Ordinary Families -Extraordinary Care Giving

Children with severe emotional problems often have multiple needs that require disparate services including child welfare, juvenile justice, health, mental health, substance abuse, and mental retardation (Stroul, 1996). However, the primary care giving responsibilities for these youngsters still remain with their families. It is the family who shelters and clothes them; provides guidance, affection, recreation, nurturing; gets them to appointments with doctors and therapists and to school dayin- and-day-out, year after year (Lourie, 1995). Despite the invaluable and irreplaceable care provided by families, they are often maligned by a system which characterizes them as having their own problems and inadequacies. The purpose of this research is to learn more about the strengths of families who care for children with severe emotional disabilities (SED). This exploratory descriptive study made use of focus groups attended by parents who are caring for such children. In order to improve services to these families, it is important that we understand how the notion of strengths play out in their everyday lives. Observations are made about the care giving plan, which all families devise in the course of caring for their child with special needs. Implications for paid professionals who serve these families are offered by presenting a model for putting family care givers at the hub of the service provision wheel.

Congential syphilis in Harris County, Texas, 1993--1996

The specific aims of this study were to: (1) To determine the incidence of congenital syphilis (CS) for the 1993-96 birth cohorts in Houston/Harris County, based on the newly revised 1989 CS surveillance definition in Houston/Harris County, Texas; (2) To study the distribution of selected variables listed in the Centers for Disease Control and Prevention (CDC) Congenital Syphilis Case Investigation and Report Form for the reported cases of CS; (3) To ascertain the relationships of maternal demographic factors, geographic distribution, and provision and utilization of prenatal care, associated with reported congenital syphilis delivery.^ This was a descriptive study analyzing reported cases of congenital syphilis in Houston/Harris, County, TX during the years 1993-96 using the data recorded on the CDC's Congenital Syphilis Case Investigation and Report forms. The population included infants delivered during 1993-96 who were diagnosed with congenital syphilis, using the revised 1990 criteria of the CDC. This study examined the risk factors associated with the occurrence of congenital syphilis in Harris County where the prevalence of maternal syphilis infection (13.7/100,000/1995) is high. (Abstract shortened by UMI.) ^

Risk, outcomes, and cost of emergency center visits in cancer patients

Cancer is a chronic disease that often necessitates recurrent hospitalizations, a costly pattern of medical care utilization. In chronically ill patients, most readmissions are for treatment of the same condition that caused the preceding hospitalization. There is concern that rather than reducing costs, earlier discharge may shift costs from the initial hospitalization to emergency center visits. ^ This is the first descriptive study to measure the incidence of emergency center visits (ECVs) after hospitalization at The University of M. D. Anderson Cancer Center (UTMDACC), to identify the risk factors for and outcomes of these ECVs, and to compare 30-day all-cause mortality and costs for episodes of care with and without ECVs. ^ We identified all hospitalizations at UTMDACC with admission dates from September 1, 1993 through August 31, 1997 which met inclusion criteria. Data were electronically obtained primarily from UTMDACC's institutional database. Demographic factors, clinical factors, duration of the index hospitalization, method of payment for care, and year of hospitalization study were variables determined for each hospitalization. ^ The overall incidence of ECVs was 18%. Forty-five percent of ECVs resulted in hospital readmission (8% of all hospitalizations). In 1% of ECVs the patient died in the emergency center, and for the remaining 54% of ECVs the patient was discharged home. Risk factors for ECVs were marital status, type of index hospitalization, cancer type, and duration of the index hospitalization. The overall 30-day all-cause mortality rate was 8.6% for hospitalizations with an ECV and 5.3% for those without an ECV. In all subgroups, the 30-day all-cause mortality rate was higher for groups with ECVs than for those without ECVs. The most important factor increasing cost was having an ECV. In all patient subgroups, the cost per episode of care with an ECV was at least 1.9 times the cost per episode without an ECV. ^ The higher costs and poorer outcomes of episodes of care with ECVs and hospital readmissions suggest that interventions to avoid these ECVs or mitigate their costs are needed. Further research is needed to improve understanding of the methodological issues involved in relation to health care issues for cancer patients. ^

A Longitudinal Assessment of Sleep Timing, Circadian Phase, and Phase Angle of Entrainment across Human Adolescence

