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PubMed2004

Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?

OBJECTIVES: To assess how important community ambulation is to stroke survivors and to assess the relation between the level of community ambulation achieved and other aspects of mobility. DESIGN: A multicenter observational survey. SETTING: Community setting in New Zealand. PARTICIPANTS: One hundred fifteen stroke survivors living at home were referred from physical therapy (PT) services at 3 regional hospitals at the time of discharge and were assessed within 1 week after returning home. Another 15 people with stroke who did not require further PT when discharged were assessed within 2 weeks after they returned home to provide insight into community ambulation status for those without mobility impairment, as recognized by health professionals. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported levels of community ambulation ascertained by questionnaire, gait velocity (m/min), Functional Ambulation Categories (FAC) score, and Rivermead Mobility Index (RMI) score. RESULTS: Mean gait velocity for the participants was 53.9 m/min (95% confidence interval [CI], 52.3-61.1); mean treadmill distance was 165.5 m (95% CI, 141.6-189.5); median RMI score was 14; and median FAC score was 6. Mobility scores for the 15 people who did not require PT were within the normal range. Based on self-reported levels of ambulation, 19 (14.6%) participants were unable to leave the home unsupervised, 22 (16.9%) were walking as far as the letterbox, 10 (7.6%) were limited to walking within their immediate environment, and 79 (60.7%) could access shopping malls and/or places of interest. Participants with different levels of community ambulation showed a significant difference in gait velocity (P<.001). The ability to "get out and about" in the community was considered to be either essential or very important by 97 subjects (74.6%). CONCLUSIONS: Community ambulation is a meaningful outcome after stroke. However, despite good mobility outcomes on standardized measures for this cohort of home-dwelling stroke survivors, nearly one third were not getting out unsupervised in the community. Furthermore, gait velocity may be a measure that discriminates between different categories of community ambulation. These findings may have implications for PT practice for people with mobility problems after stroke.

Aged↗
PubMed1997

Setting health priorities: community boards accurately reflect the preferences of the community's residents.

Setting priorities remains an important part of healthcare planning and program management. Local community input is often sought in government or publicly sponsored programs. Community policy/advisory boards are a common vehicle to represent the community's interests in program decisions and direction. Questions remain whether community boards accurately represent their communities' views. As part of a planning effort within Chicago and Cook County, Illinois, local District Health Councils (DHCs) have been created to provide assistance and leadership in systemization and improvement of the healthcare in communities with the poorest health status in the region. We sought to discover how closely the perceptions of health priorities of DHC members agreed with those of community members. A structured five-point Likert scale questionnaire of 22 of the most common diseases and conditions known to impact health were used for a random digit dialing telephone interview with a sample of 286 households from three under-served communities. The same interview was repeated with all DHC members (n = 80) representing those communities. Sociodemographic profiles and health-related behaviors were also collected. The results of this interview indicate a close and substantial agreement in priorities between community members and DHC members. Psychosocial conditions such as violence and substance abuse were ranked as the highest priorities by both groups. In contrast, sociodemographics and healthcare behavior differed significantly between DHC members and community's residents. This study demonstrates that these community policy/advisory boards can closely reflect the views of the communities they represent. Attention to their differences in sociodemographics and healthcare experiences with the community may strengthen their role even more.

Adult↗
PubMedDate not supplied

Community pediatrics: gender differences in perspectives of residents.

OBJECTIVE: The Future of Pediatric Education II Report affirmed the importance of providing resident education in community settings. Yet we know little about related experiences of trainees and whether experiences and perspectives regarding community involvement vary by gender. We assessed gender differences in pediatric residents' involvement in and perspectives regarding community activities. METHODS: A national survey of US pediatric residents assessed residents' involvement in 14 activities before medical school and the intensity and perceived importance of involvement in 17 activities during medical school and residency. Expected future involvement 10 years hence was assessed for 11 community settings. chi2 and analysis of variance were used to examine bivariate relations by gender. Multivariate linear regression was used to model the relationship between gender and expected future involvement. RESULTS: Of the 700 respondents, 68% were women. Relative to men, more women reported exposure to child health advocacy and other community activities before and during medical school. Women and men reported similar involvement in residency, although women placed greater importance on inclusion of 16 of 17 community activities in their training. Female residents were more likely to report that current training in the community would influence their future career activities. Women anticipated greater future involvement in 6 of 11 settings. In adjusted analyses, gender remained associated with future involvement in 5 settings. CONCLUSIONS: As women come to comprise an increasing proportion of the pediatric workforce, further efforts are needed to understand the impact of gender on future involvement in community child health activities.

