Needs of an uninsured equity-deserving minority patient cohort with physical disabilities during the first wave of the COVID-19 pandemic

Background

Patients with disabilities and those from diverse equity-deserving backgrounds have been disproportionately affected by the SARS COV-2 ("COVID-19") pandemic.

Objective

To describe the significant needs and social determinants of health that affected a group of uninsured patients (from equity-deserving groups) with rehabilitation diagnoses during the early months of the COVID-19 pandemic.

Design

Retrospective cohort study utilizing a telephone-based needs assessment from April to October, 2020.

Setting

Free interdisciplinary rehabilitation clinic serving patients with physical disabilities from equity-deserving minority backgrounds.

Participants

51 uninsured, diverse patients with spinal cord injuries, brain injuries, amputations, strokes, and other diagnoses requiring interdisciplinary rehabilitation care.

Methods

Using a non-structured approach, telephone-based needs assessments were collected monthly. Reported needs were summarized into themes and the frequencies of each theme were recorded.

Results

From the total number of concerns, medical issues were reported with the highest frequency (46%), followed by equipment needs (30%) and mental health concerns (30%). Other frequently mentioned needs centered around themes of rent, employment, and supplies. Rent and employment were more frequently cited in earlier months, and equipment problems were more frequently cited in later months. A minority of patients reported they had no needs, some of whom had acquired insurance.

Conclusions

Our objective was to describe the needs of a racially and ethnically diverse set of uninsured individuals with physical disabilities seen at a specialized interdisciplinary rehabilitation pro bono clinic during the early months of COVID-19. Medical issues, equipment needs, and mental health concerns were the top three needs. To optimally serve them, care providers must be aware of current and future needs for their underserved patients, especially if future lockdowns occur.

A review of the demonstration of innovative solvent extraction processes for the recovery of trivalent minor actinides from PUREX raffinate

The selective partitioning (P) of long-lived minor actinides fromhighly active waste solutions and their transmutation (T) to short-lived or stable isotopes by nuclear reactions will reduce the long-term hazard of the high-level waste and significantly shorten the time needed to ensure their safe confinement in a repository. The present paper summarizes the on-going research activities at Forschungszentrum Jülich (FZJ), Karlsruher Institut für Technologie (KIT) and Institute for Transuranium Elements (ITU) in the field of actinide partitioning using innovative solvent extraction processes. European research over the last few decades, i.e. in the NEWPART, PARTNEW and EUROPART programmes, has resulted in the development of multi-cycle processes for minor actinide partitioning. These multi-cycle processes are based on the co-separation of trivalent actinides and lanthanides (e.g. by the DIAMEX process), followed by the subsequent actinide(III)/lanthanide(III) group separation in the SANEX process. The current direction of research for the development of innovative processes within the recent European ACSEPT project is discussed additionally.

This paper is focused on the development of flow-sheets for recovery of americium and curium from highly active waste solutions. The flow-sheets are verified by demonstration processes, in centrifugal contactors, using synthetic or genuine fuel solutions. The feasibility of the processes is also discussed.

Parent participation in community activities and the persistence of criminality

This study assessed whether the lack of parental participation in community activities during late childhood is significantly related to the persistence of criminal activity from adolescence to adulthood. A prospective, longitudinal investigation of a representative cohort of 548 boys from a middle-sized Swedish community was employed. A pattern-oriented analysis identified five configurations of boys who showed different profiles of social and academic competence at the age of 13 years. The configurations were compared with respect to persistent criminality among the boys for parents who did, and who did not, show stable participation in a community activity when their sons were in late childhood. Fathers engaged in a community activity had sons with significantly lower rates of persistent criminality. This result was most marked for youth with low school achievement, and multiple problem profiles of social and academic disadvantage. The findings held after controlling for family socioeconomic status. Mother's participation in community activities was statistically dependent on father participation but was not related to persistent offending among multiple problem boys. Results are discussed in terms of the different impact associated with mother and father community activity participation on persistent offending, and the holistic perspective to development guiding this research.

Development of adjustment problems in girls: what syndromes emerge?

The development of a broad spectrum of adjustment problems in girls was studied longitudinally from late childhood to early adulthood. A specific interest concerned how well the externalizing-internalizing distinction could explain the data. The sample consisted of about 500 Swedish girls, reasonably representative of the general population. Variable-oriented methods were complemented with person-oriented methods to study syndrome formation at the level of the individual. The results suggested a rather diversified pattern of multi-problem syndromes in late childhood, whereas the syndrome structure in early adolescence was organized around a differentiation between girls with externalizing adjustment problems and girls with peer problems. An externalizing syndrome was found to be stable between late childhood and early adolescence, increasing the risk of severe maladjustment in adulthood. Internalizing problems showed no clear-cut continuity with adult maladjustment. Results are discussed in relation to the externalizing-internalizing distinction, which to some extent is called in question.

