis University;…

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

PubMed Central

Memon, Zahid; Zaidi, Shehla; Riaz, Atif

2016-01-01

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902

What variables affect public perceptions for EMS meeting general community needs?

PubMed

Blau, Gary; Hochner, Arthur; Portwood, James

2012-01-01

In the fall, 2010, a phone survey of 928 respondents examined two research questions: does the general public perceive Emergency Medical Services (EMS) as meeting their community needs? And what factors or correlates help to explain EMS meeting community needs? To maximize geographical representation across the contiguous United States, a clustered stratified sampling strategy was used based upon zip codes across the 48 states. Results showed strong support by the sample for perceiving that EMS was meeting their general community needs. 17 percent of the variance in EMS meeting community needs was collectively explained by the demographic and perceptual variables in the regression model. Of the correlates tested, the strongest relationship was found between greater admiration for EMS professionals and higher perception of EMS meeting community needs. Study limitations included sampling households with only landline (no cell) phones, using a simulated emergency situation, and not collecting gender data.

European Gravity Service for Improved Emergency Management - Status and project highlights

NASA Astrophysics Data System (ADS)

Mayer-Guerr, Torsten; Adrian, Jäggi; Meyer, Ulrich; Jean, Yoomin; Susnik, Andreja; Weigelt, Matthias; van Dam, Tonie; Flechtner, Frank; Gruber, Christian; Güntner, Andreas; Gouweleeuw, Ben; Kvas, Andreas; Klinger, Beate; Flury, Jakob; Bruinsma, Sean; Lemoine, Jean-Michel; Zwenzner, Hendrik; Bourgogne, Stephane; Bandikova, Tamara

2016-04-01

The European Gravity Service for Improved Emergency Management (EGSIEM) is a project of the Horizon 2020 Framework Programme for Research and Innovation of the European Commission. EGSIEM shall demonstrate that observations of the redistribution of water and ice mass derived from the current GRACE mission, the future GRACE-FO mission, and additional data provide critical and complementary information to more traditional Earth Observation products and open the door for innovative approaches to flood and drought monitoring and forecasting. In the frame of EGSIEM three key services should established: 1) a scientific combination service to deliver the best gravity products for applications in Earth and environmental science research based on the unified knowledge of the European GRACE community, 2) a near real-time and regional service to reduce the latency and increase the temporal resolution of the mass redistribution products, and 3) a hydrological and early warning service to develop gravity-based indicators for extreme hydrological events and to demonstrate their value for flood and drought forecasting and monitoring services. All of these services shall be tailored to the various needs of the respective communities. Significant efforts shall also be devoted to transform the service products into user-friendly and easy-to-interpret data sets and the development of visualization tools. In this talk the status of the ongoing project is presented and selected results are discussed.

Pitfalls of implementing acute care surgery.

PubMed

Kaplan, Lewis J; Frankel, Heidi; Davis, Kimberly A; Barie, Philip S

2007-05-01

Incorporating emergency general surgery into the current practice of the trauma and critical care surgeon carries sweeping implications for future practice and training. Herein, we examine the known benefits of the practice of emergency general surgery, contrast it with the emerging paradigm of acute care surgery, and examine pitfalls already encountered in integration of emergency general surgery into a traditional trauma/critical care surgery service. A MEDLINE literature search was supplemented with local experience and national presentations at major meetings to provide data for this review. Considerations including faculty complement, service structure, resident staffing, physician extenders, the decreased role of community hospitals in providing trauma and emergency general surgery care, and the effects on an elective operative schedule are inadequately explored at present. There are no firm recommendations as to how to incorporate emergency general surgery into a trauma/critical care practice that will satisfy both academic and community practice paradigms. The near future seems likely to embrace the expanded training and clinical care program termed acute care surgery. A host of essential elements have yet to be examined to undertake a critical analysis of the applicability, advisability, and appropriate structure of both emergency general surgery and acute care surgery in the United States. Proceeding along this pathway may be fraught with training, education, and implementation pitfalls that are ideally addressed before deploying acute care surgery as a national standard.

Assistive Technology and Older Adults in Disasters: Implications for Emergency Management.

PubMed

McSweeney-Feld, Mary Helen

2017-02-01

This article identifies concepts, trends, and policy gaps in the availability and service delivery of assistive technology utilized by older adults in disasters, as well as implications for emergency management planning and shelter administration. Definitions of types of assistive technology, as well as views of older adults using technology as at-risk individuals for emergency management service provision, are provided. An overview of peer-reviewed articles and gray literature is conducted, focusing on publications from 2001 to the present in the United States. Analytical frameworks used by emergency management organizations as well as regulations such as the Americans with Disabilities Act and recent court decisions on emergency shelter accessibility in disasters are reviewed. Research on the use of assistive technology by older adults during disasters is a neglected issue. The current and potential benefits of defining standards for provision and use of assistive technology for older adults during disasters has received limited recognition in emergency management planning. Older adults with disabilities utilize assistive technology to maintain their independence and dignity, and communities as well as emergency services managers need to become more aware of the needs and preferences of these older adults in their planning processes and drills as well as in service delivery during actual events. (Disaster Med Public Health Preparedness. 2017;11:135-139).

The Potential for Development of a Clearinghouse for Emergency Information in the Public Library.

ERIC Educational Resources Information Center

Magrath, Lynn L.; Dowlin, Kenneth E.

1987-01-01

Presents the role of the Pikes Peak Library District's services in the creation and dissemination of an online clearinghouse in all four phases of emergency management: mitigation, preparedness, response, and recovery. Seven agencies and organizations involved in the network of community information that has been created are briefly described.…

Purchasing and Using Personal Emergency Response Systems (PERS): how decisions are made by community-dwelling seniors in Canada.

PubMed

McKenna, Alexandra C; Kloseck, Marita; Crilly, Richard; Polgar, Jan

2015-07-11

As the demographic of older people continues to grow, health services that support independence among community-dwelling seniors have become increasingly important. Personal Emergency Response Systems (PERS) are medical alert systems, designed to serve as a safety net for seniors living alone. Health care professionals often recommend that seniors in danger of falls or other medical emergencies obtain a PERS. The purpose of the study was to investigate the experience of seniors living with and using a PERS in their daily lives, using a qualitative grounded theory approach. Five focus groups and 10 semi-structured interviews, with a total of 30 participants, were completed using a grounded theory approach. All participants were PERS subscribers over the age of 80, living alone in a naturally occurring retirement community (NORC) with high health service utilization in a major urban centre in Ontario. Constant comparative analysis was used to develop themes and ultimately a model of why and how seniors obtain and use the PERS. Two core themes, unpredictability and decision-making around PERS activation, emerged as major features of the theoretical model. Being able to get help and the psychological value of PERS informed the context of living with a PERS. A number of theoretical conclusions related to unpredictability and the decision-making process around activating PERS were generated.

Public health initiatives in South Africa in the 1940s and 1950s: lessons for a post-apartheid era.

PubMed Central

Yach, D; Tollman, S M

1993-01-01

Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought. Images p1044-a p1044-b p1045-a p1046-a p1046-b p1047-a PMID:8328604

Bushfires, 2003. A rural GP's perspective.

PubMed

Robinson, Mark

2003-12-01

Extensive bushfires in January and February of 2003 had a major impact on many communities in northeast Victoria, East Gippsland, southern New South Wales and Canberra. These fires eventually engulfed an area roughly equivalent to the entire area of Germany. This article describes the impact of the fires and the role of the general practitioner in the emergency response, and presents recommendations for the role of general practice in future disaster planning. General practitioners have critical roles in the provision of round the clock general medical services to their communities in times of bushfire or natural disaster. They also act as gatekeepers to mental health services, psychiatric referral and counselling alongside other community based programs. Divisions of general practice have a pivotal role to play in disaster plans, particularly in coordinating the maintenance of ongoing medical services, facilitating communication between GPs and essential services, and integrating general practice into postdisaster recovery.

Community health centers tackle rising demands and expectations.

PubMed

Hurley, Robert; Felland, Laurie; Lauer, Johanna

2007-12-01

As key providers of preventive and primary care for underserved people, including the uninsured, community health centers (CHCs) are the backbone of the U.S. health care safety net. Despite significant federal funding increases, community health centers are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Health centers are responding to these pressures by expanding capacity and adding services but confront staffing, resource and other constraints. At the same time, CHCs are facing other demands, including increased quality reporting expectations, addressing racial and ethnic disparities, developing electronic medical records, and preparing for public health emergencies.

National perspective on in-hospital emergency units in Iraq

PubMed Central

Lafta, Riyadh K.; Al-Nuaimi, Maha A.

2013-01-01

Background: Hospitals play a crucial role in providing communities with essential medical care during times of disasters. The emergency department is the most vital component of hospitals' inpatient business. In Iraq, at present, there are many casualties that cause a burden of work and the need for structural assessment, equipment updating and evaluation of process. Objective: To examine the current pragmatic functioning of the existing set-up of services of in-hospital emergency departments within some general hospitals in Baghdad and Mosul in order to establish a mechanism for future evaluation for the health services in our community. Methods: A cross-sectional study was employed to evaluate the structure, process and function of six major hospitals with emergency units: four major hospitals in Baghdad and two in Mosul. Results: The six surveyed emergency units are distinct units within general hospitals that serve (collectively) one quarter of the total population. More than one third of these units feature observation unit beds, laboratory services, imaging facilities, pharmacies with safe storage, and ambulatory entrance. Operation room was found only in one hospital's reception and waiting area. Consultation/track area, cubicles for infection control, and discrete tutorial rooms were not available. Patient assessment was performed (although without adequate privacy). The emergency specialist, family medicine specialist and interested general practitioner exist in one-third of the surveyed units. Psychiatrist, physiotherapists, occupational therapists, and social work links are not available. The shortage in medication, urgent vaccines and vital facilities is an obvious problem. Conclusions: Our emergency unit's level and standards of care are underdeveloped. The inconsistent process and inappropriate environments need to be reconstructed. The lack of drugs, commodities, communication infrastructure, audit and training all require effective build up. PMID:25003053

Disaster planning and emergency preparedness: lessons learned.

PubMed

Babb, John; Tosatto, Robert; Hayslett, James

2002-01-01

Following the terrorist attacks of September 11, 2001, the federal response plan was activated immediately, with most efforts focused on helping recovery workers at Ground Zero in New York City. Comprehensive pharmacy services were critical in protecting the health of those potentially exposed to anthrax at U.S. Postal Service facilities and the U.S. Capitol. Responding to anthrax attacks taught many valuable lessons to emergency workers on how to manage a bioterrorist attack. Because of its central place in the life of many American communities, pharmacy is a natural and important ally of public health.

Barriers to formal emergency obstetric care services' utilization.

PubMed

Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

2011-06-01

Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.

Configurations of EMS systems : a pilot study

DOT National Transportation Integrated Search

2008-03-01

Emergency medical services (EMS) systems are configured differently depending on several factors, including the size, demographics, geography, and politics of the local communities they serve. Although some information exists about the organization, ...

Fire Service Emergency Management Handbook

DTIC Science & Technology

1985-01-01

students to survey buildings to determine the degree to which they provide protec- t on against nuclear disaster effects. TYPES OF ASSISTANCE: Training... SURVEY A-i APPENDIX B SELECTED EMERGENCY MANAGEMENT RESOURCES B-I ILLUSTRATIONS -e (Key Figures, Tables, and Charts) 1. FOUR PHASES OF CEM ACTIVITIES 2-3 2...1979 IAFC survey ,* about 28% of Fire Chiefs are also their community’s emergency preparedness directors, i.e., "the person who is primarily responsible

Trends in Mental Health and Substance Abuse Services at the Nation’s Community Health Centers: 1998–2003

PubMed Central

Druss, Benjamin G.; Bornemann, Thomas; Fry-Johnson, Yvonne W.; McCombs, Harriet G.; Politzer, Robert M.; Rust, George

2008-01-01

Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers. Methods. Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care’s (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. Results. Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210 000 to 800 000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. Conclusions. Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve. PMID:18687596

Trends in Mental Health and Substance Abuse Services at the Nation’s Community Health Centers: 1998–2003

PubMed Central

Druss, Benjamin G.; Bornemann, Thomas; Fry-Johnson, Yvonne W.; McCombs, Harriet G.; Politzer, Robert M.; Rust, George

2006-01-01

Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers. Methods. Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care’s (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. Results. Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210 000 to 800 000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. Conclusions. Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve. PMID:17008573

Developing and marketing a community pharmacy-based asthma management program.

PubMed

Rupp, M T; McCallian, D J; Sheth, K K

1997-01-01

To develop a community pharmacy-based asthma management program and successfully market the program to a managed care organization. Community-based ambulatory care. Independent community pharmacy. Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.

Understanding the LCA and ISO water footprint: A response to Hoekstra (2016) “A critique on the water-scarcity weighted water footprint in LCA”

EPA Science Inventory

Water footprinting has emerged as an important approach to assess water use related effects from consumption of goods and services. Assessment methods are proposed by two different communities, the Water Footprint Network (WFN) and the Life Cycle Assessment (LCA) community. The p...

Higher Education and Peacebuilding--A Bridge between Communities?

ERIC Educational Resources Information Center

Rasheed, Rebeen A.; Munoz, Alexander

2016-01-01

As the Syrian civil war enters its fifth year, with over four million refugees and no solution in the near future, the international community must better consider long-term planning in regards to the plight of refugees and services to support them, not just short-term emergency responses. Critically, higher education is all too often ignored when…

Issue of emergency hormonal contraception through a casualty department in a community hospital.

PubMed

Heard-Dimyan, J

1999-10-01

The results of this survey show that sexually active women seeking emergency hormonal contraception are finding that a casualty department in a community hospital offers convenience, confidentiality and accessibility above all else. There is a growing tendency for those registered with the local practice to prefer to come to the hospital for post-coital contraception, even though casualty nurses are not family planning qualified. This applies especially to the under twenties. More needs to be done in persuading patients that ongoing contraception should be addressed. To this end, if casualty departments are the preferred outlets in the rural communities, then nurses need further training. All providers of emergency contraception in rural areas need to be aware that offering such a service by well trained RGNs working to a protocol could reduce the incidence of unintended conceptions amongst teenagers. At the same time, every effort has to be made to increase awareness of the availability of emergency hormonal contraception by advertising the sources of contraceptive advice, which could soon include pharmacists.

A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service

PubMed Central

Ryan, Alexandra; Uppal, Meenakshi; Cunning, Imelda; Buckley, Claire M.

2015-01-01

Objective The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. Methods An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the ‘Guidelines on prevention & management of foot problems in Type 2 Diabetes’ by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. Results An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. Discussion During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines. PMID:26048860

A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service.

PubMed

Ryan, Alexandra; Uppal, Meenakshi; Cunning, Imelda; Buckley, Claire M

2015-01-01

The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the 'Guidelines on prevention & management of foot problems in Type 2 Diabetes' by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines.

Picture This: Exploring the Lived Experience of High-Functioning Stroke Survivors Using Photovoice.

PubMed

Maratos, Marie; Huynh, Linh; Tan, Julia; Lui, Jordon; Jarus, Tal

2016-07-01

An increasing number of high-functioning stroke survivors are present with minimal functional impairments and are often discharged with reduced access to community reintegration. Our objectives were to explore the lived experience of high-functioning stroke survivors and to identify gaps in community and rehabilitation services. Photovoice was used with five high-functioning stroke survivors to photo-document their experiences. A modified inductive thematic analysis was used, and meanings behind the photographs were elicited through four focus group sessions followed by photography exhibitions. Five themes emerged: lack of understanding and consideration for persons with disability, emotional and behavioral impacts after stroke, self-reliance and dependence on others, importance of appropriate and accessible services, and financial determinants of quality of life. By including service users' voices; investing in adapted, community-based programs; and providing educational programs for creating attitudinal change among service providers, the polarization between who can and cannot access services will be reduced. © The Author(s) 2016.

"Nothing is going to change three months from now": A mixed methods characterization of food bank use in Greater Vancouver.

PubMed

Holmes, Eleanor; Black, Jennifer L; Heckelman, Amber; Lear, Scott A; Seto, Darlene; Fowokan, Adeleke; Wittman, Hannah

2018-03-01

North American food bank use has risen dramatically since the 1980s, and over 850,000 Canadians were estimated to have visited a food bank monthly in 2015. Food banks serve multiple roles in communities, ranging from 'emergency responses' to individualized and short-term experiences of hunger, to 'chronic' supports as part of long-term subsistence strategies. This study used a mixed-methods design to examine the spectrum of food bank user experiences in a large urban context, as part of a community-based project aiming to envision a redesign of the food bank to contribute to broader community food security outcomes. Survey (n = 77) and focus group (n = 27) results suggested that participants widely viewed food banks as a long-term food-access strategy. Inadequate financial resources, steep increases in housing and food costs, and long-term health challenges emerged as the most prominent factors influencing food bank use. Participants commonly reported unmet food needs despite food bank use, limited agency over factors influencing access to sufficient food, and anticipated requiring food bank services in future. These findings contest global constructions of food banks as "emergency" food providers and support growing evidence that food banks are an insufficient response to chronic poverty, lack of affordable housing and insufficient social assistance rates underlying experiences of food insecurity. Participants envisioned changes to the food bank system to increase community food security including improved food quality and quantity (short-term), changes to service delivery and increased connections with health services (capacity building), and a greater role in poverty reduction advocacy (system redesign). Copyright © 2018. Published by Elsevier Ltd.

The Emergence of a Human Services Cooperative to Support Families and Young Adults with Disabilities: Implications for Disability Services and Supports

ERIC Educational Resources Information Center

Shogren, Karrie A.; Forber-Pratt, Anjali J.; Nittrouer, Christine; Aragon, Steven R.

2013-01-01

This paper documents the experiences of a group of parents who came together to form a human service cooperative in their local community to address the needs of their adult children with intellectual and developmental disabilities. Each parent felt that their child's needs were not (or could not be) met by existing providers. Parent leaders who…

[Relations with emergency medical care and primary care doctor, home health care].

PubMed

Azuma, Kazunari; Ohta, Shoichi

2016-02-01

Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society.

Relationship Between Forage Allowance and Grazing Efficiency in the Great Plains: Implications for Managing Rangelands for Both Livestock Production and Desired Ecosystem Goods and Services

USDA-ARS?s Scientific Manuscript database

Emergence of desired ecosystem goods and services from rangelands as a societal benefit and a potential income source for land managers has implications regarding the management of plant communities traditionally used primarily for livestock production. Contemporary decision-making on rangelands in ...

The Impact of the "Village" Model on Health, Well-Being, Service Access, and Social Engagement of Older Adults

ERIC Educational Resources Information Center

Graham, Carrie L.; Scharlach, Andrew E.; Price Wolf, Jennifer

2014-01-01

Background: Villages represent an emerging consumer-driven social support model that aims to enhance the social engagement, independence, and well-being of community-dwelling seniors through a combination of social activities, volunteer opportunities, service referral, and direct assistance. This study aimed to assess the perceived impact of…

42 CFR 51d.1 - To what does this subpart apply?

Code of Federal Regulations, 2010 CFR

2010-10-01

... communities created by mental health or substance abuse emergencies, as authorized under section 501(m) of the... 42 Public Health 1 2010-10-01 2010-10-01 false To what does this subpart apply? 51d.1 Section 51d.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MENTAL HEALTH...

42 CFR 51d.1 - To what does this subpart apply?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false To what does this subpart apply? 51d.1 Section 51d.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MENTAL HEALTH... communities created by mental health or substance abuse emergencies, as authorized under section 501(m) of the...

42 CFR 51d.1 - To what does this subpart apply?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false To what does this subpart apply? 51d.1 Section 51d.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MENTAL HEALTH... communities created by mental health or substance abuse emergencies, as authorized under section 501(m) of the...

42 CFR 51d.1 - To what does this subpart apply?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false To what does this subpart apply? 51d.1 Section 51d.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MENTAL HEALTH... communities created by mental health or substance abuse emergencies, as authorized under section 501(m) of the...

42 CFR 51d.1 - To what does this subpart apply?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false To what does this subpart apply? 51d.1 Section 51d.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MENTAL HEALTH... communities created by mental health or substance abuse emergencies, as authorized under section 501(m) of the...

Transforming community services through the use of a multidimensional model of clinical leadership.

PubMed

Leigh, Jacqueline Anne; Wild, Jill; Hynes, Celia; Wells, Stuart; Kurien, Anish; Rutherford, June; Rosen, Lyn; Ashcroft, Tim; Hartley, Victoria

2015-03-01

To evaluate the application of a Multidimensional Model of Clinical Leadership on the community healthcare leader and on transforming community services. Healthcare policy advocates clinical leadership as the vehicle to transform community and healthcare services. Few studies have identified the key components of an effective clinical leadership development model. The first two stages of Kirkpatrick's (Personnel Administrator 28, 1983, 62) Four/Five Levels of Evaluation were used to evaluate the application of the multidimensional model of clinical leadership. Eighty community healthcare leaders were exposed to this multidimensional clinical leadership development model through attendance of a community clinical leadership development programme. Twenty five leaders participated in focus group interviews. Data from the interviews were analysed utilising thematic content analysis. Three key themes emerged that influenced the development of best practice principles for clinical leadership development: 1. Personal leadership development 2. Organisational leadership 3. The importance of multiprofessional action learning/reflective groups Emergent best practice principles for clinical leadership development include adopting a multidimensional development approach. This approach encompasses: preparing the individual leader in the role and seeking organisational leadership development that promotes the vision and corporate values of the organisation and delivers on service improvement and innovation. Moreover, application of the Multidimensional Model of Clinical Leadership could offer the best platform for embedding the Six C's of Nursing (Compassion in Practice - Our Culture of Compassionate Care, Department of Health, Crown Copyright, 2012) within the culture of the healthcare organisation: care, compassion, courage, commitment, communication, and competency. This is achieved in part through the application of emotional intelligence to understand self and to develop the personal integrity of the healthcare leader and through supporting a culture of lifelong leadership learning. Embedding the best practice principles of clinical leadership development within a multidimensional model of clinical leadership provides a promising approach to: equipping the healthcare leader with those transferable leadership skills required to help them embark on a journey of lifelong leadership learning; and producing the healthcare leader who is caring, compassionate and can confidently and effectively transform community services. © 2014 John Wiley & Sons Ltd.

Consensus methodology to determine minor ailments appropriate to be directed for management within community pharmacy.

PubMed

Nazar, Hamde; Nazar, Zachariah; Yeung, Andre; Maguire, Mike; Connelly, Alex; Slight, Sarah P

2018-01-04

National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative. To design and evaluate a new NHS111 pathway re-directing patients with low acuity conditions to community pharmacy. Two consensus development stakeholder workshops were undertaken. A "low acuity" condition was defined as one that can be clinically assessed by a community pharmacist and requires a treatment and/or advice available within a community pharmacy. Retrospective NHS111 patient data (February-August 2016) from the North East of England and access to the NHS Pathways clinical decision support software were available to stakeholders. The NHS111 data demonstrated the volume of patient calls for these conditions that could have been redirected to community pharmacy. Stakeholders reached consensus that 64 low acuity conditions could be safely redirected to community pharmacy via NHS111. This represented approximately 35,000 patients (11.5% of total) being shifted away from the higher cost settings in the North East region alone during February-August 2016. The stakeholder group discussions provided rationale behind their classifications of conditions to ensure patient safety, the care experience and added value. The resulting definitive list of low acuity conditions that could be directed to community pharmacy via NHS111 could result in a shift of workload from urgent and emergency care settings. Future work needs to evaluate the cost, clinical outcomes, patient satisfaction of a community pharmacy referral service that has the potential to improve integration of community pharmacy in the wider NHS. Copyright © 2018 Elsevier Inc. All rights reserved.

Unité de Coordination Clinique des Services Préhospitaliers d'Urgence: A clinical telemedicine platform that improves prehospital and community health care for rural citizens.

PubMed

Bussières, Sylvain; Tanguay, Alain; Hébert, Denise; Fleet, Richard

2017-01-01

Access to health care in Canada's rural areas is a challenge. The Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU) is a telemedicine program designed to improve health care in the Chaudiere-Appalaches and Quebec City regions of Canada. Remote medical services are provided by nurses and by an emergency physician based in a clinical unit at the Alphonse-Desjardins Community Health and Social Services Center. The interventions were developed to meet two objectives. The first is to enhance access to quality health care. To this end, Basic Life Support paramedics and nurses were taught interventions outside of their field of expertise. Prehospital electrocardiograms were used to remotely diagnose ST segment elevation myocardial infarction and to monitor patients who were en route by ambulance to the nearest catheterization facility or emergency department. Basic Life Support paramedics received extended medical authorization that allowed them to provide opioid analgesia via telemedicine physician orders. Nurses from community health centres without physician coverage were able to request medical assistance via a video telemedicine system. The second objective is to optimize medical resources. To this end, remote death certifications were implemented to avoid unnecessary transport of deceased persons to hospitals. This paper presents the telemedicine program and some results.

MVERT: common solutions for technological disasters--a study on cooperation

NASA Astrophysics Data System (ADS)

Roberts, Walter O.; Allred, William D.

1999-01-01

Most Idaho communities are not prepared to handle a hazardous materials incident and must rely on resources outside of their jurisdiction for assistance. Idaho has established four Regional Response Teams (RRT) to help the communities. The teams are located in the northern, north-central, south-western and south-eastern parts of the state. The south-central area is served by a team from Boise or Pocatello. Response from either team requires nearly four hours of travel time. After analyzing the problems of time and distance, six counties from south-central Idaho have agreed to provide a team to function as an RRT during the initial phases of an incident. This organization is unprecedented because it consists of members from law enforcement, local fire protection organizations, emergency medical personnel, and local government agencies who will share personnel, equipment, resources, and training. The Magic Valley Emergency Response Team (MVERT) is locally funded and self- governed. MVERT has received support from the Idaho Bureau of Hazardous Materials, State Bureau of Disaster Services, Idaho Division of Environmental Quality, Idaho Emergency Services Training and Idaho State Police. MVERT is not limited to hazardous materials incidents and can respond to any emergency requiring specialized training and equipment.

Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

PubMed

Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

2011-08-19

Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.

Emergency department utilization among recently released prisoners: a retrospective cohort study

PubMed Central

2013-01-01

Background The population of ex-prisoners returning to their communities is large. Morbidity and mortality is increased during the period following release. Understanding utilization of emergency services by this population may inform interventions to reduce adverse outcomes. We examined Emergency Department utilization among a cohort of recently released prisoners. Methods We linked Rhode Island Department of Corrections records with electronic health record data from a large hospital system from 2007 to 2009 to analyze emergency department utilization for mental health disorders, substance use disorders and ambulatory care sensitive conditions by ex-prisoners in the year after release from prison in comparison to the general population, controlling for patient- and community-level factors. Results There were 333,369 total ED visits with 5,145 visits by a cohort of 1,434 ex-prisoners. In this group, 455 ex-prisoners had 3 or more visits within 1 year of release and 354 had a first ED visit within 1 month of release. ED visits by ex-prisoners were more likely to be made by men (85% vs. 48%, p < 0.001) and by blacks (26% vs. 16%, p < 0.001) compared to the Rhode Island general population. Ex-prisoners were more likely to have an ED visit for a mental health disorder (6% vs. 4%, p < 0.001) or substance use disorder (16%vs. 4%, p < 0.001). After controlling for patient- and community-level factors, ex-prisoner visits were significantly more likely to be for mental health disorders (OR 1.43; 95% CI 1.27-1.61), substance use disorders (OR 1.93; 95% CI 1.77-2.11) and ambulatory care sensitive conditions (OR 1.09; 95% CI 1.00-1.18). Conclusions ED visits by ex-prisoners were significantly more likely due to three conditions optimally managed in outpatient settings. Future work should determine whether greater access to outpatient services after release from prison reduces ex-prisoners’ utilization of emergency services. PMID:24188513

Assessing support for supervised injection services among community stakeholders in London, Canada.

PubMed

Bardwell, Geoff; Scheim, Ayden; Mitra, Sanjana; Kerr, Thomas

2017-10-01

Few qualitative studies have examined support for supervised injection services (SIS), and these have been restricted to large cities. This study aimed to assess support for SIS among a diverse representation of community stakeholders in London, a mid-sized city in southwestern Ontario, Canada. This qualitative study was undertaken as part of the Ontario Integrated Supervised Injection Services Feasibility Study. We used purposive sampling methods to recruit a diversity of key informants (n=20) from five sectors: healthcare; social services; government and municipal services; police and emergency services; and the business and community sector. Interview data, collected via one-to-one semi structured interviews, were coded and analyzed using thematic analyses through NVivo 10 software. Interview participants unanimously supported the implementation of SIS in London. However, participant support for SIS was met with some implementation-related preferences and/or conditions. These included centralization or decentralization of SIS; accessibility of SIS for people who inject drugs; proximity of SIS to interview participants; and other services and strategies offered alongside SIS. The results of this study challenge the assumptions that smaller cities like London may be unlikely to support SIS. Community stakeholders were supportive of the implementation of SIS with some preferences or conditions. Interview participants had differing perspectives, but ultimately supported similar end goals of accessibility and reducing community harms associated with injection drug use. Future research and SIS programming should consider these factors when determining optimal service delivery in ways that increase support from a diversity of community stakeholders. Copyright © 2017 Elsevier B.V. All rights reserved.

Management of hypertension in an Australian community pharmacy setting - patients' beliefs and perspectives.

PubMed

Bajorek, Beata V; LeMay, Kate S; Magin, Parker J; Roberts, Christopher; Krass, Ines; Armour, Carol L

2017-08-01

To explore patients' perspectives and experiences following a trial of a pharmacist-led service in hypertension management. A qualitative study comprising individual interviews was conducted. Patients of a community pharmacy, where a pharmacist-led hypertension management service had been trialled in selected metropolitan regions in Sydney (Australia), were recruited to the study. Emergent themes describing patients' experiences and perspectives on the service were elicited via thematic analysis (using manual inductive coding). Patients' (N = 18) experiences of the service were extremely positive, especially around pharmacists' monitoring of blood pressure and provision of advice about medication adherence. Patients' participation in the service was based on their trust in, and relationship with, their pharmacist. The perception of working in a 'team' was conveyed through the pharmacist's caring style of communication and the relaxed atmosphere of the community pharmacy. Patients felt that the community pharmacy was an obvious place for such a service because of their regular contact with the pharmacist, but was limited because the pharmacists were not able to prescribe medication. Patients were extremely positive about the role of, and their experience of, the pharmacy-based hypertension management service. Factors contributing to the patients' positive experiences provide important insights for community pharmacy practice. Good rapport with the pharmacist and a long-term relationship underpin patient engagement in such services. Restrictions on the pharmacists' scope of practice prevent their expertise, and the benefits of their accessibility as a primary point of contact, from being fully realised. © 2016 Royal Pharmaceutical Society.

The Australian Natural Disaster Resilience Index

NASA Astrophysics Data System (ADS)

Thoms, Martin

2016-04-01

The Australian Natural Disaster Resilience Index Martin Thoms, Melissa Parsons, Phil Morley Bushfire and Natural Hazards Cooperative Research Centre, Geography and Planning, University of New England, Armidale NSW 2351, Australia. Natural hazard management policy directions in Australia - and indeed internationally - are increasingly being aligned to ideas of resilience. Resilience to natural hazards is the ability of individuals and communities to cope with disturbance and adversity and to maintain adaptive behaviour. Operationalizing the measurement and assessment of disaster resilience is often undertaken using a composite index, but this exercise is yet to be undertaken in Australia. The Australian Natural Disaster Resilience Index is a top-down, national scale assessment of the resilience of communities to natural hazards. Resilience is assessed based on two sets of capacities: coping and adaptive capacities. Coping capacity relates to the factors influencing the ability of a community to prepare for, absorb and recover from a natural hazard event. Adaptive capacity relates to the arrangements and processes that enable adjustment through learning, adaptation and transformation. Indicators are derived under themes of social character, economic capital, infrastructure and planning, emergency services, community capital, information and engagement and governance/leadership/policy, using existing data sets (e.g. census data) or evaluation of policy and procedure (e.g. disaster management planning). A composite index of disaster resilience is then computed for each spatial division, giving national scale coverage. The results of the Australian Natural Disaster Resilience Index will be reported in a State of Disaster Resilience report, due in 2018. The index is co-designed with emergency service agencies, and will support policy development, planning, community engagement and emergency management.

Emergency responders' critical infrared (ERCI)

NASA Astrophysics Data System (ADS)

Konsin, Larry S.

2004-08-01

Emergency Responders (Fire, Police, Medical, and Emergency Management) face a high risk of injury or death. Even before September 11, 2001, public and private organizations have been driven to better protect Emergency Responders through education, training and improved technology. Recent research on Emergency Responder safety, health risks, and personal protective requirements, shows infrared (IR) imaging as a critical need. Today"s Emergency Responders are increasingly challenged to do more, facing demands requiring technological assistance and/or solutions. Since the introduction of Fire Service IR imaging in the mid 1990s, applications have increased. Emergency response IR is no longer just seeing through smoke to find victims or the seat of a fire. Many more mission critical needs now exist across the broad spectrum of emergency response. At the same time, Emergency Responder injuries and deaths are increasing. The Office of Domestic Preparedness (ODP) has also recognized IR imaging as critical in protecting our communities -- and in preventing many of the injuries and deaths of Emergency Responders. Currently, only 25% of all fire departments (or less than 7% of individual firefighters) have IR imaging. Availability to Police, EMS and Emergency Management is even lower. Without ERCI, Emergency Responders and our communities are at risk.

A cross-functional service-oriented architecture to support real-time information exchange in emergency medical response.

PubMed

Hauenstein, Logan; Gao, Tia; Sze, Tsz Wo; Crawford, David; Alm, Alex; White, David

2006-01-01

Real-time information communication presents a persistent challenge to the emergency response community. During a medical emergency, various first response disciplines including Emergency Medical Service (EMS), Fire, and Police, and multiple health service facilities including hospitals, auxiliary care centers and public health departments using disparate information technology systems must coordinate their efforts by sharing real-time information. This paper describes a service-oriented architecture (SOA) that uses shared data models of emergency incidents to support the exchange of data between heterogeneous systems. This architecture is employed in the Advanced Health and Disaster Aid Network (AID-N) system, a testbed investigating information technologies to improve interoperation among multiple emergency response organizations in the Washington DC Metropolitan region. This architecture allows us to enable real-time data communication between three deployed systems: 1) a pre-hospital patient care reporting software system used on all ambulances in Arlington County, Virginia (MICHAELS), 2) a syndromic surveillance system used by public health departments in the Washington area (ESSENCE), and 3) a hazardous material reference software system (WISER) developed by the National Library Medicine. Additionally, we have extended our system to communicate with three new data sources: 1) wireless automated vital sign sensors worn by patients, 2) web portals for admitting hospitals, and 3) PDAs used by first responders at emergency scenes to input data (SIRP).

