Health service utilization by people experiencing homelessness and engaging with community paramedics: a pre-post study.

OBJECTIVES: To compare health service utilization of patients interacting with a mobile integrated health care program consisting of advanced care paramedics delivering community paramedic care to people experiencing homelessness before and after their initial visit. METHODS: ED visits, physician claims, and pharmaceutical dispensations were compared in the year prior to and in the year following the initial community paramedic visit. Administrative databases were linked and utilization rates were calculated and analyzed between periods in this pre-post cohort study. RESULTS: The 1360 community paramedic patients included in this study had no significant change in ED visits (IRR: 1.02) following their initial visit. There were 17,699 ED visits in the pre-period and 18,398 visits in the post-period. There was an observed increase in rates of primary care physician claims (IRR 1.22) and pharmaceutical dispensations from community pharmacies (IRR 1.04). Patients who did not have pharmaceutical dispensations and those without physician claims in the pre-period were significantly less likely to not access these services in the post-period. CONCLUSIONS: In the year following the initial community paramedic visit there were small but significant increases in community-based care utilization of people experiencing homelessness. These data suggest that the continued development and implementation of paramedics as part of an interdisciplinary care team can increase access to care for a traditionally underserved population with complex health needs. Patients would likely benefit from the integration of community paramedics in community-based management that aim to improve access to care following ED visits.

RéSUMé: OBJECTIFS: Comparer l'utilisation des services de santé des patients interagissant avec un programme de soins de santé mobile intégrés composé d'ambulanciers paramédicaux de soins avancés fournissant des soins paramédicaux communautaires aux personnes sans domicile fixe avant et après leur visite initiale. MéTHODES: Les visites aux urgences, les demandes de remboursement des médecins et les prescriptions pharmaceutiques ont été comparées dans l'année précédant et dans l'année suivant la visite initiale du personnel paramédical communautaire. Les bases de données administratives ont été reliées, et les taux d'utilisation ont été calculés et analysés entre les périodes dans cette étude de cohorte avant et après. RéSULTATS: Les 1 360 patients paramédicaux communautaires inclus dans cette étude n'ont pas connu de changement significatif dans les visites aux urgences (IRR : 1,02) après leur visite initiale. Il y a eu 17 699 visites aux urgences dans la pré-période et 18 398 visites dans la post-période. On a observé une augmentation des taux de demandes de remboursement des médecins de soins primaires (IRR : 1,22) et des dispensations de produits pharmaceutiques par les pharmacies communautaires (IRR : 1,04). Les patients qui n'ont pas bénéficié d'une dispensation de produits pharmaceutiques et ceux qui n'ont pas fait l'objet d'une demande de remboursement par un médecin au cours de la période précédente étaient significativement moins susceptibles de ne pas avoir accès à ces services au cours de la période suivante. CONCLUSIONS: Au cours de l'année qui a suivi la première visite du personnel paramédical communautaire, on a constaté une augmentation faible mais significative de l'utilisation des soins communautaires par les personnes sans domicile. Ces données suggèrent que le développement et la mise en œuvre continus des ambulanciers paramédicaux au sein d'une équipe de soins interdisciplinaire peuvent accroître l'accès aux soins pour une population traditionnellement mal desservie et présentant des besoins de santé complexes. Les patients bénéficieraient probablement de l'intégration des ambulanciers communautaires dans la gestion communautaire qui vise à améliorer l'accès aux soins après une visite aux urgences.

Adjustment to infertility: the role of intrapersonal and interpersonal resources/vulnerabilities.

BACKGROUND: Great variability exists in the degree of adjustment to infertility, which in turn is known to influence wellbeing. The main objective of this study is to identify intrapersonal [neuroticism, adult attachment style (AAS), perceived internal control, meaning of parenthood and intrinsic religiosity] and interpersonal (social support and marital adjustment) associates of adjustment to infertility. METHOD: A cross-sectional analysis of 85 consecutive heterosexual women, attending three infertility clinics in northern India during July 2005-March 2006, participated in the study. A range of scales were used to measure the intrapersonal and interpersonal attributes. The degree of adjustment to infertility was assessed using the Fertility Adjustment Scale. The data were analysed using multiple regression. RESULTS: The intrapersonal model (49.3%) explained a larger proportion of variance than did the interpersonal model (28.4%). Perception of children as necessary for marital completion, and the avoidance type of AAS was associated with poorer adjustment and constituted intrapersonal vulnerabilities. In contrast, intrinsic religiosity, sexual satisfaction and familial support were associated with better adjustment and were identified as helpful intrapersonal and interpersonal coping resources. CONCLUSIONS: The findings of the study highlight the merit of understanding intra- and interpersonal attributes for achieving better wellbeing outcomes. These findings would also prove valuable for researchers and practioners involved in designing and implementing psychosocial interventions.

