Search

Abstract Background Stone mining is one of the main livelihood activities in areas close to major cities in Ethiopia. Mining tends to make a notable impact on woody plant species and soil properties. Information regarding the effect of stone mining on woody plant species diversity and soil properties is limited in Ethiopia. It is also less known how people perceive the impact of stone mining on existing natural resource in the watershed after mining. Therefore, this paper analyzed the effect of stone mining on woody plant species diversity, selected soil properties and perception of nearby community on mining in northern Ethiopia. Methods Vegetation and soil sampling were conducted using 6.32 ha sample plots. Samples were randomly selected from mining and adjacent unmined areas. Species abundance, density, basal area, selected soil physical and chemical properties were analyzed. The differences in species diversity and soil physical and chemical properties between the mined and unmined areas were analyzed using independent t test. Household survey was also conducted to assess the view of the local people regarding the effect of mining on ecology. Results A total of 35 species representing 19 families in the mining site were recorded while 43 species representing 27 families were recorded in the unmined site. Abundance and density of species were higher in unmined than in mining areas. The most abundant species in the mining and unmined sites were Euclea racemosa subsp. schimperi, Senna singueana, Maytenus arbutifolia, Calpurnia aurea and Buddleja polystachya. Woody species diversity at mining (1.97) was significantly different from that unmined (2.49) site (p = 0.0005). Bulk density significantly varied between the mined (1.9 g cm−3) and unmined (1.38 g cm−3) sites (p

Objective: To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer.Design: A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients.Setting: A large managed care population in California.Subjects: A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n = 98), primary pelvic irradiation (n = 56), and observation alone (n = 60).Main Outcome Measures: General HRQOL was measured with the RAND 36-Item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form. Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel.Results: No differences among treatment groups were seen in comparisons of general HRQOL: Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains. When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bowel function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low.Conclusions: Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL: We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer. [ABSTRACT FROM AUTHOR]

Nurses play a major role in the health care delivery system; therefore, education of nurses is critical to successful prevention programs for persons with HIV. Little is known about nurses' knowledge of HIV in India. The purpose of this study was to determine the effects of a nurse-led train-the-trainer HIV education program on improving the HIV knowledge of nurses. A group of senior nurses (N = 10), were responsible for training a cohort of 10 nurses each, totaling 100 nurses. The 2-day training program included HIV epidemiology and etiology, infection control, psychosocial support, counseling, modes of transmission, natural history of the disease, symptoms of early and late disease, diagnostic testing, and legal and ethical issues. Pre- and posttest scores were calculated using a self-administered structured questionnaire that measured HIV-related knowledge in terms of cognitive and transmission knowledge. Paired t-tests indicated that both measures of HIV knowledge improved significantly from pretest to posttest. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine predictors of screening results for depressive symptoms in a Los Angeles homeless population with latent tuberculosis (TB). Four hundred and fifteen homeless adults participating in a nurse case managed intervention were included in this analysis. Logistic regression results indicated that those who reported a physical health limitation, multiple sex partners, daily drug use, alcohol dependence, or not having completed high school, were more likely to screen positive. Social support from non-drug users was protective. Given the importance of adherence to TB treatment regimens, the high prevalence of a positive screening for depressive symptoms in the homeless and the potential for depression to reduce adherence rates, routine screening and treatment for depression in high risk homeless adults being treated for TB may be warranted. [ABSTRACT FROM AUTHOR]

