Health Professions Students' Assessment of an Interprofessional Rural Public Health-Focused Rotation: A Pilot Study Based on the Community-Oriented Primary Care Approach.

Using a community-oriented primary care (COPC) approach, the format for this interprofessional rural rotation was a public health focused team project based in a local health department and primary care setting. The target audience included fourth-year dental students, fourth-year undergraduate students in imaging science, second-year master of public health students, third-year medical students enrolled in the MD/MPH program, second-year nurse practitioner students, fourth-year pharmacy students, second-year MSN nursing students, and first-year PhD students. The specific learning objectives of the curriculum were drawn from emphasis areas of the Interprofessional Education Collaborative's competency domains and included the development of students' knowledge to function as a member of an interprofessional team to (1) engage diverse health care professionals, (2) communicate with team members to clarify each member's responsibility in executing components of a public health intervention, (3) choose effective communication tools and techniques, (4) integrate knowledge and experience of other professions, and (5) engage themselves and others to constructively manage disagreements. Additional learning objectives centered on 10 competencies from the Master's Degree in Public Health Core Competency Project. Assessment of 13 student participants, as a group, showed increased perceived knowledge in 4 out of 5 selected interprofessional emphasis areas and 9 out of 10 public health competencies. Our curriculum provides promising evidence for one interprofessional rural education model with proven short-term effectiveness among six health professions disciplines, in increasing student knowledge in interprofessional emphasis areas and public health competencies.

Análisis del sistema de salud cubano y del modelo atención primaria orientada a la comunidad / Analysis of the Cuban Health System and the Model of Community-Oriented Primary Care

La integración del cuidado de la salud individual con el de la población a través de la salud pública se ha podido llevar a cabo de forma efectiva a partir del modelo de la atención primaria orientada a la comunidad. En Cuba, la atención primaria es la base del sistema nacional de salud, con acceso universal y cuidado de los individuos, sus familias y la comunidad. El sistema nacional de salud y la atención primaria orientada a la comunidad contribuyen a la mejora de la salud y a la disminución de desigualdades en salud e iniquidades en la provisión de servicios. Este artículo presenta su descripción y análisis(AU)

Individual healthcare integrated with population healthcare through public health has been effective and possible through the model of community-oriented primary care. In Cuba, primary healthcare is the supporting structure of the national health system, including universal coverage and the care for individuals, their families, and the community. The national health system and community-oriented primary care contribute with health improvement and the decrease in health inequalities and in inequities of provided care. This article presents their comprehensive description and analysis(AU)

Community-oriented primary care (COPC) and the affordable care act: an opportunity to meet the demands of an evolving health care system.

Community-oriented primary care (COPC) is a model of health care delivery that tightly integrates primary care and public health. This model of care, applied around the globe, could be more widely adopted in the United States as clinical delivery systems respond to the growing demand for population health management, which has been driven largely by various provisions of the Affordable Care Act (ACA). For that purpose, there is need for changes in capacitating health professionals and changes in organizational structures that will address the needs and health priorities of the population, considering individual care management in the context of population health for a defined population. This article presents how the Affordable Care Act is an appropriate framework for COPC to succeed and the way forward to develop COPC through practical alternatives for the delivery of primary care within a population context.

Salud comunitaria: una integración de las competencias de atención primaria y de salud pública. Informe SESPAS 2010 / Community health: Integration of primary care and public health competencies. SESPAS report 2010

La atención primaria y la salud pública han tenido trayectorias paralelas, con escasos puntos de encuentro y coordinación en lo que se refiere a la acción comunitaria para la mejora de la salud de la población. Considerando la salud comunitaria como «la salud individual y de grupos en una comunidad definida, determinada por la interacción de factores personales, familiares, por el ambiente socio-económico-cultural y físico», y la intervención en salud comunitaria como la acción en el nivel local para lograr su mejora, la AP y la SP son actores clave del entorno sanitario para llevarla a cabo. De todas formas, su actuación deberá contar con otros agentes territoriales, incluida la población. La inclusión de la salud comunitaria como un objetivo del sistema sanitario hace evidente la necesidad de buscar y lograr una acción más coordinada e integral, lo cual debe introducir cambios en diversas áreas, entre las que destacan la formación de los profesionales, los contratos a los proveedores de servicios, los sistemas de definición de las carteras de servicios y la organización de los servicios (AU)

