Rehabilitation outlooks for rural Louisiana: educational developments,economic trends,and global perspectives

The objective of this article is to examine current medical, economic, and social trends affecting the provision of rehabilitation services for rural citizens with disabilities. While the population of interest is citizens of Louisiana, the concepts are applicable across all geographic boundaries. The article is a review of clinical practice, job placement alternatives, economic trends, and assessment of process applications. It is concluded numerous steps may be taken to enhance the availability and quality of services provided for rural citizens with disabilities: greater statistical inquiry into rural disability trends, increased incorporation of the Internet into all aspects of rural economic and educational developments, further development of distance learning, promotion of sensitivities towards rural cultures, and continued recruitment of rural allied and vocational rehabilitation professionals.     

Gift Giving, Identity, and Transformation: The AIDS Memorial Quilt

Those who have originated the AIDS Memorial Quilt have often referred to it as a gift. In this essay, the author discusses theories related to gift giving to discuss the quilt and its constructed effects for those who experience it as a gift. In particular, Weiner's notion of inalienable possessions is highlighted to address how the quilt, as a gift that is kept inalienable from its original creators, maintains historical identity and immortality for its originators, many of whom are gay and bisexual men. Also, Hyde's notion of erotic gifts is presented to consider the quilt's ability to draw people together, create feeling-bonds among them, and affect their transformation.     

Identity in political context: lesbian/gay representation in the public sphere

Discourses constructed to represent lesbians and gay men in the public sphere generate an essentialist identity which is both necessary and damaging. Legislative debate illustrates the production of a constrictive and homogeneous identity rejected by many gay/lesbian scholars and activists. Discussion of the rhetorical power of identity claims has produced alternative stances toward variant sexuality. This discussion can be advanced by challenging dominant constructions of civil rights and the public sphere.     

Improving performance in a contracted physician network

Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors.     

Positive and negative affect: A maximum-likelihood approach

Using the LISREL maximum-likelihood program, the relation between Bradburn's positive affect and negative affect scales is examined for three age groups of adults. It is found that (a) unequal item loadings fit significantly better than equal item loadings; (b) the best-fitting loadings for the elderly are significantly different from those of the non-elderly; (c) the positive and negative affect scales are substantially correlated and (d) correlations with related variables are stronger when positive and negative affect scales are formed by maximum-likelihood loadings rather than by unit loadings. Given the widespread use of Bradburn's scales, implications of these results for subjective well-being are discussed.     

The demography of Tristan da Cunha

Abstract The eruption of the volcano on Tristan da Cunha in 1961 and the subsequent arrival of the island population in the United Kingdom provided a unique opportunity for studying the health of this formerly isolated community. During their stay, while the facilities and services of modern medicine were made available to them, investigations of many facets of their general biology were made under the auspices of the Medical Research Council, co-ordinated by Dr. H. E. Lewis. Analysis of their demographic history was essential to understand many features of their disease pattern, and the results of this analysis are presented here. They are of interest in that they not only show some consistent trends in the common variables of demography, but also demonstrate biological principles, some perhaps for the first time in man, which may be fundamental in the process of colonization as a biological phenomenon, e.g. the initial difficulty of establishment of a population in a new area, the curious demographic structure that may emerge in its earliest years, the bottleneck effect of population-size reduction, the founder principle.     

Exploring self-care among dementia caregivers:the role of perceived support in accomplishing exercise goals

Support provided by family and friends may influence the extent to which older women who are primary caregivers for a spouse with dementia adhere to an exercise routine. The current study reports on qualitative interviews with 30 older female caregivers taking part in an exercise intervention regarding the support they received for their exercise goals. Results indicate that nearly all women received some level of verbal encouragement from family and friends, though far fewer had exercise partners or someone to stay with their husbands while they exercised. To reflect the wide variation observed in the amount of exercise support received and needed by caregivers, a typology of support situations was constructed as follows: Self-reliant, Well-supported, Under-supported, and Superfluous support. Implications for future exercise interventions targeting this population are discussed.     

Combining Food Frequency and Survey Data to Quantify Long-Term Dietary Exposure: A Methyl Mercury Case Study

Twenty-four-hour recall data from the Continuing Survey of Food Intake by Individuals (CSFII) are frequently used to estimate dietary exposure for risk assessment. Food frequency questionnaires are traditional instruments of epidemiological research; however, their application in dietary exposure and risk assessment has been limited. This article presents a probabilistic method of bridging the National Health and Nutrition Examination Survey (NHANES) food frequency and the CSFII data to estimate longitudinal (usual) intake, using a case study of seafood mercury exposures for two population subgroups (females 16 to 49 years and children 1 to 5 years). Two hundred forty-nine CSFII food codes were mapped into 28 NHANES fish/shellfish categories. FDA and state/local seafood mercury data were used. A uniform distribution with minimum and maximum blood-diet ratios of 0.66 to 1.07 was assumed. A probabilistic assessment was conducted to estimate distributions of individual 30-day average daily fish/shellfish intakes, methyl mercury exposure, and blood levels. The upper percentile estimates of fish and shellfish intakes based on the 30-day daily averages were lower than those based on two- and three-day daily averages. These results support previous findings that distributions of "usual" intakes based on a small number of consumption days provide overestimates in the upper percentiles. About 10% of the females (16 to 49 years) and children (1 to 5 years) may be exposed to mercury levels above the EPA's RfD. The predicted 75th and 90th percentile blood mercury levels for the females in the 16-to-49-year group were similar to those reported by NHANES. The predicted 90th percentile blood mercury levels for children in the 1-to-5-year subgroup was similar to NHANES and the 75th percentile estimates were slightly above the NHANES.