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Descriptors:
Intervention; Older Adults; Housing; Home Visits; Pharmacy; Public Housing; Nursing Education; Health Sciences; Service Learning; Prevention; Grants; Clinical Experience; Pharmaceutical Education; College Faculty; Partnerships in Education; Nutrition; Medical Evaluation; Cooperation

Abstract:
Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences for students by partnering with the College of Pharmacy, the College of Clinical & Rehabilitative Health Sciences, and the local public housing authority. Select faculty from each college met and developed a plan to form student teams from all three colleges to conduct in-home comprehensive medical and nutrition assessments and medication chart reviews of high-risk older adults. Following the in-home visit, students and faculty discuss the assessment findings at planned interprofessional meetings. Students present their findings from each discipline's perspective and collaboratively set health priorities and develop intervention strategies and an inclusive follow-up plan. Excerpts from students' reflective narratives discussing the impact of the interprofessional service-learning experiences are shared. (Contains 5 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Foreign Countries; Probability; Males; Heart Disorders; Diabetes; Followup Studies; Clinical Diagnosis; Older Adults; Medical Evaluation; Death; Cancer; Mortality Rate; Risk; Multivariate Analysis

Abstract:
Purpose: Of all Canadian and American men who live to age 75 years, about half can expect to live to age 85. Our objective is to examine how clinical diagnoses made before age 75 relate to a man's survival to age 85 years. Design and Methods: Since 1948, a cohort of 3,983 young men (mean age of 31 years at entry) has been followed with routine contact and medical examinations to prospectively document incident disease. Over 62 years of follow-up, 2,414 of the cohort lived to celebrate their 75th birthday. Of these survivors, 1,060 (44%) died before their 85th birthday. Cox proportional hazard models were used to examine the effects of ischemic heart disease, cancer, cerebrovascular disease, diabetes mellitus, peripheral arterial disease, and chronic obstructive pulmonary disease on all-cause mortality between age 75 and 85 years. Results: Modeled as six binary risk factors at age 75 years, all were significantly (p less than 0.01) and independently related to 10-year mortality. Multivariate risk ratios ranged from 1.36 to 1.46 except for chronic obstructive pulmonary disease with a risk ratio of 1.85 (95% CI: 1.38, 2.49). The cumulative 10-year probability of survival from age 75 to 85 among men with none of these diagnoses was 63%, 52% for any one diagnosis, 39% for two diagnoses, and 22% for three or more diagnoses. Implications: Joint independence of these six common clinical diagnoses implies that each is important and their effects on mortality are cumulative. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Elder Abuse; Persuasive Discourse; Law Enforcement; Crime; Comparative Analysis; Older Adults; Referral; Regression (Statistics); Predictor Variables; Intervention; Interdisciplinary Approach; Medical Evaluation; Records (Forms); Neuropsychology; Psychological Testing; Cooperation; Court Litigation; Scores

Abstract:
Purpose: Despite growing awareness of elder abuse, cases are rarely prosecuted. The aim of this study was to examine the effectiveness of an elder abuse forensic center compared with usual care to increase prosecution of elder financial abuse. Design and Methods: Using one-to-one propensity score matching, cases referred to the Los Angeles County Elder Abuse Forensic Center (the Forensic Center) between April 2007 and December 2009 for financial exploitation of adults aged 65 and older (n = 237) were matched to a population of 33,650 cases that received usual care from Adult Protective Services (APS). Results:1 Significantly, more Forensic Center cases were submitted to the District Attorney's office (DA) for review (22%, n = 51 vs. 3%, n = 7 usual care, p less than 0.001). Among the cases submitted, charges were filed by the DA at similar rates, as was the proportion of resultant pleas and convictions. Using logistic regression, the strongest predictor of case review and ultimate filing and conviction was whether the case was presented at the Forensic Center, with 10 times greater odds of submission to the DA (Odds ratio = 11.00, confidence interval = 4.66-25.98). Implications: Previous studies have not demonstrated that elder abuse interventions impact outcomes; this study breaks new ground by showing that an elder abuse multidisciplinary team increases rates of prosecution for financial exploitation. The elder abuse forensic center model facilitates cooperation and group problem solving among key professionals, including APS, law enforcement, and the DA and provides additional resources such as neuropsychological testing, medical record review, and direct access to the Office of the Public Guardian. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Risk; Health Behavior; Youth; Drinking; Depression (Psychology); Foreign Countries; Suicide; Trend Analysis; Predictor Variables; Cross Cultural Studies; Human Body; Self Concept; Comparative Analysis; Medical Evaluation; Clinical Diagnosis; Diseases; Body Weight; Mental Health; Health Services

