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PubMed1980

Office of Human Development Services--Grants for state and community programs on aging. Final rule.

The Administration on Aging (AoA) in the Office of Human Development Services is issuing new and revised regulations to implement Title III of the Older Americans Act, as amended. Title III authorizes formula grants to State agencies on aging to assist States and local communities to develop comprehensive and coordinated systems for the delivery of services to older persons. Title III provides separate allotments for social services (including long-term care ombudsman program and multipurpose senior centers), congregate nutrition services and home-delivered nutrition services. These regulations set forth the requirements a State agency on aging must meet to receive a grant from the Administration on Aging. The regulations include requirements and procedures for designation of State and area agencies, submission and approval of State and area plans, services requirements and hearing procedures.

Ethnicity↗
PubMed1976

Municipal child health services: a ten-year reorganization.

There has been increasing interest within the medical community in developing primary care programs in teaching hospitals that meet the medical needs of a community. The Cambridge Hospital system provides a working model for such a mutually beneficial interaction. Based on principles of administrative centralization and utilization of the pediatric nurse practitioner, the neighborhood health centers operate as part of a cost-effective series of concentric circles. Administrative centralization within the Department of Pediatrics at the Cambridge Hospital has permitted the elimination of duplicate medical services and the development of a responsive community health service. The pediatric nurse practitioner under close senior staff supervision, serves as the primary caretaker in the neighborhood centers. In addition to her role as the provider of a protocol-determined, age-related series of physical psychometric, and laboratory examinations the pediatric nurse practitioner also cares for minor injuries and illnesses of childhood. Any child deviating from a clearly established range of norms for any physical, developmental, or laboratory parameter is immediately referred to the senior staff pediatrician for further evaluation. Finally, any patient requiring subspecialized inpatient care is referred to the Massachusetts General Hospital. The senior pediatric staff of the Cambridge Hospital serves the function of coordinating and supporting the rapid interlevel communication which must occur between community service, primary hospital, and a tertiary care facility. This neighborhood health care system is, we feel, a medically sound, educationally exciting, and fiscally responsible solution to a problem facing many urban areas and their academic medical institutions.

Adolescent↗
PubMed2002

Two decades of "research-practice" encounters in the development of European therapeutic communities for substance abusers.

In 1981, a "research-practice" breakthrough was realized through the foundation of the European Federation of Therapeutic Communities (EFTC). Since its foundation EFTC regularly organized conferences and symposia. A few years later (in 1983), the European Workshop On Drug policy Oriented Research (EWODOR) was established at the Erasmus University in Rotterdam, including a special section devoted to the therapeutic community (TC). The authors examined the proceedings of all meetings organized by EFTC and EWODOR. The major topics presented throughout the last 20 years are highlighted in a chronological selection and these presentations largely focus on the challenges of the TC and the state of the art regarding scientific knowledge. In this overview only those authors who published articles in scientific journals indexed in the "Web of Science" (Institute for Scientific Information-ISI) were retained. Although research has never been the primary consideration in TCs, it played a far from negligible role in its development. Research findings prompted innovations and thus often provoked resistance, but on the other hand they functioned as a catalyst between the necessity of a belief system and the reality of society. The role of "grey" literature and the availability of information through the Internet will become more and more important in the communication between researchers and practitioners.

Communication↗
PubMed1987

Development of mammography and breast services in a community hospital.

The growth and development of mammography and related breast services in one community hospital are chronicled and described. With mammography providing the initial stimulus, substantial growth, diversification, and sophistication in diagnosis and treatment of breast disease have developed. The achievement of a cooperative and mutually supportive relationship among radiologists, pathologists, and surgeons committed to the goal of early detection of potentially curable breast cancer has succeeded in identifying increasing numbers of such lesions. The more frequent employment of breast-sparing surgical procedures and the encouraging survival rates in patients detected and treated for these early lesions represents an important contribution to the care of these women. Improvement in the detection of early breast cancer can be achieved by community radiologists, whether in private hospitals or office-based practices.

Breast Neoplasms↗
PubMedDate not supplied

An approach to the development of practice guidelines for community health interventions.

The Community Health Practice Guidelines (CHPG) project was initiated to develop a systematic approach to the critical evaluation of evidence on the effectiveness and efficiency of community health interventions and to the formulation of evidence-based practice recommendations. Three community health interventions--immunization delivery methods, partner notification for sexually transmitted diseases and the combination of restaurant inspection and education of food handlers--were used as prototypes to develop a standardized approach. The CHPG process consists of three components: a review of scientific evidence, a practice survey and formulation of practice guidelines. Imperatives for further development of the CHPG and define research priorities process include creating a coalition of public health organizations to sponsor the process and refining the consensus process so that the practice guidelines accurately reflect both the scientific basis of public health practice and the values of those affected.

Canada↗
PubMed2006

People Improving the Community's Health: community health workers as agents of change.

