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Parents' resources and home management of the care of chronically ill infants.

PURPOSE: To identify resources of parents or primary caretakers who managed chronically ill infants at home and to determine psychometric properties of Home Care Resources Inventory (HCRI). DESIGN: Cross-sectional, descriptive SETTING: Outpatient clinics. PARTICIPANTS: Parents or primary caretakers (N = 100) of chronically ill infants who were discharged from hospital at least one week; 93% of sample were mothers; infants' ages ranged from 1-22 months. MAIN OUTCOME MEASURES: HCRI, the Spielberger State Anxiety Inventory, and a demographic questionnaire. RESULTS: Parents reported strong resources in the area of support and inconsistent resources in areas of coping, time, and respite. The HCRI has acceptable psychometric properties. CONCLUSIONS: Identifying resources, especially personal time and respite, is essential for successful home management of chronically ill infants. The HCRI can be used to pinpoint areas that are strong or weak in the two resource areas measured.

Adaptation, Psychological↗

Psychosocial resources and the SES-health relationship.

Psychosocial resources, which include optimism, coping style, a sense of mastery or personal control, and social support, influence the relationship between SES and health. To varying degrees, these resources appear to be differentially distributed by social class and related to health outcomes. Such resources may partially mediate the impact of SES on health. For example, environments that undermine personal control may have an impact on chronic arousal and the corresponding development of disease, such as CHD. Psychosocial resources may also moderate the impact of SES on health. For example, a large number of positive social relationships and a few conflictual ones may buffer individuals against the adverse effects of SES-related stress. These psychosocial resources are moderately intercorrelated, and so a research strategy that explores their coherence as a psychosocial profile that promotes resilience to stress is tenable and merits empirical examination. The erosion of these resources as one moves lower on the SES scale and specific factors that contribute to such erosion are discussed.

Adaptation, Psychological↗

Neighbourhoods and health: a GIS approach to measuring community resource accessibility.

OBJECTIVE: Recent studies suggest an association between the contextual attributes of neighbourhoods and the health status of residents. However, there has been a scarcity of studies that have directly measured the material characteristics of neighbourhoods theorised to have an impact on health and health inequalities. This paper describes the development of an innovative methodology to measure geographical access to a range of community resources that have been empirically linked to health. Geographical information systems (GIS) were applied to develop precise measures of community resource accessibility for small areas at a national scale. DESIGN: Locational access to shopping, education, recreation, and health facilities was established for all 38,350 census meshblocks across New Zealand. Using GIS, distance measures were calculated from the population weighted centroid of each meshblock to 16 specific types of facilities theorised as potentially health related. From these data, indices of community resource accessibility for all New Zealand neighbourhoods were constructed. RESULTS: Clear regional variations in geographical accessibility to community resources exist across the country, particularly between urban and rural areas of New Zealand. For example, the average travel time to the nearest food shop ranged from less than one minute to more than 244 minutes. Noticeable differences were also apparent between neighbourhoods within urban areas. CONCLUSIONS: Recent advances in GIS and computing capacity have made it feasible to directly measure access to health related community resources at the neighbourhood level. The construction of access indices for specific community resources will enable health researchers to examine with greater precision, variations in the material characteristics of neighbourhoods and the pathways through which neighbourhoods impact on specific health outcomes.

Cross-Sectional Studies↗

Physicians' use of medical knowledge resources: preliminary theoretical framework and findings.

The recurring decision of selecting among potential knowledge resources was modeled as a cost-benefit tradeoff, with associated observable features. Internal medicine and community family practice physicians (n = 228) completed a self-administered questionnaire designed to elicit reported use and cost-benefit features of nine knowledge resources. The subjects reported most frequent use of clinical colleagues, intermediate use of textbooks and journals, and least use of indexing systems. Resources' benefit-related qualities (extensiveness and credibility) were not related to reported use. In contrast, the model's access cost variables (availability, searchability, understandability, and clinical applicability) were significantly related to use. Results were generally favorable to the model's framework of knowledge resource selection. Multiple linear regression analysis suggested that physicians' use of clinical knowledge resources could be described by the physician's level of training, availability, applicability, and the resource medium (colleague, index, or text/journal).

Cost-Benefit Analysis↗

Perceptions of help resources for victims of intimate partner violence.

