Close relationships and disordered eating: Partner perspectives.

The role and potential significance of romantic partners have been acknowledged in the eating disorder literature; yet, few studies have addressed partner perspectives, and none of these have involved dating relationships or considered the implications of the initiation of recovery for partner perceptions. In this study, common themes in the analysis of 12 partner interviews included changing understandings of disordered eating, development of strategies to support their partners, and lack of resources. In addition, participants whose partners did not initiate recovery reported confusion and helplessness, while those whose partners initiated recovery expressed responsibility for and gratification in the positive changes.

Older Women in New Romantic Relationships.

Although research has found that sexual activity declines with age, most of this literature examines people in long-term marriages. Little is known about the initiation of new sexual relationships in later life. In-depth interviews with 14 women aged 64 to 77 years were conducted to examine their personal and collective narratives regarding sexuality in later life. In contrast to common perceptions, none of the participants felt that aging had negatively impacted their own sexuality. For many, this was a time in their lives when they were experiencing renewed sexual desire and enjoyment. Even though sex might not have held the same priority as when they were younger, it held a place of importance in their romantic relationships. The discussion focuses on understanding women's sexual relationships and behaviors within the context of their cohort and lives.

Using attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR) to study the molecular conformation of parchment artifacts in different macroscopic states.

Maintaining appropriate temperatures and relative humidity is considered essential to extending the useful life of parchment artifacts. Although the relationship between environmental factors and changes to the physical state of artifacts is reasonably understood, an improved understanding of the relationship between the molecular conformation and changes to the macroscopic condition of parchment is needed to optimize environmental conditions. Using Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR FT-IR) analysis, the conformation of the molecular structure in selected parchment samples with specific macroscopic conditions, typically discoloration and planar deformations (e.g., cockling and tearing), have been made. The results of this investigation showed that the Fourier transform infrared signal differs for parchment samples exhibiting different macroscopic conditions. In areas exhibiting planar deformation, a change in the Fourier Transform Infrared signal was observed that indicates unfolding of the molecular conformation. In comparison, the discolored samples showed a change in molecular conformation that indicates a chemical change within the collagen molecular structure. This paper discusses the possible causal associations and implications of these findings for the conservation and preservation of parchment artifacts.

Older adults navigating medicare: when benefits are denied.

Guided by Bourdieu's theory of practice and symbolic violence, this qualitative study explored experiences and perceptions of elderly beneficiaries who had been denied rehabilitation services by Medicare. In semistructured interviews, 12 beneficiaries or family members told of the physical, psychological, and financial consequences of service denial/termination. The resulting perception of Medicare was as a cumbersome, difficult to negotiate system. Findings have implications for future research on service denial and indicate the need for better communication with, and support of, consumers by health care professionals when this occurs.

Meal patterns and food choices of young African-American men: understanding eating within the context of daily life.

Although young African-American men are at particularly high risk of developing hypertension at an early age, dietary interventions that have successfully reduced blood pressure among African-American adults have not been translated into programs for this group. Life contexts such as school enrollment, participation in competitive athletics, and employment influence the daily activities and meal patterns of African-American men. This study explored the activities of young African-American men to identify opportunities to increase healthful food choices. A purposive sample was recruited that included five groups of African-American men aged 15 to 22 years (N=106): high school athletes and nonathletes, college athletes and nonathletes, and nonstudents. A structured interview guided participants through a description of their activities, meal patterns, and food choices during the course of a typical weekday. Common elements emerged that provided a contextual view of the participant meal patterns and food choices. These elements were sports team participation, college employment, school as a food source, nonstudent status, and eating dinner at home. These findings suggest opportunities for the design of dietary interventions for young African-American men that take into consideration how school, athletics, and employment may influence opportunities to eat regular meals that include healthful foods.

Women narrate later life remarriage: Negotiating the cultural to create the personal.

Narrative provides a window to experience in a way that is different from traditional research methods. In this study, narrative affords both a holistic vantage point on later life relationships, and at the same time, a "view from the inside"-older women's own accounts of single life, relationship development, and remarriage. The narratives were obtained in interviews with eight recently remarried women between the ages of sixty-five and eighty. A two-stage analysis addresses, first, the narrative content-the phenomenology of remarriage for these older women. The second stage focuses on process, analyzing how cultural-level narratives are drawn upon in the creation of the women's personal stories. Based upon these analyses, we discuss the ways that a narrative approach can inform our understanding of later life relationships, and we comment on the potential of narratives such as these to rewrite a script for older women's relationships.

