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PubMedDate not supplied

Prevalence of sleep disordered breathing in a population of Canadian grainworkers.

OBJECTIVES: To determine the prevalence of sleep disordered breathing (SDB) in a Canadian population of industrial workers (grainworkers). To determine the clinical features that are predictive of SDB and the validity of self-reported snoring. DESIGN: Cross-sectional, interviewer-administered questionnaire with selective recruitment of subjects for home sleep monitoring. SETTING: Community setting, Vancouver, British Columbia. PARTICIPANTS: All male grainworkers at grain elevators in Vancouver were approached for completion of a questionnaire. Eighty-three per cent of 524 subjects completed the questionnaire and were divided by presumed risk for SDB into four groups. All subjects in the highest risk group (group 1- frequent snoring and witnessed apneas) and a random sample of 40 subjects in the other three groups (group 2 - frequent snoring without witnessed apneas; group 3 - infrequent snoring rare; group 4 - nonsnoring) were approached for home sleep monitoring and 42% consented. INTERVENTIONS: Interviewer-administered questionnaire and home sleep monitoring. RESULTS: The overall prevalence of SDB in this relatively overweight group was estimated to be 25%, with a stepwise increase from group 4 to group 1 (7%, 29%, 40%, 60%). Presence of snoring and witnessed apneas, a greater body-mass index and a larger neck circumference were associated with SDB. Self-reported snoring was not found to be predictive. CONCLUSIONS: This first study of the prevalence of SDB in Canada suggests that SDB is at least as prevalent in Canada as in other industrialized nations and may actually be more common than previously thought. Further studies are required to determine the morbidity, mortality and economic loss associated with SDB in industrial workers.

Adult↗

PubMed2000

The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients.

OBJECTIVE: To develop a measure of social integration following stroke. DESIGN: Question and response scale generation from qualitative interview-based work followed by item and factor analytic methods of test construction. Analysis of the psychometric properties of final index. MEASURES: Frenchay Activities Index, Nottingham Health Profile, Wakefield Depression Inventory, Barthel Index. SETTING: Community setting, Bath, UK. SUBJECTS: Two hundred and sixty survivors of stroke, discharged at least six months previously from a general hospital. RESULTS: A 10-item Subjective Index of Physical and Social Outcome (SIPSO) was developed. Each question is scored on a scale of 0-4 with a low score indicating a poor level of integration. From the 157 completed questionnaires, total scores ranged from 0 to 40 with a median of 24 (interquartile range 15-32). Initial testing of the psychometric properties of the SIPSO suggest that it is able to provide assessment of two distinct areas of patient integration. From analysis of completed questionnaires it is suggested that questions 1-5 on the SIPSO measure a factor related to physical functioning/mobility whilst questions 6-10 measure a factor related to social/emotional functioning. Internal consistency, test-retest reliability and construct validity were established. CONCLUSIONS: The SIPSO provides a brief, valid and reliable assessment of an individual's ability to reintegrate to a 'normal' lifestyle. The SIPSO differs from other measures in that it provides assessment of both quantity and quality of activities and interaction, reflecting an individual's ability to reintegrate to his/her own satisfaction. As a 10-item self-report questionnaire the SIPSO can be administered quickly and cheaply to large numbers of patients.

Adaptation, Psychological↗

PubMed2003

The validation of the Subjective Index of Physical and Social Outcome (SIPSO).

