SEARCH · PubMed Health

Results for “Community setting”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources

PubMed2005

Factors affecting choice of community residential care setting.

UNLABELLED: To investigate factors associated with residents' choice of type of Medicaid-funded community residential care setting in western Washington State. METHOD: Prospective cohort design including residents new to any of three setting types (264 residents entering 170 different facilities), using data from state and Medicaid databases and in-person interviews. The authors used analysis of variance and multinomial logistic regression to examine bivariate associations and estimate effects of resident and facility characteristics on choice of facility type at baseline. RESULTS: Several resident characteristics appear to be associated with choice of community residential care setting, including age, marital status, education, functional status, and reported memory and behavior problems. Facility policies differ significantly among types of facilities and also appear to be associated with choice of setting. DISCUSSION: Selection processes operate in choice of community residential care setting, with residents choosing facility type based on the fit of their needs with facility characteristics.

Activities of Daily Living↗

PubMed1998

Creating and evaluating an independent ambulatory internal medicine clerkship.

Patient care is shifting from an inpatient setting to an ambulatory setting. Despite this shift, most internal medicine clerkships provide the majority of medical student training in inpatient settings or in university tertiary care clinics, which are not representative of patient care in a community setting. We created a separate ambulatory clerkship that used volunteer community faculty at local and distant sites. The steps involved are described here, including finding time within the clerkship, reaching consensus within the department, defining the curriculum, identifying sites, and developing preceptors. Various parameters were measured to ensure quality in educational design. Comparisons of the 1-year pilot program, the full implementation program, and the inpatient program revealed that use of community sites does not affect cognitive knowledge acquisition but does influence students' satisfaction level.

Clinical Competence↗

PubMed2003

Cost comparisons of community and institutional residential settings: historical review of selected research.

A review of the literature on cost comparisons between community settings and institutions for persons with mental retardation and developmental disabilities was conducted. We selected literature for review that was published in peer-reviewed journals and had either been cited in the area of cost comparisons or provided a novel approach to the area. Methodological problems were identified in most studies reviewed, although recent research employing multivariate methods promises to bring clarity to this research area. Findings do not support the unqualified position that community settings are less expensive than are institutions and suggest that staffing issues play a major role in any cost differences that are identified. Implications are discussed in light of the findings.

Community Mental Health Services↗

PubMed2002

When and where do youths have sex? The potential role of adult supervision.

OBJECTIVE: Interventions to reduce high-risk behaviors such as sex and substance use among youths have focused mainly on promoting abstinence, refusal skills, and negotiation skills, yet the frequency of high-risk behaviors among youths may also be influenced by opportunity, particularly the amount of time during which they are not supervised by adults. In this study, we examined when and where youths have sex and whether there is a relationship between unsupervised time and sex, sexually transmitted diseases (STDs), and substance use. METHODS: A cross-sectional survey was conducted in 6 public high schools in an urban school district. Participants were 1065 boys and 969 girls from a school-based STD screening program. Ninety-eight percent of students were black, and 79% were in the free or reduced lunch program. Most students reported living with 1 parent only, primarily the mother (52%); only 27% lived in 2-parent families. Sexual activity, substance use, and the prevalence of gonorrhea or chlamydia as determined by a ligase-chain reaction test on a urine sample were measured. RESULTS: Fifty-six percent reported being home without an adult present 4 or more hours per day after school. There was no difference in the number of unsupervised after-school hours between children in 1- and 2-parent families. Fifty-five percent of boys and 41% of girls were participating in or planned to participate in after-school activities during the school year. Boys were more likely than girls to report having had sex for the first time before age 14 (42% vs 9%) and had a greater number of lifetime sex partners (mean: 4.2 vs 2.4 partners). Among the respondents who had had intercourse, 91% said that the last time had been in a home setting, including their own home (37%), their partner's home (43%), and a friend's home (12%), usually after school. Boys were more likely than girls to report having had sex in their own homes (43% vs 28%) and less likely than girls to report having had sex in their partner's homes (30% vs 59%). Fifty-six percent of youths who had had intercourse reported that the last time was on a weekday: 18% before 3:00, 17% between 3:00 and 6:00, and 21% after 6:00. There were no gender differences in the day of the week or time of day during which students reported having had intercourse. Youths who were unsupervised for 30 or more hours per week were more likely to be sexually active compared with those who were unsupervised for 5 hours a week or less (80% vs 68%). In addition, for boys, the greater the amount of unsupervised time, the higher the number of lifetime sex partners. Among girls but not among boys, sexual activity was associated with nonparticipation in after-school programs; 71% of those who were not participating in an after-school activity were sexually active compared with 59% of those who were participating. Tobacco and alcohol use were associated with unsupervised time among boys but not among girls. Boys who were unsupervised >5 hours per week after school were twice as likely to have gonorrhea or chlamydial infection as boys who were unsupervised for 5 hours or less. CONCLUSIONS: We found that substantial numbers of youths currently spend long periods of time without adult supervision and have limited opportunities to participate in after-school activities. More than half of sexually active youths reported that they had sex at home after school, and, particularly for boys, sexual-and drug-related risks increased as the amount of unsupervised time increased. As youths come of age, parents probably believe that it is appropriate to leave them increasingly on their own, and, accordingly, prevention approaches have concentrated on providing information and motivation for abstinence or safer sex. However, given the independent association between the amount of unsupervised time and sexual behaviors (with STD rates suggestive of particularly risky sexual behaviors) and substance use behaviors, it is worth considering increasing youth supervision, if not by parents, then by programs organized at schools organized at school or other community settings. Parents and community members should consider increasing opportunities for supervised activities to determine whether this will reduce risk-taking among youths.