Adult↗
PubMed2001

Infant sleep problems and postnatal depression: a community-based study.

OBJECTIVES: To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting. DESIGN: Cross-sectional community survey. Setting. Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia. PARTICIPANTS: Mothers of infants 6 to 12 months of age. MAIN OUTCOME MEASURES: Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire). RESULTS: The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased. Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (<10, 10-12, and >12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score >12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and >10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression. CONCLUSIONS: Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.

Adult↗
PubMedDate not supplied

Stepwise approach to developing point-of-care testing services in the community/ambulatory pharmacy setting.

OBJECTIVE: To provide a stepwise approach to development and implementation of a point-of-care testing (POCT) patient care service. SETTING: Community and ambulatory care pharmacy practice. PRACTICE DESCRIPTION: To provide community and ambulatory pharmacists with the steps involved in integrating POCT services into their pharmacy practice site. PRACTICE INNOVATION: Authors used various resources to detail the process of implementing pharmaceutical care in community or ambulatory pharmacy settings in combination with individual practice experiences. The five steps involved in developing a POCT service include conducting a needs assessment, researching and organizing information, developing program materials, implementing the service, and evaluating the service. The narrative description of each step is illustrated by a case study example. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS/CONCLUSION: POCT patient care services are a valuable addition to a pharmacy's services, benefiting patients, health care providers, and the pharmacy. This article presents a structured, deliberate approach with resources that can be used to develop a successful POCT service within a community or ambulatory pharmacy setting.

Ambulatory Care↗
PubMed2005

Do women in the community recognize hereditary and sporadic breast cancer risk factors?

PURPOSE/OBJECTIVES: To describe knowledge of hereditary, familial, and sporadic breast cancer risk factors among women in the community and to identify characteristics associated with this knowledge. DESIGN: Descriptive, cross-sectional. SETTING: Community settings in the San Francisco Bay Area. SAMPLE: 184 women who had never been diagnosed with cancer, were 30-85 years old (mean = 47 + 12), and agreed to complete a questionnaire in English. Participants were from diverse racial and cultural backgrounds (i.e., 43% European descent, 27% African descent, 16% Asian descent, and 14% Hispanic descent). Many (49%) were college graduates, and 24% had a median annual family income of $30,000-$50,000. METHODS: Survey. MAIN RESEARCH VARIABLES: Knowledge of hereditary, familial, and sporadic breast cancer risk factors and characteristics associated with this knowledge. FINDINGS: Although most women recognized heredity as a risk factor, some did not understand the impact of paternal family history on risk. Some women did not recognize the relationship between breast and ovarian cancer, risk factors associated with the Gail model, and that aging increases risk. Education level was the most important characteristic associated with knowledge of risk factors. CONCLUSIONS: Although age and family history are independent predictors of sporadic, hereditary, and familial breast cancer risk, women in the community could not distinguish between the three forms of the disease. Although the sample included a large number of educated women, their knowledge of breast cancer risk factors appeared incomplete. IMPLICATIONS FOR NURSING: Advanced practice nurses should provide individualized risk assessment and education regarding breast cancer risk factors.

Adult↗
PubMed2003

Impulsivity, gender, and response to fenfluramine challenge in borderline personality disorder.

