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At least 253 records · Page 14Linked to original sources
PubMed2004

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128].

BACKGROUND: This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly. DESIGN: The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls. The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.

Aged↗
PubMed1999

Pediatrician-led community child health initiatives: case summaries from the evaluation of the community access to child health program.

OBJECTIVES: Case study investigations of projects identified with the Community Access to Child Health (CATCH) Program were conducted to illustrate the range of achievements of CATCH and to identify those elements related to successful or unsuccessful implementation. METHODS: We developed a purposive sample of 12 projects, selected based on time of initiation (1989-1995), level of intensity of involvement in CATCH, project locus (statewide or local), nature of program service(s), project setting, and target population(s). Two investigators spent approximately 1.5 days at each site using a preestablished case study guide that included document review and multiple in-person interviews. A total of 171 interviews were conducted with project leadership and staff, community and institutional partners, and public health officials. In seven communities, we also met with individuals receiving project services (consumers). RESULTS AND CONCLUSIONS: The premise of CATCH that with information, support, and tools, pediatricians can be agents of change in their communities was confirmed. The CATCH pediatricians with whom we met capitalize on their status in the community as physicians, their expertise, and their programmatic and political connections to create opportunities to expand and improve health and social services for children. The specific leadership of these pediatricians is often key in overcoming political and cultural barriers to implement system changes. CATCH was and continues to be an effective program strategy for stimulating and enhancing community-based child health initiatives.

Adolescent↗
PubMedDate not supplied

Using a stages of readiness model to address community capacity on tobacco control in the Asian American and Pacific Islander community.

OBJECTIVES: This paper describes the Asian Pacific Partners for Empowerment and Leadership (APPEAL) Stages of Community Readiness Model, a framework for assessing and evaluating tobacco control in the diverse Asian American and PaCific Islander (AAPI) communities. METHODS: This model extends the work of existing community capacity models by applying a "stage of readiness" continuum of the five stages of pre-contemplation, contemplation, preparation, action and maintenance in terms of developing, launching and sustaining AAPI tobacco control efforts. FINDINGS: The APPEAL Model allows communities to diagnose, then address their unique needs through appropriate technical assistance, training and resources. The APPEAL Model benefits both communities and funders through its ability to better understand their readiness to conduct tobacco control and have realistic expectations on the outcomes of those efforts. CONCLUSIONS: This paper describes the elements of the Readiness model for AAPIS, particularly those addressing research and data issues, current applications of the model in specific AAPI ethnic communities, and the lessons learned thus far regarding the model's applicability to, and support of, the development of AAPI tobacco control efforts nationally.

Asian↗
PubMed1987

Longitudinal study on the health status of children in a rural Tanzanian community: comparison of community-based clinical examinations, the diseases seen at village health posts and the perception of health problems by the population.

Standardised household interviews among adults and children, open-ended questionnaires, and clinical examinations administered during cross-sectional health status surveys, as well as the registers of village health posts (VHP), were used to assess the pattern of health problems of a rural community in southeastern Tanzania, and their results compared. All four approaches gave very similar results for the two major health problems (fever/malaria and abdominal pain or discomfort) which were mentioned by both children and adults. The parasitological data from the cross-sectional surveys also revealed hyperendemic P. falciparum malaria and a high prevalence and incidence for infections with hookworm (N. americanus), Strongyloides, and G. lamblia. However besides consistently revealing the two major health problems, each approach showed a distinct pattern for the additional health problems: household interviews and open-ended questionnaires resulted in a higher ranking of problems that had not yet been solved by the health care facilities available in the community at the time of the interview. This view was further biased by the fact that the interviews were done by people representing the health professionals. The statistics from the registers of VHP clearly reflected the types of treatment provided by this service. Malnutrition and various eye problems only became evident during the clinical examination of the population. However, the clinical examination did not identify the importance of the abdominal problems in the community. The cross-sectional survey (questionnaires, clinical examination) chiefly showed the health problems affecting the population around the time of the surveys (end of the dry season). Interestingly, the registers of the VHP did not show marked seasonal variations in the morbidity statistics for this community. Both questionnaire approaches and the registers of VHP showed a change in both the morbidity and the disease perception pattern that may reflect the effects of interventions launched at community level (activities of village health workers, mass-treatment against hookworm and G. lamblia). The study indicated that the individual ranking of the major health problems matched with data from health status surveys. It also pointed to the possibility that disease perception patterns could become a tool for community diagnosis and for the monitoring of health care programs.

Abdomen↗
PubMed1981

The Mayo three-community hypertension control program. IV. Five-year outcomes of intervention in entire communities.

Beginning in 1974, the Mayo three-community hypertension control program initiated intervention studies in three southeastern Minnesota communities. This paper reports on the blood pressure outcomes 5 years after the inception of graduated programs involving public and professional education, detection, referral, and, in one community, systematic stepped care. Despite differences in local physician-population ratios and organization of medical care, perseverant long-term reductions of blood pressure were noted in all communities. However, the mean diastolic pressures were lower and the number of individuals at goal (diastolic blood pressure 90 mm Hg or less) was higher in the community offering categorical care. These data suggest that while programmatic efforts to control hypertension resulted in favorable blood pressure declines, the outcomes were particularly impressive in the community with a categorical hypertension clinic model offering systematic management of hypertensive patients.

