Use Of Available Services Research Articles

Characteristics, Needs, and Perspectives of Individuals Living Alone With Dementia: An Integrative Review.

The number of individuals living alone with dementia is increasing throughout the world, and they have unique needs that are poorly understood. The aim of this integrative review was to understand the characteristics, needs, and perspectives of individuals living alone with dementia as well as the available community resources to guide future research and clinical practice. Electronic (PubMed, CINAHL, and PsycINFO) and manual searches were utilized to identify articles using MeSH terms. Among 5693 identified articles, 31 articles met the eligibility criteria. The quality of the articles was determined utilizing the Joanna Briggs Institute (JBI) Critical Appraisal Tools applicable to the study design. Individuals living alone with dementia are more likely to be widows, of older age, and lower income, have a higher risk of severe loneliness despite more social contact, higher functional ability, and higher unmet needs despite the use of services, compared to those living with others. Perspectives of individuals living alone with dementia focus on the uncertainty of diagnosis, cognitive fluctuations, and maintaining independence. Lack of specialized services available after diagnosis and barriers to accessing services may lead to decreased independence and increased uncertainty. Overall, there is a lack of specialized services, person-centered care, and support to meet their unique needs. Individuals living alone with dementia have unique characteristics, unmet needs, and use of available services, which should be assessed regularly. Future research is needed to develop community-based, person-centered services for them and remove barriers to service use.

Medical Demography and Access to Prenatal Care in the Foumbot Agricultural Production Basin (West Cameroon)

This article analyzes the dynamics of medical demography and access to prenatal care in the agricultural production basin of Foumbot, located in western Cameroon. This region, characterized by strong agricultural activity, presents particular challenges in terms of maternal and child health. Lack of adequate access to prenatal care is a major concern that can influence maternal and neonatal health indicators. In our work, we conducted a six-month study in the commune of Foumbot. We used a research methodology that included multidimensional analysis, drawing on data from field surveys of 140 randomly selected women in the villages of Baigom, Fosset, Foumbot 1, 2, 3, 4, 5, Maka, Momo and Njone. These data were analyzed using descriptive statistical techniques. This enabled us to highlight the variation in qualities of prenatal care according to environments and types of health facility. The results show a significant disparity in access to prenatal care according to different socio-economic and geographical factors. Only 70% of pregnant women made the minimum four visits required, 22% did not use prenatal care, while 8% had fewer than four visits. The study also reveals that the main obstacles are the remoteness of health centers, the costs associated with cares and cultural practices that can limit the use of available services. The impact of agricultural activity, which is often the main source of income and subsistence for local populations, exacerbates these challenges by reducing the time available for medical care and increasing economic constraints. In rural areas, the use of medicinal plants also predominates, at 30%. The maternal mortality rate rose from 20 to 25 deaths per 100,000 live births between 2020 and 2023. Life expectancy at birth is 56 years; the infant mortality rate is 54‰, and the adult literacy rate is 63%. This research sheds light on the challenges faced by rural populations in terms of prenatal cares, and proposes concrete avenues for strengthening the healthcare system in similar contexts. The results of this study could also serve as a reference for public health policies aimed at improving access to care in other rural areas of Africa.

“It is worth hanging in there” – Psychotherapeutic experiences shaping future motivation for outpatient psychotherapy with refugee clients in Germany

BackgroundA high prevalence of mental disorders in refugees contrasts with a low rate of treatment and limited access to health care services. In addition to pre-, peri- and post-migration stress, language, cultural barriers together with lack of information about cost reimbursement, and access to German (mental) health care institutions are discussed as barriers to use of available services. Such barriers together with insufficient experience of treating traumatized refugee clients may lower therapists’ motivation and facilities to accept refugee clients. A model project called “Fearless” trained, and supervised therapists, translators, and peer counsellors to reduce these barriers and increase therapists’ motivation and engagement in future treatment of refugees.MethodsFrom a total 14 therapists participating in the project N = 13 were available for semi-structured interviews. The interviews were scheduled during or after their outpatient psychotherapy of refugee clients and lasted one hour on average. Based on qualitative assessment strategies, open questions addressed the therapists’ experience of challenges, enrichments, and motivation throughout the therapy. Therapists’ responses were analyzed using content structuring qualitative content analysis.ResultsThree major challenges modulated therapists’ future motivation for treating refugee clients: specific bureaucratic efforts (e.g., therapy application), organizational difficulties (e.g., scheduling appointments), and clients’ motivation (e.g., adherence, reliability). Still, most interviewed therapists (n = 12) evaluated the therapy as enriching and expressed their motivation to accept refugee clients in the future (n = 10).ConclusionResults recommend the reduction of bureaucratic effort (e.g., regular health insurance cover for all refugees) and implementation of organizational support (e.g., peer counsellors) in support of therapists’ motivation for future treatment of refugee clients. Further structural support e.g., with organizing and financing professional translators and referring refugee clients to psychotherapists should be deployed nationwide. We recommend the training in, and supervision of, the treatment of refugee clients as helpful additional modules in psychotherapy training curricula to raise therapists’ motivation to work with refugee clients.

