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PubMed1975

Rheumatic disorders in the South African Negro. Part I. Rheumatoid arthritis and ankylosing spondylitis.

Epidemiological studies to determine the prevalence of rheumatoid arthritis (RA) have been carried out in two South African Negro populations: one rural people in the north-western Transvaal, and the other an urban community in Johannesburg. Altogether 1352 subjects over the age of 15 years were examined clinically and radiologically; serological tests for rheumatoid factor (RF) were carried out in 920. Rheumatoid arthritis was graded 'definite' or 'probable' on the basis of a modification of the 'Rome criteria' of 1963. A marked difference in the prevalence of RA was encountered in the two populations. Among the rural Blacks only 1 respondent had definite RA and 6 had probable RA, giving a prevalence of 0,87% for combined definite and probable RA. Among the urban group 5 respondents had definite RA and 13 had probable RA, a combined prevalence of 3,3%. This difference is statistically highly significant (P less than 0,01). Moreover, the form and severity of the disorder differed markedly in the two populations. In the rural community such changes as were encountered were invariable mild and no-one had clinical features resembling classical rheumatoid arthritis; by contrast, among the urban Blacks the changes resembled those of rheumatoid disease in White populations. Such marked differences in genetically closely related communities point to the importance of sociological and environmental factors in the pathogenesis of rheumatoid arthritis.

Adolescent↗
PubMed1995

Fetal monitoring--midwifery attitudes.

OBJECTIVE: to survey midwives' attitudes and practices related to intrapartum fetal monitoring. DESIGN: descriptive correlational study. SETTING: regional and district maternity unit and related community area within one health authority. PARTICIPANTS: all midwives were invited to participate. Two hundred and forty two questionnaires were administered and 117 were returned (48% response rate). MEASUREMENTS AND FINDINGS: in the questionnaire information was collected on professional/demographic details, education and practices related to intrapartum fetal monitoring, together with a 20-item attitude scale which encompassed attitudes towards fetal monitoring and related issues. As expected, the findings suggest that midwives' preferred methods of fetal monitoring varied with the client's risk category. However, midwife preference did not necessarily match actual choice of method. There are many factors influencing choice, not least of which is confidence in ability. Significant differences were found between midwives. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings highlight some of the issues relating to individual confidence. 97% of the midwives felt they would benefit from in-service training in CTG interpretation. The findings support the development of continuing in service education programmes for midwives.

Adult↗
PubMed2002

Beliefs and perceptions of African American women who have had hysterectomy.

This study used a qualitative, ethno-nursing, ethnographic design to identify cultural beliefs within the African American community related to hysterectomy. Three themes were derived from interviews with 30 women: African American cultural myths, fears, and sexual symbolism related to hysterectomy; benefits of hysterectomy that included freedom from pain and public embarrassment and freedom from risk of pregnancy; and improved self-esteem and sexuality. Results of this study indicate that there are negative connotations of hysterectomy in the African American community, which may cause some African American women to delay the procedure until they have no choice. Education and knowledge of cultural beliefs will enable health care providers to provide culturally sensitive and comprehensive care to African American women; it also will enable health care providers to instruct African American women to avoid unnecessary delay of hysterectomy.

Adult↗
PubMedDate not supplied

1993 Governance Award recipients announced.

In honor of outstanding service to hospitals and the community, two trustees of Michigan hospitals were awarded the 1993 Hospital Governance Award at the Michigan Hospital Association's Fall Medical Staff-Trustee-Administrator Forum. Each year, the MHA presents the Hospital Governance Award to recognize trustees who demonstrate exceptional service based on overall leadership, overall contributions, and improved community relations. This year's forum was held at the Grand Traverse Resort in Traverse City. James E. Coleman, chairman of the board of directors of Pennock Healthcare System, Hastings, and Alan R. Ryan, chairman of the board of trustees of Saint Mary's Community Health Care System, Grand Rapids, were named the 1993 Governance Award winners.

