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PubMed1999

Substance use among young people: the relationship between perceived functions and intentions.

AIMS: To explore the relationship between young people's use of psychoactive substances, perceived functions for using, the experience of negative effects, and the influences of these variables on their intention to use substances again. DESIGN: Cross-sectional survey in which respondents were purposively recruited using snowballing techniques. SETTING: Interviews were conducted in informal community settings. PARTICIPANTS: One hundred young drug and alcohol users (45 females) aged between 16 and 21 years. MEASUREMENTS: Life-time prevalence, current frequency and intensity of substance use and intentions to use again were assessed for four target substances (alcohol, cannabis, amphetamines and ecstasy) together with measures of the perceived functions for their use and peer substance involvement. FINDINGS: The life-time experience of negative effects from using the assessed substances was not found to correlate with current consumption patterns. Statistically significant associations were observed between the reported frequency of taking substances and the perceived social/contextual and/or mood altering functions cited for their consumption. The substance use function measures together with the reported extent of peer use were significant predictors of intentions to use again. CONCLUSIONS: If these findings are confirmed in larger studies, educational and preventative efforts may need to acknowledge the positive personal and social functions which different substances serve for young people. The results also call into question the extent to which the experience of negative effects influences future patterns of use.

Adolescent↗

PubMed2001

Risk factors for HIV/AIDS and hepatitis C among the chronic mentally ill.

OBJECTIVE: The objective of this study was to document the prevalence of risk factors for HIV/AIDS and hepatitis C among people with chronic mental illness treated in a community setting. METHOD: 234 patients attending four community mental health clinics in the North-western Health Care Network in Melbourne, Australia, completed an interviewer-administered questionnaire which covered demographics, risk behaviour and psychiatric diagnosis. RESULTS: The sample was 58% male, and 79% of the sample had a primary diagnosis of schizophrenia. Forty-three per cent of mentally ill men and 51% of mentally ill women in the survey had been sexually active in the 12 months preceding the survey. One-fifth of mentally ill men and 57% of mentally ill women who had sex with casual partners never used condoms. People with mental illness were eight times more likely than the general population to have ever injected illicit drugs and the mentally ill had a lifetime prevalence of sharing needles of 7.4%. CONCLUSIONS: The prevalence of risk behaviours among the study group indicate that people with chronic mental illness should be regarded as a high-risk group for HIV/AIDS and hepatitis C. It is essential that adequate resources and strategies are targeted to the mentally ill as they are for other high-risk groups.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Teaching about the female condom.

Reality female condoms became available for over-the-counter purchase in the fall of 1994. Because the female condom is a new sexual barrier device, women need to learn how to use it correctly. Health care providers must also be knowledgeable about the correct use of the female condom so that they can teach women how to use it as a barrier method. To facilitate learning about the female condom, a curriculum was developed that included a quiz on knowledge about the female condom. Content validity was established through a content validity index completed by six content experts. This quiz was used to evaluate educational sessions offered to 42 persons in an urban college setting and 18 women in a community setting. The article describes the female condom along with the curriculum that was developed to teach its correct use and the reactions of potential users of the female condom.

Adult↗

PubMed1999

MediCaring: development and test marketing of a supportive care benefit for older people.

OBJECTIVES: To develop an alternative healthcare benefit (called MediCaring) and to assess the preferences of older Medicare beneficiaries concerning this benefit, which emphasizes more home-based and supportive health care and discourages use of hospitalization and aggressive treatment. To evaluate the beneficiaries' ability to understand and make a choice regarding health insurance benefits; to measure their likelihood to change from traditional Medicare to the new MediCaring benefit; and to determine the short-term stability of that choice. DESIGN: Focus groups of persons aged 65+ and family members shaped the potential MediCaring benefit. A panel of 50 national experts critiqued three iterations of the benefit. The final version was test marketed by discussing it with 382 older people (men > or = 75 years and women > or = 80 years) in their homes. Telephone surveys a few days later, and again 1 month after the home interview, assessed the potential beneficiaries' understanding and preferences concerning MediCaring and the stability of their responses. SETTINGS: Focus groups were held in community settings in New Hampshire, Washington, DC, Cleveland, OH, and Columbia, SC. Test marketing occurred in New Hampshire, Cleveland, OH; Columbia, SC, and Los Angeles, CA. PARTICIPANTS: Focus group participants were persons more than 65 years old (11 focus groups), healthcare providers (9 focus groups), and family decision-makers (3 focus groups). Participants in the in-home informing (test marketing group) were persons older than 75 years who were identified through contact with a variety of services. MEASUREMENTS: Demographics, health characteristics, understanding, and preferences. RESULTS: Focus group beneficiaries between the ages of 65 and 74 generally wanted access to all possible medical treatment and saw MediCaring as a need of persons older than themselves. Those older than age 80 were mostly in favor of it. Test marketing participants understood the key points of the new benefit: 74% generally liked it, and 34% said they would take it now. Preferences were generally stable at 1 month. In multivariate regression, those preferring MediCaring were wealthier, more often white, more often living in senior housing, and using more homecare services. However, they were not more often in poor health or needing ADL assistance. CONCLUSIONS: Older persons aged more than 80 years can understand a health benefit choice; most liked the aims of a new supportive care benefit, and 34% would change immediately from Medicare to a supportive care benefit such as MediCaring,. These findings encourage further development of special programs of care, such as MediCaring, that prioritize comfort and support for the old old.