DCServCG: A data-centric service code generation using deep learning

Modern software development paradigms, including Service-Oriented Architecture (SOA), tend to make use of available services e.g., web service Application Programming Interfaces (APIs) to generate new software. Thus, for the further advancement of SOA, the development of accurate automatic tasks, such as service discovery and composition, is necessary. Most of these automated tasks rely heavily on web service metadata annotation. The lack of machine-readable documentation and structured metadata reduces the accuracy and volume of automatic data annotation, negatively affecting the performance of automated SOA tasks. This study aims to propose automatic code completion for improving web service-based systems by identifying and capturing service usage collected from public repositories that share Open Source Software (OSS). To this end, a Data-Centric Service Code Generation (DCServCG) model is proposed to improve old-fashioned, general-purpose code generators that neglect essential service-based code characteristics e.g., sequence overlap and bias issues. DCServCG takes advantage of the data-centric concept, i.e., conditional text generation, to overcome the mentioned issues. We have evaluated the approach from the point of view of language modeling metrics. The obtained results indicate that the usage of the data-centric approach reduces perplexity by 1.125. Moreover, the DCServCG model uses de-noising and conditional text generation, which is trained on the transformer by distilling the knowledge, DistilGPT2 (82M parameters) trained faster and its perplexity is 0.363 lower than ServCG (124M parameters) without de-noising and conditional text generation, which lower perplexity value indicates better model generalization performance.

Patterns of distress and psychosocial support 2 years post-displacement following a natural disaster in a lower middle income country.

Displacement due to natural disaster exposure is a major source of distress, and disproportionately affects people in low- and middle-income countries (LMICs). Public mental health resources following natural disasters and displacement are often limited in LMICs. In 2017, the population of one island in Vanuatu, a lower-middle income country, was displaced due to volcanic activity. Following the launch of a public mental health policy in 2009, psychosocial support interventions are increasingly available, providing an opportunity to assess relationships with distress following displacement. 440 people contributed data. We assessed distress using a local adaptation of the Impact of Event Scale-Revised, and types of psychosocial support available and received, including from health professionals, support groups, and traditional networks such as chiefs, traditional healers, and church leaders. We analyzed relationships between distress and psychosocial support, controlling for sociodemographic covariates. Professional and group support was reported available by 86.8-95.1% of participants. Traditional support networks were widely used, especially by men. Availability of professional support predicted lower distress among men (p < 0.001) and women (p = 0.015) ( = 0.026-0.083). Consulting church leaders for psychosocial support was associated with higher distress among men (p = 0.026) and women (p = 0.023) ( = 0.024-0.031). Use of professional and group support was lower than reported availability. Increased collaboration between professional and traditional support networks could help respond to mental health needs following natural disasters in LMICs with limited infrastructure. Providing training and resources to church leaders might be a specific target for improvement. Promoting use of available services represents a continued public health need.

Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma.

