Who uses community mental health centres? A study of one health district

A caseload analysis was undertaken to investigate those clients seen by five community mental health centre teams within one healthcare district. The 985 clients are described in terms of demographic and clinical features and questions relating to service provision are discussed.     

PROMPTING ONE LOW-FAT,HIGH-FIBER SELECTION IN A FAST-FOOD RESTAURANT

Evidence increasingly links a high-fat, low-fiber diet to coronary heart disease and certain site cancers, indicating a need for large-scale dietary change. Studies showing the effectiveness of particular procedures in specific settings are important at this point. The present study, using an A-B-A-B design and sales data from computerized cash registers, replicated and extended previous work by showing that inexpensive prompts (i.e., signs and fliers) in a national fast-food restaurant could increase the sales of salads, a low-fat, high-fiber menu selection. Suggestions also are made pertinent to more widespread use of the procedures.     

Genetics and adoption: Forming a partnership

Genetic issues are demanding more attention in the area of public health. Adoption agencies and policymakers are beginning to address these issues where they relate to the adoption process and to the many families involved in adoption in this country. Genetic counselors need to play an active role as both educators of and consultants for adoption professionals and the families with whom they work. To facilitate a partnership between genetics and adoption we have developed a workshop intended to educate adoption professionals about the lifelong implications of genetic conditions on the adoption triad.     

Ordinal consistency and ordinal true scores

This paper argues that test data are ordinal, that latent trait scores are only determined ordinally, and that test data are used largely for ordinal purposes. Therefore it is desirable to develop a test theory based only on ordinal assumptions. A set of ordinal assumptions is presented, including an ordinal version of local independence. From these assumptions it is first shown that the gamma-correlation between two tests is the product of their gamma-correlations with the true latent order. The theory is generalized to allow for heterogeneous tests by defining a weighted average local independence. The tau-correlations between total score and the latent order can be found in both homogeneous and heterogeneous cases, and a system of differential item weighting to maximize the tau-correlation between weighted items and the latent order is provided. Thus a purely ordinal test theory seems possible.Part of this work was done while the author was a Visiting Fellow at Macquarrie University. The paper has benefitted from discussions with Professors Thomas J. Reynolds and Roderick P. McDonald and from the comments of several anonymous reviewers.     

The health needs of the majority versus the health needs of the individual: The reorganization of medical education in Colombia

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people.As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.     

Sequential effects in dimensional contrast

Two experiments examined pigeons' response rates during short trials signaled by stimuli closely spaced along a wavelength continuum. In Experiment 1 separate halves of the continuum were correlated with different reinforcement schedules. In Experiment 2, the middle stimulus was accompanied by a lower probability of reinforcement than were the remaining wavelengths. Both procedures resulted in dimensional contrast “shoulders,” seen as relatively enhanced or depressed response rates in the presence of stimuli between the extreme of the continuum and the border separating the positive and negative stimuli. Sequential analyses addressed possible contributions of the following interactions: (a) local contrast, seen when rate during a given schedule depends on the schedule in the just-preceding trial; (b) modification of local contrast by the similarity of the signaling stimuli (P. Blough, 1983); and (c) schedule-independent rate contrast, seen when rate in a given trial depends on the rate controlled by the stimulus that accompanied the just-preceding trial (Malone & Rowe, 1981). Dimensional contrast functions were similar when isolated according to the schedule, to the similarity of the signaling stimulus, and to the response rate of the just-preceding trial. The interactions noted above do not appear to make important contributions to this effect.     

A nonparametric approach for assessing latent trait unidimensionality

Assuming a nonparametric family of item response theory models, a theory-based procedure for testing the hypothesis of unidimensionality of the latent space is proposed. The asymptotic distribution of the test statistic is derived assuming unidimensionality, thereby establishing an asymptotically valid statistical test of the unidimensionality of the latent trait. Based upon a new notion of dimensionality, the test is shown to have asymptotic power 1. A 6300 trial Monte Carlo study using published item parameter estimates of widely used standardized tests indicates conservative adherence to the nominal level of significance and statistical power averaging 81 out of 100 rejections for examinee sample sizes and psychological test lengths often incurred in practice.The referees' comments were remarkably detailed and greatly enhanced the writeup and sensitized the author to certain pertinent issues. Discussions with Fritz Drasgow, Lloyd Humphreys, Dennis Jennings, Brian Junker, Robert Linn, Ratna Nandakumar, and Robin Shealy were also very useful.This research was supported by the Office of Naval Research under grant N00014-84-K-0186; NR 150-533, and by the National Science Foundation under grant DMS 85-03321.     

INCREASING APPOINTMENT KEEPING BY REDUCING THE CALL-APPOINTMENT INTERVAL

We examined the effect of reducing the interval between a patient's call for an appointment and the appointment itself. In Experiment 1, patients calling a family planning unit of a public health department were assigned appointments within either 1 or 3 weeks of their call. Data on patient “shows” and “no-shows” were recorded weekly for 6 weeks. Show rates for those in the 1-week appointment group were significantly higher than those in the 3-week group. In Experiment 2, patients were assigned to appointment dates either the next operating clinic day (next-day group) or 2 weeks from the call date (2-week group). Show rates for those in the next-day group were significantly better than show rates for patients in the 2-week group. Clinic productivity, time spent with patients, and consumer satisfaction were also assessed. Implications for appointment scheduling are discussed.