Measuring outcomes in the changing environment of child welfare services.

Child welfare service organizations are undergoing profound changes with the advent of managed care. Expensive development of new infrastructures is required, including information systems to track services and outcomes. The authors examine key considerations in designing an outcomes measurement program for child welfare agencies and challenges for implementation. In addition, they review national initiatives to determine best practices for outcomes measurement of children's services, and how these initiatives can help guide others' efforts.

Corticosteroids and ulcers: is there an association?

The literature presented supports a small but highly probable association between corticosteroids and ulcers. The following characteristics appear to be exhibited by patients who are at high risk for developing corticosteroid-induced ulcers: corticosteroids coadministered with NSAIDs, a total dosage greater than 1000 mg of prednisone equivalent, a duration of therapy longer than 30 days, and a history of PUD. Further prospective research examining the association of corticosteroids and PUD in conjunction with other contributing factors is needed. The role of prophylactic therapy to prevent corticosteroid-induced ulcers is not well established. Even though a small study in liver transplant recipients, who are already at increased risk for GI ulceration, has suggested beneficial effects with prophylactic regimens, generalization of these results to all corticosteroid-treated patients would be inappropriate. Large prospective trials to determine the most efficacious prophylactic regimen (e.g., histamine2-receptor antagonists, proton pump inhibitors, cytoprotective agents [misoprostol]) for corticosteroid-induced ulcerations are not currently available. We suggest that most prophylaxis currently performed is unnecessary. In high-risk patients, however, prophylaxis appears to be prudent until further information is available.

Risk assessment as a practice method in child protective services.

This article offers an overview of the development of risk assessment and its purpose and goals, a summary of research on risk assessment to date, and suggestions regarding future research. This overview indicates that the use of risk assessment is a widespread phenomenon, with differing goals and purposes. Research on risk assessment confirms the lack of conceptual clarity and the difficulty of incorporating it into a child protective services system that emphasizes findings of abuse and/or neglect as the key to continuing involvement in the system.

In-home family-focused reunification: an experimental study.

Intensive, in-home family-based services were employed in reunifying families separated by the placement of a child in out-of-home care. After a 90-day service period, 93% of the 57 families randomly assigned to receive the intensive treatment were reunited-compared to 28% of the 53 families in a control group who received routine out-of-home care services. Follow-up data were collected six and 12 months after the end of treatment. Estimates of outcomes suggest that the experimental treatment had a substantial impact on families and that treatment effects endured for upwards of 12 months following cessation of direct intervention services.

Improving the quality of child welfare services: needs assessment for staff training.

Competency-based needs assessment surveys can be useful in assessing worker training needs in child welfare. Worker and supervisor surveys, consisting largely of task-based ability statements, constitute the core of this approach. Additional information can also be obtained from supervisors and allied professionals. Data from a study of 276 frontline child welfare workers in Alaska and Oregon are used to illustrate the utility of this approach.

Carotenoids, retinoids and alpha-tocopherol in human serum: Identification and determination by reversed-phase HPLC.

A rapid, simple and specific high performance liquid chromatographic procedure for assaying alpha- and beta-carotene is described. The method also enables the simultaneous determination of retinol and dl-alpha-tocopherol in human serum. The same chromatographic procedure can be used to assay the major carotenoids in human serum, provided analyses are replicated and the effluent is monitored at 450 nm. The conditions described also enable determination of licopene, cryptoxanthine and lutein with zeaxanthine. An aliquot of 0.5 ml serum is deproteinized with ethanol (0.5 ml) and extracted with petroleum ether (0.75 ml). The petroleum ether extract is evaporated until dry and then redissolved immediately with 0.5 ml of an eluent mixture consisting of methanol-hexane (85:15, v/v). Aliquots of 50 microl are then injected onto a 250 x 4.6 mm column packed with Spherisorb ODS-2. Owing to its good reproducibility, the procedure can be used for assays with external standards. Clinical applications are described for cases of hypercarotinemia associated with endocrine dysfunctions such as hypothyroidism and diabetes.

Evaluating child protective services training: the participant action plan approach.

As part of protective services training, participants developed action plans-lists of practice behaviors or organizational changes they planned to carry out as a result of the training. A three-month follow-up indicated that a number of action items were successfully implemented, particularly in the areas of risk assessment and therapeutic interventions.

[Effect of renal and liver failure on blood levels of vitamin A, its precursor (beta-carotene) and its carrier proteins (prealbumin and retinol binding protein)]. / Influenza dell'insufficienza renale ed epatica sul tasso ematico della vitamina A, dei suoi precursori (beta-carotene) e dei suoi vettori proteici (PA e RBP).

Plasma beta-carotene and retinol assay was performed by high pressure liquid chromatography (HPLC) in subjects with chronic renal failure or liver cirrhosis. In the same subjects blood prealbumin (PA) and retinol binding protein (RBP) were determined by immunological technique. A considerable increase of retinol and in a lesser extent of beta-carotene was noted in the blood of patients with renal insufficiency. In cirrhotic patients it was shown a marked decrease both of beta-carotene and retinol plasma concentrations. PA and RBP there were greatly increased in renal failure and decreased in liver cirrhosis. This results suggest that kidney and liver chronic failure interfere with vitamin A metabolism throughout their action on metabolic processes of synthesis and elimination of PA and RBP.

