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Results for “Community setting”

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PubMed2006

Binge-eating disorder as a distinct familial phenotype in obese individuals.

CONTEXT: Binge-eating disorder (BED)-a syndrome that only recently has attracted scientific attention-is often seen in obese individuals, especially those with severe obesity. However, it remains unclear whether BED represents an etiologically distinct behavioral phenotype of obesity or simply a nonspecific eating pattern sometimes seen in obese individuals. OBJECTIVE: To test whether BED aggregates in families independently of obesity, and if so, whether familial factors for BED also independently increase the risk of obesity. DESIGN, PATIENTS, AND SETTING: Blinded family interview study of overweight or obese probands with (n = 150) and without (n = 150) BED, and their first-degree relatives (n = 888) in a community setting evaluated between October 2002 and July 2004. MAIN OUTCOME MEASURES: Lifetime diagnosis of BED; current and highest lifetime body mass index (calculated as the weight in kilograms divided by the square of the height in meters). RESULTS: Binge-eating disorder aggregated strongly in families independently of obesity (odds ratio, 2.2; 95% confidence interval, 1.4-3.6; P<.001). Furthermore, relatives of probands with BED displayed a markedly higher prevalence of severe obesity in adulthood (body mass index >/=40) than relatives of probands without BED even when controlling for proband body mass index (odds ratio, 2.5; 95% confidence interval, 1.4-4.4; P = .002). CONCLUSIONS: Binge-eating disorder is a familial disorder caused in part by factors distinct from other familial factors for obesity. Furthermore, these BED-specific familial factors may independently increase the risk of obesity, especially severe obesity. It follows that targeted interventions capable of preventing or treating traits influenced by these BED-specific familial factors could reduce the public health burden of obesity.

Adolescent↗

PubMed2007

Demographic and clinical characteristics of motor vehicle accident victims in the community general health outpatient clinic: a comparison of PTSD and non-PTSD subjects.

Motor vehicle accidents (MVAs) are the leading cause of posttraumatic stress disorder (PTSD) in the general population, often with enduring symptomatology. This study details epidemiological and clinical features that characterize PTSD among MVA victims living in a nonhospitalized community setting long after the MVA event, and includes exploration of premorbid and peritraumatic factors. MVA victims (n=60; 23 males, 37 females) identified from the registry of a community general health outpatient clinic during a 7-year period were administered an extensive structured battery of epidemiological, diagnostic and clinical ratings. Results indicated that 30 subjects (50%; 12 males, 18 females) had MVA-related PTSD (MVAR-PTSD). Among those with PTSD, 16 individuals exhibited PTSD in partial remission, and six, in full remission. There were no significant demographic or occupational function differences between PTSD and non-PTSD groups. The most common comorbid conditions with MVAR-PTSD were social phobia (20%), generalized anxiety disorder (7.8%) and obsessive-compulsive disorder (0.5%). Previous MVA's were not predictive of PTSD. Subjects with MVAR-PTSD scored worse on the Clinician-Administered Posttraumatic Stress Disorder Scale, Part 2 (CAPS-2), Impact of Event Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Impulsivity Scale, and Toronto Alexithymia Rating Scale. Study observations indicate a relatively high rate of PTSD following an MVA in a community-based sample. The relatively high rate of partially remitted MVAR-PTSD (N=16) underscores the importance of subsyndromal forms of illness. Alexithymia may be an adaptive method of coping with event stress. The development of PTSD appears not to be associated with the severity of MVA-related physical injury.

Accidents, Traffic↗

PubMed2001

Chronic pain associated with spinal cord injuries: a community survey.

OBJECTIVE: To investigate, in a community sample of people with spinal cord injuries (SCIs), chronic pain prevalence, associated factors, sites, characteristics, interference with daily functioning, treatments received, and treatment helpfulness. DESIGN: Postal survey. SETTING: Community. PARTICIPANTS: Three hundred eighty-four individuals aged over 17 years with SCIs. MAIN OUTCOME MEASURES: Chronic Pain Grade questionnaire, Short-Form McGill Pain Questionnaire, pain sites, and treatments. RESULTS: Current pain was reported by 79% of respondents and was significantly more common in less highly educated persons, and individuals not employed or in school. Most common locations of current pain were the back (61%), hips and buttocks (61%), and legs and feet (58%). Upper extremity pain was experienced by 76% after the injury and by 69% currently. Individuals with tetraplegia were significantly more likely to have neck and shoulder pain than were those with paraplegia. On average, respondents reported a high level of pain intensity and a moderate level of pain interference with activities, and rated treatments received for pain as being only somewhat helpful. CONCLUSION: Most individuals with SCI experience chronic pain that is refractory to medical treatment. Further research is needed to delineate the causes of, and optimal treatments for, the various pain problems in this population.