Awards and Prizes↗
PubMed1983

Primary health care in Southeast Asia: attitudes about community participation in community health programmes.

Although community participation in health has become a major plank in WHO's Primary Health Care platform, comparatively little concrete programme data has been collected which helps to define its potentials and problems. In an effort to expand knowledge in this area, a study of three Church-related community health programmes in Southeast Asia was undertaken. All three programmes have the stated goal of 'having the community take responsibility for its own health care' and as a concrete step in this direction, have developed training programmes for community health workers (CHWs). Starting about the same time, 1973-1975, they provide data for comparative examination of the development of community participation. As part of the study, a questionnaire was designed to elicit information from three categories of programme participants (the medical professionals, the community development workers and the CHWs) in community health programmes. It sought to discover their attitudes about the objectives of community health programmes; impact and measurements of success of these programmes; the role of health services; the role of medical professionals and community development workers in community health programmes; the role and training of community health workers; and financing community health programmes. The hypothesis of the investigation was that all three categories of programme participants in one programme share attitudes distinct from participants in the other two programmes. Although, due to technical reasons, it was not possible to test this hypothesis, the survey produced other conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Asia, Southeastern↗
PubMedDate not supplied

[Electric power generation and transmission: the impact on indigenous peoples in Brazil].

This paper presents an overview of the effects of electric power generation and transmission on indigenous communities in Brazil. According to data from FUNAI (the Brazilian government's Board of Indian Affairs), there are 156 cases of direct impact, present or future, of the electric power sector on Indian settlements geographically distributed throughout Brazil, 65% of which are located in the Northern Region of the country. The principal complaints by indigenous communities relate to the direct effects of flooding following construction of hydroelectric dams, destruction of sacred sites like cemeteries, mosquito proliferation, and health-related hazards such as malaria and other infectious diseases, decrease in game for hunting, crowding out of farm land, and increased invasion of indigenous lands. Future perspectives include a scenario with further construction of hydroelectric dams, especially in the Amazon region, with possible similar effects on indigenous communities.

Brazil↗
PubMed1990

[AIDS-related mortality among Puerto Rican women in New York City, 1981-87].

The present study analyzes the impact of AIDS on the mortality experience of Puerto Rican women in New York City for the time period 1981-1987. This study shows that Puerto Rican women in New York City are at higher risk for AIDS than any other racial or ethnic group. Economic and sociocultural factors in the Puerto Rican community related to the use of intravenous drug use, as well as trends in migration and marriage, are associated to the high risk of AIDS in this group. This information is of particular interest for Puerto Rico and New York City given the migration patterns of Puerto Ricans traveling between Puerto Rico and New York City.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Factors influencing the detection rate of drug-related problems in community pharmacy.

This study analyzes relationships between the number of drug-related problems detected in community pharmacy practice and the educational level and other characteristics of pharmacy personnel and their work sites. Random samples of pharmacists, prescriptionists and pharmacy technicians were drawn nationwide in Sweden. One hundred and forty-four (63%) of those meeting the inclusion criteria agreed to take part. The participants documented medication-related problems, interventions and patient variables on a data collection form. The drug-related problems were weighted by the number of patients served by each professional. The regression analysis showed the educational level of the professional to have a statistically significant effect on the detection rate, with pharmacists finding on average 2.5 more drug-related problems per 100 patients than prescriptionists and about 3.6 more than technicians. Previous participation in a study or activity on drug-related problems and the size of the pharmacy also had statistically significant effects on the problem detection rate. The use of open-ended questions to create a dialogue with the patient seemed to be a successful means to discover problems. The results of this study indicate the importance of education and training of pharmacy personnel in detection of drug-related problems. This findings speaks in favor of increasing the pharmacist to other personnel ratio, provided the higher costs will be offset by societal benefits.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1999

Characteristics of asthma care provided by hospitals in a large metropolitan area: results from the Chicago Asthma Surveillance Initiative.

