Cultivating curricular reform

Since the 1960s there has been pressure to reform medical education in a more humanistic direction. One reason this has been difficult is that most medical schools have been forced to maintain themselves on resources allocated to support research and the technology of specialized tertiary care. Nevertheless, many people believe that medical education can still change because of changes taking place outside the sciences, such as a redefinition of the meaning of health and the need to provide better health care to the U.S. population at a lower cost. Taking this optimistic view will help strengthen reformers' resolve for curricular change and the incorporation of important areas such as family violence into medical students' education. There are numerous barriers to curricular change. Yet there are useful principles that can guide reform efforts, such as having an explicit rationale for the desired change, focusing on educational goals rather than on resources for their implementation, recruiting support from the departmental and school leadership, anticipating negative reactions, and recognizing the need for negotiation. There are also principles to foster successful implementation, the most important of which is to have everyone involved agree on the goals of the new program and participate in the process. The way to increase an emphasis on family violence issues is to find areas in the curriculum where these issues can be integrated with current teaching. Finally, a medical school curriculum on family violence does not need to be all-inclusive, but instead should prepare a good foundation so that students can expand their knowledge and skills during residency training and medical practice.     

Anterograde transport of neurotrophin proteins in the CNS--a reassessment of the neurotrophic hypothesis

Teenage Pregnancy is recognized as one of this country's most critical social issues. Each year, one out of ten females aged 15 to 19 becomes pregnant. In addition, there are a number of documented complications and consequences for the pregnant teenagers, their children, families and society. In response a number of health education programs have been developed to meet the myriad needs of this aggregate. Unfortunately, most of this cohort do not participate in these health education programs. This study, a part of a larger study, was conducted to identify the health education program elements most important to attract and sustain the participation of pregnant and parenting teens in a health education program. The sociodemographics of the pregnant and parenting teens were identified and linked to program elements. Since sociodemographics are often the first information known about a target group, linking these demographics to health education program elements has implications for program development and marketing. An exploratory survey methodology was used in this study and data were analyzed by measures of central tendency, dispersion, and analysis of variance to understand better the relationship between sociodemographic characteristics and importance of the health education program environment for pregnant and parenting teens.     

Issues in Infrastructure Health Monitoring for Management

The most critical issues that have been identified as being needed to implement meaningful and beneficial applications of health monitoring for infrastructure management are discussed. Issues related to infrastructure health monitoring for management can be defined in three overlapping categories. In this context, engineering tools, methods, and knowledge should be developed and utilized to answer societal and educational aspects of the problem while taking advantage of the information tools and methodologies available today. The need for integrated research, education, and practice for infrastructure management is emphasized. The challenges in the integration of intelligent transportation and structural systems concepts within an optimum integrated asset management framework are described and illustrated. Examples from ongoing research on the health monitoring of short-span bridge families and long-span bridges are presented to illustrate the issues.     

Population and Initial Validation of a Formal Model for Construction Safety Risk Management

The transient, unique, and complex nature of construction projects makes safety management exceptionally difficult. Most construction safety efforts are applied in an informal fashion under the premise that simply allocating more resources to safety management will improve site safety. Currently, there is no mechanism by which construction-site safety professionals may formally evaluate safety risk and select safety program elements for implementation. This paper introduces and validates a risk-based safety and health analytical model that can be used to evaluate expected risk given specific worker activities, strategically select highly effective safety program elements for implementation when resources are limited, and quantify resulting risk once the identified safety elements have been implemented. Specifically, the paper has three primary objectives: (1) introduce a risk-based construction safety and health analytical model; (2) validate relevant data used to populate the model; and (3) illustrate the applications of the model in practice. The findings of this research indicate that the values used to populate the model are reliable and that the model has the potential to significantly improve construction safety management.     

In the echoes of gunfire: Practicing psychologists' responses to school violence.

The recent rash of school shootings has thrust practicing psychologists into the role of assisting communities prevent such high profile incidents of juvenile violence. Although many psychologists are involved in assessing and treating children at risk for violent behavior, their efforts are rarely linked with other organized prevention efforts. This article describes how practicing psychologists represent a critical resource to school districts in developing and implementing a comprehensive violence prevention strategy. The authors outline a model school and mental health clinic collaborative program that can be replicated in various practice settings and discuss the benefits and essential steps for building such a collaboration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Supported employment: Models, methods, and issues.

