Black and white chains of risk for hospitalization over 20 years

Drawing from the life course perspective, racial disparities in hospitalization are considered in light of a chain of risk. We ask whether race influences admission to, length of stay in, and mortality following hospitalization. Analyses address these questions with data from a national longitudinal sample of adults to assess racial disparities in the hospitalization experience (n = 6,833). Survey data were merged with hospital records abstracted over 20 years of observation. Multivariate analyses revealed that there were no racial differences in admission, but that black adults generally had longer stays. When isolating each stay prospectively, black adults had longer stays during the first, third, and fourth hospitalizations. Post-hospital mortality after the first stay was also higher for black adults than for their white counterparts, even after controlling for morbidity and status resources. The findings suggest that the racial disparities in hospital length of stay and mortality are explained by the cumulative effects of social and health inequalities over the life course.     

Sexual Dysfunction in HIV-Seropositive Women Without AIDS

During a 5.5 year biopsychosocial study, we prospectively assessed the psychiatric status and sexual functioning of women during the natural history of HIV infection (non-AIDS) detected as part of an HIV screening program in the military. Participants were serving on active duty or were spouses of servicemen who have tested HIV-positive since 1986. Patients were psychiatrically evaluated every 6-18 months for three assessments (TI-73). Initial evaluation (Tl) was completed by 54 HIV+ women without AIDS (avg. length of knowledge of seroconversion = 8.9 months). Thirty-eight were reevaluated at T2 (avg. knowledge, = 26.5 months), and 28 at T3 (avg. knowledge = 52.3 months). The most prevalent DSM-III-R psychiatric diagnosis at each evaluation time was Hypoactive Sexual Desire Disorder (HSDD). At T1, 21% met threshold criteria for this diagnosis; an additional 25% had more than a 33% decrease in desire. At T2, 50% had HSDD (new onset in 71% of those women). HSDD was persistently present in 50% at T3 and 50% at T4. A total of 64% (n = 18) were diagnosed with HSDD on at least one visit. Only two then recovered to baseline levels of desire during the time of the study. By the fourth evaluation, 25% of the women seen three times had been pregnant at least once. Twenty-nine percent reported that their male partners actively discouraged their insistence on condom use. We conclude there is persistent, chronic impairment in sexual functioning in HIV+ women. independent of HIV-related medical symptoms as reflected in high rates of new onset sexual desire phase disruptions. Potential etiologies are discussed.     

Severe premenstrual syndrome and bipolar disorder: a tragic confusion

Bipolar disorder and severe premenstrual syndrome (PMS) have many symptoms in common, but it is important to establish the correct diagnosis between a severe psychiatric disorder and an endocrine disorder appropriately treatable with hormones. The measurement of hormone levels is not helpful in making this distinction, as they are all premenopausal women with normal follicle-stimulating hormone and estradiol levels. The diagnosis of PMS should come from the history relating the occurrence of cyclical mood and behaviour changes with menstruation, the improvement during pregnancy, postnatal depression and the presence of runs of many good days a month and the somatic symptoms of mastalgia, bloating and headaches. Young women with severe PMS do not respond to the antidepressants and mood-stabilizing drugs typically used for bipolar disorder.     

Psychiatric nursing & medication adherence

A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenge imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).     

Psychiatric nursing for the 21st century. The PACED model.

Health care reform has had a profound effect on the way psychiatric treatment occurs in this country. Decreasing length of stay, increasing acuity, and reducing staff levels are making traditional approaches to mental health care infeasible. Resources already in place may still be focusing on long-term treatment issues and do not facilitate rapid stabilization and discharge planning that includes continued care within an integrated system. Research supports the feasibility of quality mental health care, which can be accomplished in shortened lengths of stay, as long as clinical managers plan inpatient programs focused on short-term goals followed by appropriate aftercare. In addition to recommendations for clinical managers, this article provides a proposal for executives redesigning a mental health care delivery system, which includes the goals of rapid assessment and stabilization, as well as discharge planning and appropriate follow up within an integrated system.     

