Psychological needs and resources as perceived by rural and urban psychologists.

Practicing psychologists in rural and urban Oregon were surveyed about their perceptions of psychological needs and resources in their communities. Both groups indicated the most salient unmet community needs as adequate access to appropriately trained medication prescribers, comprehensive psychological assessment services, and psychological services for children. When compared with urban communities, those in rural communities have more difficulties with accessing all professional services, and rural psychologists have access to fewer professional resources. However, there appear to be few differences between perceived needs and resources in rural and urban communities. Psychologists who practice in these communities perceive a strong need for more access to psychological services in both settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Painless dentistry. Fact or fiction?

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.     

Prosthodontic profiles relating to economic status, social network, and social support in an elderly population living independently in Canada

STATEMENT OF PROBLEM: Previous evaluations of life satisfaction and health have not completely explained the impact of social network, social support, and economics on the oral health-related behavior of elderly patients, particularly in relation to missing teeth. PURPOSE: This study measured the strength of associations between social network/support/class and the use of complete and removable partial dentures in elderly patients living independently. MATERIAL AND METHODS: A multiple stepwise logistic regression was used to contrast data from previous studies relating to the subject and to explore the influence of these social variables. RESULTS: The results substantiated the links observed in a previous study between some social features and oral fitness. More frequent use of complete dentures was identified among participants who reported higher incomes and among those who thought their incomes were sufficient for their needs. Unreplaced missing anterior teeth were associated more commonly with subjects less willing or able to leave their homes. CONCLUSIONS: Some salient features of prosthodontic care and oral health status were common to 2, comparable social environments. A minority within the elderly population may not see a need to make use of clinical dental services, regardless of how accessible these services are to them. Social network and social support issues may be important determinants in this perceived need to use clinical services.     

Emergency department-based home care

STUDY OBJECTIVE: To assess the feasibility of coordinating home care services from an inner-city emergency department. INTERVENTION: In a preintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who arranged and managed rapidly deployed home care services then was assigned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status. SETTING: Teaching hospital serving a large indigent population. PARTICIPANTS: Adult patients about to be discharged home from the ED. MAIN RESULTS: Forty-five of 650 (7%) surveyed patients were not receiving home care services for which they were eligible. In the subsequent eight-month period, 670 patients were referred for home care on discharge from the ED (2% of all discharges). Seventy-six percent of these patients were women, and the average age was 73.5 years. Four hundred fifty patients (67%) received visits from home care providers managed by the ED coordinator. For 99 of these patients (22%), the availability of rapidly deployed home care services obviated the need for emergency admission to the hospital. Net billings to third-party payers exceeded the costs of the program. CONCLUSION: A significant proportion of elderly patients being discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admission for a select group of debilitated patients. The provision of home care services from the ED is economically feasible.     

Modification of liposomes for liver targeting

BACKGROUND: Unemployment has become a serious social problem in industrialized countries. Job loss produces health-related disorders. Health-related data of the unemployed are scarce and prompted us to survey this group. METHODS: A database of a health survey conducted between 1989 and 1993 in 79 selected rural communities of Styria (Austria) was used to analyze risk factors and employment status. The sample consisted of 8,747 individuals, 345 unemployed and 8,402 employed. RESULTS: Risk behavior is higher among unemployed individuals than among those employed, particularly for males. Unemployed males were significantly less motivated to reduce weight and to change dietary habits than their counterparts, and they had significantly more anxieties, sleeping disorders, and lack of appetite. A similar pattern was found with regard to gastrointestinal and chronic liver and respiratory diseases. In addition, the unemployed utilized medical services more often. CONCLUSIONS: This is the first study on health-related indicators and unemployment status in Austria. Job loss implies health-related disorders. The effectiveness of reducing the morbidity of the population in general is also dependent on intervention programs focusing on the specific needs of this high-risk group, e.g., adapting primary health care to its needs and fostering social support networks.     

Structural changes in the tissues of white rats after capsaicin administration

Attitudes to health and illness may differ between rural and urban dwellers. Issues that may relate to the provision of health services to rural dwellers are raised for consideration. The response of urban dwellers to illness or disability has often been linked to discomfort caused by pain or cosmetic attractiveness, while for rural dwellers the response to illness or disability is often related to the degree to which the illness or disability affects productivity. Often the rural resident will postpone seeking medical or associated services until it is economically or socially convenient. The notion of exposing their private lives to strangers or acquaintances from the local based services or to undertake the journey to distant services where the cultural or behavioural differences could be misunderstood, may impact on rural dwellers' well-being. Health service providers in rural areas need to understand such differences and difficulties when offering services.     

