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PubMed2004

Runoff-related agricultural impact in relation to macroinvertebrate communities of the Lourens River, South Africa.

A field study at the Lourens River, South Africa, was undertaken during the pesticide application period between November 2001 and January 2002 in order to investigate the potential relation of agricultural pollution to the aquatic macroinvertebrate fauna. The upper regions of the Lourens River were free of contamination (LR1), whereas subsequent stretches flowing through a 400-ha orchard area (LR2) received transient insecticide peaks. Continuously operating suspended-particle samplers as well as flood samplers operating during runoff events were used to measure pesticide contamination. In addition, various physicochemical and morphological parameters were examined. A survey of the macroinvertebrate communities associated with the rocky substrates was carried out every three weeks. Community indices were calculated using the South African Scoring System (SASS 5) for bioassessment of water quality in rivers. The two sites differed in pesticide pollution as well as in average turbidity levels (LR1 5.5 mg/L; LR2 64.3 mg/L), but were similar in bottom substrate composition and most other abiotic factors. At the downstream site (LR2), pesticide values of 0.05 microg/L azinphos-methyl in water as well as 49 microg/kg azinphos-methyl, 94 microg/kg chlorpyrifos and 122 microg/kg total endosulfan in suspended particles were found during runoff conditions. The macroinvertebrate communities of the two sampling sites were similar in terms of number of total individuals, but differed significantly (ANOVA) in average number of taxa (LR1 11.7, LR2 8.9). Seven out of 17 investigated taxa occurred in significantly reduced numbers or were even absent at the downstream site LR2. The community characteristics determined by SASS 5 showed a significantly less sensitive community structure at the downstream site (TS 41; ASPT 4.6), indicating continuously lower water quality compared to site LR1 (TS 80; ASPT 6.9). It is concluded that the Lourens River macroinvertebrate communities are affected by agricultural pollution, with pesticides and increased turbidity as the most important stressors.

Agriculture↗
PubMed2005

Reflecting the relative values of community, faculty, and students in the admissions tools of medical school.

BACKGROUND: In defining the characteristics of medical students that society and the medical profession find desirable, little effort has been spent assessing the relative value of the dozens of characteristics that have been identified. Furthermore, many institutions go to great lengths to ensure equal representation across stakeholder groups in an effort to maximize the heterogeneity of the pool of students accepted to study medicine; however, the extent to which different stakeholders value different characteristics has yet to be determined. PURPOSE: This study was an attempt to assess the relative value of the characteristics of medical students that society and the medical profession find desirable. METHODS: Using documents created internationally to identify the core competencies of medical personnel, a series of 7 characteristics were generated for inclusion in a study that adopted the paired comparison technique. Of 347 surveyed, 292 respondents indicated the rank ordering they would assign to each characteristic by circling the more important characteristic in all possible pairings. RESULTS: Overwhelmingly, "ethical" was deemed to be the most important characteristic on which selection tools should be based. Surprisingly, the pattern of responses was highly consistent regardless of stakeholder group and degree of affiliation with the undergraduate medical program. CONCLUSIONS: The generalizable features of this study not only include the empirical findings but also demonstrate useful survey protocol that can be adapted by any admission committee to guide the generation of an institution-specific admissions blueprint. A novel protocol that provides the necessary flexibility is discussed.

Faculty↗
PubMed2001

Women's health and pregnancy outcomes: do services make a difference?

We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services on health and pregnancy outcomes for women of reproductive age. Between 1990 and 1998 Indonesia trained some 50,000 midwives. Between 1993 and 1997 these midwives tended to be placed in relatively poor communities that were relatively distant from health centers. We show that additions of village midwives to communities between 1993 and 1997 are associated with a significant increase in body mass index in 1997 relative to 1993 for women of reproductive age, but not for men or for older women. The presence of a village midwife during pregnancy is also associated with increased birthweight. Both results are robust to the inclusion of community-level fixed effects, a strategy that addresses many of the concerns about biases because of nonrandom program placement.

Adult↗
PubMed2000

Drug related deaths in the community: a preventive role for accident and emergency departments?

Reducing drug related deaths has been identified as a priority by the British government. This study examined the link between drug related deaths in the community and prior contact with local accident and emergency (A&E) services. Most drug related deaths were found among male opioid users in their early 30s who had previously attended the local A&E department. It is suggested that A&E departments have a vital part to play, not only in the acute management but also in the prevention of drug related deaths in the community. Models for primary prevention, liaison and ongoing referral are discussed.