Activities of Daily Living↗

PubMed1996

Advanced practice nursing in the care of the high-risk infant.

Advanced practice nursing encompasses a range of roles and services. Tertiary care settings such as neonatal intensive care units provide a variety of opportunities for the advanced practice nurse, including direct care, case management, and developmental care. Primary care and community settings may also provide opportunities for advanced practice nursing in the care of high-risk infants. Challenges related to role implementation, control of practice, and reimbursement also exist, however. The article examines the evolution of advanced practice nursing in the care of the high-risk infant as well as current opportunities and challenges.

Career Mobility↗

PubMed1996

Quality and quality assurance in the health care setting: an equitable life?

Research studies alluding to quality and quality assurance within the health care arena are increasingly utilized to justify management initiatives, particularly in relation to the provision and resourcing of patient services, both within the institutional and community setting. The following paper considers the role and utility of quality indicators and presents a critical analysis of the literature pertaining to the concept of quality as it applies to the provision and organization of health care and the relationship between quality assurance and patient satisfaction per se. The paper concludes with a dual challenge not only to nurses to better understand and articulate the specific contribution of the discipline, particularly in relation to positive patient outcomes, but also to current, narrow focused interpretations of quality assurance and calls for definitions of quality to reflect an appreciation of the particular involvement and role of the patient in determining policy affecting care provision.

Health Services Administration↗

PubMed1988

An evaluation of the accuracy of the Reflotron system in the field.

The Reflotron system (Boehringer-Mannheim, West Germany) is a dry-chemistry analyser which has been used in cholesterol screening in the United States and Australia. The accuracy and precision of the instrument for use as a screening device for whole-blood cholesterol levels have been evaluated in clinical settings in both the United States and Australia; however, questions still arise from healthy practitioners about its performance in the field. We selected 30 participants in a community-screening programme to undergo a comparative analysis of cholesterol measurement by the Reflotron system compared with two standard laboratory procedures (one of which was carried out in a World Health Organization accredited laboratory). Analysis of the data showed that, after a minimum of training, results can be obtained on the Reflotron system in a community setting which are acceptable when compared with results that have been obtained on more commonly-used laboratory instruments.

Adult↗

PubMed1990

Normalization and integration: a look at the Swedish experience.

Quality service provision is seen as an integral and essential element of the normalization effort in Sweden. Results of the present study suggest that Sweden's well-developed system of comprehensive services and support for individuals with mental retardation ensures a level of security and material well-being that allows these people to live and function within society-at-large. Considered in relation to Nirje's (1980) elaboration of integration as it pertains to normalizing the life conditions of persons with mental retardation, functional and physical integration are clearly evident in many community settings. At the same time, other indicators of integration, such as social relations and association with people without mental retardation, suggest that social integration continues to challenge the community living endeavors in Sweden in much the same way as it does in North America.

Adult↗

PubMed1995

Medical sociology and the study of severe mental illness: reflections on past accomplishments and directions for future research.

Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centered on treatment in community settings. While medical sociology has played a prominent role in the study of psychiatric hospitalization and the deinstitutionalization process, the systematic exploration of the sociological dimensions of community-based mental health care is only just beginning. This essay reflects on past disciplinary contributions and explores some important empirical and theoretical directions in the field of mental illness research that could benefit from more extensive sociological analysis. The central argument is that the shift to a community-based mental health system has increased the need for the sociological perspective and that medical sociologists, in particular, have the theoretical and analytical perspective essential for developing a more complete understanding of the current conditions impacting the lives of people with severe mental disorders. Drawing on recent work in medical sociology, we illustrate some important topical areas at the center of controversies over treatment, social change, and public policy regarding severe mental illness. We conclude with a discussion of the barriers to this type of sociological research and suggestions for ways medical sociologists might contribute to the study of severe mental disorders in the future.

Deinstitutionalization↗

PubMed1998

Community validation of the United Kingdom diagnostic criteria for atopic dermatitis in Romanian schoolchildren.

Although the U.K. modification of Hanifin and Rajka's diagnostic criteria for atopic dermatitis (AD) for use in epidemiological studies has demonstrated good validity and repeatability when previously tested in a U.K. community setting, little is known about its performance in other countries where different cultural, educational and linguistic factors could impair validity. We used a questionnaire to test the validity of the U.K. criteria as a point prevalence measure of AD in 1114 Romanian schoolchildren aged 6-12 years against the clinical diagnosis of a dermatologist with an interest in AD, who was unaware of the questionnaire content and responses. The sensitivity and specificity of the U.K. criteria for AD in this setting was 74% and 99%, respectively, an improvement rather than a deterioration in validity when compared with the previous U.K. study. Test-retest repeatability for all of the questions pertaining to the U.K. criteria using the chance-corrected kappa statistic was high, with values of 0.72 and over. The positive predictive value of the criteria was lower than in the U.K. study (63% compared with 80%, respectively) due to the very low prevalence of AD in this study (2.4%). The validity of a parental report of 'eczema' was poor, with a sensitivity of 22%, specificity of 97% and positive predictive value of 18%. This study suggests that the U.K. criteria perform well in settings outside the U.K., although care has to be taken when using the criteria to ascertain cases in settings where the prevalence of AD is very low.

