Understanding patients from the former Soviet Union.

BACKGROUND: Increasing numbers of immigrants from the former Soviet Union (FSU) are coming to the United States. Educated and resilient, this population has many ethnic origins, but all have shared a common experience under the Soviet system and the deterioration of health care since the collapse of the Soviet Union. An ethnomedical approach was used to review published work and integrate material obtained in interviews with physicians in the FSU. Information is organized into concepts of causality, therapists, and forms of therapy. FSU medicine incorporates many Western treatments but also uses natural and spa remedies. Mainstream FSU physicians make diagnoses and use therapies that are unknown in the West. In addition, the active traditions of folk medicine and magical curing persist. US health care practitioners need to go to extra lengths to understand the perspectives and experiences of these patients and must explain basic concepts of health care in this country that will be new. An open approach to the patients' non-Western beliefs and remedies will support a successful patient-practitioner interaction.

The health status of elderly persons in the last year of life: a comparison of deaths by suicide, injury, and natural causes.

OBJECTIVES: This study identified health status variables related to suicide by elderly persons and compared the health status of suicide decedents with natural death and injury decedents. METHODS: Data were obtained from the 1986 National Mortality Followback Survey. RESULTS: When other variables were controlled for, suicide decedents were significantly more likely than injury decedents to have a history of cancer (odds ratio [OR] = 51.94), moderate (OR = 29.37) or heavy (OR = 22.87) alcohol use, and mental or emotional disorder (OR = 10.91) and to be White (OR = 18.54) and male (OR = 9.12). CONCLUSIONS: The findings indicate that a history of cancer should be considered as a risk for suicide in the elderly.

Functional status and the use of formal home care in the year before death.

A national sample of persons who died in 1986 was analyzed to obtain a valid estimate of the relationship between functional status and the provision of formal home care during the last year of life. Community-based care has become increasingly important as the size of the elderly population increases and the cost for institutional care rises. When people need help in caring for themselves because of illness, frailty, or disability, community-based care may be more appropriate than acute or institutional care. The year before death is often a time of dependence and a high intensity of health service consumption. Although care at home is provided primarily by families, formal home care is also a critical component in any continuum of care.

A comparison of clinical evaluation tools in hospitals and baccalaureate nursing programs.

This study compared nurse educators' and hospital administrators' expectations of graduating baccalaureate students by analyzing the content of clinical evaluation tools in two settings: the last medical-surgical rotation and the beginning staff-level position. Ten baccalaureate nursing programs and 10 large university hospitals were studied as pairs. Evaluation tool criteria were divided into six role categories: care giver, client teacher, manager-team member, communicator, investigator, and professional. The study yielded data regarding similarities and differences regarding behaviors expected by schools and hospitals. The highest rates of similarity were found in the care giver and professional roles. The greatest difference was found in the manager-team member role with hospitals including many more of the behaviors. Few behaviors in the investigator role were included by school-hospital pairs, but schools included more of the behaviors than hospitals.