Restoring mortality as a measure of community health

In the last several decades traditional community health indicators have become ambiguous and lost some of their relevance. During this same period national and international health agencies adopted new expanded definitions of Health that include underlying social determinants. These two influences are responsible for a proliferation of new health indicators and many are constructed from a combination of older mortality measures and available information on morbidity. Problems inherent in attempting to combine these sources of information have produced a situation where some indicators are difficult to calculate at the national level and may not function at all for small communities. What is needed is a relevant measure of the burden of ill health appropriate for smaller populations that is accessible to local health planners. ^ Death records are still the best available population health information. In Europe the burden of health problems is often portrayed using 'premature' death. Health agencies in the United States have moved to adopt Years of Potential Life Lost. Both these regions are also developing systems of 'avoidable' or 'preventable' death as health indicators. This research proposes a method combining these methodologies to produce a relevant indicator portraying the burden of ill health in communities. ^

The local safety net, health insurance, preventable hospitalizations and costs: Harris County (Houston), Texas

The aim of this study was to examine the association between determinants of access to healthcare and preventable hospitalizations, based on Davidson et al.'s framework for evaluating the effects of individual and community determinants on access to healthcare. The study population consisted of the low income, non-elderly, hospitalized adults residing in Harris County, Texas in 2004. The objectives of this study were to examine the proportion of the variance in preventable hospitalizations at the ZIP-code level, to analyze the association between the proximity to the nearest safety net clinic and preventable hospitalizations, to examine how the safety net capacity relates to preventable hospitalizations, to compare the relative strength of the associations of health insurance and the proximity to the nearest safety net clinic with preventable hospitalizations, and to estimate and compare the costs of preventable hospitalizations in Harris County with the average cost in the literature. The data were collected from Texas Health Care Information Collection (2004), Census 2000, and Project Safety Net (2004). A total of 61,841 eligible individuals were included in the final data analysis. A random-intercept multi-level model was constructed with two different levels of data: the individual level and the ZIP-code level. The results of this study suggest that ZIP-code characteristics explain about two percent of the variance in preventable hospitalizations and safety net capacity was marginally significantly associated with preventable hospitalizations (p= 0.062). Proximity to the nearest safety net clinic was not related to preventable hospitalizations; however, health insurance was significantly associated with a decreased risk of preventable hospitalization. The average direct cost was $6,466 per preventable hospitalization, which is significantly different from reports in the literature. ^

Evaluation of a solid phase microextraction method for community-based monitoring of 1,3-butadiene and benzene in Houston, Texas

The Houston region is home to arguably the largest petrochemical and refining complex anywhere. The effluent of this complex includes many potentially hazardous compounds. Study of some of these compounds has led to recognition that a number of known and probable carcinogens are at elevated levels in ambient air. Two of these, benzene and 1,3-butadiene, have been found in concentrations which may pose health risk for residents of Houston.^ Recent popular journalism and publications by local research institutions has increased the interest of the public in Houston's air quality. Much of the literature has been critical of local regulatory agencies' oversight of industrial pollution. A number of citizens in the region have begun to volunteer with air quality advocacy groups in the testing of community air. Inexpensive methods exist for monitoring of ozone, particulate matter and airborne toxic ambient concentrations. This study is an evaluation of a technique that has been successfully applied to airborne toxics.^ This technique, solid phase microextraction (SPME), has been used to measure airborne volatile organic hydrocarbons at community-level concentrations. It is has yielded accurate and rapid concentration estimates at a relatively low cost per sample. Examples of its application to measurement of airborne benzene exist in the literature. None have been found for airborne 1,3-butadiene. These compounds were selected for an evaluation of SPME as a community-deployed technique, to replicate previous application to benzene, to expand application to 1,3-butadiene and due to the salience of these compounds in this community. ^ This study demonstrates that SPME is a useful technique for quantification of 1,3-butadiene at concentrations observed in Houston. Laboratory background levels precluded recommendation of the technique for benzene. One type of SPME fiber, 85 μm Carboxen/PDMS, was found to be a sensitive sampling device for 1,3-butadiene under temperature and humidity conditions common in Houston. This study indicates that these variables affect instrument response. This suggests the necessity of calibration within specific conditions of these variables. While deployment of this technique was less expensive than other methods of quantification of 1,3-butadiene, the complexity of calibration may exclude an SPME method from broad deployment by community groups.^

