The role of social workers in addressing nonmedical needs in primary health care

Nonmedical needs are intricately linked to health. Unaddressed nonmedical needs often result in poorer health and increased healthcare costs. Although social workers are well positioned to address nonmedical needs, their role in healthcare environments to address nonmedical needs is limited. The limited role relates to a lack of reimbursement streams, which stems from poor articulation about their unique contributions. An analysis of a case study in which a social worker using AIMS, a protocolized care coordination model, was undertaken to highlight specific activities performed by social workers. Implications for patient health outcomes and healthcare costs are discussed.     

Anxiety and depression in children and adolescents with spinal cord injuries

Aim  To determine the levels of anxiety and depression in young people with spinal cord injuries (SCI) and their associated factors and outcomes.
Method  Children and adolescents aged 7 to 17 years at interview who had sustained SCI at least 1 year before the study were assessed using the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Pediatric Quality of Life Inventory, the Children's Assessment of Participation and Enjoyment, and a demographic questionnaire designed for the study.
Results  The 118 participants (61 males, 57 females) had a mean age of 12 years 4 months, SD 3y 1mo, range 7-17y. Mean age at injury was 5 years 11 months, SD 4y 11m, range 0-16y; 89 participants (75%) had paraplegia and 29 (25%) had tetraplegia. Fifty-seven (52%) had complete injuries and 52 (48%) had incomplete injuries according to the American Spinal Injury Association impairment scale. Thirteen participants (13%) reported significant symptoms of anxiety, and seven (6%) reported significant levels of depression, which were comparable to the normative population. Age, race, and sex were not associated with anxiety or depression, but participants with shorter duration of injury were more likely to be anxious, and those with less functional independence were more likely to be depressed. Only one dimension of participation was associated with anxiety and depression, but all aspects of quality of life were decreased among those with anxiety or depression.
Interpretation  The levels of anxiety and depression in young people with SCI are comparable to the normative range. When anxiety and depression occur they are associated with reduced levels of quality of life.     

Physicians' Decisions to Prescribe Benzodiazepines for Nervousness and Insomnia

OBJECTIVE: To assess the effects of particular clinical cues on decisions about prescribing benzodiazepines. DESIGN: A factorial survey based on social judgment theory. SETTING: A midwestern U.S. medical school. PARTICIPANTS: Physicians (n = 115) recruited from the staff by invitation and interview. MEASUREMENTS AND MAIN RESULTS: Physicians indicated their level of agreement with prescribing a benzodiazepine for 24 hypothetical cases of nervousness and insomnia. The cases stemmed from the same scenario but varied systematically with regard to psychiatric diagnosis, recent ability to work, and long-term social stability. A fourth cue, called 'health status,' covertly depicted the presence or absence of three common alcohol-related medical problems. One fourth of the physicians agreed with prescribing for 15 or more cases, and 15% disagreed for all of them. Agreement was cumulative and least common for major depression, more common for adjustment disorder, and most common for generalized anxiety. Agreement with prescribing for cases with alcohol-related medical problems was 14% less than that for cases without them. Over half the physicians agreed with prescribing for 4 or more of the 12 cases with alcohol-related medical problems. CONCLUSIONS: Prescribing decisions varied widely. Some physicians avoided benzodiazepines unnecessarily for some cases, while others agreed with prescribing for patients with a high probability of alcohol abuse. Blanket calls for more or less prescribing are overly simplistic; physicians should be able to recognize substance use disorders among anxious patients and make prescribing decisions based on relevant literature and clinical cues.     

State/University Collaboration to Strengthen Children's Residential and Placement Services

This article presents a model of collaboration between a state child welfare licensing division and a public university to develop and administer online examinations for persons seeking licensure as administrators of residential child care facilities or child placing agencies. The exams assess knowledge of state standards and various practice domains. The article presents the project's underpinnings in child welfare history, contingency theory, and literature on contracting and collaboration. The article examines other states' practices and details the evolution of this project since 2003. It concludes with discussion of the project's usefulness as a model for other states and jurisdictions.     

A survey of dietetics professionals' knowledge of and attitudes toward cholesterol management

Dietetics professionals in Wisconsin (n = 687) were surveyed to assess their knowledge, attitudes, practices, experience, and educational interests regarding cholesterol management. The survey, conducted to guide the development of cholesterol education programming in the state, found that most dietetics professionals are familiar with and support the guidelines of the National Cholesterol Education Program (NCEP). Ninety-three percent of dietetics professionals responding to the survey believe that reducing serum cholesterol levels will reduce the risk of heart disease; the same percentage of respondents were familiar with NCEP guidelines for detecting and treating blood cholesterol levels and knew which cholesterol levels should be treated. Seventy-three percent were familiar with the American Heart Association step 1 diet, and 69% were familiar with the step 2 diet. On average, survey respondents defined a cholesterol level of 6.12 mmol/L as “high risk”; this value is almost identical to the NCEP definition. Respondents were optimistic about patients' ability to reduce their blood cholesterol levels through dietary modifications. Dietetics professionals are interested in education on cholesterol management, although individual educational interests vary depending on the respondent's area of practice.     

Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine

Answer questions and earn CME/CNE Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e‐cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current‐generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine‐containing products. Because nicotine is the common core—and highly addictive—constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine‐replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm‐reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of “harm,” their relationship to smoking cessation, the so‐called gateway effect, and dual use/poly‐use. CA Cancer J Clin 2017;67:449‐471. © 2017 American Cancer Society.     

Depression Care Need Among Low-Income Older Adults: Views from Aging Service Providers and Family Caregivers

This study reports findings from focus group discussions with aging service providers and family caregivers about low-income ambulatory or homebound older adults' depressive symptoms and barriers to seeking treatment. It also reports the participants' suggestions about interventions for depression that can be integrated into existing aging service settings or implemented in older adults' homes, as well as the type of training the aging service providers need if they are to provide services for depression. Participants identified social isolation, loneliness, and loss and grief as major correlates of depression in older adults. Barriers to seeking treatment included older adults' denial of or lack of understanding about depression, a sense of stigma, financial worries, and lack of mobility. Suggested depression treatments included brief cognitive behavioral interventions, friendly visitors, and physical exercise. Bachelor's-level service providers expressed their need and desire for training in mental health assessment and brief psychotherapy.