The role of the primary care physician in the care of children with serious heart disease

OBJECTIVE: To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. SETTING: Pediatric Cardiology Division; Tertiary Care Children's Hospital. SUBJECTS: Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. DESIGN: Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. RESULTS: All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. CONCLUSIONS: Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.     

Parental health attitudes, illnesses and supports and the referral of children to medical specialists

Parental illness and maternal health beliefs in the parents of a group of 40 children referred to a paediatric neurology service because of headaches were compared with illness histories and health beliefs in the parents of a matched group of 40 children presenting to the same service with recognized structural pathology, mainly epilepsy. The study focused on the mother's perceptions of her own health (current and past), on life events, social supports and on her beliefs about her own health and the validity of medical reassurance. Significant differences between the two groups were found in relation to: (a) the greater amount of illness experienced by both parents in the index group (i.e. parents of children with headaches), particularly the mothers, both as children and as adults; (b) the greater amount of illness present in the families of the index group in the 3 years prior to being seen by the neurologist; (c) the greater number of index mothers who had experienced the loss of their own mothers caused by death; (d) the greater tendency of the index mothers to express feelings of loneliness; (e) the greater proportion of index mothers who, in response to the Whiteley Attitudes to Health Questionnaire, expressed both (i) concern about serious disease in themselves, and (ii) reluctance to accept medical reassurance; (f) on the other hand, significantly more 'comparison mothers' complained of currently suffering 'many different symptoms'.     

Staying connected: Young adults’ felt obligation toward parents with and without mental illness.

The present study compares 94 young adults’ self-reported felt obligation toward parents, psychological symptoms, psychological well-being, and interpersonal loneliness in three family types: families where a mother has serious mental illness, families where a father has serious mental illness, and families with nondistressed parents. Results indicated no significant differences in felt obligation toward mothers or fathers as a function of family type. Young adults with a mother with serious mental illness reported significantly more psychological adjustment difficulties than their peers with a father with serious mental illness or nondistressed parents. Young adults’ reports of felt obligation toward both parents were significantly positively correlated with young adults’ psychological adjustment in families with a parent with serious mental illness, but were not significantly correlated in families with nondistressed parents. Study limitations, future directions for research, and implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and geographical distribution of Giardia spp. and Cryptosporidium spp. in dairy farms in Québec

Many patients with psychotic disorders lack awareness of being ill. This often presents a serious impediment to treatment compliance. We hypothesized that exposing partially remitted patients to videotapes of themselves, made while they were acutely psychotic, might increase their insight into the nature of their illness. Eighteen acutely psychotic inpatients were assigned randomly to a control or experimental group and interviewed on videotape 24 to 48 hours after admission, using scales that measure insight (Insight and Treatment Attitudes Questionnaire [ITAQ]) and psychopathology (Brief Psychiatric Rating Scale [BPRS]). One to six weeks later, when judged to be significantly improved, subjects were shown either a videotape of their initial interview (experimental group) or a placebo videotape (control group) and then reinterviewed 24 to 48 hours later on videotape, using the BPRS and ITAQ scales. Evaluation of initial and final ITAQ and BPRS scores revealed significantly greater improvement in insight scores and in delusionality in the experimental group. However, no significant difference in overall psychopathology was seen for the two groups. These results suggest that exposure of hospitalized patients to videotapes of their own psychotic behavior may be a cost-effective therapeutic tool for developing personal insight into psychotic illness.     

The seriously ill or dying analyst and the limits of neutrality.

Discusses a major dilemma that confronts the analyst who suffers from a prolonged or terminal illness. How much factual information should be revealed to patients concerning the illness and the prognosis? The impact of the illness on communications with the patient (e.g., how appointments are canceled) is explored. Discussion focuses on accounts by 4 analysts who suffered serious illnesses and wrote about their experiences. Transference and countertransference issues are considered, followed by relevant references to neutrality—its uses and abuses—when serious illness strikes. It is argued that the analyst cannot hide behind the concept of neutrality to avoid facing the demands of unusual situations in the analytic experience. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transgender and gender variant populations with mental illness: Implications for clinical care.

There is a scarcity of literature on clinical care for transgender and gender variant populations with serious mental illness. At times, gender identity issues among individuals with serious mental illness have been labeled as delusions that should not be reinforced by providers. However, there are significant limitations to attributing gender variance among populations with mental illness solely to a psychotic process. The following case study research demonstrates the variation in gender identity issues among individuals with serious mental illness. These individuals may experience gender dysphoria exclusively in the context of acute psychosis or may have gender identity issues that are distinct from the mental illness. Denial of an individual's gender variant presentation by treatment staff may heighten distress, thus interfering with a collaborative treatment alliance while posing additional barriers to recovery from mental illness. Implications and applications for clinical training and further research will be presented in order to promote awareness and competent care of gender issues when co-occurring with mental illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive-behavioral treatment of panic complicated by medical illness.

