Iowa Maternal and Child Health Comprehensive Title V Assets and Needs Assessment, July 15, 2010

The Iowa Department of Public Health Bureau of Family Health and the Child Health Specialty Clinics embarked on a five-year needs assessment in March 2008 with a daylong strategic planning session involving key administrative and staff personnel from both agencies. As part of the strategic planning, the participants began preparation of a comprehensive assessment to identify the need in Iowa for: preventive and primary care services for pregnant women, mothers, and infants; preventive and primary care services for children; and services for children and youth with special health care needs.

Medical residents' feedback on needs and acquired skills following a short course on cross-cultural competence

Objectives The purpose of this study is to assess short and long term changes in knowledge, attitudes, and skills among medical residents following a short course on cultural competency and to explore their perspectives on the experience. Methods Eighteen medical residents went through a short training programme comprised of two seminars lasting 30' and 60' respectively over two days. Three months later, we conducted three focus groups, with 17 residents to explore their thoughts, perspectives and feedback about the course. To measure changes over time, we carried out a quantitative sequential survey before the seminars, three days after, and three months later using the Multicultural Assessment Questionnaire. Results Residents expressed a wide variety of perspectives on the main themes related to the content of the training - culture, trialogue, stereotypes, status, epidemiology, history and geopolitics - and related to its organization - relevance, volume, timing, target audience, training tools, and working material. Using the MAQ, we observed a higher global performance score (n=16) at three days (median=38) compared to results before the training (median=33) revealing a median difference of 5.5 points (z=2.4, p=0.015). This difference was still present at three months (∆=4.5, z=2.4, p=0.018), mainly due to knowledge acquisition (∆=3) rather than attitudes (∆=0) or skills (∆=1). Conclusions Cross-cultural competence training not only brings awareness of multicultural issues but also helps participants understand their own cultures, perception of others and preconceived ideas. Physicians' education should however also focus on improving implementation of acquired knowledge in cross-cultural competence.

Development of mental disorders one year after exposure to psychosocial stressors; a cohort study in primary care patients with a physical complaint.

BACKGROUND: Mental disorders, common in primary care, are often associated with physical complaints. While exposure to psychosocial stressors and development or presence of principal mental disorders (i.e. depression, anxiety and somatoform disorders defined as multisomatoforme disorders) is commonly correlated, temporal association remains unproven. The study explores the onset of such disorders after exposure to psychosocial stressors in a cohort of primary care patients with at least one physical symptom. METHOD: The cohort study SODA (SOmatization, Depression and Anxiety) was conducted by 21 private-practice GPs and three fellow physicians in a Swiss academic primary care centre. GPs included patients via randomized daily identifiers. Depression, anxiety or somatoform disorders were identified by the full Patient Health Questionnaire (PHQ), a validated procedure to identify mental disorders based on DSM-IV criteria. The PHQ was also used to investigate exposure to psychosocial stressors (before the index consultation and during follow up) and the onset of principal mental disorders after one year of follow up. RESULTS: From November 2004 to July 2005, 1020 patients were screened for inclusion. 627 were eligible and 482 completed the PHQ one year later and were included in the analysis (77%). At one year, prevalence of principal mental disorders was 30/153 (19.6% CI95% 13.6; 26.8) for those initially exposed to a major psychosocial stressor and 26/329 (7.9% CI95% 5.2; 11.4) for those not. Stronger association exists between psychosocial stressors and depression (RR = 2.4) or anxiety (RR = 3.5) than multisomatoforme disorders (RR = 1.8). Patients who are "bothered a lot" (subjective distress) by a stressor are therefore 2.5 times (CI95% 1.5; 4.0) more likely to experience a mental disorder at one year. A history of psychiatric comorbidities or psychological treatment was not a confounding factor for developing a principal mental disorder after exposure to psychosocial stressors. CONCLUSION: This primary care study shows that patients with physical complaints exposed to psychosocial stressors had a higher risk for developing mental disorders one year later. This temporal association opens the field for further research in preventive care for mental diseases in primary care patients.

