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PubMed1994

Clinical trials in the community. The community clinical oncology program experience.

In 1983, the National Cancer Institute initiated the community clinical oncology program (CCOP), the goal of which was to hasten the adoption of state-of-the-art cancer medicine in community-based institutions. The strategy adopted was to link community oncologists to major cancer centers and research bases for the conduct of clinical trials. Since the program was initiated, a significant amount of literature has been developed, providing insight into the operation and success of the program. These reports have been combined with experience of the author, a principal investigator of an established CCOP, in an effort to characterize the critical features of the program. Experience to date indicates that CCOPs have been successful in accruing patients to cancer-treatment clinical trials, contributing approximately one third of patients placed in investigational protocols. Since 1987, CCOPs have been required to participate in nontreatment-related research in cancer prevention, detection, and mitigation of cancer symptoms, or cancer control research. After a slow beginning, both the research bases and CCOPs have accumulated experience in the development of and accrual of patients in cancer control protocols. This review suggests that CCOPs, as they mature, will fulfill their goal as an important mechanism for the transfer of technology and the conduct of clinical research.

Clinical Trials as Topic↗
PubMed1996

CCPP-Copenhagen Community Psychiatric Project. Implementation of community mental health centres in Copenhagen: effects of service utilization, social integration, quality of life and positive and negative symptoms.

Deinstitutionalization of psychiatry in Denmark has been extensive and the number of psychiatric beds per 1,000 inhabitants is among the lowest in Europe. The effect of supplementing hospital treatment with treatment in community mental health centres was evaluated in a quasi-experimental design. The patient group examined consisted of patients with long-term contact with psychiatric services. When development in intervention and control districts was compared, the only significant difference was that the total patient group in the intervention district had an increased number of day attendances per year. Comparison of patients from intervention districts who attended day-centres regularly with patients from control districts before and after implementation of community mental health centres indicated that patients from intervention districts had a reduction in the use of inpatient services, a significant increase in quality of life and a significant decrease in the presence of the negative symptom, alogia. We concluded that implementation of community mental health centres can increase the quality of life for the patients and decrease the frequency of the negative symptom, alogia.

Adult↗
PubMed1976

Perspectives of clinical students on training in community mental health and community psychology.

Three hundred eighty-five advanced doctoral students from 102 training programs in clinical, clinical--community, and community psychology participated in as assessment of their training in community psychology/community mental health (CP/CMH). Significant findings included: (a) 66% consider training in CP/CMH as very helpful to their career goals, (b) 54% are very much interested in post-doctoral training in CP/CMH, and (c) 62% consider the training in CP/CMH available in their graduate programs below adequate. Respondents rated the coverage and adequacy of coverage of 30 CP/CMH-related topics. Only four topics were reported by 50% or more of the respondents as having been covered. For the 30 topics, reported adequacy of coverage ranged from 40% to 67%; the percentage of respondents who considered coverage inadequate ranged from 18% to 56%.

Attitude of Health Personnel↗
PubMed1998

[The local community as a life environment for the elderly--on the future role of the community in supporting the elderly].

This paper is based on the assumption that the community has--by constitutional law--an all-embracing responsibility for concerns/matters on the local level. In this context, special emphasis is put on the meaning of the local community as "social space". From this fundamental understanding, important tasks are derived for the community which refer to the needs assessment, planning, and co-ordination of help and services for older people. Here, this contribution draws upon recommendations which were given by the "Deutscher Verein für öffentliche und private Fürsorge" in Frankfurt/Main at the end of 1997.

Aged↗
PubMed1990

Community health workers in Bolivia: adapting to traditional roles in the Andean community.

Community health workers (CHW) constitute an outreach program where community members become involved in their health concerns and elect someone to be trained and administer primary health care. A major problem is that CHWs do not fit into leadership roles of either modern or traditional medicine. CHWs of Oruro, Bolivia, are discussed to examine the success of this program in which CHWs adapted to political, economic, and cultural patterns of Andean communities.

Bolivia↗
PubMed1994

Qualities of an ideal volunteer community malaria worker: a comparison of the opinions of community residents and national malaria service staff.

