Community-based Health Care Center Research Articles

Isolation of Staphylococcus aureus Urinary Tract Infections at a Community-Based Healthcare Center in Riyadh.

Background The aim of this study was to assess the clinical presentation, risk factors, and comorbidities of the patients with Staphylococcus aureus bacteriuria, and to analyze the antimicrobial susceptibility data of S. aureus isolated from their urine samples. Methods A total of 90 isolates of S. aureuswere collected from patients with urinary tract infections (UTIs). Urinalysis was performed manually, including macroscopic examination of color and appearance, and microscopic examination for the presence of urinary WBCs, RBCs, and bacteria. Full identification and susceptibility testing ofS. aureuswere performed by the VITEK 2 system (BioMérieux, Marcy-l'Étoile, France) using standard criteria. Results The majority of the patients were female (62%), with a mean age of 32.9 years. Most of the patients were outpatients (85%), and 52% were previously healthy with no underlying disease. Seventy positive urine cultures were associated with UTI symptoms, and the most common symptom was dysuria (40%). Out of 77 urinalyses performed, 58 were positive for UTI. Of theS. aureusisolated, 24% were methicillin-resistant S. aureus (MRSA). Susceptibility to vancomycin, teicoplanin, and linezolid was 100%, while susceptibility to erythromycin, clindamycin, gentamicin, trimethoprim-sulfamethoxazole, fusidic acid, and tetracycline, was 86%, 93%, 97%, 91%, 68%, and 87%, respectively. Conclusion Although S. aureusUTI is known to be associated with other risk factors such as urinary catheterization, long hospital stay, or complicated UTI, our results show the community-acquired presentation of UTI. Trimethoprim-sulfamethoxazole may be used as an effective treatment for UTI caused byS. aureus.S. aureusUTI could be an alarming sign of more invasive infections such as S. aureusbacteremia, though clinical evaluation and finding the source of S. aureus are crucial for effective treatment and prevention of further complications.

Evaluation of climate induced hazards risk for coastal Bangladesh: a participatory approach-based assessment

Bangladesh has been identified as one of the most susceptible countries to climate induced disasters. Geographical location of the country in the foothill of Himalayan system and in the mouth of north Bay of Bengal make it to experience frequent extreme environmental events such as flood, cyclone, draught, river erosion, sea level rise, salinity etc. The coastal region of Bangladesh is highly vulnerable to climate change and climate induced natural disasters. This study identifies the potential climate induced hazards, their vulnerability, capacity, associated risk and explores the potential strategies to reduce the disaster risk. This study was carried out in Uttar Bedkashi Union, Koyra Upazila under Khulna District in south west coastal region of Bangladesh. The information has been collected through individual level and key informant interview, focus group discussion, life history from local people to explore the context of the disaster risk and how they perceived it from their experiences. The study revealed that flooding as a result of high tide and salinity intrusion were the most prominent hazards followed by riverbank erosion and cyclone associated storm. Vulnerability assessment showed that cyclone associated storm surge was the major cause of vulnerabilities in the study area which followed by flooding and riverbank erosion. On the other hand, capacity assessment showed that community people have less capacity to deal with the multi-hazards risk. This study also revealed that riverbank erosion poses the highest risk in the study area followed by cyclone associated storm surge, flooding, and salinity intrusion. The study suggests some potential DRR strategy such as build disaster resilient house using indigenous and scientific knowledge, build or improve embankments, build or improve the communication roads, improve rain water harvesting system, provision of community-based health care center, create alternative and sustainable livelihood opportunity such as self-sustaining agriculture systems and further development of sustainable shrimp farming. The outcome of this study is expected to be useful for preparing an effective disaster risk mitigation plan by decision-makers. Further in-depth research on potential risk reduction options will be analyzed to measure efficiency and effectiveness.

