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 1,063 records · Page 59Linked to original sources

PubMedDate not supplied

Population-based osteoporosis education for older women.

With an increased focus on wellness and health promotion, there is a need for community-based strategies to complement traditional strategies aimed at improving individual and aggregate health. An educational program on the prevention, diagnosis, and treatment of osteoporosis was provided for 188 women age 60 and older in three different community settings: churches, retirement homes, and senior citizen centers. The major purposes of the study were to determine whether a community-based program might (a) contribute to older women's knowledge about osteoporosis and (b) promote their intent to use this knowledge. Each participant completed a demographic profile, the Osteoporosis Risk Checklist, and the Osteoporosis Knowledge Questionnaire (OKQ), with the OKQ serving as a pre- and post-test. Before post-testing, a 30-min educational program was provided. Differences among the three groups were risk factors, prior knowledge about osteoporosis, and knowledge at the completion of the program. A majority of the clients indicated an intent to increase calcium in their diet, discuss osteoporosis with their health care provider, check their home environment for safety/falls, and discuss what they had learned with others. Nurses need to plan educational programs in all settings to teach older clients about the risk factors, prevention, diagnosis, and treatment of osteoporosis.

Aged↗

PubMedDate not supplied

Community pharmacists' work environments: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe characteristics of community pharmacists' current practice environments and pharmacists perceptions' about aspects of their work environments. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies) in the United States. PARTICIPANTS: 1,564 actively practicing pharmacists. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Hours the pharmacy was open; staffing; workload, perceptions of workload, and impact of the current workload on them and their work; equipment and technology available and used; and impact of equipment and technology at the practice site. Responses were compared with those from the 2000 National Pharmacist Workforce Survey. RESULTS: Hours of operation varied across practice settings in 2004 and were similar to those reported in 2000. Pharmacist and technician staffing varied somewhat across settings, but overall pharmacists were working with more technicians in 2004 compared with 2000. The number of prescriptions personally dispensed daily (personal workload) increased for pharmacists in all practice settings from 2000 to 2004. When pharmacists reported the impact of their current workload, motivation to work at the pharmacy and job satisfaction were rated most positive, and opportunity to take adequate breaks were rated most negative. Equipment used for facilitating the dispensing process was more common in pharmacies than equipment related to patient care activities. More than one half of pharmacists reported that equipment and technology increased their level of productivity, quality of care, financial performance, and job satisfaction in the pharmacy. CONCLUSION: Pharmacists' work environments tend to be oriented toward traditional dispensing roles and activities. Staff, equipment, and information technology resources are available to facilitate both dispensing and patient care activities, and these resources have increased productivity, quality of care, and pharmacists' satisfaction.

Community Pharmacy Services↗

PubMed1989

Munchausen syndrome by proxy: a survey of professionals' knowledge.

This study examined professionals' knowledge of a relatively rare form of child abuse, Munchausen syndrome by proxy (MSBP). Eighty-six professionals representing hospital or other medical settings, community services programs, the state children's service agency, and various law enforcement agencies were surveyed. Results indicated that professionals employed in medical or hospital settings were three times more likely to have heard of the syndrome than those employed by community service agencies. Journal articles and colleagues were the most popular sources of information pertaining to MSBP. Respondents identified 77 possible cases of MSBP in their caseloads over the past year. Findings suggest the need for educating community professionals as well as the possibility that the incidence of MSBP has been grossly underestimated. Implications for future research and preventive efforts are discussed.

Adult↗

PubMed2005

Patterns of care for adults with newly diagnosed malignant glioma.

