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A community coalition board creates a set of values for community-based research.

BACKGROUND: Researchers generally agree that communities should participate in the community-based research process, but neither a universally accepted approach to community participation nor a set of guiding principles exists. CONTEXT: The Morehouse School of Medicine Prevention Research Center was established in 1999 with the support of a grant from the Centers for Disease Control and Prevention. Its partners include a low-income, predominantly African American community, six public agencies, and two other academic institutions. A Community Coalition Board was established to represent the partners. The majority of the board is community members; it serves in a governance rather than an advisory capacity, with the community acting as the senior partner in interactions with the medical school, the agencies, and other academic institutions. METHODS: The Community Coalition Board developed a set of research priorities and a set of 10 community values, or principles, to guide research. A board committee reviews each protocol to ensure they uphold the values. CONSEQUENCES: The Community Coalition Board has been using the values since 1999, and in this article we describe its experience. After an initial period that included some disagreements between researchers and community members on the board, relationships have been good, and protocols have been approved with only minor changes. INTERPRETATION: Although the established community values reflect universally acknowledged principles of research ethics, they also address local concerns. An equal partnership between community members and researchers is most beneficial if the partners can agree on a set of values to govern research.

Black or African American↗

Comprehensive services in the community for the chronic mental patient: one program's experience.

A major shortcoming of community mental health programs has been their limited success with chronic patients. This paper describes how one mental health center has addressed this problem by creating an administratively autonomous treatment program exclusively for chronic patients. The organization, staffing, and activities of the program's treatment and community support services are outlined. The program's day treatment component and interdisciplinary treatment team concept are detailed. The program has had success in creating and coordinating community-based services, in maintaining continuity of care, in sustaining high staff morale and commitment, and in integrating former state hospital staff into a community setting.

Chronic Disease↗

Epidemiology of status epilepticus.

This study presents a review of the epidemiology of status epilepticus (SE) in Richmond, Virginia, U.S.A. The data summarize some of the first population-based information on the natural presentation of SE in a controlled community setting. SE occurred with an absolute incidence rate of 41 patients per 100,000 residents per year in Richmond. The frequency of total SE occurrences was 50 patients per 100,000 residents per year. Overall mortality in this population was 22%. Absolute incidence and occurrences of SE in this population were shown to be underestimates due to the inability, for multiple reasons, to document all cases of SE. Based on the Richmond data, the number of SE cases, frequencies of occurrence, and deaths per year occurring in the United States were estimated to be 102,000-152,000, 125,000-195,000, and 22,000-42,000, respectively. In Richmond, nonwhites had a much higher incidence of SE than did whites. Partial SE was the most common form of seizure initiating SE. Age and etiology were also found to contribute to mortality. Infants <1 year of age had the highest incidence of SE, but the elderly population represented the largest number of SE cases. This study provides a review of the first prospective, population-based, epidemiological data on SE and shows that SE is a major medical and neurological emergency in both academic and community hospital settings.

Adolescent↗

Tuberculosis care in community care organizations in sub-Saharan Africa: practice and potential.

SETTING: Community care organizations in sub-Saharan Africa. OBJECTIVES: To evaluate current tuberculosis (TB) care in community health care organizations in sub-Saharan Africa, to assess their potential contribution to tuberculosis care, and to develop a model for expanded community participation in effective TB control. DESIGN: Quantitative assessment of tuberculosis care and cross-sectional assessment of qualitative measures in 14 community care organizations in Uganda, Zambia, South Africa and Malawi. RESULTS: The community care organizations assessed mainly provided care for human immunodeficiency virus (HIV) and aquired immune deficiency syndrome (AIDS) patients, and received funding from non-governmental organizations. Shortcomings in tuberculosis care included delays in diagnosis (which was often not based on sputum examination), drug shortages, low completion rates, high default rates, inadequate recording, little interaction with government tuberculosis programmes, and inadequate training of staff. However, one organization that provided primarily tuberculosis care and collaborated closely with the district tuberculosis programme and hospital attained a high treatment completion rate. The strong points of the community care organizations that favour a potential role of community participation in tuberculosis care were accessibility and staff motivation. CONCLUSION: Despite most community care organizations' shortcomings in tuberculosis care, they do have the potential to improve the care of tuberculosis patients, thus reducing the load on overstretched health facilities. Their potential impact on tuberculosis control depends on their population coverage and sustainability. HIV/AIDS community care organizations with strengthened management of tuberculosis care could serve as a model for expanded community participation in tuberculosis control. Operational research is needed to assess the feasibility and cost-effectiveness of community-based TB care.