Adolescent medicine : from clinical practice to public health

In most countries, adolescent health problems have shifted from pure medical conditions to more psychosocial burdens such as injuries and violence, substance use, unsafe sex and chronic conditions including under nutrition or obesity. This new situation requires specific actions which have to take into account the specificities of the bio psychosocial development of the adolescent. Youth friendly services offering adequate environment and policies as well as carefully trained physicians represent one answer to the health needs of adolescents. Another lies in the development of school prevention and health promotion. Finally, policies aiming at securing a safe environment represent an effective mean to improve the health of adolescents.

Le Resident Assessment Instrument-Home-Care (RAI-Domicile): ce que le médecin de premier recours doit savoir [The Resident Assessment Instrument Home care: what primary care physician needs to know].

Following the decision of the Swiss Association for Home Care Services to adopt the Resident Assessment Instrument (RAI), the RAI-Home Care is gradually implemented in all home care services in Switzerland. Based on a comprehensive geriatric assessment, the RAI not only allows to establish an individualized plan of care, but also generates quality indicators and a case-mix classification system that helps financing and planning resources. This article describes the five steps of the RAI-Home Care process and discusses the strengths, future and limitations of the RAI.

Disability in Iowa: Public Health Needs Assessment

According to the Centers for Disease Control and Prevention (CDC), the number of adults reporting a disability is expected to increase, along with the need for appropriate medical and public health services. People with disabilities (PWD) face many barriers to good heath, including having overall poorer health, less access toadequate health care, limited access to health insurance, skipping mediacl care because of cost, and engaging in risky health behaviors including smoking and physical inactivity. The goals of the Iowa public health needs assessment were to assess the burden of disability in Iowa counties including health risk factors such as chronic conditions, determine access to preventive health care, and determine the effect of socioeconomic conditions. The state level assessment was based on th 2009-2012 American Community Survey (ACS) and publiccally available Behavioral Risk FactorSurveillance System (BRFSS) 2011 survey. The 2001-2010 combined BRFSS data was used for county level assessment. The needs assessment led us to conclude that adult Iowans with idsabilities face several challenges compared to non-disabled adults. They are more likely to suffer from debilitating chronic conditions and social disparities. Counties with the higher levels of poverty were more likely to have PWD with higher levels of disability related disparities.

An Investigation of Signing Needs at Uncontrolled Local Road Intersections, HR-230, 1982

Iowa Counties have been experiencing significant tort claim liability due to the signing of local roads. One such problem is relative to the real or alleged need for signing at uncontrolled intersections of local roads. It has been assumed that the standard CROSS ROAD sign, which calls for a yellow diamond with a black cross, was sufficient to provide the necessary warning that a driver may be approaching an intersection which requires special precautionary driving attention. However, it is possible that this sign on a through highway might conflict with the legal status of the local county road. In light of this situation, it seemed worthwhile to know the extent to which uncontrolled local road intersections were perceived as a potential liability problem; the degree to which the standard CROSS ROAD sign communicated to the driver the message a county engineer wanted at these local road intersections; and whether there were any better signing alternatives available to communicate this hazard to the driver in this situation.

Psychosocial analysis of the collective processes in the United States after September 11