BackgroundMobile health (mHealth) has great potential to both improve the quality and efficiency of care and increase health literacy and empowerment of patient users. There are several studies related to the introduction of mHealth tools for supporting pregnancy and the postnatal period, with promising but not yet rigorously evaluated impacts. This article presents the protocol for evaluating an mHealth intervention (hAPPyMamma) applied in the maternal and child care pathway of a high-income country (in a pilot area of Tuscany Region, Italy).ObjectiveThe protocol describes hAPPyMamma and the methods for evaluating its impact, including the points of view of women and practitioners. The research hypothesis is that the use of hAPPyMamma will facilitate a more appropriate use of available services, a better care experience for women, and an improvement in the maternal competencies of the women using the app compared to the control group. The protocol also includes analysis of the organizational impact of the introduction of hAPPyMamma in the maternal pathway.MethodsA pre-post quasiexperimental design with a control group is used to undertake difference-in-differences analysis for assessing the impact of the mHealth intervention from the mothers’ points of view. The outcome measures are improvement of maternal health literacy and empowerment as well as experience in the maternal care pathway of the control and intervention groups of sampled mothers. The organizational impact is evaluated through a quantitative and qualitative survey addressing professionals and managers of the maternal care pathway involved in the intervention.ResultsFollowing study recruitment, 177 women were enrolled in the control group and 150 in the intervention group, with a participation rate of 97%-98%. The response rate was higher in the control group than in the intervention group (96% vs 67%), though the intervention group had less respondent loss at the postintervention survey (10% compared to 33% of the control group). Data collection from the women was completed in April 2018, while that from professionals and managers is underway.ConclusionsThe study helps consolidate evidence of the utility of mHealth interventions for maternal and child care in developed countries. This paper presents a protocol for analyzing the potential role of hAPPyMamma as an effective mHealth tool for improving the maternal care pathway at individual and organizational levels and consequently helps to understand whether and how to scale up this intervention, with local, national, and international scopes of application.International Registered Report Identifier (IRRID)DERR1-10.2196/19073

A Global Perspective on Screening.

Breast cancer is emerging as a major global public health problem. Incidence and mortality continues to rise in low- and middle-income countries (LMICs). A significant and growing disparity exists between high-income countries and LMICs in the availability of screening services and associated preventable mortality. However, population imaging-based screening programs are not appropriate for all settings. Planners should perform a thorough assessment of the target setting prior to implementing any breast cancer detection program, as appropriate guidelines vary according to the resources available. Financial, social, and cultural barriers to breast cancer care need to be addressed to sustainably improve the morbidity and mortality of the populations and make efficient use of available services. Creative approaches, such as mobile and portable imaging and bundling of services, can facilitate the installation of early breast cancer detection programs in LMICs. While image-based screening programs are not initially resource-appropriate in many LMICs, planners can work towards this goal as part of their comprehensive breast cancer detection strategy.

NCCN Frameworks for Resource Stratification of NCCN Guidelines: Adult Cancer Pain and Palliative Care.

The NCCN Framework aims to provide adapted guidelines for low- and middle-resource countries to improve the experience of patients with cancer. In particular, the NCCN Frameworks for Adult Cancer Pain and Palliative Care and were designed to help expand access to pain management and palliative care for patients in low-resource countries. The NCCN Framework is one of several tools that can improve cancer care in the developing world. The NCCN Harmonized Guidelines for Sub-Saharan Africa, a collaborative effort between NCCN, American Cancer Society, Clinton Health Access Initiative, and African Cancer Coalition, was developed to harmonize NCCN recommendations with local guidelines across Africa and to make best use of available services and resources.

The Support, Health, Activities, Resources, and Education program for early stage dementia: Results from a randomized controlled trial.

Purpose A randomized controlled trial was conducted to test the effectiveness of the Support, Health, Activities, Resources, and Education Program. This six-session psycho-educational program provides dyadic counseling for individuals in the early stages of dementia and their family caregivers. The goal is to prevent common problems in care that emerge during the course of dementia by (1) actively engaging the person with dementia in developing a balanced plan of future care with his/her caregiver, (2) increasing use of available services, (3) enhancing dyadic relationship functioning, (4) improving well-being, and (5) evoking satisfaction with components of the intervention. Design and methods Persons with early stage dementia ( n = 128) and their caregivers ( n = 128) were randomly assigned either to Support, Health, Activities, Resources, and Education Program or a control condition. Intervention efficacy was evaluated for completion of a care plan, use of services, dyadic relationship functioning, participant well-being, and program satisfaction. Results Dyads in the treatment condition were able to construct a balanced care plan and increased their use of services. Dyadic functioning improved for one dimension (decreased emotional disruptions). Compared to the control condition, satisfaction with the intervention was higher for caregivers enrolled in Support, Health, Activities, Resources, and Education Program on four of five dimensions and one dimension for persons with dementia. Implications: Support, Health, Activities, Resources, and Education Program is a promising prevention approach that takes advantage of the early stage of dementia when both members of the dyad can participate fully in making decisions about later care.

