Are you treating youngsters who are or should be receiving mental health services?

Psychiatrists now recognize that the disorders of children are serious, treatable conditions and as precursors of adult psychopathology. These conditions can seriously influence the patient's behavior when undergoing dental treatment. The dentist will probably assume that the behavior problems are directly related to the nature of the dental service, rather than particular underlying personality characteristics of preschool and school-age children. It is important that practitioners recognize and understand these conditions as they attempt to provide adequate treatment. No national epidemiological studies have been conducted in this country that would provide valid indicators of either the prevalence or incidence of mental disorders among children. Local studies, however, have been done that diagnosable disorders in children range from 17.6 percent to 22 percent, including 3 percent to 5 percent who have severe emotional or behavioral problems. The prevalence of many mental disorders is greater in males than in females, ranging from a ratio of 2:1 to 9:1. Lifetime prevalence of mental disorders, first diagnosed in infancy, childhood, and adolescence range as high as 15,000 cases per 100,000 persons. It is important for the dentist to recognize that (1) even the youngest of children seen in a dental practice may be in need of mental health services, (2) management problems may stem from mental health problems, and (3) families are unaware or unwilling to admit that a child may need help.     

Teaching writing to children who are underserved.

Writing instruction for children from low-income families has been dominated by 2 antithetical views, one emphasizing component skills and drill-and-practice instruction, the other emphasizing natural processes of learning language. A 3rd approach, one that reflects pedagogical principles that are based on a sociocognitive model of writing was investigated. Writing instruction that featured these principles in varying degrees was examined in 26 4th-grade and 16 6th-grade classrooms. Regression analysis indicated that more than 40% of the variance in children's posttest writing-quality scores was accounted for by degree of adherence to the model, and scores in writing mechanics did not suffer from application of the model. The results suggest that sociocognitive approaches to writing instruction have much to offer this population of children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Flexible sigmoidoscopy training for nurses

Colorectal cancer will account for approximately 55,300 deaths in 1995. In addition, 138,200 new cases of colorectal cancer will occur. The American Cancer Society encourages accessible, affordable sigmoidoscopy by primary care physicians or highly trained paramedical personnel for all persons, aged 50 years and older, every 3 to 5 years or as advised by their physician. As a result of these recommendations, there has been an increase in demand for the screening sigmoidoscopy. The increase in requests for this examination has overwhelmed existing resources, including physician time, space, and staff in the ambulatory care setting. The Kaiser Foundation Health Plan of Georgia, Inc., has developed an innovative approach to performing screening sigmoidoscopies by training two registered nurse endoscopists to conduct these examinations. The goal of the nurse endoscopy program is to provide quality colorectal cancer screening within an established appointment standard while promoting comfort and safety.     

Obstetricians' receptiveness to teen prenatal patients who are Medicaid recipients

OBJECTIVE: To test the accuracy of various physicians' participation in Medicaid models. DATA SOURCES/STUDY SETTING: Primary data on 221 obstetricians and gynecologists in the Chicago area by telephone interviews over a four-month period. These data were combined with secondary data from the American Medical Association Master File (1993) and U.S. Census data (1990). STUDY DESIGN: Telephone interviewers posing as the older sisters of a pregnant teenager who is a Medicaid recipient sought information regarding the care provided in a first prenatal care appointment (e.g., appointment duration, tests administered, delivery privileges, appointment availability). DATA COLLECTION/EXTRACTION METHODS: A "receptionist helpfulness" variable was developed through pretesting on obstetricians in another city. Inter-interviewer reliability was enhanced through common interview technique education. PRINCIPAL FINDINGS: Only 81 obstetricians (36.7 percent) accepted new Medicaid patients. This finding is lower than previous research on physician participation in Medicaid. There was strong empirical support for both dimensions-cost containment and limited access-of the physicians' receptiveness model, the model introduced with this research. There was limited support for the dual market and residential segregation models of physician participation in Medicaid. CONCLUSIONS: It is argued that this study's research design is more accurate in reflecting the barriers that a pregnant Medicaid-eligible patient encounters when seeking office-based prenatal care. As such, combining the physicians' receptiveness model with other physician participation in Medicaid models provides a more complete picture of access barriers to prenatal care for our most needy populations.     