Five-year clinical evaluation of Procera AllCeram crowns

STATEMENT OF PROBLEM

Esthetic demands of patients and practitioners for an all-ceramic crown in both anterior and posterior regions of the dental arches has prompted the development of the Procera AllCeram crown. Long-term clinical trials that evaluate the strength and naturalness of the Procera AllCeram crown are lacking.

PURPOSE

This prospective study was initiated to evaluate the clinical performance of 100 Procera AllCeram crowns after 5 years in service.

MATERIAL AND METHODS

One hundred Procera AllCeram crowns were fabricated for 58 patients (20 men and 38 women). Patients were treated by 4 general dental practitioners. Crown placement involved both the anterior and posterior regions of the dental arches. Crowns were examined at baseline and once a year during the 5 years that followed and evaluated at each appointment with the California Dental Association's quality assessment system.

RESULTS

Of the 97 crowns remaining in the study after 5 years, only 3 crowns had experienced a fracture through the veneering porcelain and the aluminum oxide coping material. Two additional crowns were replaced as a result of fractures of only the veneering porcelain. One crown was replaced as a result of recurrent caries. All remaining crowns were ranked as either excellent or acceptable for surface/color, anatomic form, and marginal integrity.

CONCLUSION

The 5-year clinical observations and ranking with the California Dental Association's quality assessment criteria supported the conclusion that Procera AllCeram crowns may be used in all areas of the mouth.

A person-oriented approach in research on developmental psychopathology

There is a growing acceptance of a holistic, interactionistic view in which the individual is seen as an organized whole, functioning and developing as a totality. This view emphasizes the importance of patterns of operating factors. Within this framework, a standard variable-oriented approach, focusing on the variable as the main theoretical and analytical unit, has limitations. A person-oriented approach would often be preferable, where the main theoretical and analytical unit is the specific pattern of operating factors. Such an approach is presented here, focusing on individual development and psychopathology. A brief theoretical and methodological overview is given and a classification approach is emphasized. Empirical examples concerning the longitudinal study of adjustment problems illustrate a number of issues believed to be important to development and psychopathology: problem gravitation, the significance of single variables and of patterns, the developmental study of syndromes (= typical patterns), and the detection of "white spots" in development.

School performance and IQ-test scores at age 13 as related to birth weight and gestational age

The cohort in the present longitudinal research program consisted of 873 children in an entire school grade, in a Swedish community. The present results showed a main effect of birth weight; low birth weight (LBW) children had lower school performance and intelligence-test (IQ) scores at age 13 than did normal birth weight (NBW) children irrespective of parental SES. Second, there was no significant main effect of gestational age (GA) on scholastic performance and IQ-test scores. Third, there was a significant main effect of the combination of birth weight and GA on scholastic performance and IQ-test scores. The LBW children born at term (38-40 pregnancy weeks; pw) had significantly lower scores and school grades as compared to the control group while the LBW children born with short gestational age (34-37 pw) and with very short gestational age (less than 34 pw) had significantly lower scores and marks in fewer areas of academic attainment.

WISC-test scores at the age of 10 for children born to women with risk pregnancies

The subjects (N = 50) were born to mothers who had earlier participated in an extensive clinical investigation during their pregnancies. Maternal serum hormone levels were investigated from pregnancy week 20 and on to partus. Fourteen children were born small-for-gestational age (SGA) and eight pre-term appropriate-for-gestational age (AGA). Each SGA child had two control children, born to mothers with normal or high serum levels of alpha-fetoprotein (AFP) in pregnancy week 16-17. Elevated serum levels of AFP was considered to be a sign of fetal stress. All 50 children were administered the WISC-test at 10 years of age. The SGA children had lower scores than control children in Performance and Full scale scores. The pre-term SGA children had lower scores than the controls in Verbal, Performance and Full scales. That was not the case for on-time SGA and pre-term AGA children. Girls born to smoking mothers performed less well than girls of non-smoking mothers on the Verbal scale. Positive correlations of maternal serum hormone levels (oestriol, hCG, and hPL) and WISC-test scores were present for girls. For boys a single maternal hormone in pregnancy (prolactin) was correlated with WISC-test scores at 10 years of age.

