bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatry and the Role of the General Practitioner
Authors: Wittkower E. D. , Stauble W. J. 
Published: May 2005

The psychiatric role of the general practitioner covers a wide field and depends crucially upon his efforts to understand himself, his patient, and the doctor-patient relationship. The patient must be approached in terms of how he is affected emotionally by physical illness, and how his state of physical health is affected by his emotions. His behavior during initial stages of physical illness, his reaction to the diagnosis, and his feelings and interactions during the full-blown stages of illness are important areas for the doctor to explore in order to deal more effectively with a patient's withdrawal, depression, narcissism, frustration, or anxiety. The doctor must also explore his own motivations for choosing the medical profession in order to implement his role in caring for patients. Each of the models of the doctor-patient relationship–activity-passivity, guidance-cooperation, mutual participation-requires different degrees of emotional involvement on the part of the doctor. An understanding of the psychodynamics of this relationship, involving the attitudes and conflicts of both members, can help the general practitioner to handle effectively and successfully his patients in everyday practice. Practical suggestions are made for teaching psychological concepts to general physicians: improved courses in psychiatry in medical schools, emphasizing the “whole person” approach; ongoing seminars for doctors in practice–“Balint Groups”–in which the aim is to understand the nature of the patient's emotional conflicts, the doctor-patient relationship, and the part the doctor plays in it; refresher courses; and consultations with psychiatrists.
AIDS Prevention Programs: A Critical Review
Authors: Buchanan David , Cernada George 
Published: May 2005

One way to measure the state of the art in HIV/AIDS educational intervention policy, practice, and research is to review the contents of professional journals directed primarily to health education. One such journal, the International Quarterly of Community Health Education, has seen the number of articles submitted which deal with community health education aspects of HIV/AIDS prevention increase by five times from 1984–89 to 1990–95. The number of articles on this subject actually published increased by more than six times, from three to twenty. A critical review of the content of those articles published during the 1990s in this Journal provides a diversity of views about the kinds of theoretical models and typologies that are applicable to HIV/AIDS educational interventions. It also suggests the crying need to focus more of these social and behavioral models in a cultural context. This article provides a brief overview of AIDS in the U.S. and international settings, a description of the complexity of application of social and behavioral change models in their present context, and a review of the three categories of articles which have been published in the Journal: dogma, dissent, and innovation.
Huntington's Disease: Update and Review of Neuropsychiatric Aspects
Authors: Mendez Mario F. 
Published: May 2005

Objective: This article presents a general update on Huntington's disease (HD) and reviews the psychiatric and cognitive features of this disorder. Method: HD is discussed in five sections: an introduction and update, the psychiatric aspects, the cognitive aspects, brain-behavior relationships, and the differential diagnosis and management. Results: Recent advancements in HD include the identification of presymptomatic testing methods and HD gene defect, structural and metabolic neuroimaging findings, and a neuropsychological profile. HD is associated with mood disorders, personality changes, irritable and explosive behavior, a schizophrenia-like illness, suicidal behavior, sexuality changes, and specific cognitive deficits. Conclusions: HD results in organic mental disorders from dysfunction of prefrontal-subcortical circuits coursing through the caudate nuclei. The diagnosis of HD is aided by genetic testing, neuroimaging, and neuropsychological testing. Management involves education, genetic counseling, and psychotropic medications. Finally, the future of HD holds promise for the development of rational, neurobiologically-based treatments and genetically engineered therapies.
Citizen Participation in Health in the Republic of Cuba
Authors: Minkler Meredith 
Published: May 2005

Community participation in health was established as a guiding principle in the development of Cuban health services as early as 1961. This paper examines the nature and scope of popular participation in health utilizing Arnstein's “ladder of participation” as a theoretical framework for analysis. Attention is focused in particular on two of Cuba's mass organizations — the Committees for the Defense of the Revolution (CDR's) and the Cuban Women's Federation (FMC) — and on the broad-based People's Commissions on Health and Public Health Commissions which they help comprise. Cuba's strong accent on consumer participation at all levels of society, and particularly at the broad institutional level, is seen as providing an important example to health professionals in other nations concerned with facilitating consumer involvement in the quest for healthier societies.
A Comparative Study of Screening Instruments for Mental Disorders in General Hospital Patients
Authors: Clarke David M. , Smith Graeme C. , Herrman Helen E. 
Published: May 2005

