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PubMed2004

Community-based prevention of marital dysfunction: multilevel modeling of a randomized effectiveness study.

This study is a cluster randomized controlled trial of the Prevention and Relationship Enhancement Program (PREP; H. J. Markman, S. M. Stanley, & S. L. Blumberg, 2001). Fifty-seven religious organizations (ROs), consisting of 217 newlywed couples, were randomly assigned to 1 of 3 intervention conditions: PREP delivered by university clinicians (U-PREP), PREP delivered by RO clergy (ROPREP), and naturally occurring (NO) marriage preparation. Self-reported relationship satisfaction, negative behavior, and positive behavior were assessed at preintervention, postintervention, and 1-year follow-up. Trajectories of relationship satisfaction showed no change over time and did not differ across conditions. Trajectories of negative behavior for RO-PREP wives showed significantly greater linear declines in comparison with NO trajectories. Trajectories of positive behavior for NO and U-PREP partners showed significant declines compared with RO-PREP trajectories. Effectiveness, transportability, and dissemination of marital distress prevention programs in community settings are discussed.

Adult↗

PubMed2001

Community supports for individuals with challenging behavior after brain injury: an analysis of the New York state behavioral resource project.

OBJECTIVE: To articulate a framework for supporting individuals with behavioral challenges following brain injury, to describe a state-funded clinical intervention program established to provide community support to individuals with challenging behaviors following brain injury using such a framework, to present data from which it can be concluded that such a program is cost-effective, and to offer policy recommendations. DESIGN: Retrospective analysis of cost data and living arrangements for individuals with behavioral challenges served for a period of 3-4 years through the New York State Home and Community-Based Services Traumatic Brain Injury (HCBS-TBI) Waiver program and the State Behavioral Resource Project. SUBJECTS: 80 individuals with TBI and severe behavioral challenges that included criminal behavior, physical threats, assault and physical aggression, sexually inappropriate behavior, substance abuse, refusal to participate in intervention programs, and psychiatric disturbances, all of whom were at least 2 years postinjury (X = 7.33 years postinjury). RESULTS: The majority of individuals (82% of the 1996 cohort; 89% of the 1997 cohort) with challenging behaviors were living successfully in their home communities 3-4 years after the initiation of behavioral supports. In addition, the costs of serving these individuals decreased in the first year of community integration and for that last year that a cost analysis was completed. CONCLUSIONS: Many individuals with behavioral impairments can be supported successfully in community settings, so long as those supports are flexibly implemented to meet the changing needs of those individuals. Moreover, even with intensive supports, it is cost-effective to serve this population in the community.

Brain Injuries↗

PubMed1992

HIV seropositivity in community-recruited and drug treatment samples of injecting drug users.

OBJECTIVE: To assess the representativeness of drug use treatment samples for measuring HIV seroprevalence among injecting drug users (IDU) in community settings. DESIGN: Seroprevalence was determined in two cross-sectional, convenience samples including an unlinked survey of IDU entrants to all publicly-funded drug-treatment programs and a survey of community-recruited IDU. METHODS: Unconditional logistic regression [odds ratio (OR)] was used to calculate unadjusted and adjusted OR to measure the association between HIV seropositivity and site of recruitment. RESULTS: Between 1988 and 1989, 25% of 870 community-recruited IDU were seropositive, compared with 13% of 671 entrants to drug-treatment programs. This twofold risk of HIV seropositivity among community-recruited IDU remained after adjustment for sample differences in gender, race-ethnicity, and age group (adjusted OR, 2.09; 95% confidence interval, 1.58-2.78). CONCLUSIONS: These results suggest the importance of extending HIV surveillance outside of drug-treatment facilities. Active serologic surveillance may be feasible by coupling recent saliva and fingerstick sampling techniques with existing community outreach education efforts.

Adult↗

PubMed2006

Telephone interventions by nursing students: improving outcomes for heart failure patients in the community.

