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PubMed2006

Health care utilization and needs after pediatric traumatic brain injury.

OBJECTIVE: Children with moderate to severe traumatic brain injury (TBI) show early neurobehavioral deficits that can persist several years after injury. Despite the negative impact that TBI can have on a child's physical, cognitive, and psychosocial well-being, only 1 study to date has documented the receipt of health care services after acute care and the needs of children after TBI. The purpose of this study was to document the health care use and needs of children after a TBI and to identify factors that are associated with unmet or unrecognized health care needs during the first year after injury. METHODS: The health care use and needs of children who sustained a TBI were obtained via telephone interview with a primary caregiver at 2 and 12 months after injury. Of the 330 who enrolled in the study, 302 (92%) completed the 3-month and 288 (87%) completed the 12-month follow-up interviews. The health care needs of each child were categorized as no need, met need, unmet need, or unrecognized need on the basis of the child's use of post-acute services, the caregiver's report of unmet need, and the caregiver's report of the child's functioning as measured by the Pediatric Quality of Life Inventory (PedsQL). Regardless of the use of services or level of function, children of caregivers who reported an unmet need for a health care service were defined as having unmet need. Children who were categorized as having no needs were defined as those who did not receive services; whose caregiver did not report unmet need for a service; and the whose physical, socioemotional, and cognitive functioning was reported to be normal by the caregiver. Children with met needs were those who used services in a particular domain and whose caregivers did not report need for additional services. Finally, children with unrecognized needs were those whose caregiver reported cognitive, physical, or socioemotional dysfunction; who were not receiving services to address the dysfunction; and whose caregiver did not report unmet need for services. Polytomous logistic regression was used to model unmet and unrecognized need at 3 and 12 months after injury as a function of child, family, and injury characteristics. RESULTS: At 3 months after injury, 62% of the study sample reported receiving at least 1 outpatient health care service. Most frequently, children visited a doctor (56%) or a physical therapist (27%); however, 37% of caregivers reported that their child did not see a physician at all during the first year after injury. At 3 and 12 months after injury, 26% and 31% of children, respectively, had unmet/unrecognized health care needs. The most frequent type of unmet or unrecognized need was for cognitive services. The top 3 reasons for unmet need at 3 and 12 months were (1) not recommended by doctor (34% and 31%); (2) not recommended/provided by school (16% and 17%); and (3) cost too much (16% and 16%). Factors that were associated with unmet or unrecognized need changed over time. At 3 months after injury, the caregivers of children with a preexisting psychosocial condition were 3 times more likely to report unmet need compared with children who did not have one. Also, female caregivers were significantly more likely to report unmet need compared with male caregivers. Finally, the caregivers of children with Medicaid were almost 2 times more likely to report unmet need compared with children who were covered by commercial insurance. The only factor that was associated with unrecognized need at 3 months after injury was abnormal family functioning. At 12 months after injury, although TBI severity was not significant, children who sustained a major associated injury were 2 times more likely to report unmet need compared with children who did not. Consistent with the 3-month results, the caregivers of children with Medicaid were significantly more likely to report unmet needs at 1 year after injury. In addition to poor family functioning's being associated with unrecognized need, nonwhite children were significantly more likely to have unrecognized needs at 1 year compared with white children. CONCLUSIONS: A substantial proportion of children with TBI had unmet or unrecognized health care needs during the first year after injury. It is recommended that pediatricians be involved in the post-acute care follow-up of children with TBI to ensure that the injured child's needs are being addressed in a timely and appropriate manner. One of the recommendations that trauma center providers should make on hospital discharge is that the parent/primary caregiver schedule a visit with the child's pediatrician regardless of the post-acute services that the child may be receiving. Because unmet and unrecognized need was highest for cognitive services, it is important to screen for cognitive dysfunction in the primary care setting. Finally, because the health care needs of children with TBI change over time, it is important for pediatricians to monitor their recovery to ensure that children with TBI receive the services that they need to restore their health after injury.

Adolescent↗
PubMed2003

Beyond Maslow's culture-bound linear theory: a preliminary statement of the double-Y model of basic human needs.

Maslow's theory of basic human needs is criticized with respect to two of its major aspects, unidimensional linearity and cross-cultural validity. To replace Maslow's linear theory, a revised Y model is proposed on the base of Y. Yu's original Y model. Arranged on the stem of the Y are Maslow's physiological needs (excluding sexual needs) and safety needs. Satisfaction of these needs is indispensable to genetic survival. On the left arm of the Y are interpersonal and belongingness needs, esteem needs, and the self-actualization need. The thoughts and behaviors required for the fulfillment of these needs lead to genetic expression. Lastly, on the right arm of the Y are sexual needs, childbearing needs, and parenting needs. The thoughts and behaviors entailed in the satisfaction of these needs result in genetic transmission. I contend that needs for genetic survival and transmission are universal and that needs for genetic expression are culture-bound. Two major varieties of culture-specific expression needs are distinguished for each of the three levels of needs on the left arm of the Y model. Collectivistic needs for interpersonal affiliation and belongingness, esteem, and self-actualization prevail in collectivist cultures like those found in East Asian countries. Individualistic needs are dominant in individualist cultures like those in North America and certain European nations. I construct two separate Y models, one for people in collectivist cultures and the other for those in individualist ones. In the first (the Yc model), the three levels of expression needs on the left arm are collectivistic in nature, whereas in the second (the Yi model), the three levels of needs on the left arm are individualistic in nature. Various forms of the double-Y model are formulated by conceptually combining the Yc and Yi models at the cross-cultural, crossgroup, and intra-individual levels. Research directions for testing the various aspects of the double-Y model are identified for comparisons at these three levels. Future studies theoretically guided by the double-Y model will enable us to systematically understand, at both aggregate and individual levels, the characteristics and interactions of expression and transmission needs, the characteristics and interactions of collectivistic and individualistic expression needs, and the dynamic processes involved in the transformation of needs from collectivistic to individualistic and vice versa under certain specific conditions. The double-Y model, as a whole, represents a serious, systematic attempt to theoretically and empirically integrate the biological and cultural influences on basic motivational states and propensities. Whether this model will eventually prove to be able to survive future empirical testing and conceptual revision remains to be seen. I must hasten to add, however, that there may be other potentially viable models that are worth being advanced in the future for accomplishing the same purpose of integrating the biological and cultural determinants of the formation, development, and function of human motivation.

Cross-Cultural Comparison↗