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PubMed1990

A simplified methodology for the community-based assessment of breast-feeding and amenorrhoea in Mexico.

Reported is the use of a simplified methodology for carrying out a community-based epidemiological assessment that is compatible with the goals of primary health care research. For this purpose, a current-status life table analysis of data from 1131 women who were served by community health workers in the State of México was used to determine the distributions of the duration of postpartum breast-feeding, amenorrhoea, and contraceptive use. The field methods used incorporated quality assurance procedures. At 1 month postpartum, 78% of the infants were still being breast-fed, at 5 months 50%, and at 12 months 25%. The level of amenorrhoea at 1 month postpartum was 85%, at 3 months 50%, and at 5 months 25%. Use of contraceptives was initiated at an early stage, with 42% of all users beginning during the first month postpartum. The simplified method described permitted the area's primary health care administrators to carry out research projects for programme development rapidly and was compatible with the locally available resources.

Adult↗
PubMed1989

Parasitic, bacterial and viral pathogens isolated from diarrhoeal and routine stool specimens of urban Bangladeshi children.

Few data exist in Bangladesh on longitudinal, community-based studies of bacterial or parasitic pathogens identified in routine and diarrhoeal stools of urban dwelling children. We undertook the following study on 343 children of age less than 6 years who resided in one of 51 slum settings in Dhaka, Bangladesh, between October 1984 and February 1986. Specimens from diarrhoeal episodes and from routine stools obtained at 3-monthly intervals were examined for parasites, rotavirus and pathogenic bacteria. Parasites were isolated from 509 (51%) of the 1006 routine stools and from 95 (42%) of the 225 diarrhoeal stools. Isolation rates steadily increased with age. Ascaris lumbricoides and Trichuris trichiura accounted for approximately 80% of all parasitic isolates in routine and diarrhoeal stools. Giardia lamblia was isolated from 11% diarrhoeal stools. Entamoeba histolytica was an uncommon isolate (less than 1%). Bacterial pathogens were identified in 55 (24%) of the diarrhoeal stools but were identified in only 164 (16%) of the 1028 routine stools examined (P less than 0.01). Toxigenic Escherichia coli, Shigellae and Campylobacter were the most frequent isolates from diarrhoeal and routine specimens. This pathogen profile appears to be more in keeping with that from urban settings in other developing countries than from rural Bangladesh, suggesting that extrapolations from rural-based data should not be made for urban settings.

Age Factors↗
PubMed1995

Prostate-specific antigen in a community screening program.

BACKGROUND: This study was designed to determine who participates in community-based prostate-specific antigen (PSA) screening programs and what serum PSA levels can be expected. METHODS: A descriptive analysis of men who participated in an annual community health screening program was used to compare men who chose PSA screening with those who did not. The relationship of demographic variables to PSA level was evaluated by multivariate regression analysis. Data were available on 5548 men, 6% of whom were black. RESULTS: The population of PSA screening participants included proportionately more middle-aged white men with higher median income, as compared with men who did not participate. Those who did not participate in the screening were more likely to be either very old or very young. PSA levels increased with age, and the percentage of men with elevated PSA levels increased with age. One tenth (9.6%) of all participants had PSAs between 4 ng/mL and 10 ng/mL, and 1.9% had levels greater than 10 ng/mL. Within 1 year of the screening, 1.7% of the screened participants had a diagnosis of prostate cancer. The mean PSA in this group was 15.9 ng/mL. CONCLUSIONS: These data confirm the need for age-specific PSA reference ranges. It is likely that the same reference range can be used for all racial ethnic populations.

Black or African American↗
PubMed1995

Community-based prevalence of anal incontinence.

OBJECTIVE: To determine the prevalence of and characteristics associated with anal incontinence in the general community. SETTING: Community survey. PARTICIPANTS: The population of the state of Wisconsin sampled in the Wisconsin Family Health Survey. Subjects were identified by random digit dialing with telephone interview. The individual within each household identified as most knowledgeable about the health status of all other members of the household was asked about the health status of each member of the household. Approximately 200 households were surveyed each month. MAIN OUTCOME MEASURES: The presence of anal incontinence to solid or liquid feces or gas, who suffered from it, the frequency of anal incontinence, and how the incontinent person coped with it. RESULTS: A total of 2570 households comprising 6959 individuals were surveyed, and 153 individuals were reported to have anal incontinence, representing 2.2% of the population (95% confidence interval [Cl], +/- 0.3%). Thirty percent of the incontinent subjects were older than 65 years, and 63% were women. Of those with anal incontinence, 36% were incontinent to solid feces, 54% to liquid feces, and 60% to gas. In a multivariate analysis, independent associations of the following risk factors with anal incontinence were found: female sex (odds ratio [OR], 1.5; Cl, 1.1 to 2.1), age (continuously adjusted) (OR, 1.01; Cl, 1.01 to 1.02), physical limitations (OR, 1.8; Cl, 1.2 to 2.7), and poor general health (OR, 1.6; Cl, 1.4 to 1.9). CONCLUSIONS: Anal incontinence was reported in 2.2% of the general population. Independent risk factors for incontinence include female sex, advancing age, poor general health, and physical limitations.

