The prediction of major depression in women: toward an integrated etiologic model

OBJECTIVE: The authors develop an exploratory, integrated etiologic model for the prediction of episodes of major depression in an epidemiologic sample of women. METHOD: Both members of 680 female-female twin pairs of known zygosity from a population-based register were assessed three times at greater than 1-year intervals. The last two assessments included a structured interview evaluation for presence of episodes of major depression, defined by DSM-III-R, in the preceding year. The final structural equation model contained nine predictor variables: genetic factors, parental warmth, childhood parental loss, lifetime traumas, neuroticism, social support, past depressive episodes, recent difficulties, and recent stressful life events. RESULTS: The best-fitting model predicted 50.1% of the variance in the liability to major depression. The strongest predictors of this liability were, in descending order, 1) stressful life events, 2) genetic factors, 3) previous history of major depression, and 4) neuroticism. While 60% of the effect of genetic factors on the liability to major depression was direct, the remaining 40% was indirect and mediated largely by a history of prior depressive episodes, stressful life events, lifetime traumas, and neuroticism. The model suggested that at least four major and interacting risk factor domains are needed to understand the etiology of major depression: traumatic experiences, genetic factors, temperament, and interpersonal relations. CONCLUSIONS: Major depression is a multifactorial disorder, and understanding its etiology will require the rigorous integration of genetic, temperamental, and environmental risk factors.     

Empowerment and team effectiveness: An empirical test of an integrated model.

The authors developed a model of team empowerment as an emergent state linking inputs (I) with processes (P) and, thereby, with outcomes (O) in the context of an expanded team IPO framework. Using survey responses from 452 members of 121 empowered service technician teams, along with archival quantitative performance and customer satisfaction criteria, the authors tested the model using structural equation modeling techniques. The model was generally supported, although areas for improvement were evident. Specifically, empowerment partially mediated the influences of various inputs on team processes, whereas team processes fully mediated the influence of empowerment on outcomes. Directions for future research and application are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed community health: an integrated health model

As hospitals and physicians pursue integrated health delivery models, they may be overlooking the most effective locations and partnerships for maintaining and improving health outcomes: those in the community. Since the early 1990s, a St. Louis area group known as the Archbishop's Commission on Community Health has been involved in implementing community-based health and wellness programs and services. The programs have been successful because they focus on keeping people healthy in homes, schools, churches, and neighborhoods. This article describes these holistic approaches that include attention to the physical, mental, social, and spiritual needs of members of the community.     

Enculturation of foreign nurse graduates: an integrated model

Graduates of foreign nursing schools are a unique and valuable resource of the U.S. health care delivery system. Due to inadequate communication skills and a lack of cultural enculturation of many foreign nurse graduates (FNGs), some may not reach their full potential as a professional nurse. Agencies who employ FNGs can greatly improve their integration by providing continuing education to enhance communication and cultural enculturation. This model of a communications skills course addresses all aspects of communication: therapeutic, verbal and non-verbal, while integrating a cultural component. Thus, the implementation of this model can enhance foreign nurse graduates' ability to practice in the U.S. health care system.     

Fieldwork in schools: a model for alternative settings

Gilles de la Tourette syndrome is characterized by (a) onset usually in childhood and adolescence between 2 and 15 years of age, (b) violent facial tics and coprolalia, (c) increased excitability and apathy, (d) progressive increase in the intensity of symptoms, and (e) a chronic course. The syndrome is three times more common in males than in females. It is no longer considered the rarity it used to be, with a reported frequency of 1 to 5 per 10,000 population in western countries. This paper is the first report of Gilles de la Tourette syndrome in Papua New Guinea. The family history method and the family study method were used for this study after the index patient had been identified. The case report is presented with a diagram of the pedigree of the extended family of the index patient. A total of four cases of Gilles de la Tourette syndrome were reported in three generations of the extended family. In conclusion, further clinical and genetic research (including twin studies) into Gilles de la Tourette syndrome is recommended in Papua New Guinea.     

The effectiveness of an intervener model of services for young deaf-blind children

Project Validation of the Intervener Program (VIP) studied and documented the effectiveness of the Intervener Service Model which provides the services of a paraprofessional (called an intervener) to families of young children who are deaf-blind. The intervener provides auditory, visual, and tactile stimulation for the child and helps the child develop interactive behaviors instead of isolated, defensive, or self-stimulatory behaviors. The intervener also enables the parents to obtain much needed respite. Project VIP obtained abundant quantitative and qualitative data on the effectiveness of the Intervener Service Model. The data strongly support the need for Intervener Services for young children who are deaf-blind and their families.     

Improving clinical effectiveness through an evidence-based approach: meeting the challenge for nursing in the United Kingdom

Improving clinical effectiveness is a major challenge facing nurses working in the United Kingdom and requires a coordinated approach in order to ensure that the information about which interventions work is made available to those in a position to use it. This means that policy makers, administrators, and nurses need to base decision making on the best available evidence. In this article we explore the background to the drive for evidence-based practice and discuss how a group of nurse researchers have begun working with nurse administrators and practitioners in a large acute hospital to help change the rhetoric of evidence-based practice in nursing into reality.     

A multiplicity of roles for genetic nursing: building toward holistic practice

Nursing's unique contribution to human genetics is holism. There are many roles for basic and advanced practice nurses involved in genetics. Describing these roles makes it easy for nurses to learn more about genetic nursing and helps promote collaboration among professionals. Education for nurses about genetics helps foster greater nursing participation in human genetics. The goal is for nurses to be informed about genetics so that they can better understand people as whole persons whose growth and development, human response patterns, and biopsychosocial processes are affected by and have an effect on human DNA.     

