System-Linked Research Unit on Health and Social Service Utilization, School of Nursing, McMaster University, Room 3N46, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. mreid@mcmaster.ca
This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
Of 45 first admission schizophrenics from 1963, an incidence by first admission group for northern Alberta, 43 were followed-up 14 years later. Based on these figures the expectancy was found to be 0.49%. The proportion of patients who were married was less than expected in comparison with the general population, but amongst the married, fertility was probably comparable to the population's. At follow-up about half the patients were managing well with little or no disability, one quarter had moderate to marked disability and the remainder were socially, psychiatrically and occupationally disabled. From the time of first admission, patients had spent an average of 15% of their time in hospital and lost 28% of the total time due to psychiatric disability.
Patient care classification in Canada in the past has been largely dictated by insurance coverage and the fiscal policies of the individual provinces. In recent years, however, the Canadian Department of Health and Welfare has been promoting the development of a standard patient care classification based on assessment of client or patient needs in regard to the category, type, and level of care. Experimentation with the proposed classification system in several provinces confirms the need in long-term care to include assessment of nursing requirements, physical functioning, and psychosocial assets and liabilities, and points to the importance of using such a classification for planning and evaluating patient care as well as for administrative purposes.
A register investigation was carried out as of December 31, 1980, with the aim of giving a broad description of a child psychiatric clientele 30 years after admission to hospital. The material consists of 322 patients--189 boys (59%) and 133 girls (41%)--who were admitted during the period 1949-1951 to the only 2 child psychiatric departments at that time in Denmark. We succeeded in identifying 93% of the patients. The mean age at the time of analysis was 38.6 years (range 32-46). The material was compared with the age-related Danish population by marital status, vocational education, and socioeconomic class. A total of 115 patients (36%) had been admitted to an adult psychiatric department, and 50 patients only once. A total of 95 patients (30%) had committed criminal offences and 12 had only committed traffic offences. A total of 60 patients (19%) had obtained disability pensions. During the 30-year follow-up period, 19 patients (6%) had died. A statistically significant extra mortality was found only for women. Four patients had committed suicide. By logistic regression analysis, a statistically significant correlation was found between criminal record and admission to psychiatric department and the variables: divorce, no vocational education, and lowest socioeconomic class. About 54% had managed well, judging by the variables employed.
Child abuse and neglect is of growing concern in many American Indian and Alaska Native communities. The present paper represents one attempt to add to the existing, albeit sparse, knowledge base concerning the abuse and neglect of American Indian children. It reports the results of a survey of federal human service providers in which the subject of child abuse and neglect in Indian communities figured prominently. The study took place at several locations in Arizona and New Mexico. Data were obtained using the key-informant method from 55 federal service providers who identified 1,155 children, from birth to 21 years for inclusion in the survey. Children were included if they were currently in mental health treatment, if they were in need of mental health treatment, or if they were known to have been abused or neglected. Particular emphasis was given in the data collection to abuse- and neglect-related factors such as living arrangements, familial disruption, psychiatric symptoms, substance abuse, and school adjustment. The patterns evident in this sample closely resemble those trends identified among abused and/or neglected children in the general population. Sixty-seven percent of the sample was described as neglected or abused. The presence of abuse and/or neglect was strongly related to severe levels of chaos in the family. Children who were described as both abused and neglected had more psychiatric symptoms, greater frequency of having run away or been expelled, and greater frequency of drug use.
Is the abuse of psychoactive drugs in psychotic patients linked to social adjustment?
Fifty-five psychotic men from a detention centre or a psychiatric hospital were assessed with the Social Adjustment Scale (SAS-II) and a French version of the Phillips Rating Scale of Premorbid Adjustment in Schizophrenia.
In psychotic patients, the abuse of psychoactive drugs is linked to some indicators of social adjustment and premorbid sexual adaptation.
Differences were found in some aspects of social functioning, but it is difficult to establish an overall assessment of social adjustment.
The hypothesis that it is the variability of a person's identity--as opposed to the particular combinations of identities--that produces stress during the acculturation process was examined. Two hundred ninety-five native Anglophone students at the University of Ottawa, Ontario, Canada, provided demographic data and completed the following measures: the Beck Depression Inventory (Beck & Beck, 1972), Rosenberg's Self-Esteem Scale (1965), the Situated Identity Measure (Clément & Noels, 1992), and the Psychological Stress Measure (Lemyre, Tessier, & Fillion, 1990). Results of ANOVAs contrasting level of identification and variability of identification indicated that an exclusively Anglophone identity was related to a higher level of depression, lower self-esteem, and a higher level of stress than the other modes of acculturation, but only when the variability in identity with the English group was high. Thus, the participants who identified strongly with the English group but were not committed to this identity experienced more psychological adjustment problems.
