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At least 19 recordsLinked to original sources
PubMed1990

Improving the quality of community health surveys and community health promotion campaigns by feedback from the community: experience from the Wallsend community and health project.

A lifestyle and health risk survey was conducted in two socially disadvantaged Collector's Districts, as the basis for a health promotion intervention in one of the Districts. After community input into the planning, and local advance publicity, 395 people responded to the survey (a response rate of 39%). Three sources of community feedback were used: (i) reasons for refusal to participate; (ii) written comments solicited at a two-month follow-up; (iii) later, in-depth interviews with a subset of respondents. The data from this feedback related both to the process and outcomes of the survey; the latter included increased personal and community awareness of health, as well as lifestyle changes. The data are discussed in terms of their representativeness and the factors influencing participation, the implications of the low response rate, the stages of health behaviour change, and the potential conflict between scientific and human value-systems in community research.

Australia↗
PubMed2000

Flexible community structure correlates with stable community function in methanogenic bioreactor communities perturbed by glucose.

Methanogenic bioreactor communities were used as model ecosystems to evaluate the relationship between functional stability and community structure. Replicated methanogenic bioreactor communities with two different community structures were established. The effect of a substrate loading shock on population dynamics in each microbial community was examined by using morphological analysis, small-subunit (SSU) rRNA oligonucleotide probes, amplified ribosomal DNA (rDNA) restriction analysis (ARDRA), and partial sequencing of SSU rDNA clones. One set of replicated communities, designated the high-spirochete (HS) set, was characterized by good replicability, a high proportion of spiral and short thin rod morphotypes, a dominance of spirochete-related SSU rDNA genes, and a high percentage of Methanosarcina-related SSU rRNA. The second set of communities, designated the low-spirochete (LS) set, was characterized by incomplete replicability, higher morphotype diversity dominated by cocci, a predominance of Streptococcus-related and deeply branching Spirochaetales-related SSU rDNA genes, and a high percentage of Methanosaeta-related SSU rRNA. In the HS communities, glucose perturbation caused a dramatic shift in the relative abundance of fermentative bacteria, with temporary displacement of spirochete-related ribotypes by Eubacterium-related ribotypes, followed by a return to the preperturbation community structure. The LS communities were less perturbed, with Streptococcus-related organisms remaining prevalent after the glucose shock, although changes in the relative abundance of minor members were detected by morphotype analysis. A companion paper demonstrates that the more stable LS communities were less functionally stable than the HS communities (S. A. Hashsham, A. S. Fernandez, S. L. Dollhopf, F. B. Dazzo, R. F. Hickey, J. M. Tiedje, and C. S. Criddle, Appl. Environ. Microbiol. 66:4050-4057, 2000).

Anaerobiosis↗
PubMedDate not supplied

Community based and community focused: nursing education in community health.

Nurses have always cared for individuals, families, groups, and communities in their practice. Recently there has been an increase in the focus on nurses working outside of the hospital, primarily in community-based settings that focus on individuals and families. There is also increasing emphasis on community-focused nursing care with the community as the client. In some nursing programs, nurse educators have tried to adjust to this change by increasing the amount of time that nursing students spend in the community. The focus of this experience ranges from individuals to populations. This article describes a one-semester community health course in a baccalaureate nursing program that gives students both theoretical and practical knowledge in caring for individuals, families, groups, and communities. This allows for practice and understanding of both community-based and community-focused nursing care.

Community Health Nursing↗
PubMed1999

Advanced practice community health nursing in community nursing centers: a holistic approach to the community as client.

Community nursing centers are unique arenas for advanced practice community health nursing. These innovative nurse-managed delivery models are grounded in a holistic approach to the community-as-client. They provide the public with direct access to a range of advanced practice professional nursing services that are not otherwise available. Community Nursing Centers are collaborative with other health professions and organizations. They aim to meet the assessed needs of underserved populations using extant resources to achieve optimal health for all members of the community. This article discusses the underlying conceptual basis for development of community nursing centers and provides a case study example.

Community Health Centers↗
PubMed1997

Community participation in determining the needs of users and carers of rural community care services. Highland Community Care Forum.

