Comparison of key informant and survey methods for ascertainment of childhood epilepsy in West Bengal, India

BACKGROUND: This study aimed to compare efficacy and cost of key informants and survey for ascertainment of childhood epilepsy within a treatment context in rural India. METHODS: The study was set in a non-governmental, community programme for the functional and socioeconomic rehabilitation of children with disabilities in rural West Bengal, India. Ascertainment was by two methods: house-to-house survey of 15000 households and also by 430 key informants including village leaders, health workers and 670 schoolchildren. Methods were compared for positive predictive value, and sensitivity by capture-recapture technique. Ninety four children were enrolled into treatment. Predictors of treatment success were determined by multiple logistic regression analysis, giving adjusted odds ratios for remission. The costs of identifying one case and one treatment success were measured by costing personnel, materials and overheads. RESULTS: The survey was four times as sensitive as key informants although the positive predictive values were similar (36%, 40%). The survey had an absolute sensitivity of only 59%. Identification by key informants strongly predicted successful treatment outcome (odds ratio [OR] = 4.74, 95% confidence interval [CI] : 1.19-18.85). The cost of finding one case was US$11 and US$14, and of finding one successful treatment outcome US$35 and US$67 for informants and survey respectively. Key informants were essential in attaining longer term programme objectives. CONCLUSIONS: In the context of a treatment programme, key informants were the more cost-effective method, but community involvement was traded against low sensitivity in the short term. Overall ascertainment costs were significant in the context of primary health care in India.     

Genomic organization of the mouse adrenocorticotropin receptor

PURPOSE: This paper describes the perceived risk of occupationally contracting HIV and reported compliance with universal precaution guidelines among Australian dental hygienists and dentists. METHODS: This examination is based upon responses to a mailed questionnaire from all registered dental hygienists (63% response rate, n = 208) and dentists (76% response rate, n = 550) in Western Australia. RESULTS: Results indicate that: 1) oral healthcare providers who perceive a high risk of occupationally contracting HIV report a more conservative, cautious approach to HIV infection than do providers who perceive less risk of contracting the virus; 2) dental hygienists are more likely than dentists to report a higher degree of perceived risk of occupationally contracting HIV; and 3) dentists are more likely than dental hygienists to report compliance with universal precaution guidelines in the dental practices where they work. CONCLUSION: Educating oral healthcare providers on the realistic risks of occupationally contracting HIV and the value of compliance with universal precaution guidelines may reduce undue stress and hindrances in the provision of safe and effective oral healthcare in this era of AIDS.     

The rural psychologist as generalist: A challenge for professional identity.

Discusses how the psychologist who practices in a rural mental health facility performs many tasks identical to those done by other mental health professionals. While a nonpluralistic and financially constrained mental health system is best served by flexible professionals with a wide range of skills, psychologists in such a setting must utilize their unique training to establish their identity among the service providers. The unique identity of the psychologist is found in the heritage, perspective, and methodology of psychology and not just in clinical activity. Psychologists should begin to develop their methodology by using the larger university context in which they were trained and thereby establish themselves also as researchers and community psychology practitioners. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of key informants, parents, and teenagers for planning adolescent substance abuse prevention programs.

Surveyed 102 key informants about their knowledge of adolescent substance abuse in their community. Results were compared to findings from similar surveys administered to 402 teenagers and 266 parents in the same geographic area. Key informants matched teenagers' judgments about the prevalence of alcohol and marijuana use, but overestimated other drug use. Parents greatly underestimated all drug use. Key informants, parents, and teenagers differed on attitudes toward resources for prevention and alternatives to drug use. Implications for the use of community resources in primary prevention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Western bioethics on the Navajo reservation. Benefit or harm?

OBJECTIVE: To understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives. DESIGN: Focused ethnography. SETTING: Navajo Indian reservation in northeast Arizona. PARTICIPANTS: Thirty-four Navajo informants, including patients, biomedical health care providers, and traditional healers. RESULTS: Informants explained that patients and providers should think and speak in a positive way and avoid thinking or speaking in a negative way; 86% of those questioned considered advance care planning a dangerous violation of traditional Navajo values. These findings are consistent with hózhó, the most important concept in traditional Navajo culture, which combines the concepts of beauty, goodness, order, harmony, and everything that is positive or ideal. CONCLUSIONS: Discussing negative information conflicts with the Navajo concept hózhó and was viewed as potentially harmful by these Navajo informants. Policies complying with the Patient Self-determination Act, which are intended to expose all hospitalized Navajo patients to advance care planning, are ethically troublesome and warrant reevaluation.     

