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Biomedical subjects

E R Wright

Publications and source records attributed to E R Wright.

At least 19 recordsLinked to original sources
PubMed2003

The social organization of HIV/AIDS care in treatment programmes for adults with serious mental illness.

As the HIV epidemic expands within the mental health system, mental health professionals (MHPs) are under increased pressure to provide more HIV-related care to clients in treatment for serious mental illness. Scientific understanding of MHPs' readiness to provide these services, however, is limited. This paper examines the distribution of HIV care experience, HIV care-related knowledge, and related attitudes among 524 MHPs employed in three CMHCs and two state psychiatric hospitals in central Indiana. The results indicate that both clinical experience and subjective readiness to provide HIV care are concentrated among a few MHPs--primarily gay, lesbian, or bisexual (g/l/b) staff--within each facility. This informal system for organizing HIV care highlights the unique contributions g/l/b staff members make both in providing direct HIV care and in making sure that HIV-related issues are addressed in mental health settings. The implications of g/l/b staff members' "gate making" function for improving the provision of HIV-related mental health services are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2000

The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer.

Does the impact of stigma on the self differ by illness type? This study focuses on a comparison of the effects of the stigma associated with HIV/AIDS and cancer on self-esteem, body image, and personal control. We test the hypothesis that individuals' perceptions of stigma account for significant differences in the impact of an illness on the self. We examine four dimensions of perceived stigma: social rejection, internalized shame, social isolation, and financial insecurity. In turn, we consider how these dimensions medicate the effects of HIV/AIDS and cancer. Our sample includes 130 persons with HIV/AIDS and 76 persons with cancer. We control for illness severity by including a measure of functional health status that is based on participants' subjective perspectives of the severity of their symptomatology. Our findings provide additional support for modified labeling theory; however, our findings also point to the dimensionality of stigma and its differential negative impact on particular elements of the self, regardless of illness type.

Adult↗
PubMed2000

Deinstitutionalization, social rejection, and the self-esteem of former mental patients.

Modified labeling theorists have long argued that the stigma of mental illness has important consequences for the lives of people with mental illness. We propose that social rejection is an enduring force in the lives of people with mental illness and that these experiences are central to understanding the poor self-concepts described by many former psychiatric patients. We explore changes in a cohort of recently deinstitutionalized mental patients' (N = 88) self-esteem and experiences with social rejection using data from a three wave panel survey conducted while institutionalized and over a two-year period following the patients' discharge from a long-term state hospital. Our results indicate that social rejection is a persistent source of social stress for the discharged patients. Moreover, these experiences increase feelings of self-deprecation that, in turn, weaken their sense of mastery. Where the patients' received their follow-up care--whether in a community setting or in another state hospital--had little impact on their self-related feelings or on their experiences of social rejection. Our results provide further support for modified labeling theory and underscore the need to consider the dynamic relationship between stigmatizing experiences and self-related changes.

Female↗
PubMed1999

Closing of a state hospital: an overview and framework for a case study.

This article introduces the trends in deinstitutionalization, the limitations of previous research, and the design and research questions of the Central State Hospital (CSH) closing studies. Previously, the central engine of deinstitutionalization has been the downsizing, and not the closing, of facilities to decrease available beds. Only 14 state hospitals closed between 1970 and 1990. However, since 1990, 40 hospitals have closed. Moreover, beginning in 1993, for the first time since deinstitutionalization began, funding for state psychiatric facilities was less than for community-based services. Previous research on both the downsizing and closing of hospitals has focused predominantly on relatively short-term clinical and social outcomes of patients. The current study is a multidisciplinary, longitudinal, multiple-stakeholder study of the closing of a state-run, long-term care facility in Indiana. The articles that follow focus on the clinical, psychological, social, and attitudinal outcomes for patients, workers, families, and the public following the closing of CSH.

Deinstitutionalization↗
PubMed1999

The closing of Central State Hospital: long-term outcomes for persons with severe mental illness.