A Su Salud Injury Prevention expansion: Analysis of injury prevention perceptions in a Hispanic community

Unintentional injury is the leading cause of death for American ages one to 44 and is ranked in the top ten causes of death for all age groups (CDC, 2006a). A Su Salud Injury Prevention was developed to address injury prevention awareness and education. The program is a mass media education campaign that uses role models, mass media, and community outreach to prevent injury. In 2009, University Health System (UHS) expanded the program. Baseline data were collected from 426 residents in targeted neighborhoods northwest of downtown San Antonio to support the expansion. The purpose of this study was to explore injury perceptions, knowledge, and behaviors of adults living in the expansion area, and define the predominant factors associated with these perceptions. A secondary aim was to assess community awareness and willingness to participate in the program.^ Survey results showed motor vehicle crashes (MVC), falls, drinking and driving, and guns and assaults were considered the most serious injures for adults. The most serious child injuries were MVC, abuse and neglect, falls, and head injuries. Residents were knowledgeable of state seatbelt policy, and over 90% responded as compliant for seatbelt and child car seat use. Most were knowledgeable about drinking and driving state policy and negative outcomes. However, 70% of those reporting driving under the influence of alcohol within the last year engaged in repeat high risk behavior. Men and residents under the age of 55 were more likely to engage in repeat drinking and driving (OR= 3.6, 7.0 respectively). Residents consider injury prevention an important issue, and have interest in a local injury prevention program. Younger women are the most likely to participate in a local program as potential role models and volunteers.^ Results from the study are summarized into an injury prevention and demographic profile of the community that will be used to develop tailored injury prevention messages to create a more effective program, and support program coordinators in effective community engagement. Results will also be used as a comparative basis for future evaluation of a behavioral injury prevention program focused on a predominantly Mexican-American community.^

Liberation of hope: An ethnographic study of community-based initiatives in Houston, Texas

This is an ethnographic study about the worldview of community-based initiatives in Houston, Texas, and the people who work in them. People who participated in this study recognize that their direct constructive action is at the heart of authentic social change in their minority communities. Through qualitative data analysis, a constellation of relationships and process patterns were found to constitute themselves into the system of the community-based initiative. The predominant patterns identified from the findings in this study are: the pervasiveness of place, the importance of people, unique initiatory patterns, the concrete local sustainability, the ever-present action orientation, the resourceful use of networks and inter-relationships, the significance of church influence, the core sense of spirituality and the essence of hope. These patterns emerged out of the local knowledge, which is acutely sensitive to the elements of history and lived experience, embedded in the distinctive moral and visionary patterns of meaning and expression. Findings from the research reveal that these community-based initiatives are not programs--they are people--people who keep hope alive in their communities and who, by their daily practice, liberate others. ^

Community health workers: The critical link to sustainable, healthy societies in low-resource settings---A model for the Baylor Shoulder to Shoulder Foundation

Community health workers (CHWs) can serve as a bridge between healthcare providers and communities to positively impact social determinants of health and, thus, the overall health of the population. The potential to effect lasting change is particularly significant within resource-poor settings with limited access to formally trained health care providers such as the small, rural village of Santa Ana Intibucá, Honduras and surrounding areas—located on the geographically and politically isolated border of Honduras and El Salvador. The Baylor Shoulder to Shoulder Foundation (BSTS) works in conjunction with Santa Ana's volunteer health committee to bring a health brigade that has provided health care and public health projects to the area at least twice a year since 2001. They have also hired a full-time Honduran physician, a Honduran in-country administrative director, and built a clinic; yet, no community health worker program exists. This CHW program model is the response to a clear need for a CHW program within the area served by BSTS and presents a CHW program model specific to Santa Ana Intibucá and surrounding areas to be implemented by BSTS. Methods used to develop this model include reviewing the literature for recommendations from leading authorities as well as successfully implemented CHW programs in comparable regions. This information was incorporated into existing knowledge and materials currently being used in the area. Using the CHW model proposed here, each brigade, in conjunction with the communities served, can help develop new modules to respond to the specific health priorities of the region at that time, incorporating consistent modes of contact with the local physician and the CHWs to provide refresher courses, training in new topics of interest, and to be reminded of the importance of community health workers' role as the critical link to healthy societies. With cooperation, effort, and support, the brigade can continue to help integrate a sustainable CHW system in which communities may be able to maximize the care they receive while also learning to care for their own health and the future of their communities.^

