The realities of risk, the nature of hope, and the role of science: A response to Cook and VandeCreek.

A response is offered to the critiques of both Cook and VandeCreek. Among the points emphasized are the simple realities of risk with suicidal patients, existing empirical research with informed consent in both clinical psychology and other health care areas, as well as the persistence of common myths in clinical practice with suicidal patients. Although empirical science provides a firm foundation to much of what is proposed, it is critical for practitioners to recognize and respond to the ethical demands for openness and transparency with high-risk clients in an effort to achieve shared responsibility in care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Establishing an integrated care practice in a community health center.

In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization's unique circumstances inform the best approach for that particular organization, we highlight the clinical-level and system-level variables that we consider necessary for successful practice development and address how our behavioral health program operates despite funding limitations. We conclude that organizations that aim for integrated primary care must mobilize leadership to implement systemic changes while making difficult decisions about program development, financing, staffing, and interagency relationships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Health promotion in the community: Development of a curriculum for predoctoral clinical psychologists.

There is increasing evidence that life-style choices play a major role in premature illness and death from cardiovascular disease and cancer. Skyrocketing health care costs have promoted interest in health promotion activities. Although clinical psychologists appear to be in a unique position to contribute to health promotion activities, predoctoral training programs in clinical psychology have not generally included health promotion as a significant component. My colleagues and I are developing a curriculum for predoctoral clinical psychologists in the area of health promotion. Our emphasis on community interventions, rather than office- or hospital-based interventions, is consistent with the National Institutes of Health's funding of cardiovascular disease prevention programs at Stanford, Pawtucket, and Minnesota and appears valid from both a public health perspective and a psychological perspective. Our curriculum currently includes didactic and research components, as well as two community health promotion projects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary examination of the relationship between exposure to community violence and academic functioning.

Provides a preliminary examination of the relationship between exposure to community violence and academic functioning in a group of 45 African American children (aged 11–14 yrs) living in an impoverished urban environment. In addition, the role of family achievement expectations and religion, 2 previously identified family compensatory factors related to academic resilience, were evaluated as moderators of the relationship between community violence and academic functioning. Ss completed questionnaires about the variables mentioned above. Results suggest that exposure to community violence had a weak relationship with academic functioning in general, but that relationship was intensified under certain circumstances. Significant interactions between exposure to community violence, and both family achievement orientation and religious emphasis suggest that exposure to community violence may alter the role of previously identified compensatory factors. Children who perceived very high achievement expectations and a very strong moral-religious emphasis were most at risk for poor academic functioning as exposure to community violence increased, although children from these types of families displayed the highest academic functioning at lower levels of community violence exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health psychology and the ashes of community psychology.

Suggests that while health psychology can have an impact on health behaviors, as noted by J. D. Matarazzo (see record 1982-25842-001), enthusiasm for this field should not overshadow the important contributions that can be made by community psychology in mobilizing people to fight for their political, economic, and health rights. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care policy, psychotherapy research, and the future of psychotherapy.

In a quest for accountability in the delivery of health services, health care policymakers in both government and private sectors are creating clinical practice guidelines, many of which heavily emphasize medical and pharmacological approaches. Yet, there are now sufficient data to support the efficacy of psychotherapeutic procedures for a wide variety of specific disorders, and it seems now is the appropriate time to communicate these findings to health care policymakers and the public at large. At the same time, data must be developed on the delivery of these interventions by frontline clinicians in the settings where they practice. The emergence of practice research networks may accomplish this latter goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care, Medicare, and health policy for older people: A conversation with Arthur Flemming.

Fleming, former secretary of the Department of Health, Education, and Welfare and former US Commissioner on Aging, addresses (a) national health policy and how it might be more supportive of mental and general health needs of older people; (b) the need for changes to the Medicare program, such as enabling psychologists to provide mental health services to the elderly; (c) the need for a national health insurance other than Medicare; and (d) the importance of the Age Discrimination in Employment Act. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caring for the graduate from the neonatal intensive care unit. At home, in the office, and in the community

This article focuses on recent progress in the understanding of optimal care for the neonatal intensive care unit (NICU) graduate in three domains that have relevance to primary care pediatricians: the concept of developmentally supportive care for the immature central nervous system of fragile premature infants; an understanding of the function and systems of community-based early intervention available for medically complex, developmentally challenged and at-risk infants; and the management of technology-dependent children at home.     