Adult↗
PubMed1994

Three faces of integrative coordination: a model of interorganizational relations in community-based health and human services.

OBJECTIVE: This study develops a theoretically justified, network-based model of integrative coordination in community-based health and human services, and it uses this model to measure and compare coordination in six elder service systems. DATA SOURCES AND STUDY SETTING: We collected data between 1989 and 1991 in six Alabama counties, including two major MSAs, two small MSAs, and two rural areas. STUDY DESIGN AND DATA COLLECTION/EXTRACTION METHODS: Our measurement of coordination is based on patterns of interorganizational relationships connecting the agencies constituting a community-based health and human services system. Within each site, we interviewed representatives from these agencies, asking them to indicate client referral, generalized support, and agenda-setting relationships they had developed with each of the other agencies in the system. Using network analysis procedures we then identified the network associated with each of these organizational functions (i.e., service delivery, administration, and planning) in each site, and we assessed levels of coordination in each network. PRINCIPAL FINDINGS: Our measure of integrative coordination is consistent with other indicators of coordination we derive from our data, suggesting its validity. In addition, levels of integrative coordination across sites for each organizational function are generally comparable. Comparisons across sites show integrative coordination to be consistently highest for service delivery networks and lowest for planning networks. CONCLUSIONS: Previous attempts to assess interorganizational coordination without regard to organizational function are subject to misinterpretation. The differing interorganizational dynamics involved in service delivery, administration, and planning appear to generate different patterns of interorganizational relationships, and different levels of coordination.

Aged↗
PubMed2005

Phytoplankton size-distribution and community structure in relation to mucilage occurrence in the northern Adriatic Sea.

The spatial and temporal variations of pico-, nano- and microphytoplankton abundance and composition were investigated over a 37 month period, focusing on the ecological role of different size classes of phytoplankton, and on the changes of the community structure that might occur during periods when large mucilage macroaggregates appear. Samples were collected monthly from June 1999 to July 2002 at 11 stations, along three transects covering the northern Adriatic basin. Highest abundances were observed in late-winter/spring for microphytoplankton (mainly diatoms), in spring-summer for nanophytoplankton, and in summer for picophytoplankton. The autotrophic component was more abundant in the summers of 2000 and 2002 (when large mucilage aggregates occurred) than in the summers of 1999 and 2001 (when a massive phenomenon was not observed). This increase was statistically significant for pico-, nano- and, among microphytoplankton, only for dinoflagellates. Blooms of picophytoplankton were often observed at the bottom layer during mucilage summers. The microphytoplankton community during mucilage phenomena was characterized by a species composition (Chaetoceros spp., Cerataulina pelagica, Pseudo-nitzschia delicatissima, P. pseudodelicatissima, Cylindrotheca closterium, Dactyliosolen fragilissimus) comparable to that observed in summers without extensive mucilage occurrence. However, some species appeared with significantly higher densities in the summers of 2000 and 2002: Ceratium furca, C. closterium, Oxytoxum spp., Hemiaulus hauckii and Gonyaulax fragilis. Microscopic observation of aggregates revealed that the microphytoplankton species composition inside the aggregates was comparable to that observed in the water column, with an enrichment of opportunistic species such as C. closterium and P. delicatissima. The presence of mucilage aggregates affects the phytoplankton populations in the water column, even when aggregates are at early stages. It seems that there is a mutual relationship between phytoplankton and aggregates, i.e., several diatom and dinoflagellate species may contribute to the aggregate formation and enlargement, but mucilage aggregates themselves may also affect the phytoplankton populations, allowing the development of a rich diatom community and in general enhancing nanophytoplankton growth.

Demography↗
PubMed1990

Problems reported by relatives in a community study of dementia.

The supporters of 120 demented elderly people completed rating scales of the frequency and severity of the problems they faced, the amount of strain they experienced and their psychological well-being. Problems and strain increased with the degree of dementia. Problems relating to physical dependency, forgetfulness and inertia were relatively common, while disturbed behaviours were relatively uncommon. Physical dependency and disturbed behaviour were less well tolerated than forgetfulness and inertia, but all problem categories were positively associated with measures of strain. Wives reported more problems and strain than husbands, and co-resident children were under greater strain than children who lived independently.

Activities of Daily Living↗
PubMed1977

Client evaluation of community mental health services: relation to demographic and treatment variables.

