HealthSouth's Inpatient Rehabilitation Facilities: How Does Their Performance Compare With Other For-Profit and Nonprofit Inpatient Rehabilitation Facilities?

McCue MJ, Thompson JM. HealthSouth's inpatient rehabilitation facilities: how does their performance compare with other for-profit and nonprofit inpatient rehabilitation facilities?

Objectives

To assess the financial and operational differences in freestanding inpatient rehabilitation facilities (IRFs) that are operated by HealthSouth Corporation relative to other for-profit and nonprofit system-affiliated ownership groups. Since 2003, when it faced fraud charges and financial penalties, HealthSouth has experienced new management and refocused its business strategy. Because HealthSouth is the largest provider of freestanding IRF services, it is important to understand how their performance may differ relative to other ownership groups.

Design

We used the Mann-Whitney U test to assess differences in median values for financial and operational variables of HealthSouth-owned IRFs compared with other for-profit system IRFs and nonprofit system IRFs.

Setting

System-affiliated freestanding IRFs in the United States.

Participants

Sixty-four HealthSouth IRFs, 18 nonprofit system-affiliated IRFs, and 18 for-profit system-affiliated IRFs.

Interventions

Not applicable.

Main Outcome Measures

Net patient revenue per adjusted discharge, operating expense per adjusted discharge, salary expense per full-time equivalent, and cash flow margin.

Results

HealthSouth IRFs had significantly lower net patient revenue per adjusted discharge and operating expense per adjusted discharge; however, its cash flow margin was significantly higher than other comparison groups. HealthSouth IRFs treated a higher case mix of patients relative to these comparison groups.

Conclusions

The financial and operating performance of HealthSouth IRFs is stronger than other ownership groups. Strong cash flow will enable HealthSouth to pay down long-term debt.     

Do Changes in Panic Appraisal Predict Improvement in Clinical Status Following Cognitive-Behavioral Treatment of Panic Disorder?

The effects of changes in panic appraisal dimensions during cognitive-behavioral treatment (CBT) on both short- and long-term improvement in panic disorder symptoms were examined. Panic disorder severity and panic appraisal measures were collected from 120 CBT-treated patients at pretreatment, post-treatment, and 6-month follow-up. Several panic appraisal dimensions investigated in panic disorder and agoraphobia include (a) perceived likelihood of panic occurrence (i.e., anticipated panic), (b) perceived negative consequences of panic occurrence, and (c) perceived panic coping efficacy. Of those panic appraisal dimensions studied, change in anticipated panic during treatment emerged as the most potent predictor of short-term improvement across each of the major clinical status measures (i.e., panic attack frequency, agoraphobic avoidance, and anxiety). Change in perceived consequences of panic uniquely contributed to short-term improvement in both anxiety and global disability, and reduction in perceived panic coping efficacy was unique predictor of short-term improvement in only agoraphobic avoidance. Both changes in perceived consequences of panic and in anticipated panic uniquely contributed to long-term improvement in agoraphobic avoidance and anxiety, respectively. In addition, only change in perceived consequences of panic uniquely contributed to long-term improvement in global disability. In contrast, perceived panic coping efficacy was generally a weak predictor of long-term improvement in any measures of clinical status. These results suggest that changes in cognitive appraisal factors predict both short- and long-term improvement during CBT of panic disorder.

Diabetes Prevention and Treatment Strategies: Are we doing enough?

OBJECTIVE

Effective interventions to prevent, delay, or remit diabetes are currently available. However, their impact on the prevalence of diabetes at the population level is unknown. This study aimed to estimate the impact of a range of diabetes interventions on the population prevalence of diabetes for Australian adults between 2010 and 2025.

RESEARCH DESIGN AND METHODS

We used the Australian Diabetes Projection Model to estimate the impact of a population-wide strategy, high-risk prevention, surgical diabetes treatment, and a combination strategy on the future population prevalence of diabetes and to estimate the number of diabetes cases that could be potentially prevented in the year 2025.

RESULTS

We estimate that a population-wide strategy would reduce the number of diabetes cases by 60,000–85,000 in 2025 from an estimated 2 million cases under the status quo scenario. A high-risk prevention strategy would result in 106,000 to 150,000 fewer cases of diabetes in 2025, and surgically induced weight loss would result in 3,000–6,000 fewer cases. No single intervention, or combination of interventions, reversed the increasing trend in diabetes prevalence over the next 15 years.