The aim of this descriptive analysis was to examine sleep timing, circadian phase, and phase angle of entrainment across adolescence in a longitudinal study design. Ninety-four adolescents participated; 38 (21 boys) were 9-10 years ("younger cohort") and 56 (30 boys) were 15-16 years ("older cohort") at the baseline assessment. Participants completed a baseline and then follow-up assessments approximately every six months for 2.5 years. At each assessment, participants wore a wrist actigraph for at least one week at home to measure self-selected sleep timing before salivary dim light melatonin onset (DLMO) phase - a marker of the circadian timing system - was measured in the laboratory. Weekday and weekend sleep onset and offset and weekend-weekday differences were derived from actigraphy. Phase angles were the time durations from DLMO to weekday sleep onset and offset times. Each cohort showed later sleep onset (weekend and weekday), later weekend sleep offset, and later DLMO with age. Weekday sleep offset shifted earlier with age in the younger cohort and later in the older cohort after age 17. Weekend-weekday sleep offset differences increased with age in the younger cohort and decreased in the older cohort after age 17. DLMO to sleep offset phase angle narrowed with age in the younger cohort and became broader in the older cohort. The older cohort had a wider sleep onset phase angle compared to the younger cohort; however, an age-related phase angle increase was seen in the younger cohort only. Individual differences were seen in these developmental trajectories. This descriptive study indicated that circadian phase and self-selected sleep delayed across adolescence, though school-day sleep offset advanced until no longer in high school, whereupon offset was later. Phase angle changes are described as an interaction of developmental changes in sleep regulation interacting with psychosocial factors (e.g., bedtime autonomy)

Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

AIMS Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. METHODS AND RESULTS A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. CONCLUSION Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged.

Social capital and adolescent health risk behavior in El Salvador

An emerging body of research suggests that the social capital available in one's social environment, as defined by supportive and caring interpersonal relationships, may provide a protective effect against a number of youth risk behaviors. In exploring the potential protective effect of social capital at school and at home on adolescent health and social risk behavior, a comprehensive youth risk behavior study was carried out in El Salvador during the summer of 1999 with a sample of 984 secondary school students attending 16 public rural and urban schools. The following dissertation, entitled Social Capital and Adolescent Health Risk Behavior in El Salvador, presents three papers centered on the topics of social capital and risk behavior. ^ Paper #1. Dangers in the Adolescent River of Life: A Descriptive Study of Youth Risk Behavior among Urban and Rural presents prevalence estimates of four principal youth risk behavior domains—aggression, depression, substance use, and sexual behaviors among students primarily between the ages of 13 and 17 who attend public schools in El Salvador. The prevalence and distribution of risk behaviors is examined by gender, geographic school location, age, and subjective economic status. ^ Paper #2. Social Capital and Adolescent Health Risk Behavior among Secondary School Students in El Salvador explores the relationship between social resources (social capital) within the school context and several youth risk behaviors. Results indicated that students who perceived higher social cohesion at school and higher parental social support were significantly less likely to report fighting, having been threatened or hurt with a weapon, suicidal ideation, and sexual intercourse than students with lower perceived social cohesion at school and parental social support after adjusting for several socio-demographic variables. ^ Lastly, paper #3. School Health Environment and Social Capital : Moving beyond the individual to the broader social developmental context provides a theoretical and empirical basis for moving beyond the predominant individual-focus and physical health concerns of school health promotion to the larger social context of schools and social health of students. This paper explores the concept of social capital and relevant adolescent development theories in relation to the influence of social context on adolescent health and behavior. ^

Prenatal care content and utilization among pregnant women enrolled in managed care programs in Harris County, Texas

This research study was conducted as a descriptive study of prenatal care experiences of women enrolled in public and private managed care programs. The study's aim was to describe the demographic characteristics of the women in the study and to analyze and compare their prenatal care experiences. ^ The objective of this study was to examine the research question: Do pregnant women enrolled in Medicaid Managed Care receive the same level of care as women enrolled in other Managed Care Programs in Harris County, Texas? ^ The study population was a convenience sample of pregnant women enrolled in managed care programs who presented to one of the two hospital study sites for delivery of their infant. The study utilized a self administered survey to measure adequacy and content of prenatal care received by the women during this pregnancy. Adequacy of prenatal care utilization was determined based on the Kessner Index criteria of timing of initiation of care and number of visits. Content of care was measured by the number of different medical services the women reported they had received and the number of health information topics the women reported on which they had received information. Demographic characteristics were described with univariate and bivariate statistics of frequencies and cross tabulations. Associations were evaluated using measures of linear correlations. ^ Results from the study showed there is an association between enrollment in Medicaid Managed Care (public) and prenatal care received compared to women enrolled in other Managed Care Programs (private). The results were derived from statistical tests on data the postpartum women gave when they completed the self-administered survey. Provider type was a moderate predictor of quality and quantity of prenatal care. The results also indicate that in the study population, minority ethnicity, income and lower educational status were associated with intermediate and inadequate prenatal care. ^

