Medication Abortion Within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

Abstract

Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants: Female patients presenting for medication abortion at a student health care clinic between October 1, 2006, and April 1, 2009. Methods: Retrospective consecutive case review. Results: Successful completion not requiring uterine aspiration occurred in 85% of the cases that were not lost to follow-up. Six cases (15%) required uterine aspiration for completion: 3 underwent uterine aspiration only; 3 had aspiration after failing an additional dose of misoprostol. Only 1 patient visited the emergency room. There were no hospitalizations. Conclusions: Medication abortion services in a student health care clinic are safe and feasible. However, additional treatment may be required with some patients.     

Book Review

Abstract

Kim Witte, Gary Meyer, and Dennis Martell. Effective Health Risk Messages: A Step-by-Step Guide: Thousand Oaks, CA: Sage; 2000. 216 pps; paper, $24.95, cloth, $64.95.     

Assessing Overweight,Obesity, Diet,and Physical Activity in College Students

Abstract

The authors surveyed 738 college students aged 18 to 27 years to assess overweight, obesity, dietary habits, and physical activity. They used BMI (body mass index) > 25 kg/m² or BMI > 85th percentile and BMI > 30 kg/m¹ or BMI > 95th percentile to estimate overweight and obesity in those aged < 19 years. To define overweight and obesity in those > 20 years, they used BMI > 25 kg/m² and > 30 kg/m². They found overweight rates of 21.6% using BMI directly and 16.2% using BMI percentile and obesity rates of 4.9% using BMI directly and 4.2% using BMI percentile. More than 69% of the participants reported < 5 servings of fruits and vegetables per day and more than 67% reported < 20 g of fiber per day; participants reported physical activity on fewer than 3 d/wk. Most college students are not meeting dietary and physical activity guidelines, suggesting the need for prevention interventions and increased understanding of overweight in college students.     

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.     

Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

Conceptual Model and Map of Psychological Abuse of Older Adults

Psychological abuse of older adults is a hidden and pervasive problem that is not well conceptualized nor well measured. Goals. The goals were to (a) conceptualize psychological abuse using three-dimensional concept maps, and (b) develop theoretical models. Methods. Statements describing the construct were generated by local and national panels. These were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. Results. The concept maps guided development of theoretical hierarchies. Significance. Theoretical models may help to develop measures to estimate prevalence better and may enable more precise screening for triage into appropriate interventions.     

Elder Abuse: What Coroners Know and Need to Know

This article presents findings from a survey examining knowledge of elder abuse among Georgia's coroners. More than half of the 116 respondents indicated that they know “almost nothing” or “a little” about distinguishing signs of physical abuse from signs of aging (54%) and mandatory reporting laws and related elder abuse statutes (63%). When asked the frequency with which older adult cases were referred to the medical examiner, 49% indicated “rarely if ever.” Study findings reveal specific opportunities for enhancing training efforts aimed at coroners, who play a critical role in the identification of elder abuse.     

Walking the Tightrope: Developing a Systems Approach to Balance Safety and Mobility for an Aging Society

In an aging population, safety and mobility are often viewed as being in conflict, when in fact they are two values that must be reflected equally in transportation policy. The challenge for policy makers and for society is to emphasize and optimize both. To achieve this, a comprehensive systems approach to driver health, personal decision-making and planning, community and transportation systems construction, vehicle design, and licensing regulations is needed. Such an approach requires crafting policies based on conceptualizing the issue as a continuum of resources facilitating safety and mobility regardless of driving status. The discussion that follows reviews components of the issue and suggestions for developing a comprehensive approach.     

Mesede and the Limits of Reciprocity in Fieldwork at Kamusi,Western Province,Papua New Guinea

This paper outlines some of the ways I and my research were defined by Bamu speakers living at Kamusi, the headquarters of the Wawoi Guavi logging concession in the Western Province of PNG. These definitions often involved stories about Mesede and other great Bamu ancestors. The stories about Mesede outlined Bamu experiences of colonial and post-colonial development and suggested that Mesede had the power to transform the Bamu's current poverty and marginalisation. The possibility that Mesede could institute a new epoch of development was linked to the Bamu's ability to maintain inalienable ties with Mesede despite his removal overseas. Mesede's story also required me to acknowledge, and productively respond to, past appropriations by Australians, and others, of Mesede. His history placed me in a project of im/possible reciprocity that should have involved me in returning Mesede to his rightful place.     

Assessing the effectiveness of a responsible gambling behavioural feedback tool for reducing the gambling expenditure of at-risk players

The current study assessed the utility of a responsible gambling (RG) tool that provides players with behavioural feedback about their gambling. Data was obtained from 779 people (n = 694 male; n = 85 female) who gambled online with Svenska Spel (the Swedish gambling operator) and who opted to receive behavioural feedback via an RG tool (Playscan). Importantly, data was also obtained from a matched sample of 779 players who did not opt to receive behavioural feedback. Feedback took the form of a colour-coded risk rating (Green = no issues, Yellow = at-risk, Red = problematic), which was determined by a proprietary algorithm. Additionally, gambling expenditure data (amounts deposited and wagered) was gathered for the week in which players enrolled to use the RG tool, the subsequent week and 24 weeks later (this data was also gathered for the matched sample). Results showed that Yellow (i.e. at-risk) players who used the tool significantly reduced the amounts of money deposited and wagered compared to players who did not use the tool – an effect observed the week following enrolment as well as 24 weeks later. Thus, informing at-risk players who have opted to receive feedback about their gambling appears to have a positive impact on subsequent expenditures.