Developing community capacity to treat post-deployment mental health problems: A public health initiative.

Meeting the mental health needs of Veterans returning from recent deployment requires the coordinated effort of partnerships across Department of Defense (DoD), Department of Veterans Affairs (VA), and state and local communities. Although the proportion of Veterans of Iraq and Afghanistan who have accessed VA health care has grown, the majority of these new combat Veterans have yet to present for VA care. The stigma associated with reporting a deployment-related mental health problem may be one factor in this, but access to treatment may also be an important concern among the one third of American Veterans who live in rural or highly rural areas. As these Veterans are more likely to present to a primary care, faith-based or mental health provider in their own community, partnerships between community providers, DoD, and VA are of critical importance in ensuring appropriate care, regardless of treatment setting. In an effort to improve services and access to services, especially to rural Veterans, an educational public health initiative was created to educate community providers about military culture, deployment-related mental health issues, VA resources, and evidence-based treatments. We describe the development, dissemination and evaluation of this initiative, as well as lessons learned for future similar endeavors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Human service needs assessment: Three non-epidemiological approaches.

Examines 3 major approaches to needs assessment, each defined by the degree of citizen involvement entailed in it. Within the framework of the first approach, emphasis is placed on social indicators; the 2nd approach is concerned with survey techniques, both residential and institutional; and in the 3rd approach, community impressions are discussed in terms of forums, nominal groups, and key informants. The value of using several methods in combination is suggested. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decisions and justifications by community mental health providers about hypothetical ethical dilemmas

OBJECTIVE: Community-based treatment of persons with serious mental illness requires providers to become involved in clients' personal lives to a greater degree than does hospital-based treatment. The study examined attendant ethical dilemmas, especially for staff who lack professional training or work in rural communities. METHODS: A total of 95 staff members from five community mental health centers read 14 vignettes describing ambiguous ethical dilemmas involving professional role boundaries or client confidentiality. Twenty-seven staff members were from rural agencies, and 68 from urban-suburban agencies; 60 were direct care staff, and 35 were supervisory. Participants were asked to make and justify a more conservative or a less conservative decision in response to each dilemma. RESULTS: Years of experience as a mental health provider and previous ethics training correlated positively with staff having experienced more situations similar to those in the vignettes; however, these variables were not related to the decision made or the type of ethical justification for it. When the analysis controlled for experience and previous ethics training, staff made fewer conservative decisions in boundary dilemmas than in confidentiality dilemmas. Compared with nonrural providers, rural providers had experienced more boundary dilemmas and made fewer conservative decisions in response to them. CONCLUSIONS: Boundary problems occur frequently in community-based services, especially in rural settings, and may or may not be handled conservatively. With the expansion of case management and other in vivo services, better understanding of ethical risks and informal practices will help improve services and provide appropriate training and supervision of staff.     

Barriers to nutritional well-being for rural elders: community experts' perceptions

Older adults use public and private services, as well as personal resources, to meet nutritional needs. In-depth interviews conducted with 73 service providers and community experts in two rural North Carolina counties were analyzed for these experts' perceptions of barriers to adequate nutrition for older adults. Perceived barriers included characteristics of the county and programs, transportation, and kin, as well as older adult medical and economic conditions, food habits, knowledge, and attitudes. The importance given each of these domains varied by respondents' area of expertise. Community experts and providers may not see the connection between their services and nutritional well-being of older adults.     

Review of The elderly in rural society: Every fourth elder.