[Behavior of vitamin A, beta-carotene, retinol binding protein and prealbumin in the plasma of hypo- and hyperthyroid subjects]. / Comportamento della vitamina a, dela beta-carotene, della proteina legante il retinolo e della prealbumina nel plasma di soggetti ipo ed ipertiroidei.

Plasma concentrations of beta-carotene and retinol, determined by HPLC, and of transport proteins, ascertained by immunodiffusion technique, in hypo and hyperthyroid subjects are reported. In hypothyroid subject a considerable increase in carotene was noted. This was not the case for retinol. In hyperthyroids both beta-carotene and retinol levels were found to be normal. Transport protein (PA and RBP) levels were found to be lower only in cases of hyperthyroidism but unchanged for hypothyroids. According to the Authors the results show that the alteration in plasma carotene levels to be found in hypothyroid subjects is not the direct consequence of a lack of thyroid hormone in the metabolism of vitamin A but the indirect effect of thyroid disease.

[Oral load test with beta-carotene in normal and dysthyroid subjects]. / La prova da carico per os con beta-carotene nei soggetti normali e distiroidei.

An oral load of beta-carotene (500 mg) was administered to four normal, four hypo and four hyperthyroid subjects. Plasma beta-carotene content was determined at the 2nd, 4th, 6th, 8th, 10th, 12th and 24th hour after administration and at every 24th hour thereafter for 5 consecutive days. Plasma assays were performed by HPLC. No significant differences were revealed by Student's T test for one group to the other. The authors sustain that, as there is no impairment in intestinal uptake of beta-carotene in disthyroid subjects, the elsewhere described increase in carotinemia in hypothyroids is due to other mechanisms.

[Serum content of vitamin A binding proteins (prealbumin and retinol binding proteins) in normal and pathological conditions]. / Contenuto sterico delle proteine vettrici la vitamina A (PA e RBP) in condizioni normali e patologiche.

Blood PA and RBP content were estimated in 100 normal subjects (50 men and 50 women). Mean values of 28.2 and 3.75 mg/dl were ascertained for PA and RBP, respectively. The molar ratio RBP/PA was calculated as 0.31 +/- 0.05. Serum concentrations of PA and RBP are seen to be sex-dependent (20% higher in males). Hyperthyroid subjects exhibit a decrease in the two vitamin A-binding proteins whereas no modification could be revealed for hypothyroid states. In patients on maintenance hemodialysis mean serum PA and RBP concentrations were remarkably higher than normal, whereas liver cirrhotic subjects showed a highly significant depression of mean serum RBP and PA values.

[Changes induced by parturition in serum cholesterol and triglycerides in obese and normal weight women]. / Modificazioni indotte dal parto sul colesterolo e sui trigliceridi sierici in donne obese e normopeso.

It is shown that total cholesterol levels in the blood before and immediately after delivery in obese and normal weighing women remain within normal values. Conversely blood triglycerides levels, higher than normal prior to delivery, are shown to drop back to normal values within three days (p 0.001). This is not thought to be attributable to labor stress.

[Effect of parturition on serum glycerol and non-esterified fatty acids in obese and normal weight women]. / Influenza del parto sul contenuto silrico di glicerolo e di acidi grassi non esterificati in donne obese e normopeso.

Serum glycerol and NEFA content variations are examined before and after labor in obese and normal weighing women (35 subjects). Blood glycerol and NEFA are shown to increase before delivery. Glycerol values are shown to drop to normal immediately after delivery, while NEFA values diminish to a lesser extent. Statistical analysis shown that blood glycerol increase could be pregnancy-dependent in both normal weighing and obese women, but that NEFA increase could be pregnancy-dependent in normal weighing women only. Obesity increases blood glycerol and NEFA concentration considerably, thus masking the effects of pregnancy.

Constipation and obesity: a statistical analysis.

Constipation frequency was investigated among 1897 subjects (874 males and 1023 females), ranging in age from 6 to 70 years, chosen at random between city inhabitants and farmers. Bowel habit was studied in 966 obese patients (390 males and 576 females). The authors followed for the diagnosis of constipation either the commonest and restrictive criterion of the weekly bowel actions or the clinical one which implies also others parameters, like hard or small stools, difficulties of expulsion or feeling of incomplete evacuation after defecation. The statistical analysis showed that constipation frequency is 8.3% in obese patients and 1.5% in normal-weighting, according to weekly bowel actions criterion: the difference is statistically significative (p less than 0.001).

Blood glycerol meaning in obese patients.

The authors studied the behaviour of blood glycerol concentration after glycerol i.v. infusion in obese and normal subjects. The aim of research was to clarify the meaning of blood glycerol increase observed by some one in obese subjects. Results obtained showed that in obese subjects there is not any abnormal behaviour of blood glycerol concentration after infusion and that in none of patients studied was observed any significative increase of basal blood glycerol concentration values.