Objective: Self-administered questionnaires are frequently used in studies of hospitalized physically ill patients to identify and measure psychiatric morbidity. This study examines the validity of some commonly used questionnaires in this context. Method: One hundred and seventy-nine patients in a general hospital completed the GHQ, HAD, BDI and STAI and were interviewed using the SCID-R. The findings were evaluated against DSM-III-R diagnoses using the QROC curve. Results: Thirty-eight percent of patients obtained one or more DSM-III-R diagnoses; 25 percent mood disorder, 12 percent anxiety disorder, 11 percent drug abuse or dependence, 2 percent a somatic syndrome. Eleven percent had more than one diagnosis. As screening instruments for general psychiatric morbidity there were no statistically significant differences between versions of the GHQ and the HAD. With respect to identifying depression, the GHQ tended to perform better than the other instruments. Conclusions: The questionnaires identified general morbidity and depression satisfactorily but anxiety and drug abuse and dependence syndromes poorly. The results also support the notion that the DSM-III-R classification has a number of deficiencies when used in this population.
The Relationship between Trauma, PTSD, and Medical Utilization in Three High Risk Medical Populations
Authors: Rosenberg Harriet J. , Rosenberg Stanley D. , Wolford George L. , Manganiello Paul D. , Brunette Mary F. , Boynton Robin A. 
Published: May 2005

Objective: Increased use of medical and psychiatric services has been reported as a correlate of exposure to trauma. Recent studies suggest that: 1) physical and sexual abuse traumas are particularly associated with increased utilization and 2) posttraumatic stress disorder (PTSD), a common sequela of abuse, mediates the relationship between trauma exposure and elevated utilization. The goal of this study was to explore the relationships between trauma, abuse, PTSD, and medical utilization in three medical help seeking groups reported to be at high risk for trauma exposure. Method: One hundred and seven patients receiving care at a university-affiliated medical center were surveyed for trauma history and PTSD using the Trauma History Questionnaire (THQ) and the PTSD Checklist (PCL). The sample included: forty-eight gynecologic outpatients, thirty-five inpatients with seizure disorders, and twenty-four psychiatric inpatients with non-PTSD admitting diagnoses. Medical utilization data were obtained from a computerized medical center data base. Results: Ninety-six patients reported a trauma history. Of these patients, sixty-six reported abuse and forty-five qualified for PTSD diagnoses. Total number of traumas and reported sexual and physical abuse correlated significantly with elevated medical utilization and PTSD prevalence. PTSD diagnosis was not significantly correlated with utilization, but the five highest utilizers received PTSD diagnoses. Conclusions: Study results supported hypotheses regarding the relation of trauma exposure to medical utilization, but were less clear about the mediating role of PTSD. These findings suggest that routine screening of high-risk patient groups might promote timely identification of trauma history and PTSD, and subsequently impact health care utilization.
Galantamine in the Treatment of Adult Autism: A Report of Three Clinical Cases
Authors: Hertzman Marc 
Published: May 2005

Objective: To study the usefulness of galantamine, a competitive, reversible acetylcholinesterase inhibitor (AChEI), in adults diagnosed with autism (in accordance with DSM-IV-TR Axis I clinical criteria) before age three years. Methods: To promote verbalization and meaningful speech sound production through biochemical enhancement of the serotonergic subsystem of the central nervous system (CNS), galantamine 4 mg qhs was administered, with indicated dose increases. Results: Verbal fluency increased in all patients, according to their caregivers. One patient developed a macular rash that abated when the medication was discontinued. After one month on donepezil 5 mg qhs, verbal and behavioral regression again led to discontinuation. Doses for the other patients have been escalated by 4 mg daily each month to a maximum of 12 mg, with improvement following each increase. Conclusions: Cholinergic stimulation of the CNS serotonergic subsystem with galantamine may enhance expressive language and communication in autistic adults. Clinical trials are needed to study adjuvant therapy with galantamine in such patients.
Systems of Safety and Active Worker-Participation Strategies for a Safe Workplace: The Philosophical and Structural Underpinnings of the Labor Institute, and the Paper, Allied-Industrial, Chemical and Energy Workers International Union, Accident Prevention Programs
Authors: Renner Paul 
Published: May 2005

For the last ten years, The Labor Institute, in cooperation with the Paper, Allied-Industrial, Chemical and Energy Workers International Union (PACE) and several other international unions, has been training workers and managers to prevent accidents in the workplace using what we call a Systems of Safety (SOS) approach. We teach workers to identify major categories of safety systems and sub-systems in the workplace and to assign a hierarchical prevention value to each category. The SOS approach enables workers to look beyond the simplest explanations for an accident to identify the full range of factors that contributed to the event. As a result, Systems of Safety training provides workers with an unparalleled opportunity to reduce the frequency and severity of in-plant accidents. Unfortunately, the full benefits of an SOS system cannot be realized in most workplaces as they are now organized. Our decades of experience—and a review of relevant literature—tell us that worker participation is the key to preventing accidents. Maximum accident prevention is only achievable through maximum worker participation. In most workplaces, hierarchical structures—and workers' internalization of that hierarchy—prevent full worker participation. This article will explore barriers to achieving maximum worker participation, and strategies for providing workers with some measure of control over the systems of safety that determine the level of safety at their work sites.
Attendance Problems and Disciplinary Procedures in Nebraska Schools
Authors: Scott David M. , Friedli David 
Published: May 2005

