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PubMed2006

Drug-related problems in the community setting: pharmacists' findings and recommendations for people with mental illnesses.

BACKGROUND AND OBJECTIVE: Adverse drug events are a leading cause of morbidity in Australia and internationally. People taking psychotropic drugs for mental illnesses may be particularly susceptible. This study aimed to classify and describe pharmacists' Home Medicines Review (HMR) findings and recommendations for people with mental illnesses. METHODS: This was a descriptive study conducted from March to November 2003. General practitioners and community pharmacists practising in two regions of metropolitan Sydney were invited to participate. General practitioners recruited and referred community-dwelling people with mental illnesses to receive HMRs conducted by accredited pharmacists. Reviewing pharmacists interviewed 49 people in their homes. During the interviews the pharmacists provided drug information, assessed drug knowledge and beliefs, and assessed drug adherence. Pharmacists then produced written referenced reports that outlined drug-, patient- and prescriber-related findings and recommendations. These findings and recommendations were presented to the referring general practitioners at follow-up case conferences. MAIN OUTCOME MEASURES: Drugs were classified using the Anatomical Therapeutic Chemical Classification System. Pharmacists' findings and recommendations were classified using the Clinical Pharmacy Activity Classification System. RESULTS: The most common types of nervous system drugs taken by people who received a HMR were antidepressants (n = 39.33%), analgesics (n = 29.24%) and antipsychotics (n = 17.14%). Pharmacists reported 403 findings and made 360 recommendations for 49 people, with 90% of recommendations being accepted by the referring general practitioners. The most common findings related to potential adverse drug reactions (n = 53, for 47% of people), suspected adverse drug reactions (n = 48, for 55% of people), potential interactions (n = 30, for 37% of people), and people taking additional drugs unbeknown to their referring general practitioner (n = 26, for 25% of people). The most common recommendations were to switch a drug (n = 37, for 49% of people), suggest a non-drug treatment (n = 29, for 41% of people) and to suggest a new drug (n = 27, for 49% of people). At the time of referral, general practitioners documented people to be taking 7.8 +/- 4.4 (mean +/- SD) drugs each (range 1-18). Following home interviews, pharmacists determined people to be taking 9.1 +/- 4.8 drugs (range 1-20). This difference was statistically significant (p < 0.001). CONCLUSIONS: Pharmacists identified a high incidence of drug-related problems among people receiving treatment for mental illnesses. Pharmacists also identified a higher incidence of overall drug use than documented by the referring general practitioners. HMRs and case conferences, undertaken collaboratively by general practitioners and pharmacists, may be a useful strategy to identify drug-related problems among people with mental illnesses.

Adult↗
PubMed2002

Discrimination, crime, ethnic identity, and parenting as correlates of depressive symptoms among African American children: a multilevel analysis.

This study investigated the correlates of childhood depressive symptoms in an African American sample. We included processes that are likely to operate for all children, regardless of race or ethnicity, as well as events and circumstances that are largely unique to children of color. These various constructs were assessed at both the individual and community level. The analyses consisted of hierarchical linear modeling with a sample of 810 African American families living in Iowa and Georgia. Three individual-level variables were associated with childhood depressive symptoms: uninvolved parenting, racial discrimination. and criminal victimization. At the community level, prevalence of both discrimination and criminal victimization were positively related and community ethnic identification was negatively related to depressive symptoms. Further, there was evidence that community ethnic identification and neighborhood poverty serve to moderate the relationship between criminal victimization and depressive symptoms. Overall, the findings underscore the importance of considering factors unique to the everyday lives of the cultural group that is the focus of study, while demonstrating the dangers of a 'one model fits all" approach to studying children of color.

Black or African American↗
PubMed2006

Response of rhizobial populations to moderate copper stress applied to an agricultural soil.