INTRODUCTION: Little is known of the approaches of United States hospitals to the management of persons with asthma. The purpose of this study is to characterize the extent to which hospitals within a large community have implemented various types of asthma-specific health-care delivery processes. METHODS: A cross-sectional, self-administered survey was mailed to a "key informant" in asthma care at each of the hospitals in the Chicago area. The survey instrument covered the following content areas: asthma-related inpatient services, asthma-related outpatient services, selected asthma-related quality improvement activities, and asthma-related community outreach. The survey was administered between August 1996 and January 1997. RESULTS: Data were collected from respondents at 59 of the 89 eligible hospitals, yielding a response rate of 66.3%. Of the responding hospitals, 42.4% indicated they had clinical practice guidelines for inpatient asthma management, and 37.3% reported using critical pathways. Four selected aspects of bedside care were also explored. All of the responding hospitals reported routine provision of nebulization therapy at the bedside, and nearly all routinely obtained peak flow measurements (96.6%). In the area of patient instruction, 93.2% provided bedside evaluation of proper inhaler technique, and 86.4% routinely provided instruction on the use of peak flowmeters. Only 54.0% of the hospitals reported routinely administering some type of asthma education program prior to discharge. The hospitals with clinical practice guidelines in place were also more likely to have critical pathways (p < 0.01); to have asthma-specific ICU policies/guidelines/critical pathways (p < 0.01); to provide bedside instruction on the use of peak flowmeters (p < 0.01); to provide an asthma education (p < 0.01) prior to discharge; and to conduct utilization review. Very few hospitals indicated that they had community outreach programs for asthma care. CONCLUSION: The results of this survey suggest that among Chicago-area hospitals appropriate bedside care for persons with asthma is provided, but there are large variations in other types of asthma services and programs. The hospitals that have adopted asthma clinical practice guidelines are more likely to have other asthma-specific quality improvement activities than hospitals without guidelines. This relationship between use of guidelines and quality of services needs further exploration, as it may prove to be an important marker for hospitals with staff that are interested in improving asthma care.

Adolescent↗
PubMedDate not supplied

Modeling year 1 outcomes with treatment process and post-treatment social influences.

Follow-up studies of drug user treatment generally find significant improvements in client functioning, but information about the therapeutic components associated with client behavioral changes over time is limited. An integrative model developed previously to predict treatment retention was expanded and applied to post-treatment outcomes. This study is based on 321 daily opioid users treated in three methadone treatment clinics. Effects of pre-treatment motivation, treatment process measures representing therapeutic relationship, counseling session attendance, and length of treatment are examined in relation to measures of family relations, peer deviancy, return to treatment, drug use, and criminality in the year after treatment. Models were tested in two stages. The first was built on a during-treatment process model for predicting time in treatment to include post-treatment outcomes. The second model was expanded further to include the effects of intervening social support variables as predictors of post-treatment drug and criminality outcomes. The results supported both models and emphasize the importance of considering social influences and related community contextual factors that affect recovery dynamics.

Adult↗
PubMed1998

The quality of social relationships as a public health issue: Exploring the relationship between health and community in a disadvantaged neighbourhood.

This paper explores the relationship between the health of residents and the quality of social relationships within a disadvantaged urban neighbourhood. The author draws on her experience both as a nurse and an elected district councillor to illuminate connections between crime, antisocial behaviour, health and well-being. It is argued that these connections are neglected in health literatures, to the detriment of the development of a theoretical basis for health related community development work.

Journal Article↗
PubMed2006

Decision making in childbirth: the influence of traditional structures in a Ghanaian village.