CONTEXT: Patients with malignant glioma (grade III or IV) face a poor prognosis, and few evidence-based treatment guidelines are available. There is a dearth of prospective data on patterns of care for these patients. OBJECTIVE: To provide benchmark data to enable comparison of individual practice patterns and outcomes. DESIGN, SETTING, AND PATIENTS: The Glioma Outcomes (GO) Project enrolled 788 patients at 52 clinical sites, both academic and community practices, between December 1997 and July 2000. The enrollment criteria included adult patients with primary grade III or IV glioma undergoing a first or second operation for diagnosis or treatment. The data collection instruments included questionnaire forms given at enrollment, during the perioperative period, and at follow-up intervals of 3 months until death or a maximum of 24 months. Of the patients recorded in the GO database, 565 patients with newly diagnosed tumors were used for this analysis. MAIN OUTCOME MEASURES: Patterns of care (surgical management, perioperative care, postoperative management). RESULTS: Most patients underwent magnetic resonance imaging (n = 518; 92%) and an attempt at tumor resection (n = 425; 75%). Cortical mapping (n = 107; 19%) and intraoperative image guidance (n = 161; 29%) were uncommon. Most received perioperative corticosteroids (n = 535; 99%) and antiepileptic medications (n = 497; 88%), but few received antidepressants (n = 38; 8%) or prophylactic heparin (n = 42; 7%). Most received adjuvant radiation therapy (n = 479; 87%), but fewer received chemotherapy (n = 300; 54%). Practice patterns varied significantly between academic and community settings. CONCLUSIONS: Reliance on magnetic resonance imaging, surgery, and radiation is generally accepted; however, relatively infrequent chemotherapy use may conflict with published literature, and frequent use of prophylactic antiepileptic medications contradicts established practice guidelines. Other practice patterns involving surgical adjuncts, prophylactic heparin, and antidepressants require further investigation to clarify appropriateness. Establishing further clinical guidelines may help reduce variability in practice patterns.

Adult↗

PubMed2001

Challenging behaviour in community services.

The implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty-eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self-injury as well as a range of behaviours of the 'hard to engage' type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty-five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out-of-borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.

Activities of Daily Living↗

PubMed1991

Program evaluation as a measure of the quality of a new approach to community psychiatric care.

The effectiveness of a new approach to providing psychiatric rehabilitation services in community settings will be assessed using a combination of quality assurance principles and program evaluation techniques. A new Assertive Community Rehabilitation Program (ACRP) is evaluated and compared with existing hospital rehabilitation programs. Measures of service efficiency, admission, discharge and readmission rates, and service costs are made for 100 new referrals, 99 inpatients and 117 outpatients. Follow-up interviews use standardized measures of clients' quality of life, clinical status, client and staff satisfaction, and community resource utilization. After 19 weeks of operation, the ACRP has prevented more admissions, and discharged more inpatients than the comparison programs. Readmission rates have not differed. Results at the end of the one-year project using this program-based quality assurance approach will facilitate managerial decisions about the future of rehabilitation services.

Adult↗

PubMed1992

Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers.

OBJECTIVE: To identify which Instrumental Activities of Daily Living (IADL) are related to cognitive impairment, independent of age, sex, and education; to assess the performance of an IADL score using these items in screening for cognitive impairment and dementia in elderly community dwellers. DESIGN: Survey based on the baseline interview of the PAQUID study on functional and cerebral aging. SETTING: Community survey in 37 randomly selected parishes in Gironde, France. SUBJECTS: Random sample of 2,792 community dwellers aged 65 and over (participation rate: 69%). MEASUREMENTS: Two-phase screening: (1) functional assessment, Mini-Mental State Examination (MMSE) and DSM-III criteria for dementia; (2) in DSM-III-positive patients, NINCDS-ADRDA criteria applied by a neurologist. Functional assessment: IADL scale of Lawton and Brody. Criterion standards: cognitive impairment: MMSE score lower than 24; dementia: DSM-III and NINCDS-ADRDA criteria. RESULTS: Four IADL items are correlated with cognitive impairment independent of age, sex, and education: telephone use, use of means of transportation, responsibility for medication intake, and handling finances. A score adding the number of IADL dependencies has a sensitivity of 0.62 and a specificity of 0.80 at the lowest cut-off point (score > 0) for the diagnosis of cognitive impairment. The same score at the same cut-off has a sensitivity of 0.94 and a specificity of 0.71 for the diagnosis of dementia. The prevalence of dementia (2.4%) is reduced by a factor of 12 in subjects independent for the four IADL. CONCLUSION: The four IADL score could be incorporated into the screening procedure for dementia in elderly community dwellers.

Activities of Daily Living↗

PubMed1995

Venous ulcer healing: effect of socioeconomic factors in London.

