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.     

Caring for the caregivers

National Family Caregivers month is a reminder of the invaluable contributions of family caregivers--contributions that are too often unrecognized when addressing the costs of health care. Unpaid caregivers spend a substantial percentage of each week "helping out," often with older relatives, which requires major changes in their work patterns. It is clear that these caregivers may need help balancing their work and caregiving responsibilities, and it is tempting to want to help them by "taking over" some of the seemingly overwhelming tasks they face daily. Yet, it is also important to recognize the ways in which these tasks may enrich caregivers' own quality of life. Through listening to caregivers, nurses and other health care professionals can better understand the embedded values, goals, joys, and disappointments that connect their lives with those for whom they care.     

Relationship of interpersonal behaviors and health-related control appraisals to patient satisfaction and compliance in a university health center

OBJECTIVE: The authors' aim was to evaluate patient-provider relationships in a college health center. PARTICIPANTS: Eighty student patients and their health-care providers. METHODS: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. RESULTS: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. CONCLUSION: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

Pearls and pitfalls in evaluating a Student Assistance Program: a five-year case study

This article presents data from a five-year evaluation-research case study of a large urban schools district's internal Student Assistance Program (SAP). The district employed specially trained and licensed school-based counselors to implement an internal SAP expanded to include tertiary prevention, and modeled after an employee assistance program established for adults. From the population of more than 10,000 students who received some type of program assistance for at-risk behaviors, a stratified random sample of 2,238 cases, over a five year period, were reviewed. Results indicate a statistically significant decline (p < .05) in students' drug use and a significant improvement in internal locus of control occurred each year. While not statistically significant, the average number of student discipline referrals was less than the year prior to program admission; however, there was no significant change in academic performance. A significant correlation between students' drug use and the amount of time in program, the type of assistance received, and the student's custody status was also found.     

Rhetoric and Reality of Economic Self-sufficiency Among Rural,Low-Income Mothers: A Longitudinal Study

This study examined the contributions of maternal labor force participation and marital status on economic self-sufficiency over time for rural mothers. Data were from 174 rural families participating in three waves of data collection in Rural Families Speak. χ ² and multiple logistic regression were utilized. Results revealed only one-third of mothers moved toward economic self-sufficiency over three years. Maternal education, employment status, and weekly work hours were associated with improved economic well-being. Compared to single-parent families, unmarried-couple and married-couple families had increased odds of improving economically. In an analysis of all mothers with partners, married or unmarried, martial status was not significant in economic improvement. Findings suggest the role of marriage in welfare reform for rural families should be reconsidered.

'Where are the lesbians in Chaucer?' Lack, opportunity and female homoeroticism in Medieval Studies today

This article explores the study of lesbians in the Middle Ages and proposes that the unstable construct of lesbian poses a problem for traditional Medieval Studies that can lead to the development in Medieval Studies of more nuanced and productive theorizing.     

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.