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PubMed1997

Exercise by prescription.

General Practitioners (GPs) see over 90% of their practice population in three years. Over 50% of the adult population is below the perceived level of physical activity as recognised by the Allied Dunbar Physical Activity score (Allied Dunbar, Health Education Authority and Sports Council, 1992). Physical fitness levels in adolescents and children are declining, while the incidence of obesity is increasing. GPs, with their Primary Health Care Team, are in a unique position to be able to discuss the health benefits of regular physical activity with their patients during the consultation and offer, if appropriate, a prescription for a course of physical activity to a local leisure centre or community activity centre. Many communities have facilities for physical activity. These include leisure centres, schools, village and church halls, the home and the general practice surgery. A directory of resources for physical activity for all age groups should be available in the surgery waiting room area. A community co-ordinator can network community facilities and resources to meet individual need. The co-ordinator can be funded by the general practice surgery, Health Authority, Local Authority, Parish or District Council. An agreed protocol for exercise prescription referrals to suitable community facilities can benefit patient health care for a variety of medical, surgical, social and mental conditions. Auditing exercise prescriptions shows a health benefit, with improved quality of living and reduced prescription medicines.

Adolescent↗
PubMed2002

Enhancing lives through the development of a community-based participatory action research programme.

A community-based participatory action research (PAR) programme that has spanned 5 years is discussed in this article. A primary healthcare philosophy requires research in this practice setting and supports the way healthcare is ideally organized within an integrated team and supported by a community network that includes not only the healthcare workers and service providers but also the community as partners. The principles driving three PAR inquiries are described: the development of a model for prevention of workplace violence; working with clinicians towards improving wound management practice; and management of continence for community-dwelling women living with multiple sclerosis. Participatory action research is a potentially democratic process that is equitable and liberating as participants construct meaning in the process of group discussions. We conclude that the cyclical processes inherent in PAR promote reflection and reconstruction of experiences that can lead to the enhancement of people's lives, either at an individual or community level, or both.

Chronic Disease↗
PubMed2003

Burden of influenza in children: preliminary data from a pilot survey network on community diseases.

BACKGROUND: The burden of influenza and its clinical presentation are both poorly documented in French children. METHODS: To measure the prevalence of acute respiratory infections over two winters (2000 to 2001 and 2001 to 2002), we performed a prospective community survey of 0- to 15-year-olds (n = 11 500 and 40 000, respectively) through a network [Grippe et Infections Respiratoires Aiguës Pédiatriques (GIRAP)] of general practitioners and pediatricians. Influenza viruses were detected by antigen detection and culture from nasopharyngeal swabs. Data on the clinical presentation of children infected with influenza A/H1N1, A/H3N2 or B viruses were derived from standardized forms. RESULTS: The prevalences of symptomatic acute respiratory infections were 28% and 27% for 2000 to 2001 and 2001 to 2002, respectively. In the winter of 2000 to 2001, a mild outbreak of influenza A/H1N1 affected 5.4% of the study population. The attack rates of influenza A/H1N1 were highest in children 5 to 15 years of age. In the winter of 2001 to 2002, influenza activity remained at a subepidemic level (5.9%; A/H3N2, 60%; B, 40%). The incidence of influenza A/H3N2 infections was highest in 2- to 4-year-old children, whereas influenza B strains were most frequently detected in children 4 to 10 years of age. CONCLUSIONS: Despite subepidemic levels of influenza, the GIRAP network was able to detect influenza A or B viruses in 35 to 60% of the samples during the peak of influenza epidemic. The frequency of influenza virus excretion in children with mild clinical symptoms indicates that children are an important reservoir and source of transmission of this virus.

Adolescent↗
PubMed1993

Networking the rural community.

A branch network of affiliate hospitals has been providing home care services to rural North Dakota residents successfully for a decade. Here's how this effective system meets the special challenges that a rural environment poses for hiring, training, scheduling, and supporting home care aides.

Allied Health Personnel↗
PubMed2001

[Public, decentralized and community health networks in Bolivia].