Since the late 1950s, most malaria surveillance and treatment in rural areas of Latin America has been carried out by networks of unpaid community malaria workers, known as Volunteer Collaborators, who are selected and supervised by staff of the national malaria services (NMSs) in each country. In spite of the free and readily accessible antimalarial treatment available at these Volunteer Collaborator posts, many residents continue to seek treatment elsewhere and in most cases take doses of antimalarials that are insufficient to cure their infections. To identify ways in which the Volunteer Collaborator Network could be made more attractive to residents and to improve the process of selection of new workers, we asked community residents and Guatemalan NMS workers to rank order, according to their importance, 11 qualities or characteristics of an 'ideal' volunteer malaria worker. Community residents preferred someone who is available to take care of patients at all times of the day, is a responsible person, and has a general knowledge of medicine. No significant differences were noted in the rank orders of male and female residents or literate and illiterate residents. National Malaria Service workers also preferred someone who takes care of patients at all times of the day, even when busy. In addition, they wanted individuals who recognize the importance of their work as a Volunteer Collaborator, but choosing volunteers who had a general knowledge of medicine was not important. By modifying the procedures used to select Volunteer Collaborators so as to identify candidates with the qualities preferred by residents, it should be possible to increase acceptance and improve the performance of these volunteer workers.

Adolescent↗
PubMed1994

Results from a community intervention project in the Nicaraguan mining community El Limon. An overview.

The first steps of a community involvement health project using the principles of community diagnosis and popular participation were carried out in a small Nicaraguan mining village during the second half of the 1980s. Using existing archives and obtaining new information aided by local organizations, priorities could be established for health and safety surveillance within the mining company, as well as for further investigations concerning what seemed to be dominant health problems in the community: serious accidents among the economically active population and diarrhoea and respiratory tract infections among children, as well as infections, and other health indicators of malnutrition. Workers also presented chronic simple bronchitis, ventilatory obstructive disturbance and hearing loss that were strongly associated with working conditions. These results helped to direct health priorities and educational activities at the local level with both the general and working population. The wide experience gained from this study has encouraged us to strengthen the link between research and action and in performing studies in close cooperation with local organizations.

Adult↗
PubMed1996

Community participation in HIV prevention: problems and prospects for community-based strategies among female sex workers in Madras.

The concept of strengthening community action within the context of HIV prevention is gaining popularity among health circles, with organizations such as gay volunteer groups in the U.S. providing positive evidence of the potential role of community participation in HIV/AIDS prevention and care efforts. Care must be taken, however, in assuming that participation can easily be achieved among all high-risk groups. This paper examines problems and prospects for participation in HIV prevention strategies among commercial sex workers (CSWs) in Madras. Based upon the experiences of a pilot project established by the Tamil Nadu State Government AIDS Cell and WHO, it finds that the organization of the commercial sex trade in Madras is not highly conducive to collective action. Identifying factors that have frustrated attempts to promote community-based strategies in the city, the paper suggests that this approach is unlikely to succeed unless there are significant changes to the institutional arrangements that keep sex workers in a position of subordination and exploitation.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Barriers to community integration for participants in community-based psychiatric rehabilitation.

This pilot study examined barriers to community integration for adults with serious mental illness (SMI) enrolled in a community-based psychiatric rehabilitation program. Program staff administered a self-report scale to 135 adults (mean age = 43.3 years, 53% men, 65.1% White). Staff completed the same measure. Individuals with mental illness and staff differed significantly in their reports of the type, number, F (1, 73) = 29.25, P < .0001, and severity (F (1, 176) = 43.53, P < .0001) of barriers to community integration. Clinicians should assist adults with SMI to identify relevant barriers, and participate in treatment planning and outcome evaluation.

Adult↗
PubMed2004

Mechanisms by which area-based regeneration programmes might impact on community health: a case study of the new deal for communities initiative.

