Managed care and unintended pregnancy

This article assesses the adequacy of coverage of contraceptive services and supplies for US women in the various types of managed care plans, with special attention to Medicaid. Between 1993 and 1995, the percent of insured private-sector employees enrolled in managed care plans rose from 51% to 73%. By 1996, the health care of 40% of low-income Medicaid recipients was also under managed care administration. Although 84% of managed care plans cover oral contraceptives--a rate substantially higher than that for traditional indemnity plans, several logistic factors impede access to this and other reproductive health benefits. The requirement of preauthorization may delay access to care when timely presentation is essential to the prevention of unwanted pregnancy. Some plans restrict members to one visit per year with an obstetrician-gynecologist. Coordination of an enrollee's total health care through the primary care physician can raise confidentiality problems for those who seek sensitive reproductive health services. There are fewer restrictions on the access of Medicaid recipients to family planning providers and services, but treatment of sexually transmitted diseases may not be part of the reproductive health package. The explosion of managed care onto the US health care market has led to public sector regulation legislation--a process that is proceeding in a piecemeal rather than comprehensive way. Because of the importance of reproductive health care to the lives of women, communities, and the broader society, more systematic action on this front is essential.     

Bilateral prophylactic mastectomy: issues and concerns

At present, the care of women at increased risk of developing breast cancer poses a clinical dilemma and remains an area of controversy. A number of investigators have addressed the pros and cons of prophylactic mastectomy versus close follow-up, utilizing annual mammography, semiannual or even more frequent physical examinations of the breast, and proficient monthly breast self-examinations. Recent efforts to isolate a gene (BRCA1) on chromosome 17q12-21 raise additional concerns about the management of women testing positive for BRCA1 mutations. These women are estimated to have an 85% lifetime risk of developing breast cancer. Testing for BRCA1 mutation carriers may soon be available for population screening. This article describes preliminary studies investigating health care provider and patient perceptions of bilateral prophylactic mastectomy. In addition, a number of research questions remain regarding the efficacy and utilization of bilateral prophylactic mastectomy as a treatment option for women at increased risk of developing breast cancer. These women include those testing positive for BRCA1 mutations. In addition, women with a strong family history opting against testing for BRCA1 mutations may express interest in surgery.     

Defining and measuring sexual orientation: a review

We have reviewed the literature relating to the health effects of diesel emissions with particular reference to acute and chronic morbidity and to carcinogenicity. It is apparent that exposure to diesel fumes in sufficient concentrations may lead to eye and nasal irritation but there is no evidence of any permanent effect. A transient decline of ventilatory capacity has been noted following such exposures. There is also some evidence that the chronic inhalation of diesel fumes leads to the development of cough and sputum, that is chronic bronchitis, however, it is usually impossible to show a cause and effect relationship because of the concomitant and confounding exposures to mine dust and cigarette smoke. Although there have been a number of papers suggesting that diesel fumes may act as an carcinogen, the weight of the evidence is against this hypothesis. Finally, the role of small particles, less than 10 microns, which are frequently present in diesel emissions requires further study since there is some limited evidence that they may be partly responsible for some of the exacerbations of asthma.     

Defining and measuring of attachment bonds: Comment on Kurdek (2009).

Kurdek’s (see record 2009-12106-001) study of dog owners raises a series of provocative questions about the nature of attachment bonds and whether dogs can serve as attachment figures for their owners. This commentary suggests that it is important to distinguish attachment from other types of affectional bonds that are motivated by caregiving, reproductive or affiliative concerns. It is suggested that preferences for attachment figures are best tested in situations involving danger and in situations in which preferences are not confounded with immediate physical proximity. Using these distinctions as a guide, this commentary concludes that although dog owners undoubtedly form affectional bonds with their pets, these bonds are more likely to meet criteria for caregiving rather than attachment bonds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial issues in pregnancy

For many women, psychosocial problems may directly contribute to poor pregnancy outcome, or impede effective care for medical or obstetric problems. Prenatal care should begin with a comprehensive risk assessment and development of a plan to respond to psychosocial problems or identified risks. These efforts may be accomplished through actions the primary provider initiates or through referral or use of community services. The contribution of psychosocial risks to adverse pregnancy outcomes, approaches to risk assessment, and prevention and management strategies are described.     

Multicultural issues and ethical concerns in the delivery of nursing care interventions

Targeted mutagenesis was used to investigate the roles of the CsmA and CsmC proteins of the chlorosomes of the green bacteria Chlorobium tepidum and Chlorobium vibrioforme 8327. Under the photoautotrophic growth conditions employed, CsmA is required for the viability of the cells but CsmC is dispensable. The absence of CsmC caused a small red shift in the near-infrared absorption maximum of bacteriochlorophyll d in whole cells and chlorosomes, but chlorosomes were assembled in and could be isolated from the csmC mutant. The doubling time of the csmC mutant was approximately twice that of the wild-type strain. Fluorescence emission measurements suggested that energy transfer from the bulk bacteriochlorophyll d to another pigment, perhaps bacteriochlorophyll a, emitting at 800-804 nm, was less efficient in the csmC mutant cells than in wild-type cells. These studies establish that transformation and homologous recombination can be employed in targeted mutagenesis of Chlorobium sp. and further demonstrate that chlorosome proteins play important roles in the structure and function of these light-harvesting organelles.     

Ethics of psychological research: New policies; continuing issues; new concerns.

