Consumer-Run Drop-In Centers and Clubhouses: Comparisons of Services and Resources in a Statewide Sample.

Consumer-run programs and clubhouses are 2 important models in the emerging field of psychosocial rehabilitation according to the 1999 Surgeon General's report (U.S. Department of Health and Human Services, 1999). However, no published studies have compared the operations and services of these 2 models. The research reported here involves a statewide study of a matched sample of 29 clubhouses and 29 consumer-run drop-in centers (CDIs), with data gathered by obtaining documents from and conducting on-site interviews with agency directors. As expected, the authors found greater member control and involvement at CDIs and more instrumental services and activities at clubhouses. The authors also found that clubhouses had substantially more resources than CDIs and that CDIs showed significantly greater variance across programs on most measures. Implications for planning and further research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The human Musashi homolog 1 (MSI1) gene encoding the homologue of Musashi/Nrp-1, a neural RNA-binding protein putatively expressed in CNS stem cells and neural progenitor cells

In 1992 Congress mandated the Department of Veterans Affairs to provide treatment to veterans traumatized by sexual assault experienced during active military duty. A 1995 survey of how VA medical centers had responded to this mandate indicated that 51 percent of 136 centers had established a sexual trauma treatment team. Teams treated a mean+/-SD of 5.5+/-10 patients a week, and newly referred veterans waited a mean of 3.3+/-4 days for evaluation. Teams varied in the discipline mix of providers, training, organizational structure, services offered, and caseload. Medical centers without dedicated treatment teams offered nonspecialized services to sexually traumatized veterans or offered community referrals for sexual trauma treatment services.     

Who uses psychological services in Canada?

This paper used data collected in the 1994–95 National Population Health Survey to provide a profile of consumers of psychological services. The survey was designed to assess the health status of Canadians by collecting data from a representative sample of 12+ yr olds in Canadian households. Approximately 515,000 Canadians indicated that they had consulted a psychologist in the 12 mo prior to the survey. The demographic profile of consumers of psychological services is consistent with patterns of utilization of mental health services found in other studies. Consumers were more likely to be female, to be middle-aged and to be separated, divorced or widowed. Those with higher education and higher income were more likely to receive psychological services. Consumers of psychological services reported poorer health status than the general population, a higher number of past and recent stressors, higher levels of distress, and were more likely to have received psychotropic medication. The majority of those likely to meet criteria for a diagnosis of depression did not receive psychological services. Another important theme was the apparent underutilization of psychological services, especially by people with the greatest mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Constraints faced by hospitalized maternity patients in Niamey (Niger)

A cross-sectional survey was conducted in the main maternity hospital in Niamey (Maternité Poudrière) in July 1995 to evaluate the domestic and financial pressures faced by the patients. One-hundred-and-five women were included in this exhaustive survey which analyzed the socio-demographic characteristics of the patients' households, the reasons for their hospitalization, the organization of their daily life while in hospital, and the costs involved (type of costs, the amounts, and who paid which cost). Fifty-seven women lived in Niamey, and forty-eight in a rural area. The socio-demographic characteristics of the survey population were in agreement with the characteristics of Niger's census in 1988. Analysis of the patients' incomes showed that they were highly dependent on their husbands. Fifty-eight received surgical treatment, and forty-seven received medical treatment. The costs of hospitalization included the standard fee, traveling expenses, and the costs of drugs and surgery. On average, 72% of the hospitalization costs were paid by the husbands, and 15% by close members of the family. The contribution by extended family members and friends was very small. Only 40.5% of the total amounts exceeding 25,000 FCFA were wholly paid. Niger has a policy of recovering medical costs. Our survey shows the difficulties of attempting to reconcile the operation of health centers with access to specialist care.     

A national survey of emergency department chest pain centers in the United States

Although chest pain centers are promoted as improving emergency cardiac care, no data exist on their structure and processes. This national study determines the 1995 prevalence rate for emergency department (ED)-based chest pain centers in the United States and compares organizational differences of EDs with and without such centers. A mail survey was directed to 476 EDs randomly selected from the American Hospital Association's database of metropolitan hospitals (n = 2,309); the response rate was 63%. The prevalence of chest pain centers was 22.5% (95% confidence interval 18% to 27%), which yielded a projection of 520 centers in the United States in 1995. EDs with centers had higher overall patient volumes, greater use of high-technology testing, lower treatment times for thrombolytic therapy, and more advertising (all p <0.05). Hospitals with centers had greater market competition and more beds per annual admissions, cardiac catheterization, and open heart surgery capability (all p <0.05). Logistic regression identified open heart surgery, high-admission volumes, and nonprofit status as independent predictors of hospitals having chest pain centers. Thus, chest pain centers have a moderate prevalence, offer more services and marketing efforts than standard EDs, and tend to be hosted by large nonprofit hospitals.     