Advance Care Planning↗

PubMed2003

Factors involved in deciding to start preventive treatment: qualitative study of clinicians' and lay people's attitudes.

OBJECTIVES: To explore the views of clinicians and lay people about the minimum benefit needed to justify drug treatment to prevent heart attacks, and to explore the rationale behind treatment decisions. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: 4 general practitioners, 4 practice nurses, and 18 lay people. SETTING: 8 general practices and 6 community settings across Liverpool. RESULTS: Participants varied widely in the minimum acceptable benefits chosen. Most people found the concepts difficult initially, and few appreciated that increased length of treatment should increase absolute benefits. Lay people usually wanted to make decisions for themselves, and clinicians supported this. Participants wanted to consider adverse effects and costs of treatment. Dislike of drug taking was common, and many people preferred lifestyle change to an imperfect treatment. Quality of life and personal views were more important than an individual's age. CONCLUSIONS: Evidence based guidelines make assumptions about people's preferences, and, by using 10 year estimates of risk, inflate the apparent benefits of treatment. It is unlikely that guidelines could incorporate the wide range of people's preferences, and true dialogue is necessary between clinicians and patients before starting long term preventive treatment.

Adult↗

PubMed2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.

OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Adult↗

PubMed2000

Issues surrounding record keeping in district nursing practice.

This article examines some aspects of nursing documentation following the publication of the document 'Guidelines for Records and Record Keeping' (UKCC, 1998). The importance of nursing documentation in patient care, in guiding practice and in providing information for members of the interprofessional healthcare team is highlighted. Record keeping forms an important part of the clinical governance initiative in terms of quality improvement and risk management. The issues surrounding the legal requirements of record keeping in district nursing practice are discussed. Suggestions are made for assessing the quality of nursing documentation by audit and research, in order to establish the suitability of using the present systems in the community setting.

Community Health Nursing↗

PubMed1987

Person-environment congruence: a rehabilitation perspective.

The present paper outlines a model of person-environment congruence within a rehabilitation context. The model suggests the following: a) The person component may be conceptualized as being composed of two separate dimensions, namely, the functional or activity level involved, e.g., Sub-Body, Self, and Exterio Self-Systems and an operational context within which these functions are performed, e.g., Biophysical, Mental and Affective Contexts. b) The environment component is comprised of a single dimension, that of environmental settings, e.g., treatment, home, work, and community settings. Environmental settings are further noted for their physical, personal, and social properties. The resulting three-dimensional model was, then, utilized in a discussion aimed at clarifying the concepts of disease, impairment, disability and handicap. The paper concludes with a brief suggestion of the nature of the relationship between the concept of functional assessment and the present model.

Activities of Daily Living↗

PubMed1984

Family, community residence, and institutional placements of a sample of mentally retarded children.

The current residential placement of mentally retarded children living in an institution during the late 1970s was described, and the differences between children still in an institution, in a community setting, or with their natural families were analyzed. Results indicated that the majority of sampled children remained in institutional settings, and of those released, very few were placed in their natural home. Significant differences among the children in various settings were reported, and predictors of community vs. institutional placements were presented.

Activities of Daily Living↗

PubMed1984

The Journal of Family Practice--1974-1983: analysis of an evolving literature base.