The use of pesticides in agricultural soils may affect the soil microbiota. The effect of repeated application of copper sulfate in soil on indigenous populations of rhizobia was assessed in a medium-term field experiment. Copper sulfate was applied over 8 years at two different rates, 12.5 and 50 kg of CuSO4 ha(-1) year(-1), in the field. The concentrations of total copper in soil varied between 14.0 (control plots that did not receive copper sulfate) and 91.0 mg kg(-1) (the most contaminated plots) at the time of sampling, 3 years after the end of the copper treatments. All the other physicochemical parameters were similar among the plots that also shared the same cropping history. The target rhizobia were monospecific populations of Rhizobium leguminosarum bv. viciae nodulating Vicia sativa and communities of rhizobial species nodulating Phaseolus vulgaris. The size of the vetch rhizobial populations was significantly reduced in the soils with the higher Cu content, whereas the size of the Phaseolus rhizobial populations was not significantly affected. However, the number of nodules formed on both vetches and common beans were reduced for the plants grown in the most contaminated soils, suggesting an additional toxic effect of copper on plant physiology. The diversity (Simpson's indices) of rhizobial genotypes, as characterized by polymerase chain reaction restriction fragment length polymorphism of 16S-23S rDNA intergenic spacer (IGS), was not influenced by copper application. Also, the genetic structure of the R. leguminosarum bv. viciae populations was not modified by copper treatments. By contrast, a shift was observed in the composition of the Phaseolus-nodulating communities in relation to soil copper content. The communities were composed of three 16S rDNA haplotypes: one corresponding to the R. leguminosarum (biovar phaseoli) species, the two others forming a new lineage of Phaseolus rhizobia based on 16S rDNA sequence analysis. The reduced frequency of the R. leguminosarum species in the Phaseolus-nodulating communities from the copper-treated soils was linked to its higher sensitivity to copper as compared to the higher tolerance of isolates belonging to the other rhizobial lineage. The new lineage was functionally efficient for symbiotic nitrogen fixation with P. vulgaris. Our results suggest that functional redundancy among species exhibiting variability for copper tolerance preserved the size of Phaseolus-nodulating communities. In contrast, the abundance of the vetch-nodulating rhizobia, which was a monospecific functional group mainly constituted by copper-sensitive genotypes, was adversely affected by repeated application of copper sulfate.

Agriculture↗
PubMed2003

Personality dimensions in schizophrenia: associations with symptoms and coping.

While individual differences in personality exist among persons with schizophrenia and predate the onset of illness, less is known about their relationship to outcome. This study examined whether levels of three personality dimensions-neuroticism, extraversion, and agreeableness-are associated with symptomatology and coping in persons with schizophrenia. Symptom, personality, and coping measures were obtained for 59 participants with schizophrenia. Personality and coping measures were obtained for 17 persons in a community comparison group. Relative to the community comparison groups, participants with schizophrenia had higher levels of neuroticism, lower levels of extraversion and agreeableness, and tended to employ more avoidant styles of coping. Participants with schizophrenia who had higher levels of neuroticism had greater positive and emotional discomfort symptoms and greater preferences for avoidant coping strategies. Participants with schizophrenia who had higher levels of agreeableness had lower levels of positive and excitement symptoms. No links were found between extraversion and outcome measures. Implications for understanding how personality may affect outcome are discussed.

Adaptation, Psychological↗
PubMed2004

Breaking the sod: humankind, history, and soil.

For most of history, few things have mattered more to human communities than their relations with soil, because soil provided most of their food and nutrients. Accordingly, some of the earliest written documents were agricultural manuals intended to organize, preserve, and impart soil knowledge. Indeed, ancient civilizations often worshipped the soil as the foundry of life itself. For the past century or two, nothing has mattered more for soils than their relations with human communities, because human action inadvertently ratcheted up rates of soil erosion and, both intentionally and unintentionally, rerouted nutrient flows.

Agriculture↗
PubMed2002

The challenge of preventing environmentally related disease in young children: community-based research in New York City.