Intimate partner violence (IPV) constitutes a major public health problem in the United States. This cross-sectional survey of 108 emergency department (ED) care providers and 146 ED visitors at three metropolitan EDs compared the beliefs of ED health care providers with those of community members about the relative benefits of the helpfulness of resources for IPV victims using hypothetical case scenarios. Although providers generally indicated that help resources were helpful in all scenarios, visitors were more discriminating, showing less support for resources in the lower-risk scenario. Regarding differences between groups, visitors selected police and attorneys more frequently than providers as a helpful resource, whereas providers selected shelters and counselors more frequently than visitors. Adjustment for previous experience with IPV did not change these results. Understanding the differences between health care providers' and community members' perceptions of resources for victims of IPV may improve the effectiveness of referral to IPV resources.

Adult↗

Predictors of resourcefulness in African American women.

UNLABELLED: Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. OBJECTIVE: Using Rosenbaum's theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. METHODS: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. RESULTS: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. DISCUSSION: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.

Adaptation, Psychological↗

Patterns of asthma-related health care resource use in children treated with montelukast or fluticasone.

OBJECTIVE: To examine the impact of controller monotherapy with montelukast or fluticasone on asthma-related health care resource use among children aged 2-14 years old. DESIGN AND METHODS: A retrospective claims-based analysis of asthmatic children, 2-14 years old, receiving a prescription (index) for montelukast or fluticasone between January 1, 1999 and June 30, 2000 was conducted. Children were matched by age and propensity score to obtain comparable treatment groups. The propensity score was derived using patient demographics, pre-existing respiratory conditions, and asthma-related pharmacy and health service utilization (i.e. ambulatory visits, emergency department visits and hospitalizations). Claims for asthma-related emergent care and medication use were examined for the 12-month periods before and after the index prescription. Treatment group comparisons of asthma-related resource use were conducted for the total pediatric population and separately for children 2-5 years and 6-14 years. Persistent controller medication use was assessed at 6 and 12 months post-index. RESULTS: A total of 2034 children were matched (1017 in each treatment group). Post-index rates of asthma-related resource use were similar among children treated with montelukast or fluticasone. Among children 2-5 years old, fewer emergency department visits were observed with montelukast versus fluticasone (relative risk = 0.52, 95% confidence interval [CI]: 0.28-0.96); no significant difference was observed among children 6-14 years old. No significant differences between montelukast and fluticasone cohorts in hospitalizations or rescue medication fills were noted in either age group. Evidence of at least one medication refill was significantly greater with montelukast at both 6 and 12 months post-index. CONCLUSIONS: Similar levels of resource use were achieved by children 2-14 years initiating montelukast or fluticasone, as indicated by use of asthma-related emergent care and rescue/acute medications. Subgroup analyses suggest a differential effect of age on the relationship between treatment and asthma-related resource use, with children 2-5 years observed to have less resource use while on montelukast.

Acetates↗

The effect of medical work groups on hospital resource use.

This study tests the ability of medical work groups to overcome coordination problems related to group decision-making in allocating clinical resources to inpatients. The study was conducted over a 32-month period in two medium-sized acute-care hospitals located in Montreal, Quebec, Canada. The data were collected by hand from the medical charts of 10,456 patients in the surgical and medical departments. The Linear Structural Relations (LISREL) approach was employed to address the work-group issue using a task contingent model of work-group organization. In this model, the nature of the task is fundamental because its level of complexity determines both the organization of the work group and the use of resources. Medical work-group mechanisms should be efficient to the extent that resource utilization is explained solely by task characteristics rather than by work-group structure. In this study, the following two major organizational concepts were used as factors to explain resource use: task characteristics and work-group characteristics. Our analysis confirmed the main points of the task contingency theory as applied to the field of medicine. First, the results confirm that resource utilization is explained mainly by task complexity. Second, they confirm that medical work groups modulate their structures on the basis of task characteristics and do not explain resource use. The results also reveal a more complex model in which, for instance, the concepts of medical task and medical professional work are not easy to separate. The results highlight the interest in conceptualizing and analysing medical practice in work groups. It raises important issues that have seldom been taken into account in the study of medical practice variations, which has tended to focus on attending physicians.

Efficiency, Organizational↗

Hospital and hospice resource use of HIV-positive patients in Edinburgh.

