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PubMed2002

A collaborative model for supporting community-based interdisciplinary education.

Development and support of community-based, interdisciplinary ambulatory medical education has achieved high priority due to on-site capacity and the unique educational experiences community sites contribute to the educational program. The authors describe the collaborative model their school developed and implemented in 2000 to integrate institution- and community-based interdisciplinary education through a centralized office, the strengths and challenges faced in applying it, the educational outcomes that are being tracked to evaluate its effectiveness, and estimates of funds needed to ensure its success. Core funding of $180,000 is available annually for a centralized office, the keystone of the model described here. With this funding, the office has (1) addressed recruitment, retention, and quality of educators for UME; (2) promoted innovation in education, evaluation, and research; (3) supported development of a comprehensive curriculum for medical school education; and (4) monitored the effectiveness of community-based education programs by tracking product yield and cost estimates needed to generate these programs. The model's Teaching and Learning Database contains information about more than 1,500 educational placements at 165 ambulatory teaching sites (80% in northern New England) involving 320 active preceptors. The centralized office facilitated 36 site visits, 22% of which were interdisciplinary, involving 122 preceptors. A total of 98 follow-up requests by community-based preceptors were fulfilled in 2000. The current submission-to-funding ratio for educational grants is 56%. Costs per educational activity have ranged from $811.50 to $1,938, with costs per preceptor ranging from $101.40 to $217.82. Cost per product (grants, manuscripts, presentations) in research and academic scholarship activities was $2,492. The model allows the medical school to balance institutional and departmental support for its educational programs, and to better position itself for the ongoing changes in the health care system.

Community Medicine↗
PubMed1985

Effect of metal-rich sewage sludge application on the bacterial communities of grasslands.

The effect of long-term application of heavy metal-laden sewage sludge on the total heterotrophic aerobic and the cadmium-resistant soil bacterial communities was studied. Gram-positive bacteria were completely absent from resistant communities. These findings suggest that this group is highly susceptible to Cd. Shannon's diversity indices estimated for total communities did not reveal negative effects on the communities that developed in the presence of sludge. However, Cd-resistant communities isolated from long-term sludge-amended soils were more diverse than the resistant communities from a control sample, suggesting that adaptation to Cd as a stressor had occurred in the presence of sludge constituents. This higher diversity was attributed to Cd resistance in pseudomonads and gram-negative fermenters. Resistance did not develop by dissemination of Cd resistance plasmids, because these were rarely detected in the genomes of resistant strains.

Journal Article↗
PubMed2006

Crenarchaeal community assembly and microdiversity in developing soils at two sites associated with deglaciation.

Non-thermophilic Crenarchaeota are recognized as ubiquitous and abundant components of soil microbial communities. Previous studies of the foreland of the receding Rotmoosferner glacier in the Austrian Central Alps have demonstrated that crenarchaeal communities in soil at different stages of development are distinct from each other, with Group 1.1b crenarchaeal populations dominating throughout the successional gradient, while Group 1.1c crenarchaea are present in mature soils only. To determine whether this highly structured succession was unique to the Rotmoosferner glacier foreland, 1.1b and 1.1c communities were compared with those present along a successional gradient at Odenwinkelkees glacier, 125 km away, by denaturing gradient gel electrophoresis (DGGE) of 16S rRNA reverse transcription polymerase chain reaction products. Similarities in community structure were observed; 1.1b communities were present throughout both successional gradients (though lacking the defined structure at Odenwinkelkees) and 1.1c communities were present only in mature soil. Comigration of bands on DGGE gels indicated that a number of similar crenarchaeal populations were present at both sites. To compare populations, and examine microscale diversity, 16S rRNA genes and complete 16S-23S internal transcribed spacer (ITS) regions representing six major band positions in DGGE analysis were amplified, cloned and sequenced and represented four 1.1b and two 1.1c lineages. The data provide no evidence of endemism, but large differences in the rate of sequence divergence in the ITS region (relative to that in 16S rRNA genes) were observed. Two of the 1.1b lineages (each possessing > 98% 16S rRNA gene similarity) had relatively long and highly divergent ITS sequences. In contrast, two other 1.1b and two 1.1c lineages (each possessing > 99% 16S rRNA gene similarity) exhibited markedly less variation in their respective 16S-23S ITS regions. The results reveal common patterns in the ecology and assembly of crenarchaeal communities in spatially separated soil systems and may indicate different evolutionary rates between soil crenarchaea lineages.