This study examined the clinical/community functioning of long-stay patients following closing of a large state psychiatric hospital. Two overlapping samples were followed: (1) the tracking project collected information on patient location, treatment provision, legal contacts, and level of functioning (LOF) and followed all discharged patients and (2) the research study subsample, drawn from the final group of discharged patients, gathered information on quality of life (QOL), LOF, and general physical and mental health. At follow-up, patients were functioning equal to or better than prior to discharge. There were consistent improvements in QOL (especially safety and occupational satisfaction) and LOF (especially housing and income/benefits). Fewer than 27% of patients discharged into the community were rehospitalized, and fewer than 4% were either in jail or homeless after 24 months. The study demonstrates that even persons who have been hospitalized for extremely long periods can do well in the community.

Adult↗
PubMed1999

Fiscal outcomes of the closing of Central State Hospital: an analysis of the costs to state government.

This study reports estimates of the preclosure and postclosure costs of mental health services for patients directly affected by the closing of Central State Hospital. The data come from state budget documents and from the billing records of the community mental health centers serving the discharged clients. On average, it cost Indiana approximately $68,347 (in 1995 dollars) to provide 12 months of state hospital care for this client cohort in fiscal year 1993. In contrast, during the first year following the closure, the average per patient cost to the state was $55,417. When clients were served exclusively in community care settings, the average annual per patient cost was $40,618. The analyses suggest that the closing reduced the costs of caring for this cohort of patients by approximately 18.9%. A significant portion of the cost savings to the state mental health budget was achieved by shifting some of the direct patient care costs to Medicaid/Medicare.

Cost of Illness↗
PubMed1999

The changing hopes, worries, and community supports of individuals moving from a closing long-term care facility.

This study examines client's hopes, worries, and social networks before, one year, and two years following release from a long-term care facility. More clients expressed hopes than worries before closure but, over time, hopes decreased and worries increased significantly. Before closing, independence was cited most often as a hope, followed by work and finances. Criminal opportunities headed up concerns, followed by mental health treatment, finances, living arrangements and independence. Over time, respondents were less excited about independence and living arrangements but more hopeful about social opportunities and everyday practicalities. Worries relating to family increased while concerns about deviance decreased. Respondents reported an average increase in network ties but the proportion of family members decreased while professional supports and ties with former CSH patients increased. The trends highlight particular vulnerability at the one-year point, the necessity of viewing movement into the community as a nonlinear process, and the importance of marking outcomes periodically.

Adaptation, Psychological↗
PubMed1999

The family experience of deinstitutionalization: insights from the closing of Central State Hospital.

Since the early 1970s, policy makers and researchers have expressed concern about the potential negative consequences of deinstitutionalization on families. This article summarizes results of a survey of family and lay caregivers of patients discharged from Central State Hospital, which closed in June 1994. The survey was designed to assess the impact of the closing on family members, including their attitudes, caregiving responsibilities, and involvement in the treatment of the patients. Results indicate that family members have mixed feelings about the closure. Family caregivers also reported that they have not been asked to take on significant amounts of the caregiving responsibilities since the clients were moved from the hospital. Family members described a significant reduction in the frequency of contact they had with their loved ones and with professional caregivers since the closure. Implications for behavioral health policy makers considering or planning closing or downsizing long-term care facilities are discussed.

Adult↗
PubMed1999

"Stakeholder" attitudes over time toward the closing of a state hospital.

For four groups--patients (N = 80), their families or lay caregivers (N = 120), hospital workers (N = 124), and the public (N = 108)--attitudes toward the decision to close the only long-term, urban state hospital are traced over time. Initially, patients were most supportive of the closing decision (65.4%), followed by family members (39.8%), the general public (27.8%), and workers (10.4%). A majority of all groups favored fixing the hospital. Almost half of the clients and more than half of other stakeholders expressed concerns about homelessness. Most attitudes were consistent despite respondents' sociodemographic characteristics. The overall profile of group attitudes remained remarkably stable, although there was a good deal of change in individuals' positions. Public support for fixing the hospital decreased significantly, and differences among stakeholders regarding homelessness disappeared. These findings reinforce the importance of ascertaining different constituencies' positions and recognizing the slowly changing response of stakeholders even under massive and successful policy change.

