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PURPOSE: To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. METHODS: Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. RESULTS: Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. CONCLUSIONS: A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

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Patient education programs in rheumatology are emerging as important therapeutic interventions. The current evidence for their efficacy, economic benefits, and underlying causal mechanisms is discussed. Current meta-analytic studies suggest that patient education can affect knowledge, pain, joint counts, depression, exercise, and coping behaviors. Evidence is presented suggesting that self-efficacy and social support are strong underlying causal mechanisms. Although studies of the economic impact of patient education are still scant, most that exist indicate that the programs evaluated tended to reduce health care service utilization. An example of a complex cost-effectiveness study is discussed.

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PURPOSE: We characterize infertility training in urology residency programs. MATERIALS AND METHODS: A pilot survey was sent to randomly selected urological training programs. The modified final survey was sent to 126 approved urological residencies in North America. RESULTS: Of the 126 surveys 110 (87%) were returned. Among the programs 38% expressed interest in recruiting a faculty member with expertise in infertility, 32% indicated an inadequate number of patients available to train residents and 56% indicated that their residents were least competent in the treatment of infertile patients compared to the other urological subspecialty disciplines. CONCLUSIONS: This survey confirms the underemphasis of infertility in urological training programs and the need to enhance this training.

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Managing patient-nonadherence with prescribed exercise regimens is not an uncommon task for physical therapists working with individuals with arthritis. Yet little is known about the factors that influence patient adherence with exercise programs or therapist knowledge and use of theoretically based adherence management techniques. Survey research with physical therapists and patients was used to provide a database for further insight into the barriers experienced in implementing exercise programs in clinical practice. In this paper, we suggest that the cooperation with an exercise regimen is mediated by the patient's belief system and requires a therapeutic process of mutual inquiry, problem solving, and negotiation between the therapist and patient. Concepts from research, theory, and practice are integrated into a Process Model for Patient-Practitioner Collaboration for use in clinical practice.

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OBJECTIVE: The objectives of this study were to develop a valid screening tool for anatomical urinary stress incontinence (AUSI), to use it to determine the frequency of AUSI in women with RA, and to identify the cognitive, behavioral, and psychological coping strategies used by these women to deal with incontinence. METHODS: A screening tool concerning AUSI was validated by comparing self-reported incidences of AUSI with clinical evaluation. Questionnaires regarding presence of AUSI and cognitive, behavioral, and psychological coping strategies were sent to 750 women clinically diagnosed with RA. RESULTS: Of the 262 respondents (35% response rate), 21% had characteristics of AUSI, a rate similar to general population studies. Coping strategies varied depending on whether the women were at home or away from home and whether the women were alone or with others. CONCLUSIONS: There is a need for women with incontinence and the health care workers who serve them to be educated about AUSI and its treatments.

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The validity and reliability of self-administered joint counts are reported in a group of 32 rheumatoid arthritis patients being followed at a university-based practice located in the Southeast region of the United States, serving low to middle income urban and rural patients. Adequate inter-rater reliability among the patients' and the research assistant's joint counts was obtained for upper (r = 0.74), lower (r = 0.96), and upper and lower extremities (r = 0.89). Convergent validity correlations for pain, helplessness, and the Joint Alignment and Motion scale were found to be adequate. We conclude that rheumatoid arthritis patients can reliably assess their joint counts. Self joint counts along with other validated self-reports of health status may be applicable to busy outpatient settings, as well as in clinical research.

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Trainees were randomized into four groups: (1) control; (2) consult; (3) liaison; or (4) consult-plus-liaison to evaluate the psychiatric knowledge gained after two different training programs for primary care residents. Consult was a 1-month rotation on the Psychiatry Consultation Service. Liaison consisted of 31-hour workshops over 1 year. Consult-plus-Liaison refers to both training programs, experienced in consecutive years. An oral examination was administered before and after training. The analysis of variance and tests of simple effects revealed significant training effects for both groups. The effect size of training was greater for residents exposed to both programs, compared with either one alone. The two different training programs were both effective in improving the psychiatric knowledge of primary care residents and exposure to both programs proved superior to either one alone.