Adult↗
PubMed1994

Epidemiology of celiac sprue: a community-based study.

OBJECTIVE: To address the frequency and outcome of celiac disease in a United States community. METHODS: We identified all Olmsted County, Minnesota, residents diagnosed with this condition during the period, 1960 through 1990, using the resources of the Rochester Epidemiology Project. Twenty-eight incident cases (19 women, nine men) were identified. RESULTS: The overall age- and gender-adjusted incidence of celiac disease in the community was 1.2 per 100,000 person-yr (95% CI 0.7, 1.6). There were no significant changes in incidence over time, although rates did increase; the incidence was similar in men and women and rose with age in both genders (p < 0.05). Survival in this inception cohort was 100% at 6 months and 96% at 5 yr, which was not significantly different from expected. The estimated prevalence on January 1, 1991, was 21.8 per 100,000. CONCLUSION: This study provides the first epidemiologic data on celiac disease in the United States.

Adult↗
PubMed1993

Schistosomiasis and intestinal parasites in rural villages in southwest Nigeria: an indication for expanded programme on drug distribution and integrated control programme in Nigeria.

A cross sectional survey of schistosomiasis, intestinal parasite infections and pattern of schistosomiasis transmission was undertaken in four rural villages around the Erinle dam, Nigeria. The prevalence of Schistosoma haematobium ranged from 10% to 60%. 30% of infected school children excreted over 50 eggs/10 ml urine and high rates of haematuria, proteinuria, leucocyturia and nitrites in urine were observed in infected children and the villagers. Prevalence of infection with S. mansoni ranged from 11.4% to 36.8%. Intensity of infection based on geometric mean eggs/gram of faeces ranged between 100 and 545.7 eggs/g. Malacological surveys showed that Biomphalaria pfeifferi was the predominant potential snail hosts recovered at all the contact sites. Higher infections with schistosome parasites were also recorded for B. pfeifferi than Bulinus globosus. The pattern of transmission of schistosomiasis by the snails is consistent and makes incorporation of community-based focal application of a molluscicide such as Tetrapleura tetraptera in integrated control of schistosomiasis feasible in the area. Prevalence and intensity with Ascaris lumbricoides was high. The highest prevalence was 68.9% while the highest intensity of infection was 2,440.9 eggs/gram of faeces. Multiple infections occured with various combinations of Ascaris lumbricoides, hookworm, S. haematobium, Fasciola gigantica, S. mansoni, and Entamoeba histolytica (as double, triple or quadruple infections). The results suggest an integrated approach to the control of schistosomiasis and intestinal parasites in this part of the country.

Adult↗
PubMedDate not supplied

Use of peer role models to increase Pap smear and mammogram screening in Mexican-American and black women.

We evaluated the use of a community-based intervention model to increase Pap smear and mammogram screening in minority women. The community programs were based on the A Su Salud (To Your Health) model, which includes the presentation of positive role models in the media and positive social reinforcement by community volunteers. Mexican-American women 40-70 years of age in Corpus Christi, Texas, and black women 40-70 years of age in Galveston, Texas, were targeted. Role models from the target community told their personal stories about cancer screening through local media (television, radio, and newspapers). Volunteers reinforced media messages among the target audience by distributing newsletters. Preintervention and postintervention cross-sectional surveys among the target group measured relative increases in knowledge, attitude, and practice. Pap smear use (past two years) was not substantially improved. Mammogram use (past two years) increased 57% among Mexican-American women (prevalence rate ratio [PRR] = 1.57; 90% confidence interval [CI] = 1.19, 2.08) and 30% among black women (PRR = 1.30; 90% CI = 1.04, 1.63). We demonstrated the feasibility of implementing a peer role model intervention at the local health department level. The improvement in mammogram use among high-risk women is encouraging, but further controlled research is needed to test the effectiveness and cost-efficiency of this approach.