This paper examines the spontaneous evolution of original work in the field of family practice as published in this journal over the past ten years. An analysis was carried out by principal content, by type, and by source of the more than 1,700 papers published during that period. More than one half (currently 60 percent) of published papers have dealt with biomedical subjects; a majority of the remaining papers have dealt with health services and educational subjects. The most common type of paper has been observational research, with case studies, reviews, methods, opinion, and experimental research following in that order. The last five years have seen a continuing increase in the proportion of observational research papers, a slight decrease in reviews and opinion, and a marked decrease in methods papers. Sixty percent of published papers have been contributed by family physicians or others working in family practice settings. About three fourths of papers have been contributed from university or medical school settings, with one fourth from various community settings. All parts of the country have contributed to the publication of original work in the field. The trends that have been identified over the first ten years in terms of focus and content of the literature of record seem quite appropriate for the current and next stages of development of family practice as a clinical specialty.

Family Practice↗

PubMed1997

Use of proxies to measure health and functional outcomes in effectiveness research in persons with Alzheimer disease and related disorders.

As the focus in the study of Alzheimer disease moves from the laboratory and research-oriented care setting to the broader array of community settings where effectiveness research takes place, it becomes necessary to rely less on medical records and reports of health care professionals experienced in following research protocols and more on observers who are not trained to interpret and report their observations in a standardized way. The present paper targets the use of proxy interviews to obtain information about health and functional outcomes for effectiveness research. Included are indications of the type of information that may be obtained from proxies, a discussion of issues surrounding the use of proxies in research on older persons with cognitive impairment, a summary of the current state of knowledge in this area, identification of practical strategies researchers may employ when using proxies, and recommended directions for further research.

Aged↗

PubMed1996

[The Braden Scale--validity and reliability of a measuring tool for decubitus risk factors].

In this article the results of explorative research into the validity and reliability of a Dutch version of the Bradenscale are described. The Bradenscale is a risk assessment tool for measuring the risk of developing pressure sores. With a prospective longitudinal design the Bradenscale has been investigated in a hospital and a community setting in Belgium and the Netherlands. Results of the research in hospital indicate a fair to moderate agreement with respect to interraterreliability and a reasonable amount of predictive validity. In the community care setting interraterreliability indicates slight to fair agreement while predictive validity could not be established due to several reasons. Further research into the Bradenscale is recommended considering the limited research population in both studies and the results in community care.

Adult↗

PubMed2000

Effect of community-based interventions on high-risk drinking and alcohol-related injuries.

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

Accidents, Traffic↗

PubMed2005

Safe community in different settings.

This paper describes the Safe Community concept and how communities aspired to safety through a structured, collaborative approach rather than a community that is already perfectly safe. The Safe Community movement started in Sweden at the end of the 1980s and was based on community-based injury prevention activities. Safe Communities are the communities that meet a set of 12 criteria (later changed to six indicators) set out by the WHO Collaborating Centre (WHO CC) on Community Safety Promotion at Karolinska Institutet in Stockholm. The communities may apply to the WHO CC to be designated as an official member of the WHO International Safe Community Network. To date, 83 communities around the world have been designated as members of the Safe Community Network, ranging in population from 1000 to nearly 2 million. Lidkjöping in Sweden was the first designated safe community in 1989 and Rapla in Estonia was the last, designated in October 2004. The movement recognizes that it is the people who not only live, learn, work and play in a community but also best understand their community's specific problems, needs, assets and capacities. Their involvement and commitment are critical factors in identifying and mobilizing resources so as to create an effective, comprehensive and coordinated community-based action on unintentional and intentional injuries.

Community Health Planning↗

PubMed1997

Validation of the Ottawa ankle rules. Experience at a community hospital.

OBJECTIVE: To test the validity of a set of defined and tested rules for decisions on use of radiography for acute ankle injuries. DESIGN: Prospective survey. SETTING: Community hospital emergency department managing 42000 visits annually. PARTICIPANTS: A non-consecutive sample of 318 adults and children presenting during 1 year was evaluated by 25 family physicians in part-time emergency practice. INTERVENTIONS: Participating physicians interpreted the Ottawa ankle rules for all enrolled patients and ordered radiographs in 96% of cases. MAIN OUTCOME MEASURES: Sensitivity of the Ottawa ankle rules to predict whether radiography is required for acute ankle injuries. RESULTS: Of the 318 cases, 22 incomplete records were excluded, leaving 259 records of adults and 37 records of patients younger than 16 accepted for analysis. Of 34 adult patients with identified fractures, only one was predicted by the rules not to require radiographs. Sensitivity of the rules was 0.971 (confidence interval [CI] 0.914 to 1.00), specificity was 0.302 (CI 0.242 to 0.362), positive predictive value was 0.174 (CI 0.120 to 0.228), and negative predictive value was 0.986 (CI 0.971 to 1.00). Radiography could have been reduced by 26.3% had the rules been applied. Of the 37 children, seven had fractures. All were properly identified by the rules. Radiography in this group could have been reduced by 22%. CONCLUSIONS: This study validates the Ottawa ankle rules and supports their use. Further research on how the rules apply to children is required.

