Use of a statewide system to improve health and safety in child care facilities.

BACKGROUND: The Early Childhood Education Linkage System (ECELS) in Pennsylvania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly developed statewide systems and about how users compare with nonusers of such a system. OBJECTIVES: Our objectives were 1) to assess knowledge and use of ECELS among child care providers in PA, 2) to compare users and nonusers of ECELS with regard to health concerns, advice-seeking preferences, and infant sleep positioning, and 3) to assess satisfaction among users of ECELS. METHODS: Cross-sectional telephone survey of directors of 400 licensed child care centers (CCCs) and providers of 400 registered family child care homes (FCCHs) in PA. RESULTS: The proportion of children with certain special health care needs mirrored the prevalence in the national child population. Of the facilities surveyed, 88% of CCCs and 71% of FCCHs had heard of ECELS. Among these, 85% had used ECELS's services in the previous 12 months. Significantly more nonusers than users consulted doctors, whereas more users consulted health professionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing infants on their backs only to sleep. Users who placed infants on their backs were more likely than nonusers to have a written policy about the correct practice (55% and 26%, respectively; P =.02). Overall, 46% of users and 28% of nonusers reported having a sleep position policy (P =.02). Users were at least 95% satisfied with ECELS's services. CONCLUSION: This statewide system reached most child care providers surveyed: more outreach is needed to providers in FCCHs. The health concerns, safety practices, and advice-seeking preferences of child care providers described in this article can inform others who are developing similar collaborative services in each state. Further research on the impact of HCCA programs on health and safety practices (such as correct infant sleep positioning) is warranted.

Effect of different recruitment sources on the composition of a bipolar disorder case registry.

BACKGROUND: Conducting research on low-prevalence conditions presents an ongoing challenge for clinical and services researchers. Recruitment through health professionals versus other forms of self-referral may affect study group composition. METHODS: We compared members of a voluntary case registry for bipolar disorder who were recruited through a variety of sources including health professionals, support groups, an Internet website, and mailings, brochures, and other general public relations activities. We also compared the cost of recruitment methods. We hypothesized that self-referred registry members would be of higher socioeconomic status and less likely to be in treatment compared to members recruited through health professionals. RESULTS: Registrants referred through the Internet and patient support groups were better educated and more likely to be married than other registrants. However, Internet registrants were younger, had fewer lifetime hospitalizations and were more likely to be working. Nearly all registrants were in treatment with a psychiatrist. Local registrants were predominantly recruited through health professionals and public presentations. Registrants outside of the local region most often learned about the registry from patient support groups and the Internet. Local registrants were less likely to be using non-lithium mood stabilizers. Recruitment through public relations efforts was the most expensive method of recruitment, and the Internet website was the cheapest. CONCLUSIONS: Diverse recruitment methods can expand the population available for clinical trials. For services research, the Internet and patient support groups are less expensive ways to identify persons served in diverse settings and health plans, but these recruitment methods yield a sample that is better educated than the remainder of the population. It remains a difficult task to identify minorities and persons not in treatment.

Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services.

OBJECTIVE: To determine whether classification as pediatric "somatizers" identifies a group of children and adolescents at high risk for psychopathology, functional impairment, and frequent use of health services in a large, multisite study of pediatric primary care. METHOD: Parental reports of frequent aches and pains and visits to the doctor for medically unexplained symptoms in children aged 4 to 15 years were used to construct a classification of somatization in pediatric primary care. Affected and unaffected children and adolescents were compared on measures of demographics, family functioning, psychopathology, functional status, and service use. RESULTS: Classification as a somatizer was more common in adolescents, females, minority subjects, urban practices, nonintact families, and families with lower levels of parental education and was associated with heightened risk of clinician- and parent-identified psychopathology, family dysfunction, poor school performance and attendance, perceived health impairment, and more frequent use of health and mental health services. CONCLUSIONS: Children classified as pediatric somatizers are at heightened risk for psychiatric disorder, family dysfunction, functional impairment, and frequent use of health services. Additional research is warranted, and clinicians should recognize the need for careful assessment and potential behavioral health referral in this population.