Adult↗
PubMedDate not supplied

A community-based program to facilitate dental care for senior citizens.

This article presents findings of a one-year trial which examined a community-based program in Clinton County, Indiana, to help facilitate entry of senior citizens into the oral health care delivery system. A multifaceted approach addressed the senior citizens' limited knowledge of oral health care, personal barriers to obtaining dental services, and the community's concern for the health of older citizens. Program components included oral health education (newspaper articles, presentations, pamphlet distribution), personalized patient motivation ("Bring-a-Friend" campaign), and oral health screenings (public screenings and "Senior Day at the Dentist"). During the study year, 345 patients visited the dentist, compared to 179 in the baseline year. Ninety-three participated in the two "Senior Day" screenings, and 53 percent of the total 134 screening patients returned for follow-up care. Given its experimental nature, the program was a success.

Aged↗
PubMed1996

Using audiotapes to monitor student-preceptor interactions in a decentralized clerkship.

BACKGROUND: Community-based preceptors are increasingly being used to provide clinical experiences for medical students; therefore, the issue of when and how to monitor the appropriateness of teacher-learner interactions in the clinical setting has become increasingly complex and urgent. This paper describes how an audiotaping program in a department of family medicine was designed to account for preceptor and student needs and what this audiotaping experience revealed about the teaching strengths and weaknesses of full-time and volunteer faculty. METHODS: Audiotaped case discussions between third-year students and preceptors were evaluated using a structured instrument that reflected important responsibilities of clerkship preceptors. Reviews were compared using chi-square to evaluate for significant differences between university and community preceptors in overall quality of interaction with students and in specific deficiency areas. Ninety-five percent confidence intervals were used to evaluate for significant differences in frequency of occurrence among deficiencies. RESULTS: A total of 376 audiotaped case discussions were reviewed between July 1992 and June 1994. University preceptors had significantly more "superior" interactions with students than their community peers (P < .05). However, university and community preceptors had nonsignificant differences when specific deficiency areas were compared. Deficiencies in students who were allowed to present cases and assessments occurred significantly less frequently, while deficiencies in preceptors using open-ended questions occurred significantly more frequently than deficiencies in other areas. CONCLUSIONS: This study shows that volunteer faculty performed comparably to full-time university faculty in both the frequency of deficiencies in teacher-learner interactions identified and in the types of deficiencies identified. Both university and volunteer faculty had the most deficiencies in higher-order teaching skills--those involving synthesizing and assessing student knowledge and selecting appropriate questions based on that information. Audiotaped case discussions have a potentially significant role in monitoring teacher-student interactions, particularly on decentralized clinical rotations.

Chi-Square Distribution↗
PubMed1996

Blood pressure, diabetes, and body mass index among Chippewa and Menominee Indians: the Inter-Tribal Heart Project Preliminary Data.

THE HEART DISEASE MORTALITY RATES of the Chippewa and Menominee, who reside in the upper Midwest, are higher than the rates of most other tribes in the United States. Little is known, however, about the prevalence of hypertension, diabetes, and obesity among these communities. The Inter-Tribal Heart Project (ITHP) was designed to determine the prevalence of risk factors for heart disease and to implement community-based heart disease prevention programs. Age-stratified random samples of active users of the tribal-Indian Health Service (IHS) clinics, ages 25 and older, were drawn from three communities within the Bemidji Service Area. Between September 1992 and June 1994, 1396 people completed an extensive questionnaire and underwent a physical exam for heart disease risk factors. Preliminary data indicate mean blood pressure levels of 126 mmHg for systolic blood pressure (SBP) and 74.4 mmHg for diastolic blood pressure (DBP). Mean SBP and DBP were higher among men than women. Mean body mass index (BMI), which did not vary by gender, was 30.6 mmHg. The prevalence of hypertension was 33%; and diabetes, 33%. Men had a higher prevalence of hypertension than women, but there was little gender difference in the prevalence of diabetes. These preliminary data suggest that the prevalences of hypertension, diabetes, and obesity in these communities are higher than the recent estimates for the total United States. The next stage of the ITHP will focus on policies and programs to prevent and treat these conditions.

Adult↗
PubMed1996

An electronic consumer health library: NetWellness.

NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org.

Community Participation↗
PubMed1996

[Living conditions of prostitutes: consequences for the prevention of HIV infection].