The relationship between health-related quality of life, pain and coping strategies in juvenile idiopathic arthritis.

OBJECTIVES: To investigate the relationship between health-related quality of life (HRQL), experience of pain and pain coping strategies in children with juvenile idiopathic arthritis (JIA). To compare reports describing these variables obtained from children and their parents. METHODS: Participants were 59 children aged 8 to 18 yr with JIA and their parents. Parents and children completed the PedsQL generic core scales and arthritis module, the visual analogue scale of the Varni-Thompson Pediatric Pain Questionnaire, and the Waldron/Varni Pediatric Pain Coping Inventory. Parents rated children's functional disability using the Childhood Health Assessment Questionnaire. RESULTS: Parents reported significantly lower scores (indicating worse HRQL) than children on five of the eight PedsQL scales rating children's HRQL. Parents and children reported a significant negative relationship between pain levels and the PedsQL scores assessing children's physical, emotional and social functioning. They also reported a significant negative relationship between scores on several pain coping scales and scores on the PedsQL scales. However, the pattern of these relationships varied for reports from parents and children. CONCLUSIONS: Pain intensity and pain coping strategies have a significant and independent relationship with several domains that comprise the HRQL of children with JIA. However, parents and children have differing perceptions of the nature of these relationships. The differences emphasize the importance of clinicians obtaining information about children's HRQL, pain levels and pain coping strategies from both parents and children.

The year of the Salmonella seekers--1977.

In 1977 two major outbreaks of salmonella infection originated in Victoria. The first of these, involving Salmonella Bredeney, continued over some seven months and was traced to contamination of powdered milk-based infant formulae during manufacture. This caused cases of gastroenteritis among young children throughout Australia. Another incident led to the discovery that salmonella serovars were colonising not one, but a number of dairy factories through the State. The second outbreak was of typhoid, stemming from a carrier working in a sandwich bar, and occurred during the course of the first, almost overwhelming public health resources and delaying investigation of the first outbreak. The background, recognition, course, investigation and resolution of these, previously unpublished, outbreaks are described, drawing upon the experiences of authors involved at the clinical, public health and laboratory levels, and preserved, contemporary records. Taken together, these outbreaks directly stimulated radical improvements in the construction and management of dairy factories in the State; initiated the adoption of risk management concepts in food factories; caused the launch of regional regulations compelling notification of salmonellas found in food manufacture; and led to the setting-up of an enhanced national, laboratory-based system for the collection, analysis and dissemination of information on enteric pathogens.

Unravelling age effects and sex differences in needle pain: ratings of sensory intensity and unpleasantness of venipuncture pain by children and their parents.

Age and sex differences were investigated in children's self-report of venipuncture pain. Equal numbers of boys and girls aged 3-15 years (n = 110) made separate ratings of the intensity and unpleasantness of their needle pain, using a paired Visual Analogue Scale (VAS) technique. The parents of these children used the same method to give ratings of predicted pain and unpleasantness before the needle, as well as ratings based on observing their child during the needle. Results showed that, across age, children's intensity and unpleasantness scores were highly correlated (r = 0.78), and that both of these ratings decreased with increasing age. Analyses of covariance showed that, with the variance in the unpleasantness ratings accounted for, a significant age main effect persisted for the intensity ratings (scores decreasing with increasing age), with no effect of sex. In the corollary analysis, with intensity scores entered as a covariate, unpleasantness ratings showed no main effect of age, but a significant main effect of sex emerged: girls' ratings of pain unpleasantness, when averaged across age, were significantly higher than boys'. The interaction between age and sex was explored in analysis of the relative difference between intensity and unpleasantness ratings. The results indicated that, from approximately 8-years of age, children (especially girls) gave significantly higher ratings of unpleasantness than sensory intensity of needle pain. Prior to the age of 8 years, children tended to give equivalent ratings of intensity and unpleasantness, with no evidence of a sex difference. The agreement between parental and children's ratings was higher for parents' observed, as opposed to predicted, scores, especially for pain intensity, with no systematic influence of the child's age and sex. In conclusion, it is suggested that age effects in children's self-report of needle pain are predominantly manifest in ratings of sensory intensity, whilst sex effects are predominantly manifest in ratings of an affective (unpleasantness) dimension. It is argued that both age and sex differences are largely the function of pain reporting variables, rather than reflecting fundamental age or sex based variance in nociceptive processing.