Reviews the book, Supported employment: Models, methods, and issues, edited by Frank R. Rusch (see record 1991-97391-000) as consisting of 25 chapters by 49 contributors, including many well-known supported employment researchers, educators and administrators. Of the book's four sections, the first is an update on the spread of SE, with three chapters presenting survey data on program implementation in Virginia, Illinois, and Pennsylvania. Although informative, such data are now widely available and, unfortunately, quickly dated. The second section consists of nine "how-to" papers describing how integration can be in fact actualized. The third section addresses a range of issues affecting the future of SE, including conversion of sheltered workshops, employment opportunities of the future, and national strategies in implementation. The book's final section includes four chapters on the transition from school to work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The decline of youth suicidal behavior in an urban, multicultural public school system following the introduction of a suicide prevention and intervention program

A 5-year longitudinal study of suicidal behavior of students attending Dade County Public Schools (DCPS) in Miami, Florida, between the 1989-1990 and 1993-1994 school years, is described. As the fourth largest public school system in the United States, DCPS is representative of an urban, multicultural community. The prevalence of suicidal behavior among DCPS students necessitated the development of a districtwide Suicide Prevention and School Crisis Management Program (SPSCMP), including the creation of the "Youth in Crisis Hotline." A review of eight national school districts' suicide prevention and intervention programs indicates similarities with the DCPS model. Statistical data compiled by the DCPS program are organized into annual, monthly, grade level, and school level classifications, and are analyzed to determine the degree and direction of self-destructive behavior among youth in a culturally and linguistically diverse school population following the introduction of a suicide prevention and intervention program. Evaluative data regarding the effectiveness of the program as well as implications for suicide prevention and intervention are discussed.     

Developing curricula in spirituality and medicine

In recent years patients and some members of the medical community have expressed the concern that doctors have forgotten about compassion and too often ignore their patients' spiritual concerns. Patients can and should expect their physicians to respect their beliefs and be able to talk with them about spiritual concerns in a respectful and caring manner. Medical schools must teach their students how to meet these expectations, and health care systems need to provide practice environments that foster compassionate caregiving. Medical educators are recognizing the need to bring the art of compassionate caregiving back into the medical school curriculum. This paper focuses on one approach to achieving this goal, the study of spirituality and medicine. The authors discuss the relationship of spirituality and healing, and describe studies that have shown patients' desire to have spiritual issues addressed by their physicians and the potential health benefits of spiritual beliefs. Finally, they describe common elements of the spirituality courses offered by approximately 50 U.S. medical schools, including 19 schools that have been awarded grants from the National Institute for Healthcare Research for the development of curricula in spirituality and medicine.     

Working with difficult-to-treat eating disorders using an integration of twelve-step and traditional psychotherapies

In summary, we have a multidimensional treatment program that attempts to integrate psychodynamic, cognitive-behavioral, systemic, psychopharmacologic, and 12-step interventions. For patients who have not had previous treatments or patients who are young adolescents, we do not emphasize the 12-step approach. For our difficult-to-treat patients, our current overall impression is that the benefits of adding the 12-step component have outweighed the costs. We began the program with an expressed intent of experimenting with the integration. Staff were subsequently recruited who were open to the experiment and the success of the integration has been a function of the flexibility within the staff. Our hunch is that this integration would not work as well with an existing staff who harbored prejudice toward either position. Actually, we have found working on the integration quite invigorating. Our recovering counselors have raised issues that we have not heard raised in the more traditional settings we have been associated with. Likewise, we have seen our counselors grow professionally from hearing alternative views of why individuals struggle and how they get better. The exchange has been synergistic rather than divisive. Although we are encouraged by our early experience, it is the long-term outcome that will clarify the relative usefulness of this treatment strategy. We are confident that as we live with the integration longer, more of the advantages and disadvantages will become apparent and perhaps we can refine our understanding of which subgroup of patients makes most use of this type of integrated approach.     

Herbs as medicines

Herbs and related products are commonly used by patients who also seek conventional health care. All physicians, regardless of specialty or interest, care for patients who use products that are neither prescribed nor recommended. Some herbs have been extensively studied, but little is known about others. When a patient asks for advice regarding the use of a particular herb, how should a physician respond? Similarly, how does a physician determine if a patient's symptoms are caused by a "remedy"? This review attempts to answer these questions by investigating pertinent definitions, the history of herbs in medicine, epidemiology and prevalence of herbal use, and relevant psychosocial issues.     

Training issues.