HOME BLOOD PRESSURE MONITORING SURVEY IN CHINA (HBPM-C)

Objective: To characterize doctor's knowledge and behavior model on HBPM in urban outpatient clinics in China. Design and method: A questionnaire-based survey was conducted on 204 doctors in 23 hospital or community-based outpatient clinics in Beijing and other cities from 5/2013∼9/2013. The contents of the questionnaire include the cut points of systolic and diastolic BP for diagnosis of hypertenstion on HBPM, attitude on significance of morning or nocturnal blood pressure values, and time, frequency and methods of measuring. Results: 194 subjects responded (response ratio: 194/204). 20.1% were male, 79.9% were female. Average age was 39.7 years old. 52.6% doctors were from tertiary-level hospitals, 47.4% from community-based health care centers or other non-tertiary-level hospitals. 49.5% doctors regarded the importance of HBPM equal to office blood pressure measurement (OBPM) or ambulatory blood pressure monitoring (ABPM), and 31.4% considered HBPM more important; 81.4% doctors considered the equal importance of HBPM during daytime and night. 95.9% doctors acknowledged HBPM would help to improve the awareness of hypertension, 82.5% believed HBPM could raise the accuracy of diagnosis, and 83.5% believed HBPM might help to improve accuracy of prediction of prognosis. Only 34.0% doctors could correctly answer the cut-point of systolic blood pressure/diastolic blood pressure (>=135/85 mmHg) on diagnosis of hypertension by HBPM, while 51.0% choose >=140/90 mmHg (cut-point of OBPM). 85.6% doctors recommended HBPM as patients visit, 85.6% prefer arm-style electronic device, 94.8% suggested measuring at least once daily, 74.2% advised measuring after getting up and before sleeping, 43.3% proposed measuring twice and 53.6% proposed measuring three times each time. 32.5% doctors advised to record the average value of the second and third readings and 40.7% doctors recommended to record the mean of all readings. Conclusions: The behavior models on HBPM recommendations are in accordance with the guidelines, but the knowledge level are still low among doctors in urban outpatient clinics, indicating a compelling need for education and training to improve the awareness and behaviors on BP measurement and monitoring.

Factors affecting the cultural competence of visiting nurses for rural multicultural family support in South Korea

BackgroundWith the recent growth of multicultural families in the Korean society, the importance of the role of qualified visiting nurses in the delivery of culturally sensitive health care has grown dramatically. As the primary health care provider for multicultural families enrolled in public community-based health care centers, the cultural competence of visiting nurses is an essential qualification for the provision of quality health care for multicultural families, especially in rural areas. Cultural competence of visiting nurses is based on their cultural awareness and empathetic attitude toward multicultural families. This study aimed to examine the levels of cultural competence, empowerment, and empathy in visiting nurses, and to verify the factors that affect the cultural competence of visiting nurses working with rural multicultural families in South Korea.MethodsEmploying a cross-sectional descriptive study design, data from 143 visiting nurses working in rural areas were obtained. Data collection took place between November 2011 and August 2012. The measurement tools included the modified Korean version of the Cultural Awareness Scale, the Text of Items Measuring Empowerment, and the Interpersonal Reactivity Index to measure the level of empathy of visiting nurses. Analyses included descriptive statistics, a t-test, an ANOVA, a Pearson correlation coefficient analysis, and a multiple linear regression analysis.ResultsThe cultural competence score of the visiting nurses was 3.07 on a 5-point Likert scale (SD = 0.30). The multiple regression analysis revealed that the cultural competence of visiting nurses was significantly influenced by experience of cultural education, empathy, and scores on the meaning subscale of the empowerment tool (R2 = 10.2%).ConclusionsInstitutional support to enhance visiting nurses’ empowerment by assuring the significance of their job and specific strategies to enhance their empathy would be helpful to improve the cultural competence of visiting nurses. Additionally, regular systematic education on culturally sensitive care would be helpful to enable visiting nurses to provide culturally sensitive care for multicultural families.

Quality Improvement Project to Reduce Pain and Distress Associated With Immunization Visits in Pediatric Primary Care

This quality improvement project implemented an evidence-based immunization protocol aimed at decreasing pain and distress associated with immunizations for children ages 4 to 6 by utilizing distraction and a benzocaine-based anesthetic spray. The original protocol is used at a large, university-based pediatric primary care hospital. A convenience sample of 30 children from a community-based healthcare center was utilized to assess effectiveness in alternate settings. This quasi-experimental project collected survey information from child participants and consenting caregivers. Statistical analysis by paired t-test indicated a statistically significant decrease in reported distress by both the child and the caregiver utilizing the immunization protocol.