AIDS-Related Opportunistic Infections↗

Room for improvement? Reporting response rates and recruitment in nursing research in the past decade.

AIMS: This paper reports an analysis of recruitment and response rates in published nursing research in three peer reviewed nursing journals in 2002. We wished to establish if the deficits in reporting nursing research identified a decade earlier had been addressed. BACKGROUND: This analysis was informed by our personal experiences of research which produced widely differing response rates. An examination of the literature revealed a lack of consensus on desirable response rates in nursing research. Previous analyses have shown deficits in describing participants, sampling methods and reporting recruitment. METHODS: Papers reporting empirical research in three nursing journals in 2002 were reviewed in terms of a number of variables including research methodology, respondent type, recruitment method, response rate, location, and data collection method. Nominal coding was used as necessary. Data were analysed using the Statistical Package for Social Sciences and a variety of descriptive statistics were employed. RESULTS: Half of the papers did not report a response rate. Of those which did, over three-quarters of both qualitative and quantitative studies had response rates of 60% or more. Research conducted in hospital and educational settings produced higher response rates than those in community settings. Studies with response rates of less than 60% did not always refer to their rates in the study limitations, and low response rates do not appear to be a barrier to publication. CONCLUSION: Reporting of sampling, recruitment and response rates in nursing research must be improved to support nursings' claim to be an evidence-based profession and to underpin clinical governance requirements. Only through improvements in the quality of nursing research publications can knowledge be extended and a better-informed research community be created.

Bibliometrics↗

VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers.

OBJECTIVES: To compare the clinical and cost-effectiveness of two different compression bandages for the healing of venous leg ulcers. DESIGN: A pragmatic, randomised controlled trial with an economic evaluation. SETTING: Community, district nurse-led services; community leg ulcer clinics; hospital leg ulcer clinics with community outreach. A range of urban and rural settings in England and Scotland. PARTICIPANTS: Patients with a venous leg ulcer of at least 1-week's duration, at least 1 cm in length or width and an ankle:brachial pressure index of at least 0.8. INTERVENTIONS: The four-layer bandage (4LB) (which is multilayer elastic compression) compared with the short-stretch bandage (SSB) (multilayer, inelastic compression). MAIN OUTCOME MEASURES: The primary end-point was complete healing of all the ulcers on the trial leg. Secondary outcomes were the proportion of patients healed at 12 and 24 weeks, rate of recurrence, costs of leg ulcer treatment and quality of life. RESULTS: Between April 1999 and December 2000 the trial recruited 387 people aged from 23 to 97 years at trial entry. The majority of patients in this trial (82%; 316/387) had a reference ulcer of area </=10 cm(2). To test the difference over time of Kaplan--Meier curves for the two bandage groups, the distribution of the cumulative times to healing of individuals in the two trial groups was compared using the log-rank test. The difference in the distribution of cumulative healing times between the individuals in the two groups was not statistically significant at the 5% level. Adjusting for the effects of variables which may influence healing (centre, baseline ulcer area, duration, episodes, ankle mobility, weight) in a Cox proportional hazards model, a statistically significant treatment effect in favour of the 4LB was identified. At any point in time, the probability of healing for individuals in the SSB treatment arm is significantly lower than that for people treated with the 4LB. Our base case economic analysis showed that the 4LB is the dominant strategy, that is, it is associated with a greater health benefit and lower costs than the SSB, although the differences are not statistically significant. This result is explained largely by the greater number of community nurse visits required by participants in the short-stretch arm. CONCLUSIONS: The 4LB, which is currently the UK standard compression bandage for people with venous leg ulcers, was more clinically and cost-effective than the SSB. The bandage costs were less important than the costs of treatment visits, and patients in SSBs required more treatment overall. Generally, this trial supports the use of the 4LB in preference to the SSB. Recommendations for future research include: exploration of the relationship between bandager skill, application technique and ulcer healing; the relative cost-effectiveness of community leg ulcer clinics; and the study of nurse decision-making in venous ulcer management.

Adult↗

Evaluation of youth preferences for rapid and innovative human immunodeficiency virus antibody tests.