Primary care and public health have run on parallel tracks with scarce points of contact or coordination in community action to improve the population’s health. If community health is defined as the «health of individuals and groups in a defined community, determined by the interaction of personal and familial factors and by the socioeconomic-cultural and physical environments» and of community intervention is defined as local action to improve community health, primary care and public health are the key players to implement this aim. However, their actions should take into account other local actors, including the population. The inclusion of community health as an objective of the health system highlights the need to achieve more coordinated and comprehensive action, and to introduce advances in several areas, which include training for health professionals, contracts to service providers, systems for defining service portfolios, and organizational aspects of services (AU)

[Community health: integration of primary care and public health competencies. SESPAS report 2010]. / Salud comunitaria: una integración de las competencias de atención primaria y de salud pública. Informe SESPAS 2010.

Primary care and public health have run on parallel tracks with scarce points of contact or coordination in community action to improve the population's health. If community health is defined as the "health of individuals and groups in a defined community, determined by the interaction of personal and familial factors and by the socioeconomic-cultural and physical environments" and of community intervention is defined as local action to improve community health, primary care and public health are the key players to implement this aim. However, their actions should take into account other local actors, including the population. The inclusion of community health as an objective of the health system highlights the need to achieve more coordinated and comprehensive action, and to introduce advances in several areas, which include training for health professionals, contracts to service providers, systems for defining service portfolios, and organizational aspects of services.

Training and application of community-oriented primary care (COPC) through family medicine in Catalonia, Spain.

The community-oriented primary care (COPC) approach, implemented in various countries by family physicians, general practitioners, and other primary care workers, integrates clinical medicine with aspects of public health. A process of 20 years of training health professionals (40-hour workshop) by the professional association of family physicians (Catalan Society of Family and Community Medicine), training family medicine residents and giving support to health teams in Catalonia, Spain, generated a present group of 30 primary care teams involved in community health projects. This paper describes and analyzes factors related to changes in the health system, the role of family medicine in Spain, and to features of the COPC approach and its training methods as elements that narrow the gap between training and practice.

[Community-oriented primary care: a public health model in primary care]. / Atención primaria orientada a la comunidad: un modelo de salud pública en la atención primaria.

The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members.

Atención primaria orientada a la comunidad: un modelo de salud pública en la atención primaria / Community-oriented primary care: a public health model in primary care

The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members.(AU)

Atención primaria orientada a la comunidad: un modelo de salud pública en la atención primaria / Community-oriented primary care: a public health model in primary care

The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members.

Butyrylcholinesterase activity, cardiovascular risk factors, and mortality in middle-aged and elderly men and women in Jerusalem.

BACKGROUND: The association of butyrylcholinesterase (BuChE) with Alzheimer disease and the association of this disease with cardiovascular risk factors raise interest in the association of BuChE activity with cardiovascular risk factors and mortality. METHODS: A baseline cross-sectional study was conducted between 1985 and 1987, encompassing residents > or =50 years of age living in a Jewish neighborhood in western Jerusalem. Interviews were followed by examinations and nonfasting blood sampling (available for 1807 participants). Follow-up data to April 1996 on mortality and causes of death were obtained through record linkage with the Israeli Population Registry. RESULTS: BuChE activity was inversely related to age and was positively associated with serum concentrations of albumin (r = 0.35; P <0.001), cholesterol (r = 0.31; P <0.001), and triglycerides (r = 0.30; P <0.001). Enzyme activity was associated with measures of overweight, obesity, and body fat distribution (e.g., body mass index, r = 0.20; P <0.001). In multivariate analysis, the associations of enzyme activity with serum cholesterol, triglycerides, and albumin persisted strongly. After adjustment by Cox proportional hazards regression for other predictors of mortality in this population, individuals in the lowest quintile of BuChE activity had significantly higher mortality than those in the highest quintile [hazard ratios (95% confidence intervals): all-cause mortality, 1.62 (1.15-2.30); cardiovascular deaths, 1.79 (1.05-3.05)]. The association was attenuated by introduction of serum albumin into the models. CONCLUSIONS: This is the first study to report on the association between BuChE and mortality. The relatively strong association of BuChE with serum lipid and albumin concentrations requires elucidation. Our results suggest that low BuChE activity may be a nonspecific risk factor for mortality in the elderly.

Health status and mortality in Holocaust survivors living in Jerusalem 40-50 years later.

