Length of patient-physician relationship and patients' satisfaction and preventive service use in the rural south: a cross-sectional telephone study

BACKGROUND: Physicians and patients highly value continuity in health care. Continuity can be measured in several ways but few studies have examined the specific association between the duration of the patient-doctor relationship and patient outcomes. This study (1) examines characteristics of rural adults who have had longer relationships with their physicians and (2) assesses if the length of relationship is associated with patients' satisfaction and likelihood of receiving recommended preventive services. METHODS: Cross-sectional telephone survey of health care access indicators of adults in selected non-metropolitan counties of eight U.S. predominantly southern states. Analyses were restricted to adults who see a particular physician for their care and weighted for demographics and county sampling probabilities. RESULTS: Of 3176 eligible respondents, 10.8% saw the same physician for the past 12 months, 11.8% for the previous 13–24 months, 20.7% for the past 25–60 months and 56.7% for more than 60 months. Compared to persons with one year or less continuity with the same physician, respondents with over five years continuity more often were Caucasian, insured, a high school graduate, and more often reported good to excellent health and an income above $25,000. Compared to those with more than five years of continuity, participants with either less than one year or one to two years of continuity with the same physician were more often not satisfied with their overall health care (OR 2.34; OR 1.78), participants with less than one year continuity were more often not satisfied with the concern shown them by their physician (O.R. 1.90) and having their health questions answered, and those with one to two years continuity were more often not satisfied with the quality of their care (OR 2.37). No significant associations were found between physician continuity and use rates of any of the queried preventive services. CONCLUSION: Over half of this rural population has seen the same physician for more than five years. Longer continuity of care was associated with greater patient satisfaction and confidence in one's physician, but not with a greater likelihood of receiving recommended preventive services

Teacher Wellbeing: The Importance of Teacher–Student Relationships

Many studies have examined the importance of teacher-student relationships for the development of children. Much less is known, however, about how these relationships impact the professional and personal lives of teachers. This review considers the importance of teacher-student relationships for the wellbeing of teachers guided by the Transactional Model of Stress and Coping of Lazarus (1991). Based on theories on interpersonal relationships, it is postulated that teachers have a basic need for relatedness with the students in their class that originates from the close proximity between teacher and student. It is discussed that teachers internalize experiences with students in representational models of relationships that guide emotional responses in daily interactions with students, and changes teacher wellbeing in the long run. In addition, the notion of mental representations of relationships at different levels of generalization could offer a window to understand how individual teacher-student relationships may affect the professional and personal self-esteem of teachers. Lastly, it is argued that the influence of student misbehavior on teacher stress may be more fully understood from a relationship perspective. The review shows that few studies have directly tested these propositions and offers suggestions for future research

Re-Arrest Among Juvenile Justice-Involved Youth: An Examination Of The Static And Dynamic Risk Factors

The purpose of this study is to investigate the static and dynamic risk factors for re-arrest among detained youth by examining gender, race/ethnicity, age, special education and mental health variables (i.e., anger/irritability, depression/anxiety, somatic complaints, suicide ideation, thought disturbances, and traumatic experiences). The demographic profiles of detained youth with one admit were also compared with those with multiple admits to the juvenile detention center. With regards to static risk factors, older, white, and special education were significantly at risk of re-arrest. Concerning dynamic risk factors, only anger/irritability predicted re-arrest. Practice implications are also discussed

Proximal Peer-Level Effects of a Small-Group Selected Prevention on Aggression in Elementary School Children: An Investigation of the Peer Contagion Hypothesis

Examined peer contagion in small group, selected prevention programming over one school year. Participants were boys and girls in grades 3 (46 groups, 285 students) and 6 (36 groups, 219 students) attending school in low-resource, inner city communities or moderate resource urban communities. Three-level hierarchical linear modeling (observations within individuals within groups) indicated that individual change in aggression over time related to the average aggression of others in the intervention group. The individual child was “pulled” toward peers’ mean level of aggression; so the intervention appeared to reduce aggression for those high on aggression, and to make those low on aggression more aggressive. Effects appeared to be magnified in either direction when the child was more discrepant from his or her peers. From these results we derive a principle of “discrepancy-proportional peer-influence” for small group intervention, and discuss the implications of this for aggregating aggressive children in small group programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44593/1/10802_2005_Article_3568.pd

Community Violence and Youth: Affect, Behavior, Substance Use, and Academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research