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PubMed2000

Problem gambling and comorbid psychiatric and substance use disorders among drug users recruited from drug treatment and community settings.

Little is known about gambling rates of drug users recruited from drug treatment compared with those recruited from the community. We use the Diagnostic Interview Schedule (DIS) to provide lifetime prevalence estimates of problem gambling (i.e., at least one gambling problem) and DSM-III-R pathological gambling (i.e., at least four gambling problems) and describe the association between gambling and psychiatric disorders for drug users recruited from drug treatment settings (n = 512) and from the community (n = 478). We also report the relative risk of being a recreational and problem gambler in this sample. The sample was first interviewed in 1989-90 as a part of two NIDA-funded St. Louis-based studies. The prevalence of problem gambling in the overall sample was 22% and the prevalence of pathological gambling was 11%. There were no statistically significant differences in problem and pathological gambling rates for subjects recruited from drug treatment and those recruited from the community. The conditional prevalence rates, that is, the rate of problem and pathological gambling only among gamblers were 27% and 13.5%, respectively. Major findings indicate that problem gambling was associated with Antisocial Personality Disorder (ASPD), even after controlling for recruitment source and socio-demographic characteristics. In fact, when examining the temporal order of these disorders, we found that pathological gambling was always secondary to ASPD, occurring on average 11.4 years after the onset of ASPD. Problem gamblers, compared with everyone else, were more likely to be male, African-American, recruited from drug treatment, have ASPD and be dependent on illicit drugs. Multinomial logistic regression analysis predicted the relative risk of being a recreational and problem gambler (compared with a nongambler) in this sample according to socio-demographics, ASPD, and dependence on illicit drugs. Results imply that screening for gambling problems will need to be broad-based among drug users.

Journal Article↗
PubMed2003

Hassles and uplifts associated with caring for people with cognitive impairment in community settings.

In this study we explored the hassles and uplifts (i.e. negative and positive emotional events) experienced by registered nurses, nursing assistants and personal carers working with people with cognitive impairment in community and residential healthcare settings in Brisbane, Queensland, Australia. The primary aim of the research was to explore what aspects of caring for cognitively impaired clients hassles nurses, what helps to relieve these hassles, what aspects of this work nurses find rewarding and what detracts from those rewards, as well as the intensity with which each of these aspects were felt. A questionnaire developed to explore hassles and uplifts at work was administered and 57 responses obtained. Results indicated that caring for the cognitively impaired client provides many uplifts for nurses and few hassles. However, the hassles that occurred were of high importance. This paper will be of interest to managers, nurses and carers in settings where there are people with cognitive impairment as well as scholars, who may find that assessing emotional hassles and uplifts provides additional insights into other areas of nursing.

Adaptation, Psychological↗
PubMed1992

Laparoscopic cholecystectomy in a private community setting.

In order to evaluate early results and safety of laparoscopic cholecystectomy in community hospitals, the charts of 380 consecutive patients, scheduled between February 8 and November 28, 1990, were reviewed. There were 294 women and 86 men, with a mean age of 48 years. Forty-one patients required conversion to open cholecystectomy, for reasons including adhesions in 18 patients, intraductal filling defects in 11, marked inflammation in 6, excessive bleeding in 3, poor visualization of the operative field in 2, and gangrenous gallbladder in 1. Hospital stay (excluding patients converted to laparotomy) ranged from 0.29-18 days, with a mean of 1.4 days. Operative time ranged from 29-280 min, with a mean of 114 min. Cystic duct operative cholangiography was performed in 71% of patients. In 29%, operative cholangiography was either not performed at all or was attempted and unsuccessful, due to inability to cannulate the cystic duct. Procedure-related morbidity was 2.6%, which includes three common bile duct injuries, three intraabdominal abscesses requiring drainage, and one pneumonia. There was one death resulting from respiratory failure. Our results compare favorably with those reported in the literature. We conclude that laparoscopic cholecystectomy in community hospitals is a safe procedure in properly selected patients.