Prevalence of intellectual disability in northern Sydney adults.

The prevalence of intellectual disability, defined as IQ < 70, was determined in a population of adults aged 20-50 years who lived in the northern suburbs of Sydney, Australia. Case finding was carried out in the community, and all those ascertained were interviewed and psychometrically assessed. The overall prevalence was 3.31 per thousand with severe intellectual disability (IQ < 55) 2.19 per thousand and mild (IQ 56-70) 1.12 per thousand. Down's syndrome had a frequency of 0.96 per thousand. Thirty-eight per cent of the total group were living in institutional care.

Development of conceptual knowledge in children with mental retardation.

Nine and 14-year-old children with mild mental retardation and children without mental retardation matched for mental and chronological age were first shown a novel category made up of five visual figures. They were then given a recognition test with a set containing the previously presented figures, novel category members, and the category prototype. The relative contribution of prototypical and exemplar-specific information to subjects' performance on the recognition test was evaluated. Results showed that the children without mental retardation employed both forms of information in arriving at a recognition decision whereas both of the retarded groups tended to rely only on prototype information. Use of exemplar-specific information was also found to be positively correlated with IQ and, in particular, with measures of short-term memory span.

Developmental differences in the use of prototype and exemplar-specific information.

This study is an attempt to clarify the nature of developmental differences in the use of prototypical features or information about specific exemplars for object categorization and to identify stimulus factors that may modulate the use of these information sources. To this end, 6-year-olds, 11-year-olds, and adults were taught to sort visual patterns into one of two overlapping categories. Immediately or 24 h following category acquisition subjects were presented with a set of transfer stimuli consisting of both old and new patterns, including the theoretical prototype. Categorization responses to these test stimuli were examined against predictions derived from the prototype and nearest-old-exemplar accounts of categorization. A significant developmental change in the process of categorization was noted. For the youngest group, only the prototype model was found to fit the test data, whereas for the older groups both models independently explained significant amounts of variance in performance. This trend was not affected by the delay between training and testing, nor by a manipulation of intracategory variability. The emergence of the specific exemplar model as a viable explanation of ill-defined categorization thus appears to be related to the developmental level attained.

Hypothyroidism reduces content and increases in vitro release of pro-thyrotropin-releasing hormone peptides from the median eminence.

To determine the effect of thyroid status on proTRH-derived peptide processing and secretion, the content and release of TRH and prepro-TRH25-50 (PYE27), as well as somatostatin (SRIF) from median eminence (ME) or olfactory lobe (OL) tissue was studied in the rat. In hypothyroid animals treated by thyroidectomy (Tx), the ME content of TRH and PYE27 was reduced by more than 50%; further, when compared with euthyroid controls there was a significant 2-fold enhancement of the in vitro release of these peptides from ME fragments in response to depolarizing concentrations (60 mM) of potassium. Hyperthyroidism (T4 treatment) caused either no change or an increase in the ME content of these peptides and their response to K+ in vitro did not differ from control animals. The OL content of TRH and PYE27 was unaffected by thyroid status. SRIF levels in both ME and OL as well as in vitro secretion from the ME did not change with either Tx or T4 treatment. The ratio of TRH/PYE27 secretion throughout release and content studies remained stable at 3:1 to 4:1. These findings support the view that TRH in the hypothalamus but not OL is regulated by thyroid hormone. In this location hypothyroidism enhances not only pro TRH synthesis but also release of TRH and another proTRH-derived peptide. The consistent ratio of TRH/PYE27 suggests that regulation of TRH production by thyroid hormone occurs predominantly at the transcriptional level and not through posttranslation processing.

