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PubMed1996

A federal perspective on special education technology.

This article examines more than a decade of changes in special education research and in the use of technology. It discusses evolving research and projects funded by the Office of Special Education Programs (OSEP) and raises questions about the use of specific methodologies and about whether children with disabilities are being prepared for the world in which they will live. And, finally, it describes OSEP's Technology, Educational Media, and Materials strategic program agenda that will drive future planning and priorities.

Audiovisual Aids↗
PubMedDate not supplied

What we know about using research findings: implications for improving special education practice.

This article discusses the alternative roles and responsibilities that researchers might assume to bridge the gap between special education research and classroom practice. Literature is reviewed that addresses why some research-based practices fail, and the factors likely to lead to sustained use of research-based practices. The roles of researchers as collaborators, facilitators and coaches, interpreters of the culture and dynamics of the school, and critics are described in an attempt to promote researchers as leaders in efforts to improve practices in the field of special education.

Child↗
PubMed2005

General practitioners with a special interest in respiratory medicine: national survey of UK primary care organisations.

BACKGROUND: To meet the universally recognised challenge of caring for people with long-term diseases many healthcare cultures are encouraging family physicians to develop specialist skills. We aimed to determine the major factors influencing the appointment of respiratory General Practitioners with a Special Interest (GPwSI) in the UK, and to determine the priority attached to the potential roles, perceived barriers to implementation, and monitoring planned. METHODS: We sent a piloted semi-structured questionnaire to a random sample of 50% of English and Welsh primary care organisations (PCOs) (n = 161) during winter 2003. In addition to descriptive statistics, we used hierarchical cluster analysis to classify service priorities. Free-text responses to open-ended questions were analysed qualitatively by a multidisciplinary group to identify emerging themes. RESULTS: Of the 111 (69%) PCOs who responded, 7 (6%) already have, and a further 35 (32%) are planning, a respiratory GPwSI service. This proportion is considerably lower than in specialities linked to National Health Service clinical priorities. Local needs and pressure on hospital beds were the main described motives for developing a service. Stated service priorities were to relieve pressure on secondary care and to improve quality of care, including the strategic planning of respiratory services within PCOs. CONCLUSION: The relatively few respiratory GPwSIs currently in post reflects the lack of government prioritisation of respiratory care. However, respiratory GPwSI services are increasingly being considered as a local strategy for reducing pressure on secondary care respiratory services and raising standards of chronic disease management in primary care.

Attitude of Health Personnel↗
PubMed1999

Route of discharge for special (high-security) hospital patients with personality disorder. Relationship with re-conviction.

BACKGROUND: A considerable proportion of patients with personality disorder are discharged directly to the community from special (high-security) hospitals. AIMS: To examine whether patients with personality disorder discharged directly to the community are more likely to be re-convicted than those transferred to psychiatric hospitals of lesser security. METHOD: Re-conviction data for a five- to nine-year follow-up were collected for a four-year (1988-1991) special hospital discharge cohort of patients with personality disorder. RESULTS: Individuals discharged directly to the community were not significantly more likely to be re-convicted than those transferred to less secure psychiatric hospitals. However, patients discharged to the community without formal conditions of supervision were more likely to be re-convicted than those discharged to the community with conditions or those transferred to other psychiatric hospitals. CONCLUSIONS: Formal supervision after discharge may be more important than actual destination in influencing the likelihood of re-conviction.

Adult↗
PubMed1986

Programming for special groups through closed-circuit television.

At Winnipeg's Children's Hospital Television (CHTV), there was concern that the closed-circuit alternative television station was not realizing its full potential in helping to meet the special needs of the adolescent and native Canadian patients. Consequently, CHTV hired workers to produce programming targeted at these two groups. This article documents the underlying philosophy and structure of this programming. It also discusses how other children's health care institutions might adapt this kind of programming to suit their own groups with special needs.

