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Vulnerable Population (vulnerable + population)
Selected AbstractsDomestic Violence Research: Methodological Issues Related to a Community-Based Intervention With a Vulnerable Population,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2005Clarissa A. Shavers Presently, in our society, thousands of children, adolescents, and adults are physically, mentally, and emotionally traumatized from exposure to domestic violence (DV). Exposure to DV, defined here as male violence against their female partners, occurs among all ethnic, cultural, socioeconomic, geographical, and racial groups. DV can lead to depression, negative self-esteem, and general psychological distress in women. Children exposed to DV have an increased risk of behavioral, emotional, and social problems. DV shelters often provide group counseling and support services for battered women, children, and adolescents residing there, but the programs do not reach the majority of women living in the broader community. Furthermore, few studies have examined the effectiveness and efficacy of support group treatment intervention programs for battered women and children. This is due, in part, to the methodological difficulties inherent in this design. As a way to meet the needs of families that have experienced DV, academic researchers from a Midwestern university and a director of counseling services from a local domestic violence agency have partnered to offer a psycho-educational intervention designed to [source] Predictors of dental care utilization among working poor CanadiansCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 3 2009V. E. Muirhead Abstract,,, Objective:, This study used the Gelberg,Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians. Methods:, A cross-sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked ,20 h a week, were not full-time students and had annual family incomes <$34 300. A pretested questionnaire included sociodemographic items, self-reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits. Results:, Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25,34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self-rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001). Conclusions:, This study identified predisposing and enabling vulnerabilities that jeopardize the dental care-seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults. [source] Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory UniversityDEPRESSION AND ANXIETY, Issue 6 2008Ph.D., Steven J. Garlow M.D. Abstract The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002,2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = ,9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (,2 = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5,4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults. Depression and Anxiety 0:1,7, 2007. © 2007 Wiley-Liss, Inc. [source] An open-label trial of enhanced brief interpersonal psychotherapy in depressed mothers whose children are receiving psychiatric treatment,,DEPRESSION AND ANXIETY, Issue 7 2006Holly A. Swartz M.D. Abstract Major depression affects one out of five women during her lifetime. Depressed mothers with psychiatrically ill children represent an especially vulnerable population. Challenged by the demands of caring for ill children, these mothers often put their own needs last; consequently, their depressions remain untreated. This population is especially difficult to engage in treatment. We have developed a nine-session intervention, an engagement session followed by eight sessions of brief interpersonal psychotherapy designed to increase maternal participation in their own psychotherapy, resolve symptoms of maternal depression, and enhance relationships (IPT-MOMS). This open-label trial assesses the feasibility and acceptability of providing this treatment to depressed mothers. Thirteen mothers meeting DSM-IV criteria for major depression were recruited from a pediatric mental health clinic where their school-age children were receiving psychiatric treatment. Subjects (mothers) were treated openly with IPT-MOMS. Eighty-five percent (11/13) completed the study. Subjects were evaluated with the Hamilton Rating Scale for Depression, and completed self-report measures of quality of life and functioning at three time points: baseline, after treatment completion, and 6-months posttreatment. A signed rank test was used to compare measurement changes between assessment time points. Subjects showed significant improvement from baseline to posttreatment on measures of maternal symptoms and functioning. These gains were maintained at 6-month follow-up. Therapy was well tolerated and accepted by depressed mothers, who are typically difficult to engage in treatment. A high proportion of subjects completed treatment and experienced improvements in functioning. Future randomized clinical trials are needed to establish the efficacy of this approach. Depression and Anxiety 23:398,404, 2006. Published 2006 Wiley-Liss, Inc. [source] Patriotism for Citizens of the Penultimate SuperpowerDIALOG, Issue 4 2003Walter Brueggemann Abstract: The United States of America