Community mental health center (CMHC) outpatient clients' satisfaction and perceived problem improvement were assessed by telephoning 108 clients, representing 40% of clients discharged during the period under investigation. The CMHC's services were perceived positively, and most clients were satisfied with their therapy experience, found it helpful, and felt more able to handle future problems. Data on reasons for termination, expected future behavior, and extratherapeutic factors were also gathered. Of particular interest were the findings that satisfaction and improvement were unrelated to client age, sex, marital status, or social class, but significantly more positive outcome responses were found for those clients who terminated therapy with a mutual client--therapist decision as compared to those who terminated unilaterally.

Adaptation, Psychological↗
PubMed1988

Generalist health and welfare workers' response to alcohol related problems: role legitimacy and the need for role-support, an example from an Australian rural community.

In relating measures of therapeutic commitment (TC) in a sample of Australian rural town generalist health and welfare workers to their urban counterparts (modelled on Cartwright's study) it was confirmed that the former lacked the knowledge, training and support required to function as effective interventionists in alcohol related problems. Rural generalists were worse off than urban generalists when it came to gaining greater access to the variables that predict a positive TC.

Alcoholism↗
PubMed1993

Prevention of alcohol-related accidents in the community.

This paper establishes a conceptual and operational basis for development of community prevention programs to reduce alcohol-related accidents. A public health perspective of accidents is proposed as the philosophical basis for local prevention interventions in which accidents are viewed as system problems (system outputs, if you will) not simply problems caused by a few alcohol-dependent individuals. Since there are no examples of controlled community prevention research projects (trials) which have demonstrated a reduction in community-level alcohol-related accidents, such controlled trials are needed in the future. An example of one being developed by the Prevention Research Center, Berkeley, CA is provided. Without such controlled trials, prevention research will be unable to demonstrate that such accidents can actually be reduced. This paper explores the applications of a public health perspective to the prevention of alcohol-involved accidents at the community level including a conceptual model of alcohol-involved trauma and suggested design, alternative local interventions, possible outcome measures, and phases for community prevention of alcohol-related accidents.

Accident Prevention↗
PubMed1999

HIV-related malignancies: community-based study using linkage of cancer registry and HIV registry data.

For people immunosuppressed by human immunodeficiency virus (HIV), we expect an increase in cancer incidence similar to that documented in transplant patients. We examined the cancer spectrum in an HIV-infected cohort, specifically malignancies not currently associated with acquired immunodeficiency syndrome (AIDS), in relation to the general population. Cancer incidence data for residents of Harris County, Texas, diagnosed between 1975 and 1994, were linked to HIV/AIDS registry data by Soundex code and date of birth to identify malignancies in an HIV-infected cohort of 14,986 persons. Incidence of cancer in this cohort was compared to the general population by standardized incidence ratio (SIR) analysis. From the HIV-infected cohort, 2289 persons (15%) were identified as having one or more malignancies, with 97% occurring in males. The linkage alone identified 29.5% of the malignancies, of which only 28.7% were diagnosed in males. Adjusting for age, HIV-infected men and women had incidences of cancer that were 16.7 [95% confidence interval (CI) 16.1-17.3] and 2.9 (95% CI 2.3-3.7) times that expected for the general population of Harris County, Texas. Besides Kaposi's sarcoma, non-Hodgkin's lymphoma, cervix cancer and brain lymphoma, non-AIDS related malignancies of Hodgkin's lymphoma, non-melanotic skin cancer in males and colon cancer in females, exhibited significant SIRs of 5.6 (95% CI 3.6-8.4), 6.9 (95% CI 4.8-9.5) and 4.0 (95% CI 1.1-10.2). Increased incidences of lung, prostate and breast malignancies were not seen in this HIV cohort. Persons infected with HIV appear to be at increased risk for the non-AIDS related malignancies, Hodgkin's lymphoma, non-melanotic skin cancer in males and colon cancer in females.