Behavior at 10 and 13 years of age for children with low birth weight

This study was based on data from a longitudinal research program. The cohort consisted of 874 normal children in an entire school grade in a Swedish community. The aim of the study was to investigate the relation between birth weight and behavior at school, for all children and for each sex separately. The results identified specific aspects of behaviour disorder significantly related to low birth weight (LBW) for children at the age of 10 but not at the age of 13. When the sexes were separated, there were no relations between birth weight and deviant behaviour for boys of low birth weight as compared to boys of normal birth weight, while girls of low birth weight showed specific behavioural disorders at age 10 as compared to girls of normal birth weight. For girls reared in families of low parental socioeconomic status, aggressiveness and motor restlessness at age 10 but not at age 13 was also present. Further analyses showed that girls born small-for-gestational age showed lack of school motivation and concentration difficulties both at age 10 and age 13.

Coping Behaviors in Relation to Frequency and Intensity of Anxiety-Provoking Situations

The relationships between coping strategies (constructive, passive, and escape), on the one hand, and anxiety reactions and individuals’ frequency of experiences of anxiety, and situations’ rate of recurrence, and general anxiety-inducing effect on the other, were explored. The investigated factors and their associations were studied both as individual characteristics and situational properties. Data for boys and girls were treated separately. The results for individuals showed that both trait-anxiety and frequency of stressful experience were related positively to escape strategies and negatively to constructive solutions. For situations, general situational effect correlated positively with escape solutions and negatively with constructivity. Rate of recurrence was correlated positively with constructive strategies and negatively with escape solutions. No significant sex differences were found.

Coping behaviors in relation to frequency and intensity of anxiety-provoking situations

The relationships between coping strategies (constructive, passive, and escape), on the one hand, and anxiety reactions and individuals' frequency of experiences of anxiety, and situations' rate of recurrence, and general anxiety-inducing effect on the other, were explored. The investigated factors and their associations were studied both as individual characteristics and situational properties. Data for boys and girls were treated separately. The results for individuals showed that both trait-anxiety and frequency of stressful experience were related positively to escape strategies and negatively to constructive solutions. For situations, general situational effect correlated positively with escape solutions and negatively with constructivity. Rate of recurrence was correlated positively with constructive strategies and negatively with escape solutions. No significant sex differences were found.

The role of early aggressive behavior in the frequency, seriousness, and types of later crime

This study reports on the relation between aggressive behavior at early school age and later delinquent activities of 1,027 subjects (517 boys and 510 girls) prospectively followed from late childhood to adulthood. The research group was a fairly unbiased age sample of children, covering most of the range of social and psychological upbringing conditions for 10-year-old children in a Swedish community. Aggressiveness was measured by teacher ratings at ages 10 and 13 years. Delinquency, defined as registered lawbreaking, was covered through age 26. There was a strong connection between both the aggressiveness ratings at ages 10 and 13 and adult delinquency for boys, with the majority of delinquents and recidivists being recruited from the early-aggressive boys. High ratings of aggressiveness were characteristic of boys who later committed violent crimes and damage to public property and generally of subjects with a diversified offense pattern. Aggressiveness was not predictive of later crime for girls until they reached the age of 13. For both sexes the relation between aggressiveness and crime was to a large extent independent of intelligence and family education. The possibility of making individual prognoses and the role of aggressiveness for the sexes are discussed.

Drinking habits and alcohol abuse among young men: a prospective longitudinal study

The relationship between self-reported frequency of drunkenness at 14-16 years of age and registered alcohol abuse at age 15-25 was studied in a large and representative group of Swedish men. The results showed that the proportion of boys who had experienced drunkenness more than 10 times increased rapidly between ages 14-16. Before the age of 25, 17% of the boys were registered in governmental records (police, social authorities or psychiatric services) because of alcohol abuse. A high frequency of self-reported drunkenness at age 14-16 was found to be significantly related to registered alcohol abuse at age 18-24. At the same time, however, it was found that 70-80% of the adolescent boys with the greatest frequency of drunkenness were not registered for alcohol abuse in early adult years. Using self-reported frequency of drunkenness at age 14-16 as a basis for predicting registered alcohol abuse at age 18-24 allowed correct classification of only 6% more boys than would have been expected by using a random procedure. The present study indicated that initial drinking habits per se are of limited importance in the development of alcohol abuse in early adulthood. However, the results showed that the combination of high self-reported frequency of drunkenness and appearance in government registers as early as age 15-17 constitutes a serious indication of continuing alcohol abuse.

