Does Home- and Community-Based Care Affect Nursing Home Use?

A study was conducted to assess change in numbers, expenditures, and case mix of nursing home residents as Medicaid investment in home- and community-based services (HCBS) 1915(c) waivers increased in seven states. The seven states provided Medicaid expenditure and utilization data from 2001 to 2005, including waiver and state plan utilization. The Minimum Data Set was used for nursing home residents. For three states, community assessment data were also used. In six states, the number of nursing home clients decreased as the numbers of HCBS clients grew. However, in most states, the number of additional waiver clients often greatly exceeded reductions in nursing home residents. Nursing home payments decreased moderately, but this decrease was offset by increases in HCBS waiver and state plan expenditures, leading to a net increase in long-term support services (LTSS) expenditures from 2001 to 2005. Increases in waiver expenditures outpaced increases in waiver clients, indicating expansion of services on top of expansion in clients. States that showed substantial increases in HCBS showed only modest increases in nursing home case mix. The case mix for nursing home residents was more acute than that for HCBS users. The expectation that greater HCBS use would siphon off less severe LTSS users and hence lead to a higher case mix in nursing homes was partially met. The more acute case mix in nursing homes suggests that HCBS serves some individuals who were previously cared for in nursing homes but many who were not. Efforts to promote substitution of HCBS for institutional care will require more proactive strategies such as diversion.     

Gender,Racial, and Ethnic Disclosure in NIH K-Award Funded Diabetes and Obesity Clinical Trials∗

In 1993, the National Institutes of Health (NIH) passed The Revitalization Act (Subtitle B) which mandated that all NIH funded clinical trials have “appropriate representation” of minority and women subjects. Our aim was to evaluate the impact of the mandate by examining the reporting and inclusion of minority and female subjects into NIH K-Award funded clinical trials, addressing the minority predominant diagnoses of diabetes and clinical obesity. Using the CRISP search engine and PUBMED, we selected publications published by the National Institute on Aging (NIA) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) K-grant recipients during 1989–2004, associated with all the diabetes and obesity clinical trials. Studies were stratified into three timeline categories (1989–1993, pre-mandate; 1993–1996, post-mandate, and 1997–present, well past mandate) to evaluate trends in the recruiting of minorities and women before, during, and after the passing of the Revitalization Act. Of the 165 papers, only 37% disclosed race, a number that did not improve over time (p = .15), whereas 92% disclosed gender. Clinical trials that focused on females increased across the 3 timeframes (p < .001) for diabetes studies but not obesity studies. Overall, disclosure of race declined over the 3 timeframes whereas individually, the disclosure of African Americans improved.     

Evaluation of school‐based AIDS education curricula in San Francisco

Students in 3 middle (n=385) and 3 high schools (n=254) in the San Francisco Unified School District participated in the evaluation of an AIDS education curriculum. Classes within‐schools were designated as either intervention classes or nonintervention classes. Students in intervention classes received 3 class periods of AIDS instruction with a newly developed curriculum. Students in nonintervention classes did not receive any special AIDS instruction. All students completed a pretest and posttest AIDS knowledge and attitude survey. The results indicated that AIDS instruction classes demonstrated a significant knowledge‐advantage, as well as change in attitudes (e.g., reflecting greater tolerance for attending class with students who may have AIDS or HIV infection).     

Sexual behaviour in aids‐related research: Reliability and validity of recall and diary measures

In order to assess the reliability and validity of two data collection instruments for measuring sexual practices in homosexual men, we administered a recall data collection instrument to 30 sexually active men, and a diary instrument to a subset of 19 participants. Each instrument covered a period of one month. For the recall instrument, the correlation coefficients between the test‐retest showed a good level of reliability for a number of infrequent sexual practices but was poor for frequent sexual practices. Correlation coefficients were calculated for sexual practices recorded in the first two and the second two weeks for both the recall and the diary. Generally, the level of agreement between the first and second two weeks for sexual practice data recorded in the diary was lower than the recall questionnaire. While the reliability of the recall method was found to be limited to certain sexual practices, it was concluded to be the most reliable and efficient method presently available for the collection of important high‐risk AIDS‐related sexual activities for a one‐month period.     

Adaptation and Coping in Childhood and Adolescence for those at Risk for Depression in Emerging Adulthood

Emerging adulthood is a time of great possibility and of considerable risk. This qualitative study explored the adaptation and coping strategies used over time by twenty-five emerging adults. Respondents were selected from a longitudinal community study cohort of 26-year-olds and had experienced adversity in early life. Participants mentioned using a variety of strategies, such as active evasion, seeking support, and “letting go,” in order to cope with difficulties. These strategies varied by context and according to respondents’ developmental level at the time of the adversity. Flexibility in understanding life circumstances and in choosing coping strategies to deal with specific adversities was noted as beneficial through childhood, adolescence, and emerging adulthood.     

Medical Complications of Female Genital Mutilation

Abstract

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation “surgery.”     

The History of College Health Nursing

Abstract

Almost from the beginning of formal college health programs in the second half of the 19th century, college health nurses were there to care for students in college and university settings. By the end of the 20th century, the role of college health nurses had evolved with the nursing field in general, but with enough unique features for the American Nurses’ Credentialing Center to recognize college health nursing as a professional subspecialty and administer the first College Health Nurse Certification examinations. In addition, new nurse practitioner programs provided practicing nurses with more independence, and their duties continued to expand beyond care of the sick to include health promotion, administrative, and teaching activities. As a result of these changes, college health nurses now play a larger role in the life of students and promoting a healthy campus community than ever before in the history of college health.     

Dealing with Disruptive Students

Abstract

Gerald Amada. Coping With the Disruptive College Student: A Practical Model. Asheville, NC: College Administration Publications. 1994. 110 pps. $14.95.