Health sector reform in Bolivia is based primarily on the principles of decentralization and equity, and with the objectives of improving quality and of expanding health services coverage in rural and low-income areas of the country. As an experiment in reform, the Bolivian Ministry of Health and Social Welfare, the department of La Paz, and the municipality of El Alto signed an agreement with a nongovernmental organization (NGO), transferring to the NGO the overall management of one of the health services networks in El Alto. The transfer was based on a management contract that had process and outcome indicators for the network. A year after implementation began, the preliminary results suggest that through the agreement the quality of management and services has improved, health services coverage has expanded, and the network's primary care services have been strengthened. Bed occupancy rates are generally very low in secondary hospitals in Bolivia, with that figure being just 43% in the department of La Paz in 1999. However, in the second 6 months of operation of the El Alto network the occupancy rate for the network's hospital reached 84%. Between the first 6 months of 1999 and the same period in 2000, outpatient consultations increased by 55% in the network (83% in the hospital and 18% in the network's primary care centers). Over that same period, institutional deliveries increased by 41% and the percentage of deliveries in the primary care centers grew from 5% of the total to 9%. A recent user survey found that 87% of the people receiving care in the network felt highly satisfied with the service they had received, and 75% of the persons surveyed said they would recommend the service to others. These are not typical data for health services in Bolivia. This pilot effort suggests that a change in the organization and management of a health services network, with a separation of the roles of purchaser and provider, combined with management based on results and with community participation in the process, can improve the quality and efficiency of those health services, stimulate demand for them, and increase user satisfaction.

Adolescent↗
PubMed1997

Building managed care networks for rural communities.

Managed health care networks in both urban and rural communities seek to improve quality, cost, and access; however, rural community health care systems must also curb patient outmigration. A primary care network (PCN) can effectively keep more of the patient care within the rural community. This PCN can then expand to include secondary contractual relationships with the rural community hospital and specialist physicians. As this expanded PCN affiliates with a tertiary provider network, an integrated delivery system (IDS) emerges. This enables the full health care service continuum to be managed by the rural primary care physicians. Such managed cooperation initiatives are best carried out as a joint effort between community employers and providers.

Community Networks↗
PubMed1995

Cost effective Internet access and video conferencing for a community cancer network.

Utilizing the ubiquitous personal computer as a platform, and Integrated Services Digital Network (ISDN) communications, cost effective medical information access and consultation can be provided for physicians at geographically remote sites. Two modes of access are provided: information retrieval via the Internet, and medical consultation video conferencing. Internet access provides general medical information such as current treatment options, literature citations, and active clinical trials. During video consultations, radiographic and pathology images, and medical text reports (e.g., history and physical, pathology, radiology, clinical laboratory reports), may be viewed and simultaneously annotated by either video conference participant. Both information access modes have been employed by physicians at community hospitals which are members of the Jefferson Cancer Network, and oncologists at Thomas Jefferson University Hospital. This project has demonstrated the potential cost effectiveness and benefits of this technology.

Computer Communication Networks↗
PubMed2005

Morehouse Community Physicians Network (CPN) hypertension registry: patterns of care and opportunities for targeted medical education.

BACKGROUND: Provider-focused strategies for improving outcomes in hypertension have produced mixed results. Studies suggest that the effectiveness of a chosen strategy increases when it is tailored to the specific situation. The hypertension registry includes data on African-American hypertensives who receive care in community-based primary care settings. We examined the registry to identify patterns of care and opportunities for provider-focused interventions to improve patient outcomes. METHODS AND RESULTS: The registry will include all records of hypertensive patients from 50 community-based primary care practices at full enrollment. Data from nine practices were manually abstracted into an electronic database and analyzed. Seven hundred and ten records were included in this report. Approximately 70% are female, average age 47 +/- 13 years, 5.3% are uninsured, and more than 60% have at least a high school education. Registry patients have multiple co-morbid conditions: 28% are diabetic, 8% have left ventricular hypertrophy, 5% have congestive heart failure, 6.5% have renal insufficiency, 5% have cerebrovascular disease, 3.5% have previous myocardial infarction and 2% have peripheral vascular disease. Among those with diabetes, mean glycosylated hemoglobin was 7.4 +/- 2. Pattern of antihypertensive use showed 43% on diuretics, 28% on calcium channel blockers, 24% on angiotensin converting enzyme inhibitors, 20% on beta blockers and 16% on angiotensin receptor blockers. Overall, 37% were at goal blood pressure and among those with diabetes, only 16% reached goal blood pressure. CONCLUSION: We conclude that the blood pressure control rates of African Americans in the registry trail those of the general population. This provides a unique opportunity to study the underlying factors and design tailored interventions to address this disparity in health outcome.

