Health care characteristics associated with women's satisfaction with prenatal care

OBJECTIVES: The objective of this study was to explore the relation between prenatal care characteristics and satisfaction among Medicaid recipients. METHODS: African-American (n = 75) and Mexican-American (n = 26) nonadolescent primiparous pregnant women who had at least three prenatal care visits participated in a 25-minute telephone survey that asked them about satisfaction with prenatal care (art of care, technical quality, physical environment, access, availability and efficacy); prenatal care characteristics (practitioner attributes, service availability, and features of the delivery of care); and, personal characteristics (sociodemographics, health status and behaviors, and pregnancy-related variables). Univariate and multivariable analyses were conducted to explore the relations between personal characteristics and satisfaction and between care characteristics and satisfaction. RESULTS: For the overall sample, the following prenatal care characteristics were associated with increased satisfaction: having procedures explained by the provider, short waiting times at the prenatal care site, the availability of ancillary services, and reporting that the prenatal care practitioner was male. When examining the data by ethnicity, whether the provider explained procedures was the most important determinant of satisfaction for both African-American and Mexican-American women. CONCLUSIONS: Knowledge of the care characteristics that impact low-income pregnant women's satisfaction can be utilized to alter service delivery to increase use of prenatal care and ultimately to improve perinatal outcomes.     

Organizational change in a human service agency.

An organizational change consultation was conducted with a large nonprofit human service organization. The consultation began with negotiations to gain entry to the agency followed by start-up activities at all levels of the organization. Seventy-two individual interviews were conducted. Interviews surfaced issues and concerns related to the climate, management, and operations of the agency and its eight programs. The mirroring (feedback) activity brought attention to the most critical issues in the organization for which action plans were developed and implemented. Employee follow-up survey results indicate favorable ratings for most action items. Lessons learned in the SHARE (pseudonym) consultation are presented for consideration by consultants working in human service and other organization settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contextual community prevention theory: Building interventions with community agency collaboration.

Translation from research to practice faces numerous problems that include replicating effectiveness, fidelity to the protocol and processes, and adaptations to different types of target populations. Working collaboratively with existing service providers can speed up the time for development and can ease the implementation of empirical randomized trials. Contextual community prevention theory is an innovative approach that focuses on changing behaviors of community members by creating a visible institutional presence that draws and pulls the targeted population into the organization’s activities and interventions. The result is an institution or organization within the community that provides a new active and dynamic context, engaging its community members into its activities, interventions, and functions. An HIV prevention program developed collaboratively from the ground up for Latino gay/bisexual men is presented. Results from the program evaluation efforts across the years suggest promise for testing its efficacy through a randomized trial. HIV prevention efforts need to develop dynamic support systems within communities where these men have ownership, have control, and feel safe; otherwise HIV infection rates in this population will increase. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The professional psychologist as evaluator in a community agency setting.

Describes a process evaluation of an industrial work unit for persons with disabilities and comments on the role of the psychologist as evaluator in an agency of this type. The relationship of process evaluation to other aspects of evaluation is discussed, and reasons are offered for establishing aims before embarking on an outcome evaluation. Suggestions are offered for ways of using ranked aims in every phase of the evaluation, and steps to facilitate the implementation of evaluation results are outlined. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of governmental policy on community health partnerships and community care networks: an analysis of three cases

This is a comparative analysis of hospitals' efforts in three communities to pursue collaborative ventures to advance community health. The events occurred over a two-year period characterized by increasing market competition and national debate about comprehensive health care financing reform. The study objectives are to better understand factors that contributed to the initiation of the collaborative efforts, and factors that sustained, hindered, or thwarted these efforts. The study explores how the collaborative ventures in these three communities fared in the face of multiple and conflicting policies and the simultaneous creation of larger, competing health systems. A number of concluding generalizations address the impact of interorganizational dynamics and public policy initiatives on community health partnerships.     

