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At least 1,243 records · Page 69Linked to original sources
PubMed2005

Effects of breast feeding on neuropsychological development in a community with methylmercury exposure from seafood.

Breastfeeding has been associated with an advantage to infant neurobehavioral development, possibly in part due to essential nutrients in breast milk. However, breast milk may be contaminated by environmental neurotoxicants, such as methylmercury. In the Faroe Islands, where maternal consumption of pilot whale may cause transfer of marine toxicants into breast milk, a cohort of 1022 consecutive singleton births was generated during 1986-87. Methylmercury exposure was assessed from mercury concentrations in cord blood and in the hair of the child at age 12 months, and the duration of breastfeeding was recorded. At approximately 7 years of age, 917 (90%) of the children underwent detailed neurobehavioral examination. After adjustment for confounders, breastfeeding was associated with only marginally better neuropsychological performance on most tests. These associations were robust even after adjustment for cord-blood and hair mercury concentration at age 1 year. Thus, in this cohort of children with a relatively high prenatal toxicant exposure and potential exposure to neurotoxicants through breast milk, breastfeeding was associated with less benefits on neurobehavioral development than previously published studies though not associated with a deficit in neuropsychological performance at age 7. Although the advantage may be less, Faroese women can still safely breastfeed their children.

Adult↗
PubMedDate not supplied

Development of a community cancer education program: the Forsyth County, NC cervical cancer prevention project.

The authors outline the development and implementation of a public health education program for cervical cancer screening among black women in Forsyth County, NC. The educational program includes distributing electronic and printed information media messages, a program of direct education for women, and providing information on current issues in cervical screening to primary-care physicians. Program development was based on social marketing principles, the PRECEDE model, and the communication-behavior change (CBC) model. Since a true experimental design was not feasible, program evaluation is based on several complementary quasi-experimental designs. Analysis of baseline data indicate that the county where the intervention is taking place, and the control county, are similar with respect to both demographic characteristics and the current level of screening activity. Preliminary results indicate that the program has been successful in raising women's level of awareness of cervical cancer and cervical screening.

Adult↗
PubMed2003

Developing culturally competent community faculty: a model program.

The Liaison Committee on Medical Education recently set standards for cultural diversity training as part of the medical school curriculum. To the authors' knowledge, this is the first description of a faculty-development program designed to develop the capacity of the clinical faculty to integrate culture and advocacy education into clinical training. The paper describes the first two years of the development of an ongoing cultural competence curriculum that has been integrated into the training of community preceptors from 13 medical schools in New England and New York. The training, entitled"Teaching the Culture of the Community," consists of four 2.5-hour modules that include interactive lectures and small-group role-play exercises on cultural needs assessment, patient-centered interviewing, feedback on cultural issues and use of the community to enhance cultural understanding. The 137 participants in the first two years of the program (1999-00 and 2000-01) reported a high level of acceptance of the curriculum. In the second year, the program began to document participants' self-reported"intention to change" in relation to the cultural competence curriculum. Many participants reported plans to change aspects of their clinical care and their teaching practices. Intentions to change were most frequently expressed in the context of content on effective communication skills. In summary, cultural competency training has been successfully integrated into an existing faculty-development program for community-based preceptors.

Clinical Competence↗
PubMed1984

Progressive immune failure in dyskeratosis congenita. Report of an adult in whom Pneumocystis carinii and fatal disseminated candidiasis developed.

Community-acquired Pneumocystis carinii pneumonia developed in a young adult patient with dyskeratosis congenita. His hospitalization ended fatally with disseminated candidiasis. Evaluation during the admission showed evidence of cellular immune dysfunction as indicated by skin test anergy and absent lymphocyte proliferation in an in vitro mixed lymphocyte culture. Treatment with transfer factor failed to reverse the cutaneous anergy or affect the clinical course. Dyskeratosis congenita is a rare multisystem disorder with prominent dermatologic manifestations; bone marrow failure or malignant neoplasm are common fatal outcomes. Immune system abnormalities are not classically considered a part of the disease complex. Serial evaluation of our patient's condition over several years suggests that depressed immune function, especially of the cellular limb, may evolve as a feature of clinical importance in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Lung volume reduction surgery at a community hospital: program development and outcomes.