confesses its penultimate status as "One nation under God." Yet this relationship,of the ultimacy of God and the penultimacy of nations,is frequently forgotten when foreign policy is crafted. The arrogant autonomy of such superpowers operates on the mistaken conviction that they will not be called into account. But the preacher says otherwise. The Old Testament witness teaches us that there is a grave danger to nations making such unrestricted claims of temporal ultimacy. Any state that imagines that it can use its power in unrestrained ways against any other state or vulnerable population,no matter how weak,misunderstands its place in a world under divine rule. It is thus essential that the preacher, along with the congregation, must dare to recover the rhetoric of prophetic imagination concerning God's governance in the public sphere. Empowered and humbled by the mandate of scripture, the preacher must counter the rhetoric of popular patriotism and witness to God's sovereignty over nations. We may then move beyond analysis to alternative, and finally set our hearts and minds on the evangelical task of empowering the faithful to alternative forms of citizenship. [source] Minimization of socioeconomic disruption for displaced populations following disastersDISASTERS, Issue 3 2010Omar El-Anwar In the aftermath of catastrophic natural disasters such as hurricanes, tsunamis and earthquakes, emergency management agencies come under intense pressure to provide temporary housing to address the large-scale displacement of the vulnerable population. Temporary housing is essential to enable displaced families to reestablish their normal daily activities until permanent housing solutions can be provided. Temporary housing decisions, however, have often been criticized for their failure to fulfil the socioeconomic needs of the displaced families within acceptable budgets. This paper presents the development of (1) socioeconomic disruption metrics that are capable of quantifying the socioeconomic impacts of temporary housing decisions on displaced populations; and (2) a robust multi-objective optimization model for temporary housing that is capable of simultaneously minimizing socioeconomic disruptions and public expenditures in an effective and efficient manner. A large-scale application example is optimized to illustrate the use of the model and demonstrate its capabilities ingenerating optimal plans for realistic temporary housing problems. [source] Still falling short: protection and partnerships in the Lebanon emergency responseDISASTERS, Issue 4 2007David Shearer The Israeli,Hezbollah conflict in the summer of 2006, although brief, had a lasting impact on the region and prompted an intense humanitarian response. The conflict raised challenging questions for the United Nations (UN) about how to assist a middle-income yet extremely vulnerable population in a context where global and local relations are highly politicised. This paper focuses on two key questions that emerged from the humanitarian response. First, how can humanitarian agencies, and particularly the UN, improve the protection of civilians, and was what they did in Lebanon enough? Second, how can humanitarian agencies create partnerships with local actors and still remain true to core humanitarian principles when local actors are fiercely divided along confessional lines and influenced by external actors, and when some, such as Hezbollah, are parties to the conflict? This paper argues that despite the importance of protection and partnerships to the humanitarian response, their role in the UN emergency response still falls short. [source] Measurement error and estimates of population extinction riskECOLOGY LETTERS, Issue 1 2004John M. McNamara Abstract It is common to estimate the extinction probability for a vulnerable population using methods that are based on the mean and variance of the long-term population growth rate. The numerical values of these two parameters are estimated from time series of population censuses. However, the proportion of a population that is registered at each census is typically not constant but will vary among years because of stochastic factors such as weather conditions at the time of sampling. Here, we analyse how such sampling errors influence estimates of extinction risk and find sampling errors to produce two opposite effects. Measurement errors lead to an exaggerated overall variance, but also introduce negative autocorrelations in the time series (which means that estimates of annual growth rates tend to alternate in size). If time series data are treated properly these two effects exactly counter balance. We advocate routinely incorporating a measure of among year correlations in estimating population extinction risk. [source] Phenotype and function of neonatal DCEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 1 2009Fabienne Willems Abstract Newborns face complex physical and immunological changes before and after birth. Although the uterus is a sterile environment for the fetus, it also contains non-self material from the mother. Birth involves the transition from the sterile intra-uterine environment to an environment rich