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PubMed1999

Effectiveness and quality of individual planning in residential settings: an analysis of outcomes.

Individual Habilitation Plan objectives for adults with mental retardation living in institutional or community settings were evaluated for effectiveness and quality. Effectiveness was assessed by contrasting change in relevant outcomes over time for participants with and without individual plan objectives in specified content areas. No significant change in outcomes associated with having an objective was detected for any of the content areas. Except for functionality, ratings of individual plans on all quality domains were poor. Regression analyses mostly failed to show any significant relationship between quality domain ratings and outcomes, although there was weak but inconsistent evidence for validity of the technical adequacy and data-collection quality domains. Findings present a challenge to current expectations that presence and quality of IHP objectives are associated with improved outcomes.

Adult↗

PubMed2006

Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires.

OBJECTIVES: Our goal for this study was to prospectively test whether parent-completed questionnaires can be effectively used in the setting of a busy ambulatory pediatric clinic to accurately screen for developmental impairments. Specific objectives included (1) assessing the feasibility of using parent-report instruments in the setting of a community pediatric clinic, (2) evaluating the accuracy of 2 available screening tests (the Ages and Stages Questionnaire and Child Development Inventory), and (3) ascertaining if the pediatrician's clinical judgment could be used as a potential modifier. METHODS: Subjects were recruited from the patient population of a community clinic providing primary ambulatory pediatric care. Subjects without previous developmental delay or concerns noted were contacted at the time of their routine 18-month-old visit. Those subjects who agreed to participate were randomly assigned to 1 of 2 groups and completed either the Ages and Stages Questionnaire or Child Development Inventory. The child's pediatrician also completed a brief questionnaire regarding his or her opinion of the child's development. Those children for whom concerns were identified by either questionnaire underwent additional detailed testing by the Battelle Development Inventory, the "gold standard" for the purposes of this study. An equal number of children scoring within the norms of the screening measures also underwent testing with the Battelle Development Inventory. RESULTS: Of the 356 parents contacted, 317 parents (90%) agreed to participate. Most parents correctly completed the Ages and Stages Questionnaire (81%) and the Child Development Inventory (75%). Predictive values were calculated for the Ages and Stages Questionnaire and the Child Development Inventory (sensitivity: 0.67 and 0.50; specificity: 0.39 and 0.86; positive predictive value: 34% and 50%; negative predictive value: 71% and 86%, respectively). Incorporating the physician's opinion regarding the developmental status of the child did not improve the accuracy of the screening questionnaires. CONCLUSIONS: Three important conclusions were reached: (1) parent-completed questionnaires can be feasibly used in the setting of a pediatric clinic; (2) the pediatrician's opinion had little effect in ameliorating the accuracy of either questionnaire; and (3) single-point accuracy of these screening instruments in a community setting did not meet the requisite standard for development screening tests as set by current recommendations. This study raises important questions about how developmental screening can be performed, and we recommend additional research to elucidate a successful screening procedure.

Ambulatory Care Facilities↗

PubMed2006

Urban Australians using recycled water for domestic non-potable use--an evaluation of the attributes price, saltiness, colour and odour using conjoint analysis.

Recycled water use in urban areas is viewed as one part of the solution to Australia's water shortage. The effectiveness of policies designed to promote recycled water systems depends on the acceptance by the community of the price, colour, odour and salt content of the recycled water. In Australia and other countries, limited research has been conducted that investigates community attitudes to and willingness to pay for recycled water, especially in urban settings. Community acceptance of recycled water and the economic feasibility of such projects have not been widely evaluated, even though the long-term feasibility of many projects is dependent on such information. This paper examines the attitudes of an urban Australian community living at Mawson Lakes in South Australia, to using recycled water for non-potable domestic purposes. Conjoint analysis (CA) was used to evaluate participant's (n=136) preferences for various attributes of recycled water (colour, odour, salt content and price) for various uses (garden watering, toilet flushing and clothes washing). The analysis was used to estimate the respondent's willingness to pay (WTP) for quality increases for each of the attributes. Differences in WTP were investigated according to various demographic variables including income and education. Results indicate that for garden watering having 'low salt levels' is the most important attribute of recycled water, for clothes washing 'colourless' is the most important attribute, and for toilet flushing a 'low price' was the most important attribute. Respondents were willing to pay for increases in the quality of recycled water. The amount they were willing to pay varied depending on applied use and the attribute in question. Respondents were most willing to pay for an increase in quality of recycled water when used for clothes washing (willing to pay Australian dollars (A$) 0.07/cubic meter (m(3)) for removal of colour, A$0.065 per cubic meter for an increase in quality of recycled water from 'salty' to 'low salt,' and A$ 0.06/m(3) for removal of odour (1A$=0.75 US $ and 0.62 euro, August 24, 2005)). Segmentation of the price attribute by demographic sectors reveals that those in the higher income bracket, higher education sector, middle age group, and who are male, had a higher marginal valuation on price. The results of this study provide important information for recycled water retailers and water policy developers, helping achieve greater economic feasibility for future recycled water projects, to the satisfaction of the communities involved.