Psychiatric care and course of psychiatric disorders from childhood to early adulthood in a representative sample

The incidence and prevalence of registered and psychiatric disorders were studied from birth to 24 years of age in a total population. The cumulative incidence of psychiatric disorders (meeting DSM III criteria) below 25 years was 13.9% for boys and 14.2% for girls. The outcomes of psychiatric disorders during childhood were generally good. Only 11% of children with an onset before age 10 remained in psychiatric care as young adults. Psychiatric disorders were more common among boys who had attended special classes. Low intelligence was related to psychiatric disorders with an onset before 15 years of age in males, but after 15 in females.

Type A behavior: a longitudinal study from childhood to adulthood

In a longitudinal study of a sample of Swedish males and females (n = 170), Type A-related behavior at age 13 was related to the scores on an abbreviated Type A scale based on JAS which was administered when the same subjects were 27 years old. Aggression, Motor Hyperactivity, Overambition, and Overachievement measured at age 13 were used as predictors in a multiple regression analysis, with Type A score at age 27 as the dependent variable. The following results were obtained: 1) for men the multiple correlation was 0.41 (p less than 0.01), with Aggression and Overambition accounting for most of the prediction, and b) for women the multiple correlation was 0.36 (p less than 0.05), with Motor Hyperactivity accounting for most of the prediction. It was concluded that Type A-related behavior could be identified rather early and that it shows an unexpected degree of stability over a period of 14 years.

Influence of sex, blood group, secretor character, smoking habits, acetylsalicylic acid, oral contraceptives, fasting and general health state on blood coagulation variables in randomly selected young adults

Blood samples were drawn from 129 randomly selected young adults. Intake of acetylsalicylic acid (ASA), contraceptive drugs, smoking habits and health state were registered. Males had significantly higher systolic blood pressure, shorter bleeding time and lower VIII:C. Smoking was only correlated to some variables assessed in the female group. Users of oral contraceptives smoked more, had a shorter bleeding time and higher fibrinogen levels. Factor VIIIR;Ag was elevated only in female smokers with blood group non-O. Non-secretors had shorter bleeding times and a tendency towards higher VIIIR:Ag.

Overachievement and catecholamine excretion in an achievement-demanding situation

We have studied the relationship between overachievement (defined as high school achievement in relation to intelligence) and catecholamine output (adrenaline and noradrenaline). The subjects were 176 children aged 13 yr. Adrenaline and noradrenaline excretions were measured in (1) a neutral situation (attending a nonexciting film), and (2) in an achievement-demanding situation. In the achievement-demanding situation, overachieving boys had much higher adrenaline excretion levels than the other boys. This difference was not found for girls. For boys, overachievement in combination with overambition (as rated by teachers) was related to a higher output of both adrenaline and noradrenaline in an achievement-demanding situation.

Co-frequency ratings of anxiety reactions

The method of direct co-frequency rating was explored for the study of relationships among individuals' self-reported anxiety reactions. The subjects were 40 adolescents who gave co-frequency ratings (how often the reactions co-occurred) for all pairs of 10 preselected reactions to anxiety. The mean co-frequency matrix was subjected to multidimensional scaling and cluster analysis. The same subjects also rated the intensity of the same reactions in an anxiety inventory of the "S-R" type. The correlations among reactions were computed and compared with corresponding co-frequency estimates. The relationship between these two types of data was relatively high. Factor analysis of the correlations gave a "Psychic" and a "Somatic" reaction factor, whereas the main dimension obtained from co-frequency ratings reflected a general reaction factor. This outcome was supported by the cluster analyses, which yielded two and one clusters, respectively, interpretable in accordance with the dimension analyses.

Perceptions of and reactions to stressful situations

Two approaches to the study of the psychological significance of situations were compared, one using data for individuals' perceptions of situations and the other using data for individuals' reactions to situations. Perception and reaction data for 40 subjects were used for multidimensional classification of 12 situations, which were selected so as to cover four different types of stressful situations. For three of the a priori groupings of situations the congruence in outcomes between the two methods was high. The implications of the congruence and the discrepancies in outcomes for the two approaches are discussed. The main conclusion is that one should distinguish clearly between situation perception factors and situation reaction factors in further research on the psychological significance of situations.

Integration of information in a clinical judgment task, an empirical comparison of six models

Six models were compared for their effectiveness in reproducing six clinical psychologists' judgments of 38 patients on intelligence, ability to establish contact, and control of affect and impulses. In two of the models, subjective weights were used in the prediction of a judge's ratings. The judges based their judgments solely on verbal protocols from the Rorschach, a sentence completion test, and the Thematic Apperception test. The stability of the linear aspect of the judgment process was very high but decreased as the depth of interpretation of the rating variable increased. The nonlinear aspect of the judgment process had considerably low stability. In general, a model based on subjective weights was most effective in reproducing the judges' ratings.