in microbes and requires rapid induction of appropriate responses to control these microbes. In this review we focus on the similarities and differences of human and murine neonatal DC and their reaction to various stimuli. A better understanding of the newborn immune system , in particular, the DC,T-cell interaction , will be beneficial for the development of improved strategies to prevent or treat infections in this vulnerable population and prepare the immune system to cope with allergens and tumors later in life. [source] Termination as a therapeutic intervention when treating children who have experienced multiple lossesINFANT MENTAL HEALTH JOURNAL, Issue 1 2009Michele M. Many Children who have endured traumatizing events often have a history of prior disruptions and losses which also have been experienced as traumatic. Termination of therapy with these children, therefore, provides a unique opportunity for the clinician to provide the traumatized child and his or her caregiver with a new experience of loss; one that is controlled, predictable, and paced. Through this experience, the child and caregiver can develop a new model for loss, one that permits for losses that are a natural part of healthy growth and change. This article outlines one approach to utilizing termination as an integral component of the therapeutic process with infants, toddlers, and preschoolers and their caregivers. Using a psychodynamic model and working dyadically with the child and the caregiver, termination is approached as a primary intervention, pivotal to the successful treatment of this vulnerable population. [source] EVIDENCE SYNTHESIS: Appropriateness of using a symbol to identify dementia and/or deliriumINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2010Sonia Hines RN BN Abstract Aim, The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. Methods, Using the methods of the Joanna Briggs Institute, we conducted a systematic search of a wide range of databases, Internet resources and unpublished literature. Papers meeting the inclusion criteria were critically appraised by two independent reviewers. Data were extracted, using the standardised tool from the Joanna Briggs Institute, from those papers considered to be of sufficient quality. Because of significant methodological heterogeneity, no meta-analysis was possible and results are presented narratively instead. Results, From a total of 37 retrieved papers, 18 were found to be of sufficient relevance and quality to be included in the review. There was general consensus among the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one that explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. Conclusions, Both staff and health consumers seem to have largely positive perceptions and attitudes towards the use of a symbol for dementia. Families and carers of people with dementia are frequently concerned about their loved one wandering away and becoming lost and unable to identify themselves, and these concerns seem to outweigh any reservations they hold about the use of a symbol or some other identifier. In healthcare settings the use of symbols to indicate special needs seems well established and widely accepted. However, regarding the use of a symbol for dementia in the broader community, there remain concerns about issues such as stigmatisation and the potential for victimisation of this vulnerable population and so further research is indicated. [source] Migration, Displacement, and Violence: Prosecuting Romanian Street Children at the Paris Palace of JusticeINTERNATIONAL MIGRATION, Issue 5 2004Susan J. Terrio This paper examines the displacement and vulnerability associated with the migration of unaccompanied illegal Romanian minors who came as economic migrants to Western Europe, found no legal opportunities for work or education, and were forced into criminal activity on the streets of French cities such as Paris, Lyon, and Nice. Beginning in 1997 growing numbers of unaccompanied Romanians, mostly boys, some as young as age ten, many younger than age 15, were subject to systematic prosecution rather than protection in Paris, the site of the largest and most influential juvenile court in the nation. They were arrested, detained, indicted, released pending trial, judged, and sentenced in absentia, multiple times with different identities. The Romanian minors were caught without legal papers or visas, claimed to be squatters living in abandoned buildings, trailers, or camps outside Paris, and gave little reliable information about their families or lives. Initially arrested for the destruction of city property and the theft of the proceeds from city parking meters, they gradually turned to begging, shoplifting, and prostitution when the city switched from coin to card payment. Deeply concerned by the penalization of a vulnerable population, the president of the Paris juvenile court created a special court to deal more humanely with unaccompanied minors in general, and Romanian children in particular, by establishing their identities and reconnecting them with their families. This article explores the contradictions that emerged between the representation of Romanian