Austria↗
PubMed2006

Lessons learned in developing a research partnership with the Transgender community.

The challenge facing the authors was to develop a relationship with members of the Transgender community in a large urban city in order to develop research that would benefit this group. The situation is presented from the differing perspectives of the three women involved (one Transgender woman and two biological women); they provide their accounts of a meeting with key members of the Transgender community where the challenge became apparent. During the meeting, the issue of representation arose resulting in a discussion of whether the research agenda should be focused on a specific subgroup under the Transgender umbrella or be open to all members of this diverse and underserved group. Reflections on what was learned about the diversity of individuals under the Transgender umbrella and the lessons that helped them respond to the challenge are discussed.

Behavioral Research↗
PubMed2001

Health, biodiversity, and natural resource use on the Amazon frontier: an ecosystem approach.

This study aims to improve the health of rural Amazonian communities through the development and application of a participatory ecosystem approach to human health assessment. In the study area marked seasonal fluctuations dictate food availability, water quality and disease outbreak. Determining the causal linkages between ecosystem variables, resource use and health required a variety of forms of inquiry at multiple scales with local participation. Landscape spatial mapping of resource use demonstrated the diversity of the ecological resources upon which communities depend. Household surveys detailed family and individual consumption and production patterns. Anthropometric measurements, parasite loading, water quality and anemia levels were used as indicators of health status. This was complemented with an ethnographic and participatory health assessment that provided the foundation for developing community action plans addressing health issues. Discussion is focused on three attributes of an ecosystem approach; (a) methodological pluralism, (b) cross-scale interactions and (c) participatory action research.

Conservation of Natural Resources↗
PubMedDate not supplied

The deep South network for cancer control: eliminating cancer disparities through community-academic collaboration.

African Americans have a substantially increased mortality rate compared to Whites in many cancers, including breast and cervix. The Deep South Network for Cancer Control (the Network) was established to develop sustainable community infrastructure to promote cancer awareness, enhance participation of African Americans and other special populations in clinical trials, recruit and train minority investigators, and develop and test innovative community-based cancer control measures to eliminate cancer mortality disparities in special populations. This article describes the steps necessary to form the network and the process and activities required to establish it as an effective infrastructure for eliminating disparities between Whites and African Americans in the United States.

Black or African American↗
PubMed2000

Between the laboratory, the school, and the community: the psychology of human development, Toronto, 1916-1956.

In the twentieth century, Canadian psychologists have been involved with the educational system and the community at several points in time. In this article, the psychology of human development as developed at the Department of Psychology at the University of Toronto from 1916 to 1956 is investigated. In a variety of projects, the mental health of children was investigated in educational settings while measures were designed and tested to prevent maladjustment and to promote mental health. Initially, research and intervention aimed at adjusting school children to the educational setting. Later, a critical perspective on social institutions and Canadian society was articulated.

Adjustment Disorders↗
PubMed1999

Competency in community-oriented health care. Instrument development.

To competently deal with changes in the health care system, health professionals for the future must have expanded abilities and new attitudes. Education of health professionals for community-oriented health care (COHC) is being promoted as one approach to achieve this focus. This article reports on the development and testing of the Community-Oriented Health Care Competency Scale, which measures knowledge, attitudes, and intention to practice COHC. Results of testing demonstrate adequate reliability for a new instrument: an alpha coefficient of .95 for the Knowledge subscale, .68 for the Attitude subscale, and .93 for the Intention to Practice subscale. Content Validity of the instrument is based on the literature review, focus group sessions, and expert opinion. The instrument may be used to assess competency of health professions students in COHC, but continued testing is needed.

Community Health Services↗
PubMed1978

Community health education fostered by hospital program.