OBJECTIVE: To validate the Subjective Index of Physical and Social Outcome (SIPSO) in its final 10-item version as a measure of reintegration to pre-stroke lifestyle. DESIGN: Postal and interview administration of questionnaires. MEASURES: SIPSO, Functional Limitations Profile (FLP), Reintegration to Normal Living Index (RNLI). SETTING: Community setting, Bath, UK. SUBJECTS: Two hundred and sixty-one survivors of stroke discharged from a district general hospital. RESULTS: Internal consistency (item-total correlations >0.6) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.96) of the measure were confirmed. Construct validity was confirmed through significant correlations with the six subsections of the FLP and the RNLI. Confirmatory factor analysis of the measure found that the first five items form a robust subscale that clearly relates to physical function. The items within the second subscale (questions 6-10) measure several domains (social, leisure, self-image) and do not form a homogeneous group. The SIPSO was able to detect an improvement in integration within a sample of patients over a three-month period soon after discharge (effect size = 0.26). The hypothesis that the degree of improvement experienced by patients following discharge from hospital would be small, but should be detectable was confirmed. The agreement between proxy and patient on the SIPSO was acceptable for individual items (kappa value range = 3.1-5.8) and total score (ICC = 0.96). CONCLUSIONS: The SIPSO is a brief self-complete measure, with proven validity and reliability, which addresses both quantitative and qualitative aspects of activities and interaction. It provides a useful measure for evaluating rehabilitation programmes that aim to reintegrate patients to their pre-stroke lifestyle. The authors suggest that the SIPSO should be used as a 10-item measure.

Aged↗

PubMed2004

Evaluation of a multiprofessional community stroke team: a randomized controlled trial.

OBJECTIVES: There is inconclusive evidence of the effectiveness of stroke rehabilitation by a community stroke team. The aim was to evaluate a specialist multiprofessional team in a community setting. DESIGN: Randomized controlled trial. SETTING: Community. PARTICIPANTS: Stroke patients and their informal carers who were referred to receive rehabilitation from a community stroke team. OUTCOME MEASURES: Barthel Index, Extended Activities of Daily Living Scale (EADL), General Health Questionnaire (GHQ-12) by patient and carer, Carer Strain Index (CSI), Euroquol, knowledge of stroke and satisfaction with services six months after recruitment. RESULTS: There were no significant differences between patients who received rehabilitation from community stroke team (n = 189) and those who received routine care (n = 232) in their independence in activities of daily living, mood, quality of life or knowledge of stroke. The patients in the community stroke team group were significantly more satisfied with the emotional support they had received (p < 0.01). There were no significant differences between the groups in satisfaction with practical help or overall satisfaction. Carers of patients in the community stroke team were under significantly less strain than carers in the routine care group (p < 0.04). Carers of patients in the community stroke team group were significantly more satisfied with their knowledge of stroke (p < 0.01) and were more satisfied overall (p < 0.01). CONCLUSIONS: The patients treated by the community stroke team were more satisfied with the emotional support they received and had equivalent outcomes in terms of independence in activities of daily living and mood. Their carers were under less strain and were more satisfied with their knowledge of stroke recovery, the emotional support they received and overall satisfaction with services. The results support the provision of rehabilitation by a community-based specialist multiprofessional team.

Adult↗

PubMed2005

Falls and injury prevention should be part of every stroke rehabilitation plan.

OBJECTIVE: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed. DESIGN: Prospective cohort study. SETTING: Community. SUBJECTS: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study. MAIN MEASURES: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM). RESULTS: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p < 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p < 0.05). CONCLUSION: Falls are common when people return home after stroke. Of concern are the small number seeking health professionals' assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.

Accidental Falls↗

PubMed1999

Social reintegration after stroke: the first stages in the development of the Subjective Index of Physical and Social Outcome (SIPSO).

OBJECTIVE: To ensure at outset the content validity of a measure (to be developed) of social integration following stroke. DESIGN: Qualitative study, using in-depth interviews with patients at least six months following stroke. SETTING: Community setting, Bristol, UK. SUBJECTS: Thirty survivors of stroke, discharged at least six months previously from a neurological rehabilitation unit in a district general hospital. RESULTS: Patients reported a change, usually for the worse, in their levels of integration following stroke. More specifically they alluded to a decrease in both the quantity and quality of activities, especially with regard to leisure and those activities occurring outside the home. Social interaction was reduced in most patients, in terms of frequency and quality of contact. From the data, six dimensions of change in quality of interaction emerged. Finally, changes in patients' physical and financial environments were reported. Based on the findings, four diagrams were developed, providing a structure for questionnaire development. CONCLUSIONS: The results of this study confirm the findings of previously reported research. An individual's level of social integration can be affected by stroke in a wide variety of areas and along many different dimensions. Data from this study have highlighted the importance of the patient's subjective impression of the quality of both functional and social performance. This has provided the opportunity to develop a questionnaire based on the patient's perspective, rather than that of health professionals.