The global initiative to eradicate polio- A review of Nigeria's situation

Poliomyelitis is one of the worlds remaining vaccine preventable infectious diseases. In 1988 the World Health Assembly in its general assembly resolved to eradicate polio in the year 2000 and the Global Initiative to Eradicate Polio was launched. ^ This initiative sprang from the successful eradication of smallpox from the world in the year 1979, and the World Health Organization sought to eradicate polio from the world's populations by the year 2000. ^ Several years have passed since this objective was launched, and while some advances have been made, the goal of global eradication remains elusive. At this present time (2007), only four countries are considered polio endemic regions (areas in which the transmission of wild poliovirus has never been truncated). These countries are Nigeria, India, Pakistan and Afghanistan. ^ This descriptive study seeks to examine the process and progress of polio eradication worldwide, with particular emphasis on the polio eradication efforts in Nigeria, problems encountered and progress that has been made towards attaining this goal. ^ The methodology of this study is an extensive examination of documentation and data from the Global Initiative to Eradicate Poliomyelitis (GPEI), the World Health Organization through the World Health Organization Library Information Service (WHOLIS), UNICEF, the Centers for Disease Control and related peer reviewed journals. ^

Factors related to employment among chronically mentally ill patients

A descriptive study of demographic and psychosocial factors believed to be associated with employment was carried out through face-to-face interviews with 417 chronically mentally-ill patients. Subjects had been hospitalized a minimum of two times for psychiatric treatment, had been discharged from at least one of these hospitalizations in the two years prior to the study, and were currently residing within a specific community mental health center catchment area in Texas. The study group ranged in age from 16 to 68 years and over one-half had chart diagnoses of schizophrenia.^ A structured interview was developed which addressed current employment status, length of current employment, job title of current or last job, and detailed work history for the prior five years. Four measures of social support were included in the interview. Each subject was asked to identify one recent work and one recent non-work situation which had been stressful or very demanding. A coping questionnaire was verbally administered to measure the ways in which subjects had coped with these specific stressful situations.^ Analysis of results revealed that 27 percent of the sample was gainfully employed at time of interview. Differences between the employed and unemployed groups were analyzed by t-test an chi square. The employed demonstrated significantly more weeks of employment in the prior five years than the unemployed. The current jobs of the employed required a significantly higher relationship to "things" or inanimate objects than the last jobs of the unemployed. Subjects diagnosed as schizophrenic were significantly less likely to be employed than subjects with other diagnoses.^ Employed subjects scored significantly higher on three of four measures of social support than unemployed subjects, including reported frequency of social group attendance and/or meetings with mental health professionals. Problem-focused coping was used significantly more by the employed than by the unemployed to deal with stressful situations in the work, but not the non-work, context. ^

A DESCRIPTION AND EVALUATION OF EDUCATIONAL PROGRAMS FOR HEALTH MANPOWER IN NIGERIA

A descriptive study of the current educational programs of selected health personnel in Nigeria was made in 1986. Data on the content of educational programs was obtained from personal communication with the Heads of the various institutions and from their published materials (catalogs, course outlines and program descriptions). Adequacy of these programs was judged in the light of current health problems and needs of the population. Evaluation was based on the following criteria: (a) Selection of students to maximize their usefulness in the provision of health care. (b) Relevance of the curriculum to the tasks the trainee will be called upon to perform. (c) Types of courses that focus on community health needs. Using official reports, the health situation in the country was described to give a relative priority of health services.^ Findings indicate the following: (1) Health conditions in Nigeria are related to a high prevalence of illness and disease, unsanitary living conditions, a high ratio of infant mortality and a shortage of public health services. Priority needs for improvement call for attitudinal and environmental changes. (2) All health training programs have improved the relevance of education to community health needs by strengthening practical field experience, and teaching those courses which focus on disease prevention. (3) Prospective nurses and community health workers are selected on the basis of a number of personal and intellectual characteristics, but academic performance alone is the criterion for medical students. (4) The curriculum in the medical school needs to be restructured to cut back on time devoted to enriching the medical "background". Basic sciences need better integration with hospital work. (5) Managerial and organization courses have been well incorporated into the nursing and community health workers' curricula. (6) There is a marked overlap in the tasks the community health workers are expected to perform. This causes some redundancy in having four separate categories of these health personnel. ^

AN ASSESSMENT OF THE CURRENT STATUS OF MENTAL ILLNESS IN BENDEL STATE OF NIGERIA: IMPLICATIONS FOR PUBLIC MENTAL HEALTH POLICY AND EDUCATION