Background: Traditional recommendations hold that open fractures in both children and adults require urgent surgical debridement for a number of reasons, including the preservation of soft-tissue viability and vascular status as well as the prevention of infection. Following the widespread use of early administration of antibiotics, a number of single-institution studies challenged the belief that urgent surgical debridement decreases the risk of acute infection.Methods: We performed a retrospective, multicenter study of open fractures that had been treated at six tertiary pediatric medical centers between 1989 and 2000. The standard protocol at each medical center was for all children to be given intravenous antibiotics upon arrival in the emergency department. The medical records of all children with open fractures were reviewed to identify the location of the fracture, the interval between the injury and the time of surgery, the Gustilo and Anderson classification, and the occurrence of acute infection.Results: The analysis included 554 open fractures in 536 consecutive patients who were eighteen years of age or younger. The overall infection rate was 3% (sixteen of 554). The infection rate was 3% (twelve of 344) for fractures that had been treated within six hours after the injury, compared with 2% (four of 210) for those that had been treated at least seven hours after the injury; this difference was not significant (p = 0.43). When the fractures were separated according to the Gustilo and Anderson classification system, there were no significant differences in the infection rate between those that had been treated within six hours after the injury and those that had been treated at least seven hours after the injury. Specifically, these infection rates were 2% (three of 173) and 2% (two of 129), respectively, for type-I fractures, 3% (three of 110) and 0% (zero of forty-four), respectively, for type-II fractures, and 10% (six of sixty-one) and 2% (two of thirty-seven), respectively, for type-III fractures (p > 0.05 for all three comparisons).Conclusions: In the present retrospective, multicenter study of children with Gustilo and Anderson type-I, II, and III open fractures, the rates of acute infection were similar regardless of whether surgery was performed within six hours after the injury or at least seven hours after the injury. The findings of the present study suggest that, in children who receive early antibiotic therapy following an open fracture, surgical debridement within six hours after the injury offers little benefit over debridement within twenty-four hours after the injury with regard to the prevention of acute infection. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient-physician concordance about recommended geriatric health care. DESIGN: Case-series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA). SETTING: Community. PARTICIPANTS: Community-dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians. MEASUREMENTS: Concordance variables were generated using physician and patient responses to 10 questions on health- and CGA-related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self-report. RESULTS: In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6, P <.001) and patient adherence to (OR = 2.7, 95% CI = 1.7-4.2, P <.001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient-physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient-physician concordance on health-related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not. CONCLUSION: Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient-physician agreement on geriatric healthcare recommendations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to determine the health status of adults with developmental disabilities residing in community settings and the quality of the preventive, medical, dental, and psychiatric services they receive. METHODS: Data were collected on a sample of 353 adults residing in Los Angeles, California, in 1997. Historical data were obtained from study subjects or caregivers, physical and dental examinations were performed, blood was drawn for analysis, and a psychiatrist reviewed medical records for reports of psychiatric diagnoses and consultations. RESULTS: Health markers, such as rates of obesity, and laboratory test results of routine screening panels including blood cell counts, hemoglobin, and hematocrits; blood concentrations of liver enzymes and other enzymes, cholesterol, and tryglycerides; and urinalyses were within normal limits for an adult population. However, preventive services were notably lacking, especially for individuals living at home. Fewer than half of the study subjects had received influenza vaccine; only a third of those living alone or with family or friends had received this vaccination. Chart audits revealed that about a third received psychotropic medications, but only 24% of these individuals had psychiatric consultations noted in their record. Further, 36% of this medicated group received psychotropic drugs without any identifiable diagnosis, and simultaneous receipt of two or more antipsychotics was not uncommon. CONCLUSIONS: Given that the U.S. health care system fails to ensure the provision of preventive services for all people, including the developmentally disabled, a systematic overhaul is necessary to establish an effective quality assurance program that will provide preventive medical, dental, and psychiatric services for people with developmental disabilities. [ABSTRACT FROM AUTHOR]

