Interventions and documentation for drug-related problems in Dutch community pharmacies.
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Clinical Pharmacy Information Systems↗
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Results for “Community Relations”
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Suicidal ideation and health-related quality of life in the community.
OBJECTIVE: To examine the health-related quality of life of people with suicidal ideation in the general community. DESIGN: A Health Omnibus Survey of a random, representative sample of the South Australian population in 1998, conducted by experienced interviewers. SUBJECTS: 3010 people over the age of 15 years. OUTCOME MEASURES: The survey included questions about utilisation of health services and the Short-form Health-related Quality of Life (SF-36) and Assessment of Quality of Life (AQoL) instruments. Suicidal ideation was determined in response to a direct question. RESULTS: 79 (2.6%) subjects reported suicidal ideation in the past two weeks. Compared with those without suicidal ideation, subjects with suicidal ideation reported significantly greater use of general practitioners, psychiatrists, psychologists, social workers and outpatient clinics (P<0.001), community health services and other counsellors (P<0.01), and more hospital admissions (P<0.05). Those subjects also scored significantly poorer on all subscales of both instruments (P<0.001), to the extent that they were below the 4th percentile on the role-emotional and mental health dimensions of the SF-36 and the social relationships, psychological wellbeing and overall scores of the AQoL. CONCLUSIONS: Suicidal ideation is associated with poor health-related quality of life. These results in a random and representative community sample add support to the need to improve targeting of those with suicidal ideation on a population basis with a view to earlier intervention.
Adolescent↗
Morbidity from asthma in relation to regular treatment: a community based study.
BACKGROUND: The extent to which asthma morbidity in the community occurs in patients who are having relatively little treatment or in those on step 3 or above of the British asthma management guidelines is uncertain. We have looked at this in a community population in southern Nottinghamshire. METHODS: A cross sectional review of treatment in all patients over the age of four with diagnosed asthma was carried out in five large general practices (population 38 865) in 1995/6 using computerised general practice records. The patients' usual treatment was obtained from prescription data and categorised by the appropriate step on the British guidelines on asthma management. Two measures of morbidity, the request for 10 or more short acting beta agonist inhalers a year or the need for a course of oral corticosteroids in the last year, were related to the regular treatment of the patients. RESULTS: Of the 3373 patients (8. 7%) given a diagnosis of asthma, the percentage on steps 1, 2, 3, 4, and 5 of treatment were 54%, 22%, 11%, 3.6%, and 1%, respectively, with a further 8% having had no treatment. During the past year 13. 6% had been prescribed 10 or more beta agonist inhalers and 12.5% had received at least one course of oral corticosteroids. Both measures occurred more frequently in patients taking more prophylactic treatment (step 3 or above). Nevertheless, because most patients were on steps 1 and 2 of the treatment guidelines, more than half the patients requiring high doses of inhaled beta agonists or a course of oral prednisolone came from those taking low dose or no regular inhaled corticosteroid. CONCLUSIONS: Evidence of morbidity from asthma was found in many patients taking little or no prophylactic medication and this should be amenable to improved education. A different approach may be needed for patients with continuing morbidity who are already taking higher doses of prophylactic medication.
Adolescent↗
[Alcohol-related admissions in a community hospital].
We reviewed 150 alcoholic patients (1.3% of all admissions) hospitalized in this department during 1983-1987 and compared them with a random sample of 450 other patients in the department during the same period. In the alcoholic group were more males, an increased prevalence of those of Yemenite and Indian origin, and a higher rate of unemployed. The clinical presentation was heterogenous. In 26% of the chronic alcoholics no abnormality related to alcoholic injury was detected. The other patients in that group suffered from a variety of clinical problems related to alcohol. In 41% the immediate cause of admission was related to chronic alcoholism, and in others (31%) we observed alcohol-related pathology in addition to the main cause of hospitalization. We wish to increase awareness of the medical problems of chronic alcoholics encountered in a community hospital in order to promote quicker diagnosis, avoid unnecessary diagnostic procedures, and lead to better medical care.
Alcoholism↗
Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents.
This article reviews major risk factors for cigarette smoking, alcohol, and other drug abuse and promising community-based approaches to primary prevention. In a longitudinal experimental study, 8 representative Kansas City communities were assigned randomly to program (school, parent, mass media, and community organization) and control (mass media and community organization only) conditions. Programs were delivered at either 6th or 7th grade, and panels were followed through Grade 9 or 10. The primary findings were (a) significant reductions at 3 years in tobacco and marijuana use and (b) equivalent reductions for youth at different levels of risk. This study provides evidence that a comprehensive community program-based approach can prevent the onset of substance abuse and that the benefits are experienced equally by youth at high and low risk.
Adolescent↗
Family caregivers' experiences with community services: a qualitative analysis.
