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A scale of acculturation and its development and use are discussed. In a study, 851 Arabic-speaking adults seen by 20 Arabic-speaking general practitioners in Australia showed significant inverse associations between acculturation and preferences for patient, vs family, involvement in medical decision making. Data were from an eight-item scale assessing acculturation.

Seven major conceptual/perceptual shifts which influence approaches to the prevention of alcohol-related problems have been identified. These occurred in recent years. The shift away from measures of mean consumption as the principal indicator of use and problems is emphasized. The move has been toward an incorporation of temporal patterns of use. Prevention strategies and their relative merits are considered for the whole population and for those at high risk. No single distribution theory adequately accounts for alcohol consumption. Alcohol may be an exception to population health models based on mean distributions. Several other conclusions were reached.

Levels of fecal contamination were measured over a three-year period at certain ocean swimming pools and at stormwater outlets in eastern Sydney, Australia, to see whether the levels constitute a threat to public health. The highest microbe levels were seen in a pool used largely by children and fecal coliform bacteria counts in the ocean pools at times were at levels likely to be associated with illness in pool users. Stormwater outlets had counts that got lower over the three-year period. Better systems of sampling and testing are apparently needed, along with a better way to communicate to users that there is a danger

The relationship between access to social services, the demand to limit fertility and the prevalence of contraceptive use in Tunisia was examined. Results revealed that access to family planning services plays a key role in enhancing people's motivation to use reversible modern contraception methods. Hence, expansion of access to such services can significantly boost contraceptive use in Tunisia.

This paper begins with a critical review of studies which have examined the effects of caring on health. Most are shown to suffer from defects in sampling and design, so that the evidence for detrimental effects is suggestive rather than conclusive. The substantive part of the paper then utilizes data on a cohort of 55-year-olds to compare the health of carers with the health of non-carers and to examine changes in caring and health over a 3-year period. The comparison yields no systematic evidence of the deleterious effects of caring on health; indeed, if there is a tendency in the accumulated data, it is in the opposite direction i.e. that carers report better health and functioning than non-carers. It is suggested that part of the explanation relates to selection and self-selection and the longitudinal data reveals high volatility in caring status, even over a short time period. The paper goes on to examine sub-groups of carers considered to be at greater risk. There is no evidence that their health is compromised but the authors acknowledge weaknesses in the data and argue for a specially designed study. The paper concludes with a discussion of the findings and their implications for research, policy and practice. Key words - carer, caregiver, health, community care

Many of the difficulties of implementing the new community care policy arise from the fact that local authorities are being asked to make substantial changes on a large number of fronts. However, studies to date have tended to concentrate on only single areas of change. This article aims to provide a wide-ranging discussion of the new policy and its implementation, drawing on empirical research for illustration. The article suggests first that it is important to situate the difficulties local authorities are experiencing in implementing the changes in the context of the unresolved tensions contained within the objectives of the reforms. The problems these issues raise for implementation are then examined in relation to two main areas: care management and assessment, and enabling, drawing on a two-year monitoring project (from mid-1992 to mid-1994) in one shire county, one inner London borough and three outer London boroughs. The article concludes by speculating on what the changes will mean for the future of social service provision.

Acquired Immunodeficiency Syndrome (AIDS) has become the biggest problem facing the health profession of Thailand today. The Ministry of Public Health reports that there are 400,000 individuals in Thailand already infected with the Human Immunodeficiency Virus (HIV) and is predicting that 4 million will be infected by the year 2000. This explosive epidemic first occurred among intravenous drug abusers (IVDAs) and subsequently spread to other high risk groups, especially prostitutes. The heterosexual population was next affected. The AIDS problem in Thailand was seen close-up by this writer, then a fourth year medical student, studying during an international health elective. At all three hospitals where I worked, I encountered large numbers of AIDS related admissions. Ten percent of medical beds at a Bangkok hospital were occupied by patients with AIDS related problems. In comparison, two hospitals located in the northern province of Chiang Mai had 15-20% and 30-40% of their beds occupied by patients with AIDS complications. Opportunistic infections were the primary reason for admissions. This paper describes the current AIDS epidemic in Thailand and the preventive measures being undertaken to combat it. Strategies to combat AIDS focus on preventive measures. The current program in Thailand emphasizes AIDS education and awareness, the promotion of condom usage, decreasing needle sharing, the screening of donated blood, and the development of the GP160 vaccine. The program, however, has been undermined by the country's well organized sex industry. Without a clear commitment from the Thai government, Thailand faces serious health and economic consequences from this epidemic in the coming decade.

Elderly men may in certain circumstances undertake the care of their wives, with some men feeling rewarded by this work and derive an identity from it. The development of men's caring and the conditions under which it is carried out should be examined in order to promote community care by men. Community care policy should be adapted to take into account the work of older male carers. Men apparently suffer similar difficulties as women and are motivated by similar factors.

This paper describes the rationale, conceptual framework, and program components of a peer participation program for prevention of alcohol use among young adolescents. The peer participation program was one component of Project Northland, a community-wide program that seeks to prevent or delay onset of alcohol use among a cohort of young adolescents. The peer participation program, implemented in 20 northeastern Minnesota schools when students were in seventh grade, consisted of student groups who planned supervised, alcohol-free activities for themselves and their classmates. Program goals included 1) providing peer leadership and social support for non-use of alcohol, 2) creating opportunities for alternative behaviors to alcohol use, thereby 3) creating a norm of non-use among young adolescents. (J Sch Health. 1994;64(8):318-322), At least one-third of all adolescents experience problems related to their alcohol consumption. Those who begin drinking before age 15 are at increased risk of sustained problematic use in the [...]