Are human service agencies ready for disasters? Findings from a mixed-methods needs assessment and planning project.

PubMed

Hipper, Thomas J; Orr, Ashley; Chernak, Esther

2015-01-01

A mixed-methods design was used to assess the current capacity of human service agencies to provide services in a major disaster, identify challenges and successful strategies for providing those services, and formulate specific recommendations for government planners and the nonprofit sector to promote the integration of human service agencies into emergency preparedness and response. A web-based survey was completed by 188 unique human service agencies, 31 semistructured interviews were conducted with human service agency and government leaders from southeastern Pennsylvania and the mid-Atlantic region, and a collaborative planning meeting was held to review the findings and develop systems-based recommendations. Survey results indicated that human service agencies serve the most vulnerable communities during disasters and would welcome integration into preparedness and response plans, but they currently face challenges that include a lack of real-time communication and opportunities for collaborative planning with government partners. Interview findings were grouped according to 5 themes that emerged: capacity, coordination, communication, training, and leadership. This study identified recommendations to assist human service agencies, local health departments, and emergency management agencies as they work to ensure that needed human services are available during disasters, despite the resource challenges that most agencies face.

The community case management program: for 12 years, caring at its best.

PubMed

Luzinski, Cyndy Hunt; Stockbridge, Eleanor; Craighead, Janet; Bayliss, Deborah; Schmidt, Marie; Seideman, Janice

2008-01-01

One of the most complex issues currently under debate in this country is how best to provide health care for our society. Since 1995, Poudre Valley Hospital in Fort Collins, Colorado, has been effectively addressing one facet of this national crisis by providing services to a population of primarily elderly, chronically ill individuals perpetually caught in the gaps between acute and end-of-life services. Community case managers link program participants with appropriate health care services and providers that enhance physiological and functional status, identify resources that enrich quality of life, and encourage relationships and skills which foster self-efficacy. By emphasizing timely access to health-maximizing services, this program documented an impressive 81% reduction in financial losses to the organization during 2006 for emergency and inpatient services provided to a specific sample from this population.

Barriers to Male Involvement in Antenatal Care in Rural Mozambique

PubMed Central

Audet, Carolyn M.; Chire, Yazalde Manual; Vaz, Lara; Bechtel, Ruth; Carlson-Bremer, Daphne; Wester, C. William; Amico, K. Rivet; Calvo, Lázaro

2015-01-01

Low rates of antenatal care (ANC) service uptake limit the potential impact of mother-to-child HIV-prevention strategies. Zambézia province, Mozambique, has one of the lowest proportions of ANC uptake among pregnant women in the country, despite the availability of free services. We sought to identify factors influencing ANC service uptake (including HIV counseling and testing) through qualitative methods. Additionally, we encouraged discussion about strategies to improve uptake of services. We conducted 14 focus groups to explore community views on these topics. Based on thematic coding of discourse, two main themes emerged; (1) gender inequality in decision making and responsibility for pregnancy and (2) community beliefs that uptake of ANC services, particularly if supported by a male partner, reflects a woman’s HIV-positive status. Interventions to promote ANC uptake must work to shift cultural norms through male partner participation. Potential strategies to promote male engagement in ANC services are discussed. PMID:25854615

Implications of bed reduction in an acute psychiatric service.

PubMed

Bastiampillai, Tarun J; Bidargaddi, Niranjan P; Dhillon, Rohan S; Schrader, Geoffrey D; Strobel, Jörg E; Galley, Philip J

2010-10-04

To evaluate the impact of psychiatric inpatient bed closures, accompanied by a training program aimed at enhancing team effectiveness and incorporating data-driven practices, in a mental health service. Retrospective comparison of the changes in services within three consecutive financial years: baseline period - before bed reduction (2006-07); observation period - after bed reduction (2007-08); and intervention period - second year after bed reduction (2008-09). The study was conducted at Cramond Clinic, Queen Elizabeth Hospital, Adelaide. Length of stay, 28-day readmission rates, discharges, bed occupancy rates, emergency department (ED) presentations, ED waiting time, seclusions, locality of treatment, and follow-up in the community within 7days. Reduced bed numbers were associated with reduced length of stay, fewer referrals from the community and subsequently shorter waiting times in the ED, without significant change in readmission rates. A higher proportion of patients was treated in the local catchment area, with improved community follow-up and a significant reduction in inpatient seclusions. Our findings should reassure clinicians concerned about psychiatric bed numbers that service redesign with planned bed reductions will not necessarily affect clinical care, provided data literacy and team training programs are in place to ensure smooth transition of patients across ED, inpatient and community services.

Breastfeeding Supports and Services in Rural Hawaii: Perspectives of Community Healthcare Workers.

PubMed

Flood, Jeanie L

2017-01-01

Background . In the state of Hawaii, breastfeeding initiation rates are higher than the national average but fall below target rates for duration. Accessing breastfeeding support services is challenging for mothers living in rural areas of the state. Healthcare workers (HCWs) working with mothers and infants are in a key position to encourage and support breastfeeding efforts. The purpose of this study is to gain a better understanding of a Hawaiian community's (specifically Hilo, Hawai'i) breastfeeding service and support issues. Method . The qualitative study design utilized was a focused ethnography. This approach was used to gather data from participant HCWs ( N = 23) about their individual or shared experience(s) about the breastfeeding supports and services available in their community. An iterative process of coding and categorizing the data followed by conceptual abstraction into patterns was completed. Results . Three patterns emerged from the qualitative interviews: Operating within Constraints of the Particular Environment , Coexisting Messages , and Process Interrupted. Participants identified a number of gaps in breastfeeding services available to their clients including the lack of available lactation consultants and the inconsistent communication between hospital and community providers. A number of implications for practice and further research were suggested within the results and are discussed.

Community health workers and medicaid managed care in New Mexico.

PubMed

Johnson, Diane; Saavedra, Patricia; Sun, Eugene; Stageman, Ann; Grovet, Dodie; Alfero, Charles; Maynes, Carmen; Skipper, Betty; Powell, Wayne; Kaufman, Arthur

2012-06-01

We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico's 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed. Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost.

75 FR 65456 - Information Collection; Submission for OMB Emergency Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

... Corporation for National and Community Service, Bruce Kellogg, (202) 606-6954, or by e-mail at [email protected] Therefore, there will be no comment period for this request. FOR FURTHER INFORMATION CONTACT: Bruce Kellogg...

Community Partnerships: The Key to Preventing Injuries

DOT National Transportation Integrated Search

1998-06-09

Success to emergency medical and fire services personnel is every injury that : has been prevented. In the 1990s, however, it became difficult to maintain : prevention programs as budgets declined. The critical components of injury : prevention -- pr...

Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

PubMed Central

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-01-01

ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model. Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. PMID:25745123

Housing and Child Welfare: Emerging Evidence and Implications for Scaling up Services

PubMed Central

Farrell, Anne F.; Marcal, Katherine E.; Chung, Saras; Hovmand, Peter S.

2018-01-01

Inadequate housing threatens family stability in communities across the United States. This study reviews emerging evidence on housing interventions in the context of scale-up for the child welfare system. In child welfare, scale-up refers to the extent to which fully implemented interventions sustainably alleviate family separations associated with housing instability. It incorporates multiple aspects beyond traditional measures of effectiveness including costs, potential reach, local capacities for implementation, and fit within broader social services. The framework further encompasses everyday circumstances faced by service providers, program administrators, and policymakers who allocate resources under conditions of scarcity and uncertainty. The review of current housing interventions reveals a number of systemic constraints for scale-up in child welfare. Reliance on rental assistance programs limits capacity to address demand, while current practices that target the most vulnerable families may inadvertently diminish effectiveness of the intervention and increase overall demand. Alternative approaches that focus on homelessness prevention and early intervention must be tested in conjunction with community initiatives to increase accessibility of affordable housing. By examining system performance over time, the scalability framework provides an opportunity for more efficient coordination of housing services within and outside of the child welfare system. PMID:28815623

An exploration of strategies used by older people to obtain information about health- and social care services in the community.

PubMed

Mc Grath, Margaret; Clancy, Kathleen; Kenny, Anne

2016-10-01

To explore the strategies used by older people living in Ireland to obtain information about community health and social services. A qualitative exploratory design was used. Focus groups (n = 3) were conducted with community dwelling older people (n = 17). A series of vignettes were used to guide discussion regarding hypothetical situations that approximated real-life scenarios for older people. Data were transcribed verbatim and analysed using content analysis. Obtaining information about community health and social services is an ongoing process that requires continuous commitment by older adults. Key strategies which emerged from the data included (i) taking a proactive stance towards accessing health information, (ii) making use of personal networks in your community and (iii) developing 'insider' knowledge. Older people in this study had a proactive approach to obtaining health information and identified the importance of taking responsibility for managing their own needs. Despite this, obtaining basic information about community health and social services was a challenging and time-consuming process. Future research should focus on developing health literacy interventions that build upon and expand the strategies currently used by older people. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

A new paradigm for retrieval medicine.

PubMed

Moloney, John

2018-06-12

A number of new time critical medical interventions are highly specialised. As such, they are not available in many hospitals and EDs. This necessitates transfer to another facility, which is often associated with some degree of delay. Processes to facilitate timely access to these interventions should aim to replicate or improve on that which would have been available should the patient have been in the community, and responded to, primarily, by an emergency medical service. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Models of Integrating Physical Therapists into Family Health Teams in Ontario, Canada: Challenges and Opportunities

PubMed Central

Mandoda, Shilpa; Landry, Michel D.

2011-01-01

ABSTRACT Purpose: To explore the potential for different models of incorporating physical therapy (PT) services within the emerging network of family health teams (FHTs) in Ontario and to identify challenges and opportunities of each model. Methods: A two-phase mixed-methods qualitative descriptive approach was used. First, FHTs were mapped in relation to existing community-based PT practices. Second, semi-structured key-informant interviews were conducted with representatives from urban and rural FHTs and from a variety of community-based PT practices. Interviews were digitally recorded, transcribed verbatim, and analyzed using a categorizing/editing approach. Results: Most participants agreed that the ideal model involves embedding physical therapists directly into FHTs; in some situations, however, partnering with an existing external PT provider may be more feasible and sustainable. Access and funding remain the key issues, regardless of the model adopted. Conclusion: Although there are differences across the urban/rural divide, there exist opportunities to enhance and optimize existing delivery models so as to improve client access and address emerging demand for community-based PT services. PMID:22654231

Collaboration between non-governmental organizations and public services in health - a qualitative case study from rural Ecuador.

PubMed

Biermann, Olivia; Eckhardt, Martin; Carlfjord, Siw; Falk, Magnus; Forsberg, Birger C

2016-01-01

Non-governmental organizations (NGOs) have a key role in improving health in low- and middle-income countries. Their work needs to be synergistic, complementary to public services, and rooted in community mobilization and collective action. The study explores how an NGO and its health services are perceived by the population that it serves, and how it can contribute to reducing barriers to care. A qualitative exploratory study was conducted in remote Ecuador, characterized by its widespread poverty and lack of official governance. An international NGO collaborated closely with the public services to deliver preventative and curative health services. Data were collected using focus group discussions and semistructured interviews with purposively sampled community members, healthcare personnel, and community health workers based on their links to the health services. Conventional qualitative content analysis was used, focusing on manifest content. Emerging themes relate to the public private partnership (PPP), the NGO and its services, and community participation. The population perceives the NGO positively, linking it to healthcare improvements. Their priority is to get services, irrespective of the provider's structure. The presence of an NGO in the operation may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively. To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the population's trust in the organization, an NGO should operate in a manner that is as integrated as possible within the existing structure. The NGO should work close to the population it serves, with services anchored in the community. PPP parties should develop a common platform with joint messages to the target population on the provider's structure, and regarding partners' roles and responsibilities. Interaction between the population and the providers on service content and their expectations is key to positive outcomes of PPP operations.

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises.

PubMed

Singh, Neha S; Aryasinghe, Sarindi; Smith, James; Khosla, Rajat; Say, Lale; Blanchet, Karl

2018-01-01

Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries. We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach. Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers. Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations.

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises

PubMed Central

Aryasinghe, Sarindi; Smith, James; Khosla, Rajat; Say, Lale; Blanchet, Karl

2018-01-01

Introduction Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries. Methods We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach. Results Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers. Conclusions Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations. PMID:29736272

Emerging new practices in technology to support independent community access for people with intellectual and cognitive disabilities.

PubMed

Stock, Steven E; Davies, Daniel K; Wehmeyer, Michael L; Lachapelle, Yves

2011-01-01

The concept of community access is a multidimensional term, which may involve issues related to physical access, knowledge and information, power and control, relationships and communications, advocacy, participation and quality of life [21]. This paper discusses historical and emerging practices and interventions related to physical access to community and community based information for individuals with cognitive disabilities such as intellectual disability, autism or traumatic brain injury. While much societal attention has been paid to features of independent community access for populations such as individuals with hearing, vision or physical disabilities, less attention has focused on independent community access for people with intellectual and other significant cognitive disabilities. Attitudes and actions by families and professional service communities are often mixed for some individuals in this population. The somewhat limited research base in these areas is explored, including a case study review and results from several promising feasibility studies. The paper concludes with comments concerning future prospects and recommendations for improving independent community access for persons with significant cognitive disabilities.

Aboriginal Community Education Officers' Border Work: Culturally Safe Practices for Supporting Migrating Indigenous Students from Country into Urban and Semi-Rural Schools

ERIC Educational Resources Information Center

MacGill, Bindi

2012-01-01

Since 2001 there has been an increase in migration patterns by Indigenous families from remote communities to urban and semi-rural locations. Indigenous student emigration from remote Indigenous schools to urban and semi-rural schools is an emerging crisis as there are routinely inadequate service providers for Indigenous emigres. Migration away…

Dentists' partnership of Michigan's Calhoun County: a care model for uninsured populations.

PubMed

Higbea, Raymond J; Palumbo, Charles H; Pearl, Samantha A; Byrne, Mary Jo; Wise, Jill

2013-09-01

Community leaders in Calhoun County, Michigan, identified access to dental care as an acute local need and in early 2007 organized Calhoun County Dentists' Partnership. A group of stakeholders developed a program centered on local dentists who donated a designated number of office visits per month to care for uninsured county residents. Residents enrolled in the program were required to attend an oral health class; receive a dental screening, cleaning, and dental x-rays by a dental hygienist; and complete a designated number of hours of community service before seeing a dentist. Since the program's 2007 inception, approximately 4,000 people have received dental services valued at approximately $510,000. In turn, program participants provided more than 57,000 hours of community service. The program is credited with reducing the number of patients presenting to a local hospital emergency department for dental pain by 70 percent between 2006 and 2012. Similar programs are now under way in thirteen other communities in the Midwest, which shows that such local initiatives, volunteerism, and community organization can address dental care access needs.

The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need.

PubMed

Sun, Jared H; Wallis, Lee A

2012-08-01

As many as 90% of all trauma-related deaths occur in developing nations, and this is expected to get worse with modernisation. The current method of creating an emergency care system by modelling after that of a Western nation is too resource-heavy for most developing countries to handle. A cheaper, more community-based model is needed to establish new emergency care systems and to support them to full maturity. A needs assessment was undertaken in Manenberg, a township in Cape Town with high violence and injury rates. Community leaders and successfully established local services were consulted for the design of a first responder care delivery model. The resultant community-based emergency first aid responder (EFAR) system was implemented, and EFARs were tracked over time to determine skill retention and usage. The EFAR system model and training curriculum. Basic EFARs are spread throughout the community with the option of becoming stationed advanced EFARs. All EFARs are overseen by a local organisation and a professional body, and are integrated with the local ambulance response if one exists. On competency examinations, all EFARs tested averaged 28.2% before training, 77.8% after training, 71.3% 4 months after training and 71.0% 6 months after training. EFARs reported using virtually every skill taught them, and further review showed that they had done so adequately. The EFAR system is a low-cost, versatile model that can be used in a developing region both to lay the foundation for an emergency care system or support a new one to maturity.

7 CFR 1778.36 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.36 Section 1778.36 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.36 [Reserved] ...

7 CFR 1778.2 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.2 Section 1778.2 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.2 [Reserved] ...

7 CFR 1778.12 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.12 Section 1778.12 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.12 [Reserved] ...

7 CFR 1778.8 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.8 Section 1778.8 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.8 [Reserved] ...

7 CFR 1778.5 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.5 Section 1778.5 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.5 [Reserved] ...

7 CFR 4274.301 - Introduction.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL... emerging businesses, in partnership with other public and private resources, and in accordance with State... for business facilities and community developments in a rural area. (c) Proposed intermediaries are...

Outdoor Air Pollution, Heart Attack and Stroke

EPA Science Inventory

Elevated outdoor ambient air particle pollution triggers heart attacks, strokes, and abnormal heart rhythms and worsens heart failure in individuals at high risk due to underlying medical conditions. Emergency Medical Services in communities are the first responders to these eme...

The role of the bilingual/bicultural worker in dementia education, support and care.

PubMed

Boughtwood, Desiree; Shanley, Christopher; Adams, Jon; Santalucia, Yvonne; Kyriazopoulos, Helena; Rowland, Jeffrey; Pond, Dimity

2013-01-01

Members of minority populations often have difficulty knowing about and accessing dementia services. One of the strategies used to promote access is the employment of bilingual/bicultural workers (sometimes referred to as multicultural, link or outreach workers). This study involved interviews with 24 bilingual/bicultural workers in south western Sydney, Australia to gain a better understanding of their role within the dementia field. Seven themes emerged: importance of working with family; process of building trust when moving between two cultures; importance of understanding the culture; self-care and culture; flexibility of their role; linking community members; and linking communities to mainstream services. Bilingual/bicultural workers play a significant and complex role in supporting individuals and families within their community who are affected by dementia. The significance of their role needs to be more clearly acknowledged in the development of policy, further research and service provision within the dementia field.

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice.

PubMed

Mahaffey, Lisa; Burson, Kathrine A; Januszewski, Celeste; Pitts, Deborah B; Preissner, Katharine

2015-01-01

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.

Tsunami Preparedness Along the U.S. West Coast (video)

USGS Publications Warehouse

Filmed and edited by: Loeffler, Kurt; Gesell, Justine

2010-01-01

Tsunamis are a constant threat to the coasts of our world. Although tsunamis are infrequent along the West coast of the United States, it is possible and necessary to prepare for potential tsunami hazards to minimize loss of life and property. Community awareness programs are important, as they strive to create an informed society by providing education and training. This video about tsunami preparedness along the West coast distinguishes between a local tsunami and a distant event and focuses on the specific needs of each region. It offers guidelines for correct tsunami response and community preparedness from local emergency managers, first-responders, and leading experts on tsunami hazards and warnings, who have been working on ways of making the tsunami affected regions safer for the people and communities on a long-term basis. This video was produced by the US Geological Survey (USGS) in cooperation with the California Emergency Management Agency (CalEMA), Oregon Department of Geology and Mineral Industries (DOGAMI), Washington Emergency Management Division (EMD), Marin Office of Emergency Services, and Pacific Gas and Electric (PG&E).

The value of trophic interactions for ecosystem function: dung beetle communities influence seed burial and seedling recruitment in tropical forests

PubMed Central

Bardgett, Richard D.; Louzada, Julio; Barlow, Jos

2016-01-01

Anthropogenic activities are causing species extinctions, raising concerns about the consequences of changing biological communities for ecosystem functioning. To address this, we investigated how dung beetle communities influence seed burial and seedling recruitment in the Brazilian Amazon. First, we conducted a burial and retrieval experiment using seed mimics. We found that dung beetle biomass had a stronger positive effect on the burial of large than small beads, suggesting that anthropogenic reductions in large-bodied beetles will have the greatest effect on the secondary dispersal of large-seeded plant species. Second, we established mesocosm experiments in which dung beetle communities buried Myrciaria dubia seeds to examine plant emergence and survival. Contrary to expectations, we found that beetle diversity and biomass negatively influenced seedling emergence, but positively affected the survival of seedlings that emerged. Finally, we conducted germination trials to establish the optimum burial depth of experimental seeds, revealing a negative relationship between burial depth and seedling emergence success. Our results provide novel evidence that seed burial by dung beetles may be detrimental for the emergence of some seed species. However, we also detected positive impacts of beetle activity on seedling recruitment, which are probably because of their influence on soil properties. Overall, this study provides new evidence that anthropogenic impacts on dung beetle communities could influence the structure of tropical forests; in particular, their capacity to regenerate and continue to provide valuable functions and services. PMID:27928036

The value of trophic interactions for ecosystem function: dung beetle communities influence seed burial and seedling recruitment in tropical forests.

PubMed

Griffiths, Hannah M; Bardgett, Richard D; Louzada, Julio; Barlow, Jos

2016-12-14

Anthropogenic activities are causing species extinctions, raising concerns about the consequences of changing biological communities for ecosystem functioning. To address this, we investigated how dung beetle communities influence seed burial and seedling recruitment in the Brazilian Amazon. First, we conducted a burial and retrieval experiment using seed mimics. We found that dung beetle biomass had a stronger positive effect on the burial of large than small beads, suggesting that anthropogenic reductions in large-bodied beetles will have the greatest effect on the secondary dispersal of large-seeded plant species. Second, we established mesocosm experiments in which dung beetle communities buried Myrciaria dubia seeds to examine plant emergence and survival. Contrary to expectations, we found that beetle diversity and biomass negatively influenced seedling emergence, but positively affected the survival of seedlings that emerged. Finally, we conducted germination trials to establish the optimum burial depth of experimental seeds, revealing a negative relationship between burial depth and seedling emergence success. Our results provide novel evidence that seed burial by dung beetles may be detrimental for the emergence of some seed species. However, we also detected positive impacts of beetle activity on seedling recruitment, which are probably because of their influence on soil properties. Overall, this study provides new evidence that anthropogenic impacts on dung beetle communities could influence the structure of tropical forests; in particular, their capacity to regenerate and continue to provide valuable functions and services. © 2016 The Author(s).

Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge.

PubMed

Noureldin, Marwa; Hass, Zachary; Abrahamson, Kathleen; Arling, Greg

2017-09-04

Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge. Participants in the Minnesota Return to Community Initiative who were assisted in achieving a community discharge (N = 1459) comprised the study sample. The main outcome was fall occurrence within 30 days of discharge. Factor analyses were used to estimate latent models from variables of interest. A structural equation model (SEM) was estimated to determine the relationship between the emerging latent variables and falls. Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p < .05). Within the context of a state-implemented transition program, findings highlight the importance of supports/services in mitigating against medication-related risk of falling post NH discharge. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

An alternative model of health delivery system to improve public health in India.

PubMed

Ahmed, Faruqueuddin

2014-01-01

Three distinct groups of people, the sick, at risk and a healthy population constitute the beneficiaries of any health services. Available health care packages are based on the paradigm of the "natural history of the disease and the five levels of the prevention." Patient-centric "personal care services" and community centric "public health care" are the two packages universally provided to a community. A health care system can only be effective and efficient if there is balanced mix of the personal and public health care delivered as a comprehensive package in a regionalized graded manner by a well-trained manpower. The current health care delivery system is mostly personal care centered and public health component is in the fringes and being delivered as vertical programs through the multipurpose health worker. The alternative model speaks about bi-furcating the two types of services and delivering both as a comprehensive package to the community. As per the constitution of India health services including major public health services are state subject but the nature of emerging public health problems relates to mass movement of people and goods, environmental changes due industry and other developmental activities etc. resulting in the spread of the same beyond the manmade geographical boundary, some public health activity may be included in the union/concurrent list. To deliver the packages a public health cadre may be created at the state and center and be equipped with public health knowledge and skill to deliver well-defined evidence-based service package to control the existing problem and keep strict vigilance to prevent entry/emergence of new health problems.

Completing the circle: providing comprehensive care to children with special healthcare needs.

PubMed

Kondrad, Monica

2009-01-01

Providing a medical home for children with special healthcare needs presents challenges such as allowing time during the office visit to address the child's and parent's concerns, the provision of comprehensive medical care, and identifying resources to support these children in the community. The care coordinator serves as a link between the child/family, physician, school, and community resource to promote communication and prevent duplication of services to ensure optimal outcomes for these children. A plan of care or medical summary is developed by the care coordinator with input from the parent/child, pediatrician, specialists, and allied healthcare personnel to use as a communication tool with staff/physicians in the emergency room, new specialists, schools, and community agencies to promote access to services.

Ensuring Access to Quality Health Care in Vulnerable Communities.

PubMed

Bhatt, Jay; Bathija, Priya

2018-04-24

For millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed.In this Invited Commentary, the authors outline characteristics and parameters of vulnerable communities as well as the essential health care services that hospitals should strive to maintain locally identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. They also describe four of nine emerging strategies-recommended by the task force-to reform health care delivery and payment and allow hospitals to provide the essential health care services, along with implementation barriers and how to address them. While this Invited Commentary focuses on vulnerable communities, the four highlighted strategies (addressing the social determinants of health, adopting new and innovative virtual care strategies, designing global budgets, and using inpatient/outpatient transformation strategy), as well as the other five strategies, may have broader applicability for all communities.

Looking to the Future: Communicating with an expanding cryospheric user community

NASA Astrophysics Data System (ADS)

Gergely, K.; Scott, D.; Booker, L.

2009-12-01

The National Snow and Ice Data Center (NSIDC) at the University of Colorado is known for its customer service. Through the User Services Office (USO) NSIDC provides end-to-end data support with timely, friendly, and professional assistance. This service includes expertise in selecting, obtaining, and handling of data, as well as the dissemination of information related to NSIDC’s cryospheric data and information. This dissemination happens across many mediums, such as email, newsletters, and Web-published data documentation. With surveys like the American Customer Service Index, we are learning more and more about what the user’s informational needs are, and beginning to anticipate what the user's needs might be in the future. In this presentation, we will examine the current USO processes for communicating with our user community, and explore how social networking tools, such as Twitter, Blogging, or Facebook may enhance the overall user experience. We will assess a communication approach that combines mainstream and emerging technologies in order to maintain a high standard of customer service with an expanding cryospheric user community.

Emergency department presentations by Aboriginal children: issues for consideration for appropriate health services.

PubMed

Duncan, Catriona; Williams, Katrina; Nathanson, Dania; Thomas, Susan; Cottier, Carolyn; O'Meara, Matthew; Zwi, Karen

2013-09-01

This study describes the presentations made to the Sydney Children's Hospital (SCH) Emergency Department (ED) by local Aboriginal and Torres Strait Islander (Aboriginal) children with particular reference to children who present frequently or whose presentation was preventable. Data from the SCH ED Information System were extracted for all presentations made by children who identified as Aboriginal, aged between 0-15 years, who presented between 2005-2008. Presentations were coded according to the presenting problem, diagnosis, outcome, and whether the presentations were potentially preventable. Preventable presentations include those presentations considered to be avoidable and those that could have been managed by a local primary care or community service. There were 1252 presentations to the SCH ED by 453 Aboriginal children aged 0-15 years. More than 50% of children presented more than once. Seventy-nine children presented more than five times. Nearly 45% of presentations were coded as potentially preventable. A significant proportion of ED presentations were potentially preventable with the use of culturally appropriate and accessible local community and primary health care services and better referral pathways back to these services. Community engagement is required to raise awareness of common presentations and to look at strategies to prevent common problems both occurring and presenting to the ED. This will enhance the health of urban Aboriginal children. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Australian Community Pharmacists' Experience of Implementing a Chronic Kidney Disease Risk Assessment Service.

PubMed

Gheewala, Pankti A; Peterson, Gregory M; Zaidi, Syed Tabish R; Jose, Matthew D; Castelino, Ronald L

2018-06-14

Community pharmacists are well positioned to deliver chronic kidney disease (CKD) screening services. However, little is known about the challenges faced by pharmacists during service implementation. This study aimed to explore community pharmacists' experiences and perceived barriers of implementing a CKD risk assessment service. Data collection was performed by using semistructured, open-ended interview questions. Pharmacists who had implemented a CKD screening service in Tasmania, Australia, were eligible to participate. A purposeful sampling strategy was used to select pharmacists, with variation in demographics and pharmacy location. A conventional content analysis approach was used to conduct the qualitative study. Transcripts were thematically analyzed by using the NVivo 11 software program. Initially, a list of free nodes was generated and data were coded exhaustively into relevant nodes. These nodes were then regrouped to form highly conceptualized themes. Five broad themes emerged from the analysis: contextual fit within community pharmacy; perceived scope of pharmacy practice; customer perception toward disease prevention; CKD - an underestimated disease; and remuneration for a beneficial service. Pharmacists found the CKD service efficient, user-friendly, and of substantial benefit to their customers. However, several pharmacists observed that their customers lacked interest in disease prevention, and had limited understanding of CKD. More importantly, pharmacists perceived the scope of pharmacy practice to depend substantially on interprofessional collaboration between pharmacists and general practitioners, and customer acknowledgment of pharmacists' role in disease prevention. Community pharmacists perceived the CKD service to be worth incorporating into pharmacy practice. To increase uptake, future CKD services should aim to improve customer awareness about CKD before providing risk assessment. Further research investigating strategies to enhance general practitioner involvement in pharmacist-initiated disease prevention services is also needed.

Flexibility in community pharmacy: a qualitative study of business models and cognitive services.

PubMed

Feletto, Eleonora; Wilson, Laura K; Roberts, Alison S; Benrimoj, Shalom I

2010-04-01

To identify the capacity of current pharmacy business models, and the dimensions of organisational flexibility within them, to integrate products and services as well as the perceptions of viability of these models. Fifty-seven semi-structured interviews were conducted with community pharmacy owners or managers and support staff in 30 pharmacies across Australia. A framework of organisational flexibility was used to analyse their capacity to integrate services and perceptions of viability. Data were analysed using the method of constant comparison by two independent researchers. The study found that Australian community pharmacies have used the four types of flexibility to build capacity in distinct ways and react to changes in the local environment. This capacity building was manifested in four emerging business models which integrate services to varying degrees: classic community pharmacy, retail destination pharmacy, health care solution pharmacy and networked pharmacy. The perception of viability is less focused on dispensing medications and more focused on differentiating pharmacies through either a retail or services focus. Strategic flexibility appeared to offer pharmacies the ability to integrate and sustainably deliver services more successfully than other types, as exhibited by health care solution and networked pharmacies. Active support and encouragement to transition from being dependent on dispensing to implementing services is needed. The study showed that pharmacies where services were implemented and showed success are those strategically differentiating their businesses to become focused health care providers. This holistic approach should inevitably influence the sustainability of services.

Learning to deal with crisis in the home: Part 2 - preparing preregistration students.

PubMed

Gibson, Caroline E; Dickson, Caroline; Lawson, Bill; McMillan, Ailsa; Kelly, Helena

2015-12-01

The global shift of health care is from acute services to community and primary care. Therefore, registrants must be prepared to work effectively within diverse settings. This article is the second in a series discussing the preparation of nurses for contemporary health-care challenges in the community. In it, we outline the design, implementation, and evaluation of simulated emergency scenarios within an honours degree-level, pre-registration nursing curriculum in Scotland. Over 3 years, 99 final-year students participated in interactive sessions focusing on recognition and management of the deteriorating patient and emergency care. Clinical scenarios were designed and delivered collaboratively with community practitioners. Debriefing challenged the students to reflect on learning and transferability of skills of clinical reasoning and care management to the community context. Students considered the scenarios to be realistic and perceived that their confidence had increased. Development of such simulation exercises is worthy of further debate in education and practice.

BANANAS: providing child care services to a multi-ethnic community.

PubMed

Vu, Catherine M; Schwartz, Sara L; Austin, Michael J

2011-01-01

BANANAS, Inc. is a nonprofit organization that has provided child care resource and referral services for over 35 years. BANANAS emerged as a grassroots effort initiated by a group of female volunteers who sought to build a network of women with children who needed childcare. As the organization developed, its leaders recognized and responded to additional needs, including resource and information sharing, workshops and classes, and political advocacy. Beginning as a collective, BANANAS has grown into a multifaceted service delivery and advocacy nonprofit operating with an annual budget of $12 million. This history of the agency reflects the development of a unique community-based effort, its challenges and rewards, and the multiple successes that this pioneering nonprofit has experienced.

Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand

PubMed Central

Blake, Denise; Lyons, Antonia

2016-01-01

Opioid Substitution Treatment (OST) is a harm reduction strategy enabling opiate consumers to avoid withdrawal symptoms and maintain health and wellbeing. Some research shows that within a disaster context service disruptions and infrastructure damage affect OST services, including problems with accessibility, dosing, and scripts. Currently little is known about planning for OST in the reduction and response phases of a disaster. This study aimed to identify the views of three professional groups working in Aotearoa/New Zealand about OST provision following a disaster. In-depth, semi-structured interviews were conducted with 17 service workers, health professionals, and emergency managers in OST and disaster planning fields. Thematic analysis of transcripts identified three key themes, namely “health and wellbeing”, “developing an emergency management plan”, and “stock, dose verification, and scripts” which led to an overarching concept of “service continuity in OST preparedness planning”. Participants viewed service continuity as essential for reducing physical and psychological distress for OST clients, their families, and wider communities. Alcohol and drug and OST health professionals understood the specific needs of clients, while emergency managers discussed the need for sufficient preparedness planning to minimise harm. It is concluded that OST preparedness planning must be multidisciplinary, flexible, and inclusive. PMID:27834915

Transfer of care and offload delay: continued resistance or integrative thinking?

PubMed

Schwartz, Brian

2015-11-01

The disciplines of paramedicine and emergency medicine have evolved synchronously over the past four decades, linked by emergency physicians with expertise in prehospital care. Ambulance offload delay (OD) is an inevitable consequence of emergency department overcrowding (EDOC) and compromises the care of the patient on the ambulance stretcher in the emergency department (ED), as well as paramedic emergency medical service response in the community. Efforts to define transfer of care from paramedics to ED staff with a view to reducing offload time have met with resistance from both sides with different agendas. These include the need to return paramedics to serve the community versus the lack of ED capacity to manage the patient. Innovative solutions to other system issues, such as rapid access to trauma teams, reducing door-to-needle time, and improving throughput in the ED to reduce EDOC, have been achieved by involving all stakeholders in an integrative thinking process. Only by addressing this issue in a similar integrative process will solutions to OD be realized.

