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At least 1,603 records · Page 89Linked to original sources
PubMed2006

Pharmacologic treatment of portal hypertension in the prevention of community-acquired spontaneous bacterial peritonitis.

INTRODUCTION: Given that beta-blockers reduce the incidence of bacterial translocation in cirrhotic rats, the aim of this study was to compare the long-term incidence of spontaneous bacterial peritonitis in cirrhotic patients submitted to pharmacologic versus endoscopic treatment to prevent variceal rebleeding. PATIENTS AND METHODS: Two hundred and thirty patients with variceal hemorrhage were included in two previous randomized trials performed to compare the efficacy of medication (nadolol plus isosorbide mononitrate, n=115) versus endoscopic treatment (n=115) with sclerotherapy or ligation for the prevention of rebleeding. RESULTS: The mean follow-up was 23+/-1.4 months. The characteristics of the patients and the number of patients on long-term prophylaxis with norfloxacin were similar in both groups. The incidence of spontaneous bacterial peritonitis was lower in the medication group (9 versus 14.7%, P=NS). The probability of spontaneous bacterial peritonitis was also lower in the medication group (6 versus 12% at 1 year, 22 versus 36% at 5 years; P=0.08), due to a significantly lower probability of community-acquired spontaneous bacterial peritonitis in this group (1 versus 10% at 1 year, 18 versus 32% at 5 years; P=0.02). Patients with no hemodynamic response to therapy had a significantly higher probability to develop community-acquired spontaneous bacterial peritonitis during follow-up than hemodynamic responders (P<0.03). Long-term probability of developing community-acquired spontaneous bacterial peritonitis is lower in patients submitted to pharmacologic treatment for preventing variceal rebleeding than in those submitted to endoscopic treatment. CONCLUSION: Long-term pharmacologic prophylaxis of variceal rebleeding contributes to the prevention of community-acquired spontaneous bacterial peritonitis.

Adrenergic beta-Antagonists↗
PubMed1979

Identity degradation and mental disorder: an empirical assessment of the Conduct Impairment Scale.

Proponents of the medical models have held that mental disorder is best measured in terms of some inventory of symptoms indicative of an underlying disease. Alternatively, critics have argued that mental disorder is the result of a degraded ascribed role, a discrepancy between the person and his environment, or the degradation of identity. The issue goes beyond academic debate, with important implications for case-finding and program development in community mental health. Theodore Sarbin has developed a 58-item "Conduct Impairment Scale" to operationalize the concept of "Identity Degradation" and proposed it as a substitute for the medical model. Three dimensions are posited: status, value, and involvement. An appropriate level of reliability and clustering of scale items are reported by Sarbin. In order to subject the scale to a more rigorous test, it was administered to a random sample of 208 respondents in four neighborhoods in Grand Rapids, Michigan, as part of a larger epidemiological study. In an effort to assess the validity of the scale, factor analytic methods were employed. A principal components model with varimax rotation was performed. It was found that items purporting to tap the three theoretical dimensions explicated by Sarbin did not load in the expected pattern. Additionally, the first three extracted factors accounted for only a small proportion of the total variance. Efforts to assess the reliability of the scale were more fruitful. A corrected split-half of .82 and coefficient alpha of .86 were obtained. It was concluded that the validity of the scale was not adequately demonstrated, and its use as an alternative to the medical model open to serious reservation.

Achievement↗
PubMed2002

Reflections on genetic manipulation and duties to posterity: an engagement with Skene and Coady.

In addressing the regulation of human genetic futures, scientific standards concerning human kinds are endorsed by philosophical approaches that tend to exclude many people with genetic conditions from the deliberative process. In broadening the axiological, ontological and epistemological framework to include disability perspectives, the focus is shifted from questions of regulation to practical matters of participation, invoking ideals of community equality and enabled choice. In developing practical community engagements to deliberate upon genetic futures, a process that allows dialectical encounter between eugenic and non-eugenic approaches is envisioned so that strong versions of eugenics are avoided.