People Improving the Community's Health (PITCH) uses teams of community health workers to provide targeted outreach, to enroll those eligible in health coverage plans, to provide information and linkages to health and social support services, and to engage community members in community improvement activities. The initiative is based on the assumption that communities must work on the determinants of health and effectively mobilize all their assets to improve not only individual health, but also community health. Developed with support from the Kellogg Foundation's Community Voices Initiative, PITCH addresses intertwined public health concerns about access to health care and community health improvement. Outcomes of PITCH include increased enrollment in health coverage plans as well as increased participation in community improvement activities. The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.

Community Health Planning↗
PubMedDate not supplied

Community blood supply model: development of a new model to assess the safety, sufficiency, and cost of the blood supply.

BACKGROUND: Through a combination of predonation donor screening and donated unit testing, the blood supply is safer than ever. However, as a result of increasingly stringent screening measures, one of the greatest threats may be an insufficient supply. The balance between safety and adequacy of the blood supply has not received enough attention. STUDY DESIGN AND METHODS: The authors developed a model to allow for empirical investigation of the determinants of a safe and sufficient supply. The model is a cohort simulation of allogeneic whole-blood donation, with the population of presenting donors stratified into 8 age and gender groups because the probability of donor and donation deferral varies by these characteristics. Parameters are estimated from year 2000 Blood Centers of Pacific (BCP) data. The model includes cost parameters, which were estimated using BCP expenditure data. The main outcomes are the number of transfusable units of blood and the unit cost of procurement. RESULTS: The model tracks the production of a supply of blood, highlighting the influence of demographic characteristics, predonation deferral, underweight collection of blood units, and associated costs. The authors sought to establish model validity by showing that modeled results closely mimic the outcomes and costs observed by blood bank administrators. CONCLUSION: The model was developed to evaluate blood safety and policy decisions; it can be used to assess the impact of predonation deferrals, such as expanded European travel deferral for variant Creutzfeldt-Jakob disease, or the impact of new testing strategies, such as nucleic acid testing for West Nile virus.

Blood Donors↗
PubMed2006

Effects of habitat disturbance from residential development on breeding bird communities in riparian corridors.

This study assessed the relationship among land use, riparian vegetation,and avian populations at two spatial scales. Our objective was to compare the vegetated habitat in riparian corridors with breeding bird guilds in eight Rhode Island subwatersheds along a range of increasing residential land use. Riparian habitats were characterized with fine-scale techniques (used field transects to measure riparian vegetation structure and plant species richness) at the reach spatial scale,and with coarse-scale landscape techniques (a Geographic Information System to document land-cover attributes) at the subwatershed scale. Bird surveys were conducted in the riparian zone,and the observed bird species were separated into guilds based on tolerance to human disturbance,habitat preference,foraging type, and diet preference. Bird guilds were correlated with riparian vegetation metrics,percent impervious surface,and percent residential land use,revealing patterns of breeding bird distribution. The number of intolerant species predominated below 12%residential development and 3% impervious surface,whereas tolerant species predominated above these levels.Habitat guilds of edge,forest, and wetland bird species correlated with riparian vegetation. This study showed that the application of avian guilds at both stream reach and subwatershed scales offers a comprehensive assessment of effects from disturbed habitat,but that the subwatershed scale is a more efficient method of evaluation for environmental management.

Animals↗
PubMed2002

Developing wound management guidelines for community nurses.

Quality improvements are at the forefront of the Government's agenda and the advent of clinical governance has increased interest in the evidence base on which clinical decisions are made. Clinical guidelines are seen as an important tool in achieving evidence-based practice and there has recently been a proliferation in guideline development, nationally and locally. This article describes the rationale for the development of wound management guidelines for community nurses and the key steps that were involved in this process. It discusses and highlights the importance of an implementation strategy, and the need to evaluate, review and ensure that guidelines are up to date. It is intended to be of use to those nurses in the community who are considering undertaking guideline development.

Community Health Nursing↗
PubMed2006

Stretching the safety net to serve undocumented immigrants: community responses to health needs.

A small but increasing proportion of immigrants to the United States is undocumented. Because most undocumented immigrants lack health insurance, they primarily rely on safety net providers for care. Communities with more developed safety nets and historically large numbers of immigrants appear more adept at caring for both legal and undocumented immigrants, according to Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities. Communities with less experience caring for immigrant populations and less-developed safety nets face challenges caring for this population, but many are taking steps to improve their ability to meet immigrant needs. As the number of immigrants in the U.S. grows, the need to develop community health care capacity for immigrants will intensify.

Communication Barriers↗
PubMed1975

Developing a utilization review model for community mental health centers.

During their struggles to develop a utilization review model for a community mental health center, members of an interdisciplinary committee identified several issues they believe are important in establishing such a model. They include comprehensiveness of participation and of areas for review (the review committee should represent all disciplines and programs, and should be concerned with any aspect of center functioning), a problem-review approach in which subcommittees carry out documented studies of issues or problems, and specific provision for feedback and implementation of the results.

Community Mental Health Services↗
PubMed1984

Project outreach: volunteer transitional employment.

The importance of individual and group volunteer transitional placement as work activity is addressed as a primary component of the hospital-based psychiatric rehabilitation process. The current model synthesizes traditional volunteerism and transitional employment as a viable rehabilitation step to facilitate vocational awareness, vocational choice, or re-entry into the work world. The model has further application for vocational counseling and exploration, goal development, and rehabilitation planning. Aspects of program development, implementation, and maintenance are presented. Discussion of community resource development and public relations strategies which have helped this project expand and improve are included. Client contribution and involvement is emphasized.