Cancer early-detection services in community health centers for the underserved. A randomized controlled trial

BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.     

The Medical Expenditure Panel Survey: a national health information resource

This article describes the Medical Expenditure Panel Survey (MEPS), the third in a series of nationally representative surveys of medical care use and expenditures sponsored by the Agency for Health Care Policy and Research. The MEPS is designed to provide extensive data on the types of health care services American use, how frequently they use them, how much is paid for the services, and who pays for them. It also will provide information on the types and costs of private health insurance available to the U.S. population. The survey is unparalleled in its degree of detail, as well as its ability to link medical care use, payments, and health insurance coverage to specific survey respondents and their families. It allows analysts to examine how individual and family characteristics, including the characteristics of their health insurance, affect medical care use and spending. This article discusses each of the MEPS components, focusing on design enhancements that have been made since the survey was last conducted nearly a decade ago.     

Preoperative aspirin therapy--a contraindication for kidney transplantation?

INTRODUCTION: The influence of ASA treatment on haemostasis is still debated. There are doubts in case of emergency operations, especially in transplant patients, concerning dosage and change of medication. METHODS: Our results are based on an analysis of the therapeutical behavior in German transplantation centers. The question of transplant suitability, dosage and haemostatic effects will be discussed in comparison to the literature. RESULTS: 85.7% of the transplantation centers perform the operation despite of and under ASA treatment. In these cases an increased bleeding tendency is tolerated and observed in 33.3% of the centers. An increased mortality has not been reported. Most of the transplantation centers accept a dosage of 100 mg ASA daily. Only 14.3% of the transplantation centers refuse the operation in ASA treated patients. CONCLUSIONS: Correctly indicated ASA treatment (cardiac arrhythmia, patients with embolism or thrombosis) isn't a contraindication for renal transplantation (daily dosage up to 100 mg). In elective cases however, a preoperative change of the medication is recommended, e.g. the use of heparin instead of ASA.     

Psychology positions in comprehensive community mental health centers and community clinics.

Analyzed data from 655 questionnaires completed by community mental health centers and community clinics in the US in 1968. 71% of the agencies offered services to adults and children. 15% served primarily adults, while 14% served primarily children. The major sources of financial support, in descending order, were state, county, and federal governments. 69% of agencies had private consultation privileges associated with positions, and a small percentage of agencies also paid professional membership dues. The median maximum salary for the chief psychologist was $16,750. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

State of the national's poison centers: 1995 American Association of Poison Control Centers Survey of US Poison Centers

The American Association of Poison Control Centers (AAPCC) 1995 annual survey is summarized. A decline in the total number of poison centers was noted (from 104 in 1991 to 83 in 1995). The 83 US poison centers handled 2,431, 599 human exposure cases. Certified centers (44) served 63.1% of the US population, handled 72.5% of all poison exposures handled by poison centers nationally, and achieved higher utilization rates within their regions (10.9 vs 7.4 human exposure cases handled/1,000 population). Certified centers had superior staff credentials as measured, by passing the certification examinations for specialists in poison information or board certification for medical and managing directors. Funding for poison centers in 1995 to-total $74.6 million, although this funding level was recognized to be inadequate as only 63.1% of the population was served by certified centers and utilization of poison centers was not optimal. The annual cost of covering the entire US with adequate poison control services (meeting AAPCC certification standards and with utilization at a level of 15 human exposures per thousand population) is estimated at $120 million. Funding difficulties were prevalent. Thirty-five centers indicated that closure had been a real threat at least once in the previous 5 years. Analysis of cost per human exposure case by center volume demonstrated that economies of scale were achieved when a center handled at least 20,000 to 30,000 human exposure calls/year. Increasing human exposure volume beyond 30,000/year did not lead to a reduction in the average cost per human exposure case.     