BACKGROUND: The regional health administration of the Brong-Ahafo Region in Ghana identified that although informed about the advantages of both aspects of care, pregnant women made use of antenatal services but not of the supervised delivery. Quantitative studies have identified economic factors that influence the decisions of pregnant women. AIM: To describe and understand the traditional structures of childbirth in Kwame Danso/Ghana and to explore why the pregnant women do not make use of supervised deliveries in the modern institutions. METHODS: A mini-ethnographic study, using participant observation and ethnographic interviews. FINDINGS: Cultural and social factors have a significant influence on the decisions related to childbirth. One of the most important factors identified was that the responsible persons for decisions related to a delivery were the older female relatives, rather than the mothers themselves. Older females used rational judgements to weigh up the possibilities of risks, interests and advantages related to their cultural, spiritual and social system. Other factors were staff behaviour that was characterized as unfriendly and lacking for respect as to the living conditions and thinking of the pregnant women in the village. CONCLUSIONS: Ethnographic research provided an understanding of traditional structures that have an influence on the decisions and behaviour of the community related to childbirth. Appreciation of these structures enabled health promotion and structured health services to be delivered in a more culturally appropriate way.

Adult↗
PubMed2006

Association between solitary keratoacanthoma and cigarette smoking: a case-control study.

Solitary keratoacanthoma (KA) is a common benign epithelial tumor of the skin characterized by rapid growth and a tendency toward spontaneous regression. The exact etiology and classification of KA are a matter of debate. Smokers also seem to be more affected than persons who never smoke. The objective of this study was to evaluate the association between solitary KA and smoking habit. A case-control study involving 78 patients diagnosed with KA and 199 controls from the related community was performed to evaluate the association between cigarette smoking and KA. A higher smoking prevalence was noted in cases (69.2 %) than controls (21.6 %) and the odds ratio adjusted for sex and age was 9.1 (95 % CI 4.9 to 17.1, p< 0.01). The mean tumoral diameter at surgery and the site of involvement was not statistically related to smoking. These findings suggest that cigarette smoking is associated with the development of KA.

Adult↗
PubMed2005

Do supervised injecting facilities attract higher-risk injection drug users?

BACKGROUND: In Western Europe and elsewhere, medically supervised safer injection facilities (SIFs) are increasingly being implemented for the prevention of health- and community-related harms among injection drug users (IDUs), although few evaluations have been conducted, and there have been questions regarding SIFs' ability to attract high-risk IDUs. We examined whether North America's first SIF was attracting IDUs who were at greatest risk of overdose and blood-borne disease infection. METHODS: We examined data from a community-recruited cohort study of IDUs. The prevalence of SIF use was determined based on questionnaire data obtained after the SIF's opening, and we determined predictors of initiating future SIF use based on behavioral information obtained from questionnaire data obtained before the SIF's opening. Pearson's chi-square test was used to compare characteristics of IDUs who did and did not subsequently initiate SIF use. RESULTS: Overall, 400 active injection drug users returned for follow-up between December 1, 2003 and May 1, 2004, among whom 178 (45%) reported ever using the SIF. When we examined behavioral data collected before the SIF's opening, those who initiated SIF use were more likely to be aged <30 years (odds ratio [OR]=1.6, 95% confidence interval [CI]=1.0-2.7], p=0.04); public injection drug users (OR=2.6, 95% CI=1.7-3.9, p<0.001); homeless or residing in unstable housing (OR=1.7, 95% CI=1.2-2.7, p=0.008); daily heroin users (OR=2.1, 95% CI=1.3-3.2, p=0.001); daily cocaine users (OR=1.6, 95% CI=1.1-2.5, p=0.025); and those who had recently had a nonfatal overdose (OR=2.7, 95% CI=1.2-6.1, p=0.016). CONCLUSIONS: This study indicated that the SIF attracted IDUs who have been shown to be at elevated risk of blood-borne disease infection and overdose, and IDUs who were contributing to the public drug use problem and unsafe syringe disposal problems stemming from public injection drug use.

Adult↗
PubMed2000

Information needs and information-seeking behaviors of HIV positive men and women.