children in the media, the legal establishment, nongovernmental organizations (NGOs), and the Government, on the one hand, and their treatment in the juvenile justice system, on the other. It examines the discourse and the context of judging as well as the interactions between court personnel and Romanian minors from in-take interviews in jail and indictment hearings in chambers to judgment in absentia in the formal court. It compares and contrasts cases heard before and after the creation of the special court and centres on the gaps between official rhetoric, legal norms, and judicial practice. It concludes that the creation of the special court may be having the unintended effect of reinforcing and institutionalizing the very judicial practice it was designed to prevent, namely the penalization of marginality. [source] Non-psychiatric hospitalization of people with mental illness: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 8 2009Cindy Diamond Zolnierek Abstract Title.,Non-psychiatric hospitalization of people with mental illness: systematicreview. Aim., This paper is a report of a literature review of the evidence regarding outcomes experienced by severely mentally ill individuals hospitalized in general medical-surgical settings for non-psychiatric conditions. Background., Severely mentally ill individuals experience chronic medical illnesses at a rate greater than the general population. When hospitalized in non-psychiatric settings, they tend to be experienced as ,difficult' by nurses and to have longer lengths of stay. Data sources., The CINAHL and PUBMED databases were searched from 1 to 9 March 2008 to identify studies published between 1998 and 2008 investigating outcomes among people with mental illness hospitalized for non-psychiatric illness in general hospitals. Methods., Included studies were those published in English in peer reviewed journals and investigating patient outcomes. The studies were reviewed for relevance and inclusion criteria; the methodological quality of studies was not evaluated. Results., Twelve studies met inclusion criteria. All studies examining length of stay, costs of care or resource utilization showed increased measures for patients with psychiatric comorbidity. Interventions described included psychiatric liaison psychiatry and nursing, which failed to demonstrate improvement in outcomes. Conclusion., Nurses play a pivotal role in improving the inpatient care of this vulnerable population, but they struggle in their attempts to do so. Research to determine the best approaches to promote nurses' knowledge, positive attitudes and self-confidence in caring for patients with psychiatric comorbidity is needed. Investigation of the patient perspective on the inpatient experience might also provide insight for designing effective care processes. [source] Constitutive expression of the low-affinity neurotrophin receptor and changes during axotomy-induced death of sensory neurones in the neonatal rat dorsal root ganglionJOURNAL OF ANATOMY, Issue 2 2003Simon S. Murray Abstract Sensory neurones in the dorsal root ganglion (DRG) of the neonatal rat express the 75-kDa low-affinity neurotrophin receptor (p75NTR) and these neurones degenerate rapidly after axotomy. p75NTR belongs to the tumour necrosis factor superfamily, several members of which have a role in cell death and it is constitutively expressed within a subpopulation of DRG neurones. p75NTR has been implicated in mediating the degeneration of these neurones after axotomy. In this study, we characterize the expression of p75NTR in sensory neurones of the newborn rat DRG using immunohistochemistry. Furthermore, we investigate the change in constitutive expression pattern of p75NTR in these neurones following axotomy. In the C7 and C8 DRG of the newborn rat, p75NTR is expressed in approximately 70% of DRG neurones. Those expressing p75NTR can be classified into subpopulations with moderate or intense p75NTR expression, each present in approximately equal proportions. Whilst p75NTR expression is observed in neurones throughout the entire neuronal diameter range, a correlation exists between neuronal diameter and p75NTR expression intensity. We also found that the most vulnerable population following axotomy were those sensory neurones which constitutively express the highest levels of p75NTR, i.e. the large-diameter neurones. [source] Prevalence and incidence of urinary incontinence of Swiss nursing home residents at admission and after six, 12 and 24 monthsJOURNAL OF CLINICAL NURSING, Issue 18 2008Susi Saxer Aims and objectives., To study the prevalence and incidence of urinary incontinence in a Swiss nursing home population at admission and at six, 12, 18 and 24 months after admission. Background., No prevalence data for urinary incontinence in people older than 65 years living in nursing homes are available in Switzerland and other German-speaking parts of Europe. Prevalence of urinary incontinence elsewhere varies between 49% and 77%. Methods., This is a secondary analysis of the data of the minimum data set of the Resident Assessment Instrument 2.0 in which 2719 residents were assessed. Prevalence rates and incidence were calculated