Screening Elders in the Emergency Department at Risk for Mistreatment: A Pilot Study

Impaired functional status is associated with risk of elder mistreatment. Screening for functional impairment in elderly patients admitted to emergency departments could be performed to identify patients at risk for elder mistreatment who might benefit from further evaluation. This study utilized a modified Identification of Seniors at Risk (ISAR) screening tool to identify the proportion of elderly at risk for mistreatment due to functional difficulties presenting to two emergency departments in southeastern Virginia, one urban, the other rural. Of a 180-patient cohort (90 per site), 82 screened positive (46%), ISAR > 2 (range 0–6), indicating nearly half of all patients enrolled are at risk for mistreatment. Patients presenting to the urban emergency departments were potentially more at risk than their rural counterparts (p < 0.01). Health care professionals, particularly in urban settings, should consider screening seniors with a simple tool to identify patients at risk of elder mistreatment.     

The hospital accident and emergency department: what is its role?

The problem over the use of accident and emergency departments is portrayed in terms of a typical conflict between professional and lay needs. However, in contrast with the more common image of the professional hospital doctor successfully developing both structural and interactional strategies for maintaining professional dominance over the patient, it is argued that the structural characteristics of the accident and emergency department pose control problems for the profession. These control problems have been exacerbated by developments in other areas of the health service and have led to the development of policies which emphasize both clinical and social elements of patient need. Although there is apparent recognition by providers of the importance of taking into account patient need, the proposed policies are based on professional images of how patients 'ought' to use the service. What is clearly lacking is comprehensive data on how the public and the community wishes to use the service and how they actually use the service. Data from national and local studies on patient felt needs and patient demand for the hospital accident and emergency departments are presented and the implications for policy are discussed.     

Implementation of a Mental Health Task Force in a collegiate-based emergency medical services organization

Abstract

Objective: A Mental Health Task Force (MHTF) was implemented in 2016 by a collegiate-based emergency medical services (CBEMS) organization to (1) improve mental health emergency response and to (2) address concerns for the mental health of CBEMS providers. Participants: Skidmore College EMS is a Basic Life Support First Response service staffed by volunteer undergraduate students. Methods: In coordination with faculty and staff, students in the MHTF developed trainings, peer support structures, community events, policies, and informational resources. Results: Sixteen students joined the MHTF within 1 year. Over 35 Skidmore College EMS members received training on mental health emergency response, peer-support, and self-care. Debriefing programs, mindfulness-based events, shift-length limitations, and access to informational resources promoted the mental health of Skidmore College EMS members. Conclusions: Implementing an MHTF is an innovative, student-led approach to coupling education on emergency response with programming that supports the mental health of CBEMS providers.     

Detecting suicide risk in adolescents and adults in an emergency department: a pilot study

The investigators conducted a pilot study to detect suicide risk in adolescents and adults seeking treatment in an emergency department, as well as to test the reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ). This study expanded the implementation of the RSQ beyond its initial use with children and adolescents with psychiatric symptoms who were seeking treatment in a pediatric emergency department to include adolescent and adult patients in a Level I trauma center. An advanced practice psychiatric nurse verbally administered the RSQ to a convenience sample of 104 emergency department patients ages 12 to 82. Psychometric analysis demonstrated an adequate degree of reliability and criterion-related validity for the RSQ. Approximately 30% of all patients who participated screened positive for suicide risk. The results support the continued use of the 4-item RSQ with all adolescents and use of a reduced 2-item form of the RSQ with adults exhibiting psychiatric chief complaints to determine imminent risk of suicide in patients who seek treatment in the emergency department. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed toward suicide prevention.     

Network diversity,contact diversity,and status attainment

We propose that diversity in social relations measured by network diversity and cross-race/cross-gender contacts affords job seekers higher contact status that in turn brings better status attainment outcomes. Controlling for traditional strength of tie measures and other confounders, the empirical study confirms that (1) network diversity in race and gender are significantly associated with actual utilization of cross-race/cross-gender contacts in job search, (2) use of cross-race/cross-gender contacts is significantly related to higher contact status for nonwhite and female job seekers, but (3) contact status (activated social capital) partially provides jobs of higher SEI scores for white job seekers. Similarly, male job seekers obtain better jobs through female contacts, but the same does not apply to female job seekers. These findings show relative return deficits of social capital experienced by racial minorities and females even when they exert extra effort to obtain heterogeneous social relations and contacts.     