Adult↗
PubMed1999

Growth inhibition of Streptococcus anginosus (milleri) by three calcium hydroxide sealers and one zinc oxide-eugenol sealer.

The inhibition of growth of Streptococcus anginosus (milleri) by three calcium hydroxide sealers--calciobiotic root canal sealer (Hygienic Corporation, Akron, OH), Sealapex (Kerr Division, Sybron Corporation, Romulus, MI), and Apexit (Vivadent, USA, Amherst, NY)--was compared with a zinc oxide-eugenol sealer: Roth (Roth International, Chicago, IL). Sixteen brain heart infusion agar plates were inoculated with S. anginosus. Each plate was divided into five separate areas. In each area, a 0.1 ml droplet of a given sealer was placed such that each plate had five areas with the same sealer. There were four plates (for each of the four sealers) for a total of 20 observation areas to evaluate each sealer. The plates were incubated at 37 degrees C in a 5% CO2 atmosphere. After varying periods of incubation, the zones of inhibition of bacterial growth were observed and measured. Roth sealer had a statistically significant larger mean zone of inhibition than the calcium hydroxide sealers. However, all of the sealers exhibited clinically relevant antimicrobial activity. It is likely that the eugenol in the Roth sealer is responsible for its greater antimicrobial activity.

Analysis of Variance↗
PubMed1998

Indiana Youth Access Project: a model for responding to the HIV risk behaviors of gay, lesbian, and bisexual youth in the heartland.

The Indiana Youth Access Project (IYAP) is supported by the Special Projects of National Significance Program, Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) Bureau, Health Resources and Services Administration. The IYAP is a model HIV care program being developed at the Indiana Youth Group, Inc. (IYG) in conjunction with the Indiana State Department of Health and Indiana University. Previous studies indicate that gay, lesbian, and bisexual youth are at increased risk of acquiring HIV because of the stigmatization and social marginalization they experience as a result of their sexual identities. During the course of the first 3 years of the demonstration, the program has served 418 young people, including nine who are HIV infected. The IYAP targets the special needs of this special population by confronting institutional barriers which limit these young people's access to HIV care services, assisting them in building stronger peer support networks, and providing them with professional case management and related services. The model builds upon the successful peer-support program established at IYG by incorporating a unique set of health, mental health, and social case-management services provided by trained professionals. In addition, the program incorporates an extensive peer-counselor training and outreach program which targets street youth and other at-risk young people. The program has provided education and training workshops on the special needs of gay, lesbian, and bisexual youth to thousands of health care, education, and social service professionals both in central Indiana and around the nation.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Social networks and patterns of use among the poor with mental health problems in Puerto Rico.

OBJECTIVES: This study uses the recently developed Network-Episode Model (NEM) to examine the nature and correlates of utilization among Puerto Ricans reporting mental health problems. The NEM highlights two issues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability and content of social networks influences patterns of care. METHODS: Using data from the 1989 Mental Health Care Utilization Among Puerto Ricans Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlates of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year. RESULTS: A combination of clustering and multinomial logit techniques indicates that there are six unique care patterns. Two patterns include the use of mental health providers and are associated with different contingencies. CONCLUSIONS: In general, patterns of use are shaped by age, education, gender, and illness severity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direct entry into the mental health sector. These results are in line with NEM's predictions for lower class populations and help clarify inconsistencies in previous research on social networks. The implications of this perspective for health services research and treatment are discussed.

Adolescent↗
PubMed1997

New ethical challenges to mental health services research in the era of community-based care.

