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Biomedical subjects

D J Jessop

Publications and source records attributed to D J Jessop.

At least 19 recordsLinked to original sources
PubMed2000

Developing a measure of unmet health care needs for a pediatric population.

BACKGROUND: Quantified measures of unmet health care needs can be used to evaluate health care interventions, assess the impact of managed care, monitor health status trends in populations, or assess equity of access to medical care across population subgroups. Such a measure needs to be simple, relatively easy to obtain, inexpensive, and appropriately targeted to the population of interest. OBJECTIVE: To develop a measure of unmet health care needs that is specifically targeted to a pediatric population. SUBJECTS: Study participants consisted of children, aged 1 to 5 years (n = 1,031), and adolescent mothers, aged 13 to 19 years (n = 172), predominantly from poor, minority families in New York City. RESEARCH DESIGN: Based on a measure, the symptoms-response ratio, developed for all age groups, this study replicated Taylor's procedures specifically for children and adolescents. Respondents were asked if they had experienced a set of physical symptoms and if they saw a doctor in response. A panel of pediatricians rated the same symptoms as to whether health care should be sought. RESULTS: The measure achieved adequate inter-rater reliability and good construct validity. The children's overall use of health services did not differ from the pediatric panel's expectations, but with differing degrees of unmet needs by symptom. Adolescents sought care less often than the expert panel members believed they should. CONCLUSIONS: The symptoms-response ratio provides a good balance of a simple and inexpensive measure while yielding a fair estimate of unmet needs for primary care. This analysis created a pediatric measure targeted to the needs of young children and adolescent females.

Adolescent↗
PubMed1995

Consistent but not the same. Effect of method on chronic condition rates.

OBJECTIVE: To determine rates of chronic physical conditions for children and youths. DESIGN: Secondary analysis of the Health Examination Surveys, cycles 2 and 3, National Center for Health Statistics. SETTING: National household survey of noninstitutionalized civilians in the United States. PARTICIPANTS: Multistage probability samples of children aged 6 to 11 years (cycle 2, 1963 to 1965) and youths aged 12 to 17 years (cycle 3, 1966 to 1970), and a longitudinal subsample assessed at both times. Excludes persons with an IQ lower than 80. RESULTS: Selected items from developmental and medical histories and screening physical examinations were used to classify those with chronic physical conditions. Rates of persons with chronic conditions are 25.2% for the children and 35.3% for the youths. Parental histories produce rates equal to or greater than 11%, and physical examinations produce rate of 15.7% for children and 22% for youths. About 4% in each cycle are identified by both screening physical examination and parental history. Little overlap occurs in identification by the two sources, accounting for the higher rates for the combined indicators. Combining data sources identifies 13% of the longitudinal subsample as having a chronic physical condition at both times. CONCLUSIONS: Rates of chronic physical conditions seem to be altered by combining different indicators to categorize children. For either source used alone (eg. parental report or physical screening physical examination) the estimate is similar in magnitude, but the composition of the affected group differs. These findings have major implications for research, service, and policy.

Adolescent↗
PubMed1995

Employers' attitudes towards persons with disabilities: a comparison of national and New York State data.

This paper compares the results of two large-scale studies conducted as part of an ongoing research programme on employers' attitudes towards the employability of persons with severe disabilities--a study of Fortune 500 corporations and a study of employers doing business in New York State. The results indicated that both groups of employers were favourable towards the employability of persons with disabilities. Executives from large national corporations were more favourable than those from the predominantly small companies doing business in New York State. Prior contact with persons with disabilities that was positively evaluated appeared to differentiate those more and less favourable in both study groups, especially in the smaller companies of the New York State study group. Employers' characteristics associated with differences in attitudes in the literature (e.g. education, work experience) also appeared to be confirmed by data from New York State companies more than from the corporations of the Fortune 500.

Administrative Personnel↗
PubMed1994

Providing comprehensive health care to children with chronic illness.