This article studies alterations in the values, attitudes, and behaviors that emerged among U.S. citizens as a consequence of, and as a response to, the attacks of September 11, 2001. The study briefly examines the immediate reaction to the attack, before focusing on the collective reactions that characterized the behavior of the majority of the population between the events of 9/11 and the response to it in the form of intervention in Afghanistan. In studying this period an eight-phase sequential model (Botcharova, 2001) is used, where the initial phases center on the nation as the ingroup and the latter focus on the enemy who carried out the attack as the outgroup. The study is conducted from a psychosocial perspective and uses "social identity theory" (Tajfel & Turner, 1979, 1986) as the basic framework for interpreting and accounting for the collective reactions recorded. The main purpose of this paper is to show that the interpretation of these collective reactions is consistent with the postulates of social identity theory. The application of this theory provides a different and specific analysis of events. The study is based on data obtained from a variety of rigorous academic studies and opinion polls conducted in relation to the events of 9/11. In line with social identity theory, 9/11 had a marked impact on the importance attached by the majority of U.S. citizens to their identity as members of a nation. This in turn accentuated group differentiation and activated ingroup favoritism and outgroup discrimination (Tajfel & Turner, 1979, 1986). Ingroup favoritism strengthened group cohesion, feelings of solidarity, and identification with the most emblematic values of the U.S. nation, while outgroup discrimination induced U.S. citizens to conceive the enemy (al-Qaeda and its protectors) as the incarnation of evil, depersonalizing the group and venting their anger on it, and to give their backing to a military response, the eventual intervention in Afghanistan. Finally, and also in line with the postulates of social identity theory, as an alternative to the virtual bipolarization of the conflict (U.S. vs al-Qaeda), the activation of a higher level of identity in the ingroup is proposed, a group that includes the United States and the largest possible number of countries¿ including Islamic states¿in the search for a common, more legitimate and effective solution.

Psychosocial analysis of ETA's violence legitimation discourse

This study analyses the fundamental components shaping the violence legitimation discourse of ETA (Euskadi Ta Askasuna). With this aim, a category system has been built, which organizes the psychosocial processes identified in previous studies related to violence legitimation. Based on the proposed category system, a content analysis was conducted on 21 statements of ETA, released between 1998 and 2011. An intraobserver and inter-observer reliability analysis reveals high level stability and replicability of the categorization. The results show, firstly, that outgroup components have a predominant presence over ingroup components. Secondly, in the components hierarchy, we observe that elements referring to identity come in first place, followed in similar frequencies by those related to violence representation and the definition of the situation.

Validation of the 34-item Supportive Care Needs Survey and 8-item Breast module French versions (SCNS-SF34-Fr and SCNS-BR8-Fr) in breast cancer patients.

This study aimed to assess the psychometric robustness of the French version of the Supportive Care Needs Survey and breast cancer (BC) module (SCNS-SF34-Fr and SCNS-BR8-Fr). Breast cancer patients were recruited in two hospitals (in Paris, France and Lausanne, Switzerland) either in ambulatory chemotherapy or radiotherapy, or surgery services. They were invited to complete the SCNS-SF34-Fr and SCNS-BR8-Fr as well as quality of life and patient satisfaction questionnaires. Three hundred and eighty-four (73% response rate) BC patients returned completed questionnaires. A five-factor model was confirmed for the SCNS-SF34-Fr with adequate goodness-of-fit indexes, although some items evidenced content redundancy, and a one-factor was identified for the SCNS-BR8-Fr. Internal consistency and test-retest estimates were satisfactory for most scales. The SCNS-SF34-Fr and SCNS-BR8-Fr scales demonstrated conceptual differences with the quality of life and satisfaction with care scales, highlighting the specific relevance of this assessment. Different levels of needs could be differentiated between groups of BC patients in terms of age and level of education (P < 0.001). The SCNS-SF34-Fr and SCNS-BR8-Fr present adequate psychometric properties despite some redundant items. These questionnaires allow for the crucial endeavour to design appropriate care services according to BC patients' characteristics.