Australia↗

PubMedDate not supplied

Victimization of the mentally ill: an unintended consequence of deinstitutionalization.

Twenty years ago, legal interventions and dramatic advancements in psychopharmacology provided the impetus for a mass exodus from public mental health institutions to community settings. This well-intended move was predicated on the development of a community mental health center network. An unintended consequence, however, is that many deinstitutionalized mentally ill clients have been forced onto the street with little or no treatment. Moreover, a new wave of never treated youth and elderly have joined the street subculture. Without adequate clinical treatment, these people are vulnerable to victimization and to arrest and incarceration. In this article, the history of the problem is reviewed and steps to create a more responsive clinical network to cope with the problem are discussed.

Community Mental Health Services↗

PubMed1991

Community responsive medicine: defining an academic discipline.

Academic medicine is entering a period of introspection created by changing patterns of health and disease and changing patterns in reimbursement and health policy. To respond to existing health challenges, innovative strategies for health care delivery and education must be devised. The migration of medical education and health care delivery into centralized and frequently difficult-to-access campuses is being reviewed by payors, policy analysts, and purchasers of care. One proposed solution to this problem responds to the identified shortcomings in medical education and some of the failures of our health care delivery system. Community Oriented Primary Care (COPC) and the related discipline of Community Responsive Medicine define health-oriented strategies that blend traditional primary care and public health. The classroom in Community Responsive Medicine is the community. The curriculum is defined by the elements and skills necessary to improve the health status of the target community. The model allows the student and resident to appreciate and experience the entire spectrum of health and disease and to understand the sequence of events that may lead to illness. Tertiary care is a critical curriculum component, but in Community Responsive Medicine the curriculum is balanced between the ambulatory and tertiary care settings. Community Responsive Medicine defines a role for new leadership that can create responsive educational and health care delivery systems accountable to the communities they serve.

Community Medicine↗

PubMed2004

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

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure]. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

Adult↗

PubMed2000

Training residents for community psychiatric practice: the resident perspective.

OBJECTIVE: To capture the views and experiences of psychiatry residents in 5 Canadian training programs with respect to community psychiatric training. METHOD: We sent a questionnaire regarding respondent demography, career interests, and community psychiatry training experiences to psychiatry residents at 5 training programs in Ontario. We undertook descriptive analyses and frequency comparisons on the returned data. RESULTS: The overall response rate was 48%, with considerable variation between programs. With respect to career planning, respondents indicated highest interest in urban hospital-based practice. An interest in additional community psychiatry training was, however, expressed, particularly by junior residents. Residents' suggestions for improving community psychiatry training included better promotion of training opportunities, improved quality of supervision in community settings, and more didactic teaching. CONCLUSION: Psychiatry residents are obtaining training experiences in community psychiatry, but objectives and guidelines are quite variable, as is reflected in their understanding of the definition of "community psychiatry." Residents' career paths are still focused on urban hospital-based practice or solo private practice, which likely reflects their prevalent training experiences. There is, however, interest in community psychiatry training. Junior residents may be more open to this type of practice, and curricula should allow more exposure to community psychiatry at this stage of training.

Adult↗

PubMed2005

School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome.

This article examines the effectiveness of an evidence-based behavioral treatment package for children with inattentive and disruptive behavior problems when delivered in the context of a school-based mental health program. Child symptomatology and functioning are assessed in a treatment group (n = 30) and a waitlist control group (n = 12) across multiple time points (fall, winter, and spring). Treatment includes a daily report card procedure, year-long teacher consultation, and parenting sessions. According to the parent report, treated children show marked reductions in hyperactive and impulsive, oppositional or defiant and aggressive behavior, and marked improvement in peer relationships. Teachers observe treatment-related group differences in inattention, academic functioning, and the student-teacher relationship. Feasibility and acceptability data have implications for transporting evidence-based treatments to community settings and for integrating mental health services into the culture of the school community.