Adult↗
PubMed1995

A practical tool for community-oriented primary care community diagnosis using a personal computer.

BACKGROUND AND OBJECTIVES: Community-oriented primary care (COPC) is considered an attractive concept by many but has had limited implementation due to a lack of practical methodology. An important step in COPC is assessment of a community's health status, using health indicators as one means of assessment. Currently, there is no easy way to combine these indicators and examine their distribution over a community. This study analyzed a process for doing that by using a personal computer. METHODS: For the community studied, all available community-based health indicators were identified. A process for combining these indicators, using commonly available database and spreadsheet software, was developed and analyzed for cost, clinical utility, and problems encountered. RESULTS: Problems were encountered with collecting and combining some data, but a clinically useful tool was produced. Costs, including purchase of all software (with mapping software), were $1,500-$2,000. CONCLUSIONS: With efforts to reduce the initial costs, this is a practical and clinically useful tool for viewing the geographic distribution of community health indicators. Such practical methodology is essential for COPC development.

Community Health Planning↗
PubMed1994

The development of community orientated recommendations for diabetes care in south Auckland. South Auckland Community Diabetes Planning Group.

Growing numbers and costs associated with diabetes and its tissue damage are of increasing concern. We describe the development of community orientated recommendations aimed at primary and secondary prevention of diabetes in an area with a high proportion of Maori and Pacific Islands people. Preliminary results from structured face-to-face interviews with patients (n = 555), general practitioners (n = 163) and other health professionals were discussed by a core group of elected or selected community and health professional representatives. Twelve meetings and one full day workshop were held over a 7 month period. Formal and informal consultation occurred among community and health groups between meetings. The 68 recommendations included the need to: empower communities and diabetic patients; improve coordination and standardisation of care and the importance of the general practitioner in this process; improve access to care by removing transport, cultural and language barriers to care; subsidize preventative treatment costs; improve foot and eye services; improve monitoring of those with past diabetes in pregnancy or impaired glucose tolerance; improve detection of diabetes by increased high risk screening linked to ongoing diabetes care programmes. Implementation requires quality information systems and a cooperative partnership approach between hospital, general practitioner and the community, particularly local Maori and Pacific Islands communities.

Community Health Services↗
PubMedDate not supplied

[Specialist community social services as a form of community social support].

Art. 9 of the Polish Mental Health Act provides two forms of community-based social support--specialist social help services and community self-help houses for persons who, due a to serious mental illness or severe mental retardation, face considerable difficulties in their daily life, especially with respect to interpersonal relations, employment and welfare matters. The first form could only be implemented after coming into force of the suitable regulation of the Ministry of Labour and Social Policy of December 18, 1996 (Dz. U. z 1997 r., nr. 2, poz. 12). Hence, it may be understood that information on these services is exceptionally scarce. The author presents: a draft of legal evolution of the specialist services, from the vague idea of "community care" provided by psychiatric care facilities to the present regulation of community specialist social help services run by social help agencies in consultation with psychiatric facilities, main guidelines for staff to be observed in performing community specialist social help services (training in maintenance and development of basic skills necessary to independent living and others), the first promising experiences of a team rendering community specialist social help services in one of the communes in Warsaw.

Community Mental Health Services↗
PubMedDate not supplied

Community development theory. Planning a community nursing center.

The authors describe the use of community development theory to assess the need for a community-based, nurse-managed primary care clinic. A community development model provided the framework for citizen participation in identifying collective health needs of public housing residents. The model facilitated the following: 1) planning for delivery of culturally appropriate primary care services that respond to health needs perceived by community residents; 2) ensuring acceptability and use of services; and 3) empowering residents to take responsibility for their own health. This article focuses on the assessment phase of the model and meeting the perceived needs of community residents.

Adolescent↗
PubMed2001

"I was not invited to be a [CHW] ... I asked to be one": motives for community mobilization among women community health workers in Mexico.

Despite health educators' revitalized interest in community mobilization for health, little attention has been given to participants' motives for mobilizing. The purpose of this article is to contribute to the understanding of community mobilizing by analyzing the motives for mobilization among a group of women community health workers (CHWs), members of a community-based organization in Mexico. The study is guided by critical feminist and social constructivist theories. It aims at identifying the categories of motives used by women CHWs and exploring how these motives are created while presenting women's own voices. Women's motives fall into four categories: getting out, serving, learning, and women's betterment. These motives blend personal andpublic motives. The analysis suggests that mobilization for health may be enhanced by addressing both the personal satisfaction of individuals and the accomplishment of public goods. The study of motives may be useful for the recruitment and retention of participants in community mobilization efforts.

Adult↗
PubMed2005

The community action model: a community-driven model designed to address disparities in health.

