Coping strategies during legally enforced quarantine and their association to psychological distress level: a cross-sectional study.

OBJECTIVES: The non-pharmacological measures to contain the COVID-19 pandemic may lead to considerable psychological distress. The aim of the CoCo-Fakt study was to investigate possible coping strategies and their effects on psychological distress during legally enforced quarantine of infected persons (IPs) and their close contacts (CPs). STUDY DESIGN: This was a cross-sectional cohort study. METHODS: From 12 December 2020 to 6 January 2021, all IPs and their CPs (n = 8232) registered by the public health department (Cologne, Germany) were surveyed online. Psychosocial distress and coping were measured using sum scores; free-text answers related to specific strategies were subsequently categorised. RESULTS: Psychosocial distress was higher in IPs than in CPs (P < .001). Although the mean coping score did not differ between both groups, it was influenced by the reason for quarantine (IP vs CP) besides gender, age, socio-economic status, living situation, psychological distress, resilience, physical activity and eating behaviour. This final regression model explained 25.9% of the variance. Most participants used active coping strategies, such as contact with the social environment, a positive attitude and hobbies. CONCLUSIONS: Although psychological distress was higher in IPs than in CPs during the quarantine period, the mean coping score did not differ. The strategies most frequently used by IPs and CPs were activating social networks, a healthy lifestyle and professional support systems, such as the health department helpline. Appropriate advice should be implemented to prevent long-term psychological consequences when supporting affected people.

Essential case management services for young children in foster care.

A growing number of children in the United States are being placed into foster care. Past studies indicate that effective case manager interventions have helped foster families with a variety of different problems. This study enrolled a randomly selected sample of 130 children under age four who had been newly placed into foster care. The purpose of this study was to identify the services needed by foster care families and determine which services require the most case manager effort. Consistent with other research, many foster care children in this study exhibited developmental, medical and psychosocial concerns. Nevertheless, we found that it was services aimed at the foster care parents, rather than the foster care children, that required the most labor-intensive case management services.

Combined radical retropubic prostatectomy and rectal resection.

OBJECTIVES: To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. METHODS: Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. RESULTS: All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. CONCLUSIONS: Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

Foster care children and family homelessness.

OBJECTIVES: This study examined the association between family homelessness and children's placement in foster care. METHODS: The prevalence of homelessness in a random sample of 195 young foster children was examined. RESULTS: Almost half of the birth parents of the foster children had experienced homelessness. Those children were more likely than other foster children to have siblings in foster care and to be place with nonrelatives. CONCLUSIONS: An extremely high prevalence of family homelessness was found among children in foster care. Policy implications of the association between family homelessness and placement into foster care are discussed.

Foster care's youngest: a preliminary report.

The impact of welfare reform on foster care is examined in relation to children's mental health. Initial assessment of 125 young foster children randomly assigned to a special program found that half rated below normal on mental and psychomotor development, with two-thirds below normal on emotional regulation and motor quality. Implications for social policy and program planning, and the need for ongoing research, are discussed.

Combining methods to identify new measures of women's drinking problems. Part I: The ethnographic stage.

In recent years, some researchers in the alcohol survey field have raised concerns about the shortcomings in severity/frequency scales for drinking and drinking problems used for both clinical and household survey purposes, especially with regard to women. This article reports on Part I of a two-part study that used ethnographic and survey methods to assess indicators of drinking problems among women across various US subcultures. Methodology for the ethnographic component consisted of three steps: analysis of findings in literature on indicators of women's drinking problems, and analysis of indicators addressed in the most commonly used standard instruments for alcohol assessment; semi-structured interviews with 12 specialists in treatment and/or research who focused on alcohol problems of women; and semi-structured interviews with 65 women from four ethnic populations who were clients in alcohol treatment centers. Analysis of these data from the ethnographic component produced a taxonomy of indicators of women's drinking problems and fourteen novel indicators that are not included or are inadequately examined in the most commonly used alcohol assessment instruments. The novel indicators were then incorporated into a questionnaire used for a county-wide survey of men and women that assessed indicators of drinking problems. Report of findings from the survey are presented in the second paper of this series.

Long-term histopathological changes observed in rats subjected to augmentation cystoplasty.