Rates of developmental and respiratory diseases are disproportionately high in underserved, minority populations such as those in New York City's Washington Heights, Harlem, and the South Bronx. Blacks and Latinos in these neighborhoods represent high risk groups for asthma, adverse birth outcomes, impaired development, and some types of cancer. The Columbia Center for Children's Environmental Health in Washington Heights uses molecular epidemiologic methods to study the health effects of urban indoor and outdoor air pollutants on children, prenatally and postnatally, in a cohort of over 500 African-American and Dominican (originally from the Dominican Republic) mothers and newborns. Extensive data are collected to determine exposures to particulate matter < 2.5 microm in aerodynamic diameter (PM(2.5)), polycyclic aromatic hydrocarbons (PAHs), diesel exhaust particulate (DEP), nitrogen oxide, nonpersistent pesticides, home allergens (dust mite, mouse, cockroach), environmental tobacco smoke (ETS), and lead and other metals. Biomarkers, air sampling, and clinical assessments are used to study the effects of these exposures on children's increased risk for allergic sensitization, asthma and other respiratory disorders, impairment of neurocognitive and behavioral development, and potential cancer risk. The center conducts its research and community education in collaboration with 10 community-based health and environmental advocacy organizations. This unique academic-community partnership helps to guide the center's research so that it is most relevant to the context of the low-income, minority neighborhoods in which the cohort resides, and information is delivered back to these communities in meaningful ways. In turn, communities become better equipped to relay environmental health concerns to policy makers. In this paper we describe the center's research and its academic-community partnership and present some preliminary findings.

Adult↗
PubMed2006

Factors related to successful collaboration in community-campus partnerships.

Collaboration and community partnership have become buzzwords in academic settings, which have received little direction regarding how to make these efforts successful and sustainable. This study attempted to discern the factors involved in setting up one successful community-campus partnership. Four years after opening an all-volunteer free health clinic in Laramie, Wyoming, we interviewed community members and university faculty who were involved in the initial partnership. Analysis of these interviews identified several dynamic tensions that kept the group together Communitand moving toward its goal.

Clinical Clerkship↗
PubMedDate not supplied

Retaining public health nurses in rural British Columbia: the influence of job and community satisfaction.

BACKGROUND: Although the need to retain rural registered nurses is pressing, little is known about what influences them to stay in their current employment. The objectives of the study were: to examine public health nurses' (PHNs) job and community satisfaction; to relate job and community satisfaction to their decision to stay in their current employment in rural British Columbia. METHODS: A survey was mailed to all front-line PHNs in 48 rural and small urban communities in British Columbia. Of the 164 eligible PHNs, 124 responded (76% response rate). RESULTS: PHNs were most satisfied with their professional status, professional interaction and autonomy, their communities' acceptance of their partners, friendliness of the community and their friends. They were least satisfied with their salary. Job satisfaction or community satisfaction was not found to influence retention. Instead, "filter factors" such as age, retirement, family needs and the economy affected PHNs' intent to stay or leave. CONCLUSION: If PHNs are to be retained in rural areas, their economic and family life situations merit greater attention, as does their experience of living and working in rural communities.

Adult↗
PubMed1987

Psychosocial and demographic correlates of temporomandibular disorders and related symptoms: an assessment of community and clinical findings.

This study investigated the factor structure and relative prevalence of temporomandibular disorder (TMD) symptoms, in relation to demographic and psychosocial variables in a community sample. Two empirically distinct clusters of TMD symptoms were identified. Similar to reports of TMD clinic patients, more symptoms were reported by females than males and the greatest symptom prevalence was found in subjects between the ages of 30 and 49 years. Further, the number of symptoms reported was significantly and linearly related to scores on depression and repression-sensitization scales. These relationships, however, were similar for both sets of symptom composites even though one composite is clearly identifiable as the core TMD symptoms and the second composite consists of peripheral symptoms. Since the two symptom composites share some common variance, the relationship between demographic and psychosocial characteristics and the number of composite I and composite II symptoms was examined while controlling for the presence of symptoms from the other composite. When controlling for the presence of composite II symptoms, the correlations between psychosocial and demographic characteristics and composite I symptoms are small. When the presence of composite I symptoms is controlled there is little change in the magnitude of the correlations between psychosocial and demographic characteristics and composite II symptoms. It is concluded that the psychosocial profile described in clinical research is actually more characteristic of individuals with pain/dysfunction symptoms other than the classic TMD symptoms and that the relationship between core TMD symptoms (composite I) is largely spurious. It is suggested that this psychosocial profile of TMD patients may have developed through associating certain psychosocial characteristics with TMD while such characteristics are actually present in TMD clinic patients because of the covariation of the two symptom composites in individuals seeking treatment in TMD clinics.

Adolescent↗
PubMed2006

[Antibiotic consumption between 1996 and 2003: national survey and international comparison].