Community care for heart failure patients is difficult due to multiple comorbidities, polypharmacy, and advanced age of patients. Studies show that hospital admissions and emergency room visits decrease with increased nursing interventions in home and community settings. The purpose of this study(1) was to assess the effectiveness of regular telephone interventions by nursing students on outcomes of heart failure patients in the home. Senior students were paired with community nursing staff and assigned 2 heart failure patients to follow up by telephone calls for 12 to 14 weeks. Patients who received telephone interventions had fewer hospital readmissions (13%) than the comparison group (35%). Patients in the telephone intervention group also had fewer overt heart failure symptoms as measured by the Minnesota Living With Heart Failure Questionnaire.

Aftercare↗

PubMedDate not supplied

The introduction of a "trial without catheter" model in primary care.

Action research was used to compare and evaluate the current nursing practice of urinary catheter removal. The aim of this study was to plan, implement and evaluate a trial without catheter (TWOC) model in primary care and compare it with the clinical procedure being performed in the secondary care setting. Two sample groups were used; the first sample consisted of 10 patients who had undergone a TWOC in hospital, and the second consisted of 10 patients who had a TWOC in the community. An interview with the urology nurse specialist was also undertaken to gain further qualitative data. Statistics were analysed using an unpaired t-test. Results showed that 80% of hospital patients and all community patients stated that given the choice they would prefer to have their TWOC at home. Infection rates were monitored and 40% of hospital TWOC patients developed a urine infection, whereas no infection was reported in the community group. From this small study, it was evident that there were major benefits to providing a TWOC service within the community setting.

Aged↗

PubMed2002

Oximeter performance: the influence of acquisition parameters.

STUDY OBJECTIVE: This study was designed to determine whether different desaturation indexes (DIs) would be obtained in patients with sleep-disordered breathing by systematically altering two acquisition parameters: the recording setting and the display mode. DESIGN: Prospective clinical study. SETTING: Community sleep-disorders center. PATIENTS: The study included 75 patients who were suspected of having sleep-disordered breathing. INTERVENTIONS: Each patient had simultaneous pulse oxyhemoglobin saturation (SpO2) traces at three recording settings (3 s, 6 s, and 12 s) during the diagnostic phase of split-night polysomnography. On-line and memory displays of those data at each recording setting were obtained. DIs for > or = 3% desaturation events per hour were calculated for each of the six traces. RESULTS: The mean on-line DIs significantly differed from each other, with slower (longer) recording settings resulting in lower values than faster (shorter) settings. The memory DIs all significantly underestimated the on-line DIs. Pearson correlations ranged from 0.82 to 0.90 between the on-line/memory DI pairs, but Bland-Altman analysis detected disagreement at higher levels of disordered breathing. CONCLUSIONS: These findings confirm that significantly different SpO2 data are obtained at various acquisition options. The recording setting and display mode parameters should be disclosed in all reports employing oximetry with the fastest recording setting and on-line display mode preferable for case finding of sleep-disordered breathing.

Adult↗

PubMed1999

Cost of illness and disease severity in a cohort of French patients with Parkinson's disease.

OBJECTIVE: To assess the relationship between severity and progression of illness in Parkinson's disease and the use of healthcare resources. DESIGN AND SETTING: This was a prospective cost-of-illness study conducted in France based on clinical observation over a 6-month period of patients with Parkinson's disease treated in the hospital or community setting. Regression analyses were performed to construct the model that offered the best explanation for health expenditures using clinical and sociodemographic indicators. PATIENTS AND PARTICIPANTS: All patients included in the study had well-defined idiopathic Parkinson's disease, were aged > 35 years, were receiving treatment with levodopa or other antiparkinsonian agents, and were capable of completing questionnaires, alone or with the help of a household member. The final study population consisted of 294 patients, of whom 54 were enrolled by general practitioners and 240 by neurologists. INTERVENTIONS: Investigators completed a clinical questionnaire at the beginning and end of the 6-month observation period. Patients completed a questionnaire on their daily living conditions at the beginning and end of the study, and also completed monthly reports of healthcare use and loss of productivity. Patients with motor fluctuations also filled in fluctuation diaries on 4 consecutive days at the beginning and end of the 6-month period. Resource data collected included hospital stays, ancillary care, drug therapy, medical visits and transportation. Social costs were evaluated in nonmonetary terms, with the exception of costs of adapting the home environment. Transfer payments were analysed using reports from patients. MAIN OUTCOME MEASURES AND RESULTS: Hospital stays were the most expensive component of care (39% of costs), followed by ancillary care (30%) and drug therapy (22%). The mean medical cost was 308 euros (EUR) [$US357] for patients followed by a general practitioner and EUR2580 ($US2993) for patients followed by a neurologist. Costs also varied with age and motor fluctuations. Medical costs were strongly correlated with most clinical indicators and the cost generally progressed in line with the severity of the disease. The strongest correlation was between clinical indicators and ancillary care costs. CONCLUSIONS: These results confirm the importance of the social burden of Parkinson's disease. The regression results could be used to evaluate the benefit of novel treatments that reduce the intensity of motor fluctuations.