PURPOSE: The goal of this study was to develop a diabetes-specific scale of patient desire to participate in medical decision making (DPMD) and examine its internal consistency reliability, stability, and validity (content, discriminant, convergent, and construct). METHODS: In a cross-sectional study, 65 patients with type 2 diabetes from a teaching hospital's general medical clinic were interviewed at baseline and 2 weeks later to measure their DPMD scores. Data were collected on demographic/clinical features, health value, social support, desire to make a final decision, and value of patient autonomy. RESULTS: Of the 11 DPMD items, 2 distinct factors emerged representing desire for discussion and desire for information. The DPMD scale had high internal consistency reliability, was stable over 2 weeks and demonstrated good content validity. DPMD scale items were more correlated with each other than with health value or social support. Overall, patients who obtained diabetes education reported greater desire to participate in decisions. Younger patients had a greater overall desire for discussion. The DPMD desire for discussion subscale correlated with patients' desire to make the final treatment decision but not with patients' value of autonomy. CONCLUSIONS: The DPMD is a brief, reliable, valid measure for assessing patient desire to participate in diabetes medical decision making. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This article presents the 6-month impact of three cognitive-behavioral HIV risk-reduction programs on substance use, sexual risk behaviors, and cognitive and psychological resources of homeless women and their intimate sexual partners.DESIGN: Prospective, convenience sample.SETTING: Homeless shelters.POPULATION: Homeless African American, Hispanic, and Anglo women and their intimate partners living in an inner-city area of Los Angeles. Ages ranged from 18 to 50 years.INTERVENTIONS: The baseline instrument was a 45-minute interview, which occurred in a private room in the shelters, administered to the women and their intimate partners. All women and their partners were offered HIV pretest and posttest counseling, had blood drawn for HIV antibody testing, provided a urine sample for drug testing, and received a list of available community resources. Women and their intimate partners in the nurse case-managed program engaged in a 2-hour session weekly for 6 weeks. The couples received information on HIV/AIDS, risk behaviors, and risk-reducing behaviors. Women and their intimate partners assigned to the peer-mentored program received the same intervention as those in the nurse case-managed program, except that the role of the nurse was assumed by a female peer mentor who matched the participants' ethnicity. Those assigned to the standard care program were administered the instrument packet by the research staff and received a standard traditional 15-min HIV antibody pretest as well as posttest counseling. The Coopersmith Self-Esteem Inventory (SEI), the Mental Health Index (MHI-5), the Brief Symptom Inventory (BSI) and the revised Drug History Form were all administered.MAIN OUTCOME MEASURE(S): Except for self-esteem, significant improvements in all cognitive, psychological, and behavioral factors were observed in all three HIV risk-reduction programs, supporting the theoretical framework that culturally competent AIDS education can exert a direct influence on a number of outcome variables. However, differential program effects were found for self-esteem, as well as for being highly knowledgeable about AIDS and for depression and hostility. The standard care approach effectively modified HIV risk behaviors for a majority of the homeless participants.RESULTS/CONCLUSIONS: In addition to suggesting ways of helping to prevent the spread of HIV, our results suggest that overall psychological well-being can be improved through concerted efforts directed toward this vulnerable population. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purposes of this study were to describe the nature, extent, and reported perpetrators of violence against homeless women and to examine the psychosocial, behavioral, and environmental profiles of homeless women with and without a history of victimization and of their intimate male partners.DESIGN: Quasi-experimental, cross-sectional.SETTING: Los Angeles homeless shelters and streets.POPULATION: Five hundred and ten homeless women, residing in 36 homeless emergency and sober-living shelters or on the streets, along with their intimate sexual partners were invited to participate. The final sample consisted of 507 women. The mean of the ages reported by the homeless women was 35, with a mean of 11.1 years of education. Approximately 60% of the women were African American, 22% Latina, and 17% White.INTERVENTIONS: History of adult victimization was assessed with two items using a yes/no response format that asked women if they had been: (a) physically assaulted or attacked, not including sexual assault; or (b) sexually assaulted. Self-esteem was measured using a revised version of the Coopersmith Self-Esteem Inventory (SEI). Psychological profile was measured with the Brief Symptom Inventory (BSI). Drug and alcohol use was assessed with the Drug History Form. After consent was obtained, appointments were made for instrument administration to take place in a private room set aside by the director of the homeless shelter or a private place selected by women.MAIN OUTCOME MEASURE(S): Thirty-nine percent of the women reported being physically and/or sexually assaulted as adults. About half the women in the study reported physical assault involving an intimate partner; the corresponding figure for rape was 20%. Of the homeless women victimized as adults, half reported childhood sexual abuse, and 42% experienced childhood physical abuse. Controlling for potential confounders, victimized women were more likely than others to have a history of childhood sexual and physical abuse, lifetime substance use, greater mental health symptomatology, and current risky sexual activity.RESULTS/CONCLUSIONS: Findings from this study support the contention that homeless women are one of the most vulnerable segments of our society and are at high risk for a variety of health and social problems, including victimization. This suggests the need for intervention and screening programs by nurses and other health professionals that target homeless women. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