This descriptive study assesses the current status of mental illness in Bendel State of Nigeria to determine its implications for mental health policy and education. It is a study of the demographic characteristics of psychiatric patients in the only two modern western psychiatric facilities in Bendel State, the various treatment modalities utilized for mental illness, and the people's choice of therapeutic measures for mental illness in Bendel State.^ This study investigated ten aspects of mental illness in Bendel State (1) An increase of the prevalence of mental illness (psychiatric disorder) in Bendel State. (2) Unaided, unguided, and uncared for mentally ill people roaming about Bendel State. (3) Pluralistic Treatment Modalities for mentally ill patients in Bendel State. (4) Traditional Healers treating more mentally ill patients than the modern western psychiatric hospitals. (5) Inadequate modern western psychiatric facilities in Bendel State. (6) Controversy between Traditional Health and modern western trained doctors over the issue of possible cooperation between traditional and modern western medicine. (7) Evidence of mental illness in all ethnic groups in Bendel State. (8) More scientifically based and better organized modern western psychiatric hospitals than the traditional healing centers. (9) Traditional healers' level of approach with patients, and accessibility to patients' families compared with the modern western trained doctors. (10) An urgent need for an official action to institute a comprehensive mental health policy that will provide an optimum care for the mentally ill in Bendel State, and in Nigeria in general.^ Of the eight popular treatment modalities generally used in Bendel State for mental illness, 54% of the non-patient population sampled preferred the use of traditional healing, 26.5% preferred the use of modern western treatment, and 19.5% preferred religious healers.^ The investigator concluded at this time not to recommend the integration of Traditional Healing and modern western medicine in Nigeria. Rather, improvement of the existing modern western psychiatric facilities and a proposal to establish facilities to enable traditional healing and modern western medicine to exist side by side were highly recommended. ^

Biomedical informatics applications for epilepsy management: A systematic review

Epilepsy is a very complex disease which can have a variety of etiologies, co-morbidities, and a long list of psychosocial factors4. Clinical management of epilepsy patients typically includes serological tests, EEG's, and imaging studies to determine the single best antiepileptic drug (AED). Self-management is a vital component of achieving optimal health when living with a chronic disease. For patients with epilepsy self-management includes any necessary actions to control seizures and cope with any subsequent effects of the condition9; including aspects of treatment, seizure, and lifestyle. The use of computer-based applications can allow for more effective use of clinic visits and ultimately enhance the patient-provider relationship through focused discussion of determinants affecting self-management. ^ The purpose of this study is to conduct a systematic literature review on informatics application in epilepsy self-management in an effort to describe current evidence for informatics applications and decision support as an adjunct to successful clinical management of epilepsy. Each publication was analyzed for the type of study design utilized. ^ A total of 68 publications were included and categorized by the study design used, development stage, and clinical domain. Descriptive study designs comprised of three-fourths of the publications and indicate an underwhelming use of prospective studies. The vast majority of prospective studies also focused on clinician use to increase knowledge in treating patients with epilepsy. ^ Due to the chronic nature of epilepsy and the difficulty that both clinicians and patients can experience in managing epilepsy, more prospective studies are needed to evaluate applications that can effectively increase management activities. Within the last two decades of epilepsy research, management studies have employed the use of biomedical informatics applications. While the use of computer applications to manage epilepsy has increased, more progress is needed.^

Frecuencia de resangrado en los primeros veintiún días luego de ruptura de aneurisma cerebral no sometido a tratamiento quirúrgico

Objetivo: Determinar la frecuencia de resangrado en los primeros 21 días como complicación de una ruptura de aneurisma cerebral. Diseño: Estudio descriptivo, retrospectivo Materiales y método: Se analizó una muestra pacientes obtenida de la base de datos de Unidad de Terapia Intensiva (UTI) del Hospital Central que habían sufrido una hemorragia subaracnoidea (HSA) por ruptura de aneurisma cerebral en el período comprendido entre junio de 2006 a enero de 2010. Se identificó el número de pacientes que sufrieron un resangrado como complicación del evento no sometido a tratamiento quirúrgico durante los 21 días posteriores al mismo. Resultados: Se analizó una muestra de 81 pacientes, 44 mujeres (54%) y 37 hombres (46%), edad media de 51 años (DS+/-14). Se registraron 6 resangrados (7,4%) en los 44 meses de seguimiento. El 50% de los resangrados (3 pacientes) acontecieron durante las primeras 24 horas. El 50% (3 pacientes) ocurrieron en mujeres. La edad media en la que apareció la complicación fue 52 años (DS+/-14). Conclusión: La frecuencia de resangrado luego de una ruptura de aneurisma es del 7,4%, con un pico de aparición en las primeras 24 horas.