Adolescent↗

PubMedDate not supplied

The Limerick Leg-Ulcer Project: early results.

Nurse led clinics in joint hospital and community settings are now being advocated as the most effective and economic way of dealing with leg ulcers. However, little information exists on the profile and outcome of patients with venous ulcers treated either in the community or in the hospital setting. Over a 2 yr period we assessed 134 patients with leg ulcers of whom 122 were deemed suitable for compression bandaging therapy. Thirty-four patients (28 per cent) were treated by the newly developed community service and 88 (72 per cent) were treated at the hospital clinic. Our overall healing rate for venous ulcers was 50 per cent @ 40 weeks. This probably reflects the long duration (48 per cent > 2 yr) and large size (0.5-600 cm2) of ulcer prior to treatment. There were no differences in outcome between hospital (50 per cent @ 40 weeks) and community (35 per cent @ 40 weeks) based treatment (p > 0.05). We conclude that most venous ulcers can be effectively treated in the community and resources should be provided to achieve this goal.

Adult↗

PubMed1993

Training residents for community psychiatric practice: guidelines for curriculum development.

There is a critical need to recruit and retain more psychiatrists with the required skills and interest to work with seriously mentally ill and/or socially disadvantaged patients within organized programs in community settings. More residency training programs having the capacity to prepare psychiatrists for community practice can help to meet this need. A consensus definition of the clinical, administrative, consultative and academic areas of contemporary community psychiatric practice developed by the American Association of Community Psychiatrists is used to determine the goals of the training curriculum described in this paper. A comprehensive list of knowledge, skill, and attitude objectives, as well as suggestions for structuring clinical training assignments are provided as guidelines for curriculum development.

Adult↗

PubMed1998

Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being.

OBJECTIVE: To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN: Survey. SETTING: Community. PARTICIPANTS: Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD: Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS: Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS: Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.

Activities of Daily Living↗

PubMed2000

Reported quality of life of people with spinal cord injuries: a longitudinal analysis of the first 6 months post-discharge.

