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PubMed1998

Community health promotion nursing practice.

Evolving definitions of community and health promotion require the examination of community nursing practice. This article critically explores how the meanings of community may influence community nursing practice. In nursing, the most common definitions of community are of community as context/resource and community as client. The authors postulate that these definitions of community influence the nature of community practice. Moreover, if nurses are to practice within the context of health promotion, focusing on community as a relational experience, new patterns of community health promotion practice will need to emerge. This pattern of practice must honor people's experiences of community including power relations present in community. A new pattern of community health promotion nursing practice encompasses the four components of listening and critical reflection; participatory dialogue and critical questioning; pattern emergence and recognition; and movement to action.

Community Health Nursing↗
PubMed1987

Age-related prevalence and intensity of Trichuris trichiura infection in a St. Lucian community.

Age-related changes in the average worm burden and the prevalence of Trichuris trichiura infection, in a village community in St. Lucia, were examined by field studies based on worm expulsion techniques. Horizontal age-intensity profiles were convex in form with peak parasite loads occurring in the 2 to 15-year-old children. Prevalence is shown to be a poor indicator of changes in average worm load with age. Faecal egg counts (epg and epd) provide a qualitative measure of worm burdens since fecundity is shown to be approximately independent of worm load. The parasites were highly aggregated within the study community, with most people harbouring low burdens while a few individuals harboured very heavy burdens. Of the total parasite populations in the study sample, 84% were harboured by the 2 to 15-year-old children. Of those individuals harbouring 100 worms or more, 87% were in the 2 to 10-year-old age range. Crude estimates of population parameters (basic reproductive rate, 4-5; rate of reinfection, 90 year-1) suggest that the rate of reinfection is higher than for other helminth parasites of man. The control of morbidity and parasite transmission is discussed in the context of targeting drug treatment at the child segment of the study population.

Adolescent↗
PubMed2003

Professional identities and interprofessional relations: evaluation of collaborative community schemes.

Despite the widespread support for integrated community care in the U.K., interdisciplinary working between health and social service staff remains complex and tentative. This paper represents the findings of an evaluative research study of two collaborative community nursing schemes at differing stages of project development within West Yorkshire, England. The studies set out to explore in depth the ways social and health care professionals construe their identity and relationships within the changing context of collaborative projects. The research adopted a constructivist phenomenological approach, conducting focus groups with social workers and district nurses; supplemented by in-depth individual interviews. Using template analysis enabled the researchers to explore themes and issues generated from the groups and individuals. A number of areas associated with professional identity and the development of roles in response to changing situations were identified as pertinent including; role ambiguity, role erosion and extension. In cases where joint working required a reconstructing of professional identity, individuals were constrained by their personal meanings, organizational arrangements and public perceptions. Implications for research and practice are discussed.

Community Health Services↗
PubMed2004

[Community structure organization and its relation with environmental factors of sown grassland in South China].

Contribution of environmental factors, spatial factors, biological and random factors to community structure within a man-made grassland in southern terra was partitioned using canonical correspondence analysis. Under mowing and grazing, environmental factors explained (27.4% and 25.9%) variation of community structure. Contribution of spatial factors was 32.5%, 24.2%, respectively. Contribution of biological and random factors was 48% and 56%, respectively. Gradient in community structure and species abundance is evident along environmental gradient in mowing grassland. The environment-community/species relations were more complex in grazed grassland. Patches under different grazing intensity develop toward different directions.

China↗
PubMed1985

Prevalence of bronchial asthma and chronic bronchitis in a community in northern Sweden; relation to environmental and occupational exposure to sulphur dioxide.