Adult↗

PubMed2001

Varicella vaccine in post-exposure prophylaxis.

Evidence concerning the effectiveness of Oka-based varicella vaccines when administered following exposure to varicella zoster virus in domestic and hospital settings is reviewed. The evidence appears to support post-exposure use of Oka-derived varicella vaccines in children within 3 days of rash onset in the index case. Despite vaccination, a small proportion will develop mild, but infectious, chickenpox, especially if they have been exposed in the household setting. Controlled studies of post-exposure prophylaxis in adults using both Varilrix and Varivax II are still needed. The applicability of this approach to disease control in health care facilities and in community settings warrants wider discussion.

Australia↗

PubMed2005

Evaluation of a health visitor-led sleep and behaviour clinic.

Behaviour problems in children aged 0-5 are common and distressing; given a tendency to persist, early behaviour problems also foreshadow later ill-health. Reliance tends to be placed upon the health visitors and nursery nurse to provide advice and support to those experiencing difficulties with young children. This paper describes the evaluation of a new, second tier health visitor-led sleep and behaviour clinic in one inner London borough, introduced for those whose difficulties persist despite support from agencies such as Sure Start and Newpin and initial advice from health visitors and nursery nurses. The theoretical framework underpinning the initiative is behavioural and intervention is offered to those seeking help with a relatively specific parenting difficulty. Behaviour therapy involves working in partnership with the parent(s)/client, assessing and meeting needs through dialogue and action planning while providing appropriate advice and support. The therapy is consistent with the health visitor approach. Evaluation focused upon three aspects: audit of the clinic activities, effectiveness of the intervention according to parental perception of change in the child's behaviour and client satisfaction with the service. Findings suggest that the clinic is acceptable to parents of a wide variety of social and ethnic groups and successful in improving the behaviour of young children. This small study suggests that a specialist health visitor-led clinic offering behaviour therapy within a community setting represents a feasible development that is within the scope of existing resources.

Behavior Therapy↗

PubMed1994

King's theory as a framework for quality: linking theory to practice.

Quality care has long been an elusive concept. The pushing of health care services into community settings by health care reform demands new attention to the concept of quality. King's theory of goal attainment can provide a framework for the definition and delivery of quality care in community-based health services.

Community Health Nursing↗

PubMed1994

Evolution of a Mock Oral Board Examination Program in Surgery.

This paper describes the evolution of a Mock Oral Board Examination Program for surgical residents in a university-affiliated community setting. The Mock Oral Board Examination Program has familiarized residents with the process of the Certifying Examination, assisted program directors in improving their training programs and creating a scholarly environment, and improved our community exchange of information through this collaborative effort.

Capital Financing↗

PubMed2003

Potentially reversible risk factors and urinary incontinence in frail older people living in community.

BACKGROUND: urinary incontinence is a common problem among older people living in different community settings. The multifactorial origin of urinary incontinence has been largely addressed and many previous studies have identified several reversible factors associated with incontinence. However, few data exist concerning the potentially reversible causes of this condition among frail community-dwelling older individuals. OBJECTIVE: the aim of the present study is to estimate, in a large population of frail elderly people living in the community, the prevalence of urinary incontinence and to determine physical, social, and psychological factors associated with it. DESIGN: observational study. SUBJECTS AND METHODS: we analysed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programmes (n=5418). A total of 22 Home Health Agencies participated in this project evaluating the implementation of the Minimum Data Set for Home Care instrument. The main outcome measures were the prevalence and factors associated with urinary incontinence. RESULTS: urinary incontinence was recorded in 51% of patients, and it was more common in women than men (52% versus 49%, respectively; P=0.01). After adjustment for each of the variables considered in this study, three potentially reversible factors were strongly associated with urinary incontinence: urinary tract infection (adjusted odds ratio, 3.46; 95% confidence interval, 2.65-4.51), use of physical restraints (adjusted odds ratio, 3.20; 95% confidence interval, 2.19-4.68), environmental barriers (adjusted odds ratio, 1.53; 95% confidence interval, 1.15-2.02). These associations were consistent in both men and women. CONCLUSIONS: the major finding of our study is that potentially reversible factors were strongly and independently associated with urinary incontinence. Failure to make all reasonable efforts to assess and to treat all these factors among frail elderly people should be considered one of the most important indicators of poor quality of care.