Reviews the book, The elderly in rural society: Every fourth elder edited by Raymond T. Coward and Gary R. Lee (1985). Until recently, the gerontological literature has had a decidedly urban bias. This book is an important effort to fill the knowledge gap concerning the rural elderly and is a useful reference for students, academicians, service providers, and policy makers who share a concern for America's rural elderly. For many of the more than 59.5 million rural residents of this country, the romanticized vision of a tranquil and prosperous rural lifestyle has been replaced by the realities of economic deprivation, inadequate housing, and unaddressed physical and mental health problems. This book brings together a wealth of current information to understand these realities better. In addition to the editors, 16 distinguished contributors, primarily from the fields of sociology and social work, examine rural-urban differences and the implication of those differences for the rural elderly population. Chapters cover demographics, socioeconomic considerations, physical and mental health status, housing characteristics, family and community relationships, and the development and delivery of health and human services to the elderly in rural society. This book helps service providers to understand and be sensitive to the value system and social ecology of rural areas so that they can address real rather than assumed needs more effectively. Overall, the book is comprehensive and well-written and can serve as a resource for students and professionals from a variety of disciplines, including rehabilitation psychology, who may work with, live with, help, or study the rural elderly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rural perspective on health care for the whole person.

The authors summarize the health care problems facing rural and frontier America by addressing five key issues within the framework of health care for the whole person: how to (a) provide health care access, (b) ensure health care quality, (c) provide a range of health care or meet the scope of practice demands, (d) address regional, rural-specific characteristics that may exist, and (e) address health professionals' quality of life. When working in rural and frontier areas it is crucial for providers to collaborate across all types of health care to provide better care and better utilize a region's tautly stretched resources. Rural health care resources are provided. The authors attempt to demonstrate characteristics of rural culture and rural and frontier populations' health care disparities, highlighting the need for collaborative care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alzheimer's Rural Care Healthline: Linking Rural Caregivers to Cognitive-Behavioral Intervention for Depression.

Objective: To describe the challenges faced by rural caregivers in providing assistance to older family members with Alzheimer's disease and closely related conditions. Procedure: Preliminary focus group findings from a new grant initiative, Alzheimer's Rural Care Healthline, that assesses the efficacy of telephone-based cognitive- behavioral intervention for rural dementia caregivers. Groups identified specific caregiver educational and skills-training requirements and best methods for soliciting referrals from rural health providers, community elder care agencies, and churches. Results: Trust emerged as an overarching theme, along with family and community privacy issues and the stigma associated with dementia. Conclusions: Future studies should consider the educational priorities, technological requirements, and sociocultural context of rural caregivers in designing telehealth-based interventions, including issues of privacy, stigma, and trust. Recognition of these factors may lead to increased acceptability, frequency of use, and sustainability of rural telehealth programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Painful justice: an ethical perspective on the allocation of trauma services in Australia

Australia faces general and particular problems in the just distribution of trauma services, such as a proliferation of expensive technologies, economic and geographic limitations on their provision, and inequities in allocation. The ethics of shalom in which people live in harmonious relationships with each other, the world and God provide a moral framework for the discussion of the allocation of health care. Ethics deal with people and their relationships, which entails examining the nature and consequences of an action or policy and the character of the persons and institutions involved. The goal of health care, including trauma services, is not to 'fight disease' or to improve the health of the community, but to return people to proper functioning as people-in-relationships, as far as this is practicable. In applying this to the equitable provision of trauma services in Australia, we should distinguish between sustenance rights and community-provided mercies. The former are basic services that we need in order to function meaningfully in the community, and to which we are entitled (eg., basic health care). The latter are other benefits that we as members of the community choose to provide for each other, but to which we are not entitled per se (eg., ICU, Tertiary Trauma Centres). We should do all we reasonably can to ensure that all people receive their healthcare sustenance rights, that healthcare mercies are equitably distributed, and that the person-orientation of health care is maintained in the face of 'technological imperatives'.     

'The dwindles'. Failure to thrive in older patients

Geriatric failure to thrive has three elements: deterioration in the biological, psychological, and social domains; weight loss or undernutrition; and lack of any obvious explanation for the condition. It results from the combined effects of normal aging, malnutrition, and specific physical, social, or psychological precipitants (eg, chronic disease, dementia, medication, dysphagia, depression, social isolation). Failure to thrive can be managed with a commonsense approach by primary care physicians and healthcare providers such as social workers and dietitians; extensive referral is not necessary. The key to effective care is to identify all of the precipitants and intervene early to prevent progression.     