The prevalence of chronic bronchitis and bronchial asthma has been studied in a community in northern Sweden, where the major air pollutant is sulphur dioxide (SO2) from a sulphite pulp factory. In the town the annual mean winter concentration of SO2 during the years 1975-1979 was 20-40 micrograms SO2/m3 air. A questionnaire concerning respiratory symptoms was distributed to all individuals (2374) within the age group 16-72 years, and was answered by 2203 individuals (93%). Bronchial asthma was found in 78 (3.5%) individuals, chronic bronchitis in 57 (2.6%) and both diagnoses in 3 individuals (0.1%). There was a statistically significant relationship between presence of chronic bronchitis and sex, age, smoking and employment at the sulphite pulp factory. Sulphur dioxide exposure at the factory apparently acted synergistically with smoking in increasing the relative risk for chronic bronchitis in smoking employees compared to non-smoking non-employees. However, our results indicate no excess risk of chronic bronchitis in a population with long-term environmental exposure to SO2 in concentrations between 20-40 micrograms, when the concentration of other air pollutants is low.

Adolescent↗
PubMed1993

A survey on drug-related hospitalization in a community teaching hospital.

We retrospectively studied 2,695 patients admitted to the Department of Medicine over a 10-month period in 1990 to determine the incidence of drug-related hospitalization. A drug-related problem was identified as the primary cause of hospitalization in 109 (4.0%) admissions. The incidence was significantly greater in the elderly group as compared with the non-elderly group (5.2% vs 3.2%). Non-steroidal anti-inflammatory drugs, hypoglycemic agents, herbal medicine, adrenocorticosteroids and antihypertensive drugs were most often involved. The five most common adverse events were upper gastrointestinal tract bleeding, skin rashes, hypoglycemia, hypercorticism and hepatitis. Iatrogenic disease was fatal in 2 cases. Patients used drugs without medical supervision in 45 cases. In view of the increasing complexity of modern pharmacotherapy and the popularity of self-medication in our society, educational efforts should be enhanced for medical professionals and the general population to reduce the risk of drug-related hospitalization.

Adolescent↗
PubMed2005

Community experiences and perceptions related to demolition and gut rehabilitation of houses for urban redevelopment.

Reports about current residential demolition practices received from residents and plans for large-scale urban redevelopment in East Baltimore provided impetus for this study to assess community concerns and develop approaches to addressing them. This article describes the following themes regarding residents' experiences with demolition and gut rehabilitation of older housing performed as part of urban redevelopment: (1) lack of notification and awareness about protective measures; (2) concerns about environmental and safety hazards; (3) psychosocial impact from displacement, disruption in daily life, and inattention to community concerns; and (4) recommendations to improve redevelopment practices, including ideas to control neighborhood exposure to environmental hazards potentially exacerbated by residential demolition and gut rehabilitation. The findings from focus groups substantiated and deepened our understanding of earlier anecdotal reports of residents' concerns and emphasized the need for including community perceptions and ideas in addressing environmental and psychosocial issues related to urban redevelopment.

Adolescent↗
PubMed1996

Psychiatric aspects of food-related physical symptoms: a community study.

Beliefs about symptoms, food and health, mood disturbance, consulting behavior, and eating habits and attitudes were assessed by postal questionnaire in 273 adults who complained of food intolerance in a community study. In contrast to previous studies conducted in allergy clinics, most subjects who reported symptoms related to foods that were judged not to be allergic on clinical grounds did not manifest significant mood disturbance, impaired social adjustment, or excessive consultation for other nonspecific physical or psychological symptoms. Subjects attributing symptoms to food sensitivity suffered less psychological impairment than those attributing symptoms to other causes such as stress, stomach or bowel disorder, or food contamination. However, an important subgroup of patients did report marked impact of symptoms on everyday life, frequent consultation in traditional and complementary medical contexts, and appreciable mood disturbance. The reported association between perceived food intolerance and psychiatric disorder in allergy clinic patients is likely to be an artifact of referral bias.

Adult↗
PubMed2006

The assessment and validity of stress-related growth in a community-based sample.

In an investigation of the assessment and construct validity of stress-related growth, community-dwelling women (N = 163) wrote essays about the impact of a stressful life event that had occurred in the previous few years and completed the Posttraumatic Growth Inventory (PTGI). Independent ratings of growth in the essays were positively correlated with PTGI scores, suggesting that endorsement of growth on questionnaires can be substantiated by personal accounts. There was no relation between reports of growth on the PTGI and socially desirable responding or negative mood. Higher PTGI scores were associated with greater positive mood and greater depth of processing in the essays. These findings support the validity of stress-related growth as a construct and its assessment via questionnaire.