at admission and at six, 12, 18 and 24 months after admission. Special focus was placed on sex- and age-related differences. Results., Prevalence of urinary incontinence was 51·5% (men 51·4%, women 51·5%) and was found to rise with increasing age. At the time of admission, 37% (men 43%, women 34%) were urinary incontinent. The prevalence increased from admission to 24 months after admission. Conclusion., The high prevalence rates indicate the relevance of the problem for residents and caregivers alike. Early identification of individuals likely to become incontinent is crucial in the development of interventions and the prevention of urinary incontinence in this vulnerable population. Relevance to clinical practice., The study provides valuable data about the extent of the problem of urinary incontinence in nursing homes. [source] Network financial support and conflict as predictors of depressive symptoms among a highly disadvantaged populationJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 1 2007Amy R. Knowlton The study examined multiple dimensions of social support as predictors of depressive symptoms among a highly vulnerable population. Social network analysis was used to assess perceived and enacted dimensions of support (emotional, financial, instrumental), network conflict, closeness, and composition. Participants were 393 current and former injection drug users who were 72% , poverty level, 96% African American, 39% HIV seropositive. At baseline, 37% had high depression scores (CES-D , 16). Adjusted logistic regression indicated that for every additional network member providing financial support, the odds of probable depression 1 year later decreased by 23%, and for every additional conflictive network tie the odds of depression increased by 57%. Findings suggest the greater importance to this population's psychological well-being of received support specific to environmental demands, rather than support perceived potentially available. The findings suggest potential directions for intervention. © 2007 Wiley Periodicals, Inc. [source] Quality of Care for Acute Myocardial Infarction in Elderly Patients with Alcohol-Related DiagnosesALCOHOLISM, Issue 1 2006David A. Fiellin Background: Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction. Methods: We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure. Results: In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive ,-blockers at the time of discharge (55% vs. 60%, p=0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics. Conclusions: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction. [source] Health Care for the Homeless Assesses the Use of Adapted Clinical Practice GuidelinesJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2005Aaron J. Strehlow RN, FNP-C COLUMN EDITOR: Mary Jo Goolsby This article describes a process of evaluating and adapting existing clinical practice guidelines (CPGs) for homeless individuals by different healthcare providers in multiple healthcare settings across the country. Data were collected using a standardized evaluation tool in nine sites across the United States. Clinicians completed an evaluation of the CPG after every use. Most clinicians used the CPG five times. Descriptive statistics were reported on the characteristics of the clinicians, and the utility of the guidelines and written comments. Clinicians had an average of 12 years of clinical experience, 8 years of which were specifically spent working with homeless individuals. Ninety-one percent of the clinicians practiced in urban settings. The majority of clinicians felt the adapted guidelines met evaluation criteria. The major weaknesses reported the delineation of outreach and case management activities. Results did not vary by clinicians' disciplines, years of experience, or any other indicators. Clients and clinicians providing primary care to homeless individuals may benefit from utilizing Health Care for the Homeless Clinicians' Network adapted CPGs to assure quality, evidenced-based care to a vulnerable population. [source] Mental health status of vulnerable tsunami-affected communities: A survey in Aceh Province, IndonesiaJOURNAL OF TRAUMATIC STRESS, Issue 3 2007Renato Souza The authors determined the prevalence of severe emotional distress and depressive symptoms using the Hopkins Symptoms Checklist-25 (HSCL; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) in tsunami-affected communities that had experienced armed conflict arising from the ongoing independence movement in Aceh Province, Indonesia. We also evaluated determinants of severe emotional distress. The data were collected for the purposes of a mental health assessment. In our sample (N = 262), 83.6% demonstrated severe emotional distress, and 77.1% demonstrated depressive symptoms. In multivariate regression models, severe emotional distress was positively associated with the number of tsunami-related deaths among household members. Our data suggests a need for effective interventions in this vulnerable population. [source] Clinical trial: a primary-care-based model for the delivery of anti-viral treatment to injecting drug users infected with hepatitis CALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009K. JACK Summary Background, Injecting drug use is the main risk factor for hepatitis C virus (HCV) infection. Secondary-care-based strategies for the management of HCV do not effectively target this vulnerable population. Aims, To evaluate the feasibility, safety and efficacy of a primary-care-based model for the delivery of HCV services including anti-viral therapy to injecting drug users. Methods, A partnership between a clinical nurse specialist employed by, and working under the supervision of, a secondary-care-based hepatitis service and drug workers and general practitioners. Three hundred and fifty-three clients attending opiate substitution clinics in primary care were evaluated. Outcomes were: number of new diagnoses of HCV infection, number of clients assessed as suitable for anti-viral treatment, and number of patients treated. Results, 174 HCV antibody positive clients were identified. Of these, 124 were chronically infected with HCV of whom only six had been previously identified. Of 118 new chronically-infected individuals, 86 entered the care pathway, 43 were assessed as suitable for anti-viral treatment and 30 have so far been treated. Outcomes of anti-viral treatment are comparable with those obtained in secondary care settings. Conclusion, A primary-care-based model offers a new paradigm for the treatment of HCV in injecting drug users. [source] Zero to Three: Critical Issues for the Juvenile and Family CourtJUVENILE AND FAMILY COURT JOURNAL, Issue 2 2004JULIE COHEN ABSTRACT Infants are the fastest growing population in foster care. Without intervention they are at great risk of poor developmental outcomes. Juvenile and family courts have a unique opportunity to make a positive difference in the lives of the babies in their care. This article outlines six critical issues that impact the development of very young children in the child welfare system and recommends strategies that juvenile and family courts can use to address the needs of this most vulnerable population. [source] Infants admitted to neonatal units , interventions to improve breastfeeding outcomes: a systematic review 1990,2007MATERNAL & CHILD NUTRITION, Issue 4 2008Rhona J. McInnes Abstract This review aimed to identify interventions to promote breastfeeding or breast milk feeding for infants admitted to the neonatal unit. The medical electronic databases were searched for papers listed between 1990 and June 2005 which had breastfeeding or breast milk as an outcome and which targeted infants who had been admitted to a neonatal unit, thus including the infant and/or their parents and/or neonatal unit staff. Only papers culturally relevant to the UK were included resulting in studies from the USA, Canada, Europe, Australia and New Zealand. This search was updated in December 2007 to include publications up to this date. We assessed 86 papers in full, of which 27 ultimately fulfilled the inclusion criteria. The studies employed a range of methods and targeted different aspects of breastfeeding in the neonatal unit. Variations in study type and outcomes meant that there was no clear message of what works best but skin-to-skin contact and additional postnatal support seemed to offer greater advantage for the infant in terms of breastfeeding outcome. Galactogogues for mothers who are unable to meet their infants' needs may also help to increase milk supply. Evidence of an effect from other practices, such as cup-feeding on breastfeeding was limited; mainly because of a lack of research but also because few studies followed up the population beyond discharge from the unit. Further research is required to explore the barriers to breastfeeding in this vulnerable population and to identify appropriate interventions to improve breastfeeding outcomes. [source] Low zinc status: a new risk factor for pneumonia in the elderly?NUTRITION REVIEWS, Issue 1 2010Junaidah B Barnett Low zinc status may be a risk factor for pneumonia in the elderly. This special article reviews the magnitude of the problem of pneumonia (its prevalence, morbidity, and mortality) in the elderly, pneumonia's etiology, and the dysregulation of the immune system associated with increasing age. In addition, recent evidence from the literature is presented demonstrating that low zinc status (commonly reported in the elderly) impairs immune function, decreases resistance to pathogens, and is associated with increased incidence and duration of pneumonia, increased use and duration of antimicrobial treatment, and increased overall mortality in the elderly. Inadequate stores of zinc might, therefore, be a risk factor for pneumonia in the elderly. Randomized, double-blind, controlled studies are needed to determine the efficacy of zinc supplementation as a potential low-cost intervention to reduce morbidity and mortality due to pneumonia in this vulnerable population. [source] Ethics and medical research in childrenPEDIATRIC ANESTHESIA, Issue 10 2009ANDREW J. DAVIDSON MBBS MD FANZCA Summary The ethics of clinical research is based on several well-known guidelines and documents. The guidelines vary between countries, but the principles of respect for