The Physician Belief Scale and psychosocial problems in children: a report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network.

Clinicians' management of children with psychosocial problems may vary with their attitudes and beliefs. However, we lack sound instruments to assess these factors. This study examined the psychometric properties of the Physician Belief Scale (PBS). A modified version of the PBS was sent to clinicians who participated in two primary care research networks. Using factor analysis, we reduced the PBS to 14 items and 2 subscales. Cronbach's alpha values were high. Female clinicians, those using DSM-IV, and those having completed training earlier rated themselves as more psychosocially oriented. Identification and treatment of psychosocial problems were significantly related to scores on the Belief and Feeling subscale. The PBS provided only a modest amount of information regarding primary care practices. It is not clear if these limitations are attributable to the instrument or the many other barriers to effective psychosocial care.

Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women?

OBJECTIVE: In this article, we evaluated the prospective association between measures of trait anger, hostility, and anxiety and indices of carotid atherosclerosis in 200 healthy middle-aged postmenopausal women. METHODS: Starting in 1983, 541 premenopausal women were evaluated for their levels of standard cardiovascular risk factors and psychosocial attributes, including their scores on Spielberger Trait Anger, Anxiety, and Anger-in, and Public Self-Consciousness. Starting in 1991, the Cook-Medley Hostile Attitudes Scale was also administered. Starting in 1993, 200 women who had been menopausal for at least 5 years were scanned for carotid atherosclerosis using B-mode ultrasound. The scans were scored for average intima-media thickness (IMT) and plaque index. RESULTS: Women who had high Trait Anger, Anger-In, and Public Self-Consciousness scores had high IMT scores on average 10 years later. Women who had high Cook-Medley scores also had high IMT scores on average 1.5 years later. Multivariate analyses adjusting for the standard cardiovascular risk factors that most highly predicted IMT scores indicated that holding anger in, being self aware, and having hostile attitudes were significant predictors of IMT. Women with higher plaque scores also tended to report holding in their anger. CONCLUSIONS: Anger suppression and hostile attitudes do predict women's carotid IMT in midlife. Ultrasound measures of carotid atherosclerosis can be used to advance our understanding of the early development of atherosclerosis in women.

Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study.

The authors ascertained cardiovascular events (myocardial infarction and angina pectoris) in 498 women with systemic lupus erythematosus seen at the University of Pittsburgh Medical Center from 1980 to 1993 (3,522 person-years). Subjects were stratified by age, and cardiovascular event incidence rates were determined. The authors compared these rates with cardiovascular event rates were determined. The authors compared these rates with cardiovascular event rates occurring over the same time period in 2,208 women of similar age participating in the Framingham Offspring Study (17,519 person-years). Age-specific rate ratios were computed to determine whether the cardiovascular events in the lupus cohort were greater than expected. The risk factors associated with cardiovascular events in women with lupus were determined. There were 33 first events (11 myocardial infarction, 10 angina pectoris, and 12 both angina pectoris and myocardial infarction) after the diagnosis of lupus: two thirds were under the age of 55 years at the time of event. Women with lupus in the 35- to 44-year age group were over 50 times more likely to have a myocardial infarction than were women of similar age in the Framingham Offspring Study (rate ratio = 52.43, 95% confidence interval 21.6-98.5). Older age at lupus diagnosis, longer lupus disease duration, longer duration of corticosteroid use, hypercholesterolemia, and postmenopausal status were more common in the women with lupus who had a cardiovascular event than in those who did not have an event. Premature cardiovascular disease is much more common in young premenopausal women with lupus than in a population sample. With the increased life expectancy of lupus patients due to improved therapy, cardiovascular disease has emerged as a significant threat to the health of these women. The impact of this problem has been underrecognized, with little focus placed on aggressive management of hypercholesterolemia and other possible risk factors.