OBJECTIVE: To determine which social and clinical factors are associated with healing in patients with venous ulceration. DESIGN: Patients were questioned about social factors at their first visit to a community ulcer clinic. They were treated by high compression bandage system and were interviewed again after 12 weeks. SETTING: Community leg ulcer clinics held in health centres throughout Riverside Health Authority in London. PATIENTS: All patients referred to five community leg ulcer clinics with venous ulceration over a six month period. MAIN OUTCOME MEASURES: These were factors significantly associated with healing within 12 weeks of beginning treatment, measured by odds ratio (OR) given by logistic regression analysis. MAIN RESULTS: Of 168 patients with venous ulceration, 87 (52%) healed after 12 weeks of treatment. Univariate analysis showed that low social class (OR = 3.44, 95% CI 1.17, 10.14), lack of central heating (OR = 2.22, 95% CI 1.18, 4.18), and being single (OR = 2.77, 95% CI 1.15, 6.69) were all significantly associated with delayed healing. After adjustment for the known risk factors of ulcer size, ulcer duration, and general mobility only lack of central heating was still significant (OR = 2.27, 95% CI 1.11, 4.55). The remaining factors failing to achieve statistical significance because of their inter-relationship with the known risk factors. CONCLUSIONS: Clinical features of the ulcer seem to determine the progress of healing in patients with leg ulceration. Although there were associations between socio-economic factors and poor healing, adjustment for clinical risk factors generally led to lower non-significant associations. Only lack of central heating retained its association and may play a part in prolonging healing of venous ulceration.

Aged↗

PubMed2005

Examining the Community Integration Measure (CIM): a replication study with life satisfaction.

OBJECTIVE: To examine instrument reliability, validity, factor structure, and conceptual underpinnings of the Community Integration Measure (CIM) with the Community Integration Questionnaire Revised (CIQ-R) and the Satisfaction with Life Scale (SWLS). DESIGN: A replication study. SETTING: Community living. PARTICIPANTS: Ninety-one participants: 51 individuals with a brain injury, and 40 without brain injury. MAIN OUTCOMES: Internal consistency, criterion validity, construct validity, discriminant validity factor structure. RESULTS: CIM items produced standardized alphas ranging from 0.72 to 0.83. Significant positive correlations were found among the CIM and both the CIQ-R and SWLS, with the CIM performing better with the SWLS than did the CIQ-R. The CIM discriminated between subject samples as well as by living arrangement. The factor loading solution revealed a three-factor model that explained 63.72 percent of the variance. CONCLUSION: The CIM shows good promise for capturing an individual's perception of community integration. The factor structure supports the original Model of Community Integration. Further research is needed to examine the influence of objective items on the CIM and Model of Community Integration.

Adult↗

PubMed2005

Community-based organizations' perspective on health information outreach: a panel discussion.

OBJECTIVE: A panel was convened to elicit guidance for librarians in initiating and implementing community-based health information outreach. PARTICIPANTS: Participants included a panel of individuals from communities or community organizations who represented the types of groups with which librarians or information specialists need to interact and an audience who represented health sciences libraries, public libraries, academic institutions, government agencies, funding agencies, and community-based organizations and could contribute to a discussion on community-based health information outreach. PROGRAM: The panel was presented with a hypothetical community setting and asked to respond to a series of questions: What do librarians need to learn about the community before they make their visits? What methods of outreach have been successful in your work? How would you implement and sustain a health information program in your community? How would health information interventions reduce racial and ethnic disparities in health? MAIN RESULTS: The panel helped to frame many of the issues that may confront librarians as they initiate information-related programs in communities. CONCLUSION: There is clear consensus on the need for librarians to make the effort to reach out into the community, to make the contacts, to seek to understand the community, to talk with leaders, and to respect the community as they promote and teach the use of health information resources. It was confirmed that librarians and libraries have an important role in diminishing health disparities by improving access to health information.

Community-Institutional Relations↗

PubMed1996

Donation of frozen embryos after in vitro fertilization is uncommon.

OBJECTIVE: To determine the availability of donated cryopreserved embryos. DESIGN: Retrospective review. SETTING: Community hospital-based IVF-ET program. PATIENTS: Eighty-three consecutive infertile couples who had 98 sets of embryos cryopreserved after IVF-ET and GIFT between January 1, 1989 and December 31, 1991. INTERVENTION(S): Cryopreservation of fertilized oocytes or cleaving embryos after IVF-ET and GIFT. MAIN OUTCOME MEASURE(S): Disposition of frozen embryos as of December 31, 1995. RESULT(S): Of 98 sets of frozen embryos, 71 (72.4%) were thawed for transfer into the infertile woman. At an average of 6 years since the treatment cycle, six sets of embryos (6.1%) remain in storage. Of 21 sets of embryos not thawed for autologous transfer, the majority (17.4%) were discarded, leaving only four clutches (4.1%) available for donation. CONCLUSION(S): Couples who did not use their frozen embryos after IVF-ET and GIFT were four times more likely to destroy them than to donate them.

Cryopreservation↗

PubMed2001

Relationship between knee extension force and stand-up performance in community-dwelling elderly women.