Abstract:
Suicidal trends and related characteristics such as sociodemographic factors, psychological factors, and health behaviors can differ between countries. This study investigated the predictors of suicidal ideation and attempted suicide including health behaviors among American and Korean youth from two national representative data sets. In both countries, depression was the most predominant predictor to suicidal ideation and attempted suicide. Unique predictors of suicidal youth in each country were also found. In America, attempted suicide was predicted by poor body image, whereas in Korea attempted suicide was predicted by medical diagnosis such as asthma, concern about weight, and alcohol consumption. The value of our approach lies in the comparative analysis of analogous and unique characteristics of suicidal youths in these two huge data sets from different countries. These results should be helpful for school and mental health care providers to plan interventions for youth at risk of suicide to prevent suicidal completion in these nations. (Contains 5 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Employment Level; Educational Attainment; Alcohol Abuse; Depression (Psychology); Attention Deficit Hyperactivity Disorder; Case Studies; Questionnaires; Incidence; Referral; Clinics; Prediction; Medical Evaluation; Records (Forms); Multiple Regression Analysis; Income; Comorbidity; Substance Abuse; Stimulants; Adults; Correlation; Age

Abstract:
Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in the present study. Cross-sectional data were collected from the participant's medical records and from self-report questionnaires. A multiple regression model was applied to identify possible predictors of occupational outcome. Results: Only 22.2% had ordinary work as their source of income, compared with 72% in the general population. The most prevalent comorbid disorders were lifetime depression (37.8%), substance abuse (28.1%), and alcohol abuse (23.3%). Age at first treatment with central stimulants and inattentiveness negatively predicted occupational outcome. Conclusion: Adult ADHD was associated with lower educational attainment and lower level of employment. Later age of first central stimulant treatment and higher inattentiveness ratings were associated with lower level of employment. (Contains 3 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Teaching Methods; Superintendents; Expertise; Principals; Teachers; Medical Education; Medical Evaluation; Educational Improvement; Educational Strategies; Classroom Observation Techniques; Power Structure; Professional Development; Models; World Views

Abstract:
This article examines the literature on medical rounds to inform the recent move toward instructional rounds as a practice of districtwide improvement and professional learning for superintendents and administrators. Based on the practice of medical rounds as a method for creating shared norms and understandings about medicine and patient care, instructional rounds is a process in which networks of superintendents (and, increasingly, principals and teachers) observe and analyze classroom teaching to develop shared norms and understandings about instruction. Research on the practice of medical rounds highlights potential challenges for the medical community that also might apply to education: challenges of purpose, worldview, pedagogy, content, expertise, voice, and power/status. Understanding and addressing these challenges can inform the development of instructional rounds. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Identification; Intervention; Clinical Teaching (Health Professions); Clinical Experience; Feedback (Response); Communication Skills; Video Technology; Educational Benefits; Workshops; Medical Education; Physician Patient Relationship; Medical Students; Scores; Comparative Analysis; Teaching Methods; Clinical Diagnosis; Medical Evaluation; Instructional Effectiveness