Persons with Disabilities↗
PubMed2006

Analysis strategies for a community trial to reduce adolescent ATOD use: a comparison of random coefficient and ANOVA/ANCOVA models.

The Community Youth Development Study (CYDS) will evaluate the Communities That Care (CTC) operating system for its effects on alcohol, tobacco, drug use, and other outcomes among adolescents resident in the 24 participating communities. The CYDS employs a combination of both cross-sectional and cohort designs. We use data from an earlier study that included the CYDS communities to estimate power for CYDS intervention effects given several analytic models that might be applied to the multiple baseline and follow-up surveys that define the CYDS cross-sectional design. We compare pre-post mixed-model ANCOVA models against random coefficients models, both in one- and two-stage versions. The two-stage pre-post mixed-model ANCOVA offers the best power for the primary outcomes and will provide adequate power for detection of modest but important intervention effects.

Adolescent↗
PubMed1994

Strengthening social networks: intervention strategies for mental health case managers.

The enhancement of social support networks for people with chronic mental illness is an important thrust of case management services. However, despite the worthy intentions of the National Institute of Mental Health Community Support Program, the development of comprehensive, community-based social support systems for people with chronic mental illness remains an elusive goal. Case managers face many obstacles in their efforts to enhance the natural support systems of their clients, and they need specific training in social network interventions with individuals with mental illness to overcome these obstacles. This article presents conceptual framework of social network interventions and discusses obstacles to enhancing natural support systems. The need for community resource development, especially in the building of community ties, is highlighted.

Chronic Disease↗
PubMed1975

Community Mental Health--new approaches for rural areas using psychiatric social workers.

In 1970, a private medical group practice serving a large rural area introduced pyschiatric social workers in an integrated clinic to provide accessible mental health services to all economic levels in the community. Public acceptance confirmed the demand. The rapidity with which other community mental health needs were subsequently recognized in the area, service instituted, and community funds and manpower mobilized to develop new community programs documents the rising awareness of health care needs in traditionally conservative rural areas. The acceptance by community members and physicians of psychiatric social workers as members of the health care team suggests the desirability of the group practice clinic for the introduction of nonphysician mental health care professionals. The unique position of the medical group practice for innovation in community health care delivery in outlying areas is evident.

Attitude of Health Personnel↗
PubMedDate not supplied

Public education programs in the nursing curriculum.

The author describes the integration of a structured public education program of the American Cancer Society with didactic and clinical experiences in the nursing curriculum. Sixty-five nursing students and their clinical instructors were trained as public education speakers for the breast health program. This experience integrated concepts of public education, community health, health behavior, professional role development, and community volunteerism, and served as an excellent learning opportunity for undergraduate nursing students.

Breast Neoplasms↗
PubMed1994

Ethnographic approach to community organization and health empowerment.

The purpose of this article is to address pertinent issues relative to the association between community organization and health empowerment methods in ethnic communities of colour. It seeks to address these issues by utilizing ethnographic procedures for documenting community health concerns and by advocating for empowerment for people of colour and their participation in coalition partnerships. Increasingly the importance of citizen participation in the planning, assessment, and implementation of community-based health initiatives has been identified as essential for effective health promotion and disease prevention programs. This article argues for the utility of a community organization approach for achieving health empowerment, and subsequently decreasing the excess deaths in communities of colour. The interface of ethnographic procedures, community organization, and development of community-owned action plans for programming health interventions is discussed.

Black or African American↗
PubMed1990

Anthropometric measurements in rural school children.

