A cost-effectiveness comparison of supported employment and rehabilitative day treatment

Recent research suggests that, for some people with severe mental illness, supported employment could improve vocational outcomes for little additional expense. This study describes the costs and client outcomes in one mental health center that converted two rehabilitative day treatment programs to supported employment. Converting from day treatment to supported employment improved vocational outcomes significantly without increasing costs. Although total costs for community treatment were lower in both sites after implementing supported employment, differences appeared to be due to decreasing unit costs over the study period. Results illustrate the importance of testing the effects of cost estimation methods on findings.This study was supported by West Central Services, the New Hampshire Division of Mental Health and Developmental Services, and NIMH grant K02-MH-00839. The authors are grateful to Jesse Turner and Phil Wyzik for facilitating the research.     

Experimental stress fractures of the tibia. Biological and mechanical aetiology in rabbits

We have shown that stress fractures can be induced in the tibial diaphysis of an animal model by the repeated application of non-traumatic impulsive loads. The right hind limbs of 31 rabbits were loaded for three to nine weeks and changes in the bone were monitored by radiography and bone scintigraphy. The presence of stress fractures was confirmed histologically in some cases. Most animals sustained a stress fracture within six weeks and there was a positive correspondence between scintigraphic change and radiological evidence. Microscopic damage was evident at the sites of positive bone scans. The progression, location, and time of onset of stress fractures in this animal model were similar to those in clinical reports, making the model a useful one for the study of the aetiology of stress fractures.     

Symposium on rectal cancer: 2. Local recurrence after surgery for rectal cancer

Local recurrence is a serious complication in patients with rectal cancer because of the frequency with which it occurs, its impact on quality of life and the fact that treatment is rarely successful. Although local recurrence rates varying from 4% to 51% have been reported, recent series have reported rates of less than 10%. Various factors may affect the rate of local recurrence, including the stage and location of the tumour. Other prognostic factors may be of importance, but it is controversial whether they are independent risk factors. Finally, there is mounting evidence that the local recurrence rate varies with the surgeon. Whether this is due to the surgical technique or surgical expertise is not clear, but randomized controlled trials addressing the issue of extent of resection are indicated in order to optimize surgical results.     

Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C.

Hepatitis C virus (HCV) infection is a major public-health-care problem, with over 170 million infected worldwide. Patients with chronic HCV infection often complain of various cognitive problems as well as symptoms of depression, anxiety, and fatigue. Relatively little is known, however, about the specific cognitive deficits that are common among HCV patients, and the influence of psychiatric symptomatology on cognitive functioning. In the current study of 21 chronically infected HCV patients, we assessed subjective cognitive dysfunction, depression, anxiety, and fatigue and compared these symptom areas to cognitive tests assessing visuoconstruction, learning, memory, visual attention, psychomotor speed, and mental flexibility. Results revealed that cognitive impairment ranged from 9% of patients on a visuoconstruction task to 38% of patients on a measure of complex attention, visual scanning and tracking, and psychomotor speed, and greater HCV disease severity as indicated by liver fibrosis was associated with greater cognitive dysfunction. Objective cognitive impairment was not related to subjective cognitive complaints or psychiatric symptomatology. These findings suggest that a significant portion of patients with chronic HCV experience cognitive difficulties that may interfere with activities of daily living and quality of life. Future research using cognitive measures with HCV-infected patients may assist researchers in identifying if there is a direct effect of HCV infection on the brain and which patients may be more likely to progress to cirrhosis and hepatic encephalopathy.     

Assessing organizational capacity to deliver HIV prevention services collaboratively: tales from the field.

Collaborative efforts between university researchers and community entities such as citizen coalitions and community-based organizations to provide health prevention programs are widespread. The authors describe their attempt to develop and implement a method for assessing whether community organizations had the organizational capacity to collaborate in a national study to prevent HIV infection among young men who have sex with men and what, if any, needs these institutions had for organizational capacity development assistance. The Feasibility, Evaluation Ability, and Sustainability Assessment (FEASA) combines qualitative methods for collecting data (interviews, organizational records, observations) from multiple sources to document an organization's capacity to provide HIV prevention services and its capacity-development needs. The authors describe experiences piloting FEASA in 13 communities and the benefits of using a systematic approach to partnership development.     

The Confidence of Community Health Nurses in Caring for Ethnically Diverse Populations

Community health nurses (N = 190) responded to a Likert-type cultural self-efficacy scale to determine their degree of confidence in caring for three distinct populations (blacks, Puerto Ricans and Southeast Asians). The highest confidence scores were reported for caring for the black population, the lowest ratings were reported for Southeast Asians, while Puerto Ricans fell between the other two groups. Low scores were observed on items that included knowledge of health beliefs and practices as well as beliefs about respect, authority and modesty. Higher scores were observed in using an interpreter correctly. In no instance did ratings reach even moderate levels of confidence. Results suggest that nurses do not feel confident about caring for any of the three major ethnic groups in our communities. Furthermore, this perceived weakness cuts across the three groups and across nurses' educational and demographic variables.