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Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults.
This study describes use of medical, mental health, alcohol, and drug services by 832 adult residents of the New York City homeless shelter system and examines associations between service use during the past three months and an array of predisposing, enabling, and need factors. Utilization rates were 23% for medical services, 13% for mental health services, and 10 and 7.5% for alcohol and drug treatment services, respectively. Service contacts were more often hospitals than ambulatory care clinics. Logistic regression analyses revealed that need factors were stronger predictors of all four types of service use. Predisposing factors other than education and black ethnic status were not significant, and the enabling factor of enrollment in Medicaid and/or Medicare was significant only for use of medical and drug services. Among the need factors, measures of mental health status were analyzed as indices of distress to test a stress-utilization model of prediction for all four types of service use. While these measures did not predict use of nonmental health services, physical health problems were associated with use of all four types of services. Implications for future health services research and for service delivery to the homeless are discussed, including the need for more information on availability of services and on psychosocial and cultural characteristics of homeless persons that may affect their help-seeking behavior.
Delay in breast cancer care: a study in Thai women.
BACKGROUND: Breast cancer is the second most common cause of cancer death in Thai women. Cancer registry data reveal a high prevalence of late-stage disease at diagnosis. The factors resulting in delay in Thailand have not yet been investigated. OBJECTIVES: To determine the extent of, and the factors contributing to, delay in breast cancer care. DESIGN: Women with breast cancer who were first treated at Songklanagarind Hospital between June 1994 and June 1996 were interviewed with retrospective chart audits of care. MEASURES: Dependent variables included patient delay (symptom recognition to first care) and system delay (first care to treatment). Independent variables tested included demographic factors, help-seeking behavior, and cancer knowledge. Nonparametric rank sum tests were used for univariate analysis, and Cox regression was used for multivariate analysis. RESULTS: Ninety-four cases were included in the study. The median patient and system delays were 4 weeks; 26.6% and 24.4% of patients, respectively, experienced patient and system delay >12 weeks. Only marital status (unmarried compared with married women) was significantly associated with patient delay (hazard ratio [HR] 2.78, 95% CI 1.23-6.25). Contacting a provincial hospital instead of a university hospital as first medical care (hazard ratio 2.50, 1.23-5.26), being given a diagnosis rather than being told nothing (HR 2.04, 1.14-3.57) and being given treatment rather than being immediately referred (HR 4.55, 2.22-9.09) were associated with system delay. CONCLUSIONS: Patient delay and system delay in breast cancer care are important weaknesses of disease control in Thailand. Educational programs should target unmarried women, who are at higher risk of delay. System delay in hospitals outside the university needs to be improved by a good referral system.
How nurses can help women whose spouses are deployed to a war zone.
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Parental perceptions of the lasting effects of infant colic.
PURPOSE: To describe the experience of families with previously colicky infants. STUDY DESIGN: This qualitative, descriptive study explored parents' perspectives of the lasting effects of infant colic on their children's development and on their family relationships. METHODS: Through in-depth interviews, the parents had the opportunity to share what they remembered most about this experience. Participants volunteered by accessing the Infant Colic Study Web site advertised on numerous search engines. Forty-four participants, all of whom had an infant with colic at some time in the past, answered open-ended questions regarding their feelings about the colicky period and how their children developed later. Data were analyzed from a phenomenologic perspective. RESULTS: The majority of participants reported no later problems in their previously colicky children. Some did believe, however, that family relationships had been affected by the colic experience, and that communication and support had been impaired. Most described feelings about the colic experience that were negative. CLINICAL IMPLICATIONS: Continued support needs to be provided to families of colicky infants throughout their growth and development at a primary care level. Nurses need to recognize that the experience of infant colic may have residual effects on the entire family unit. These families need to be provided with the support and resources to enable them to successfully care for their children and to engage in nurturing relationships.
Adolescent gestational weight gain: does it contribute to obesity?
Does gestational weight gain have an impact on the future weight pattern of adolescent mothers? Pregnant adolescents gain weight with childbearing, and weight retention following pregnancy potentially contributes to long-term overweight and obesity, but the literature to date has focused on the effect of gestational weight on the neonate and not on the mother. In 1990, the Institute of Medicine (IOM) released recommendations for weight gain during pregnancy. According to these recommendations, young adolescents (< or =16 years old) should gain weight at the upper end of the recommendations, while older adolescents (>16-19 years old) should gain weight similarly to adult women. The purpose of this article is to provide a current understanding of adolescent gestational weight gain and its impact on both maternal and neonatal outcomes. If adolescent weight gain during pregnancy leads to overweight and obesity without a clear benefit for the neonate, there may be resultant health implications for maternal health. This literature review demonstrates that there are no clear answers to the question of the influence of gestational weight gain on future maternal health. It is certain, however, that helping adolescents achieve good prepregnant nutritional status is an important first step in health promotion.