Activities of Daily Living↗

PubMedDate not supplied

The management of malodour and exudate in fungating wounds.

The topic of malodour and exudate in fungating wounds is of particular interest and relevance for community nurses who care for patients with fungating wounds in the community setting. Community nurses can work together with community oncology and palliative care services to manage patients with fungating wounds at home, where once hospital admission would have been needed to provide the level of support and care these patients require. Fungating wounds present unique challenges and can be problematic as a result of the levels of exudate and malodour which they produce. This review sought to establish whether recent advances in wound care products and/or techniques, could be of value in the control of these symptoms. The review established that there is little clinical research into the care of fungating wounds, and that the development of new dressings and techniques for controlling malodour and exudate is badly needed.

Administration, Oral↗

PubMedDate not supplied

Use of medical care after a community-based health promotion program: a quasi-experimental study.

PURPOSE: To assess the effects of health promotion on the use of medical care services in a community setting. DESIGN: Quasi-experimental, multiple time points, case-comparison group. SETTING: Community health center in Ottawa, Canada. SAMPLE: 520 volunteer participants in a health promotion program and 932 matched comparison subjects. INTERVENTION: The health promotion program consisted of a weekend workshop on health behaviors, lifestyle assessment, and identification of weekly goals for change. This was followed by 18 months of support (5 group sessions, weekly telephone calls, and optional individual sessions). MEASUREMENT: Computerized data on health care use 6 months before, 18 months during, and 6 months after the program were obtained from Ontario's universal Health Insurance Plan (OHIP). These data were used to determine the number and system costs of visits made by participants and comparisons. RESULTS: When controlling for baseline differences through analysis of covariance, program participants were found to have higher costs and more visits for ambulatory care during the first year (p < .01) and second year (p < .05) of follow-up. Participants used significantly more diagnostic services than comparisons during both years of follow-up. Participants were also more likely to use more counseling and psychotherapy services in year 1 (relative risk, 1.53; 95% confidence interval, 1.28, 1.81) and year 2 (relative risk, 1.57; 95% confidence interval, 1.31, 1.89). No differences were found between participant and comparison groups in visits for medical consultations and assessments or preventive services. CONCLUSION: No evidence shows that this health promotion program reduced use in this population over the 2-year follow-up period.

Analysis of Variance↗

PubMed1996

Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial.

OBJECTIVE: To determine whether vitamin D supplementation decreases the incidence of hip fractures and other peripheral bone fractures. DESIGN: Prospective, double-blind trial. SETTING: Community setting (Amsterdam and surrounding area). PATIENTS: 2578 persons (1916 women, 662 men) 70 years of age and older (mean age +/- SD, 80 +/- 6 years) living independently, in apartments for elderly persons, or in homes for elderly persons. INTERVENTION: Participants were randomly assigned to receive either vitamin D3, 400 IU in one tablet daily, or placebo for a maximum of 3.5 years. MEASUREMENTS: Dietary calcium intake and serum 25-hydroxyvitamin D [25(OH)D] were estimated in a subset of participants. During follow-up, attention was concentrated on hip fractures and other peripheral fractures. The maximal follow-up period was 4 years. The results were evaluated by survival analysis. RESULTS: Mean dietary calcium intake from dairy products was 868 mg/d. Mean serum 25(OH)D concentration in the third year of the study was 23 nmol/L in the placebo group and 60 nmol/L in the vitamin D group. Median follow-up was 3.5 years, and total follow-up was 8450 patient-years. During follow-up, 306 persons in the placebo group and 282 persons in the vitamin D group died (P = 0.20). Hip fractures occurred in 48 persons in the placebo group and 58 persons in the vitamin D group (P = 0.39, intention-to-treat analysis). Other peripheral fractures occurred in 74 persons in the placebo group and 77 persons in the vitamin D group (P = 0.86). CONCLUSION: Our results do not show a decrease in the incidence of hip fractures and other peripheral fractures in Dutch elderly persons after vitamin D supplementation.

