A continuous improvement process for health providers of victims of domestic violence.

BACKGROUND: Health care providers can play an important role in the prevention of domestic violence through established processes of identification, safety assessment, validation, documentation, and referral. In 1998 the Safe Family Project, funded by University Health System (UHS), affiliated with University of Texas Health Science Center at San Antonio, provided for a clinical review of existing services for victims of domestic violence. A subsequent review of the health system's policy and clinical practice supported the need for resources and training and for an improved care process for victims of domestic violence. THE CONTINUOUS IMPROVEMENT PROCESS (CIP) MODEL: UHS adapted the Shewhart cycle of activities popularly referred to as PDSA (plan change, do change, study results, act on results), a systematic, process-focused approach to achieving continuous and measurable improvement, as its CIP model, and it formed a process improvement team. This process led to translation of research findings into best practice guidelines for treatment of domestic violence and staff education. RESULTS: Significant improvements were made in the overall qualitative chart reviews, although the diagnostic coding (using ICD-9 codes and e-codes) did improve. The CIP can be replicated in other settings to improve the care of victims of domestic violence. DISCUSSION: The CIP effort is being extended to outpatient facilities, and managers have requested that the training manual be replicated and placed throughout UHS as a resource manual. Other activities are intended to improve prevention of domestic violence and intervention when it occurs.

Sociodemographic and health characteristics of Anglophone Canadian and U.S. snowbirds.

Data from a survey of anglophone Canadian snowbirds wintering in Florida and one of U.S. snowbirds in the Texas Lower Rio Grande Valley are used to compare the two groups in terms of sociodemographics, chronic health conditions, and use of health services. The Canadians were younger and reported fewer chronic problems than did the U.S. snowbirds; Canadians aged 65 and over had a lower reported prevalence for four of five chronic conditions than did persons of the same age in the Canadian population. In contrast, the U.S. snowbirds had higher reports on four of the conditions than did U.S. Whites aged 65 and over. Hypotheses are suggested for future research, and methodological issues are discussed.

Acculturation and drinking patterns among U.S. Anglos, blacks, and Mexican Americans.

The relationship between acculturation, generational status/nativity and drinking patterns is examined using data from a 1988 community survey of 1286 adult regular drinkers (at least two drinks/month) in San Antonio, Texas. This sample includes 412 Anglo, 239 Black, and 635 Mexican American respondents, with Mexican Americans further classified into high, medium, and low acculturation groups using a language-use-based acculturation measure. This data set allows comparisons between racial/ethnic majority and minority groups with further comparisons between Black and Mexican American subgroups. These racial/ethnic and acculturation level comparisons highlight the effects of minority status and cultural differences between groups with regard to drinking patterns. Overall, the analyses indicate little evidence to support an 'acculturation stress' model of alcohol use, wherein the stresses of acculturation produce higher levels of alcohol consumption among moderately or higher acculturation groups. Generally, in our data, quantity and frequency consumption was somewhat higher among the least acculturated males and moderately acculturated females. Further analyses by generational status indicate heavier consumption patterns among second-generation individuals, especially among the less acculturated, though those differences were eliminated by controls. The findings highlight inadequacies of using generational status/nativity measures alone to assess acculturation level. Further, joint effects of acculturation level and generational status suggest the viability of a cultural marginality model of acculturation, though many of the effects of acculturation and generational status are explained by demographic and psychosocial factors.

"Machismo," self-esteem, education and high maximum drinking among anglo, black and Mexican-American male drinkers.

This study seeks to clarify the relevance of machismo to patterns of high maximum drinking among male drinkers. Specifically, the study describes the psychometric properties of a newly developed 7-item machismo measure, compares levels of machismo and self-esteem for a sample of Anglo, black and Mexican-American males, and examines both main and interaction effects of machismo, self-esteem and education as predictors of alcohol use in these racial/ethnic subgroups. Logistic regression analyses document interaction between race/ethnicity, machismo, self-esteem and education, which calls into question the presumed importance of machismo as a cultural element causing heavy drinking patterns among Mexican-American males.

Mental disorders among family practice patients in the United States-Mexico border region.

A standardized interview including parts of the Diagnostic Interview Schedule was used to determine the prevalence of depressive and generalized anxiety disorders among female family practice patients in San Antonio, Texas, and Monterrey, Mexico. Rates of depression and anxiety were not significantly different in Texas and Mexico. There were differences in age-specific rates of anxiety with the disorder being prominent among middle-aged women in Mexico. In both countries, women with mental disorders had higher rates of hospitalization, use of psychotropic medication(s), and physical complaints than women without such disorders.

Depression and anxiety among Mexican Americans in a family health center.

A standardized interview including parts of the NIMH-Diagnostic Interview Schedule was used to determine the prevalence of depression (major depression or dysthymia) and generalized anxiety in a random sample of predominantly low-income Mexican American patients attending an inner-city family health center. Overall rates of current DSM-III-diagnosable depression and anxiety were similar to rates reported for other primary care patient populations in the United States. There were racial/ethnic and sex differences in the rates of these disorders, with Anglo females having disproportionately high rates. Among women, the rate of mental disorders was higher for those with many somatic symptoms, three or more children, low scores on a scale of family integration, and numerous missed appointments in the last year.

Psychoactive substance use among medical students.

A survey of 133 senior medical students revealed that noteworthy proportions had used the following psychoactive substances during their lifetime: cigarettes, 44%; alcohol, 96%; marijuana, 57%; amphetamines, 22%; cocaine, 20%; sedatives, 17%; benzodiazepines, 37%; hallucinogens, 15%; and opioids, 40%. Smaller percentages reported use of these substances during the last year and the last month. Lifetime use did not vary significantly by sex, ethnic status, or marital status. Twelve percent reported nearly daily use of one or more substances during the last month; a different but overlapping 11% reported substance abuse symptoms during the last year. Use of illicit substances and substance abuse symptoms were associated with depressed mood.

Physician knowledge and clinical behavior regarding automobile safety for children.

A mail survey was conducted in May 1983 of pediatricians and family and general practitioners in San Antonio, TX, to assess their influence on automobile safety of patients. Information on sociodemographic data and personal and professional behavior with respect to automobile safety for children was elicited. A 17-item knowledge index was significantly correlated with physician's own use of seat belts, number of children less than 5 years old, exposure to use of child restraints during residency, clinical behavior (asking about use of child restraints during the first and subsequent well-child visits, instructing parents about automobile safety for children, dispensing literature in the office), being a pediatrician, and being Board certified. Knowledge was inversely correlated with physician's age. Education of parents by physicians about automobile safety for children was infrequent. Only 29% of physicians always or usually ask at the first well-child visit if child restraints are being used. Only 8% of physicians received training during their residencies; this points to a need for educating physicians in automobile safety for children.

Coping in the barrio: case studies of Mexican-American families.

This paper reports preliminary finds of a study of coping abilities of Mexican-American families. The purpose of the study was to identify variables related to styles of behavior that can be characterized as adaptive. A complex of factors differentiated families who were judged to be dealing effectively with their environment ("copers") from those who were not ("noncopers"). The factors included the health status of the children, various child-rearing attitudes and practices, and patterns of decision making as they related to a more general ability of parents to conceptualize and organize time.