A small, acute care hospital in Massachusetts develops its community outreach program by offering health care services to area schools and industries. The Clinton Hospital Industrial Program (CHIP) offers special first aid courses, testing and rehabilitation services, and employee health plans to the town's numerous small industries. The School Nurses Program and CPR training for high school teachers are two services the hospital offers Clinton public schools.

Community Health Services↗
PubMed2003

Promoting signing of advance directives in faith communities.

OBJECTIVE: To develop a participatory educational program implemented in faith communities that would increase discussion and signing of two types of advance directives-living will and durable power of attorney for health care decisions. DESIGN: Longitudinal study with four annual cycles of program implementation, evaluation, and revision incorporating a program that fostered the discussion, signing, and/or revision of advance directives. The program involved an educational workbook and ongoing support by parish nurses. SETTING: Seventeen faith communities in Wichita, Kansas. Faith communities included several predominantly white congregations, as well as several primarily African-American and Hispanic congregations. PARTICIPANTS: Seventeen faith communities, their pastors, and 25 parish nurses worked with 361 self-selected residents, living in community settings, to participate in the program as members of their faith communities. Congregations were recruited by the executive director of a local interfaith ministries organization and parish nurses. MAIN RESULTS: Two hundred forty-eight (69%) of the congregants who started the program completed it. Of the program completers, 83 (33%) had a directive prior to the program and 140 (56%) had a directive after completion. One hundred eighty-six of the completers discussed directives with family members. Overall, 89 (36%) of the 248 program completers revised an existing directive or signed one for the first time. Age was positively related to having signed/revised a directive prior to the program. Fear that advance directives would be used to deny medical care was negatively related to signing both prior to the program and after program completion, and contributed to participants' reluctance to sign directives. CONCLUSIONS: Educational programs implemented by parish nurses in faith communities can be effective in increasing rates of discussion, revision, and/or signing of advance directives.

Adult↗
PubMed1989

Acute pain services in a community hospital.

The development of an acute pain service in a community hospital is described. A plan of operation is proposed, including accurate record maintenance to avoid complications. Results are presented on over 10,000 patients treated by the acute pain service.

Acute Disease↗
PubMed2001

Canopy development of a model herbaceous community exposed to elevated atmospheric CO2 and soil nutrients.

To test the prediction that elevated CO2 increases the maximum leaf area index (LAI) through a stimulation of photosynthesis, we exposed model herbaceous communities to two levels of CO2 crossed with two levels of soil fertility. Elevated CO2 stimulated the initial rate of canopy development and increased cumulative LAI integrated over the growth period, but it had no effect on the maximum LAI. In contrast to CO2, increased soil nutrient availability caused a substantial increase in maximum LAI. Elevated CO2 caused a slight increase in leaf area and nitrogen allocated to upper canopy layers and may have stimulated leaf turnover deep in the canopy. Gas exchange measurements of intact communities made near the time of maximum LAI indicated that soil nutrient availability, but not CO2 enrichment, caused a substantial stimulation of net ecosystem carbon exchange. These data do not support our prediction of a higher maximum LAI by elevated CO2 because the initial stimulation of LAI diminished by the end of the growth period. However, early in development, leaf area and carbon assimilation of communities may have been greatly enhanced. These results suggest that the rate of canopy development in annual communities may be accelerated with future increases in atmospheric CO2 but that maximum LAI is set by soil fertility.

Journal Article↗
PubMed2005

Community permission for medical research in developing countries.

The realization of the need for community consent, or more accurately community permission, for research has occurred relatively recently. Practical experience with it is scarce. This article describes the Malian experience at a malaria vaccine study site. We describe a process that we used to obtain community permission. The process had 6 steps: (1) a study of the community, (2) an introductory meeting with leaders, (3) formal meetings with leaders, (4) personal visits with leaders, (5) meetings with traditional health practitioners, and (6) recognition that obtaining permission is a dynamic process. We discuss documentation of community permission for research and outline the reasons why the community-level process we used was practically necessary and ethically appropriate. Far from competing with the individual informed consent process, the process of obtaining community permission both initiated and facilitated the process of disclosure for individual informed consent.