Legislation relevant to perinatal care

The legislative process is one route to follow in the attempt to change and improve perinatal care. Payment by the State Crippled Children's Service for medical care of certain costly high-risk neonatal conditions, only to qualified specialists and in centers meeting acceptable standards has had a snowball effect on upgrading neonatal care in this state. Not only has a large network of neonatal care centers and infant transport systems been developed, but there has been a rush especially on the part of nurses, to get special training in neonatal care. This has included not only the care of the sick neonate, but a look at newborn evaluation and resuscitation in the delivery and newborn areas. It is expected that this same center development and education and training process will now be extended to obstetrical care, as there is renewed interest in special care for high-risk mothers because of Assembly Bill 1326. The new hospital perinatal regulations mandate improvement of care in community hospitals where the majority of deliveries take place. The emphasis is on a larger and better educated staff, more concern with patients rights, and provision of a more humanistic family centered care as well as continual evaluation of maternal and neonatal outcome. The greatest limitation has been lack of Health Department staff to provide adequate consultation and surveillance of these services for compliance with the new laws. There has been an approximate 10 per cent reduction in the number of hospitals with maternity services- from 416 in 1968 to 369 today. While much of this consolidation may have been due to the fall in birth rate, these regulations have also contributed to the process. Most important of all, these laws have kept perinatal care constantly in the consciousness of California health care providers and consumers.     

Use of psychiatric services by patients referred to a consultation unit

The psychiatric case registers for the hospital catchment area were examined to determine the use of psychiatric services over a 14-year period by a 4-year cohort of consecutive inpatient referrals to the consultation-liaison service of a British general hospital. Two-thirds of the subjects had no other psychiatric care during the survey period, but a third made considerable use of a wide range of specialist psychiatric services. Alcohol problems and dementia were notably associated with complex history of psychiatric management. Management of patients with repeated episodes of psychiatric care requires close collaboration with other services.     

Reassigning clients: Practices used by counseling centers.

Investigated circumstances necessitating internal counselor reassignments and classified procedures used to conduct reassignments at 122 college and university counseling centers that responded to a survey of reassignment practices. Most frequently reported reasons for reassignments were completion of practica and internships, provision of alternate services, counselor–client incompatability, and insufficient therapeutic progress. Reassignment practices were grouped using block cluster analysis. Four blocks of practices were obtained that varied on level of client participation in selecting new counselors, as well as on amount and types of client preparation. Implications for development of reassignment policies and the effects of reassignment procedures in subsequent therapeutic progress are discussed. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient satisfaction. The survey says...

Health care organizations and providers compete in a marketplace where loyal consumers are essential to a successful business. Contemporary consumers have health care knowledge and power. As employers negotiate benefits with providers, most will consider input from employees receiving care. Negative feedback from dissatisfied recipients of care can affect employers' selection of facilities and providers. This is significant leverage that health care organizations should consider when providing services to customers. Information obtained through patient satisfaction programs has proven to be a valuable source for quality improvement marketing, risk management, strategic planning, and finance initiatives. In this article, the authors describe variables associated with a patient satisfaction survey, identify key elements of a patient satisfaction survey program, and offer workable solutions to maximize patient satisfaction programs.     

Alcohol beverage drinking, diet and body mass index in a cross-sectional survey

OBJECTIVE: The study was carried out to determine the associations of alcohol beverage drinking with macronutrients, antioxidants, and body mass index. SETTING: Dietary subsample of the 1992 Finmonica cardiovascular risk factor survey in Finland; a cross-sectional study. SUBJECTS: 985 women and 863 men were drawn from the population register in the four monitoring areas. All subjects were 25-64 y of age. METHODS: The mailed questionnaire included questions covering socioeconomic factors, physical activity, smoking, and alcohol consumption. The diet was assessed using a three-day food record. RESULTS: The dietary differences between abstainers and alcohol consumers were more significant than between consumers of different alcoholic beverages. Among drinkers, fat intake as a percentage of energy was higher and carbohydrate intake was lower than among abstainers. Those who preferred wine, however, had the highest vitamin C intake; female wine drinkers also had the highest carotenoid intake. With the exception of those who mainly preferred spirits, alcohol energy was not added to the diet but seemed to substitute food items both in men and women. Despite the similar total daily energy intakes, daily energy expenditure, and physical activity index, male drinkers were leaner than abstainers. In women, the proportion of underreporters of energy intake increased with increasing alcohol consumption, and the association between alcohol and body mass index was similar to that in men after the exclusion of underreporters. CONCLUSIONS: Alcohol consumers were leaner than abstainers, and wine drinkers in particular had more antioxidants in their diet.     