Researchers of family caregiving have presented mixed results in evaluating the effectiveness of community services in reducing family caregiver stress and have indicated that many caregivers use limited services or access services late in their caregiving experience. The purpose of this study was to describe the experience of the use of community services, including benefits and barriers, by family caregivers of relatives with Alzheimer's disease or a related disorder. Community services included assistance with caregiving or related tasks and educational or emotional support that was provided by health professionals or community service providers. In this qualitative descriptive study, a convenience sample of 21 family caregivers was interviewed. Open-ended questions were used to explore the caregivers' experiences with community services. Transcribed data were analyzed using qualitative content-analysis techniques. Results indicated that family caregivers received benefits of renewal, sense of community, and new knowledge and believed that their patient benefited from the services. Barriers to service use included care receiver resistance, reluctance of the caregiver, hassles for the caregiver, concerns over quality, and concerns over finances. These findings provide direction for community nurses and other health professionals in targeting interventions that will meet the expressed needs of caregivers.
Aged↗
Effects on alcohol related fatal crashes of a community based initiative to increase substance abuse treatment and reduce alcohol availability.
OBJECTIVE: This analysis tested whether comprehensive community interventions that focus on reducing alcohol availability and increasing substance abuse treatment can reduce alcohol related fatal traffic crashes. INTERVENTION: Five of 14 communities awarded Fighting Back grants by The Robert Wood Johnson Foundation to reduce substance abuse and related problems attempted to reduce availability of alcohol and expand substance abuse treatment programs (FBAT communities). Program implementation began on 1 January 1992. DESIGN: A quasi-experimental design matched each program community to two or three other communities of similar demographic composition in the same state. MAIN OUTCOME MEASURES: The ratio of fatal crashes involving a driver or pedestrian with a blood alcohol concentration of 0.01% or higher, 0.08% or higher, or 0.15% or higher were examined relative to fatal crashes where no alcohol was involved for 10 years preceding and 10 years following program initiation. RESULTS: Relative to their comparison communities, the five FBAT communities experienced significant declines of 22% in alcohol related fatal crashes at 0.01% BAC or higher, 20% at 0.08% or higher, and 17% at 0.15% or higher relative to fatal crashes not involving alcohol. CONCLUSIONS: Community interventions to reduce alcohol availability and increase substance abuse treatment can reduce alcohol related fatal traffic crashes.
Accidents, Traffic↗
Causes of horse-related injuries in a rural western community.
OBJECTIVE: To determine the causes of horse-related injuries in a rural western community. DESIGN: Prospective identification of persons with horse-related injuries and retrospective interviews with patients or witnesses to determine causes. SETTING: A small rural community in Alberta where the western style of riding predominates. PATIENTS: All patients presenting to two family medicine clinics or to the Sundre General Hospital emergency department. MAIN OUTCOME MEASURES: Factors contributing to the injury as recalled by patients or witnesses, and characteristics of the persons, horses, and injuries. RESULTS: Two thirds of the 150 injuries were caused primarily by horses and one third primarily by patients risk taking or inattention. The most common horse behaviour that caused injuries was "spooking," but several other behaviours also were identified as primary causes. The injuries were varied and relatively severe. Only one person was wearing a helmet. CONCLUSIONS: Horse-related injuries often are caused by characteristic horse behaviours.
Accidents, Occupational↗
Downstream changes in the composition of the parasite community of fishes in an Appalachian stream.
The spatial distribution of 6 parasite species (Myxobolus sp., Dactylogyrus sp., Sterliadochona ephemeridarum, Plagioporus sinitsini, Allopodocotyle chiliticorum, Allocreadium lucyae) was studied in 5 species of fishes (Oncorhynchus mykiss, Clinostomus funduloides, Notropis chiliticus, Rhinichthys atratulus, Semotilus atromaculatus) in Basin Creek, an Appalachian stream in North Carolina. Nonmetric multidimensional scaling and vector fitting were used to determine if the proximity of sampling sites was related to community similarity. Position along Basin Creek was significantly related to parasite community structure. Breaks in parasite community composition were imposed by waterfalls at upstream areas of Basin Creek that restricted distributions of C. funduloides, N. chiliticus, and S. atromaculatus and at the downstream limit of the study area by a break in the distribution of S. ephemeridarum coincident with the existence of a dam but were independent of suitable piscine host distributions. These discontinuities in parasite community composition imply that the relationship between proximity of sites and community similarity is predictive because distance between sites is related to the probability that fish at different sampling sites recruit parasites from different species pools. This relationship is not the same for all component communities.
Analysis of Variance↗
Flemish community pharmacists' motivation and views related to continuing education.
