AN EMPIRICAL ANALYSIS OF THE UTILIZATION PATTERNS OF WITHIN FACILITY AND SECONDARY HEALTHCARE SERVICES BY KENTUCKY STATE PRISON INMATES

The inmate population is increasing, aging and generally in poorer health than the non-incarcerated population. Providing healthcare to inmates is constitutionally mandated, and expensive. Little published research exists to assist corrections health policy makers strategically plan for future inmate healthcare needs. This research provides an extensive description of the healthcare utilization patterns of a sample of 577 male and female inmates incarcerated at state-operated prisons in Kentucky during the period January 1, 2007, to December 31, 2007 and who have at least one of the chronic conditions of diabetes, hypertension or hyperlipidemia. The primary outcome measures were a count of the number of encounters documented in the inmate‟s electronic health record by 1) medical doctors and advanced registered nurse practitioners (medical care utilization) and 2) psychiatrists and psychologists (mental healthcare utilization), and 3) a dichotomous variable indicating if the inmate had received care from a health provider located outside the prison. The explanatory variables included demographic variables, health status variables, health risk factors, sentence-related variables, facility characteristics, inmate to corrections and medical staff ratios and quality of care indicators. Differences in healthcare utilization between various groups of inmates were tested using Pearson‟s chi-squared test for categorical variables and Student t-test for continuous variables. In the bivariate analysis increasing age, being female, having comorbidities, having a diagnosis of mental illness, being obese, not adhering to diet, exercise and medications, refusing or missing treatment, being at a facility with more corrections or medical staff and having better quality of care were all associated with greater healthcare utilization. Negative binomial regression was used to analyze the count outcomes, and multivariate logistic regression analysis was used to analyze the dichotomous outcome. Regression analysis revealed that the number of problems an inmate had recorded in their electronic health record and increasing age were the two greatest predictors of within facility and secondary healthcare utilization. Carrying out case management and disease management for inmates with comorbidities may have benefits for Departments of Corrections and inmates

Toronto Star Coverage of the Politics of Breast Cancer

Research on media coverage of breast cancer has illustrated a tendency to report most often on prevalence, detection and treatment with a general lack of environmental and prevention oriented stories. In spite of growing evidence of links of causation between environmental and occupational exposures to breast cancer, the media seem generally to omit these factors. A detailed Critical Discourse Analysis was conducted on 125 articles from the Toronto Star from the year 2012, with the Propaganda Model as the theoretical framework. Seven different themes were found in the coverage of breast cancer. The study exposed how the dominant ideology came to bear on those texts, including the general omission and/or downplaying of environmental and occupational exposures in relation to breast cancer, as well as primary prevention. Given the significance for public health, understanding how the media cover the breast cancer epidemic can reveal necessary paradigm shifts

An exploration of the effect of servicescape on student institution choice in UK universities

In recent years there has been increased discussion of the subjective, emotional and sociological factors influencing student choice of university. However there is a dearth of information exploring what constitutes these feelings. This exploratory paper uses the conceptual model of the servicescape to provide insight into the emotional factors driving student choice. In-depth interviews with prospective students revealed first impressions really do count. Students are deterred by poor physical environments and excited by enthusiastic staff and students. Most significantly the study revealed the necessity of a restorative servicescape to provide both a sense of escape and feeling of belonging. This paper contributes to broadening the application of the servicescape model, to a greater understanding of the impact of the environment on prospective students, and creates an opportunity to inform policy by providing university marketing decision makers with a better understanding of what constitutes the university environment and what makes it appealing to prospective students

A problem-based approach to clinical education in dietetics

Developing the clinical skills and knowledge of dietetic students provides a challenge for both universities and health care agencies. Deakin University has recently adopted a group learning model using problem-based learning to deliver the clinical component of the Master of Nutrition and Dietetics course. This approach was designed to enhance integration of clinical theory and practice, develop closer links between on-campus and off-campus learning environments and provide students with more active learning experiences. The impact of the new approach was evaluated using student questionnaires, academic and competency outcomes, and a focus group convened with hospital supervisors. The evaluation indicated that students generally thought that this method of learning had helped to integrate their basic knowledge with dietetic case management. There was no difference in academic scores from the previous year and an apparent reduction in the number of students requiring additional placement time to mee t competency standards. Hospital supervisors were supportive of the changes, although they had some reservations regarding the time and structure of clinical placements. As a result of this evaluation, recommendations for future development of the program include introducing problem-based learning to students earlier in their course, providing additional placement days during the block and increasing the amount of time dedicated to more complex topics. Based on the evaluation results obtained, this collaborative learning using a problem-based approach will continue to be used in the clinical education program at Deakin University. <br /

Poems

Poems include: GO! , by Frederick Winter, Beyond Waters , by Christie Rudolph, and Classicism and Romanticism , by Jane Beure

Nutritional risk in community dwelling older adults.