Child↗

PubMed1999

Dedicated psychiatric care within general practice: health outcome and service providers' views.

Health service reforms have led to relocation of care of the chronic mentally ill from institutions to the community, with subsequent demands on the primary health care team. Few studies have attempted to identify satisfactory models of care for this patient group. This study explores the impact of the employment of a community psychiatric nurse (CPN) by a general practice in Aberdeen city to co-ordinate care of discharged long-stay psychiatric patients resettled in hostels. A similar general practice with a comparable group of registered patients was selected as a control group. Patient health outcome was measured using the Health of the Nation Outcome Scales (HoNOS) and service providers' views on dedicated psychiatric care within general practice were explored using qualitative methods. Improvements in communication, liaison and drug management were reported in the intervention practice. A primary care-based CPN service dedicated to the care of the chronic mentally ill promoted a smooth transfer of care from long-term institutionalized care to the community setting.

Adult↗

PubMed1980

The contributions of consumer health education to primary care practice: a review.

The inclusion of health education in high quality primary care has been suggested on the basis of 1) definitions and descriptions and descriptions of the content of primary care practice; 2) observational studies which have found that about 25 per cent of the direct patient-care time of the primary care physician is devoted to health education and counseling; and 3) surveys of physicians, who identified the most important "critical incidents" contributing to desired medical outcomes. This article reviews empirical studies of the role of health education in improving behavioral and medical outcomes for such conditions as hypertension, diabetes, congestive heart disease, streptococcal infections and others. Other contributions of health education in primary care in schools and other community settings are cited. Finally, the possible role of health education in medical education programs is described.

Community Health Services↗

PubMed1992

Prescribing problems and pharmacist interventions in community practice.

Interventions performed by 89 community pharmacists in 5 states to correct the prescribing problems they identified on new prescription orders were documented by trained observers. Pharmacists intervened to resolve a prescribing-related problem in 623 (1.9%) of 33,011 new prescription orders that were screened and dispensed during the study period. A panel of three expert evaluators concluded that 28.3% of the prescribing problems identified during the study could have caused patient harm if the pharmacist had not intervened to correct the problem. The rate at which pharmacists identified prescribing problems was negatively related to the number of prescriptions they dispensed per hour, suggesting that in pursuing distributive efficiency, some pharmacists may be exceeding their safe dispensing threshold. The authors recommend that the interprofessional system of oversight and verification (i.e., "checks and balances") in the delivery of pharmaceutical care in the community setting should be maintained and strengthened.

Adolescent↗

PubMed1998

Psychiatric morbidity in cohabitants of community-dwelling elderly depressives.

OBJECTIVE: To determine the effect of living with a depressed elderly individual on the mental health of the cohabitant carer. METHOD: Case-control study comparing rates of psychiatric morbidity in cohabitants of depressed versus well elderly. SETTING: Community sample. PARTICIPANTS: 44 couples, one partner with AGECAT depression, and 44 couples, one partner diagnosed well by AGECAT. Cohabitants were matched for gender, age and physical health status. All subjects were aged 65 years and over. MAIN OUTCOME MEASURE: Odds ratio of case or subcase depression and/or neurotic disorder in cohabitants of depressed elderly. RESULTS: 28/44 (64%) cohabitants of depressed subjects were cases (N = 9) or subcases (N = 19) of depression, neurotic disorder or both, compared to 13/44 (29%) cases (N = 1) or subcases (N = 12) in cohabitants of well subjects (OR = 6.33, 95% CI (1.7-18.3), p = < 0.001). CONCLUSION: This study reveals high levels of psychiatric morbidity, primarily depression and anxiety symptoms, in the cohabitants of depressed community-dwelling elderly. This suggest that living with a depressed elderly person may have an adverse effect on the mental health of the cohabitant. Increased recognition of the potential psychiatric morbidity in this group is needed.

Aged↗

PubMed1997

Suicidal thinking in community residents over eighty.