Aged↗

PubMed1998

The transfer of child patients from the community dental service to the general dental service.

OBJECTIVE: To determine an effective strategy for the transfer of children from the CDS to the GDS. DESIGN: Single centre study comprising a retrospective analysis of a 50% random sample of dental records for children transferred from CDO to GDP. SETTING: Community dental clinic in an urban area of south Manchester with relatively little material deprivation. SUBJECTS AND METHODS: Between 1990 and 1995, a GDP worked up to 5 hours a week in the CDS clinic seeing routine child patients referred by the CDO. MAIN OUTCOME MEASURES: Numbers of children registered with a GDP after varying periods of time. Attendance records of children transferred from CDS to GDS and rates of failed appointments. RESULTS: After 4 1/2 years, 264 child patients had been registered with the GDP under capitation and a further 55 adults were registered under continuing care. The majority of children had retained registration for more than 2 1/2 years. The mean rate of failed appointments was 16%. CONCLUSION: Children can be transferred successfully from the CDS to the GDS if the GDP works at the community clinic and there are further benefits which accrue to the scheme.

Adolescent↗

PubMed2003

Barriers to managing mental health in Western Australia.

OBJECTIVE: To explore the views of community-care and mental health workers on barriers to the management of mental health problems in rural Western Australia, and how these could be addressed. DESIGN: Qualitative content analysis of semi-structured interviews. SETTING: Community and mental health services in Esperance. SUBJECTS: One hundred per cent of relevant mental health workers, 86% of community health professionals and representatives from a wide range of community organisations were interviewed (n = 38). MAIN OUTCOME MEASURES: The views of community-care and mental health workers on barriers to the management of mental health, and how these could be addressed. RESULTS: Barriers included confusion about the role of mental health services, limited after-hours access and help for those in situational crisis, communication problems between services, differences in working practices and difficulties in dealing with the stigma of mental illness in rural communities. Suggested solutions were an expansion of counselling services and multi-agency shared care with clinical streams for adults, those aged > 65 and children. CONCLUSION: This study revealed a number of barriers that are being addressed through a memorandum of understanding between services. WHAT IS ALREADY KNOWN: Initiatives to foster collaboration between rural mental health services and general practitioners have not included other providers of primary care. We wished to explore the views of community-care and mental health workers on barriers to the management of mental health problems in rural Western Australia and how these could be addressed. WHAT THIS STUDY ADDS: We identified a number of barriers to collaboration between mental health and community-based services, including poor communication, difficulties with referral and cultural differences between services. Of all these themes, the most significant was the lack of communication at individual, case management and organisational levels.

Attitude of Health Personnel↗

PubMed1984

Teaching and funding of primary care education in third-year clerkships.

The authors in this article describe a 12-week primary care elective for third-year medical students. The administrative and teaching resources of the Boston University School of Medicine, clinical sites at three Boston community health centers, and federal/state and private foundation funding are coordinated to provide a longitudinal, integrated experience in ambulatory pediatrics and medicine. A literature review revealed no prior medical student programs combining psychiatric, pediatric, and internal medicine teaching in a community setting. Case vignettes and questionnaire results indicate that the program has been a success at introducing students to primary care and the biopsychosocial model. The implications of bridging disciplines as well as academic and community health centers and providing funding resources are discussed. The authors recommend this integrative model for enhancing the development of future primary care physicians.

Boston↗

PubMed2005

Incidence and clinical characteristics of National Institutes of Health type III prostatitis in the community.