OBJECTIVE: IPSA (Institute for Permanent Study for Pharmacists) wanted to assess community pharmacists' opinion on CE-related issues in order to develop more tailored CE programs. METHOD: A survey for self-administration was sent to 1691 community pharmacists. The method of stratified sampling was used to include pharmacists who do not take up CE courses as well. MAIN OUTCOME MEASURES: (1) Preferences for course formats, topics of interest and opinion on different CE providers; (2) Facilitators and barriers for participation in CE courses; (3) Opinion on rewarding and participation, obligation and willingness to pay. RESULTS: A response rate of 62.8% was obtained after three mailings. Lectures remain the most favorite course format. Topics related to pharmaceutical care are the most wanted. The strongest facilitators for attending CE courses are gathering practical knowledge and keeping scientific knowledge up to standard. Social contact with colleagues and receiving a syllabus are perceived as moderately motivating factors. Most frequently mentioned barriers were lack of time, family constraints, distance to the classes and uninteresting subjects. Around 2/3rd of questioned pharmacists are willing to invest more time in CE when participation would be rewarded. When it comes to opinion on mandatory CE, disagreement exists between pharmacists who take up CE courses and those who don't, the latter being less in favor. CONCLUSION: This survey revealed community pharmacists' opinions, wishes and needs concerning CE. This should enable CE providers to develop more tailored CE programs.
Adult↗
A community study of gynecological and related morbidities in rural Egypt.
This study assesses the prevalence of gynecological and related morbidity conditions in a rural Egyptian community. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women. For gynecological morbidities, genital prolapse was diagnosed in 56 percent, reproductive tract infections in 52 percent, and abnormal cervical cell changes in 11 percent of the women. For related morbidities, anemia was present in 63 percent of the women, followed by obesity (43 percent), hypertension (18 percent), and urinary tract infection (14 percent). Regression analysis of risk factors demonstrated the contribution of social conditions and medical factors to these diseases. Reproductive tract infections were shown to occur more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload showed significant associations with related morbidity conditions. This evidence challenges national health programs to go beyond safe motherhood, child survival, and family planning in its services to women, and to consider the social context of health as well.
Adult↗
Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice.
Criticisms of existing nursing theories in relation to community health nursing practice are that they focus on individuals and have been developed primarily for practice within the context of infirmity and disease, making them inadequate to guide community health nursing practice. Despite being developed for individuals, Watson's theory is proposed as a nursing framework that is philosophically congruent with contemporary global approaches to community health and health promotion. An overview of her theory identifies the centrality of caring, holism, and ecology in the theory as it has evolved over the past 20 years. Concepts developed for individual-nurse interactions are extrapolated to the community in a discussion of the suitability of the theory to guide community health nursing practice. A community assessment tool based on Watson's theory is provided.
Community Health Nursing↗
Making a difference: the social ecology of social transformation.
A multidisciplinary and multilevel framework for social transformation is proposed, encompassing four foundational goals: capacity-building, group empowerment, relational community-building, and culture-challenge. Intervention approaches related to each goal are presented at the setting, geographic community, and societal levels. Four exemplars of social transformation work are then discussed: the Accelerated Schools Project, Meyerhoff Program, ManKind Project, and women's movement. These examples illustrate the synergistic relationship among the four transformational goals, within and across levels of analysis, which is at the heart of the social transformation process. The paper concludes with three challenges to guide our efforts as we enter the new century: (1) to move social transformation to the center of our consciousness as a field; (2) to articulate jointly with allied disciplines, organizations, and citizen groups an encompassing, multidisciplinary, and multilevel framework for social transformation; and (3) to do the above with heart, soul, and humility.
Culture↗
Community programs and screening related to diabetes and its complications.
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Community Health Services↗
Relational experiences of elderly women living alone in rural communities: a phenomenologic inquiry.
The purpose of this phenomenological study was to develop a beginning description of the relational experiences of elderly women living alone in rural communities. Relational theories provided the conceptual framework. Data were gathered through in-depth interviews of 8 elderly Caucasian women. Using Colaizzi's (1978) descriptive phenomenologic methodology, two central themes emerged from the written transcripts: connectedness and the need for control. Connections were to family, friends, the community, and God. The women in this study controlled their relational boundaries, balancing their need for connection with the desire for solitude and privacy. The women also exhibited strong independence and the desire to continue to live alone at home.
Activities of Daily Living↗
[Japanese version of the Short-Memory Questionnaire and Mini-Mental State Examination in relation to demographic variables: community survey of elderly healthy residents in Nakayama, Japan].