Determinants of patterns of maternal and child health service utilization in a rural community in south eastern Nigeria

BackgroundWomen and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them.MethodsThe study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs) involving 8–10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs.ResultsThe study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073–0.986) and number of children (OR: 1.196, p < 0.01,CI: 1.563–7.000) were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244–2.164) and age (OR: 0.115, p < 0.001, CI: 0.838–0.948) determined better use of delivery and family planning services respectively.ConclusionsImproved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these services and should be considered in programs which seek to reduce maternal and child mortality.Behavioral change programs with high local content need to be implemented within rural areas especially among younger, illiterate women .

Birth preparedness and complication readiness among rural women of reproductive age in Abeshige district, Guraghe zone, SNNPR, Ethiopia.

BackgroundBirth preparedness and complication readiness (BPCR) is a strategy that helps women to consider all available maternal health care services during pregnancy and prepare for potential complications. Federal Ministry of Health in Ethiopia has taken steps to roll out the strategy at community level. Yet, women in rural communities still do not make use of available services to avoid complications in connection to pregnancy and delivery.ObjectiveThis study aims to assess the current BPCR practice and determine associated factors among rural women of reproductive age in Abeshige district, Guraghe zone, SNNPR, Ethiopia.MethodsA community-based cross-sectional study was carried out from February to March 2015. A total of 454 women were randomly selected and interviewed using pretested structured questionnaires, while opinion leaders, health extension workers, and selected women in the community were engaged in in-depth interviews and focus group discussions, using checklists prepared to guide the interviews. Data from different sources were analyzed, triangulated, and interpreted to respond to the objectives.ResultsThirty-seven percent of the respondents were found to have prepared for birth and its complications. BPCR was higher among women who lived within a 1-hour walk from a health center (adjusted odds ratio [AOR] =3.51, 95% confidence interval [CI]: 1.78, 36.79) and who were aware of the danger signs of pregnancy (AOR =1.72, 95% CI: 1.78, 2.94) and postpartum complications (AOR =2.32, 95% CI: 1.32, 4.21). A major source of information was found to be health extension workers and one-to-five women networks (AOR =2.81, 95% CI: 1.34, 6.21) and (AOR =2.52, 95% CI: 1.17, 5.54), respectively. Qualitative finding revealed that lack of transportation and concern over cost of services are key barriers to BPCR.ConclusionBPCR in Abeshige was found to be relatively low, calling for more interventions beyond mere awareness. Availing transportation services and ensuring services free of charge would help in improving BPCR in the study area.

The care needs and experiences with the use of services of people with young-onset dementia and their caregivers: a systematic review.

In this review, the care needs and experiences with the use of available services of individuals with young-onset dementia (YOD) and their caregivers were investigated. This knowledge is an important prerequisite for the development of appropriate interventions and personalized care to address their specific needs and problems. A systematic literature search was performed in PubMed, Psycinfo and Cinahl. A quality checklist for observational and qualitative studies was used to appraise the methodological quality of the studies. Twenty-seven studies were included, and a synthesis of the literature revealed six themes. The first theme concerned problems in the diagnostic period. Early recognition and referral was reported as an essential area that required improvement in order to obtain appropriate help in time. The second theme discussed the need for information about YOD and the availability of care throughout the caregiving trajectory. The third theme described barriers in access to care that hindered caregivers in finding the right services. The fourth theme showed the availability of appropriate services and specific unmet needs. The fifth theme illustrated that behavioural and personality changes pose a significant challenge for caregivers and other family members. The last theme showed the profound impact of YOD on caregivers. The literature indicates that people with YOD and their caregivers face a wide range of difficulties during the disease process. The reviewed studies provide an important foundation for knowledge and awareness about the specific care needs and experiences of people with YOD and their caregivers. Copyright © 2016 John Wiley & Sons, Ltd.

In Reply to: Minimal Requirements in Reporting Qualitative and Quantitative Studies: Critics on Two Papers.