Anxiety Profiles Based on Both Situational and Response Factors

It was argued that a comprehensive picture of an individual's anxiety pattern could be obtained by taking into account different types of anxiety reactions and different categories of stressful situations reacted to. An anxiety inventory utilizing these two factors was analyzed with regard to the anxiety profiles of different subgroups of 116 adolescents. The original situation and response scales were categorized on the basis of factor analyses, in order to reduce the total matrix. Ss with similar response profiles across categories of situations were classified in homogeneous groups using latent profile analysis (LPA). For each sex, three categories of individuals were obtained, two of which differed mainly in anxiety level whereas the their group was characterized by a high transsituational inconsistency. For the total sample of Ss, "Psychic" responses were reported as more intense than "Somatic" responses and "Anticipation fear" situations were reported as less anxiety provoking than "Inanimate threat" situations and "Threat of punishment" situations.

Intertrait correlations as a function of amount of judgmental information about the ratee

Intrajudge intertrait correlations were studied as a function of amount of information (interview length). The trait ratings were based on interviews of 4 different lengths and made by 6 observers of 160 Ss with respect to 4 personality variables. Inrertrait correlations were unaffected by amount of information and fluctuated around the same high level of magnitude.

Decision time as a function of subjective confidence and amount of information

The time used to carry out ratings (decision time) was studied as a function of subjective confidence in the ratings and interview length (amount of information). The ratings were based on interviews of 4 different lengths and made by 6 observers of 160 Ss with respect to 4 personality variables. Decision time showed to be a positively monotonic function of both subjective confidence and amount of information.

AN ANALYSIS OF SITUATIONAL DIMENSIONS: A REPLICATION

An analysis of individuals' perceptions of situations was performed and confirmed the main results obtained in an earlier study by Magnusson (1971). Ss gave similarity ratings of situakions from a specific domain. A dimensional analysis and a categorization were mad on data. The method showed good agreement. Stability over time in factor structure was high as well as the agreement between individual structures. The analyses gave a clear and subjectively meaningful structure for both individual data and group data.

PREDICTIVE EFFICIENCY AS A FUNCTION OF AMOUNT OF INFORMATION

The effect of changing the amount of information on judges' predictive efficiency in a clinical prediction task was studied. Thirty judges predicted 30 students' average achievement scores on the basis of different amount of test data. One group of judges had information about the intercorrelations among the tests and the ecologkal validity of the tests. Another group of judges had only informahion about which tests were used. The predictive efficiency was not a monotonically increasing function of amount of test data. The most marked result was that the relative predictive efficiency decreased from four to six tests in both groups.

A PSYCHOPHYSICAL APPROACH TO THE STUDY OF PERSONALITY TRAITS

A total of 366 school children were rated by 12 teachers in respect of 11 personality traits. In a laboratory experiment, a group of 10 teachers estimated the degree of perceived similarity between the same traits. In a second laboratory experiment, estimates were obtained of the frequency with which the traits occur together. It was found that similarity of traits was proportional to the squared coefficient of inter-trait ccmelation. A similar relation was demonstrated for estimated co-frequency and inter-trait corre- lation. Furthermore, factor analyses of the three sets of data revealed essentially the same three factors of Intelligence, Sociability and Dependability. The results are discussed within a psychophysical framework regarding the subjects rated and traits estimated as stimuli in a person-perception experiment.

THE GENERALITY OF BEHAVIORAL DATA II: REPLICATION OF AN EXPERIMENT ON GENERALIZATION FROM OBSERVATIONS ON ONE OCCASION'

In two experiments previously reported the effect was studied of variation of task and group composition on ratings of behavior based on observation of individuals in group situations. The experiment reported here was planned as a replication of one of these studies. The main results of the two previous experiments were completely confirmed: When the situation variation encompassed both task and group com- position simultaneously the relationship was random between ratings made independently by two teams of judges, after one observation instance for each team.

THE GENERALITY OF BEHAVIORAL DATA I: GENERALIZATION FROM OBSERVATIONS ON ONE OCCASION

The results of two experiments designed to study the generalization potential in behavioral data are reported. Both experiments investigated the effect of variation of task and group composition on ratings of behavior based on direct observation of individuals in group situations. Experiment I under- took ratings of military conscripts and Experiment II undertook ratings of children seven years of age. One main result was obtained common to both experiments: When the situation variation encompassed both task and group composition simultaneously the relationship was random between ratings made independently by two teams of judges, after one observation instance for each team. The correlation was mostly of considerable size, when the situations in which the two teams made their observations were identical o r differed only in respect to task or group composition.