Biomedical Research↗
PubMed2005

A multilevel ecological approach to promoting walking in rural communities.

BACKGROUND: Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This study's purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking. METHODS: A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003-2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week. RESULTS: At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking. CONCLUSIONS: Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.

Adolescent↗
PubMed2000

Mid-arm circumference at birth as predictor of low birth weight and neonatal mortality.

In Bangladesh, like other developing countries, most births occur at home or in the community, so logistic problems and taboos prevent the weighing of every newborn child. This study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight. A total of 1676 live births at the Chittagong Medical College Hospital constituted the study sample, and this showed a high correlation between mid-arm circumference and birth weight (r=0.792, p<0.000). A mid-arm circumference of <9.0 cm had the best sensitivity and specificity for identifying newborns with a birth weight of less than 2500 g. These neonates were followed up to record neonatal deaths. Neonatal mortality showed an inverse relation with mid-arm circumference. A mid-arm circumference of <9.0 cm and a birth weight of <2500 g were equally useful in predicting neonatal outcome. Mid-arm circumference is a simple, quick and reliable indicator for predicting low birth weight and neonatal outcome, and can be easily measured by medical practitioners and traditional birth attendants (TBAs) in the community of developing countries like Bangladesh.

Anthropometry↗
PubMed1995

Stress and the community mental health nurse: the development of a measure.

The issue of stress amongst health care professionals is currently a major concern within the British National Health Service. It is important for researchers to develop both reliable and valid psychometric measures to assess occupational stress. This paper outlines the development and piloting of a measure of professional stress for community mental health nurses, the CPN Stress Questionnaire (Revised). Data on the reliability and validity of this new measure are presented. It is concluded that this measure has good psychometric properties. A range of possible research applications is outlined.

Burnout, Professional↗
PubMed1998

Characterization of a defined 2,3,5, 6-tetrachlorobiphenyl-ortho-dechlorinating microbial community by comparative sequence analysis of genes coding for 16S rRNA.

Defined microbial communities were developed by combining selective enrichment with molecular monitoring of total community genes coding for 16S rRNAs (16S rDNAs) to identify potential polychlorinated biphenyl (PCB)-dechlorinating anaerobes that ortho dechlorinate 2,3, 5,6-tetrachlorobiphenyl. In enrichment cultures that contained a defined estuarine medium, three fatty acids, and sterile sediment, a Clostridium sp. was predominant in the absence of added PCB, but undescribed species in the delta subgroup of the class Proteobacteria, the low-G+C gram-positive subgroup, the Thermotogales subgroup, and a single species with sequence similarity to the deeply branching species Dehalococcoides ethenogenes were more predominant during active dechlorination of the PCB. Species with high sequence similarities to Methanomicrobiales and Methanosarcinales archaeal subgroups were predominant in both dechlorinating and nondechlorinating enrichment cultures. Deletion of sediment from PCB-dechlorinating enrichment cultures reduced the rate of dechlorination and the diversity of the community. Substitution of sodium acetate for the mixture of three fatty acids increased the rate of dechlorination, further reduced the community diversity, and caused a shift in the predominant species that included restriction fragment length polymorphism patterns not previously detected. Although PCB-dechlorinating cultures were methanogenic, inhibition of methanogenesis and elimination of the archaeal community by addition of bromoethanesulfonic acid only slightly inhibited dechlorination, indicating that the archaea were not required for ortho dechlorination of the congener. Deletion of Clostridium spp. from the community profile by addition of vancomycin only slightly reduced dechlorination. However, addition of sodium molybdate, an inhibitor of sulfate reduction, inhibited dechlorination and deleted selected species from the community profiles of the class Bacteria. With the exception of one 16S rDNA sequence that had the highest sequence similarity to the obligate perchloroethylene-dechlorinating Dehalococcoides, the 16S rDNA sequences associated with PCB ortho dechlorination had high sequence similarities to the delta, low-G+C gram-positive, and Thermotogales subgroups, which all include sulfur-, sulfate-, and/or iron(III)-respiring bacterial species.

Alkanesulfonic Acids↗

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