Dear Editor After publication of our study on baloch women's decision making about childbirth settings (1), I noticed a letter about my published article in your journal (2) and I am very glad that this article has been helpful. Now, I want to mention some points in detail about my study. Zahedan (the capital city of Sistan and Baluchestan Province and the setting of this study) has four equipped hospitals (comprehensive EOC services). In spite of geographical and drive-time accessibility of these hospitals, about 10% - 12% of local women still choose to deliver their babies at home (3, 4). Therefore, the main question is not about maternal mortality rate or the impact of childbirth place on maternal death, but about the use of available services. In this regard, and aiming at to clarify the study motivation, the introduction section was written about the utilization of the available services. As a result, the study primarily aimed to identify and define the factors influencing the choice of the place of delivery by Iranian Baluch women during their decision making process. Gibson and Brown (5) explained that not all qualitative researches necessarily include research question in a very formal way, but they can be more concerned with a conceptual problem, or an area of interest. Therefore, research can take an exploratory path, and formulate and reformulate the research problem during the analysis of the data. Accordingly, analysis is not limited to an area but an ongoing feature of the research which its questions can change and reshape (5). In this regard, the criteria for reporting qualitative research questions are not obligatory (6). Of course, having some focused interest in the form of a question is necessary for research design (5) that can be stated as a research aim (7); and although it facilitates the development of research plan, the fact is that the primary question may change. During this process the researcher may find far more interesting things than he or she at first thought (5); as we found during the study and published them within different articles (3, 4). As Barbour noted, the goal of qualitative sampling is not to collect a representative sampling (generalization), but to provide potential for exploring (thick description of) the central issue of interest and reflect diversity through case relevance (5, 8, 9). Therefore, we chose Sistan and Baluchestan Province with the highest percentages of home birth. Among the cities of this province, Zahedan City, the capital of this province was selected to achieve maximum diversity (of ethnicity, socioeconomic, and demographic) sampling. Moreover, this city has four equipped hospitals that helped us to have a deep understanding of the issues of concern in the context of available medical services. Hence, women who were living and had given birth at home in Zahedan City were selected as rich data sources to provide the most meaningful information on the topic (8-10).

Italian Language in Istria: Status Planning, Corpus Planning and Acquisition Planning

The geopolitical features and the historical cohabitation of the Slavic and Romance ethnic and socio-cultural components in the Croatian Istria County marked the overall heterogeneity of the multicultural and multilingual Istrian territory. A particulary important issue regarding language planning and policy is the statutary official status of the Italian language, besides Croatian. This paper focuses on analyzing language policies and practices based on status planning, acquisition planning and corpus planning. Language planning in the context of the Croatian-Italian bilingualism in Istria is considered significant the role of the legal system which guarantees the preservation of the Italian language as the language of the social environment, helping to create the conditions for its use and the availability of its services, ensuring linguistic rights to the members of the Italian national community, the only (autochthonous) national community in Istria (status planning). In order to determine and increase its prestige on the social level, learning Italian as the language of the social environment is encouraged among members of the majority in Croatian language teaching schools, for broadening its knowledge and the use of available services for a wider range of users (acquisition planning). The least efforts are applied to the development of attempts to ensure and expand its use within various social language functions (corpus planning). Although Italian is institutionally protected and its teaching is widely encouraged, the goal of its application in everyday socialization remains unreached. DOI: 10.5901/mjss.2015.v6n2s5p385

Prevalence of traumatic brain injury and access to services in an undergraduate population: A pilot study

Objectives: The aim of this pilot study was to identify the prevalence of traumatic brain injury (TBI) among undergraduate college students, compare common TBI symptoms reported by students with and without a history of TBI and explore how often students with and without TBI access campus services.Methods: A campus-wide email recruited participants to an online survey containing questions about their history of TBI, experience of TBI symptoms and use of services.Results: Of 201 undergraduates, 55.7% reported no history of TBI or hospitalization, 27.9% reported a history of hospitalization but not TBI and 16.4% reported a history of TBI. Significant differences were seen among groups in their experience of some physical and psychosocial symptoms such as dizziness and difficulty with relationships. Healthy and TBI groups reported significantly more symptoms than the hospitalized group, but did not differ from each other. Most participants reported using no services and there were no significant differences in the average number of symptoms experienced by those seeking vs not seeking services.Conclusions: A substantial proportion of undergraduates reported a history of TBI and the experience of symptoms that could negatively impact academic performance. Further study is needed to examine factors influencing their use of available services.

P5-S7.15 STI knowledge and testing practices among FSW working outside of the main entertainment district in Tijuana, Mexico

BackgroundRegular sexual healthcare among FSW is important to reduce transmission and susceptibility of STIs and to enable earlier intervention and treatment for HIV and cervical cancer. Test and treat programs...