OBJECTIVE: To describe the relationship between knee extension force and stand-up performance. DESIGN: Prospective, cross-sectional, descriptive, and correlational. SETTING: Community. PARTICIPANTS: Fifty-five community-dwelling women 60 or more years old. INTERVENTIONS: Information pertaining to stand-up performance was gathered via structured questions. The time to complete 1 sit-to-stand from a bench of known height (16in) was obtained in conjunction with subjects' ratings of perceived exertion (RPEs) relative to the task. Bilateral lower extremity knee extension strength was measured with a hand-held dynamometer and normalized against body weight. MAIN OUTCOME MEASURES: Total knee extension forces (raw and body-weight normalized values) generated by each subject were correlated with 3 measures of stand-up performance. RESULTS: Low to moderate correlations (r = -.323 to -.526) were found between knee extension forces and the stand-up performance measures of bench stand time and stand-up difficulties. Normalized knee extension force had a higher correlation than raw knee extension force with stand-up difficulties and RPE. Correlations were higher when the curvilinear nature of the relationship was taken into account. The highest correlation was between normalized knee extension force and the RPE associated with the bench stand task (r = -.767). CONCLUSION: Knee extension force offers an important but incomplete explanation of stand-up performance from low surfaces by elderly women. Interventions leading to increased knee extension force may improve stand-up performance.

Activities of Daily Living↗

PubMed1992

Project School Care: integrating children assisted by medical technology into educational settings.

The increasing number of children assisted by medical technology in the U.S. has led to a need for systematic planning for the children's care in community settings such as schools. Project School Care in Massachusetts provides consultation to school systems as schools respond to the challenge of integrating children assisted by medical technology into educational settings. The model of practice described includes the step-wise planning process and the ensuing training, enrollment, and monitoring procedures. Implications are explored with particular emphasis on upgrading of skills at all medical and educational levels. More input from school health personnel in administrative decision-making around enrollment of children with special health care needs is recommended. For these children, a health care plan should be incorporated into their Individualized Education Plans and into their school records.

Boston↗

PubMed1992

Prevalence of venous disease: a community study in west London.

OBJECTIVE: To find out the prevalence of venous disease in patients aged between 35 and 70 years. DESIGN: Self-administered questionnaire. SETTING: Community study in west London, England. SUBJECTS: A random sample of 2,103 patients aged between 35 and 70 years who were registered with three general practices. RESULTS: 1,338 (64%) subjects filled in the questionnaires. Of these, 323/1,303 (25%) said that they had varicose veins, 81/1,338 (6%) had a deep vein thrombosis or pulmonary embolism, and 52/1,336 (5%) said that they had had phlebitis. In addition, 94/1,326 (7%) had worn support stockings, and 84/1,304 (6%) had been treated with anticoagulants at some time; 31% of responders reported that they had had some form of venous disease. CONCLUSIONS: Increased age and female sex were independent risk factors for varicose veins and phlebitis. Thrombosis and pulmonary embolism were both significantly associated with the presence of diabetes, female sex, and increased age. The facts that a quarter of the sample had varicose veins, and that nearly a third had had venous disease of some kind at some time, suggest that venous disease may place a heavier burden on health resources than had been realised.

Adult↗

PubMed2006

Cost savings associated with the use of fine-needle aspiration biopsy (FNAB) for the diagnosis of palpable masses in a community hospital-based FNAB clinic.

BACKGROUND: Generally, it is assumed that fine-needle aspiration biopsy (FNAB) for the diagnosis of superficial, palpable masses is a less expensive alternative to diagnostic open surgical biopsy; however, to the authors' knowledge few studies to date have sought to quantify the number of diagnostic surgical procedures avoided and cost savings involved. In this article, the authors report their experience with 664 FNAB procedures that were performed by a cytopathologist/cytotechnologist team practicing in a community setting. METHODS: Records from a total of 664 consecutive FNAB cases from 607 patients who underwent FNAB in a community hospital-based FNAB clinic between 2003 and 2005 were reviewed retrospectively, and follow-up data were obtained. RESULTS: Surgery was averted entirely as a result of the FNAB in 83% or 505 of 609 cases with follow-up available. The FNAB procedure was highly accurate and considerably less expensive than surgical biopsy. CONCLUSION: For patients who presented with palpable masses, FNAB was a reliable, cost-effective initial method for obtaining a tissue diagnosis.

Adolescent↗

PubMed2007

An Australian perspective of fatherhood and sexuality.

