Transitions in the care of adolescent and young adult survivors of childhood cancer.
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Current trends in the management of health care show increasing pressure for earlier discharge of children, and their families may or may not be ready to continue the child's care at home. This article provides information that helps the home care provider bridge the transition from hospital care to home care. Care frequently is coordinated by a hospital-based clinical nurse specialist who provides psychosocial support, reinforces teaching, minimizes risks for complications, and performs home infusion therapy, such as antibiotics, chemotherapy, analgesics, total parenteral nutrition, and biologic therapy.
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Warren (1972) proposed a means for determining differences between rural and urban social contexts that expands on the population definitions. Essentially, these differences are geographical, social, and economic in nature, and the health status of individuals in either setting may be affected by these variations. The health issues of women that evolve from these rural factors are the focus of this article.
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The authors describe the process used and outcomes achieved by five patient care vice presidents who became a cohesive working group after the system integration of their separate organizations. Overcoming the hurdles that face any emerging group, these nurse executives developed a common patient-centered care delivery system and common leadership structure. They committed to four major leadership roles with common obligations and expectations for patient care vice presidents and hospital presidents, and role changes in terms of time spent as coach, interventionist, and crisis manager.
A review of the findings from a 1996 survey of women visiting a Planned Parenthood clinic reveals that some members of managed care organizations (MCOs) may not be receiving appropriate preventive services and information from their primary care providers. This article details the results of a survey of 115 women who attended a Planned Parenthood of New York City clinic for reproductive health services. Based on these survey findings, the authors provide recommendations for MCOs and traditional providers of reproductive health to improve service delivery.
Seventy 15-month-old infants were studied at home before starting child care, during adaptation (mothers present) and separation (first 9 days without mothers) phases, and 5 months later. Security of infant-mother attachment was assessed before and 3 months after child care began. In the separation phase, salivary cortisol rose over the first 60 min following the mothers' departures to levels that were 75% to 100% higher than at home. Compared with insecure infants, secure infants had markedly lower cortisol levels during the adaptation phase and higher fuss and cry levels during the separation phase, and their fuss and cry levels were significantly correlated with their cortisol levels. Attachments remained secure or became secure if mothers spent more days adapting their children to child care.
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The system of psychiatric care in Greece is described. It was based until recently on overcrowded, large asylums inhabited by chronic mental patients. The mental health system was highly centralized, with an uneven distribution of both facilities and manpower. Out-patient and rehabilitation facilities were particularly scarce. Recent reforms funded by both the Greek State and the Social Fund of the EC are outlined. These changes started in the late Seventies and are aimed at creating a comprehensive system of community-oriented mental health care. The new system is gradually being deployed, and it is expected that in the following years it will effectively cover the needs of the whole country.