STUDY DESIGN: A repeated measures design was employed with measures taken on two observational periods during the first 6 months post-discharge from hospital. OBJECTIVES: To investigate the perceived importance of specific needs implicated in the development of quality of life (QOL), and the extent to which these aspects have been achieved, in a group of people with spinal cord injury (SCI) living in the community. SETTING: The National Spinal Injuries Centre, Stoke Mandeville Hospital and the general community. METHODS: The study sample comprised 24 spinal cord injured patients discharged from a national rehabilitation centre following a rehabilitation programme. The Quality of Life and Needs Assessment Questionnaire was completed by participants at 1 and 6 months post discharge. RESULTS: No significant differences were found between the importance that participants attributed to specific needs at months 1 and 6 post discharge. Moreover, no significant differences were found between the extent to which these needs were met at 1 and 6 months post discharge. CONCLUSION: The reported quality of life of people who have a spinal cord injury remains stable during the first year following discharge.

Female↗

PubMedDate not supplied

Promoting fecal occult blood testing in rural African American women.

PURPOSE: The purpose of this experimental study was to test the effectiveness of a multiphasic culturally relevant intervention, delivered over a 1-year period to increase the rates of participation in fecal occult blood testing (FOBT) at the initial screening opportunity and at the 1-year follow-up screening opportunity among rural African American women. DESCRIPTION OF STUDY: The study used a pretest/post-test design among African American women who attended senior citizen centers in a rural southern state. The centers were randomly assigned to the cultural and self-empowerment group, who received the five-phased intervention, the modified cultural group, who received phase I of the intervention only, or the traditional group, who served as the control group. Data were collected at the initial and 1-year follow-up screenings. Hemoccult kits were distributed, collected, and analyzed at no cost to the participants. Data were analyzed using descriptive statistics, repeated measures, and longitudinal models for binary outcomes. RESULTS: Women in the cultural and self-empowerment group had a significantly higher rate of participation in FOBT than did those in the modified cultural group and the traditional group. The modified cultural group had a significantly higher rate of participation in FOBT than the did the traditional group. Predictors of participation in FOBT were the women's family history of colorectal cancer and the average number of visits to their healthcare provider. CLINICAL IMPLICATIONS: Colorectal cancer screening and diagnostic testing opportunities should be offered consistently to women who visit their provider for routine, nonemergent office visits. As successful interventions to increase colorectal cancer screening are introduced into community settings, these interventions also should be tested within physicians' offices and other community agencies.

Black or African American↗

PubMed1990

A stepwise approach to developing and maintaining an oncology multidisciplinary conference.

In recent years, there has been a shift in cancer treatment sites, from university-based to community settings. Approximately 85% of cancer patients are now diagnosed and treated in community hospitals. This change has been accompanied by an expansion of oncology services and specialists. One method that has increased communication and knowledge among departments providing oncology services, has been the Oncology Multidisciplinary Conference. This paper provides practical guidelines for establishing and maintaining such a group in a community hospital.

Communication↗

PubMed2003

Falls in community-dwelling older persons followinig hip fracture: impact on self-efficacy, balance and handicap.

OBJECTIVE: To compare the four-month outcomes of fallers and nonfallers as well as those with slow gait speed in patients with hip fracture successfully discharged back to the community. DESIGN: Prospective study with four-month follow-up data. SETTING: Community sample of survivors of hip fracture who have completed their rehabilitation programme. SUBJECTS: A consecutive sample of 73 community-dwelling, cognitively intact older adults admitted to hospital following a fall-related hip fracture and available to complete a follow-up assessment at four months. MAIN OUTCOME MEASURES: At baseline, data collection consisted of the Modified Barthel Index (MBI), Mini Mental State Examination (MMSE), sociodemographics and medical history. At four months follow-up, data collection consisted of the MBI, London Handicap Scale (LHS), Berg Balance Scale (BBS), a 10-metre timed walk test, Falls Efficacy Scale (FES) and the Activities Balance Confidence (ABC) scale. Participants were also asked to recall if they had fallen in the four months since their fracture. RESULTS: Seventy-three participants had complete data for evaluation. There was minimal disability with a mean MBI of 91.2 but there was some residual handicap with a mean LHS of 0.67. Those who had fallen had lower self-efficacy (FES) and greater handicap (LHS). Those with slower gait speed were more handicapped (LHS), had lower self-efficacy (FES and ABC) and lower balance scores (BBS). CONCLUSIONS: Measuring ADL disability alone loses valuable information in community-dwelling survivors of hip fracture. Falls after hip fracture should be a target for treatment and our data give some weight to the idea of a fall fracture cycle. Gait speed, which may reflect lower limb strength, is also a target for therapeutic interventions. These measures should be included in clinical practice.