Notes that cognitive-behavior therapy combined with medication can be an effective treatment combination for individuals suffering from panic attacks. Certain cases may prove difficult however, particularly when an individual is recovering from a serious medical illness in which many of the symptoms of the medical illness overlap with the symptoms of panic. This article reviews some of the complicating factors that may occur with such cases as well as techniques for helping individuals differentiate between symptoms that denote a recurrence of the medical illness and those that involve panic disorder and anxiety. Two case vignettes, one of a 54-yr-old steel worker and one of a 19 yr-old gymnast, are included that portray how cognitive-behavioral techniques can be used to help individuals reduce their anxiety and panic and also effectively differentiate symptoms of a recurring medical illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considering adaptation in preference elicitations.

Objective: Patients with chronic health conditions usually place higher utility on their condition than the public does. One explanation for this discrepancy is that healthy people focus on the negative aspects of the condition without considering their own ability to emotionally adapt to the condition over time. The aim of this randomized experimental study was to test whether people would give higher utility ratings for chronic health conditions when they were encouraged to consider their own ability to adapt to difficult situations before giving their ratings. Main Outcome Measure: Utility ratings for four chronic health conditions. Results: The authors presented scenarios describing 4 chronic health conditions to 1,117 respondents drawn from a demographically balanced U.S. Internet panel. The adaptation exercise did not influence respondents' valuations. However, utility values increasingly improved with decreasing ratings of how upsetting it would be to live with the condition over time. Conclusion: The authors speculate that asking people to think about adaptation changes their evaluations of what it would feel like to live with chronic illness, but doing so does not change how much they are willing to trade off to avoid that chronic illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of federal definitions of severe mental illness among children and adolescents in four communities

OBJECTIVE: Using data from an epidemiological survey, the study compared existing definitions of severe mental illness and serious emotional disturbance among children and adolescents to demonstrate the range of prevalence rates resulting from application of different definitions to the same population. METHODS: Three definitions of severe mental illness and serious emotional disturbance were applied to data from the Methods for the Epidemiology of Child and Adolescent Mental Disorders survey, with a sample of 1,285, conducted in 1991-1992 by the National Institute of Mental Health. The resulting proportions of cases identified, demographic characteristics, service use, and perceived need for services were compared. RESULTS: From 3 to 23 percent of the sampled youth met criteria for severe mental illness or serious emotional disturbance. From 40 percent to as many as 78 percent of the defined youth used a mental health service in the year before the survey. School and ambulatory specialty settings were used most frequently. Generally, more than half of the parents of children with severe mental illness or serious emotional disturbance thought that their child needed services. CONCLUSIONS: The prevalence and characteristics of severe mental illness and serious emotional disturbance among children are sensitive to the definition used and its operationalization. Care should be taken by policy makers and service planners to avoid either over- or underestimating the prevalence of impaired youth in need of intensive interventions.     

The empty debate over the existence of mental illness: Comments on Gorenstein.

The present authors disagree with the contention of E. E. Gorenstein (see record 1984-26018-001) that the debate concerning the existence of mental illness is empty or moot. It is argued that Gorenstein's dismissal of the "myth of mental illness" question appears to be due to his misunderstanding of what is meant by a hypothetical construct and his failure to apply the concept to the myth question. Hypothetical constructs are concepts with varying degrees of truth and their validity is of major interest to science, and mental illness is an imperfectly defined construct whose validity and definition have serious social and professional implications. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions of mental illness and judgments about help seeking among Japanese-American and White American students.

Perceived causes of mental illness and help-seeking preferences among Japanese-American and White American college students (72 men and 72 women in each ethnic group) were compared in order to investigate the reported underuse of mental health services by Japanese Americans. Results of a 2 (ethnicity of S)?×?2(severity of disorder)?×?2(gender of person with disorder)?×?2(gender of S) multivariate analysis of variance (MANOVA) revealed that Japanese-American students were more likely than White American students to attribute mental illness to social causes, to resolve problems on their own, and to seek help from family members or friends or both. Possible barriers to use of services by this sample of Japanese Americans include both a preference for informal resources and the stigmatization of mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Present status of medical care for foreigners in Tochigi Prefecture, Japan (1). Survey at all clinics and hospitals

The number of foreign workers in Japan has rapidly increased during the last several years, because of the nation's insufficient work force. The influx of laborers into Japan has brought various issues to the forefront of society, one of the most serious being their medical care. To clarify the present status of their medical care, we sent a questionnaire to 1,004 clinics and hospitals in Tochigi Prefecture. The response rate was 55.6%, and the results are summarized as follows: 1. Clinics were rather reluctant to accept foreign patients because of the language barrier and the consequent time-consuming medical care. 2. Two-thirds of foreign patients did not enroll in any health insurance system. Most clinics and hospitals requested foreign patients with no health insurance to pay 100% of the medical cost set by the national insurance system of Japan. Some hospitals required more than 200% of the set cost, while some clinics reduced the cost. 3. Only a few doctors can communicate with patients in English. It is very difficult for doctors to communicate with foreign patients, who speak only their own native language, but not English. Most doctors felt it necessary to have the assistance of translators or booklets for translation. 4. Foreign patients endured illness, that is, ignored illness, delayed or stopped medical care at clinics and hospitals, because of communication problems and high medical costs. Labor injury cases among foreign workers were more frequent than among Japanese workers. 5. The medical cost for foreign workers per year has been estimated to be 44 billion yen (370 million dollars).(ABSTRACT TRUNCATED AT 250 WORDS)     

Consequences of caring: Pain in the human context.

