Comparing practice patterns of consumer and non-consumer mental health service providers.

The practice patterns of consumer and non-consumer providers of assertive community treatment are compared using both quantitative and qualitative data collected as part of a randomized trial. Activity log data showed that there were few substantive differences in the pattern of either the administrative or direct service tasks performed by the two teams. In contrast, the qualitative data revealed that there were discernable differences in the "culture" of the two teams. The consumer team "culture" emphasized "being there" with the client while the non-consumer team was more concerned with accomplishing tasks.

Utilization of specialty mental health organizations by older adults: U.S. national profile.

Data from the four most recent biennial inventories of mental health organizations and general hospital mental health services conducted by the U.S. Department of Health and Human Services (1988 through 1994) were used to examine utilization of specialty mental health organizations by older adults. The data show steady inverse trends in utilization rates for inpatient and ambulatory care. The oldest clients (age 75 and older) had both the highest percentage decrease in use of inpatient services and the highest percentage increase in use of ambulatory services. The expected growth of the older adult population will challenge the ability of systems of care to maintain or increase the rate of ambulatory mental health care.

Client outcomes II: Longitudinal client data from the Colorado treatment outcome study.

The outcomes of a reform of the Denver mental health system, cosponsored by the state and the RWJF, are contrasted with changes in a comparison area of the state. The study examines the structural characteristics of the mental health system, staff attitudes and satisfaction, and client-reported services and outcome. Results indicate that, in Denver, structural changes, the introduction of new services, and an intervening financial crisis increased worker dissatisfaction. Client reports documented parallel changes in the following variables: continuity of care, unmet need for case management services, frequency of symptoms, and satisfaction with services. The reform had no impact, however, on most quality-of-life indicators. The possibly adverse consequences of centralizing the system and the indirect influences of system integration on quality of life are discussed.

Differentiated bronchiolar epithelium in alveolar ducts of rats exposed to ozone for 20 months.

The effects of exposure to 1.0 ppm of ozone for twenty months were studied in male Fischer 344 rats. Light microscopic, morphometric, and immunohistological approaches were used to determine the distribution and degree of differentiation of ciliated and nonciliated bronchiolar epithelial (Clara) cells lining alveolar ducts of the central acinus, a primary target of ozone-induced lung injury. Alveolar duct pathways extending beyond the level of the most proximal alveolar outpocketing of terminal bronchioles were isolated in longitudinal profile. The distance that ciliated and nonciliated bronchiolar epithelial (Clara) cells projected down each alveolar duct pathway was determined by placing concentric arcs radiating outward from a single reference point at the level of the first alveolar outpocketing. A high degree of heterogeneity in the magnitude of bronchiolar epithelial cell extension into alveolar ducts was noted for each isolation and animal. Age-matched control animals also demonstrated variation in the degree of bronchiolar epithelial cell extension down alveolar ducts. In animals exposed to ozone, a striking similarity was noted by scanning electron microscopy in the surface characteristics of cells lining both terminal bronchioles and alveolar ducts. The presence of Clara cell secretory protein in cells of bronchioles and alveolar ducts was also detected immunohistochemically and visualized using confocal laser scanning microscopy in the reflectance mode. Well-differentiated ciliated and nonciliated bronchiolar epithelial cells were found lining alveolar septal tips and alveoli up to a depth of 1,000 mu into the pulmonary acinus after 20 months of exposure to ozone. No evidence of inflammation was present in alveolar ducts, suggesting that epithelial cell transformations in alveolar ducts is a natural consequence of lifetime exposures to oxidant gases.

[Intramedullary nailing as an alternate method in the management of slow-healing or pseudarthrotic upper and lower leg fractures]. / Die Marknagelung als Methodenwechsel in der Versorgung verzögert heilender oder pseud-arthrotischer Ober- und Unterschenkelfrakturen.

Intramedullary nailing of delayed healing fractures and non-unions in the lower extremity is the method of choice in biological and biomechanical aspects. With the technic of interlocking screws the indication is extended to the metaphyseal areas of tibia and femur. By nailing as alternative method an ossification of fractures and non-unions can be reached at a rate of about 90 per cent. This result is rather unique in the literature. In the treatment of shaft non-unions after cast fixation or rigid stabilisation by plates or external fixation nailing must succeed throughout its weight-bearing system and only fails in the case of infection and wrong indication.