Accidental Falls↗

PubMed2001

Acute asthma. Emergency management in the community.

BACKGROUND: The prevalence of asthma in Australia is one of the highest in the world. Statistics suggest that two million or more Australians across all age groups have the disease. It is one of the top five medical problems referred to hospital and one of the commonest presentations seen in emergency departments. Asthma was the cause of death of 685 Australians in 1998. All general practitioners will have a cohort of asthmatics in their practice and consequently must be prepared to manage these people at any time, but especially at times of acute exacerbation. OBJECTIVE: To outline the features of acute asthma and its management in the community setting. DISCUSSION: General practitioners have a crucial role to play in the community and prehospital management of asthma. An awareness of the features and treatment of acute exacerbations will help them reduce an enormous burden on the health system and contribute to a reduction in morbidity and mortality in their patients.

Acute Disease↗

PubMed1992

Reclaiming the community: the strengths perspective and deinstitutionalization.

In the past decade, concern for the plight of severely mentally ill people has centered on such issues as mental illness among the homeless population, the burden placed on families who care for ill loved ones, and the impoverished quality of life experienced by those who attempt to survive on their own. Some have called for a rethinking of the abandonment of the asylum and a relaxation of civil commitment laws, while others have advocated for increasing community-based services that specifically target severely mentally ill people. This article discusses these issues and considers how the response to severe mental illness has overrelied on pathology-based models of helping. The strengths perspective provides an alternative. Although severe mental illness presents a formidable obstacle to the afflicted, mentally challenged individuals have strengths and abilities that can be tapped to foster their continued integration in community settings. This adjustment is best conducted through the use of naturally occurring community resources rather than specialized, segregated programs.

Community Mental Health Services↗

PubMed2005

Trends in sexual risk-taking among urban young men who have sex with men, 1999-2002.

As part of an HIV prevention study, 15-25 year-old young men who have sex with men (YMSM) were surveyed in community settings annually from 1999 to 2002. Data are presented from six comparison communities in the study; these communities recruited Latinos (Jackson Heights, NYC; San Gabriel Valley, CA), African Americans (Atlanta, GA); Asians/Pacific Islanders (San Diego, CA); and primarily white men (Detroit, MI and Twin Cities, MN). Men were asked about unprotected anal intercourse (UAI) in the past three months with male partners. The prevalence of UAI reported in these six communities ranged 27-35% in 1999, compared with 14% to 39% in 2002. Significant reductions in UAI over time were observed in Jackson Heights and San Gabriel Valley. A quadratic trend was noted in Detroit, with a significant increase in UAI from 1999 to 2000 followed by a significant decrease in UAI from 2000 to 2002. There was a nonsignificant increase in UAI in the Twin Cities, and no significant trends in UAI in Atlanta or San Diego. Behavioral trends among YMSM vary considerably across subpopulations and highlight the necessity of local behavioral surveillance and culturally tailored prevention efforts for specific racial and ethnic groups.

Adolescent↗

PubMedDate not supplied

Behavior modification approach in a partial day treatment center.

Since the beginning of the program in September 1970, we have found that a combined behavioral program of individual therapy, home intervention, and group therapy to be the most effective for maintaining a person in his community. In addition, we have not seen a need for a full eight-hour day in the clinic. Rather, we operate on the principle that it is more adaptive to keep a patient functioning in the community (natural environment) with support from us. For the extremely or severely disorganized person, we have found the application of behavior modification principles to be the most useful in the terms of establishing and maintaining adaptive behaviors, of interruptin and decreasing maladaptive behaviors and of offering support and guidance (generalization) to patients and families. We have also increased the amount of individual therapy and intensified the home intervention program. These changes have been based upon subjective data as well as objective data (change in patient behavior while receiving and following a particular mode of therapy). The program has undergone many changes since its inception. We have found the behavior modification modality to be effective for establishing a program that patients can generalize to their community setting. Our constant thrust is to utilize already existing agencies in the community and to optimally assist the patient so that he may remain in his community. We have gone from an eclectic program to a systematic behavior modification program. The present behavioral program has been demonstrated to be an effective modality for the training of personnel. We are grateful to our staff for their cooperation and suggestions in making the program successful. In addition, we are indebted to our late Director, Curtis W; Gifford--a loyal and dedicated friend. We particularly appreciate his administrative skills and encouragement in developing an autonomous program.