Reconceptualizing the nurse's role in the newborn period as an "attacher".
In the first few days and weeks after a child's birth, attachment is a major task for the mother and her newborn. Success in this long-term psychological process is associated with positive life-long outcomes for both the parenting mother and her child. This article proposes a relational approach to newborn nursing grounded in the principles of attachment theory. Understanding this "attacher" approach can benefit nurses by bringing a gratifying depth to their practice and can benefit families by helping mothers and newborns address the most compelling task before them.
Development and testing of the caregiver reciprocity scale.
The purpose of this study was to develop and validate the dimensions of caregiver reciprocity. Social exchange and equity theory served as a conceptual framework for examining recprocal intergenerational exchanges of assistance and support. In the first phase of the study, 12 caregivers of elderly parents, including in-laws, were interviewed to provide narrative data from which items were developed. Content validity was judged by two separate panels of experts. The revised CRS was tested with 303 adult children for reliability and validity, including internal consistency, test-retest reliability, exploratory factor analysis, and convergent and discriminant validity testing using structural equation modeling. Support for construct validity was demonstrated for four factors: Warmth and Regard, Intrinsic Rewards of Giving, Love and Affection, and Balance within Family Caregiving.
A model for bridging the gap: from theory to practice to reality.
A successful future for the nursing profession requires leaders who are willing and able to lead. The Graduate Nursing Administration Program at UCLA has developed a program to prepare these future leaders. Based on the leadership model of James Kouzes and Barry Posner, this program includes the 5 practices of exemplary leadership: Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart.
Empathy can be learned.
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Maximizing learning among students from culturally diverse backgrounds.
As student diversity in the classroom increases, it is imperative that faculty use a variety of teaching methods. Although culture generally focuses on ethnicity, diversity can be defined by numerous student characteristics and other factors related to learning. These factors included ethnicity, place of birth, immigration status, age, gender, lifestyle, and educational and career background. The authors address diversity in the classroom, propose a model for viewing diversity, and suggest ways to maximize learning among students from culturally diverse backgrounds.
5 steps to jump start faculty research.
Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.
Coming to grips with a peer's domestic abuse.
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Steady the course of Parkinson's disease.
Review the signs and symptoms of Parkinson's disease and available treatment options.
Making the grade: help staff pass the NCLEX-RN.
Help nursing candidates identify factors associated with their NCLEX-RN failure and take actions that will increase their likelihood of passing it.
Who speaks for the vulnerable?
Feeling vulnerable is a common human experience; everyone has probably felt powerless or unable to exert personal control in various situations. Lacking information, feeling stigmatized, being unable to control what is happening, or lacking access to services may lead people to have a heightened sense of vulnerability. They may wonder what rights they have, whether they have been stripped of their rights, or whether anyone cares about their situation. Although a more consumer-oriented approach is being used in many healthcare facilities, patients do not know how to get the help they need or to whom to turn for help. Therefore, the purposes of this article are to explore the concept of vulnerability, discuss advocacy as an ethical response for nurses, and offer recommendations for creating an ethical environment that supports efforts of nurses to act as advocates and uphold the rights of patients and families.
Caregiving may be hazardous to your health.
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A comparison of various angles of halo pin insertion in an immature skull model.
STUDY DESIGN: A basic science biomechanical study involving an animal model. OBJECTIVES: To evaluate the effect of varying angles of halo pin insertion on the force generated at the pin-bone interface, and thereby the stability of the halo pin-bone interaction during insertion. BACKGROUND DATA: Because of variations in the shape and size of the pediatric skull, halo pins often are inserted at various angles rather than perpendicular to the skull. Concern exists that the high complication rate associated with pediatric halo use may result in part from less than ideal structural properties at the halo pin-bone interface. METHODS: The authors used a fetal calf skull model to simulate the thickness and structural properties of the pediatric skull. Halo pins were inserted at angles of 0 degree (perpendicular), 10 degrees, 15 degrees, and 30 degrees into skull segments via a halo ring. Load generated at the pin-bone interface was measured using a modified mechanical testing device. Twenty trials were conducted per angle, with the endpoint being specimen failure, pin penetration, or maximum load. RESULTS: Mean maximum loads per unit thickness were 82.15 +/- 7.54 N/mm at 0 degree, 68.80 +/- 4.79 N/mm at 10 degrees, 51.49 +/- 5.08 N/mm at 15 degrees, and 42.38 +/- 3.51 N/mm at 30 degrees, There was a significant difference between perpendicular insertion (0 degree) and 15 degrees angles of insertion. There was also a significant difference between the 10 degrees and 30 degrees angles of insertion. CONCLUSIONS: Perpendicular halo pin insertion in an immature skull model was shown to result in increased load at the pin-bone interface. This improved structural behavior may help to reduce the incidence of complications of halo application in children.