Possible development of proliferative lesions in bladders subjected to augmentation cystoplasty is a matter of concern for many clinicians. We have previously reported on the development of bladder papillomas in 5 of 15 rats approximately 18 months after gastrocystoplasty. We now report a followup study designed to investigate histopathological changes occurring in rat bladders approximately 2 years after augmentation cystoplasty using various gastrointestinal segments. Prepubescent Long-Evans female rats were randomly divided into 4 groups and underwent either gastrocystoplasty, ileocystoplasty, colocystoplasty or a sham operation (controls). Animals were sacrificed 14 to 27 months (average 21.5) postoperatively and bladders were examined histologically. Metaplastic and/or hyperplastic changes were observed in the gastrointestinal patches or surrounding urothelium in all bladders having undergone augmentation cystoplasty. Tumors occurred on or adjacent to the lumenal surface of the augmented segment in 4 of 10, 3 of 11 and 2 of 11 rats that underwent gastrocystoplasty, ileocystoplasty or colocystoplasty, respectively. None of the tumors was observed to invade blood vessels, lymphatics or the underlying muscle layers. However, histological features of malignancy characterized by varying degrees of cellular pleomorphism occurred in some tumors. Control rats (10) had only minor changes related to reapposition of tissues and remnants of suture. Possible etiologies and the potential significance of these augmentation cystoplasty related proliferative lesions are discussed.

Indomethacin suppositories versus intravenously titrated morphine for the treatment of ureteral colic.

STUDY OBJECTIVES: To develop a protocol for the blinded IV titration of morphine and to compare the analgesic efficacy and side effect profile of indomethacin suppositories versus IV morphine in the treatment of acute ureteral colic. DESIGN: Randomized, double-blind, double-dummy, two-period crossover study. SETTING: Emergency department of a central-city, teaching hospital. PARTICIPANTS: Patients 18 to 75 years of age with pain suggestive of ureteral colic. Exclusions included pregnancy, adverse reactions to the study drugs, chronic nonsteroidal anti-inflammatory drug (NSAID) therapy, or any pain medicine taken within four hours of ED admission. INTERVENTIONS: Patients were randomized to one of two groups: indomethacin 100-mg rectal suppository or morphine by IV titration (5-mg loading dose and up to two additional 2.5-mg doses if needed). At the end of 30 minutes, if adequate pain relief had not been obtained, treatment was crossed over. MEASUREMENTS: Verbal analog scale (initial pain) and visual analog pain relief scale. MAIN RESULTS: Seventy-five patients were entered into the study. Only data from those patients with stone presence confirmed by IV pyelogram or stone passage were analyzed. Twenty-four could not be evaluated (23 who did not meet criteria for stone presence and one whose pain resolved spontaneously before study medications could be administered). Of the remaining 51 patients, 31 received indomethacin first and 20 received morphine first. Morphine recipients reported more pain relief at ten minutes (P = .02), but at 20 and 30 minutes, no significant difference (P = .17 and .74, respectively) existed between the two groups. CONCLUSION: IV morphine produced more rapid analgesia than rectally administered indomethacin. There were no significant differences in vital sign changes or number of side effects between the two treatment groups. This study is the first to compare an NSAID with morphine administered by IV titration, considered by many to be the "gold standard" for relief of acute, severe pain. Future studies could evaluate the simultaneous administration of an opioid combined with an NSAID or compare an IV titrated opioid with an IV NSAID.

Development of an integrated case management program for vulnerable children.

Although case management is a recognized technique to organize and coordinate human services, its use with high-risk children is relatively new. This article describes the development of a case management program for children at the Center for the Vulnerable Child at Children's Hospital, Oakland, California, a health care setting that brings together health, social work, and child welfare services. Case management was introduced into multidisciplinary clinical programs for foster children, drug-exposed infants, and adolescent mothers and their infants. Case management activities differed in each of the clinical programs in relation to the unique characteristics of each population and the different obstacles encountered. A time management analysis indicated consequent differences in case management time allocations. The implications of these findings are discussed.

Urethral polyp presenting as interlabial mass in young girls.

We describe two young girls who presented with an interlabial mass. Histologic examination of each excised mass revealed a benign urethral polyp covered with transitional and squamous epithelium. Urethral polyps should be included in the differential diagnosis of an interlabial mass in young female patients.

Children in foster care in California: an examination of Medicaid reimbursed health services utilization.

