Behavioral Health Screening and Care Coordination for Rural Veterans in a Federally Qualified Health Center

Many rural veterans receive care in community settings but could benefit from VA services for certain needs, presenting an opportunity for coordination across systems. This article details the Collaborative Systems of Care (CSC) program, a novel, nurse-led care coordination program identifying and connecting veterans presenting for care in a Federally Qualified Health Center to VA behavioral health and other services based upon the veteran’s preferences and eligibility. The CSC program systematically identifies veteran patients, screens for common behavioral health issues, explores VA eligibility for interested veterans, and facilitates coordination with VA to improve healthcare access. While the present program focuses on behavioral health, there is a unique emphasis on assisting veterans with the eligibility and enrollment process and coordinating additional care tailored to the patient. As VA expands its presence in community care, opportunities for VA-community care coordination will increase, making the development and implementation of such interventions important.

     

Removing risk stratification in food allergy prevention guidelines

There is now level one evidence based on randomized controlled trials that early ingestion of allergenic solids in infancy has a preventive effect against food allergy development. As a result, guidelines now recommend early ingestion of allergenic solids as a means of food allergy prevention. However, guidelines in Canada currently focus this intervention specifically on infants at risk, defined currently as an infant who has a history of atopy such as eczema or food allergy, or who has an immediate family history of atopy. However, this definition fails to account for studies supporting early ingestion as a preventive measure within the broader population. Not all of these risk factors (such as immediate family history of atopy) are consistently supported by the literature to date. Finally, a more universal approach to food allergy prevention simplifies the message, decreases stigmatization, and reduces medicalization of infant feeding. It also has the potential to reduce reticence to feed in infancy. The goal of this commentary is to argue that food allergy prevention guidelines should focus their interventions on the broader population and not just those defined as at higher risk.     

RENAL TRANSPLANTATION – AN EARLY EXPERIENCE

Renal transplant (RT) is now a therapy of choice for end stage renal disease (ESRD). The Nephrology Unit, Asvini started functioning in Dec 90 and to date 1298 sittings of hemodialysis have been given to 45 patients. Of these, 35 were in ESRD and 11 patients underwent renal transplantation at this hospital during the period Jan 91 – Dec 93. One patient expired after 18 months of transplantation due to infection. Early experience in screening patients for RT, use of immunosuppression, management of rejection episodes and protocol are presented with special emphasis on its relevance to the Armed Forces.KEY WORDS: Transplantation, Renal Failure, Immunosuppression, Rejection     

Dietary, alcohol, and tobacco intake among Mexican-American women of childbearing age: results from HANES data

PURPOSE. Dietary intake and substance abuse are important predictors of pregnancy outcome yet little is known about these behaviors in Mexican Americans. Dietary, tobacco, and alcohol intake of Mexican-American and non-Hispanic white women were compared across the reproductive cycle. DESIGN. Four cross-sectional groups--interconceptional, pregnant, lactating, and postpartum non-lactating--were compared within and between ethnic groups. SUBJECTS. A stratified sample of 682 women, 16 to 44 years old, of Mexican birth or origin from the Hispanic HANES was contrasted with a similarly stratified sample of 1,396 white non-Hispanic women from the NHANES. MEASURES. Demographic, behavioral and health characteristics, food practices, and fluid intake were examined. Data on food servings were combined into five major food groups. RESULTS. Compared with white non-Hispanics, Mexican-American women had lower socioeconomic status and worse perceived health. However, Mexican Americans reported lower consumption of tobacco, alcohol, diet soda, and caffeine, particularly during pregnancy and lactation. Although portion sizes for the foods consumed were not assessed, frequency of consumption of fruits and vegetables and milk was lower and meat higher among Mexican Americans. CONCLUSIONS. Despite socioeconomic disadvantages, Mexican-American women have better health habits than white non-Hispanic women. From these data it is unclear how diet affects pregnancy outcomes in Mexican Americans.     