Adaptation, Psychological↗
PubMed1997

Evaluation of brain injury related behavioral disturbances in community mental health centers.

As a result of improved emergency trauma services, more individuals suffering a traumatic brain injury are surviving. Unfortunately, most of these survivors suffer chronic neuropsychiatric sequelae related to both the brain damage and the psychosocial impact of the injury on self-esteem, self-image, primary role, and vocational function. Current community supports are often inadequate to deal with the complex array of neurologic and psychiatric difficulties. This article outlines common features of brain injury, explores the link between these features and the common neuropsychiatric sequelae of brain injury, and suggests some principles helpful in the evaluation of the behaviorally challenged brain injured patient.

Adult↗
PubMed1992

Health needs of a suburban community: a nursing assessment approach.

Community health nursing can play an important role in conducting community needs assessments that provide critical data upon which programming, planning, and evaluation should be based. The community health services developed for any given community should be planned with the specific needs of the community residents in mind. A community needs survey is one method that should be periodically employed to ascertain the specific needs and concerns of community residents. Nursing conceptual models developed by CHNs are very appropriate to the assessment of all aspects of community life related to health and well-being. Comprehensive community needs surveys should include assessment of environmental, psychosocial, and physiological aspects of health as well as indicators of health-related behaviors in the population. The Omaha classification system adapted for this study provides a broad conceptual framework that facilitates the development of comprehensive programs of assessment. Public health services are in a state of crisis in many states. Traditional program offerings may no longer be the key to providing the types of services most needed by some communities. Analysis of data on problems related to personal and family well-being in one upper middle class suburban community indicate a need for health promotion and services focused on many of the psychosocial aspects of health. The stress experienced by younger community residents appears to be related to issues of parenting and balancing the dual roles required at work and home. Families of elders are also confronted by issues concerning the decreasing independence of these individuals and the need to find additional support services for them. Community health services must be designed that take these factors into account. Professional nurses can provide the leadership necessary to assess health needs and current public health practices in these communities and to recommend and implement programs appropriate to the needs of the present and the goals of the future.

Adult↗
PubMed2002

Community study of the relative impact of HIV-1 and HIV-2 on intrathoracic tuberculosis.

BACKGROUND: HIV-1 infection is associated with an increased incidence of and mortality from tuberculosis. Few community studies have examined the effect of HIV-2 on tuberculosis. METHODS: We investigated the association between HIV-1, HIV-2 and active tuberculosis in four districts (population 42 709) in Bissau, capital of Guinea-Bissau, with the highest known seroprevalence of HIV-2 infection in the world. From May 1996 to June 1998, tuberculosis surveillance and active case finding among contacts was conducted. Patients were HIV-tested, given specific tuberculosis treatment for 8 months and followed regarding mortality. Simultaneously, an HIV sero-survey was performed in a random sample of 1748 permanent residents. RESULTS: During a 25-month period, 366 tuberculosis cases were identified. After excluding cases among visitors to the area, and adjusting for age, the incidence of tuberculosis was 18.3 times higher (95% CI 12.9-26.0) among HIV-1-positive individuals, 13.7 times higher (9.0-20.7) among dually infected (HIV-1 and HIV-2), and 3.0 times higher (2.1-4.3) among HIV-2-infected compared with HIV-negative individuals. HIV-1 and dually infected tuberculosis patients had a higher mortality rate than HIV-negative tuberculosis patients [mortality ratio (MR) 2.68; CI 1.11-6.48 and 2.89; CI 1.13-7.39, respectively]. The survival of HIV-2-positive tuberculosis patients was similar to that of HIV-negative tuberculosis patients (MR 1.19; CI 0.46-3.06). CONCLUSION: The presence of HIV-2 infection increases the incidence of tuberculosis compared with that in non-HIV-infected individuals, but does not affect tuberculosis-related mortality in the short term. In contrast, the presence of HIV-1 infection, alone or with HIV-2, has a several-fold greater impact on both the incidence of and mortality from tuberculosis.

