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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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At least 433 records · Page 24Linked to original sources
PubMed1990

A study of community differences in stress among the elderly: implications for community health nursing.

It has long been known that stressful states are linked to physical and mental health. An important dimension of emotional stress is community environment. That is, communities can produce stress in individuals but can also provide the coping resources that help modify these stressors. We examined differences in stress responses among a random samples of 900 elderly living in nine metropolitan and nine non-metropolitan, randomly chosen communities in six northeastern states. Respondents were asked if, in the past year, they had experienced anything upsetting or stressful in their lives connected with family and friends, their health, and their finances. The findings support the existence of community differences in stress responses for these elderly respondents, and show evidence of a link between community structure and individual behaviors.

Aged↗
PubMedDate not supplied

Responsibility of the infectious disease community for optimal use of antibiotics: views of the membership of the Infectious Diseases Society of America.

A questionnaire was sent to 1,500 members and fellows of the Infectious Diseases Society of American to elicit their views on the use of antimicrobial agents. The rate of return was 58.7%. A high proportion of respondents (86.8%) stated that they had a strong professional interest in antimicrobial therapy and were active in infection control and antibiotic use in their institutions--488 hospitals including community, university, children's, and governmental facilities. The membership was concerned with problems of antibiotic use in hospitals, laboratory methods of reporting susceptibility, promotional practices of industry, and development of microbial resistance. Members were troubled by how best to deal with excessive use of antibiotics in hospitals. Respondents strongly supported efforts to improve the control of antimicrobial use in hospitals and to examine issues of drug use and resistance in developing countries; they provided suggestions for development of a code of ethical conduct with industry.

Aminoglycosides↗
PubMed1989

Home care nursing practice: the new frontier.

Home care is an integral part of the health care delivery system. Although home care has been discussed as a less costly alternative to hospital care, it is quite reasonable to consider the home the primary site for the delivery of health care, with the institution the alternative site. Thus, home care nursing, as the new frontier of health care, does and will continue to involve an array of nursing responsibilities from high-technology skills to case management of the chronically ill patient's multiple needs. There are specific areas that need to be addressed in home care, three of which were included in this discussion. These include the changing practice of the home care nurse, the lack of preventive and supportive services, and home care financing. Home care nursing has changed since the first sick poor people were visited in their homes by nurses in 1877. It would behoove nurses to try creative ways to reconstruct Wald's model of home care in today's home care system. Nurses in home care must be actively involved in practice (including care of the sick, chronically ill, and those at risk for potential health problems), continuing education, research, and political action. Home care nursing is more than caring for an individual or family at home; it is being aware of and involved in changing the home care climate for a holistic nursing practice.

Community Health Nursing↗
PubMed1995

Cancer clinical trials in the community setting: a 20 year retrospective.

During the past two decades clinical cancer research in the United States has grown dramatically and has been significantly enhanced by the participation of community hospitals, practicing oncologists, and the creation of community cancer clinical trials organizations. More than 102,000 patients have been enrolled by these community based groups to important clinical trials which have answered questions that have improved cancer treatment in this country and worldwide (Figure 3, Table 8). Practicing oncologists are now well trained in the practice of clinical research and efforts should be directed to ensure that their participation in clinical research continues to increase. There are many obstacles to performing clinical cancer research, but none is greater than the issue of cost. We are currently facing the daunting prospect that health care reform may dramatically curtail or bias future cancer clinical trials. Consumers, providers, politicians, and the general public must be educated to protect and expand the cancer clinical research structure so that we can continue the pursuit of optimal cancer management.

Clinical Trials as Topic↗
PubMed1989

A community sojourn from the perspective of one who relapsed.

Research focusing on the recent community sojourn of 30 newly rehospitalized individuals with chronic schizophrenia is summerized. The story of one protagonist is presented. His rich descriptions defining circumstances, thoughts, and feelings are organized into eight categories: living arrangements, employment, finances, social situation, knowledge and use of community facilities, compliance with discharge plan, other events and reactions, and factors related to community tenure. An alliance with suggested nursing roles and actions outlined in closing comments could infuse similar dreary situations with more health-engendering opportunities.

Activities of Daily Living↗
PubMedDate not supplied

The illusion of change.

Explore the source record for details and available documents.

Community Health Services↗
PubMed2003

A fuzzy logic approach toward solving the analytic enigma of health system financing.

Improved health, equity, macroeconomic efficiency, efficient provision of care, and client satisfaction are the common goals of any health system. The relative significance of these goals varies, however, across nations, communities and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, payment to providers, and public-private mix. The intricate set of multiple goals, elements and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, "health system finance" is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. "Fuzzy logic" models human reasoning by managing "expert knowledge" close to the way it is handled by human language. It is used here for guiding policy making by a systematic analysis of health system finance. Assuming equal welfare weights for alternative goals and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German-type health system is best. Other solutions depend on the welfare weights for system goals and mixes of policy options.

Journal Article↗
PubMed1999

NGOs in community health insurance schemes: examples from Guatemala and the Philippines.

In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process.

Accreditation↗
PubMed2006

Community approaches to providing care for the uninsured.