Social contacts and political behaviour in Northern Ireland, 1968–1978

Using Northern Ireland as a case study, this note examines the political consequences of different types of social contacts between two rigidly segregated religious communities. Multivariate analysis is applied to two large sample surveys, one collected in 1968 before the present civil disturbances began, the other in 1978, some nine years after the start of the violence. The results show that while social contacts between friends, workmates or neighbours of the opposite religion have no consistent political importance, social contacts with relatives by marriage of the opposite religion is significant for both surveys. Certain types of social contact therefore have a stronger political contact than others, and in the context of Northern Ireland social contacts involving immediate kin are more important than other forms of contact.     

An Elder Care Training Needs Assessment Among Employee Assistance Program Staff Employed by New York State Government:

A mail survey of 224 EAP staff members employed by various departments of New York State government explored the issue of elder care. Self-report questionnaire data evaluated training history competence to handle employed caregiver problems/questions, and individual department commitment. Major findings generally replicated those of a previous regional study conducted with 95 Western New York EAP staff members. Survey results showed: (1) EAP staff members estimated that one in five employees currently provides care for an older dependent; (2) the majority (56.9%) of staff members have not received any training relevant to elder care; (3) self-assessed competence to handle elder care problems was low for 13 of 17 problem-solving domains constituting the Elder Care Competence Index (ECCI); (4) the few (14.9%) EAP staff members with extensive (two or more sessions) elder care training experience achieved ECCI scores nearly 150% higher than staff members without such training, p < .001; (5) most (73.0%) departments have not dealt with elder care in any formal way and only 3.6% of the EAP staff believe this inaction to be appropriate; and (6) department commitment to the issue of elder care is predictive of both training (p < .01) and staff competence (p < .01). The implications for training, policy, and future research are discussed.     

The sexual division of leadership in volunteer emergency medical service squads

This article reports on theoretical and empirical research that explored the hypothesis that there is a sexual division of leadership in volunteer emergency medical service (EMS) squads. This hypothesis was tested against survey data obtained from 216 current members of nine upstate New York volunteer EMS squads. Despite several mitigating characteristics of these organizations, and despite the lack of supporting statistical evidence at the aggregate level of officership, the research found statistically significant confirmation of sex bias in officer selection when leadership was disaggregated into line and staff officer positions. Medical qualifications and length of EMS squad membership were also included in the model as determinants of leadership experience. These results are discussed relative to the question of the sexual division of leadership in the overarching nonprofit and voluntary sector of the U.S. economy.     

Which Child Immigrants Face Earnings Disparity? Age‐at‐immigration,Ethnic Minority Status and Labour Market Attainment in Canada

Using Canadian Census microdata from 1990 to 2005, we investigate the earnings attainment of immigrants to Canada in 6 age‐at‐arrival cohorts. In comparison to past work we extend our understanding regarding three dimensions of the age at immigration debate: we explore heterogeneity across fine grained age‐at‐arrival cohorts, over a fifteen‐year period and across different ethnic groups. We find that white immigrants and female immigrants arriving in Canada prior to age 18 face little earnings disparity. In contrast, visible minority male immigrants face significant earnings disparity regardless of their age‐at‐migration, and additionally this disparity increases sharply with age‐at‐migration. We find a break in earnings attainment at an age‐of‐arrival of 17, with immigrants arriving after this age performing much worse than those arriving at this age or earlier. The patterns observed are found for visible minority immigrants as a whole, and for Chinese, South Asian and African/Black origin immigrants examined separately.     