This interesting set of articles, taken as a group, suggests that we have come a long way toward the integration of family therapy into the training of psychologists. The question is no longer "Should psychologists be trained in family therapy?" but "How can such training best be accomplished, in what settings, with what approaches, and how related to other elements of the graduate or postdoctoral program?" The articles by Ribordy (see record 1989-13401-001) and by Lebow (see record 1989-13365-001) address the central issues in training from different vantages (the family institute versus the academic program) but converge on many points. I will comment mainly on these two articles, but first I want to take note of some of the ideas raised by Berger and Jurkovic (see record 1989-12730-001). They describe and persuasively illustrate a contextual approach to family work that emphasizes the varying settings in which therapy may occur. Thus they are concerned with a "supersystem" that incorporates these extra therapeutic systems as well as clinicians and family. It will be no great surprise to the readers of this Journal that many of these same points emerge from Ribordy's and Lebow's more general discussions of training issues. They explore the separate territories of the academic graduate program and the family institute as settings for training and ably outline the advantages and disadvantages of each. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deficient expression of mRNA for the putative inductive factor bone morphogenetic protein-7 in chemically initiated rat nephroblastomas

During 1996, representatives from two professional organizations--American School Health Association and National Association of School Nurses--met collaboratively to identify and rank order key questions regarding contemporary research needs in school nursing services. This article summarizes existing literature and proposes areas for research. Recommendations are offered for nurses, school health program administrators, educators of school nurses, professional organizations, and others who plan and provide health care for school-aged youth.     

Notable multicultural training in APA-approved counseling psychology and school psychology programs

On the basis of the initial work of M.R. Rogers, J. Martin, and L. Druckman (1994) regarding exemplary multicultural training occurring at school psychology programs, the authors examined salient aspects of 5 American Psychological Association (APA)-approved counseling psychology and 5 APA-approved school psychology programs nominated for their reputation for multicultural training. Twenty-two percent of the program faculty represented a racial-ethnic minority group, at least 2 faculty members per program were involved in multicultural teaching, and 90% of the programs offered a multicultural course. Program faculty at the notable programs were actively involved in relevant research, routinely made presentations at national conferences regarding their scholarship, regularly participated in campuswide multicultural committees, and generally reported their university training environment to be supportive of multicultural issues.     

The Rural Hawai'i Behavioral Health Program: Increasing access to primary care behavioral health for native Hawaiians in rural settings.

Health care access issues present significant challenges for rural populations and health providers. Psychology can support improved access and quality of rural health services through the development of integrated behavior health programs within primary care settings. This article reviews a clinical training and service delivery program, the Rural Hawai'i Behavioral Health Program, which has evolved in response to the pressing health needs of Native Hawaiians in rural communities. Native Hawaiian cultural factors and components of the primary care model that have supported the development of this program will be reviewed. Program expansion, sustainability, and treatment efficacy research will be discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competency in integrative psychotherapy: Perspectives on training and supervision.

Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anticipatory guidance for the adolescent. Parents' concerns

Parents' opinions regarding anticipatory guidance for adolescents have not been adequately investigated. In this study, 932 parents of adolescents completed a computerized questionnaire listing 30 common psychosocial-medical concerns of adolescence. Respondents were asked how important it is for private pediatricians to discuss these topics with their teenagers during regular checkups. Ten items were rated important by > or = 90% of parents, 22 items by > or = 80%, and 29 items by > or = 66%. Heeding parents' expectations and concerns, pediatricians should incorporate discussions of psychosocial-medical issues as a meaningful component of routine adolescent health care.     

Association analysis of the SHC1 gene locus with longevity in the Japanese population

The SHC1 gene encodes a signaling and transforming protein that has been implicated in the aging process in worms and mammals. In this study we examined 230 Japanese centenarians and 180 healthy younger controls and looked at the SHC1 locus as a candidate region that may be associated with longevity. We identified 12 single nucleotide polymorphisms (SNPs) within a 10-kb region encompassing the entire SHC1 gene from the DNA of 30 centenarians and 24 healthy younger controls. Five SNPs, including three nonsynonymous sites, lay within coding elements, six were located within introns, and one was in the 3' untranslated region. All of these SNPs were relatively rare, with a minor allele frequency of less than 5% in our subjects. A pairwise linkage disequilibrium analysis using the r2 statistic showed that two of the SNP pairs are in tight linkage disequilibrium at this locus. We investigated the possible association of SHC1 with longevity using association analyses with allelotypes and haplotypes but found that the SNPs identified in SHC1 had no impact on longevity for Japanese centenarians.     

Building the capacity of schools to improve the health of the nation: A call for assistance from psychologists.

During the past several years, about two dozen major reports have called for the nation to reconceive and regenerate its school health programs. Proposals to reform health, education, and social services have included means to improve such programs. This article (a) identifies the leading causes of mortality and morbidity in the United States, (b) delineates 6 categories of behavior established during youth that contribute to these causes, (c) outlines ways in which a modern school health program might prevent such behaviors and address critical health and social problems among students, (d) describes practical research and development strategies that are being established to help schools implement effective school health programs, and (e) suggests how psychologists might help improve these programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)