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Evaluating school-based mental health services for children and youth with emotional disturbance (ED) has been a challenge for researchers. One particular challenge is the study design of using the student as the statistical unit of analysis, which in certain cases may lead to a violation of the "independence of error" assumption. However, the alternative to this nested design, including fewer students and more schools, can be costly and administratively complex. This study examines data from two national studies including 314 students with ED and served in special education programs and their caregivers from 24 schools in the US to identify the extent to which nesting or design effects occur in this population. The results show that variables focusing on psychopathology are less affected by nesting but school-related variables such as academic functioning are more affected. Design effects varied by grade level, suggesting that grade should be considered when designing such evaluations. (Contains 3 tables and 1 figure.)

In this study, we compared the depressive symptoms reported by Mexican American elders who scored higher and lower on a linguistic acculturation scale. Prevalence, equality of covariance matrices, equality of error variances, and factor structures were examined for the 20 items included in the Center for Epidemiologic Studies Depression (CES-D) Scale. The sample consisted of 3,050 community-dwelling Mexican Americans from five states. Significant differences were found on all parameters, indicating that level of acculturation is associated with pervasive differences in the way items are endorsed on the most commonly used inventory of depressive symptoms. Results add to literature suggesting that there may not be a universal structure to symptoms. Higher or lower scores may have different implications for people representing different cultures and/or stages of acculturation, something that both researchers and clinicians should be sensitive to when interpreting results of screening tests. (Contains 3 tables.)

We examined the predictors for successful discharge from out-of-home care of children with complex needs placed in a novel comprehensive service intervention (Manatee Model) and compared their discharge experiences to their out-of-home counterparts from the same county. The study design consisted of a longitudinal two-year comparison of these two groups. A total of 147 cases were included in the analysis, and the propensity scoring technique was used to equate the groups. Among children admitted to the Manatee Model, boys, White children, younger children, those who came from a single-parent family, those who were abused, and those who had a disability (physical or emotional disability or medical condition) were found less likely to successfully exit within the two years when these predictors were examined separately. Multivariate analyses indicated that only age at the time of removal and health status were significantly associated with successful discharge. Implications of the findings are discussed.

A week-long residential program in the United Kingdom combines ritual with psychotherapy to assist men in coming to terms with the meaning of masculinity. The program recognizes no fixed notion of manhood, but aims to support each man as he finds within himself, and marks with ritual, the next step in his unique journey. (TD)

Program-level effects at 6 months are reported from meta-analysis of a nine-site quasi-experimental study of comprehensive, integrated, trauma-informed, and consumer-involved services for women who have mental health problems, substance use disorders, and who have experienced interpersonal violence. The average weighted effect size is significant for the treatment condition for improved post-traumatic symptoms (p < 0.02), drug use problem severity (p < 0.02), and nearly significant for mental health symptoms (p < 0.06). There is significant heterogeneity in effect sizes across sites. Program-level variables were examined in an effort to explain this heterogeneity. The findings indicate that sites which provided significantly more integrated counseling produced more favorable results in mental health symptoms (p < 0.01) and both alcohol (p < 0.001 ) and drug use problem severity (p < 0.001). The same trend is observable for reductions in post-traumatic stress symptoms, although the difference does not attain statistical significance. Keywords: Women's services; Co-occurring disorders; Trauma; Service integration; Meta-analysis

The long-term effectiveness of a structured health education program (HEP) for spouses and frail older adults was evaluated in a staff model health maintenance organization (HMO). HEP is a multicomponent group program that includes emotion-focused and problem-focused coping strategies, education, and support. For caregivers, HEP was more effective than usual care (UC) in reducing depression, increasing knowledge of community services and how to access them, and changing caregivers' feelings of competence and the way they respond to the caregiving situation. For care recipients, HEP was more effective than UC in preventing increases in somatic symptoms and symptoms of anxiety/insomnia.