Subprograma de salud bucal "El hospital y los chicos" : del diagnóstico del estado dental a la priorización de programas necesarios

Los objetivos de este trabajo fueron determinar el estado dental de la población bajo estudio, detectar subgrupos de riesgo específico para enfermedades bucales y proponer estrategias de intervención apropiadas para la promoción de la salud bucal para ellos. Método: sobre la base de datos del subprograma de salud bucal "El hospital y los chicos" se efectuó un estudio descriptivo del estado dental sobre 277 niños entre 2 meses y 13 años de edad asistentes al CDlF Nº11, Guaymallén, Mendoza. Se registraron: ceod, CPOD, ceos CPOS, índice de Necesidad de tratamiento de caries, índice de Paca de Silness y Loe, ICDAS II, y datos demográficos. Además, como parte del programa, se llevó a cabo la enseñanza de Técnicas de Higiene Bucal adecuada a la edad, dirigidas a madres y niños, y una topicación de flúor profesional siguiendo protocolos específicos según edad del niño. Resultados: la población libre de caries fue del 31,4%, mientras que el 68,6% tuvo experiencia de caries pasada o presente. La media de la sumatoria de ceod+ cpod fue 4,91 = 5, con una carga de enfermedad muy alta denotada por un componente c+C de 4.25=4.55. Presentó un valor para ceos+CPOS de 9,22+11 96 y de c+CS de 6.8918 61. En cuanto a la severidad de las lesiones de caries expresadas con las categorías de ICDAS II del 2 al 6, se observó que las medias mayores corres- , ponden al nivel 6 (x2 Friedman= 20,999, p= 0,000). La media de necesidad de tratamiento de caries fue de 5,74, pero los niveles 8 y más abarcan al 33.2% de la población de estudio Se observó un aumento progresivo de estos indicadores en la primera infancia comenzando en la primera franja etaria con una media de ceod+CPOD de 0.8811,92, de 3, 93t4.65a los tres años, de 6,38+6,36 a los 5 años, y de 8,40+5,47 a los 7 años, siendo esta población la que presentó el mayor valor del indicador (x2 Kruskall Wallis= 104,637, p=O,OO). El índice CPOD fue de 1,35~1,34 a los 7 años y de 4.65+3 99 a los 9 ( x2 Kruskall Wallis =17,609 y p=0,001) Conclusiones~ este grupo de niños de alto riesgo social presentó elevados índices de caries y de necesidad de tratamiento, que requerirán de un sistema de salud que pueda contenerlos. Al observar las medias de ceod+CPOD según las categorías de edad se pone de manifiesto una tendencia a agravarse el estado dentario en la primera infancia, llegando a valores muy por encima de la media general para los 5, 6 ,7 y 8 años El CEOD también tiende a aumentar con la edad, poniendo en evidencia la susceptibilidad de caries de los molares permanentes erupcionados Las tendencias de los indicadores permitieron reconocer dos subgrupos de riesgo para desarrollar programas preventivos' el de niños de O a 3 años, y el de 6 a 12, es decir niños escolares. Se sugieren dos programas prioritarios Materno- infantil y Protección de 1er molar permanente.

Percepción parental de calidad de vida relacionada con la salud bucal en niños preescolares

Los estudios de calidad de vida no sólo son usados para evaluar resultados de programas preventivos y terapéuticos, sino también para acercar a la comunidad científica las percepciones sociales y personales de los individuos estudiados. Por ello el presente proyecto desarrolló un estudio correlacional, descriptivo y transversal con el objetivo de llegar a conclusiones válidas acerca de la relación entre la percepción parental del impacto en la calidad de vida de la población de niños estudiada, y su experiencia de caries expresada a través del índice ceod. Se elaboró un cuestionario para padres de niños preescolares con el objeto de valorar la percepción parental de la salud bucal en la calidad de vida de sus hijos, que incluye 18 preguntas unidas en cuatro grupos de dominio: síntomas orales, limitaciones funcionales, bienestar emocional y bienestar social. Del análisis de los porcentajes discriminados de las respuestas se puede inferir que la percepción parental con respecto a la calidad de vida en relación a la salud bucal de sus hijos está distorsionada. La mayor actividad de caries no es percibida por los padres como un problema o como una disminución de la calidad de vida en relación a la salud bucal de sus hijos.