Study Purpose: School principals were surveyed in rural and urban Nebraska schools to compare policies and procedures on school attendance, and to contrast the use of disciplinary procedures for attendance, violence and substance abuse. Methods: A survey was sent to a 50 percent random sample of Nebraska schools. Respondent school addresses in metropolitan statistical areas (MSA) areas were categorized as urban, and non-MSA respondents were classified as rural area schools. Results: Of the 680 surveys mailed, 464 (68.2 percent) completed surveys were returned. Overall, 86.2 percent of respondents were from rural schools and 13.8 percent from urban schools. A list of disciplinary problems and procedures was reported for a first-time offense by rural and urban schools. Both an “occasional attendance problem” and a “chronic attendance problem” were most frequently addressed through parent contact in both urban and rural areas. For “fighting with another student,” rural schools most commonly reported discipline by teacher, followed by discipline by principal and parent contact. In urban schools, discipline by principal was most common. For “using drugs other than alcohol or tobacco at school” in both areas, disciplinary procedures included parent contact and short-term suspension. A list of disciplinary problems and procedures was also reported for a second-time offense and third-time offense. For “fighting with another student,” the most commonly reported procedure was discipline by principal and parent contact for a second-time offense, followed by short-term suspension and long-term suspension for a third-time offense. For “using drugs other than alcohol or tobacco at school,” for a second time offense was long-term suspension and semester expulsion for a third-time offense. Principals were also asked in an open-response format, what program or procedures were currently in place to prevent violence in their school. Common responses were “conflict resolution training,” followed by “the Boys Town social skills and behaviors model” and “a zero tolerance policy.” Conclusions: School principals generally reported similar disciplinary actions for most disciplinary problems. For recurrent offenses and for serious problems, principals generally used tougher disciplinary procedures. Some of the discrepancies in disciplinary actions, however, suggest the need for consistent enforcement and communication of policies for both urban and rural schools.
The Capitalist World-System and International Health
Authors: Elling Ray H. 
Published: May 2005

A number of world health problems which have been discretely considered in the past are viewed in this paper as interwoven with each other and with the functioning of the capitalist political-economic world-system. Thus, climactic explanations (“tropical medicine”), and even poverty when conceived in cultural terms or as a structural problem resident entirely within a single nation, are seen as inadequate for understanding any or all of the problems discussed briefly here: poor general health levels in peripheral and semi-peripheral nations, especially rising infant mortality rates in countries such as Brazil; comerciogenic malnutrition; dumping and exploitative sale of drugs, pesticides and other products banned or restricted in core nations; genocidal and other threatening approaches to population control; export of hazardous and polluting industry to peripheral and semi-peripheral nations; similar export of human experimentation; the sale of irrelevant, high medical technology to countries lacking basic public health measures; the “brain drain”; and medical imperialism. Also discounted are moralistic inveighing, complaints about inadequate information and its transfer, discussions of bureaucratic bumbling or inter-agency politics and professional rivalries, various forms of victim-blaming, and other explanations and corrective approaches which ignore class structures and the control, distribution, and expropriation of resources in nations and the world-system. The framework suggests the importance of a worldwide cultural hegemony, including a medical cultural hegemony, established by and in the service of the ruling classes. Socialist-oriented nations which are quasi-independent of the capitalist world-system are seen as suffering less from its effects. This suggests that we should conceive of world socialist health and world capitalist health, rather than any kind of unified phenomenon called “international health.”
The Proletarianization of Nursing in the United States, 1932–1946
Authors: Wagner David 
Published: May 2005

There have been many studies of the development of an industrial work force with all its attendant hardships as newly proletarianized peasants were thrown off the land and into factory labor. The author postulates that a similar process occurred in the creation of at least one modern “profession”—nursing—as the traditional autonomy of private practice nursing was displaced by institutional nursing in hospitals and nursing homes. Prior to the Depression, most nurses worked in private duty—as independent entrepreneurs—without the regimentation, rigid division of labor, and intense supervision characteristic of modern hospitals. The collapse of the U.S. economy made it impossible for most nurses to continue to earn a living privately at the same time that hospitals required cheap labor power in order to develop as viable businesses. Despite the promise of job security in hospital work, most nurses resisted the change by criticism, sabotage, walking away from jobs, and attempts at unionization. Hospitals sought in response to inculcate loyalty by a variety of methods, including screening of applicants, in-service training, and professional ideology. In some instances, hospitals coerced private nurses into “staff jobs by threatening their ability to secure business on their own. By the end of World War II, the majority of nurses were employed, for the first time, as wage earners for institutions. The entire period was marked by such discord and revolt on the part of nurses, however, that the American Nurses' Association was transformed as an organization in order to avoid massive unionization. The study points out that this unwritten history of nursing has been obscured by professional nursing leaders who are still suppressing revolts of rank-and-file nurses against the conditions of hospital work.
The Effective Use of Audiovisual Aids in Presenting Technical Information Orally
Authors: Meyer James I. 
Published: May 2005