OBJECTIVE: To determine youth preferences for Food and Drug Administration (FDA)-approved and investigational human immunodeficiency virus (HIV) antibody collection and testing methods before and after subjects learned of test result response times; to determine how influential test result response times are on participants' preferences. DESIGN: After health educators explained and demonstrated 6 different HIV antibody collection and testing strategies (3 saliva, 1 urine, and 2 fingerstick methods), participants completed a confidential survey about test method preference and tried the different testing methods. The participants had an opportunity to re-rank their test method preference after learning about each test's result response time. SETTING: Health education sessions in both clinical and community settings. PARTICIPANTS: Youths aged 12 to 24 years. RESULTS: An oral collection device with a rapid saliva test was the most highly preferred test method. The preference for this method and the rapid response test methods via fingerstick procedures improved significantly after subjects learned of the rapid result response time, while the other methods were given significantly lower preference rankings after subjects learned of the longer result response times. Shifts in preference rankings were not related to sex, age, ethnic group, experience with HIV testing, or practice of risk behaviors. CONCLUSIONS: Our research supports the use of noninvasive and rapid HIV testing methods with rapid response times for adolescents to assist in the early identification of HIV status, while offering HIV prevention opportunities and immediate linkage to care.

Adolescent↗

Conducting clinical trials with practicing community oncologists.

The practicing community oncologist has limited time and opportunity to participate in clinical trials of new cancer therapy. However, the majority of patients treated are seen in the community setting that there is increasing interest in getting community oncologists involved in these trials. This paper outlines a currently active program that has succeeded in engaging the participation of 70% of the available oncologists in the Colorado region.

Attitude↗

Who stays, who goes? Downsizing the institution in America's most rural state.

Between 1988 and 1993, Wyoming reduced the census of its only state institution for persons with mental retardation by more than 50%, with a significant percentage occurring as a result of a class action suit in 1990. This article demonstrates the similarities between the characteristics of the individuals who left the Training School and those who remain, as well as the differences in the characteristics of those leaving during three 2-year periods--prelawsuit, transition, and postlawsuit. Descriptive data were gathered in 1988 and 1993 using the Inventory for Client and Agency Planning. Individuals left the large, residential institutional settings for less restrictive, rural placements in the community. This study updates the literature and confirms that all of the residents of the state-operated institutions can be placed into community settings even in America's most rural state.

Activities of Daily Living↗

The role of community nurses for people with learning disabilities: working with people who challenge.

The locus of care for people with learning disabilities has transferred from institutional to community-based services. Increasingly people who have learning disabilities and additional challenging behaviours live in community settings. Spearheading the care for these people are community nurses for people with learning disabilities. This study aimed to explicate the role of these nurses in their day-to-day work with people who challenge. Using grounded theory methodology, 22 nurses were selected by theoretical sampling and interviewed. An analytical story and theoretical framework that emerged from the grounded data is presented. It is suggested that this framework has utility for practice.

Community Health Services↗

The prevalence of dementia in older people in an urban population of Korea: the Seoul study.

OBJECTIVES: To estimate prevalence of dementia and its subtypes in older people in Seoul, a metropolitan area of Korea, and compare these findings with estimates reported for other populations. DESIGN: The study employed a two-stage design for case identification. Initially, the Mini-Mental State Examination in the Korean version (MMSE-KC) of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) assessment packet was administered to all participants. Two hundred seventeen persons sampled from three levels of performance on MMSE-KC underwent the second-stage clinical evaluation based on the Korean Version of the CERAD assessment packet. SETTING: The study was conducted in an urban community setting. PARTICIPANTS: Six hundred forty-three persons aged 65 and over participated in the study. MEASUREMENTS: Dementia was defined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic features of dementia. RESULTS: Dementia prevalence ranged from 2.6% in persons aged 65 to 69 to 32.6% in persons aged 85 and older. Age-standardized prevalence was 8.2% for dementia, 5.4% for Alzheimer's disease, and 2.0% for vascular dementia. The prevalence estimates, which excluded very mild cases (clinical dementia rating index 0.5), were approximately 5.3% for dementia and 4.3% for Alzheimer's disease. CONCLUSION: The prevalence of dementia in older people in Seoul appears to be somewhat lower than in rural areas of Korea. Considering the difficulties involved in establishing a diagnostic threshold for dementia, actual differences in dementia prevalence between Asian populations are probably minimal.