Adverse Childhood Experiences and Diabetes in Adulthood: Support for a Collaborative Approach to Primary Care

Prior studies have demonstrated an association between retrospective reports of experiencing trauma in childhood and the current incidence of type 2 diabetes in adulthood. Much less is known about this association among low-income minority patients in primary care settings. We replicated the adverse childhood experiences (ACEs) Centers for disease control and prevention (CDC) study with a low-income minority sample of primary care patients (N = 801) at a community-based healthcare center. We conducted a cross-sectional retrospective quantitative survey study to examine the association between participants’ reports of past childhood trauma and their current health care outcomes. Data were analyzed using binary logistic regression to evaluate the hypothesis that low income minority patients who reported more childhood trauma (abuse, neglect, household dysfunction, cumulative adverse childhood experiences [ACEs]) would more likely be diagnosed with type 2 diabetes. Results suggest that the number of ACEs in our sample were considerably higher than the original CDC ACEs study, as almost 50 % of patients surveyed at our clinic reported 4 or more ACEs, confirming that trauma is central in our urban primary care setting. The results of the cumulative ACEs score was in the expected direction and was significant, suggesting that participants who cumulatively reported experiencing more childhood trauma were more likely to be diagnosed with type 2 diabetes in adulthood. These findings have implications for family therapists, primary care providers, researchers, and policy makers to develop more collaborative approaches to primary care that better target the negative sequelae of ACEs.

Self-Rated Health and Association with ACEs

Background: Prior studies have demonstrated an association between experiencing trauma in childhood and poorer self-rated health in adulthood. Much less is known about this association among low-income minority patients in primary care settings. Methods: We replicated the Adverse Childhood Experiences (ACE) Study, a collaborative venture between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, with a low-income minority sample of primary care patients (N = 801) at a community-based healthcare center. We conducted a cross-sectional retrospective quantitative survey study. Data were analyzed using binary logistic regression to evaluate the hypothesis that low-income minority patients who reported more childhood trauma (abuse, neglect, household dysfunction, cumulative adverse childhood experiences [ACEs]) would more likely have reported poorer health in adulthood. Results: The number of ACEs in our sample was considerably higher than the original CDC ACE Study, as almost 50% of patients surveyed at our clinic reported 4 or more ACEs, confirming that trauma is central among individuals served in many urban primary care settings. The results of the ACE abuse, neglect, and cumulative ACEs score were in the expected direction and statistically significant suggesting that participants who reported more childhood abuse and neglect and who reported more childhood trauma (cumulative/total ACEs) were more likely to report poorer health in adulthood. Conclusion: These findings have implications for providers, researchers, and policy makers to develop more collaborative approaches to primary care that better target the negative sequelae of ACEs.

경인지역 보건소 방문간호사의 의사결정유형에 따른 셀프리더십과 의사소통 능력

현장에서 직접 대상자의 가정을 방문하여 요구사정에서부터 중재, 평가에 이르기까지 간호제공의 전 과정을 수행해야 하는 방문간호사의 업무수행 능력을 제고의 관점에서 의사결정 유형과 셀프리더십 그리고 의사소통 능력간의 관련성을 분석하였다. 방문간호사들의 의사결정 유형과 의사소통 능력과 셀프리더십은 모두 상관관계가 있었으며 서로 유기적인 관계가 있음을 확인하였다. 방문간호사의 의사결정 유형은 합리적 유형이 가장 많은 것으로 나타났으며, 이와 관련하여 셀프리더십 정도와 의사소통 능력 측면에서도 합리적 의사결정 유형에서 가장 높은 점수를 나타냈다. 합리적 의사결정 유형은 의사결정 유형 중 가장 바람직한 것으로 논의되어 온 바 방문간호사가 높은 문제해결 능력을 가지고 있음을 실증적으로 보여준 사례로 해석할 수 있다. The aim of this study was to explore relations among the decision making style, self leadership and communication competence of visiting nurses. The research design was a descriptive survey study, and 219 people were selected through convenience sampling among the visiting nurses who worked in the 28 community based health care centers. The most frequent decision making style of visiting nurses was a rational style. The scores of self leadership and communication competence of visiting nurses were also showed the highest score when the visiting nurse had a rational decision making style. The statistical significant correlations were found among the decision making style, self leadership and communication competence. The results of this study were useful to develop jop-training programs for visiting nurses to enhance their problem-solving abilities. We suggest more various education programs to increase the visiting nurse's self leadership and communication competence will be implemented and refined protocols according to situations will be developed, too.

