Licensing and training requirements for direct care workers in Japan: what can the United States and Japan learn from each other?

Shortages of direct care workers have been of concern both in the United States and in Japan. This article compares issues surrounding long-term care provisions in the two countries and introduces Japan's unique licensure and certificate system for direct care workers. Japan has established three levels of direct care worker certificates and a direct care licensure, which can be potentially used as a career ladder. Studies show that this system has resulted in different work conditions and benefits between different certificate and licensure levels but had a limited impact on hourly wage and task differentiation. Implications for the United States are also discussed.     

Trends in marijuana and other illicit drug use among college students: results from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001

The authors examined changes in college students' illicit drug use, patterns of polydrug use, and the relationship between students' ages of initiation of substance use and later use of marijuana and other illicit drugs between 1993 and 2001. Data from 119 US colleges and universities in the Harvard School of Public Health College Alcohol Study were used in the study. They found significant increases in percentages of students' use of marijuana in the past 30 days (from 13% to 17%), past year (from 23% to 30%), and lifetime (from 41% to 47%) between 1993 and 2001, with most of the increase occurring between 1993 and 1997. Past 30-day use of other illicit drugs increased from 4% to 7% and past year use increased from 11% to 14%. More than 98% of marijuana and other illicit drug users used another substance. They also either smoked, were binge drinkers, and/or were users of another illicit drug. Drug prevention programs should emphasize heavy alcohol use and smoking and should start when students are in high school or earlier.     

The balancing act. Collaboration between frontline forensic staff and hospital administration

1. Flexibility, creativity, and consistency are critical characteristics for both frontline staff and administrators in the delivery of treatment and care for complex forensic patients who may be difficult to manage. 2. Through collaborative efforts and ongoing communication, plans can be identified and implemented that enhance patient and staff safety and facilitate positive behavioral and rehabilitation outcomes for patients. 3. Effective partnerships among frontline staff, administration, patients, their families, labor unions, and communities contribute significantly to the effective resolution of conflicts and dilemmas in the provision of holistic care to forensic patients.     

PRN medication use in inpatient psychiatry

1. Administration of p.r.n. medications occurs frequently for staff nurses in inpatient psychiatry. 2. The appropriate use of p.r.n. medications is not well addressed in nursing textbooks or hospital policies and procedures. 3. Thorough assessment of patients is an essential step in the safe administration of p.r.n. medications. 4. Concise, accurate clinical evaluations may be the most successful way to determine the best dose of medication for each patient.     

The Four S Model in action for de-escalation. An innovative state hospital-university collaborative endeavor

In this article, the Four S Model is presented as a working clinical framework for generating structured nursing interventions and treatment plans. The de-escalation process, formalized by the De-escalation/Alternative to Restraint Flowsheet, is one way in which the model is being operationalized to reduce seclusion and restraints. As shown by the flowsheet, the model allows for integration of mental health and mental illness. It spans the scope of nursing practice at all levels, from para-professional to advanced practice nurse, by integrating the mental health concepts of communication, leadership, clinical judgement, critical thinking, and caring within its framework. Most important, the flexibility to individualize treatment that is built into the model allows for generalization to all psychiatric presentations.     

Social support as a mediator of revictimization of low-income African American women

Mediating effects of social support on the link between childhood maltreatment and adult intimate partner violence (IPV) were explored in a sample of 362 low-income, African American women. We examined relations between childhood maltreatment experiences (total maltreatment, sexual abuse, physical abuse, emotional abuse, emotional neglect, and physical neglect) and adult maltreatment (physical IPV and nonphysical IPV). Results of hierarchical multiple regression analyses revealed small, but significant, effects. Further, social support mediated revictimization. Social support fully mediated relations in which the form of childhood maltreatment was different than the form of adult IPV (e.g., the relation between childhood sexual abuse and adult nonphysical IPV), but only partially mediated the relations in which the form of childhood maltreatment was similar to adult IPV (e.g., the relation between childhood emotional abuse and adult nonphysical IPV). Implications for clinical interventions for women with intimate partner violence experiences are discussed.     

Definition and Measurement of Chasing in Off-Course Betting and Gaming Machine Play

The attempt to recover gambling losses by continuing to gamble (chasing) has featured prominently in accounts of excessive gambling. This research represents the first attempt to operationalize and measure chasing in terms of its cognitive (behavioral intention), emotive (urges) and behavioral components, and to investigate the role of chasing in relation to impaired control over gambling. Two survey samples of 84 male off-course (betting shop) race gamblers (mean age 41, SD = 15) and 137 gaming machine players (73 females, mean age 48, SD = 15 and 64 males, mean age 43, SD = 16) were recruited at gambling venues. Respondents completed a structured questionnaire that investigated retrospective report of chasing and an impaired control scale (The Scale of Gambling Choices). It was found that the various components of chasing formed a composite measure with high internal reliability that was strongly related to indicators of excessive gambling (e.g. time spent gambling, expenditure as a proportion of income) and to impaired control scores. Reacting to large wins by further betting was almost as strongly related to impaired control as was persistence after losing. Those who returned later to chase had significantly higher impaired control scores than those who only chased within a session. Alcohol-related chasing was associated with impaired control over gambling. Chasing of losses and impaired control appear to be generic processes in evidence across both forms of gambling and gender (most format and sex differences were of minor significance).     

Cost-effectiveness of a prework screening program for the University of Illinois at Chicago physical plant

A post-offer screening program jointly developed by the Occupational and Physical Therapy Departments (University of Illinois at Chicago) was first implemented in March 1998. A total of 712 screens were completed from 3-01-98 through 2-28-01. A quasi-experimental design was utilized to analyze changes in Workers' Compensation costs between the three-year period prior to, and the three-year period following program inception. Additionally, injury rates and mean cost per injury were compared between injuries sustained between 3-98 and 3-01 which were incurred by workers who had passed screening and those that had not been screened. Finally, the tabulated cost per screen and reduction in Workers' Compensation costs allowed derivation of a dollar spent/ dollar saved ratio. Dramatic declines in number of injuries, total costs and mean cost per case occurred in the three-year period following program inception. Mean cost per case also dramatically declined comparing injured workers who had passed screening versus those who had never been screened. Cost savings were over US dollars 18 per dollar spent on the program. While a number of mitigating variables may have accounted for some of the profound effects noted, decrease in average cost per case (indicating possible reduction in severity of injury) was consistent with existing literature.     

Learning technologies at the service of higher education: global trends and local Israeli opportunities

This paper provides an overview of global trends in e-Learning and opportunities opened by harnessing learning technologies at the service of the Israeli higher education. The introduction of innovative learning technologies is examined in light of an organizational change. A series of substantial issues should be taken into account to successfully manage the change. Among these are: rethinking of academic learning and instruction, redefining the role of the teachers and the students, decoupling the learning materials and the learning process, new approaches to student assessment and program evaluation, and instituting a well thought out organizational plan including a support center. The above-mentioned issues guided the introduction of a recent call for project proposals for the integration of technologies into Israeli higher education. The main principles, criteria and results of this call are described.