Since 1990, several community-based interventions have been set up for populations of prostitutes in France with the principal objective of preventing HIV infection in prostitutes and their sexual partners. Field workers have suggested that extremely precarious living conditions are a major obstacle for the diffusion of prevention messages. A multidisciplinary working group thus set up a study in order to determine which living conditions could affect the adoption of behaviour at low risk for HIV infection. In May 1995, six of the seven teams conducting prevention actions among prostitutes in France used a short standardised questionnaire to collect information including type of housing, health insurance cover, physical aggressions, drug use. It was planned to collect data from all persons attending the drop-in centres. A total of 355 questionnaires were completed (sampling was exhaustive for 3 of the 6 teams). The population comprised women, men and transvestites. The median age was 28 years. Only 39% (135/348) of the subjects had access to health insurance. Approximately 50% (160/324) of the persons lived in precarious accommodation (hotel or no fixed address) and 33% (119/355) had been victims of physical aggressions during the 5 months preceding the study. Transvestites and young people had the most precarious living conditions. Despite the limits of this study due to the difficulty in carrying out a survey in this very marginalised population, the unique information collected may enable community health action strategies to be suitably adapted. In particular, it is important to improve partnership between field workers and existing social and health services, to improve access to better accommodation, health care and physical security while disseminating prevention messages and distributing condoms.

Adolescent↗
PubMed1997

ERCP and sphincterotomy in the context of laparoscopic cholecystectomy: academic and community practice patterns and results.

OBJECTIVE: To study the effect of practice setting and practitioner experience on the use and results of ERCP and sphincterotomy in the context of laparoscopic cholecystectomy. METHODS: Data were collected on 780 ERCPs performed before or after laparoscopic cholecystectomy. Biliary endoscopists at four academic centers and 33 community-based gastroenterologists of varying experience participated. RESULTS: Indications for perioperative ERCP were similar in academic centers and community practice, but academic experts performed a significantly higher proportion of postoperative procedures. Success rates were high for all participants, although the least experienced group of community-based gastroenterologists had a significantly lower rate of success with sphincterotomy. Complication rates did not vary significantly among participants. CONCLUSIONS: Experienced community-based gastroenterologists can perform ERCP and sphincterotomy in the context of laparoscopic cholecystectomy with results comparable to those of academic experts. Gastroenterologists with a life-time experience of fewer than 200 ERCPs have lower success rates for sphincterotomy than more experienced practitioners in either practice setting. ERCP performed in community or academic settings can provide safe and effective management of common bile duct stones and biliary leaks or strictures that occur after laparoscopic cholecystectomy.

Academic Medical Centers↗
PubMed1997

Peer social networks of young boys with developmental delays.

Community-based peer social networks of young boys with developmental delays and parental arranging and monitoring of their child's peer contacts were examined. Comparisons were made to matched groups of children who were developing typically and to children with communication disorders. Results showed more limited peer social networks for both groups of children with disabilities based primarily on the frequency of contacts with peers and linkages established across school and community settings. All three groups were indistinguishable from one another on numerous measures of peer social networks, including duration and quality of individual relationships and participation in organized group activities with peers. Groups also differed on parental arranging and monitoring, which appeared to be related to children's developmental level.

Analysis of Variance↗
PubMed1996

Seroprevalence and risk factors of human cysticercosis in a community of Shandong, China.

A community-based seroepidemiologic survey on Taenia solium cysticercosis in humans was carried out in Shandong Province, China. Blood specimens from 2,898 residents were collected and examined for anti-cysticercus antibody. Information on demographic and potential risk factors was obtained using a standardized questionnaire. The overall seroprevalence of cysticercosis was 3.2%. Seropositivity tended to increase with age ranging from 1.8% in children under 6 years of age to 5.7% in those over 60 years old. Distance between village residence and the town of the community was negatively associated with seropositivity (Chi-square for trend test p = 0.02). Multivariate logistic regression analysis identified four risk factors for cysticercosis infection in the community: defecating indiscriminately (OR = 1.35, 95% CI 1.01-1.81), being unable to identify diseased pork (OR = 4.09, 95% CI 1.53-10.97), raising pigs (OR = 1.36, 95% CI 1.09-1.69), and more than 60 years old (OR = 1.49, 95% CI 1.10-2.02. These findings have implications for developing appropriate strategies for the control of Taenia solium cysticercosis in the community.

Adolescent↗
PubMed1996

High prevalence of trichomonal vaginitis and chlamydial cervicitis among a rural population in the highlands of Papua New Guinea.