OBJECTIVES: To test whether a program of outreach and comprehensive health care for children with chronic disorders provides more complete care and reduces unmet health needs compared with traditional care. DESIGN: A pretest-posttest randomized control trial. SETTING: An inner-city municipal teaching hospital. SAMPLE: Two hundred nineteen systematically enrolled mothers of children with diverse chronic physical health conditions. INTERVENTIONS: A comprehensive outreach program, Pediatric Home Care (PHC), contrasted with Standard Care. MEASUREMENTS AND RESULTS: Nine elements of comprehensive care established in the literature as components of a basic package of care for those with chronic conditions. The PHC intervention addressed gaps in services and improved both the acquisition and maintenance of elements of comprehensive care. CONCLUSIONS: These data suggest mechanisms through which comprehensive care programs may contribute to the improvement in psychological and social outcomes previously reported for those in the PHC intervention.

Child↗
PubMed1992

Attitudes of Fortune 500 corporate executives toward the employability of persons with severe disabilities: a national study.

Executives (N = 341) responsible for hiring decisions in Fortune 500 industrial and service corporations returned a mail questionnaire measuring their attitudes toward persons with severe disabilities and their employability. Responses indicated that attitudes were favorable to persons with disabilities and to their employability, both in terms of advantages for the individual and lack of disadvantages for others in the work setting. Significant differences in attitudes existed among subgroups of executives. Executives who had contact with persons with disabilities in the corporate work world had more positive attitudes than did executives who did not have such experiences.

Activities of Daily Living↗
PubMed1991

Employment of persons with severe disabilities in large businesses in the United States.

A mail survey of the largest businesses in the US, the Fortune 500 industrial and service corporations, examined the attitudes of personnel and human resource executives towards the employability of persons with severe disabilities and actual corporate practices regarding the employment of persons with disabilities. The 341 executives who responded are found to be favourable to the employment of persons with disabilities, especially if the executives work in corporations that have hired persons with disabilities within the past three years, and/or have had personally good contact with persons with disabilities in the past. Almost two-thirds of the corporations have a policy regarding hiring persons with disabilities; over one-half have hired such persons within the past three years; and over one-third have supported work programmes.

Administrative Personnel↗
PubMed1991

Long-term mental health effects of a pediatric home care program.

The increased survival of youngsters with chronic physical disorders has led to concern about their long-term psychological adjustment. Few data are available on how to reduce the psychological morbidity that occurs in the presence of chronic childhood illness. An earlier report of a randomized controlled trial of a pediatric home care program demonstrated that this program, combining comprehensive biomedical and psychosocial care, reduced the short-term psychological morbidity of those receiving home care. However, data have not previously been available on whether the short-term improvement in adjustment is associated with any long-term benefits. This report presents long-term follow-up data collected 4 1/2 to 5 years after enrollment on 68% of the original sample. After this interval there were even larger differences between the experimental and control groups than those previously observed at 6 months and 1 year. This finding provides strong evidence that a comprehensive family-oriented outreach program for youngsters with chronic physical disorders can have long-term mental health benefits. It should encourage clinicians to develop similar programs and investigators to look for long-term effects of other interventions.

Adaptation, Psychological↗
PubMed1991

Who benefits from a pediatric home care program?

Earlier reports of a randomized controlled trial of the Pediatric Home Care (PHC) program for children with chronic physical illness demonstrated overall benefits for the group enrolled in the PHC program. This paper examines which subgroups benefited most (relative to control subjects) and which benefited least from the PHC intervention. Prior to the randomized controlled trial, PHC served those with the most burdensome medical conditions from the families with the fewest coping resources. However, data from the randomized controlled trial (N = 219) show that these were not the subjects who benefited most. Maximal benefit was evident when illness burden was small, but coping resources were low (social, educational, financial, and personal). Analyses of covariance show that subjects in PHC with both low burden and low resources had consistently better outcomes than similar subjects in Standard Care. When the illness burden was similarly low, but resources were more abundant, those in Standard Care appear to have had better outcomes than those in PHC. For those whose illness burden was more severe, the results were mixed. These findings suggest that the conventional priority of allocating existing intervention resources to the medically most burdensome cases may not always be maximally beneficial. Those with less burdensome conditions may derive greater benefit relative to control subjects from an intervention than those with extreme needs. Both medical and social factors should enter into the decision regarding the allocation of scarce resources.

Adaptation, Psychological↗
PubMed1990

Functional status II(R). A measure of child health status.