Measles: Current Status and Outbreak Control on Campus

Abstract

This study is part of a nationwide research project dealing with all suicides in Finland. It includes all suicides among university students during the 1-year period from April 1, 1987, to March 31, 1988. Ten students (6 men and 4 women) committed suicide during the period studied. The observed suicide rates per 100,000 students per year were 13.8 (95% CI = 5.1–30.1) for men and 9.0 (95% CI = 2.4–22.8) for women. The difference between the observed and expected suicide rate for men (13.8 v 47.7, standard mortality rate [SMR] = 29) was statistically significant. For women (9.0 v 8.3, SMR = 108), the difference was not statistically significant. Most of the suicides had experienced serious difficulties since early childhood, including narcissistic problems, difficulties in human relations, severe depressive periods, previous suicidal behavior, and alcohol problems; they had also had earlier psychiatric treatment.     

Prevalence of wife rape and other intimate partner sexual coercion in a nationally representative sample of women

This article provides a national estimate of wife rape and various other types of sexual coercion by a spouse or intimate partner. Findings from a 1997 national probability sample revealed that 34% of women were victims of some type of sexual coercion with a husband or partner in their lifetime. Of these women, 10% experienced rape by a current partner. This rate increased to 13% when only victims of rape by a current husband were included, which is consistent with previous studies on wife rape. Other findings reveal that women had unwanted sex with a current spouse or partner in return for a partner's spending money on them (24%), because they thought it was their "duty" (43%), after a romantic situation (29%), after the partner begged and pleaded with them (26%), and after their partner said things to bully them (9%). The importance of examining a continuum of sexual coercion is discussed and findings are compared and contrasted with other prevalence rates for sexual coercion in marriage.     

Transition from the hospital to the community: small group program.

1. Clients in a psychiatric hospital often experience loss of control over their lives and dissatisfaction with their quality of living. A small group rehabilitation program can counteract the effects of institutionalization and restore a sense of mastery to chronic psychiatric clients. 2. The therapeutic nurse-client relationship provides consistency and stability for clients who must cope with the stress of the mental health system and the transition to a community setting. 3. The program strives to restore individuals' self-confidence and dignity, improve their quality of life, and decrease the frequency and length of hospitalization.     

Immediate Effects of a 16-Week Life Skills Education Program on the Mental Health of Adult Psychiatric Patients

ABSTRACT

A total of 206 (105 men, 101 women) adult psychiatric patients participated in life skills programming 5 half days per week for 16 weeks. Psychosocial adjustment was assessed pre- and post-treatment with the three primary scales of the Holden Psychological Screening Inventory (HPSI). A multivariate pre- versus post-treatment analysis resulted in a nonsignificant effect for the covariate age (p= .136) but significant effects for time (p<.0005), gender (p<.0005), and the time by gender interaction (p= .003). Depression Symptomatology improved significantly for both men and women, whereas on the other two HPSI scales (Psychiatric and Social Symptomatology) statistically significant improvements were only obtained for women. The Social Symptomatology effect size for women (.25) was small and of the same order of magnitude as a treatment as usual psychiatric patient control sample and is therefore primarily a retesting effect. The effect sizes for Depression Symptomatology for men and women (.77 and .87, respectively) and Psychiatric Symptomatology for women (.57) were large and at least four times larger than the control sample. Improvement in Depression Symptomatology has considerable support in the literature but improvement in Psychiatric Symptomatology does not and will therefore require replication.     

Sexual Activity During Menstruation: A Qualitative Study

This study utilized a grounded theory method to analyze qualitative narratives about sexuality and menstruation from 108 young women (ages 18–23; M = 19.8, SD = 1.07) and 12 young men (ages 18–24; M = 20.4, SD = 1.46). Five patterns were found: Sixteen women identified themselves as virgins and had not faced the issue of negotiating sex during menstruation. Among the 92 women who said they were sexually active, 37 women said they would never have intercourse during menstruation, eight women said they tried it once but never would again, and seven women said they rarely would and only under certain conditions. The largest group, 40 women, said they do have menstrual sex. Compared to the other groups, more of the women who do have sex during menstruation were in committed relationships, and none espoused a discourse of disgust. Considering the 12 men, three were virgins. Among the nine sexually experienced men, seven said they did have sex with a menstruating partner. Young adults who were comfortable with menstrual sex saw it as just another part of a committed intimate relationship.     