First-contact rate for schizophrenia in community psychiatric care. Consideration of the oestrogen hypothesis

The study deals with the incidence of schizophrenia in Finland. All patients aged 15 years and over who during 1 year for the first time in their life contacted any psychiatric treatment unit in six health care districts (catchment areas), with a total population of 1.1 million people, and suffered from schizophrenia as defined by the DSM-III (schizophrenic and schizophreniform disorders) or ICD-8 classifications were studied and followed for 5 years. A total of 186 DSM-III and 158 ICD-8 schizophrenia patients were registered. The incidence rate of DSM-III schizophrenia was 17 per 100,000 total population and that for ICD-8 schizophrenia 14 per 100,000. The incidence rates for individuals aged 22-34 years, singles and those with low education were higher than average, but there were no gender differences. The comprehensiveness of the psychiatric services may explain why the age distributions were similar for both genders and why the mean age of patients at their first psychiatric contact was lower than in many other studies dealing with hospitalized patients. The patients' age at first psychiatric contact did not support the view that oestrogens specifically delay the onset of schizophrenia in women. There is some evidence, however, that oestrogens as antidopaminergic agents may protect women from psychotic disorders in general and that the reduction in oestrogen production may explain why at menopause and afterwards admissions for psychotic disorders for women increase more than for men.     

Health care coverage and access for children in an urban state: the New York perspective

To clarify the role of the intestine, kidney, and bone in maintaining calcium homeostasis during pregnancy and lactation and after the resumption of menses, a longitudinal comparison was undertaken of 14 well-nourished women consuming approximately 1200 mg Ca/d. Measurements were made before conception (prepregnancy), once during each trimester of pregnancy (T1, T2, and T3), early in lactation at 2 mo postpartum (EL), and 5 mo after resumption of menses. Intestinal calcium absorption was determined from the enrichment of the first 24-h urine sample collected after administration of stable calcium isotopes. Bone mineral of the total body and lumbar spine was measured by dual-energy X-ray absorptiometry and quantitative computerized tomography, respectively. Twenty-four-hour urine and fasting serum samples were analyzed for calcium, calcitropic hormones, and biochemical markers of bone turnover. Despite an increase in calcium intake during pregnancy, true percentage absorption of calcium increased from 32.9+/-9.1% at prepregnancy to 49.9+/-10.2% at T2 and 53.8+/-11.3% at T3 (P < 0.001). Urinary calcium increased from 4.32+/-2.20 mmol/d at prepregnancy to 6.21+/-3.72 mmol/d at T3 (P < 0.001), but only minor changes in maternal bone mineral were detected. At EL, dietary calcium and calcium absorption were not significantly different from that at prepregnancy, but urinary calcium decreased to 1.87+/-1.22 mmol/d (P < 0.001) and trabecular bone mineral density of the spine decreased to 147.7+/-21.2 mg/cm3 from 162.9+/-25.0 mg/cm3 at prepregnancy (P < 0.001). Calcium absorption postmenses increased nonsignificantly to 36.0+/-8.1% whereas urinary calcium decreased to 2.72+/-1.52 mmol/d (P < 0.001). We concluded that fetal calcium demand was met by increased maternal intestinal absorption; early breast-milk calcium was provided by maternal renal calcium conservation and loss of spinal trabecular bone, a loss that was recovered postmenses.     

An examination of the prevalence of mental disorders among the elderly in the community.

Administered the Older Americans Resources and Services multidimensional functional assessment questionnaire to a multistage statewide area probability sample of 2,146 noninstitutionalized Virginians 60 yrs of age and older. Findings indicate that the vast majority of Ss in the community possessed the cognitive capacity and psychological resources necessary to manage the tasks of living independently. Only a relatively small proportion experienced psychological dysfunction, and these rates closely approximated those suggested by literature reviews. Overall, health self-ratings, education, and income were positively correlated with psychological well-being for nearly all psychological status measures. Age, sex, race, and marital status were related only to certain psychological disorders. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care psychology: Prospects for the well-being of children.

Reviews historical as well as recent developments in the area of health care psychology for children. This area is contrasted with both behavioral medicine for adults and the traditional areas of child psychology. Certain unique characteristics of psychodiagnosis and psychotherapy in health care psychology are pointed out. Promising areas for future research are described, and implications for the wellbeing of children are drawn. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care in the 105th Congress: A hopeful look forward.

Addresses the issue of health care reform by both reviewing events of the past few years up to and including the 104th Congress and by discussing issues of health care reform facing the 105th Congress. Issues discussed include Medicare and Medicaid, insurance reform, the uninsured, quality and consumer protection, and long-term care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)