Aged↗

PubMed1995

Community-based prevalence of anal incontinence.

OBJECTIVE: To determine the prevalence of and characteristics associated with anal incontinence in the general community. SETTING: Community survey. PARTICIPANTS: The population of the state of Wisconsin sampled in the Wisconsin Family Health Survey. Subjects were identified by random digit dialing with telephone interview. The individual within each household identified as most knowledgeable about the health status of all other members of the household was asked about the health status of each member of the household. Approximately 200 households were surveyed each month. MAIN OUTCOME MEASURES: The presence of anal incontinence to solid or liquid feces or gas, who suffered from it, the frequency of anal incontinence, and how the incontinent person coped with it. RESULTS: A total of 2570 households comprising 6959 individuals were surveyed, and 153 individuals were reported to have anal incontinence, representing 2.2% of the population (95% confidence interval [Cl], +/- 0.3%). Thirty percent of the incontinent subjects were older than 65 years, and 63% were women. Of those with anal incontinence, 36% were incontinent to solid feces, 54% to liquid feces, and 60% to gas. In a multivariate analysis, independent associations of the following risk factors with anal incontinence were found: female sex (odds ratio [OR], 1.5; Cl, 1.1 to 2.1), age (continuously adjusted) (OR, 1.01; Cl, 1.01 to 1.02), physical limitations (OR, 1.8; Cl, 1.2 to 2.7), and poor general health (OR, 1.6; Cl, 1.4 to 1.9). CONCLUSIONS: Anal incontinence was reported in 2.2% of the general population. Independent risk factors for incontinence include female sex, advancing age, poor general health, and physical limitations.

Adult↗

PubMed1996

-Factors of dissatisfaction with health care. A Delphi study-.

OBJECTIVE: To study the causes of the disagreement between the general atmosphere of insatisfaction inherent in the assistance offered by the health care system and the favourable evaluation that the public shows in the questionnaires carried out in the field of primary health care. The less satisfactory issues of the health service offert are also identified. DESIGN: A Delphi thecnique has been used as consensus method. SETTING: Community setting: Salamanca urban area. PARTICIPANTS: The Delphi group is made up of people working in jobs with a pronounced social character: members of neighbour associations, educators, social workers, etc. Three consecutive questionnaires were distributed among fifty people. Twenty-seven of them completed the three rounds. MEASUREMENTS AND MAIN RESULTS: The score of the reasons of disagreement perceived as the most important were: the difficulties of access at a specialised level, 8.3 points; the inequality of the services offered by the two organizative models that coexist in the primary health care, 7.1; the lack of discrimination between the primary and the specialized level, 6.8. The highest scores were for the following complaints: excessive waiting lists at the second care level (8.5), delay in solving the problems (7.8) and masification at the consultancy (7.1). The most satisfactory aspects are the possibility of free choice of doctor, 7.9 points; the previous appointement system, 7.6; and a reliable relationship with the doctor, 7.3. CONCLUSIONS: To take into account these factors in the future design and interpretation of inquiries will increase their information validity and usefulness.

Adult↗

PubMed1998

[Prevalence of obesity and its relationship with cardiovascular risk in the general population of Albacete].