CONCLUSIONS

To reverse upward trends in diabetes prevalence in future years, it is essential that current approaches to diabetes prevention and treatment are optimized and implemented and that alternative approaches to reduce the prevalence of diabetes at a population level are developed.In Australia, predictions suggest that among adults over 25 years of age, diabetes prevalence will increase from 7.4% (1) in 1999/2000 to 11.4% in the year 2025 (2). This increase is likely to be paralleled by decreasing quality of life, increased morbidity, and increasing healthcare costs.Effective interventions to prevent, delay, or remit diabetes are currently available. These range from population-wide strategies to alter energy balance or targeted strategies to prevent the progression to diabetes among those at high risk to surgically induced weight loss for those with severe obesity and newly diagnosed diabetes. Population-wide approaches, targeting the whole population regardless of risk, can be achieved through community or regulatory interventions that aim to alter the environment in which unhealthy behaviors occur and incentivize healthy behaviors. However, the evidence base for such policy and intervention is difficult to obtain, and we are currently dependent mostly on modeling studies to draw conclusions regarding effectiveness. On the other hand, landmark randomized controlled trial (RCT) evidence shows that intensive lifestyle interventions can reduce the progression to type 2 diabetes by 58% among those with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) (3). Real-world translations of these studies have yielded similar results (4,5). Therapeutic interventions such as bariatric surgery have also shown to be effective. RCT evidence demonstrates that weight-loss surgery for obese patients with recently diagnosed type 2 diabetes is associated with a 60–80% remission rate of diabetes (6–8).The potential impact of implementing these interventions at the population level is not known. Such evidence is essential to inform policy and to ensure that resources are appropriately directed toward diabetes prevention and treatment strategies to reduce the burden of diabetes.In these analyses, we use a multistate life table model, developed to project the prevalence of diabetes in Australian adults between 2005 and 2025 (2), to estimate the potential impact of a population-wide strategy, a high-risk prevention strategy, and a surgical diabetes treatment strategy on the population prevalence of diabetes for Australian adults between 2010 and 2025.     

Sex and substances: Does body image play a role?

ABSTRACT

Objective: Having sex under the influence of alcohol and/or drugs places individuals at high risk for STI transmission and unplanned pregnancy. Although the relationship between body image and sexual behavior has been well established, research on the relationship between body image and sexual behavior under the influence among adolescents is scant. The purpose of this study is to investigate the relationship between body image and unprotected sex and unprotected sex while under the influence among adolescents.

Methods: We conducted logistic regression analyses using data from the Oregon Youth Substance Use Project (N = 937). Measures included body image, unprotected sex, unprotected sex while inebriated, age, sex, and BMI.

Results: Body image was not related to unprotected sex, but was significantly related to unprotected sex while inebriated in the past year and in their lifetime (OR = 2.17, 2.33).

Conclusions: Results suggest substance use may be important to the relationship between body image and sexual behavior among adolescents. Additional research is warranted to inform future interventions.     

Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review

There is increasing evidence that contextual forms of cognitive-behavioral therapy (CBT) are effective in the management of chronic pain, yet little is understood about the factors that moderate or predict outcomes in these treatments. This systematic review aimed to identify pretreatment participant characteristics associated with positive treatment responses in contextual CBT for chronic pain. Medline, EMBASE, PsychINFO, and CENTRAL were searched to identify eligible studies. Studies were included if the participants were adults with chronic pain, designs were longitudinal, treatments focused on psychological flexibility or mindfulness, and reported results allowed for examination of moderators or predictors of standard treatment outcomes. Of 991 records initially identified, 20 were eligible for inclusion in the review. Some evidence suggested that baseline emotional functioning predicts treatment response, but the direction of this association varied between studies. Substantive findings were inconsistent and inconclusive, however, methodological limitations were consistent. These included treatment heterogeneity, and a lack of theoretical, a priori guidance in examining potential predictors. Future research should adopt a theoretically based approach to examining moderators in relation to specific treatment methods and therapeutic processes. Considering moderation without first considering mediation is probably a limited strategy.

Alcohol Expectancies and Alcohol Use Frequency: Does Drinking Context Matter?