The long-term health sequelae of the Holocaust were assessed 40-50 years later in the framework of a Jerusalem community health study. Holocaust survivors (N = 288, mean age = 67.6 years) and European-born Jews, not exposed to the Holocaust (N = 486, mean age = 68.9 years), were studied in 1985-87. Our objective was to compare psychobehavioral factors, clinical variables, and mortality outcomes. The comparisons revealed higher emotional distress scores in female Holocaust survivors than in unexposed women and poorer self-appraised health status in male Holocaust survivors than unexposed men. A 10-year mortality follow-up that terminated in April 1996 showed no significant association with Holocaust exposure. Long-term Holocaust survivors may represent a selective resilient group.

Siesta and mortality in a Mediterranean population: a community study in Jerusalem.

STUDY OBJECTIVE: In light of contradictory studies relating to the health effects of siesta, we investigated the practice of siesta in relation to all-cause and cardiovascular mortality, controlling for recognized predictors of mortality. DESIGN: Prospective study with 9 to 11 years of mortality follow-up. SETTING: West Jerusalem neighborhood of Kiryat Yovel. PARTICIPANTS: 1859 residents (55% women), aged at least 50 years in 1985-87 (85% response). MEASUREMENTS AND RESULTS: Data on daytime napping, its average duration, and duration of night sleep were collected in addition to a rich array of covariates. We identified 405 deaths (206 women) during an average 10-year follow-up undertaken by linkage with the National Population Registry. Cox regression was used to control for potential confounders. In multivariable models among men, there was a weak association with all-cause mortality (hazard ratio [HR], 1.36; 95%CI, 0.93-1.97), which was restricted to ages 65 to 74 years (HR, 2.21; 95%CI, 1.28-3.80; P for age interaction, 0.008). Exclusion of patients with chronic conditions attenuated the association. In women, siesta was not associated with mortality. Long siesta (>2h), a marker of daytime somnolence, was strongly associated with excess risk of all-cause and cardiovascular mortality in men. CONCLUSIONS: The weak overall relation of siesta with mortality in men that was attenuated upon exclusion of patients with chronic conditions, the absence of internal consistency in the association across age and sex groups, and the association with long daytime naps tend to argue against a causal role for siesta. Nevertheless, the data are also compatible with long siestas conferring excess risk. However, without persuasive data, recommendations related to this traditional practice should not be made.

Over 8 hours of sleep--marker of increased mortality in Mediterranean population: follow-up population study.

AIM: To investigate night and total sleep duration in relation to all-cause, cardiovascular, and non-cardiovascular mortality, controlling for recognized predictors of mortality in a population where the practice of siesta is common. METHODS: Our community-based sample included 1,842 residents (1,001 women) of a West Jerusalem neighborhood, aged 50 years and over. The study was conducted in the 1985-87 period, with a response rate of 85%. The participants were followed-up for 9-11 years. At the beginning of the study, the participants were asked at what time they usually fell asleep at night and awoke in the morning, and the average duration of their daytime nap if they slept during the day. Cox survival analysis was used to predict time to death for all-cause, cardiovascular, and non-cardiovascular mortality. RESULTS: The overall number of deaths was 403 (205 women), which included 170 deaths from cardiovascular causes (93 women). Men who reported long total sleep duration (>8h) had a substantially elevated risk of all-cause mortality (adjusted hazard ratio, 2.1; 95% confidence interval [CI], 1.2-3.7), and a stronger association with cardiovascular mortality (hazard ratio, 2.9; 95% CI, 1.2-7.1). The population attributable risk associated with more than 8 h of sleep was 12% (95% CI, 4-21%) for total mortality and 17% (95% CI, 4-33%) for cardiovascular causes of death. There was no significant association in women, although those who slept 6-8 h seemed to have the lowest risk. CONCLUSION: Duration of sleep is an important risk marker of mortality also in populations that practice afternoon siesta.

The Jerusalem experience: three decades of service, research, and training in community-oriented primary care.

Community-oriented primary care (COPC) developed and was tested over nearly 3 decades in the Hadassah Community Health Center in Jerusalem, Israel. Integration of public health responsibility with individual-based clinical management of patients formed the cornerstone of the COPC approach. A family medicine practice and a mother and child preventive service provided the frameworks for this development. The health needs of the community were assessed, priorities determined, and intervention programs developed and implemented on the basis of detailed analysis of the factors responsible for defined health states. Ongoing health surveillance facilitated evaluation, and the effectiveness of interventions in different population groups was illustrated. The center's international COPC involvement has had effects on primary health care policy worldwide.