This article presents a programme for cardiovascular health for 9 to 12 years old children, called "Healthy Heart" Saint-Louis du Parc and carried out in low socioeconomic and multiethnic part of Montreal, Quebec, Canada. These five years programme targets were more both spheres: school and community (leisure centre, ethnocultural centre, groceries and other places). We develop the objectives, the conceptual models underlying to the programme, the perspective of work, the infrastructure of the programme: its staff and financing, the partnerships and the structure organising. Then we present the various interventions carried out along the period and so a description of many evaluations. At last, we discuss about the programme continuation.
A report is given of a visit to an Indian village community project which is supported by a small Swedish foundation. The project was started about 40 years ago by a female relative of Mahatma Gandhi. The community is a small village of about 2000 inhabitants and consists of an irrigated agricultural project, a school through 10th grade, a small hospital, a home for 140 poor or orphan girls and a nursery. The program employs 12 community health workers who have some healthcare training. Each worker cares for 200-250 households and usually knows his/her families well. Primary emphasis is on care of children which includes help with nutrition and a vaccination program. For every 4 community health workers there is an auxiliary nurse midwife who has 3 years special training following 10th grade. The midwives check up on pregnant women once a month through the 7th month, 2 visits in the 8th month and once/week in the 9th month. Undernourishment and anemia are the most common problems of pregnancy. Children are often born in the parents' home without any trained obstetric help. In spite of this, maternal mortality is very low. Even infection from childbirth is extremely rare. The visitor was particularly impressed by the respect and affection everyone in the village showed for children and for each other.
In an effort to assess and advance the community-based model of chronic care, we reviewed a contemporary spectrum of Canadian chronic disease management and prevention (CDMP) programs with a participatory audience of administrators, academics, professional and non-professional providers and patients. While many questions remain unanswered, several common characteristics of CDMP success were apparent. These included community-based partnerships with aligned goals; inter-professional and non-professional care, including patient self-management; measured and shared information on practices and outcomes; and visible leadership. Principal improvement opportunities identified were the enhanced engagement of all stakeholders; further efficacy evidence for team care; facile information systems, with clear rationales for data selection, access, communication and security; and increased education of, and resource support for, patients and caregivers. Two immediate actions were suggested. One was a broad and continuing communication plan highlighting CDMP issues and opportunities. The other was a standardized survey of team structures, interventions, measurements and communications in ongoing CDMP programs, with a causal analysis of their relation to outcomes. In the longer term, the key needs requiring action were more inter-professional education of health human resources and more practical information systems available to all stakeholders. Things can be better.
Expanding community care for elderly persons is a pivotal issue in the reform of long-term care. However, the age and sex of caregivers are important concerns that, unless confronted, will undermine the success of these reforms.