Achievement↗

PubMed2000

Epoetin alfa therapy for anaemia in HIV-infected patients: impact on quality of life.

To evaluate the effect of epoetin alfa on the quality of life (QOL) of HIV-infected patients in the community setting, 221 anaemic (haemoglobin < or = 11 g/dl) HIV-positive patients from community-based treatment centres and physicians' offices were treated with epoetin alfa (100-300 units/kg subcutaneously 3 times a week) in a 4-month, open-label, non-randomized, phase IV trial. Epoetin alfa therapy significantly (P<0.01) increased and maintained haemoglobin levels (mean increase=2.5 g/dl; n=207); the improvement in haemoglobin levels was independent of changes in CD4+ cell counts. Transfusion requirements were also significantly reduced from 20% to 5% of patients (P<0.01). Mean total QOL score measured by the Functional Assessment of HIV Infection (FAHI) scale and Physical Well-Being subscale score improved significantly (P<0.05). QOL improvements associated with increases in haemoglobin were independent of changes in CD4+ counts and baseline anaemia severity. Adverse events observed during epoetin alfa therapy were consistent with HIV disease and not likely due to the drug. Epoetin alfa therapy should be considered a treatment option for HIV-infected patients with mild-to-moderate anaemia.

Adult↗

PubMedDate not supplied

Opsite Plus in the managment of low to moderate exuding wounds.

This article discusses the use of OpSite Plus (formerly known as OpSite Post-Op) in the community setting. This semipermeable film dressing with an absorbent pad was evaluated by the community hospital and by practice and district nurses within Plymouth's NHS Primary Care Trust.

Clinical Nursing Research↗

PubMed1980

Some promising dimensions for behavioral community technology.

In recent years, the search for effective and replicable approaches to planned change in communities has escalated. Applied behavior analysts have participated in these efforts to remedy existing community problems and to increase the capacities of community residents to meet their goals. Examples of behavioral technologies for community settings are described and their advantages are noted. Criteria for more contextually appropriate community technologies are suggested and strategies for developing behavioral methods according to these criteria are described. This paper outlines some promising dimensions for behavioral community technology and discusses several possible limitations to a behavioral approach to addressing societal problems.

Journal Article↗

PubMed1992

Tuberculosis.

In the United States, the incidence of tuberculosis (TB) is higher in elderly persons than in any other segment of the population, except in HIV-infected persons. The diagnosis of TB, however, is all too often not considered in geriatric patients. Although elderly nursing home residents are at a greater risk for TB than the aging population in the community setting, the majority (80%) of active TB cases in elderly persons occur in community dwellers. The diagnosis, treatment, and prevention of TB are reviewed in this article.

Age Factors↗

PubMed2006

Prevalence of vancomycin-resistant enterococci in hospitalized patients and those living in the community in the Czech Republic.

Between July 1, 2002 and December 31, 2003, rectal swabs from both hospitalized patients and community subjects in the Czech Republic were taken to ascertain the prevalence of vancomycin-resistant enterococci (VRE). The swabs were used for isolating and identifying enterococci and their susceptibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in Enterococcus faecium VanA strains. During the observed period, 2691 rectal swabs from the hospitalized patients and 6529 rectal swabs from the subjects in community setting were examined. In total, 31 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 1.9% in the hospitalized patients and 0.4% in the community subjects. The prevailing strains were Enterococcus faecium VanA (61.3%) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2%) in the community VRE. Mutual comparison between the hospital and community Enterococcus faecium VanA strains showed no similarity.

Cross Infection↗

PubMed1994

[Intervention with community health agents in immunization programs in the gypsy population].

OBJECTIVE: To measure how the vaccination coverage of the Gypsy child population in the Cartuja and Almanjayar quarters evolved throughout a Health Education Intervention using Community Health workers belonging to the Gypsy community. DESIGN: A descriptive study, pre-test/post-test, with no control group. SETTING: Community level. Primary Care. PATIENTS AND OTHER PARTICIPANTS: The whole of the Gypsy child population under 14, consisting of 1,073 children, and four Community Health workers. INTERVENTIONS: Health Education for mothers and carers, by means of home visits carried out by four Health workers, previously trained and contracted for this purpose for a year by the Andalusian School of Public Health. MEASUREMENTS AND MAIN RESULTS: We measured the Vaccination Coverage in September 1988 (42.2%) in order to establish the situation both at the start of the intervention in March 1990 (46.2%) and at its end in March 1991 (68.2%). We measured Vaccination Coverage of the different vaccine doses through frequency allocations. CONCLUSIONS: The Health Centre increased Vaccination Coverage by 4% in 18 months. The intervention increased it by 22.2% in 12 months. This demonstrates the intervention's effectiveness and underlines the importance of carrying out this kind of intervention when working with at-risk population groups.