AIMS: To describe the qualitative and quantitative changes of antibiotic consumption in Hungarian hospitals and in the primary care setting between 1996 and 2003. METHODS: Sales data relating to community and hospital care antibiotic consumption were obtained for the 8 years period of 1996-2003. The 2003 version of the world health organisation (WHO) anatomical therapeutic chemical (ATC)/ defined daily dose (DDD) system was used for calculations and the 2005 version for classifications. The final expression units were DDD/100 bed-days and DDD/1000 inhabitants/day for hospital and community care utilization, respectively. Trend analysis was applied to assess the annual changes in antimicrobial consumption. RESULTS: The total antibiotic consumption in the community setting and in the hospitals remained relatively stable during the study period. The average antibiotic consumption in the community setting (20.20 +/- 1.42 DDD/1000 inhabitants/day was in line with the European average, while the national average hospital antibiotic consumption (24.81 +/- 1.69 DDD/ 100 bed-days) was very low in international benchmark. Changes in the pattern of antibiotic consumption was observed in both settings. Internationally outstanding consumption of penicillins plus beta-lactamase inhibitor combinations (J01CR) and sulphonamides and extremely low utilisation of beta lactamase resistant penicillins (J01CF) were detected. The hospital antibiotic consumption was characterized by extended use of sulphonamides, tetracyclines, and second generation cephalosporins. CONCLUSIONS: The low hospital consumption of antibiotics and the internationally extreme usage of certain antibiotic groups needs further pharmacoepidemiologic analysis.

Ambulatory Care↗
PubMed1990

Health-related behaviour in a small Scottish community.

A survey of health-related behaviours was carried out in a small Scottish town. A random sample stratified by age and sex was drawn from the records of the sole local health centre. A previously validated questionnaire was sent by post with a covering letter from the general practitioners and a reply paid envelope. An overall response rate of 71.3% was achieved. The results indicated very high rates of smoking for women with manual jobs, but differences between men in manual & non manual groups were not significant. Younger women reported higher alcohol consumption than older women, but there were no significant differences between occupational groups or employed and unemployed men. Only a minority of respondents reported regular consumption of high fibre products, low fat milk and polyunsaturated margarine and few claimed to undertake vigorous exercise. In general health-related behaviours showed little association with self-rated health. Whilst the data confirm the importance of socio-demographic factors in certain behaviours they also indicate that these are inadequate to predict the pattern of such behaviours within a community.

Adolescent↗
PubMed2006

Familiality of obsessive-compulsive disorder in nonclinical and clinical subjects.

OBJECTIVE: Studies of the familiality of obsessive-compulsive disorder (OCD) have yielded inconsistent results. This study compared the familial aggregation of OCD in first-degree relatives of community subjects with never-treated OCD, outpatients with OCD, and comparison subjects. METHOD: Fifteen persons from the community with untreated OCD were matched on age and interview type (direct or through family informants) with 90 OCD patients from four treatment facilities and 70 comparison subjects. Direct or indirect interviews using the German-language version of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version for Anxiety Disorders (DSM-IV) were obtained from 58, 285, and 247 first-degree relatives, respectively, of the three groups. The rate of OCD in case versus comparison relatives was assessed with chi-square tests, and odds ratios were calculated for risk estimation. Cox proportional hazards analysis was used to estimate the age-related risk of relatives of being affected by OCD. RESULTS: Cox proportional hazards analyses revealed a 6.2-fold higher risk (hazard ratio) for relatives of all OCD cases for definite OCD and a 2.2-fold higher risk for subclinical OCD compared with relatives of comparison subjects. For relatives of community subjects with OCD, the risk for definite OCD (10.3% versus 5.6%) was 1.6, and the risk for subclinical OCD (15.4% versus 4.1%) was 3.4 compared with relatives of OCD patients from treatment sites. CONCLUSIONS: These results from the first controlled European family study of OCD confirm earlier U.S. data on the familiality of OCD in patients recruited from treatment facilities. The finding of a comparable familial aggregation of definite OCD and a higher familial aggregation of subclinical OCD in relatives of never-treated persons with OCD from the community strongly supports the impact of familial-genetic factors in OCD.

Ambulatory Care↗
PubMed1999

Burnout and AIDS care-related factors in HIV community clinical nurse specialists in the North of England.

Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Better functional mobility in community-dwelling elderly is related to D-hormone serum levels and to daily calcium intake.

The influence of calcitropic hormones on functional mobility has been studied in vitamin D (calcidiol) deficient elderly or elderly with a history of falls, however, data in community-dwelling independent vitamin D replete elderly are missing. We therefore assessed in an observational survey the association of calcidiol (25(OH)D3) and calcitriol (D-hormone / 1,25(OH)2D3) status as well as of daily calcium intake on functional mobility in older subjects We evaluated 192 women and 188 men, aged superior 70 years and living independently. Average Timed-up and go test (TUG-test) in seconds was taken as measure of functional mobility. Calcidiol and D-hormone serum concentrations and daily calcium intake were studied in multivariate controlled linear regression models with TUG-test performance as the dependent variable and/or as dichotomous variables (deficient vs. non-deficient, above vs. below the median, respectively). Subjects with low D-hormone serum concentrations took significantly more time to perform the TUG-test (low = 7.70s +/- 2.52 SD ; high = 6.70s +/- 1.29 SD; p = 0.004). In the linear multivariate controlled regression model increased D-hormone serum concentrations predicted better TUG-test performance (estimate -0.0007, p = 0.044). Participants with a calcium intake of > or =512 mg/day were significantly faster to perform the TUG-test than participants with a daily calcium intake of <512 mg/day (estimate:-0.43, p = 0.007). Other significant predictors of better TUG-test performance in both models were: male gender, less comorbid conditions, younger age, lower BMI, iPTH serum levels and creatinine clearance. Calcidiol serum levels were not associated with TUG-test performance. Higher D-hormone status and a calcium intake of > or =512 mg/day in community-dwelling independent older persons are significant determinants of better functional mobility. Therefore, to ensure optimal functional mobility, the care of older persons should address correction of D-hormone deficiency and increasing daily calcium intake.

Aged↗
PubMed1993

Community health in eastern Africa--and the East African Medical Journal's contribution over seventy years.

The East African Medical Journal which started in 1923 has now reached its 70th year. To what extent has the journal focused the attention of policy and decision makers on the most relevant problems of and solutions for Community Health in Eastern Africa? To answer this question this paper surveys the Journal's publications on Community Health in four eras into which the 70 years can be subdivided. It then tries to match these publications with what has been happening in the political field and in the development of health services related to community health. The conclusion is that the journal has, in this geographical region, been keeping pace with important trends and has been a stimulus to the development of improved and more relevant services for communities. Although the predominant focus has often been on publications based on clinical research in hospital settings, it is hoped that the journal will step up even further its publication of papers related to community health and Primary Health Care. By doing so it can make an even greater contribution to the health and well being of the populations of Eastern Africa and not just to the care of individuals who gain access to medical institutions.

Community Medicine↗
PubMed2005

Prostate-specific antigen screening in a high-risk population: lessons from the community and how they relate to large-scale population-based studies.

OBJECTIVES: To estimate the incidence of prostate cancer among African-American men and Caribbean immigrants to the United States, to assess the applicability of large-scale prostate screening trials to a community screening program, and to recruit unscreened men. METHODS: African-American and Caribbean-American men were targeted with a community-based prostate cancer screening program in Jamaica, New York. Serum prostate-specific antigen determination and digital rectal examination were used to determine abnormal findings. The incidence of an abnormal screening examination was used to project the incidence of prostate cancer, which was compared with that in other reported trials. RESULTS: The projected incidence of prostate cancer among African-Americans and Caribbean-Americans older than 50 years was 8% and 7%, respectively, similar to that reported in other trials of African-American men. The projected incidence of prostate cancer in Caribbean-American men aged 40 to 49 years was 1%, the same as the high rate reported among Caribbean men. As in other trials, a family history of prostate cancer and age were strong predictors of abnormal findings. Of the recruited men older than 50 years, 58% had never been screened compared with 42% nationally. CONCLUSIONS: Large population-based screening trials have identified ethnic groups at high risk of prostate cancer. This trial detected high rates of abnormal screening findings by targeting ethnicity. The incidence of an abnormal examination was high in Caribbean-American men younger than 50 years old. Finally, this trial successfully recruited underscreened men.

Adult↗