Contends that painful experiences and their observable manifestations reflect the sufferer's personal background in a particular family and culture. People's interest and compassion for the suffering of others can have a powerful impact on their own experiences and expression of pain and illness as well as determine the care provided for others in physical distress. The complex processes whereby patterns of pain and illness behavior are acquired, both verbal and nonverbal, are examined, and various cognitive, affective, behavioral, and social processes are suggested as potential targets for prevention and intervention in the lives of people suffering chronic pain. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the impact of illness representations on psychological adjustment to chronic illnesses.

Illness representations were assessed in 63 adults with rheumatoid arthritis (RA) and 66 with multiple sclerosis (MS). The relationship of illness representations to concurrent and later mood was explored. MS patients' beliefs in symptom variability were associated with higher depressed mood 4 months later, over and above initial levels of depression. RA patients who saw RA as curable or who saw themselves as responsible for the illness reported significant increases in depression over time. Belief in the serious consequences of RA interacted with later illness severity to predict change in depression. When belief in the serious consequences of RA was high, less severe illness status was associated with less depression and more severe illness status was associated with more depression. When RA was initially viewed as only moderately serious, less severe illness was associated with somewhat higher levels of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of absence from work: People's Republic of Chine versus Canada.

Cross-cultural theory was marshaled to predict how views of absence from work would be similar and different in Canada and the People's Republic of China. Respondents (N?=?1,209) from both cultures had self-serving perceptions of their own absence levels, seeing them as exemplary compared with those of their work group and occupational peers. The Chinese showed a stronger tendency to generate estimates that favored their work group. Both cultural groups underreported their own actual absence. Chinese managers and employees agreed on absence norms, whereas Canadian managers provided lower estimates than did employees. Canadians and Chinese ranked the legitimacy of reasons for absence and attendance fairly similarly, but ratings showed that Canadians were less likely to endorse domestic reasons for absence, whereas Chinese were less likely to endorse illness, stress, and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient management without antibiotics of fever in selected infants

BACKGROUND: In many academic centers it is standard practice to hospitalize all febrile infants younger than two months of age, whereas in community settings such infants are often cared for as outpatients. METHODS: We conducted a controlled study of 747 consecutive infants 29 through 56 days of age who had temperatures of at least 38.2 degrees C. After a complete history taking, physical examination, and sepsis workup, the 460 infants with laboratory or clinical findings suggestive of serious bacterial illness were hospitalized and treated with antibiotics. The screening criteria for serious bacterial illness included a white-cell count of at least 15,000 per cubic millimeter, a spun urine specimen that had 10 or more white cells per high-power field or that was positive on bright-field microscopy, cerebrospinal fluid with a white-cell count of 8 or more per cubic millimeter or a positive Gram's stain, or a chest film showing an infiltrate. The 287 infants who had unremarkable examinations and normal laboratory results were assigned to either inpatient observation without antibiotics (n = 148) or outpatient care without antibiotics but with reexaminations after 24 and 48 hours (n = 139). RESULTS: Serious bacterial illness was diagnosed in 65 infants (8.7 percent). Of these 65 infants, 64 were identified by our screening criteria for inpatient care and antibiotic treatment (sensitivity = 98 percent; 95 percent confidence interval, 92 to 100). Of the 287 infants assigned to observation and no antibiotics, 286 (99.7 percent) did not have serious bacterial illness. Only two infants assigned to outpatient observation were subsequently admitted to the hospital; neither was found to have a serious illness. Outpatient care without antibiotics of the febrile infants at low risk for serious illness resulted in a savings of about $3,100 per patient. CONCLUSIONS: With the use of strict screening criteria, a substantial number of febrile one-to-two-month-old infants can be cared for safely as outpatients and without antibiotics.     

Decline in the prevalence of HIV-1 infection in young women in the Kagera region of Tanzania

Illness representations were assessed in 63 adults with rheumatoid arthritis (RA) and 66 with multiple sclerosis (MS). The relationship of illness representations to concurrent and later mood was explored. MS patients' beliefs in symptom variability were associated with higher depressed mood 4 months later, over and above initial levels of depression. RA patients who saw RA as curable or who saw themselves as responsible for the illness reported significant increases in depression over time. Belief in the serious consequences of RA interacted with later illness severity to predict change in depression. When belief in the serious consequences of RA was high, less severe illness status was associated with less depression and more severe illness status was associated with more depression. When RA was initially viewed as only moderately serious, less severe illness was associated with somewhat higher levels of depression.     

Editorial.

Details the personal challenges and professional accomplishments of M. Pressley, editor of Journal of Educational Psychology for the past 6 years. The editor credits his associate editors, editorial assistants and the editorial board for their performance during his absence due to serious illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)