The community action model is a 5-step, community-driven model designed to build communities' capacity to address health disparities through mobilization. Fundamental to the model is a critical analysis identifying the underlying social, economic, and environmental forces that create health and social inequities in a community. The goal is to provide communities with the framework necessary to acquire the skills and resources to plan, implement, and evaluate health-related actions and policies. The model was developed in the context of tobacco-related health disparities. Concrete policy outcomes demonstrate the model's potential application to a wide variety of grassroots policy development efforts.

California↗
PubMedDate not supplied

Making a real difference. Beyond community service to community benefit.

Community benefits or community benefit? Plural or singular? In general, the "pluralists" come from a health insurance perspective and think about community benefits as elements, like benefits in health insurance contracts. The "singularists" come from a broader perspective, and think about community benefit like community service, as a broad direction and commitment related to mission. But there are important exceptions to this rule, of which the Michigan health & Hospital Association is an outstanding example. That organization clearly belongs in the camp of the singularists, but is currently with the pluralists, perhaps reflecting their strong commitment to a pluralistic health system.

Community Health Planning↗
PubMed1988

The Community Placement Scale: an adaptation of the Community Competence Scale for placement of the deinstitutionalized mentally ill.

The Community Placement Scale (CPS), an abbreviated form of the Community Competence Scale (Anderten, 1979) suitable for placement of deinstitutionalized mental patients in the community, was developed in a combined sample of 87 subjects placed in the community in California and Missouri. Although the Community Competence Scale has shown considerable promise as a placement instrument with the deinstitutionalized mentally ill, a briefer measure is needed in order to increase acceptance by both patients and professional staff. Other improvements sought were determining the acceptability of items to placement personnel nationwide, eliminating nondiscriminating items, and heightening internal consistency reliability of subscales. In a series of discriminant analyses, remaining subscales were used to predict community placement with minimal and maximal degrees of structure. From these analyses, a measure that consisted of 5 subscales and 41 items and required approximately 20 minutes to administer was selected. This short form has many similarities to and a few important differences from the previously published short form.

Adult↗
PubMed2006

Small-scale spatial heterogeneity of arbuscular mycorrhizal fungal abundance and community composition in a wetland plant community.

Although it has become increasingly clear that arbuscular mycorrhizal fungi (AMF) play important roles in population, community, and ecosystem ecology, there is limited information on the spatial structure of the community composition of AMF in the field. We assessed small-scale spatial variation in the abundance and molecular diversity of AMF in a calcareous fen, where strong underlying environmental gradients such as depth to water table may influence AMF. Throughout an intensively sampled 2 x 2 m plot, we assessed AMF inoculum potential at a depth of 0-6 and 6-12 cm and molecular diversity of the AMF community using terminal restriction fragment length polymorphism of 18S rDNA. Inoculum potential was only significantly spatially autocorrelated at a depth of 6-12 cm and was significantly positively correlated with depth to water table at both depths. Molecular diversity of the AMF community was highly variable within the plot, ranging from 2-14 terminal restriction fragments (T-RFs) per core, but the number of T-RFs did not relate to water table or plant species richness. Plant community composition was spatially autocorrelated at small scales, but AMF community composition showed no significant spatial autocorrelation. Saturated soils of calcareous fens contain many infective AMF propagules and the abundance and diversity of AMF inoculum is patchy over small spatial scales.

DNA, Fungal↗
PubMed2026

Comparative metagenomic analysis of microbial communities: unravelling microbial communities from the great Rann of Kachchh and coastal saltpans, Gujarat, India.

Hypersaline environments exhibit extreme physiochemical conditions yet support diverse microbial communities. These communities are not only ecologically important but also possess substantial potential for biotechnological exploitation. In this study, we employed a comparative metagenomic approach to assess microbial diversity using two distinct methodologies: (1) direct DNA extraction from raw sediment, and (2) DNA extraction following halophilic enrichment in selective media. Sediment samples were collected from multiple sites and pooled together within the Rann of Kachchh and close-by saltpans and were analysed using 16S rRNA sequencing coupled with bioinformatics pipelines. The results revealed pronounced differences in microbial community composition between the two approaches. Raw sediment samples exhibited significantly higher alpha diversity, with dominant taxa including Halobacterota, Cyanobacteria, and Desulfobacterota, with a substantial proportion of unclassified genera. In contrast, enriched samples were dominated by fast-growing, culturable genera such as Halobacterium, Alkalibacillus, and Candidatus haloredivivus. Principal Coordinate Analysis (PCoA) of beta diversity demonstrated distinct clustering between raw and enriched communities, even within samples from the same sites, underscoring the selective bias introduced by enrichment procedures. These findings emphasise that the methodological choice strongly influences the observed microbial diversity. The aim of this study was to compare microbial community composition in raw hypersaline sediments and enrichment cultures using metagenomic sequencing, to evaluate how enrichment selectively favours specific halophilic taxa. This comparative approach allows identification of the microbial groups that rapidly proliferate under controlled hypersaline conditions, thereby complementing direct environmental sequencing. By integrating both direct and enrichment-based metagenomic approaches, a more comprehensive understanding of microbial community structure in hypersaline environments can be achieved.

India↗