Medical Specialty Referrals from a Student Health Service

Abstract

During a 10-week period, 51 referrals resulted from 3171 visits to the Student Health Service, a referral rate of 1.6%. Specialties receiving the most frequent referrals were orthopedics (31%), ophthalmology (16%), general surgery (10%), and gynecology (10%). Data from this study suggest that specialty referrals occur infrequently in the Student Health Service. It would appear that this low referral rate, along with a relatively small student population, would not justify provision of in-house specialty consultation in the Student Health Service.

“The Prognosis of Inflammatory Bowel Disease,” DAVID J. SALES AND JOSEPH B. KIRSNER. The complications of ulcerative colitis generally develop during the first two years of disease. The mortality is higher than expected and the highest likelihood of colectomy also occurs early in the disease. Mortality in Crohn's disease is greater than expected, especially in males. For both conditions, the overall mortality has decreased steadily, and currently is less than 5%. Ulcerative colitis is curable with proctocolectomy and lieostomy. In Crohn's disease, intestinal resection and reanastomosis is followed by recurrence in the majority of patients. The recurrence rate after proctocolectomy and lieostomy for Crohn's disease of the colon also is considerable, ranging from 20% to 35%. In ulcerative colitis, the more colon involved, the more frequent and more serious are the complications. In Crohn's disease, the anatomic pattern of disease tends to predict the type and extent of complications. Both ulcerative colitis and Crohn's disease appear to follow a more severe course in children and adolescents with “inflammatory bowel disease.” Patients with either ulcerative colitis or Crohn's disease are at increased risk for the later development of cancer. In ulcerative colitis, the excess risk is limited to colorectal cancer. Patients with Crohn's disease have increased cancer rates for both the small and large bowel. Finally, most patients with these diseases are able to maintain normal occupations and enjoy reasonably stable social and economic situations. The successful adaptation of patients with inflammatory bowel disease is influenced by a hopeful, optimistic personality and by an encouraging, supportive physician.     

Predictors of Cycling in College Students

Abstract

Objectives: To (1) assess cycling-related questions that have been added to the electronic version of the American College Health Association National College Health Assessment II (ACHA-NCHA), (2) examine cycling prevalence, and (3) identify predictors of cycling in college students. Participants: Predominately female (69%), undergraduate (89%), and white (85%) students (N = 949) from a large, urban, northwestern, bicycle-friendly university completed the electronic version of the ACHA-NCHA II. Methods: Thirty cycling-related questions were added to the ACHA-NCHA II and a subsample of questions was analyzed. Results: Cycling questions added to the ACHA-NCHA II scale were reliable and valid, based on the psychometric data analysis. More than half (59%) of this sample cycled; of those, 58% cycled for transportation and 44% for recreation. Facilitators and barriers to cycling were different for cycling in general and cycling for transportation. Conclusions: Cycling questions added to the ACHA-NCHA II can be utilized to enhance knowledge relative to cycling on college campuses.     

“Is This Something You Want?”: Genetic Counselors’ Accounts of Their Role in Prenatal Decision Making

With the widespread availability of prenatal genetic diagnosis, bioethical concerns have emerged about why women make use of these technologies, and the potential eugenic implications. Research on women's experience with genetic screening often suggests that genetic counselors encourage women to undergo prenatal testing and to terminate pregnancies with abnormalities. Yet, this key professional remains relatively understudied. To fill this lacuna, this article examines genetic counselors’ accounts of their role in the decision‐making process, drawing on 26 qualitative interviews with master's‐trained genetic counselors and illustrative observations of a prenatal counselor. In the context of debates about reproductive politics and genomic medicine, I identify the ways in which genetic counselors view their work and position themselves. I find that contrary to assumptions, genetic counselors provide accounts of being just as likely to discourage as to encourage invasive testing, and persuade against instead of promote termination of affected pregnancies. These findings suggest that genetic counselors may play a more nuanced and less coercive role than their critics contend, challenge assumptions about genetic counselors’ roles in prenatal genetic testing uptake and abortion, and shed light on how this specific professional may curb rather than promote eugenic tendencies feared with the normalization of prenatal screening.     

Pioneering partnerships: Resident involvement from multiple perspectives

Resident involvement in residential care homes is a challenge due to shortcomings of consumerist and formal approaches such as resident councils. The PARTNER approach aims to involve residents through collective action to improve their community life and wellbeing. The purpose of this article is to provide insights into the process of resident involvement by the PARTNER approach from the perspectives of multiple stakeholders, including residents, volunteers and staff members. A responsive evaluation was conducted, using participant observations, semi-structured interviews with residents, volunteers and professionals (n = 16), and three focus groups. The findings show that critical elements in this process of resident involvement were the agenda-setting by residents, the formation of a cohesive resident group, the sharing of experiences and stories, the development of collective action, and the development of partnerships between residents and professionals and other stakeholder groups. Residents developed actions (gallery parties and a buddy project) to strengthen social interactions and realized these with the help of volunteers and professionals. We conclude that bringing residents together around a shared topic creates room for activism and leads to empowerment, feelings of social belonging and learning processes. We argue that it is a worthwhile enterprise to further develop structural partnership relations between residents, volunteers and staff in residential care homes.     