Anomie↗

PubMed1993

Developing community faculty. Principles, practice, and evaluation.

Medical education is increasingly emphasizing outpatient experiences in community settings, and, concurrently, the development and assessment of the teaching skills of community faculty. These skills can be addressed through a faculty development program focusing on (1) issues relevant to community education, (2) adult learning principles, and (3) logistics that facilitate the participation of community medical faculty. Using a series of 1- to 3-day seminars, the program described focused on clinical precepting and brief presentations, used interactional teaching and practicums, and actively involved participants in the evaluation and planning fo the seminars. Evaluation of the program suggested that it was successful in increasing participants' knowledge and application of educational principles taught. Such programs can result in the development of an effective and potentially abundant resource of faculty members for the medical education of students and residents.

Clinical Competence↗

PubMed2006

Design and evaluation of a drama-based intervention to promote voluntary counseling and HIV testing in a South African community.

BACKGROUND: Voluntary counseling and testing (VCT) services are a major component of HIV prevention and treatment efforts. We developed a drama-based intervention to promote VCT services in a peri-urban community in South Africa. METHODS: Young adults from the community received training in HIV/AIDS and drama, and developed sketches to address perceived barriers to VCT. Over 12 months, 80 performances were held in busy community settings. The intervention was evaluated through changes in VCT uptake at the local clinic compared with comparable communities nearby. RESULTS: After the start of the intervention in August 2003, a 172% increase in the uptake of VCT services was observed in the intervention community. This was significantly greater than demand for VCT in either of the control communities during the same period (P < 0.0001). CONCLUSION: A structured, community-based education program based on drama can lead to substantial increases in the demand for VCT services in resource-limited settings.

Adult↗

PubMed2006

Muévete Bogotá: promoting physical activity with a network of partner companies.

In 1998 the mayor's office and the District Institute for Sports and Recreation created Muévete Bogotá, a physical activity and health promotion programme for the capital city of Colombia. Muévete means to move or to be active, and this campaign to promote physical activity was designed to improve the health and quality of life of the citizens of Bogotá through regular physical activity. The programme is based on the 1995 recommendations on physical activity of the U.S. Centers for Disease Control and Prevention and the American College of Sports Medicine (Pate el al, 1995), and was developed in close consultation with the Agita São Paulo programme in Brazil (Matsudo el al., 2003). Muévete Bogotá couples a mass media campaign with programmes targeted to change physical activity behaviour. The interventions, which are conducted at work sites, schools, health care centers and in community settings rely on partnerships created among professionals in areas of education and health, business officials and personnel, and community members, to deliver the programmes in each of these settings and populations. Like many developing countries, Colombia suffers from a growing epidemic of chronic diseases. In 1993 35.7% of total mortality in the city of Bogotá was due to chronic diseases (Espinosa, 1993). In 2002 cardiovascular diseases accounted for 40.3% of mortality among the population aged 60 years or older and 26.8% for persons 45 to 59 years of age. (Cardona, 2002) Bogotá has implemented extensive physical and social environmental changes over the last decade, which has increased opportunities for physical activity, but sedentary lifestyle continues to be a significant public health problem in the city. Programmes such as Muévete Bogotá that educate and motivate the population to become more physically active appear to be needed to complement the underlying environmental and policy changes. Muévete Bogotá provides an example of successful implementation of a comprehensive multi-sectoral approach to physical activity promotion in a large metropolitan area. This model may be used as an exemplary effort elsewhere in Latin America and in urban areas in developing countries around the world.

Colombia↗