Adolescent↗
PubMed2003

Emotional security with teachers and children's stress reactivity: a comparison of special-education and regular-education classrooms.

Examined children's exposure and reactivity to negative peer and teacher events in special-education and regular-education classrooms. Participants were 40 children in regular classrooms and 20 children classified as seriously emotionally disturbed (SED) in special-education classrooms. Children completed 7 days of diary data over the course of the school year. SED children reported higher rates of exposure to negative teacher and peer events than comparison children. The self-esteem of both SED and comparison children was reactive to negative peer events in the classroom, but emotional security with teacher (EST) reduced this reactivity. The self-esteem of SED children was also reactive to negative teacher events but, EST, once again, reduced reactivity to negative events. Finally, SED children's perception of maternal warmth moderated their self-esteem reactivity and was concordant with their views of teachers. Results are discussed in light of treatment implications for SED children.

Adolescent↗
PubMed1982

Differences by sex in economic returns associated with physician specialization.

Women comprised only 8.8 percent of active physicians in the United States in 1977. However, recent trends in the sex composition of medical school classes indicate that women will make up at least one-fourth of total physician supply in the future. Consequently, the effect of sex-composition changes on the supply of physicians' services is of importance, especially since much current federal policy is based upon assumptions about physician behavior drawn from observation of the current stock of physicians. This article explores the issue of differences by sex in lifetime earnings associated with alternative specialty choices. Economic incentives to specialize rather than enter general/family practice are examined initially. Then the incentives influencing the decision to specialize in either primary care or non-primary care fields are considered. Findings are reviewed and implications for future trends in specialty distribution of physicians, as well as implications for current and future federal policy affecting physicians' specialty decisions, are discussed.

Adult↗
PubMed2006

General practitioners with special interests: evolution and evaluation.

General practitioners with special interests (GPSIs) have emerged in the UK as a government initiative aimed at improving access in specialities that traditionally have long waiting times for investigations and treatment. This represents, to some extent, a formalisation of existing working practices of general practitioners who had obtained specialist experience during hospital training. GPSIs are working in a wide range of clinical areas including coronary heart disease, drug abuse, echocardiography and sexual health. Similar changes at the primary-secondary care interface are taking place in other European health systems. Key issues in the development of these services include the assurance of high-quality health care, clinical governance and risk management, cost-effectiveness and impact on outpatient care, and the work and role of specialists. It is possible that these new opportunities for general practitioners and other health care professions will aid recruitment and retention of staff in primary care, enhance education and encourage commissioners of services to look carefully at unmet needs in their health economies. Further challenges include the need to train a cadre of practitioners and to provide the research evidence on which to base continued investment in this promising initiative.

Health Services Accessibility↗
PubMedDate not supplied

Does specialization improve outcome in abdominal aortic aneurysm surgery?

Specialization and high volume are reported to be related to a better outcome after abdominal aortic aneurysm repair. The aim of this study was to compare, in patients undergoing abdominal aortic aneurysm repair, the outcomes of those whose surgery was done by general surgeons with the outcomes of those whose surgery was done by specialist vascular surgeons. All patients undergoing abdominal aortic aneurysm repair at the Basel University Hospital (referral center) from January 1990 to December 2000 were included. Patients with endovascular treatment were excluded. Operations in group A (n = 189), between January 1990 and May 1995, were done by general surgeons. Operations in group B (n = 291), between June 1995 and December 2000, were done by vascular surgeons. In-hospital mortality and local and systemic complications were assessed. In-hospital mortality rates were significantly lower for group B (with specialist surgeons) than for group A, both overall (group B, 11.7%; group A, 21.7%; p = .003) and for emergency interventions (group B, 28.1%; group A, 41.9%; p = .042). The reduction in mortality for elective surgery in group B was not statistically significant (group B, 1.1%; group A, 4.9%; p = .054). There were significantly fewer pulmonary complications in group B compared with group A (p = .000). We conclude that in patients undergoing abdominal aortic aneurysm repair, those whose surgery is done by a specialized team have a significantly better outcome than those whose surgery is done by general surgeons.