Target Problems,Time Limits,Task Structure

This paper documents the opportunities for student field training within university-based institutes on aging. Both the advantages and disadvantages of operating such field-work programs are analyzed. A practicum is proposed which reflects an emphasis on planning, administration, policy analysis, and program development. The benefits to students include collaboration with the allied professions, availability of specialized training resources, and emphasis on proposal writing and communication skills. Potential complicating factors for student learning grow out of the institute’s close proximity to academic accountability, the multiplicity of roles carried by field-instruction staff, and placement in an environment different from that of traditional service agencies.     

Need to know vs. need to share: information technology and the intersecting work of police,fire and paramedics

Emergency preparedness concerns over inadequate emergency interoperability among police, fire and emergency medical services (EMS) have led to the adoption of shared information technologies. Using a social worlds/arenas framework, I ethnographically study police, fire and EMS, as ‘users’ of technology, to understand how they interact with their technologies, and the ways in which their respective organizational contexts, cultures and practices shape technological functioning and collaborative action. From this analysis, I uncover social world contexts (ideologies) and individual actions (social legitimation and hierarchy of credibility) that alter technological functioning and create impediments to emergency interoperability. I further highlight an important ideological disconnect between the design and in-situ application of emergency technologies. I conclude by discussing the extent to which policies and technological innovations cannot, in and of themselves, address emergency preparedness concerns.     

Meatpacking and the Transformation of Rural Communities: A Comparison of Brooks,Alberta and Garden City,Kansas*

Abstract North America's meatpackers have relied upon immigrants to staff their plants from the earliest days of the industry in the late nineteenth century when packinghouses were located in urban areas adjacent to stockyards. A hundred years later the industry remains dependent on an immigrant labor force, but now most of its plants are located in rural areas. This means rural communities are transformed with the arrival of immigrants to staff their plants. But Canada and the United States have different immigration policies, which means they draw upon different immigrant sources. Canada favors the recruitment of highly skilled labor while the United States emphasizes family reunification. This paper examines whether this difference affects the labor force composition of a Canadian and U.S. meatpacking plant, and the associated transformation of the plants' host communities.     

Male‐male sexual contact in the U.S.A.: Findings from five sample surveys, 1970–1990

Estimates of the prevalence of male‐male sexual contact are derived using data from five probability surveys conducted between 1970 and 1990. Estimated minimums of 5 to 7 percent of U.S. men report some same‐gender sexual contact during adulthood. Because of the likelihood of underreporting, these estimates might be considered lower bounds on the actual prevalence of such contact. Estimates show relatively little variation across social and demographic subgroups with the major exception that higher prevalence is reported among never‐married men, particularly those 35 and older. Some lesser variations are also found by service in the military, current residence, and current religious affiliation. Fragmentary evidence from these surveys suggests that some men may have episodic male‐male contact in adulthood while other men may have a relatively consistent and exclusive pattern of same‐gender contacts. Only one‐quarter to one‐half of the U.S. men who report male‐male contacts in adulthood also report having had such contacts during the preceding 12 months. In addition, the majority of men reporting same‐gender contacts in adulthood also report some male‐female contacts. Among men reporting same‐gender contacts in the preceding 12 months, however, the majority report exclusively male sexual contacts throughout adulthood. Potential implications of these findings for HIV prevention and research are discussed.     

Naloxone administration for suspected opioid overdose: An expanded scope of practice by a basic life support collegiate-based emergency medical services agency

Opioid abuse is a growing and significant public health concern in the United States. Naloxone is an opioid antagonist that can rapidly reverse the respiratory depression associated with opioid toxicity. Georgetown University's collegiate-based emergency medical services (EMS) agency recently adopted a protocol, allowing providers to administer intranasal naloxone for patients with suspected opioid overdose. While normally not within the scope of practice of basic life support prehospital agencies, the recognition of an increasing epidemic of opioid abuse has led many states, including the District of Columbia, to expand access to naloxone for prehospital providers of all levels of training. In particular, intranasal naloxone is a method of administering this medication that potentially avoids needlestick injuries among EMS providers. Universities with collegiate-based EMS agencies are well positioned to provide life-saving treatments for patients acutely ill from opioid overdose.     

Save the World on Your Own Time: Or, What’s the Matter with Sociology?