Preceptors' Experience of Nursing Service-Learning Projects.

PubMed

Voss, Heather C

2016-03-01

Service-learning is a teaching-learning strategy in higher education that provides hands-on experiences in authentic clinical environments. Mutual decision making, shared goals, reciprocity, and tangible benefits to organizations and the people they serve are hallmarks of service-learning. However, the literature is sparse pertaining to preceptor experiences with service-learning projects, the extent of reciprocity, or the projects' impact on those who received the service. A small phenomenological study was conducted to better understand the experiences of four community-based health professionals who worked with nursing students on service-learning projects. Four themes emerged from face-to-face interviews and written reflections: (a) reciprocity among preceptor, clinical faculty, and student, (b) intentional planning and project clarity, (c) meaningful and authentic experience, and (d) valued and beneficial contributions that addressed a need. Insight gained from the experiences of the four preceptors in this study suggest that through careful planning and reciprocity, service-learning can have a positive impact on community-based organizations and the people they serve. Copyright 2016, SLACK Incorporated.

Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

PubMed Central

Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

2015-01-01

Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. PMID:26515687

7 CFR 1778.21 - Application processing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Application processing. 1778.21 Section 1778.21 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.21 Application...

7 CFR 1778.31 - Performing development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Performing development. 1778.31 Section 1778.31 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.31 Performing...

7 CFR 1778.14 - Other considerations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Other considerations. 1778.14 Section 1778.14 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.14 Other...

An Overview Of The Ecosystem Services Research Program Decision Support Framework

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. Such problems require ways to dee...

Overcoming Barriers for "Niche" Learners Through Distance Education.

ERIC Educational Resources Information Center

Miller, Lawrence G.; Hyatt, Sue Y.; Brennan, Joyce; Bertani, Raymond; Trevor, Thomas

1999-01-01

Focuses on students who fit into "niches," and discusses how the Chattanooga State Technical Community College's distance-learning program accommodates these learners. Describes five "niche" learner categories: students with disabilities, power-line maintenance technicians, emergency-service personnel, truckers, and industrial…

An integrated computer system for analysis, selection, and evaluation of unconventional intersections.

DOT National Transportation Integrated Search

2011-03-01

The emergence of unconventional intersections in the traffic community has been motivated by the notion : of improving service quality with innovative control strategies, such as rerouting the turning movements : or flipping the paths of two traffic ...

Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country.

PubMed

Mir, Azeem Sultan; Malik, Raees

2010-08-01

Unsafe abortion is a major Public health problem in developing countries, where women make several unsafe attempts at termination of the unintended pregnancy before turning to health services. Community health workers can act as a bridge between the community and their health facilities and can use Emergency Contraceptive Pills to significantly reduce the mortality and morbidity related to unsafe abortions. This study explores the knowledge, attitudes and practices of the Lady Health Supervisor of the National Program for Family Planning, district Rawalpindi, regarding emergency contraception pills. The cross sectional survey was conducted during the monthly meeting of Lady Health Supervisors. Self administered, anonymous and voluntary questionnaire consisting of 17 items, regarding demographic profile, awareness, knowledge, attitudes and practices, was used. Insufficient knowledge, high misinformation and strongly negative attitudes were revealed. More than half did not know that emergency contraceptive pills do not cause abortion. About four fifths believed that emergency contraceptive pills will lead to 'evil' practices in society. More than four fifths recognized that the clients of National Program for Family Planning need emergency contraceptive pills. The attitudes were significantly associated with knowledge (P=0.034, Fisher's Exact Test). The awareness of emergency contraceptive pills is high. Serious gaps in knowledge have been identified. There is a clear recognition of the need of emergency contraceptive pills for the clients of National Program for Family Planning. However, any strategy to introduce emergency contraceptive pills must cater for the misplaced beliefs of the work force.

Ensuring the effectiveness of community-wide emergency cardiac care.

PubMed

Becker, L B; Pepe, P E

1993-02-01

To improve emergency cardiac care (ECC) on the national or international level, we must translate to the rest of our communities the successes found in cities with high survival rates. In recent years, important developments have evolved in our understanding of the treatment and evaluation of cardiac arrest. Some of the most important of these developments include 1) recognition of the chain of survival, which is necessary to achieve high survival rates; 2) widespread acceptance that survival rates must be assessed routinely to ensure continuous quality improvements in the emergency medical services (EMS) system; and 3) development of improved methods for performing survival rate studies that will maximize the effectiveness of information gathering and analysis. While each community should determine how to optimize their own ECC services, some general guidelines are useful. Successful treatment of cardiac arrest starts in the community with prevention and education, including early recognition of the signs and symptoms of cardiovascular ischemia. Obtaining 911 service (and preferably enhanced 911) should be a top priority for all communities. EMS dispatchers should dispatch the unit to the scene in less than one minute, provide critical information to the responders regarding the type of emergency, and offer the caller telephone-assisted CPR instructions. The EMS first-responders should strive to arrive at the patient's side in less than four minutes, be able to immediately defibrillate if necessary, and begin basic CPR. An excellent strategy to accomplish this is to equip and train all fire-fighting units in the operation of automatic external defibrillators and dispatch them as a first-responder team. To manage the cardiac arrest patient, a minimum of two rescuers trained in advanced cardiac life support plus two or more rescuers trained in basic life support are needed. Furthermore, an EMS system is not complete without on-going evaluation. Therefore, the 1992 National Conference on CPR and ECC strongly endorses the position that all ECC systems assess their survival rates through an ongoing quality improvement process and that all members of the chain of providers should be represented in the outcome assessment team. We still have much to discover regarding optimal techniques of CPR, methods for data collection, and optimal structure of an EMS system. Research in these areas will provide the foundation for future changes in EMS systems development.

Community pharmacy supply of emergency hormonal contraception: a structured literature review of international evidence.

PubMed

Anderson, C; Blenkinsopp, A

2006-01-01

We could find no previous published review of the evidence relating to pharmacy supply of emergency hormonal contraception (EHC). Our objectives were to review, summarize and evaluate the peer-reviewed evidence relating to community pharmacy supply of EHC both in the UK and internationally. Systematic searches were conducted for peer-reviewed international research from January 1990 to January 2005. The UK Health Development Agency's Evidence Base 2000 standards and the evidence categories used by the UK Department of Health were applied to each paper. We included 24 peer-reviewed papers. There was one randomized controlled trial (RCT); the remainder of the studies were qualitative or observational studies. Pharmacy supply of EHC enables most women to receive it within 24 h of unprotected sexual intercourse. Services were highly rated by women. One RCT showed that improving access to EHC did not reduce the use of other contraceptives, lead to an increase in risky sexual behaviour or increase the incidence of sexually transmitted infections (STIs). Users expressed some concerns about the appropriateness of receiving additional pharmacist advice regarding future contraception use and STIs. One study found pharmacy supply had led to a decrease in attendances at accident and emergency departments. There is good evidence that community pharmacy EHC services provide timely access to treatment and are highly rated by women.

Multiple stakeholder views on changes in delivery of public health nursing services in Ireland.

PubMed

Hanafin, Sinead; Dwan O'Reilly, Emma

2015-08-01

In contrast with community nursing services in the UK and other parts of the world, the public health nursing service in the Republic of Ireland operates as a generalist service, providing both public health and wellbeing services in addition to clinical nursing services to a wide range of patient groups. While much discussion has taken place over the years about the benefits and challenges of a generalist service, little consensus has emerged about whether the current generalist approach should be maintained or whether a more specialised approach is required. This article presents key findings from an evaluation, using research methods, of a community nursing service that was restructured from a generalist, geographically based service, to a more specialist team-based model. The findings across multiple stakeholders show a number of positive effects in the areas of quality, safety, risk, governance, active caseload management, and finances. Some challenges were also identified, particularly with respect to continuity of services, loss of expertise, role of the team leader, and engagement in population-based activities.

ASHP national survey of hospital-based pharmaceutical services--1992.

PubMed

Crawford, S Y; Myers, C E

1993-07-01

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during summer 1992 are reported and compared with the results of earlier ASHP surveys. A simple random sample of community hospitals (short-term, nonfederal) was selected from community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 889. The net response rate was 58% (518 usable replies). The average number of hours of pharmacy operation per week was 105. Complete unit dose drug distribution was offered by 90% of the respondents, and 67% offered complete, comprehensive i.v. admixture programs. A total of 73% of the hospitals had centralized pharmaceutical services. Some 83% provided services to ambulatory-care patients, including clinic patients, emergency room patients, patients being discharged, employees, home care patients, and the general public. A computerized pharmacy system was present in 75% of the departments, and 86% had at least one microcomputer. More than 90% participated in adverse drug reaction, drug-use evaluation, drug therapy monitoring, and medication error management programs. Two thirds of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records, and the same proportion provided patient education or counseling. One third provided drug management of medical emergencies. One fifth provided drug therapy management planning, and 17% provided written histories. Pharmacokinetic consultations were provided by 57% and nutritional support consultations by 37%; three fourths of pharmacist recommendations were adopted by prescribers. A well-controlled formulary system was in place in 51% of the hospitals; therapeutic interchange was practiced by 69%. A total of 99% participated in group purchasing, and 95% used a prime vendor. The 1992 ASHP survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys (e.g., growth in clinical services, ambulatory-care services, computerization) and identified static areas that merit the attention of pharmacy leaders (e.g., provision of complete, comprehensive i.v. services).

Improving Injury Prevention Through Health Information Technology

PubMed Central

Haegerich, Tamara M.; Sugerman, David E.; Annest, Joseph L.; Klevens, Joanne; Baldwin, Grant T.

2015-01-01

Health information technology is an emerging area of focus in clinical medicine with the potential to improve injury and violence prevention practice. With injuries being the leading cause of death for Americans aged 1–44 years, greater implementation of evidence-based preventive services, referral to community resources, and real-time surveillance of emerging threats is needed. Through a review of the literature and capturing of current practice in the field, this paper showcases how health information technology applied to injury and violence prevention can lead to strengthened clinical preventive services, more rigorous measurement of clinical outcomes, and improved injury surveillance, potentially resulting in health improvement. PMID:25441230

Streaming primary urgent care: a prospective approach.

PubMed

Bickerton, Jane; Davies, Jacqueline; Davies, Helen; Apau, Daniel; Procter, Susan

2012-04-01

To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice. An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients' records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results. Adult health consumers attending ED and urgent care services in North East London. The health user survey identified younger rather than older users (mean age of 35.6 years--SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance. A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery.

Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh.

PubMed

El Arifeen, Shams; Christou, Aliki; Reichenbach, Laura; Osman, Ferdous Arfina; Azad, Kishwar; Islam, Khaled Shamsul; Ahmed, Faruque; Perry, Henry B; Peters, David H

2013-12-14

In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the effects of climate change, and chronic disease. Past experience should guide future efforts to address rising public health concerns for Bangladesh and other underdeveloped countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Aboriginal and Torres Strait Islander Worldviews and Cultural Safety Transforming Sexual Assault Service Provision for Children and Young People

PubMed Central

Funston, Leticia

2013-01-01

Child Sexual Assault (CSA) in Aboriginal and Torres Strait Islander communities is a complex issue that cannot be understood in isolation from the ongoing impacts of colonial invasion, genocide, assimilation, institutionalised racism and severe socio-economic deprivation. Service responses to CSA are often experienced as racist, culturally, financially and/or geographically inaccessible. A two-day forum, National Yarn Up: Sharing the Wisdoms and Challenges of Young People and Sexual Abuse, was convened by sexual assault services to identify the main practice and policy concerns regarding working with Aboriginal and Torres Strait Islander children and young people (C&YP), families and communities in the context of CSA. The forum also aimed to explore how services can become more accountable and better engaged with the communities they are designed to support. The forum was attended by eighty invited Aboriginal and Torres Strait Islander and non-Aboriginal youth sexual assault managers and workers representing both “victim” and “those who sexually harm others” services. In keeping with Aboriginal Community-Based Research methods forum participants largely directed discussions and contributed to the analysis of key themes and recommendations reported in this article. The need for sexual assault services to prioritise cultural safety by meaningfully integrating Aboriginal and Torres Strait Islander Worldviews emerged as a key recommendation. It was also identified that collaboration between “victims” and “those who sexually harm” services are essential given Aboriginal and Torres Strait Islander C&YP who sexually harm others may have also been victims of sexual assault or physical violence and intergenerational trauma. By working with the whole family and community, a collaborative approach is more likely than the current service model to develop cultural safety and thus increase the accessibility of sexual assault services. PMID:23975109

An evaluation of a multi-site community pharmacy-based chronic obstructive pulmonary disease support service.

PubMed

Wright, David; Twigg, Michael; Barton, Garry; Thornley, Tracey; Kerr, Clare

2015-02-01

Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition that can be effectively managed by smoking-cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management, and COPD is one area where they are ideally located to provide a comprehensive service. This study aims to evaluate the effect of a community pharmacy-based COPD service on patient outcomes. Patients in one UK location were recruited over a 10-week period to receive a community pharmacy-based COPD support service consisting of signposting to or provision of smoking-cessation service, therapy optimisation and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data were collected over a 6-month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and National Health Service (NHS) resource utilisation were measured. Three hundred six patients accessed the service. Data to enable comparison before and after intervention was available for 137 patients. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine general practitioner (GP) visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and accident and emergency visits and hospital admissions). Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective. © 2014 Community Pharmacy Futures. International Journal of Pharmacy Practice published by. John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.

Emergency Medical Services Professionals' Attitudes About Community Paramedic Programs.

PubMed

Steeps, Robert J; Wilfong, Denise A; Hubble, Michael W; Bercher, Daniel L

2017-06-01

The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program. We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma) were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05. Of the 350 EMS professionals receiving an invitation, 283 (81%) participated. Of those participants, 165 (70%) indicated that they understood what a CP program entails. One hundred thirty-five (58%) stated they were likely to attend additional education in order to become a CP, 152 (66%) were willing to perform CP duties, and 175 (75%) felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03) and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p < 0.001). The majority of EMS professionals in this study believe they understand CP programs and perceive that their communities want them to provide CP-level care. While fewer in number, most are willing to attend additional CP education and/or are willing to perform CP duties.

Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate.

PubMed

Snooks, Helen A; Anthony, Rebecca; Chatters, Robin; Dale, Jeremy; Fothergill, Rachael; Gaze, Sarah; Halter, Mary; Humphreys, Ioan; Koniotou, Marina; Logan, Phillipa; Lyons, Ronan; Mason, Suzanne; Nicholl, Jon; Peconi, Julie; Phillips, Ceri; Phillips, Judith; Porter, Alison; Siriwardena, A Niroshan; Smith, Graham; Toghill, Alun; Wani, Mushtaq; Watkins, Alan; Whitfield, Richard; Wilson, Lynsey; Russell, Ian T

2017-03-01

Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use. Cluster randomised controlled trial. Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas. Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal. The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation. Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied with assessments carried out by paramedics. Paramedics reported that the intervention had increased their confidence to leave patients at home, but barriers to referral included patients' social situations and autonomy. Findings indicate that this new pathway may be introduced by ambulance services at modest cost, without risk of harm and with some reductions in further emergency calls. However, we did not find evidence of improved health outcomes or reductions in overall NHS emergency workload. Further research is necessary to understand issues in implementation, the costs and benefits of e-trials and the performance of the modified Falls Efficacy Scale. Current Controlled Trials ISRCTN60481756 and PROSPERO CRD42013006418. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 13. See the NIHR Journals Library website for further project information.

Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors' housing buildings in Ontario, Canada.

PubMed

Agarwal, Gina; McDonough, Beatrice; Angeles, Ricardo; Pirrie, Melissa; Marzanek, Francine; McLeod, Brent; Dolovich, Lisa

2015-06-11

Chronic diseases and falls substantially contribute to morbidity/mortality among seniors, causing this population to frequently seek emergency medical care. Research suggests the paramedic role can be successfully expanded to include community-based health promotion and prevention. This study implements a community paramedicine programme targeting seniors in subsidised housing, a high-risk population and frequent users of emergency medical services (EMS). The aims are to reduce EMS calls, improve health outcomes and healthcare utilisation. This is a pragmatic clustered randomised control trial in four communities across Ontario, Canada. Within each, four to eight seniors' apartment buildings will be paired and within each pair one building will be randomly assigned to receive the Community Health Assessment Programme through EMS (CHAP-EMS) intervention, while the other building receives no intervention. During the 1-year intervention, paramedics will run weekly sessions in a common area of the building, assessing risk factors for cardiovascular disease, diabetes and falls; providing health education and referrals to community programmes; and communicating results to the participant's primary physician. The primary outcomes are rate of emergency calls per 100 residents, change in blood pressure and change in Canadian Diabetes Risk (CANRISK) score, as collected by the local EMS and study databases. The secondary outcomes are change in health behaviours, measured using a preintervention and postintervention survey and healthcare utilisation, available through administrative databases. Analysis will mainly consist of descriptive statistics and generalised estimating equations, including subgroup cluster analysis. This study is approved by the Hamilton Integrated Research Ethics Board and will follow the Tri-Council Policy Statement. Findings will be disseminated through reports to local stakeholders, publication in peer-reviewed journals and conference presentations. NCT02152891. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Assessing program efficiency: a time and motion study of the Mental Health Emergency Care - Rural Access Program in NSW Australia.

PubMed

Saurman, Emily; Lyle, David; Kirby, Sue; Roberts, Russell

2014-07-31

The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia. This is the first time and motion (T&M) study to examine program efficiency and capacity for a telepsychiatry program. Clinical services are an integral aspect of the program accounting for 6% of all activities and 50% of the time spent conducting program activities, but half of this time is spent completing clinical paperwork. This finding emphasizes the importance of these services to program efficiency and the need to address variability of service provision to impact capacity. Currently, there is no efficiency benchmark for emergency telepsychiatry programs. Findings suggest that MHEC-RAP could increase its activity without affecting program responsiveness. T&M studies not only determine activity and time expenditure, but have a wider application assessing program efficiency by understanding, defining, and calculating capacity. T&M studies can inform future program development of MHEC-RAP and similar telehealth programs, both in Australia and overseas.

Breastfeeding Supports and Services in Rural Hawaii: Perspectives of Community Healthcare Workers

PubMed Central

2017-01-01

Background. In the state of Hawaii, breastfeeding initiation rates are higher than the national average but fall below target rates for duration. Accessing breastfeeding support services is challenging for mothers living in rural areas of the state. Healthcare workers (HCWs) working with mothers and infants are in a key position to encourage and support breastfeeding efforts. The purpose of this study is to gain a better understanding of a Hawaiian community's (specifically Hilo, Hawai‘i) breastfeeding service and support issues. Method. The qualitative study design utilized was a focused ethnography. This approach was used to gather data from participant HCWs (N = 23) about their individual or shared experience(s) about the breastfeeding supports and services available in their community. An iterative process of coding and categorizing the data followed by conceptual abstraction into patterns was completed. Results. Three patterns emerged from the qualitative interviews: Operating within Constraints of the Particular Environment, Coexisting Messages, and Process Interrupted. Participants identified a number of gaps in breastfeeding services available to their clients including the lack of available lactation consultants and the inconsistent communication between hospital and community providers. A number of implications for practice and further research were suggested within the results and are discussed. PMID:28168053

Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia.

PubMed

Titaley, Christiana R; Hunter, Cynthia L; Heywood, Peter; Dibley, Michael J

2010-10-12

Antenatal, delivery and postnatal care services are amongst the recommended interventions aimed at preventing maternal and newborn deaths worldwide. West Java is one of the provinces of Java Island in Indonesia with a high proportion of home deliveries, a low attendance of four antenatal services and a low postnatal care uptake. This paper aims to explore community members' perspectives on antenatal and postnatal care services, including reasons for using or not using these services, the services received during antenatal and postnatal care, and cultural practices during antenatal and postnatal periods in Garut, Sukabumi and Ciamis districts of West Java province. A qualitative study was conducted from March to July 2009 in six villages in three districts of West Java province. Twenty focus group discussions (FGDs) and 165 in-depth interviews were carried out involving a total of 295 respondents. The guidelines for FGDs and in-depth interviews included the topics of community experiences with antenatal and postnatal care services, reasons for not attending the services, and cultural practices during antenatal and postnatal periods. Our study found that the main reason women attended antenatal and postnatal care services was to ensure the safe health of both mother and infant. Financial difficulty emerged as the major issue among women who did not fulfil the minimum requirements of four antenatal care services or two postnatal care services within the first month after delivery. This was related to the cost of health services, transportation costs, or both. In remote areas, the limited availability of health services was also a problem, especially if the village midwife frequently travelled out of the village. The distances from health facilities, in addition to poor road conditions were major concerns, particularly for those living in remote areas. Lack of community awareness about the importance of these services was also found, as some community members perceived health services to be necessary only if obstetric complications occurred. The services of traditional birth attendants for antenatal, delivery, and postnatal care were widely used, and their roles in maternal and child care were considered vital by some community members. It is important that public health strategies take into account the availability, affordability and accessibility of health services. Poverty alleviation strategies will help financially deprived communities to use antenatal and postnatal health services. This study also demonstrated the importance of health promotion programs for increasing community awareness about the necessity of antenatal and postnatal services.

Voices from the Gila: health care issues for rural elders in south-western New Mexico.

PubMed

Averill, Jennifer B

2002-12-01

A goal of the Healthy People 2010 initiative is to reduce or eliminate health disparities in vulnerable populations, including populations from rural and minority ethnic backgrounds. Rural communities, including elderly populations, experience lower rates of personal income, educational attainment, health-insurance coverage, access to emergency and specialty care services, and reported health status than do urban communities. A need exists to address identified research priorities, such as the perceptions of rural elders, their family members, and health care providers. The purposes of this study were to explore the health care perceptions, needs, and definitions of health for multicultural rural elders in one county of south-western New Mexico, and to consider practice implications. Informed consent procedures followed the University of New Mexico Health Sciences Center Human Research Review Committee guidelines. Research methods. This critical ethnography incorporated ethnographic interviews, ethnographic participant observation, photography, review of pertinent documents, and analysis of contextual factors. The sample consisted of 22 participants. Definitions of health varied with socioeconomic status, encompassing avoidance of contact with the health care system, obtaining needed medications, remaining independent, a sense of spiritual belonging, eating wisely, and exercising moderately. Three major concerns emerged from the analysis: the escalating cost of prescription drugs, access-to-care issues, and social isolation. The primary limitation was the small sample size. Although the researcher's position as an outsider to local communities may also have affected the outcome, it provided fresh insight to regional problems. The study addressed national research priorities for a vulnerable group of rural elders. Nursing implications include the need for expanded knowledge and educational preparation regarding elder issues and community-level services, inclusion of elders' perspectives in the planning and delivery of health services, and the need for community-level, interdisciplinary collaboration and advocacy.

7 CFR 1778.35 - Subsequent grants.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Subsequent grants. 1778.35 Section 1778.35 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.35 Subsequent grants...

7 CFR 1778.3 - Objective.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Objective. 1778.3 Section 1778.3 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.3 Objective. The objective of the...

Elderly patients discharged from an accident and emergency department--their dependency and support.

PubMed Central

Currie, C T; Lawson, P M; Robertson, C E; Jones, A

1984-01-01

One hundred elderly patients who had attended an accident and emergency department and had been discharged were visited at home shortly afterwards. Compared to their previous level of function, 52 showed a minor or major increase in dependency, usually related to trauma. Scrutiny of accident and emergency records showed only scanty documentation of dependency, function and support arrangements. Available statutory services for dependent elderly in the community were under-utilized by these patients. In 39 of the 52 cases with increased dependency relatives had provided additional support. PMID:6100354

Challenges to accessing pediatric health care in the Mississippi delta: a survey of emergency department patients seeking nonemergency care.

PubMed

Grant, Roy; Ramgoolam, Andres; Betz, Ryan; Ruttner, Laura; Green, John J

2010-10-01

Increases in hospital emergency department use have been driven by insured patients with problems accessing primary care services. Access problems are especially pronounced in rural communities with health professional shortages. This qualitative study explored reasons for nonurgent pediatric emergency department use in the Mississippi Delta. Using a community-based participatory research framework, a semistructured survey was administered face-to-face in a hospital emergency department waiting room with parents/caregivers who brought their children. Interviews were done over 144 hours in 2-hour blocks covering regular "business hours" and "after hours" (evenings/weekends). Open-ended items allowed qualitative data to be gathered describing reasons for emergency department use and perceptions of urgency of the visit in the parents'/caregivers' own words. There were 112 children, with a response rate of 87%. The mean child age was 5.7 years; 52% were male; 95% were African American and 5% white; 80.6% had Medicaid/SCHIP, 7.8% commercial, and 3.9% other insurance; 7.8% were uninsured. Most (88%) had a usual source of pediatric care. Only 24.3% tried to obtain care before emergency department visit; 23.2% said their children required "urgent" care. Mean distance from home to usual source of care was 10 miles. Ten percent cited transportation as a barrier to keeping health care appointments; 5.5% cited insurance or cost. Families who used the emergency department during evening/weekends were significantly more likely to have cited clinic hours of operation as a reason care was not sought previously than were "business hours" users, who emphasized convenience. Nonurgent pediatric emergency department use could be reduced by extending clinic hours, adding a walk-in service, and making transportation more available.

Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth.

PubMed

Kim, Jung-Eun; Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2016-09-01

This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities. Copyright © 2016. Published by Elsevier B.V.

Developing A Shared Service Unmanned Aerial Vehicle Capability For Regional Emergency Services

DTIC Science & Technology

2016-09-01

training institutions from actually flying UAVs, and treated these institutions as commercial UAVs that were not approved for flight.52 The CFR Part 107...Homeland Security Policy Institute Task Force has determined that regional collaboration is essential for the integration of local assets into...airspace system.106 In order to overcome the possible negative community reaction to instituting a public UAV program, the University of North Dakota

[Health Promotion and care of immigrant population in the eighth Municipality of Rome: the experience of the Medicine Service of Solidarity and the University Hospital of Tor Vergata].

PubMed

Palombi, Leonardo; Ercoli, Lucia; Buonomo, Ersilia; Mancinelli, Sandro; De Luca, Simona; Laurenti, Serena; Visconti, Giuseppe; Bollero, Patrizio

2013-01-01

The VIII Municipality of Rome is characterized by a high poverty rate, by the presence of many immigrant communities and by the lack of health services available to vulnerable social groups. In 2005 , the " Servizio di Medicina Solidale" of the University Hospital of "Tor Vergata", for the first time intervened in this Municipality regarding Immigrant Health. The paper describes the activities and organization of this service from January 2005 to December 2007. It demonstrates a complex epidemiological picture of 2,374 immigrants, characterized by a young population, mostly women with reproductive health issues, followed by children with infectious and nutritional problems and, ultimately, adults who accessed the service, firstly for gastroenterological problems, secondly for cardiovascular problems and finally for dysmetabolic disorders. The paper describes the culture-centered actions of Health Promotion and Health Education in order to improve health awareness and promote integration of immigrants. The study indicates that the limited number of hospital admissions ( n.20) with respect to the number of outpatient visits (n.70.000) in the first seven years of the service " Medicina Solidale" has significantly reduced the number of unnecessary admissions to emergency wards. In conclusion it is notable that the cost of such intervention results eight times inferior to emergency admissions and further confirms that a Community medicine approach is sustainable.

Non-dental primary care providers' views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study.

PubMed

Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

2015-10-29

To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Qualitative study with semistructured interviews and thematic analysis. Four remote communities in outback Queensland, Australia. 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The 2011 Tuscaloosa tornado: integration of pediatric disaster services into regional systems of care.

PubMed

Kanter, Robert K

2012-09-01

To empirically describe the integration of pediatric disaster services into regional systems of care after the April 27, 2011, tornado in Tuscaloosa, Alabama, a community with no pediatric emergency department or pediatric intensive care unit and few pediatric subspecialists. Data were obtained in interviews with key informants including professional staff and managers from public health and emergency management agencies, prehospital emergency medical services, fire departments, hospital nurses, physicians, and the trauma program coordinator. A single hospital in Tuscaloosa served 800 patients on the night of the tornado. More than 100 of these patients were children, including more than 20 with critical injuries. Many children were unaccompanied and unidentified on arrival. Resuscitation and stabilization were performed by nonpediatric prehospital and emergency department staff. More than 20 children were secondarily transported to the nearest children's hospital an hour's drive away under the care of nonpediatric local emergency medical services providers. No preventable adverse events were identified in the resuscitation and secondary transport phases of care. Stockpiled supplies and equipment were adequate to serve the needs of the disaster victims, including the children. Essential aspects of preparation include pediatric-specific clinical skills, supplies and equipment, operational disaster plans, and interagency practice embedded in everyday work. Opportunities for improvement identified include more timely response to warnings, improved practices for identifying unaccompanied children, and enhanced child safety in shelters. Successful responses depended on integration of pediatric services into regional systems of care. Copyright © 2012 Mosby, Inc. All rights reserved.

Digital detectives and virtual volunteers: Integrating emergent online communities into disaster response operations.

PubMed

Griswold, Alisha

2013-01-01

The demonstration of altruistic behaviours by disaster survivors, and even those observing emergencies from afar, is well documented. Over the past few decades, government-sponsored crisis planning has evolved to include affiliated volunteer agencies, with a general acknowledgment of the need to plan for unaffiliated or spontaneous volunteers. Just as the understanding of the need for volunteers has grown, so too have the ways in which volunteers are able to donate their time and skills. The popularity of social media networks and online communities provide new ways for the public to get involved in disaster response. Public service agencies should be proactive in investigating these emerging platforms and understanding their impacts during crises. Established methods of integrating on-scene volunteers into post-disaster response operations can be used as templates for creating virtual volunteer programmes.

Developing an operational capabilities index of the emergency services sector.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Collins, M.J.; Eaton, L.K.; Shoemaker, Z.M.

2012-02-20

In order to enhance the resilience of the Nation and its ability to protect itself in the face of natural and human-caused hazards, the ability of the critical infrastructure (CI) system to withstand specific threats and return to normal operations after degradation must be determined. To fully analyze the resilience of a region and the CI that resides within it, both the actual resilience of the individual CI and the capability of the Emergency Services Sector (ESS) to protect against and respond to potential hazards need to be considered. Thus, a regional resilience approach requires the comprehensive consideration of allmore » parts of the CI system as well as the characterization of emergency services. This characterization must generate reproducible results that can support decision making with regard to risk management, disaster response, business continuity, and community planning and management. To address these issues, Argonne National Laboratory, in collaboration with the U.S. Department of Homeland Security (DHS) Sector Specific Agency - Executive Management Office, developed a comprehensive methodology to create an Emergency Services Sector Capabilities Index (ESSCI). The ESSCI is a performance metric that ranges from 0 (low level of capabilities) to 100 (high). Because an emergency services program has a high ESSCI, however, does not mean that a specific event would not be able to affect a region or cause severe consequences. And because a program has a low ESSCI does not mean that a disruptive event would automatically lead to serious consequences in a region. Moreover, a score of 100 on the ESSCI is not the level of capability expected of emergency services programs; rather, it represents an optimal program that would rarely be observed. The ESSCI characterizes the state of preparedness of a jurisdiction in terms of emergency and risk management. Perhaps the index's primary benefit is that it can systematically capture, at a given point in time, the capabilities of a jurisdiction to protect itself from, mitigate, respond to, and recover from a potential incident. On the basis of this metric, an interactive tool - the ESSCI Dashboard - can identify scenarios for enhancement that can be implemented, and it can identify the repercussions of these scenarios on the jurisdiction. It can assess the capabilities of law enforcement, fire fighting, search and rescue, emergency medical services, hazardous materials response, dispatch/911, and emergency management services in a given jurisdiction and it can help guide those who need to prioritize what limited resources should be used to improve these capabilities. Furthermore, this tool can be used to compare the level of capabilities of various jurisdictions that have similar socioeconomic characteristics. It can thus help DHS define how it can support risk reduction and community preparedness at a national level. This tool aligns directly with Presidential Policy Directive 8 by giving a jurisdiction a metric of its ESS's capabilities and by promoting an interactive approach for defining options to improve preparedness and to effectively respond to a disruptive event. It can be used in combination with other CI performance metrics developed at Argonne National Laboratory, such as the vulnerability index and the resilience index for assessing regional resilience.« less

Reflecting on the tensions faced by a community-based multicultural health navigator service.

PubMed

Henderson, Saras; Kendall, Elizabeth

2014-11-01

The community navigator model was developed to assist four culturally and linguistically diverse communities (Sudanese, Burmese, Pacific Islander Group, Afghani) in south-east Queensland to negotiate the Australian health system and promote health. Using participatory action research, we developed the model in partnership with community leaders and members, the local health department and two non-governmental organisations. Following implementation, we evaluated the model, with the results published elsewhere. However, our evaluation revealed that although the model was accepted by the communities and was associated with positive health outcomes, the financial, social and organisational durability of the model was problematic. Ironically, this situation was inadvertently created by critical decisions made during the development process to enhance the durability and acceptability of the model. This paper explores these critical decisions, our rationale for making those decisions and the four hidden tensions that subsequently emerged. Using a reflective case study method to guide our analysis, we provide possible resolutions to these tensions that may promote the longevity and utility of similar models in the future. WHAT IS KNOWN ABOUT THE TOPIC?: The use of community navigators to assist culturally diverse communities to access health services is not new. Many benefits have been documented for communities, individuals and heath service providers following the use of such models. What is not well documented is how to maintain these models in a safe and cost-effective way within the Australian health system while respecting cultural and community practices and reducing the burden of service delivery on the navigators. WHAT DOES THIS PAPER ADD?: This paper provides a perspective on how the development of community-based service models inherently places them in a position of tension that must be resolved if they are to be long lasting. Four core tensions experienced during the development and implementation of our model in south-east Queensland are explored to develop potential resolutions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reducing the tensions inherent in culturally appropriate community-based service models will increase the durability of the approach. By addressing these tensions, we can create a more durable pool of community navigators that can facilitate community empowerment, self-governance of health issues and a sense of community ownership of health services.