Acute Disease↗

PubMed2006

Exploring ego-integrity in old adults: a Q-methodology study.

BACKGROUND: Achieving ego-integrity involves fully accepting oneself and is important in quality of later life, but the concept of ego-integrity in old adults has not yet been well articulated in nursing practice. OBJECTIVES: This study aimed to elucidate the concept of ego-integrity in late adulthood in terms of the range of meanings this concept embraces within contemporary Korean society. DESIGN: Q-methodology was applied, which represents a method for measuring subjectivity. SETTINGS: The study was performed in a community setting in the Republic of Korea. PARTICIPANTS: The participants were 26 old adults, aged 65-70 years, living in the community in Korea. Two inclusion criteria were applied: (1) the participants had to be literate and competent to ensure that they were able to sort the cards stating the Q-samples in a forced distributive manner, and (2) the participants were regarded by researchers as having achieved ego-integrity in late adulthood as described in the literature. METHODS: Data obtained from June 2004 to December 2004 from a sample of 26 older adults were analyzed by PCQ software (a factor analysis program for the Q-technique) to delineate the factors of ego-integrity in late adulthood. RESULTS: A four-factor solutions for the study subjects indicates that there were differences in the frames of reference in achieving ego-integrity in late adulthood. The frames of reference of the four factors were: (1) a satisfactory connection between the generations, (2) enjoying a peaceful life, (3) peace through acceptance, and (4) achieving a praiseworthy life in spite of adversity. CONCLUSION: The projected property of ego-integrity in late adulthood is closely related to cultural and psycho-social environmental influences throughout the life span. Culturally sensitive life-reviews methods need to be developed to intervene in the specific ways that individual older adults achieve their own ego-integrity throughout their life experiences.

Aged↗

PubMed2000

MRSA carriage: the relationship between community and healthcare setting. A study in an Italian hospital.

From May 1997 to June 1998, all patients admitted to the study institution were screened at entry for MRSA carriage (both colonization and infection). Eighty-six MRSA carriers were identified; of these, 85 were nasal carriers. Risk factors were compared to those of 86 controls. Although the vast majority of both carriers and controls had at least one previous hospital stay, carriers were less likely than controls to be referred from a community setting, and had resided within the community for a shorter time before the current admission. The number of underlying conditions was comparable in the two groups, but those infected were more likely to have cancer than the controls. While community-acquired MRSA carriage is rare, exposure to a health care setting (particularly if repeated) within six months from the current admission, is a risk factor for MRSA carriage and introduction of the organism into an institution.

Aged↗

PubMedDate not supplied

Developing a community program on cancer pain and fatigue.

PURPOSE: The overall purpose of this project was to establish a community-based educational model on pain and fatigue management for individuals with cancer. The specific aims were: 1) to develop an appropriate educational program; 2) to pilot test this program in a community setting that supported a self-care approach; and 3) to evaluate the program process and outcomes. DESCRIPTION OF PROGRAM: The I Feel Better program was implemented through a two-session educational workshop taught by masters-prepared oncology nurses and was held at four Southern California sites of The Wellness Community. The focus of the sessions was to provide participants with general information about each symptom, assessment and management of those symptoms, and strategies for effectively communicating with their healthcare providers. Sessions of 2.5-hour duration were held on Saturday mornings and required preregistration. RESULTS: The participants were primarily female and White, with an average age of 58 years. Participants reported considerable pain and fatigue. They also lacked accurate information about pain management. Program evaluation revealed that the content and format were well received by the participants. They rated the program as extremely useful and reported positive outcomes after the first session. CLINICAL IMPLICATIONS: This pilot educational intervention program has strong implications for multidisciplinary educational approaches for patients with cancer. Limitations resulted from the setting selected and the possibility that participants were already active in their fight against cancer. Generalization to other community settings may not be as successful. Programs could be cosponsored by several collaborating institutions to share resources. Referral to community programs by physicians, nurses, and social workers can occur as needed when identified during patient interventions. The voluntary participation of health professionals in community education programs could provide a valuable service for patients and a rewarding experience for educators.

Adult↗