A prospective study of health service and hospice resource utilization (average length of stay or ALOS, discharge rate, bed day use, outpatient consultation) analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) for the financial year 1992-93 was undertaken at the Regional Infectious Disease Unit (RIDU), City Hospital, Edinburgh, Scotland where 72% of 513 patients were infected via injection drug use. Not surprising therefore overall, drug users were the heaviest users of the inpatient facilities (74% of the discharges and 65% of the bed days) although homosexuals had the highest discharge rate (114 per 100 person years) and rate of bed day use (1654 days per 100 person years). Immunodeficiency (CD4 count < 200 cells/ul) and a clinical diagnosis of AIDS were both associated with greater inpatient and outpatient resource use compared to those without immunodeficiency (CD4 count > or = 200 CD4 cells/ul) or AIDS. Gender effects were complex; the ALOS for women was increased for all risk groups whatever the CD4 count whilst there was no consistent trend of more resource use for women by risk group. Drug users were the heaviest overall users of the local hospice (84% of all admissions, 83% of the bed days and a discharge rate of 76.4 per 100 person years), more than double the rates experienced by the other risk groups. Thus both clinical and immunological staging (AIDS or a CD4 count < 200 cells/ul) were associated with increased resource use in HIV infection and estimates of resource use for AIDS need to be increased by around one-third to take into account hospice use. Despite the preponderance of drug users in Edinburgh, comparisons with other centres did not reveal increased resource use.

Acquired Immunodeficiency Syndrome↗

Update in handheld electronic resources for evidence-based practice in the community setting.

OBJECTIVE: To provide an update on the handheld electronic resources for evidence-based practice (EBP) in the community setting. DATA SOURCES: Electronic resources for EBP in the community setting were identified by compiling the commonly used, well-established resources and by searching MEDLINE and other Internet sites. Search terms included evidence-based medicine, evidence-based practice, resources, and abstraction. Only sources available for personal digital assistants were included. DATA EXTRACTION: Three databases were identified that provided abstraction and evaluation of the medical literature for the handheld platform. Content, features, ease of use, system requirements, and costs of each resource were evaluated. DATA SYNTHESIS: FIRSTConsult, InfoRetriever, and UpToDate were evaluated, and the utility of each in the community pharmacy setting was evaluated by tracking a clinically relevant example through each system. FIRSTConsult provides evidence-based information organized by diagnosis but is not searchable on the handheld platform. InfoRetriever focuses on searchable evidence-based summaries, while UpToDate includes comprehensive topic reviews. The latter 2 platforms have large system memory requirements. All 3 sources provide evidence-based abstraction of the medical literature for the PDA platform, convenient for use at the point of care in community pharmacy. CONCLUSIONS: While users may select a particular resource based on unique features, each provides evidence-based abstraction of the medical literature that is a practical approach to EBP in the community pharmacy setting.

Community Health Services↗

Resource partitioning among savanna grazers mediated by local heterogeneity: an experimental approach.

Recent theoretical studies predict that body size-related interspecific differences in spatial scale of perception and resource use may contribute to coexistence of species that compete for the same class of resources. These studies provide a new theoretical framework for explaining resource partitioning patterns among African ungulates that coexist in spatially heterogeneous savanna grasslands. According to these studies, different-sized ungulates can coexist because larger species forage at a coarser scale but can tolerate lower quality food, whereas smaller species need higher quality food but forage at a finer scale. To test this hypothesis in an African savanna, we created an experimental mosaic with variation in grain (spatial detail) and quality of short-grass patches and directly observed the visitation of naturally occurring grazers to this mosaic over a two-year period (total of 903 observation hours). Of the seven species that visited our experiment, warthog, impala, zebra, and white rhino visited long enough to allow data analysis. We showed that warthog and impala avoided plots with a finer grain of short grass and that warthog preferred fertilized plots to unfertilized plots. Zebra and white rhino did not avoid the finer grain plots. Our results suggest that differences in grain and quality of a resource might indeed contribute to partitioning of this resource by savanna ungulates. Although four focal species is unusually high for an experimental study on resource partitioning among naturally occurring savanna ungulates, this number is too low to evaluate the allometric basis of our hypothesis. Our results, however, encourage wider experimental testing of the role of spatial heterogeneity in facilitating the coexistence of potentially competing savanna herbivores.