Adaptation and coping: a look at a sickle cell patient population over age 30--an integral phase of the life long developmental process

Individuals with sickle cell disease experience a variety of psychosocial issues, some of which lead to maladjustments. To gather baseline data on coping and adjustment by a group of individuals over 30 years of age, a pilot study was conducted with 30 patients followed routinely at the Duke University Comprehensive Sickle Cell Center. The purpose of the study was to characterize such psychosocial parameters as coping behaviors, education, employment, group affiliation, health beliefs, marital status, parenting and perceptions regarding the disease. Using Erickson's stage of development as a point of reference, the middle adulthood stage was used as a theoretical framework for explaining and interpreting the results of this study. Study results reflect that, on the whole, the participants employed a wide variety of life skills to promote positive psychological and physical well being. These data suggest that this population of sickle cell disease patients have attained a reasonable level of psychosocial adjustment and many are leading productive lives. However, the minority of patients, who use the health care facilities more frequently, might lead one to speculate otherwise.     

Use of stable isotopic tracers in studies of whole body calcium metabolism

Stable isotopic tracers of calcium have been used to characterize the absorption of dietary calcium and the subsequent distribution of this element through the body. For a group of 7 healthy children, ages 4-14, and 7 children with osteogenesis imperfecta (OI), types I, III and IV, ages 6-17, there were no detectable differences in the fractional absorption of dietary calcium, 0.29+/-0.11 and 0.28+/-0.16, respectively. The total exchangeable pool of calcium was found to be 161+/-52 mg/kg for the healthy children and 95+/-29 mg/kg for the 3 children with Type I OI, 250+/-75 mg/kg for the 3 children with Type III OI and 216 mg/kg for the child with Type IV OI.     

Bladder-outlet obstruction — assessment of symptoms

Summary Assessment of symptoms plays a central role in the evaluation of men with suspected bladder-outflow obstruction (BOO) secondary to benign prostatic hyperplasia (BPH). It is on the basis of symptoms that treatment designed to relieve outflow obstruction is recommended. However, a variety of studies have suggested that a considerable proportion of men presenting with suspected outflow obstruction are not obstructed as determined by pressure-flow criteria. The relationship between many so-called obstructive symptoms and BOO has not yet been defined. Furthermore, all previous studies have defined BOO on the basis of urethral resistance factors, which are now regarded as outdated. Using current concepts of urethral pressure-flow relationships, we studied in detail the relationship between the obstructive symptoms of BPH, objective evidence of abormal voiding and BOO. Only the symptoms of hesitancy and poor flow were found to be significantly related to BOO. The symptoms of straining to void, intermittency, terminal dribbling and feeling of incomplete bladder emptying were not specific for BOO. Objective evidence of an intermittent flow pattern and of terminal dribbling do, however, have a high specificity and positive predictive value for BOO. The assessment of men with lower-urinary-tract symptoms must include objective tests of voiding function. A better understanding of the pathophysiology of lower-urinary-tract symptoms should lead to an improved symptomatic outcome of prostatectomy.     

Using stable isotopes to assess mineral absorption and utilization by children

Adequate mineral intake is a crucial part of a healthy diet for children-it supports appropriate growth and development and provides protection against childhood conditions like anemia and helps to prevent future adult diseases such as osteoporosis. Challenges in performing and interpreting studies in infants and children have hampered the accurate assessment of their mineral utilization. Many of the most powerful techniques used in adults, such as radioisotope testing, are not appropriate for use in children. In recent years, advanced mineral stable-isotope techniques have been developed to fill this gap. Pediatric applications include studies of calcium absorption and kinetics during puberty and evaluation of the calcium-iron interaction in infants and toddlers. The effects of genetics in determining calcium absorption and bone turnover may become an important research area. The goals and methods of ongoing mineral stable-isotope research in infants and children are examined in this report. In the past, the cost and difficulties in obtaining isotopes have limited such research. This situation has improved considerably, although relatively few nutrition research laboratories are prepared to perform sample analyses.