Objective: To contrast sociodemographic characteristics, physical and mental health status, substance use, sexual behaviors, victimization, and utilization of health services between homeless women residing in sheltered and non-sheltered environments.Design: Cross-sectional survey. A structured scale was used to measure mental health status. Physical health status, substance use, sexual behavior, history of adult victimization, and health services utilization were measured by content-specific items.Setting: Shelters (N = 47) and outdoor locations in Los Angeles.Participants: One thousand fifty-one homeless women.Results: Homeless women living on the streets were more likely than sheltered women to be white and longer-term homeless. Controlling for sociodemographic characteristics, multiple logistic regression analyses revealed that unsheltered women had over 3 times greater odds of fair or poor physical health, and over 12 times greater odds of poor mental health than sheltered homeless women. They were also more likely than sheltered women to report using alcohol or noninjection drugs, to have multiple sexual partners, and to have a history of physical assault. About half of the overall sample reported utilization of a variety of health services; however, unsheltered homeless women were less likely to utilize all of the health services that were assessed, including drug treatment.Conclusions: There is a critical need for aggressive outreach programs that provide mental health services and substance abuse treatment for homeless women on the streets. Comprehensive services that also include medical care, family planning, violence prevention, and behavioral risk reduction may be particularly valuable for homeless women, especially those living in unsheltered environments. [ABSTRACT FROM AUTHOR]

There is limited understanding of the physical health, mental health, and substance use or abuse correlates of sexual violence against homeless women. This study documents the association of rape with health and substance use or abuse characteristics reported by a probability sample of 974 homeless women in Los Angeles. Controlling for potential confounders, women who reported rape fared worse than those who did not on every physical and mental health measure and were also more likely to have used and abused drugs other than alcohol. Results should serve to alert clinicians about groups of homeless women who may benefit from rape screening and treatment interventions. [ABSTRACT FROM AUTHOR]

Objectives: (1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prospective study designed to define and determine predictors of the course of health services utilization and physical health outcomes within one vulnerable population: homeless adults. We paid particular attention to the effects of mental health, substance use, residential history, competing needs, and victimization.Methods: A community-based probability sample of 363 homeless individuals was interviewed and examined for four study conditions (high blood pressure, functional vision impairment, skin/leg/foot problems, and tuberculosis skin test positivity). Persons with at least one study condition were followed longitudinally for up to eight months.Principal Findings: Homeless adults had high rates of functional vision impairment (37 percent), skin/leg/foot problems (36 percent), and TB skin test positivity (31 percent), but a rate of high blood pressure similar to that of the general population (14 percent). Utilization was high for high blood pressure (81 percent) and TB skin test positivity (78 percent), but lower for vision impairment (33 percent) and skin/leg/foot problems (44 percent). Health status for high blood pressure, vision impairment, and skin/leg/foot problems improved over time. In general, more severe homeless status, mental health problems, and substance abuse did not deter homeless individuals from obtaining care. Better health outcomes were predicted by a variety of variables, most notably having a community clinic or private physician as a regular source of care. Generally, use of currently available services did not affect health outcomes.Conclusions: Homeless persons are willing to obtain care if they believe it is important. Our findings suggest that case identification and referral for physical health care can be successfully accomplished among homeless persons and can occur concurrently with successful efforts to help them find permanent housing, alleviate their mental illness, and abstain from substance abuse. [ABSTRACT FROM AUTHOR]