Animals↗

The Resource Mothers Program for Maternal Phenylketonuria.

OBJECTIVES: The purpose of this study was to measure the effectiveness of resource mothers in reducing adverse consequences of maternal phenylketonuria. METHODS: Nineteen pregnancies in the resource mothers group were compared with 64 pregnancies in phenylketonuric women without resource mothers. Weeks to metabolic control and offspring outcome were measured. RESULTS: Mean number of weeks to metabolic control was 8.5 (SE = 2.2) in the resource mothers group, as compared with 16.1 (SE = 1.7) in the comparison group. Infants of women in the resource mothers group had larger birth head circumferences and higher developmental quotients. CONCLUSIONS: The resource mothers program described here improves metabolic control in pregnant women with phenylketonuria.

Adolescent↗

Algorithms for resource allocation of substance abuse prevention funds based on composite risk-factor index score: a case study on state of Florida--Part 2.

The purpose of Part 2 is to develop a model for resource allocation of state prevention funds to be distributed to its substate jurisdictions based on the relative need for prevention services measured in terms of composite risk-factor index (COMRISK) scores computed for each county. The risk factors are extracted from an extensive review of risk and protective factors addressed in the prevention literature. Based on twenty-two risk and protective factors identified, we were able to explain 71.3 percent of the total variation in student drug using behavior observed at the individual level. By aggregating individual COMRISK scores to the county level, we were able to determine aggregated COMRISK index scores at the county level. By determining the proportion of each county's share of the total statewide COMRISK and by weighting the latter proportion by the population size of each county, we have devised Prevention Needs Index (PNI) score based on the risks for each county. Finally, the county's share of PNI score as a proportion of the total statewide PNI score is computed. The latter proportion is then multiplied by the total amount of prevention resources available at the state. In this way, we were able to develop an alternative resource allocation model solely based on risk and protective factors for determining prevention needs of each county, independent of composite index score of drug use (COMDRUG) presented in Part 1. A comparison of three models for resource allocation has shown a significant amount of similarity of the total funds computed for each county. Accordingly, no preference is made among the resource allocation models suggested, although it is emphasized that the final decision concerning the level of funding must be made on the selection of the resource allocation algorithms rather than the suggested amount of funding computed for each county.

Adolescent↗

Algorithms for resource allocation of substance abuse prevention funds based on social indicators: a case study on state of Florida--Part 3.

The purpose of Part 3 is to develop an algorithm for an equitable distribution of state prevention funds to its substate jurisdictions based on the need for prevention services. In this series, the need for prevention services is measured in terms of the existing social indicators observed at the county level. In order to establish a conceptual link as well as the empirical relevance of the selected social indicators as proxy measurements of the estimated need for prevention at the county level, we have employed both concurrent and construct validity tests using the following three constructs as the criterion variables in a multiple regressing setting: 1) county-based composite drug use index score (COMDRUG) measured via the statewide drug survey; 2) county-based proportions of prevention target populations using the conceptual definition advanced by the Institute of Medicine (IOM); and 3) the composite risk factor score (COMRISK) assembled from a list of twenty-two risk and protective factors observed for each county. These constructs were identified previously in Parts 1 and 2. While employing eight social indicators to estimate the overall prevention needs observed at the county level, the social indicators thus selected were able to explain 69 percent of the variations in COMDRUG, 68 percent of the variation in the proportions of students in need of prevention services using IOM definition, and 60 percent of the variation in COMRISK. Following successful validations of the social indicators as viable media with which to estimate county-based prevention needs, the ensuing multiple regression equation is, then, used to build a resource allocation model by determining the proportion of each county's share of the total statewide COMDRUG-predicted from the social indicators and, then, by weighting the latter proportion by the population size of each county under age eighteen. In this way, we have devised county-based Prevention Needs Index (PNI) scores based solely on social indicators. Finally, the county's share of PNI score is computed as a proportion of to the total statewide PNI score. Following this line of algorithm for resource allocation, we were able to develop yet another resource allocation model solely based on social indicators without the benefits of survey data. Comparing the funding results originating from four resource allocation models (i.e., COMDRUG, IOM Definition, COMRISK, and Social Indicators), it has been learned that there is a remarkable similarity from one funding level to another. Since all four schedules of county-based prevention funding levels have shown very high intercorrelations with a range from .9862 to .9993, it has been determined that these schedules are measuring essentially either the same domain or latent domains that are functionally equivalent to one another. Accordingly, no preference is made among the resource allocation models suggested, although it is suggested that the final decision on the level of funding must be based on the selection of the schedule for resource allocation rather than the suggested amount or level of funding computed for each county.