This is one of the papers from technical writing students that the Journal publishes from time to time. Lt. Meyer, formerly a student at New Jersey Institute of Technology, discusses static and dynamic audiovisual aids. Included are flip charts, graphs, pictures, transparencies, slides, cassette tapes, and movies.
Critical Elements in the Design of Help and Hypertext Systems
Authors: Wasserman David 
Published: May 2005

The demand for help and hypertext systems has created a problem for many documentation departments, particularly those in smaller companies inexperienced in creating these forms of online documentation. The scarcity of existing literature compounds this problem. Literature that specifically addresses how to create such systems with limited resources and considerable time constraints would ease the burden faced by these companies. This article gives writers in small companies with limited resources some suggestions for undertaking a hypertext project. The writer views help text as a simple form of hypertext, and, as such, frequently refers to both simply as “hypertext.” This article is not concerned with describing in detail the various design features of hypertext.
Restricted Emotional Processing and Somatic Attribution in Fibromyalgia
Authors: Brosschot Jos F. , Aarsse Henriette R. 
Published: May 2005

Objective: Medically unexplained symptoms or syndromes, such as fibromyalgia (FM), might be partly caused or sustained by a mechanism involving restricted emotional processing (REP) and the subsequent attribution of emotional arousal to somatic or syndrome-consistent causes. In this study, it was hypothesized that FM patients, compared to healthy individuals, would be higher on trait measures of REP (defensiveness and alexithymia), and would show affective-autonomic response dissociation, that is, higher standardized scores of heart rate responses than affective responses, during negative emotional stimulation. Additionally, FM patients were expected to attribute their bodily symptoms more to somatic than to psychological causes. Method: Emotional movie excerpts were shown to 16 female FM patients and 17 healthy women. Affective response and heart rate were monitored continuously, while symptoms and their causal attributions were measured before and after the excerpts. Repressor coping style and alexithymia were measured, along with negative affectivity and habitual attributions of somatic complaints. Results: FM patients nearly all showed the relatively uncommon combination of high defensiveness and high anxiousness. Compared with healthy women FM patients were more alexithymic, showed a higher level of affective-autonomic response dissociation, and lower within-subject emotional variability. The groups showed opposite attributional patterns, with FM patients attributing symptoms less to psychological causes and more to somatic causes. There was no evidence of a shift in these attributions caused by the emotional stimuli. Conclusions: The results provide preliminary support for the hypotheses. Both at trait and at state level, FM showed restricted emotional processing on most of the parameters measured, and a high ratio of somatic to psychological symptom attribution, coupled with high negative affectivity.
Repeat Prescription Patients: Are They an Identifiable Group?
Authors: Balint Michael 
Published: May 2005

In this article, Dr. Balint examines the use of repeat prescriptions in medical practice as a way of dealing with patients' personal emotional problems and as an attempt to diminish conflicts in doctor-patient relations. A clinical and statistical study of 1,000 patients of 10 medical practitioners suggests that repeat prescription patients need and seek a reliable, continuing, but non-threatening relationship with a physician as a substitute gratification for frustrations in certain life experiences. This search can lead to frequent contacts with doctors. resulting in tense or negative relationships which tend to be superficially relieved by introduction of the “repeat prescription regime.” Illness-centered medicine (“traditional diagnosis”) is contrasted with patient-centered medicine (“overall diagnosis”) in terms of their respective influence on the patient, his illness, and on the development of the relationship to his doctor.
The Advanced Clinical Skills Program in Medical Interviewing: A Block Curriculum for Residents in Medicine
Authors: Gordon James H. , Walerstein Steven J. , Pollack Simcha 
Published: May 2005

Objective: This study sought to demonstrate whether an intensive block curriculum would lead to learning of basic medical interviewing skills by first year residents in medicine. Method: Pairs of brief clinical interviews done before and after a four week block program in medical interviewing were rated using the Rhode Island Hospital Interview Checklist (RIC). The data were analyzed using the McNemar Test to look for possible improvement following the course. Results: Of the nineteen categories measured, fourteen showed statistically significant improvement ( p < .05) in Year 1 and twelve in Year 2. Combining the data for the two years gave statistically significant results in sixteen of the nineteen categories. Conclusions: An intensive block curriculum in medical interviewing led to a significant degree of learning of basic skills by first year medical residents as judged by interviews done at the end of the block. The intensive approach also allowed for a degree of personal growth and solidification of identity as a physician. These factors can be expected to influence interviewing proficiency as well.