OBJECTIVE: To find the prevalence of obesity and overweight in the population of Albacete, and their relationship to other cardiovascular and coronary risk factors. DESIGN: A descriptive, crossover population study. SETTING: Community setting in the province of Albacete. PARTICIPANTS: A sample of 2121 people over 18 (843 from the capital and 1278 from the rest of the province) was selected from Albacete's population through stratified random sampling in two stages. MEASUREMENTS AND RESULTS: Appointments were made with each person by mail. All those attending underwent Anamnesis, a physical examination, ECG and basic analytic tests. 1230 people between 20 and 93 years old were studied. 394 were considered not obese (32%) and 836 were adjudged obese or overweight (68%). 47% of men were overweight and 23.2% of them obese; 33.5% of women were overweight and 32.5% obese. CONCLUSIONS: Obesity is a highly prevalent pathology in this province and increases with age. Overweight is more common among men and obesity among women. Hypertension, Hyperlipaemia, Diabetes and high Fibrinogen are more prevalent in obese than in non-obese patients and increase in prevalence along with the obesity. Patients with the risk factors under study are generally obese. The coronary risk calculated was higher among the obese, the risk increasing along with excess of weight.

Adult↗

PubMed1998

[An evaluation of the surveillance system of mandatory disease reporting].

OBJECTIVE: Study of the exhaustibility and reliability of the recording of obligatory notifiable diseases (EDO) and the accumulated incidence of the EDO in a health area. DESIGN: Descriptive study. SETTING: Community setting. Epidemiological surveillance. PATIENTS: People who have suffered in 1996 some EDO (excluded measles, rubella, mumps, chickenpox and influenza). MEASUREMENTS AND MAIN RESULTS: They have been selected a total of 205 EDO-disease cases starting from the two recording systems: laboratory and obligatory surveillance diseases system. The exhaustibility of the laboratory has been 82%, 95% confidence interval (76-87%) and that of the EDO system 45%, 95% confidence interval (38-52%). The rate kappa for the diseases global is 0.42 95%, confidence interval (0.4-0.43) and the specific accordance proportion 0.27, 95% confidence interval (0.21-0.34). The cases search in the recording of the laboratory increases the incidence declared to the EDO system in all the diseases. The diseases with greater incidence are the hepatitis (73.59 x 10(5)), the pulmonary tuberculosis (27.07 x 10(5)) and the syphilis (18.05 x 10(5)). CONCLUSIONS: The EDO system presents a clear understatement, variable according to the different diseases and being maximum for the hepatitis B and C. The laboratory quantifies a high exhaustibility, and it can increase between 55 and 30% the EDO recording cases, increasing the knowledge of the morbidity caused by EDO in the Area 11. The valuation of the EDO in addition to improving the information for the assumptions of decisions in sanitary planning, optimizes the necessary elements when it is compared the EDO incidence among different geographical areas or within a same area at a different time.

Communicable Diseases↗

PubMed2004

Leisure activities, friendships, and quality of life of persons with intellectual disability: foster homes vs community residential settings.

Living in the community does not, in itself, guarantee social integration and inclusion for persons with intellectual disability. Friendships and leisure participation can indicate the beginning of such a process and their impact on quality of life. The present study investigated the quality of life, friendships and leisure activities of persons with intellectual disability who live in community settings or in foster families. Three hypotheses were examined: 1. Persons with intellectual disability who live in foster families have more friends than do those who live in community residential settings. 2. Persons with intellectual disability who live in community residential settings participate in more leisure activities than those who live in foster families. 3. The more friendships and leisure activities in which one is involved, the higher the quality of one's life. The sample consisted of 85 adults with intellectual disability, ranging in age from 18 to 55 years. Forty-five live in community residential settings and 40 live in foster families in Israel. Five questionnaires were used: 1) a demographic questionnaire; 2) Quality of Life Questionnaire, 1990); 3) the Revised UCLA Loneliness Scale; 4) Social Relationships List; and 5) Leisure Activities List. The main findings show no significant differences between the two groups in the number of friendships or feelings of loneliness. Foster residents were more involved and more independent in their leisure activities than were those who live in community residences. An association between friendships, leisure activities and quality of life was partly confirmed. The need for intervention programs and leisure education programs is discussed.

Adolescent↗

PubMedDate not supplied

Hepatitis C and HIV in incarcerated populations: fights, bites, searches, and syringes!