Community Engagement in Disaster Preparedness and Recovery: A Tale of Two Cities - Los Angeles and New Orleans

PubMed Central

Wells, Kenneth B.; Springgate, Benjamin F.; Lizaola, Elizabeth; Jones, Felica; Plough, Alonzo

2013-01-01

Awareness of the impact of disasters globally on mental health is increasing. Known difficulties in preparing communities for disasters and a lack of focus on relationship building and organizational capacity in preparedness and response have led to a greater policy focus on community resiliency as a key public health approach to disaster response. This perspective emphasizes relationships, trust and engagement as core competencies for disaster preparedness and response/recovery. In this paper, we describe how an approach to community engagement for improving mental health services, disaster recovery, and preparedness from a community resiliency perspective emerged from our work in applying a partnered, participatory research framework, iteratively, in Los Angeles County and the City of New Orleans. Our approach has a specific focus on behavioral health and relationship building across diverse sectors and stakeholders concerned with under-resourced communities. We use as examples both research studies and services demonstrations discuss the lessons learned and implications for providers, communities, and policymakers pertaining to both improving mental health outcomes and addressing disaster preparedness and response. PMID:23954058

Prehospital Care of Canine Gastric Dilatation and Volvulus.

PubMed

Palmer, Lee E

The intent of the Operational K9 (OpK9) ongoing series is to provide the Special Operations Medical Association community with clinical concepts and scientific information on preventive and prehospital emergency care relevant to the OpK9. Often the only medical support immediately available for an injured or ill OpK9 in the field is their handler or the human Special Operations Combat Medic or civilian tactical medic attached to the team (e.g., Pararescueman, 18D, SWAT medic). The information is applicable to personnel operating within the US Special Operations Command as well as civilian Tactical Emergency Medical Services communities that may have the responsibility of supporting an OpK9. 2018.

Developing a multidisciplinary approach within the ED towards domestic violence presentations.

PubMed

Basu, Subhashis; Ratcliffe, Giles

2014-03-01

To improve the detection and quality of care of patients who attend the emergency department (ED) with confirmed or suspected domestic abuse (DA). A quality improvement report on the design, implementation and evaluation of a specialised service and structured training programme to detect and manage DA presentations within an emergency medicine department. The study was set in the ED at the Northern General Hospital, Sheffield, UK. Key measures for improvement included introducing a service within the ED to help staff manage DA and coordinate responses; improve staff confidence in detecting DA; develop a structured and consistent process by which to manage DA presentations. An Independent Domestic Violence Advocate service was introduced into the department in July 2011 through a multiagency agreement. A structured training and education programme was delivered to ED staff. A 'communications form' was developed for DA risk assessment and case management. The process was reviewed quarterly. One hundred and seventy-two referrals were made to the service (121 distinct clients) over a 12-month period. Staff reported greater confidence in detecting DA, and community partners highlighted the role the service had in improving DA detection and care quality within the city. Strong leadership and prioritising the issue within the department has facilitated the development of the process and contributed substantially to its success. Support from community partners has been invaluable in tailoring the service and education programme to the needs of staff and patients within the department.

Caring for Kids: Bridging Gaps in Pediatric Emergency Care Through Community Education and Outreach.

PubMed

Luckstead-Gosdin, Ann; Vinson, Lori; Greenwell, Cynthia; Tweed, Jefferson

2017-06-01

The Pediatric Emergency Services Network (PESN) was developed to provide ongoing continuing education on pediatric guidelines and pediatric emergency care to rural and nonpediatric hospitals, physicians, nurses, and emergency personnel. A survey was developed and given to participants attending PESN educational events to determine the perceived benefit and application to practice of the PESN outreach program. Overall, 91% of participants surveyed reported agreement that PESN educational events were beneficial to their clinical practice, provided them with new knowledge, and made them more knowledgeable about pediatric emergency care. Education and outreach programs can be beneficial to health care workers' educational needs. Copyright © 2017 Elsevier Inc. All rights reserved.

Strengthening partnerships between Black Churches and HIV service providers in the United States.

PubMed

Obong'o, Christopher O; Pichon, Latrice C; Powell, Terrinieka W; Williams, Andrea L

2016-09-01

Across the United States, Black Churches play a significant role among the Black community and are increasingly being used to deliver Human Immunodeficiency Virus (HIV) prevention services. This study sought to investigate HIV service providers' strategies for strengthening partnerships with churches to deliver HIV prevention services. Using a community-based participatory research approach, an HIV coalition and an academic institution formed a partnership to address the study aim. Individual interviews (n = 16) were conducted with providers from medical institutions and HIV social support agencies. A thematic analysis focusing on recommendations for addressing the challenges and benefits of partnership with churches for HIV services was conducted. Participants' interest in and intention to work with churches, as well as their comfort level discussing sexual health-related topics with religious congregations, was high. Four themes emerged to highlight the different perspectives of service providers' recommendations for addressing challenges and strengthening partnerships with churches to deliver HIV services including: (1) carefully selecting churches and HIV services to provide, (2) gaining "buy-in" and support of church leadership, (3) taking advantage of conflict with church doctrine, and (4) choosing appropriate delivery strategies. Study findings demonstrate that although challenges exist, heath service providers in this region of the United States may be interested in addressing HIV among faith communities. Study findings also provide concrete solutions to previously documented barriers to HIV prevention in Black Churches. Such information will benefit researchers and practitioners seeking to expand effective HIV prevention efforts with Black Churches in communities who bear a disproportionate burden of HIV infections.

77 FR 46104 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Internal Agency Docket No... inspection at both the online location and the respective Community Map Repository address listed in the... online through the FEMA Map Service Center at www.msc.fema.gov for comparison. You may submit comments...

7 CFR 1778.23 - Grant closing and disbursement of funds.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Grant closing and disbursement of funds. 1778.23 Section 1778.23 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS...

7 CFR 1778.100 - OMB control number.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false OMB control number. 1778.100 Section 1778.100 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.100 OMB control number...

7 CFR 1778.37 - Forms, Instructions and Bulletins.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Forms, Instructions and Bulletins. 1778.37 Section 1778.37 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.37...

7 CFR 1778.9 - Uses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Uses. 1778.9 Section 1778.9 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.9 Uses. Grant funds may be used...

7 CFR 1778.22 - Planning development and procurement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Planning development and procurement. 1778.22 Section 1778.22 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.22...

7 CFR 1778.11 - Maximum grants.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Maximum grants. 1778.11 Section 1778.11 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.11 Maximum grants. (a) Grants not...

A Framework for Facilitating Ecosystem Services-based Decision-making and the Development of Decision-making Tools

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. The vast majority of environmenta...

7 CFR 1955.105 - Real property affected (CONACT).

Code of Federal Regulations, 2014 CFR

2014-01-01

...); Economic Opportunity (EO); Economic Emergency (EE); Softwood Timber (ST); Community Facility (CF); Water... crime after December 23, 1985. (c) Effects of farm property sales on farm values. State Directors will... values and trend reports such as those available from the Economic Research Service or professional...

7 CFR 1955.105 - Real property affected (CONACT).

Code of Federal Regulations, 2013 CFR

2013-01-01

...); Economic Opportunity (EO); Economic Emergency (EE); Softwood Timber (ST); Community Facility (CF); Water... crime after December 23, 1985. (c) Effects of farm property sales on farm values. State Directors will... values and trend reports such as those available from the Economic Research Service or professional...

7 CFR 1955.105 - Real property affected (CONACT).

Code of Federal Regulations, 2012 CFR

2012-01-01

...); Economic Opportunity (EO); Economic Emergency (EE); Softwood Timber (ST); Community Facility (CF); Water... crime after December 23, 1985. (c) Effects of farm property sales on farm values. State Directors will... values and trend reports such as those available from the Economic Research Service or professional...

Feedback on flood risk management

NASA Astrophysics Data System (ADS)

Moreau, K.; Roumagnac, A.

2009-09-01

For several years, as floods were increasing in South of France, local communities felt deprive to assume their mission of protection and information of citizens, and were looking for assistance in flood management. In term of flood disaster, the fact is that physical protection is necessary but inevitably limited. Tools and structures of assistance to anticipation remain slightly developed. To manage repeated crisis, local authorities need to be able to base their policy against flood on prevention, warnings, post-crisis analysis and feedback from former experience. In this objective, after 3 years of test and improvement since 2003, the initiative Predict-Services was developed in South of France: it aims at helping communities and companies to face repeated flood crisis. The principle is to prepare emergency plans, to organize crisis management and reduce risks; to help and assist communities and companies during crisis to activate and adapt their emergency plans with enough of anticipation; and to analyse floods effects and improve emergency plans afterwards. With the help of Meteo France datas and experts, Predict services helps local communities and companies in decision making for flood management. In order to reduce risks, and to keep the benefits of such an initiative, local communities and companies have to maintain the awareness of risk of the citizens and employees. They also have to maintain their safety plans to keep them constantly operational. This is a part of the message relayed. Companies, Local communities, local government authorities and basin stakeholders are the decision makers. Companies and local communities have to involve themselves in the elaboration of safety plans. They are also completely involved in their activation that is their own responsability. This applies to other local government authorities, like districts one's and basin stakeholders, which participle in the financing community safety plans and adminitrative district which are responsible of the transmission of meteorological alert and of rescue actions. In the crossing of the géo-information stemming from the space technology, communication, meteorology, hydraulics and hydrology, Predict-services brings help to local communities in their mission of protection and information to the citizens, for flood problems and helps companies to limit and delete operating losses facing floods. The initiative, developped by BRL, EADS Astrium, in association with Meteo France, has been employed and is functioning on cities of south of France, notably on Montpellier, and also on the scale of catchment area ( BRL is a regional development company, a public private partnership controlled by the local gouvernments of the Languedoc-Roussillon Region). The initiative has to be coordinated with state services to secure continuity and coherence of information. This initiative is developped in dialogue with State services as Météo France, the Ministry for the interior, the Ministry for ecology and the durable development, the Regional Direction of the Environment (DIREN), the Central service of Hydrometeorology and Support to the Forecast of the Floods ( SCHAPI) and service of forecast of rising (SPC). It has been successfully functioning for 5 years with 300 southern cities from South West to South East of France and notably Montpellier and Sommières, famous for it's flood problems on the Vidourle river where no human loss was to regret and where the economic impacts were minimized. Actually developed in cities of South of France, this initiative is to be developed nationaly and very soon internationally. Thanks to the efficiency of it's method, this initiative is also developed in partnership with insurance company involved in prevention actions. After more than 100 events observed and analysed in South of France, the experience gained, allowed PREDICT Services to better anticipate phenomena and also to better manage them. The presentation will expose the feedback of this initiative and lessons learned on risk management.

Outpatient alcohol withdrawal management for Aboriginal and Torres Strait Islander peoples.

PubMed

Brett, Jonathan; Lawrence, Leanne; Ivers, Rowena; Conigrave, Kate

2014-08-01

There is concern from within Aboriginal and Torres Strait Islander communities about the lack of access to alcohol withdrawal management ('detox') services. Outpatient detox is described within national Australian guidelines as a safe option for selected drinkers. However, uncertainly exists as to how suited Aboriginal and Torres Strait Islander peoples are to this approach. 
 Consultations were conducted with stakeholders of four health services providing outpatient detox for Aboriginal and Torres Strait Islander peoples in NSW. Thematic analysis was performed to determine elements perceived as important for success. Key themes that emerged were individual engagement, flexibility, assessment of suitability, Aboriginal staff and community engagement, practical support, counselling, staff education and support, coping with relapse and contingency planning. 
 There is a need to improve access to alcohol detox services for Aboriginal and Torres Strait Islander peoples. The outpatient setting seems to be a feasible and safe environment to provide this kind of service for selected drinkers.

Implementing transnational telemedicine solutions: a connected health project in rural and remote areas of six Northern Periphery countries Series on European collaborative projects.

PubMed

Casey, Monica; Hayes, Patrick S; Heaney, David; Dowie, Lee; Ólaighin, Gearoid; Matero, Matti; Hun, Soo; Knarvik, Undine; Alrutz, Käte; Eadie, Leila; Glynn, Liam G

2013-03-01

This is the first article in a Series on collaborative projects between European countries, relevant for general practice/family medicine and primary healthcare. Telemedicine, in particular the use of the Internet, videoconferencing and handheld devices such as smartphones, holds the potential for further strides in the application of technology for the delivery of healthcare, particularly to communities in rural and remote areas within and without the European Union where this study is taking place. The Northern Periphery Programme has funded the 'Implementing Transnational Telemedicine Solutions' (ITTS) project from September 2011 to December 2013, led by the Centre for Rural Health in Inverness, Scotland. Ten sustainable projects based on videoconsultation (speech therapy, renal services, emergency psychiatry, diabetes), mobile patient self-management (physical activity, diabetes, inflammatory bowel disease) and home-based health services (medical and social care emergencies, rehabilitation, multi-morbidity) are being implemented by the six partner countries: Scotland, Finland, Ireland, Northern Ireland, Norway and Sweden. In addition, an International Telemedicine Advisory Service, created for the project, provides business expertise and advice. Community panels contribute feedback on the design and implementation of services and ensure 'user friendliness'. The project goals are to improve accessibility of healthcare in rural and remote communities, reducing unnecessary hospital visits and travel in a sustainable way. Opportunities will be provided for comparative research studies. This article provides an introduction to the ITTS project and how it aims to fulfil these needs. The ITTS team encourage all healthcare providers to at least explore possible technological solutions within their own context.

Collective response to public health emergencies and large-scale disasters: putting hospitals at the core of community resilience.

PubMed

Paturas, James L; Smith, Deborah; Smith, Stewart; Albanese, Joseph

2010-07-01

Healthcare organisations are a critical part of a community's resilience and play a prominent role as the backbone of medical response to natural and manmade disasters. The importance of healthcare organisations, in particular hospitals, to remain operational extends beyond the necessity to sustain uninterrupted medical services for the community, in the aftermath of a large-scale disaster. Hospitals are viewed as safe havens where affected individuals go for shelter, food, water and psychosocial assistance, as well as to obtain information about missing family members or learn of impending dangers related to the incident. The ability of hospitals to respond effectively to high-consequence incidents producing a massive arrival of patients that disrupt daily operations requires surge capacity and capability. The activation of hospital emergency support functions provides an approach by which hospitals manage a short-term shortfall of hospital personnel through the reallocation of hospital employees, thereby obviating the reliance on external qualified volunteers for surge capacity and capability. Recent revisions to the Joint Commission's hospital emergency preparedness standard have impelled healthcare facilities to participate actively in community-wide planning, rather than confining planning exclusively to a single healthcare facility, in order to harmonise disaster management strategies and effectively coordinate the allocation of community resources and expertise across all local response agencies.

Community stakeholders' perspectives on the role of occupational therapy in primary healthcare: Implications for practice.

PubMed

Naidoo, Deshini; Van Wyk, Jacqueline; Joubert, Robin

2017-01-01

Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately. This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum. An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14). Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention. The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders' on the role. This study highlighted the gaps in community-based services that OTs should offer in this context.

Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country

PubMed Central

Mir, Azeem Sultan; Malik, Raees

2010-01-01

Background: Unsafe abortion is a major Public health problem in developing countries, where women make several unsafe attempts at termination of the unintended pregnancy before turning to health services. Community health workers can act as a bridge between the community and their health facilities and can use Emergency Contraceptive Pills to significantly reduce the mortality and morbidity related to unsafe abortions. Aims: This study explores the knowledge, attitudes and practices of the Lady Health Supervisor of the National Program for Family Planning, district Rawalpindi, regarding emergency contraception pills. Materials and Methods: The cross sectional survey was conducted during the monthly meeting of Lady Health Supervisors. Self administered, anonymous and voluntary questionnaire consisting of 17 items, regarding demographic profile, awareness, knowledge, attitudes and practices, was used. Results: Insufficient knowledge, high misinformation and strongly negative attitudes were revealed. More than half did not know that emergency contraceptive pills do not cause abortion. About four fifths believed that emergency contraceptive pills will lead to ‘evil’ practices in society. More than four fifths recognized that the clients of National Program for Family Planning need emergency contraceptive pills. The attitudes were significantly associated with knowledge (P=0.034, Fisher's Exact Test). Conclusion: The awareness of emergency contraceptive pills is high. Serious gaps in knowledge have been identified. There is a clear recognition of the need of emergency contraceptive pills for the clients of National Program for Family Planning. However, any strategy to introduce emergency contraceptive pills must cater for the misplaced beliefs of the work force. PMID:22737673

Disaster Response and Decision Support in Partnership with the California Earthquake Clearinghouse

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Rosinski, A.; Vaughan, D.; Morentz, J.

2014-12-01

Getting the right information to the right people at the right time is critical during a natural disaster. E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) is a NASA decision support system designed to produce remote sensing and geophysical modeling data products that are relevant to the emergency preparedness and response communities and serve as a gateway to enable the delivery of NASA decision support products to these communities. The E-DECIDER decision support system has several tools, services, and products that have been used to support end-user exercises in partnership with the California Earthquake Clearinghouse since 2012, including near real-time deformation modeling results and on-demand maps of critical infrastructure that may have been potentially exposed to damage by a disaster. E-DECIDER's underlying service architecture allows the system to facilitate delivery of NASA decision support products to the Clearinghouse through XchangeCore Web Service Data Orchestration that allows trusted information exchange among partner agencies. This in turn allows Clearinghouse partners to visualize data products produced by E-DECIDER and other NASA projects through incident command software such as SpotOnResponse or ArcGIS Online.

Towards understanding the availability of physiotherapy services in rural Australia.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2016-01-01

A recent exploration of factors affecting rural physiotherapy service provision revealed considerable variation in services available between communities of the study. Multiple factors combined to influence local service provision, including macro level policy and funding decisions, service priorities and fiscal constraints of regional health services and capacity and capabilities at the physiotherapy service level. The aim of this article is to describe the variation in local service provision, the factors influencing service provision and the impact on availability of physiotherapy services. A priority-sequence mixed methods design structured the collection and integration of qualitative and quantitative data. The investigation area, a large part of one Australian state, was selected for the number of physiotherapy services and feasibility of conducting site visits. Stratified purposive sampling permitted exploration of rural physiotherapy with subgroups of interest, including physiotherapists, their colleagues, managers, and other key decision makers. Participant recruitment commenced with public sector physiotherapists and progressed to include private practitioners, team colleagues and managers. Surveys were mailed to key physiotherapy contacts in each public sector service in the area for distribution to physiotherapists, their colleagues and managers within their facility. Private physiotherapist principals working in the same communities were invited by the researcher to complete the physiotherapy survey. The survey collected demographic data, rural experience, work setting and number of colleagues, services provided, perspectives on factors influencing service provision and decisions about service provision. Semi-structured interviews were conducted with consenting physiotherapists and other key decision makers identified by local physiotherapists. Quantitative survey data were recorded in spreadsheets and analysed using descriptive statistics. Interviews were recorded and transcribed verbatim, with transcripts provided to participants for review. Open-ended survey questions and interview transcripts were analysed thematically. Surveys were received from 11/25 (44%) of facilities in the investigation area, with a response rate of 29.4% (16/54) from public sector physiotherapists. A further 18 surveys were received: five from principals of private physiotherapy practices and 13 from colleagues and managers. Nineteen interviews were conducted: with 14 physiotherapists (nine public, five private), four other decision makers and one colleague. Three decision makers declined an interview. The variation in physiotherapy service availability between the 11 communities of this study prompted the researchers to consider how such variation could be reflected. The influential factors that emerged from participant comments included rurality and population, size and funding model of public hospitals, the number of public sector physiotherapists and private practices, and the availability of specialised paediatric and rehabilitation services. The factors described by participants were used to develop a conceptual framework or index of rural physiotherapy availability. It is important to make explicit the link between workforce maldistribution, the resultant rural workforce shortages and the implications for local service availability. This study sought to do so by investigating physiotherapy service provision within the rural communities of the investigation area. In doing so, varying levels of availability emerged within local communities. A conceptual framework combining key influencing factors is offered as a way to reflect the availability of physiotherapy services.

Collaboration between non-governmental organizations and public services in health – a qualitative case study from rural Ecuador

PubMed Central

Biermann, Olivia; Eckhardt, Martin; Carlfjord, Siw; Falk, Magnus; Forsberg, Birger C.

2016-01-01

Background Non-governmental organizations (NGOs) have a key role in improving health in low- and middle-income countries. Their work needs to be synergistic, complementary to public services, and rooted in community mobilization and collective action. The study explores how an NGO and its health services are perceived by the population that it serves, and how it can contribute to reducing barriers to care. Design A qualitative exploratory study was conducted in remote Ecuador, characterized by its widespread poverty and lack of official governance. An international NGO collaborated closely with the public services to deliver preventative and curative health services. Data were collected using focus group discussions and semistructured interviews with purposively sampled community members, healthcare personnel, and community health workers based on their links to the health services. Conventional qualitative content analysis was used, focusing on manifest content. Results Emerging themes relate to the public private partnership (PPP), the NGO and its services, and community participation. The population perceives the NGO positively, linking it to healthcare improvements. Their priority is to get services, irrespective of the provider's structure. The presence of an NGO in the operation may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively. Conclusions To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the population's trust in the organization, an NGO should operate in a manner that is as integrated as possible within the existing structure. The NGO should work close to the population it serves, with services anchored in the community. PPP parties should develop a common platform with joint messages to the target population on the provider's structure, and regarding partners’ roles and responsibilities. Interaction between the population and the providers on service content and their expectations is key to positive outcomes of PPP operations. PMID:27852423

Recent changes in Medicaid policy and their possible effects on mental health services.

PubMed

Buck, Jeffrey A

2009-11-01

As Medicaid has emerged as the primary funder of public mental health services, its character has affected the organization and delivery of such services. Recent changes to the program, however, promise to further affect the direction of changes in states' mental health service systems. One group of changes will further limit the flexibility of Medicaid mental health funding, while increasing provider accountability and the authority of state Medicaid agencies. Others will increase incentives for deinstitutionalization and community-based care and promote person-centered treatment principles. These changes will likely affect state mental health systems, mental health providers, and the nature of service delivery.

Web Services Implementations at Land Process and Goddard Earth Sciences Distributed Active Archive Centers

NASA Astrophysics Data System (ADS)

Cole, M.; Bambacus, M.; Lynnes, C.; Sauer, B.; Falke, S.; Yang, W.

2007-12-01

NASA's vast array of scientific data within its Distributed Active Archive Centers (DAACs) is especially valuable to both traditional research scientists as well as the emerging market of Earth Science Information Partners. For example, the air quality science and management communities are increasingly using satellite derived observations in their analyses and decision making. The Air Quality Cluster in the Federation of Earth Science Information Partners (ESIP) uses web infrastructures of interoperability, or Service Oriented Architecture (SOA), to extend data exploration, use, and analysis and provides a user environment for DAAC products. In an effort to continually offer these NASA data to the broadest research community audience, and reusing emerging technologies, both NASA's Goddard Earth Science (GES) and Land Process (LP) DAACs have engaged in a web services pilot project. Through these projects both GES and LP have exposed data through the Open Geospatial Consortiums (OGC) Web Services standards. Reusing several different existing applications and implementation techniques, GES and LP successfully exposed a variety data, through distributed systems to be ingested into multiple end-user systems. The results of this project will enable researchers world wide to access some of NASA's GES & LP DAAC data through OGC protocols. This functionality encourages inter-disciplinary research while increasing data use through advanced technologies. This paper will concentrate on the implementation and use of OGC Web Services, specifically Web Map and Web Coverage Services (WMS, WCS) at GES and LP DAACs, and the value of these services within scientific applications, including integration with the DataFed air quality web infrastructure and in the development of data analysis web applications.

Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru

PubMed Central

Perez-Brumer, Amaya G.; Reisner, Sari L.; McLean, Sarah A.; Silva-Santisteban, Alfonso; Huerta, Leyla; Mayer, Kenneth H.; Sanchez, Jorge; Clark, Jesse L.; Mimiaga, Matthew J.; Lama, Javier R.

2017-01-01

Abstract Introduction: In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community-level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru. Methods: Using qualitative methodology to provide an in-depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community-level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV-related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18–44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18. Results: Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency-based strategies included peer-to-peer and intergenerational knowledge sharing, supportive clinical services (e.g. group-based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community). Conclusion: This study highlights the importance of TW communities as support structures that create and deploy social resiliency-based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts. PMID:28362064

Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru.

PubMed

Perez-Brumer, Amaya G; Reisner, Sari L; McLean, Sarah A; Silva-Santisteban, Alfonso; Huerta, Leyla; Mayer, Kenneth H; Sanchez, Jorge; Clark, Jesse L; Mimiaga, Matthew J; Lama, Javier R

2017-02-28

In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community-level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru. Using qualitative methodology to provide an in-depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community-level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV-related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18-44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18. Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency-based strategies included peer-to-peer and intergenerational knowledge sharing, supportive clinical services (e.g. group-based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community). This study highlights the importance of TW communities as support structures that create and deploy social resiliency-based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for individual TW in Peru. Public health strategies seeking to provide HIV prevention, treatment and care for this population will benefit from recognizing existing social capital within TW communities and incorporating its strengths within HIV prevention interventions. At the intersection of HIV vulnerabilities and collective agency, dimensions of bridging and bonding social capital emerged as resiliency strategies used by TW to access needed healthcare services in Peru. Fostering TW solidarity and peer support are key components to ensure acceptability and sustainability of HIV prevention and promotion efforts.

Application of ESE Data and Tools to Air Quality Management: Services for Helping the Air Quality Community use ESE Data (SHAirED)

NASA Technical Reports Server (NTRS)

Falke, Stefan; Husar, Rudolf

2011-01-01

The goal of this REASoN applications and technology project is to deliver and use Earth Science Enterprise (ESE) data and tools in support of air quality management. Its scope falls within the domain of air quality management and aims to develop a federated air quality information sharing network that includes data from NASA, EPA, US States and others. Project goals were achieved through a access of satellite and ground observation data, web services information technology, interoperability standards, and air quality community collaboration. In contributing to a network of NASA ESE data in support of particulate air quality management, the project will develop access to distributed data, build Web infrastructure, and create tools for data processing and analysis. The key technologies used in the project include emerging web services for developing self describing and modular data access and processing tools, and service oriented architecture for chaining web services together to assemble customized air quality management applications. The technology and tools required for this project were developed within DataFed.net, a shared infrastructure that supports collaborative atmospheric data sharing and processing web services. Much of the collaboration was facilitated through community interactions through the Federation of Earth Science Information Partners (ESIP) Air Quality Workgroup. The main activities during the project that successfully advanced DataFed, enabled air quality applications and established community-oriented infrastructures were: develop access to distributed data (surface and satellite), build Web infrastructure to support data access, processing and analysis create tools for data processing and analysis foster air quality community collaboration and interoperability.

The process of developing a community-based research agenda with lesbian, gay, bisexual, transgender and queer youth in the Northwest Territories, Canada.

PubMed

Logie, Carmen H; Lys, Candice

2015-01-01

Youth in Canada's Northwest Territories (NWT) experience sexual and mental health disparities. Higher rates of sexual and mental health concerns among lesbian, gay, bisexual, transgender and queer (LGBTQ) youth in comparison with heterosexual and cisgender peers have been associated with stigma and discrimination. Although LGBTQ youth in the NWT are situated at the nexus of Northern and LGBTQ health disparities, there is little known about their health, well-being and experiences of stigma. This short communication discusses the process of developing a LGBTQ youth community-based research programme in the NWT. We developed an interdisciplinary research team of LGBTQ and allied young adults, including indigenous and non-indigenous researchers, community organisers and service providers in the NWT. We conducted meetings in Yellowknife with LGBTQ youth (n=12) and key stakeholders (n=15), including faculty, students, community groups and health and social service providers. Both meetings included LGBTQ and allied participants who were LGBTQ, indigenous, youth and persons at the intersection of these identities. LGBTQ youth participants discussed community norms that devalued same sex identities and stigma surrounding LGBTQ-specific services and agencies. Stigma among LGBT youth was exacerbated for youth in secondary schools, gender non-conforming and transgender youth and young gay men. In the stakeholder meeting, service providers discussed the importance of integrating LGBTQ issues in youth programmes, and LGBTQ community groups expressed the need for flexibility in service delivery to LGBTQ youth. Stakeholders identified the need to better understand the needs of indigenous LGBTQ youth in the NWT. Community-based LGBTQ groups, researchers and health and social service providers are interested in addressing LGBTQ youth issues in the NWT. The emergence of LGBTQ community building, support groups and activism in Northern Canada suggests that this is an opportune time to explore LGBTQ youth health.

Evaluation of community pharmacy-based services for type-2 diabetes in an Indonesian setting: pharmacist survey.

PubMed

Wibowo, Yosi; Parsons, Richard; Sunderland, Bruce; Hughes, Jeffery

2015-10-01

Diabetes is an emerging chronic disease in developing countries. Currently the management of diabetes in developing countries is mainly hospital or clinic based. With burgeoning numbers of patients with diabetes, other models need to be evaluated for service delivery in developing countries. Community pharmacists are an important option for provision of diabetes care. Currently, data regarding practices of community pharmacists in diabetes care have been limited to developed countries. To evaluate current community pharmacy-based services and perceived roles of pharmacists in type 2 diabetes care, and characteristics (pharmacist and pharmacy) associated with current practice. Community pharmacies in a developing country setting (Surabaya, Indonesia). A questionnaire was administered to pharmacists managing a random sample of 400 community pharmacies in Surabaya, Indonesia. Current practice and pharmacists' perceived roles were rated using Likert scales, whilst an open-ended question was used to identify priority roles. Logistic regression models determined characteristics associated with current practice. A response rate of 60% was achieved. Dispensing (100%) and education on how to use medications (72.6%) were common current pharmacy practices. More than 50% of pharmacists were supportive towards providing additional services beyond dispensing. The highest priorities for services beyond dispensing were education on medications [i.e. directions for use (58.6%) and common/important adverse effects (25.7%)], education on exercise (36.5%), education on diet (47.7%), and monitoring medication compliance (27.9%). Facilitators identified were: being perceived as part of a pharmacist's role (for all priority services), pharmacies with more than 50 diabetes customers per month (for diet education), and pharmacists' involvement in diabetes training (for compliance monitoring). The key barrier identified was lower pharmacist availability (for diet education as well as compliance monitoring). Most community pharmacies in Surabaya, Indonesia have only provided a basic service of dispensing for type 2 diabetes patients. Many pharmacists believed that they should extend their roles particularly regarding patient education and monitoring. The development of pharmacist professional roles would assist in managing the burgeoning burden of diabetes. The identified facilitators/barriers provide baseline data to support the development of community pharmacy-based diabetes services.

78 FR 29765 - Changes in Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-21

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2013-0002... inspection at both the online location and the respective community map repository address listed in the... online through the FEMA Map Service Center at www.msc.fema.gov for comparison. Submit comments and/or...

77 FR 50709 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-22

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2012-0003... inspection at both the online location and the respective Community Map Repository address listed in the... online through the FEMA Map Service Center at www.msc.fema.gov for comparison. You may submit comments...

7 CFR 1778.32-1778.33 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.32-1778.33 Section 1778.32-1778.33 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.32-1778.33 [Reserved] ...

7 CFR 1778.13 - Set-aside.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Set-aside. 1778.13 Section 1778.13 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.13 Set-aside. (a) At least 70...

Do You Know Whats In Your Community A Strategic Risk Management Approach to Better Prepare for Chemical Emergencies

DTIC Science & Technology

2016-03-01

existing, or out-of-service process equipment • Track historical data concerning natural disasters such as tornados , hurricanes, floods, fires, or...hydrological, and meteorological (wildfire, flood, hurricane, tornado , earthquakes, tsunamis, volcanoes, etc.) • Identification of other

The emerging issue of 25-hydroxyvitamin D in foods

USDA-ARS?s Scientific Manuscript database

Scientists at the U.S. Department of Agriculture’s (USDA) Agricultural Research Service and the National Institutes of Health’s Office of Dietary Supplements (ODS) write to notify the nutrition community of concerns and needs regarding measurement of vitamin D’s metabolized form, 25-hydroxyvitamin D...

A System Overview of the Electronic Surveillance System for the Early Notification of Community-based Epidemics

DTIC Science & Technology

2004-11-15

Doctors’ Visits Animal Health Diagnostic Labs Hospital Emergency Room Local Military & Civ. Users Public Health Surveillance & Epidemiology...Environmental Samples EPA Over the Counter Sales Animal Health Absenteeism ESSENCE I NCR Military Data Tri-Service Outpatient Visits Pharmacy Data

Home | Oregon State University Extension Service

Science.gov Websites

"How To" Communities OSU Open Campus Oregon's Agricultural Progress Magazine Emerging Issues Oregon's Agricultural Progress cover image Oregon's Agricultural Progress, the research magazine for the Oregon State University Agricultural Experiment Station. Read current OAP issue » Bridges logo image

44 CFR 206.62 - Available assistance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... community services; (2) Issuance of warnings of risks or hazards; (3) Public health and safety information, including dissemination of such information; (4) Provision of health and safety measures; and (5) Management... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Available assistance. 206.62...

44 CFR 206.62 - Available assistance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... community services; (2) Issuance of warnings of risks or hazards; (3) Public health and safety information, including dissemination of such information; (4) Provision of health and safety measures; and (5) Management... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Available assistance. 206.62...

44 CFR 206.62 - Available assistance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... community services; (2) Issuance of warnings of risks or hazards; (3) Public health and safety information, including dissemination of such information; (4) Provision of health and safety measures; and (5) Management... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Available assistance. 206.62...

44 CFR 206.62 - Available assistance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... community services; (2) Issuance of warnings of risks or hazards; (3) Public health and safety information, including dissemination of such information; (4) Provision of health and safety measures; and (5) Management... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Available assistance. 206.62...

Decision Analysis for a Sustainable Environment, Economy, and Society: A Participatory Framework for Ecosystem Services-Based Decision-Making

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. The vast majority of environmenta...

Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers.

PubMed

Caro, Denis H J

2010-11-10

Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations.

Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers

PubMed Central

2010-01-01

Background Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. Aims This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. Methods This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. Results This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Conclusions Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations. PMID:21373305

First contact: acute stress reactions and experiences of emergency department consultations following an incident of intimate partner violence.