Although alcohol use varies across settings, current measures of alcohol outcome expectancies (i.e., perceived likelihood of experiencing a drinking outcome; AOE) and valuations (i.e., desirability of specific drinking outcomes) do not specify the drinking context explicitly. Therefore, the contextual factors (which may affect both AOE and valuations) respondents use when completing these measures are unknown and make interpretation of measures potentially challenging. As such, the present study examined AOE and valuations among 334 college student drinkers (71.0 % women; M _age = 21.05; 74 % Hispanic) as a function of three drinking contexts: convivial (e.g., at a party, a bar), negative coping (e.g., when experiencing negative affect), and personal-intimate (e.g., with a romantic partner, on a date). As expected, results indicated that endorsement of AOE and valuations differed by context. Participants generally perceived the effects of alcohol—both positive (e.g., I would be friendly) and negative (e.g., I would be clumsy)—as being less likely to occur and less desirable in the negative coping context than in convivial and personal-intimate contexts. Patterns of AOE and valuations for convivial and personal-intimate context varied by specific drinking outcomes; however, all valuations of negative effects were rated highest in the personal-intimate context. Further, certain context-specific beliefs about the effects of alcohol were differentially associated with reported frequency of alcohol use in each context. Findings suggest that context should be made explicit by researchers and clinicians in assessment and intervention of college student drinking.     

Sex selection and abortion: a case for legal re-evaluation?

This question of sex selection and abortion in the UK was highlighted by recent reports in a national newspaper. This paper explores the current legal position and whether there is a case for reforming the law to align the situation of abortion with that of sex selection in the context of pre-implantation genetic diagnosis.     

Do Males and Females Conceptualise Work and Social Impairment Differently Following Treatment for Different Mental Health Problems?

The Work and Social Adjustment Scale (WSAS) is used by psychiatric nurses for screening and evaluating patients' treatment outcomes for a variety of mental health problems. This study investigated longitudinal and gender measurement invariance of WSAS using structural equation modeling within a help-seeking problem gambling sample (n = 445), and an intervention program for depression and anxiety sample (n = 444). The concept of functional impairment was defined by all WSAS items in males and females at pre- and post-treatment assessments. These findings confirm that the WSAS is a robust and efficacious instrument for evaluating treatment outcomes in two differing populations.     

Does the Hopelessness Theory Account for Sex Differences in Depressive Symptoms Among Young Adults?

The present study examined whether the sex difference in depression could be accounted for within the framework of the hopelessness theory of depression. Specifically, we tested whether young adults’ negative inferential styles mediated the sex difference in depressive symptoms or whether sex moderated the cognitive vulnerability-stress effects on depressive symptoms in a multi-wave longitudinal study. In doing so, we examined the different forms of negative inferential styles separately (causes, consequences, self-characteristics, composite, weakest link). Results did not support the mediation hypothesis. In terms of the moderation hypothesis, we found significant sex × inferential style × stress interactions predicting depressive symptoms across the follow-up, with the vulnerability-stress effects significant for men but not women. Among women, negative inferential styles and life events were independent predictors of depressive symptoms. In these moderation analyses, each of the inferential styles exhibited similar predictive validity.     

Inflammatory Morbidity due to Compound Mandibular Body Fractures: Does It Have a Relationship with Treatment Outcome?

Objective

The aim of this study was to evaluate the relationship between the degree of preoperative pain and trismus with the development of complications following the repair of isolated unilateral compound mandibular body fractures using a closed reduction technique.

Subjects and Methods

This was a 7-year prospective study carried out at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria. Of a total of 97 patients, 83 (85.6s%) subjects (66 males, 17 females, ratio 5:1) were preoperatively evaluated for trismus and pain in a blinded manner by a single examiner, and complications were recorded postoperatively. The data obtained were statistically analyzed with EPI Info 2008 software.

Results

Of the 83 patients treated, 13 (15.7s%) developed complications. The fractures were most common in the age range of 21–40 years (n = 45, 54.2s%). The age (p = 0.02) and gender (p = 0.01) distribution of the subjects was significant. The more severe the limitation of mouth opening (p = 0.03) and pain (p = 0.04) before treatment, the more complications developed, and these significantly affected treatment outcome. Impaired mastication and facial asymmetry (n = 17, 41.5s%) were the most common complications.

Conclusion

This study showed that posttrauma pain and trismus due to unilateral mandibular body fractures may be associated with the development of complications. An adequately powered prospective study treating patients at 5 or 7 days is required in order to make the case for later intervention.Key Words: Mandible, Body fracture, Pain, Trismus, Complications