persons, beneficence, and justice are constant. These principles are reflected in requirements to obtain free and informed consent, to minimize risk or harm, and to not overly burden or disadvantage particular populations. For research to be ethical, it must also be of such a standard, and be conducted in such a manner that it will generate knew and useful knowledge. Children have limited capacity for understanding and may be more open to coercion. Therefore, they are regarded as a particularly vulnerable population, and specific clauses regarding children are incorporated into many guidelines. A key concept in these clauses is the degree of risk acceptable for children involved in research. While it is generally agreed that children require particular attention because of their vulnerability, there is also increasing concern that children in general should not be disadvantaged by lack of knowledge due to reduced research activity. Finally, an increasingly active area of research in children involves genetics and biobanking. Research in these areas raises new and challenging ethical issues. [source] Growth effects of methylphenidate among childhood cancer survivors: A 12-month case-matched open-label studyPEDIATRIC BLOOD & CANCER, Issue 1 2009Bruce W. Jasper PhD Abstract Background To investigate the effect of stimulant medication [methylphenidate (MPH)] on growth patterns among survivors of childhood cancer (acute lymphoblastic leukemia or brain tumor). Procedure Using a case-matched comparison design, childhood cancer survivors participating in a 12-month open-label MPH trial (n,=,51) were compared with childhood cancer survivors not taking MPH (n,=,51). Measures of body mass index (BMI), height, and weight were obtained at hospital visits and corrected for gender and age using Centers for Disease Control normative data. Results Significant deceleration of BMI and weight, but not height, was observed during the 12-month MPH trial for those children taking MPH. Conclusions Childhood cancer survivors taking MPH experience significant, though modest, deceleration of BMI and weight across the first year of MPH intervention. The absence of height deceleration, and the presence of only modest BMI and weight deceleration, suggests that MPH is reasonably well tolerated by childhood cancer survivors with respect to growth. Such findings are encouraging in light of increasing evidence that MPH mitigates some of the cognitive late-effects of cancer treatments. Nevertheless, on a case-by-case basis, clinicians should balance the intended benefits of MPH with potential growth effects in this vulnerable population. Pediatr Blood Cancer 2009;52:39,43. © 2008 Wiley-Liss, Inc. [source] Metabolic syndrome: signs and symptoms running togetherPEDIATRIC TRANSPLANTATION, Issue 1 2010Tammy M. Brady Brady TM, Parekh RS. Metabolic syndrome: signs and symptoms running together. Pediatr Transplantation 2010: 14: 6,9. © 2010 John Wiley & Sons A/S. Abstract:, Children with kidney disease are at increased risk of having several comorbidities such as obesity, dyslipidemia, hypertension, and impaired glucose tolerance, and patients with a constellation of these symptoms are considered to have the MS. Children with kidney disease, and ESRD in particular, are at increased CV risk, as are patients with the MS. To determine the impact MS has on a particularly vulnerable population of children, those who have received a kidney transplant, Wilson et al. explored the prevalence of MS and the association of MS with cardiac abnormalities among this subset of children. They found an overall high prevalence of MS among pediatric transplant recipients and that the risk of left ventricular hypertrophy was higher among children with MS after renal transplant compared to those without MS. Review of the most common definitions of MS and also the clinical implications are discussed. While there is no doubt that children with kidney disease have a high prevalence of CV risk factors and that these children are at risk for CV events early in life, whether the sum of the parts of MS confers increased risk over what is seen with individual risk factors that often run together remains to be seen. [source] Sociodemographic determinants of growth among Malian adolescent femalesAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2010Timothy F. Leslie In Africa, research concerning the social determinants of poor nutritional status has typically focused on children under 5 years of age and has used defined categorical boundaries based on international reference standards. In this article, stunting and wasting of 1,157 Malian adolescent girls is measured through both categorical and continuous data. The focus on adolescent girls is significant because there is relatively little literature examining this group, and because adolescence marks the time when girls gain greater workload responsibilities, autonomy of food choices, and, as a result of the adolescent growth spurt, require the greatest amount of caloric intake respective to their weight since infancy. To differentiate stunting and wasting causes, a number of socioeconomic, geographic, and demographic factors are explored. The