To pilot Koa, rural Pacific Island dyads (28 veterans and 28 family members) participated via video teleconference and completed pre- and post- intervention measures. Outcome data indicated that participants perceived the intervention to be highly acceptable, useful, and relevant. Relationship quality scores substantially improved postintervention as measured by the Dyadic Relationship Scale (95% CI [-10.97, -1.84], t(22) = -2.9, p = .008, d = -0.53 for veterans; 95% CI [-11.06, -2.47], t(21) = -3.28, p = .004, d = -0.68 for family members). Family caregiving burden also improved significantly. The positive results of this investigation support the development of culturally adapted mental health interventions for culturally distinct subgroups of veterans and their families. (PsycINFO Database Record
Diagnostic methods are limited for detecting microscopic soft tissue metastases in patients with prostate cancer. Previous studies using 111 Indium Capromab Pendetide (ProstaScint TM scan) analyzed patients with extensive localized tumor (prostate specific antigen (PSA) > 20 ng/ml) not optimal for surgical therapy. We evaluated the role of the ProstaScint TM scan in a preoperative population to provide histological documentation and to assess its utility in a surgical population. A total of 22 preoperative patients, underwent a ProstaScint TM scan. The mean preoperative PSA was 16.0 ng/ml (range 3.9 -33 ng/ml). The mean Gleason score at biopsy was 6.9 (range 6 -9). Each patient underwent a radical retropubic prostatectomy and bilateral pelvic lymph node dissection, which included resection of both obturator and common iliac lymph nodes. Histologic analysis of the resected lymph nodes provided the standard of comparison with the ProstaScint TM scan. The results of the scan and pathology for all 22 patients were compared with the bilateral obturator and iliac nodes, creating 88 data points. Nine areas (10%) were positive on the scan. One of these (11%) was a true positive while the other eight (89%) were false positives. Seventy-nine areas (90%) were negative on scan results. Of these, five areas (6%) were false negatives and 74 areas (94%) were true negatives. The scan yielded a sensitivity of 17%, specificity of 90%, negative predictive value (NPV) of 94% and a positive predictive value (PPV) of 11%. The high false positive rate and low PPV of ProstaScint scans overestimates metastatic lymph nodes disease, and is not useful when used preoperatively.
To identify the per-child cost of providing Part C services, the authors analyzed extensive statewide expenditure data in Hawai'i to determine the monthly and annual costs of providing early intervention services to infants and toddlers and their families. Identified were the costs of serving children with various numbers and percentages of delay, the cost of providing care-coordination services, and the administrative costs for local-and state-level providers of Part C services. Furthermore, the data provided an opportunity to identify the cost of transportation in providing Part C services. The authors also analyzed the cost of serving 2 special populations of children: (1) children receiving Medicaid and (2) children with an autism-spectrum diagnosis. In addition to findings on costs, other significant findings emerged from the study. Two-thirds of the enrolled children had 3 or more significant delays. The cost of transportation consumed more than onefourth of service expenditures. Children received on the average fewer than 3 hours of service per month. Overall administrative costs amounted to 41.4% of total program expenditures. Most surprising was that the state was spending less per child than it was a decade ago. The study provides previously unavailable information on the cost of early intervention services.
Pacific Island veterans suffer from greater severity of posttraumatic stress disorder (PTSD) compared with Caucasian veterans but face substantial barriers to mental health care. However, the factors that may dissuade or facilitate veterans in the Pacific Islands from seeking mental health care are not known. The main aim of this study was to identify how internal and external factors interact to impact wounded warriors' access to and use of mental health services. Veterans residing in 5 rural Pacific Island locations were mailed recruitment materials. Other veterans were made aware of the project by key stakeholders in their communities. Thirty-seven male veterans (across 5 focus groups) and 1 female veteran (via individual interview) participated. The study utilized an analytic design in which taped focus group discussions were transcribed verbatim and coded for major themes. Results indicated that most veterans identified Veterans Affairs (VA) as a positive source for health care. However, common concerns acknowledged were as follows: (a) difficulty navigating the VA system, (b) time associated with receiving care, (c) family stigma, (d) community stigma, (e) cultural differences, and (f) a lack of knowledge about VA services and benefits. Facilitators of care included the following: (a) individual knowledge and self-efficacy, (b) networking with other veterans, (c) family support, and (d) rural community support. All factor levels interacted in subtle ways to ultimately impact access to care. Next steps are described, including projects designed to better meet the needs of rural Pacific Island veterans. (PsycINFO Database Record
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