Prevalence of DSM-IV major depression among Spanish university students

OBJECTIVE: The authors' purpose in this study was to estimate prevalence and correlates of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), major depressive episodes (MDEs) among Spanish university students. PARTICIPANTS AND METHODS: In October and November 2004, interviewers administered a screening tool to a sample of 554 students aged 18-34 years (65.9% women). RESULTS: The prevalence of MDEs was 8.7% (95% confidence interval = 6.5%-11.3%). The most common symptoms were depressed mood (81.3%) and altered sleep (79.2%). MDEs were more prevalent among women than men (p < .05). The mean number of previous episodes of depression among currently depressed students with previous episodes was 2.2 (SD = 1.4). Of depressed students, 0.6% had considered suicide and 0.2% had attempted suicide. CONCLUSIONS: Depression was highly prevalent among university students. The results suggest the need to develop some type of program or service for university students with the aim of preventing depression and improving their adaptation to university life.     

Utility of the Maryland Assisted Living Functional Assessment Tool

Abstract

The purpose of this study was to consider the utility of the Maryland Assisted Living Functional Assessment (MALFA) in terms of predicting successful living in an assisted living facility. Consideration of utility of this tool was based on the predictive ability of the measure at baseline to explain length of stay and level of care needed for residents (nursing home versus assisted living) over a five year period. A total of 76 residents from a single ALF in the Baltimore area were tested annually over five years. Those who transitioned to a nursing home at some point during the 5-year period (47%) had higher mean scores on admission with regard to need for nursing interventions because of cognitive and psychiatric problems or to perform medical treatments. Medical illness influenced number of years in assisted living and accounted for 7% of the variance (F = 7.2, p < .05). The assessment tool provides a wealth of information about the resident and can be used to alert providers to consider individuals with high scores in subscales such as need for monitoring of cognitive and psychiatric problems or need for medical treatments in terms of being at risk for nursing home placement. Future work should consider how to optimally use the MALFA to implement interventions in assistive living that will prevent decline in areas that seem likely to result in a need for a higher level of care.     

Spouse-aided Therapy and Psychiatric Nursing: A Preliminary Report

The training of psychiatric nurses as behavioural nurse therapists has been successfully established in the U.K. by Marks et al. However, their approach has a number of theoretical and practical limitations, such as a rigid adherence to an illness model of psychiatric disorder. This paper describes and evaluates an approach to the training of psychiatric nurses based on systems theory. Four nurses were trained in the use of Spouse-aided Therapy, a time-limited, goal-orientated outpatient approach to the treatment of married psychiatric patients with persisting psychological disorders. Patients' spouses are involved throughout therapy, with the aim of making full use of resources within marriage which may facilitate patients' recovery. Questionnaire and anecdotal data from 12 patients showed a mean fall of 30% in patients' symptoms and a mean fall of 20% in marital dissatisfaction after therapy. The pattern of results supported a systems theory interpretation of outcome.     

Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who disclosed sexual abuse/attack were more likely to disclose physical abuse, psychological problems, psychological treatment, psychiatric medication, and psychiatric hospitalization. Among bariatric surgery patients who disclosed sexual abuse/attack, females were more likely to disclose suicidal ideation. A logistic regression found that for females, physical abuse and suicidal ideation reliably predicted abuse/attack status. For males, psychological problems, psychiatric medications, hospitalization, and suicidal ideation, reliably predicted abuse/attack status.     

Moving targets: bicycle-related injuries and helmet use among university students.