STUDY OBJECTIVE: To explore mechanisms by which area-based regeneration initiatives may impact on health. DESIGN: Case study of the New Deal for Communities programme, part of the UK National Strategy for Neighbourhood Renewal. MAIN RESULTS: Health impacts may result from three mechanisms: sociospatial stigma, community participation and the commissioning of projects designed to change the distribution of determinants of health, including access to services and healthy lifestyles. CONCLUSIONS: The present UK National Strategy for Neighbourhood Renewal includes improving health status as one of its key outcome measures. Area-based regeneration schemes such as the New Deal for Communities initiative should, intuitively, bring about health gain through their participatory approach to changing the physical and socio-economic environments. At present, however, the direction and magnitudes of these impacts are not clear.

Community Health Services↗
PubMed1999

Bloodless surgery: establishment of a program for the special medical needs of the Jehovah's witness community--the gynecologic surgery experience at a community hospital.

OBJECTIVE: My purpose was to describe the rationale behind the establishment of a hospital-based program instituted to enhance the health of the Jehovah's Witness community and to evaluate patient profiles and outcomes of gynecologic patients treated surgically at our institution, during the past 5 years, whose intake was through the Bloodless Surgery Program and who were not accepting of blood or most blood products. I further describe how a coordinated program dedicated to serving this particular population might improve outcomes and patient satisfaction. STUDY DESIGN: A retrospective review of the charts of 89 patients, all Jehovah's Witnesses, who were enrolled through the Bloodless Surgery Program and underwent gynecologic surgery involving at least 1 night's hospitalization at our institution between January 1, 1993, and December 31, 1997, was performed. A comparison of patient length of stay, hospital charges, and surgical blood loss, in a subset of 41 patients who underwent abdominal hysterectomy, with a cohort of patients not affiliated with the Jehovah's Witnesses or the Bloodless Surgery Program was performed. Data regarding patient satisfaction were obtained through surveys and are presented. RESULTS: Patients enrolled through the Bloodless Surgery Program and undergoing abdominal hysterectomy were significantly younger (average age 43.4 vs 47.7 years) and incurred significantly lower hospital charges (average cost $8754 vs $9539). No significant difference between the group studied and the control group could be found in average length of stay or the average change between preoperative and postoperative hemoglobin levels. Data from patient satisfaction surveys suggest a high level of satisfaction with the Bloodless Surgery Program. CONCLUSION: A program dedicated to the special needs of the Jehovah's Witness community can be instituted in a community-based hospital with no evidence of increased morbidity, as evidenced by length of stay, hospital charges, and surgical blood loss, in a gynecologic patient population. Development of such programs is associated with a high level of patient satisfaction and the potential for improved patient care.

Adult↗
PubMed1998

Measuring progress and outcome in community rehabilitation after brain injury with a new assessment instrument--the BICRO-39 scales. Brain Injury Community Rehabilitation Outcome.

OBJECTIVE: Construction and validation of a new instrument, the Brain Injury Community Rehabilitation Outcome scales, to assess problems experienced by brain-injured patients living in the community. DESIGN: Seventy-six items describing aspects of personal and social functioning were generated. Two hundred thirty-five patients and/or their carers (separately) rated the items on 6-point scales, and patients retrospectively rated their functioning before injury. Seven scales were derived from factor analysis; one was included a priori. Thirty-nine items with high factor loadings were retained. Test-retest reliability, interrater reliability, and construct validity were examined in subsamples. SETTING: Patients were recruited from four centers: two community-based teams, a day-patient clinic, and an outpatient clinic. PATIENTS: Of the patients, 127 had traumatic brain injury, 72 had cerebrovascular accidents, 15 had multiple sclerosis, and 21 had acquired brain injury of other origins. Mean time since brain injury was 2.6 years; mean age was 43 years; 164 were men and 71 were women. RESULTS: All scales showed good test-retest reliability, and agreement between patient and carer ratings was moderate to high. They showed predicted moderate correlations with other relevant scales. Postinjury scores differed significantly from preinjury scores, and 6 of the 8 scales showed change over a period of recovery/rehabilitation. CONCLUSIONS: The scales appear reliable and easy to complete. They may have utility as quantitative measures of outcome for clinical and treatment evaluations.