Implications of hepatitis C (HCV) infection in corrections settings and learning needs of nurses whose primary expertise is care of HIV-infected individuals will be presented. This target group of nurses who provide care for HCV-infected patients includes nurses working in corrections settings, and community settings, whose clients have been or will be incarcerated, and advanced practice nurses working in a variety of settings. For nurses who work in the community setting, background information is presented on characteristics of the incarcerated and the environments of some different settings where incarceration occurs, such as county, state, juvenile, and federal institutions. Barriers to HCV prevention, testing, and treatment for incarcerated people are unique and different than for those living in the community. These distinctions are an important area of knowledge for nurses caring for patients who are HCV positive or at risk, whether they are practicing in a community or correctional setting.

HIV Infections↗

PubMed2004

Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study.

OBJECTIVES: The purpose of this study was to evaluate the prognostic value of community-based myocardial perfusion imaging (MPI) and to assess the incremental value of individual components of (99m)Tc-sestamibi single photon emission computed tomography (SPECT). BACKGROUND: Although the most rapid growth of MPI has been in community outpatient laboratories, its prognostic value has not been validated in this setting. METHOD: We prospectively followed 1,612 consecutive patients undergoing stress (99m)Tc-sestamibi SPECT in an outpatient community laboratory who experienced 71 hard events over 24 +/- 7 months (0.2% lost to follow-up). RESULTS: Patients whose scans were normal incurred an annualized event rate of 0.4%, compared with 2.3% for those with abnormal scans (p < 0.0001). Subset analysis demonstrated comparable risk stratification for women and men, diabetics, patients with normal resting ECGs, and those referred for pharmacologic and exercise stress. After adjusting for pre-test variables, multivariable Cox regression analysis found the most potent independent components of MPI to be, in order of importance, transient ischemic dilation, extent of reversibility, post-stress ejection fraction, extent and severity of the stress perfusion defect, and the overall test result (normal or abnormal). Each 1% decrement of ejection fraction predicted a 3% increase in risk (p = 0.0009). Post-MPI angiography and revascularization increased commensurate with the extent and severity of MPI result. CONCLUSIONS: The prognostic value of perfusion imaging is portable and transferable to the outpatient community setting, with multiple components of MPI providing incremental prognostic information.

Aged↗

PubMedDate not supplied

Ensuring quality nursing education in community-based settings.

With the shift to more nursing practice occurring in community settings, nurse educators are seeking ways to guarantee a quality education in community settings. The authors describe one nursing student's activities at a community health center, reflecting the movement toward a community-based curriculum at the University of Hawaii School of Nursing.

Community Health Nursing↗

PubMed1999

Incentives and accessibility: a pilot study to promote adherence to TB prophylaxis in a high-risk community.

SETTING: A community-based directly observed preventive therapy (DOPT) program for treatment of latent tuberculosis infection among injection drug users (IDUs) in an inner-city neighborhood. OBJECTIVE: To test adherence to a 6-month course of DOPT using cash incentives and an easily accessible neighborhood location. DESIGN: Street-recruited IDUs (N = 205) were screened for Mycobacterium tuberculosis (TB) infection using the Mantoux test and two controls. Subjects who had a purified protein derivative (PPD) reaction of > or =5 mm, were anergic, or had a history of a positive PPD received clinical evaluation at a community field site, provided in collaboration with the San Francisco Department of Public Health Tuberculosis Clinic. Twenty-eight subjects were considered appropriate candidates for prophylaxis with isoniazid, and 27 enrolled in the pilot study. Participants received twice-weekly DOPT at a community satellite office, with a $10 cash incentive at each visit. RESULTS: The 6-month (26-week) regimen was completed by 24/27 (89%) participants. The median time to treatment completion was 27 weeks (range 26 to 34 weeks). The median proportion of dosing days attended in 6 months was 96%. CONCLUSION: Community-based DOPT using cash incentives resulted in high levels of adherence and treatment completion among drug users.

Adult↗