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At least 217 records · Page 12Linked to original sources
PubMed1985

Medication and programming in controlling the behavior of mentally retarded individuals in community settings.

Behavioral outcomes of a behavioral-chemical intervention procedure on stereotypic and non-compliant behavior were evaluated. One group (n = 22) of community-based mentally retarded clients was initially on psychotropic medication (major tranquilizers). Their dosage was either increased, decreased, or kept the same following behavioral intervention. A second group (n = 19) was placed on psychotropic medication following behavioral intervention. A nonequivalent between-groups design was employed that permitted 36 outcome combinations involving Conditions X Subject X Group. The effects of behavioral intervention, the validity of drug-intervention decision rules, drug-intervention effects, and the validity of the behavioral-chemical intervention model were evaluated. Results indicated that the behavioral-chemical intervention produced expected and desirable behavioral change as well as reduced levels of psychotropic drug usage.

Adult↗
PubMedDate not supplied

A palliative medicine program in a community setting: 12 points from the first 12 months.

This paper reports the first year's experience of a consultative, interdisciplinary, integrated palliative medicine program in a community hospital system. Prospective data collection was performed on 308 consecutive consultations. A computer database was developed and used to analyze demographics, reason for consultation, complexity of medical problems, current medications and allergies, physical suffering, spiritual concerns, personal and family concerns, consult recommendations, and mortality. In addition, data were collected on patient rating of the severity of physical symptoms, pain, spiritual suffering, and personal and family suffering; this data also was analyzed using the database. Cancer was the most frequent diagnosis (34 percent) and pain the most common reason for consultation (43 percent). Population medians were identified as follows: five (range, 1 to 10) acute medical problems; three (range, 1 to 10) chronic medical problems; and one (range, 0 to 10) medication allergy/intolerance. Patients were taking a median of 10 (range, 0 to 29) medications, including a median of two analgesics. Eighty percent could communicate concerning physical symptoms and had a median of two (range, 0 to 7) bothersome symptoms, with pain the most frequent. Fifty percent or fewer could rate physical suffering, pain, hope, spiritual suffering, or personal/family suffering using a 0 to 10 scale at consultation. Individual patient ratings provided over time for physical suffering, pain, hope, spiritual suffering, and personal/family suffering were available for less than 25 percent. A median of eight recommendations was made for each consultation, with medication changes suggested for 84 percent. For those known to have died, the median survival from time of consultation to death was 11 days.

Adult↗
PubMed1989

Nonemergent cardiac catheterization and risk-stratified revascularization following thrombolytic therapy for acute myocardial infarction. A critical analysis of therapy in the community setting. University of North Carolina Cardiology Consortium.

We evaluated a strategy for administering thrombolytic therapy without emergent cardiac catheterization to patients with acute myocardial infarction in community hospitals. Fifty-nine patients were treated with intravenous streptokinase and heparin, and referred for elective catheterization. Angioplasty or bypass surgery was performed only in patients judged to be at risk for reinfarction. One or more predetermined criteria for infarct segment viability were present in 47 (80%) of 59 patients. Angina recurred in 24 patients and enzyme-positive reinfarction in 9 patients, but only 2 patients developed new Q waves or a creatine kinase rise to over twice the normal value. Of 18 patients judged to be at low risk for reinfarction, only 1 required urgent angioplasty or bypass surgery. Fourteen-day mortality was 7% and infarct vessel patency was 94%. These data indicate that physicians in small community hospitals with a close relationship to a referral center and with a carefully designed protocol can administer thrombolytic therapy safely and effectively. By subsequent stratification of patients according to the risk of recurrent infarction, 22% of patients eligible for revascularization were spared urgent angioplasty or bypass surgery.

Angioplasty, Balloon↗
PubMed2003

Ecological and individual predictors of maternal smoking behaviour. Looking beyond individual socioeconomic predictors at the community setting.

The aim of this study is to examine the prevalence of smoking during pregnancy by the individual mother's sociodemographic characteristics and ecological factors at the community level (suburbs). This analysis combined 1996 Australia Census and data on 3424 women attending Well-Baby-Clinics (WBC) between January 1996 and February 1998 within a region in South Western Sydney (SWS), Australia. The prevalence of maternal smoking was 31%. Maternal factors such as marital status, country of birth, education, occupation, socioeconomic status (SES), and types of antenatal care (ANC) were independent risk factors for maternal smoking. Small area analysis revealed suburbs within SWS with high rates of maternal smoking (47-57%). Community level characteristics such as low income, low educational level, young mothers, and unemployment can explain 85.7% of the variation in maternal smoking in SWS. Smoking during pregnancy is recognised as a serious risk factor to the unborn child. The present study draws attention to local community level factors, other than individual SES, which may be important when developing strategies for maternal smoking prevention programs.

Adolescent↗
PubMed1991

Life events, social problems and physical health status as predictors of emotional distress in men and women in a community setting.

The main aim of this study was to construct logistic models of emotional distress (defined as a GHQ-30 score of 6 or greater) in a community sample of 226 men and 225 women. The independent variables included were: sociodemographic characteristics, physical health status, social problems and undesirable life events. Univariate comparisons showed that in both sexes undesirable life events and social problems were associated with emotional distress; in men the presence of physical symptoms and widowed, separated or divorced status also showed such an association. Separate logistic regression models for men and women confirmed the importance of undesirable life events and social problems as predictors for emotional distress. In women there was also a significant interaction effect between the two variables on emotional distress. Sociodemographic characteristics and physical health status did not exert a statistically significant effect in these models.