Organizational effectiveness in the rehabilitation hospital: A cross-national comparison.

Compared the organizational effectiveness of 1 US and 1 Canadian rehabilitation hospital. The mix of patient cases and the severity of patients' conditions varied between the 2 facilities, with the US hospital admitting more patients who were close to the onset of impairment but keeping them for a much shorter period. Costs per day were also much higher in the US. Differences in philosophy of care, funding, and regulatory climate produced differing organizational responses and rendered comparisons of effectiveness difficult. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The chief of nursing practice: a model for nursing leadership

The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.     

External review for promotion and tenure in schools of nursing

A literature review conducted for a 1989 article on assessing the quality of life in surgical studies revealed that quality of life was more often mentioned than measured. Few authors reported the use of known, standardized scales. The objective of this study was to determine if and to what extent this situation has changed. A MEDLINE search of surgical studies published between 1989 and 1995 produced over 277 abstracts of surgical studies containing the words "quality of life." The abstracts were studied in three time periods: 1989-1990, 1991-1992 and 1993-1995. Findings indicated that the use of the term "quality of life" increased markedly over the study period, and studies using standardized measures escalated from 27.4% in 1989-1990 to 48.3% in 1993-1995. Those abstracts not stating how quality of life was assessed decreased from 48.4% in the early period to 21.7% in the last period. Of the abstracts reporting studies that used quality of life measures, 33% came from cancer studies, 21.7% from cardiovascular or respiratory studies, 14.8% from gastroenterology studies, 13.4% from nephrology studies and 6.1% from orthopedic studies. Surgical investigators selected a variety of global measures of quality of life as well as disease-specific instruments. The abstracts also revealed that surgeons are using quality-of-life assessment to monitor patients over time, to help select patients for surgery, to determine the effect of surgical treatment and for making policy decisions. Notwithstanding the limitations of this project, there is evidence in the literature that surgeons are increasingly willing to assess the impact of the surgical interventions by quality-of-life measures and are becoming more familiar with the diverse measures used to assess quality of life.     

Community nursing: nurses' effectiveness in supporting carers

This article outlines the results of a research project to evaluate the effectiveness of service support to informal carers. There are many ways in which community nurses can support carers, and carers frequently report the benefits of the service. The potential significance of the community nursing service in this role, however, is yet to be realised as nursing is still highly task-orientated, with priority given to specific medical interventions. As a result, some carers face difficulties in obtaining nursing support.     

Chronic low back pain: Toward an integrated psychosocial assessment model.

Reports on the integration of 6 dimensions of chronic low back pain to provide a multidimensional profile of the patient. These dimensions were pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, and illness behavior. Cluster analysis of the data obtained from 100 patients with chronic low back pain revealed the presence of 3 distinct patient groups: patients who were in control, patients who were depressed and disabled, and patients who were active copers with high denial. The validity of these clusters was supported by significance testing on several external variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Flashbulb memories and the underlying mechanisms of their formation: toward an emotional-integrative model

Flashbulb memories (FBMs) are detailed recollections of the context in which people first heard about important events. The present study investigates three models of the formation and maintenance of FBM. Two models have previously been proposed in the literature (Brown & Kulik, 1977; Conway et al., 1994). A third model of FBM that integrates theories of FBM and recent developments in the field of emotions is proposed. The present study compares these three competing models by investigating the FBMs that Belgian citizens developed upon learning of the unexpected death of their king Baudouin. Structural equation modeling revealed that, as compared to the two previously proposed models, the third model, which takes into account emotional processes, better explains FBM.     

Infertility education in baccalaureate schools of nursing

The increasing number of couples who enter the current health care system for assistance with fertility needs warrants an examination of the ways nurse educators are preparing nurse generalists to meet those needs. A survey was conducted of baccalaureate nursing programs to determine what, if any, information was being presented on infertility. Analysis of data with a 50% return rate indicated most schools of nursing in this sample are in fact including some information on infertility in their curricula. What is interesting to note is only slightly more than half of respondents included information on the emotional and psychosocial issues of infertility, despite the fact that the greatest cost of infertility is the emotional one. One of the major concerns of infertile couples is health care providers, including nurses, do not seem to understand what they are experiencing. How do nurses obtain such understanding if they are not prepared in their educational program to do so?     

Organizational structure and roles of psychologists in schools of medicine.

Conducted a questionnaire survey of medical school psychologists to assess attitudes toward work, advantages and disadvantages of working in medical schools, organizational structure, job satisfaction, and salary, from which 794 usable responses were obtained. 90% of Ss preferred that psychology be represented as an independent department or as part of an autonomous department of behavioral science. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of depression. Presentation of an integrated therapeutic model

In clinical work, research data must be integrated in the daily handling of patients. At the same time, symptoms must be treated and respect paid to the different personalities of the patients. Based on clinical experience and research data I present an integrated model for the treatment of patients with moderate to severe depression. I used the main principles in the model over 4 to 5 years, and where research has pointed to new, clinically relevant findings, these have also been included. The model can be used in psychiatric out-patient-clinics, on emergency wards and for general practitioners with a special interest in psychiatry. After 5 to 8 sessions spread over 8 to 12 weeks, the condition of most patients will have stabilized and improved, and the psychological part of the treatment can than be terminated.