Activities of Daily Living↗
PubMed1997

Community midwives' and general practitioners' perspectives, of antenatal care in the community.

OBJECTIVE: to ascertain who was providing antenatal care in the community in a defined geographical area in the north of England, and whether the care could achieve the government objectives presented in Changing Childbirth (DoH 1993). DESIGN: a questionnaire was used to obtain demographic information and semi-structured interviews were held with care providers in order to assess the perspective of those providing care. PARTICIPANTS: a purposive sample of nine community midwives and six general practitioners (GPs). FINDINGS: the midwife was the professional undertaking most of the antenatal care although in most instances there was a GP available on site if required. GPs saw the midwife as the main provider of care with themselves as 'back up'. Conflict over responsibility for care was an issue in some instances. Whilst changes in antenatal care provision had been, or were about to be made, only one midwife expressed a clear positive feeling towards midwife-led care. Giving women the opportunity for choice provoked an overwhelming feeling of helplessness for midwives. Midwives and GPs believed their education adequately prepared them to provide antenatal care in the community, however, GPs did not attend regular updating sessions. IMPLICATIONS FOR PRACTICE: whilst it was recognised that midwives are taking increasing responsibility for antenatal care, GPs still believe that overall responsibility lies with them; therefore, there is a need to clarify roles. The majority of midwives expressed reservations about midwife-led care.

Adult↗
PubMed2002

Oral gatifloxacin in outpatient community-acquired pneumonia: results from TeqCES, a community-based, open-label, multicenter study.

Gatifloxacin is an 8-methoxy fluoroquinolone with broad activity against respiratory tract pathogens, including those commonly associated with community-acquired pneumonia (CAP). To evaluate the efficacy and safety of oral gatifloxacin 400 mg once daily for seven to 14 days, community-based physicians enrolled adult outpatients with confirmed or suspected CAP in a prospective, single-arm, open-label, noncomparative study. Of 1488 clinically evaluable patients with radiographically confirmed or clinically suspected CAP, 1417 (95.2%) were cured. All strains of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the most commonly isolated pathogens, were susceptible to gatifloxacin. Penicillin nonsusceptibility was seen in 32.6% of S. pneumoniae isolates, and beta-lactamase production was detected in H. influenzae (26.9%) and M. catarrhalis (88%) isolates. Clinical cure rates of 91%, 94%, and 92% were achieved in patients with S. pneumoniae, H. influenzae, and M. catarrhalis, respectively. All seven patients with fully penicillin-resistant S. pneumoniae (MIC > or =2 micro g/ml) were cured. Gatifloxacin was well tolerated, with the most common drug-related adverse events being nausea (2.8%) and diarrhea (1.7%). Gatifloxacin is effective and well tolerated as empiric therapy for CAP in the outpatient community setting.

Administration, Oral↗
PubMed2007

Using lay counsellors to promote community-based voluntary counselling and HIV testing in rural northern Ghana: a baseline survey on community acceptance and stigma.

Access to voluntary counselling and HIV testing (VCT) remains limited in most parts of Ghana with rural populations being the least served. Services remain facility-based and employ the use of an ever-dwindling number of health workers as counsellors. This study assessed approval for the use of lay counsellors to promote community-based voluntary counselling and testing for HIV and the extent of HIV/AIDS-related stigma in the Kassena-Nankana district of rural northern Ghana. A cross-sectional questionnaire survey was conducted. Logistic regression was used to identify predictors of the tendency to stigmatize people living with HIV/AIDS (PLWHAs). Focus group discussions were held and analytical coding of the data performed. The majority (91.1%) of the 403 respondents indicated a desire to know their HIV status. Most (88.1%) respondents considered locations outside of the health facility as preferred places for VCT. The majority (98.7%) of respondents approved the use of lay counsellors. About a quarter (24%) of respondents believed that it was possible to acquire HIV through sharing a drinking cup with a PLWHA. About half (52.1%) of the respondents considered that a teacher with HIV/AIDS should not be allowed to teach, while 77.2% would not buy vegetables from a PLWHA. Respondents who believed that sharing a drinking cup with a PLWHA could transmit HIV infection (OR 2.50, 95%CI 1.52-4.11) and respondents without formal education (OR 2.94, 95%CI 1.38-6.27) were more likely to stigmatize PLWHAs. In contrast, respondents with knowledge of the availability of antiretroviral (ARV) drugs were less likely to do so (OR 0.40, 95%CI 0.22-0.73). Findings from the thirteen focus group discussions reinforced approval for community-based VCT and lay counsellors but revealed concerns about stigma and confidentiality. In conclusion, community-based VCT and the use of lay counsellors may be acceptable options for promoting access. Interventional studies are required to assess feasibility and cost-effectiveness.