A Presidential Blueprint for Success and Change

When the senior editors of our journal asked me to write an editorial as a companion piece to Dr. Nicholas Petrelli’s Society of Surgical Oncology (SSO) presidential address entitled ‘‘I’m in a New York State of Mind’’, I was honored and delighted, but frankly incredulous. For those of us who attended the Society of Surgical Oncology Cancer Symposium in March 2008 in Chicago and were fortunate to have heard Nick’s presentation, to my mind there was no way that the publication of the address could convey the humor, pathos, exuberance, and bluster that emanated from that oration. In addition, no commentary could ever do justice to a well-presented and carefully scripted presidential address – and frankly that is why most representations of this genre rarely are fodder for editorial comment. This presidential address, however, is different – it really contains a strong message and outlines a plan. If I accomplish nothing else in this commentary, I hope that you – those who heard the oral presentation and those who did not – will share my excitement regarding Dr. Petrelli’s message, turn a few pages to the published manuscript and take the time to understand the power, commitment, and superb outcome that a visionary leader working with a good team can accomplish in creating a metamorphosis of both a community-based health care center and the entire cancer care culture in the state of Delaware. Dr. Petrelli and his colleagues, working with support from the National Cancer Institute (NCI), have attacked the critical problem of cancer in their state and, embracing the power of their community/ academic teaching center and its dedicated staff, have transformed the mindset of the community. In addition, they have played a key role in partnering with a state government dedicated to reducing the suffering from cancer within Delaware’s borders. Through hard work and using a blueprint that utilizes the excellence in clinical cancer care demonstrated by community oncologists from all disciplines, Dr. Petrelli and colleagues were successful in their application to the NCI Community Cancer Center Program (NCCCP). The initial group of 14 community cancer centers was chosen for their commitment to clinical trials, transitional research, outstanding data collection, and a goal to reduce healthcare disparities in their community. While barely 1 year into this NCI designation, the group at the Helen F. Graham Cancer Center has achieved 20% accrual to NCI-group trials and will no doubt reach their goal of 30%. Since accrual to adult trials in cancer is generally below 5%, the outstanding commitment to reach these benchmarks is selfevident. All of us who are dedicated to realizing excellence in cancer care through the power of our community hospital cancer programs will gain much insight from reviewing Dr. Petrelli’s blueprint. In my role as chairman of the Commission on Cancer of the American College of Surgeons, I am particularly heartened to see the heights that a strong community cancer program can achieve. Dr. Petrelli and his colleagues at the Graham Cancer Center have thrown down the gauntlet, challenging the majority of the 1,480 facilities recognized by the Commission on Cancer Approvals Program which are labeled community hospitals. The achievements of our Delaware colleagues can be repeated at our community healthcare facilities if we adhere carefully to their published blueprint. Published online July 15, 2008. Address correspondence and reprint requests to: Frederick L. Greene, MD; E-mail: frederick.greene@carolinashealthcare.org

Insuficiência cardíaca com fração de ejeção preservada e com disfunção sistólica na comunidade

In developed countries, heart failure with preserved ejection fraction (HFpEF) is more prevalent than heart failure with reduced ejection fraction (HFrEF) in the community. However, it has not been completely established if this fact is also observed within our community. To determine the most prevalent form of heart failure (HFpEF or HFrEF) and whether the prevalence of HFpEF is higher in the community. This is a cross-sectional study conducted with patients clinically diagnosed with HF who were seen in community-based health care centers from January to December 2005. Echodopplercardiograms were performed for all patients. The form of HF was stratified according to the presence of abnormalities and the shortening fraction observed on the echodopplercardiogram. The study evaluated 170 patients (61.0 +/- 13.3 years of age), most of them women and elderly. HFpEF was the more prevalent form of HF (64.2%, p<0.001), affecting mostly elderly women (62%, p = 0.07), whereas the opposite condition, HFrEF, was observed mostly in elderly men (63.6%, p = 0.07). Patients with no HF represented one-third of the cases (27.6%). HFrEF patients had more lower-limb edema, coronary disease, diabetes, chronic renal failure, higher Boston scores and hospital readmissions. Use of alcoholic beverages and smoking were also more common among HFrEF patients. HFpEF is the most prevalent form of HF in the community especially among elderly women, whereas HFrEF affects mostly elderly men and is associated with greater clinical severity, main risk factors and no changes in lifestyle. Despite the signs and symptoms of HF, this condition was not confirmed for one-third of the cases.