PubMed

Olive, Philippa

2017-08-01

The aim of this research was to explore women's emotional and affective responses following an incident of intimate partner violence experienced during emergency department attendances. A growing body of research has explored women's experiences of emergency departments following intimate partner violence still little remains known about the experience and impact of emotional and affective responses during these attendances. A descriptive qualitative design was used, underpinned theoretically by critical realism and postmodern complexity theory to attend to multiple, intersecting mechanisms that lie behind events and experiences. Semistructured interviews with six women who had attended an emergency department directly following an incident of intimate partner violence. Interview data were transcribed and thematically analysed in nvivo9 using a coding framework. There were three interconnected key findings. First, was the commonality of acute stress experiences among women attending an emergency department following partner violence, second was that these acute stress reactions negatively impacted women's consultations, and third was the need for specialist domestic violence services at the point of first contact to assist service users navigate an effective consultation. Acute stress reactions were an important feature of women's experiences of emergency department consultations following intimate partner violence. Attending to psychological first aid; providing a safe and quiet space; and affording access to specialist violence advocacy services at the point of first contact will limit harm and improve health consultation outcomes for this population. This research provides an account of emotional and affective responses experienced by women attending emergency departments following intimate partner violence and explicates how these acute stress reactions impacted their consultation. This research has relevance for practitioners in many first contact health services, such as urgent and emergency care, general practice, community public health and mental health. © 2016 John Wiley & Sons Ltd.

The role of groundwater governance in emergencies during different phases of natural disasters

NASA Astrophysics Data System (ADS)

Vrba, Jaroslav

2016-03-01

The establishment of water governance in emergency situations supports timely and effective reaction with regard to the risk and impact of natural disasters on drinking-water supplies and populations. Under such governance, emergency activities of governmental authorities, rescue and aid teams, water stakeholders, local communities and individuals are coordinated with the objective to prevent and/or mitigate disaster impact on water supplies, to reduce human suffering due to drinking-water failure during and in the post-disaster period, and to manage drinking-water services in emergency situations in an equitable manner. The availability of low-vulnerability groundwater resources that have been proven safe and protected by geological features, and with long residence time, can make water-related relief and rehabilitation activities during and after an emergency more rapid and effective. Such groundwater resources have to be included in water governance and their exploration must be coordinated with overall management of drinking-water services in emergencies. This paper discusses institutional and technical capacities needed for building effective groundwater governance policy and drinking-water risk and demand management in emergencies. Disaster-risk mitigation plans are described, along with relief measures and post-disaster rehabilitation and reconstruction activities, which support gradual renewal of drinking-water services on the level prior to the disaster. The role of groundwater governance in emergencies differs in individual phases of disaster (preparedness, warning, impact/relief, rehabilitation). Suggested activities and actions associated with these phases are summarized and analysed, and a mode of their implementation is proposed.

Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis.

PubMed

Martinez, William; Galván, Jorge; Saavedra, Nayelhi; Berenzon, Shoshana

2017-05-01

Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge. Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.

The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study.

PubMed

Roche, Tina E; Gardner, Glenn; Jack, Leanne

2017-06-27

Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities. This study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care. The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models. There was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations. Australian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Feedback on flood risk management

NASA Astrophysics Data System (ADS)

Moreau, K.; Roumagnac, A.

2009-09-01

For several years, as floods were increasing in South of France, local communities felt deprive to assume their mission of protection and information of citizens, and were looking for assistance in flood management. In term of flood disaster, the fact is that physical protection is necessary but inevitably limited. Tools and structures of assistance to anticipation remain slightly developed. To manage repeated crisis, local authorities need to be able to base their policy against flood on prevention, warnings, post-crisis analysis and feedback from former experience. In this objective, after 3 years of test and improvement since 2003, the initiative Predict-Services was developped in South of France: it aims at helping communities and companies to face repeated flood crisis. The principle is to prepare emergency plans, to organize crisis management and reduce risks; to help and assist communities and companies during crisis to activate and adapt their emergency plans with enough of anticipation; and to analyse floods effects and improve emergency plans afterwards. In order to reduce risks, and to keep the benefits of such an initiative, local communities and companies have to maintain the awareness of risk of the citizens and employees. They also have to maintain their safety plans to keep them constantly operational. This is a part of the message relayed. Companies, Local communities, local government authorities and basin stakeholders are the decision makers. Companies and local communities have to involve themselves in the elaboration of safety plans. They are also completely involved in their activation that is their own responsability. This applies to other local government authorities, like districts one's and basin stakeholders, which participle in the financing community safety plans and adminitrative district which are responsible of the transmission of meteorological alert and of rescue actions. In the crossing of the géo-information stemming from the space technology, communication, meteorology, hydraulics and hydrology, Predict-services brings help to local communities in their mission of protection and information to the citizens, for flood problems and helps companies to limit and delete operating losses facing floods. The initiative, developped by BRL, EADS Astrium, in association with Meteo France, has been employed and is functioning on cities of south of France, notably on Montpellier, and also on the scale of catchment area( BRL is a regional development company, a public private partnership controlled by the local gouvernments of the Languedoc-Roussillon Region). The initiative has to be coordinated with state services to secure continuity and coherence of information. This initiative is developped in dialogue with State services as Météo France, the Ministry for the interior, the Ministry for ecology and the durable development, the Regional Direction of the Environment (DIREN), the Central service of Hydrometeorology and Support to the Forecast of the Floods ( SCHAPI) and service of forecast of rising (SPC). It has been successfully functioning for 5 years with 300 southern cities from South West to South East of France and notably Montpellier and Sommières, famous for it’s flood problems on the Vidourle river where no human loss was to regret and where the economic impacts were minimized. Actually developed in cities of South of France, this initiative is to be developed nationaly and very soon internationally. Thanks to the efficiency of it’s method, this initiative is also developed in partnership with insurance company involved in prevention actions. The presentation will expose the feedback of this initiative and lessons learned.

Inappropriate--the patient or the service?

PubMed

Steel, J

1995-07-01

The inappropriate use of Accident and Emergency (A & E) departments by the public has been the subject of debate for many years. Patients often attend departments with problems which could equally have been treated by the primary care services in the community. However, despite much research into why patients choose to visit A & E departments rather than their general practitioners, efforts to reverse this trend have generally failed. If the professional view of what is appropriate cannot be enforced, perhaps the label 'inappropriate' belongs to the A & E services rather than the patient.

Cold-spotting: linking primary care and public health to create communities of solution.

PubMed

Westfall, John M

2013-01-01

By providing enhanced primary care and social services to patients with high utilization of expensive emergency and hospital care, there is evidence that their health can improve and their costs can be lowered. This type of "hot-spotting" improves the care of individual patients. It may be that these patients live in communities with disintegrated social determinants of health, little community support, and poor access to primary care. These "cold spots" in the community may be amenable to interventions targeted at linking primary care and public health at broader community and population levels. Building local communities of solution that address the individual and population may help decrease these cold spots, thereby eliminating the hot spots as well.

Sexual assault support services and community systems: understanding critical issues and needs in the LGBTQ community.

PubMed

Todahl, Jeffrey L; Linville, Deanna; Bustin, Amy; Wheeler, Jenna; Gau, Jeff

2009-08-01

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals encounter social conditions that create important considerations for LGBTQ sexual assault victims. This exploratory, mixed-methods study examines the relationship between community attitudes toward LGBTQ persons and associated community responses to LGBTQ sexual assault victims. An online and paper-and-pencil survey (n = 130) and four focus group interviews (n = 14) are analyzed using frequency distributions and grounded theory methods. The central theme that emerged in focus group interviews, titled "low community awareness and support for sexual violence in the LGBTQ community," was corroborated by survey participants. Participants' views of unique considerations for LGBTQ sexual assault victims are presented, including causal factors, consequences, and recommended strategies.

The impact of student diversity on interest, design, and promotion of Web-based tailored nutrition and physical activity programs for community colleges.

PubMed

Quintiliani, Lisa M; De Jesus, Maria; Wallington, Sherrie Flynt

2011-01-01

To examine an organizational level perspective of the process of adopting Web-based tailored nutrition and physical activity programs for community college students. In this qualitative study, 21 individual key informant interviews of community college student services and health center administrators were used to examine organizational-level perceptions of interest in, design characteristics of, and ways to promote health programs. A cross-classification matrix of a priori and emergent themes related to student diversity was created to describe cross-cutting patterns. Findings revealed 5 emergent themes for consideration in program development related to student diversity: (1) multiple roles played by students, (2) limited access to financial resources, (3) varied student demographics, (4) different levels of understanding, and (5) commuting to campus. Nutrition and physical activity programs for community colleges need to specifically address the diverse nature of their students to increase the potential of adoption. Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Deployment of Small Unmanned Aerial Systems (sUAS) in Emergency and Disaster Response Scenarios to Support Local Emergency Management Agencies

NASA Astrophysics Data System (ADS)

Calamaio, C. L.; Walker, J.; Beck, J. M.; Graves, S. J.; Johnson, C.

2017-12-01

Researchers at the Information Technology and Systems Center at the University of Alabama in Huntsville are working closely with the Madison County Emergency Management Agency (EMA), GeoHuntsville's UAS Working Group, and the NOAA UAS Program Office, to conduct a series of practical demonstrations testing the use of small unmanned aerial systems (sUAS) for emergency response activities in Madison County, Alabama. These exercises demonstrate the use of UAS to detect and visualize hazards in affected areas via the delivery of aerial imagery and associated data products to law enforcement first responders in a variety of different scenarios, for example, search and rescue, tornado track mapping, damage assessment, and situational awareness/containment during active shooter incidents. In addition to showcasing the use of UAS as a tool for emergency services, these pilot exercises provide the opportunity to engage the appropriate stakeholders from several communities including first responders, geospatial intelligence, active members of the unmanned systems industry, and academia. This presentation will showcase the challenges associated with delivering quality data products for emergency services in a timely manner as well as the related challenges in integrating the technology into local emergency management.

Ecological mechanisms underpinning climate adaptation services.

PubMed

Lavorel, Sandra; Colloff, Matthew J; McIntyre, Sue; Doherty, Michael D; Murphy, Helen T; Metcalfe, Daniel J; Dunlop, Michael; Williams, Richard J; Wise, Russell M; Williams, Kristen J

2015-01-01

Ecosystem services are typically valued for their immediate material or cultural benefits to human wellbeing, supported by regulating and supporting services. Under climate change, with more frequent stresses and novel shocks, 'climate adaptation services', are defined as the benefits to people from increased social ability to respond to change, provided by the capability of ecosystems to moderate and adapt to climate change and variability. They broaden the ecosystem services framework to assist decision makers in planning for an uncertain future with new choices and options. We present a generic framework for operationalising the adaptation services concept. Four steps guide the identification of intrinsic ecological mechanisms that facilitate the maintenance and emergence of ecosystem services during periods of change, and so materialise as adaptation services. We applied this framework for four contrasted Australian ecosystems. Comparative analyses enabled by the operational framework suggest that adaptation services that emerge during trajectories of ecological change are supported by common mechanisms: vegetation structural diversity, the role of keystone species or functional groups, response diversity and landscape connectivity, which underpin the persistence of function and the reassembly of ecological communities under severe climate change and variability. Such understanding should guide ecosystem management towards adaptation planning. © 2014 John Wiley & Sons Ltd.

An economic toolkit for identifying the cost of emergency medical services (EMS) systems: detailed methodology of the EMS Cost Analysis Project (EMSCAP).

PubMed

Lerner, E Brooke; Garrison, Herbert G; Nichol, Graham; Maio, Ronald F; Lookman, Hunaid A; Sheahan, William D; Franz, Timothy R; Austad, James D; Ginster, Aaron M; Spaite, Daniel W

2012-02-01

Calculating the cost of an emergency medical services (EMS) system using a standardized method is important for determining the value of EMS. This article describes the development of a methodology for calculating the cost of an EMS system to its community. This includes a tool for calculating the cost of EMS (the "cost workbook") and detailed directions for determining cost (the "cost guide"). The 12-step process that was developed is consistent with current theories of health economics, applicable to prehospital care, flexible enough to be used in varying sizes and types of EMS systems, and comprehensive enough to provide meaningful conclusions. It was developed by an expert panel (the EMS Cost Analysis Project [EMSCAP] investigator team) in an iterative process that included pilot testing the process in three diverse communities. The iterative process allowed ongoing modification of the toolkit during the development phase, based upon direct, practical, ongoing interaction with the EMS systems that were using the toolkit. The resulting methodology estimates EMS system costs within a user-defined community, allowing either the number of patients treated or the estimated number of lives saved by EMS to be assessed in light of the cost of those efforts. Much controversy exists about the cost of EMS and whether the resources spent for this purpose are justified. However, the existence of a validated toolkit that provides a standardized process will allow meaningful assessments and comparisons to be made and will supply objective information to inform EMS and community officials who are tasked with determining the utilization of scarce societal resources. © 2012 by the Society for Academic Emergency Medicine.

Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study

PubMed Central

Barratt, Helen; Harrison, David A.; Raine, Rosalind; Fulop, Naomi J.

2015-01-01

Objectives In England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process. Methods A documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n = 20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories. Results The commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners’ dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven. Discussion Government policy emphasises the importance of clinical leadership and ‘evidence’ in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care. PMID:25975768

Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study.

PubMed

Barratt, Helen; Harrison, David A; Raine, Rosalind; Fulop, Naomi J

2015-09-01

In England, proposed service changes such as Emergency Department closures typically face local opposition. Consequently, public consultation exercises often involve protracted, hostile debates. This study examined a process aimed at engaging a community in decision-making about service reconfiguration, and the public response to this process. A documentary analysis was conducted to map consultation methods used in an urban area of England where plans to consolidate hospital services on fewer sites were under discussion. In-depth interviews (n=20) were conducted with parents, older people, and patient representatives. The analysis combined inductive and deductive approaches, informed by risk communication theories. The commissioners provided a large volume of information about the changes, alongside a programme of public events. However, the complexity of the process, together with what members of the public perceived to be the commissioners' dismissal of their concerns, led the community to question their motivation. This was compounded by a widespread perception that the proposals were financially driven. Government policy emphasises the importance of clinical leadership and 'evidence' in public consultation. However, an engagement process based on this approach fuelled hostility to the proposals. Policymakers should not assume communities can be persuaded to accommodate service change which may result in reduced access to care. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia.

PubMed

King, Rosemary; Jackson, Ruth; Dietsch, Elaine; Hailemariam, Asseffa

2015-05-01

to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia. researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups. fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups. participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women׳s low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant. many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation. ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women׳s preferred caregiver), health extension workers and skilled birth attendants will help ensure timely consultation and referral and reduce delay for women if they require emergency maternity care. Copyright © 2015 Elsevier Ltd. All rights reserved.

A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.

PubMed

Asimos, Andrew W; Ward, Shana; Brice, Jane H; Enright, Dianne; Rosamond, Wayne D; Goldstein, Larry B; Studnek, Jonathan

2014-01-01

Our goal was to determine if a statewide Emergency Medical Services (EMSs) Stroke Triage and Destination Plan (STDP), specifying bypass of hospitals unable to routinely treat stroke patients with thrombolytics (community hospitals), changed bypass frequency of those hospitals. Using a statewide EMS database, we identified stroke patients eligible for community hospital bypass and compared bypass frequency 1-year before and after STDP implementation. Symptom onset time was missing for 48% of pre-STDP (n = 2385) and 29% of post-STDP (n = 1612) cases. Of the remaining cases with geocodable scene addresses, 58% (1301) in the pre-STDP group and 61% (2,078) in the post-STDP group were ineligible for bypass, because a community hospital was not the closest hospital to the stroke event location. Because of missing data records for some EMS agencies in 1 or both study periods, we included EMS agencies from only 49 of 100 North Carolina counties in our analysis. Additionally, we found conflicting hospital classifications by different EMS agencies for 35% of all hospitals (n = 38 of 108). Given these limitations, we found similar community hospital bypass rates before and after STDP implementation (64%, n = 332 of 520 vs. 63%, n = 345 of 552; P = .65). Missing symptom duration time and data records in our state's EMS data system, along with conflicting hospital classifications between EMS agencies limit the ability to study statewide stroke routing protocols. Bypass policies may apply to a minority of patients because a community hospital is not the closest hospital to most stroke events. Given these limitations, we found no difference in community hospital bypass rates after implementation of the STDP. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2015-03-27

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required. A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities. Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision. The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

Trust of community health workers influences the acceptance of community-based maternal and child health services.

PubMed

Grant, Merridy; Wilford, Aurene; Haskins, Lyn; Phakathi, Sifiso; Mntambo, Ntokozo; Horwood, Christiane M

2017-05-29

Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings. To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves. Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa. A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing. Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW's role; if they appeared to question the CHW's competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community. Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

The effects of continuing care on emerging adult outcomes following residential addiction treatment.

PubMed

Bergman, Brandon G; Hoeppner, Bettina B; Nelson, Lindsay M; Slaymaker, Valerie; Kelly, John F

2015-08-01

Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts. Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates. Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups). Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

"Care": Moral Concept or Merely an Organisational Suffix?

ERIC Educational Resources Information Center

Clapton, J.

2008-01-01

Background: Over recent decades, a couple of interesting trends have occurred in regard to human services practices in Australia. First, there has been a significant shift from practices that previously have intentionally responded to emerging and continuing human need within communities to practices that are now managed within a context of…

7 CFR 1778.38-1778.99 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.38-1778.99 Section 1778.38-1778.99 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS §§ 1778.38-1778.99 [Reserved] ...

7 CFR 1778.24-1778.30 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.24-1778.30 Section 1778.24-1778.30 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS §§ 1778.24-1778.30 [Reserved] ...

7 CFR 1778.15-1778.20 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1778.15-1778.20 Section 1778.15-1778.20 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS §§ 1778.15-1778.20 [Reserved] ...

Ten Reasons Service Science Matters to Universities

ERIC Educational Resources Information Center

Spohrer, Jim; Fodell, Dianne; Murphy, Wendy

2012-01-01

Higher education is being reshaped little by little every day. Slowly but surely, from the smallest community colleges to the teaching institutions to the most prestigious research universities, a new set of key performance indicators (KPIs) is transforming what excellence means in higher education. For developed and emerging market nations…

7 CFR 1778.4 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Definitions. 1778.4 Section 1778.4 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) EMERGENCY AND IMMINENT COMMUNITY WATER ASSISTANCE GRANTS § 1778.4 Definitions. Acute shortage. An acute shortage is a situation in whic...

Strengthening Rural Schools: Training Paraprofessionals in Crisis Prevention and Intervention.

ERIC Educational Resources Information Center

Allen, Melissa; Ashbaker, Betty Y.; Stott, Kathryn A.

The long-term effects of crisis and tragedy can be improved significantly by immediate intervention and emergency mental health services. Providing crisis intervention in rural schools poses challenges related to lack of financial resources, community resources, and trained personnel; isolation of rural schools; and long distances between school…

75 FR 52544 - Notice of Submission of Proposed Information Collection to OMB; Emergency Comment Request; Choice...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... Neighborhoods will employ a comprehensive approach to community development centered on housing transformation... investing and leveraging investments in well-functioning services, effective schools and education programs... primarily fund the transformation of public and/or HUD- assisted housing developments through preservation...

Smart Grid Interoperability Maturity Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Widergren, Steven E.; Levinson, Alex; Mater, J.

2010-04-28

The integration of automation associated with electricity resources (including transmission and distribution automation and demand-side resources operated by end-users) is key to supporting greater efficiencies and incorporating variable renewable resources and electric vehicles into the power system. The integration problems faced by this community are analogous to those faced in the health industry, emergency services, and other complex communities with many stakeholders. To highlight this issue and encourage communication and the development of a smart grid interoperability community, the GridWise Architecture Council (GWAC) created an Interoperability Context-Setting Framework. This "conceptual model" has been helpful to explain the importance of organizationalmore » alignment in addition to technical and informational interface specifications for "smart grid" devices and systems. As a next step to building a community sensitive to interoperability, the GWAC is investigating an interoperability maturity model (IMM) based on work done by others to address similar circumstances. The objective is to create a tool or set of tools that encourages a culture of interoperability in this emerging community. The tools would measure status and progress, analyze gaps, and prioritize efforts to improve the situation.« less

Why do Chinese Canadians not consult mental health services: health status, language or culture?

PubMed

Chen, Alice W; Kazanjian, Arminée; Wong, Hubert

2009-12-01

Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.

Cleanups In My Community (CIMC) - Removals/Responses, National Layer

EPA Pesticide Factsheets

This data layer provides access to Removal/Response sites as part of the CIMC web service. Removals are hazardous substance releases that require immediate or short-term response actions. These are generally addressed under the Emergency Response program and are initially tracked centrally by the federal government's National Reporting Center. Cleanups in My Community maps and lists removals that are included in EPA??s epaosc.org site, and provides direct links to information on these sites. CIMC obtains updated removal data through a web service from epaosc.org just before the 18th of each month.The CIMC web service was initially published in 2013, but the data are updated on the 18th of each month. The full schedule for data updates in CIMC is located here: http://iaspub.epa.gov/enviro/data_update_v2.

A community-based participatory research study of HIV and HPV vulnerabilities and prevention in two Pacific Islander communities: ethical challenges and solutions.

PubMed

DiStefano, Anthony; Peters, Ruth; Tanjasiri, Sora Park; Quitugua, Lourdes; Dimaculangan, Jeany; Hui, Brian; Barrera-Ng, Angelica; Vunileva, 'Isileli; Tui'one, Vanessa; Takahashi, Lois

2013-02-01

We describe ethical issues that emerged during a one-year CBPR study of HIV and human papillomavirus (HPV) vulnerabilities and prevention in two Pacific Islander (PI) communities, and the collaborative solutions to these challenges reached by academic and community partners. In our project case study analysis, we found that ethical tensions were linked mainly to issues of mutual trust and credibility in PI communities; cultural taboos associated with the nexus of religiosity and traditional PI culture; fears of privacy breaches in small, interconnected PI communities; and competing priorities of scientific rigor versus direct community services. Mutual capacity building and linking CBPR practice to PI social protocols are required for effective solutions and progress toward social justice outcomes.

Not just bricks and mortar: planning hospital cancer services for Aboriginal people

PubMed Central

2011-01-01

Background Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i) being alone and lost in a big, alien and inflexible system; (ii) failure of open communication, delays and inefficiency in the system; (iii) practicalities: costs, transportation, community and family responsibilities; (iv) the need for Aboriginal support persons; and (v) connection to the community. Conclusions Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes. PMID:21401923

CM experts: hospitals need ED case managers now more than ever.

PubMed

2012-10-01

It's no longer a luxury for hospitals to have case managers in their emergency departments, according to some case management experts--it's a necessity to make sure patients are admitted in the proper status and to ensure that those being discharged from the emergency department have what they need to manage their conditions. Hospitals need to ensure that patients meet medical necessity criteria to avoid losing reimbursement. Case managers can help provide a smooth transition from the emergency department back to the community and connect patients with post-discharge services. Case managers can work with patients who frequently utilize the emergency department and educate them about more appropriate venues of care.

Informal and formal support among community-dwelling Japanese American elders living alone in Chicagoland: an in-depth qualitative study.

PubMed

Lau, Denys T; Machizawa, Sayaka; Doi, Mary

2012-06-01

A key public health approach to promote independent living and avoid nursing home placement is ensuring that elders can obtain adequate informal support from family and friends, as well as formal support from community services. This study aims to describe the use of informal and formal support among community-dwelling Nikkei elders living alone, and explore perceived barriers hindering their use of such support. We conducted English and Japanese semi-structured, open-ended interviews in Chicagoland with a convenience sample of 34 Nikkei elders age 60+ who were functionally independent and living alone; 9 family/friends; and 10 local service providers. According to participants, for informal support, Nikkei elders relied mainly on: family for homemaking and health management; partners for emotional and emergency support; friends for emotional and transportation support; and neighbors for emergency assistance. Perceived barriers to informal support included elders' attitudinal impediments (feeling burdensome, reciprocating support, self-reliance), family-related interpersonal circumstances (poor communication, distance, intergenerational differences); and friendship/neighbor-related interpersonal situations (difficulty making friends, relocation, health decline/death). For formal support, Nikkei elders primarily used adult day care/cultural programs for socializing and learning and in-home care for personal/homemaking assistance and companionship. Barriers to formal support included attitudinal impediments (stoicism, privacy, frugality); perception of care (incompatibility with services, poor opinions of in-home care quality); and accessibility (geographical distance, lack of transportation). In summary, this study provides important preliminary insights for future community strategies that will target resources and training for support networks of Nikkei elders living alone to maximize their likelihood to age in place independently.

Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia.

PubMed

Bellamy, Kim; Ostini, Remo; Martini, Nataly; Kairuz, Therese

2017-10-01

The aim of this study was to explore the barriers to accessing medicines and pharmacy services among refugees in Queensland, Australia, from the perspectives of resettled African refugees. A generic qualitative approach was used in this study. Resettled African refugees were recruited via a purposive snowball sampling method. The researcher collected data from different African refugee communities, specifically those from Sudanese, Congolese and Somalian communities. Participants were invited by a community health leader to participate in the study; a community health leader is a trained member of the refugee community who acts as a 'health information conduit' between refugees and the health system. Invitations were done either face-to-face, telephonically or by email. The focus groups were digitally recorded in English and transcribed verbatim by the researcher. Transcripts were entered into NVIVO© 11 and the data were analysed using inductive thematic analysis. Four focus groups were conducted between October and November 2014 in the city of Brisbane with African refugees, one with five Somali refugees, one with five Congolese refugees, one with three refugee community health leaders from South Sudan, Liberia and Eritrea and one with three refugee community health leaders from Uganda, Burundi and South Sudan. Eleven sub-themes emerged through the coding process, which resulted in four overarching themes: health system differences, navigating the Australian health system, communication barriers and health care-seeking behaviour. With regard to accessing medicines and pharmacy services, this study has shown that there is a gap between resettled refugees' expectations of health services and the reality of the Australian health system. Access barriers identified included language barriers, issues with the Translating and Interpreter Service, a lack of professional communication and cultural beliefs affecting health care-seeking behaviour. This exploratory study has established a foundation for further research into the barriers to accessing medicines and pharmacy services for resettled refugees. The findings are likely to be applicable to a wider population. © 2016 Royal Pharmaceutical Society.

Community stakeholders’ perspectives on the role of occupational therapy in primary healthcare: Implications for practice

PubMed Central

Van Wyk, Jacqueline; Joubert, Robin

2017-01-01

Background Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately. Objectives This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum. Method An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14). Results Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention. Conclusion The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders’ on the role. This study highlighted the gaps in community-based services that OTs should offer in this context. PMID:28730063

Health related vulnerability due to chronic diseases: Impact on clinical services across emergency shelters in mass disasters

NASA Astrophysics Data System (ADS)

Koleva, Yordanka Nikolova

Chronic diseases are increasingly recognized as major contributors to the global burden of disease. Individuals with chronic disease are particularly vulnerable during mass emergencies as they may suffer an interruption in their therapeutic programs, leading to life-threatening conditions and complications. Based on the individual and community risk factors framework, three categories are defined as the most vulnerable to extreme natural events: physically, psychologically, and socially vulnerable. Complex emergencies that occurred in the recent decade have provided evidence that these groups suffer more pronounced effects than others. Individuals seeking community support during emergencies have been predominantly medically dependent, elderly, children, people with chronic health conditions, and lower socioeconomic status. The purpose of this study was to investigate the effect of health-related vulnerability on shelter operations, and to estimate the burden of chronic disease on community resources following catastrophic events. A comprehensive survey data collection conducted by the United States Public Health Service in 2005 was used to evaluate clinical services for populations with health conditions accommodated by Louisiana temporary disaster shelters. Correlation and multiple regression analyses determined the relationship between shelter characteristics and the factors predicting shelters' needs for short-term assistance. Significant predictors were identified in all three explored domains: structural shelter characteristics (sponsor, interpreter needed); clinical characteristics (access to health providers, clinic on site, staff had no days off); population characteristics (census, compromised mental health alone, or in combination with chronic conditions and diseases with epidemic potential). Shelters sponsored by faith-based organizations were less likely to be in risk of rapid resource depletion. Shelters with large census demonstrated association with the need of short-term assistance to maintain operations, as larger census was positively correlated with large numbers of individuals with vulnerabilities. Combined health-related vulnerability factor (chronic conditions, psycho-social disorders, and epidemic diseases) influenced significantly the risk of resource depletion. This study provides cross-sectional evidence that large concentration of populations with health-related vulnerabilities during disaster recovery phase is associated with increased demand for medical services. Chronic diseases with high prevalence and incidence like psycho-social disorders, diabetes, and cardiovascular conditions diagnosed during screenings could predict the overall burden on the health network.

Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India

PubMed Central

Shaikh, Simran; Mburu, Gitau; Arumugam, Viswanathan; Mattipalli, Naveen; Aher, Abhina; Mehta, Sonal; Robertson, James

2016-01-01

Introduction Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach. Methods We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks. Results There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups. Conclusions The Pehchan programme's community involvement, rights-based collectivization and gender-affirming approaches significantly improved both demand and access to tailored HIV, health and social services for transgender individuals across India. Furthermore, the Pehchan programme successfully fostered both self-efficacy and collective identity and served as a model for addressing the unique health needs of transgender communities. Continued strengthening of health, social and community systems to better respond to the unique needs of transgender communities is needed in order to sustain these gains. PMID:27431474

Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India.

PubMed

Shaikh, Simran; Mburu, Gitau; Arumugam, Viswanathan; Mattipalli, Naveen; Aher, Abhina; Mehta, Sonal; Robertson, James

2016-01-01

Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach. We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks. There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups. The Pehchan programme's community involvement, rights-based collectivization and gender-affirming approaches significantly improved both demand and access to tailored HIV, health and social services for transgender individuals across India. Furthermore, the Pehchan programme successfully fostered both self-efficacy and collective identity and served as a model for addressing the unique health needs of transgender communities. Continued strengthening of health, social and community systems to better respond to the unique needs of transgender communities is needed in order to sustain these gains.

[Quality of mental health services: a self audit in the South Verona mental health service].

PubMed

Allevi, Liliana; Salvi, Giovanni; Ruggeri, Mirella

2006-01-01

To start a process of Continuous Quality Improvement (CQI) in an Italian Community Mental Health Service by using a quality assurance questionnaire in a self audit exercise. The questionnaire was administered to 14 key workers and clinical managers with different roles and seniority. One senior manager's evaluation was used as a benchmark for all the others. Changes were introduced in the service practice according to what emerged from the evaluation. Meetings were scheduled to monitor those changes and renew the CQI process. There was a wide difference in the key workers' answers. Overall, the senior manager's evaluation was on the 60th percentile of the distribution of the other evaluations. Those areas that required prompt intervention were risk management, personnel development, and CQI. The CQI process was followed up for one year: some interventions were carried out to change the practice of the service. A self audit exercise in Community Mental Health Services was both feasible and useful. The CQI process was easier to start than to carry on over the long term.

Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1).

PubMed

Dickson, Jon M; Taylor, Louise H; Shewan, Jane; Baldwin, Trevor; Grünewald, Richard A; Reuber, Markus

2016-02-23

Suspected seizures are a common reason for emergency calls to ambulance services. Prehospital management of these patients is an important element of good quality care. The aim of this study, conducted in a regional ambulance service in the UK, was to quantify the number of emergency telephone calls for suspected seizures in adults, the associated costs, and to describe the patients' characteristics, their prehospital management and their immediate outcomes. Quantitative cross-sectional study using routinely collected data and a detailed review of the clinical records of a consecutive series of adult patients (≥ 16 years). A regional ambulance service within the National Health Service in England. Cross-sectional data from all 605,481 adult emergency incidents managed by the ambulance service from 1 April 2012 to 31 March 2013. We selected a consecutive series of 178 individual incidents from May 2012 for more detailed analysis (132 after exclusions and removal of non-seizure cases). Suspected seizures made up 3.3% of all emergency incidents. True medical emergencies were uncommon but 3.3% had partially occluded airways, 6.8% had ongoing seizure activity and 59.1% had clinical problems in addition to the seizure (29.1% involving injury). Emergency vehicles were dispatched for 97.2% of suspected seizures, the seizure had terminated on arrival in 93.2% of incidents, 75% of these patients were transported to hospital. The estimated emergency management cost per annum of suspected seizures in the English ambulance services is £45.2 million (€64.0 million, $68.6 million). Many patients with suspected seizures could potentially be treated more effectively and at lower cost by modifying ambulance call handling protocols. The development of innovative care pathways could give call handlers and paramedics alternatives to hospital transportation. Increased adoption of care plans could reduce 999 calls and could increase the rates of successful home or community treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A burn center paradigm to fulfill deferred consent public disclosure and community consultation requirements for emergency care research.

PubMed

Blackford, Martha G; Falletta, Lynn; Andrews, David A; Reed, Michael D

2012-09-01

To fulfill Food and Drug Administration and Department of Health and Human Services emergency care research informed consent requirements, our burn center planned and executed a deferred consent strategy gaining Institutional Review Board (IRB) approval to proceed with the clinical study. These federal regulations dictate public disclosure and community consultation unique to acute care research. Our regional burn center developed and implemented a deferred consent public notification and community consultation paradigm appropriate for a burn study. Published accounts of deferred consent strategies focus on acute care resuscitation practices. We adapted those strategies to design and conduct a comprehensive public notification/community consultation plan to satisfy deferred consent requirements for burn center research. To implement a robust media campaign we engaged the hospital's public relations department, distributed media materials, recruited hospital staff for speaking engagements, enlisted community volunteers, and developed initiatives to inform "hard-to-reach" populations. The hospital's IRB determined we fulfilled our obligation to notify the defined community. Our communication strategy should provide a paradigm other burn centers may appropriate and adapt when planning and executing a deferred consent initiative. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

The Internet. Building knowledge & offering integrated solutions to health care.

PubMed

Russo, H E

2000-07-01

Technology is changing the way we do things, including how the health care community provides information and services to the public. Disparate populations, once separated by distance and time, will experience dramatic changes as they become part of a global community. Fundamental changes will continue to occur in the way health information is received, utilized, exchanged and stored. This article explores access to the Internet as well as applications of interactive health technology and the emerging issues surrounding technology use.

Practicing preventive health: the underlying culture among low-income rural populations.