Outcome for people with schizophrenia before and after Medicaid capitation at a community agency in Colorado

OBJECTIVE: To investigate the effect of a capitated funding mechanism for the psychiatric care of Medicaid recipients, a study of outcome, satisfaction, and service utilization among adults with schizophrenia and schizoaffective disorder was conducted at a Colorado agency before and after the introduction of the new funding mechanism. METHODS: Two random samples of 100 clients each were selected, one a year before capitation was introduced and one a year after. Subjects were interviewed about their quality of life, needs, and service satisfaction. Psychopathology and service utilization were also measured. RESULTS: Psychopathology was lower after capitation in most dimensions. The number of subjects admitted to the hospital during a six-month period beginning a year after capitation was 57 percent lower than in the equivalent period before capitation, with no increase in the amount of outpatient treatment provided. Subjects reported improved quality of life in the domains of work, finances, and social relations. Significant changes in needs or service satisfaction were not detected. CONCLUSIONS: No evidence was found that Medicaid capitation had an adverse effect on the client population after one year. Findings suggested that capitation led to an efficient use of treatment resources.     

Experience with clozapine in a community mental health care setting

BACKGROUND: Clozapine has been heralded as the first major breakthrough in antipsychotic drug therapy for treatment-resistant schizophrenia in 40 years. This study reports on the experience with clozapine in an outpatient, community mental health care setting. METHODS: All clinic patients receiving clozapine during the 4-year period 1992 to 1996 were retrospectively studied. Measures of improvement were changes in the Clinical Global Improvement (CGI) Scale and reduction in the number of hospital days after clozapine therapy. RESULTS: Testing with the CGI scale showed moderate or marked improvement in 63% of patients. Hospital days dropped from 7,919 to 1,833 for comparable time periods. Clozapine therapy had to be discontinued in only 21% of patients, and no serious side-effects occurred. CONCLUSION: Clozapine is an effective medication for treatment-resistant schizophrenia and can be safely used in chronic mental illness. Although the drug is expensive, the cost is offset by a remarkable reduction in hospital days.     

Creating community power in health care

With healthcare systems changing at a rapid pace and resources becoming scarcer, communities and institutions together can create new ways to provide health care and uncover previously overlooked resources. Below, what these partnerships can teach nurses about the power that can come from sharing power.     

Primary care of adults with mental retardation living in the community

An increased number of adults with mental retardation are living in the community and seeking health care from family physicians. When mentally retarded patients are enrolled in a medical practice, guardianship status should be determined, but these patients should be involved in their own care to as great an extent possible. Since a verbal history may be difficult to obtain, a systematic, thorough physical examination is important. Certain Illnesses, such as hepatitis B, recurrent aspiration syndrome, leukemia and atlantoaxial instability, are much more common in adults with Down syndrome then in adults with mental retardation from other causes. Seizures and mental illness are equally common in all mentally retarded adults. The behavior management and pharmacologic therapy of patients with mental retardation are best handled in close association with caregivers, as well as psychiatrists and neurologists who are familiar with the special needs of this population.     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Rural health care networks in South Dakota

To address health care access concerns, a Regional Coordinated Care Network (RCCN) program, through Robert Wood Johnson Foundation Practice Sights Initiative funding, is being developed by the South Dakota Office of Rural Health. The intent of the initiative is to expand primary and preventive care and, hopefully, permanently reduce the number of Health Professional Shortage Areas (HPSAs) in the state by linking and enhancing providers and services. In rural areas such networking will be crucial for the delivery of health care. Surely, the impact on family physicians will be significant and salutary.     

Organizational characteristics, work characteristics, and relationships with psychologic work reactions in nursing: A longitudinal study.