The aim of this study was to identify predictors of the use of health and human services by community residing persons with dementia and their family caregivers. Telephone interviews were conducted with a sample of 608 primary caregivers of community residing persons with dementia who were randomly selected from a state-wide dementia registry. The Anderson Behavioral Model of Health Care Use was used as the analytic framework. Hierarchical ordinary least squares regression models were developed to analyze predictors of health and human services use. Predisposing, enabling, and need variables explained 40.9% of the variance in service use, 29.8% of the variance in health service use, and 38.1% of the variance in the use of human services. Enabling variables explained more variance in the use of health and human services than did need or predisposing variables. In contrast to the health services utilization literature that points to the importance of need variables, the results of this study lend support to findings in the caregiving literature that indicate that enabling variables are at least as important as need variables in predicting the use of community services by family caregivers of persons with dementia. Keywords: Alzheimer's disease; Dementia; Caregiving; Community services; USA

This article describes the development and evaluation of a Nursing Assistant Communication Skills Program (NACSP). NACSP was designed to help nursing assistants (NAs) interact more effectively with nursing home residents with moderate and severe dementia. In two skilled-care nursing homes, NAs in four units were randomly assigned by unit to NACSP or to a wait-list control condition (UC) and were assessed at baseline, 3 months, and 6 months. NACSP resulted in improvement in the well-being of nursing home residents being cared for by NAs who had received the NACSP training. It was also found that NACSP resulted in greater knowledge of caregiving responses and reduced turnover rates among NAs, but the program had no impact on their knowledge of dementia. To disseminate the NACSP program, a leader manual, an accompanying training videotape, and a workbook for participants were developed.

The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared to usual outpatient primary care (UPC). Although GEM had no overall impact on health care utilization or cost of care for the entire study period, significant reductions were found during the sixteen- to twenty-four-month study period, suggesting a possible investment effect. In the first eight months of the study, GEM patients incurred 34.8% more in health care costs than UPC patients, but in the final eight months of the study the cost of care for UPC patients exceeded that for GEM patients by 37.8%. Key Words: Geriatric evaluation and management, Frail elderly, Primary care, Health services utilization, Team care, Veterans

The use of N (super omega)-monomethyl-L-arginine (L-NMMA), an inhibitor of nitric oxide (NO) synthesis, does not show therapeutic effects in endotoxemic dogs. L-NMMA-induced reduction in cardiac index and oxygen delivery went with enhanced arterial lactate levels and lower arterial pH. L-NMMA reduced survival at the highest tested dose. The occurrence of these effects of L-NMMA in septic patients is not known.

Resistance to job burnout requires a sense of involvement in ones work, a high degree of peer cohesion and supervisor support, a strong sense of personal autonomy and a sense of physical comfort. But in this study, copy editors were found to be significantly less satisfied with their work environment and to feel less involved, less encouraged to make their own on-the-job decisions, and less physically comfortable than were reporters.

Abstract Background Meta-analyses of N-acetylcysteine (NAC) for preventing contrast-induced nephrotoxicity (CIN) have led to disparate conclusions. Here we examine and attempt to resolve the heterogeneity evident among these trials. Methods Two reviewers independently extracted and graded the data. Limiting studies to randomized, controlled trials with adequate outcome data yielded 22 reports with 2746 patients. Results Significant heterogeneity was detected among these trials (I2 = 37%; p = 0.04). Meta-regression analysis failed to identify significant sources of heterogeneity. A modified L'Abbé plot that substituted groupwise changes in serum creatinine for nephrotoxicity rates, followed by model-based, unsupervised clustering resolved trials into two distinct, significantly different (p < 0.0001) and homogeneous populations (I2 = 0 and p > 0.5, for both). Cluster 1 studies (n = 18; 2445 patients) showed no benefit (relative risk (RR) = 0.87; 95% confidence interval (CI) 0.68–1.12, p = 0.28), while cluster 2 studies (n = 4; 301 patients) indicated that NAC was highly beneficial (RR = 0.15; 95% CI 0.07–0.33, p < 0.0001). Benefit in cluster 2 was unexpectedly associated with NAC-induced decreases in creatinine from baseline (p = 0.07). Cluster 2 studies were relatively early, small and of lower quality compared with cluster 1 studies (p = 0.01 for the three factors combined). Dialysis use across all studies (five control, eight treatment; p = 0.42) did not suggest that NAC is beneficial. Conclusion This meta-analysis does not support the efficacy of NAC to prevent CIN.