PubMed

Murimi, Mary W; Harpel, Tammy

2010-01-01

Health disparities on the basis of geographic location, social economic factors and education levels are well documented. However, even when health care services are available, there is no guarantee that all persons will take preventive health measures. Understanding the cultural beliefs, practices, and lifestyle choices that determine utilization of health services is an important factor in combating chronic diseases. The purpose of this study was to investigate personal, cultural, and external barriers that interfered with participating in a community-based preventive outreach program that included health screening for obesity, diabetes, heart diseases, and hypertension when cost and transportation factors were addressed. Six focus groups were conducted in a rural community of Louisiana. Focus groups were divided into 2 categories: participants and nonparticipants. Three focus groups were completed with Dubach Health Outreach Project (DUHOP) participants and 3 were completed with nonparticipants. The focus group interviews were moderated by a researcher experienced in focus group interviews; a graduate student assisted with recording and note-taking during the sessions. Four main themes associated with barriers to participation in preventive services emerged from the discussions: (1) time, (2) low priority, (3) fear of the unknown, and (4) lack of companionship or support. Health concerns, free services, enjoyment, and free food were identified as motivators for participation. The findings of this study indicated that the resulting synergy between low-income status and a lack of motivation regarding health care prevention created a complicated practice of health care procrastination, which resulted in unnecessary emergency care and disease progression. To change this practice to proactive disease prevention and self care, a concerted effort will need to be implemented by policy makers, funding agents, health care providers, and community leaders and members.

Changes in hospital competitive strategy: a new medical arms race?

PubMed

Devers, Kelly J; Brewster, Linda R; Casalino, Lawrence P

2003-02-01

To describe changes in hospitals' competitive strategies, specifically the relative emphasis placed on strategies for competing along price and nonprice (i.e., service, amenities, perceived quality) dimensions, and the reasons for any observed shifts. This study uses data gathered through the Community Tracking Study site visits, a longitudinal study of a nationally representative sample of 12 U.S. communities. Research teams visited each of these communities every two years since 1996 and conducted between 50 to 90 semistructured interviews. Additional information on hospital competition and strategy was gathered from secondary data. We found that hospitals' strategic emphasis changed significantly between 1996-1997 and 2000-2001. In the mid-1990s, hospitals primarily competed on price through "wholesale" strategies (i.e., providing services attractive to managed care plans). By 2000-2001, nonprice competition was becoming increasingly important and hospitals were reviving "retail" strategies (i.e., providing services attractive to individual physicians and the patients they serve). Three major factors explain this shift in hospital strategy: less than anticipated selective contracting and capitated payment; the freeing up of hospital resources previously devoted to horizontal and vertical integration strategies; and, the emergence and growth of new competitors. Renewed emphasis on nonprice competition and retail strategies, and the service mimicking and one-upmanship that result, suggest that a new medical arms race is emerging. However, there are important differences between the medical arms race today and the one that occurred in the 1970s and early 1980s: the hospital market is more concentrated and price competition remains relatively important. The development of a new medical arms race has significant research and policy implications.

Changes in Hospital Competitive Strategy: A New Medical Arms Race?

PubMed Central

Devers, Kelly J; Brewster, Linda R; Casalino, Lawrence P

2003-01-01

Objective To describe changes in hospitals' competitive strategies, specifically the relative emphasis placed on strategies for competing along price and nonprice (i.e., service, amenities, perceived quality) dimensions, and the reasons for any observed shifts. Methods This study uses data gathered through the Community Tracking Study site visits, a longitudinal study of a nationally representative sample of 12 U.S. communities. Research teams visited each of these communities every two years since 1996 and conducted between 50 to 90 semistructured interviews. Additional information on hospital competition and strategy was gathered from secondary data. Principal Findings We found that hospitals' strategic emphasis changed significantly between 1996–1997 and 2000–2001. In the mid-1990s, hospitals primarily competed on price through “wholesale” strategies (i.e., providing services attractive to managed care plans). By 2000–2001, nonprice competition was becoming increasingly important and hospitals were reviving “retail” strategies (i.e., providing services attractive to individual physicians and the patients they serve). Three major factors explain this shift in hospital strategy: less than anticipated selective contracting and capitated payment; the freeing up of hospital resources previously devoted to horizontal and vertical integration strategies; and, the emergence and growth of new competitors. Conclusion Renewed emphasis on nonprice competition and retail strategies, and the service mimicking and one-upmanship that result, suggest that a new medical arms race is emerging. However, there are important differences between the medical arms race today and the one that occurred in the 1970s and early 1980s: the hospital market is more concentrated and price competition remains relatively important. The development of a new medical arms race has significant research and policy implications. PMID:12650375

Low-acuity presentations to regional emergency departments: What is the issue?

PubMed

Cheek, Colleen; Allen, Penny; Shires, Lizzi; Parry, Denise; Ruigrok, Marielle

2016-04-01

To explore GP-referrals and self-referrals to EDs and factors associated with patients seeking low-acuity care at ED. Retrospective analysis of all ED presentations to Mersey Community Hospital and North West Regional Hospital (Tasmania) between 1 January 2009 and 31 December 2013. Cross-sectional survey of patients presenting to the EDs for care triaged as low-acuity. There were 255,365 ED presentations in the retrospective data: 11,252 (4.4%) GP-referrals and 218,205 (85.4%) self-referrals. At ED 49% of GP-referrals were triaged ATS 4 or 5 and 35% of self-referrals were triaged ATS 1-3. There were 138 (84.2%) low-acuity patients who completed the survey; predominantly, all attended for acute injury or illness. Single point-of-care convenience was most commonly selected (71%) as a reason for attending ED. Over 85% of patients who seek emergency care in this region self-refer, so understanding health-seeking behaviour is important. Most low-acuity patients are acutely injured or unwell, and the decision to go to ED is based on their perception of accessibility of expertise aligned with their need. The term 'GP-type' is misleading in this context and should not be used. Providing low-acuity care in parallel with providing a specialised emergency service meets the needs of the local community and is likely to be the lowest cost model in a regional and rural area. Funding models must reflect the actual cost of delivering this important service rather than presentation types. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Peace-building and reconciliation dividends of integrated health services delivery in post-conflict Burundi: qualitative assessments of providers and community members.

PubMed

Christensen, Cathryn; Edward, Anbrasi

2015-01-01

While demonstrating causality remains challenging, several 'health-peace' mechanisms have been proposed to describe how health systems contribute to peace-building and stability in post-conflict settings. A qualitative study was undertaken in southern Burundi to identify drivers of social tension and reconciliation in the catchment area of Village Health Works, a health services organisation. Key informant interviews and focus group discussions were conducted in early 2014 with a total of one hundred and twenty community members and staff representing a range of conflict and recovery experience. Themes emerging from these interviews indicated mechanisms at the individual, household, community, and regional levels through which health provision mitigates tensions and promotes social cohesion. This peace dividend was amplified by the clinic's integrated model, which facilitates further community interaction through economic, agricultural and education programmes. Land pressure and the marginalisation of repatriated refugees were cited as drivers of local tension.

Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

PubMed

Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

2017-11-01

A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Self-help and help-seeking for communication disability in Ghana: implications for the development of communication disability rehabilitation services.

PubMed

Wylie, Karen; McAllister, Lindy; Davidson, Bronwyn; Marshall, Julie; Amponsah, Clement; Bampoe, Josephine Ohenewa

2017-12-29

In low and middle-income countries, such as Ghana, communication disability is poorly recognised and rehabilitation services for people with communication disability are limited. As rehabilitation services for communication disability develop, and the profession of speech-language pathology grows, it is important to consider how services can most appropriately respond to the needs and preferences of the community. Understanding the ways in which people currently self-help and seek help for communication disability is central to developing services that build on existing local practices and are relevant to the community. A qualitative descriptive survey was used to explore likely self-help and help-seeking behaviours for communication disability, in Accra, Ghana. The survey required participants to describe responses to hypothetical scenarios related to communication disability. A mix of theoretical sampling and convenience sampling was used. Qualitative content analysis was used to analyse data and develop categories and subcategories of reported self-help behaviours and sources of help and advice for communication disability. One hundred and thirty-six participants completed the survey. Results indicated that community members would be likely to engage in a variety self-help strategies in response to communication disability. These included working directly with a person with a communication disability to attempt to remediate a communication impairment, altering physical and communication environments, changing attitudes or care practices, educating themselves about the communication disability, providing resources, and responding in spiritual ways. Participants indicated that they would seek help for communication disability across a range of sectors - including the Western healthcare, religious, and traditional sectors. Understanding existing community actions to self-help and help-seek may allow emerging communication rehabilitation services, including the profession of speech-language pathology, to build on existing community practices in resource-limited contexts such as Ghana.

Exploring Counseling Services and Their Impact on Female, Underrepresented Minority Community College Students in Science, Technology, Engineering, and Math: A Qualitative Study

NASA Astrophysics Data System (ADS)

Strother, Elizabeth

The economic future of the United States depends on developing a workforce of professionals in science, technology, engineering and mathematics (Adkins, 2012; Mokter Hossain & Robinson, 2012). In California, the college population is increasingly female and underrepresented minority, a population that has historically chosen to study majors other than STEM. In California, community colleges provide a major inroad for students seeking to further their education in one of the many universities in the state. The recent passage of Senate Bill 1456 and the Student Success and Support Program mandate increased counseling services for all California community college students (California Community College Chancellors Office, 2014). This dissertation is designed to explore the perceptions of female, underrepresented minority college students who are majoring in an area of science, technology, engineering and math, as they relate to community college counseling services. Specifically, it aims to understand what counseling services are most effective, and what community college counselors can do to increase the level of interest in STEM careers in this population. This is a qualitative study. Eight participants were interviewed for the case study, all of whom are current or former community college students who have declared a major in a STEM discipline. The semi-structured interviews were designed to help understand what community college counselors can do to better serve this population, and to encourage more students to pursue STEM majors and careers. Through the interviews, themes emerged to explain what counseling services are the most helpful. Successful STEM students benefited from counselors who showed empathy and support. Counselors who understood the intricacies of educational planning for STEM majors were considered the most efficacious. Counselors who could connect students with enrichment activities, such as internships, were highly valued, as were counseling services that helped students learn to negotiate being a woman in male-dominated classes. The interviews shed light on the particular skills required to effectively counsel underrepresented minority females in STEM majors in the community college.

Use of SMS-Based Surveys in the Rapid Response to the Ebola Outbreak in Liberia: Opening Community Dialogue.

PubMed

Berman, Amanda; Figueroa, Maria Elena; Storey, J Douglas

2017-01-01

During an emerging health crisis like the 2014 Ebola outbreak in West Africa, communicating with communities to learn from them and to provide timely information can be a challenge. Insight into community thinking, however, is crucial for developing appropriate communication content and strategies and for monitoring the progress of the emergency response. In November 2014, the Health Communication Capacity Collaborative partnered with GeoPoll to implement a Short Message Service (SMS)-based survey that could create a link with affected communities and help guide the communication response to Ebola. The ideation metatheory of communication and behavior change guided the design of the survey questionnaire, which produced critical insights into trusted sources of information, knowledge of transmission modes, and perceived risks-all factors relevant to the design of an effective communication response that further catalyzed ongoing community actions. The use of GeoPoll's infrastructure for data collection proved a crucial source of almost-real-time data. It allowed for rapid data collection and processing under chaotic field conditions. Though not a replacement for standard survey methodologies, SMS surveys can provide quick answers within a larger research process to decide on immediate steps for communication strategies when the demand for speedy emergency response is high. They can also help frame additional research as the response evolves and overall monitor the pulse of the situation at any point in time.

A question of place: medical power in rural Australia.

PubMed

Kenny, Amanda; Duckett, Stephen

2004-03-01

In Australia, like many countries, government, medicine and the community have maintained an interdependent and symbiotic relationship based on mutual resource dependency and reciprocity. The services of medicine have been indispensable to government and the community and in return medicine has achieved power, elitism and financial gain. Traditionally, doctors have controlled and directed medical knowledge in an absolute manner and this has been the basis of increasing power and dominance. There are, however, claims that medicine's power and dominance over the health care system is being eroded by the emergence of major social trends. The corporatization of medicine, manageralism and proletarianization are touted as factors that are increasingly countervailing medical dominance and power. Whilst it could be suggested that as these trends become more firmly established government and the community gain greater discretionary control over how the resources of medicine can be allocated and utilized, this article argues that the geographic and social dimensions of the community in which doctors practice must be considered. Using a qualitative descriptive approach research was conducted in rural Victoria, Australia. The overall aim of the study was to identify the issues that impact upon service delivery in rural hospitals. The most significant issue that emerged related to medical relationships. The results of this research indicate that in this rural area the power of medicine is strengthened and institutionalized by geographically determined resource control. The sustainability of rural communities is linked to the ability of the town to attract and retain the services of a doctor. Crucial shortages of rural doctors provide medicine with a mandate to dictate the way in which medical resources will be allocated and used by hospitals and the community. Organizations that control critical resources are in an extremely powerful position to control others. Doctors in rural Victoria maintain a position of strength and use their power to exert control over the state, the community and the hospital. Although medical power and dominance may be declining in some areas, in rural Victoria it remains firmly entrenched.

The needs of health promoters on a health promotion programme for families with adolescents orphaned by HIV and AIDS.

PubMed

Mthobeni, Maseapo P; Peu, Mmapheko D

2013-02-01

The South African communities has shown to have a challenge in accessing health services especially in rural areas; hence the national strategic objective 1.7 aimed at strengthening community systems to expand access to services using the community-based care programmes (NSP 2012-2016). The programmes enhance access to health services whilst promoting health and educating the community to improve health knowledge and work towards attaining a healthy living (NSP 2012-2016). However, the health promoters from the rural Hammanskraal region in the North West Province of South Africa often found themselves rendering the health promotion services in their communities with limited resources. This study aimed at exploring and describing the challenges faced by health promoters in implementing health promotion programmes for families with adolescents orphaned by HIV and AIDS. The study followed a qualitative design. Data was collected using focus group interviews. Participants were purposely selected by the social worker and the health promotion coordinator working at Hammanskraal. The process of data analysis was adapted from the eight steps of Tesch method of data analysis where categories, sub-categories and themes were isolated. The following categories emerged as the needs of health promoters on health promotion programmes for families with adolescents orphaned by HIV and AIDS, (1) financial needs, (2) resources, (3) basic life needs, (4) educational needs and (5) health promoter's needs. It is therefore recommended that equal distribution of resources: including medicine, equipment and finances, should be maintained in order to ensure non-interrupted services.

Adolescent health care: improving access by school-based service.

PubMed

Gonzales, C; Mulligan, D; Kaufman, A; Davis, S; Hunt, K; Kalishman, N; Wallerstein, N

1985-10-01

Participants in this discussion of the potential of school-based health care services for adolescents included family medicine physicians, school health coordinators, a school nurse, and a community worker. It was noted that health care for adolescents tends to be either inaccessible or underutilized, largely because of a lack of sensitivity to adolescent culture and values. An ideal service for adolescents would offer immediate services for crises, strict confidentiality, ready access to prescribed medications, a sliding-scale scheme, and a staff that is tolerant of divergent values and life-styles. School-based pilot adolescent clinics have been established by the University of New Mexico's Department of Family, Community, and Emergency Medicine to test the community-oriented health care model. On-site clinics provide urgent medical care, family planning, pregnancy testing, psychological counseling, alcohol and drug counseling, and classroom health education. Experience with these programs has demonstrated the necessity for an alliance among the health team and the school administration, parents, and students. Financial, ethical, and political factors can serve as constraints to school-based programs. In some cases, school administrators have been resistant to the provision of contraception to students on school grounds and parents have been unwilling to accept the adolescent's right to confidentiality. These problems in part stem from having 2 separate systems, each with its own values, orientation, and responsibilities, housed in 1 facility. In addition, there have been problems generating awareness of the school-based clinic among students. Health education theater groups, peer counseling, and student-run community services have been effective, however, in increasing student participation. It has been helpful to mold clinic services to meet the needs identified by teenagers themselves. There is an interest not only in curative services, but in services focused on depression and feelings of uncertainty about the future.

Emergency medical service providers' role in the early heart attack care program: prevention and stratification strategies.

PubMed

MacDonald, G S; Steiner, S R

1997-01-01

Emergency Medical Services-Early Heart Attack Care (EMS-EHAC) is a community-based program where paramedics increase the consumer's awareness about early chest pain symptom recognition. EMS-EHAC prevention, along with seamless chest pain care (between the paramedic and chest pain emergency department) can be the basis for an outcome-based study to examine the impact of advanced life support EMS. Studies that show the impact of care given by paramedics on the outcome of patient care must be designed to demonstrate the value and the cost benefit of providing advanced life support (ALS). Third party payers are going to examine if there are significant quality differences between ALS and basic life support (BLS) services. If significant benefits of ALS care cannot be demonstrated, the cost differences could potentially place the future of advanced life support paramedic programs in jeopardy. A positive outcome resulting in a lower acute cardiac event, and the realization of the cost benefits from the EMS-EHAC program could be utilized by EMS management to justify or expand advanced life support programs.

Selection Bias and Utilization of the Dual Eligibles in Medicare and Medicaid HMOs

PubMed Central

Zhang, Hui; Kane, Robert L; Dowd, Bryan; Feldman, Roger

2008-01-01

Objective To examine the existence of selection bias in the first 3 years of the Minnesota Senior Health Options (MSHO) demonstration and to estimate the MSHO effects on medical services utilization after adjusting for selection bias. Data Sources Monthly dual eligibility data and MSHO encounter data of March 1997–December 2000 and Medicaid encounter data of January 1995–December 2000 from the Minnesota Department of Human Services; Medicare fee-for-service claims data of January 1995–December 2000 from the Centers for Medicare and Medicaid Services. Study Design Quasi-experimental design comparing utilization between MSHO and control groups; multiple econometric and statistical models were estimated with time-invariant and time-varying covariates. Principal Findings Favorable MSHO selection was found in the nursing home (NH) and community populations, but selection bias did not substantially affect the findings. Enrollment in MSHO for more than 1 year reduced inpatient hospital admissions and days, emergency room and physician visits for NH residents, and lowered physician visits for community residents. Conclusions There was favorable selection in the first 3 years of the MSHO program. Enrollment in MSHO reduced several types of utilization for the NH group and physician visits for community enrollees. PMID:18479403

Diversion at re-entry using criminogenic CBT: Review and prototypical program development.

PubMed

Heilbrun, Kirk; Pietruszka, Victoria; Thornewill, Alice; Phillips, Sarah; Schiedel, Rebecca

2017-09-01

Society and the criminal justice system prioritize the reduction of reoffending risk as part of any criminal justice intervention. The Sequential Intercept Model identifies five points of interception at which justice-involved individuals can be diverted into a more rehabilitative alternative: (1) law enforcement/emergency services; (2) booking/initial court hearings; (3) jails/courts; (4) re-entry; and (5) community corrections/community support. The present article focuses on diversion as part of Intercept 5 - re-entry planning and specialized services in the community. We describe the challenges associated with diversion at this stage, and review the relevant research. Next, we describe a "criminogenic cognitive behavioral therapy" project that has been developed and implemented as part of a federal re-entry court. Finally, we discuss the implications of the challenges of intervention at this stage, and the recently developed "Re-entry Project," for research, policy, and practice. Copyright © 2017 John Wiley & Sons, Ltd.

Surviving the Distance: The Transnational Utilization of Traditional Medicine Among Oaxacan Migrants in the US.

PubMed

González-Vázquez, Tonatiuh; Pelcastre-Villafuerte, Blanca Estela; Taboada, Arianna

2016-10-01

Transnational health practices are an emergent and understudied phenomenon, which provide insight into how migrants seek care and tend to their health care needs in receiving communities. We conducted in depth interviews with return migrants (N = 21) and traditional healers (N = 11) to explore transnational health practices among Mixtec migrants from Oaxaca, specifically in relation to their utilization of traditional healers, medicinal plants, and folk remedies. In established migrant destination points, folk remedies and plants are readily available, and furthermore, these resources often travel alongside migrants. Traditional healers are integral to transnational networks, whether they migrate and provide services in the destination point, or are providing services from communities of origin. Findings encourage us to rethink migrants' communities of origin typically thought of as "left behind," and instead reposition them as inherently connected by transnational channels. Implications for transnational health care theory and practice are addressed.

Integrating hospitals into community emergency preparedness planning.

PubMed

Braun, Barbara I; Wineman, Nicole V; Finn, Nicole L; Barbera, Joseph A; Schmaltz, Stephen P; Loeb, Jerod M

2006-06-06

Strong community linkages are essential to a health care organization's overall preparedness for emergencies. To assess community emergency preparedness linkages among hospitals, public health officials, and first responders and to investigate the influence of community hazards, previous preparation for an event requiring national security oversight, and experience responding to actual disasters. With expert advice from an advisory panel, a mailed questionnaire was used to assess linkage issues related to training and drills, equipment, surveillance, laboratory testing, surge capacity, incident management, and communication. A simple random sample of 1750 U.S. medical-surgical hospitals. Of 678 hospital representatives that agreed to participate, 575 (33%) completed the questionnaire in early 2004. Respondents were hospital personnel responsible for environmental safety, emergency management, infection control, administration, emergency services, and security. Prevalence and breadth of participation in community-wide planning; examination of 17 basic elements in a weighted analysis. In a weighted analysis, most hospitals (88.2% [95% CI, 84.1% to 92.3%]) engaged in community-wide drills and exercises, and most (82.2% [CI, 77.8% to 86.5%]) conducted a collaborative threat and vulnerability analysis with community responders. Of all respondents, 57.3% (CI, 52.1% to 62.5%) reported that their community plans addressed the hospital's need for additional supplies and equipment, and 73.0% (CI, 68.1% to 77.9%) reported that decontamination capacity needs were addressed. Fewer reported a direct link to the Health Alert Network (54.4% [CI, 49.3% to 59.5%]) and around-the-clock access to a live voice from a public health department (40.0% [CI, 35.0% to 45.0%]). Performance on many of 17 basic elements was better in large and urban hospitals and was associated with a high number of perceived hazards, previous national security event preparation, and experience in actual response. Responses reflect hospitals' self-perception of linkages. The quality of linkages and the extent of possible biases favoring positive responses were not assessed. In this baseline assessment, most hospitals reported substantial integration. However, results suggest that relationships between hospitals, public health departments, and other critical response entities are not adequately robust. Suggestions for enhancing linkages are discussed.

Impact of Illness Management and Recovery Programs on Hospital and Emergency Room Use by Medicaid Enrollees

PubMed Central

Salyers, Michelle P.; Rollins, Angela L.; Clendenning, Daniel; McGuire, Alan B.; Kim, Edward

2011-01-01

Objective Illness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization. Methods This was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations, for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status. Results Consumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers. Conclusions This is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT. PMID:21532077

From hypothetical scenario to tragic reality: A salutary lesson in risk communication and the Victorian 2009 bushfires.

PubMed

Burns, Robin; Robinson, Priscilla; Smith, Penelope

2010-02-01

To investigate the ways that the risk of a bushfire emergency and communication strategies are perceived by different community segments. A brief questionnaire preceded focus group discussion of a bushfire scenario with four communications from different sources. Groups were recruited to represent different community segments within a bushfire-prone peri-urban Shire in Victoria. Four groups (28 participants) were recruited. Bushfire experience was highest in the over 40-year-olds, who would use a variety of information sources, preferred to receive information from trusted local sources, such as emergency services and the council, and were more likely to be a member of a local organisation than the under 40s. Younger people used television, local papers, and friends, family and neighbours as information sources. Young parents felt disempowered through lack of local knowledge, and trusted government departments less than older residents. All wanted clear, current, specific local information about ground conditions and actions to be taken during a fire outbreak. Knowledge of and preparedness for bushfire is unequally spread throughout a bushfire community. There is a need in public health risk and emergency situations to focus on community development, information and consultation. © 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.

Community-based health care for indigenous women in Mexico: a qualitative evaluation

PubMed Central

2014-01-01

Introduction Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the “Casa de la Mujer Indígena”, a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives. Methods The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis. Results Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies. Conclusions The model’s cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user’s input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care. PMID:24393517

Community-based health care for indigenous women in Mexico: a qualitative evaluation.

PubMed

Pelcastre-Villafuerte, Blanca; Ruiz, Myriam; Meneses, Sergio; Amaya, Claudia; Márquez, Margarita; Taboada, Arianna; Careaga, Katherine

2014-01-06

Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the "Casa de la Mujer Indígena", a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives. The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis. Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies. The model's cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user's input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.

[The patient and family satisfaction with the department of mental health in Rome].

PubMed

Cozza, M; Amara, M; Butera, N; Infantino, G; Monti, A M; Provénzano, R

1997-01-01

Satisfaction's measurement with Mental Health Services in patients and their relatives. Satisfaction scale administration to the patients who were treated in community-based psychiatric service from 1.1.1996 to 31.3.1996 and the relatives who were primarily involved in caring for the patient. The ASL Rome "C" community-based psychiatric service. Verona Service Satisfaction Scale-54, a multidimensional instrument which measure satisfaction with community-based psychiatric service. Main results (301 scales for patients, 163 scales for relatives), pointed out for patients a higher satisfaction for the technical and interpersonal skills of psychiatrists and psychologists (score of specific items > 4). Lowest scores of satisfaction were towards the appearance, comfort level and physical layout of the facility (score 2.95) and towards the response of the service to emergencies during the night, weekend and Bank Holidays (score 2.87). Relatives were not particularly keen for the item regarding help to find open employment (score 2.76). Furthermore patients and their relatives gave a negative evaluation of the publicity and information offered by Mental Health Services. Dimension's analysis reaches the same conclusions deduced items's average score. The result of this study emphasizes the patients higher degree of satisfaction than the relatives. The above results point out three aspects to be improved by the Mental Health Service in order to satisfy the demands of the patients and relatives: 1. appearance, comfort level and physical layout of the facility, 2. publicity and information, 3. social activities and social skills.

[Terrorism, public health and health services].

PubMed

Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Pérez-Berrocal Alonso, Jorge

2009-01-01

Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.

Ditchin' the Master's Gardening Tools for Our Own: Growing a Womanist Methodology from the Grassroots

ERIC Educational Resources Information Center

Marr, Vanessa L.

2014-01-01

This essay explores the autoethnographic possibilities of critical service-learning research and the emerging realities of a community-centered womanist methodological response. Drawing from Alice Walker's definition of "womanist" as a commitment to "survival and wholeness of entire people, male 'and' female," the author argues…

Lessons from Crisis Recovery in Schools: How Hurricanes Impacted Schools, Families and the Community

ERIC Educational Resources Information Center

Howat, Holly; Curtis, Nikki; Landry, Shauna; Farmer, Kara; Kroll, Tobias; Douglass, Jill

2012-01-01

This article examines school and school district-level efforts to reopen schools after significant damage from hurricanes. Through an empirical, qualitative research design, four themes emerged as critical to the hurricane recovery process: the importance of communication, resolving tension, coordinating with other services and learning from the…

The Rural Practicum: Preparing a Quality Teacher Workforce for Rural and Regional Australia

ERIC Educational Resources Information Center

Kline, Jodie; White, Simone; Lock, Graeme

2013-01-01

Communities play a critical role in supporting pre-service teachers during rural and regional professional experience. This support, coupled with access to teacher educators and university resources, appears to positively influence graduate attitudes toward taking up a rural appointment. These are among the key findings to emerge from open-ended…

Responding to the Needs of the Homeless and Hungry.

ERIC Educational Resources Information Center

American National Red Cross, Washington, DC.

This report describes the Hotels-Motels in Partnership Program, a human services resource sponsored by the Red Cross and other organizations to respond to housing needs of the homeless, disaster victims, and others in need of emergency assistance. The partnership program involves several hundred businesses in more than 240 communities. Since its…

School Psychology Goes to College: The Emerging Role of School Psychology in College Communities

ERIC Educational Resources Information Center

Sulkowski, Michael L.; Joyce, Diana J.

2012-01-01

Many college students display academic and social-emotional needs that are not being addressed by extant university supports. School psychologists who work in postsecondary settings and have expertise in providing psychoeducational services may be uniquely positioned to help many of these students. However, few school psychologists currently work…

75 FR 16066 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-31

..., electric, and water and waste facilities in rural areas with a loan portfolio that totals nearly $42.... Rural Utilities Service Title: 7 CFR Part 1778, Emergency and Imminent Community Water Assistance Grants... under Section 306A of the Consolidated Farm and rural Development Act, (7 U.S.C. 1926(a) to provide...

The Student Support Team as a Professional Learning Community.

ERIC Educational Resources Information Center

DuFour, Richard; Guidice, Aida; Magee, Deborah; Martin, Patricia; Zivkovic, Barbara

This chapter discusses three emerging national trends that could serve as catalysts for fundamental change in student services programs. First is the concept of the learning organization, which offers a superior model for enhancing the effectiveness of institutions and the people within them. Second is the movement away from standardization and…

Ensuring Ethical Behavior of School District Leaders

ERIC Educational Resources Information Center

Ruder, Robert

2010-01-01

When employees of public school entities retire after 35 or 40 years of service, they usually take with them a reputation built on goodwill and trust within the community in which they worked. While their physical departure is immediate, their legacy continues. But what happens if months later, evidence emerges that the educator behaved in a…

Environmental Education as Teacher Education: Melancholic Reflections from an Emerging Community of Practice

ERIC Educational Resources Information Center

Ormond, Carlos; Zandvliet, David; McClaren, Milton; Robertson, Patrick; Leddy, Shannon; Metcalfe, Selina

2014-01-01

During 2011 at Simon Fraser University, the Faculty of Education hosted the implementation of a pre-service teacher education program with an emphasis on sustainability and environmental learning. This cohort, termed SEEDs (Sustainability Education in an Environment of Diversity), enrolled 32 teacher education students in an intensive 12-month…

New Realities in the Management of Student Affairs: Emerging Specialist Roles and Structures for Changing Times

ERIC Educational Resources Information Center

Tull, Ashley, Ed.; Kuk, Linda, Ed.

2012-01-01

Student affairs organizations are at a crossroads. They face expanding enrollments; a concomitant increase need for often more complex services; changing demographics; a growing cohort of non-traditional and first-generation students; shifting and more demanding responsibilities; and increased expectations from the greater campus community,…

Emergent modes of work and communities of practice.

PubMed

Iedema, Rick; Meyerkort, Shannon; White, Les

2005-02-01

This paper argues that the recent emphasis on teams in the health services research literature tends to be attributed to our rising recognition that flexible and self-organizing teams are in the best position to handle the increasing complexity and fragmentation of health services. With a brief review of two papers on health-care teams as its point of departure, this paper argues that the concern with teams harbours a realization that the organizational-managerial point of gravity of most clinical work lies with those who do the work. In the context of health reforms sweeping across most countries in the industrialized world, this means that teams are to embody dynamic self-organization as do 'communities of practice (CoPs)', and be the origin of the managerial and documentary realities that describe, define and validate them. Following through on this last point, the paper reflects on some of the constitutive facets of teams as CoPs, and proposes that in the context of health reform such emergent teamness encompass participating, knowledging and boundary spanning. Fusing contextual, attributional and processual dimensions of team conduct, these notions are elaborated to show how descriptions of teamness can be rendered sensitive to the prerogatives of health reform. The paper concludes with outlining some of the implications of this proposal for how we reconceptualize health services management.

General surgery 2.0: the emergence of acute care surgery in Canada

PubMed Central

Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

2010-01-01

Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

Cleanups in My Community

EPA Pesticide Factsheets

Cleanups in My Community (CIMC) is a public web application that enables integrated access through maps, lists and search filtering to site-specific information EPA has across all cleanup programs. CIMC taps into data publicly available from EPA's EnviroFacts (RCRA Corrective Action facilities, Brownfields properties and grant areas, Superfund NPL sites, other facility data) and web services (water monitoring stations, impaired waters, emergency responses, tribal boundaries, congressional districts, etc.) and connects to other applications (e.g., Superfund's CPAD) to provide easy seamless access to site-specific cleanup information with explanatory text and within the context of related data. Data can be filtered by cleanup program, geography, environmental indicators, controls, and cleanup stage. CIMC also provides some web services that integrate these data for others to use in their applications.

Developing plans and priorities for climate science in service to society

NASA Astrophysics Data System (ADS)

Asrar, Ghassem; Busalacchi, Antonio; Hurrell, James

2012-03-01

World Climate Research Programme (WCRP) Open Science Conference; Denver, Colorado, 24-28 October 2011 The WCRP Open Science Conference (OSC), which had the theme "Climate Research in Service to Society," was held to consult with the international community of experts on future plans and priorities for the WCRP. More than 1900 participants, including 541 young scholars from 86 nations and 300 scientists from developing nations, made the conference a success. Several major scientific priorities emerged from OSC.

Using CBPR to Assess Client Needs at a Social Service Agency.

PubMed

Amendola, Mary Grace; Nazario, Noelia; Sanchez, Veronica

2016-01-01

Community-based participatory research (CBPR) has become an important research approach for universities to partner with social service agencies by uniting them in project design, planning, implementation, and evaluation. This study involved FOCUS, an urban social service agency, and Rutgers College of Nursing (RUCON) collaboratively conducting a needs assessment to compare the health needs of its clients and their employees' perception of their clients health needs, utilizing CBPR. Qualitative data was collected using the focus group method, field notes, photographs, and observation. The employees of FOCUS facilitated focus groups, participant recruitment, and transcribed and translated data. Three themes emerged: Health Education, Cost of Health Care, and Barriers to Health Care. This study contributes to the growing body of knowledge of integrating the CBPR approach when conducting a community needs assessment with a social service agency. The CBPR approach closely reflects the identified health needs of its clients resulting in interventions that will meet their specific health needs. © 2015 Wiley Periodicals, Inc.

Developing a Set of Uniform Outcome Measures for Adult Day Services.

PubMed

Anderson, Keith A; Geboy, Lyn; Jarrott, Shannon E; Missaelides, Lydia; Ogletree, Aaron M; Peters-Beumer, Lisa; Zarit, Steven H

2018-06-01

Adult day services (ADS) provide care to adults with physical, functional, and/or cognitive limitations in nonresidential, congregate, community-based settings. ADS programs have emerged as a growing and affordable approach within the home and community-based services sector. Although promising, the growth of ADS has been hampered by a lack of uniform outcome measures and data collection protocols. In this article, the authors detail a recent effort by leading researchers and practitioners in ADS to develop a set of uniform outcome measures. Based upon three recent efforts to develop outcome measures, selection criteria were established and an iterative process was conducted to debate the merits of outcome measures across three domains-participant well-being, caregiver well-being, and health care utilization. The authors conclude by proposing a uniform set of outcome measures to (a) standardize data collection, (b) aid in the development of programming, and (c) facilitate the leveraging of additional funding for ADS.