Aged↗
PubMed1985

Family practice social work: a new area of specialization.

Many physical problems presented to family physicians by their patients often involve psychosocial variables with stress being a major one. Though family medicine advocates a biopsychosocial focus, one that is compatible with social work, the psychosocial aspects of health are often ignored. The involvement of social workers in the private practices of family physicians to deal with such problems is discussed in this paper as a new area of specialization. Issues such as the medicine-social work gap and the financing of social work services in private family medical practice are also addressed. It is concluded that this should be considered a new area of specialization. However, social workers must take the initiative in its development.

Behavioral Medicine↗
PubMed2000

Perspectives of an African American mother on parent-professional relationships in special education.

A case study focused on the perspectives of a low-income, African American mother of a child with disabilities was presented. How an African American parent may begin to perceive characteristics of special education services and aspects of professional behavior as problematic was discussed as was her growing dissatisfaction with the services and eventual decision to withdraw her participation in the special education process The mother's perspective on specific encounters with professionals and the cumulative ways in which these encounters build toward her sense of growing dissatisfaction have implications for professional practice. Further understanding of how African American parents perceive their initial interactions with professionals and how they come to interpret these interactions may contribute towards building increased parental participation and parental satisfaction.

Adult↗
PubMed2001

Intellectual classification of Black and White children in special education programs using the WISC-III and the Cognitive Assessment System.

The Wechsler Intelligence Scale for Children--Third Edition and the Cognitive Assessment System were compared for a sample of 78 White and Black students in special education programs for children with mental retardation. Results showed that the WISC-III identified more children as having mental retardation than did the Cognitive Assessment System. More important, however, the WISC-III classified disproportionately more Blacks than Whites as having mental retardation as compared to the Cognitive Assessment System. Results imply that the problem of disproportionate representation of Black children in special education classes for children with mental retardation may be addressed if the Cognitive Assessment System were used instead of the WISC-III.

Adolescent↗
PubMed2003

Causative and contributive factors to asthma severity and patterns of medication use in patients seeking specialized asthma care.

STUDY OBJECTIVES: (1) To assess the prevalence of specific factors considered causative or contributive to asthma in a population of patients seen in a specialized asthma clinic, and to determine whether any of these factors were associated with more severe disease; and (2) to assess the utilization of inhaled steroids by asthma severity in this population and compare it with published guidelines of the National Heart, Lung, and Blood Institute (NHLBI). DESIGN, SETTING, AND PATIENT POPULATION: We conducted a retrospective chart review of new patients seen in a specialized asthma treatment center over a 2.5-year period and recorded the prevalence of 14 causative or contributive factors, the severity of asthma, and the intensity of treatment with inhaled corticosteroids in each patient. Patients were grouped as mild asthma vs moderate/severe asthma and compared by chi(2) analysis and stepwise logistic regression to determine whether certain factors were associated with more severe asthma. MEASUREMENTS AND RESULTS: The average number of factors recorded was 2.9 +/- 1.8 in the mild group (+/- SD) and 3.5 +/- 1.6 in the moderate/severe asthma group. This difference was statistically significant (p = 0.014). Increasing age, male gender, symptomatic gastroesophageal reflux disease (GERD), and chronic sinusitis were independently associated with more severe asthma. Suboptimal use of inhaled corticosteroids was more common in patients with mild persistent asthma, but suboptimal dosing of inhaled corticosteroids was equally common in mild and moderate/severe asthma. No relationship was found between allergen sensitization combined with exposure to cats, dogs, dust mite, or molds and more severe asthma. CONCLUSIONS: This study confirms earlier studies showing that symptomatic GERD and chronic sinusitis are important comorbid conditions in patients with asthma, both being associated with greater asthma severity. This study further shows that the doses of inhaled corticosteroids used for treatment of asthma fall short of NHLBI guidelines in the majority of patients regardless of asthma severity.

