The purpose of this study was to examine the factors that were most predictive of hospital admission for Congestive Heart Failure (CHF) patients admitted to a large urban home care organization. The Andersen Behavioral Model of Health Services Use served as the conceptual framework for the study. A retrospective design using administrative data from the OASIS instrument investigated client characteristics measured at admission (predisposing, enabling and need) and resource utilization that were predictive of hospital admission from a home health episode. This secondary data analysis included 710 CHF patients, of whom 150 or 21% were admitted to the hospital during a home health episode. A logistic hierarchical regression was performed to determine predictors of hospital admission. Four questions were tested to determine predictors. Three measures--increase in dyspnea, fewer physical therapy visits and higher visit intensity--predicted hospital admission. Chi-square and t-tests were conducted to determine if there was a difference between those hospitalized and those not hospitalized. Patients were more likely to be hospitalized if they: had Medicaid as their primary payer; had increased shortness of breath with activity; had a higher acuity level as measured by symptom control; required more assistance in upper body dressing; needed more assistance in ambulating; had difficulty transferring; were more dependent in all Activities of Daily Living; had significantly fewer physical therapy visits; and had a higher intensity of visits per day. The findings demonstrate the value of using OASIS for a specific disease, CHF, in examining the outcome of hospitalization from a home care agency. Findings provide information for nurses on the importance of the assessment of dyspnea during the first home care visit, the use of physical therapy services and the role of the visit intensity during a home care episode. Further research needs to explore the restrictive policies of the state Medicaid programs that may contribute to the significantly higher hospitalization rates of these CHF patients.
Background. Over the last decade, methamphetamine (yabaa) has become a drug of choice for Thai youths. There were 19,253 people with substance use disorders treated at the legal treatment center in 2000. After completing the treatment program, a high percentage (80-90%) relapse to their previous drug use behavior. However, measuring the stages of change, treatment motivation, and abstinence self-efficacy among adolescents with methamphetamine use have not been studied in Thailand. Purpose. To determine whether the boot camps for Thai adolescents with yabaa use history affect their stages of change, treatment motivation, and self-efficacy for abstinence and to examine predictors of change in the stages of change, treatment motivation, and self-efficacy for abstinence. Methodology. A pretest-posttest design was conducted on Thai adolescents with yabaa use. Four hundred and thirty-eight adolescents, between 12 to 21 years of age, who entered to boot camp in Thailand answered questionnaires which consisted of four parts: (1) background information; (2) the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES) assessing stage of change, (3) the Texas Christian University Treatment Motivation Scale (TMS) assessing motivation for treatment; and (4) the Drug Taking Confidence Questionnaire (DTCQ) assessing self-efficacy for abstinence. The entire questionnaire was translated into Thai.;Results. The findings showed that the adolescents' mean scores of Recognition and Ambivalence subscales of SOCRATES significantly decreased while the mean score of Taking Steps subscale significantly increased as a result of participation in boot camp. In addition, the boot camp also significantly increased participants' treatment motivation and self-efficacy for abstinence. Adolescents' age, education, and pressure to get rehabilitation influenced changes in stage of change and treatment motivation. Also the number of drugs used influenced changes in self-efficacy for abstinence. Moreover, there was significant variation among the study sites for the stages of change, treatment motivation, and self-efficacy for abstinence. Conclusion/implication. The results of this study will be useful for nurses and other health care providers to better assess the stage of change, treatment motivation, and the self-efficacy for abstinence before, during, and after the drug treatment program. Moreover, the results from the study could be used to help staff identify interventions that will promote movement toward behavior changes.
This cross-sectional study was conducted to examine the relationships among physiologic, well-being, and coping resource variables and their influence on functional performance in community-dwelling people with chronic obstructive pulmonary disease (COPD). The sample consisted of 119 patients (53.8% male, Mage = 68.17 +/- 8.45 years, 99.1% Caucasian). Two physiologic variables (forced expiratory volume in one second converted to a percent of a predicted value that is adjusted for height, age, gender, and race [FEV1%pred] and concomitant medical comorbidity), four well-being variables (depression, anxiety, happiness, and life satisfaction), two coping resource variables (perceived social support and mastery) and gender were proposed as predictors of functional performance. When functional performance was regressed on each proposed predictor individually (controlling for age) all except comorbidity and gender were significant predictors. However, the multiple regression of functional performance in all proposed predictors plus gender simultaneously showed that only depression (beta = -.707, p = .000), FEV1%pred (beta =.242, p =.000), gender (beta = -.189, p =.012), and the control variable of age (beta = -.322, p = .000) were significant predictors. These variables combined to explain 46% of the variance in functional performance. The low tolerance of depression (.411) indicates the possibility of multicollinearity with the other well-being and coping resource variables, although the bivariate correlations did not suggest this. Neither social support nor mastery was a mediator between depression and functional performance. Social support mediated the effects between anxiety and functional status, but mastery did not. Depressed participants reported worse functional performance than did non-depressed participants. Anxious participants reported worse functional performance than did non-anxious participants. Additional analyses showed that depression was a mediator between social support and functional performance, and between mastery and functional performance. Anxiety (beta = .253, p = .001), life satisfaction (beta = .230, p =.004), mastery (beta = -.236, p = .003), and social support (beta = -.152, p = .036) (but neither happiness nor the control variable of age) were significant predictors of depression.
Background. Evidence suggests that adolescent HIV/AIDS prevention intervention has been substantially effective for preventing HIV/AIDS risk-taking behavior. However, it is not clear what specific variables related to program design and implementations have the strongest effect. Purpose. The purposes of this study were to (1) examine whether adolescent HIV/AIDS prevention intervention programs designed to change knowledge, attitudes, beliefs, self-efficacy, and behaviors have been effective and (2) to determine the relationship between program design and implementation elements and outcomes. Method. A meta-analysis was conducted to evaluate the status of these programs. A systematic review of 8 computerized databases, hand searching of 6 journals, and reference lists were undertaken for primary studies published from 1990 to 2002. To be included in the meta-analysis, primary studies had to have: (1) an experimental design, (2) the intervention designed to affect HIV/AIDS risk-taking behaviors targeting adolescent, and (3) outcome data along with details sufficient for calculation of effect size. Data on demographic characteristics of participants, intervention characteristics, methodological considerations, and information necessary for calculation of effect size were extracted independently by 3 reviewers to assess inter-rater reliability. Effect sizes and homogeneity of variance measures were calculated. A number of potential moderators then were examined. Result. A total of 28 studies met the inclusion criteria. The effect sizes for all outcomes were statistically significant. However, most of the effect sizes were small, except for knowledge. Taken collectively, the largest mean effect size is for knowledge (ES = .58, 95%CI = .42 to .72), followed by attitudes toward condoms (ES = .29, 95%CI = .14 to .43), condom use (ES = .28, 95%CI = .14 to .41),attitudes toward AIDS (ES = .26, 95%CI = .11 to .41), self-efficacy (ES = .22, 95%CI = .12 to .31), beliefs regarding condoms (ES = .16, 95%CI = .41 to .31), and beliefs regarding AIDS (ES = .12, 95%CI = .003 to .24). Participant's gender and ethnicity, setting, interventionist, and number of sessions were typical moderators explaining the results. Conclusion. The findings of this study provide state of science information that could enable policy makers to identify the overall effectiveness of these programs and can provide program designers to improve HIV/AIDS prevention programs information. This can help reduce the spread of HIV/AIDS among young people.
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