Cholangiography↗
PubMed1979

Pre-hospital coronary care in the community setting.

Technological advances have made pre-hospital coronary care programs possible for communities of all sizes. The author describes and illustrates with case reports a successful Newport News program in which physicians, hospitals, paramedics, and local government services work together.

Adolescent↗
PubMed1994

Palliative care in the community: setting practice guidelines for primary care teams.

BACKGROUND: Previous studies have demonstrated deficiencies in palliative care in the community. One method of translating the results of research into clinical practice, in order to produce more effective health care, is the development of clinical guidelines. Setting standards for such care has been performed by care teams in both hospital and hospice settings but not in primary care. AIM: This study set out to develop guidelines for primary care teams to follow in the provision of palliative care in the community using facilitated case discussions with the members of such teams, as a form of internal audit. METHOD: Five practices were randomly chosen from the family health services authority medical list. Meetings between the facilitators and primary care teams were held over a period of one year. The teams were asked to describe good aspects of care, areas of concern and suggestions to improve these, in recent cases of patient deaths. RESULTS: In total 56 cases were discussed. All practices felt that cohesive teamwork, coordinated management, early involvement of nursing staff and the identification of a key worker were essential for good terminal care. Concerns arose in clinical and administrative areas but the majority were linked to poor communication, either between patient and professionals within the primary care team or between primary and secondary care. All the positive aspects of care, concerns and suggestions were collated by the facilitators into guidelines for teams to refer to from the initial diagnosis of a terminal illness through to the patient's death and care of the relatives afterwards. CONCLUSION: Developing multidisciplinary as opposed to medical guidelines for palliative care allows primary health care teams to create standards that are acceptable to them and stimulates individuals within the teams to accept responsibility for initiating the change necessary for more effective care. The process of facilitating teams to discuss their work allows for recognition and respect of individuals' roles and more importantly provides shared ownership, an important contributory factor in the implementation of guidelines.

Clinical Protocols↗
PubMed2002

Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings.

OBJECTIVE: To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community-based individuals with schizophrenia. METHOD: A total of 418 individuals with schizophrenia from 10 sites were interviewed with regard to quality of life, psychopathology, social network and needs for care. Characteristics of the living situation investigated were: living alone or not, living with family or not, and having an independent or a sheltered housing situation. RESULTS: An independent housing situation was related to a better quality of life concerning living situation and living with the family to a better quality of life concerning family relations. An independent housing situation was associated with a better social network regarding availability and adequacy of emotional relations. CONCLUSION: People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not.

Activities of Daily Living↗
PubMed1991

The role of temafloxacin in the community setting: an overview.

The use of new quinolones has become established therapy for many community infections including urinary tract infection, genital infection, soft tissue infection and some forms of lower respiratory tract infection. However, there has been an undercurrent of anxiety concerning their efficacy in pneumococcal infections. Temafloxacin has improved activity against pneumococci and its high oral bioavailability and excellent penetration into respiratory tissues now combine to provide a suitable profile for the management of a wider range of respiratory infections. Eradication rates in acute exacerbations of chronic bronchitis collated from individual studies are 98% overall and 100% in pneumococcal infections. Furthermore, eradication rates in smokers and the elderly illustrate significant advantages for temafloxacin when compared with previous quinolones. In pneumonia, a twice-daily temafloxacin regimen has given equivalent overall results to those of amoxycillin (84.6% vs 80%). In proven pneumococcal pneumonia, equivalent results (78.6% vs 78.4%) have been obtained with both drugs. A daily 600 mg dose of temafloxacin eradicated 94% of pneumococcal isolates in one study and in another this agent given twice-daily orally proved comparable to parenteral cephalosporin treatment. Temafloxacin shares with other quinolones excellent bacteriological and clinical efficacy against Haemophilus influenzae and Moraxella catarrhalis. These results and the lack of potential interaction with theophylline indicate temafloxacin to be suitable for domiciliary management of respiratory tract infections in addition to a broad range of other community infectious diseases.

Anti-Infective Agents↗