Transdisciplinary collaboration of academia and practice in the area of serious mental illness.

PubMed

Connolly, P M

1995-12-01

The Transdisciplinary Collaboration Project at San Jose State University in San Jose, California, focuses on providing high-quality services for persons with serious mental illness living in the community while preparing future mental health professionals to practise in an environment of cultural diversity and cost containment. Rehospitalization and emergency psychiatric services were decreased and community tenure increased at two board and care sites. The total cost savings for 1 year for 25 individuals was $373,830. Nursing, communication disorders, occupational therapy, social work, and therapeutic recreation students and faculty provided over 5000 hours of direct care during the 1993-95 academic years. Studies on client and student satisfaction revealed high levels of satisfaction. Unique components of the project include university organized transdisciplinary seminars for students, agency personnel and, when appropriate, residents, faculty practice, faculty led groups, employment for former clients/consumers and faculty consultation services.

The sustainability of community-based therapeutic care (CTC) in nonemergency contexts.

PubMed

Gatchell, Valerie; Forsythe, Vivienne; Thomas, Paul-Rees

2006-09-01

Concern Worldwide is an international humanitarian nongovernmental organization that piloted and is now implementing and researching community-based therapeutic care (CTC) approaches to managing acute malnutrition. Experience in several countries suggests that there are key issues to be addressed at the international, national, regional, and community levels for community-based treatment of acute malnutrition to be sustainable. At the national level there must be demonstrated commitment to a clear health policy and strategy to address outpatient treatment of acute malnutrition. In addition, locally available, affordable ready-to-use therapeutic food (RUTF) must be accessible. At the regional level a functional health system and appropriate capacity for service provision are required. Integration of outpatient services should be viewed as a process with different levels of inputs at different phases depending on the capacity of the Ministry of Health (MOH). There is a need for indicators to facilitate scale-up and scale-back for future emergency response. Strong community participation and active screening linked to health service provision at the local level is paramount for sustainable assessment and referral of severe acute malnutrition. FUTURE CHALLENGES TO SUSTAIN COMMUNITY-BASED THERAPEUTIC CARE. Key challenges to the sustainable treatment of severe acute malnutrition include the development of locally produced RUTF, development of international standards on local RUTF production, the integration of outpatient treatment protocols into international health and nutrition guidelines, and further operational research into integration of community-based treatment of severe acute malnutrition into health systems in nonemergency contexts.

Providing long-acting reversible contraception services in Seattle school-based health centers: key themes for facilitating implementation.

PubMed

Gilmore, Kelly; Hoopes, Andrea J; Cady, Janet; Amies Oelschlager, Anne-Marie; Prager, Sarah; Vander Stoep, Ann

2015-06-01

The purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners. We conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups. The most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff. LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Resident and proprietor perspectives on a recovery orientation in community-based housing.

PubMed

Piat, Myra; Boyer, Richard; Fleury, Marie-Josée; Lesage, Alain; O'Connell, Maria; Sabetti, Judith

2015-03-01

Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O'Connell, Tondora, Croog, Evans, & Davidson, 2005). The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Resident and Proprietor Perspectives of a Recovery Orientation in Community-Based Housing

PubMed Central

Piat, Myra; Boyer, Richard; Fleury, Marie-Josée; Lesage, Alain; O’Connell, Maria; Sabetti, Judith

2016-01-01

Objective Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O’Connell, Tondora, Croog, Evans, & Davidson, 2005). Methods The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. Results Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. Conclusions and Implications for Practice This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. PMID:25559078

The future of community pharmacy practice in South Africa in the light of the proposed new qualification for pharmacists: implications and challenges.

PubMed

Malangu, Ntambwe

2014-08-15

Community or retail pharmacies are regarded as one of the most common sources of health services throughout the world. In South Africa, community pharmacies have been providing some primary health care services to clients who could afford to pay. These services included screening, family planning, and emergency care for minor ailments. With the introduction of the new qualification, community pharmacies are poised to become providers of expanded services.  This paper describes the contents, the implications and challenges of the new qualification in light with future directions for community pharmacy practice in South Africa. Its purpose is to inform relevant stakeholders in South Africa and those outside South Africa that may pursue similar offerings. Published papers were identified through searches in MEDLINE and Google Scholar using a combination of search terms, namely: 'community, retail pharmacy, pharmacist/non-medical prescribing, South Africa'. Only articles published in English were considered. In addition, documents from the Ministry of Health of South Africa, the South African Pharmacy Council and curricula materials from schools of pharmacy were also reviewed. Laureates of the new qualification will essentially have the right to examine, diagnose, prescribe and monitor the treatment of their clients or patients. In doing so, this expanded function of prescribing for primary healthcare will imply several practice and infrastructural adjustments; and with many challenges laying ahead in need to be addressed. In conclusion, the authorized pharmacist prescriber qualification augurs a new era for community pharmacy practice in South Africa. This has many implications and some challenges that need to be managed. The pharmacy profession, academia, legislators and political decision-makers need to work together to resolve outstanding issues in a constructive manner.

Comorbid depression and substance abuse among safety-net clients in Los Angeles: a community participatory study.

PubMed

Chang, Evelyn T; Wells, Kenneth B; Gilmore, James; Tang, Lingqi; Morgan, Anna U; Sanders, Starr; Chung, Bowen

2015-03-01

Depression and substance abuse are common among low-income adults from racial-ethnic minority groups who receive services in safety-net settings, although little is known about how clients differ by service setting. This study examined characteristics and service use among depressed, low-income persons from minority groups in underresourced communities who did and did not have a substance abuse history. The study used cross-sectional baseline client data (N=957) from Community Partners in Care, an initiative to improve depression services in Los Angeles County. Clients with probable depression (eight-item Patient Health Questionnaire) from substance abuse programs were compared with depressed clients with and without a history of substance abuse from primary care, mental health, and social and community programs. Sociodemographic, health status, and services utilization variables were examined. Of the 957 depressed clients, 217 (23%) were from substance abuse programs; 269 (28%) clients from other sectors had a substance abuse history, and 471 (49%) did not. Most clients from substance abuse programs or with a substance abuse history were unemployed and impoverished, lacked health insurance, and had high rates of arrests and homelessness. They were also more likely than clients without a substance abuse history to have depression or anxiety disorders, psychosis, and mania and to use emergency rooms. Clients with depression and a substance abuse history had significant psychosocial stressors and high rates of service use, which suggests that communitywide approaches may be needed to address both depression and substance abuse in this safety-net population.

The Opportunities of Crises and Emergency Risk Communication in Activities of Serbian Public Health Workforce in Emergencies

PubMed Central

Radović, V; Ćurčić, L

2012-01-01

Background: The aim of the study was a recommendation and establishment the concept of the appropriate communication between public health, other competent services and population in emergency as the corner stone which guarantee that all goals which are important for community life will be achieved. Methods: We used methodology appropriate for social science: analyses of documents, historical approach and comparative analysis. Results: The finding shows the urgent need for accepting of crises and emergency risk communication principles, or some similar concepts, in Serbia, and implementing effective two way communication especially in multiethnic region. The pragmatic value of the paper lays in information about the recent improvement of health workforce and emergency services in emergencies using new concept of communication and as source of numerous useful documents published in USA and few recent Serbian examples. Conclusion: Health workforce has significant role in the process of protection of population in emergencies. Policy makers should work on finding a way to improve their coordination and communication, creating new academic programs, providing of adequate training, and financial means in order to give them different role in society and provide visibility. From other side health workforce should build back to the citizen trust in what they are doing for society welfare using all their skills and abilities. PMID:23308348

A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania.

PubMed

George, Siân; Daniels, Katy; Fioratou, Evridiki

2018-04-03

Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The "Health Care Access Barriers" (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre's family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Identified themes from both groups aligned with HCAB's themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals' attitudes and discrimination and the vulnerable population's lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a charity community centre in Romania. The "Healthcare Access Barriers for Vulnerable Populations" (HABVP) model is proposed as an adaption to the existing HCAB model to account for the unique perceived barriers to healthcare for this population. Recommendations for future resolution of these identified barriers are proposed.

Preparedness for Cardiac Emergencies among Cambodians with Limited English Proficiency

PubMed Central

Meischke, Hendrika; Taylor, Victoria; Calhoun, Rebecca; Liu, Qi; Sos, Channdara; Tu, Shin-Ping; Yip, Mei-Po; Eisenberg, Devora

2011-01-01

In the United Sates, populations with limited English proficiency (LEP) report barriers to seeking emergency care and experience significant health disparities, including being less likely to survive cardiac arrest than whites. Rapid utilization of 9-1-1 to access emergency services and early bystander CPR (cardiopulmonary resuscitation) is crucial for successful resuscitation of out-of-hospital cardiac arrest patients. Little is understood about Asian LEP communities’ preparedness for emergencies. In this exploratory survey, we sought to assess intentions to call 9-1-1 in an emergency and knowledge of CPR in the Cambodian LEP community. We conducted an in-person interview with 667 Cambodian adults to assess their intentions to call 9-1-1 and their awareness of and training in bystander CPR. While the majority of participants stated that they would call 9-1-1 in an emergency, almost one-third of the sample would call a friend or family member. Awareness of CPR was very high but training in CPR was lower, especially for women. A higher level of English proficiency and greater proportion of time in the US was a strong predictor of CPR training and intention to call 9-1-1 in an emergency. This suggests that greater efforts need to be made to reach the most linguistically-isolated communities (those with little or no English) with emergency information in Khmer. PMID:21748487

Using Photovoice, Latina Transgender Women Identify Priorities in a New Immigrant-Destination State

PubMed Central

Rhodes, Scott D.; Alonzo, Jorge; Mann, Lilli; Simán, Florence; Garcia, Manuel; Abraham, Claire; Sun, Christina J.

2016-01-01

Little is known about the immigrant Latino/a transgender community in the southeastern United States. This study used photovoice, a methodology aligned with community-based participatory research, to explore needs, assets, and priorities of Latina transgender women in North Carolina. Nine immigrant Latina male-to-female transgender women documented their daily experiences through photography, engaged in empowerment-based photo-discussions, and organized a bilingual community forum to move knowledge to action. From the participants’ photographs and words, 11 themes emerged in three domains: daily challenges (e.g., health risks, uncertainty about the future, discrimination, and anxiety about family reactions); needs and priorities (e.g., health and social services, emotional support, and collective action); and community strengths and assets (e.g., supportive individuals and institutions, wisdom through lived experiences, and personal and professional goals). At the community forum, 60 influential advocates, including Latina transgender women, representatives from community-based organizations, health and social service providers, and law enforcement, reviewed findings and identified ten recommended actions. Overall, photovoice served to obtain rich qualitative insight into the lived experiences of Latina transgender women that was then shared with local leaders and agencies to help address priorities. PMID:27110226

Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study.

PubMed

Lee, Yi-Hui; Chu, Dachen; Yang, Nan-Ping; Chan, Chien-Lung; Cheng, Shun-Ping; Pai, Jih-Tung; Chang, Nien-Tzu

2015-05-09

An increased number of emergency visits at the end of life may indicate poor-quality cancer care. The study aimed to investigate the prevalence and utilization of emergency visits and to explore the reasons for emergency department (ED) visits among cancer patients at the end of life. A retrospective cohort study was performed by tracking one year of ambulatory medical service records before death. Data were collected from the cancer dataset of Taiwan's National Health Insurance Research Database (NHIRD). A total of 32,772 (19.2%) patients with malignant cancer visited EDs, and 23,883 patients died during the study period. Of these, the prevalence of emergency visits in the mortality group was 81.5%, and their ED utilization was significantly increased monthly to the end of life. The most frequent types of cancer were digestive and peritoneum cancers (34.8%), followed by breast cancer (17.7%) and head and neck cancers (13.3%). Older patients, males, and those diagnosed with metastases, respiratory or digestive cancer were more likely to use ED services at the end of life. Use of an ED service in the nearest community hospital to replace medical centers for dying cancer patients would be more acceptable in emergency situations. Our study provided population-based evidence related to ED utilization. An understanding of the reasons for such visits could be useful in preventing overuse of ED visits to improve the quality of end-of-life care.

European grid services for global earth science

NASA Astrophysics Data System (ADS)

Brewer, S.; Sipos, G.

2012-04-01

This presentation will provide an overview of the distributed computing services that the European Grid Infrastructure (EGI) offers to the Earth Sciences community and also explain the processes whereby Earth Science users can engage with the infrastructure. One of the main overarching goals for EGI over the coming year is to diversify its user-base. EGI therefore - through the National Grid Initiatives (NGIs) that provide the bulk of resources that make up the infrastructure - offers a number of routes whereby users, either individually or as communities, can make use of its services. At one level there are two approaches to working with EGI: either users can make use of existing resources and contribute to their evolution and configuration; or alternatively they can work with EGI, and hence the NGIs, to incorporate their own resources into the infrastructure to take advantage of EGI's monitoring, networking and managing services. Adopting this approach does not imply a loss of ownership of the resources. Both of these approaches are entirely applicable to the Earth Sciences community. The former because researchers within this field have been involved with EGI (and previously EGEE) as a Heavy User Community and the latter because they have very specific needs, such as incorporating HPC services into their workflows, and these will require multi-skilled interventions to fully provide such services. In addition to the technical support services that EGI has been offering for the last year or so - the applications database, the training marketplace and the Virtual Organisation services - there now exists a dynamic short-term project framework that can be utilised to establish and operate services for Earth Science users. During this talk we will present a summary of various on-going projects that will be of interest to Earth Science users with the intention that suggestions for future projects will emerge from the subsequent discussions: • The Federated Cloud Task Force is already providing a cloud infrastructure through a few committed NGIs. This is being made available to research communities participating in the Task Force and the long-term aim is to integrate these national clouds into a pan-European infrastructure for scientific communities. • The MPI group provides support for application developers to port and scale up parallel applications to the global European Grid Infrastructure. • A lively portal developer and provider community that is able to setup and operate custom, application and/or community specific portals for members of the Earth Science community to interact with EGI. • A project to assess the possibilities for federated identity management in EGI and the readiness of EGI member states for federated authentication and authorisation mechanisms. • Operating resources and user support services to process data with new types of services and infrastructures, such as desktop grids, map-reduce frameworks, GPU clusters.

Ethnic matching of clients and clinicians and use of mental health services by ethnic minority clients.

PubMed

Ziguras, Stephen; Klimidis, Steven; Lewis, James; Stuart, Geoff

2003-04-01

Research in the United States has indicated that matching clients from a minority group with clinicians from the same ethnic background increases use of community mental health services and reduces use of emergency services. This study assessed the effects of matching clients from a non-English-speaking background with bilingual, bicultural clinicians in a mental health system in Australia that emphasizes community-based psychiatric case management. In an overall sample of 2,935 clients served in the western region of Melbourne from 1997 to 1999, ethnic minority clients from a non-English-speaking background who received services from a bilingual, bicultural case manager were compared with ethnic minority clients who did not receive such services and with clients from an English-speaking background. The clients' engagement with three types of services-community care teams, psychiatric crisis teams, and psychiatric inpatient services-was assessed. Compared with ethnic minority clients who were not matched with a bilingual clinician, those who were matched generally had a longer duration and greater frequency of contact with community care teams and a shorter duration and lower frequency of contact with crisis teams. Clients born in Vietnam who were matched with a bilingual clinician had a shorter annual mean length of hospital stay and a lower annual mean frequency of hospital admission than Australian-born clients. The benefits of matching clients with psychiatric case managers on the basis of ethnic background include a lower level of need for crisis intervention and, for clients from some ethnic groups, fewer inpatient interventions. These Australian results support findings of the effectiveness of client-clinician ethnic matching in the United States.

Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes.

PubMed

Luk, James K H; Chan, W K; Ng, W C; Chiu, Patrick K C; Ho, Celina; Chan, T C; Chan, Felix H W

2013-12-01

To study the demography, clinical characteristics, service utilisation, mortality, and predictors of mortality in older residential care home residents with advanced cognitive impairment. Cohort longitudinal study. Residential care homes for the elderly in Hong Kong West. Residents of such homes aged 65 years or more with advanced cognitive impairment. In all, 312 such residential care home residents (71 men and 241 women) were studied. Their mean age was 88 (standard deviation, 8) years and their mean Barthel Index 20 score was 1.5 (standard deviation, 2.0). In all, 164 (53%) were receiving enteral feeding. Nearly all of them had urinary and bowel incontinence. Apart from Community Geriatric Assessment Team clinics, 119 (38%) of the residents attended other clinics outside their residential care homes. In all, 107 (34%) died within 1 year; those who died within 1 year used significantly more emergency and hospital services (P<0.001), and utilised more services from community care nurses for wound care (P=0.001), enteral feeding tube care (P=0.018), and urinary catheter care (P<0.001). Independent risk factors for 1-year mortality were active pressure sores (P=0.0037), enteral feeding (P=0.008), having a urinary catheter (P=0.0036), and suffering from chronic obstructive pulmonary disease (P=0.011). A history of pneumococcal vaccination was protective with respect to 1-year mortality (P=0.004). Residents of residential care homes for the elderly with advanced cognitive impairment were frail, exhibited multiple co-morbidities and high mortality. They were frequent users of out-patient, emergency, and in-patient services. The development of end-of-life care services in residential care homes for the elderly is an important need for this group of elderly.

Initial experience in setting up a medical student first responder scheme in South Central England.

PubMed

Seligman, William H; Ganatra, Sameer; England, David; Black, John J M

2016-02-01

Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention in many undergraduate medical curricula. However, there is growing interest in PHEM among medical students and junior doctors. Several programmes are in existence across the UK that serve to provide teaching and exposure of prehospital care to medical students and junior doctors. However, relatively few students are able to gain significant first-hand experience of treating patients in the prehospital phase. In this short report, we discuss our experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Medical students are trained by the regional ambulance service and respond to life-threatening medical emergencies in an ambulance response vehicle. The scheme is likely to benefit the ambulance service by providing a wider pool of trained volunteer first responders able to attend to emergency calls, to benefit patients by providing a quick response at their time of need, and to benefit medical students by providing first-hand experience of medical emergencies in the community. In its first 15 months of operation, SFRs were dispatched to 343 incidents. This scheme can serve as a training model for other ambulance services and medical schools across the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Social inclusion and community participation of individuals with intellectual/developmental disabilities.

PubMed

Amado, Angela Novak; Stancliffe, Roger J; McCarron, Mary; McCallion, Philip

2013-10-01

As more individuals with intellectual/developmental disabilities are physically included in community life, in schools, neighborhoods, jobs, recreation, and congregations, the challenge of going beyond physical inclusion to true social inclusion becomes more apparent. This article summarizes the status of the research about community participation and social inclusion, summarizes some debates and points of contention, notes emerging research issues, and highlights needed areas of research. It is clear that most research on these topics has been conducted with individuals who are in paid formal services, and there are great needs for understanding the community participation of individuals who live on their own or with their families, as well as researching social inclusion by focusing on the attitudes and experiences of community members themselves, not just individuals with disabilities and paid providers.

The challenges of reshaping disease specific and care oriented community based services towards comprehensive goals: a situation appraisal in the Western Cape Province, South Africa.

PubMed

Schneider, Helen; Schaay, Nikki; Dudley, Lilian; Goliath, Charlyn; Qukula, Tobeka

2015-09-30

Similar to other countries in the region, South Africa is currently reorienting a loosely structured and highly diverse community care system that evolved around HIV and TB, into a formalized, comprehensive and integrated primary health care outreach programme, based on community health workers (CHWs). While the difficulties of establishing national CHW programmes are well described, the reshaping of disease specific and care oriented community services, based outside the formal health system, poses particular challenges. This paper is an in-depth case study of the challenges of implementing reforms to community based services (CBS) in one province of South Africa. A multi-method situation appraisal of CBS in the Western Cape Province was conducted over eight months in close collaboration with provincial stakeholders. The appraisal mapped the roles and service delivery, human resource, financing and governance arrangements of an extensive non-governmental organisation (NGO) contracted and CHW based service delivery infrastructure that emerged over 15-20 years in this province. It also gathered the perspectives of a wide range of actors - including communities, users, NGOs, PHC providers and managers - on the current state and future visions of CBS. While there was wide support for new approaches to CBS, there are a number of challenges to achieving this. Although largely government funded, the community based delivery platform remains marginal to the formal public primary health care (PHC) and district health systems. CHW roles evolved from a system of home based care and are limited in scope. There is a high turnover of cadres, and support systems (supervision, monitoring, financing, training), coordination between CHWs, NGOs and PHC facilities, and sub-district capacity for planning and management of CBS are all poorly developed. Reorienting community based services that have their origins in care responses to HIV and TB presents an inter-related set of resource mobilisation, system design and governance challenges. These include not only formalising community based teams themselves, but also the forging of new roles, relationships and mind-sets within the primary health care system, and creating greater capacity for contracting and engaging a plural set of actors - government, NGO and community - at district and sub-district level.

A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England.

PubMed

Mackridge, Adam John; Gray, Nicola Jane; Krska, Janet

2017-07-10

This study aims to provide a national picture of the extent and nature of public health services commissioned by local authorities (LAs) from community pharmacies across England in financial year 2014/15. Cross-sectional survey of public health services commissioned in community pharmacies by LAs, gathered via freedom of information requests and documentary analysis. All 152 LAs in England. A total of 833 commissioned services were reported across England (range 3-10 per LA). Four services were commissioned by over 90% of LAs: emergency hormonal contraception (EHC), smoking cessation support, supervised consumption of methadone or other opiates and needle and syringe programmes (NSPs). The proportion of pharmacies commissioned to deliver these services varied considerably between LAs from <10% to 100%. This variation was not related to differences in relevant proxy measures of need. NHS Health Checks and alcohol screening and brief advice were commissioned by fewer LAs (32% and 15%, respectively), again with no relationship to relevant measures of need. A range of other services were commissioned less frequently, by fewer than 10% of LAs.Supervised consumption and NSPs were the most frequently used services, with over 4.4 million individual supervisions and over 1.4 million needle packs supplied. Pharmacies provided over 200 000 consultations for supply of EHC, over 30 000 supplies of free condoms and almost 16 000 chlamydia screening kits. More than 55 000 people registered to stop smoking in a community pharmacy, almost 30 000 were screened for alcohol use and over 26 000 NHS Health Checks were delivered. There is significant variation in commissioning and delivery of public health services in community pharmacies across England, which correlate poorly with potential benefit to local populations. Research to ascertain reasons for this variation is needed to ensure that future commissioning and delivery of these services matches local need. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

What older people want: evidence from a study of remote Scottish communities.

PubMed

King, Gerry; Farmer, Jane

2009-01-01

The growing proportions of older people in rural areas have implications for the provision of health and social care services. Older people are more likely to have complex health needs compared with other age groups, requiring a full range of primary, community and acute hospital services. The provision of services to older people in rural areas is challenged by diseconomies of scale, travel costs and difficulties in attracting staff. Policy-makers are requested to include the 'voice' of older people to help provide services that match needs and context. In spite of this, what older people want from health and social care services is a neglected area of investigation. The reported study was conducted in 2005/2006 as part of a European Union Northern Periphery Programme (EU NPP) project called Our Life as Elderly. Its aims were to explore the views of those aged 55 years and over and living in remote communities about current and future health and social care service provision for older people. Evidence was to be collected that could inform policy-makers about changing or improving service delivery. This article summarises emergent themes and considers their implications. The study selected two small remote mainland Scottish Highland communities for in-depth case study. Semi-structured interviews (n = 23), 10 'informal conversations' and 4 focus groups were held with community members aged 55 years and over, in order to provide different types of qualitative data and 'layers' of data to allow reflection. Data analysis was assisted by computerised data management software and performed using the 'framework analysis' approach. Participants did not consider themselves 'old' and expressed the need for independence in older age to be supported by services. Several aspects of services that were undergoing change or restructuring were identified, including arrangements for home care services, meals provision and technological support. Participants valued elements of the traditional model of care they had been receiving: these were local, personal emphasis and continuity. They were suspicious of new arrangements perceived to emphasise technical efficiency. Health and care services were described as inter-linked with other aspects of rural living, including transport and housing (which might have to be relinquished to pay for care). Proximity to family was desired for social and domestic support only; health and related support should be from generic service providers. Community members were involved in reciprocal help-giving of many types. The findings compare with results of other studies of older rural people internationally, and generic 'principles' of service derived could guide restructuring. There may be systemic challenges to empowering older people's 'voice' in designing sustainable rural services that stem from society's views of older people, attitudes of communities to collective roles and responsibilities, and the fragmented ways that services are sometimes provided.

Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

PubMed

Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

2016-05-18

The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program.

PubMed

Benoit, Cecilia; Belle-Isle, Lynne; Smith, Michaela; Phillips, Rachel; Shumka, Leah; Atchison, Chris; Jansson, Mikael; Loppie, Charlotte; Flagg, Jackson

2017-08-30

Social marginalization and criminalization create health and safety risks for sex workers and reduce their access to health promotion and prevention services compared to the general population. Community empowerment-based interventions that prioritize the engagement of sex workers show promising results. Peer-to-peer interventions, wherein sex workers act as educators of their colleagues, managers, clients and romantic partners, foster community mobilization and critical consciousness among sex workers and equip them to exercise agency in their work and personal lives. A pilot peer health education program was developed and implemented, with and for sex workers in one urban centre in Canada. To explore how the training program contributed to community empowerment and transformative learning among participants, the authors conducted qualitative interviews, asked participants to keep personal journals and to fill out feedback forms after each session. Thematic analysis was conducted on these three data sources, with emerging themes identified, organized and presented in the findings. Five themes emerged from the analysis. Our findings show that the pilot program led to reduced internalized stigma and increased self-esteem in participants. Participants' critical consciousness increased concerning issues of diversity in cultural background, sexual orientation, work experiences and gender identity. Participants gained knowledge about how sex work stigma is enacted and perpetuated. They also became increasingly comfortable challenging negative judgments from others, including frontline service providers. Participants were encouraged to actively shape the training program, which fostered positive relationships and solidarity among them, as well as with colleagues in their social network and with the local sex worker organization housing the program. Resources were also mobilized within the sex worker community through skills building and knowledge acquisition. The peer education program proved successful in enhancing sex workers' community empowerment in one urban setting by increasing their knowledge about health issues, sharing information about and building confidence in accessing services, and expanding capacity to disseminate this knowledge to others. This 'proof of concept' built the foundation for a long-term initiative in this setting and has promise for other jurisdictions wishing to adapt similar programs.

Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services.

PubMed

Arch, Allison E; Weisman, David C; Coca, Steven; Nystrom, Karin V; Wira, Charles R; Schindler, Joseph L

2016-03-01

The failure to recognize an ischemic stroke in the emergency department is a missed opportunity for acute interventions and for prompt treatment with secondary prevention therapy. Our study examined the diagnosis of acute ischemic stroke in the emergency department of an academic teaching hospital and a large community hospital. A retrospective chart review was performed from February 2013 to February 2014. A total of 465 patients with ischemic stroke were included in the analysis; 280 patients from the academic hospital and 185 patients from the community hospital. One hundred three strokes were initially misdiagnosed that is 22% of the included strokes at the combined centers. Fifty-five of these were missed at the academic hospital (22%) [corrected] and 48 were at the community hospital (26%, P=0.11). Thirty-three percent of missed cases presented within a 3-hour time window for recombinant tissue-type plasminogen activator eligibility. An additional 11% presented between 3 and 6 hours of symptom onset for endovascular consideration. Symptoms independently associated with greater odds of a missed stroke diagnosis were nausea/vomiting (odds ratio, 4.02; 95% confidence interval, 1.60-10.1), dizziness (odds ratio, 1.99; 95% confidence interval, 1.03-3.84), and a positive stroke history (odds ratio, 2.40; 95% confidence interval, 1.30-4.42). Thirty-seven percent of posterior strokes were initially misdiagnosed compared with 16% of anterior strokes (P<0.001). Atypical symptoms associated with posterior circulation strokes lead to misdiagnoses. This was true at both an academic center and a large community hospital. Future studies need to focus on the evaluation of identification systems and tools in the emergency department to improve the accuracy of stroke diagnosis. © 2016 American Heart Association, Inc.

A Survey of Community Employment Placements: Where Are Youth and Adults with Disabilities Working?.

ERIC Educational Resources Information Center

Morgan, Robert L.; Ellerd, David A.; Jensen, Kari; Taylor, Matthew J.

2000-01-01

A survey of 109 high school transition programs and 55 adult supported employment programs found that of 7,553 job placements for youth and adults with disabilities, the most frequent category was in food and beverage preparation services. Emerging markets for job placements included tourism and casino jobs. (Contains references.) (Author/CR)

The National Map - Geographic Names

USGS Publications Warehouse

,

2002-01-01

Governments depend on a common set of base geographic information as a tool for economic and community development, land and natural resource management, and health and safety services. Emergency management and homeland security applications rely on this information. Private industry, nongovernmental organizations, and individual citizens use the same geographic data. Geographic information underpins an increasingly large part of the Nation's economy.

The National Map - Orthoimagery

USGS Publications Warehouse

,

2002-01-01

Governments depend on a common set of base geographic information as a tool for economic and community development, land and natural resource management, and health and safety services. Emergency management and homeland security applications rely on this information. Private industry, nongovernmental organizations, and individual citizens use the same geographic data. Geographic information underpins an increasingly large part of the Nation's economy.

An Emerging Population: Student Veterans in Higher Education in the 21st Century

ERIC Educational Resources Information Center

Falkey, Mary E.

2016-01-01

This paper, based on a qualitative study, explores the transition experiences of Post-9/11 Era military veterans from active duty military service to college students for the purpose of adding to the body of knowledge about this student population. The subjects, who voluntarily offered to participate, were 15 community college student/veterans and…

Long-term vegetation changes in a temperate forest impacted by climate change

Treesearch

Lauren E. Oakes; Paul E. Hennon; Kevin L. O' Hara; Rodolfo Dirzo

2014-01-01

Pervasive forest mortality is expected to increase in future decades as a result of increasing temperatures. Climate-induced forest dieback can have consequences on ecosystem services, potentially mediated by changes in forest structure and understory community composition that emerge in response to tree death. Although many dieback events around the world have been...

The National Map - Elevation

USGS Publications Warehouse

,

2002-01-01

Governments depend on a common set of base geographic information as a tool for economic and community development, land and natural resource management, and health and safety services. Emergency management and homeland security applications rely on this information. Private industry, nongovernmental organizations, and individual citizens use the same geographic data. Geographic information underpins an increasingly large part of the Nation's economy.

The National Map - Hydrography

USGS Publications Warehouse

,

2002-01-01

Governments depend on a common set of base geographic information as a tool for economic and community development, land and natural resource management, and health and safety services. Emergency management and homeland security applications rely on this information. Private industry, nongovernmental organizations, and individual citizens use the same geographic data. Geographic information underpins an increasingly large part of the Nation's economy.

New Technologies as a Tool for Changing Academic Communities in the Global Context

ERIC Educational Resources Information Center

Jankowska, Dorota; Tanas, Maciej

2016-01-01

It has been defined that knowledge society emerges at the end of the twentieth century as the socio-economic structure characteristic for developed societies in which unlike in industrial societies, the dominant sector of economy is services and the largest social group is the "men of knowledge". It has been indicated that the…

Developing a community based service model for disability: Listening to the needs of all beneficiaries and providers.

PubMed

Collins, Katrina

2017-12-11

To inform the strategic and operational development of a community based service model at the Crann Centre, Cork, Ireland for SB children, adults, their families and providers. A needs assessment was conducted by gathering the views of multiple stakeholder perspectives within the SB community in the geographical region the Centre will serve. The intention is to create project deliverables that are responsive to the needs highlighted through this research. The study used a multi method design with a participatory research approach to explore the needs of SB individuals, families and providers. This involved in depth interviews, focus groups and online surveys. One hundred and fifty-nine respondents contributed to this qualitative needs assessment. The research established a range of psychosocial, clinical, vocational and educational issues causing ongoing difficulties for SB individuals and families. Providers highlighted supports that would benefit the social and clinical wellbeing of persons with SB. Collectively participants in the study reported that there was an absence of coordinated, continuous and comprehensive service delivery for the SB community in the region. This was amplified by geographical location of services and access to relevant supports. Consensus across stakeholders in this research pointed to the necessity for an innovative model of community based provision at the Crann Centre. This was described as offering a service with family at the core of an assets based model of practice. A key finding was the lack of importance placed on the social and emotional development of SB individuals. Traditionally participants described a singular focus on physical health through clinically defined treatment models. The desire for a social model of disability that informed health and wellbeing of SB individuals and families emerged as a prominent recommendation from the research.

Air ambulance nurses as expert supplement to local emergency services.

PubMed

Wisborg, Torben; Bjerkan, Bjørn

2014-01-01

Flight nurses in the Norwegian National Air Ambulance Service are specialist nurse anesthetists or intensive care nursing specialists. For air ambulance bases far from hospitals, these nurses present otherwise unavailable competencies. This study reports a 6-year experience with flight nurse participation in local emergencies beyond the transportation phase. The fixed-wing air ambulance base in Alta, Northern Norway (20,000 inhabitants), with 2 aircraft and 2 on-call teams is 150 km by road from the nearest hospital. We did a prospective registration of all emergency nonflight missions near the air ambulance base from January 1, 2005, to December 31, 2010. The 217 completed missions corresponded to 3 missions per month, half during daytime. Twenty-three percent of patients were under age 18, injury rate was high (36%), 63% had potentially or manifest life-threatening conditions, and 11% died during treatment. One third of all missions (67/217) resulted in an air ambulance flight to the hospital. Mission frequency did not significantly reduce flight availability, and precision in case selection for this special service was good. The use of flight nurses in the local community promotes equal access to advanced medical services for populations far from hospitals. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Community Disasters, Psychological Trauma, and Crisis Intervention.

PubMed

Boscarino, Joseph A

The current issue of International Journal of Emergency Mental Health and Human Resilience is focused on community disasters, the impact of trauma exposure, and crisis intervention. The articles incorporated include studies ranging from the World Trade Center disaster to Hurricane Sandy. These studies are related to public attitudes and beliefs about disease outbreaks, the impact of volunteerism following the World Trade Center attacks, alcohol misuse among police officers after Hurricane Katrina, posttraumatic stress disorder after Hurricane Sandy among those exposed to the Trade Center disaster, compassion fatigue and burnout among trauma workers, crisis interventions in Eastern Europe, and police officers' use of stress intervention services. While this scope is broad, it reflects the knowledge that has emerged since the Buffalo Creek and Chernobyl catastrophes, to the more recent Hurricane Katrina and Sandy disasters. Given the current threat environment, psychologists, social workers, and other providers need to be aware of these developments and be prepared to mitigate the impact of psychological trauma following community disasters, whether natural or man-made.