Research on the use and effectiveness of mental health services conducted across a wide variety of settings, under new and diverse state-based legal statutes, and requiring the linking of a variety of existing and proposed data sources raises a number of ethical considerations. These new conditions are reviewed in the context of federal regulations for the protection of human subjects and, in particular, informed consent. Illustrations, suggestions, and resources are offered from recent experiences in a longitudinal, multisource study of the impact of a hospital closing on individual consumers, families, workers, and system costs.

Community Health Services↗
PubMed1997

The impact of organizational factors on mental health professionals' involvement with families.

OBJECTIVE: Drawing on an organizational behavior framework, this study explored the impact of attitudinal, occupational, and organizational factors on mental health professionals' involvement with clients' families. METHODS: Data came from a survey conducted with psychiatric staff at the largest public hospital and the largest private hospital in Indianapolis between 1991 and 1993 as part of the Indianapolis network mental health study. Responses of 184 clinicians who provided direct care were analyzed using multiple regression to assess the impact of their attitudes toward families, job characteristics, and organizational work environment on the amount of contact they had with clients' families. RESULTS: Providers' attitudes toward families had no significant effect on the frequency of their contact with families. Job and organizational factors were the strongest predictors. Specifically, being a social worker or therapist and working on day and evening shifts were associated with increased involvement with families. Staff members' perceptions of how well their unit functioned were also positively correlated with frequency of contact with families. CONCLUSIONS: The organizational environment in mental health agencies has a significant influence on the extent to which professionals become involved with clients' families. Administrators and policy makers should give careful consideration to how the work environment encourages or limits mental health professionals' abilities and willingness to get more involved with clients' families.

Adult↗
PubMed1995

Medical sociology and the study of severe mental illness: reflections on past accomplishments and directions for future research.

Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centered on treatment in community settings. While medical sociology has played a prominent role in the study of psychiatric hospitalization and the deinstitutionalization process, the systematic exploration of the sociological dimensions of community-based mental health care is only just beginning. This essay reflects on past disciplinary contributions and explores some important empirical and theoretical directions in the field of mental illness research that could benefit from more extensive sociological analysis. The central argument is that the shift to a community-based mental health system has increased the need for the sociological perspective and that medical sociologists, in particular, have the theoretical and analytical perspective essential for developing a more complete understanding of the current conditions impacting the lives of people with severe mental disorders. Drawing on recent work in medical sociology, we illustrate some important topical areas at the center of controversies over treatment, social change, and public policy regarding severe mental illness. We conclude with a discussion of the barriers to this type of sociological research and suggestions for ways medical sociologists might contribute to the study of severe mental disorders in the future.

Deinstitutionalization↗
PubMed1986

Cooperation between epithelial cells demonstrated by potassium transfer.

Junction-mediated communication can be measured in fibroblast cultures by determining the ability of mixed cultures of cells sensitive and resistant to ouabain to concentrate K+ in the presence of ouabain. We now report the extension of this assay procedure to cultured epithelial cells. Hamster kidney (HaK) cells maintain their ability to concentrate K+ in ouabain at levels inhibitory to dog kidney (MDCK) cells. When HaK and MDCK cells were cultured together in ouabain-containing medium, the K+ (measured as 86Rb+) in the mixed population was greater than expected if the cells were not interacting. The degree of enhancement, expressed as "index of cooperation," depended on the numbers of cells in the cultures, their opportunity for cell-to-cell contact, and (above a certain permissive level) the concentration of ouabain. As with other cell types, protein synthesis in MDCK cells depends on maintenance of cell K+. Autoradiography of cells incubated with [3H]leucine demonstrated that MDCK cells in ouabain-treated mixed cultures were able to synthesize proteins only when physically adjacent to HaK cells. The transmission of labeled nucleosides among the cells provides independent evidence of the phenomenon of cooperation, probably mediated by gap junctions. This system offers promise for investigation of stimuli modulating junctional communication.

Animals↗