Community-Institutional Relations↗
PubMed1993

A community effect in muscle development.

BACKGROUND: Most vertebrate tissues arise by embryonic induction, as a result of which new cell layers are formed. These are subsequently subdivided into discrete groups of homogeneous cell populations, each containing different cell-types with specific gene expression. There is preliminary evidence from previous work that the mesoderm-forming induction in amphibian development may be followed by a further interaction among some of the induced mesoderm cells, and that this could be required for muscle gene activation in uniform cell populations. RESULTS: We have established the existence, time and place of this further cell interaction by transplanting muscle progenitor cells from Xenopus mid-gastrulae into ectoderm sandwiches, and then culturing these constructs until the time of muscle gene activation. We find that cells implanted as reaggregates, but not those implanted as single cells, activate early myogenic genes and later muscle-specific genes. More than 100 cells must be near each other for muscle gene activation. These cells can induce non-muscle mesoderm cells to express muscle genes by emitting a signal that differs from the preceding mesoderm induction signal. Muscle gene activation under these conditions does not require gap junction communication. CONCLUSION: Cells within the muscle progenitor region of a Xenopus embryo need to interact with each other in order to activate muscle genes in homogeneous cell groups. This exemplifies the 'community effect', which may be a widespread developmental mechanism used to increase the homogeneity within, and demarkation between, embryonic tissues.

Journal Article↗
PubMed1994

The costs of accommodation and care. Community provision for former long-stay psychiatric hospital patients.

The development of community services to replace two long-stay psychiatric hospitals in the North East Thames Health Authority region of the UK has been the subject of a research programme since 1985. The economic evaluation is conducted by the Personal Social Services Research Unit; research results relating to the first five cohorts of hospital leavers are reported in this paper. When followed up 1 year after discharge, almost half of the sample were living in highly supported residential care units, most of which were managed by district health authorities. More than 40 services provided outside the accommodation facility were used by clients and, although contact with certain professionals remained constant, some changes in service use over time were marked. The average total cost of community care for this group was 493 pounds per week (1992-93 prices), accommodation facility costs comprising approximately 85% of the total. In the new service configuration, district health authorities fund half of the costs of supporting the hospital leavers, 50% less than when they funded long-stay hospital placements. The rest of the funding burden is borne by a range of agencies, resulting in pressure on budgets and staff case loads.

Adult↗
PubMed2006

COPD is associated with increased mortality in patients with community-acquired pneumonia.

Patients with chronic obstructive pulmonary disease (COPD) who develop community-acquired pneumonia (CAP) may experience worse clinical outcomes. However, COPD is not included as a distinct diagnosis in validated instruments that predict mortality in patients with CAP. The aim of the present study was to evaluate the impact of COPD as a comorbid condition on 30- and 90-day mortality in CAP patients. A retrospective observational study was conducted at two hospitals. Eligible patients had a discharge diagnosis and radiological confirmation of CAP. Among 744 patients with CAP, 215 had a comorbid diagnosis of COPD and 529 did not have COPD. The COPD group had a higher mean pneumonia severity index score (105+/-32 versus 87+/-34) and were admitted to the intensive care unit more frequently (25 versus 18%). After adjusting for severity of disease and processes of care, CAP patients with COPD showed significantly higher 30- and 90-day mortality than non-COPD patients. Chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia exhibited higher 30- and 90-day mortality than patients without chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease should be evaluated for inclusion in community-acquired pneumonia prediction instruments.

Community-Acquired Infections↗
PubMed1999

[Effective use of time in community psychiatry--utopia and the reality of network management].

OBJECTIVE: The development of community psychiatry needs an increasing network management between inpatient and outpatient care. As a whole the question of management structure is open for discussion. Instruments such as psychosocial workshops and community psychiatric team conferences are in need of a critical survey. METHODS: Our paper offers data in basic network management referring to false connections in interinstitutional cooperation by phone. RESULTS: The number of false connections is on a highly significant level, up to six times higher when contacting ambulant complementary staffs or administrative levels than within medical systems. CONCLUSION: These results demonstrate a large gap between utopia and reality of network management. Community psychiatric systems must take care for longitudinal medical staff orientation in structural management.

Case Management↗
PubMed2004

Collaborative community empowerment: an illustration of a six-step process.

This article illustrates a method used in a community empowerment project where community members and university facilitators collaborated to increase the capacity of the community. The method may have practical uses in collaborations with community groups. The six-step process enabled the community groups to accomplish their short-term community goals: developing effective after-school programs and resolving problems of damaged homes and blighted properties in a relatively short time and continuing on their collaborative work. Having a social ecological model as a conceptual framework was helpful for the community to assess their status and develop action plans. Consistent community meetings, open communication, focused community leadership, community networking, and collaboration of community organizations and a university were the factors that reinforced the empowerment process. Challenges such as maximizing limited resources and generating more participation from the community need to be resolved while the reinforcing factors are cultivated.

Community Participation↗