This research investigated nutritional risk in older adults living in the community. A key finding was that a different healthy weight range should be applied to older adults, which has important implications for nutritional assessment. Recommending a higher BMI for older adults has now been incorporated into some National nutritional guidelines

Direct patient contacts of dietetic students during their final clinical placement

Direct student-patient contacts, during the professional clinical placement of a Master of Nutrition and Dietetics course, were collected and analysed for the first time using a computerised method. In the final eight-week hospital placement, 26 dietetic students submitted data on direct patient contacts which included: dietetic activities (e.g. assessing, counselling and reviewing); the primary nutritional condition of the patient (e.g. type 2 diabetes and liver disease); and the time spent in contact with patients. The most common dietetic activities were reviews, followed by collection of dietary information and counselling. The most common nutritional condition encountered by students was an inadequate nutrient intake, followed by patients receiving enteral nutrition. Contact time with patients increased over the placement, with proportionately more time spent by students seeing patients independently than when being observed by supervising dietitians. The data collected provided valuable informa tion on the amount of time spent by students in direct patient contacts, the range of dietetic activities undertaken and the amount of time student activities were directly observed. This information will be useful in the development of benchmarks for clinical skill development, hospital and university staff planning and the assessment of the impact of any changes to the format of student placement experience in the clinical setting.<br /

A cohort study of the recovery of health and wellbeing following colorectal cancer (CREW study): protocol paper

Background: the number of people surviving colorectal cancer has doubled in recent years. While much of the literature suggests that most people return to near pre-diagnosis status following surgery for colorectal cancer, this literature has largely focused on physical side effects. Longitudinal studies in colorectal cancer have either been small scale or taken a narrow focus on recovery after surgery. There is a need for a comprehensive, long-term study exploring all aspects of health and wellbeing in colorectal cancer patients. The aim of this study is to establish the natural history of health and wellbeing in people who have been treated for colorectal cancer. People have different dispositions, supports and resources, likely resulting in individual differences in restoration of health and wellbeing. The protocol described in this paper is of a study which will identify who is most at risk of problems, assess how quickly people return to a state of subjective health and wellbeing, and will measure factors which influence the course of recovery. Methods: this is a prospective, longitudinal cohort study following 1000 people with colorectal cancer over a period of two years, recruiting from 30 NHS cancer treatment centres across the UK. Questionnaires will be administered prior to surgery, and 3, 9, 15 and 24 months after surgery, with the potential to return to this cohort to explore on-going issues related to recovery after cancer. Discussion: outcomes will help inform health care providers about what helps or hinders rapid and effective recovery from cancer, and identify areas for intervention development to aid this process. Once established the cohort can be followed up for longer periods and be approached to participate in related projects as appropriate and subject to funding<br/

A proposed in-service program for cooperating teachers based on a study of Oregon State University home economics cooperating teachers

The purpose of the study was to develop a proposed in-service program for cooperating teachers who supervise student teachers. Forty-one cooperating teachers for the Home Economics Education Department of Oregon State University rated the competencies of a good supervisor of student teachers. Also, 17 heads of home economics teacher education departments in universities and colleges suggested what preparation and on-going help cooperating teachers should have. An analysis of the data revealed that the department heads believe a formal graduate course in supervision was a necessity. In addition, seminars or workshops at regular intervals were also deemed important for updating. It was learned the majority of the respondents had never had a course or in-service training in supervision other than cooperating teacher seminars and a large number felt themselves deficient in many areas. It was found a number of the cooperating teachers experience common problems, such as: methods of evaluation, techniques in developing ability within the student teacher to express and use her own ideas, need for a class on supervision, ways of being more helpful in general to the student teacher, how to effectively guide the student teacher without doing too much for them and help the student teacher build self-confidence. The respondents were asked to rate 30 competencies of cooperating teachers. Twenty-nine competencies were rated by the majority of cooperating teachers as being "important" or "very important." Using the data in the study, a proposed in-service program was outlined and methods by which it could be taught