Aged↗

Multidisciplinary mental health teams.

This study surveyed current practice amongst 91 Indian and Australian staff working within multidisciplinary mental health teams, looking at leadership skills, conflict resolution and therapeutic abilities. Length of training was associated with management skills, though these skill were more developed by psychiatric nurses and occupational therapists working in community settings. Hospital settings involved less consensual decision-making than community teams. Psychiatric nurses spent most time in clinical work, and occupational therapists were rated as less skilled in the therapeutic activities assessed than any other profession. Psychiatrists and clinical psychologists undertook most research. The activities assessed in this study could be undertaken by a team comprising psychiatrists, psychiatric nurses and social workers, with clinical psychologists employed where possible, especially for research or service evaluation.

Australia↗

The use of a new overlay mattress in patients with chronic pain: impact on sleep and self-reported pain.

OBJECTIVE: To evaluate the use of an air flotation mattress overlay in patients with chronic pain. DESIGN: Four-week prospective AB design. SETTING: The mattress overlay was used in a community setting. SUBJECTS: Adult patients attending an outpatients clinic in a department of rheumatology, with chronic pain plus sleep problems, or pain sufficient to disturb sleep. INTERVENTIONS: An inexpensive low-pressure inflatable mattress overlay (Repose), which is readily portable and has no electrical supply, was introduced to the patients. They were encouraged to use the support surface every night. MAIN OUTCOME MEASURES: The primary outcome was measured by self-reported changes in sleep quantity and frequency of sleep disturbance. Secondary outcomes were self-reported changes in pain and use of analgesia, verified by medical notes. RESULTS: Nineteen female patients (mean age 61 years) completed the study. At baseline, mean length of sleep time was 3.8 h, with mean of 4.9 interruptions of mean 25.3 min: week 4, mean sleep time = 6.4 h, with a mean of 2.3 interruptions for mean 14.2 min (all measures p < 0.001). At baseline, median pain during the day was 6 and at night-time was 7; by week 4 a reduction in pain was reported both for the day (median = 5) and the night (median = 5) (both p < 0.001). Thirteen patients reported a reduction in the use of analgesia during the study. CONCLUSIONS: In this pilot study of a new mattress overlay, statistically significant improvements in sleep and pain were noted over a four-week period.

Adult↗

Dietary calcium intake protects women consuming oral contraceptives from spine and hip bone loss.

CONTEXT: It is estimated that 80% of all women have used oral contraceptives (OCP), but OCP use may prevent attainment of maximal peak bone mass in young women and thus increase the risk of osteoporosis later in life. OBJECTIVE: This study examined whether increased calcium intake could reduce the detrimental effects of OCP use on bone mass in young women. DESIGN: The study design was a 1-yr intervention. SETTING: The study was performed in a general community setting. SUBJECTS: One hundred fifty-four young (18-30 yr old) healthy women with a dietary calcium intake of less than 800 mg/d began the study, and 135 completed the trial. INTERVENTION: Subjects were randomly assigned to one of three diet intervention groups: 1) control, continuous established (<800 mg/d) dietary calcium intake; 2) medium dairy, increase calcium intake to approximately 1000-1100 mg/d; and 3) high dairy, increase calcium intake to approximately 1200-1300 mg/d. Randomization was stratified by OCP use. MAIN OUTCOME MEASURES: The main outcome measures were total body bone mineral density (BMD) and content (BMC); total hip BMD, BMC, and bone area; and spine BMD, BMC, and bone area. RESULTS: Dairy product intervention positively impacted the percentage change in total hip BMD and BMC. In addition, dairy product intake prevented a negative percentage change in total hip and spine BMD in OCP users. CONCLUSION: Dairy product intake, at levels necessary to achieve the recommended intakes of calcium, protected the total hip BMD and spine BMD from loss observed in young healthy women with low calcium intakes who were using OCP.

Absorptiometry, Photon↗

Ankle pulses are not sufficient to detect impaired arterial circulation in patients with leg ulcers.