"It has made college possible for me": feedback on the impact of a university-based center for students in recovery.

OBJECTIVE: The authors aimed to gain information on (1) the challenges for recovering students on a university campus and (2) the most helpful components of a collegiate recovery program. PARTICIPANTS: The 15 students in the study were all in recovery from substance abuse. They entered the university and also entered the campus recovery program either in fall 2002 or fall 2003. METHODS: Semistructured interviews were conducted with students multiple times during their first academic year. RESULTS: Participants identified several challenges on the university campus. Many believed they would have dropped out of school or relapsed without the support of the recovery program, and they described aspects of the program that were particularly important to them. CONCLUSIONS: Support from a campus recovery program is essential for many recovering students. There are a variety of recovery program components that can foster the sense of community that was so important to the students in this study.

Situating alcohol use and delinquency within developmental and societal context: the case of Korean youth.

In this study involving self-report questionnaire data from 955 tenth-grade students in three locations within Korea, we address the meanings of alcohol use and delinquency for Korean youth. Findings (a) supported a facilitative role for alcohol, but not delinquency, with respect to perceived peer social competence; (b) indicated negative associations of both alcohol use and delinquency with parental relations, valuing academic achievement, and collectivistic values, and positive associations with friends' risk behaviours; (c) showed no relationship of these behaviours with self-esteem, coping, parental permissiveness or individualistic values; and (d) revealed that perceived benefits of alcohol use and delinquency include not only social facilitation but also exploration and assertion of independence, suggesting a potential connection, as in Western societies, between risk taking, and identity exploration.

Narratives of development, experiences of risk: adult women's perspectives on relationships and safer sex.

Mid-life women are increasingly at risk for HIV/AIDS, yet relatively few studies have targeted this age group. In this study, we explored views of relationships and safer sex practices among eight well-educated, single, heterosexual adult women through in-depth interviews and supplemental questionnaires. The women viewed themselves as competent, responsible, and mature in terms of their relationship and sexual choices. However, their actual sexual practices, and reasons given for these practices, were similar to those of adolescents and of inner-city women living in high-risk environments. Findings are significant in highlighting the power and importance of relationship factors, especially trust, as these relate to safer sex practices and prevention initiatives.

Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomised controlled trial.

BACKGROUND AND PURPOSE: Evidence on which to base decisions about the management of radiation skin reactions is lacking. The purpose of this study was to investigate whether sucralfate or aqueous cream reduced acute skin toxicity during radiotherapy to the head and neck, breast or anorectal area (phase A), and to evaluate the effect of hydrogels and dry dressings on moist desquamation (phase B). This paper presents the results of phase A. PATIENTS AND METHODS: Three hundred and fifty seven patients were randomised to apply aqueous cream, sucralfate cream or no cream to the irradiated area from day one of radical radiotherapy treatment. All patients were instructed to wash using unperfumed soap. Acute skin toxicity was measured using a modified radiation therapy oncology group (RTOG) score, reflectance spectrophotometry, patient diary card and dermatology life quality index (DLQI). A cost minimisation approach was used to compare the costs of each skin care approach. RESULTS: No consistent differences were found in the severity of skin reactions or levels of discomfort suffered by patients in each of the randomised groups. Patients with a higher body mass index, who smoked, received concomitant chemotherapy, boost or bolus during treatment were more likely to develop skin reactions. CONCLUSIONS: There is no evidence to support the prophylactic application of either of the creams tested for the prevention of radiation skin reactions. Our results show that it is possible to predict which patients are at greatest risk of skin reactions. We suggest that known risk factors should be incorporated into future study protocols.

Self-reflecting in developmental context: variations in level and patterning during the first 2 university years.

Self-reflection, typically operationalized in scales of egocentrism and introspectiveness, is portrayed as problematic in much of the literature on adolescents. Self-reflection has been linked to dysfunctional self-consciousness, symptomatology, and risk behaviors. Yet, self-reflection also is seen as essential for adolescent development, particularly with respect to individuation and identity. In this exploratory study, the authors focused on the process of self-reflecting. From interviews with 10 students conducted over the first 2 university years, the authors longitudinally assessed and then evaluated self-reflecting patterns in relationship to a narrative analysis of developmental change. Students who showed evidence of developmental change or sustained engagement in developmental work over the study period devoted a higher percentage of their interview conversation to self-reflecting content. Differences in self-reflecting patterning over time among the students who showed developmental change further suggest linkages between self-reflecting and development. The authors discuss implications for the conceptualization of self-reflecting in relationship to development and for the reinterpretation of previous studies.