Adult↗
PubMed1996

Tuberculosis infection in human immunodeficiency virus-positive adolescents and young adults: a New York City cohort.

OBJECTIVES: Adolescents with human immunodeficiency virus (HIV) infection are at increased risk for tuberculosis (TB), underscoring the importance of early identification of TB infection. The goals of this study were to assess the factors associated with the completion of evaluations for TB in a cohort of HIV-positive adolescents and young adults and to describe the prevalence of Mycobacterium tuberculosis infection and adherence to antituberculous treatment regimens. METHODS: A retrospective chart review was done for all HIV-positive adolescents and young adults, ages 13 to 21 years (n = 49), seen in a comprehensive care program from January 1991 through December 1992. Data collected included CD4 cell count, HIV clinical status, living situation, substance use history, and the completion of an annual evaluation for TB infection. The evaluation consisted of a tuberculin skin test (Mantoux test), using an intraepidermal injection of 0.1 mL of 5 tuberculin units of purified protein derivative (PPD) and a simultaneous Merieux multitest anergy panel. Chi-square analysis was used to assess the association between the completion of the evaluation for TB and both living status and substance use. RESULTS: Thirty-one (63%) of 49 patients completed evaluations for TB. Of the 31 completed evaluations, 18 were assessed by clinic staff on site, and 13 were assessed by other medical or trained nonmedical observers through community networking efforts. Neither homelessness nor illicit substance use were factors in the completion of the evaluation. Six (19%) of the 31 patients had positive PPD skin test results. Three had medical histories and chest radiographs suggesting active TB, and all were hospitalized for at least 2 weeks. Two had positive cultures for M tuberculosis, although the third also responded clinically to antituberculous therapy. All three were otherwise asymptomatic for HIV infection, with only moderately depressed CD4 cell counts. All three were homeless and used crack cocaine. After the initial treatment as inpatients, none completed treatment within the prescribed time period. CONCLUSIONS: The completions of the evaluations for TB were greatly facilitated by community networking, but innovative strategies to enhance both screening and treatment programs, such as training youth service providers in the community to read PPD skin tests, expansion of directly observed therapy services, and youth-centered programs for housing and substance use, need further development. The high prevalence of TB in the cohort underscores the need for providers to increase efforts to identify cases of TB infection among adolescents and young adults and to incorporate HIV risk assessment, counseling, and testing into their practices routinely.

Adolescent↗
PubMedDate not supplied

Why women still die from cervical cancer.

Cervicovaginal cytology, known as Pap smear, is the most effective screening test in medical oncology. Introduced by Dr. George Papanicolaou in 1940, the Pap smear is now being recognized as a major contributor to the remarkable decrease in cervical cancer morbidity and mortality among women throughout the world. However, there are still significant numbers of women who lose their lives to cervical cancer every day. To overcome this major problem, first, we must search for the reasons for these lost lives and then take appropriate measures to resolve the existing issues. There is now substantial evidence that emphasizes the importance of an effective screening program. This program must integrate education and accessibility to health care for all women regardless of age, race, ethnic background and socioeconomic status. The public, the media, the government and health care providers must also become acutely aware of the inherent difficulties involved in providing a high-quality Pap smear. Compounded by medicolegal pressures and reimbursement issues, the Pap smear has become one of the more difficult tests to perform. Current reimbursement mechanisms are not appropriate for the cost of providing the service and cannot guarantee the resources necessary for a high-quality Pap smear. Congress should consider mandating direct billing to the patient for the service, so that cervicovaginal cytology could be reimbursed on a level commensurate with the requirements of providing quality service. A concerted effort should also be made to enhance the level of public knowledge about the issues surrounding Pap smear. This could be achieved by fostering the idea of designating a "Cervical Cancer Awareness Month," and by encouraging the spirit of community networking.

Age Factors↗