Psychosocial analysis of ETA"s violence legitimation discourse

Este artículo analiza los componentes fundamentales que configuran el discurso legitimador de la violencia de ETA (Euskadi Ta Askatasuna). Con este objetivo, se construye un sistema de categorías, el cual organiza los procesos psicosociales identificados en investigaciones previas relacionadas con la legitimación de la violencia. A partir del sistema de categorías propuesto, se realiza un análisis de contenido en 21 comunicados de ETA publicados entre 1998 y 2011. El análisis de fiabilidad intraobservador e interobservador muestra una alta estabilidad y replicabilidad de la categorización. Los resultados muestran, en primer lugar, que los componentes exogrupales son predominantes respecto a los endogrupales. Segundo, en la jerarquización, se observa la preminencia de los elementos referidos a la identidad, seguido por frecuencias similares los relacionados con la representación de la violencia y la definición de la situación.

Psychosocial analysis of the collective processes in the United States after September 11

This article studies alterations in the values, attitudes, and behaviors that emerged among U.S. citizens as a consequence of, and as a response to, the attacks of September 11, 2001. The study briefly examines the immediate reaction to the attack, before focusing on the collective reactions that characterized the behavior of the majority of the population between the events of 9/11 and the response to it in the form of intervention in Afghanistan. In studying this period an eight-phase sequential model (Botcharova, 2001) is used, where the initial phases center on the nation as the ingroup and the latter focus on the enemy who carried out the attack as the outgroup. The study is conducted from a psychosocial perspective and uses "social identity theory" (Tajfel & Turner, 1979, 1986) as the basic framework for interpreting and accounting for the collective reactions recorded. The main purpose of this paper is to show that the interpretation of these collective reactions is consistent with the postulates of social identity theory. The application of this theory provides a different and specific analysis of events. The study is based on data obtained from a variety of rigorous academic studies and opinion polls conducted in relation to the events of 9/11. In line with social identity theory, 9/11 had a marked impact on the importance attached by the majority of U.S. citizens to their identity as members of a nation. This in turn accentuated group differentiation and activated ingroup favoritism and outgroup discrimination (Tajfel & Turner, 1979, 1986). Ingroup favoritism strengthened group cohesion, feelings of solidarity, and identification with the most emblematic values of the U.S. nation, while outgroup discrimination induced U.S. citizens to conceive the enemy (al-Qaeda and its protectors) as the incarnation of evil, depersonalizing the group and venting their anger on it, and to give their backing to a military response, the eventual intervention in Afghanistan. Finally, and also in line with the postulates of social identity theory, as an alternative to the virtual bipolarization of the conflict (U.S. vs al-Qaeda), the activation of a higher level of identity in the ingroup is proposed, a group that includes the United States and the largest possible number of countries¿ including Islamic states¿in the search for a common, more legitimate and effective solution.

Psychosocial analysis of ETA's violence legitimation discourse

This study analyses the fundamental components shaping the violence legitimation discourse of ETA (Euskadi Ta Askasuna). With this aim, a category system has been built, which organizes the psychosocial processes identified in previous studies related to violence legitimation. Based on the proposed category system, a content analysis was conducted on 21 statements of ETA, released between 1998 and 2011. An intraobserver and inter-observer reliability analysis reveals high level stability and replicability of the categorization. The results show, firstly, that outgroup components have a predominant presence over ingroup components. Secondly, in the components hierarchy, we observe that elements referring to identity come in first place, followed in similar frequencies by those related to violence representation and the definition of the situation.

Needs Assessment Study of the Iowa DOT Maintenance Facility Construction Needs, 1989

The purpose of this study is to provide recommendations relative to the location and construction needs for highway maintenance facilities within the state of Iowa. These recommendations were to be developed with consideration being given to the public's expectations and priorities for highway maintenance services. As a part of the study effort, a review was made of the methods used by other states to deliver highway maintenance services. To accomplish the study, Wilbur Smith Associates undertook a series of tasks. These efforts included gathering of data and information to characterize the various maintenance programs and the delivery of maintenance and operations services by the Department. We researched the delivery of highway maintenance services in other states. Interviews with Iowa DOT maintenance personnel were accomplished. A schedule of public hearings was developed and ten hearings were held. All the information was integrated and various analyses were made. From these analyses we drew conclusions and developed recommendations.