Behavioral impulsivity in borderline personality disorder (BPD) is associated with indices of diminished central serotonergic function, independent of suicidal behavior, depression or alcohol use disorder. Many of these studies have been conducted among males in specialized settings. Studies of BPD females, who constitute the majority of BPD patients, are generally conducted in community settings and report inconsistent findings. We studied gender differences in behavioral impulsivity and the prolactin response to D,L-fenfluramine (FEN) in BPD subjects in a community setting. A FEN challenge study was conducted with 64 BPD subjects (20 male, 44 female), and 57 controls (36 male, 21 female). Axis I and II disorders, including BPD, and suicidal histories were assessed by structured interviews. Controls were free of Axis I and II disorders. Impulsivity and aggression were assessed by the Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, Minnesota Multiphasic Personality Inventory-Psychopathic Deviate subscale, and the Brown-Goodwin Lifetime History of Aggression. Male, but not female, BPD subjects had significantly diminished prolactin responses compared to controls. Impulsivity and aggression each predicted prolactin responses. A significant effect of BPD diagnosis on prolactin response was eliminated when impulsivity was co-varied. Impulsivity and aggression were inversely related to delta-prolactin and peak-prolactin responses among male but not female subjects. Gender differences in central serotonergic function may contribute to variations in impulsivity in BPD.

Adult↗
PubMed1989

Marketing the pharmacist as a community health specialist.

The marketing of pharmacy services in the community setting has traditionally focused on the sale or delivery of a product. The public in general is not aware of the typical community pharmacist's involvement in the overall health and well being of the populace he or she serves. This paper proposes a new focus to the marketing of pharmacy services that will highlight the expanded health role of pharmacists in the community and allow them to move away from a product-oriented practice toward a more service-oriented practice. Several examples of specialized services that can be easily implemented in the community setting are also presented.

Community Pharmacy Services↗
PubMed1993

Factors affecting student nurses' learning in community placements: a phenomenological study.

The study aimed to explore the question, what factors affect student nurse learning in a community setting? A phenomenological approach was taken by carrying out in-depth interviews with eight Project 2000 students who had just completed 8 weeks of community placements. The factors which emerged centred around three themes: the students themselves, the mentors and the placements. Students recognized that their own approach to the placement was important. They found that the role they fulfilled in the placements affected their learning, preferring a participative role to observation only. The role of the mentor was found to be crucial for learning. Important factors were the mentors' knowledge and attitude towards the Project 2000 course and their professionalism (particularly communication skills), as perceived by the students. Also significant were the mentors' skills at facilitating learning in the placements, by encouraging questions and reflection, and organizing a variety of experiences. Factors relating to the placements concerned their relevance to the course (as perceived by the students) and the breadth of experience available. Whilst this was a small sample, from which no generalizations can be made, the study gives insight into students, teachers and community staff of the experience of learning in the community setting.

Attitude↗
PubMed2004

Utilization of intravenous tissue plasminogen activator for acute ischemic stroke.

BACKGROUND: Intravenous tissue plasminogen activator (tPA) is the only approved therapy for acute ischemic stroke, although only 2% of patients with stroke receive intravenous tPA nationally. OBJECTIVE: To determine the rate of tPA use for stroke in the Cleveland, Ohio, community and the reasons why patients were excluded from thrombolysis treatment. DESIGN: Retrospective cohort study. SETTING: Community. Subjects Patients admitted because of stroke to the 9 Cleveland Clinic Health System hospitals from June 15, 1999, to June 15, 2000. MAIN OUTCOME MEASURES: Utilization of intravenous tPA and reasons for ineligibility. RESULTS: There were 1923 admissions for ischemic stroke in the 1-year period. Of these, 288 (15.0%) arrived within the 3-hour time window, and approximately 6.9% were considered eligible for tPA. The most common reasons for exclusion among patients arriving within 3 hours were mild neurologic impairment and rapidly improving symptoms. The overall rate of tPA use among patients presenting within 3 hours was 19.4%, and the rate of use among eligible patients was 43.4% (n = 56). The use of tPA did not differ significantly according to race or sex. CONCLUSIONS: Only 15% of patients arrived within the 3-hour time window for intravenous tPA, making delay in presentation the most common reason patients were ineligible for i.v. thrombolysis. Neurologic criteria were the second most common group of exclusions. Overall tPA use was low, but it was used in nearly half of all patients with no documented contraindications. Intravenous tPA use in a community setting can compare favorably with the rate of use seen in academic medical settings.

Age Factors↗
PubMed2006

Predictors of the quality of life of older people with heart failure recruited from primary care.

