Predictors of Coordinated and Comprehensive Care Within a Medical Home for Children With Special Healthcare (CHSCN) Needs.

The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.

Assessing the transactional nature of wilderness experiences: construct validation of the wilderness-hassles appraisal scale.

Concerns over the increasing popularity of wilderness recreation have resulted in attempts to determine the amount of use that different areas can tolerate without adverse affects to the resource. Early attempts to establish recreational carrying capacities focused on managers' assessments of biophysical impacts. The perceptions of wilderness visitors, however, are now considered integral to capacity decisions. This study used a stress appraisal framework to understand wilderness visitors' perceptions of on-site conditions. It was based on the premise that negative appraisals of wilderness conditions produce stress and that individual perceptions vary based on personal and situational characteristics. The purpose of the study was to assess the validity of a wilderness-hassles appraisal scale by testing hypothesized relationships between experience-use history (EUH), place attachment, and stress appraisal. Data collection occurred through a postal survey of hikers (n = 385) contacted in the High Peaks and Pemigewasset Wilderness Areas during the summer of 2004. An exploratory factor analysis indicated that stress appraisal is a multi-dimensional construct. Validity testing procedures were restricted to those dimensions that were consistent between study areas and provided partial support for the hassles scale. As hypothesized, EUH did not influence perceptions of wilderness conditions. Place attachment, on the other hand, was positively correlated with stressful appraisals of social and managerial conditions. Although Kruskall Wallis tests revealed significant differences in visitors' perceptions of managerial conditions between study sites, perceptions of social conditions did not vary significantly. Implications for management and recommendations for further refinement of the wilderness hassles construct are discussed.