The implementation over the past year within Canadian universities of the new Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS) usher in a new era in the oversight of the ethics of psychological research in Canada. Although these new policies apply to all human research, our interest is how they apply to psychology, primarily to deception, undergraduate subject pools, and other continuing concerns. Why have the granting agencies decided that government regulation of research ethics is necessary and what is the relationship between federal regulations and discipline codes? The history of the Canadian Psychological Association's involvement in protecting psychology's interests in the final revisions to the TCPS is recounted. In spite of what has been achieved, many psychologists feel that the TCPS has created new concerns for the discipline. Although there is the potential for startup problems, it is in our collective and individual best interests to make the policy work, thereby ensuring that escalation of government regulation or legislation will not be pursued. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

First pregnancy: Therapeutic issues for both female and male psychotherapists.

Discusses the reactions of psychotherapy clients to their therapist's 1st pregnancy, including the stimulation of unresolved oedipal and early developmental conflicts, fear of rejection and abandonment, and separation anxiety. Intensification of a maternal transference, sexual identity issues, and maternal loss and deprivation issues, along with hostile fantasies toward the unborn child and envy of the therapist as a mother and a sexual and fertile person, may arise. The reactions of the female therapist to her pregnancy may include emotional changes related to hormonal fluctuations, fatigue, and a growing sense of physical vulnerability; distraction due to the kicking of the fetus; and reduced functioning as a therapist due to feelings of fear, anger, guilt, and confusion over leaving her patients. Despite the paucity of research into the impact of impending parenthood on male therapists, it is suggested that they may experience many of the same role changes and conflicts, emotions, and reactions experienced by female therapists. Two case vignettes are presented to illustrate patient and therapist reactions to pregnancy, and suggestions to help both therapists and clients prepare to deal with issues surrounding the pregnancy are offered. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodological issues of measuring the skillfulness of therapeutic techniques.

Discusses methodological issues associated with measuring the extent to which a given treatment approach is carried out and the extent to which it is done skillfully. The skillfulness of interventions (molecular units) or operations (molar units) can be rated. It is suggested that researchers use concrete and clear theories of psychotherapy to derive well-specified measures of type and skillfulness of therapist behavior. Judges should be acquainted with and have confidence in the theory being studied. The construct validity of the measures should be studied separately from the predictive validity of the measures. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic issues arising from the pregnancy of the therapist.

Evaluates 3 case studies of female patients (21–25 yrs old) to illustrate possible effects of pregnancy of the therapist on the therapeutic process. In each case, the patient exhibited a transference reaction compatible with her underlying character structure. In addition to being aware of her own feelings and conflicts that may interfere with treatment, the pregnant therapist needs to be alert to intensified transference reactions that may profoundly alter the course of therapy. Finally, she must be prepared to modify treatment in order to maximize the positive therapeutic possibilities of the altered emotional climate. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intravenous therapy: current practice and nursing concerns

The field of intravenous (i.v.) therapy has been subject to major change, with increasing numbers of nurses taking on the high profile, technical aspects of care. The transfer of previously medicalized tasks such as cannulation has been welcomed by nurses who are keen to develop practical skills in order to embrace the concept of holistic patient care. This literature review aims to clarify the role of the nurse in i.v. therapy, exploring cannulation as a specific issue. Legal and professional aspects are discussed in terms of extended/expanded practice and practical aspects in terms of i.v. access and maintenance. Discussion focuses on a team approach to the management of i.v. therapy. Finally, the nursing process is applied to an i.v. therapy scenario. Exploration of the nursing issues enables practitioners to justify the expansion of individual practice in order to deliver holistic care and improve standards of service. The review concludes that nurses cannot afford to lose sight of the caring component of their role as a result of immersion in the culture of technical skill acquisition.     

Hydrocephalus in children: neurosurgical and neuroimaging concerns

The neuroimaging of hydrocephalus from the perspective of the pediatric neurosurgeon is discussed. Processes with new developments in therapy and imaging are described, including congenital causes of hydrocephalus, unilateral hydrocephalus, trapped fourth ventricle, and benign external hydrocephalus.     

P scale and psychosis: Continued concerns.

Notes that the reply by H. J. Eysenck (see record 1978-20108-001) to D. V. Bishop's (1977) criticism of the Psychoticism scale of the Eysenck Personality Questionnaire relies heavily for its rebuttal on information contained in a new book by the Eysencks (H. J. Eysenck and S. B. Eysenck, 1976) that was not available to Bishop for her critique. This new additional evidence did not, however, provide the present author with reassurance regarding the usefulness and validity of the P scale. It is argued that because of the extraordinary skewness of the P score distribution, high P scores can be a function simply of attention fluctuation, the error of measurement is especially large for high P scores, and the internal-consistency reliability of the P scale is inflated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient commitment: Additional concerns.

The E. P. Mulvey et al (see record 1987-32366-001) evaluation of involuntary commitment to outpatient treatment of the chronic mentally ill gave inadequate attention to the social systems of clients in the community and underestimated the complexity of implementing a policy of involuntary outpatient commitment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-assisted judgement: Defining strengths and liabilities.

Clinicians often fail to recognize limitations in their own subjective judgments, make use of well-developed mechanical-prediction methods, or carefully evaluate which computer-based aids warrant their consideration. This article addresses issues regarding computer-based test interpretations (CBTIs) and computer-based decision making. Comments highlight conclusions reached by other contributors to this Special Section, additional literature bearing on these observations, and implications for consumers of computer-assisted techniques and researchers developing or evaluating these methods. The future of computer-assisted assessment depends on educating clinicians and researchers to be better consumers of existing as well as emerging technologies in this domain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)