BACKGROUND: Current understanding of quality of life in heart failure is largely derived from clinical trials. Older people, women and those with co-morbidities are underrepresented in these. Little is known about factors predictive of quality of life amongst older people with heart failure recruited from community settings. OBJECTIVE: To identify factors predictive of quality of life amongst older people recruited from community settings. DESIGN: prospective questionnaire survey. SETTING: General practice surgeries located in four areas of the UK: Bradford, Barnsley, East Devon and West Hampshire. SUBJECTS: A total of 542 people aged >60 years with heart failure. METHODS: Participants completed a postal questionnaire, which included a disease-specific measure (Kansas City Cardiomyopathy Questionnaire), a generic quality-of-life measure (SF-36) and sociodemographic information. RESULTS: A multiple linear regression analysis identified the following factors as predictive of decreased quality of life: being female, being in New York Heart Association (NYHA) functional class III or IV, showing evidence of depression, being in socioeconomic groups III-V and experiencing two or more co-morbidities. Older age was associated with decreased quality of life, as measured by a generic health-related quality-of-life tool (the SF-36 mental and physical health functioning scales) but not by a disease-specific tool (the Kansas City Cardiomyopathy Questionnaire). CONCLUSION: Findings from the study suggest that quality of life for older people with heart failure can be described as challenging and difficult, particularly for women, those in a high NYHA class, patients showing evidence of depression, patients in socioeconomic groups III-V, those experiencing two or more co-morbidities and the 'oldest old'. Such information can help clinicians working with older people identify those at risk of reduced quality of life and target interventions appropriately.

Age Factors↗
PubMed2003

Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community.

Antibiotic resistance within the community setting is an emerging public-health concern. Infection with antibiotic-resistant organisms in the community among people lacking traditional risk factors has been reported. In addition, prevalence studies have identified individuals carrying antibiotic-resistant organisms in the absence of known risk factors. These studies strongly suggest the presence of contributing factors that have yet to be identified. In this paper we review the burden of antibiotic resistance and known risk factors within the community setting, assess the potential role of antibacterial cleaning and hygiene products containing triclosan in the emergence of resistance, and recommend future research on the assessment of household cleaning and hygiene products containing triclosan.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Adult inpatient training for a family practice residency: a university-versus community-based setting.

BACKGROUND AND OBJECTIVES: Some educators have expressed concern about the quality of inpatient training received by family practice residents in community-based residency programs because of insufficient patient numbers and resources in those programs. This study compared the number, diagnoses, and lengths of stay of patients seen by first-year family practice residents in a large inner-city, university-based medical center's internal medicine service versus those in a family practice teaching service in a smaller, community-based suburban regional hospital. METHODS: The adult inpatient training services of the two training sites were compared for 6 months to determine if any differences existed between the sites in patients'age, gender, primary and secondary diagnoses, average length of hospital stay, or in the number of monthly admissions. RESULTS: A total of 247 patients were admitted to the teaching service of the suburban community hospital, while 317 patients were admitted to the teaching service at the university hospital. The average length of stay for the suburban hospital was 6.1 days and 5.7 days at the university hospital. A total of 107 different diagnoses were made on admission at Kenner Regional Medical Center, while 90 were made at University Hospital. Chest pain/angina was the most frequent diagnosis encountered at admission at both hospitals. CONCLUSIONS: Based on the two inpatient services studied, a broad variety of diagnoses and patient demographics are encountered at community-based hospitals, with similar numbers of patients, lengths of stay, and variation in diagnoses in comparison to an urban-based university hospital. The results indicate that there can be adequate numbers of patients and diagnostic variability to permit effective inpatient teaching at community-based hospitals.

Academic Medical Centers↗
PubMedDate not supplied

Health behavior research: the quality of the evidence base.

All 1210 manuscripts published in the 12 most prestigious health promotion research journals in 1994 were reviewed and coded based on stage of research and setting. Of the total, 34% were nonresearch articles, 35% were health-behavior research, and 31% were related to innovation, diffusion, and institutionalization. Of the 469 health behavior research articles, 57% were observation studies, 11% were methods development, 19% were intervention studies, 1% were meta-analyses, and 13% addressed diffusion and institutionalization. Half (46) of the intervention studies had randomized controlled designs. Studies were conducted in nonspecific community settings (206), health care settings (88), schools (75), specific community settings (53), workplaces (32), and universities (11).

Evidence-Based Medicine↗