The possibility of preserving the causative agent of plague in soil in resting (nonculturable) form

The purpose of this study was to find criteria characteristic for patients in need of care and social services. The criteria should serve as a guideline for patients and staff to facilitate care planning before discharge. The sample consisted of 49 patients, born before 1925, in need of emergency inpatient treatment, admitted to medical- or orthopaedic wards. Data of the patient's self care needs were collected by interviews, assessment of self care status and need of treatment. The patients could be divided into three groups depending on type of discharge. Group A (n = 27) discharged home, group B (n = 7) discharged to geriatric clinic and group C (n = 15) discharged and in need of further care and social services. Criteria indicating the patients further assistance from the community were in group C (medical- and orthopaedic wards) deficit in daily living activities and locomotion. Group B had an increased need of support from the physiotherapist and the occupational therapist, in locomotion as well as daily living activities The physician's assessment showed that the criteria behind the decision "no further medical treatment appropriate" and "ready for discharge" were not related to medical impairment but to lack of self care, need of care, rehabilitation and social services.     

Seniors' needs for health-related personal assistance

OBJECTIVES: This article examines social and economic differences in the prevalence of needs and unmet needs for health-related personal assistance among the household population aged 65 and older and the sources from which they received support. DATA SOURCE: The data are from the 1991 Health and Activity Limitation Survey (HALS). ANALYTICAL TECHNIQUES: All calculations were based on weighted data. Age-standardized percentages of people with needs and unmet needs for personal assistance were calculated by sex, marital status, living arrangements, education, and household income. MAIN RESULTS: In 1991, 30% of seniors living in private households had some need for health-related personal assistance. Three-quarters of them required help only with instrumental activities of daily living (IADL); the remainder needed help with basic activities of daily living (ADL). The prevalence of need and unmet need was higher among women than men, was inversely related to household income and education, and was relatively high among formerly married seniors and those living alone. Household seniors were more likely to receive personal assistance from informal than formal sources, although this varied depending on their socioeconomic characteristics and the type of assistance they received.     

Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of problem solving and communication skills of persons with schizophrenia

This study examined gender differences in 162 female and 65 male patients with cancer referred to home care. Data were collected before hospital discharge using the Multidimensional Functional Assessment Questionnaire, the Karnofsky Performance Status, and the Quality of Life-Cancer Scale. Controlling for age and stage of disease, the results showed that men reported significantly more cancer-related impairments, more limitations in activity of daily living, and poorer social resources than women. No gender differences were found in quality of life, perceived emotional health, perceived physical health, performance status, and comorbidity. Significant predictors of self-care activities were: for women perceived physical health, Karnofsky Performance Status, and stage of disease (58% variance explained); for men Karnofsky Performance Status and medication taken (67% variance explained). Gender differences should be considered in discharge planning to provide appropriate home care services for male and female patients with cancer.     

Quantitative evaluation of local drug delivery using the InfusaSleeve catheter

BACKGROUND: Rural women are less likely to receive screening mammography at recommended intervals. This study evaluated efforts to promote screening mammography among women in rural communities through community education interventions and low-cost mobile mammography van services. METHODS: Two matched sets of communities were identified in an isolated rural region. One area received community education programs in addition to the mammography van for 2 years; the second area received only the van services. The educational programs were designed using diagnostic research methods; they included recruitment of opinion leaders to organize small group breast screening education sessions, an information campaign using direct mail, and primary health care provider education. RESULTS: A household telephone survey conducted 6 months after completion of these programs indicated that mammography utilization and perceived mammography norms were higher among women in the Program area than among women in the Comparison area. Process data were consistent with these findings. Clinical examination and self-examination behaviors were not influenced by the programs. CONCLUSIONS: This study showed that well-focused educational interventions for rural women can increase utilization of screening mammography when access and cost barriers also are reduced.     

Rural America: Unique opportunities for health care delivery and health services research.

A general deterioration is occurring in the quality of life of rural Americans, and it is affecting the quality of health and mental health service delivery. About 24% of the U.S. population lives in nonmetropolitan areas where the citizens are older, less well educated, have lower incomes, and are more homogeneous in terms of ace and ethnicity. Medicare and private insurance discriminate against rural services in their reimbursement policies, and there is a shortage of health personnel in rural areas. However, there has been renewed congressional action to meet rural needs. Both the House and Senate have established rural caucuses, and an Office of Rural Health Policy has been established in the federal executive branch. Legislative successes were achieved between 1985 and 1988. Rural initiatives will provide psychology with unique opportunities in the next several years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of subsequent home health care nursing service use by hospitalized patients with cancer

BACKGROUND: The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. METHODS: The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. RESULTS: A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. CONCLUSIONS: The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.     

Practising Psychology in Rural Settings: Issues and Guidelines.

