Articles: community-health-services.
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Randomized Controlled Trial Multicenter Study
The impact of community-based sexually transmitted infection screening results on sexual risk behaviors of African American adolescents.
To examine the effect of a community-based sexually transmitted infection (STI) screening program on sexual risk behavior among African American adolescents. We hypothesized that adolescents testing positive for an STI and receiving post-test counseling would reduce risky sexual practices, whereas STI-negative adolescents would show little or no change in protective sexual behavior after screening. ⋯ Community-based STI screening can help to reduce sexual risk behavior in youth who test positive for STIs. Alternative approaches will be needed to reduce risk behavior in youth who test negative but who are nevertheless at risk for acquiring an STI.
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Randomized Controlled Trial Multicenter Study
Study protocol: home-based telehealth stroke care: a randomized trial for veterans.
Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. ⋯ For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans.
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Multicenter Study Comparative Study
Reaching staff, parents, and community partners to prevent childhood obesity in Head Start, 2008.
Lowering the prevalence of childhood obesity requires a multilevel approach that targets the home, school, and community. Head Start, the largest federally funded early childhood education program in the United States, reaches nearly 1 million low-income children, and it provides an ideal opportunity for implementing such an approach. Our objective was to describe obesity prevention activities in Head Start that are directed at staff, parents, and community partners. ⋯ Head Start programs reported using a multilevel approach to childhood obesity prevention that included staff, parents, and community partners. More information is needed about the content and effectiveness of these efforts.
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Randomized Controlled Trial Multicenter Study
Rationale and design of the ADDITION-Leicester study, a systematic screening programme and randomised controlled trial of multi-factorial cardiovascular risk intervention in people with type 2 diabetes mellitus detected by screening.
Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in type 2 diabetes mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester). ⋯ ADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians.
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Multicenter Study
Standardization of severe sepsis management: a survey of methodologies in academic and community settings.
Evidence-based therapies for severe sepsis include early antibiotics, early goal-directed therapy, corticosteroids, recombinant human activated protein C, glucose control, and lung protective strategies. ⋯ Implementation of a sepsis management protocol incorporating evidence-based therapies can be accomplished in both academic and community hospitals, with minimal additional staffing. The presence of a protocol champion and education program is crucial to success, and may result in improved patient outcome.