Algorithms↗

Resource for temporal information processing in interval production.

The resource required to process temporal information in interval production was investigated. 12 undergraduates performed 4-sec. interval production and nontemporal tasks, the probe digit task and the missing digit task. Although both tasks required memory search and employed the same modality for input and for responding, the probe digit task required a phonological resource and the missing digit task required a spatial resource. Analysis showed that both concurrent nontemporal tasks caused interval productions to be longer, suggesting that the temporal processing required a resource which both tasks used commonly. This resource may be a general purpose, capacity-limited resource associated with a central executive function in working memory.

Adult↗

Death anxiety, coping resources, and comfort with dying patients among nurses in AIDS care facilities.

437 nursing staff members in seven AIDS residential health care facilities in New York City were asked to complete a questionnaire consisting of the Death Anxiety Scale, the Coping Resources Inventory, the Comfort with Dying Patients Scale, and a Demographic Section. 197 usable questionnaires were returned. There were statistically significant racial or ethnic differences in scores on physical coping resources, with African-Americans reporting the fewest resources. No significant relations were found between scores on death anxiety, coping resources, and comfort with dying patients. Multivariate analysis of variance was used to assess the interaction of the Nursing group (professional or paraprofessional nurses), Death anxiety, and Coping resources with Comfort with dying patients. There were no statistically significant differences for death anxiety, coping resources, and comfort with dying patients by the Nursing group.

Acquired Immunodeficiency Syndrome↗

Use of Internet-based resources to support an introductory animal and poultry science course.

This article describes the development and implementation of a World Wide Web page to support a team-taught introductory animal and poultry science course. The objectives were to examine the capabilities of this type of instructional resource, determine students' willingness to use this type of resource, create opportunities for interactive learning, and improve students' enthusiasm for the subject area. A variety of course materials were made available through the Internet, including the class syllabus, lecture notes, and practice questions to support and augment class lectures. Additional on-line resources included a bulletin board for instructor announcements, a list-serve for student discussions concerning administrative and educational issues arising during the semester, a class E-mail list, and a page with links to other sites of agricultural interest. Materials were accessible from a variety of computer resources, including campus computing laboratories, dial-up access, and access via other Internet service providers. Use of the materials was evaluated by analysis of log files from the server. Effectiveness of the resources was determined from surveys of students conducted before and after implementation of the on-line resource. Students indicated that the most useful components of the Web page were the class notes and practice/review questions. Effectiveness of the site was related to the amount of material available through the site, the level of interaction, whether the task was required, and the ease of access to computers and the Web site. Student evaluations indicated that this form of instructional supplement is a viable method for enhancing the learning experience in the introductory animal sciences.

Animal Husbandry↗

Women's self-assessed personal health resources.

OBJECTIVE: To contribute to the development of a resource-oriented medical language by identifying self-assessed personal health resources in women. DESIGN: Key questions were developed to invite the patient to tell the general practitioner about such resources. Patients' answers were audiotaped and analysed qualitatively according to Giorgi's phenomenological approach. The theoretical frame of reference included salutogenesis, patient-centredness, and gender perspectives. SETTING: Two female general practitioners and their consultations. SUBJECTS: 37 consecutive female patients aged 24-85 years. MAIN OUTCOME MEASURES: Common aspects of personal qualities and strategies considered by women as their health resources. RESULTS: The material unveiled health resources related to 1) internal strength mobilized by external strain, 2) interactive networks within and outside the family, 3) lifestyle practices, 4) physical and social activity, 5) acceptance and facilitation of the natural course of Disease, and 6) constitution. CONCLUSION: Female patients have explicit and intelligible ideas about their self-assessed personal health resources, which can be identified and mobilized by the general practitioner and form part of potentially empowering strategies in medical practice.

Adaptation, Psychological↗