Mandatory Testing of Drivers on the Basis of Age and Degenerative Diseases: Stakeholder Opinions

Concerns about the driving competence of older drivers have led to policy discussions about mandatory aged-based and disorder-based assessments. This study explored the attitudes, beliefs, and preferences of older adults, law enforcement officers, and licensing authorities toward reexamination of driving skills for persons with Alzheimer's disease (AD) and Parkinson's disease (PD) and at varying ages. With few exceptions, participants across all groups supported retesting drivers with AD. Moderate support was given for further evaluation of 90-year-olds and those with PD. Least endorsement was given for reassessment of 70-year-old drivers. Findings have implications for legislative changes to address drivers with AD and PD and at older ages.     

Family members’ experiences and management of resident-to-resident abuse in long-term residential care

ABSTRACT

Objectives: Resident-to-resident (RRA) abuse is increasingly recognized as a significant problem in long-term residential care.Families have a constant presence in this setting, yet their inclusion in research about RRA is minimal. The purpose of this study was to examine family members’ experiences and management of RRA. Methods: The methodology was critical ethnography.Twelve family members participated in in-depth interviews and 56 hours of participant observation were conducted. Data were analyzed thematically. Results: The main themes illuminate families’ experiences of RRA in a context that largely normalizes it.In the absence of formal supports, families developed a range of management strategies, ranging from passive to active intervention.Organizational factors, such as staffing levels and mix, and the physical environment also contributed to RRA. Discussion: Families are actively managing RRA in long-term residential care. Policies and programs, including educational supports, should be developed to validate and support families.     

Neuropsychological Profiles of Victims of Financial Elder Exploitation at the Los Angeles County Elder Abuse Forensic Center

The current article examines neuropsychological correlates of financial elder exploitation in a sample of older adults who have been documented victims of financial elder exploitation. The purpose of this exploratory study was twofold. First, a subsample of the referrals at the Los Angeles County Elder Abuse Forensic Center (LACEAFC) was compared to community dwelling adults in terms of the specific cognitive domains linked to financial capacity including memory, calculation, and executive functioning. Next, the correlation between presence of neuropsychological data and the likelihood of filing a case with the LA County’s District Attorney office was examined. Twenty-seven LACEAFC cases and 32 controls were assessed. Overall, the forensic center group performed worse than a community-based age-matched control group on the MMSE, calculation, and executive functioning (ps < .01). The presence of neuropsychological data was significantly correlated to an increased likelihood of a case being filed.     

Inclusion of children with disabilities in mainstream child development research

This study investigated whether children with disabilities are excluded from mainstream child development research. Fifteen per cent of 533 articles from Child Development and Developmental Psychology (1996–2010) were randomly selected. The exclusion rate was 89.9% when no mention of participants with disabilities was interpreted as exclusion and 66.7% when only studies mentioning disabilities were surveyed; 74% of studies did not provide justification for exclusion. Most studies could have included children with disabilities. Inclusion could be increased by adopting universal design principles and accommodations so that more children with disabilities can gain equal access to research opportunities and the benefits that accrue.     

The dynamics of support over time in the intentional support networks of nine people with intellectual disability

This paper describes the dynamics of support observed in the networks of nine adults with intellectual disability, developed by families who had committed to achieving a ‘good life’ for this person. Network members, including the person with a disability, participated in this longitudinal ethnographic study. Three principles that underpinned their work were positive and respectful relationships, mentorship and providing opportunities and expectations. Participants worked actively with other network members to develop higher levels of autonomy and social participation.     

Mobilizing Urban Publics,Imagining Democratic Possibilities

Publics are not what they were once imagined to be. A growing body of interdisciplinary work is shifting attention to processes in which publics are summoned, constituted and mobilized within political struggles. Nowhere is the formation of publics, as multiple, contingent and contested, more evident than in the varied responses to the transformation of urban spaces. Publics are emerging around issues of belonging, heritage, rights and participation within increasingly divided and unequal cities. Through a close reading of discourses of revitalization and gentrification in the case study of the controversial redevelopment of the Woodward's building in Vancouver, Canada, I examine how the formation of issues imagines and mobilizes publics and further how these discourses work to define possibilities of democratic participation. I show that discourses of revitalization, relying on economic and cultural logics of urban redevelopment, imagine an exclusive, individualized and passive public. In contrast, anti-gentrification discourses, advancing social and political logics of redevelopment, mobilize a collective, active and more inclusive public. In exploring publics within the relationship between issue formation and political participation, I suggest that urban struggles, such as that at Woodward's, are sites in which to understand how meanings of democracy are being contested and rewritten in the contemporary moment.