A qualitative research approach was used to explore the factors that influence the initiation of drug and alcohol use among homeless women and the health and social consequences of drug and alcohol use. The sample consisted of 238 women; of whom 209 women reported drug and/or alcohol use in the past month and 29 women reported no history of drug or alcohol use. Findings of the study revealed homeless women who currently used drugs and alcohol, homeless women who currently used drugs only, and to a lesser extent current alcohol users only, had suffered traumatic childhood events and family dysfunction and had to cope with low self-esteem, emotional distress, and poor physical health. The initiation of drug and/or alcohol use was strongly affected by the social influence of other users. In comparison, homeless women who did not use drugs or alcohol reported a positive self-image, few traumatic events, and chose partners who did not use drugs or alcohol. Common among current drug and/or alcohol users were the reported social benefits of drug use. Quantitative analyses revealed homeless women who were current drug users were significantly more likely to have experienced childhood and adult victimization as compared with women in the other groups. Thus, the need for social interventions and positive social support early in the lives of these women are strongly implicated in these findings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to examine associations between the quality of the intimate relationship and the health and well-being of homeless women. For this study, the intimate relationship was characterized in terms of presence or absence of conflictive interaction with the partner. DESIGN: Quasi-experimental. SETTING: Rooms within the shelter, or in a variety of places considered convenient by the subjects. POPULATION: Women were recruited from 40 homeless shelters or sober living shelters, or by street outreach strategies. Ages ranged from 18-50. Of the 558 women in the study, 480 had an intimate partner. The majority (73%) of the intimate partnerships were conflictive. INTERVENTIONS: After obtaining voluntary informed consent, data were collected from 1995 to 1997 by means of structured survey instruments administered face-to-face in English or Spanish by trained research nurses and outreach workers. Psychological well-being was measured by the Mental Health Inventory (MHI-5). Symptomatology was measured by the Brief Symptom Inventory (BSI). Self-esteem was measured using a revised version of the Coopersmith Self-Esteem Inventory (SEI). Coping was assessed by the 16-item Medical Outcomes Study Modes of Coping Battery. Life satisfaction was measured by a series of faces with expression ranging from very happy to very sad. Health-threatening behaviors were injection and noninjection drug use and sexual risk behaviors. Health-promoting behaviors were whether the women reported having a TB test and a Pap test within the past year. MAIN OUTCOME MEASURE(S): Women in nonconflictive relationships reported significantly greater psychological well-being, self-esteem, and life satisfaction and less hostility than women with conflictive relationships and those without an intimate partner. Women with nonconflictive relationships had less anxiety and depression than women without intimate partners, but they were more anxious and depressed than those with nonconflictive relationships. Women with nonconflictive relationships were less likely than those with conflictive relationships and those without intimate partners to report sex with multiple partners, and non-injection drug use. RESULTS/CONCLUSIONS: Although results show that many homeless women have intimate partners and report deriving social support from their partners, the results of this investigation generally indicate that it would be inappropriate to view intimate partnerships as uniformly supportive and therefore beneficial for homeless women. The specific linkages between partnership status and health and well-being require rigorous, longitudinal research that also addresses the characteristics of the interactions and the longevity of the relationship to help determine how best to assist couples versus women on their own to adopt healthier and safer behaviors. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