OBJECTIVE: to describe and explore the effect that pregnancy, childbirth and adjustment to a new baby have on the sexual relationship of fathers. DESIGN: a content analysis, using a qualitative approach, was undertaken on the written comments provided by fathers on a 6-week postpartum postal survey. The survey was undertaken to provide information relating to fathers' adaptation to fatherhood. The father's functional status was measured using, the Inventory of Functional Status-fathers (IFS-F) Tool. SETTING: a regional location within New South Wales, Australia. Participants (fathers) were recruited through postnatal services within hospital and community settings. PARTICIPANTS: volunteer study participants consisting of 204 fathers were sent a questionnaire at 6 weeks postpartum. The questionnaire was returned by 128 study participants (fathers). The participants were men experiencing fatherhood for the first time or who were adding to their existing families. FINDINGS: comments by the study participants revealed that sexual relationships during pregnancy and the postnatal period undergo a variety of changes that may affect the couple's relationship. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: it is important for health-care professionals, particularly midwives, to recognise that variance in sexual activity during the childbearing period does occur, and that there is a need for the midwife to be open to individual discussion of sexual activity with the woman and her partner during pregnancy and postnatal periods. Holistic care of women and their partners in the childbearing period requires health professionals to effectively communicate current information and education on sexuality.

Adult↗

PubMed1993

Medical audit of community screening for undescended testes in Halton District.

OBJECTIVES: To evaluate the quality of screening in the community for undescended testis and to determine the percentage of boys referred for surgery before their second birthday. DESIGN: Population-based retrospective study of hospital and community clinic records of boys resident in Halton Health District who underwent surgery for undescended testicle during 1987-89. SETTING: Community Child Health Clinics. Medical Records Department of referral hospitals surrounding Halton district. RESULTS: During 1987-89, 76 boys from Halton district underwent surgery for undescended testis in the neighbouring hospitals: 64 (84%) of these boys had attended at least one screening examination in the community clinics; 12 (16%) did not attend any. Among the 64 who attended 18 (28%) were not considered to have undescended testis. Of the 30 boys diagnosed to have undescended testis after school entry, six were diagnosed incidentally in hospital and 24 were detected by general practitioners and School Medical Service. The age range for surgical referral varied from six months to 12.5 years. The percentage of boys referred for surgery before their second birthday was only 13%. CONCLUSION: Many cryptorchid boys were not picked up in community screening and many of these did not receive early surgery. This audit report suggested the following recommendations: (a) increased awareness of the condition amongst doctors and health visitors performing screening examination; (b) early surgical referral. These recommendations have been implemented in the district. Our further plan is to repeat the audit in three years to assess changes.

Child, Preschool↗

PubMed2000

Interceptive orthodontics in the real world of community dentistry.

OBJECTIVE: To test the applicability and effectiveness of interceptive orthodontics in a community field trial. DESIGN: Prospective screening for suitable malocclusions, implementation of treatment and analysis of outcomes 12 months later. SETTING: Community dentistry in urban and rural areas of Northern Ireland, 1996-98. SUBJECTS AND METHODS: The initial sample consisted of 2002 children (1014 boys, 988 girls) who were screened in routine community dental inspections. One thousand and sixty (523 aged 9 years, 537 aged 11 years) were domiciled in the urban area of greater Belfast and 942 (479 aged 9 years, 463 aged 11 years) in the rural area of Enniskillen and Omagh, Co. Tyrone. INTERVENTIONS: Interceptive orthodontic treatment. OUTCOME MEASURES: Dental health component of the Index of Orthodontic Treatment Need (IOTN) and specially devised local indices of treatment outcomes. RESULTS: With the use of an interception gauge, orthodontic screening was included in the community dental inspections without difficulty. Thirty-three per cent of children were in need of interceptive treatment. Only 20% of those in need both attended for recall and underwent treatment. Compliance was better in the rural area but the need, with particular reference to extraction of carious first molars, was greater in the urban area. The numbers of children in IOTN grades 4 and 5 fell from 69% at the beginning of the study to 42% at the end. The outcome judged by local indices was 94% in the range of complete success to minimal improvement with only 2% showing deterioration. CONCLUSIONS: One in three children screened in community dental inspections at age 9 and 11 years would benefit from interceptive orthodontics. Parents and children seem reluctant to accept offers of interceptive orthodontics and to having the treatment carried out. Among those complying fully, the interceptive measures are very successful. Not only does community interceptive orthodontics improve the condition being treated but also reduces the need for further treatment.

Chi-Square Distribution↗