Few measures are available to assess the health status of the growing numbers of children who now survive long-term with chronic physical disorders. A Functional Status Measure, FS I, that had considerable promise for measuring individual child health status and characterizing populations was developed in 1978. This paper describes a revised version of that measures. Data were collected using a new sample of 732 children (aged 0 to 16 years) with and without chronic physical conditions in order to assess the psychometric properties of the new instrument. The FS II(R) has both a long (43-item) and a short (14-item) version. The long version has a total score derived from a one factor solution and a two factor solution consisting of General Health and Stage Specific factors for each age group. The 14-item version of FS II(R) uses a common core of items across the entire age span. Internal consistency estimates (alphas) for the factor-based and 14-item versions are all greater than 0.80. At each age, long and short versions behave similarly in a wide range of tests of discriminant, construct, and content validity--strong support that they constitute a common measure. The FS II(R) has excellent psychometric properties and provides concise measures of health status of children spanning the entire childhood age range from 0 to 16 years. It has particular strengths for the measurement of health status of children with chronic physical conditions who are not disabled.

Activities of Daily Living↗
PubMed1990

Assessing psychosocial adjustment of children with chronic illnesses: a review of the technical properties of PARS III.

Four groups of investigators in the Research Consortium on Chronic Illness in Childhood have used the Personal Adjustment and Role Skills Scale (PARS) III to assess the psychosocial adjustment of children with chronic physical illnesses and no mental impairment. The PARS III consists of 28 items that measure psychosocial functioning in six areas: peer relations, dependency, hostility, productivity, anxiety-depression, and withdrawal. Analyses of the measure's reliability and validity, using a total combined sample of 450 school-age children (ages 5-18 years) with a variety of chronic illnesses and three comparison samples of healthy children, provide evidence that the PARS III can be used successfully to assess psychosocial adjustment of children with chronic illnesses and no cognitive impairments.

Adolescent↗
PubMed1989

What diagnosis does not tell: the case for a noncategorical approach to chronic illness in childhood.

Medical training, practice and research are traditionally organized around body systems and disease categories. There is, however, a disciplinary split over the question of whether the clinical diagnosis is the central issue in describing an individual with an illness. Data from two studies, one institutional and one population based (The Pediatric Ambulatory Care Treatment Study and the National Health Examination Survey--Cycles II and III), are used to test the usefulness of diagnostic groupings in examining correlates of illness. A series of analyses of variance with the diagnostic groupings as the independent variable and a range of psychological, social and educational measures as the dependent variables reveal only the number of significant differences expected by chance. The only area in which a pattern of significant differences is found in the family's interaction with the health care delivery system. These results indicate that there is more variability within diagnostic groupings than between them and suggest that diagnosis is not a helpful categorization in the examination of psychological and social variables. While not surprising to social scientists, these data suggest the need for a major reorientation of the research paradigm when examining the psychological, social, rehabilitative and preventive issues raised by chronic illness in children and families.

Analysis of Variance↗
PubMed1988

Essential concepts in the care of children with chronic illness.

Children with chronic illness constitute an increasingly significant segment of the child population seeking care in Western industrialized countries. There are concerns that traditional disease-specific ways of thinking about these children and organizing their care may not meet the real life needs of the children and their families. This article examines a series of concepts that are fundamental for the humane and biomedically sound care of children with chronic illness, and a model of care is proposed. Relevant data from one program are presented.

Child↗
PubMed1988

Chronic childhood illness and maternal mental health.

The relationship between the health status of a child and the psychiatric symptoms of a mother is examined for an inner-city sample (n = 209) of chronically ill children with heterogeneous physical diagnoses. Whereas no relationship exists between the mother's psychiatric symptoms and a medical provider's report of the burden that the child's condition entails, there is a relationship between the functional status of the child and the mental health status of the mother. Children with more functional limitations have mothers who are more symptomatic. The presence of other stressors in the family, familial impact of the illness, poor physical health of the mother, and the absence of a confidant for the women are also associated with the mother's psychiatric symptoms in a multivariate analysis that includes traditional predictors of women's mental health. In contrast with the results from more general population studies, a greater number of children may be protective for a mother of a child with a chronic illness.

Affective Symptoms↗