Availability of school health services for young children

A survey to assess availability of school health services was distributed to 221 directors of Schools of the 21st Century, an educational model that provides integrated services to children and families. Of this distribution, 126 (57%) surveys were returned; 88% of respondents reported they provided some type of school health services for their students; 75% of schools had access to school nursing services, yet only 33% had a school nurse on-site; 50% had less than daily access to a school nurse. Despite a high reported prevalence of physical and mental health problems, other services such as acute care, nutrition counseling, dental screenings, or mental health services were provided less frequently. Barriers perceived as problematic for schools providing health services included inadequate funding, limited parental awareness, and opposition by school or community members. Respondents believed transportation, limited financial resources, and inadequate health insurance were barriers to care for children and families. Among this sample of schools, school health services varied in availability and comprehensiveness. Educators, health providers, and parents must work together to provide improved school health services for children.     

Women's utilization of outpatient psychiatric services: Some emerging priorities for rehabilitation psychologists.

Provides a brief profile of women's utilization of outpatient psychiatric services, based on a 1975 survey conducted by the National Institute of Mental Health, and focusing on population characteristics that have special implications for rehabilitation psychologists, including race, age, marital status, diagnosis, and type of treatment. Findings reveal that more than 60% of adult admissions (aged 18–64 yrs) were female. Black females had the highest admission rate, followed by Black males, White females, and White males. Most female admissions 14 yrs or older, both Black and White, were married, and depression was the leading diagnosis, suggesting that developing effective rehabilitation strategies for women will require special attention to the causes and consequences of depression. Results also indicate that minorities were less likely than Whites to receive individual psychotherapy, and more than 40% of clients diagnosed as having a depressive disorder received drug therapy. Sources of information on mental health of women and minorities are identified, including reviews of the literature, journals, and research centers that deal specifically with the mental health needs of special populations. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative assessment of the referral system at district level in Zimbabwe: implications on efficiency and effective delivery of health services

This exploratory study describes the nature and magnitude of the problem of health referrals, health-seeking behavior, perceptions, and knowledge at the district level in Zimbabwe. Data were obtained from focus groups with 159 persons in Tsholotsho and 132 persons in Murewa; from discussions with health personnel from the 6 health centers in Murewa and the 2 rural hospitals in Tsholotsho; and from records among a systematic sample of 400 new outpatients during October 1993 and March 1994 in Murewa district. Findings indicate that 71.8% in outpatient departments at Murewa Hospital had no access to a health center. 24.3% by-passed the health center for treatment at the hospital. 3.8% were referred by health centers. The absolute number of referrals did not change during 1991-93. However, the number directly accessing services from outside the district rose. Focus group participants reported their intention to use the nearest clinic for an illness. In Tsholotsho, people initially used the village community worker/headman. If illness was perceived as serious, patients would go to a hospital. For minor illness, people used traditional herbal remedies. If illness did not change after remedies, the clinic was consulted. Some illnesses were perceived as outside the realm of medicine. Most distinguished between a health center and a hospital, but were unaware of the important, superior functions of the health center. Most did not understand the logic behind the referral system, but appreciated referrals and not the cost of hospital treatment or transportation. The community was unaware of Ward Health Teams. Many did not understand the new fee policy introduced in 1994.     

Survey of college counseling centers' follow-up practices with former clients.

We investigated the follow-up methods used by counseling centers to evaluate the individual counseling services that they provide. A sample of 80 centers was selected for study; these were centers that indicated that the primary form of evaluation was a locally developed instrument used to assess clients' post counseling status and satisfaction with their counseling. We used a questionnaire to assess data-gathering procedures, follow-up practices, rates of return, and uses made of the data as well as resulting problems and trends. Major issues addressed include the low percentage of return rates of satisfaction questionnaires and the effect of these rates on possible response bias. The use of center survey results to evaluate client status and counselors' work is discussed. The issue of the timing of satisfaction surveys of clients is raised, particularly in light of procedures that combine clients who have previously terminated counseling and clients still in the process of counseling. The issues of self-report and the need for more rigorous methodologies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)