In this paper we present the methods and key outcomes of a community led needs assessment exercise. The needs assessment sought to enhance the development of rural community care services by ensuring the views of users and carers were secured and considered in joint planning processes. The research was developed by members of the North and West Sutherland Community Care Forum. A community profiling template was developed and employed in five parish areas of Sutherland. This was drawn from 45 interviews with key informants and 2 community workshops, In addition 54 users and carers were interviewed. The outcomes of the needs assessment exercise identified geographical and cultural factors which present difficulties in developing services as well as posing barriers to user involvement.

Community Health Services↗
PubMed1999

The community and orthodontic care. Part II: Community-perceived importance of correcting various dentofacial anomalies. Part III: Community perception of the importance of orthodontic treatment.

Part II. A professionally-managed telephone survey was undertaken to assess the community-perceived importance of correcting various dentofacial anomalies. The sample included 505 respondents, aged eighteen and over, from metropolitan and non-metropolitan households across the state of Victoria. The sample distribution had a 95 per cent confidence limit with a 5 per cent margin of error and closely matched the known population distributions for age, sex and geographical location. This article forms part two of a series. It was found that the correction of functional problems such as "difficulty chewing or speaking" was considered to be very important, regardless of age, sex or geographical area. The correction of other factors such as "top teeth which stick out in front", "bottom teeth which stick out in front" or "crooked or crowded front teeth" was also considered to be important. "Spaced front teeth" was the factor considered least important for correction within all groups. It is interesting to note that, for all factors, correction seemed to be considered more important by females and non-metropolitan respondents than by males and metropolitan respondents, In contrast to previous studies in which it has been suggested that patients seek treatment mainly for reasons of aesthetics, the results of this study have shown a definite community recognition of the importance of functional problems as well. Part III. A professionally-managed telephone survey was undertaken to assess the community's perceptions of the importance of having "straight teeth and a nice smile", to assess if a Medicare (the Australian government health benefit scheme) rebate should be provided for orthodontic treatment and to assess whether respondents had any private health insurance that would help cover the cost of orthodontic treatment. The sample included 505 respondents, aged eighteen and over,, from metropolitan and non-metropolitan households across the state of Victoria. The sample distribution had a 95 per cent confidence limit with a 5 per cent margin of error and closely matched the known population distributions for age, sex and geographical location. It was found that a very large percentage of respondents considered the need for "straight teeth and a nice smile" to be very important. This finding is supported by the many studies showing the importance of facial attractiveness to the lives of all people, young and old. Only a small percentage of respondents indicated that they had any private dental health insurance that would help cover the cost of orthodontic treatment. Efforts should be made to inform those responsible for the planning of orthodontic services in both the public and private sectors of the importance of the community's perceptions of aesthetics, and the large amount of published work that reinforces the impact of facial attractiveness on people's lives.

Adolescent↗
PubMed2000

Community interventions for preventing smoking in young people.

BACKGROUND: Decisions to smoke are made within a broad social context. Community interventions use co-ordinated, widespread, multi-component programmes to try and influence behaviour. OBJECTIVES: To determine the effectiveness of community interventions in preventing the uptake of smoking in young people. SEARCH STRATEGY: The Tobacco Addiction group specialised register, Medline and 21 other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and contact was made with content area specialists. SELECTION CRITERIA: Randomised and non randomised controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years. DATA COLLECTION AND ANALYSIS: Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined using qualitative narrative synthesis. MAIN RESULTS: Thirteen studies were included in the review, 44 studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with four using random allocation of schools or communities. Of nine studies which compared community interventions to no intervention controls, two, which were part of cardiovascular disease prevention programmes, reported lower smoking prevalence. Of three studies comparing community interventions to school-based programmes only, one found differences in reported smoking prevalence. One study reported a lower rate of increase in prevalence in a community receiving a multi-component intervention compared to a community exposed to a mass media campaign alone. One study reported a significant difference in smoking prevalence between a group receiving a media, school and homework intervention compared to a group receiving the media component only REVIEWER'S CONCLUSIONS: There is some limited support for the effectiveness of community interventions in helping prevent the uptake of smoking in young people.

Adolescent↗
PubMed1993

Community health assessment. The first step in community health planning.

