Psychiatric unit fall event

Patient falls in psychiatric units may have an impact on patient outcomes. Fall risk assessment among psychiatric patients is an important issue. Gait/balance problems and history of falling are important considerations in assessing psychiatric patients for fall risk.     

Paving the road to hell: why change programs ultimately fail

A successful change program must have clearly delineated and honestly defined goals. Change requires conviction, money, and effort and the willingness to invest all three. Change programs fail when any of these requirements are lacking. Many health care executives have the conviction, but are unwilling to spend the money or expend the effort. Some lack conviction, despite having money; the effort is merely spinning wheels with no forward motion. Often all three are lacking, despite an outward appearance to the contrary--the result of management delusions. Employees are quick to see through misleading and insincere schemes. It is much easier to foster trust from the outset than to rebuild it after it has been violated.     

Gender and physician-assisted suicide: an analysis of the Kevorkian cases, 1990-1997

This study examines the seventy-five suicide cases Dr. Jack Kevorkian acknowledged assisting during the period between 1990-1997. Although these cases represent a range of regional and occupational backgrounds, a significant majority are women. Most of these individuals had a disabling, chronic, nonterminal-stage illness. In five female cases, the medical examiner found no evidence of disease whatsoever. About half of the women were between the ages of forty-one and sixty, and another third were older adults. Men's conditions were somewhat less likely than women's to be chronic and nonterminal-stage. The main reasons for the hastened death mentioned by both the person and their significant others were having disabilities, being in pain, and fear of being a burden. The predominance of women among Kevorkian's assisted suicides contrasts with national trends in suicide mortality, where men are a clear majority. It is possible that individuals whose death was hastened by Kevorkian are not representative of physician-assisted suicide cases around the country, because of Kevorkian's unique approach. Alternatively, the preponderance of women among Kevorkian's assisted suicides may represent a real phenomenon. One possibility is that, in the United States, assisted suicide is particularly acceptable for women. Individual, interpersonal, social, economic, and cultural factors encouraging assisted suicide in women are examined.     

Residential Building Codes,Affordability, and Health Protection: A Risk-Tradeoff Approach

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through income and stock effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.     

Return migration: changing roles of men and women

The study concerns Greek returnees from the Federal Republic of Germany and explores changes in task sharing behaviour and gender role attitudes resulting from changes in cultural environments.
A group of return migrants was compared with a group of non-migrants, both living in villages in the District of Drama, Greece. Groups were interviewed to investigate the extent to which each spouse shared house tasks as well as their attitudes towards gender roles in the family.
The data were factor analysed and a t-test was used to determine any differences between the groups. In addition to demographic variables, those concerning the "time lived abroad" and the "number of years in Greece" after return were inserted into a series of regression analyses for the purpose of explaining task sharing and gender role attitudes.
The results showed that: (a) task sharing of return migrants differs from on-migrants with respect to tasks which are peripheral to house organization. It seems that migrants' task sharing behaviour changes to a certain degree as a result of their changing socio-cultural environments. Results also suggest that migrant husbands and wives either take on new patterns of behaviour or maintain traditional ones only when these are congruent with the financial aims of the family or can be integrated into living conditions in Greece upon return. (b) Lack of differences between groups in an Attitude Questionnaire suggest that gender role attitudes have changed for both migrants and non-migrants over the last 15 to 20 years, although for different reasons and the different conditions under which these groups had lived.     

A qualitative exploratory study of substance abuse prevention outcomes in a heterogeneous prevention system

The prevention of abuse of alcohol and other drugs is a concern for parents, policy-makers, educators, and social service professionals. Prevention programs are sponsored by many different types of social and educational agencies using a variety of intervention strategies. This article reports a study of a sample of such programs in the state of Nevada. The overall prevention system in the state espouses a "risk and resiliency" approach to prevention. Focus group methodology was used to study perception of outcomes of these programs from the viewpoints of various program stakeholders (youth participating in the programs, parents of participants and program staff). Analysis of the qualitative data yielded findings about potential outcomes as well as implicit program theories. Implications for future planning efforts as well as further evaluation efforts are discussed.     

Multilevel mediation modeling in group-based intervention studies

This article proposes and evaluates a method to test for mediation in multilevel data sets formed when an intervention administered to intact groups is designed to produce change in individual mediator and outcome variables. Simulated data of this form were used to compare ordinary least squares (OLS) and two multilevel estimators of the mediated effect. OLS and multilevel standard error approximations were also evaluated and recommendations given for optimal estimator choice. These methods were applied to data from an existing substance use intervention to show the impact multilevel mediation modeling can have on the conclusions drawn from real-world evaluation studies.