Is who you are who you're talking to? Interpersonal style and complementarily in mixed-sex interactions.

To investigate interpersonal theory, the authors examined the social behavior of 112 previously unacquainted male-female pairs collaborating on a joint task. Structural equation modeling analyses provided clear evidence of complementarity: In addition to trait affiliation and dominance both predicting situational behavior, each interaction partner's behavior influenced the other's in accordance with the theory, eliciting similar levels of affiliation and opposite levels of dominance. There were also clear biases related to participants' interpersonal traits: When behavior, as indexed by observers, was held constant, more trait affiliative participants tended to view themselves and their partner as warmer during the interaction; likewise, more trait dominant participants perceived themselves to act more dominantly than they actually did. Throughout, there were no sex differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A history of the training of asylum nurses

The national training scheme for asylum attendants, devised in the late 19th century, did not arise ex nihilo. Several philanthropic and imaginative madhouse keepers of the previous century had understood the link between successful treatment of lunatics and the quality of staff who cared for them. They had therefore aimed to recruit a 'good class' of person to work in their institutions, and to create an environment which would tend towards the civilization of the patients. A few even entertained the notion that training attendants would enhance their ability to understand and care for those in their charge. Training received increasing attention in both medical and political circles throughout the 19th century until a national scheme was inaugurated in 1891. The scheme achieved only a modest success in that, while it drew upon the undoubted enthusiasm of those who trained under it, it did not enhance the attendants' career opportunities or their pay once they had qualified. Training as a means of solving management problems was doomed to failure, and widespread dissatisfaction amongst asylum nurses erupted during the 1920s, only 30 years after the scheme had started.     

Nutritional assessment for children who are HIV-infected

Pathophysiologic, psychosocial, and economic considerations are important in nutritional assessment of infants and children who are HIV-infected. Nutritional assessment guidelines vary based on the child's circumstances. Specific assessment guidelines are proposed for (a) ongoing ambulatory care; (b) when growth decelerates or its below the fifth percentile; (c) acute illness; and (d) home and community care. The guidelines are based on data collected from a sample of 16 children who were HIV-infected and their families during a pilot study of transitional nursing care using advanced practice nurses. The guidelines were inductively derived from patient care records and from a review of the literature.     

Truth and investment: Lies are told to those who care.

Participants discussed paintings they liked and disliked with artists who were or were not personally invested in them. Participants were urged to be honest or polite or were given no special instructions. There were no conditions under which the artists received totally honest feedback about the paintings they cared about. As predicted by the defensibility postulate, participants stonewalled, amassed misleading evidence, and conveyed positive evaluations by implication. They also told some outright lies. But the participants also communicated clearly their relative degrees of liking for the different special paintings. The results provide new answers to the question of why beliefs about other people's appraisals do not always correspond well with their actual appraisals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Uncomplicated gallstones: who should be operated on?

Gallstones are common and occur asymptomatically or symptomatically with or without complications. Treatment is only required for symptomatic gallstones and complications in gallstones. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones and is performed with an increasing frequency. One may fear, that the indications for cholecystectomy have changed, and surgery is now undertaken for a lesser degree of morbidity. Cholecystectomy does not increase life expectancy, and 20-30% of patients cholecystectomized for symptomatic gallstones complain of abdominal pain of unknown origin after the operation. New valid parameters in order to predict which patients will benefit from cholecystectomy are therefore necessary. Symptoms specific to gallstones are not precisely known, and greatest success in treatment seems to be related to the occurrence of severe, often steady pain, of hours' duration, often located in the epigastrium or upper right quadrant, with or without radiation and/or vomiting. Dyspepsia alone is not an indication for cholecystectomy. Psychological vulnerability may predict a poor outcome after cholecystectomy and should lead to reconsideration of the indication for surgery.