The aim of this study was to investigate longitudinal relationships between (a) organizational characteristics and work characteristics and (b) organizational characteristics and psychologic work reactions. To get insight into patterns of relationships, self-administered questionnaires were distributed to 596 nurses at time 1 and 379 at time 2. A two-wave full crosslagged structural panel model was used to analyze the data. With regard to the relationships between organizational characteristics and work characteristics, the crosslagged analyses showed stronger support for a pattern of reversed "causation." Considering relationships between organizational characteristics and psychologic work reactions, no reversed crosslagged relationships were found, although hypothesized cross-sectional relationships were supported. This lack of relationships over time was explained by methodological as well as theoretical arguments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The determinants of user satisfaction with community psychiatric nursing care

A 70-year-old diabetic woman with sensory polyneuropathy presented with osteonecrosis of the toes and a plaque-like lesion on the dorsum of the ipsilateral foot. Histological diagnosis of eccrine syringofibroadenoma (ES) was made. A review of the literature reveals several cases of solitary ES of the foot in diabetic patients with peripheral neuropathy. This variant of ES seems to be an eccrine sweat duct hyperplasia during the restoration of skin structures damaged by traumas in a situation of peripheral neuropathy. Diabetes and polyneuropathy should be searched for in patients with ES, particularly in acral locations.     

Intractable cough associated with the supine body position. Effective therapy with nasal CPAP

We describe five patients with severe nocturnal cough and daytime somnolence in whom the coughing attacks are triggered by assuming the supine body position. Quantity and quality of the nocturnal cough were evaluated in the sleep laboratory with and without nasal continuous positive airway pressure (N-CPAP). Air flow characteristics were assessed using flow volume and airway resistance loops. Airway anatomy was evaluated bronchoscopically. In all five patients, the cough had a barking quality. Flow-volume loops showed an expiratory collapse phenomenon in two of the patients. Endoscopically, all five patients had signs of airway collapse. All patients had difficulty falling asleep because of coughing and were awakened by it frequently. Sleep times ranged from 2.5 to 4.5 h per night. With N-CPAP pressures ranging from 5 to 13 cm H2O, all five patients had clinically significant improvement in their symptoms. Their sleep times increased to a range of 5 to 7.5 h per night and the daytime somnolence markedly improved or resolved. All five patients requested a N-CPAP unit for home use. We conclude that a cough that is predominantly associated with or exacerbated by the supine body position may be treated effectively with N-CPAP.     

高炉结瘤的征兆与位置判断

高炉结瘤是能够预防的。预防结瘤，应从识别结瘤征兆入手。高炉结瘤的普遍特征主要有：热流强度降低、炉墙温度低于正常值、冷却设备进出水水温差低于正常水平及炉皮温度明显降低。结瘤位置可用炉身探孔法、降料面观察法及传热计算法来确定。     

Assessing relationship quality in mandated community treatment: Blending care with control.

Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n=90; n=322), the authors developed and validated the revised Dual-Role Relationships Inventory (DRI-R). The authors found that (a) relationship quality in mandated treatment involves caring and fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relationship quality, is internally consistent, and relates in a theoretically coherent pattern with ratings of within-session behavior and with measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual-role relationships predicts future compliance with the rules, as assessed by probation violations and revocation. The DRI-R covaries with multiple domains more strongly than a leading measure of the therapeutic alliance, suggesting that it better captures the nature and effect of relationship quality in mandated treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ocular characteristics associated with rigid gas-permeable lens adherence

PURPOSE: Rigid gas-permeable (RGP) lens adherence after overnight lens wear is clearly a patient-dependent phenomenon. However, no previous study has attempted to determine whether specific ocular characteristics are associated with an increased frequency of lens adherence. METHOD: In this study, clinically applicable tests were used to measure a range of ocular characteristics, including central and peripheral corneal curvature, tear film status, eyelid characteristics, central corneal thickness, and ocular rigidity in a group of 22 young adult subjects for whom reliable estimates for frequency of overnight RGP lens adherence had been obtained from earlier studies. RESULTS: Linear discriminant analysis revealed that a higher frequency of lens adherence was associated with lower ocular rigidity, thinner central corneas, greater eyelid tension, and lower amounts of corneal astigmatism. CONCLUSIONS: These findings suggest a clinical approach for identifying patients who may develop clinically significant lens adherence during RGP extended wear, and also provide support for the "thin film adherence" theory of RGP lens adherence.