BACKGROUND AND PURPOSE: The Short-Memory Questionnaire (SMQ) developed by Koss et al. is a standardized, validated reliable informant-based scale to assess everyday memory problems. In the previous study, we prepared its Japanese version and validated the reliability in assessing patients with Alzheimer Disease. In the present study, we examined the relations between the performance evaluated by the Japanese version of the SMQ combined with the Mini-Mental State Examination (MMSE) and demographic variables (age, sex, and education). SUBJECTS AND METHODS: Subjects were a total of 613 elderly healthy individuals living in the rural residency of Nakayama, Japan. They consisted of 287 males and 326 females and ranged from 65 to 94 years in age and from 0 to 16 years in education. The MMSE was conducted by neuropsychiatrists to assess the severity of cognitive impairment, and the SMQ was conducted by public health nurses, who asked a family member of each subject. The effects of age, sex and education on the MMSE and SMQ scores were analyzed by analysis of variance (ANOVA) using post-hoc Scheffé test. RESULTS: The mean MMSE and SMQ scores (+/- SD) were 27.6 (+/- 2.5) and 44.5 (+/- 2.1), respectively. The post-hoc Scheffé test revealed significantly higher MMSE scores for individuals with 8 years or more in education than for those with less than 8 education years. Between males, no significant differences were observed in MMSE score; however, among females, significantly higher scores were noted in those aged 69 or younger than in those aged 70-74 or those aged 80 or older. Of individuals aged 80 or older, males showed significantly higher scores than females, whereas no significant differences were observed between sex in other age groups. As to the SMQ, higher scores were shown by persons with longer education years and by females than males. CONCLUSION: Low MMSE scores were related to low education level and older females. Low SMQ scores were not related to aging, but linked to low education level and males. Both the MMSE and SMQ, which can be easily administered, are affected by education years and sex. In addition, MMSE score depends on age. Therefore, careful consideration should be paid to age, education level and sex for future execution of the MMSE and SMQ.
Aged↗
Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: the Asthma-Specific Quality of Life Questionnaire for Native American Adults (AQLQ-NAA).
The Asthma Quality of Life Questionnaire for Native American Adults (AQLQ-NAA) was developed by modifying the Asthma Quality of Life Questionnaire-Marks (AQLQ-M) using the focus group technique. The 19-item AQLQ-NAA has emphasis on restrictions in social, community, and cultural activities. Higher scores indicate a better quality of life. The modified questionnaire was administered to a sample of 51 Native American adults with asthma at the Albuquerque USPHS Indian Hospital and its affiliated field clinics. Principal components analysis identified three domains with eigenvalues greater than 1.00: Community and Social Restrictions (CSR), Psychological Impact (PIM), and Symptoms (SYM). Cronbach's coefficient alpha for the AQLQ-NAA was 0.95 and ranged from 0.82 to 0.93 for the individual domains, indicating good internal consistency. The AQLQ-NAA score correlated negatively and significantly to urgent care visits, physician visits, and total number of medications taken for asthma in the past 6 and 12 months (p < 0.05). Additionally, the AQLQ-NAA score was correlated positively and significantly to medication adherence in the past 6 and 12 months (p < 0.05). Similar patterns of correlations were found with all three domain scores. These results indicated that there is evidence for the construct validity of the AQLQ-NAA and its domains. The AQLQ-NAA should provide a useful measure of HRQOL in asthma-specific medical interventions for the population in which it was developed.
Adult↗
Ten-year change in disability prevalence and related factors in two generations of French elderly community dwellers: data from the PAQUID study.
BACKGROUND AND AIMS: Some studies have reported a decline in disability prevalence in older people, but few data were available for Europe, especially for France. Our aim was to study the 10-year evolution of disability prevalence in elderly community dwellers and related factors. METHODS: Two generations of subjects aged 75 to 84, participants in the PAQUID (Personnes Agées QUID) cohort were compared. The first generation included 1496 subjects (born between 1903 and 1912) and the second 910 subjects (born between 1913 and 1922). Three domains of disability were assessed: mobility, Activities of Daily Living (ADL) and Instrumental ADL (IADL). Logistic regressions were used to explain the effect of generation on disability, controlling for sociodemographic characteristics, impairment, life-style, medical care, and social support. RESULTS: The percentage of subjects fully independent increased from 13.5 to 23.3% (p < 0.001). A large decline in disability prevalence independent of the controlled factors was observed for mobility in both genders [Odds Ratio for the second generation (OR(G2)) = 0.48, 95% CI 0.38-0.60]. When adjusting for age and education, the risk of IADL disability was significantly lower in women in the second generation (ORG2 0.61, 95% CI 0.49-0.77), and the generation effect was strengthened when adjusting for the other covariates, but unchanged in men (ORG2 1.09, 95% CI 0.81-1.48). There was no significant change for ADL. CONCLUSIONS: A significant decline in disability prevalence was observed over 10 years, which was not explained by the selected covariates. These aggregate changes differed by gender, education, and the domain of disability considered.
Activities of Daily Living↗