Adolescent↗
PubMed1990

The relative influence of the community and the health system on work performance: a case study of community health workers in Colombia.

A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHWs) conducted in two departments (provinces) in Colombia in 1986. The research was based on a theoretical model of worker performance that focuses on job related sources of rewards and feedback. A survey research design was employed to obtain information from a random sample of rural health promoters (N = 179) and their auxiliary nurse supervisors about CHW performance and contributing factors. The findings indicate that feedback and rewards from the community have a greater influence on work performance (defined as degree of perceived goal attainment on job tasks) than do those stemming from the health system.(ABSTRACT TRUNCATED AT 250 WORDS)

Colombia↗
PubMed2005

Fish community responses to metal pollution.

The effect of metal pollution on fish communities was assessed at 47 sites, including a Cd and Zn gradient. Fish community structure was assessed by applying diversity indices, index of biotic integrity and the abundance/biomass comparison method (ABC-index). To relate the community responses to metal pollution, toxic unit values for dissolved metals (TU(w)) and for metals in fish liver (TU(t)) were calculated. If all sites were considered only a good relationship was found between the IBI and the TU(w), with 56% of the variation in IBI being described. Within the pollution gradient (sites 1--12) the described variation increased up to 85%. Relating the community structure to TU(t), the described variation in IBI further increased to 87%. Our results indicate that besides water quality other factors influenced diversity and ABC-index. The IBI proved a suitable index for the assessment of metal pollution, provided that other water quality characteristics meet the water quality criteria.

Animals↗
PubMed1989

Consistency of reported levels of alcohol-related problems in the community.

Regular drinkers identified in a general population survey of adults in the Lothian region were followed up 3 or 4 years later, with respect to alcohol-related problems. Using a variety of analytic methods, a moderate degree of temporal consistency in problems was found, for total number of problems, and for individual problems, with feeling ashamed of having done something while drunk being the most consistent.

Adult↗
PubMed2000

Community indicators of health-related quality of life--United States, 1993-1997.

It is known that persons' longevity is affected by the environmental and population characteristics of their community. Studies that identify community-level characteristics associated with the health-related quality of life (HRQOL) of residents could help guide local health planning. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993-1997 indicate that HRQOL differs among U.S. counties according to county population size. In addition, socioeconomic and health status indicators, such as poverty, noncompletion of high school, unemployment, number of persons with severe work disabilities, mortality, and births to adolescents, also might affect county-level HRQOL differences. This report examines initial findings on the relation between selected community health status indicators (CHSIs) and the mean number of days that persons aged > or =18 years reported ill health (i.e., unhealthy days), a surveillance measure of population HRQOL. The findings suggest that CHSIs may be useful in the public health planning process.

Adult↗
PubMed2005

Racial disparities in the receipt of osteoporosis related healthcare among community-dwelling older women with arthritis and previous fracture.

OBJECTIVE: To examine potential racial/ethnic disparities in osteoporosis care among community-dwelling older women with self-reported arthritis and previous fracture. METHODS: We conducted a computer assisted telephone interview using a population based random sample drawn from 6 counties in Alabama, USA. Eligible respondents had self-reported arthritis and were over 50 years of age; 1424 people responded to the survey. Logistic regression was used to examine the association of race/ethnicity with the receipt of dual energy x-ray absorptiometry (DEXA) and prescription osteoporosis treatments (including bisphosphonates, calcitonin, hormone replacement, or selective estrogen receptor modulators) among older women with a history of fracture. RESULTS: Of eligible African American and Caucasian female respondents, 251 (25%) reported a history of fracture after 45 years of age. Women with a history of self-reported fracture were predominantly Caucasian (n = 178, 71%) and had a mean age of 68 +/- 11 years. After multivariable adjustment, African American women with a fracture history were less likely than Caucasian women with a history of fracture to receive a DEXA (OR 0.39, 95% CI 0.19-0.81) or prescription osteoporosis medicines (OR 0.17, 95% CI 0.08-0.37). CONCLUSION: In this population of community-dwelling older women, African American respondents at high risk for fracture were far less likely than Caucasians to receive osteoporosis related healthcare.

Absorptiometry, Photon↗