Faced with rising uninsurance rates and little response at the state or federal levels in recent years, communities have developed various strategies to provide care for uninsured people. This paper profiles local strategies in the Community Tracking Study sites, focusing on efforts that go beyond traditional safety-net access. Our findings suggest that more-recent community efforts--which tend to be privately sponsored--are relatively modest in scope compared with more-mature programs that enjoy public financing. Although local strategies can fill some holes, communities often do not have the resources necessary to fully address the problems of the uninsured on their own.

Community Health Planning↗
PubMed1996

Medicaid managed care: how do community health centers fit?

Managed care has brought about important changes in how the health care system is financed and services delivered. The authors describe the approaches adopted by community health centers to participate in Medicaid managed care and argue that these providers, commonly referred to as providers of last resort, have a role to play in this system. Many challenges lie ahead for these centers, such as the potential imposition of Medicaid block grants, the increasing number of uninsured persons, and cuts in both Federal grants and State budgets. These various forces may adversely impact health centers, leaving them with more uninsured patients and fewer resources.

Community Health Centers↗
PubMed1997

ICS-II USA research locations: environmental, dental care delivery system, and population sociodemographic characteristics.

Secondary data sources are used to describe the ICS-II USA research locations in terms of external environment, dental care delivery system, and population sociodemographics. The Native American reservations located in Arizona, New Mexico, and South Dakota were rural, while the other research locations were primarily urban. Baltimore, Maryland, and the Native American communities had fluoridated water, but San Antonio did not. Dental services in Baltimore and San Antonio were predominantly financed by private sources, with a small public health component. Dental care services in Native American communities were largely Indian Health Services (IHS) financed by the US Government. Each geographical area exhibited diverse characteristics indicating unique challenges for the delivery of community and clinical dental services.

Adult↗
PubMed1994

Community-oriented primary care. Implementation of a national rural demonstration.

A major objective of community-oriented primary care (COPC) is to focus the clinical practice on the health care problems of the community that the practice serves. The COPC process defines the community of interest, identifies and prioritizes community health problems, and implements and evaluates interventions. Under sponsorship from the W. K. Kellogg Foundation, the COPC National Rural Demonstration Program was established to explore the feasibility of implementing COPC in 13 rural practices. An evaluation of the program found that local communities played critical roles in defining and implementing COPC interventions. These interventions were most often focused on health promotion/illness prevention activities. At most sites, clinical practices were limited in their ability to incorporate COPC activities by staff and physician turnover and the extensive patient demands on the time of rural primary care physicians. While the COPC process proceeded at different rates across the sites, after 2 1/2 years of grant funding, most sites continued to devote the majority of their resources to designing and implementing interventions. Thus, it appears that coordination by dedicated nonphysician staff and more than 2 years of effort are required to implement COPC concepts in rural practices in underserved areas.

Community Health Services↗
PubMed1975

Mail-order medicine; An analysis of the Sears Roebuck Foundation's Community Medical Assistance Program.

Of the 625 rural communities that originally applied to the Sears Roebuck Foundation's Community Medical Assistance Program, 253 were accepted. One hundred sixty-three went on to build clinics, and 132 had physicians at the time of follow-up. From the standpoint of physician coverage of the community once a clinic had been built, the rate of physician availability was 78 percent, The communities' success in recruiting and retaining physicians was compared against 13 variables; none was significantly related to the recruitment, and only two--numbers of service clubs and distance to nearest physician--were related to retention.

Community Health Services↗
PubMed2006

Shortages of medical personnel at community health centers: implications for planned expansion.

CONTEXT: The US government is expanding the capacity of community health centers (CHCs) to provide care to underserved populations. OBJECTIVE: To examine the status of workforce shortages that may limit CHC expansion. DESIGN AND SETTING: Survey questionnaire of all 846 federally funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia, conducted between May and September 2004. Questionnaires were completed by the chief executive officer of each grantee. Information was supplemented by data from the 2003 Bureau of Primary Health Care Uniform Data System and weighted to be nationally representative. MAIN OUTCOME MEASURES: Staffing patterns and vacancies for major clinical disciplines by rural and urban location, use of federal and state recruitment programs, and perceived barriers to recruitment. RESULTS: Overall response rate was 79.3%. Primary care physicians made up 89.4% of physicians working in the CHCs, the majority of whom are family physicians. In rural CHCs, 46% of the direct clinical providers of care were nonphysician clinicians compared with 38.9% in urban CHCs. There were 428 vacant funded full-time equivalents (FTEs) for family physicians and 376 vacant FTEs for registered nurses. There were vacancies for 13.3% of family physician positions, 20.8% of obstetrician/gynecologist positions, and 22.6% of psychiatrist positions. Rural CHCs had a higher proportion of vacancies and longer-term vacancies and reported greater difficulty filling positions compared with urban CHCs. Physician recruitment in CHCs was heavily dependent on National Health Service Corps scholarships, loan repayment programs, and international medical graduates with J-1 visa waivers. Major perceived barriers to recruitment included low salaries and, in rural CHCs, cultural isolation, poor-quality schools and housing, and lack of spousal job opportunities. CONCLUSIONS: CHCs face substantial challenges in recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students. The success of the current US national policy to expand CHCs may be challenged by these workforce issues.

Community Health Centers↗