Administration, Inhalation↗
PubMed2004

Unmet need for routine and specialty care: data from the National Survey of Children With Special Health Care Needs.

OBJECTIVE: To assess the prevalence of unmet needs for routine and specialty care among children with special health care needs (CSHCN) and to identify factors associated with the likelihood of having unmet need for medical care. METHODS: Data come from the respondents for 38 866 children interviewed for the National Survey of Children With Special Health Care Needs. Bivariate analyses were used to assess differences in unmet need for medical care by various environmental, predisposing, enabling, and need factors. Logit analyses were used to determine independent effects of these variables on the likelihood of having an unmet need for medical care. RESULTS: Nationally, 74.4% and 51.0% of CSHCN needed routine and subspecialty physician care, respectively. Of those reporting that they needed routine care, 3.2% were unable to obtain these services. Of those reporting a need for specialty care, 7.2% reported not obtaining all needed specialty care. The prevalence of unmet need for specialty care significantly exceeded the prevalence of unmet need for routine care. In logit analyses, African American children and children whose mothers had less than a high-school education faced twice the odds of having an unmet need for routine care. Compared with nonpoor children, children living below the federal poverty level were significantly more likely to have an unmet need for routine (adjusted odds ratio [aOR]: 1.97; 95% confidence interval [CI]: 1.23-3.14) and specialty (aOR: 2.50; 95% CI: 1.49-4.18) care. Near-poor children were also significantly more likely than nonpoor children to have unmet needs for routine and specialty care. Uninsured children were significantly more likely than continuously insured children to report an unmet need for routine (aOR: 7.51; 95% CI: 4.99-11.30) and specialty (aOR: 4.29; 95% CI: 2.99-6.15) care. Our findings also show that higher levels of general pediatrician supply, relative to the pediatric population, are associated with a significantly lower likelihood of having an unmet need for routine care. Likewise, a greater supply of pediatric subspecialists is associated with a decreased likelihood of having an unmet need for specialty care. CONCLUSIONS: Compared with previous reports of the general pediatric population, CSHCN have higher levels of unmet need for medical services. Our regression results emphasize that children vulnerable because of their social circumstances (eg, poverty, etc) have significantly greater odds of having unmet need for routine and specialty physician care. Furthermore, our findings highlight the importance of insurance coverage in ensuring access to needed routine and specialty medical services.

Adolescent↗
PubMed1992

Which newborns in New York City are at risk for special education placement?

In this study of 162 third graders in New York City public schools, we found that slightly over half of the children in special education were males who had Medicaid coverage at birth and mothers with medical conditions or adverse health habits noted on the birth certificate; two thirds of the children with this combination of characteristics actually were placed in special education. These findings suggest that newborns at risk for later learning disabilities can be targeted to receive preventive interventions.

Birth Certificates↗
PubMed1984

Disturbing behaviors: comparison of regular and special education teachers.

77 regular and 45 special education teachers rated how disturbing various students' behaviors would be when working with the students in the classroom setting. Comparison of the two groups of teachers' ratings showed that the regular teachers reported more disturbance than special education teachers on two of the scales of the Teacher Checklist of School Behavior, Aggressive Interaction and Teacher Avoidance.

Child↗
PubMed1994

Knowledge of and attitudes towards children with special needs by selected groups.

To explore knowledge of and attitudes about children who have special needs, a questionnaire was submitted to 1145 persons (305 lyceum students, 94 teachers of secondary education, 247 medical students, 354 physical education students, and 145 persons having an exceptional child in their families). Questions concerned the knowledge of categories of children with special needs, acceptance of them in regular classrooms, and willingness to work with them. Analysis showed that most people including teachers had limited awareness of exceptional children, their problems, education, and integration. They showed partial acceptance of mainstreaming and desire to work with such children. Careful education for all, especially teachers, seems advisable.

Adolescent↗