findings suggest that continuous data provides a basis for modeling stunting and wasting superior to utilizing international reference categories. Estimations show that decreasing age, the presence of servants, a greater number of wives in a compound, and residence in a large urban area correlate with improved nutritional status while wealthier families appear to correlate with greater stunting and wasting, and no correlation exists with estimated energy expenditure. Future studies should incorporate continuous data, and the need exists for greater analysis of social determinants of growth indicators among adolescent females. Further, these findings have significant implications in the development of nutrition intervention programs aimed at the vulnerable population in Mali, leading us to conclude that factors beyond socioeconomic indicators such as household structure and location should be more fully examined. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] HIV and sexually transmitted disease risk among male Hispanic/Latino migrant farmworkers in the Southeast: Findings from a pilot CBPR studyAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2010Scott D. Rhodes PhD Abstract Background Little is known about the HIV and sexually transmitted disease (STD) risk behaviors of Hispanic/Latino farmworkers. This study was designed to describe risk factors for HIV and STD infection, explore personal characteristics associated with condom use, and evaluate the feasibility of collecting self-report and biomarker data from farmworkers. Methods Self-report and biomarker data were collected from a sample of male farmworkers living in 29 camps in North Carolina during the 2008 growing season. Results Over half of the 100 male workers, mean age 37.1 (range 19,68) years, reported binge drinking during the past 12 months. Forty percent of those who reported having had sex during the past 3 months indicated that they were under the influence of alcohol. Knowledge of HIV and STD transmission and prevention was low. Among the 25 workers who reported having had sex during the past 3 months, 16 and 2 reported using a condom consistently during vaginal and anal sex, respectively, and nearly 1 out of 6 workers reported paying a woman to have sex. Two workers tested positive for syphilis. Conclusions Farmworkers in this sample demonstrated significant HIV and STD risks; however, when exploring potential bivariate associations with consistent condom use no statistically significant associations were identified perhaps due to the small sample size. Because it was feasible to collect self-report and biomarker data related to HIV and STDs from Hispanic/Latino farmworkers, research needed to further explore risks and develop interventions to reduce disease exposure and transmission among this vulnerable population. Am. J. Ind. Med. 53:976,983, 2010. © 2010 Wiley-Liss, Inc. [source] Traumatic occupational injuries in Hispanic and foreign born workersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Linda Forst MD Abstract Background Hispanic and foreign-born workers suffer high rates of occupational fatality. Reasons for this are not well understood. Our aim was to gather information about the details related to severe, non-fatal occupational injuries in this vulnerable population. Methods Eight years of data were obtained from an urban trauma center. In addition, medical consultations of individuals admitted for an occupational injury during an 8-month period are reported. Results Hispanics were more highly represented than expected; their number of injuries steadily rose. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job. Conclusion Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations. Am. J. Ind. Med. 53:344,351, 2010. © 2009 Wiley-Liss, Inc. [source] Effects of Social Support and Conflict on Parenting Among Homeless MothersAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2009Jaime V. Marra MA Research has shown that having a supportive social network is generally beneficial for individuals, particularly those who arc homeless or at risk of homelessness. However, conflict within these networks may diminish the positive effects of social support on well-being, and these effects may be felt acutely within a vulnerable population with multiple needs. This study examined the impact of conflict and social support on parenting behaviors in a sample of mothers who are homeless and were involved in a study of case management interventions of varying intensity. We found that women who reported high emotional and instrumental social support self-reported greater improvements in parenting consistency over time than those who reported lower levels of support. However, three-way interactions showed that conflict in support networks was a risk factor for harsh parenting practices among participants who reported lower levels of instrumental social support. Results suggest that social support may enhance homeless mothers' ability' to provide consistent parenting, but that these benefits may he undermined if conflict occurs in combination with limited levels of instrumental social support. [source] | |||||||||||||||||||||||||||||||||||||