Domestic violence against women: Definitions, epidemiology, risk factors and consequences

Domestic violence is considered one of the most common forms of gender-related violence, and various studies estimate that between 10 and 35% of women experience domestic violence at some point in their lives. Nevertheless, it is a frequently neglected problem in crisis intervention centres, emergency wards, and obstetrics and gynaecological emergency rooms. This paper contributes to clarifying the definition, epidemiology, risk factors and consequences of domestic violence against women as well as the psychopathological profile of victims with a focus on Central European countries. Although different studies on domestic violence report different risk factors, such as younger age, being unmarried, lower education, violence experienced during childhood and alcohol/drug abuse of the partner or the victim herself, the results show no overall consistency. There seems to be neither a definite risk profile nor a specific association with a psychopathological profile. Women who have been victimised find it hard to share their experiences and seek help. It is often difficult for medical personnel who encounter these women to recognise violence and discuss this problem with them, just as it is difficult to offer adequate help. Medical personnel should be alerted to this subject and prepare guidelines for the further management and treatment of abused women. Infor-mation and support for medical staff can help to identify domestic violence, and encourage communication about this problem, thereby leading to a better and more efficient use of available services and resources.

Mediators Affecting Family Function in Families of Children with Duchenne Muscular Dystrophy

Most families of children with Duchenne muscular dystrophy (DMD) first receive professional information about the disease at the time of their child's diagnosis. Generally, as the families begin to build a supportive care system for their children, the parents will research DMD on their own or gather formal knowledge about the disease from professionals. However, gaining access to care is a major challenge because they often do not know how to ask the right questions. In particular, vulnerable populations may experience difficulties in assisting their child's emotional adjustment to the disability and use of available services. The purpose of this study was to test the possible effects of psychosocial mediators of parental health, family hardiness and family support on family function in relation to the age at diagnosis of children with DMD. One hundred and twenty-six Taiwanese parents of children with DMD who are members of the Taiwan Muscular Dystrophy Association filled out questionnaires. Subjects received a phone call before and again within the first week after we mailed them a questionnaire, a stamped return-addressed envelope, and a consent form. The questionnaires included the Family Hardiness Index, Family Assessment Device, Family APGAR, Duke Health Profile and demographic questions. Hierarchical multiple regressions were conducted to test whether family hardiness, parental health, or family support mediated or moderated the association between age at diagnosis and family function. Family hardiness positively mediated the association between age at diagnosis and family function. These findings may help the design of interventions to develop family hardiness in families of children with DMD.

Homeless youths’ perceptions of services and transitions to stable housing

Use of available services is low among homeless youths, and how youth make decisions to access services or seek housing is unclear. This study explored perspectives of current and former street youth about these processes. Recruited from the streets and a drop-in center, 27 youth ages 16–24, participated in individual qualitative interviews. Findings from consensual qualitative analyses indicated choices to use services were embedded within developing autonomy and identification with street lifestyles. Themes of self-reliance, substance use, and relationships with street and housed persons were expressed as critical for both using services and transitioning to stable housing. Agency-related factors such as caring staff, a nonjudgmental atmosphere, and flexible policies were perceived as important for service use while youth-related factors such as experiencing major events, being internally motivated, and embracing mainstream values were seen as conducive to transitioning off the streets. Implications for service providers and future research are discussed.

Evaluating key dimensions of the breast care nurse role in Australia.

A survey of women who had surgery for breast cancer during 1997-1998 at The St George Public and St George Private Hospitals identified substantial deficits in information provision, perceived support, and use of available services. Consequently, a breast care nurse (BCN) was appointed for a 12-month trial to assess women's needs and provide emotional support, education, and referral to appropriate services from diagnosis through to completion of treatment, according to evidence-based guidelines set out by the Australian National Breast Cancer Centre. A questionnaire regarding the role of the BCN was sent to 63 women who had surgery at either hospital from September 1999 to January 2000. Fifty women responded, for a 79% response rate. Ninety percent of respondents reported that it was helpful to talk to the BCN and rated verbal information given as helpful. Women accessed significantly more services than reported in 1998, and disparities in service use by age and public/private sector were eliminated. These results show strong consumer endorsement of service provision by the BCN. During this 12-month trial, consumer demand resulted in service expansion from 24 hours per week to 80. Ongoing evaluation of this developing role is required to ensure that women's needs are managed optimally.