Although a portion of the HIV/AIDS population has long been active in seeking out information in support of self-care, little work has been done to examine closely the information needs and information-seeking behaviors of this community relative to the provision of medical reference. This exploratory study provides insight into the types of information HIV positive individuals seek and the resources they consult in gathering information to bolster health and well-being. Having a better understanding of the information needs and information-seeking behaviors of individuals with HIV/AIDS will facilitate information intervention for this community.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Seroepidemiology of hepatitis A in six departments in West-Central France in 1991].

Antibodies to hepatitis A virus were sought for among residents of 6 "départements" of West-Central France during a routine medical check up provided by the national health insurance system to all affiliated persons. Among them 5,641 subjects (aged 6 to 60) were randomly selected to a sample size of 256 +/- 15 male or female subjects for each five-year age group. Anti-HAV were detected in 51% of the screened population. The prevalence was less than 5% in the 6-15 age group and increased by successive steps to exceed 90% in the subjects over 50. The highest increase was observed between the 26-30 (39%) and the 31-35 (57%) age groups. This study confirms the influence of socio-economical factors on the anti-HAV prevalence rate. Factors such as profession or scholar education were previously known, but the housing conditions and especially the number of siblings were identified in our present report. In relation to this low prevalence of anti-HAV among young adults, one may fear an increase of overt hepatitis cases which are known to be more frequent in adults than in infants or children. Moreover any break in hygiene may expose the population to an epidemia. Only active immunization with a vaccine against hepatitis A could efficiently prevent these individual and community-related risks.

Adolescent↗
PubMed2005

The time dimension for scene analysis.

A fundamental issue in neural computation is the binding problem, which refers to how sensory elements in a scene organize into perceived objects, or percepts. The issue of binding is hotly debated in recent years in neuroscience and related communities. Much of the debate, however, gives little attention to computational considerations. This review intends to elucidate the computational issues that bear directly on the binding issue. The review starts with two problems considered by Rosenblatt to be the most challenging to the development of perceptron theory more than 40 years ago, and argues that the main challenge is the figure-ground separation problem, which is intrinsically related to the binding problem. The theme of the review is that the time dimension is essential for systematically attacking Rosenblatt's challenge. The temporal correlation theory as well as its special form--oscillatory correlation theory-is discussed as an adequate representation theory to address the binding problem. Recent advances in understanding oscillatory dynamics are reviewed, and these advances have overcome key computational obstacles for the development of the oscillatory correlation theory. We survey a variety of studies that address the scene analysis problem. The results of these studies have substantially advanced the capability of neural networks for figure-ground separation. A number of issues regarding oscillatory correlation are considered and clarified. Finally, the time dimension is argued to be necessary for versatile computing.

Algorithms↗
PubMed1994

Early detection of cancer. Psychologic and social dimensions.

Major strides in early detection research can be attributed to social and behavioral research. Social scientists have been involved in research determining the epidemiologic basis of and the cost-effectiveness of screening for asymptomatic disease. The availability of well accepted screening tests has been a barrier to early detection research, especially in the area of men's health. Early detection research has focused on the individual and system levels. Theoretical models are being adapted for early detection from smoking research and are a strength of current work. These models explain why people participate in early detection and how behavior change can occur. In studying system barriers to early detection, intervention efforts have been focused in the community and in the medical care delivery system. Methodologic issues are beginning to emerge, including measuring of program outcomes, and the appropriate research designs for community studies. Except for immigrant populations, initial screening rates are high, and the periodicity of screening becomes the outcome of choice. Some of these problems are the direct result of the success of research and public education efforts to increase cancer screening. The following are priorities for the next decade: theory driven research on behavior change and on interventions; the social determinants of physicians' participation in screening; process evaluation to relate community efforts to outcomes; and reductions in the stage at which cancer is diagnosed as an outcome measure.

Adult↗