The long-term effects of two culturally competent AIDS education programs with different content on the risk behavior and AIDS-related knowledge of 410 homeless African American women 2 years after program completion were examined. Participants were members of a larger cohort of impoverished African American and Latina women recruited in Los Angeles from 1989 to 1991. Of a subsample of 527 African American women selected randomly for a 2-year follow-up interview, 410 (78%) were located and agreed to participate. Women participating in both AIDS education program reported reduced HIV risk behaviors and demonstrated greatly improved AIDS knowledge at 2-year follow-up (p <.001). Women in a specialized program were less likely than those in a traditional program to report noninjection drug use at 2 years. Women in the traditional program had significantly better AIDS knowledge at follow-up (p < .001). These findings suggest that educational programs can produce sustained benefits among impoverished women. [ABSTRACT FROM AUTHOR]

Striking is the most organized, public, and radical declaration of job dissatisfaction commonly resorted to by nurses. In light of the current national nursing shortage (Aiken & Mullinix, 1987; Ginzberg, 1990; Iglehart, 1987; Roberts, Minnick, Ginzberg, & Curran, 1989), nurses' strikes should be of major interest to hospital administrators, health policy planners, and others seeking to improve nurse recruitment and retention. In addition, nurses' strikes within county hospitals are yet another sign of a public health care system under siege (Friedman, 1987; Iglehart, 1985; Schiff et al., 1986); understanding their origins may identify or highlight important problems within public health care facilities and suggest solutions. [ABSTRACT FROM AUTHOR]

To determine the characteristics and childbearing histories of women whose infants entered foster care in Los Angeles County, we examined the cases of 1,155 drug-using women whose infants were removed from them at birth and 236 non-drug-using women whose infants were also removed at birth by court order (July 1989 through March 1991). All of the women were indigent, and less than half had graduated from high school. The drug-using women frequently had criminal records, and more than a quarter were homeless. Many comparison women had mental health problems, and some (16.7%) were teenagers under court custody. Overall, 80% of all the children born to both groups of women were under court jurisdiction. Data obtained after study infants' births on 926 drug-using women observed for 18 months revealed that 22% had borne another infant who was placed in foster care; half of these infants had a positive drug immunoassay. Of the 185 non-drug-using women with 18-month follow-ups, 7.6% had borne another child who was in foster care. The magnitude of the repeated childbearing recorded among both groups of women in this study shows that preventive programs including family planning, mental health services, and drug prevention or rehabilitation programs have not reached this population. [ABSTRACT FROM AUTHOR]

Objective: To describe quality assurance (QA) programs implemented by capitated physician groups; to measure their relative emphasis on monitoring of overuse compared with underuse and monitoring and improving preventive services compared with chronic disease care; and to examine how group characteristics influence QA activity.Design: Cross-sectional questionnaire.Setting: A large network-model health maintenance organization in California (133 contracting physician groups).Participants: Ninety-four physician groups (71%) caring for 2.9 million capitated patients.Main Outcome Measures: Self-reported use of quality monitoring and improvement methods.Results: All capitated physician groups conducted some QA. Groups' QA programs monitored areas subject to overuse, such as cesarean delivery and angioplasty rates, more than areas subject to underuse, such as childhood immunization rates and performance of retinal examinations for diabetic patients (64% vs 43%, P<.001). They monitored underuse of preventive services more than follow-up services for chronic diseases (54% vs 31%, P<.001). Groups also used reminders for preventive services more than they monitored follow-up services for chronic diseases (26% vs 15%, P<.01). Physician group characteristics independently associated with higher overall QA activity were greater number of years in existence, higher profitability, and capitated care penetration.Conclusion: Capitation places a large share of responsibility for QA in the hands of physician groups, but not all aspects of QA are being equally addressed. The emphasis on overuse may result from financial incentives inherent in capitation, while the focus on preventive services may stem from lack of adequate quality measurement tools for monitoring chronic disease care. Further research efforts should address how capitated physician groups might expand their QA programs to include monitoring of underuse, especially for patients with chronic disease. [ABSTRACT FROM AUTHOR]