The number of children in foster care in California doubled from 27,534 in 1980 to more than 62,419 in 1988, representing approximately 1% of the child population in the state. Past studies have demonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care. Although children in foster care represent 4% of Medi-Cal-eligible children younger than 18 years of age, they account for approximately 5% of children using Medi-Cal services and 6.7% of expenditures, representing a 23% greater utilization rate and 41% greater expenditure rate than all children covered by Medi-Cal. Using the entire Medi-Cal population younger than 18 years of age as comparison group, examination of inpatient and outpatient service utilization for specific condition categories showed few differences between children in foster care and the comparison group except for mental health service utilization, where children in foster care were much higher users of services.

Mental health service utilization by children in foster care in California.

An examination of Medi-Cal-paid claims was undertaken to assess the utilization of mental health services by children in California's foster care system. Using unduplicate counts of service use and diagnoses, it was determined that children in foster care account for 41% of all users of mental health services even though they represent less than 4% of Medi-Cal-eligible children. When partitioned into specific service categories, children in foster care account for 53% of all psychologist visits, 47% of psychiatry visits, 43% of Short Doyle/Medi-Cal inpatient hospitalization in public hospitals, and 27% of inpatient psychiatric hospitals. Expenditure for services paralleled utilization frequency. When compared to the non-foster care Medi-Cal-eligible child population, children in foster care have 10 to 20 times the rate of utilization per eligible child for selected services. For children in foster care, 75% of all diagnoses for billed service were accounted for by four diagnoses: adjustment disorders (28.6%), conduct disorders (20.5%), anxiety disorders (13.8%), and emotional disorders (11.9%), with clear age-related differences in the distribution of diagnoses.

Implementing critical health services for children in foster care.

This article reports recommendations that were developed at the California Conference on Health Care for Children in Foster Care, organized to discuss implementation in the state of CWLA's Standards for Health Care Services for Children in Out-of-Home Care. Programs and legislation developed in the state are also discussed.

Improving access to health care: case management for vulnerable children.

Health care providers are being confronted by a change in childhood morbidity from primarily physical problems to complex problems rooted in the social, family, and environmental conditions that accompany persistent urban poverty. The clustering of multiple problems in one family necessitates redefining preventive and treatment strategies. Yet the lack of coordination among federal, state and local service programs often exacerbates the vulnerability of these beleaguered children and families. Therapeutic case management is a powerful service coordination strategy for increasing access and improving the health of vulnerable children. An ongoing evaluation of one case management model at the Center for the Vulnerable Child at Children's Hospital in Oakland, California is described in this article. Process evaluation data show this model to be effective in improving comprehensiveness and continuity of care among participating families.

Early clinical experience with the transverse colon-gastric tube continent urinary reservoir.

The clinical results of the first 4 patients undergoing reconstruction with the transverse colon-gastric tube urinary reservoir are presented. All patients had a minimum 1-year follow-up. All 4 patients are continent with stable or improved renal function. Two patients required reoperation. Indications as well as possible modifications of this procedure are discussed.

Indicators of women's alcohol problems: what women themselves report.

In-depth interviews with 65 women in treatment contributed to a taxonomy of indicators of women's alcohol problems, with five major categories and numerous subcategories. The largest number of client indicators appeared in the Individual (psychological and behavioral) category. The Physiological category included unique indicators regarding physical appearance. Within the Social category, family/partner relationships were emphasized. The taxonomy can be useful in therapeutic assessments, to develop survey items, in comparative research, or in alcohol program development.

The clinical implications of brushite calculi.

The clinical history of 30 patients with a total of 46 proved brushite urinary calculi was reviewed. The patients were active metabolically with 87% having a history of multiple calculi. Of the brushite stones 61% appeared hyperdense on x-ray but they had no consistent shape. Of the patients who were metabolically evaluated 82% had treatable abnormalities. Treatment with percutaneous nephrostolithotomy or ureteroscopy and ureteral lithotripsy was 92% successful in rendering the patient stone-free, whereas, extracorporeal shock wave lithotripsy monotherapy resulted in a stone-free rate of only 11%. Brushite stone patients require aggressive treatment, full metabolic evaluation and close clinical followup.

Transverse colon-gastric tube composite reservoir.

We describe our technique for a new form of continent urinary diversion. This reservoir includes a detubularized segment of transverse colon to provide low pressure urine storage, tunneled ureteral reimplants to prevent reflux, and a tubularized gastric segment used as a continent catheterizable efferent limb. This technique provides a new option for continent diversion in a variety of patients.