PURPOSE: Few population-based epidemiological studies of prostatitis have been performed. We used coded physician diagnoses and subsequent chart reviews to estimate the incidence and clinical characteristics of physician diagnosed National Institutes of Health (NIH) type III prostatitis. MATERIALS AND METHODS: Computer searches of the Kaiser Permanente Northwest (Portland, Oregon) database were performed on the 2-year interval May 2002 to May 2004 to identify new diagnoses of chronic prostatitis (International Classification of Diseases, 9th Revision code 601.1) and prostatitis not otherwise specified (International Classification of Diseases, 9th Revision code 601.9). Of the 1,223 men identified with these coded diagnoses, chart reviews were performed on a random subset of 413 (33.8%). Patients were categorized based on NIH prostatitis definitions of type I/II-evidence of pyuria and/or bacteriuria on urinalysis or culture, type III-presence of at least 1 of the pain or urinary symptoms in the NIH Chronic Prostatitis Symptom Index (pain in the perineum, testicles, tip of penis, pubic or bladder area, dysuria, ejaculatory pain, incomplete emptying, urinary frequency), type IV-inflammation on prostate biopsy and Other-symptoms other than those listed. RESULTS: Of the 413 patients 57 were previously diagnosed with prostatitis (prevalent cases), 46 had no evidence of a prostatitis diagnosis in the medical record and 7 were treated by physicians outside of the Kaiser Permanente Northwest plan. Of the remaining 303 the distribution was 58 type I/II, 189 type III, 33 type IV and 23 Other. The incidence of physician diagnosed type III prostatitis was 3.3 per 1,000 person-years. If those with isolated urinary symptoms were excluded from analysis, the incidence decreased to 2.8 per 1,000 person-years. The mean age of those with type III prostatitis was 52.9 years (range 29 to 82). The most common presenting symptoms were dysuria, urinary frequency and perineal pain. Symptom duration at presentation was less than 3 months in 44%, 3 months or greater in 31% and unspecified in 25%. The majority (78%) of new prostatitis diagnoses was made by primary care physicians. CONCLUSIONS: These data indicate that prostatitis is commonly diagnosed in the community setting, and that type III prostatitis accounts for the majority of these diagnoses. The duration and complexity of symptoms are less than those reported in established prostatitis research cohorts. Most prostatitis diagnoses in the community are made by nonurologists.

Adult↗

PubMed1999

Rapid appraisal of needs in reproductive health care in southern Sudan: qualitative study.

OBJECTIVES: To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. DESIGN: Rapid appraisal. This comprised interviews with key informants, in-depth interviews, and group discussions. Secondary data were collated. Freelisting, ranking, and scenarios were used to obtain information. SETTING: Communities affected by conflict in southern Sudan. PARTICIPANTS: Interviews and group discussions were chosen purposively. Twenty interviews with key informants were undertaken, in-depth interviews were held with 14 women, and 23 group discussions were held. MAIN OUTCOME MEASURES: Need for reproductive health care. Perceived priority afforded to reproductive health issues in comparison with other health problems. RESULTS: Reproductive health in general and sexually transmitted diseases in particular were important issues for these communities. Problems in reproductive health were ranked differently depending on the age and sex of the respondents. Perceptions about reproductive health issues in communities varied between service providers, and community leaders. Settled and displaced communities had different priorities and differing experiences of reproductive health problems and their treatment. CONCLUSION: Rapid appraisal could be used as the first step to involving communities in assessing needs and planning service provision.

Age Distribution↗

PubMed1999

An integrative model for holistic community health nursing.

Health and nursing are shifting from acute care to community settings, causing confusion for clients and professionals. Although the holistic nursing perspective has improved care to human beings in interaction with their environment and has moved nursing away from pathology-focused care, the community as the focus of care has not been addressed. This article presents an integrated model of community health that expands holistic nursing to the community as client. The model clarifies nursing care for the individual, family, aggregate, and community. One can focus on any one level, with the awareness that each is part of a unified whole. Holistic community nursing completes the circle of care by moving beyond the particular part to focus on the greatest health for the community. The intent is to help nurses describe their unique areas of expertise within the complex community system and to establish a basis for collaboration and partnership.

Community Health Nursing↗