We conducted a cross-sectional study to evaluate bicycling habits and helmet use in a sample of university students in a southwestern state university. Thirty-one of 100 students in our sample owned bicycle helmets; of these, 17 (54.8%) wore helmets during most (more than three fourths) of their bicycle trips. Almost half of the students reported that more than 25% of their bicycling was done in heavy traffic but they rarely used bicycle trails. Sixty-five students in the sample had sustained at least one minor injury during the previous 5 years, and 18 had been hospitalized as a result of bicycle-related injuries. We found no substantial differences between male and female subjects in bicycle-related hospitalizations, although male subjects were more likely to sustain minor injuries than were females. Helmet ownership was most strongly associated with previous injury experience, especially hospitalization resulting from bicycling injuries (OR = 3.6; 95% CI = 1.3, 10.1). We also observed an association between helmet ownership and possession of insurance coverage for bicycling injuries (OR = 3.0; 95% CI = 1.2, 7.6). Ethnicity was a factor in helmet ownership--helmets were owned by 26 of 69 (37.7%) of non-Hispanic whites, in contrast to 1 of 24 (4.2%) of all other ethnic groups combined. Our survey data suggest that perceived risk is an important factor in bicyclists' use of safety helmets.     

Client retention in residential drug treatment for Latinos

Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.     

Simple measures of case mix in mental health services.

The concept of Case Mix in community mental health service program evaluation can be useful in mental health program evaluation if the definition of case mix is expanded beyond Diagnostic Related Groups (DRG), where DRG is solely based upon diagnosis and length of hospitalization stay. A case mix definition based upon two principal characteristics is offered. One characteristic is clinical status defined in terms of diagnostic signs and symptoms, level of functioning, and age. The other characteristic is typical treatment strategy for a given period of time (e.g., 13 weeks). Two cases mixes typical of services designed for the chronically mentally ill are discussed.     

Predictors of short-term treatment outcomes among California's Proposition 36 participants

California's voter-initiated Proposition 36 offers non-violent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. This article reports short-term treatment outcomes subsequent to this major shift in drug policy. Data are from 1104 individuals randomly selected from all Proposition 36 participants assessed for treatment in five California counties during 2004. The overall study sample was 30% female, 51% white, 18% Black, 24% Hispanic, and 7% other racial/ethnic groups. The mean+/-SD age was 37+/-10 years. Counties varied considerably in participant characteristics, treatment service intensity, treatment duration, urine testing, and employment and recidivism outcomes, but not in drug use at 3-month follow-up. Controlling for county, logistic regression analysis showed that drug abstinence was predicted by gender (female), employment at baseline (full or part-time), residential (vs. outpatient) stay, low psychiatric severity, frequent urine testing by treatment facility, and more days in treatment. Recidivism was predicted only by shorter treatment duration. Employment predictors included age (younger), gender (male), baseline employment, and lower psychiatric severity. The study findings support drug testing to monitor abstinence and highlight the need to address employment and psychiatric problems among Proposition 36 participants.     

The Inclusion of Female PhD Students in Academia: A Case Study of a Swedish University Department

The article introduces a framework for understanding women's entry into the academic world and how it interacts with internal departmental structures and practices. It presents three specific strategies applied by a group of women to gain a doctorate and acceptance in their department. Few previous studies have stressed women's strategies to cope with the organizational setting in academia. The article draws on previous research on women in academia and how organizational characteristics influence women's careers. It is based on a case study of a Swedish university department. Sweden is often recognized for creating favourable working conditions for women. Yet the Swedish academic world is very male‐dominated at the top and even the medium level. It is also more common than in many other Western countries that academics stay on at the department where they graduated. Therefore, a PhD is often a first step in a career within that department.     

The Importance of Sex in the Lives of Women Living with HIV: A Critical Quantitative Analysis

The authors explored the importance of sex for 1,289 women living with HIV in Canada. Approximately half of women viewed sex as “very” (19.6%) or “somewhat” important (32.3%) and the remaining reported “neither important or unimportant” (22.0%), “somewhat unimportant” (5.4%), or “not at all important” (20.1%). Women who had a regular sex partner, identified as African, Caribbean, or Black, were more educated, believed HIV treatment prevents transmission, or had better physical health-related quality-of-life reported greater importance of sex, whereas those who were older, used illicit drugs, or experienced violence in adulthood reported lesser importance. Findings underscore the diversity of women's perspectives within the context of their lives.