Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry.

BACKGROUND: There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians' attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning. METHODS: 411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions. RESULTS: Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups. CONCLUSION: The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.

A framework for evaluation of flood management strategies.

The resulting impact of disasters on society depends on the affected country's economic strength prior to the disaster. The larger the disaster and the smaller the economy, the more significant is the impact. This is clearest seen in developing countries, where weak economies become even weaker afterwards. Deliberate strategies for the sharing of losses from hazardous events may aid a country or a community in efficiently using scarce prevention and mitigation resources, thus being better prepared for the effects of a disaster. Nevertheless, many governments lack an adequate institutional system for applying cost effective and reliable technologies for disaster prevention, early warnings, and mitigation. Modelling by event analyses and strategy models is one way of planning ahead, but these models have so far not been linked together. An approach to this problem was taken during a large study in Hungary, the Tisza case study, where a number of policy strategies for spreading of flood loss were formulated. In these strategies, a set of parameters of particular interest were extracted from interviews with stakeholders in the region. However, the study was focused on emerging economies, and, in particular, on insurance strategies. The scope is now extended to become a functional framework also for developing countries. In general, they have a higher degree of vulnerability. The paper takes northern Vietnam as an example of a developing region. We identify important parameters and discuss their importance for flood strategy formulations. Based on the policy strategies in the Tisza case, we extract data from the strategies and propose a framework for loss spread in developing and emerging economies. The parameter set can straightforwardly be included in a simulation and decision model for policy formulation and evaluation, taking multiple stakeholders into account.

Behavioral risk factors for disease and preventive health practices among lesbians.

OBJECTIVES: This study compared the prevalence of health behaviors among lesbians and in the general population of women. METHODS: We used a cross-sectional community-based survey of 1010 self-identified lesbians 18 years or older. RESULTS: Compared with the general population of women, lesbians were more likely to report cigarette use, alcohol use, and heavy alcohol use. A higher percentage of lesbians were categorized as overweight, and lesbians were more likely to participate in vigorous physical activity. They were less likely to report having had a Papanicolaou test within the past 2 years but more likely to report ever having had a mammogram. CONCLUSIONS: While there may be differences in health behaviors between lesbians and the general population of women, how these differences influence the risk of subsequent disease is unknown.

Economic and resource utilization analysis of outpatient management of fever and neutropenia in low-risk pediatric patients with cancer.

PURPOSE: To measure resource allocation in outpatient management of fever and neutropenia in low-risk pediatric patients with cancer and its impact on their families. PATIENTS AND METHODS: A prospective clinical trial was conducted. Eligible patients received a single dose of intravenous (IV) antibiotics and were observed for several hours in clinic. Patients were randomly assigned to continue either IV or oral antibiotics and were seen daily as outpatients. Charges were calculated based on the number of resources used and Medicare/Medicaid reimbursement schedules. A questionnaire was used to measure the impact of outpatient treatment on the family. RESULTS: Seventy-three episodes of fever and neutropenia were studied. The median duration of treatment was 4 days. Eighty-six percent of the episodes were managed without hospitalization. The median calculated charge was $1840. The median calculated charge for patients receiving oral antibiotics was $1544 and was significantly less than the $2039 median charge for outpatients treated with IV antibiotics. The estimated charge for comparable inpatient treatment was $4503. Nearly all families preferred outpatient care, and few reported a loss of work hours or increased child care expenses. CONCLUSIONS: Outpatient treatment of low-risk episodes of fever and neutropenia is substantially less costly than inpatient care and is preferred by most families.

Problems in paradise: the case of Tahiti.

PIP: Tahiti, situated in the Society Islands of the South Pacific among the 130 islands in the five archipelagos of French Polynesia, has very few indigenous populations. Population growth has been rapid under the conditions of military development and increasing immigration. When nuclear testing was approved in 1966, 18,000 troops arrived as did foreign migrants seeking work. Per capita income was high for the Pacific island countries, but distribution was very uneven. The transfers of administrative systems and law resulted in the loss of lands for some, who could not adjust to a foreign system. Today urban youth are confronted with high unemployment, malnutrition, disease, and overcrowding. The once beautiful lagoons have been contaminated with sewage and pesticides from soil erosion, caused in part by the careless construction along coastal areas. The most serious health problem is irradiation caused cancers: leukemia, thyroid infection, and brain tumors. There are also high levels of miscarriages. Lagoon fish have become contaminated by the disruptions to their habitat from detonation in two atolls. On the Mangareva Islands, all 600 residents died from ciguatera fish poisoning. Anti-nuclear groups have had very little impact. Polynesian women have suffered from these conditions and from the view that women are unclean and inferior. Women do not have access to political or economic power. The first effective women's group was formed in 1975 after Tahitian women's participation in the first Pacific Women's Conference held in Suva, Fiji. Tahitian women exchanged information with other women of similar background, and valuable international contacts were made. The movement to stop nuclear testing gained momentum from these interactions, from subsequent conferences, and better press coverage at home. Knowledge of environmental issues has been hampered by language barriers and literacy. The suspension of testing in April 1992 will benefit the health of Tahitians in the long term, but loss of jobs and housing will be a difficult adjustment in the short term.^ieng