We conducted a community-based study of the prevalence of sexually transmitted diseases in rural and periurban communities in Eastern Highlands Province. We interviewed a stratified random sample of women and men, examined the women for evidence of sexually transmitted diseases (STDs) and collected specimens for diagnosis of syphilis, by serology and dark-field microscopy, gonorrhoea, by Gram stain and culture, chlamydial infection, by polymerase chain reaction (PCR) and direct immunofluorescence (DIF), trichomoniasis, by wet mount, and bacterial vaginosis, by wet mount and Gram stain. The men were tested for chlamydial infection only (first void urine tested by PCR and DIF). 201 women and 169 men were tested. Additionally, adults in the same communities who had not been randomly selected were offered the same services. An extra 243 women and 85 men were tested in this way. The laboratory results confirmed the clinical impression of an extremely high prevalence of STDs in this population. Among those randomly selected, 46% of the women had trichomonal vaginal infections and 26% had Chlamydia trachomatis infections detected by PCR, while 25% of the men had chlamydial infections. Other infections were much less common. 58% had one or more STDs. The prevalence of infection in self-selected adults was similar to that found in those randomly selected.

Adolescent↗
PubMed1996

Knowledge about sexually transmitted diseases in rural and periurban communities of the Asaro Valley of Eastern Highlands Province: the health education component of an STD study.

Community health education played a major role in a study of sexually transmitted diseases (STDs) and other reproductive tract infections which we conducted in rural and periurban communities of the Asaro Valley near Goroka in the Eastern Highlands Province of Papua New Guinea. We found that most women had little knowledge about STDs, which they often did not realize were sexually transmitted. Even major signs and symptoms were thought to be normal and many women had not sought treatment until irreversible damage was done. Knowledge of the complications of STDs, such as infertility and stillbirth, was also slight in these women. It is apparent that there is a desperate need for more reproductive health education at the community level. In developing our health education methods, we found that simple line drawings of male and female reproductive organs and of people with different signs of STDs proved useful. These were quick and easy to produce from readily available materials. It was important to separate men and women into different groups with educators of the same sex, and to create a very informal atmosphere, encouraging free-ranging discussion. Following health education and sensitive interviewing, almost all the women selected for the community-based study of the prevalence of reproductive tract infections consented to vaginal examination, even if they were asymptomatic. Additionally, many nonselected women requested examination.

Adolescent↗
PubMed1998

Nursing home applications--reasons and possible interventions.

BACKGROUND: With a rapidly ageing population like Singapore, the need for nursing homes will increase. Admission to a nursing home may be for medical and/or social reasons. We carried out case studies with the Care Liaison Service (CLS) of the Ministry of Health to determine reasons why the elderly applied for nursing home admission, and whether it was possible to prevent an admission. PATIENTS: During the 6-month study period, 331 applications were received, of which 280 (84.6%) were > or = 60 years. There was an equal distribution of male (50.4%) and female (49.6%) applicants. Applicants were predominantly Chinese (86.0%), followed by Indians (8.0%), Malays and other races (3.0% each). Most of the applicants were semi-ambulant (50.0%), fully ambulant (31.4%) and non-ambulant (18.6%). The most common medical problems of the applicants were neurological (e.g. stroke, normal pressure hydrocephalus, epilepsy), heart diseases (e.g. hypertension, ischaemic heart disease, heart failure), orthopaedic conditions (e.g. osteoarthritis, fractures neck of femur and other fractures), and psychiatric problems (e.g. dementia, depression and history of schizophrenia/paranoid psychosis). METHOD: Fifty-seven applicants (20.4%) were selected for intervention. They were 'non-psychiatric' patients whose caregivers were willing but unable to look after them. About half (28, 49.1%) of these applicants required nursing home care. The remaining 29 patients (50.9%) had the potential of improving or able to remain at home with appropriate community services. These 29 patients were contacted by the CLS nurse and the following recommendations were made: 1) inpatient rehabilitation in a community hospital (7 patients); 2) rehabilitation and day care in a community-based day care centre (17 patients); 3) domiciliary medical care (4 patients), and 4) reassessment by psychiatrist to control psychotic symptoms (1 patient). Only 6 patients were willing to accept the new recommendations. This poor result may imply that attempts at intervention at this stage may be too late. CONCLUSION: We need to identify the group at risk for nursing home admissions early, take a proactive stance towards them, increase support to their caregivers to prevent burnt-out and continue to develop and publicize community-based services. More studies need to be done in this area.

Aged↗