Individual differences in attachment-autonomy configurations: linkages with substance use and youth competencies.

Variations in attachment-autonomy configurations are explored as these relate to substance use and several adolescent competencies. Questionnaires completed by 470 university students included measures of parental attachment, autonomy (both emotional autonomy and self-reliance), substance use, problems associated with substance use, social competencies, and coping. Analyses of subgroups representing four attachment-autonomy patterns, derived from cluster analysis, showed higher competency levels and fewer problems related to substance use for the group combining strong attachment and self-reliance coupled with low levels of emotional autonomy. A subgroup characterized by low father but moderate mother attachment security differed in a number of ways from a subgroup reporting low attachment to both parents. Findings support the utility of a typological approach in investigations of adolescent attachment and autonomy.

Extent of services provided by pharmacists in the Iowa Medicaid Pharmaceutical Case Management program.

OBJECTIVE: To summarize the start-up experience with patients identified as eligible during the first four quarters of the Iowa Pharmaceutical Case Management (PCM) program and to characterize the extent of the services proved by pharmacists in the program. DESIGN: Prospective pharmaceutical care intervention project. SETTING: One hundred seventeen community pharmacies in Iowa. PATIENTS: Medicaid patients at high risk for drug-related problems based on using 4 or more nontopical medications and having 1 of 12 specific disease states. INTERVENTION: To become eligible to provide PCM services, licensed pharmacists had to undergo training and submit five care plans to the Iowa Department of Human Services. Community pharmacists were provided names of newly eligible patents each calendar quarter for 1 year. For each patient, pharmacists were asked to indicate by fax whether they had met with the patient, performed a written work-up of the patient, sent recommendations to the patient's physician, and whether the physician replied. When pharmacists were unable to provide the service, they were asked to state the reason. Both the pharmacist and the physician receive $75 for the initial assessment, with additional payments after each follow-up visit performed. MAIN OUTCOME MEASURES: An intensity score and the percentage of eligible patients for whom all steps were completed were calculated for each pharmacy. RESULTS: Fax survey results were retumed for 2,834 (96.7%) of the 2,931 patients eligible for PCM services. Pharmacists met with 943 (33.3%), worked up 763 (26.9%), sent recommendations to physicians for 500 (17.6%), and received replies from physicians for 327 (11.5%) patients. Pharmacists were unable to provide PCM services for 1,891 (66.7%) patients. The primary reasons given for this inability to provide services were patient access issues for 438 (23.2%) patients, pharmacy staffing or start-up issues for 419 (22.2%) patients, or no reason specified for 575 (30.4%) patients. A PCM intensity score was developed to represent the scope of services provided and the number of patients served. A higher intensity score indicated pharmacies that provided PCM to more patients and/or that offered higher levels of care (e.g., provided a written set of recommendations to the physician rather than simply assessing the patient without preparing or sending recommendations). Future evaluations will determine the validity of the score on the basis of patient outcomes. CONCLUSION: Some pharmacies implemented PCM services very effectively. However, 40% to 60% of the pharmacies provided little or no PCM services within 3 months of notification of patient eligibility. Future investigations will evaluate the quality of prescribing and quality of life for patients who received PCM services.

Extent of services provided by pharmacists in the iowa medicaid pharmaceutical case management program.