Adaptation, Psychological↗
PubMed2006

Changes over time in addiction security index problem dimensions among cocaine abusers1 treated in community settings.

Clinical trials have yielded evidence for the efficacy of treatment for cocaine dependence but are limited in their ability to generalize their results to those attending community treatment programs for drug dependence. This study aimed to determine whether 223 cocaine-dependent males attending one of three different residential community treatment centers in Miami-Dade County, Florida exhibited change in Addiction Severity Index (ASI) problem dimensions similar to those participating in clinical trials. Results of repeated-measures analysis of variance yielded evidence for reductions over time in six of seven ASI dimensions. These results are similar to those found in clinical trials of treatments for cocaine dependence.

Cocaine-Related Disorders↗
PubMed2003

The structure of lay consultation networks: managing illness in community settings.

OBJECTIVE: We examined the structure of lay consultation networks among elderly people. METHODS: Data were gathered through interviews with 548 elderly adults living in Florida retirement communities and in Cleveland. Respondents identified people they consulted about symptom or disease information, health worries, what the doctor said, and consulting health providers. Network size, composition, geographic dispersion, gender homogeneity, and division of labor were assessed. RESULTS: Eighty percent identified at least one network member (range = 1 to 7 consultants). Networks largely consisted of family members, particularly spouses and women. Older adults talked most frequently with network members about physician visits. Widowed individuals were more likely to rely on children and friends and have networks outside their neighborhoods than married elders. Women's networks included a broader range of relationships than men's networks. DISCUSSION: Results reaffirmed the importance of gender in structuring networks in late life. The low prevalence of friends supports Cartensen's Selectivity Theory.

Aged↗
PubMed1993

Use of therapeutic milieu in a community setting.

1. Many of the same components that contribute to the success of milieu therapy in inpatient facilities also promote treatment success for clients living in the community. 2. Treatment goals at the Rosati Center, a transitional residential program for chronically mentally ill homeless persons in St. Louis, generally include supporting residents as they secure their own permanent housing; helping residents apply for entitlements so that they can support themselves upon discharge; connecting residents with outpatient psychiatric treatment; and assisting residents to structure their time and activities as a means to improving coping skills. 3. Program evaluations of the transitional living program at the Rosati Center revealed that implementation of therapeutic milieu concepts (in combination with case management concepts) can be successful. The facility served 228 persons during a 5 1/2-year period. Nearly half of those persons were discharged having fully met the objectives of the transitional program.

Adult↗
PubMed1995

Cancer clinical trials in the community setting: a 20 year retrospective.

During the past two decades clinical cancer research in the United States has grown dramatically and has been significantly enhanced by the participation of community hospitals, practicing oncologists, and the creation of community cancer clinical trials organizations. More than 102,000 patients have been enrolled by these community based groups to important clinical trials which have answered questions that have improved cancer treatment in this country and worldwide (Figure 3, Table 8). Practicing oncologists are now well trained in the practice of clinical research and efforts should be directed to ensure that their participation in clinical research continues to increase. There are many obstacles to performing clinical cancer research, but none is greater than the issue of cost. We are currently facing the daunting prospect that health care reform may dramatically curtail or bias future cancer clinical trials. Consumers, providers, politicians, and the general public must be educated to protect and expand the cancer clinical research structure so that we can continue the pursuit of optimal cancer management.

Clinical Trials as Topic↗
PubMed1977

Aspects of outcome in a therapeutic community setting. How patients are seen by themselves and others.

How patients are seen by themselves and others close to them may influence the process of re-integration in the community after discharge. In a study in a psychiatric admission unit employing a therapeutic community approach, patients who sought little or no contact with the unit after discharge saw themselves, and were seen by others, as less "pleasant" but less "ill" than those who continued more regular contact. Perceptions were measured with the semantic differential technique. Patients' social class and household position were found to have a marked effect on the level of contact and on its association with how patients were seen. Diagnosis did not appear to influence hospital contact.

Adult↗
PubMedDate not supplied

Biomarkers of exposure in community settings.

Biomonitoring is a valuable tool for assessing human exposures to chemical contaminants in the environment. Biomonitoring tests can be divided into biomarkers of exposure, effect, and susceptibility. In studies of community exposure to an environmental contaminant, biomarkers of exposure are most often used. The ideal biomarker should be sensitive, specific, biologically relevant, practical, inexpensive, and available. Seldom does a biomarker meet all of these criteria--most biomarkers represent a compromise of these criteria. In designing a community exposure study, consideration should also be given to the selection of the test population, the practicality of collecting biological samples, temporal or seasonal variations in exposure, the availability of background comparison ranges, and interpretation of the test results. Biomonitoring tests provide unequivocal evidence of exposure, but they do not typically identify the source of exposure. Furthermore, rarely do the test results predict a health outcome. For many chemicals, testing must be conducted soon after exposure has occurred. In spite of these limitations, the use of biomonitoring is finding wider application in many scientific disciplines. Recent advances in analytical techniques are expanding the utility of biomarker testing in public health investigations.

Biomarkers↗