THE RESEARCHERS SOUGHT to explore and describe the demographic, cognitive, psychosocial, and behavioral factors associated with the continued risky behavior of a convenience sample of homeless and drug-addicted women two to four weeks after they had completed an AIDS education program. The sample included 942 crack users and 767 women who had multiple sex partners. Analyses revealed that impoverished women who maintained multiple sexual partners were less likely to be in drug recovery programs than in homeless shelters. They were more likely to share needles and be involved sexually with male injection drug users compared with impoverished women who did not maintain multiple sexual partners. Persistent crack users were older than those who reported cessation of crack use, were more often African American, and were more likely to have sex partners who were injecting drug users. Women who demonstrated less improvement in depression and distress scores, concerns, use of affective coping, appraisal of threat, and social support were more likely to maintain crack use and multiple partners. The study's implications for the design of intervention programs aimed at risk reduction based on ethnicity are discussed. [ABSTRACT FROM AUTHOR]

This study was undertaken to describe sexual behaviors and drug use and other factors that inhibit condom use and needle cleaning among impoverished women who are injection drug users (IDUs) or sexual partners of IDUs. This study also investigated whether risky sexual behavior or barriers to risk reduction differ with ethnicity and level of acculturation. Survey instruments to assess drug and sexual activity were administered to 378 African American and Latina women recruited primarily from homeless shelters and drug recovery programs. The most commonly cited barriers to condom use were belief that partners did not have acquired immunodeficiency syndrome (AIDS), lack of knowledge about where to get and how to use condoms, and discomfort discussing condom use with partners. African American women were more likely to report having multiple partners and unprotected sex, and more likely to report barriers in using, discussing, and obtaining condoms. Latina women were more likely to report partners' dislike of condoms. African American and highly acculturated Latina women were more likely to be IDUs than less acculturated Latina women. The most pervasive barriers for needle cleaning were not having personal needles, being high and not interested in needle cleaning, and not having disinfectant available. In a multiple logistic regression analysis for engaging in unprotected sex and cleaning needles, no ethnic or acculturation differences were found after controlling for selected demographic characteristics and risk factors. The data indicate a need to increase the supply of free or low cost condoms, to provide easily accessible sites for obtaining condoms, to supply clean needles, and to focus counseling for women on negotiating condom use with partners and the skillful and correct placement of the condom. [ABSTRACT FROM AUTHOR]

This research examined the impact of including a supportive person on the outcomes of two culturally sensitive AIDS education programs, an education-only (traditional) program and a program combining education with self-esteem and coping enhancement (specialized). Research participants in this quasi-experimental study included 241 homeless women, who were randomly assigned by residence (drug treatment program or shelter) to one of four treatment groups. The outcomes measured at baseline, 6, and 12 months were risk behaviors, cognitive factors, and psychological functioning. Study results demonstrated significant improvements at both 6 and 12 months for the entire sample in all psychological, behavioral and cognitive outcome variables except active coping. Women in the specialized program improved more on AIDS knowledge and reduction in non-injection drug use than did those in the traditional program, but their active coping scores declined. Participation of a supportive person did not appear to have any effect on outcome. [ABSTRACT FROM AUTHOR]

This paper evaluates and contrasts the effectiveness of two culturally sensitive AIDS education programs developed by the UCLA AIDS Nursing Network and delivered to 213 impoverished Latina homeless or drug-addicted women in Los Angeles. The Comprehensive Health Seeking and Coping Paradigm guided the program, which was implemented by specially trained Latina nurses and outreach workers. A quasi-experimental design was employed where women were randomized by site into Specialized (N = 82) and Traditional (N = 131) programs. Repeated measures ANOVAS and log-linear models were used to evaluate improvement over a two-week period for women in both groups and to identify interactions with program type. Two-week posttest analyses were also conducted to assess program effectiveness, controlling for baseline values of the measure in question, nonequivalency between groups at baseline, and selected demographic characteristics, including acculturation. Results indicated that women in both AIDS education programs improved significantly in cognitive, behavioral, and psychologic outcomes. [ABSTRACT FROM AUTHOR]