A model program for providing health services for migrant farmworker mothers and children.

A bilingual, multidisciplinary team of health professionals collaborated with a migrant health center in North Carolina to develop a model program to deliver primary health care services to migrant farmworker women and children. The program included case finding and outreach, coordination of maternal and child health services locally as well as interstate, and innovative health education programming. Data were collected on the health status of 359 pregnant migrant farmworker women and 560 children, ages birth to 5 years, the majority of Mexican descent, who received primary care services at the center. The mean age of the women was 23.1 years and their mean gravidity was 2.9. Dietary assessments showed that the protein intakes of most met or exceeded the U.S. Recommended Dietary Allowances, but their consumption of foods in the milk-dairy group and the fruit-vegetable group was below recommended standards. Low hematocrit was a common problem among the women (43 percent) and, to a lesser extent, among the children (26 percent). Among the infants and children, 18 percent were obese. Black American women had the highest proportion of low birth weight infants. The project emphasized coordinated services for migrant farmworker mothers and children, such as transportation services, language translation, followup, and advocacy. An outreach strategy involved case finding, home visits, and services by lay health advisors. By the third year of the project, there were increases in the average number of prenatal visits, the proportion of women entering prenatal care in their first trimester, and in the use of well-child services. The project demonstrated effective methods for delivering culturally appropriate health care services to migrant farmworkermothers and children using bilingual public health professionals.

Subcellular fractionation of epiphyseal cartilage: isolation of matrix vesicles and profiles of enzymes, phospholipids, calcium and phosphate.

Epiphyseal cartilage was fractionated into subcellular components by nonenzymatic methods, and analyzed for activity of marker enzymes, for phospholipids, and for calcium and inorganic phosphate. Alkaline phosphatase, a marker enzyme for matrix vesicles and plasma membranes, was concentrated in the 100 000 X g (microsomal) pellet and, upon subsequent fractionation, in the low-density fractions from the sucrose gradient. Mitochondrial and endoplasmic reticular enzymes were localized primarily in the 20 000 X g pellet, lysosomal enzymes predominantly in the supernate from the microsomal pellet. Two phospholipids characteristic of matrix vesicles, sphingomyelin and phosphatidylserine, were enriched in the low-density sucrose fractions; however, unlike matrix vesicles, there was no depletion in phosphatidylcholine or increase in lysophospolipids. Ca and inorganic P were concentrated in the higher-density fractions, the amounts in the lower-density fractions being somewhat lower than those seen in matrix vesicles. The alkaline phosphatase-rich, low-density fractions were thus not identical to matrix vesicles isolated by collagenase digestion, but rather appear to be composed primarily of plasma membranes. Enzyme profiles indicate they were relatively free of mitochondrial, endoplasmic reticular and lysosomal contaminants. the data further indicate that significant modification of the phospholipid, electrolyte, and possibly enzyme content of chondrocyte plasma membranes, must occur during blebbing and matrix vesicle formation.

Improving the effectiveness of program consultation.

In a recent project concerned with the evaluation of consultation, experienced health program consultants demonstrated difficulty in two areas: (a) integrating mutnd (b) setting objectives and specifying criteria by which to measure attainment of those objectives. This paper outlines the purposes of this project, its background and methodology, and discusses in depth the areas of concern. Through an exploration of these issues in program consultation evaluation, health professionals can understand and hopefully improve their skills in this important area of functioning.

Evaluating the impact of program consultation in health services.

This article describes a methodology developed to be useful to both consultant and consultee in evaluating their mutual efforts to improve agency health service programs. Reporting forms and instruction manuals based upon the concept of mutuality in consultation were used by 19 consultants in 29 consultations. Two-thirds of the respondents reported some increase in problem-solving ability. The implications of evaluating program consultation are discussed, as are certain issues in consultation: definition, implementation, process, utilization, impact delays, interpersonal interactions, hidden agendas, organizational learning, and outcome measurements.