Successful Academic Achievement Among Foster Children: What Did the Foster Parents Do?

Children who spend part of their childhood in foster homes have, as a group, lower academic achievement than their peers. However, some of these children do well and succeed in higher education. Resilience is about positive development enhanced by protective factors despite adversity. Protective factors may be both positive qualities in the children themselves and their social contexts. The purpose of this article is to explore how young people who spent part of their childhood in foster care succeeded in higher education. We interviewed 13 foster parents and 16 young adults with ongoing or completed university studies. Two main themes emerged as particularly important: the young adults’ motivation and effort, and qualities in the foster home. In this article, we focus on the qualities in the foster home. The analysis showed three main themes related to the foster home that supported school achievement: the promotion of a feeling of belonging in the foster home; core values such as taking school work seriously and giving one’s best; and providing order and structure in the foster children’s lives.     

What Do Pediatricians Tell Parents About Bed-Sharing?

Background and objectives Despite the risks of bed-sharing, little is known about what pediatricians tell parents about bed-sharing with infants and whether pediatricians provide specific recommendations outlined by the American Academy of Pediatrics (AAP). This study aimed to understand pediatricians’ opinions about bed-sharing and the advice pediatricians provide to parents about bed sharing. Methods The study employed a qualitative study design and the conceptual framework of the Theory of Planned Behavior. 24 primary care pediatricians from a variety of practice settings were interviewed about the anticipatory guidance they provide to families whose infants are in the at-risk age group for SIDS. Results Pediatricians’ opinions about bed-sharing differed widely both with respect to identifying bed-sharing as a topic they routinely address in anticipatory guidance as well as in what they tell parents about bed sharing. Some strongly and routinely advise against bed-sharing and identify bed-sharing as a clear risk to infants. Others believe bed-sharing to be both safe and useful. A third group allow the content of anticipatory guidance to be driven by parental concerns. Most pediatricians are clearer in their recommendation to place infants supine to sleep than in their recommendation to avoid bed-sharing. Conclusions Overall, there is considerable variation among pediatricians in the advice they provide about bed-sharing, and most advice is not congruent with the AAP recommendations. Additional efforts to educate pediatricians may be necessary to change attitudes and behaviors with respect to anticipatory guidance about safe sleep.     

What Is Driving the Growth in Medical Tourism?

The current study directly surveyed consumers on their experiences and consideration of medical tourism to test the variables thought to impact medical tourism. The sample was deployed to qSample's international traveler panel. The survey was completed by 68.5% of participants. Over a third of the respondents said they had considered medical tourism; 15% had actually traveled to another country for medical care. Dental treatment was named most often as the type of treatment pursued in another country. Cost was mentioned most frequently as the reason for medical tourism. Prior international travel emerged as an important factor.     

Preventing Obesity and Eating Disorders in Adolescents: What Can Health Care Providers Do?

This article describes five research-based recommendations for health care providers to help prevent both obesity and eating disorders among adolescents that they see within clinical, school, or other settings. The recommendations are based primarily upon findings from Project EAT, a large, population-based study of eating and weight-related issues in adolescents. Recommendations include the following: 1) discourage unhealthy dieting; instead encourage and support the use of eating and physical activity behaviors that can be maintained on an ongoing basis; 2) promote a positive body image; 3) encourage more frequent, and more enjoyable, family meals; 4) Encourage families to talk less about weight and do more at home to facilitate healthy eating and physical activity; and 5) assume that overweight teens have experienced weight mistreatment and address this issue with teens and their families. These recommendations stress the importance of helping adolescents and their families focus less on weight and more on sustained behavioral change.     

Who Are the Medical Travelers and What Do They Want?: A Qualitative Study

The ongoing debate on U.S. healthcare reform fueled by increasing cost and poor access to quality healthcare is spurring interest in medical travel. The topic of medical travel—going abroad to seek medical care—has been widely reported in various news outlets. This issue even resulted in a Senate Hearing before the Special Committee on Aging. Despite this popularity, very little empirical research has been conducted to describe and understand medical travelers. To fill this gap, the present study involves in-depth interviews of medical travel facilitators with extensive exposure to and communication with medical travelers. This article has multiple objectives. It aims to develop a demographic and psychographic profile of medical travelers and identify their underlying motives to seek medical care overseas. Based on these insights, it presents a list of propositions to be tested in further research. Finally, it offers practical implications for the healthcare industry.     