OBJECTIVE To summarize the start-up experience with patients identified as eligible during the first four quarters of the Iowa Pharmaceutical Case Management (PCM) program and to characterize the extent of the services proved by pharmacists in the program. DESIGN Prospective pharmaceutical care intervention project. SETTING One hundred seventeen community pharmacies in Iowa. PATIENTS Medicaid patients at high risk for drug-related problems based on using 4 or more nontopical medications and having 1 of 12 specific disease states. INTERVENTION To become eligible to provide PCM services, licensed pharmacists had to undergo training and submit five care plans to the Iowa Department of Human Services. Community pharmacists were provided names of newly eligible patients each calendar quarter for 1 year. For each patient, pharmacists were asked to indicate by fax whether they had met with the patient, performed a written work-up of the patient, sent recommendations to the patient's physician, and whether the physician replied. When pharmacists were unable to provide the service, they were asked to state the reason. Both the pharmacist and the physician receive $75 for the initial assessment, with additional payments after each follow-up visit performed. MAIN OUTCOME MEASURES An intensity score and the percentage of eligible patients for whom all steps were completed were calculated for each pharmacy. RESULTS Fax survey results were returned for 2,834 (96.7%) of the 2,931 patients eligible for PCM services. Pharmacists met with 943 (33.3%), worked up 763 (26.9%), sent recommendations to physicians for 500 (17.6%), and received replies from physicians for 327 (11.5%) patients. Pharmacists were unable to provide PCM services for 1,891 (66.7%) patients. The primary reasons given for this inability to provide services were patient access issues for 438(23.2%) patients, pharmacy staffing or start-up issues for 419(22.2%) patients, or no reason specified for 575(30.4%) patients. A PCM intensity score was developed to represent the scope of services provided and the number of patients served. A higher intensity score indicated pharmacies that provided PCM to more patients and/or that offered higher levels of care (e.g., provided a written set of recommendations to the physician rather than simply assessing the patient without preparing or sending recommendations). Future evaluations will determine the validity of the score on the basis of patient outcomes. CONCLUSION Some pharmacies implemented PCM services very effectively. However, 40% to 60% of the pharmacies provided little or no PCM services within 3 months of notification of patient eligibility. Future investigations will evaluate the quality of prescribing and quality of life for patients who received PCM services.

Age-related parenting stress differences in mothers of children with spina bifida.

This study examined whether ages of child and parent were risk factors for general parenting stress and disability-specific stress in families of children with spina bifida. Parents of 64 children with spina bifida completed the Parenting Stress Index-Short Form, Parents of Children with Disabilities Inventory, and measures of family support and resources. Scores of families with children under 6 years (preschool) versus 6- to 12-yr.-old children (school age) were compared, as were scores of mothers above or below Age 35. Parents of school-aged children reported significantly higher stress on the Concerns for the Child domain of the Parents of Children with Disabilities Inventory. Mothers over 35 tended to report higher stress in the Concerns for the Child and Medical/Legal Concerns domains of the Parents of Children with Disabilities Inventory. No associations with medical severity, socioeconomic status, family resources, or family support were detected. As the children age and disability-related differences become more apparent, the same level of functioning and severity of disability may be associated with additional parenting stress. Older mothers and those with school-age children may need more resources than current social support systems typically provide.

Antibiotic resistance: the Iowa experience.

BACKGROUND: In the past 10 years, the number of strains of Streptococcus pneumoniae and other common respiratory pathogens that are resistant to penicillin has increased. OBJECTIVE: The Iowa Department of Public Health convened a multidisciplinary task force in January 1998 to develop strategies to combat antibiotic resistance in the state because they were alarmed by these reports. METHODS: Within 18 months, the task force implemented statewide surveillance of resistant organisms and posted information about the surveillance on the Internet, distributed a public health guide on judicious antibiotic use and infection control measures to 7500 healthcare providers, and held a press conference to inform the public about antibiotic resistance. The task force collaborated with several major insurers in the state to profile the top prescribers of antibiotic agents in their plan. RESULTS AND CONCLUSIONS: The profiling and educational interventions led to a substantial decrease in both overall antibiotic prescribing and drug costs. Other states may want to undertake similar programs to help protect their citizens from infections caused by resistant pathogens.

The effect of financial risk arrangements on service access and satisfaction among medicaid beneficiaries.

OBJECTIVE: The relationship between financial risk arrangements, access to services, and consumer satisfaction with services was assessed in a sample of Medicaid beneficiaries who were enrolled under three different financial risk arrangements for health care and mental health care. METHODS: A survey was mailed to a stratified random sample of 9,449 recipients of Supplemental Security Income. Respondents reported their health and mental health service needs, service use, and satisfaction with services. Access was measured in terms of service needs that were met. RESULTS: Access to services was related to the type of risk arrangement. Respondents who were enrolled in plans that assumed the risk for the cost of services had poorer access to services than respondents who were enrolled in plans that did not assume the risk for the cost of these services. Satisfaction with medical services was negatively related to the plan's assuming the risk for medical expenditures. CONCLUSIONS: Financial risk arrangements may have important implications for service use patterns among persons who have disabilities. Health and mental health policy makers should carefully consider risk arrangements when designing health plans for vulnerable populations.