Anthropometric measurements of 1012 rural school-going children, selected randomly, were performed. There were 776 males and 236 females in the age group of 5-15 years. The values of weight and height were recorded for every child in the study sample. Age and sex break-up was studied and compared with the ICMR (Indian Council of Medical Research) standard. The comparison made separately for boys and girls showed that the values for both sexes and in all age groups were less than the ICMR standard. The majority (83.6%) of the children belonged to the middle and low social class according to the modified Prasad's classification. An inference is, therefore, drawn that rural school children of middle and low socio-economic status are shorter and lighter as compared with even their own counterparts on whom the ICMR values are based. The state of health of school-going children in India is far from satisfactory despite the fact that school health programmes along with other nutritional programmes have been in operation for several decades. School-going children constitute a sizeable section of India's population, i.e. about 27%, which is easily accessible and also receptive. An early and convenient method of assessing nutritional and socio-economic status of growing children is anthropometry. Physical growth, in terms of weight and height, is considered an important parameter reflecting the pattern of growth and development in a community. In the developing countries, the growing children by and large are deprived of good nutrition on account of their poor socio-economic status, ignorance and lack of health promotional facilities. This nutritional deprivation results in relative stunting of growth.

Adolescent↗
PubMed2005

Diabetes self-management among low-income Spanish-speaking patients: a pilot study.

BACKGROUND: The prevalence of type 2 diabetes and diabetes-related morbidity and mortality is higher among low-income Hispanics when compared to that of Whites. However, little is known about how to effectively promote self-management in this population. PURPOSE: The objectives were first to determine the feasibility of conducting a randomized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects. METHODS: Participants for this pilot study were recruited from a community health center, an elder program, and a community-wide database developed by the community health center, in collaboration with other agencies serving the community, by surveying households in the entire community. Participants were randomly assigned to an intervention (n = 15) or a control (n = 10) condition. Assessments were conducted at baseline and at 3 months and 6 months postrandomization. The intervention consisted of 10 group sessions that targeted diabetes knowledge, attitudes, and self-management skills through culturally specific and literacy-sensitive strategies. The intervention used a cognitive-behavioral theoretical framework. RESULTS: Recruitment rates at the community health center, elder program, and community registry were 48%, 69%, and 8%, respectively. Completion rates for baseline, 3-month, and 6-month assessments were 100%, 92%, and 92%, respectively. Each intervention participant attended an average of 7.8 out of 10 sessions, and as a group the participants showed high adherence to intervention activities (93% turned in daily logs, and 80% self-monitored glucose levels at least daily). There was an overall Group x Time interaction (p = .02) indicating group differences in glycosylated hemoglobin over time. The estimated glycosylated hemoglobin decrease at 3 months for the intervention group was -0.8% (95% confidence intervals = -1.1%, -0.5%) compared with the change in the control group (p = .02). At 6 months, the decrease in the intervention group remained significant, -0.85% (95% confidence intervals = -1.2, -0.5), and the decrease was still significantly different from that of the controls (p = .005). There was a trend toward increased physical activity in the intervention group as compared to that of the control group (p = .11) and some evidence (nonsignificant) of an increase in blood glucose self-monitoring in the intervention participants but not the control participants. Adjusting for baseline depressive scores, we observed a significant difference in depressive symptoms between intervention participants and control participants at the 3-month assessment (p = .02). CONCLUSIONS: Low-income Spanish-speaking Hispanics are receptive to participate in diabetes-related research. This study shows that the pilot-tested diabetes self-management program is promising and warrants the conduct of a randomized clinical trial.

Aged↗
PubMed1997

A community-based regional ventilator weaning unit: development and outcomes.

STUDY OBJECTIVE: Description of the development of a community-based weaning unit and the outcomes from that unit. DESIGN: Review of admissions, classified by etiology of ventilator dependence, with attention to disposition, length of stay, and time to wean. SETTING: Long-term acute-care facility in Worcester, Mass. PATIENTS: Two hundred seventy-eight ventilator-dependent patients admitted to a ventilator unit from 1988 through May 1995. Admissions criteria did not include prognostic considerations. INTERVENTIONS: Selected patients were entered into a formal weaning program beginning in 1992. MEASUREMENTS: Through the study period, there was a substantial growth in annual admissions, primarily due to increases in patients surviving a catastrophic acute illness. Overall, 107 of 278 (38%) patients were liberated from mechanical ventilation for at least 7 consecutive days and nights. Of the patients admitted 1993 to 1995, 31% died, 20% were discharged to a long-term care facility, 29% returned home, and 18% either remained as residents of the unit or had been transferred to acute-care facilities and were unavailable for follow-up. The highest weaning success was seen in patients with ventilator dependence from postoperative causes (58%) and acute lung injury (57%); the least success was seen in patients with ventilator dependence from COPD and neuromuscular diseases (22% each). The average time from admission to weaning fell within each diagnostic category throughout the study period. CONCLUSIONS: Rehabilitation-based ventilator weaning units play an important role in the spectrum of medical care necessary in population centers. Excellent results can result from community-based units with open admissions policies.