Abstract:
Background: Effective communication is essential to the practice of high-quality medicine. There are methodological challenges in communication skills training. This study was performed in order to assess the educational benefits of communication skills training by video feedback method versus traditional formats such as lectures on clinical skills. Methods: This study was performed in 2005-2006 at Isfahan University of Medical Sciences. Forty medical students were involved in this study. We had 20 medical students in each group. Both groups first participated in communication skills classes and then their communication skills were evaluated with an objective structured clinical examination (OSCE1). Then group 1 participated in a video feedback workshop and their communication skills were evaluated by OSCE2 two months after the course. The communication skills of group 2 were re-evaluated by OSCE2 after two months. The score of OSCE1 and OSCE2 of both groups were compared. Results were analysed using SPSS 11.5. Results: The mean score of communication skills in OSCE1 of both groups were compared and the results showed that there was no significant difference between the both groups (p = 0.53). Group 1 had significantly higher communication skills scores in OSCE2 after the video feedback workshop compared to the communication skill scores of the group without intervention (p = 00). The mean score of history taking, physical exam and diagnosis and treatment in OSCE1 and OSCE2 in the case group were compared by paired t-test and the results showed that there was significant difference (p = 0.00). Conclusion: Our training intervention was effective in producing significant changes in medical students' clinical competence as well as the students' skills in history taking, physical exam and diagnosis and treatment. Video feedback was more effective than traditional didactic methods such as lectures. Repetition of feedback using videotaped performance may be useful to improve communication skills for medical interviews. Despite the potential difficulties, video recording remains a most valuable tool for communication skills training. (Contains 5 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Emotional Problems; Well Being; Migrant Children; Migrant Problems; Immigrants; Immigration; Medical Evaluation; Child Welfare; Refugees; Psychological Characteristics; Psychological Evaluation; Psychological Needs; Psychiatry; Coping

Abstract:
Recent years have seen increasing attention being paid to unaccompanied asylum-seeking children. This article provides an overview of research in the field and its implications for an understanding of these children as a particularly vulnerable category. The existing research focuses primarily on investigating the children's emotional well-being from psychiatric and medical perspectives. Moreover, in these studies such emotional problems tend to be linked to previous and current traumatic experiences, in particular separation from their parents. By contrast, this article suggests that a critical need exists for research on unaccompanied children's life situations based upon exploration of their own perspectives. (Contains 3 notes.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Developmental Studies Programs; Autism; Developmental Disabilities; Clinics; Structural Equation Models; Intelligence Quotient; Longitudinal Studies; Pervasive Developmental Disorders; Medical Evaluation; Records (Forms); Scores; Intelligence Tests; Symptoms (Individual Disorders); Student Placement; Employment; Correlation; Children; Foreign Countries

Abstract:
We followed up 67 children with autistic disorder (AD) and 31 children with pervasive developmental disorder not otherwise specified (PDDNOS) for more than 10 years by reviewing medical records at a clinic for children with developmental disabilities. The participants' data were collected between their first visit to the clinic and the visit at which they applied for basic disability benefits. The standardized IQ scores and autistic symptoms were examined as measures of the children's personal functioning. For environmental factors, we examined the participants' educational placements and work and residential status. Using structural equation modeling, we examined the longitudinal developmental courses of AD and PDDNOS. Participants diagnosed with AD consistently showed lower IQ and more severe autistic symptoms than those diagnosed with PDDNOS. Relationships between personal functioning and environmental factors differed between the two groups. AD and PDDNOS are heterogeneous, so they must be treated differently to improve children's prognoses. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Self Destructive Behavior; Observation; Scientific Concepts; Computer Assisted Testing; Reinforcement; Injuries; Measurement Objectives; Measurement Techniques; Evaluation Methods; Evaluation Research; Medical Evaluation; Behavior Problems

Abstract:
We evaluated an inexpensive, efficient, and noninvasive technique for measuring tissue damage produced by self-injurious behavior (SIB). The technique involved computerized measurement of wound surface area (WSA) based on digital photographs. In Study 1, we compared photographic measurement to a more commonly used procedure, transparency measurement, in estimating WSA of 20 wound models. Results showed that both methods were reliable and that there was a high degree of correspondence between the 2 sets of measures. In Study 2, we compared photographic WSA measures to direct-observation measures in documenting changes over time in the SIB exhibited by a woman with Prader-Willi syndrome. Results showed that increases and decreases in observed SIB during baseline and treatment conditions corresponded with changes in WSA measures, indicating that the computer-assisted photographic technique may be useful as a corroborative measure or as a primary measure when direct observation of SIB is not feasible. (Contains 6 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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