Hospitals face a paradigm shift: from planning service delivery to population-based community health planning. Comprehensive community health planning is a two-step process: assessment and action, in that order. Assessment identifies community problems and resources; action follows planning, which determines which of those problems should be addressed with which resources. This paper provides an overview of the community assessment process. The first challenge in launching a community health initiative is to identify and recruit partners drawn from the ranks of prominent community organizations, such as school boards, public health agencies, and elected officials. The best enlistment strategies are those that empower persons outside the hospital to take visible control. Defining the community is the first step in analyzing the community. It is important that everyone involved in the assessment process agree on the definition, which should take in those characteristics that make the community unique, including its social systems, environmental factors, and demographics. The next step in the process is developing a community health profile, a set of key community indicators or measures that will help you set priorities, document successes and failures, and monitor trends. There are a number of models available to consult in developing indicators, whether traditional, medically oriented determinants of health or broader parameters, such as housing and public safety. Criteria for selecting indicators include validity, stability and reliability, and responsiveness. Most indicators will be developed using secondary, or already existing, sources of data, such as census data, Medicare and Medicaid files, police records, and hospital admission and exit records. Conducting the community assessment involves putting together a list of problems to be solved and a list of available resources, both of which can be compiled using the same four-step process of gathering and analyzing data: obtaining community input, identifying problems already being addressed, consulting with professional experts, and analyzing existing data. Demographics are one way of analyzing data; another is using a "community scoreboard" that groups causal factors into four categories: lifestyle, environment, human biology, and health services. Once the community assessment is complete, planning and implementation of programs can begin. At the same time, it is essential to mobilize the community to support your initiative. Again, you must look beyond the hospital walls to build a constituency for change, to community leaders in education, employment, transportation and recreation, housing, and the physical environment, as well as health education and preventive services.(ABSTRACT TRUNCATED AT 400 WORDS)

Catchment Area, Health↗
PubMed2003

Community participation in a multisectoral intervention to address health determinants in an inner-city community in central Havana.

It is increasingly acknowledged that the process of community involvement is critical to the successful implementation of community-based health interventions. Between 1995 and 1999, a multisectoral intervention called Plan Cayo Hueso was launched in the inner-city community of Cayo Hueso in Havana, Cuba, to address a variety of health determinants. To provide a better understanding of the political structures and processes involved, the Cuban context is described briefly. The interventions included improvements in housing, municipal infrastructure, and social and cultural activities. A qualitative study, consisting of interviews of key informants as well as community members, was conducted to evaluate the community participatory process. Questions from an extensive household survey pre- and postintervention that had been conducted in Cayo Hueso and a comparison community to assess the effectiveness of the intervention also informed the analysis of community participation, as did three community workshops held to choose indicators for evaluating effectiveness and to discuss findings. It was found that formal leaders led the interventions, providing the institutional driving force behind the plan. However, extensive community involvement occurred as the project took advantage of the existing community-based organizations, which played an active role in mobilizing community members and enhanced linkage systems critical to the project's success. Women played fairly traditional roles in interventions outside their households, but had equivalent roles to men in interventions within their household units. Most impressive about this project was the extent of mobilization to participate and the multidimensional ecosystem approach adopted. Indeed, Plan Cayo Hueso involved a massive mobilization of international, national, and community resources to address the needs of this community. This, as well as the involvement of community residents in the evaluation process, was seen as resulting in improved social interactions and community well-being and enhanced capacity for future action. While Cuba is unique in many respects, the lessons learned about enhancing community participation in urban health intervention projects, as well as in their evaluation, are applicable worldwide.

Community Health Planning↗
PubMed1987

Scaling of biological community structure: a systems approach to community complexity.

Local community dynamics are determined by the interaction of environmental variation and the biotic properties of communities. This interaction occurs on many spatial and temporal scales, hence the expectation is that community dynamics will be complex. Previous theoretical approaches to communities have assumed linear, near equilibrium dynamics. An alternative approach suggests that community dynamics are the result of the balance between energy use by the community and its tendency to move towards thermodynamic equilibrium, in this case extinction of all species in the community. Because this balance will be imprecise, community dynamics should be oscillatory. Furthermore, because energy use by a community can be broken down into a hierarchical set of processes occurring on different time scales, community dynamics should reflect multiple periodicities. The above theoretical treatment suggests that since community dynamics are scaled, a hierarchical observational approach should help resolve important aspects of community structure. This approach of scaling community observations provides a technique for evaluation of community responses to environmental change, including human induced perturbations. A thermodynamic approach to community dynamics can also provide the basis for new theoretical and empricial discoveries about biological communities.

Animals↗
PubMed2001

Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community.