Adult↗
PubMed2005

Ethical goals of community consultation in research.

In response to the traditional emphasis on the rights, interests, and well-being of individual research subjects, there has been growing attention focused on the importance of involving communities in research development and approval. Community consultation is a particularly common method of involving communities. However, the fundamental ethical goals of community consultation have not been delineated, which makes it difficult for investigators, sponsors, and institutional review boards to design and evaluate consultation efforts. Community consultation must be tailored to the communities in which it is conducted, but the purposes of consultation-the ethical goals it is designed to achieve-should be universal. We propose 4 ethical goals that give investigators, sponsors, institutional review boards, and communities a framework for evaluating community consultation processes.

Community Participation↗
PubMedDate not supplied

Angina and socio-economic status in Ontario: how do characteristics of the county you live in influence your chance of developing heart disease?

OBJECTIVE: To assist in the development of community heart health programming and policy development, the Central West Health Planning Information Network (CWHPIN) was asked by its partners to collaborate in obtaining information that might clarify the relationships between socio-economic status (SES) and heart disease among residents of Ontario, Canada. The purpose of this component of the project was to explore, at the county level, how much of the variation in angina pectoris (angina) could be explained by SES variables. STUDY DESIGN: Linear regression modeling was used to identify key predictors of angina hospitalization rates in counties Ontario-wide. RESULTS: Results of the linear regression modeling showed that SES variables (most notably education and occupation) were key predictors of angina, even when traditional risk factors (i.e., smoking, etc.) were included in the analysis. CONCLUSION: This study demonstrates that, at the county level, socio-economic variables such as education and occupation have a significant relationship with rates of heart disease at the population level, even when including the traditional risk factors in the analysis.

Adult↗
PubMed1988

[Intervention technics in the community: community diagnosis].

The practice of community mental health care demands the introduction of suitable models of intervention. Community medicine, which has preceded the development of community mental health, offers operative models based on epidemiologic concepts and techniques. This paper analyses the different components of community diagnosis, a necessary step in the process of community intervention. A practical example illustrates the use of the latter by the mental health worker.

Community Mental Health Services↗
PubMed2000

Grant awarded to support AIDS projects in India.

The Francois-Xavier Bagnoud Foundation (FXB), New York, New York, will develop community-based programs in rural Rajasthan, India, to stem the spread of HIV/AIDS and other sexually transmitted diseases (STDs), with the support of a US$300,000 grant from the Bill and Melinda Gates Foundation. According to the WHO and Joint UN Programme for HIV/AIDS, an estimated 3.7 million people are living with HIV/AIDS in India, more than any single country in the world except South Africa. HIV/AIDS and other STDs are spreading rapidly in Rajasthan, a rural state in northwestern India with a population of 44 million. The FXB Rajasthan Society will administer the grant. Building on the strong tradition of community health care workers in India, the society will develop a model for AIDS/STD education employing village counselors, migrant workers, and peer educators, with the goal of increasing awareness of STDs and promoting voluntary testing and treatment. The community-based model will then be adapted for use across India as well as in other developing nations. "We are thrilled to receive help from and to work with the Bill and Melinda Gates Foundation," said Countess Albina du Boisrouvray, FXB. "Stopping the spread of AIDS needs a serious financial commitment as well as a bottom-up, community-based approach. The Foundation understands this, as do our partners in India".

Acquired Immunodeficiency Syndrome↗