OBJECTIVE MAIN OBJECTIVE: to study the relationship between suicidal thinking and both cognitive impairment and depression. DESIGN: Random sample selected for interview, all of whom were a cohort in a pre-existing epidemiological study of dementia. SETTING: Community residents. PATIENTS AND OTHER PARTICIPANTS: Participants aged over 81. Study excluded the following: moved out of area/died/ too frail/severe communication difficulties/refused interview, refusal by GP/family/carers, 300 names selected at random from database. 170 eligible participants approached: 31 refused, 125 interviewed, 125 informants approached for interview; 118 interviewed. MAIN OUTCOME MEASURES: CAMDEX, 15-item Geriatric Depression Scale (GDS), and Scale for Suicidal Ideation (SSI) (including informant versions of latter 2 scales). RESULTS: 9 people showed suicidal thinking, all women: 6 had clinical evidence of cardiovascular/cerebrovascular disease. Those with suicidal thinking showed higher CAMDEX depression scores, weaker strength of the wish to go on living, higher rates of expressing wish to die and higher rates of depressive illness and mixed DAT/multi-infarct dementia as primary psychiatric diagnoses. No significant associations between suicidal thinking and GDS scores, Alzheimer-type dementia alone, awareness of memory difficulties or severity of dementia. CONCLUSIONS: Results show association between suicidal thinking and both depression and mixed DAT/multi-infarct dementia, but do not support an association between suicidal thinking and awareness of memory problems/severity of dementia. Given the methodological limitations, the significance of the results should be viewed with caution. Further exploration of the role of cerebrovascular disease in depressive disorder is suggested.

Activities of Daily Living↗

PubMedDate not supplied

The cluster committee: setting the stage for community-responsive care.

Recent reviews of medical education at the undergraduate and graduate level call for a greater emphasis on community-relevant teaching and development of partnerships between providers, academic health centers, and the community. The cluster committee, developed by the Center for Community Responsive Care, Inc., sets the stage. The cluster committee is an activity in which preventive medicine residents and fellows are trained in a community setting to participate in community-responsive health care. It is designed to meet the following goals: initiate the fellow in the steps of community-oriented primary care (COPC); develop a fellow's leadership skills; encourage relationships and coalitions within the community and among providers; and bring together the perspectives of community members, public health practitioners, academicians, and local clinicians regarding community health, as well as teach each about COPC. This article describes the cluster committee process, provides examples of a series of meetings, and presents lessons learned from the first six years of implementation.

Community Health Services↗

PubMed1999

Direct observation of health-habit counseling of adolescents.

OBJECTIVES: To determine the rate of health-habit counseling of adolescents seeing community family physicians and to identify the factors associated with the delivery of recommended preventive counseling services. DESIGN: Cross-sectional multimethod study emphasizing direct observation of patient visits. SETTING: Community family practices in northeast Ohio. PATIENTS OR OTHER PARTICIPANTS: Adolescents (n = 445) aged 11 to 21 years who were being seen for outpatient visits to community family physicians (n = 119) during 2 days of observation by trained research nurses. MAIN OUTCOME MEASURE: Direct observation of the delivery of clinical preventive counseling services recommended by the Guidelines for Adolescent Preventive Services. RESULTS: During the 445 visits made by adolescents, the most frequently delivered counseling service was exercise advice (13%). At least 1 health-habit counseling service was delivered during 38% of visits. In multivariable analyses, older patient age was strongly associated with increased service delivery. Visits for well care, longer visits, and new patient visits were also associated with the provision of counseling. Visits including preventive counseling services were on average 2.5 minutes longer than visits without preventive counseling. CONCLUSIONS: The rates of delivery of preventive counseling services in clinical practice were low, raising concern about the feasibility of current recommendations. The practical implementation of prevention guidelines may require a greater use of well-care visits and longer patient visits than are currently used in community family practice.

Adolescent↗

PubMed1995

More effective and less expensive: lessons from five studies examining community approaches to care.

Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.

Caregivers↗

PubMed1999

The community gerontological nurse: themes from a needs analysis.

With the move of care into the community, the role of nurses caring for older people is changing. However, nurses may not be adequately prepared to cope with this changing role, especially if their training and experience have been primarily hospital based. This study involves an educational needs analysis of registered nurses working in the care of older people in nursing homes and clients' own homes. It is based on focus groups with registered nurses and individual interviews with other professionals, as well as group discussions with older people. The aim of this project is to provide research-based input into the design of a new community care of older people module, to be offered at Napier University, Edinburgh from February 1998. The results presented here consist of three themes or patterns that have emerged from the interview data. The specialist/generalist theme concerns issues of role definition and gerontological specialism. The social/medical theme addresses the shift towards a social model of care when nurses move into the community settings. Finally, the physical health/mental health theme represents the need for greater integration of skills and knowledge from both mental health and general health nursing in the field of community care for older people. The results indicate the need for significant attitude changes and provide a major challenge to educationalists.

Aged↗