255 resultados para Intergovernmental personnel programs
Resumo:
Background Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). Objective To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. Design A prospective cross-sectional survey was used to conduct a national audit. Setting Community setting of CHF-MPs for patients postdischarge. Sample All CHF-MPs operating during 2005–2006 (n=55). Also 10–50 consecutive patients from 48 programmes were recruited (n=1157). Main outcome measures (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes. Results Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26–260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). Conclusion CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.
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Objectives:
Design and Methods:
This study involved a cross-sectional survey of 304 public health practitioners and policy-makers from government, non-government, and community organizations across Victoria, Australia. Participants reported their organizations' current obesity prevention programs and policies, their own perceptions of the feasibility and effectiveness of strategies to prevent obesity and their preferred settings for obesity prevention.
Results:
Thirty-nine percent had an obesity prevention policy, and 92% were implementing obesity prevention programs. The most common programs focused on education, skill-building, and increasing access to healthy eating/physical activity opportunities. School curriculum-based initiatives, social support for physical activity, and family-based programs were considered the most effective strategies, whereas curriculum-based initiatives, active after-school programs, and providing access to and information about physical activity facilities were deemed the most feasible strategies. Schools were generally perceived as the most preferred setting for obesity prevention.
Conclusion:
Many organizations had obesity prevention programs, but far fewer had obesity prevention policies. Current strategies and those considered feasible and effective are often mismatched with the empirical literature. Systems to ensure better alignment between researchers, practitioners, and policy-makers, and identifying effective methods of translating empirical evidence into practice and policy are required.
Resumo:
There is now a substantial amount of published literature describing the range of programs and interventions that have been implemented in an attempt to improve aspects of community safety. Only a small body of this work, however, has examined the outcomes of those programs delivered to Indigenous Australians or, indeed, the communities in which they live. This Issues paper provides an overview of those programs that were identified in a systematic search of relevant research databases.
Although a wide range of programs have been described, the diversity of these programs—combined with the limited published data available that documents their outcomes—makes it difficult to articulate what constitutes effective practice in this area.
It is concluded that an evidence-based approach to practice in this area is essential if the long-term aim of the Closing the Gap initiative is to be achieved. To generate this evidence, however, more attention is needed to develop evaluation methods that assess the impact of program activities on medium and longer term outcomes.
In addition, information about program outcomes needs to be integrated with what is known about the mechanisms by which effective programs are delivered, as well as with knowledge about how they might be most effectively implemented in different communities.
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Issue addressed:
Methods:
Semistructured telephone or face-to-face interviews with 25 key informants from stakeholder organisations were conducted. Key informants discussed strategies used by their organisation to effectively recruit and retain participants into community-based healthy eating and/or physical activity programs. Transcribed data were analysed with NVivo software.
Results:
Effective recruitment strategies included word of mouth, links with organisations, dissemination of printed materials, media, referrals, cross-promotion of programs and face-to-face methods. Effective retention strategies included encouraging a sense of community ownership, social opportunities, recruiting a suitable leader and offering flexibility and support. Fees and support for recruiting and retaining participants was also identified.
Conclusion:
This study provides novel insights to a greatly under researched topic in the field of health promotion. There are two key take-home messages from the present study that are applicable to health practitioners as well as developers and deliverers of community health-promotion programs: (1) it is imperative that all community health organisations report on the effectiveness of their recruitment and retention, both successes and failures; and (2) there is a clear need to tailor the recruitment and retention approach to the target population and the setting the program is occurring in.
So what?
These findings provide important insights for the development of future community-based healthy eating and physical activity programs.
Resumo:
This chapter describes the professional learning of the author while coordinating a literacy intervention program at the state secondary school where she was teaching English.
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Purpose
The physical demands and hazards associated with emergency service work place particular stress on responders’ cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel.
Methods
A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format.
Results
Fifteen studies were rated ‘Weak’ and one study was rated ‘Strong’. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk.
Conclusion
Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.
Resumo:
Obesity is an emerging problem for African migrants in Australia, but few prevention programs incorporate their cultural beliefs and values. This study reports on the application of community capacity-building and empowerment principles in 4 workshops with Sudanese families in Australia. Workshop participants prioritized health behaviors, skill and knowledge gaps, and environments for change to identify culturally centered approaches to health promotion. The workshops highlighted a need for culturally and age-appropriate interventions that build whole-of-family skills and knowledge around the positive effects of physical activity and nutrition to improve health within communities while reducing intergenerational and gender role family conflicts.