Revitalizing communities together: the shared values, goals, and work of education, urban planning, and public health.

PubMed

Cohen, Alison Klebanoff; Schuchter, Joseph W

2013-04-01

Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.

Sustainable and ICT-Enabled Development in Developing Areas: An E-Heritage E-Commerce Service for Handicraft Marketing

NASA Astrophysics Data System (ADS)

Muhammad, Tufail; Kim, Kwan Myung

2018-04-01

Human-induced threats serve as potential hazards to cultural heritage assets, especially in developing areas where the local community, in general, is a deprived class. Sustainable tourism development is acknowledged as an economic activity to ensure careful management of assets along with local community empowerment and participation. As such, ICT-enabled development is applied in rural development projects to promote sustainable rural livelihood, but success is still limited due to a lack of community involvement and sharing in the economic gains of tourism. With this perspective in mind, the present study focuses on emerging marketing models (e-commerce) that can provide new business ventures for local communities by identifying critical online marketing elements driven by local residents.

Developing a Family-Based HIV Prevention Intervention in Rural Kenya: Challenges in Conducting Community-Based Participatory Research

PubMed Central

Puffer, Eve S.; Pian, Jessica; Sikkema, Kathleen J.; Ogwang-Odhiambo, Rose A.; Broverman, Sherryl A.

2013-01-01

Community-based participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. We describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerged related to: negotiating power imbalances between APs and the CAC; CAC members’ shifting roles as part of the CAC and wider community; and anticipated challenges in decision making about sustainability. Factors contributing to ethical dilemmas included low access to education, scarcity of financial resources, and the shortage of HIV-related services despite high prevalence. PMID:23651936

Development of a prototype system for statewide asthma surveillance.

PubMed

Deprez, Ronald D; Asdigian, Nancy L; Oliver, L Christine; Anderson, Norman; Caldwell, Edgar; Baggott, Lee Ann

2002-12-01

We developed and evaluated a statewide and community-level asthma surveillance system. Databases and measures included a community prevalence survey, hospital admissions data, emergency department/outpatient clinic visit records, and a physician survey of diagnosis and treatment practices. We evaluated the system in 5 Maine communities varying in population and income. Asthma hospitalizations were high in the rural/low-socioeconomic-status communities studied, although diagnosed asthma was low. Males were more likely than females to experience asthma symptoms, although they were less likely to have been diagnosed with asthma or to have used hospital-based asthma care. Databases were useful for estimating asthma burden and identifying service needs as well as high-risk groups. They were less useful in estimating severity or in identifying environmental risks.

Post‐war development of emergency medicine in Kosovo

PubMed Central

O'Hanlon, K P

2007-01-01

Objectives To (1) investigate emergency medical care priorities in Kosovo, (2) assess Kosovo's post‐war development of emergency medical services and (3) identify expectations. Methods An instrument with seven open‐ended questions, approved by the institutional review board, was designed for in‐person interviews (preferred) or written survey. The survey was administered in October 2003 at the Kosovo University Clinical Center, Pristina, Kosovo, and one regional hospital. Targeted participants were emergency care providers, clinical consultants and health policy consultants. Surveys were conducted by interview with simultaneous interpretation by a native Albanian speaker, an orthopaedic surgeon or in written Albanian form. The responses were evaluated quantitatively and qualitatively. Results 13 respondents participated in the study: 10 gave interviews and 3 provided written response; 7 were emergency care providers, 4 were emergency care consultants and 2 were health policy consultants. Emergency care priorities were defined as trauma, cardiac disease and suicide. Most respondents believed that emergency medicine as a specialised field was a post‐war development. The international community was credited with the provision of infrastructure, supplies and training. Most respondents denied any harm from international assistance. However, some respondents described instances of inappropriate international investment. Ongoing needs are training of providers and equipping of facilities and vehicles. Improved hospital management, political administration and international involvement are thought to be necessary for continued development. Conclusions Survey respondents agreed on priorities in emergency care, credited the international community with development to date, and identified administrative structures and international training support as the keys to ongoing development. PMID:17183036

Female health workers at the doorstep: a pilot of community-based maternal, newborn, and child health service delivery in northern Nigeria.

PubMed

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-03-01

Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008-2010 (before introduction of the pilot) with data from 2011-2013 (during and after the pilot) to gauge sustainability of the model. Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. © Uzondu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-14-00117.

Community-based child health nurses: an exploration of current practice.

PubMed

Borrow, Stephanie; Munns, Ailsa; Henderson, Saras

2011-12-01

The purpose of this research was to define, the practice domain of community-based child health nursing in light of widespread political, economic and social changes in Western Australia. The project was conducted by a group of nurse researchers with experience in child health nursing from the School of Nursing and Midwifery at Curtin University and the Child and Adolescent Community Health Division at the Department of Health, Western Australia. The overall aim of the project was to map the scope of nursing practice in the community child health setting in Western Australia and to identify the decision making framework that underpins this nursing specialty. Given the widespread social, economic and health service management changes, it was important for nurses involved with, or contemplating a career in, community-based child health to have the role accurately defined. In addition, consumer expectations of the service needed to be explored within the current climate. A descriptive qualitative study was used for this project. A purposive sample of 60 participants was drawn from the pool of child health nurses in the South Metropolitan Community Health Service, North Metropolitan Health Service and Western Australian Country Health Service. Following ethical approval data was collected via participants keeping a 2-week work diary. The data was coded and thematic analysis was applied. Several themes emerged from the analysis which were validated by follow up focus group interviews with participants. This clearly demonstrated common, recurring issues. The results identified that the community-based child health nurses are currently undertaking a more complex and expanded child health service role for an increasingly diverse client population, over their traditional practices which are still maintained. Excessive workloads and lack of human and non human resources also presented challenges. There are increasing requirements for child health nurses to engage in community development and capacity building, often through a multidisciplinary partnership, which requires them to have sound brokerage and facilitation skills to enable community inclusion and inter-agency collaboration at the local level. The study has highlighted the importance and multifaceted nature of the role of the community-based child health nurse. To enable them to function optimally, the following suggestions/recommendations are offered. These being: More physical resources be allocated to community-based child health nursing More resources allocated to assist community-based child health nurses to support culturally and linguistically diverse families Mapping of child health nurses' workloads The development of community health client dependency rating criteria reflecting the social determinants of health in order for health service refinement of staffing allocations based on an acuity scale Specific staff development opportunities to reflect the increased workload complexity Managerial support for the implementation of formal clinical (reflective) supervision Additional clerical assistance with non-nursing duties.

Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial.

PubMed

Di Pollina, Laura; Guessous, Idris; Petoud, Véronique; Combescure, Christophe; Buchs, Bertrand; Schaller, Philippe; Kossovsky, Michel; Gaspoz, Jean-Michel

2017-02-14

Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults. A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers. Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously randomized nursing teams into Control (N = 179) and Intervention (N = 122) groups: Controls received usual care by their primary care physician and home visiting nursing services, the Intervention group received an additional home evaluation by a community geriatrics unit with access to a call service and coordinated follow-up. Recruitment began in July 2009, goals were obtained in July 2012, and outcomes assessed until December 2012. Length of follow-up ranged from 5 to 41 months (mean 16.3). Primary outcome measure was the number of hospitalizations. Secondary outcomes were reasons for hospitalizations, the number and reason of emergency room visits, institutionalization, death, and place of death. The number of hospitalizations did not differ between groups however, the intervention led to lower cumulative incidence for the first hospitalization after the first year of follow-up (69.8%, CI 59.9 to 79.6 versus 87 · 6%, CI 78 · 2 to 97 · 0; p = .01). Secondary outcomes showed that the intervention compared to the control group had less frequent unnecessary hospitalizations (4.1% versus 11.7%, p = .03), lower cumulative incidence for the first emergency room visit, 8.3%, CI 2.6 to 13.9 versus 23.2%, CI 13.1 to 33.3; p = .01), and death occurred more frequently at home (44.4 versus 14.7%; p = .04). No significant differences were found for institutionalization and mortality. Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary hospitalizations, emergency room visits and allowed more patients to die at home. It is an effective tool to improve coordination and access to care for frail and dependent older adults. Clinical Trials.gov Identifier: NCT02084108 . Retrospectively registered on March 10 th 2014.

ESIP Federation: A Case Study on Enabling Collaboration Infrastructure to Support Earth Science Informatics Communities

NASA Astrophysics Data System (ADS)

Robinson, E.; Meyer, C. B.; Benedict, K. K.

2013-12-01

A critical part of effective Earth science data and information system interoperability involves collaboration across geographically and temporally distributed communities. The Federation of Earth Science Information Partners (ESIP) is a broad-based, distributed community of science, data and information technology practitioners from across science domains, economic sectors and the data lifecycle. ESIP's open, participatory structure provides a melting pot for coordinating around common areas of interest, experimenting on innovative ideas and capturing and finding best practices and lessons learned from across the network. Since much of ESIP's work is distributed, the Foundation for Earth Science was established as a non-profit home for its supportive collaboration infrastructure. The infrastructure leverages the Internet and recent advances in collaboration web services. ESIP provides neutral space for self-governed groups to emerge around common Earth science data and information issues, ebbing and flowing as the need for them arises. As a group emerges, the Foundation quickly equips the virtual workgroup with a set of ';commodity services'. These services include: web meeting technology (Webex), a wiki and an email listserv. WebEx allows the group to work synchronously, dynamically viewing and discussing shared information in real time. The wiki is the group's primary workspace and over time creates organizational memory. The listserv provides an inclusive way to email the group and archive all messages for future reference. These three services lower the startup barrier for collaboration and enable automatic content preservation to allow for future work. While many of ESIP's consensus-building activities are discussion-based, the Foundation supports an ESIP testbed environment for exploring and evaluating prototype standards, services, protocols, and best practices. After community review of testbed proposals, the Foundation provides small seed funding and a toolbox of collaborative development resources including Amazon Web Services to quickly spin-up the testbed instance and a GitHub account for maintaining testbed project code enabling reuse. Recently, the Foundation supported development of the ESIP Commons (http://commons.esipfed.org), a Drupal-based knowledge repository for non-traditional publications to preserve community products and outcomes like white papers, posters and proceedings. The ESIP Commons adds additional structured metadata, provides attribution to contributors and allows those unfamiliar with ESIP a straightforward way to find information. The success of ESIP Federation activities is difficult to measure. The ESIP Commons is a step toward quantifying sponsor return on investment and is one dataset used in network map analysis of the ESIP community network, another success metric. Over the last 15 years, ESIP has continually grown and attracted experts in the Earth science data and informatics field becoming a primary locus of research and development on the application and evolution of Earth science data standards and conventions. As funding agencies push toward a more collaborative approach, the lessons learned from ESIP and the collaboration services themselves are a crucial component of supporting science research.

Lessons Learned From an Epidemiologist-Led Countywide Community Assessment for Public Health Emergency Response (CASPER) in Oregon.

PubMed

Repp, Kimberly K; Hawes, Eva; Rees, Kathleen J; Vorderstrasse, Beth; Mohnkern, Sue

2018-06-07

Conducting a large-scale Community Assessment for Public Health Emergency Response (CASPER) in a geographically and linguistically diverse county presents significant methodological challenges that require advance planning. The Centers for Disease Control and Prevention (CDC) has adapted methodology and provided a toolkit for a rapid needs assessment after a disaster. The assessment provides representative data of the sampling frame to help guide effective distribution of resources. This article describes methodological considerations and lessons learned from a CASPER exercise conducted by Washington County Public Health in June 2016 to assess community emergency preparedness. The CDC's CASPER toolkit provides detailed guidance for exercises in urban areas where city blocks are well defined with many single family homes. Converting the exercise to include rural areas with challenging geographical terrain, including accessing homes without public roads, required considerable adjustments in planning. Adequate preparations for vulnerable populations with English linguistic barriers required additional significant resources. Lessons learned are presented from the first countywide CASPER exercise in Oregon. Approximately 61% of interviews were completed, and 85% of volunteers reported they would participate in another CASPER exercise. Results from the emergency preparedness survey will be presented elsewhere. This experience indicates the most important considerations for conducting a CASPER exercise are oversampling clusters, overrecruiting volunteers, anticipating the actual cost of staff time, and ensuring timely language services are available during the event.

Exploring the determinants of health and wellbeing in communities living in proximity to coal seam gas developments in regional Queensland.

PubMed

Mactaggart, Fiona; McDermott, Liane; Tynan, Anna; Gericke, Christian A

2017-08-03

There is some concern that coal seam gas mining may affect health and wellbeing through changes in social determinants such as living and working conditions, local economy and the environment. The onward impact of these conditions on health and wellbeing is often not monitored to the same degree as direct environmental health impacts in the mining context, but merits attention. This study reports on the findings from a recurrent theme that emerged from analysis of the qualitative component of a comprehensive Health Needs Assessment (HNA) conducted in regional Queensland: that health and wellbeing of communities was reportedly affected by nearby coal seam gas (CSG) development beyond direct environmental impacts. Qualitative analysis was initially completed using the Framework Method to explore key themes from 11 focus group discussions, 19 in-depth interviews, and 45 key informant interviews with health and wellbeing service providers and community members. A key theme emerged from the analysis that forms the basis of this paper. This study is part of a larger comprehensive HNA involving qualitative and quantitative data collection to explore the health and wellbeing needs of three communities living in proximity to CSG development in regional Queensland, Australia. Communities faced social, economic and environmental impacts from the rapid growth of CSG development, which were perceived to have direct and indirect effects on individual lifestyle factors such as alcohol and drug abuse, family relationships, social capital and mental health; and community-level factors including social connectedness, civic engagement and trust. Outer regional communities discussed the effects of mining activity on the fabric of their town and community, whereas the inner regional community that had a longer history of industrial activity discussed the impacts on families and individual health and wellbeing. The findings from this study may inform future health service planning in regions affected by CSG in the development /construction phase and provide the mining sector in regional areas with evidence from which to develop social responsibility programs that encompass health, social, economic and environmental assessments that more accurately reflect the needs of the affected communities.

Geographic information systems (GIS): an emerging method to assess demand and provision for rehabilitation services.

PubMed

Passalent, Laura; Borsy, Emily; Landry, Michel D; Cott, Cheryl

2013-09-01

To illustrate the application of geographic information systems (GIS) as a tool to assess rehabilitation service delivery by presenting results from research recently conducted to assess demand and provision for community rehabilitation service delivery in Ontario, Canada. Secondary analysis of data obtained from existing sources was used to establish demand and provision profiles for community rehabilitation services. These data were integrated using GIS software. A number of descriptive maps were produced that show the geographical distribution of service provision variables (location of individual rehabilitation health care providers and location of private and publicly funded community rehabilitation clinics) in relation to the distribution of demand variables (location of the general population; location of specific populations (i.e., residents age 65 and older) and distribution of household income). GIS provides a set of tools for describing and understanding the spatial organization of the health of populations and the distribution of health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery. Implications for Rehabilitation It is important to seek out alternative and innovative methods to examine rehabilitation service delivery. GIS is a computer-based program that takes any data linked to a geographically referenced location and processes it through a software system that manages, analyses and displays the data in the form of a map, allowing for an alternative level of analysis. GIS provides a set of tools for describing and understanding the spatial organization of population health and health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery.

A study of human resource competencies required to implement community rehabilitation in less resourced settings.

PubMed

Gilmore, Brynne; MacLachlan, Malcolm; McVeigh, Joanne; McClean, Chiedza; Carr, Stuart; Duttine, Antony; Mannan, Hasheem; McAuliffe, Eilish; Mji, Gubela; Eide, Arne H; Hem, Karl-Gerhard; Gupta, Neeru

2017-09-22

It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.

Method Extreme Learning Machine for Forecasting Number of Patients’ Visits in Dental Poli (A Case Study: Community Health Centers Kamal Madura Indonesia)

NASA Astrophysics Data System (ADS)

Sari Rochman, E. M.; Rachmad, A.; Syakur, M. A.; Suzanti, I. O.

2018-01-01

Community Health Centers (Puskesmas) are health service institutions that provide individual health services for outpatient, inpatient and emergency care services. In the outpatient service, there are several polyclinics, including the polyclinic of Ear, Nose, and Throat (ENT), Eyes, Dentistry, Children, and internal disease. Dental Poli is a form of dental and oral health services which is directed to the community. At this moment, the management team in dental poli often has difficulties when they do the preparation and planning to serve a number of patients. It is because the dental poli does not have the appropriate workers with the right qualification. The purpose of this study is to make the system of forecasting the patient’s visit to predict how many patients will come; so that the resources that have been provided will be in accordance with the needs of the Puskesmas. In the ELM method, input and bias weights are initially determined randomly to obtain final weights using Generalized Invers. The matrix used in the final weights is a matrix whose outputs are from each input to a hidden layer. So ELM has a fast learning speed. The result of the experiment of ELM method in this research is able to generate a prediction of a number of patient visit with the RMSE value which is equal to 0.0426.

Nursing Home Self-assessment of Implementation of Emergency Preparedness Standards.

PubMed

Lane, Sandi J; McGrady, Elizabeth

2016-08-01

Introduction Disasters often overwhelm a community's capacity to respond and recover, creating a gap between the needs of the community and the resources available to provide services. In the wake of multiple disasters affecting nursing homes in the last decade, increased focus has shifted to this vital component of the health care system. However, the long-term care sector has often fallen through the cracks in both planning and response. Problem Two recent reports (2006 and 2012) published by the US Department of Health and Human Services (DHHS), Office of Inspector General (OIG), elucidate the need for improvements in nursing homes' comprehensive emergency preparedness and response. The Center for Medicare and Medicaid Services (CMS) has developed an emergency preparedness checklist as a guidance tool and proposed emergency preparedness regulations. The purpose of this study was to evaluate the progress made in nursing home preparedness by determining the level of completion of the 70 tasks noted on the checklist. The study objectives were to: (1) determine the preparedness levels of nursing homes in North and South Carolina (USA), and (2) compare these findings with the 2012 OIG's report on nursing home preparedness to identify current gaps. A survey developed from the checklist of items was emailed to 418 North Carolina and 193 South Carolina nursing home administrators during 2014. One hundred seventeen were returned/"bounced back" as not received. Follow-up emails and phone calls were made to encourage participation. Sixty-three completed surveys and 32 partial surveys were received. Responses were compared to data obtained in a 2010 study to determine progress. Progress had been made in many of the overall planning and sheltering-in-place tasks, such as having contact information of local emergency managers as well as specifications for availability of potable water. Yet, gaps still persisted, especially in evacuation standards, interfacing with emergency management officials, establishing back-up evacuation sites and evacuation routes, identification of resident care items, and obtaining copies of state and local emergency planning regulations. Nursing homes have made progress in preparedness tasks, however, gaps persist. Compliance may prove challenging for some nursing homes, but closer integration with emergency management officials certainly is a step in the right direction. Further research that guides evacuation or shelter-in-place decision making is needed in light of persistent challenges in completing these tasks. Lane SJ , McGrady E . Nursing home self-assessment of implementation of emergency preparedness standards. Prehosp Disaster Med. 2016;31(4):422-431.

“If Only Someone Had Told Me…”: Lessons From Rural Providers

PubMed Central

Chipp, Cody; Dewane, Sarah; Brems, Christiane; Johnson, Mark E.; Warner, Teddy D.; Roberts, Laura W.

2010-01-01

Purpose Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers’ knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. Methods Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, “What are the 3 things you wish someone would have told you about delivering health care in rural areas?” were thematically coded. Findings Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. Conclusion Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities. PMID:21204979

Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights.

PubMed

Labys, Charlotte A; Susser, Ezra; Burns, Jonathan K

2016-01-01

Growing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys. We conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach. Interviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital. Our results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.

Enhancing Ear and Hearing Health Access for Children With Technology and Connectivity.

PubMed

Swanepoel, De Wet

2017-10-12

Technology and connectivity advances are demonstrating increasing potential to improve access of service delivery to persons with hearing loss. This article demonstrates use cases from community-based hearing screening and automated diagnosis of ear disease. This brief report reviews recent evidence for school- and home-based hearing testing in underserved communities using smartphone technologies paired with calibrated headphones. Another area of potential impact facilitated by technology and connectivity is the use of feature extraction algorithms to facilitate automated diagnosis of most common ear conditions from video-otoscopic images. Smartphone hearing screening using calibrated headphones demonstrated equivalent sensitivity and specificity for school-based hearing screening. Automating test sequences with a forced-choice response paradigm allowed persons with minimal training to offer screening in underserved communities. The automated image analysis and diagnosis system for ear disease demonstrated an overall accuracy of 80.6%, which is up to par and exceeds accuracy rates previously reported for general practitioners and pediatricians. The emergence of these tools that capitalize on technology and connectivity advances enables affordable and accessible models of service delivery for community-based ear and hearing care.

[Interventions to subsidize payment for care strengthen community empowerment in Burkina Faso].

PubMed

Samb, Oumar M; Ridde, Valéry

2012-02-22

This research project assesses the impact of care subsidy interventions on the empowerment of members of community health services Management Committees (MCs) and their organization in Burkina Faso. The data collection took place in 2010 in 8 primary care centres over 6 months with 140 people. Three health districts of Burkina Faso (Dori, Sebba and Ouargaye). Since 2006, the government subsidizes 80% of emergency neonatal and obstetrical costs for pregnant women. Since 2008, an NGO assumes the remaining 20% and subsidizes 100% of health care costs for children under 5 in Dori and Sebba. In addition, a payment exemption strategy for indigents has been organized at the community level in all three districts. Interventions have strengthened MC members' and their organization's power to act. This has translated into an increased capacity to get involved in the resolution of health problems within the community. The NGO's intervention specifically in Dori and Sebba has led to even greater empowerment there than in Ouargaye. Subsidizing care payments at points of service significantly enhances the potential for increasing the empowerment of MC members and their organization.

Confronting the Emerging Epidemic of HCV Infection Among Young Injection Drug Users

PubMed Central

Khalsa, Jag; Dan, Corinna; Holmberg, Scott; Zibbell, Jon; Holtzman, Deborah; Lubran, Robert; Compton, Wilson

2014-01-01

Hepatitis C virus infection is a significant public health problem in the United States and an important cause of morbidity and mortality. Recent reports document HCV infection increases among young injection drug users in several US regions, associated with America’s prescription opioid abuse epidemic. Incident HCV infection increases among young injectors who have recently transitioned from oral opioid abuse present an important public health challenge requiring a comprehensive, community-based response. We summarize recommendations from a 2013 Office of HIV/AIDS and Infectious Disease Policy convening of experts in epidemiology, behavioral science, drug prevention and treatment, and other research; community service providers; and federal, state, and local government representatives. Their observations highlight gaps in our surveillance, program, and research portfolios and advocate a syndemic approach to this emerging public health problem. PMID:24625174

The Arctic Cooperative Data and Information System: Data Management Support for the NSF Arctic Research Program (Invited)

NASA Astrophysics Data System (ADS)

Moore, J.; Serreze, M. C.; Middleton, D.; Ramamurthy, M. K.; Yarmey, L.

2013-12-01

The NSF funds the Advanced Cooperative Arctic Data and Information System (ACADIS), url: (http://www.aoncadis.org/). It serves the growing and increasingly diverse data management needs of NSF's arctic research community. The ACADIS investigator team combines experienced data managers, curators and software engineers from the NSIDC, UCAR and NCAR. ACADIS fosters scientific synthesis and discovery by providing a secure long-term data archive to NSF investigators. The system provides discovery and access to arctic related data from this and other archives. This paper updates the technical components of ACADIS, the implementation of best practices, the value of ACADIS to the community and the major challenges facing this archive for the future in handling the diverse data coming from NSF Arctic investigators. ACADIS provides sustainable data management, data stewardship services and leadership for the NSF Arctic research community through open data sharing, adherence to best practices and standards, capitalizing on appropriate evolving technologies, community support and engagement. ACADIS leverages other pertinent projects, capitalizing on appropriate emerging technologies and participating in emerging cyberinfrastructure initiatives. The key elements of ACADIS user services to the NSF Arctic community include: data and metadata upload; support for datasets with special requirements; metadata and documentation generation; interoperability and initiatives with other archives; and science support to investigators and the community. Providing a self-service data publishing platform requiring minimal curation oversight while maintaining rich metadata for discovery, access and preservation is challenging. Implementing metadata standards are a first step towards consistent content. The ACADIS Gateway and ADE offer users choices for data discovery and access with the clear objective of increasing discovery and use of all Arctic data especially for analysis activities. Metadata is at the core of ACADIS activities, from capturing metadata at the point of data submission to ensuring interoperability , providing data citations, and supporting data discovery. ACADIS metadata efforts include: 1) Evolution of the ACADIS metadata profile to increase flexibility in search; 2) Documentation guidelines; and 3) Metadata standardization efforts. A major activity is now underway to ensure consistency in the metadata profile across all archived datasets. ACADIS is embarking on a critical activity to create Digital Object Identifiers (DOI) for all its holdings. The data services offered by ACADIS focus on meeting the needs of the data providers, providing dynamic search capabilities to peruse the ACADIS and related cyrospheric data repositories, efficient data download and some special services including dataset reformatting and visualization. The service is built around of the following key technical elements: The ACADIS Gateway housed at NCAR has been developed to support NSF Arctic data coming from AON and now broadly across PLR/ARC and related archives: The Arctic Data Explorer (ADE) developed at NSIDC is an integral service of ACADIS bringing the rich archive from NSIDC together with catalogs from ACADIS and international partners in Arctic research: and Rosetta and the Digital Object Identifier (DOI) generation scheme are tools available to the community to help publish and utilize datasets in integration and synthesis and publication.

Creating an infrastructure for comparative effectiveness research in emergency medical services.

PubMed

Seymour, Christopher W; Kahn, Jeremy M; Martin-Gill, Christian; Callaway, Clifton W; Angus, Derek C; Yealy, Donald M

2014-05-01

Emergency medical services (EMS) providers deliver the initial care for millions of people in the United States each year. The Institute of Medicine noted a deficit in research necessary to improve prehospital care, created by the existence of data silos, absence of long-term outcomes, and limited stakeholder engagement in research. This article describes a regional effort to create a high-performing infrastructure in southwestern Pennsylvania addressing these fundamental barriers. Regional EMS records from 33 agencies in January 2011 were linked to hospital-based electronic health records (EHRs) in a single nine-hospital system, with manual review of matches for accuracy. The use of community stakeholder engagement was included to guide scientific inquiry, as well as 2-year follow up for patient-centered outcomes. Local EMS medicine stakeholders emphasized the limits of single-agency EMS research and suggested that studies focus on improving cross-cutting, long-term outcomes. Guided by this input, more than 95% of EMS records (2,675 of 2,800) were linked to hospital-based EHRs. More than 80% of records were linked to 2-year mortality, with more deaths among EMS patients with prehospital hypotension (30.5%) or respiratory distress (19.5%) than chest pain (5.4%) or nonspecific complaints (9.4%). A prehospital comparative effectiveness research infrastructure composed of patient-level EMS data, EHRs at multiple hospitals, long-term outcomes, and community stakeholder perspectives is feasible and may be scalable to larger regions and networks. The lessons learned and barriers identified offer a roadmap to answering community and policy-relevant research questions in prehospital care. © 2014 by the Society for Academic Emergency Medicine.

Shared environments: a multilevel analysis of community context and child nutritional status in Bangladesh.

PubMed

Corsi, Daniel J; Chow, Clara K; Lear, Scott A; Rahman, M Omar; Subramanian, S V; Teo, Koon K

2011-06-01

The goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0-59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status. Cross-sectional survey. The data are from the nationally representative 2004 Bangladesh Demographic and Health Survey. Respondents were ever-married women (aged 15-49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community. Multilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0.18 (SE 0.07)) and weight-for-age (highest v. lowest tertile, β = 0.21 (SE 0.06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0.13 (SE = 0.06)). The community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.

Consumer opinions of emergency room medical care.

PubMed

McMillan, J R; Younger, M S; DeWine, L C

1984-12-01

If hospital management is to adapt successfully to an increasingly competitive environment, and to retain a viable emergency department, it well be necessary to objectively and accurately assess the hospital's image in the community served. Knowledge of the consumers' views is an essential input into the formulation of strategic plans. This article reports on a study in which consumer opinions on 15 dimensions of emergency room health care were obtained from 723 respondents using a mail questionnaire. Findings reveal that consumers view the emergency room as being more expensive than other health care providers. Except for being available or convenient, little or no advantage is perceived for the emergency room over the personal physician. Even though the emergency room has specialized staff and equipment, consumers do not believe patients receive better or faster treatment in an emergency room than would be obtained in a physician's office. Unless changed, these perceptions will diminish the role of the emergency room in the delivery of health care services.

Governing drug use through partnerships: Towards a genealogy of government/non-government relations in drug policy.

PubMed

Thomas, Natalie; Bull, Melissa; Dioso-Villa, Rachel; Smith, Catrin

2016-02-01

Drug policy in Australia is underpinned by the idea of partnerships wherein the non-government sector is one important partner in both delivering services and contributing to policy and decision-making processes. This article presents a genealogy of the concept of government/non-government 'partnerships', tracing its emergence and development within drug policy discourse in Australia. We find that the rise of neo-liberal policies since the 1980s has been a key factor facilitating the emergence of government/non-government 'partnerships' rhetoric in drug policy. Since the 1980s, the role of non-government organisations (NGOs) in drug policy has been articulated in relation to 'community' responsibilisation in contrast to the welfarist reliance on expert intervention. We link the rise of this rhetoric with the neo-liberal turn to governing through community and the individualisation of social problems. Furthermore, although we find that governments on the whole have encouraged the service delivery and policy work of NGOs at least in policy rhetoric, the actions of the state have at times limited the ability of NGOs to perform advocacy work and contribute to policy. Constraints on NGO drug policy work could potentially compromise the responsiveness of drug policy systems by limiting opportunities for innovative policy-making and service delivery. Copyright © 2015 Elsevier B.V. All rights reserved.

GIO-EMS and International Collaboration in Satellite based Emergency Mapping

NASA Astrophysics Data System (ADS)

Kucera, Jan; Lemoine, Guido; Broglia, Marco

2013-04-01

During the last decade, satellite based emergency mapping has developed into a mature operational stage. The European Union's GMES Initial Operations - Emergency Management Service (GIO-EMS), is operational since April 2012. It's set up differs from other mechanisms (for example from the International Charter "Space and Major Disasters"), as it extends fast satellite tasking and delivery with the value adding map production as a single service, which is available, free of charge, to the authorized users of the service. Maps and vector datasets with standard characteristics and formats ranging from post-disaster damage assessment to recovery and disaster prevention are covered by this initiative. Main users of the service are European civil protection authorities and international organizations active in humanitarian aid. All non-sensitive outputs of the service are accessible to the public. The European Commission's in-house science service Joint Research Centre (JRC) is the technical and administrative supervisor of the GIO-EMS. The EC's DG ECHO Monitoring and Information Centre acts as the service's focal point and DG ENTR is responsible for overall service governance. GIO-EMS also aims to contribute to the synergy with similar existing mechanisms at national and international level. The usage of satellite data for emergency mapping has increased during the last years and this trend is expected to continue because of easier accessibility to suitable satellite and other relevant data in the near future. Furthermore, the data and analyses coming from volunteer emergency mapping communities are expected to further enrich the content of such cartographic products. In the case of major disasters the parallel activity of more providers is likely to generate non-optimal use of resources, e.g. unnecessary duplication; whereas coordination may lead to reduced time needed to cover the disaster area. Furthermore the abundant number of geospatial products of different characteristics and quality can become confusing for users. The urgent need for a better coordination has led to establishment of the International Working Group on Satellite Based Emergency Mapping (IWG-SEM). Members of the IWG-SEM, which include JRC, USGS, DLR-ZKI, SERVIR, Sentinel Asia, UNOSAT, UN-SPIDER, GEO, ITHACA and SERTIT have recognized the need to establish the best practice between operational satellite-based emergency mapping programs. The group intends to: • work with the appropriate organizations on definition of professional standards for emergency mapping, guidelines for product generation and reviewing relevant technical standards and protocols • facilitate communication and collaboration during the major emergencies • stimulate coordination of expertise and capacities. The existence of the group and the cooperation among members already brought benefits during recent disasters in Africa and Europe in 2012 in terms of faster and effective satellite data provision and better product generation.

Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey.

PubMed

Kyei-Onanjiri, Minerva; Carolan-Olah, Mary; Awoonor-Williams, John Koku; McCann, Terence V

2018-03-15

Maternal morbidity and mortality is most prevalent in resource-poor settings such as sub-Saharan Africa and southern Asia. In sub-Saharan Africa, Ghana is one of the countries still facing particular challenges in reducing its maternal morbidity and mortality. Access to emergency obstetric care (EmOC) interventions has been identified as a means of improving maternal health outcomes. Assessing the range of interventions provided in health facilities is, therefore, important in determining capacity to treat obstetric emergencies. The aim of this study was to examine the availability of emergency obstetric care interventions in the Upper East Region of Ghana. A cross-sectional survey of 120 health facilities was undertaken. Status of emergency obstetric care was assessed through an interviewer administered questionnaire to directors/in-charge officers of maternity care units in selected facilities. Data were analysed using descriptive statistics. Eighty per cent of health facilities did not meet the criteria for provision of emergency obstetric care. Comparatively, private health facilities generally provided EmOC interventions less frequently than public health facilities. Other challenges identified include inadequate skill mix of maternity health personnel, poor referral processes, a lack of reliable communication systems and poor emergency transport systems. Multiple factors combine to limit women's access to a range of essential maternal health services. The availability of EmOC interventions was found to be low across the region; however, EmOC facilities could be increased by nearly one-third through modest investments in some existing facilities. Also, the key challenges identified in this study can be improved by enhancing pre-existing health system structures such as Community-based Health Planning and Services (CHPS), training more midwifery personnel, strengthening in-service training and implementation of referral audits as part of health service monitoring. Gaps in availability of EmOC interventions, skilled personnel and referral processes must be tackled in order to improve obstetric outcomes.