The potential role of peripheral health workers and community key informants in the rapid assessment of community burden of disease: the example of lymphatic filariasis

Data for planning disease control programs in most developing countries is often not available because they are usually expensive to gather. This study explored the potential use of peripheral health staff and community key informants in gathering community-level data about lymphatic filariasis. Agreement between findings of health workers and those of physicians was very high (kappa 0.66-0.87) for the clinical conditions examined. The prevalence of hydrocele was found to be a good predictor of communities at risk of filariasis. Community key informants provided very useful qualitative and quantitative data on the prevalence of clinical filariasis. The need to use nontraditional health professionals in gathering data for planing control programs is discussed.     

Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward

OBJECTIVES: A model of compliance by frail elderly with prescribed healthcare services was developed and tested. The discrepancy between primary care, geriatric and community health center (CLSC) services prescribed at discharge after comprehensive geriatric evaluation and treatment was measured, as were those services actually used during a 6-week interval (compliance). In this model, compliance was directly related to elders' intention to adhere to prescribed services, but this relationship was modified by organizational factors, reinforcing factors, and changes in health status during the observation period. Intention to adhere resulted from individual and reinforcing factors existing before discharge. METHODS: This model was tested on 211 patients discharged to community settings from an acute-care hospital geriatrics ward. Information was obtained through interviews with the patients or care givers and from hospital, outpatient, and local community health center charts. RESULTS: On average, patients used 56.9% of services prescribed; 13% of patients did not use any of the services prescribed for them, whereas 22% used all the services prescribed. Intention to adhere was influenced by patients' perception of the benefits of prescribed services and by their perception of the ease of access to transportation. Intention itself was not found to be an important determinant of overall compliance. Among organizational factors, having the ward staff make a follow-up appointment with the patients' family doctor and with the geriatric clinic before discharge and communication with the local community health center increased overall compliance. Moreover, patients who perceived they had access to transportation and to an accompanying person were more likely to comply. CONCLUSIONS: The results suggest that when discharging patients to the community, steps taken for them by the discharging healthcare providers will improve compliance.     

The measurement of quality of care in public sector psychiatric services based on consumer expectations

In this study the expectations of consumers of public sector psychiatric care in South Africa were identified, and formulated in the form of 13 standards, each with a set of criteria. During this phase input from the literature was incorporated, and expectations were validated with different groups of consumers, so that rural/urban, ethnicity and regional differences were taken into account. Based on the comprehensive set of standards and criteria, four instruments were developed to measure attainment of these standards. These included a questionnaire to consumers and one to the Director of Mental Health. It also included two schedules to be filled in by observers during site visits to hospital units and clinics. The observer teams included community members and consumers. The content validity of the instruments was established by setting out the items measuring each criterium, and validating that with a group of experts. The instruments were then tested in one province. The inter-rater reliability of the site visit schedules was calculated as 0.94, and the coding of the Director questionnaire by different coders was also tested. The average performance on all criteria was calculated, using items from all four data collection instruments. In the process items were revised, coding instructions developed, and criteria adjusted.     

Suppression of decorin expression and partial induction of anchorage-independent growth by the v-src oncogene in human fibroblasts

OBJECTIVE: To develop and test the intra-rater reliability of an interview-administered questionnaire that assesses lifetime patterns of total physical activity including occupational, household, and exercise/sports activities. METHODS: The questionnaire was developed and pretested using cognitive interviewing techniques on a sample of women with and without previous breast cancer diagnoses. A pilot study was conducted with 115 women who were interviewed twice, 6 to 8 wk apart by interviewers trained in cognitive interviewing methods. Respondents used recall calendars to record their education, occupations, life events, and physical activity patterns before the interviews. Interviewers helped respondents recall their lifetime exposures, including their occupational, household, and exercise/sports activities, using these calendars and memory-probing strategies. Activity levels were estimated as the average number of hours of activity per week over different time periods. Means and correlation coefficients were estimated and compared for the two time periods. RESULTS: The questionnaire was found to be highly reliable. The test-retest correlations for hours per week spent in total lifetime physical activity was 0.74, for lifetime occupational activity was 0.87, for household activity was 0.77, and for exercise/sports activities was 0.72. CONCLUSIONS: This is the first questionnaire to measure lifetime physical activity by collecting data on each type of physical activity separately over lifetime and by measuring frequency, intensity, and duration of each activity. It is also the first physical activity questionnaire to be developed, refined, and administered using cognitive-based methods employed in survey research. Respondents were able to reliably recall their lifetime physical activity patterns. This instrument can be used for any disease outcome for which physical activity may be a risk factor.