Much debate has taken place on the use of Doppler ultrasound in the community setting. A sequential study of patients attending a community ulcer clinic was undertaken to identify community nurses' ability to detect arterial disease by palpation of pedal pulses and to compare these figures with the recording of a resting pressure index. A total of 462 patients (553 limbs) were studied; 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with a reduced resting pressure index (< 0.9), 37% had detectable pulses. Of the 440 with a normal resting index (> or = 0.9), 25% had no detectable ankle pulses. A number of risk factors were identified. Palpation of pedal pulses alone by community nurses is a poor prediction of arterial disease and should be accompanied by the recording of a resting pressure index.

Aged↗

[Nursing research issues and trends: views from Korea].

The purposes of study was: 1. To identify the direction and scope of research activities in Korean Nursing. 2. To discuss the unique problems present in Korea that warrant nursing research. 3. To delineate the factors that facilitate and/or hinder nursing research in Korea. This study was conducted at six colleges of nursing in Korea. The schools which were selected had doctoral programs at the time, the data were collected in 1990. Four of the schools were located in the metropolitan area of the capital city, Seoul, and two were in two other cities similar in size. The total population of the study was 283 nurses. The instrument for the research was the English version of Research Profile Questionnaire which was translated into Korean by the researchers and was validated in its translation by two professors. A pretest procedure was done before the data collection process. Of the population of 283,210 subjects received the questionnaire and 150 subjects responded (71.4%). Excluding incomplete questionnaires, 141 questionnaires were utilized for data analysis. Data were analyzed using descriptive statistics. Responses to open-ended questions were content analyzed for themes and categories. Results of the study were as follows: Respondents currently involved in nursing research numbered 108 (76.6%), but 33 (23.4%) did not have any research experience. The inexperienced respondents tended to be younger than the experienced subjects and most (60.6%) were employed in hospitals, while 82.4 percent of the experienced nurses were employed in nursing schools. Among the respondents with research experience, 68.5 percent were involved in one to three projects and 31.5 percent were engaged in four or more projects. The experienced nurses indicated that nursing research in Korea is active. On the other hand, the responses of the inexperienced were that nursing research is not active. The most frequently selected research subjects were patients (76.9%, 83 respondents) followed by nurses, healthy persons and nursing students. The relatively high percentage of healthy persons as study subjects, could be explained as a concern of nurses for healthy persons as well as for ill patients. The aforementioned literature review showed a dramatic change in the kinds of study subjects; approximately 33 percent were patients but 25 percent were healthy subjects of various ages. The hospital was the prevailing research setting (67.6%) but at the same time various community settings were used. This is a changing phenomena in nursing research of Korea. Current research designed to build on previous studies amounted to 75 percent; about 39.8 percent were theory and hypothesis generated.(ABSTRACT TRUNCATED AT 400 WORDS)

Education, Nursing, Graduate↗

Risk management in stroke prevention: major clinical trials in hypertension.

Results of all major clinical trials on the efficacy of treatment of hypertension provide convincing evidence that judicious treatment of hypertension in a clinical setting and effective control of hypertension in a community setting significantly reduce the rate of morbidity and mortality from stroke. It is especially noteworthy to review the results of some of the trials on prevention of stroke mortality in the elderly. HDFP: Antihypertensive drug treatment reduced the incidence of stroke among the HDFP cohort in the age group 60-69 years as significantly as it did in the younger age group. SHEP: Treatment of isolated systolic hypertension (ISH) reduced the incidence of stroke in the SHEP cohort by 36% in five years. MRC Trial: Similar results were reported by the follow-up of the cohort enrolled in the MRC Trial. The Swedish Study: Antihypertensive treatment reduced significantly the incidence of stroke in this cohort as well.

Aged↗

[Work in community health is about to change].

Changes in Ontario's political, social and economic environments have necessitated an unprecedented transformation in the health care system. The change in focus from the individual to the community now includes core units such as families, groups and communities. Visiting nurses, public health nurses and community health nurses have worked in Community Health Centres (CHCs) since 1970. However, the role of nurses working in these centres has not been clearly defined in the literature. Nor is there is a general consensus on their title. Nurse practitioners, primary care nurses or community health nurses are all used. As well, there is no existing educational program in Ontario that trains this type of nurse. This article discusses and gives examples of nurses working in community health, whose primary clinical expertise is in using community based and community development program strategies to plan health programs. These programs are specifically developed to address the health needs of the communities they serve--in this case, Toronto's francophone community. Also demonstrated are new approaches to nursing care within a community setting. From health promotion to disease prevention, from community development to research, the practice of community health nursing is complex and exciting.

Community Health Nursing↗