Seeking sufficient and appropriate care during the first year after spinal cord injury: a qualitative study.

STUDY DESIGN: Longitudinal qualitative study, based on a constructivist grounded theory and transformative approach. OBJECTIVES: This study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury. SETTING: An acute inpatient rehabilitation facility in the Midwest United States. METHODS: In-depth, semi-structured interviews were conducted with 20 individuals with newly-acquired SCI. Interviews were conducted approximately every other month for one year, beginning at acute inpatient rehabilitation. Data were analyzed and interpreted using a constructivist grounded theory approach and transformative paradigm, which examines power and social structures within and across institutions and gives voice to people at risk for marginalization. RESULTS: Participants experienced variable post-injury trajectories, with an average of four transitions within and across healthcare institutions in the first three months. Half of the cohort was discharged to a skilled nursing facility (SNF). Emergent themes included discharge (un)readiness; length of stay uncertainty and insurance impacts; challenges choosing a SNF including time-sensitive decisions; and early cessation of therapy in the SNF. Participants experienced resource navigation challenges such as communication/information access barriers and contending with many concerns at once. CONCLUSIONS: The experiences of this cohort reveal significant challenges to attaining sufficient and appropriate rehabilitation. Acute inpatient rehabilitation is a critical aspect of recovery, but does not ensure sufficient intervention for maximization of functional skills and community reintegration. Innovative rehabilitation models need to be developed for positive impacts on successful transition to independent living in the community.

Definitions of recovery and reintegration across the first year: A qualitative study of perspectives of persons with spinal cord injury and caregivers.

STUDY DESIGN: Longitudinal, qualitative cohort study. OBJECTIVES: To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. SETTING: Academic and Veterans hospitals in Midwest USA. METHODS: In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. RESULTS: Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. CONCLUSIONS: This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.

Depressive Symptoms in Later Life in China: Situating "Long Arm" of Child Physical Maltreatment Within a Family Context.

Objective: This article intends to reveal the long-term effects of physical maltreatment in childhood on depressive symptoms in later life in China. Methods: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). 8676 respondents aged 45 and older were included in the study. In this study, we use ordinary least squares (OLS) regression models to estimate the long-term impact on children of physical punishment from their parents. Results: We found that individuals who recalled being hit by their mother in early life reported more depressive symptoms than those who recalled being punished by their father. Difficult family contexts (e.g., comparative poverty, family violence, and parent's poor mental health) had a weak association with higher risk of reporting physical maltreatment and more depressive symptoms among respondents in later life. Conclusion: This article extended the exploration of the long-term impact of child physical maltreatment beyond adolescence and into until later adult life. Effective policies to protect children from maltreatment in the form of physical punishment require further attention to the challenges posed by tradition and culture.

For-profit hospitals have a unique opportunity to serve as anchor institutions in the U.S.

Hospitals serve as anchor institutions in many U.S. communities and make contributions to bolster population health and reduce preventable death. Most studies to date have focused on nonprofit hospitals, but there may be significant opportunity for for-profits to fill this role in both urban and rural communities. Using 2017-2018 data, we calculated descriptive statistics and a multivariate regression model to assess economic and health characteristics for all U.S. counties that contain for-profit as compared to nonprofit or public hospitals (n = 4,622). After controlling for hospital and county characteristics, we found a significant and positive relationship between for-profit hospital presence and higher county unemployment, higher uninsured rates, and the number of residents reporting poor/fair health. For-profit hospitals were also less likely to be located in states that had expanded Medicaid or which had certificate-of-need laws. Our findings suggest that there is substantial opportunity for for-profit hospitals to serve as anchor institutions in many U.S. communities, despite this label more traditionally being applied to nonprofit hospitals. Given that there is not currently a regular reporting mechanism for documenting the community health contributions of for-profit hospitals, policymakers and researchers should evaluate the current state of these contributions and develop incentives to encourage more anchor activities to benefit economically vulnerable communities in the U.S.

The importance of environment: Neighborhood characteristics and parent perceptions of child health.

Andersen's Behavioral Model of Health Services Use acknowledges the importance of community and environment in how individuals utilize health-care services. This article questions whether and how environment influences perceptions of health, specifically parents' perceptions of their children's health. Based on data from the 2011-2012 US National Survey of Children's Health, this study investigates how parents' views of their neighborhoods (such as safety, social support, amenities, and detracting elements) shape perceptions of their child's health. Furthermore, the analysis considers how these relationships are similar or different for minority populations. Using ordinal logistic regression, this study demonstrates that neighborhood characteristics influence parents' perceptions of their children's health. Parents who report their neighborhoods as safe, supportive, and having desirable amenities perceive their children to be healthier. Parents living in neighborhoods possessing detracting elements report their children's health as worse. These findings are largely consistent for minority and nonminority neighborhoods. The findings of this study convey the importance of environments to how parents view the health of their children. Improving safety and strengthening social supports within neighborhoods could help to address health concerns. As well, health-care organizations and public health offices should launch initiatives in disadvantaged neighborhoods to address health concerns and disparities.

Rights and the role of family engagement in child welfare: an international treaties perspective on families' rights, parents' rights, and children's rights.

According to international human rights treaties, what rights do family members, parents, and children have in family engagement in child welfare decision-making? A socio-legal analytical approach produces a typology of rights, then applies the typology to eight countries' approaches to family engagement to show that strong bundles of rights are available in some countries, but not in others. This study reveals international treaties have articulated many rights necessary to family engagement, but some rights are missing.

A second opinion: rethinking the public-private dichotomy for health insurance.

Does the public-private dichotomy effectively describe health insurance systems in the advanced industrialized democracies? Is the boundary separating the public and private sectors accurate for studies o f social policy formation and cutback? This article has three goals. The first is to discuss reasons for reconsidering the public-private dichotomy, as it applies to health insurance systems. The second is to offer a reconceptualization of the public-private demarcation useful for analyses of health insurance systems; the author presents four sectors that may illuminate patterns of health insurance for different OECD countries: the social, individual, public, and market sectors. The third goal is to present results using a new methodological approach useful for studying complex social phenomena: the fuzzy-set approach, which allows researchers to treat social phenomena as partially belonging to more than one category. This approach is employed to demonstrate that health insurance provision rarely is solely public or private, but is formed by a combination of sectors. Underlying these three goals is the contention that comparative and historical sociological researchers can offer innovative approaches to the study of health insurance and the interests served by public and nonpublic health insurance programs through reconceiving the public-private dichotomy.