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This study examined the validity and reliability of full and short versions of the Arthritis Impact Measurement Scales (AIMS). One hundred fifty-five patients with Rheumatoid Arthritis followed at a University Hospital Rheumatology Clinic completed the full AIMS at baseline, 6 months, 12 months, and 18 months. After reducing the 45-item AIMS to 22, alpha reliabilities and test-retest correlations showed that, with the exception of test-retest correlations for mobility at 6 months and for pain at 12 and 18 months, the full and short scales were comparably reliable. Convergent validity correlations with theoretically related scales were also comparable. However, some of the short scales did not detect the same differences over time that the full scales did. Specifically, the short mobility, pain, anxiety, and depression scales were not as sensitive to change as the full scales. Except for these four scales, the short version appears to be a viable alternative for use by health professionals and researchers.

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One hundred and fifty-five patients with rheumatoid arthritis (RA) were randomly selected from a tertiary care outpatient rheumatology clinic. Disease, treatment, psychosocial and demographic data were collected to test a biopsychosocial model of Physical Functioning as determined by the Arthritis Impact Measurement Scales (AIMS). Cross-sectional and longitudinal hierarchical and stepwise regression analysis were performed to identify variables associated with Physical Functioning. The results of the hierarchical regression revealed that only the disease and psychosocial sets of variables were significant. Stepwise regression revealed that Disease Severity (disease set) and Arthritis Helplessness (psychosocial set) accounted for 37% (longitudinal) to 60% (cross-sectional 12 months---greater than 12 months) of Physical Functioning variance. Our results suggest a role for the inclusion of psychosocial factors in studies of the development of physical disability in patients with RA.

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Physical inactivity is a risk factor for the development of atherosclerosis. Members of a state chapter of the American Academy of Pediatrics were assessed about their practice behaviors and knowledge related to physical activity and fitness assessments. During health supervision evaluations 19% obtained a physical activity history and 7% measured a heart rate response to exercise. When assessing physical fitness 24% obtained an activity history which included kind, intensity, duration and frequency. 64% limited their physical fitness evaluation to an inspection of general appearance and weight, while 1% used a bicycle ergometer or treadmill, 4% used a step-test and 10% ran a child in place. Only 42% used the information to make recommendations about physical activity. 75% were not familiar with ACSM or AHA recommendations about exercise. Barriers cited to increasing physical activity and fitness assessments included lack of physician time, office space, staff time, and physician training. This survey demonstrates the need for increasing the awareness level of pediatricians about the role of exercise in preventing CHD and the need to incorporate such evaluations into their routine practice.

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In order to better understand issues surrounding missed medication doses, 140 patients with rheumatoid arthritis in a tertiary care clinic were interviewed about their medication-taking behavior and beliefs. Findings from work in memory and attention and concepts from Ajzen and Fishbein's theory of reasoned action were used to guide the development of questions. Key findings included: (a) some ignorance about their regimen, (b) a tendency to rely just on their memories rather than environmental cues to remember doses, (c) variation in responses to a missed dose, and (d) the use of an inferential process for judging a medication's efficaciousness. These findings suggest several areas that physicians and allied health professionals can investigate with patients to help minimize missed doses.

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A survey of 200 rheumatoid arthritis (RA) patients was conducted to identify the kinds and frequencies of intentional and unintentional reasons for missed medication dose. Planned and unplanned changes in usual activity routines accounted for most of the unintentionally missed doses, while side effects attributed to the medication accounted for most of the intentionally missed doses. Patients who did not miss medication doses were different from those who did by tending to have more financial resources and social support available to them.

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Validity and reliability studies were conducted on the Face Scale, a very brief, pictorial scale of mood which uses a sequence of 20 faces and does not require reading literacy. Correlational and experimental evidence of the Face Scale's construct validity is presented, as well as its test-retest reliability. Recommendations are made for its use as a screening tool and for additional validity studies.

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A quasi-experiment was conducted on 127 hospitalized rheumatoid arthritis patients to determine the relative success of 3 patient teaching strategies--an individualized program, a routinized program, and a no-planned-instruction program--on patients' knowledge of their disease and treatment. Data analysis revealed that the individualized program produced a 100% greater learning gain than the routinized program in patients who had low pretest scores. The results suggest that maximum patient learning occurs when the teaching process accommodates important patient differences.

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Routine and preventive health services are underutilized by low-income groups, who make greater use of inpatient and emergency services than the population at large. Studies reported on in this article suggest that the low-income population might be more effectively served, and at less expense, by health maintenance organizations that provide service on a prepaid, capitation basis.

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