CONTEXT: Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infections have been acquired primarily in nosocomial settings. Four recent deaths due to MRSA infection in previously healthy children in the Midwest suggest that serious MRSA infections can be acquired in the community in rural as well as urban locations. OBJECTIVES: To document the occurrence of community-acquired MRSA infections and evaluate risk factors for community-acquired MRSA infection compared with methicillin-susceptible S aureus (MSSA) infection. DESIGN: Retrospective cohort study with medical record review. SETTING: Indian Health Service facility in a rural midwestern American Indian community. PATIENTS: Patients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997. MAIN OUTCOME MEASURES: Proportion of MRSA infections classified as community acquired based on standardized criteria; risk factors for community-acquired MRSA infection compared with those for community-acquired MSSA infection; and relatedness of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of 112 S aureus isolates, 62 (55%) were MRSA and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified as community acquired. Risk factors for community-acquired MRSA infections were not significantly different from those for community-acquired MSSA. Pulsed-field gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired MRSA isolates were clonally related and distinct from nosocomial MRSA isolates found in the region. CONCLUSIONS: Community-acquired MRSA may have replaced community-acquired MSSA as the dominant strain in this community. Antimicrobial susceptibility patterns and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in this and possibly other rural US communities.

Community-Acquired Infections↗
PubMed2002

Evaluation of the effectiveness of UK community pharmacists' interventions in community palliative care.

INTRODUCTION: In 1997, the Royal Pharmaceutical Society of Great Britain Working Party reported that UK community pharmacists had a crucial role in effective medicines management and effective symptom control for those receiving palliative care in the community. However, prior to the integration of community pharmacists into the community palliative team, it is necessary to evaluate the effectiveness of their pharmaceutical interventions. AIM: To assess the effectiveness of community pharmacists' clinical interventions in supporting palliative care patients in primary care using an independent multidisciplinary panel review. METHODS: Patients with a life expectancy of less than 12 months were each registered with a single pharmacy and their consent was obtained for the community pharmacists to access their general practitioner (GP) case records. The community pharmacists received training in palliative pharmaceutical care and documenting interventions. The trained community pharmacists provided palliative pharmaceutical care to the recruited patients. At the end of a 10-month period, the clinical interventions were reviewed by an independent multidisciplinary expert panel consisting of a palliative care consultant, a Macmillan nurse (community palliative care nurse) and a hospital pharmacist with special interest in palliative care. RESULTS: Fourteen community palliative care teams (including community pharmacists, GPs and community nurses) took part in the study and 25 patients were recruited over the 10-month recording period. All but one patient had a diagnosis of cancer; the other patient had chronic obstructive pulmonary disease. By the end of the project, 14 patients had died. Community pharmacists recorded a total of 130 clinical interventions. Thirty interventions were excluded as insufficient information had been documented to allow review by the panel. Eighty-one per cent of the interventions were judged by the expert panel likely to be beneficial. However, 3% were judged likely to be detrimental to the patients' well-being. CONCLUSIONS: Most of the clinical interventions made by the community pharmacists for palliative pharmaceutical care were judged by the expert panel as being likely to be beneficial. The result supports the view that when community pharmacists are appropriately trained and included as integrated members of the team, they can intervene effectively to improve pharmaceutical care for palliative care patients.

Adult↗
PubMed2001

Successful implementation of community water fluoridation via the community diagnosis process.

OBJECTIVES: This paper describes the community diagnosis process and how it was used to implement community water fluoridation in Tennessee. METHODS: Public health dental staff developed a survey instrument to collect community-specific data on the oral health status of schoolchildren. Key survey findings were presented to county health councils who were determining and prioritizing the health needs of their communities. RESULTS: Community-specific data showed higher caries levels in children without access to an optimally fluoridated community water supply. Presentation of local survey findings to county health councils resulted in fluoridation being a high-priority health issue in several counties. With health council support, opposition to fluoridation by utility district officials was overcome when decision makers were challenged with local survey findings. The community diagnosis process resulted in the successful fluoridation of six community water systems serving a total of 33,000 residents. CONCLUSIONS: The community diagnosis approach was successful in implementing community water fluoridation in geographic areas historically opposed to this public health measure. The success of these fluoridation initiatives was attributed to: (1) current, community-specific assessments of children's oral health; (2) identification of communities with disparate oral health needs, problems, and resources; and (3) effective presentation of community-specific oral health survey data to community leaders, stakeholders, and decision makers.

Attitude to Health↗