Adult↗
PubMed2000

Community pharmacists' views and beliefs about the treatment of symptoms suggestive of vaginal thrush in community pharmacies.

OBJECTIVE: To investigate the views and beliefs of community pharmacists about the benefits and disadvantages to the customer, pharmacy and pharmacist of treating women with symptoms suggestive of vaginal thrush. DESIGN: Semi-structured interviews. SETTING: Community pharmacists from within Grampian Primary Care NHS Trust. OUTCOME MEASURES: Pharmacists' views and beliefs analysed using content analysis. RESULTS: Of the 26 pharmacists contacted, 19 (73%) pharmacists from 16 pharmacies completed interviews. The pharmacists were generally positive towards the treatment of women with vaginal symptoms and perceived few disadvantages. Immediate access to treatment and rapid symptom relief were perceived to be the greatest advantages to the customer. The main problems were customer embarrassment, cost and the risk of masking a serious condition. Customer embarrassment was perceived to be influenced by lack of privacy and the gender of the member of staff involved in the consultation. Five pharmacists perceived vaginal thrush to be an infection that could be spread by sexual transmission. DISCUSSION: There is a need to make pharmacists aware of the current evidence regarding the treatment of vaginal thrush, particularly the sexual partners of women with acute, uncomplicated thrush do not require treatment with an antifungal. The main difficulties that community pharmacists reported with the treatment of this condition were obtaining an accurate history and this was influenced by customer embarrassment. The gender of pharmacy staff and lack of private consultation facilities were suggested as factors that are associated with customer embarrassment and hence, the ability to obtain an accurate history.

Adult↗
PubMed1997

Children's smoking habits in an agricultural community in Japan and the importance of a no smoking program integrating family, school and community health.

The object of this study is to establish a model of integration of the health promotion projects which have been planned separately by schools and communities so far in an agricultural area in Japan, to solve the problem of children's smoking. The subjects of the study were 10-15 y old schoolchildren and their parents. The questionnaires were completed by the children themselves at school and also by their parents at home, in July 1995. One fourth of the junior high school boys had ever tried smoking, while most of their parents did not notice that their children were smoking. More than half of the children who had ever tried smoking mainly acquired tobacco from their homes. One tenth of them were prompted to smoke by their fathers or other relatives. To develop a health promotion project for children which includes prevention of smoking, the provision of a health education program and an environment which encourages health are important for children. The project should also be community-based because participation of local inhabitants in the project gives it additional impetus. In order to promote the comprehensive health of children, we emphasize the importance of setting up a healthy district plan based on the health policy of the general community.

Adolescent↗
PubMed1995

The implementation of Project 2000 in the community: a new perspective on the community nurse's role.

This paper considers some of the initiatives taken by community nurses in England in implementing Project 2000 placements. The data were obtained during an English National Board funded study in two phases. The first phase involved a series of exploratory interviews, a postal questionnaire survey, and semi-structured interviews with 15 managers. In phase two, one Project 2000 demonstration district was studied in depth by means of interviews complemented by small-scale questionnaire studies. Community nurses had confronted a number of difficulties in implementing Project 2000. Among the most serious of these were shortage of time, poor communication with the colleges of nursing and lack of preparation. As a consequence, community nurses took what they saw as independent approaches to students' placements. Many set their own aims and objectives for placements and produced written guidelines and teaching plans for students. Many also asserted the importance of their role in the assessment of students' practical work.

Attitude of Health Personnel↗