Adolescent↗
PubMed1996

Relations of Fish Community Composition to Environmental Variables in Streams of Central Nebraska, USA

Nine sites on streams in the Platte River Basin in central Nebraska were sampled as part of the US Geological Survey's National Water-Quality Assessment Program during 1993-1994. A combination of canonical correspondence analysis and an index of biotic integrity determined from fish community data produced complementary evaluations of water-quality conditions. Results of the canonical correspondence analysis were useful in showing which environmental variables were significant in differentiating fish communities at the nine sites. Five environmental variables were statistically significant in the analysis. Median specific conductance of water samples collected at a site accounted for the largest amount of variability in the species data. Although the percentage of the basin as cropland was not the first variable chosen in a forward selection process, it was the most strongly correlated with the first ordination axis. A rangeland-dominated site was distinguished from all others along that axis. Median orthophosphate concentration of samples collected in the year up to the time of fish sampling was most strongly correlated with the second ordination axis. The index of biotic integrity produced results that could be interpreted in terms of the relative water quality between sites. Sites draining nearly 100% cropland had the lowest scores for two individual metrics of the index of biotic integrity that were related to species tolerance. Effective monitoring of water quality could be achieved by coupling methods that address both the ecological components of fish communities and their statistical relationships to environmental factors.KEY WORDS: Canonical correspondence analysis; Fish communities; Environmental variables; Index of biotic integrity; National Water-Quality Assessment Program; Nebraska

Journal Article↗
PubMed2026

Relational care in community mental health: Evaluating staff experiences in Intensive Community Care Services (ICCS) vs treatment as usual.

BACKGROUND: The quality of healthcare delivery relies heavily on building strong relationships between healthcare providers (HCPs) and clients. This study presents the results of a process evaluation for a Randomised Controlled Trial (RCT) examining the effectiveness of Intensive Community Care Service (ICCS) vs Treatment as Usual (TAU; inpatient or core community CAMHS). METHODS: Thirty-four semi-structured interviews were conducted with staff across various services, including 20 from ICCS and 14 other TAU services. A thematic decomposition analysis was conducted on the data, and specific themes relevant to staff experiences of young people's engagement with services and overall recovery. RESULTS: Three main themes were observed in the HCP data (1. Relational Ecologies: barriers and enablers to engagement, 2. flexibility of approach amidst systemic pressures and 3. the web of trust in the relationship-building process). HCPs highlighted the necessity of developing trust and rapport through non-clinical engagement strategies, such as informal visits and personalised interactions. HCPs emphasised that without trust, treatment effectiveness diminishes, necessitating a tailored approach rather than a one-size-fits-all model. The flexibility in duration of treatment and methods of engagement was noted as crucial in accommodating individual client needs and fostering an open, trusting environment necessary for long-term recovery. CONCLUSION: The findings highlight the vital importance of relational care models, especially ICCS, in addressing the complex needs of Children and Young People (CYP). Flexible, family-centred approaches improve trust, engagement, and long-term recovery outcomes. Recommendations include tackling systemic barriers and expanding relational care models within CAMHS to meet increasing mental health demands effectively. Further research should investigate scalable strategies for integrating these insights into wider mental health service frameworks.

Humans↗
PubMed2000

A prospective study of age and lifestyle factors in relation to community-acquired pneumonia in US men and women.

BACKGROUND: Information is limited on risk factors for community-acquired pneumonia (CAP) in free-living populations. We examined the associations of age, smoking status, body mass index (BMI), weight change during adulthood, physical activity, and alcohol intake with risk of CAP among men and women. METHODS: The study population included 26,429 men aged 44 to 79 years from the Health Professionals Follow-up Study and 78,062 women aged 27 to 44 years from the Nurses' Health Study II. Information was collected by biennial mailed questionnaires and the main outcome was physician-diagnosed incident pneumonia. RESULTS: There were 290 cases among men (6 years of follow-up) and 305 cases among women (2 years of follow-up). Age, smoking status, BMI, physical activity, and alcohol intake were taken into account in the multivariate logistic regression model. There was a dose-response relation between aging and risk of CAP among men. Compared with never smokers, current smoking was associated with risk of CAP among men (relative risk, 1.46; 95% confidence interval, 1.00-2.14) and women (relative risk, 1.55; 95% confidence interval, 1.15-2.10). In addition, BMI was directly associated with an increased risk of CAP among women. Compared with the participants who maintained their weight during adulthood, the risks were nearly 2-fold higher among men and women who gained 40 lb or more (> or =18 kg). The risk of CAP decreased with increasing physical activity among women. We also found no significant relation between alcohol intake and risk of CAP among men and women. CONCLUSIONS: Smoking and excessive weight gain are risk factors for CAP among men and women, and physical activity was inversely associated with risk of CAP only among women. The incidence of CAP could possibly be decreased by lifestyle factors.

Adult↗