This essay explores the question of why sociology departments, compared to other university departments, are often viewed negatively by higher-level administrators (deans, provosts, chancellors and presidents). We are asked to consider, as sociologists, how departments are ranked and evaluated by administrators. The characteristics of any good university department are identified (e.g., grants, support from alumni, publications, quality of teaching, national rankings, student enrollments); and, the characteristics of dynamic and healthy departments are outlined (e.g., student learning is primary; there is a commitment to the goals of the larger organization; leadership is provided by the unit to solve all-university problems; there is a focus on learning; faculty are productive; there are strong communication links across the organization). The question is posed and then systemically answered as to how sociology departments compare in terms of these standards. It is suggested that a major factor in terms of how and why sociology departments are negatively evaluated is the fact that sociology uses narratives of power and explanations of organizational behavior that are inherently oppositional, i.e., there is an “us” and “them” mentally that sometimes develops. Other reasons for organizational marginalization are identified such as the “canon wars” and their lingering effects, and the fact that the sociological enterprise has been diluted by the teaching of “sociology” in many other campus units, such as composition programs. Finally, questions are raised about how sociology, as an intellectual enterprise, differs from other disciplines in terms of pedagogy, the sequencing of courses, “grand” theory, and forms of apprenticeship. It is recommended that sociologists act positively to help the organizations within which they work to identify common problems and solve them. It is argued that sociology can and should “own” the area of civic engagement as a means of making a positive and distinctive contribution. Sociological “stories” grounded in the reality of everyday life are compelling. It is suggested that sociologists need to deepen connections with their communities and to offer real solutions to real problems.     

Residential choices of immigrants in Australia

"In recent years Asian-Australians, especially those born in Indochina, have become a target of criticism by anti-immigration groups which accuse them of choosing to live only in ?closed societies' and ?ethnic ghettos' in Australian cities.... Evidence presented in the article shows clearly that while immigrant groups may prefer to settle in close proximity of their family and kin for practical and/or emotional reasons, their preference is not ethnically determined.... We also show that affordability, closeness to spouse's work, and neighbourhood services, rather than family and social contacts, are important factors for Asian-born immigrants when they move." (SUMMARY IN FRE AND SPA)     

The Merry-Go-Round of Meetings: Embracing Meetings in a Swedish Youth Care Project

Modern society has been called “a society of organizations,” and meetings are considered indispensable. However, a recurring cultural theme in contemporary working life is complaints about excessive and time-consuming meetings. The present article analyzes a contrasting case concerning a Swedish youth care project that employed a set of “coordinators” to maintain close contact with young people and their parents. Over time, these coordinators adopted an exceedingly administrative approach in which meetings with other professionals became more and more central. This article explores how an expanding meeting culture with strong social commitments can be generated from within interorganizational contexts, such as “projects,” and successfully competes with other concerns. Thus, the administrative orientation represents an example of the type of social interaction process that Simmel discerned as Eigendynamik or autonomous processes of social interaction.     

When naloxone alone isn't enough: Deaths in year after ED OD visits

When patients are treated for nonfatal opioid overdose in the emergency department (ED) and discharged, they have a high risk of death — 67% of the time from another overdose within the next year, and especially within the next two days — new research has found. Being offered medication such as buprenorphine, counseling and referral to treatment by the ED before discharge could reduce that risk, the researchers concluded.     

Close encounters of the stressful kind: Affective,physiological, and behavioral reactions to the experience of crowding

Ninety-six adults participated in a study of the joint effects of interpersonal density and an additional stressor. Experiential reports, psychophysiological indices, and task performance were assessed. Subjects seated either close together or far apart worked on a series of tasks while either expecting a stressful event or not expecting the stressful event. Perceptions of crowding were influenced only by interpersonal distance; those seated close together reported feeling more crowded than those seated far apart. However, if subjects were both crowded and expected a stressful event they reported feeling more stressed and evidenced psychophysiological signs of anxiety. Relevance of these results for an additive stress model is discussed but the model is rejected and an interactional model of crowding and stress effects is proposed. Evidence for processes of social comparison fear reduction was found in some crowded subjects.