Introduction: Critical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage) of existing HIV prevention options, especially in resource‐poor settings. Methods: Between January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and health literacy and assess the current need for literacy related to HIV prevention. The review included searches in electronic databases including MEDLINE, PsycINFO, PubMed, and Google Scholar. Permutations of the following search terms were used: “treatment literacy,” “treatment education,” “health literacy,” and “prevention literacy.” Through an iterative process of analyses and searches, titles and/or abstracts and reference lists of retrieved articles were reviewed for additional articles, and historical content analyses of grey literature and websites were additionally conducted. Results and discussion: Treatment literacy was a well‐established concept developed in the global South, which was later partially adopted by international agencies such as the World Health Organization. Treatment literacy emerged as more effective antiretroviral therapies became available. Developed from popular pedagogy and grassroots efforts during an intense struggle for treatment access, treatment literacy addressed the need to extend access to underserved communities and low‐income settings that might otherwise be excluded from access. In contrast, prevention literacy is absent in the recent surge of new biomedical prevention strategies; prevention literacy was scarcely referenced and undertheorized in the available literature. Prevention efforts today include multimodal techniques, which jointly comprise a toolkit of biomedical, behavioural, and structural/environmental approaches. However, linkages to community advocacy and mobilization efforts are limited and unsustainable. Success of prevention efforts depends on equity of access, community‐based ownership, and multilevel support structures to enable usage and sustainability. Conclusions: For existing HIV prevention efforts to be effective in “real‐world” settings, with limited resources, reflection on historical lessons and contextual realities (i.e. policies, financial constraints, and biomedical patents) indicated the need to extend principles developed for treatment access and treatment literacy, to support prevention literacy and prevention access as an integral part of the global response to HIV., Introduction Midway through the fourth decade of the HIV epidemic, there is room for cautious optimism. On World AIDS Day, 1 December 2015, UNAIDS triumphantly announced that 15.8 million people [...]

I. Introduction As the U.S. elderly population grows, the demand for nursing home beds and public expenditures on long-term care are expected to increase commensurately. One hope for controlling the [...]

Efforts are being made to extend the practice of Community Oriented Primary Care by reorienting existing health services or restructuring medical education curricula. Nevertheless, changes in education must be simultaneous to changes in health services so that health professionals trained in COPC will find areas to practice COPC. The experience described in this article presents an effort in these two directions. A teaching program was introduced in a traditional medical school curriculum and was extended to six health services by training the directors of the health service as teaching instructors of COPC or closely coordinating actions with the director of the health service. The results of the program show fulfillment of learning objectives and student satisfaction with the program. Evaluations of the development of COPC in the health services involved show modifications in health programs to meet community needs and stronger community leadership and organization.

Involvement of the study community in research on HIV/AIDS has presented the MRC/UVRI programme in rural Uganda with a multi-layered challenge. A typology developed in agricultural research which defines different levels of community participation in research is described where participation may be at |contract', |consultative', |collaborative' and |collegiate' level (each level indicating an increasing degree of community participation). Community involvement in the MRC/UVRI Programme is then outlined and the typology applied. It is shown that the majority of community participation in the Programme is at the contract level since the nature of the research programme as a |foreign imposition' with |foreign goals' has precluded the involvement of the community in much of the policy development and research planning. However, it is noted that as the Programme becomes more established in the area community influence grows and signs of community impact on policy and increased research inputs are beginning to be seen. The question is raised as to whether it is realistic to expect that externally imposed health research, particularly on sensitive topics, can ever be truly community participatory research.

Visual representations, such as photographs, maps, and computer graphics, have much to offer ethnography. In the early 1900s, photojournalists and sociologists used photography to document poverty in rural America and urban slums. Nonverbal representations played an important role in bringing social conditions to the attention of the citizenry. This article reports on a street outreach project taking place in San Francisco's Tenderloin district. A variety of visual representations was used to illuminate the social processes, events, relationships, and meanings of both the subculture of intravenous drug users and the outreach workers who pass out bleach and condoms to prevent transmission of the AIDS virus. Maps are used to depict the drug users' view of the Tenderloin and the centers of HIV infection in San Francisco. Computer graphics describe the demographics of the client population, while photographs portray the reality of outreach work in a way that words cannot. The article sketches a paradigm for using visual material in ethnographic investigations.

The number of inpatients in US public mental hospitals declined from 559,000 in 1955 to approximately 110,000 at present. Reductions resulted from release or transfer of long-term inpatients and from entrance barriers to new admissions. The timing and pace of deinstitutionalization substantially varied by state, but three quarters of the national reduction followed the expansion of welfare programs in the middle 1960s. The establishment of community care alternatives was highly inadequate, leaving may severely and persistently mentally ill people without essential services. Problems of care were exacerbated by the contraction of welfare programs in the 1980s, which resulted in serious neglect and homelessness. Plagued by underfinancing and fragmentation of care, new strategies in developing mental health care systems include capitation, case-management approaches, and the development of strong local mental health authorities.

Health disparities associated with race, ethnicity, and socioeconomic status are consistently observed in mortality and morbidity statistics and in indicators of health. (1) The slow progress in reducing health disparities […]