Tiempo y ritual en la organización del cuidado médico

In this paper, I focuse on several issues that are central to the anthropologycal analysis of the health care developed in an institution of the City of Buenos Aires’ primary care level, especifically a Community-based Health Care Center. I examine the central place held by time in the social organization of health care, as it is revealed by the observation of the organization of the institution’s work schedule or time table, and the patients’ waiting time. I consider that there is a difference in the temporality level between the medical care institutions and the world outside, and that the passage from one time to the other is produced by several forms of ritualized behaviour. On the inside, the registration and assignment of turns appears as the institution’s main activity, one that is analyzed here as another ritualized form that organizes social interaction according to the Health Care Center’s norms.

The long term results of open antireflux surgery in a community-based health care center.

There is no previous study concerning long term results of open Nissen fundoplication performed by general surgeons in a nonspecialized unit. Of 45 consecutive patients in a general provincial center, 39 were available for follow-up after a mean period of 78 months. All patients were interviewed using a standard questionnaire, and 35 of them consented to undergo endoscopy. Of the patients, 85% had no or only mild reflux symptoms. The figures for dysphagia, flatulence, and bloating were 31%, 67%, and 46%, respectively. Endoscopy showed defective fundic wrap in 37% of the patients and erosive esophagitis in 29%. Five patients (13%) with recurrent esophagitis were referred for H2-blocker or omeprazole medication, and five others (13%) were scheduled for repeat antireflux surgery. The results were somewhat worse in regard to prevalence of defective fundic wrap and recurrent esophagitis than in other reports, which were from specialized units.

The long term results of open antireflux surgery in a community-based health care center

OBJECTIVE: There is no previous study concerning long term results of open Nissen fundoplication performed by general surgeons in a nonspecialized unit. METHODS: Of 45 consecutive patients in a general provincial center, 39 were available for follow-up after a mean period of 78 months. All patients were interviewed using a standard questionnaire, and 35 of them consented to undergo endoscopy. RESULTS: Of the patients, 85% had no or only mild reflux symptoms. The figures for dysphagia, flatulence, and bloating were 31%, 67%, and 46%, respectively. Endoscopy showed defective fundic wrap in 37% of the patients and erosive esophagitis in 29%. Five patients (13%) with recurrent esophagitis were referred for H2-blocker or omeprazole medication, and five others (13%) were scheduled for repeat antireflux surgery. CONCLUSIONS: The results were somewhat worse in regard to prevalence of defective fundic wrap and recurrent esophagitis than in other reports, which were from specialized units.

Establishing psychological services in a community-based, health care setting: A 3-year case study

Health care practitioners are being challenged to reorganize service delivery and psychology providers are emerging as important participants in shaping the development of primary health care practices. The article outlines the 3-year process of a community/academic/health care center partnership to develop a new model for providing interdisciplinary health care services. The authors describe the process of integrating psychological services into an interdisciplinary, primary care community-based health care center, outline specific planning strategies, and identify the roadblocks and barriers encountered.

Health care needs of Hispanic Americans and the responsiveness of the health care system.

The Hispanic population in the United States is growing rapidly but this population has many health care needs that are not being met. The findings from recent research on the current health status of Hispanic people who live in the United States are presented. An assessment of how accessible and available medical care services are to Hispanic people is made. Serious gaps exist in the delivery of medical care services to this group. Human service providers, particularly social workers, can help make the current health care system more responsive to the needs of this group by helping Hispanic individuals who have no health insurance coverage to find employment that includes health insurance benefits or some other form of insurance, by establishing community-based health care centers in Hispanic communities, by developing counseling programs tailored to the alcohol and drug abuse problems of the Hispanic population, and by advocating for government agencies to improve existing sources of data on the health of this group.