Do Changes in Hospital Outpatient Payments Affect the Setting of Care?

Objective

To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting.

Data Sources/Study Setting

Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008.

Study Design

This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects.

Principal Findings

Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate.

Conclusions

Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare''s efforts to contain hospital outpatient costs.     

Food Addiction and Cognitive Functioning: What Happens in Adolescents?

This study aimed to examine cognitive factors associated to food addiction (FA) symptoms in a non-clinical sample of adolescents. A group of 25 adolescents (12–18 years; Mean age = 15.2 years) with a high level of FA symptoms (two and more) were compared to a control group without FA symptoms (n = 25), matched on sex and age, on four Cambridge Neuropsychological Test Automated Battery (CANTAB) neuropsychological tasks (MT: Multitasking Test; OTS: One Touch Stockings of Cambridge; SST: Stop Signal Task; RVP: Rapid Visual Information Processing). They were also compared on self-reported questionnaires assessing binge eating, depressive and anxiety symptoms, impulsivity levels, as well as executive functioning difficulties. Group comparisons did not show significant differences on neuropsychological tasks’ performances. However, effect sizes’ estimates showed small to medium effect sizes on three scores: adolescents with a high level of FA symptoms showed a higher probability of an error following an incorrect answer (OTS), a higher probability of false alarm, and a poorer target sensitivity (RVP). When referring to self-reported measurements, they reported significantly more executive functioning difficulties, more binge eating, depressive symptoms and higher impulsivity levels. Overall, results suggested that cognitive difficulties related to FA symptoms seem to manifest themselves more clearly when assessing daily activities with a self-reported questionnaire, which in turn are strongly related to overeating behaviors and psychological symptoms. Future longitudinal research is needed to examine the evolution of those variables, their relationships, and contribution in obesity onset. More precisely, the present findings highlighted the importance of affective difficulties related to this condition, as well as the need to take them into account in its assessment.     

Detecting HIV Associated Neurocognitive Disorders in Adolescents: What Is the Best Screening Tool?

PurposeTo examine the ability of the HIV-Dementia Scale (HDS) and Mini Mental State Exam (MMSE) to detect encephalopathy in adolescents living with human immunodeficiency virus (HIV) and/or acquired immunodeficency syndrome (AIDS).MethodThe study was based on chart review (N = 71) from 1999 to 2006, extracting data from psychological testing, disease classification, and demographic variables. HDS and MMSE scores were independent. Diagnosis of encephalopathy used American Academy of Neurology Criteria. Receiver Operating Characteristic Curves were plotted.ResultsSix patients had encephalopathy. The HDS identified five of these cases (83% sensitivity, 76% specificity). The MMSE identified three cases (50% sensitivity, 92% specificity).ConclusionBased on the study results, the HDS appears to be clinically useful.     

What Do the Theories of Egon Brunswik Have to Say to Medical Education?

Every day physicians make judgments about patient management and diagnosis based on less than perfect information from many different sources. Judgment and decision-making research has taught us a great deal about such decisions, but these insights rarely find their way into the medical curriculum. One productive line of investigation in the study of judgment and decision making has followed the insights and theories developed by the psychologist, Egon Brunswik. His theories are becoming increasingly relevant to modern judgment problems. In this paper, I outline Brunswik’s theories, trace their development over the last 50 years and speculate on what role they should play in medical education.     

How and What Do Pregnant Adolescents Want to Learn about Nutrition?

Few nutrition education materials exist that are designed specifically for pregnant adolescents. Adolescents are considered a high-risk population during pregnancy, and they differ from adult mothers emotionally, socially, and cognitively. We used qualitative methodology in a needs assessment study with pregnant and postpartum adolescents to determine how and what they wanted to learn about nutrition. Ninety-two girls, ages 13 to 19, participated in 1 of 16 focus group sessions held across the state of Tennessee. Discussion focused on (1) what media and (2) what messages they perceived would be effective in reaching other pregnant adolescents and influencing their dietary behaviors. Results of the needs assessment suggest that a videotape format is more appealing than written materials, possibly because a variety of print materials that appeal to all age groups already exist and/or some pregnant adolescents have limited interest in reading. A “talking baby” and teen actresses presenting information were preferred by the adolescents rather than adult characters or authority figures. Participants in the study expressed the need for messages related to eating for the baby's health, eating for the mother's health and physical comfort, and messages emphasizing food rather than nutrients. Nutrition educators can use this information when developing educational materials for pregnant adolescents.