Rural practice presents important yet challenging issues for psychology, especially given the North American and international distribution of the population, levels of need for psychological services in rural settings, limited availability of rural services, and migration of rural residents to urban centers. Direct service issues include the need to accommodate a wide variety of mental health difficulties, issues related to client privacy and boundaries, and practical challenges. Indirect service issues include the greater need for diverse professional activities, including collaborative work with professionals having different orientations and beliefs, program development and evaluation, and conducting research with few mentors or peer collaborators. Professional training and development issues include lack of specialized relevant courses and placements, and such personal issues as limited opportunities for recreation and culture, and lack of privacy. Psychology will need to address more fully these complex issues if rural residents are to receive equitable treatment and services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

I want to live here for rest of my life. The challenge of case management for rural seniors

The research on long-term care for seniors clearly demonstrates that efforts to integrate urban case management services with elderly people living in rural settings have not been successful. Presenting findings of the Rural Seniors Assisted Living Study conducted in northwestern Ontario, Canada, this article demonstrates the complexity of providing health and social services for seniors living in small rural communities, services that are often vastly different from those provided in urban communities. The article proposes a specialized Rural Case Management approach with rural elderly clients and identifies four intervention roles: providing direct service, consulting extensively with specialists of other disciplines, constructing and supporting natural helping networks, and resource management. The approach also requires that the rural case manager assume a leadership role at the community level in the development of services for seniors. Having a locally based case manager rather that a case manager who travels out to rural areas from an urban center is essential to the success of this rural case management approach. Finally, the article contends that rural case management differs from urban case management by requiring specialized knowledge, skills and educational programs.     

Professional practice out of the urban context: Defining Canadian rural psychology.

There is an often unacknowledged difference between urban and rural practice in psychology which lacks clarity, in part, because of the lack of a common definition of rurality. Rural psychology in Canada presents complex and nuanced aspects of professional practice. The professional and social milieus of rural communities position the practising psychologist within a context that may differ vastly from urban settings. The rural context highlights the need to define this specific practice setting. This paper proposes a tentative definition of rural Canadian professional practice in psychology. This is meant to elucidate the distinct practice, training, and ethical considerations that may be the realities of the psychologists who are in professional practice in rural Canada. Rural professional practice is unique and Canadian training programs are urban-based. Training of future psychologists needs to acknowledge the unique features of rural practice to meet our obligations to students specifically and to rural Canadians generally. This is enhanced with a shared definition of rural professional practice in psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of new valproate derivatives on epileptiform discharges induced by pentylenetetrazole or low Mg2+ in rat entorhinal cortex-hippocampus slices

This study examined physician and non-physician prescribed medication use of a growing segment of Brazilian society--the elderly. Personal interviews were conducted with 436 subjects in a stratified random sampling of elderly respondents to the previously completed 1990 Brazilian Old Age Survey (BOAS). The BOAS sample had been stratified according to the socioeconomic status (SES) of three communities within Rio de Janeiro. This study focused on medication use of these subjects as a function of the predisposing, enabling, and need variables which have been found in previous research to predict other types of health services utilization (HSU). The enabling variables of access to care were measured as patient perceived availability, affordability, and acceptability of both medical and pharmacy services. ANOVA results found differences among the different communities in perceived availability and affordability of medical and pharmacy services and acceptability of pharmacy services. Subjects from Santa Cruz, the lowest SES area, consistently reported lesser availability of services, more difficulties with affordability but greater perceived acceptability of pharmacy services than those from the highest SES area. Multivariate regressions modeling both prescribed and non-prescribed medication use for the three areas found that the access-oriented HSU framework was much more effective in explaining the variance in medication use for the lowest SES area (45% and 48% for prescribed and non-prescribed use, respectively) than for the highest SES area where only 16% and 18% of prescribed and non-prescribed medication use was explained.     

Brain lipid composition of the rat with experimental morphine dependence

OBJECTIVE: To develop and validate a prediction rule screening instrument, easily incorporated into the routine hospital admission assessment, that could facilitate discharge planning by identifying patients at the time of admission who are most likely to need postdischarge medical services. DESIGN: Prospective cohort study with separate phases for prediction rule development and validation. SETTING: Urban teaching hospital. PATIENTS/PARTICIPANTS: General medical service patients, 381 in the derivation phase and 323 in the validation phase, who provided self-reported medical history, health status, and demographic data as a part of their admission nursing assessment, and were subsequently discharged alive. MEASUREMENTS AND MAIN RESULTS: Use of postdischarge medical services such as visiting nurse or physical therapy, medical equipment, or placement in a rehabilitation or long-term care facility was determined. A prediction rule based on a patient's age and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical function and social function scores stratified patients with regard to their risk of using postdischarge medical services. In the validation set, the rate of actual postdischarge medical service use was 15% (15 of 97), 36% (39 of 107), and 58% (57 of 98) among patients characterized by the prediction rule as being at "low", "intermediate," and "high" risk of using postdischarge medical services, respectively. CONCLUSIONS: This prediction rule stratified general medical patients with regard to their likelihood of needing discharge planning to arrange for postdischarge medical services. Further research is necessary to determine whether prospective identification of patients likely to need discharge planning will make the hospital discharge planning process more efficient.     

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.