Marine Isotope Stage (MIS) 11 results of model data with Community Climate System Model version 3 including the Dynamic Global Vegetation Model (CCSM3-DGVM) in NetCDF format at global and regional scale

The climate of Marine Isotope Stage (MIS) 11, the interglacial roughly 400,000 years ago, is investigated for four time slices, 416, 410, 400, and 394 ka. The overall picture is that MIS 11 was a relatively warm interglacial in comparison to preindustrial, with Northern Hemisphere (NH) summer temperatures early in MIS 11 (416-410 ka) warmer than preindustrial, though winters were cooler. Later in MIS 11, especially around 400 ka, conditions were cooler in the NH summer, mainly in the high latitudes. Climate changes simulated by the models were mainly driven by insolation changes, with the exception of two local feedbacks that amplify climate changes. Here, the NH high latitudes, where reductions in sea ice cover lead to a winter warming early in MIS 11, as well as the tropics, where monsoon changes lead to stronger climate variations than one would expect on the basis of latitudinal mean insolation change alone, are especially prominent. The results support a northward expansion of trees at the expense of grasses in the high northern latitudes early during MIS 11, especially in northern Asia and North America.

Biology community and bottom sediments in the West Bay of the Furugelm Island, Sea of Japan

An experiment was carried out on the soft bottom in the sublitoral zone of the Furugelm Island (Peter the Great Bay, Sea of Japan) to study formation of benthic communities. Boxes with defauned sediments were placed on depths of 4, 6 and 13 m and exposed during 60 days in the summer period. Half of them were covered with a net with mesh size 2 cm to prevent effect of large predators. It was found that spatial pattern of invertebrates' sinking in the bay conforms to distribution of benthic communities. Larvae of benthic invertebrates sinks in general in places inhabited by their adult species. The main factors responsible for recolonzation are: sediment type and local hydrodynamic conditions. Heart-shaped sea urchin Echinocardium cordatum is numerically dominated in the bay on depth 3-4.5 m, but its larvae sinks in the deeper area. Community structure is supported by mature specimen migration to places inhabited by species. Predators affect largely on the species.

¿Qué es el arte comunitario? Definiciones de la literatura especializada iberoamericana y local

En esta presentación se intenta iluminar un tipo de arte en las márgenes, en espacios alternativos de producción y circulación de obras fuera de los tradicionales. Es decir, se focaliza en experiencias creativas a veces invisibles para no directamente envueltos en estas experiencias: el arte comunitario. En este trabajo se lleva a cabo entonces una revisión acerca del término arte comunitario en la actualidad, basándonos en autores nacionales. El objetivo de este trabajo es analizar si este término de gran difusión entre los países angloparlantes (community arts) es aplicable en el ámbito latinoamericano, y cuál es el grado de avance alrededor de su definición, componentes e impacto, dentro de la investigación académica hispano- parlante. En base a estas aproximaciones se concluye que lo distintivo del arte comunitario es su naturaleza grupal, envolviendo la participación activa de grupos en un proceso creativo, que se desarrolla en la comunidad. Apunta al bienestar de las personas, las ayuda a compartir experiencias y comprenderse entre sí. Se focaliza en grupos específicos, en sus necesidades y preferencias; además, puede alcanzar a personas con poca afinidad a centros culturales estandarizados; por otra parte, además de envolver a estas personas en actividades artísticas, colabora en el desarrollo progresivo de sus habilidades artísticas