STUDY OBJECTIVES: Description of the development and results of a program in lung volume reduction surgery (LVRS) at a community hospital. DESIGN: Prospective data collection. SETTING: A 320-bed community hospital. PATIENTS: Fifty-five patients consecutively discharged from the hospital following LVRS. The mean preoperative FEV1 averaged 28% (+/-8%) of predicted values, while the preoperative PaCO2 averaged 49 mm Hg (+/-11.5 mm Hg). Forty-eight patients completed a preoperative conditioning regimen and underwent the procedure on an elective basis. Seven patients underwent the procedure during a hospital admission for a COPD exacerbation. Eight patients required mechanical ventilation preoperatively, including three who had required long-term mechanical ventilatory support. RESULTS: Three patients (5%) died in the hospital following surgery. One patient developed chronic ventilator dependence. All three of the patients who required long-term mechanical ventilation preoperatively were weaned from the ventilator and returned home. Follow-up pulmonary function testing is available for 42 patients 3 months after surgery, and for 20 patients 6 months after the operation. At 3 months, the mean FEV1 improved 0.19 L (p=0.0002), the mean improvement for FVC was 0.37 L (p=0.0001), and the mean drop in residual volume was 0.97 L (p=0.0001). Similar changes are seen at 6 months. Highly significant improvements were also seen in quality of life measurements and exercise performance. The benefits of surgical treatment of emphysema seemed similar in both elective and urgent groups. CONCLUSIONS: LVRS can be done safely and effectively at a community hospital, with significant improvement in pulmonary function and quality of life.

Adult↗
PubMed2000

Integrated institution--community rehabilitation in developed countries: a proposal.

PURPOSE: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. METHODS: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries; presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. RESULTS: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. CONCLUSION: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

Community Health Services↗
PubMedDate not supplied

Getting the community involved in developing a PHC curriculum in Tonga.

To be relevant and effective, a nursing curriculum must reflect societal needs, health and community structures and resources. Below is a case study of a contractual collaboration between various stakeholders in a post-graduate programme based on primary health care in public health nursing in Tonga. It is one example of the influence and collaborative roles that communities play in the health of people.

Community Participation↗
PubMed1996

Time trends of child development in a Jerusalem community.

The study of the Development Quotient (DQ-according to the Brunet-Lezine test) of two-year-olds living in a geographically defined area in Western Jerusalem was carried out for the birth cohorts of 1971 to 1989 (n = 4314). An 'Early Stimulation' programme was implemented from 1975 through the Mother and Child Health Clinic. The stimulation programme provided mothers with skills to enhance the development of their children through social interaction, play and verbal stimulation from birth to two years of age. The mean DQ at 2 years old increased significantly from 104.6 (SD = 9.8) for the 1972 cohort to 108.9 (SD = 9.1) for those born in 1989. Coordination and posture subscores followed the trends of the total DQ while the trends in language development were less marked. There is indication that children whose mothers had 9-11 years of schooling benefited more than other children. Better achievement on the developmental test as expressed in the mean DQ was probably related to changing socio-demographic characteristics of the population, and the implementation of the 'Early Stimulation' programme. The widening gap of the DQ after an initial decrease among children whose mothers had < or = 8 years of schooling and those in higher educational groups during the 80s may have been caused by the fact that the latter are a very disadvantaged group of families compared with the rest of the population.

Analysis of Variance↗
PubMed1978

Organization development: a new modality for community mental health.

Organization development (OD) is discussed as being a valid tool for advancing mental health and for promoting the present goals of community mental health centers, as well as for accomplishing organization development's traditional objectives of increasing organizational effectiveness in business, industry, and government agencies. A comparison is made between the main objectives of the community mental health movement in the United States and the major thrusts of current OD practice, showing how the foci of the two fields are essentially similar. The psychological aspects of OD are presented in their relation to mental health. Organization development is demonstrated to be both a legitimate and an effective modality for the community mental health practitioner to use in reaching large numbers of people in promoting positive mental health, primary prevention, improved interpersonal relations, and personal growth activities in the community.

Community Mental Health Services↗
PubMed1982

Developing an enforceable "right to treatment" theory for the chronically mentally disabled in the community.

Historical developments, mental health approaches, and applicable legal authorities are examined in arguing a legal basis for pursuing greater treatment benefits for chronically mentally disabled persons in the community. Mental health lawyers have traditionally been concerned with patients' right to treatment while in the hospital. Lawyers are called on to examine the plight of (and to extend advocacy for) the chronically mentally disabled in the community.

Chronic Disease↗
PubMed1998

The development of a community child and family mental health service.

The Community Child and Family Service is a primary care and community-based child mental health service working in a socio-economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community- and hospital-based child mental health services is discussed, as is the future direction of the Service.

Child↗
PubMed2006

Charitable intentions. CHA, VHA unveil community-benefit guidelines developed to help not-for-profit hospitals justify their tax exemptions.

With new guidelines from the CHA and VHA on reporting community benefits, not-for-profit hospitals are being advised to drop bad debt and Medicare shortfalls from their accounting of how they fulfill their mission. While the AHA doesn't agree, some experts do. MedPAC member Nancy Kane, right, says bad debt "is a tough one, but I don't think a lot of bad debt is a community benefit.

Accounting↗