Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Prevalence and characteristics of sexual violence victimization among U.S. adults, 2001-2003

This article provides the most recent U.S. prevalence estimates of forced sex and unwanted sexual activity. Results of a national telephone survey conducted in 2001-2003 indicate that 1 in 59 U.S. adults (2.7 million women and 978,000 men) experienced unwanted sexual activity in the 12 months preceding the survey and that 1 in 15 U.S. adults (11.7 million women and 2.1 million men) have been forced to have sex during their lifetime. There were 60.4% of females and 69.2% of males who were 17 years old or younger at the time the first forced sex occurred. This study provides an update to the National Violence Against Women Survey with more recent national data. Findings suggest that victimization rates have remained consistent since the 1990s. These findings suggest that a continued effort toward primary prevention of sexual violence, particularly rape of children and adolescents, is needed.     

Relationships among nutrients,chloride and biological indices in urban Maryland streams

Using a spatially extensive urban database constructed from the Maryland Biological Stream Survey (MBSS), we describe the relationships of nutrients in small-order streams to eight defined categories of percent catchment urbanization, correlations between chloride and conductivity in urban streams, and relationships between nutrients and chloride with two Maryland-specific indices of biotic integrity for benthic macroinvertebrates and fish assemblages. Stream nutrients become elevated with increasing percent catchment urbanization, followed by increases in all four measured nitrogen species and total phosphorus at catchment urbanization levels greater than 10%. There was a strong collinear relationship (r ² = 0.90) between chloride and conductivity (trimeans) across all eight urbanization classes, where Cl (mg/L) = −0.397 + 0.188*conductivity (μS/cm). Critical values for all water quality parameters with the two Maryland biological indices were derived using quantile regression, with significant regressions developed for 11 of 16 water quality parameters and the two biotic indices. For nitrate (NO₃-N), the critical thresholds between fair and poor stream quality for the two Maryland biological indices were 0.83 mg/L (benthic macroinvertebrate assemblages) and 0.86 mg/L (fish assemblages). Increasing stream nutrient and chloride levels, associated with widespread catchment urbanization intensity, now affect many small streams in Maryland, with implications for decreasing water quality in major tributaries and the Chesapeake Bay.     

An Australian history of the subordination of midwifery

This paper analyses the history of the subordination of midwifery to medicine and nursing. With the important exception of Evan Willis’ work on medical dominance and Annette Summers’ work on the takeover of midwifery by nursing, other histories of Australian midwifery have taken a neutral approach to issue of power and control. The aim of analysing this period is to identify the strategies of power that were used to subordinate midwifery. With increased consciousness of how power has operated in the past, midwives and woman of today can be more empowered when seeking to promote normal birth and midwifery models of care.Concepts of ‘power’, ‘the state’ and midwife are defined and discussed. A summary of the decline of midwifery and the rise of obstetrics in Europe and the United Kingdom (UK) gives a background against which to understand the Australian experience. The historical account given here draws to a climax by focussing on the period 1886–1928. It was during this time that medicine forged an alliance with nursing and achieved both legal and disciplinary control of midwifery. Knowing how this was done is important because it helps us to recognise the power strategies that are currently being used by medicine. This is helpful when planning how these strategies might be matched or countered by contemporary woman and midwives when seeking to promote normal birth and midwifery models of care.     

Decoding Worker “Reliability”: Modern Agrarian Values and Immigrant Labor on New York Dairy Farms

This article examines the reasons offered by New York dairy farmers for hiring undocumented immigrant workers in their milking parlors, and connects those discourses to broader economic and cultural change in U.S. agrarian society. Based on interviews with 25 dairy farmers on 22 farms, this article examines farmers’ assessments of the Amish, white non‐Amish, Puerto Rican, and undocumented Latino labor pool. The analysis shows that farmers consider undocumented immigrants the most “reliable” workforce, and that their reliability stems from their deportability and from their separation from their families, which drives them to work long hours. I argue that farmer discourses about immigrant “reliability” must be understood in the context of economic pressure to adopt a more commercial orientation to dairying, and of modern agrarian values that prize urban middle‐class lifestyles. Ultimately, worker “reliability” is a euphemism for the transnational separation of workers from their families, and one that is operationalized by farmers to justify the pursuit of economic success and more leisure time off the farm.     

Building a health communication brand for University of Texas System tobacco control

Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.     

Improving medicolegal death investigative gaps of fatal elder abuse

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Inherent limitations of resources and practical realities of death investigation are discussed and recommendations are made for future research. Viewed broadly, deficiencies in elder death investigations can lead to the underreporting of elder abuse and the reduction of legal options for victims, which may reflect a systemic pattern of social injustice.     

The Impact of Formal and Informal Respite Care on Foster,Adoptive, and Kinship Parents Caring for Children Involved in the Child Welfare System

This paper reports the results of a quantitative 42-item survey that explored foster, adoptive, and kinship parents’ (N = 160) utilization of different types of respite services (formal, informal, and a mixture of formal and informal), as well as their impressions of the impact of respite care on aspects of their lives related to family cohesion and stability, caring for their children, and their personal wellbeing. An exploratory cross-sectional, survey design was used to assess both the formal and informal respite care experiences of the foster, adoptive, and kinship caregivers. Two-tailed Fisher’s exact tests were used to examine the relationship between the type of respite received and caregivers’ respite experiences. Findings indicated that parent experiences differed depending on the type of respite services they received. Specifically, parents who used a mixture of formal and informal respite reported positive experiences related to respite more frequently than the other two types of respite groups, while those who received only informal respite reported less benefit than others. Parents who used formal respite (either alone or mixed with informal respite) reported greater stress reduction. The greatest increase in family stability was reported by parents who received a mix of informal and formal respite. While this study revealed clear benefits for families to using both informal and formal respite services, the findings suggest that formal respite care was helpful to parents regardless of whether used alone or in combination with informal care.