Concepts of community psychiatry; a framework for training.

Bibliography: p. 205-211.

The role of Community Health Workers. Historical perspective of facilitators and barriers. Case study in Vaupés, Colombia

Thesis (Master's)--University of Washington, 2016-06

Emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection in Queensland, Australia

Objectives: To investigate the incidence and epidemiology of non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA) infection in south-east Queensland, Australia. Study design: A retrospective survey was done of hospital records of all patients who had non-multiresistant MRSA isolated at Ipswich Hospital (a 250-bed general hospital, 40 km south-west of Brisbane, Queensland, Australia) between March 2000 and June 2001. Laboratory typing of these isolates was done with antibiogram, pulsed-field gel electrophoresis, bacteriophage typing and coagulase gene typing. Results: There were 44 infections caused by nmMRSA. Seventeen infections (39%) occurred in patients from the south-west Pacific Islands (predominantly Samoa, Tonga and New Zealand). Laboratory typing showed that the isolates in Pacific Islanders were Pacific Island strains, and 16/17 of these infections were community acquired. Twenty-three infections (52%) occurred in Caucasians. Eleven of the isolates from Caucasians (48%) were a new predominantly community-acquired strain that we have termed the ‘R’ pulsotype, nine (39%) were Pacific Island strains, and three (13%) were health care institution-associated strains. Four infections occurred in patients who were not Caucasians or Pacific Islanders. Overall, 34 of all 44 infections (77%) were community' acquired. Conclusions: Non-multiresistant MRSA infection, relatively frequently observed in Pacific Islanders in south-east Queensland, is now a risk for Caucasians as well, and is usually community acquired. Clinicians should consider taking microbiological specimens for culture and antimicrobial susceptibility testing in patients with suspected staphylococcal infections who are not responding to empirical therapy with β-lactam antibiotics.

The performance of community organisers in promotion of community forestry in Leyte Province, Phillipines

A study was conducted to assess the role and effectiveness of community organisers in supporting the development of people’s organisations in achieving community-based forest management objectives in Leyte Province Philippines. Community organisers were found to be effective in forming people’s organisations (POs), motivating people to participate in voluntary activities organised by POs and encouraging cohesiveness among PO members. Community organisers manage to raise the level of environmental awareness and knowledge of members of people’s organisations, develop leadership interest and skills, create various livelihood opportunities and provide direction and facilitate the establishment of large tree plantations. However, the short duration of community organisers’ contracts (typically two years) is insufficient to establish mature and cohesive POs prepared to assume management on their own, including the management of tree plantations. Further, lack of training and funding support, low wages, delayed payment of salaries and limited time to work with people’s organisations, as well as the pressure to produce tangible outputs such the establishment of large tree plantations, prevents them from placing greater emphasis on the development and empowerment of the people.

The promotion and disruption of community service delivery systems

In this paper, we report data drawn from a larger project on the functioning of the Queensland community service delivery system, particularly that providing services to people with disabilities. Our reasoning for focusing at this level is that, from the service user's perspective, support is derived from the service delivery system, not just individual service providers. Defining the service delivery system as formal services and informal support networks, we undertook interviews and focus groups with service providers in six areas in Queensland: inner urban, outer urban, rural and remote. The period on which we report is one in which considerable reform activity had been undertaken by funding bodies of the Commonwealth and State governments. We report on those factors we identified which promote the integrated functioning of the service delivery system, as well as those factors that disrupt it. We conclude with a brief evaluative analysis of the current status of the system.

Wading through the quagmire: Making sense of dietary supplement utilization

Since the 1980s, numerous studies conducted in the United States have attempted to estimate the prevalence of supplement use among the population (e.g., the National Health and Nutrition Survey and the National Health Interview Surveys). Despite these efforts, the true extent of supplement use is unclear. The literature pertaining to the prevalence of supplement use refers to a confusing array of ambiguous terms. Forming accurate conclusions about supplement use is confounded by differences in terminology and methodology between studies. Direct comparisons between studies are therefore inherently problematic. The emphasis in future investigations should be on standardizing the study design; recording data on daily, weekly, or even monthly use in order to establish the safety and efficacy of supplement use; and adopting a consistent, uniform definition of the term supplement.

Use of community genetic screening to prevent HFE-associated hereditary haemochromatosis

HFE-associated hereditary haemochromatosis is a recessive, iron-overload disorder that affects about one in 200 north Europeans and that can be easily prevented. However, genetic screening for this disease is controversial, and so we assessed whether such screening was suitable for communities. Cheek-brush screening for the Cys282Tyr HFE mutation was offered to individuals in the workplace. Outcomes were assessed by questionnaires before and after testing. 11307 individuals were screened. We recorded no increase in anxiety. in individuals who were homozygous for the Cys282Tyr mutation or non-homozygous. Self-reported tiredness before testing was significantly higher in homozygous participants than in non-homozygous participants (chi(2) test, p=0.029). Of the 47 homozygous individuals identified, 46 have taken steps to treat or prevent iron accumulation. Population genetic screening for HFE-associated hereditary haemochromatosis can be practicable and acceptable.

Empiric management of community-acquired pneumonia in Australian emergency departments

Objective: To describe empiric community-acquired pneumonia (CAP) management in Australian hospital emergency departments (EDs) and evaluate this against national guidelines, including use of the pneumonia severity index and antibiotic selection. Design: A multicentre, cross-sectional, retrospective audit, April 2003 to February 2005. Setting: 37 Australian hospitals: 22 principal referral hospitals, six large major city hospitals, four large regional hospitals, four medium hospitals and one private hospital. Participants: Adult patients with a diagnosis of CAP made in the ED. Data on 20 consecutive CAP ED presentations were collected in participating hospitals. Outcome measures: Documented use of the pneumonia severity index, initial antibiotic therapy prescribed in the ED, average length of stay, inpatient mortality, and concordance with national guidelines. Results: 691 CAP presentations were included. Pneumonia severity index use was documented in 5% of cases. Antibiotic therapy covering common bacterial causes of CAP was prescribed in 67% of presentations, although overall concordance with national guidelines was 18%. Antibiotic prescribing was discordant due to inadequate empiric antimicrobial cover, allergy status (including contraindication to penicillin), inappropriate route of administration and/or inappropriate antibiotic choice according to recommendations. There was no significant difference between concordant and discordant antibiotic prescribing episodes in average length of stay (5.0 v 5.7 days; P=0.22) or inpatient mortality (1.6% v 4.1%; chi(2) = 1.82; P=0.18). Conclusions: Antibiotic therapy for CAP prescribed in Australian EDs varied. Concordance with national CAP guidelines was generally low. Targeted interventions are required to improve concordance.

Views from Hamburg : the Juno Trader case or how to make sense of the coastal State's rights in the light of its duty of prompt release

Special edition: The United Nations and international legal order - the case of the Juno Trader - on 18 December 2004, the International Tribunal for the Law of the Sea ordered the prompt release of a refrigerated cargo vessel and its cargo for fisheries violations in an exclusive economic zone - Tribunal unanimously decided that the vessel and cargo be released, upon posting of a bond in the form of a bank guarantee - crew should be free to leave without conditions - in this case, on prompt release, the Tribunal made valuable contributions to existing case law on the issue - shows that specialised tribunals may perform a decentralised application of the international rule of law - crystallises international fundamental standards of fairness and human rights.