Adolescent↗

PubMed1997

Effects of sustained weight loss and exercise on aerobic fitness in obese women.

OBJECTIVE: To assess the long term effects of weight loss with and without additional aerobic and weight training exercises on exercise tolerance and cardiorespiratory fitness in obese women. EXPERIMENTAL DESIGN: Randomized prospective study for an approximately one-year community setting. PATIENTS: 31 healthy obese women volunteers (age 42.8 yrs +/- 6 SD) recruited by community advertisement. INTERVENTION: All subjects underwent a weight loss program consisting of low calorie diet and behavior therapy for a minimum of 46 weeks. They were randomly assigned to one of the four groups. Group A: diet alone, Group B: diet plus aerobic exercise program in a supervised group setting, Group C: Diet plus weight training and Group D: diet plus weight training plus aerobic exercise program. MEASURES: Exercise time (Tex) peak sustained workload (Wp), peak oxygen consumption (VO2), oxygen pulse and the rate of change of VO2 on recovery (VO2rec) were measured at the beginning and after 47.5 weeks +/- 1.5 SD, of the program. RESULTS: All subjects lost weight and achieved increased Tex and lowered resting VO2. VO2 peak and VO2 peak kg-1 increase in Groups B and D only. O2 pulse and VO2rec improved in group D. Improvements in exercise time correlated significantly with initial exercise time and weight loss. CONCLUSIONS: Weight loss increase Tex irrespective of participation in an exercise program. However, evidence of improved aerobic fitness occurred only in groups performing aerobic exercise.

Adult↗

PubMed2005

Relationship between self-assessed masticatory disability and 9-year mortality in a cohort of community-residing elderly people.

OBJECTIVES: To examine the relationship between self-assessed masticatory disability and mortality. DESIGN: Prospective. SETTING: Community based. PARTICIPANTS: Total of 1,405 randomly selected people aged 65 and older living in Settsu, Osaka Prefecture, in October 1992. MEASUREMENTS: Data on health status as indicated by disability scores, history of health management, self-assessed masticatory ability, and psychosocial conditions were collected by means of interviews during home visits at the time of enrollment. Nine-year follow-up was completed for 1,245 (88.6%; 398 deceased and 847 alive). RESULTS: Self-assessed masticatory disability was significantly associated with being 75 and older, having overall disability, not using dental health checks or general health checks, not participating in social activities, not feeling that life is worth living (no ikigai), and finding relationships with people difficult. As for the association between self-assessed masticatory disability and mortality, the estimated survival rate for those with self-assessed masticatory disability was lower than that for those without for each group stratified by sex and age (65-74 and >or=75), and the equality of survival curves according to self-assessed masticatory disability was significant for each group. After controlling for potential predictors of mortality, self-assessed masticatory disability remained as a significant predictor of mortality (adjusted hazard ratio=1.63, 95% confidence interval=1.30-2.03, P<.001). CONCLUSION: These results indicate that self-assessed masticatory disability may be associated with a greater risk of mortality in community-residing elderly people.

Aged↗

PubMed1977

Adolescent day treatment: a community alternative to institutionalization of the emotionally disturbed adolescent.

This paper describes the need, the formation, and the structure of a partial day treatment program for severely disturbed adolescents, which uses local resources to maintain clients in the community. Components of the program, including family therapy in the home, are outlined and case illustrations are offered. Applications to other community settings are discussed.

Adolescent↗

PubMed2000

Insight: a mental health prevention intervention.

Modern health care systems are grasping the financial benefit of illness prevention programs. In mental illness prevention, psychiatric and mental health nurses are challenged to demonstrate efficacy in meeting the needs of the public and maintaining its position as one of the core mental health professions. The Center of Advanced Nursing Practice's Evidence-Based Practice Model provided the framework for guiding a pilot study intervention program, Insight, that facilitated a depression prevention program for women by an advanced practice nurse. Preliminary findings support the efficacy of Insight in a community setting and with program modifications.

Adult↗