Third-party fee for service in children's mental health: limitation and suggestions.

The current third-party fee-for-service mode of reimbursement for mental health services emphasizes individual, pathology-oriented intervention and thus has disadvantages for clients and carriers. This article focuses on the mode's effects on outpatient services for children, youth, and families. It examines the ways in which common payment modes seriously limit services and create an incentive for psychologists to take a narrow, often nonempirical, perspective. Suggestions that allow for multisystem, ecological skill building hinge on building relationships between psychologists and the carriers. Desired results take two forms: modification of contingencies between providers and carriers and modification of contingency between insured and carrier. Examples of each are presented.

Feature-processing deficits following brain injury. I. Overselectivity in recognition memory for compound stimuli.

A previous experiment (S. Wayland & J.E. Taplin, 1982, Brain and Language, 16, 87-108) demonstrated that aphasic subjects had particular difficulty performing a categorization task, which for normals involves abstraction of a prototype from a set of patterns and sorting of other patterns with reference to this prototype. This study extended the investigation to a recognition memory task similarly organized in categorical structure. The aim was to replicate the previous findings and to delineate the precise nature of aphasics' difficulties with such tasks. Aphasics were again found to be aberrant in performing this task in comparison with normal subjects, nonaphasic brain-injured control subjects also demonstrating a departure from normality. The results suggest that the problem for brain-injured subjects is one of overselectivity in terms of the features of the stimuli to which they respond rather than a difficulty with prototype abstraction itself.

Feature-processing deficits following brain injury. II. Classification learning, categorical decision making, and feature production.

The claim that overselectivity in feature processing underlies the disorders that aphasics display in processing both visual and verbal material was directly tested by exploring the relationships between the behavior of brain-injured subjects on three experimental tasks: classification learning, categorical decision making, and feature production. From each of these tests a score selected as being indicative of overselective responding was entered into a principal components analysis, together with measures of visual recognition and memory, visual reasoning, naming skills, and severity of aphasia. This analysis supported the assumption that feature-processing disability is a specific and separable deficit, although related both to naming ability and to severity of aphasia. The relevance of the overselectivity hypothesis to naming difficulties following brain injury is discussed.

The distribution of specific phage types of Salmonella typhimurium in chickens in Australia.

The distribution of specific phage types of Salmonella typhimurium within the Australian chicken industry has been studied and documented on an Australia-wide and state-by-state basis. A total of 1799 strains of S. typhimurium were obtained from Australia-wide sources and phage typing categorized 1498 of these isolates into 30 distinct phage types, with the remaining 301 strains untypable. Five phage types, 6, 26, 31, 135 and 179, accounted for 76% of the total strains typed, with the remaining 24% of strains being distributed among 25 phage types. Of the major phage types, type 31 was restricted to Victoria and Western Australia, but the other types were distributed throughout Australia. In addition, the antibiotic resistance pattern of the various phage types was determined and only five of the 30 phage types showed appreciable levels of resistance.

Evaluation of hypotheses in concept identification.

The aim of this paper is to investigate the nature of hypothesis evaluation in conceptual tasks, especially in the identification of bidimensional concepts. In such tasks, hypothesis testing is seen as being composed of sampling and evaluation stages. With complex problems only one hypothesis seems likely to be sampled on each trial, and it is suggested that this hypothesis is evaluated according to a statistical decision-making process. In Experiment I, Ss were given an initial hypothesis involving one of eight rules and required to test it in an attempt to find a concept. When this given hypothesis was true (i.e., the concept), no difference was found between rules for the number of instances selected to the criterion of solution. Moreover, there was a tendency for Ss to choose instances which were predicted to be positive according to the hypothesis under test. Experiment II examined the role of memory in hypothesis testing. Immediate recall of instances selected revealed no difference between true and false hypotheses. Both primacy and recency effects were evident in recall. The number of instances correctly recalled was more than expected by models of hypothesis sampling and evaluation, and this was attributed to Ss having a low criterion for recall without intrusions. Examination of intrusions suggested that Ss may have retained some, but not all, of the features of the stimuli selected. Some differences were found between rules and between positive and netative instances on recall. These effects were suggested to be due to different amounts of information processing when classifying each type of instance for each rule; the results of Experiment III supported this suggestion.