El gobierno local como promotor de políticas de participación ciudadana. Aprendizajes y dificultades en dos experiencias municipales

El propósito de este trabajo es analizar el proceso de surgimiento, implementación y resultados alcanzados en dos experiencias locales participativas en municipios de la Pcia. de Buenos Aires a partir de la recuperación de la perspectiva de los propios actores (funcionarios, grupos técnicos profesionales y organizaciones de la comunidad). Para la comparación de los casos se tomaron como ejes de análisis los distintos momentos de la política pública: -el surgimiento de la política: interesó indagar qué actor tuvo la iniciativa y cómo se fundamentó la política (es decir qué concepciones asumieron los procesos participativos); -respecto al proceso de implementación, a través de qué estrategias (metodologías y técnicas) se llevaron a cabo las experiencias y cuáles fueron los actores participantes; -finalmente se describieron los resultados de estas experiencias: el alcance y la calidad de los procesos que desencadenan tanto en el ámbito de la gestión de gobierno como en la relación del municipio con la sociedad

Desarrollo local sostenible y gestión ambiental pública. Articulación entre las ONG ambientales y el municipio de Luján, provincia de Buenos Aires, durante el período 2005-2007

El desarrollo local ambientalmente sostenible del territorio pondera variables económicas, sociales y ambientales, y en él es esencial la legitimidad política: necesita ser construido por consenso en un ámbito democrático. La articulación entre los actores sociales (Estado, sociedad civil y mercado) constituye una dimensión relevante para su logro. El objeto del presente artículo1 es identificar las potencialidades y restricciones de la articulación municipio organizaciones no gubernamentales para la gestión de problemáticas ambientales, teniendo en cuenta el papel que en tal relación juega la comunidad científica local. El recorte espacial válido para la investigación es el Municipio de Luján en la Provincia de Buenos Aires, que cuenta con gran cantidad y diversidad de ONG, cumple con las condiciones de escala poblacional para el desarrollo local y en el que se emplaza la sede central de la Universidad Nacional de Luján.

El gobierno local como promotor de políticas de participación ciudadana. Aprendizajes y dificultades en dos experiencias municipales

El propósito de este trabajo es analizar el proceso de surgimiento, implementación y resultados alcanzados en dos experiencias locales participativas en municipios de la Pcia. de Buenos Aires a partir de la recuperación de la perspectiva de los propios actores (funcionarios, grupos técnicos profesionales y organizaciones de la comunidad). Para la comparación de los casos se tomaron como ejes de análisis los distintos momentos de la política pública: -el surgimiento de la política: interesó indagar qué actor tuvo la iniciativa y cómo se fundamentó la política (es decir qué concepciones asumieron los procesos participativos); -respecto al proceso de implementación, a través de qué estrategias (metodologías y técnicas) se llevaron a cabo las experiencias y cuáles fueron los actores participantes; -finalmente se describieron los resultados de estas experiencias: el alcance y la calidad de los procesos que desencadenan tanto en el ámbito de la gestión de gobierno como en la relación del municipio con la sociedad

Desarrollo local sostenible y gestión ambiental pública. Articulación entre las ONG ambientales y el municipio de Luján, provincia de Buenos Aires, durante el período 2005-2007

El desarrollo local ambientalmente sostenible del territorio pondera variables económicas, sociales y ambientales, y en él es esencial la legitimidad política: necesita ser construido por consenso en un ámbito democrático. La articulación entre los actores sociales (Estado, sociedad civil y mercado) constituye una dimensión relevante para su logro. El objeto del presente artículo1 es identificar las potencialidades y restricciones de la articulación municipio organizaciones no gubernamentales para la gestión de problemáticas ambientales, teniendo en cuenta el papel que en tal relación juega la comunidad científica local. El recorte espacial válido para la investigación es el Municipio de Luján en la Provincia de Buenos Aires, que cuenta con gran cantidad y diversidad de ONG, cumple con las condiciones de escala poblacional para el desarrollo local y en el que se emplaza la sede central de la Universidad Nacional de Luján.