College students with congenital heart disease: A critical time for transition

As medical and surgical advances improve, more young adults with congenital heart disease (CHD) are attending college. This case study illustrates some of the issues that these young adults may face as they attend college and discusses the role that college health practitioners can play in easing that transition. Participants: A case of a male with CHD presenting to the college health clinic with a new onset headache. Methods: The authors discuss some of the unique challenges that college health practitioners may face when caring for students with CHD. In addition, they make recommendations on how best to care for these patients and how best to coordinate care with CHD students other care providers. Results: This student with a history of coarctation of the aorta presented with new onset headaches and was found to have high blood pressure. He was diagnosed with recurrent coarctation, underwent percutaneous treatment with stenting and quickly resumed classes. Conclusions: As more students with CHD enter college, college health providers will need to understand some of the health risks that CHD students face. In addition, understanding some of the optimal ways to coordinate care with CHD providers can ease the transition that CHD students face as they enter college.     

Playground Accessibility and Neighbourhood Social Interaction Among Parents

While the positive association between social interaction and access to green space is well accepted, little research has sought to understand the role of children??s playgrounds in facilitating social interaction within a community. Playgrounds are spaces designed to facilitate play and the interaction of children, but may also be important places of interaction between parents. In this paper we examine how access to playground spaces is related to social interaction between parents. We use two measures of accessibility (1) walking distance to the closest playground and (2) playground service area, a measure of the number of potential users of a playground based on population density. We use generalized estimating equations, an extension of generalized linear models, to control for the confounding effects of socio-economic status (income, education), neighbourhood dynamics (neighbourhood location, years in neighbourhood) and free time (daily outdoor activity, marital status, number of children) on the independent relationship between social interaction and access to playground spaces. Our results suggest that while accessibility to playgrounds is associated with social interaction among parents, the direction of the effect is opposite to existing literature on green space and social interaction; parents with low accessibility to playgrounds are more likely to interact socially with their neighbours than parents with high accessibility. Our results suggest a pattern of spatial behaviour in which the burden of poor access to some resources may actually encourage greater neighbourhood engagement. Future research studying the relationship between health and green space may benefit from studying the specific role of playground spaces.     

Deriving Behavior Model Parameters from Survey Data: Self‐Protective Behavior Adoption During the 2009–2010 Influenza A(H1N1) Pandemic

In this paper, we demonstrate how public opinion surveys can be designed to collect information pertinent to computational behavior modeling, and we present the results of a public opinion and behavior survey conducted during the 2009–2010 H1N1 influenza pandemic. The results are used to parameterize the Health Belief Model of individual health‐protective decision making. Survey subjects were asked questions about their perceptions of the then‐circulating influenza and attitudes towards two personal protective behaviors: vaccination and avoidance of crowds. We empirically address two important issues in applying the Health Belief Model of behavior to computational infectious disease simulation: (1) the factors dynamically influencing the states of the Health Belief Model variables and (2) the appropriateness of the Health Belief Model in describing self‐protective behavior in the context of pandemic influenza.     

Communicating Actionable Risk for Terrorism and Other Hazards⋆

We propose a shift in emphasis when communicating to people when the objective is to motivate household disaster preparedness actions. This shift is to emphasize the communication of preparedness actions (what to do about risk) rather than risk itself. We have called this perspective “communicating actionable risk,” and it is grounded in diffusion of innovations and communication theories. A representative sample of households in the nation was analyzed using a path analytic framework. Preparedness information variables (including content, density, and observation), preparedness mediating variables (knowledge, perceived effectiveness, and milling), and preparedness actions taken were modeled. Clear results emerged that provide a strong basis for communicating actionable risk, and for the conclusion both that information observed (seeing preparedness actions that other have taken) and information received (receiving recommendations about what preparedness actions to take) play key, although different, roles in motivating preparedness actions among the people in our nation.     

Mission Rivalry: Use and Preservation Conflicts in National Parks Policy

The purpose of this study is to explore the conflict between use and preservation in national parks policy as seen through the mission statement of the National Parks Service. The histories of the national parks were qualitatively coded in order to further explore this controversy, or what we have termed “mission rivalry”.     

Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

Being Transgender: The Experience of Transgender Identity Development

This article is based on a grounded theory analysis of interviews with transgender-identified people from different regions of the United States. Participants held a variety of gender identities under the transgender rubric (e.g., crossdresser, transman, transwoman, butch lesbian). Interviews explored the participants’ experiences in arriving at their gender identity. This article presents three clusters of findings related to the common processes of transgender identity development. This process was made possible by accessibility of transgender narratives that injected hope into what was a childhood replete with criticism and scrutiny. Ultimately, participants came to their identities through balancing a desire for authenticity with demands of necessity—meaning that they weighed their internal gender experience with considerations about their available resources, coping skills, and the consequences of gender transitions. The implications of these findings are considered in terms of their contribution to gender theory, research, and clinical support for transgender clients.     

A Deprivation Analysis for Andalusia (Spain): An Approach Based on Structural Equations

The study of deprivation, as a social indicator, is basic in the design and development of public policies because it allows decision makers to identify and analyse needy areas in order to improve their citizens’ well-being. The methodological approach proposed for the development of a new deprivation index is based on the Causal Theory whose conceptual model is analysed using Structural Equations. The domains selected for the deprivation index are: education, employment, income, housing, infrastructures and health. A structural equation model based on variance is the exploratory method used to obtain the indices pertaining to the above mentioned areas; the results obtained are seen to be quite reliable. There is a positive connection between the areas of education, employment and income while the relations between infrastructures and health are found to be negative. The results can be projected at a local level and show basic territorial deficiencies. The spatial units studied are the Andalusian (south of Spain) municipalities (770). The spatial projection of the indices obtained for the domains of deprivation highlights the existence of geographical areas which could be a potential target for public action.